ANNUAL REPORT OF THE Medical Officer of health OF THE BOROUGH OF HAMMERSMITH For the Year 1922. Public Health Department, Town Hall, Hammersmith, W. 6. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hammersmith. Ladies and Gentlemen, — I beg to present to you my Annual Report for the year 1922. The report deals with the vital statistics, and with the work carried out under the direction of your Council during the year. The statistical tables prescribed by the Ministry of Health are included, as well as the several other tables that directly or indirectly relate to the Public Health of the Borough. The vital statistics of the Borough for the year under review were of a satisfactory nature. The death-rate of 12.9 is 0.2 higher than the rate for the previous year, whilst the infantile mortality rate is 71 per 1,000 births, The infantile rate has decreased 17 per 1,000, and is the second lowest rate recorded for this Borough. This figure is very satisfactory and I can only repeat that our efforts should be maintained in an endeavour to permanently reduce the loss of infant life. The efforts of your Council have been considerably augmented by those of the voluntary societies engaged in maternity and child welfare in the Borough. With regard to infectious diseases the total number notified was above the average. Diphtheria was epidemic, the number of cases being 3 less than the highest recorded. There was a decided fall in the number of cases of Scarlet Fever, but an increase in the number of cases of Measles. The sanitary condition of the Borough is not of a very satisfactory nature and it is to be regretted that a very con- siderable amount of overcrowding still exists. The Council's Housing Scheme is being proceeded with, but up to the present very little improvement in housing conditions has resulted in the congested areas. It will be observed that 4,021 Intimation Notices and 1,281 Statutory Notices were served during the year. This fact in itself tends to show the condition of the Borough. During the year 676 houses were erected and occupied, 315 on the L.C.C. Old Oak Estate and 361 on the Borough Council's Northern Estate. I am, Ladies and Gentlemen, Your obedient Servant, J. B. HOWELL, Medical Officer of Health, 5 SUMMARY OF STATISTICS, ETC. For the Year 1922. Population of Registration area at Census (1901) 112,239 (1911) 121,521 (1921) 130,287 Estimated Population (1922) 134,400 Natural increase, i.e., excess of births over deaths 1,025 Area of Borough 2,282.5 acres Marriages registered 1,213 Births registered (corrected) 2,758 Birth-rate 20.5 Deaths registered (corrected) 1,733 Death-rate 12.9 Infantile mortality 196 deaths under one year, or 71 per 1,000 births. Density of population 58.9 persons per acre overtotalarea. NATURAL, & SOCIAL CONDITIONS OF THE DISTRICT. Population.—According to the Census of 1901, the population of the Borough was then 112,239. By the Census of 1911 the population for the same area was 121,521, shewing an increase during the 10 years of 9,282. The Census of 1921 shews the population of the Borough to be 130,287, being an increase in the 10 years of 8,766. In this report the rates are calculated on the estimated population up to the middle of the year. At the time of the last Census part of the Defence Force, which was mobilised as an emergency ,was in camp on Wormwood Scrubs. The estimated population adopted by the Registrar General is 134,400. The corrected number of births registered was 2,758. whilst the corrected number of deaths of residents was 1,733, thus showing a natural increase of population by excess of births over deaths of 1,025. The area of the Borough is 2,282.5 acres, there being 58.9 persons to the acre, shewing an increase as compared with the Census 1911 of 5.7 persons per acre . Marriages. —The number of marriages registered during the year was 1,213, the marriage rate being 18. Births. —During the year 2,564 births were registered in the Borough. Adding 257 births which occurred outside the Borough, transferred by the Registrar General as belonging to Hammersmith, and deducting 63 births which occurred in the Borough, and transferred to other districts by the Registrar General, the corrected number of births for the year was 2,758. On the estimated population, i.e., 134,400, the corrected number of births registered was equal to an annual rate of 20.5 births per 1,000 persons living. The Birth-rate for the year is 0.6 per 1,000 less than the rate for the previous year which was 21.1. The Birth-rate in London on the estimated population of London, i.e., 4,534,230, was equal to an annual rate of 21.0 births per 1,000 persons living. Notification of Births Act, 1907. Births registered 2,564 Corrected number of births 2,758 Notification Received from Midwives. Doctors. Lying-in Hospitals Poor Law Institutions. Parents. M.O.H.'s. 1,330 608 53 20 505 45 Total notifications received, 2,561. 9 Deaths. —During the year 1,223 deaths (640 males, 583 females) were registered in the Borough, as compared with 1,167 in the previous year. Adding 677 deaths of residents of this Borough which occurred in general hospitals and other public institutions, and 28 deaths of residents transferred by the Registrar-General as having occurred in various parts of England, and deducting 128 deaths of non-residents and 67 transferable deaths which occurred in the Borough, the corrected number of deaths of residents registered was 1,733. On the estimated civil population, i.e., 134,400, the corrected number of deaths of residents was equal to an annual rate of 12.9 deaths per 1,000 persons living. The death-rate in London on the estimated population of London, i.e., 4,534,230, was equal to an annual rate of 13.4 deaths per 1,000 persons living. Deaths of Infants. —The corrected number of deaths of res dents under one year of age registered during the year was 196 as compared with 245 in the previous year. The number of deaths of infants under one year of age was equal to 71 per 1,000 of the corrected births and to 113 per 1,000 of the corrected deaths. The number of deaths of infants under one year of age, residents in London, was equal to 74 per 1,000 of the total registered births. The mortality rate of infants under one year of age was, as compared with the total births registered, 3 per 1,000 less in this Borough than in London. Summer Diarrhoea. —The number of deaths from Diarrhoea was 18, being 55 less than in the previous year. Of these 11 were of children under one year of age. Danger from Flies. —During the year, illustrated leaflets were distributed, pointing out the danger from flies and showing how disease was spread by their carrying filth and germs from 8 The following Chart shows the numbers of Deaths from Diarrhoea per 100,000 inhabitants, 1903-1922. ashpits, manure heaps and decaying animal and vegetable refuse to food, &c. Deaths of Illegitimate Children. —The corrected number of deaths of illegitimate infants under one year of age was 17 or at the rate of 125 per 1,000 illegitimate births. It is interesting to note the very great difference between the death-rate of legitimate and illegitimate infants. The former being 68 per 1,000 whilst the latter is 125 per 1,000, a difference of 57 per 1,000. The following table on infantile mortality has been prepared in accordance with the direction of the Ministry of Health. TABLE III. Infantile Mortality during the year 1922. Nett Deaths from stated causes at various ages under 1 year of age. CAUSE OF DEATH. Under 1Week 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 months 3 months and under 6 Months. 6 Months and under 9 Months. 9 months and under 12 months. Total Deaths under 1 Year. ALL CAUSES. Certified 54 12 11 5 82 37 27 21 29 196 Uncertified - - - - - - - - - - Small-pox - - - - - - - - - - - - - - - Chicken-pox - - - - - - - 2 6 8 Measles - - - - - Scarlet Fever - - - - - - - 3 - - 1 4 3 3 6 17 Whooping Cough - - 1 - Diphtheria and Croup 1 - 1 - - 1 3 - - - Erysipelas - 1 1 2 - - 3 - - - Tuberculous Meningitis - - - - 1 1 1 3 - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - - 1 1 3 5 Meningitis (not Tuberculous) - - - - - Convulsions 2 3 1 1 5 - 1 - - - Laryngitis - - - - - - - - - - Bronchitis 1 1 1 1 4 - - - - - Pneumonia (all forms) 2 3 1 6 7 7 8 4 32 - Diarrhæa - - 1 1 1 3 - - - - Enteritis - 1 - 1 3 1 3 - 8 Gastritis - - - - - - - - - - 2 - 1 - 4 Syphilis 1 1 - - 1 - Rickets - - - - - - - - - - 1 1 1 3 Suffocation, overlying - - 1 - - - - - - - Injury at Birth - - - - - - Atelectasis 6 1 7 - 7 - - - - - Congenital Malformations 2 1 5 5 2 2 14 2 - - Premature Birth 30 5 - 38 3 - - - 41 3 Atrophy, Debility & Marasmus 3 - 2 - 5 6 2 1 1 15 Other causes 10 - 1 - 11 2 6 - 2 21 Totals 54 12 11 5 82 37 27 29 196 21 Nett Births in the Year : Legitimate, 2622 : Illegitimate, 136. Nett Deaths in the Year of: Legitimate Infants, 179; Illegitimate Infants, 17. 10 Deaths of Aged Persons. —The corrected number of deaths of residents at 65 years of age and upwards registered during the year was 617, against 559 in the previous year. These deaths were equal to 4.7 per 1,000 of the to al persons living, and 356 per 1,000 of the total deaths of residents registered. Statistics. —The following table gives the statistics of the Borough during 1922 and the previous five years, in the form pre cribed by the Ministry of Health : — TABLE I. Vital Statistics of Whole District during 1922 and Previous Years. Population estimated 2 to middle of each year Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belongging to the District. Year. 1 Uncorrected Number. 3 Nett. of Non-residents registered in the District. 8 of Residents not registered in the District. 9 Number. 6 Rate. 7 Under 1 Year of Age. At all Ages. Number. 4 Rate. 5 Number. 10 Rate per 1.000 Nett Births. 11 Number. 12 Rate. 13 1917 114952 2080 2278 110 17.7 1212 10.6 195 618 251 1635 14.3 104 1918 115833 1829 2014 15.5 1445 12.5 175 713 210 1983 17.1 99 13.0 1919 130981 2084 2296 16.8 1210 9.2 168 659 228 1701 1920 136200 3150 3312 24.3 1073 7.9 161 646 219 66 1558 11.4 1921 2599 2779 131500 21.1 1167 9.1 202 669 245 88 1634 12.7 705 196 1922 134400 2564 2758 20.5 1223 9.1 196 71 1733 12.9 Area of District in acres Hand and inland water) 2282 5 At Census of 1921 (cf. Census Vol. 5). Total population of all ages 130.287 Total families or occupiers 33,263 Deaths of Residents.—Belonging to the Borough, occurring in public institutions, &c., in districts outside, during the year 1922:- FEVER HOSPITALS. Western Hospital 44 North Western Hospital 2 Grove Hospital 9 Northern Hospital 1 1 1 South Western Hospital 3 Eastern Hospital 1 - 61 Park Hospital 1 11 GENERAL HOSPITALS. St. Mary's Hospital 13 St. George's Hospital 12 The Throat Hospital, Golden Square 1 Victoria Hospital, Chelsea 3 Middlesex Hospital 11 Belgrave Hospital 1 Cancer Hospital, Chelsea 8 Chiswick Hospital 1 Guy's Hospital 4 National Heart Hospital 3 Colindale Hospital 7 Children's Hospital, PaddingGreen 5 St. Thomas's Hospital 2 London Hospital 2 Central London Throat and Ear Hospital 1 University College Hospital 4 St. Bartholomew's Hospital 3 Elizabeth Garrett Anderson Hospital 2 Children's Hospital, Great Ormond Street 3 Brompton Hospital 4 Infants' Hospital, Vincent 2 Square Queen Charlotte's Hospital 3 St. Margaret's Hospital 1 St. Peter's Hospital 2 Hampstead General Hospital 1 Kensington General Hospital St. Columbus Hospital 2 1 Mount Vernon Hospital 1 Manor House Hospital, Golders Green 2 St. Mark's Hospital 1 Royal National Orthopoedic Hospital 1 Hospital of St. John and St. Elizabeth 1 Queen Mary's Hospital, Stratford 1 Westminster Hospital 1 Italian Hospital, Queen Sqr. 1 St. Joseph's Hospital 1 Charing Cross Hospital 1 113 MENTAL HOSPITALS. Hanwell Mental Hospital 22 Banstead Mental Hospital 6 Tooting Bec Hospital 8 Colney Hatch Mental Hospital 2 Leavesden Mental Hospital 4 Cane Hill Mental Hospital 1 City of London Mental Hospital ,Stone, nr. Dartford 1 1 Horton Mental Hospital 1 Long Grove Mental Hospital 1 Claybury Mental Hospital 1 47 OTHER INSTITUTIONS. Kensington Infirmary 66 St. Marylebone Infirmary 201 Fulham Infirmary 126 Chelsea Infirmary 2 Darenth Training Colony 1 Freemasons' Hospital 1 Camberwell House 1 St. Georges' Home 2 St. Davids' Home, Ealing 1 Dollis Hill House Hospital 1 Ewell Park Nursing Home 1 Peckham House 2 Maternity Hospital, Bromley, Kent 1 Ministry of Pension's Hospital, Brixton 1 Edmonton Epileptic Colony 1 Seaman's Hospital 1 409 12 VARIOUS. In High Street, Lewisham 1 The Grove, Garrads Road, Streatham 14 Pembridge Square 4 1 42a Cleveland Street, St. Pancras 164 St. John's Hill, Battersea 3 1 378 Upper Richmond Road, Putney 13 Whittington College, Islington 1 1 230 High Street, Homerton 1 230 High Street, Hackney 1 River Thames, Barnes 3 46 Ouseley Road, Balham 1 Moscow Road, Paddington 1 River Thames, Fulham 1 28 Recreation Road, wood 1 River Thames, Richmond 1 1 Abbey Road Mansions, Abbey Road, St. Marylebone 187a Wardour Street 1 On way to Middlesex Hospital 1 1 20 Ladbroke Gardens 42a Cleveland Street, St. Pancras 1 Kew Bridge Road, Brentford 1 1 11 Edith Terrace, Chelsea 1 On way to St. Thomas' Hospital 42a Cleveland Street 1 1 72a East Dulwich Grove, Camberwell 1 The Terrace, St. Pancras 1 Harrow Road, Willesden 1 2 334 Oxford Street, St. Marylebone 45 Trinity Rise, Lambeth 1 1 21 Endsleigh St., St. Pancras 1 69 Oxford Road, Chiswick 1 On way to Westminster Hospital 21 St. Edmund's Terrace, St. Marylebone 1 19 Ferdinand St., St. Pancras 1 1 9 Hoxton Square, Shoreditch 1 107 Barrowgate Rd., Chiswick 1 91 Finchley Rd., Hampstead 1 321 Upper Richmond Road Bath Road, Arlington 1 47 1 TOTALS:— Fever Hospitals 61 General Hospitals 113 Mental Hospitals 47 Other Institutions 409 Various 47 677 13 TABLE II Causes of, and ages at, Death during the Year 1922. METROPOLITAN BOROUGH OF HAMMERSMITH. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occuring within or without the District. Total Deaths whether of 'Residents' or 'Nonresidents in Institutions in the District 11 2 All ages. 3 Under 1 year. 4 1 and under 2. 5 2 and under 5. 6 5 and under 15. 7 15 and under 25. 8 25 and under 45. 9 45 and under 65 10 65 and upwards All Causes Certified 196 71 77 213 419 17 203 84 56 1733 Uncertified 0 0 Li 0 0 0 0 0 0 0 Enteric Fever 0 0 1 0 1 2 0 4 0 1 Small-pox 0 0 0 0 0 0 0 0 0 0 Measles 36 8 19 7 2 0 0 0 0 0 Scarlet Fever 11 0 1 3 3 0 4 0 0 0 Whooping Cough 40 17 16 7 0 0 0 0 0 0 Diphtheria and Croup 49 3 5 14 21 6 0 0 0 1 Influenza 70 5 3 3 3 2 10 21 23 2 0 0 0 Erysipelas 4 3 0 0 1 0 0 142 1 30 72 33 Phthisis (PulmonaryTuberculosis) Tuberculous Meningitis 0 0 0 6 5 13 3 3 1 0 0 3 3 0 10 Other Tuberculous Diseases 7 0 0 1 1 2 0 0 0 3 Cancer, maglignant disease 185 0 0 0 0 1 18 86 80 30 Rheumatic Fever 7 0 0 0 2 3 1 1 0 3 Meningitis 12 5 1 0 4 1 0 1 0 5 Organic Heart Disease 179 0 0 0 7 5 11 58 98 10 5 Bronchitis 146 4 0 0 1 0 35 101 3 Pneumonia (all forms) 17 158 32 23 13 5 3 29 36 18 Other Diseases of Respiratory Organs 2 1 1 6 6 2 25 0 2 7 Diarrhæa and Enteritis 18 11 0 0 1 7 1 1 1 3 Appendicitis and Typhlitis 12 0 0 0 3 3 2 4 0 12 Cirrhosis of Liver 9 0 0 0 0 0 1 6 2 1 Alcoholism 2 0 0 0 0 0 1 0 1 0 1 Nephritis and Bright's Disease Puerperal Fever 47 0 0 0 1 6 17 22 18 4 0 0 0 0 2 2 0 0 0 Other Accidents and Diseases of Pregnancy and Parturition 5 0 0 0 0 1 4 0 0 0 Congenital Debility and Malformation, including Premature Birth Violent Deaths, excluding Suicide Suicide 73 70 3 0 0 0 0 0 0 5 33 3 2 1 4 3 7 6 7 14 14 0 0 0 0 0 5 6 3 3 229 Other defined diseases 428 32 5 3 9 11 36 103 58 0 Diseases ill-defined or unknown 0 0 0 0 0 0 0 0 0 1733 196 56 71 77 213 419 617 203 Total 84 SUB- Entries included in above figures. Cerebro-Spinal Meningitis 3 1 1 1 0 0 0 0 1 0 14 LONDON AND THE METROPOLITAN BOROUGHS. Boroughs. Estimated population 1922. Birth rate. Death rate. Infantile Mortality rate. County of London 21.0 13.4 4,534,230 74 West. Paddington 145,300 18.8 13.0 69 Kensington 179,100 17.6 13.6 82 Hammersmith 20.5 12.9 134,400 71 Fulham 159,500 20.3 12.1 69 Chelsea 16.1 66 63.920 13.3 City of Westminster 139,389 13.4 12.9 54 North. St. Marylebone 105,200 13.7 68 15.9 Hampstead 86,920 14.8 11.1 56 212,500 21.5 St. Pancras 14.6 74 333,900 22.5 77 Islington 13.8 52,620 Stoke Newington 17.8 12.9 67 Hackney 225,400 21.0 12.7 72 Central. Holborn 42,850 16.9 13.2 66 Finsbury 76,840 25.2 1.3 82 13,706 City of London 11.1 14.1 61 East. Shoreditch 27.9 16.3 102 105,800 Bethnal Green 118,400 25.2 15.3 90 Stepney 252,170 23.8 13.8 79 Poplar 165,700 26.7 14.3 79 y I South. 187,220 24.4 15.5 79 Southwark Bermondsey 121,100 26.2 16.7 102 Lambeth 307,000 27.5 59 13.6 Battersea 169,200 21.7 13.2 69 16.7 11.2 Wandsworth 333,820 60 Camberwell 270,300 21.7 13.4 78 Deptford 114,100 23.1 13.8 74 12.9 Greenwich 101,930 21.0 56 Lewisham 176,600 18.2 11.1 54 Woolwich 138,254 21.3 11.6 62 This table is prepared from figures obtained from the Medical Officers of Health and the Registrar-General. 15 SANITARY CIRCUMSTANCES OF THE BOROUGH. Closet Accommodation. —There are as far as is known no privies in the Borough, all houses being provided with proper water-closets on the water carriage system. Scavenging. —The arrangements for the removal and disposal of house refuse include the use of both motor and horsedrawn vehicles. The motor vehicles have lately been installed, and are provided with proper covers. The horse-drawn vehicles are only covered when the van has been loaded. The practice of "totting" is still allowed, a practice with which I am not in agreement. Throughout the Borough, there are quite a number of ashpits. This means of depositing house refuse is not only out of date, but in the majority of cases leads to nuisances arising. In all cases which come before the Public Health Depaitment, the owners are advised to close the same, and provide proper metal receptacles in accordance with the L.C.C. Bye-laws. Cesspools. —During the year one cesspool has been found. This has been filled up, and the drain connected to the sewer. I have no doubt that a few cesspools still exist, and they will be revealed in course of time, when they will be dealt with in a similar manner. General Sanitary Administration. —The general sanitary condition of the Borough has been improved to some extent. Whilst a large number of notices has been served during the year it is still very obvious that the overcrowded conditions have not been relieved to any great extent. These conditions 16 are found in the course of inspection, but it is difficult to take action owing to the shortage of accommodation. The Housing schemes of the London County Council and Borough Council are nearly completed, but I am afraid the overcrowded conditions of the Borough still exist. Notices. —The following table shows the number of visits paid by the Inspectors and the Preliminary Notices served and complied with during the year :— Number of Inspections. Number of Notices Served. Number of Notices complied with. 3,292 Infectious Diseases 581 646 Complaints 4,189 1,940 2,080 499 13 14 Bakehouses Customs and Inland Revenue 5 5 6 Houses let in lodgings 542 188 160 House to House 1,203 472 507 441 Housing & Town Planning Act 286 209 Factories & Workshops &c. 1,710 104 106 202 - Slaughterhouses - Milk Vendors 1,813 15 16 181 Ice Cream Vendors - 1 128 Smoke 25 4 4,327 Food 40 42 Miscellaneoüs 19,848 352 396 38,380 4,021 4,187 During the year 1,281 Statutory Notices were served and 1,208 complied with. In several instances it was necessary to take proceedings in order to enforce compliance with Notices served. The following table shows he result of proceedings taken : 17 SUMMONSES. YEAR 1922. No. of Summoneet Situation of Premises Nature of Offence. Result of Proceedings. 48 Blythe Road Failing to comply with Statutory Notice. 2 (1) Fine £5. (2) Fined £1. 67 Masbro Road Ditto 2 (1) Fined £5. Order made. (2) Fined £1. 49 Ditto Ditto 1 2 Fined £1. 51 Ditto Ditto (1) Fined £1. (2) Fined £1. Order made. 45 Yeldham Road Ditto 1 Withdrawn. Work done. Ditto 26b Percy Road 1 Withdrawn. Work done. 22 Spring Vale Terr. Ditto 1 Fined £1. Order made. 32 Stronsa Road Ditto 2 (1) Order made. (2) Adjourned. (1) Withdrawn. 9 Richmond Road Ditto 2 (2) Withdrawn. 27 Woodstock Road 37 Ditto Ditto 1 Fined £2. Order made. Ditto 1 Order made. Ditto 12 Coningham Mews 54 Sterndale Road 24 Elm Grove 1 Withdrawn. Work done. Ditto 1 Adjourned sine die. Ditto 1 Order made. 41 Stowe Road Ditto 1 Withdrawn. Work done. Ditto 30 Rayleigh Road 45 Maclise Road 1 Withdrawn. Work done. Ditto 3 (1) Fined £4. Order made. (2) Fined £3. Order made. (3) Fined £3. 45 Raynham Road Ditto 1 Work done. Withdrawn. 104 Rayleigh Road Ditto 1 Work done. Withdrawn. Ditto 1 29 Sinclair Mansions Work done. Fined £1. 10 Sedgeford Road Ditto Withdrawn. Work done. 1 Ditto 93 Rayleigh Road 1 Withdrawn. Work done. 1 Vine Cottages Ditto 1 Withdrawn. Work done. 2 Ditto Ditto 1 Withdrawn. Work done. 3 Ditto Ditto 1 Withdrawn. Work done. 4 Ditto Ditto Withdrawn. Work done. 1 203 Latimer Road Ditto 1 Order made. 1 132 Askew Road Ditto Order Made. 1 100 Rayleigh Road Ditto (1) Order made. Fined 10s. 102 Ditto Ditto 4 (1) Order made. (2) Withdrawn. (3) Fined 10s. (4) Order made. 104 Ditto Ditto 3 (1) Withdrawn. (2) Order made. (3) Fined 10s. (1) Order made. 106 Ditto Ditto 2 (2) Fined 10s. (1) Withdrawn. Work done 1 Wellington Road Ditto 2 (2) Order made. 18 Summonses —continued. Situation of Premises Nature of Offence. No. of Summonses Result of Proceedings. 1 Rockley Road Ditto 2 (1) Fined 10s. . (2) Withdrawn. Work done. 5 Letchford Gardens Ditto 1 Work done. 3 Lurgan Street Ditto 1 Withdrawn. Work done. 270 Uxbridge Road Ditto 1 Not served. 100 Blythe Road Ditto 1 Withdrawn. Work done. Yard, Devonport Rd. Ditto 1 Order made. 81a Ormiston Road Ditto 1 Order made. 41 Raynham Road Ditto 1 Withdrawn. Work done. 102 Sinclair Road Ditto 2 (1) Adjourned. £1 1s. Costs. . (2) Adjourned sine die. 108 Ditto 1 Withdrawn. Ditto. 20 Adelaide Road Ditto Order made. 1 16 Lefroy Road Ditto. 2 (1) Withdrawn. Work done. (2) Order made. Fined £1. • _ . , 20 Wharf Road Ditto Withdrawn. Work done. 1 37 Yeldham Road Ditto 1 Order made. 35 Ditto Ditto 2 Order made. 12 Gransden Road Ditto 1 Withdrawn. Work done. 108 Sinclair Road Ditto 1 Withdrawn. Work done. 76 Masbro Road Ditto 2 (1) Withdrawn. Work done. (2) Withdrawn. Work done. 25 Rockley Road Ditto 1 Withdrawn. Work done. 27 Ditto 2 (1) Withdrawn. Work done. Ditto (2) Withdrawn. Work done. 18 Sinclair Gardens Ditto 1 Withdrawn. Work done. 114 Gt. Church Lane Ditto 1 Order made. Fined £1. 1 Devonshire Villas 1 Withdrawn. Ditto J. M. Gregory, 13 Aspen Place Depositing and exposing for sale apples unsound, unwholesome and unfit for the food of man. 2 Convicted. Sentenced to 28 days in the Second Division. Selling oysters unfit for human consumption. 3 (1) Dismissed under P.O. Act. Costs £2 2s. W. Kito, 472 Fulham Road. (2) Fined £2. Costs £1 1s. Depositing for purpose of sale oysters unfit for human consumption. Exposing for sale oysters unfit for human consumption. (3) Fined £2. Costs £1 1s. 19 Factories and Workshops, etc. — During the year 104 notices were served in reference to insanitary conditions and defects found to exist during the inspection of the factories, workshops and work-places in the Borough, and during the same period 106 notices were complied with. During the previous year there were 154 notices served and 140 complied with. The following is a list of the Factories and Workshops upon the Register:— Restaurants, Hotels, &c 176 Bakehouses (12 not in use as Bakeries) 62 Bootmakers 57 Motor and Cycle Makers 35 Dressmakers and Milliners 94 Laundries 69 Outworkers 258 Letterpress Printers and Bookbinders 14 Electrical and Mechanical Engineers 68 Smiths, Wheelwrights and Coachbuilders 23 Tailors 61 Builders, Carpenters and Joiners 40 Miscellaneous 329 Total 1,286 The whole of these premises have been under a systematic inspection by your Inspectors and numerous improvements have been carried out under their supervision. The following tables have been prepared in accordance with the form prescribed by the Home Office on the Administration of the Factory and Workshops Act, 1901, in connection with Factories, Workshops, Workplaces and Homework. 20 1.— INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Number of Premises. Inspections. Written Notices. Prosecutions. Factories (in luding Factory Laundries) 759 36 - 532 46 - Workshops (including Workshops Laundries) 866 32 - Workplaces (other than out-workers' premises included in Part 3 of this report) Total 114 2,157 - 2.— DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts. — "I — Want of Cleanliness 36 36 - - Want of Ventilation 2 2 - - Overcrowding 2 2 - - Want of Drainage of Floors 2 1 - - Other Nuisances 43 42 - - Sanitary Accommodation. insufficient 7 8 - - 23 - unsuitable or defective 26 - not separate for sexes 5 4 - - Offences under the Factory and Workshop Act. Offences under the Factory and Workshop Act. Illegal occupation of underground bakehouse (S. 101) - - - - Breach of special Sanitary requirements for bakehouses (SS. 97 to 100) - 2 3 - Other Offences (excluding offences relating to out-work which are included in Part 3 of this report.) - - - - Total 122 124 - - 21 3.— HOME WORK. Nature of Work. Outworkers' List, Section 107. Outwork in Unwholesome premises, Sec 108. Outwork in Infected Premises Secs. 109. 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Twice in the year Once in the year. 11 Instances. 12 Notices served. 13 Prosecutions. 14 Instances. 15 Orders made (Sec. 110). 16 Prosecutions (Sec. 109,110) 10 failing to keep or 9 Failing to keep or permit inspection of 2 Lists. Outworkers. 5 Lists Outworkers 3 Contractors. tors. 5 Con- tractors. 7 WorK men. 4 Work men. Wearing apparel— n n n i ' 3 ... (1) making, etc. 18 56 1 1 ... ... ... 2 2 ... 1 1 ... ... ... (2) cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 18 3 56 1 1 ... ... ... ... 2 2 ... 1 1 ... 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year Number. Bakehouses 33 Dressmakers 86 Laundries 31 Others 262 412 Total number of workshops on Register 5.—OTHER MATTERS. Class. Number. Matters notified to H.M. Inspector of Factories — Failure to affix Abstract of the Factory and Workshop Act 1901 (S. 133) 1 Notified by H. M. Inspector 7 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act 1901 (S. 5). Reports (of action taken) sent to H. M. Inspector 7 Other 10 Underground bakehouses (S. 101) — Certificates granted during year - In use at the end of the year 32 22 Customs and Inland Revenue Acts.—Three applications were received under the Customs and Inland Revenue Acts for exemption or abatement of inhabited house duty. 14 Coverdale Road Certificate not granted. 78 Blythe Road ... ... Certificate not granted. 2 Addison Court Gardens ... Certificate granted. House to House. —As a result of the house to house visitation 1,203 inspections were made, 472 notices served, and 507 complied with. It is important that this work should be systematically carried out. Houses let in Lodgings. —During the year the Public Health Committee gave directions for the registration of 1 " house let in lodgings or occupied by the members of more than one family." Upon the registration a copy of the By-laws of your Council, under which such houses are registered, was forwarded to the landlord (within the meaning of the By-laws) for his guidance. From various causes 209 houses have been removed from the register, leaving a total number of 2,495 houses registered. Five hundred and forty-two inspections were made, 188 notices were served, and 160 notices complied with. Rats and Mice {Destruction) Act, 1919. —During the year the Rats and Mice (Destruction) Act, 1919, continued in operation, the District Inspectors being responsible for its administration in their respective districts. Section I. places the responsibility of ridding the premises of the pest upon the occupier, but this is somewhat difficult when dealing with tenement houses containing in some cases three or more families. During the year many complaints were received with regard to rat infestation of premises. In each case an inspection 21 was made and advice and instructions given. A supply of poison was given where necessary and in most cases satisfactory results have been obtained. Old buildings often provide ideal accommodation for rats; hollow partitions, space between floors and ceilings and under basement flooring being used for nesting. It is a difficult matter to rid such premises of rats. Generally speaking some improvement has been made, but it appears to me that no great advance will result until systematic attack is made upon the rodents in their chief breeding grounds, the sewers. Throughout the Borough, and I have no doubt throughout the whole of London, there exist old brick sewers swarming with rats, from which they emerge at night and enter dwellings and other premises. Smoke Abatement. —During the year observations were kept in reference to black smoke emitted from the various factories, laundries, bakehouses, &c., situate in and adjoining the Borough. Sixteen Intimation Notices were served. No summons was taken out. Reports were submitted to the Public Health Committee in reference to the observations made as regards the following:— Lyons & Co., Cadby Hall, Hammersmith Road. Kensington Palace Laundry, Springvale Terrace. Swan Laundry, Blythe Road. Carpet Beating Co., Latimer Road. 134, Shepherd's Bush Road. Civic Pipe Co., Fulham Palace Road. Notting Hill & Kensington Electric Light Co., Wood Lane. Hammersmith Borough Council Electricity Works, Fulham Palace Road. Glen Laundry, Landor Road. Fuller's Ltd., Great Church Lane. Public Baths, Lime Grove. 24 PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BYE-LAWS AND REGULATIONS. The following premises and occupations have been kept under constant inspection throughout the year, and action taken where found to be necessary:— Fried Fish Vendors. Milk Vendors. Ice Cream Vendors. Slaughterhouses. Full particulars and remarks regarding these premises are to be found in another part of the report. With regard to Ice Cream Vendors, I am of opinion that it should be compulsory for all persons to register themselves with the Local Authority before being allowed to manufacture or sell this commodity. The Local Authority should be empowered to refuse such registration should the person or premises be unsuitable for this purpose. In the Spring an inspection was made of all the Ice Cream Vendors in the Borough. The premises, in the majority of cases, were found to be satisfactory, but in some cases it was necessary for action to be taken regarding their condition. Many premises are not suitable for the handling of so easily contaminated a food as ice cream, and there is often a lack of personal cleanliness about the Vendors. In a few cases the premises are used for making the cream only, it being sold from barrows in the street, but generally speaking it is sold at the premises at which it is made. The selling of this commodity from barrows is, in my opinion, very undesirable as the accommodation provided for the washing of the utensils used (glasses, wafer frames, &c.) is very inadequate and unsatisfactory. 23 Schools. —The sanitary condition and water supply of the Schools is a matter which requires very little attention from the Public Health Department. The supervision of the schools is in the hands of the London County Council, but combined action has been taken when and where required, with a view to preventing the spread of infectious disease. An arrangement exists whereby cases of Measles, Whooping Cough and Chicken Pox are notified by the Head Teacher to the Medical Officer of Health, at the same time as they send to the Medical Superintendent. These cases are followed up, and the premises are inspected with a view to any insanitary conditions being remedied. This form of co-ordination is carried out as far as possible under the present conditions. There is little or no contact between the School Medical Officers and the Medical Officers of Health of the Metropolitan Boroughs. The latter,s knowledge of the health of the school children depends entirely upon the very little information he obtains from the School Medical Officers. FOOD. Milk Supply. —The milk supply for the Borough is the same as that for the whole of London. This supply is carried out for the most part by several wholesale distributors, most of whom have recently combined to form what is known as the United Dairies, Ltd. This combine supplies something like two-thirds of the whole of the milk for London. During the year 356 samples of milk were taken and submitted to the Public Analyst for analysis, the results of which are shown in the report of the Public Analyst attached hereto. No samples were examined for the presence of Tubercle Bacilli, but this work is carried out in some of the other London areas. The results obtained by the Medical 24 Officer of Health for the City of London shewed that 25 per cent, of the samples taken were infected. This high percentage is very startling and this source is probably the cause of most of the Tuberculosis in young children. Until such time as it is possible to exclude infected cattle from all herds all milk should be pasteurised or dried before distribution, both these processes eliminate all infection and do not destroy the essential principles of milk. During the year, it was found necessary to serve a notice upon one milk vendor, at whose premises Scarlet Fever had occurred, requiring the suspension of the sale of milk until the premises had been disinfected. THE MIIK (SPECIAL D ESIGNATIONS) ORDER, 1922. This Order was made by the Minister of Health, under Section 3 of the Milk and Dairies (Amendment) Act, 1922, and provides for the issue of licenses as follows : — (1) By County and County Borough Councils (and in certain circumstances by Urban and Rural District Councils) to Producers of " Grade A " Milk. (2) By Sanitary Authorities to— (a) Distributors of " Certified " Milk. (6) Distributors of " Grade A " Milk, including " Grade A (Tuberculin Tested) " and " Grade A (Pasteurised)." (c) Distributors of " Pasteurised " Milk (Note. —A licensed producer who distributes his milk to consumers direct from the farm will not require a licence from the Sanitary Authority.) The Minister will for the present issue licences to producers of " Certified " and " Grade A (Tuberculin Tested) " Milk, who will be entitled to sell the milk produced under such licences as " Grade A " Milk without further licence from a Local Authority. Procedure of County Councils. On receipt of an application from a farmer for a licence to sell " Grade A " milk, it will be necessary for the County Council to nominate a Veter- 27 inary Surgeon to examine the herd, and until further notice the Minister concurs in the nomination of any person for the time being holding the appointment of Local Veterinary Inspector of the Ministry of Agriculture and Fisheries or the appointment of Veterinary Inspector to a Local Authority under the Diseases of Animals Acts, without reference to the Minister. If in any case it is considered desirable to nominate a Veterinary Surgeon who does not hold either of these appointments a special request should be made for the concurrence of the Minister. It is also desirable that the County Council, on receiving such an application, should require the applicant to have one or more samples of his milk submitted to bacteriological examination at his own expense, and should satisfy themselves that the results of the examinations are such as to make it reasonably probable that the milk will comply with the prescribed tests at the time of distribution. Where the producer delivers milk to the consumer direct from the farm it will be necessary for the County Council also to issue the distributor's licence and to exercise or arrange for the exercise of the functions of a Sanitary Authority with regard to such milk. Procedure of Sanitary Authorities. The action to be taken by a Sanitary Authority on receipt of an application from a distributor for a licence will depend on the designation proposed to be used. In every case except that of " Pasteurised " Milk it will be necessary for them to ascertain the source of supply and then to satisfy themselves that the corresponding licence has been issued to the producer. In the case of " Certified " Milk a licence may ordinarily be issued without further enquiry. In the case of " Grade A (Tuberculin Tested) " or " Grade A " Milk the Authority must verify that the distributor has an efficient arrangement for bottling, and that, until after bottling, the milk is being dealt with in a part of the premises separate from other milk. The Authority should also arrange for an examination of the caps and seals proposed to be used, and should require the applicant to have one or more samples of the milk submitted to bacteriological examination at his own expense. Apart from procedure in connection with new licences, the principal function of a Sanitary Authority will be to take samples of milk from time to time and arrange for them to be submitted to bacteriological examination. The Minister should be informed of the laboratories to which it is proposed to send the samples, and of the estimated cost. In taking samples of " Certified " Milk the Authority will be acting as agents for the Minister, 28 who will require to be satisfied as to the arrangements proposed and will repay the approved cost of examinations. The Minister thinks it desirable that samples of " Certified " Milk should be taken on the average at the rate of about one sample a month for each producer, the samples generally being taken from time to time from all the distributors concerned. A set of instructions as to the taking and testing of samples will be issued shortly. When an unfavourable report is received with regard to a sample of " Grade A (Tuberculin Tested) " or " Grade A " Milk the special attention of the distributor should be drawn to the matter, and he should be advised to take steps to discover the cause of the defect and to remedy it if it is due to any default of his own, or to arrange with the producer to do so if the latter is responsible. If a further unfavourable report is received, it will be necessary for the Authority to consider whether they should take steps under Article 9 of the Order to suspend or revoke the licence, and in this connection it may be observed that a distributor who cannot deliver milk that regularly satisfies the prescribed tests is not entitled to hold a licence, even though the failure may be due to the conditions of his source of supply, and not to any fault of his own. Notwithstanding the precautions taken in the examination of the herd it may occasionally happen that tubercle bacillus is found in milk of any grade. If this should at any time be reported, full information should at once be given to the Minister or the County Council, as the case may be, who will inform the producer and require him to take steps to ascertain which animals are affected and to remove them from the herd. The steps taken would generally include bacteriological examinations of the milk of individual cows or groups of cows, and the licensing authority will no doubt facilitate the enquiry by arranging, where necessary, for the bacteriological examinations at an appropriate charge. " Pasteurised " Milk. The Order lays down the general conditions governing the sale of milk as " Pasteurised," the essential condition in the matter of treatment being that the milk must be held at a temperature between 145 degrees and 150 degrees Fahrenheit for a period of at least half an hour. It is desirable for purposes of control that every pasteurising plant should be provided with an automatic recording apparatus. The prescribed conditions definitely exclude the " flash pasteurisation " process by which milk is heated to a high temperature (e.g. , 170 degrees) for a short period. But it is also to be observed that the apparatus must be such that all the milk is held for the prescribed period, and in examining other types of pasteurisers, it will be for the Licensing Authority to deter- 29 mine whether the prescribed conditions are complied with. The Minister is advised that no process except that which is commonly known as the " positive holder " process has yet been shown to satisfy these conditions. The Milk (Special Designations) Amendment Order, 1922, made by the Minister of Health, under 3 and 6 of the Milk and Dairies (Amendment) Act, 1922, provides that until the 1st day of July, 1923, it shall be deemed to be satisfactory if the milk is treated not more than once by a suit able heating process and immediately cooled to a temperature of not more than 55 degrees Fahrenheit. General. The Order prescribes the amounts of the fees payable for the various licences. These fees will be paid to the Authorities by which the relative licences are issued, and they have been fixed at such amounts as may be expected on the average to cover the expenditure of Licensing Authorities under the Order. But the amounts of the fees will be reconsidered and, if necessary, revised when sufficient experience has been gained of the working of the scheme. MILK AND DAIRIES (AMENDMENT) ACT, 1922. Section 1 of the Act provides for the postponement of the Milk and Dairies (Consolidation) Act, 1915, until the Ist September, 1925, except in so far as that Act repeals the Act of 1914 and the Postponement Act of 1915. Section 2 empowers a Local Authority under certain conditions to refuse to register a retail purveyor of milk, or to remove such a person from the register. In considering the effect of this section, reference should first be made to Article 6 of the Dairies, Cowsheds and Milkshops Order of 1885 and to subsection (3) of the present section. The Order in question requires every Sanitary Authority to keep a register of persons from time to time carrying on the trade of cowkeepers, dairymen or purveyors of milk and provides that a person may not carry on the trade unless he is registered. This Order required the Authority to register every person carrying on the trade and gave them no power to refuse to register any person or to remove him from the register. Section 2 (3) of the new Act provides that the Order is to have effect so as to require two registers to be kept, the one being restricted to retail purveyors and the other containing all other persons registered under the Order (i.e., wholesale traders and producers who do not sell milk by retail) ; and section 2 (1) empowers the Local Authority to refuse to enter any person 30 on the first of these registers or to remove him from that register if they are satisfied that the public health is or is likely to be endangered by any act or default of his in relation to the quality, storage or distribution of milk. It is to be observed that the act or default on which action may be taken is not necessarily one which is an offence against any statute, order or regulation, but it would no doubt be advisable in taking action to note whether any specific offence has been committed. The course which will be taken in removing a retailer from the register will generally be as follows : — (1) A report will be presented by the Medical Officer of Health or the Sanitary Inspector drawing attention to any act or default on the part of the retailer and showing in what respect the public health is or is likely to be endangered thereby. (2) The Authority will then serve a notice on the retailer setting out the reasons (which will generally be those given in the report referred to above) why it is proposed to remove him from the register and requiring him to appear before them to show cause to the contrary. At least seven days' notice must be given of the time of hearing. (3) If the Authority are not satisfied with the explanation given they may decide to remove the retailer from the register and they will notify him of that decision. (4) The retailer may within 21 days appeal to a Court of Summary Jurisdiction. (5) Either the retailer or the Local Authority may appeal further to a Court of Quarter Sessions. Provision is made for the removal not to take effect pending appeal. The procedure in the case of a proposed refusal to register is similar and in that case the provisions of the Order which prohibit a person from carrying on the trade of a dairyman unless he is registered are not to take effect until the appeal is finally determined. Section 2 (2) empowers the Court before whom any retailer is convicted of an offence relating to milk or dairies, in addition to any other penalty, to remove him from the register for such period as the Court may think fit. It will be observed that in any case the removal from the register may be absolute or in respect of specified premises ; this will enable the Authority or the Court to distinguish between cases in which the defect is one of general methods and those in which it has relation only to the suitability of particular premises or the methods practised thereat. Section 3 continues, with modifications, the provisions as to the grading of milk which are at present contained in Orders made by the Food Controller 31 and this Department under the Ministry of Food (Continuance) Act, 1920. These Orders are continued in force until the 1st January next, when the provisions of Section 3 will come into operation. The section provides that milk may not be sold as " Certified," " Grade A," " Pasteurised," or under any other prescribed designation, except in accordance with a licence granted by the Minister or with his authority. The conditions governing the use of these designations will be laid down in an Order and will include conditions as to the payment of fees for the licences. Section 4 continues and extends the provisions of an existing Order of the Food Controller. The section prohibits the addition of any colouring matter or water, or re-constituted milk, or skimmed or separated milk, to milk intended for sale. This will enable Local Authorities to deal with cases in which such additions are made for fraudulent purposes but difficulty is experienced in proving that the mixture is sold as milk. The section also prohibits the sale of re-constituted milk as milk. Section 5 imposes a heavy penalty on any person who sells the milk of a cow suffering from tuberculosis of the udder where it is proved that he knew, or could have ascertained by ordinary care, that the cow was suffering from that disease. The maximum penalty for a second or subsequent offence is a fine of or imprisonment with or without hard labour for a period of six months, or both such fine and imprisonment. Sections 6 and 7 lay down procedure as to the making of Orders. Section 8 requires the Minister to make regulations as to imported milk under the Public Health (Regulations as to Food) Act, 1907. It also empowers the Minister to make regulations prescribing standards for dried, and condensed milks, and the manner in which receptacles containing dried, condensed, skimmed or separated milk are to be labelled or marked. Section 9 deals with penalties and proceedings. Under subsection (2) where the Local Authority are reasonably satisfied that an offence committed by a purveyor of milk is due to an act or default of a servant or agent, without the knowledge, consent, or connivance of his employer they are required to take proceedings against the servant or agent, without first proceeding against Iris employer. Subsection (3) protects a person against conviction in respect of a sample of milk taken after the milk has left his custody and control, if it is proved that the churn or other receptacle in which the milk was contained was effectively closed and sealed when it left his custody and control, but was not so closed and sealed when it reached the person by whom the sample was taken. Section 10 specifies the Local Authorities for the enforcement of the various sections of the Act. The enforcing authorities are the same as those at present concerned with the enforcement of similar provisions in the 32 existing law. The section also provides out of what rate or fund the expenses of the Local Authority shall be paid. Section 11 deals with the case of failure of a Local Authority to perform any of their duties under the Act, and makes provision for the transfer of powers or duties from a defaulting District Council to the County Council. Section 12 exempts the retailer from actions for breach of contract if he is refused registration or removed from the register under Section 2 by reason of the quality of milk supplied to him. Section 13, which follows the lines of Section 21 of the Sale of Food and Drugs Act, 1875, provides that the certificate of a Public Analyst shall be sufficient evidence of the facts stated therein unless the defendant shall require that the analyst shall be called as a witness. CERTIFICATION OF CERTAIN FOOD PRODUCTS FOR EXPORT TO CANADA. In view of the requirements of the Food Laws in operation in the Dominion of Canada, a system of certification for food products which are derived from the flesh of cattle, sheep, swine or goats, or from game or poultry, and are prepared or packed in England and Wales for export to Canada, has been arranged. The Certifying Officer—usually the Medical Officer of Health—is required to keep himself informed, by personal inquiry and in other available ways, as to :— (1) The sanitary condition, structure and character of premises on which the food products are prepared, stored or packed, with special regard to the possibility of contamination of the food products at any stage. (2) The cleanliness and wholesomeness of the methods employed in preparing, storing or packing the food products. (3) The precautions taken to avoid the utilisation for food purposes of diseased, unsound or unwholesome material in any portion of the premises; and arrangements for the safe disposal of any material which, on account of disease, unsoundness, unwholesomeness, or for any other reason, is unfit for human food. In the case of products derived from cattle, sheep, swine, or goats, the Certifying Officer must also satisfy himself that the animals from which the products are prepared have been subjected to an ante-mortem and postmortem veterinary inspection and found free from disease and suitable for human food. 33 Where the products are prepared from animals slaughtered in the United Kingdom, the Certifying Officer before certifying as to Veterinary examination must be satisfied :— (a) That the animals were subjected to veterinary examination antemortem and post mortem by an Officer of the Local Authority for which he himself acts; or (b) That the animals were slaughtered in a public abattoir under official veterinary inspection ; or he must be furnished by the applicant with a declaration signed by a qualified veterinary surgeon, appointed by the firm with the approval of the Certifying Officer, to the effect that an ante-mortem and post-mortem examination was made by him and that the animals so examined were found free from disease. Where the products are prepared from material imported into the United Kingdom from overseas, the Certifying Officer must satisfy himself that the material was accompanied by a certificate as to ante-mortem and post-mortem veterinary inspection signed by an Official of the National Government of the country of origin, being a country whose certificates the Canadian Authorities are prepared to accept (Australia, New Zealand, Argentina, and the United States of America). If the information obtained by the Certifying Officer is not, in his view, satisfactory, certification is to be withheld and the Certifying Officer must inform the Ministry forthwith. The Certifying Officer will supply the Ministry of Health with such information as may be required in regard to the methods of inquiry, inspection and certification which have been adopted. PUBLIC HEALTH (MILK & CREAM) REGULATIONS, 1912 AND 1917. The following statement shows the action taken under the Public Health (Milk and Cream) Regulations 1912 and 1917 :— 1. Milk and Cream not sold as Preserved Cream. a. Number of samples examined for the presence of a preservative. b. Number in which a preservative was reported to be present. Milk 0 0 6 Cream 8 Nature of preservative in each case in Column (6), and action taken under Regulations in regard to it. 34 Sample No. 743. —Cream contained a preparation of Boric Acid equivalent to 0.51 per cent, of crystallised Boric Acid. Summons under Regulations. Fined £2, and £1 Is. costs. Summons under Sale of Food and Drugs Acts. Fined £3 and £1 Is. costs. Sample No. 787. —Cream contained a preparation of Boric Acid equivalent to 0.36 per cent, of crystallised Boric Acid. The receptacle in which the cream was sold was properly labelled, but label was obscured by paper bag. Letter of warning. Sample No. 790. —Cream contained a preparation of Boric Acid equivalent to 0.46 per cent, of crystallised Boric Acid. Summons under Regulations. Fined £1 Is. and £1 Is. costs. Summons under Sale of Food and Drugs Acts withdrawn. Sample No. 791.—Cream contained a preparation of Boric Acid equivalent to 0.28 per cent, of crystallised Boric Acid. Summons under Regulations. Fined £2, and £"1 Is. costs. Summons under Sale of Food and Drugs Acts, withdrawn. Sample No. 792. —Cream contained a preparation of Boric Acid equivalent to 0.3 per cent, of crystallised Boric Acid. The receptacle in which the cream was sold was properly labelled, but label was obscured by paper bag. Letter of warning. Sample No. 793. —Cream contained a preparation of Boric Acid equivalent to 0.3 per cent, of crystallised Boric Acid. Summons under Regulations. Fined £2 2s. and £1 Is. costs. Summons under Sale of Food and Drugs Acts, withdrawn. 2. Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct. 35 (i) Correct statements made 4 (ii) Statements incorrect 0 (iii) Percentage of preservative found in each sample. Percentage stated on Statutory label. Sample No. 786 0.39% or 27.3 grains of Boric Acid per pound 0.4 789 0.26% or 18.2 „ „ „ 0.4 869 0.3% or 21 „ „ „ 0.4 885 0.24% or 16.8 „ „ „ 0.4 (b) Determination made of milk fat in cream sold as preserved cream. (i) Above 35 per cent. 4 (ii) Below 35 per cent. 0 Total 4 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article 5(1) and the proviso in Article 5 (2) of the Regulations have been observed ... Nil. (d) Particulars of each case in which the Regulations have not been complied with and action taken Nil. 3. Thickening Substances. Any evidence of their addition to cream or preserved cream. Action taken where found ... ... ... Nil. 4. Other Observations. In all cases where a contravention of the Regulations has occurred, the Council has, in accordance with Article 6 of the Regulations, afforded the Vendor an opportunity of furnishing an explanation in writing. In two cases the explanation given was considered satisfactory. All samples of milk taken for analysis under Sale of Food and Drugs Acts are examined for preservatives. During the year no sample was found to contain preservative. 36 MILK (MOTHERS AND CHILDREN) ORDER, 1919. A brief report with regard to the action taken by this Council will be found in the Maternity Section, see page 69. ANNUAL REPORT OF THE PUBLIC ANALYST. Mr. P. A. Ellis Richards, F.I.C., F.C.S. Year ended 31st December, 1922. During the twelve months ended on that date 612 samples were submitted to me for examination. Of these, 600 were purchased by Inspector Arnold, under the provisions of the Sale of Food and Drugs Acts and 12 under the Public Health (Milk and Cream) Regulations. In Table I. are given the numbers of samples received under the Sale of Food and Drugs Acts during the several quarters of the year, together with the numbers classified as genuine, inferior, and adulterated. Of the total number examined 521 were reported as genuine, 41 as adulterated, whilst 38 weie of inferior quality. TABLE I. Inferior Samples received. Genuine. Adulterated. Total. Quarter ending March 31st 137 4 9 150 11 114 150 „ June 30th 25 „ Sept. 30th 135 7 150 8 „ Dec. 31st 135 2 13 150 Totals 38 41 600 521 The percentage of adulteration was 6.6 as compared with 7.1 last year. The percentage of articles of inferior quality, where actual adulteration could not be certified, was 6.3 this year and 9.3 last year. 37 In Table 11. will be found a statement of the number and nature of the various articles examined during the year, together with particulars of the prosecutions which were instituted. TABLE II. Article. No. of samples exam'd. Result of Examination. Genuine. Inferior. Adulterated. Summonses issued. Penalties imposed. Beef Loaf 1 1 - - - - Butter 52 49 2 1 - - Borax 10 9 1* - - - Camphorated Oil 2 1 - - 3 - Castor Oil 2 2 - - - - Chocolates - - - - 6 6 Citrate of Magnesia 5 5 - - - - Cocoa 18 16 - 2* - - Coffee 17 17 - - - - Coffee and Chicory 1 - - - - 1 Cornflour 1 1 - - - - Cream of Tartar 8 8 - - - - Custard powder 3 3 - - - - Dripping 1 1 - - - - Flour, Self-raising 1 1 - - - - Grape Nuts 5 5 - - ... - Gregory Powder 1 1 - - - - Jam 10 - - - - 4 Lard 10 10 - - - - 4 - - - Liquorice Powder 4 - Margarine 5 5 - - - - Meat & Fish Pastes 12 6 - 6* - - Meat Pies 3 2 - 1* - - Milk 356 307 35 14 10 £11 6s. „ Condensed 18 17 - 1* - - „ Dried 1 1 - - - - „ Separated 5 5 - - - - „ Tinned 1 1 - - - - „ Skim 1 1 - - - - Oatmeal 1 1 - - - - Olive Oil 13 12 - 1* - - Oxtail Soup 1 1 - - - - Pepper 1 1 - - - - Prawns 2 2 - - - - Preserved Vegetables 12 2 - 10* - - Salt 1 1 - - - - Sausages 5 3 - 2* - - Sponge Cakes 2 1 - 1* - - Tomato Soup 1 - 1* - - - Vinegar, Malt 7 7 - - - - 600 Totals 521 38 41 10 £11 6s. * Informal samples. 38 Milk. —During the year 356 samples of milk were examined and of these 307 were reported as genuine, 35 as inferior, and 14 as adulterated. The following Table shows the nature and extent of the adulteration :— TABLE III. No. Adulteration Certified. Penalties Imposed. 1 Fat abstracted 96 per cent. No action. Labelled as Separated Milk. 2 17 Case withdrawn. Same defendant as No. 9. 3 16 Warranty proved. Case dismissed. 4 15 „ 5 „ „ 13 „ Case withdrawn. 6 „ „ 9 „ Warranty proved. Case dismissed. 7 „ „ 3 „ Cautionary letter to vendor. 8 Added Water 6.5 „ Defence satisfied Court that milk was sold as it came from the cow. Case dismissed. 9 6 „ Fined £5 and £3 3s. costs. 10 „ „ 6 „ Cautionary letter to vendor. 11 „ „ 4 „ Warranty proved. Case dismissed. 12 „ „ 3.5 „ Defence satisfied Court that milk was sold as it came from the cow. Case dismissed. 13 Coloured with annatto Cautionary letter to vendor. 14 „ „ „ £3 3s. costs. The percentage of adulteration for the year in the case of milk is 3.9 as compared with 5.1 for the preceding year. Prosecutions were instituted in the case of most of the adulterated samples and the penalties inflicted amounted to £11 6s. The following Table gives the average composition of the milk, calculated on the total number of the samples taken in the Borough during the four quarters of the year : — 39 TABLE IV. Samples received. Fat. Non-fatty Solids. Water. Quarter ending March 31st 3.75% 9.09% 87.16% „ „ June 30th 87.72% 3.40% 8.88% „ „ September 30th 3.61% 8.98% 87.41% 3.94% 8.96% „ „ December 31st 87.10% Average for the year 3.67% 8.98% 87.35% Two milks submitted during the year were found to be artificially coloured with annatto and were reported as adulterated as the colouring of milk is now an offence under the Acts. A sample of dried milk, five of separated milk, eighteen of condensed milk, one of tinned milk and one of tinned skim milk were also analysed and were found to be genuine, with the exception of one condensed milk which was reported as adulterated on account of its contamination with tin from the container. The quantity of tin found was equivalent to 1.1 grains per pound. Butter, Margarine, etc. —Fifty-two samples of butter, five of margarine, ten of lard and one of dripping were analysed and all of these were found to be genuine, with the exception of a sample sold as butter and which was found to consist entirely of margarine. Cocoa, Coffee and Coffee Mixtures. —Eighteen specimens of cocoa, seventeen of coffee, and one of coffee and chicory were examined and were found to be genuine, with the exception of two of the cocoas, each of which contained l/70th of a grain of arsenic—as arsenious oxide —per pound. The presence of this unusual foreign ingredient was apparently due to the employment of impure potash in the alkali treatment of the cocoa during its manufacture. 40 Meat and Fish Preparations. —One sample of beef loaf, twelve of meat and fish pastes, one of oxtail soup, two of prawns, five of sausages and three of meat pies were examined. Of these, nine were found to contain boron preservative, the amounts found ranging from 2.1 grains to 9.1 grains per pound, the results being expressed in terms of crystallised boric acid. Preserved Vegetables. —Of the twelve samples of preserved vegetables examined only two were found to be genuine. A preparation of copper was detected in all the others, the amounts found ranging from half a grain to 2.3 grains per pound, the results being expressed in terms of crystallised sulphate of copper. Olive Oil. —Of thirteen specimens of olive oil, one was found to contain forty per cent, of oil other than olive oil, having the characters of arachis oil —a cheaper oil extracted from the earth nut. Sponge Cakes. —One of the two samples of sponge cakes submitted was found to contain boron preservative. The amount was 12.6 grains per pound, the result being expressed in terms of crystallised boric acid. The presence of this substance was probably due to the use of eggs containing boric acid. Tomato Soup. —A specimen of tinned tomato soup was found to be contaminated with two grains of tin per pound, derived from the container, and was therefore reported as adulterated. Drugs. —The total number of drugs analysed during the year was thirty-three and only one of these was adulterated. The latter was a specimen of borax which was found to contain twenty-five parts of arsenious oxide per million. This is exactly five times the British Pharmacopoeia limit. 41 In addition to the foregoing, the following samples on analysis were found to be genuine:— Chocolates 6 samples. Malt Vinegar 7 samples. Cornflour 1 sample. Oatmeal 1 sample. Custard Powder 3 samples. Pepper 1 sample. Grape-Nuts 5 samples. Salt 1 sample. Self-raising Flour 1 sample. Jam 4 samples. The Public Health (Milk and Cream) Regulations. —Eight samples of cream and four of preserved cream were examined under these Regulations during the year. Six of the former contained boric acid, the amounts found ranging from 0.28 per cent, to 0.6] pet cent. All of the preserved creams contained boric acid, but in no case was the limit of 0.4 per cent, exceeded. The Milk and Dairies (Amendment) Act, 1922, now in operation gives very important powers to Local Authorities when dealing with the sale of milk. Various grades of this article of food are recognised and explicit details laid down as to purity, &c. This Act also prohibits the addition of any colouring matter or water, or any dried or condensed milk or any fluid reconstituted therefrom, or any skimmed milk or separated milk to milk intended for sale. The use of colouring matter in the- case of skimmed or separated milk is also forbidden. The following Table shews action taken on adulterated samples (other than milk and cream), and other infringements of the Sale of Food and Drugs Acts. 42 TABLE V. No. Adulteration or Infringement. Action Taken. 1 Margarine exposed for sale and not marked in accordance with the Margarine Acts. Letter of warning. 2 Letter of warning. Cocoa containing l/70th grain arsenious oxide per lb. 3 Cocoa containing 1 /70th grain arsenious oxide per lb. Letter of warning. All other adulterated samples were informal and upon these no action could be taken. Meat.—With regard to meat inspection, this important commodity is kept under supervision by the Inspectors in charge of the districts. The Slaughterhouses are visited as often as possible. Licensed Slaughterhouses. —At the annual inspection of slaughterhouses in October, I received notices from seven Licensees of their intention to make application to the London County Council for the renewal of their Licenses. In all cases these premises were found to be, as far as your Council's requirements were concerned, in a satisfactory condition. No opposition was offered to the renewal of the licenses. At the Special Session at the London County Council the seven licenses were granted. I can only reiterate that I am of opinion that, although these slaughterhouses are kept in a cleanly condition, the time has arrived when public abattoirs should be established. By so doing it would be possible to arrange for the whole of the meat to be inspected before leaving the slaughterhouse. At 43 present the slaughterhouses are the subject of constant inspection, but it is impossible to arrange for all the animals killed to be examined. The following is a list of the licensed slaughterhouses in the Borough : — Premises. Name of Licensee. 185 Uxbridge Road John Mullet Allwright 40 Goldhawk Road John Trayling 138 Goldhawk Road George Langstone Moore 247 Goldhawk Road Arthur William Godfrey 55 Dalling Road Arthur Clapson 65 King Street John Garton Jenkins 321 King Street Stanley Brooks Midwinter The Dairies, Milkshops, Ice Cream Vendors, Restaurants and Food Shops have been kept under systematic inspection by your Inspectors. The following table gives a summary of the work relating to milk premises, slaughterhouses and ice cream premises:— PREMISES. Number of inspections. 1922. Number of prosecutions, 1922. NUMBER OF PREMISES. Number of notices 1922. On register at end of 1921. Added in 1922. Removed in 1922. On register at end of 1922. Milk premises 76 8 3 81 1813 15 nil. Slaughter-houses 7 - 7 202 - nil. - Ice Cream premises 112 2 - 114 181 - nil. Markets. —There are three markets in the Borough, situate in Bradmore Lane, Approach Road and Norland Road. These markets have been the subject of much inspection during the year, both by the District Inspector concerned and the Inspector carrying out the requirements of the Food and Drugs Acts. Whilst certain regulations exist regarding the sale and preparation for sale of food it is obvious that further powers are necessary for the control of the sale of food, perhaps more particularly in the case of markets. Such powers should be sufficient as to prevent the contamination by dust, flies, &c. Fried-fish Shops. —The fried-fish shops are regularly and constantly inspected for the purpose of ensuring conformity with the By-laws made by the London County Council. At the same time a careful look-out is kept on the condition of the fish. Bakehouses. —The 48 bakehouses in use in the Borough have been regularly inspected during the year. Thirteen notices were served relating to various defects, 14 being complied with. It was not necessary to apply for any summonses against Bakers whose bakehouses were found not to be in conformity with the Act, as they readily complied with the requirements of the notice served. The following is a list of bakehouses in the Borough:— No. 1 DISTRICT. Address. Name. † * Cadby Hall, Hammersmith Road J. Lyons & Co. * 7 Shepherd's Bush Road A. Janus * 13 Shepherd's Bush Green Not in use * 60 Richmond Road A. E. Cresswell * 1 Masbro Road W. A. Macklen * 67 Ditto G. Teague Not in use * 87 Ditto * 6 Beaconsfield Terrace Not in use †* 98 Blythe Road A. Schofield * 47 Milson Road W. Warwick * Underground † Factory 44 No. 2 DISTRICT. Address. Name. † 65 Bridge Road W. Bass 2 Crisp Road C. R. Gottig * 82 Great Church Lane E. C. Dunn † Great Church Lane Fullers, Ltd. †* 134 Shepherd's Bush Road F. Olliver †* 84 Ditto F. R. Ries * 94 Ditto Not in use * 75 Blythe Road F. Olliver * 31 Goldhawk Road G. Burnett † 213 Hammersmith Road G. Clifford Not in use 88 Queen Street No. 3 DISTRICT. * 77 Brackenbury Road A. Gardner † 1 The Grove Palmer's Stores, Ltd. * 33 Glenthorne Road E. Winstone †* 1 Aldensley Road H. A. Roberts, Ltd. †* 85 The Grove E. Homan * 17 Kilmarsh Road Not in use 70 Glenthorne Road Ditto 24 Bradmore Park Road T. Miller No. 4 DISTRICT. 16 Black Lion Lane B. Samels 93 Ditto G. Banham †* 102 Dalling Road P. Blum * 192 Ditto Not in use † 1 Eyot Gardens J. R. Chibnall, Ltd † 258 King Street Miller & Son † 316 Ditto A. J. Tame 348 Ditto W. Langrebe †* 11 Lamington Street H. A. Roberts, Ltd. 10 Upper Mall Not in use 7 St. Peter's Road E. Marlow No. 5 DISTRICT. †* 128 Askew Road G. Ingle † 74 Ditto J. Aver †* 167 Ditto F. Keber † 104 Ditto J. Miller 121 Ditto Not in use 41 Gayford Road Ditto No. 6 DISTRICT. †* 74 Goldhawk Road H. Smith 106 Ditto M. Lofcovitch 166 Ditto C. Owens * 242 Ditto S. T. Stoneman †*75 Uxbridge Road B. Samels †* 125 Ditto A. B. Hemmings * 55 Melina Road Harding & Son * Underground † Factory. 43 No. 7 DISTRICT. Address. Name. †* 126 Uxbridge Road V. Hughes †* 216 Ditto H. Bamford † 410 Ditto W. Dixon No. 8 DISTRICT. †* 831 Harrow Road H. T. Rogers †* 39 St. Ann's Road E. Tomlin †* 16 North Pole Road H. Allinson †* 32 Norland Road J. Lewis * 2 Hunt Street Not in use 104 Latimer Road Ditto * Underground † Factory. Seizure of Unwholesome Food. —On the 16th June, 1922, Sanitary Inspectors Pottier and Rigby seized seven bushels of apples which were exposed for sale on a stall in Bradmore Market, King Street —the property of Mr. J. M. Gregory of No. 13 Aspen Place, Hammersmith. The apples were conveyed to and submitted to the Magistrate at the West London Police Court, who condemned them as unsound, unwholesome and unfit for the food of man, and gave an order for their destruction. A summons was taken out and heard at the West London Police Court, when the Magistrate sentenced the defendant to 28 day's imprisonment. On the 27th September, 1922, Sanitary Inspectors Pottier and Rigby seized 29 dozen oysters from the shop in the occupation of Messrs. White & Co., No. 36 The Broadway, Hammersmith. The oysters were submitted to the Magistrate at the West London Police Court, who condemned the same as unsound, unwholesome and unfit for the food of man, and gave an order for their destruction. A summons was taken out and heard at the West London Police Court, when the Magistrate imposed fines amounting to 4 guineas with 4 guineas costs. 46 47 LEAD POISONING—BEER. During the year my attention was called to an outbreak of lead poisoning, due to the consumption of beer which had been kept in lead glazed white enamel lined iron tanks. Information was also received regarding certain public houses in the Borough in which such tanks had been installed, and enquiries were immediately made. The information obtained shewed that no complaints had been received by the landlords of the houses in question with regard to the beer, and I was unable to ascertain definitely whether any persons in this Borough had been affected, although many cases were traced in a neighbouring district. The tanks were removed and replaced by earthenware tanks and barrels. The following is a list of unsound food condemned during the year:— Condition. Result of Action Taken. Commodity. 1 box Herrings Decomposed Surrendered. 5 boxes Kippers Ditto Ditto 5 bags Winkles Ditto Ditto 1 box Apples Ditto Ditto 6 Pigs' Plucks Ditto Ditto 3 cases Pears Ditto Ditto Ditto Ditto 120 Crabs 28 cases Eggs Ditto Ditto 16 boxes Apples Ditto Ditto 5 boxes Apples Ditto Ditto 2 cases Rabbits Ditto Ditto 33 cases Tinned Salmon Tins Blown Ditto 1 box Kippers Decomposed Ditto 3 cases Bananas Ditto Ditto 3 cases Tinned Salmon Tins Blown Ditto 30 stone Cat Fish Decomposed Ditto 39 stone 4 lb. Meat Ditto Ditto 5 boxes Kippers Ditto Ditto 14 lbs. Pears Ditto Ditto 10½ cases Rabbits Ditto Ditto 4½ stone Skate Ditto Ditto 1 case Rabbits Ditto Ditto 8 bundles Herrings Ditto Ditto 46 PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. Infectious Diseases. —There were, omitting tuberculosis, 1,197 cases reported as due to notifiable infectious diseases in the Borough, against 2,083 in the previous year. The number of cases of Tuberculosis notified was 295 against 347 in the previous year. There were also reported 1,865 cases of infectious diseases that were not notifiable, against 332 in the previous year; 1,284 of these were Measles, 357 Whooping Cough, and 224 Chicken Pox. TABLE IV. Cases of Infectious Disease notified during the year 1922. Notifiable Disease. Number of Cases Notified. Total cases notified in each locality (e.g. Parish or ward) of the District. Total Cases Removed to Hospital. At all Ages At Ages.—Years. Under 1 1 & under 5 Years. 5 & under 15 Years 15& under 25 Years. 25 & under 45 Years. 45& under 65 Years. 65 and Upwards North. Centre. South. Small-pox ... ... ... ... ... ... ... ... ... ... ... ... Cholera (C) Plague (P) ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 440 137 224 35 32 3 ... 235 156 49 429 9 Erysipelas 39 4 1 3 3 12 11 5 14 17 8 14 Scarlet Fever 496 1 129 271 56 34 5 ... 215 220 61 479 Typhus Fever ... ... ... ... ... ... 4 ... ... ... ... ... Enteric Fever 14 ... ... 1 7 2 4 ... 4 9 1 12 Relapsing Fever (R) Continued Fever (C) ... 1C ... ... ... ... ... 1C 1C 1C ... ... Puerperal Fever 9 ... ... ... 4 5 ... ... 5 4 ... 9 Cerebro-Spinal Meningitis 4 1 1 2 ... ... ... ... 3 ... 1 3 Polio-myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... Encephalitis Letharflica 1 ... ... 1 ... ... ... ... ... 1 ... Ophthalmia Neonatorum 35 35 ... ... ... ... ... 16 16 3 7 ... Pulmonary Tuberculosis 246 1 2 12 63 119 43 6 109 97 40 72 Other forms of Tuberculosis 49 3 5 21 8 9 2 1 36 7 6 15 ... Anthrax ... ... ... ... ... ... ... ... ... ... ... Pneumonia 154 8 22 15 8 45 42 14 89 46 19 41 Malaria 4 ... ... ... 1 ... 3 ... 2 2 ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... Trench Fever ... ... ... ... ... ... ... ... ... ... ... ... Totals 1492 62 297 549 187 258 113 26 728 574 190 1071 49 Deaths from the Seven Principal Zymotic Diseases. —The total number of deaths of residents registered from the seven principal zymotic diseases was 158, against 126 in the previous year. The deaths of residents last year from these diseases were equal to 91 per 1,000 of the total deaths of resident registered and were at the rate of 1.17 deaths per 1,000 persons living. The deaths from the seven principal zymotic diseases in the whole of London were equal to 83 per 1,000 of the total deaths registered and at the rate of 1.1 deaths per 1,000 persons living. These deaths were, therefore, as compared with the total deaths of residents registered, 8 more per 1,000 deaths belonging to this Borough than in London, and, as compared with the population, 0.06 more per 1,000 in this Borough than in London. The following table shews the deaths of residents registered from the seven principal zymotic diseases which occurred in the ten years, 1913 to 1922. Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Enteric Fever. Diarrhœa and Cholera. Total. 1913 0 49 7 12 41 0 77 186 1914 0 41 5 15 20 3 74 158 1915 0 47 14 14 27 2 55 159 1916 0 27 4 15 10 1 47 104 1917 0 39 1 11 12 6 45 114 1918 0 44 3 6 28 4 31 116 1919 0 9 2 19 10 1 69 110 1920 0 16 7 35 12 1 35 106 1921 0 0 16 24 10 3 73 126 1922 0 36 11 49 40 4 18 158 Average last 10 yrs 0 31 7 20 21 3 52 134 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was 24 above the average number registered in the last ten years, 50 Smallpox. —No case of Smallpox was notified in the Borough during the year, against no ease in the previous year. Cholera. —No case was reported as due to Cholera, against no case in the previous year. Plague. —No case was reported as due to Plague, against no case in the previous year. Diphtheria and Diphtheritic Membraneous Croup. —Four hundred and forty cases were reported as due to Diphtheria or Diphtheritic Membranous Croup, against 443 cases in the previous year. Four hundred and twenty-nine cases were treated at the Isolation Hospitals and 11 at the homes of the patients. Forty-nine deaths were registered. The mortality rate on the cases reported was 11.1 per cent. It is with regret I have to report this continued increase in the number of cases of Diphtheria, being only 3 below the previous year which was the highest number recorded. The cases were fairly evenly distributed throughout the Borough, and only in a few instances was it possible to determine accurately the source of infection. Anti-toxin. —During the year a supply of Anti-toxin was kept in the Public Health Department for the use of Medical Practitioners attending patients residing in the Borough. All the Medical men in the Borough were again informed by circular letter that supplies of Anti-toxin could be obtained at the Town Hall. Although more use was made of this than in the past, it was only to a small extent. This is to be regretted, as lam convinced some of the mortality from this disease would be avoided if greater use were made of the free supply of Antitoxin supplied by the Council. No difficulty was experienced in removing cases to Hospital, the accommodation available being adequate for the number of cases. Chart shewing the number of cases of Diphtheria notified week by week in the Borough during the year 1922. 51 Chart shewing the number of cases of Scarlet Fever notified week by week in the Borough during the year 1922. 52 51 Scarlet Fever. —Four hundred and ninty-six cases were notified as due to Scarlet Fever, against 1,358 in the previous year. Four hundred and seventy-nine cases were treated at the Isolation Hospitals, and 17 at the homes of the patients. Eleven deaths were registered. The mortality rate on the cases reported was 2.2 per cent. Enteric Fever. —Fourteen cases were reported as due to Enteric Fever, against 4 cases in the previous year. Nine cases were treated at the Isolation Hospitals of the Metropolitan Asylums Board, one at the West London Hospital, one at St. George's Hospital, one at St. Marylebone Infirmary, and two at the homes of the patients. Three deaths were registered, two, however, took place in Mental Hospitals. The mortality rate on the cases reported was 28.6 per cent. Of the fourteen cases reported it was found that six of tne cases had journeyed to Epsom for the races,during Derby week, and had either partaken of water sold from buckets on the Downs or what was called " home-made lemonade." This lemonade was probably made on the spot with water obtained from the immediate neighbourhood. Enquiries were made, and as a result the facts were forwarded to the Ministry of Health, the London County Council, the Medical Officer of Health for Epsom, and the Medical Officers of Health of the London Boroughs. Four other cases were traced to patients resident at Acton, Leatherhead, Lambeth and Sutton, all of whom attended the races at Epsom and partook of " home-made lemonade," or water on the Downs. Erysipelas. —Thirty-nine cases were reported as due to Erysipelas, against 51 cases In the previous year, 54 Twenty-five cases were treated at the homes of the patients. Six at Fulham Infirmary, 7 at St. Marylebone Infirmary, and 1 at the City of Westminster Infirmary. Four deaths were registered. The mortality rate on the cases reported was 10.3 per cent. Typhus Fever. —No case was reported as due to Typhus Fever, against no case in the previous year. Relapsing Fever. —No case was reported as due to Relapsing Fever, against no case in the previous year. Continued Fever. —One case was reported as due to Continued Fever, against one case in the previous year. This case was treated at one of the Metropolitan Asylums Board's Hospitals. Puerperal Fever. —Nine cases were reported as due to Puerperal Fever, against twelve cases in the previous year. Five of the cases were treated at the Isolation Hospitals of the Metropolitan Asylums Board, 3 at the Fulham Infirmary, and 1 at St. Marylebone Infirmary. Four deaths were registered. The mortality rate on the cases reported was 44.4 per cent. Cerebro-Spinal Meningitis. —Four cases of Cerebro-Spinal Meningitis were reported, against 2in the previous year. One case was removed to one of the M.A.B. Hospitals, 2 cases were removed to the West London Hospital, and 1 being treated at the home of the patient. One death was registreated. The mortality rate on the cases reported was 50 per cent. Acute Polio-myelitis. —Three cases were reported as due to Polio-myelitis, against 6 cases in the previous year. One 55 case was treated at the West London Hospital, and 1 at Paddington Green Hospital. No death was registered. Encephalitis Lethiargica. —One case was reported as due to Encephalitis Lethiargica, against sin the previous year. The case was treated at home. No death was registered. Ophthalmia Neonatorum.— Thirty-five cases were reported as due to Ophthalmia Neonatorum, against 44 in the previous year. Nine cases were treated at Hospitals, 26 cases being treated at home. In the majority of cases treated at home arrangements were made for a nurse to attend the patient. Anthrax. —No case of Anthrax was notified during the year, against no case in the previous year. Hydrophobia. —No case was reported as due to Hydrophobia, as against no case in the previous year. Rabies Order, 1919. —No case of Rabies in dogs occurred in the Borough. Glanders. —No case was reported as due to Glanders, as against one case in the previous year. Measles and German Measles. —Twelve hundred and eighty-four cases of Measles and German Measles were notified against 38 in the previous year. Twelve hundred and fifty-two cases were treated at the homes of the patients, and 32 in the Hospitals of the Metropolitan Asylums Board. Thirty-six deaths were registered. 56 the following Chart shews the number of Deaths from Measles per 100,000 inhabitants, 1903-1922. Whooping Cough. —Three hundred and fifty-seven cases of Whooping Cough were reported, against 101 in the previous year. Forty deaths were registered. As this is not a notifiable disease, the mortal ty rate on the cases reported is of no value, as doubtless a very large number of cases occurred which were not known of in the Public Health Department. 57 I have received, as heretofore, information as to cases from the Head Teachers of the Schools of the London County Council. The homes of the patients were visited by your Inspectors, and the parents advised as to the precautions that should be taken. The following Chart shews the number of Deaths from Whooping-Cough per 100,000 inhabitants, 1903-1922. Chicken Pox. —Two hundred and twenty-four cases of Chicken Pox were reported, against 193 in the previous year. In every case the premises were visited by one of your Inspectors and Ihe parents advised as to the precautions necessary. Pneumonia. —One hundred and fifty-four cases of Pneumonia, 57 Influenzal Pneumonia and 97 Primary Pneumonia, were notified during the year. The majority of the patients were treated at home. 58 Forty-one cases were treated at various institutions. All cases were made the subject of enquiry by your lady Health Visitors, and in many cases it was found necessary to arrange for a nurse to visit and attend to the wants of the patients. This was done by arrangement with the Hammersmith District Nursing Association at Carnforth Lodge. One hundred and fifty-eight deaths were registered. From the above figures it may be assumed that a good many cases have occurred, of which no information has been received by your Public Health Department. Malaria. —Four cases were reported, against 6 in the previous year. Dysentery. —No case of Dysentery was reported, against 3 cases in the previous year. Trench Fever. —No case of Trench Fever was reported, against no case in the previous year. Influenza. —During the year 70 deaths from Influenza occurred, as compared with 34 in the previous year. Wrong Diagnosis. —Fifty-five cases of Infectious disease were removed to the Hospitals of the Metropolitan Asylums Board and subsequently returned home in consequence of the patients being found not to be suffering from the disease stated on the certificates, or any other notifiable disease. This number referred to 32 cases of Diphtheria and 21 cases of Scarlet Fever, and 2 cases of Enteric Fever. No provision has been made for the cleansing and disinfecting of verminous persons. The Public Health Committee have, however, approved plans for the erection of a Disinfection Centre. Children attending the L.C.C. Schools and requiring cleansing are dealt with at the Cleansing Stations at Sedleseombe Road, Fulham, and Blechynden Mews, Kensington. TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1913 to 1922. Year. Smallpox. Scarlet Fever. Diphtheria or Diphtheretic Croup. Typhus Fever. Enteric Fever. Simple Continued Fever. Relapsing Fever. Puerperal Fever. English Cholera. Erysipelas, Plague. Chickenpox. * Measles, ┼ * Whooping Cough. * Cerebro Spinal Fever. Anthrax. Glanders. Hydrophobia. Ophthalmia Neonatorum. Acute Polio-Myelitis. Encephalitis Lethargica. Pneumonia.‡ Malaria,‡ Dysentery.‡ Trench Fever.‡ Total. 1913 0 533 141 0 14 0 0 8 0 98 0 171 700 371 1 0 0 0 22 1 0 0 0 0 0 2060 1914 0 954 157 0 14 0 0 7 0 102 0 235 491 232 2 0 0 0 30 1 0 0 0 0 0 2225 1915 0 405 163 0 19 0 0 5 0 90 0 369 619 227 18 0 0 0 23 8 0 0 0 0 0 1946 1916 0 209 209 0 6 0 0 8 0 47 0 291 1418 195 3 0 0 0 40 2 0 0 0 0 2428 0 1917 0 139 151 0 20 0 0 0 0 52 0 245 2153 199 10 0 0 0 44 5 0 0 0 0 0 3018 1918 0 177 146 0 15 0 0 8 0 38 0 492 1664 327 11 0 0 0 36 0 0 0 0 0 0 2914 1919 1 185 238 0 9 0 0 6 0 74 0 188 786 150 6 1 0 0 36 8 3 141 95 3 0 1927 1920 0 726 380 0 8 0 0 20 0 57 0 168 763 225 4 1 0 0 53 6 165 20 9 1 2610 4 1921 0 1358 443 0 4 1 0 12 0 51 0 193 38 101 2 0 0 0 44 3 5 151 6 3 0 2415 1922 0 496 440 0 14 1 0 9 0 39 0 224 1284 357 4 0 0 0 35 0 0 154 4 0 0 3062 Average for IO years. 518 247 0 12 0 0 8 0 65 0 258 992 238 6 0 0 36 3 1 61 13 0 0 2460 * Not Notifiable. † Notifiable during year s 1916— 1919. ‡ Notifiable from 1st March 1919. ‡ 60 Tuberculosis. —Two hundred and ninety-five cases of Tuberculosis were reported during the year ; 246 of which were Pulmonary and 49 being other forms of Tuberculosis, against 311 cases in the previous year. In all cases notified the nurses visited and obtained all the necessary information. Any insanitary conditions found to exist were referred to the Sanitary Inspectors. One hundred and forty-two deaths from Pulmonary Tuberculosis were registered, against 150 in the previous year, representing a death-rate of 1.1 per 1,000, compared with 1.2 in 1921. Age Periods. Pulmonary, Males Pulmonary, Females Non-Pulmonary, Males Non-Pulmonary, Females Number of Notifications on Form " A " Primary Notifications. Total Notifications on Form " A " 0 to 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Pri. Not. 1 1 ... 1 9 16 26 21 14 10 3 102 135 314 ... 28 1 1 5 17 19 13 10 5 138 2 101 1 5 1 ... 16 ... 16 ... 3 2 1 2 2 3 3 3 25 7 ... 25 ... 1 4 1 1 2 Notifications on Form " B " Total Notifications on Form " B " Primary Notifications. Total Pri. Not. 10 to 15 5 to 10 Under 5. 7 2 1 1 ... ... 1 1 ... ... 1 1 ... 1 1 ... 2 2 ... ... 3 Number of Notifications on Form " C " Sanatoria. Poor Law Institurions. 113 19 10 83 8 ... 7 ... The notification of cases of Tuberculosis by medical practitioners is, unfortunately, not carried out as required by the Regulations, that is within 48 hours of the same coming to their knowledge. There are undoubtedly many difficulties attending the notification of this disease, but the efforts of Local Authorities, and the money spent in combating this disease are to a large extent rendered nugatory. 61 I submit a report on the work carried out at the Tuberculosis Dispensary. Tuberculosis Officer's Report for 1922. The notifications of fresh cases of all forms of Tuberculosis in the Borough during the year 1922 numbered 294, a decrease of 53 as compared with 1921. The deaths numbered 162, which is just below the average for the three previous years. The decline during the past eight years is shewn in the following figures :— Year. Deaths. Notifications. 1915 234 433 1916 210 340 1917 230 417 1918 230 374 1919 170 365 1920 157 359 1921 173 347 1922 162 294 I append figures for the years 1920, 1921 and 1922, shewing the interval between notofication and death of tuberculous persons. 162 173 157 1. Total number of deaths from Tuberculosis in the Borough 20 29 26 3. The number of cases notified within one month of death (excluding above) 16 9 16 5. The number of cases notified within six months of death (excluding above) 20 29 28 4. The number of cases notified within three months of death (excluding above) 17 8 11 2. The number of cases notified at death 1922 1921 1920 62 New Patients. During the year 657 patients attended at the Tuberculosis Dispensary for examination for the first time. Of these, 286 were under the age of 15 and 371 were adults. Males comprised 299, females 358. Diagnosis. Found to have Pulmonary Tuberculosis 159 Found to have other forms of Tuberculosis 20 Shewing no evidence of Tuberculosis 478 Total Attendances and Examinations. The total attendances of persons for purposes of examination, observation and treatment, numbered 3,305. This includes not only the new patients for 1922, but also persons who have continued attendance from previous years. Physical examinations were carried out in 1,673 instances.* * I.e., on an average one examination per two attendances. The number of insured persons under Domiciliary treatment, with Dispensary supervision, on 31st December was 289. Sputum Examination. Five hundred and twenty-five specimens of sputum and other pathological products were examined bacteriologically. One hundred and one shewed the presence of Tubercle Bacilli, while 424 proved negative. Institutional Treatment The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homes), under the London County Council's Scheme, numbered 173. 61 Others have entered Infirmaries through the agency of the Guardians, and Convalescent Homes through that of the local Invalid Children's Aid Association. Clinical Reports. To the London County Council, numbered ... 249 To the Ministry of Pensions ... ... 171 To the local War Pensions Committee ... ... 149 To General Practioners and Hospitals ... ... 318 Home Visitation. The Tuberculosis Officer made 128 visits to homes of patients for the purpose o examination, and investigation of the home conditions. In addition he met local practitioners in consultation at the homes of patients on 27 occasions, and at their surgeries on 39 occasions. The Nurses visit the tuberculous population on notification and thereafter at intervals of six months or less, as may appear advisable. During the year 3,413 such visits were made. Since the resignation, in January, 1922, of the Care- Committee Secretary, the Nurses have undertaken the duties in connection with the investigation of the social conditions. Written reports on the home conditions supplied for the London County Council purposes were 182. These enquiries form the basis upon which the Tuberculosis Care-Committee makes its decision in the assessing of individual cases. During the year 152 Home-Enquiry Schedules were submitted to the Committee. Tuberculosis Care-Committee. The Committee met on nineteen occasions during the year. There were submitted by the Staff 151 applications for residential treatment. 64 The Committee decided in 90 of these cases that no payment should be required in respect of such treatment. In the remaining 61 assessments of varying amounts were made. In 67 instances, reconsideration of these assessments was rendered necessary at subsequent meetings, mainly by changes in the family circumstances. Twenty-three patients were referred for help to other agencies including the local branch of the British Red Cross Society, Charity Organisation Society, and the Invalid Children's Aid Association. Collection of payments, on behalf of the London County Council, has been made by the Dispensary to the amount of £119 18s. The Dispensary is open as follows :— Mondays, 10.30 a.m.—Women and young children. Tuesdays, 1.30 p.m.—School children. Tuesdays, 6 p.m.—Men only. Thursdays, 6 p.m.—Women only. Saturdays, 10 a.m.—School children. The officers consist of the Tuberculosis Officer, Dr. Govan, two Nurses, Dispenser and Clerk, and Secretary to the After- Care Committee. There are no residential institutions in the Borough with beds available for the treatment of Tuberculosis. Close co-operation exists between the West London Hospital to which the Dispensary is affiliated. Cases of non-tuberculous chest diseases and " surgical tuberculosis " are admitted if a bed is available for surgical procedure. Admissions to Brompton and other special hospitals for diagnosis and treatment are arranged through the London County Council. 65 Children found to be suffering with tonsils and adenoids, bad dental conditions, and minor ailments are reported to the District Organiser of the London County Council, who arranges for the attendance of the children at the School Clinic for treatment. Certain medical practitioners send reports on patients under domiciliary treatment at three monthly intervals. The majority fail to do so, but in these cases no difficulty has been experienced in securing the attendance at the Dispensary of the patients themselves for examination purposes. Suspects attend at intervals as instructed for further examination. Failing attendance at the appointed time, a nurse visits the home. As in the case of suspects, a card system is in use which gives details of members of infected families, shewing the date and result of first examination, and the date upon which the contact has been instructed to attend for subsequent examination. No special methods of diagnosis are in use. Doubtful cases upon which a further opinion is required are referred to the London County Council for admission to Special Hospital Arrangements exist for the provision of Finsen Light treatment, and artificial pneumothorax. Tuberculin is not administered. No opinion can be expressed on the relative value of the various forms of treatment. The Council have provided in their estimates for the expenditure for Dental treatment for tuberculous patients. No definite arrangements for the provision of nursing exists, but advantage is taken of the services of the District Nurses' Association in cases where home nursing is required. 66 Patients requiring surgical apparatus are referred to one of the Voluntary Associations. A Care Committee meets at fortnightly intervals to consider cases. No provision has been found practicable for the finding of employment for T. B. patients. Shelters are not provided by the Borough Council. No special points as regards occupation have been noted. The usual maximum incidence is found in the poorer and more populated parts of the Borough. . Housing difficulties still exist, and overcrowding obtains in many instances. EXHUMATION AND RE-INTERMENT OF BODIES. St. Mary's Catholic Cemetery, Harrow Road. During the year thirteen licences were granted by the Secretary of State for the exhumation and removal of the bodies of 15 persons from the catacombs or graves in St. Mary's Cemetery. Six of the bodies were reinterred in the Cemetery, 6 removed to Belgium, 2 removed to Valpariso, Chile, and 1 removed to Ireland. The following conditions were attached to the licenses :— (1) That the removal be effected with due care and attention to decency early in the morning. (2) That freshly made ground lime be freely sprinkled over the coffin, the soil, or any matter that may be offensive. 67 In the case of bodies removed to Belgium, Valpariso or Ireland it was further required that the remains be contained in a lead lined shell which shall be hermetically sealed. The work of removal and re-interment was carried out in accordance with the conditions and under the supervision of the Sanitary Inspector on my behalf. MATERNITY AND CHILD WELFARE. The figures tabulated below, indicate in some measure the extent of the ground to be covered on the one hand, and on the other the success of the work accomplished in the interests of Maternity and Child Welfare :— Number of Births registered during the year 2,564 Corrected Number of Births 2,758 These figures represent a Birth-rate per 1,000 of the population of the Borough of 20.5 Corrected Number of Deaths of Infants under one year, of whom 54 died under one week 196 Legitimate Infants —179, or 68 per 1,000 Births. Illegitimate Infants—l 7, or 125 per 1,000 Births. Infant Mortality Rate per 1,000 Births 71 The work undertaken under this heading in the Borough during the year 1922 falls into three categories : — 1. Activities directly initiated by the Borough Council: (a) Provision of three Health Visitors, as in former years. (b) Provision of a Maternity Home. (c) Supply of Free Milk to necessitous Mothers and Young Children. (d) Treatment and Nursing of Children under School Age. 2. Activities of Voluntary Agencies in receipt of grantsin aid from the Borough Council : (a) Infant Welfare Centres. (6) Day Nurseries. 3. Activities of independent Voluntary Agencies : (a) Rescue Homes. (b) Convalescent Treatment for Invalid Children. 68 Health Visitors. —Three Health Visitors were engaged, as in former years, in visits of enquiry to Births, Infant Deaths, cases of Ophthalmia Neonatorum, Puerperal Fever, and other diseases of mothers and young children ; they have also taken an active part in the work of the Voluntary Infant Welfare Centres. The visits paid are enumerated in detail below :— First visits 2,301 Re-visits (under 1 year) 1,652 Re-visits (1 to 5 years) 866 Out and removals 2,032 Special visits 272 Ophthalmia 55 Pneumonia 23 Puerperal Fever 9 Ante-natal, first visits 364 Ante-natal, re-visits 24 Visits to Stillbirths 54 Visits to Infant Deaths 157 Total 7,809 Number of Consultations at Infant Welfare Centres, attended by Health Visitors 393 Number of Committee Meetings of Voluntary Associations attended 42 Number of Insanitary Conditions reported by Health Visitors and dealt with by Sanitary Inspectors 73 The feeding of the 2,301 infants visited was found to be as follows:— Breast-feeding 2,024 Artificial feeding 167 Mixed feeding 110 Every effort is made by the Health Visitors to encourage mothers to breast-feed their infants, and also to induce them to attend the Consultations at the Infant Welfare Centres, so that both mother and child may be kept under observation during the most critical months of the child's life. 69 The following table gives the number of births and deaths of infants and the rate per 1,000 births during the past 17 years, the year of the appointment of the first Health Visitor. Deaths of Infants. Deaths of infants per 1000 births. Year. Births. 1906 3112 430 138 1907 3029 362 117 1908 3204 383 120 1909 2995 360 120 1910 2906 329 99 1911 2929 434 146 1912 2880 259 90 1913 2951 314 103 1914 2935 276 94 1915 2708 277 102 1916 2605 222 85 1917 2278 251 110 1918 2014 210 104 1919 2296 228 99 1920 3312 219 66 1921 2779 245 88 1922 2758 196 71 It will be observed that the infant death-rate has decreased from 88 to 71 per 1,000. This figure is the second lowest recorded in Hammersmith. The activities of those who have been engaged in Infant Welfare Work have been carried on with enthusiasm by both voluntary and municipal workers. Milk [Mothers and Children) Order, 1918-1919.—Under these orders the Council has continued to supply milk to necessitous cases, each case being investigated, especially as to the financial position, before a supply is granted. The number of applications for free milk has averaged 30-40 per week during the year. The total expenditure during the year was approximately £500. The distribution of milk has entailed no increase of the administrative staff or additional expense to the Council. 70 The distribution of this free milk has been an inestimable boon, and has, without doubt, contributed very largely to the improved condition of the children generally. By this means the Public Health Department and the Maternity and Infant Welfare Centres are able to keep in close contact with these cases, and at the same time mothers have been able to obtain a proper supply of milk for their children which they could not have done otherwise. The arrangements whereby the Infant Welfare Centres are supplied with dried milk for distribution has been continued. The mothers attend the Centre and obtain their supplies on presenting an order issued from the Public Health Department, thus encouraging the mothers to attend the Centres where they can obtain advice both with regard to themselves and their children. Maternity Home. —l append figures for the year of this report regarding the work of the Maternity Home. The ante-natal clinic was held weekly by the Medical Supervisor—Dr. Llewellyn Jones. " Parkside " Maternity Home. Period Ended 31st December, 1922. 1. Total number of cases admitted 304 2. Average duration of stay, days 15½ 3. Number of cases delivered by— (a) Midwives 347 (b) Doctors 15 Two cases admitted for medical treatment only. 71 4. Number of cases in which medical assistance was sought by midwife, with reasons for requiring assistance :— All cases under medical supervision. (a) Ante-natal (admitted for treatment) — Albuminuria 3 Inductions 4 (b) During labour— Uterine inertia 4 Prolapse of cervix 1 P.P.H 5 Malpresentation ... ... ... ... 1 Ruptured perineum 1 (c) After labour — Sub-involution 1 Retained chorian 2 Rise of temperature 1 All cases under daily medical supervision since 24th July, 1922. (d) For infant- Dangerous feebleness ... ... ... 1 Cyanosis ... ... ... ... ... 1 Phimosis 1 Pemphigus neonatorum 1 Prematurity 2 Vomiting 1 Stricture of Oesophagus 1 Œdema 1 Hyperspadias 1 Suppurating ear 1 Total 34 Infants under daily medical supervision since 24th July, 1922. 72 5. Number of cases notified as puerperal sepsis, with result of treatment in each case Nil 6. Number of cases in which temperature rose above 100.4 for twenty-four hours, with rise of pulse rate 1 7. Number of cases notified as ophthalmia neonatorum, with result of the treatment in each case 2 One clear within four hours of onset, and one still under specialist—no permanent injury to sight. 8. Number of cases of inflamation of eyes, however slight 3 9. Number of infants not entirely breast-fed while in the Institution, with reasons why they were not breast-fed: — Supplementary feeds— Insufficient breast milk 17 Twins 1 18 Addition of Virol (continued loss of weight) 8 Bottle fed- Mammary abscess 1 No mammary activity, patient severe case of albuminuria 1 Pulmonary tuberculosis 6 8 Total 34 10. Number of maternal deaths with causes Nil 73 11. Number of foetal deaths (still-born or within ten days of birth) and their causes, and result of post-mortem examinations, if obtainable:— Stillbirths- Twin 1 Advanced cases of pulmonary tuber- culosis 2 Malpresentations 2 Macerated foetus 1 Prematurity 1 7 Deaths- Stricture of oesophagus 1 Prematurity 1 Congenital heart 2 4 Total 11 No post-mortem examinations were held. Treatment and Nursing of Children under School Age. — The Council accepted financial responsibility for treatment at the School Clinic of children under five years of age. During the year the cases dealt with were as follows: — Operations for Tonsils and Adenoids 8 Minor Ailments 50 Dental Treatment 8 Total 66 In addition arrangements were made, as before, with the Hammersmith District Nursing Association for the services of a nurse when required, to ensure adequate attention in cases of Ophthalmia Neonatorum, Pneumonia and Measles. 74 Voluntary Work Aided by Borough Council. Infant Welfare Centres. —There are two Voluntary Societies for the promotion of Infant Welfare in the Borough, and in spite of difficulties these continued their good work during the year. The Hammersmith Infant Welfare Centre, with its four branch Centres, had its full complement of activities, including Ante-natal Clinics, Infant Consultations and Weighings, and Mothers' Classes of Instruction. The Women's League of Service, at its one Centre in the Borough, also held Ante-natal and Infant Consultations, and supplied dinners to expectant and nursing mothers at reduced rates. A weekly Dental Clinic is held at this Centre. Day Nurseries. —Four Day Nurseries in the Borough — Princess Christian, Princess Mary Adelaide, the Latymer Road Mission Creche, and West End Baptist, King Street —were in great demand where mothers were compelled to work for the support of the family. The first three nurseries received grantsin-aid from the Council. Independent Voluntary Agencies. Rescue Homes. —There were three Homes open in the Borough throughout the year for the reception of Unmarried Mothers and their Children; the total accommodation available for such cases was 19 beds, the confinements taking place at various institutions in the London area. Convalescent Treatment of Invalid Children. —This work was carried on by the Invalid Children's Aid Association; the majority of children assisted are of school age, and a considerable number were sent to Convalescent Homes by the good offices of the Association during the year. 73 Infectious Diseases of Mothers and Children Under Five Years of Age. Statistics showing the incidence of all infectious diseases during the year are included in the general report, but in so far as they relate particularly to diseases of parturient women and children under five years of age, are tabulated below:— Disease. No. of Cases Notified. Previous Year. No. of Cases Visited. No. of Cases Nursed. No. of Cases Removed Hospital. Puerperal Fever Ophthalmia 9 12 9 9 - Neonatorum Epidemic 35 35 12 7 44 Diarrhoea 18 - 73 - - Measles & German Measles (under 5)† 391 391 12 - 7 Whooping Cough (under 5)† 153 153 - 24 4 Poliomyelitis (under 5) 2 - - - - *Summer Diarrhoea.—As this is not a notifiable disease the figures available are those of deaths which were registered as having been due to this cause. † Not notifiable diseases. Ophthalmia Neonatorum.—The number of cases reported was 35, against 44 in the previous year. The analysis of the final reports received is as follows: — Eyes satisfactory 31 Infants died (1 from Diphtheria) 2 Parents removed from District 1 Under specialist, no injury to sight 1 Total 35 All notified cases of diseases of parturient women and children under five years of age are visited immediately, and arrangements made for the attendance of a nurse where required. 74 Bacteriology. —The Bacteriological work is carried out by Dr. Elworthy at the West London Hospital, and I append figures with regard thereto. Sputa from cases of suspected Tuberculosis is examined in the majority of cases by the Tuberculosis Officer, but in a few instances Dr. Elworthy carries out the examination. The following bacteriological examinations were made on behalf of the Council: — Material from cases of suspected Diphtheria— True Diphtheria bacillus isolated 130 Negative results 385 515 Blood from cases of suspected Fever — Widal or Typhoid reaction obtained 2 Widal or Typhoid reaction not obtained 4 6 Urine from cases of Tuberculosis — Positive 0 Negative 1 1 Sputa from cases of suspected Tuberculosis — Tubercle bacillus found 111 Tubercle bacillus not found 442 553 Total examinations 1,075 Disinfection. —The following table shews the amount of disinfection carried out by your Council during the year; all 75 bedding and articles of clothing, &c., being removed to the Council's Disinfecting Station, for the purpose of disinfection. Beds 819 Mattresses 947 Pillows 2,567 Bolsters 650 Blankets 2,946 Sheets 1,442 Rugs 1,182 Articles of clothing 4,155 Rooms 1,360 Sundries 574 Total 16,642 SANITARY ADMINISTRATION. Staff. —There are nine male Sanitary Inspectors and one lady Sanitary Inspector. Eight of the male Inspectors are employed as District Inspectors being responsible for all matters excepting the taking of samples under the Sale of Food and Drugs Acts and the inspection of Ice Cream Vendors, for which the Special Inspector is responsible. The Special Inspector also inspects the Markets. The Lady Inspector inspects Factories, &c, where females are employed, makes enquiries into cases of measles, whooping cough, chicken pox, cerebro-spinal meningitis, encephalitis lethargica, &c. Increase of Rent and Mortgage Interest Restrictions Act. 1920. —During the year thirty-four applications were received for certificates under the above Act. In twenty-five cases the certificates were granted, and nine applications were refused. 78 Rag Flock Act, 1911.—The Rag Flock Regulations, 1912. —No action was taken under these regulations during the year under review. Public Mortuary. —During the year 281 bodies were removed to the Mortuary in Fulham Palace Road. There were 210 brought to the Mortuary by order of the Coroner, and 71 were received for accommodation and convenience of burial. HOUSING. Housing and Town Planning. —During the year the housing conditions have not materially improved. The Housing Schemes of the County Council and Borough Council are in progress but no further action has been taken with regard to the Southern Housing Scheme. Six hundred and seventy-six Certificates were granted during the year under Section 48 (2) of the Public Health (London) Act, 1891, with regard to newly erected houses having a proper and sufficient water supply. Three hundred and fifteen of these being houses erected by the London County Council, and 361 on the Housing Estate of the Borough Council. HOUSING CONDITIONS. Statistics. Year ended 30th December, 1922. 1. —General. (1) Estimated population 134,400 (2) General death-rate 12.9 (3) Death-rate from tuberculosis 1.34 (4) Infantile mortality 71 (5) Number of dwelling-houses of all classes (estimated) 18,456 (6) Number of working-class dwelling-houses (estimated) 12,000 (7) Number of new working-class houses erected 676 77 2. —Unfit Dwelling-houses. I. — Inspection. (1) Total number of dwelling-houses inspected for Housing defects (under Public Health or Housing Acts) 9,322 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 406 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 (4) Number of dwelling-houses (exclusive of those referred to under the preceding subheading) found not to be in all respects reasonably fit for human habitation 3,605 II.—Remedy of defects without service of formal notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers Nil III. — Action under Statutory Powers. (A) Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919 — (1) Number of dwelling-houses in respect of which notices were served requiring repairs 38 (2) Number of dwelling-houses which were rendered fit— (a) By owners 36 (b) By Local Authority in default of owners 21 78 (3) Number of dwelling-houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close Nil (B) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3,605 (2) Number of dwelling-houses in which defects remedied — (a) By owners 3,760 (b) By Local Authority in default of owners Nil (C) Proceedings under Section 17 and 18 of the Housing, Town Planning, &c, Act, 1909— (1) Number of representations made with a view to the making of Closing Orders 8 (2) Number of dwelling-houses in respect of which Closing Orders were made 8 (1 not served) (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 1 (4) Number of dwelling-houses in respect of which demolition orders were made Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil (One demolished. No Demolition Order made). 79 3.—Unhealthy Areas. Areas represented to the Local Authority with a view to Improvement Schemes under (a) Part 1, or (b) Part 11, of the Act of 1890: — (1) Name of area Nil (2) Acreage (3) Number of working-class houses in area (4) Number of working-class persons to be displaced IV. —Number of houses not complying with the building by-laws erected with the consent of the Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 Nil V. —Staff engaged on housing work with, briefly, the duties of each— Medical Officer of Health. Three Clerks (part time). Eight Sanitary Inspectors. Meteorology. The average mean temperature registered in London during the year was 49.4 degrees Fahrenheit. The highest air temperature registered being 91 degrees, in May. The lowest air temperature was 24 degrees in January, October and December. The total amount of rainfall was 23.2 inches. INDEX. Page Summary of Statistics, &c. 5 Natural. and Social, Conditions of the District. Population 5 Marriages 6 Births 6 Deaths 7 Deaths of Infants 7 Summer Diarrhoea 7 Deaths of Illegitimate Infants 9 Deaths of Aged Persons 10 Deaths in Institutions 10 Deaths (Various Causes—Table II) 13 Table—Whole of London —Comparison 14 Sanitary Circumstances. Closet Accommodation 15 Scavenging 15 Cesspools 15 Sanitary Inspection of District 15 Summonses 17 Factories and Workshops—lnspection of 19 Customs and Inland Revenue 22 House to House 22 Houses Let in Lodgings 22 Rat and Mice (Destruction) Act, 1919 22 Smoke Abatement 23 Controlled Premises and Occupations 24 Schools 25 Food. Milk Supply 25 Milk (Special Designations) Order, 1922 26 Milk and Dairies (Amendment) Act, 1922 29 Certification of Food —Export to Canada 82 Public Health (Milk and Cream) Regulations, 1912 and 1917 33 Milk (Mothers and Children) Orders 86 Public Analyst's Annual Report 36 Meat—Slaughterhouses 42 Markets 43 Bakehouses 44 Seizure of Unsound Food 46 Lead Poisoning—Beer 47 Food Surrendered 47 Prevalence and Control over Infectious Diseases. Infectious Diseases 48 Zymotic Diseases 49 Smallpox 50 Cholera 50 Plague 50 Diphtheria and Diphtheritic Membraneous Croup 50 Anti-toxin 50 Chart —Diphtheria. Chart —Scarlet Fever 51-52 Scarlet Fever 53 Enteric Fever 53 Erysipelas 53 Page Prevalence and Control over Infectious Diseases—continued Typhus Fever 54 Relapsing Fever 54 Continued Fever 54 Puerperal Fever 54 Cerebro Spinal Meningitis 54 Acute Polio-myelitis 54 Encephalitis Lethargica 55 Ophthalmia Neonatorum 55 Anthrax 55 Hydrophobia 55 Rabies 55 Glanders 55 Measles—Chart 56 Whooping Cough—Chart 57 Chickenpox 57 Pneumonia 57 Malaria 58 Dysentery 58 Trench Fever 58 Influenza 58 Wrong Diagnosis 58 Tabular Statement —Zymotic Diseases 59 Tuberculosis 60 Tuberculosis Dispensary 62 Tuberculosis Care Committee 63 Exhumation and Reinterment of Bodies 66 Maternity and Child Welfare. Health Visitors —Work of 08 Feeding of Infants —Statistics 68 Milk (Mothers and Children) Orders, 1918—1919 69 Maternity Home —Statistics 70 Treatment and Nursing—Children under School Age 73 (a) Operations. (b) Minor Ailments, (c) Dental Treatment Voluntary Work. Infant Welfare Centres 74 Day Nurseries 74 Rescue Homes 74 Convalescent Treatment of Invalid Children 74 Infectious Diseases of Mothers, and Children under five years of a ge—Tabular Statement 75 Ophthalmia Neonatorum 75 Sanitary Administration. Bacteriology 76 Disinfection 76 Staff 77 Rent Restrictions Acts 77 Rag Flock Act 78 Public Mortuary 78 HOUSING. Housing and Town Planning 78 New Houses —Water Certifientes 78 Statistics 78 METEOROLOGY 81