HAM 20 London ANNUAL REPORT OF THE Medical Officer of Health OF THE borough of hammersmith FOR THE year 1923. skelton, printer, hammersmith. INDEX. Page Summary of Statistics, &c. 7 Natural and Social Conditions of the District. Population 7 Marriages 8 Births 8 Deaths 9 Deaths of Infants 9 Summer Diarrhoea 10 Deaths of Illegitimate Infants 11 Deaths of Aged Persons 12 Deaths in Institutions 13 Deaths (Various Causes—Table II) 15 Table—Whole of London—Comparison 15 Sanitary Circumstances. Closet Accommodation 17 Scavenging 17 Cesspools 17 Sanitary Inspection of District 17 Summonses 19 Factories and Workshops—Inspection of 22 Customs and Inland Revenue 25 House to House 25 Houses Let in Lodgings 25 Rat and Mice (Destruction) Act, 1919 25 Smoke Abatement 26 Controlled Premises and Occupations 26 Ice Cream Vendors 27 Schools 28 Food. Milk Supply 28 Milk (Special Designations) Order, 1922-1923 29-31 Public Health (Condensed Milk) Regulations, 1923 33 Public Health (Dried Milk) Regulations 1923 39 Certification of Food—Export to Canada 48 Public Health (Milk and Cream) Regulations, 1912 and 1917 49 Milk (Mothers and Children) Orders 51 Public Analyst's Annual Report 51 Meat—Slaughterhouses 56 Markets 58 Bakehouses 58 Unsound Food 61 Food Surrendered 61 Prevalence and Control over Infectious Diseases. Infectious Diseases 61 Zymotic Diseases 62 Smallpox 62 Cholera 64 Plague 64 Diphtheria and Diphtheritic Membraneous Croup 64 Anti-toxin 64 Chart—Diphtheria. Chart—Scarlet Fever 65-66 Scarlet Fever 67 Enteric Fever 67 Erysipelas 67 Page Prevalence and Control over Infectious Diseases—continued. Typhus Fever 67 Relapsing. Fever 67 Continued Fever 67 Puerperal Fever 67 Cerebro Spinal Meningitis 68 Acute Polio-myelitis 68 Encephalitis Lethargica 68 Ophthalmia Neonatorum 68 Anthrax 68 Hydrophobia 68 Rabies 68 Glanders 69 Measles—Chart 69 Whooping Cough—Chart 70 Chickenpox 71 Pneumonia 71 Malaria 71 Dysentery 71 Trench Fever 71 Influenza 71 Tabular Statement—Zymotic Diseases 72 Wrong Diagnosis 73 Cleansing of Verminous Persons 73 Tuberculosis 73 Tuberculosis Dispensary 75 Tuberculosis Care Committee 77 Cancer 80 Exhumation and Reinterment of Bodies 81 Maternity and Child Welfare. Health Visitors—Work of 82 Feeding of Infants—Statistics 83 Health Visitors- Table of Comparison for London 86 Milk (Mothers and Children) Orders, 1918—1919 87 Maternity Home—Statistics 88 Treatment and Nursing—Children under School Age 91 (a) Operations. (b) Minor Ailments. (c) Dental Treatment Voluntary Work. Infant Welfare Centres 90 Day Nurseries 91 Rescue Homes 91 Convalescent Treatment of Invalid Children 91 Infectious Diseases of Mothers, and Children under five years of age—Tabular Statement 92 Ophthalmia Neonatorum 92 Sanitary Administration. Bacteriology 93 Disinfection 93 Staff 3-94 Rent Restrictions Acts 94 Rag Flock Act 95 Public Mortuary 95 Housing. Housing and Town Planning 96 New Houses—Water Certificates 96 Statistics 96 Meteorology 97 ANNUAL REPORT of the Medical Officer of Health of the BOROUGH OF HAMMERSMITH For the Year 1923. STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF THE YEAR 1923. Medical Officer of Health and Administrative Tuberculosis Officer. Year of Appointment. J. B. Howell, M.R.C.S., L.R.C.P., D.P.H. 1914 Tuberculosis Officer. R. Govan, M.A., M.D., Ch.B., D.P.H. 1918 Clerical Staff. *A. H. Wilmot (Chief Clerk) 1902 A. C. Groom 1923 C. M. White 1920 J. C. Turner 1920 Miss Cole 1923 R. J. Daw 1923 4 Sanitary Inspectors. Year of Appointment. S. Addison 1901 §*F. Arnold 1921 W. Brown 1894 §*F. Q. Barry 1919 J. S. Cromack 1899 §*A. Hayes 1910 § H. Neighbour 1901 §*P. W. Pottier 1919 §*W. Rigby 1919 Lady Sanitary Inspector *Miss M. M. Hawkins 1923 Health Visitors. *Miss R. A. Henry 1916 Miss D. G. Johnson 1922 *Miss A. M. M. Willcox 1916 Tuberculosis Dispensary Staff. Miss Digby (Nurse Visitor) 1918 Miss Longstaffe (Nurse Visitor) 1918 Miss Rees (Dispenser and Secretary) 1918 Disinfecting Staff. G. F. Nichols 1898 G. Langley 1900 Medicinal Baths Staff. Mrs. Manners 1924 Mortuary Keeper. R. W. Carter 1919 Cert. Royal Sanitary Institute (Inspector). *Cert. Sanitary Inspectors Examination Board. Board of Education (Health Visitor). Cert. Central Midwives Board. §Cert. Royal Sanitary Institute (Meat and other foods). Trained Nurse. Cert. Royal Sanitary Institute (Health Visitor). Apothecaries' Hall Certificate, 5 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 1923. 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 11.0 is 1.9 lower than the rate for the previous year, whilst the infantile mortality rate is 64 per 1,000 births. The infantile rate has decreased 7 per 1,000, and is the lowest rate recorded for this Borough. This figure is fairly satisfactory and I can only repeat that our efforts should be maintained in an endeavour to permanently reduce the loss of infant life. 6 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 below the average. The sanitary condition of the Borough is not of a very satisfactory nature and it is to be regretted that a very considerable amount of overcrowding still exists. The Council's Housing Scheme is nearing completion, but up to the present no improvement in housing conditions has resulted in the congested areas. It will be observed that 3,836 Intimation Notices and 1,044 Statutory Notices were served during the year. This fact in itself tends to show the condition of the Borough. I am, Ladies and Gentlemen, Your obedient Servant, J. B. HOWELL, Medical Officer of Health. 7 SUMMARY OF STATISTICS, ETC. For the Year 1923. Population of Registration area at Census (1901) 112,239 (1911) 121,521 (1921) 130,287 Estimated Population (1923) 133,600 Natural increase, i.e., excess of births over deaths 1,228 Area of Borough 2,282.5 acres Density of population 58.5 persons per acre over total area. Marriages registered 1,090 Births registered (corrected) 2,701 Birth-rate 20.2 Deaths registered (corrected) 1,473 Death-rate 11.0 Infantile mortality 173 deaths under one year, or 61 per 1,000 births. 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. 8 The estimated population adopted by the Registrar General is 133,600, but I believe this number to be below the actual population of the Borough. Since the census was taken, over twelve hundred houses have been built by the London County Council and the Borough Council, in the northern part of the Borough. It is probable, therefor, that the estimate of the Registrar General is considerably below the actual population. The corrected number of births registered was 2,701. whilst the corrected number of deaths of residents was 1,473, thus showing a natural increase of population by excess of births over deaths of 1,228. The area of the Borough is 2,282.5 acres, there being 58.5 persons to the acre, shewing a decrease as compared with the previous year of 0.4 persons per acre. Marriages.—The number of marriages registered duiing the year was 1,090, the marriage rate being 16. Births.—During the year 2,537 births were registered in the Borough. Adding 243 births which occurred outside the Borough, transferred by the Registrar General as belonging to Hammersmith, and deducting 79 births which occurred in the Borough, and transferred to other districts by the Registrar General, the corrected number of births for the year was 2,701. On the estimated population, i.e., 133,600, the corrected number of births registered was equal to an annual rate of 20.2 births per 1,000 persons living. The Birth-rate for the year is 0.3 per 1,000 less than the rate for the previous year which was 20.5. The Birth-rate in London on the estimated population of London, i.e., 4,564,109, was equal to an annual rate of 20.2 births per 1,000 persons living. 9 Notification of Births Act, 1907. Births registered 2,537 Corrected number of births 2,701 Notification Received from Midwives. Doctors. Lying-in Hospitals. Poor Law Institutions. Parents. M.O.H.'s. 1,318 538 572 37 63 22 Total notifications received, 2,550. Deaths.—During the year 981 deaths (495 males, 486 females) were registered in the Borough, as compared with 1,223 in the previous year. Adding 649 deaths of residents of this Borough which occurred in general hospitals and other public institutions, and 31 deaths of residents transferred by the Registrar-General as having occurred in various parts of England, and deducting 125 deaths of non-residents and 63 transferable deaths which occurred in the Borough, the corrected number of deaths of residents registered was 1,473. On the estimated population, i.e., 133,600, the corrected number of deaths of residents was equal to an annual rate of 11.0 deaths per 1,000 persons living. The death-rate in London on the estimated population of London, i.e., 4,564,109, was equal to an annual rate of 11.2 deaths per 1,000 persons living. Deaths of Infants.—The corrected number of deaths of residents under one year of age registered during the year was 173 as compared with 196 in the previous year. The number 10 The following Chart shows the numbers of Deaths from Diarrhoea per 100,000 inhabitants, 1904-1923. 11 of deaths of infants under one year of age was equal to 64 per 1,000 of the corrected births and to 117 per 1,000 of the corrected deaths. The number of deaths of infants under one year of age, residents in London, was equal to 60 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, 4 per 1,000 greater in this Borough than in London. Summer Diarrhoea.—The number of deaths from Diarrhoea was 31, being 13 more than in the previous year. Of these 26 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 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 11 or at the rate of 85 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 63 per 1,000 whilst the latter is 85 per 1,000, a difference of 22 per 1,000. The following table on infantile mortality has been prepared in accordance with the direction of the Ministry of Health, 12 TABLE III. Infantile Mortality during the year 1923. Nett Deaths from stated causes at various ages under 1 year of age. CAUSE OF DEATH Under lWeek 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 57 9 12 10 88 29 30 12 14 173 Uncertified — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — —• — — — — — — — Measles — — — 1 1 — — — — 1 Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — 2 2 — 4 8 Diphtheria and Croup — — — — — — — — 2 2 Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — 1 — — 1 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — 1 3 1 5 Convulsions 2 — — 1 3 — 1 — — 4 Laryngitis — — — — — — — — — — Bronchitis — — 1 — 1 3 1 — 2 7 Pneumonia (all forms) 4 1 2 1 8 9 5 3 3 28 Diarrhœa — — — — — — 2 — — 2 Enteritis — — 2 2 4 3 10 6 1 24 Gastritis — — — — — — — — — — Syphils — 1 — 1 2 — 1 — — 3 Rickets — — — — — — — — — — Suffocation, overlying 2 — — — 2 1 — — — 3 Injury at Birth — — — — — — — — — — Atelctasis 4 — 1 — 5 — — — — 5 Congenital Malformation 4 1 —— — 5 4 — — — 9 Premature Birth 32 5 3 3 43 — 1 — — 44 Atrophy, Debility & Marasmus 6 1 2 1 10 1 2 — — 13 Other causes 3 — 1 — 4 6 3 — 1 14 Totals 57 9 12 10 88 29 30 12 14 173 Nett Births in the Year: Legitimate, 2571: Illegitimate, 130. Nett Deaths in the Year of: Legitimate Infants, 162; Illegitimate Infants, 11. Deaths of Aged Persons.—The corrected number of deaths of residents at 65 years of age and upwards registered during the year was 576, against 617 in the previous year. These deaths were equal to 4.3 per 1,000 of the total persons living, and 398 per 1,000 of the total deaths of residents registered. Statistics.—The following table gives the statistics of the Borough during 1923 and the previous five years, in the form prescribed by the Ministry of Health:— 13 table I. Vital Statistics of Whole District during 1923 and Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. of Non-residents registered in the District. of Residents not registered in the District. Number Rate. Under 1 Year of Age. At all Ages. Number. Rate. Number- Rate per 1.000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1918 115833 1829 2014 15.5 1445 12.5 175 713 210 104 1983 17.1 1919 130981 2084 2296 16.8 1210 9.2 168 659 228 99 1701 13.0 1920 136200 3150 3312 24.3 1073 7.9 161 646 219 66 1558 11.4 1921 131500 2599 2779 21.1 1167 9.1 202 669 245 88 1634 12.7 1922 134400 2564 2758 20.5 1223 9.1 196 705 196 71 1733 12.9 1923 133600 2571 2701 20.2 981 7.3 125 649 173 64 1473 11.0 Area of District in acres Hand and inland water) 2282.5 At Census of 1921 (of. 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 1923:— FEVER HOSPITAL. Western Hospital 22 MENTAL HOSPITALS. Cane Hill Mental Hospital 4 Caterham Mental Hospital 2 Hanwell Mental Hospital 20 Leavesden Mental Hospital 3 Colney Hatch Mental Hospital 4 Horton Mental Hospital 2 Springfield Mental Hospital 3 55 Banstead Mental Hospital 5 Tooting Bec Mental Hospital 11 Fountain Temporary Mental Hospital 1 GENERAL HOSPITALS. Infants' Hospital, Vincent Sq. 1 Children's Hospital, Great Ormond Street 3 Middlesex Hospital 12 St. Mary's Hospital 12 Brompton Hospital ... 6 University College Hospital 4 Cancer Hospital, Chelsea 6 Charing Cross Hospital 6 Colindale Hospital 7 National Hospital, Queen's Square 2 St. Thomas' Hospital 2 Victoria Hospital 3 14 GENERAL HOSPITALS—continued. Willesden Hospital 1 Hospital of St. John and St. Elizabeth 1 Royal Chest Hospital 2 King Edward VII Memorial Hospital 1 Queen's Hospital, Chislehurst 1 South London Hospital 1 St. George's Hospital 9 Hospital for Erysipelas and Paralysis 2 Chelsea Hospital for Women 2 Queen Charlotte's Hospital 1 St. Columbus' Hospital 1 Mount Vernon Hospital, Ruislip, North wood 2 Queen Mary's Hospital, Stratfor 1 London Hospital 1 Chiswick Hospital 1 Royal Free Hospital 1 St. Margaret's Hospital 1 Hospital for Jewish Incurables 1 Guy's Hospital 2 Infants' Hospital, Vincent Sq. 2 Freemason's Hospital, Chelsea 1 St. Joseph's Hospital, Hackney 1 Lock Hospital, Dean Street 1 Children's Hospital, Paddington 1 King's College Hospital 1 Royal Hospital for Incurables 1 St. Bartholomew's Hospital 3 110 Homoeopathic Hospital 1 Down's Hospital, Sutton 1 OTHER INSTITUTIONS. Kensington Infirmary 54 Empire Nursing Home, Vincent Square 1 St. Marylebone Infirmary 241 Fulham Infirmary 122 Baby Clinic, 127 Ladbroke Road 1 Chelsea Infirmary 1 Home of Compassion, Thames Ditton 1 422 St. John's Home, Merton 1 VARIOUS. Addison Road Railway Station 1 River Thames, Battersea 1 14, Pembridge Square 1 285 Harrow Road 2 5 Colosseum Terrace, St. Pancras 1 45 Devonshire Street, St. Mary- lebone 1 The Broadway, Acton 1 65 South Park Road, Wimbledon 1 In Reservoir, Castelnau, Barnes 1 Private Nursing Home, 18-20 Southwold Road, Hackney Brentford Police Station 1 1 "Devon Nook," Barrowgate Road, Chiswick 2 164 St. John's Hill, Battersea 1 In street at Twickenham Green, Twickenham 1 4 Dorset Square, St. Marylebone 1 The Drill Hall, Algernon Road, Hendon 1 1006 Harrow Road, Harlesden 1 River Thames, Barnes 1 1 Thyra Grove, North Finchley 1 26 Howards Road, Plaistow 1 Twyford Abbey 1 1 Cotham Green,Hillingdon End 1 73 Oxford Road, Chiswick 1 16 Pembridge Gardens, Kensington 1 30 Twickenham Road, Isleworth 1 369 Fulham Road 3 On way to St. George's Hospital 1 River Thames, Chiswick 1 24 Church Road, Hanwell 1 40 Pellatt Green, Wood Green 1 River Thames, Fulham 1 18 Dorset Square 1 Station Road, Hendon 1 20 Glazbury Road, Fulham 1 Castlenau, Barnes 1 40 15 Welbeck Street, St. Marylebone 1 TOTALS. Fever Hospitals 22 Mental Hospitals 55 General Hospitals 110 Other Institutions 422 Various 40 649 15 TABLE II. Causes of, and ages at, Death during the Year 1923. METROPOLITAN BOROUGH OF HAMMERSMITH. Causes of Death. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of 'Residents' or 'Nonresidents in Institutions in the District All ages. Under 1 year. 1 and under 2. 2 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards 1 2 3 4 5 6 7 8 9 10 11 All Causes Certified 1473 173 24 29 49 63 173 386 576 176 Uncertified 0 0 0 0 0 0 0 0 0 0 Enteric Fever 2 0 0 0 0 1 1 0 0 0 Small-pox 0 0 0 0 0 0 0 0 0 0 Measles 6 1 0 3 1 1 0 0 0 0 Scarlet Fever 2 0 0 0 2 0 0 0 0 0 Whooping Cough 10 8 1 1 0 0 0 0 0 0 Diphtheria and Croup 20 2 3 5 10 0 0 0 0 0 Influenza 18 2 0 0 0 2 2 7 5 0 Erysipelas 0 0 0 0 0 0 0 0 0 0 Phthisis (Pulmonary Tuberculosis) 127 0 0 0 3 29 51 38 6 5 Disemminated Tuberculosis 6 0 0 1 2 1 2 0 0 2 Tuberculous Meningitis 12 1 2 3 3 2 1 0 0 9 Other Tuberculous Diseases 11 0 0 3 2 1 2 3 0 2 Cancer, malignant disease 167 0 0 0 0 0 10 77 80 31 Rheumatic Fever 4 0 0 0 0 2 1 0 1 1 Meningitis 12 5 2 2 0 0 1 2 0 6 Organic Heart Disease 165 1 0 0 2 3 16 44 99 3 Bronchitis 135 7 1 2 0 1 2 34 88 0 Pneumonia (all forms) 99 28 8 5 3 3 7 21 24 5 Other Diseases of Respiratory Organs 20 1 1 0 0 1 2 8 7 1 Diarrhoea and Enteritis 31 26 1 0 0 0 1 1 2 5 Appendicitis and Typhlitis 7 0 0 0 3 0 1 0 3 4 Cirrhosis of Liver 10 0 0 0 0 0 1 7 2 1 Alcoholism 0 0 0 0 0 0 0 0 0 0 Nephritis and Bright's Disease 54 1 0 0 0 2 7 20 24 4 Puerperal Fever 5 0 0 0 0 2 3 0 0 0 Other Accidents and Diseases of Pregnancy and Parturition 3 0 0 0 0 0 3 0 0 1 Congenital Debility and Malformation, including Premature Birth 68 66 2 0 0 0 0 0 0 14 Violent Deaths, excluding Suicide 36 0 0 0 7 3 7 11 8 23 Suicide 9 0 0 0 0 1 1 6 1 1 Other defined diseases 434 24 3 4 11 8 51 107 226 58 Diseases ill-defined or unknown 0 0 0 0 0 0 0 0 0 0 Total 1473 173 24 29 49 63 173 S86 576 176 SubEntries included in above figures. Cerebro - Spinal Meningitis 4 1 0 1 0 0 1 1 o 2 Acute Poliomyelitis 0 0 0 0 0 0 0 0 0 1 Encephalitis Lethargica 3 0 0 0 0 0 2 1 0 16 LONDON AND THE METROPOLITAN BOROUGHS. Cities and Boroughs. Estimated population to the middle of 1923. Births. Annual rate per 1,000 persons living. Zymotic Deaths. Annual rate per 1,000 persons living. Deathrate per 1,000 living. Deaths of Infants under one year to 1,000 births. LONDON 4,534,230* 20.2 — 11.2 60 West Districts. Paddington 146,200 17.9 0.4 11.7 69 Kensington 178,500 17.5 0.69 12.3 70 Hammersmith 133,600 20.2 0.5 11.0 64 Fulham 161,600 18.4 0.5 10.5 64 Chelsea 64,480 15.1 0.4 12.2 58 City of Westminster 140,430 12.5 0.09 10.6 46.6 North Districts. St. Marylebone 105,400 15.8 0.48 11.7 66 Hampstead 87,410 14.3 0.4 10.3 42 St. Pancras 214,400 20.3 0.6 12.1 63 Islington 336,600 21.1 0.38 11.6 66 Stoke Newington 52,820 18.2 0.23 10.2 46 Hackney 226,400 19.6 0.23 10.6 58 Central Districts. Holborn 43,376 13.67 0.53 12.1 79 Finsbury 77,230 23.9 0.76 13.03 60.7 City of London 13,480 8.2 0.22 11.2 60 East Districts. Shoreditch 106,200 26.9 0.8 13.0 82 Bethnal Green 118,700 24.2 0.88 11.3 69 Stepney 252,170* 23.5 0.7 11.6 63 Poplar 166,400 25.6 0.6 11.3 60 South Districts. Southwark 187,464 24.3 0.8 12.8 68 Bermondsey 121,700 24.0 0.98 12.2 76 Lambeth 308,500 27.04 0.4 11.2 42.7 Battersea 170,600 20.1 0.67 10.8 49.5 Wandsworth 336,100 16.28 0.39 10.14 52.5 Camberwell 272,300 20.7 0.7 11.0 56.7 Deptford 114,900 21.1 0.65 11.1 59 Greenwich 102,777 20,51 0.46 10.95 60 Lewisham 182,400 18.07 0.4 10.14 43 Woolwich 140,000 20.5 0.2 9.9 43 * These provisional figures are taken from a table furnished by the Registrar-General. Others figure supplied by Medical Officer of Health of borough concerned. 17 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 " has been abolished. A step, which I consider, in the right direction. 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 Department, 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 hot been relieved to any great extent. These conditions 18 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 nearing completion, 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. r of Notices complied with. Infectious Diseases 1,817 366 360 Complaints 3,817 1,955 1,952 Bakehouses 575 19 19 Customs and Inland Revenue 150 34 40 Houses let in lodgings 71 14 16 House to House 1,406 633 586 Housing & Town Planning Act 324 174 171 Factories & Workshops, &c. 2,040 114 115 Slaughterhouses. 258 2 2 Milk Vendors 1,901 13 16 Ice Cream Vendors 219 5 5 Smoke 143 10 6 Food 5,670 47 55 Miscellaneous 21,202 450 451 39,593 3,836 3,794 During the year 1,044 Statutory Notices were served and 1,015 complied with. In several instances it was necessary to take proceedings in order to enforce compliance with Notices served. The following table shows the result of proceedings taken: 19 SUMMONSES. YEAR 1923. Situation of Premises Nature of Offence No. of Summonses Result of Proceedings 9 Askew Crescent Failing to Comply with Statutory Notice. 1 (1) Adjourned. Withdrawn. Work done. 14 Rockley Road ditto 2 (1) Order made. (2) Fined £1. 46 Woodstock Road ditto 1 Adjourned. Withdrawn. Work done. 54 Porten Road ditto 2 (1) Withdrawn. Work done. (2) Withdrawn. Work done. 7 Letchford Gardens ditto 3 (1) Order made. (2) Withdrawn. Work done. (3) Withdrawn. Work done. 41 Raynham Road ditto 1 Order made. Fined £1. 20 Adelaide Road ditto 1 Fined £5. 16 Lefroy Road ditto 1 Withdrawn. 49 Gayford Road ditto 1 Withdrawn. Work done. 47 Masbro Road ditto 1 Order made. 49 Masbro Road ditto 1 Order made. 5 Porten Road ditto 3 (1) Withdrawn. Work done. (2) Order made. (3) Order made. 62 Blythe Road ditto 3 (1) Order made. (2) Order made. (3) Order made. 93 Rayleigh Road ditto 3 (1) Withdrawn. Work done. (2) Withdrawn. Work done. (3) Withdrawn. Work done. 3 Hazlett Road ditto 2 (1) Order made. (2) Order made. 18 Rayleigh Road ditto 1 Withdrawn. Work done. £1 costs. 1 Letchford Gardens ditto 1 Order made. 22 Waldo Road ditto 1 Withdrawn. Work done. 103 Black Lion Lane ditto 1 Order made. 45 Raynham Road ditto 1 Order made. 13 Bridge Street ditto 1 Withdrawn. Work done. 144b Sinclair Road ditto 1 Withdrawn. Work done. "Duke of Edinburgh," Richmond Road. ditto 1 Withdrawn. Work done. 22 Overstone Road ditto 1 Order made. 42 Stebbing Street ditto 1 Withdrawn. Work done. 24 Studland Street ditto 1 Order made. 79a Ormiston Road ditto 3 (1) Order made. (2) Order made. (3) Order made. 6 Camden Gardens ditto 3 (1) Fined 10s. (2) Withdrawn. Work done. (3) Withdrawn. Work done. 68 Rayleigh Road ditto 1 Order made. 20 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses Result of Proceedings. 161 Sulgrave Road Failing to comply with Statutory Notice. 1 Order made. 7 Letchford Gardens ditto 1 Fined £5 and £2 2s. costs. 104 Rayleigh Road ditto 1 Dismissed. Work done. 106 Rayleigh Road ditto 1 Fined £1 1s. 56 Goldhawk Road ditto 1 Withdrawn. Work done. 26 Overstone Road ditto 2 (1) Order made. (2) Order made. 161 Sulgrave Road ditto 1 Order made. 20 Girdlers Road ditto 1 Order made. Yard, Devonport Road. ditto 1 Adjourned sine die. 14 Rockley Road ditto 3 (1) Fined £2. (2) Withdrawn. Work done. (3) Withdrawn. Work done. 41 Raynham Road ditto 3 (1) Dismissed. Work done. (2) Order made. (3) Order made. 45 Raynham Road ditto 1 Order made. 99 Black Lion Lane ditto 1 Order made. 5 Porten Road ditto 1 Work done. Withdrawn. 62 Blythe Road ditto 2 (1) Fined £1 10s. (2) Withdrawn. Work done. 3 Hazlett Road ditto 1 Withdrawn. Work done. 2 Barb Mews ditto 1 Work done. Withdrawn. 3 Barb Mews ditto 1 Work done. Withdrawn. 5 Barb Mews ditto 1 Work done. Withdrawn. 6 Barb Mews ditto 1 Work done. Withdrawn. 9 Barb Mews ditto 1 Work done. Withdrawn. 10 Barb Mews ditto 1 Work done. Withdrawn. 11 Barb Mews ditto 1 Work.done. Withdrawn. 1 Letchford Gardens ditto 1 Order made. 3 Letchford Gardens ditto 2 (1) Order made. (2) Work done. Withdrawn. 5 Letchford Gardens ditto 1 Order made. 7 Letchford Gardens ditto 1 Order made. 16 Agate Road ditto 1 Work done. Withdrawn. 41 Maclise Road ditto 5 (1) Fined £1. (2) Order made. (3) Work done. Withdrawn. (4) Work done. Withdrawn. (5) Work done. Withdrawn. 43 Maclise Road ditto 3 (1) Fined £1. (2) Work done. Withdrawn. (3) Order made. 36 Blythe Road ditto 1 Dismissed. 5 Ceylon Road ditto 1 Dismissed. 42 Stebbing Street ditto 1 Withdrawn. Work done. 144b Sinclair Road ditto 1 Order made. 45 Raynham Road ditto 2 Fined £5. 22 Overstone Road ditto 1 Withdrawn. Work done. 21 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses t of Proceedings. 26 Overstone Road Failing to comply with Statutory Notice. 1 Withdrawn. Work done. 41 Raynham Road ditto 1 Withdrawn. Work done. 2a Alexandra Road ditto 1 Withdrawn. Work done. 8!) Sinclair Road ditto 1 Withdrawn. Work done. 109 Sinclair Road ditto 3 (1) Withdrawn. Work done. (2) Withdrawn. Work done. (3) Withdrawn. Work done. 15s. total costs. 57a Addison Gdns. ditto 1 Order made. 32 Adelaide Road ditto 1 Order made. £1 costs. 7 Letchford Gardens ditto 1 Dismissed. 18 Hazlett Road . Failing to comply with notice under Section 28, Housing Act, 1919. 1 Adjourned sine die. 24 Hazlett Road ditto Payments by instalments. 28 Hazlett Road ditto 30 Hazlett Road ditto 32 Hazlett Road ditto 73 Rayleigh Road ditto 1 Adjourned. 6 Rigeley Road Failing to comply with Statutory Notice. 1 Not served. 26 Redmore Road ditto 2 (1) Withdrawn. Work done. (2) Adjourned sine die. 24 Redmore Road ditto 1 Adjourned sine die. 41 Raynham Road ditto 1 Dismissed. 14 Rockley Road ditto 2 (1) Withdrawn. Notices reserved. (2) Withdrawn. Notices reserved. Mac Fisheries, Ltd., "Lever House," Blackfriars, E.C. Removing fish offal during prohibited hours. 2 £4 fine. 57 Bolingbroke Rd. Failing to comply with Statutory Notice. 4 (1) Dismissed. Work done. (2) Dismissed. (3) Dismissed. (4) Dismissed. 5 Alexandra Road ditto 3 Work done. Withdrawn. 10s. 6d. costs. 1 Raynham Road ditto 1 Order made. 30 Devonport Road ditto 1 Order made. 5 Milson Road ditto 2 Withdrawn. Work done. 16 Batoum Gardens ditto 1 Order made. £1 costs. 42 Hetley Road ditto 2 Adjourned. 10,s. 6d. costs. 32 Gratton Road ditto 3 Withdrawn. Work done. 12 Porten Road ditto 3 (1) Withdrawn. Work done. (2) Order made. (3) Withdrawn. Work done. 22 Factories and Workshops, etc.—During the year 114 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 115 notices were complied with. During the previous year there were 104 notices served and 106 complied with. The following is a list of the Factories and Workshops upon the Register:- Restaurants, Hotels, &c. 199 Bakehouses (13 not in use as Bakeries) 62 Bootmakers 70 Motor and Cycle Makers 26 Dressmakers and Milliners 86 Laundries 68 Outworkers 252 Letterpress Printers and Bookbinders 18 Electrical and Mechanical Engineers 60 Smiths, Wheelwrights and Coachbuilders 24 Tailors 54 Builders, Carpenters and Joiners 37 Miscellaneous 350 Total 1,306 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. 23 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 776 58 — Workshops (including Workshops Laundries) 630 28 1 Workplaces (other than out-workers' premises included in Part 3 of this report) 619 28 1 Total 2,025 114 2 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 .— Want of Cleanliness 41 38 — — Want of Ventilation 2 1 1 — Overcrowding 2 1 1 — Want of Drainage of Floors 2 2 - - Other Nuisances 40 40 - 1 Sanitary Accommodation. insufficient unsuitable or defective 48 45 — — not separate for sexes 1 — — 1 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) 8 7 - - Other Offences — — - — (excluding offences relating to out-work which are included in Part 3 of this report.) Total 144 134 2 2 24 3.—HOME WORK. Nature of Work. Outworkers' List, Section 107. Outwork in Unwholesome premises, Sec. 108. Outwork in In ected 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 Failing to keep or permit in-pection of Lists. Failing to send Lists. Instances. Notices served. Prosecutions. Instances. Orders made (Sec. 110). Prosecutions (Sec. 109, 110) Lists. Outworkers. Lists Outworkers Contractors. Work men. Contractors. Work men. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Wearing apparel— (1) making, etc 19 6 47 ... ... ... ... ... ... 3 3 ... ... ... ... (2) cleaning and washing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 19 6 47 ... ... ... ... ... ... 3 3 ... ... ... ... 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year Number. Bakehouses 33 Dressmakers 74 Laundries 29 Others 288 Total number of workshops on Register 424 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 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). Notified by H. M. Inspector 13 Reports (of action taken) sent to H. M. Inspector 13 Other 9 Underground bakehouses (S. 101)— Certificates granted during year — In use at the end of the year 32 25 Customs and Inland Revenue Acts.—Nine applications were received under the Customs and Inland Revenue Acts for exemption or abatement of inhabited house duty. 13 and 13a Sinclair Road Certificate not granted. 1—7 Letchford Gardens Certificate not granted. 79, 79a, 81, 81a Ormiston Road Certificate not granted. 1, la, 2, 3, 3a, 4, 5, 5a, 6, 7, 7a, 8, 9, 10, 10a, 11, Nos. 1, 3, 4, 5, 8 and 14 12, 13 and 14 Minford Garden's Mansions Certificate granted. Norfolk House, Bolingbroke Road Certificate refused. Suffolk House, Bolingbroke Road Certificate refused. Hampshire House, 190 Blytlie Road Certificate refused. 37 Milson Road Certificate refused. 16, 26, 30, 31 and 33 Addison Court Gardens Certificate refused. House to House.—As a result of the house to house visitation 1,400 inspections were made, 033 notices served, and 580 complied with. It is important that this work should be systematically carried out. Houses Let in Lodgings.—During the year no new houses were registered. 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 was made and advice and instructions given. A supply of poison was given where necessary and in most cases satisfactory results have been obtained. 26 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. Swan Laundry, Blythe Road. Carpet Beating Co., Latimer Road. Civic Pipe Co., Fulliam Palace Road. Notting Hill & Kensington Electric Light Co., Wood Lane. Hammersmith Borough Council Electricity Works, Fulham Palace Road. Fuller's Ltd., Great Church Lane. Public Baths, Lime Grove. 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 :— 27 Fried Fish Vendors. Ice Cream Vendors. Milk Vendors. Slaughterhouses. Full particulars and remarks regarding these premises are to be found in another part of the report. Ice Cream Vendors.—During the year representations were made to the London County Council on the advisibility of powers being conferred to secure the compulsory registration of ice cream vendors. The County Council after considering the views expressed by the various Borough Councils on this subject, decided that the powers already possessed by local sanitary authorities in London, if duly exercised, were sufficient to protect the public from danger arising from the consumption of ice cream. Samples of ice cream were taken by the London County Council and bacteriologically examined and, generally speaking, were found to be quite satisfactory. I am, however, still of the opinion that powers should be obtained to secure the compulsory registration of ice cream vendors, and that the local sanitary authorities should be empowered to refuse such registration should the person or premises be unsuitable for the 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. 28 The selling of this commodity from barrows is, in my opinion, very undesirable as the provision for the washing of the utensils used (glasses, wafer-frames, &c.) is very inadequate and unsatisfactory. 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 Divisional 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 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 435 samples of milk were taken and submitted to the Public Analyst for analysis, the results of 29 which are shown in the report of the Public Analyst attached hereto. No samples were examined for the presence of Tubercle Bacilli. This work is carried out by the County Council and their investigations shew that an average of 10 per cent. of the samples contain germs of Tuberculosis. 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 two notices upon milk vendors, at whose premises cases of infectious disease had occurred, requiring the suspension of the sale of milk until the premises had been disinfected. One summons was taken against Charles W. Whitehall, of 90 Railway Approach, for carrying on the trade of a purveyor of milk without being registered. Fined £1. THE MILK (SPECIAL DESIGNATIONS) ORDER, 1922. In February, 1923,I submitted the following memorandum on the above Order, together with recommendations as set out:— The action to be taken by the Council 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 Council 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 Council should 30 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, an important duty will be to take samples of milk from time to time and arrange for them to be submitted to bacteriological examination. 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. The essential condition governing the sale of milk as "Pasteurised" is that the milk must be held at a temperature between 145 deg. and 150 deg. Fahrenheit for a period of at least half an hour. This condition will, however, not be operative until 1st July next, after which date the "flash pasteurisation" process, by which milk is heated to a high temperature (e.g., 170 deg. Fahrenheit) for a short period, is definitely excluded. In addition to making a yearly inspection of and report on the premises of each holder of a Licence for the Council's guidance in issuing fresh licences, frequent inspections of the premises will have to be made during the year in order that the Council may be satisfied that the conditions required under the various licences are being maintained. Arrangements will have to be made for the immediate dispatch and bacteriological examination of the samples collected. In order to facilitate administration it will be desirable that all samples collected in Hammersmith should be examined at one Bacteriological Laboratory. Many applications have already been received from persons wishing to sell "Certified" milk, and there will probably be a number of applications to sell the lower grades of designated milk when the conditions under which licences are granted are understood by the trade and the public. At the present time it is impossible to state how many applications for licences will be received and therefore the amount of additional work to be performed by the staff of the Council's Public Health Department cannot be determined. RECOMMENDATIONS. I beg to make the following recommendations :— (a) That the Public Health Committee recommend the Council to delegate to that Committee all powers under the Milk (Special Designations) Order, 1922. 31 (b) That the Public Health Committee instruct the Town Clerk and the Medical Officer of Health to make the necessary arrangements for giving effect to the Order in Hammersmith. (c) That applications for licences which will be received and entered by the Town Clerk be handed to the Medical Officer of Health for the purpose of investigation and report to the Public Health Committee so as to enable that Committee to decide whether the licences should be issued in appropriate cases. (d) That the Medical Officer of Health enter into preliminary negotiations with some Bacteriological Laboratory of repute with a view to the making of an agreement between the Council and the Laboratory for the bacteriological examination of milk samples required to be taken in connection with the Order. (e) That the bacteriological examinations required in order to satisfy the Council, prior to the issue of a licence, should be paid for by the applicant, but that samples taken from time to time during the year in order to determine whether the required standard is maintained shall, except in those cases in which the fees will be paid by the Ministry of Health, be defrayed as part of the Council's general expenses. MILK (SPECIAL DESIGNATIONS) ORDER, 1923. In May, the Minister of Health, in view of certain representations made to him as to the working of the Milk (Special Designations) Orders, decided to issue a new Order which embodied amendments and revoked the existing Orders as from the 1st July, 1923. The new Order did not alter the general scheme of grading in operation, but it provided for some relaxation of the conditions under which licences may be granted for the sale of " Grade A " milk and " Pasteurised " milk. The alterations in regard to "Grade A" affect the conditions of production only. It is now provided that only the milch cows of the herd need be subjected to veterinary examination, and consequently only these animals will need to be registered. If a cow is suffering from a disease which is 32 not of a permanent character it will be sufficient for the cow to be isolated (the fact being reported to the Licensing Authority), but in the case of a disease whose injurious effect on the milk is likely to be of a permanent character the cow must as before be removed from the herd. Further, to meet difficulties which have arisen as to the economical disposal of dry cows, the provision as to separation of the herd has been altered so as to require only the cows in milk belonging to the herd to be kept sepaarte from all other cows in milk. But in this connection it should be noted that as in the case of the previous Orders, the licensee must take such measures as the Licensing Authority may require to ensure that "Grade A" milk is kept separate at all stages from all other milk. The following alterations have been made in the conditions applying to " Pasteurised " milk :— (1) The bacteriological condition has been relaxed so as to remove the test for coliform bacillus and to provide that the number of bacteria shall not exceed 100,000 per c.c. Until the end of the present year this limit is further increased to 200,000 bacteria per c.c. But the bacteriological test for milk sold as " Grade A Milk Pasteurised " will remain as provided in previous Orders. (2) The day of pasteurisation is not required to be shewn on the labels of vessels containing the milk. (3) The period during which the milk may be treated by a suitable heating process other than that specified in the Order (provided the other conditions are satisfied) is extended till the end of the present year. A number of minor alterations have also been made with a view to removing doubts which had been raised as to the proper interpretation of the former Orders. 33 THE PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923. Part I. These Regulations were made by the Minister of Health and came into operation on the 1st day of November, 1923. Part II. The Local Authority is responsible for enforcing and executing this Part of these Regulations, and for this purpose shall make such enquiries and take such other steps as may seem to them to be necessary for securing the due observance of this Part of the Regulations in their district. No person shall sell or expose for sale or deposit in any place for the purposes of sale, or despatch or deliver to any purchaser, broker or agent any condensed milk intended for human consumption unless the condensed milk— (1) is contained in a tin or other receptacle which is labelled in the manner prescribed in th£ First Schedule to these Regulations ; and (2) contains not less than the appropriate percentages of milk fat and milk solids as specified in the Second Schedule to these Regulations : Provided that— (a) The provisions of this Article shall not apply in any case where the condensed milk is intended to be exported or is contained in a tin or other receptacle whose gross weight exceeds five pounds; and (6) Where in any public refreshment room, restaurant, shop or other public premises condensed milk is delivered to a purchaser or other person for con 34 sumption on the premises, the receptacle containing the condensed milk shall not be required to be labelled in the manner prescribed by these Regulations. The Medical Officer of Health, and any person authorised by him or by the Local Authority in writing, may procure any sample of condensed milk, and where an analysis is required for the purposes of these Regulations shall submit the sample to the public analyst and shall forthwith notify to the seller or his agent selling the condensed milk his intention to have the same analysed by the public analyst. Except where the sample is procured for the purpose of testing the quantity of milk or skimmed milk of which the contents of a tin or other receptacle are the equivalent, the provisions of Section 14 of the Sale of Food and Drugs Act, 1875 (b) as amended by Section 13 of the Sale of Food and Drugs Act, 1899, (a) relating to the division of the sample into three parts and the separation, marking and disposal of such parts shall apply. Any Officer authorised by the Minister and any Officer of the Local Authority duly authorised by the Authority in writing shall have power to enter at all reasonable times any premises where condensed milk is prepared packed labelled or stored, and to inspect any process carried on therein and to take samples of any article used or capable of being used in the preparation of condensed milk, and of any labels designed to be used for affixing to tins or other receptacles of condensed milk. Where the Local Authority on a report to them from the public analyst or otherwise are of opinion that a consignment of condensed milk deposited within their district and intended for sale for human consumption does not comply with the 35 requirements of these Regulations they shall endeavour to ascertain where it was manufactured and labelled. If it is ascertained that such condensed milk was manufactured or labelled at a place in England or Wales, the Local Authority shall communicate the facts which they have ascertained to the Local Authority for the district in which such place is situated. If it is ascertained that such condensed milk was manufactured or labelled at a place not in England or Wales, the Local Authority shall communicate the facts to the Minister. Part III. Subject to any directions given by the Commissioners of Customs and Excise after consultation with the Minister, the Officers of Customs and Excise shall enforce and execute this Part of these Regulations and may take such samples of consignments of imported condensed milk as may be necessary for that purpose. Where an Officer of Customs and Excise takes a sample for the purpose of analysis he shall send the sample to the Government Chemist and the Government Chemist shall send a portion thereof to the importer. If in any case the Commissioners of Customs and Excise are of opinion that an offence against this Part of these Regulations has been committed, they shall communicate to the Minister for his information the name of the importer and such other facts as they may possess or may obtain as to the destination of the consignment. No condensed milk intended for sale for human consumption shall be imported into England and Wales unless the same— 36 (1) is contained in a tin or other receptacle which is labelled in the manner prescribed in the First Schedule to these Regulations ; and (2) contains not less than the appropriate percentages of milk fat and milk solids as specified in the Second Schedule to these Regulations ; Provided that the provisions of this Article shall not apply in any case where the condensed milk is intended to be reexported or is contained in a tin or other receptacle whose gross weight exceeds five pounds. Part IV. In any proceedings under these Regulations the certificate of the Government Chemist or the public analyst, as the case may be, of the result of the chemical examination of a sample shall be sufficient evidence of the facts therein stated unless the defendant requires that the person who made the examination be called as a witness. A person, in relation to anything within his knowledge, shall truly answer all such questions put to him by the authorities authorised to enforce and execute these Regulations or their Officers or by an officer authorised by the Minister as may be necessary for the purposes of these Regulations, and shall produce for inspection all such books as the authority or officer may reasonably require for the purposes of ascertaining the persons or places from which condensed milk has been obtained and to whom and where it has been consigned or otherwise. In any proceedings under these Regulations, where the fact that any condensed milk has been dealt with contrary to these Regulations has been proved, if the defendant shall desire to rely upon any exception or provision contained in these 37 Regulations with reference to condensed milk intended for export or re export, it shall be incumbent upon him to prove that the condensed milk was so intended. The First Schedule. Rules with Respect to the Labelling of Condensed Milk. 1. Every tin or other receptacle containing condensed milk shall bear a label upon which is printed such one of the following declarations as may be applicable or such other declaration substantially to the like effect as may be allowed by the Minister :— (i) In the case of full cream milk (unsweetened) :— CONDENSED FULL CREAM MILK, UNSWEETENED. THIS TIN CONTAINS THE EQUIVALENT OF (a) PINTS OF MILK. (ii) In the case of full cream milk (sweetened) :— CONDENSED FULL CREAM MILK, SWEETENED. THIS TIN CONTAINS THE EQUIVALENT OF (a) PINTS OF MILK, WITH SUGAR ADDED. (iii) In the case of skimmed milk (unsweetened):— CONDENSED MACHINE-SKIMMED MILK [or CONDENSED SKIMMED MILK], UNSWEETENED UNFIT FOR BABIES. THIS TIN CONTAINS THE EQUIVALENT OF (a) PINTS OF SKIMMED MILK. 38 (iv) In the case of skimmed milk (sweetened) :— CONDENSED MACHINE - SKIMMED MILK [or CONDENSED SKIMMED MILK], SWEETENED. UNFIT FOR BABIES. THIS TIN CONTAINS THE EQUIVALENT OF (a) PINTS OF SKIMMED MILK, WITH SUGAR ADDED. The declaration shall in each case be completed by inserting at (a) the appropriate number in words and figures, e.g., "one and a half (1½ ), "any fraction being expressed as eighths, quarters or a half. For the purposes of these Rules milk means milk which contains not less than 12.4 per cent. of milk solids (including not less than 3.6 per cent. of milk fat) and skimmed milk means milk which contains not less than 9 per cent. of milk solids other than milk fat. 3. The prescribed declaration shall be printed in dark block type upon a light coloured ground within a surrounding line and no other matter shall be printed within such surrounding line. The type to be used for the last sentence of the declarations set out above shall be not less than one-eighth of an inch in height (or if the gross weight of the tin or other receptacle does not exceed twelve ounces, one-sixteenth of an inch in height), and that to be used for the remainder of the said declarations shall be not less than onequarter of an inch in height (or if the gross weight of the tin or other receptacle does not exceed twelve ounces, one-eighth of an inch in height). 4. The label shall in addition bear the name and address of the manufacturer of the condensed milk or of the dealer or merchant in the United Kingdom for whom it is manufactured. 5. The label shall be securely affixed to the tin or other receptacle so as to be clearly visible. If there is attached to the tin or other receptacle a label bearing the name, trade mark, or design representing the brand of the condensed milk, the prescribed declaration shall be printed as part of such label. 6. There shall not be placed on any tin or other receptacle containing condensed milk— (a) any comment on, explanation of, or reference to either the statement of equivalence contained in the prescribed declaration or the words "machine skimmed," "skimmed," or "unfit for babies"; or 39 (6) any instructions as to dilution, unless either— (i) the fluid produced in accordance with such instructions would contain not less milk fat and not less milk solids than milk or skimmed milk as defined in Rule 2 of this Schedule as the case may require ; or (ii) such instructions clearly specify that the fluid so produced is not of equivalent composition to milk or skimmed milk as the case may be. 7. Wherever the word " Milk " appears on the label of a tin or other receptacle of condensed skimmed milk as the description or part of the description of the contents, it shall be immediately preceded or followed by the word " Machine-Skimmed " or " Skimmed " as the case may require. The Second Schedule. All condensed milk shall contain not less than the appropriate percentage of milk fat and milk solids as specified in the following Table :— Description of Condensed Milk. Percentage of milk fat. Percentage of all milk solids, including fat. 1. Full cream, unsweetened 9.0 31.0 2. Full cream, sweetened 9.0 31.0 3. Skimmed, unsweetened — 20.0 4. Skimmed, sweetened — 26.0 THE PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923. These Regulations were made by the Ministry of Health, and come into operation on the 1st day of May, 1924. They apply to dried milk to which no other substance has been added and to the dried milk contained in any powder or solid of which not less than 70 per cent. consists of dried milk. The Local Authority is responsible for enforcing and executing these Regulations, and for this purpose shall make such enquiries and take such other steps as may seem to them to be necessary for securing the due observance of the Regulations in their district. 40 No person shall sell or expose for sale or deposit in any place for the purposes of sale, or despatch or deliver to any purchaser, broker, or agent any dried milk intended for human consumption unless the dried milk— (1) is contained in a tin or other receptacle which is labelled in the manner prescribed in the Schedule to these Regulations ; and (2) contains not less than the following percentages of milk fat, namely :— In the case of milk described as dried full cream milk not less than 26 per cent. ; In the case of milk described as dried three quarter cream milk not less than 20 per cent. ; In the case of milk described as dried half cream milk not less than 14 per cent. ; and In the case of milk described as dried quarter cream milk not less than 8 per cent. : Provided that— (a) The provisions of this Article shall not apply in any case where the dried milk is contained in a tin or other receptacle whose gross weight exceeds ten pounds ; and (b) Where dried milk is sold by weight and is not placed in the tin or other receptacle in which it is delivered to the purchaser until immediately before such delivery, the provisions of Rules 1 to 4 of the Schedule shall be deemed to be satisfied if the matter therein required to appear on a label affixed to the tin or other receptacle is printed on a separate label or notice delivered to the purchaser, and the last sentence of the 41 declaration required by Rule 1 of the Schedule may be varied so as to relate to one pound or to any other specified weight of the article sold instead of the contents of the actual tin or other receptacle. The Medical Officer of Health, and any person authorised by him or by the Local Authority in writing, may procure any sample of dried milk, and where an analysis is required for the purposes of these Regulations shall submit the sample to the public analyst and shall forthwith notify to the seller or his agent selling the dried milk his intention to have the same analysed by the public analyst. Except where the sample is procured for the purpose of testing the quantity of milk, partly skimmed milk, or skimmed milk of which the contents of a tin or other receptacle are the equivalent, the provisions of Section 14 of the Sale of Food and Drugs Act, 1875 as amended by Section 13 of the Sale of Food and Drugs Act, 1899, relating to the division of the sample into three parts and the separation, marking and disposal of such parts shall apply. Where the sample is procured for the purpose of testing the quantity of milk, partly skimmed milk or skimmed milk of which the contents of a tin or other receptacle are the equivalent the person by whom the sample is procured shall as soon as may be after the net weight of the contents has been ascertained deliver a part of the sample to the seller or his agent. Any officer authorised by the Minister and any officer of the Local Authority duly authorised by the Authority in writing shall have power to enter at all reasonable times any premises where dried milk is prepared, packed, labelled or stored and to inspect any process carried on therein and to take samples of 42 any article used or capable of being used in the preparation of dried milk and of any labels designed to be used for affixing to tins or other receptacles of dried milk. Where the Local Authority on a report to them from the public analyst or otherwise are of opinion that a consignment of dried milk deposited within their district and intended for sale for human consumption does not comply with the requirements of these Regulations they shall endeavour to ascertain where it was manufactured and labelled. If it is ascertained that such dried milk was manufactured or labelled at a place In England or Wales, the Local Authority shall communicate the facts which they have ascertained to the Local Authority for the district in which such place is situated. If it is ascertained that such dried milk was manufactured or labelled at a place not in England or Wales, the Local Authority shall communicate the facts to the Minister. In any proceedings under these Regulations the certificate of the public analyst of the result of the chemical examination of a sample shall be sufficient evidence of the facts therein stated unless the defendant requires that the analyst be called as a witness. A person, in relation to anything within his knowledge, shall truly answer all such questions put to him by the authorities authorised to enforce and execute these Regulations or their officers, or by an officer authorised by the Minister, as may be necessary for the purposes of these Regulations, and shall produce for inspection all such books as the authority or officer may reasonably require for the purposes of ascertaining the persons or places from which dried milk has been obtained and to whom and where it has been consigned or otherwise. 43 The Schedule. Rules with Respect to the Labelling of Dried Milk. 1. (1) Every tin or other receptacle containing dried milk (other than dried milk to which sugar or some other substance has been added) shall bear a label upon which is printed such one of the following declarations as may be applicable or such other declaration substantially to the like effect as may be allowed by the Minister :— (i) In the case of full cream milk, that is to say, dried milk containing not less than 26 per cent. of milk fat:— DRIED FULL CREAM MILK. THIS TIN CONTAINS THE EQUIVALENT OF (a) PINTS OF MILK. (ii) In the case of partly skimmed milk, that is to say, dried milk containing not less than 8 per cent. but less than 26 per cent. of milk fat:— DRIED PARTLY-SKIMMED MILK. [(b) CREAM]. SHOULD NOT BE USED FOR BABIES EXCEPT UNDER MEDICAL ADVICE. THIS TIN CONTAINS THE EQUIVALENT OF (a) PINTS OF (b) CREAM MILK. (iii) In the case of skimmed milk, that is to say, dried milk containing less than 8 per cent. of milk fat:— DRIED MACHINE - SKIMMED MILK [or DRIED SKIMMED MILK]. UNFIT FOR BABIES. THIS TIN CONTAINS THE EQUIVALENT OF (a) PINTS OF SKIMMED MILK. 44 (2) The label on any tin or other receptacle containing dried milk to which sugar or some other substance has been added shall be in the appropriate form prescribed in sub-division (1) hereof, with the following modifications :— (i) There shall be added to the heading the word "Sweetened" if the only substance added to the milk is sugar, the word "Modified" if the only substance added is a constituent of milk, and the word " Compounded " in every other case ; and • (ii) The words " with (c) added " shall be added to the last sentence in each case, words being inserted at (c) to specify the substance or substances added. (3) The declaration shall be completed as follows :— (i) There shall be inserted at (a) the appropriate number in words and figures, e.g., " one and a half (1½)," any fraction being expressed as eighths, quarters, or a half. (ii) There shall be inserted at (b) the word "Three-quarter" if the percentage of milk fat is not less than 20; "Half" if such percentage is less than 20 but not less than 14; and "Quarter" if such percentage is less than 14 but not less than 8. (4) For the purposes of this Rule the terms "Milk," "Three-quarter cream milk," "Half cream-milk," and "Quarter cream milk" mean milk containing not less than the following percentages of milk fat and milk solids, that is to say :— Milk Solids Milk Fat. (including fat). Milk 3.6 12.4 Three-quarter cream milk 2.7 11.6 Half cream milk 1.8 10.8 Quarter cream milk 0.9 9.9 and " Skimmed milk " means milk which contains not less than 9 per cent. of milk solids other than milk fat. 2. The prescribed declaration shall be printed in dark block type upon a light-coloured ground within a surrounding line, and no other matter shall be printed within such surrounding line. The type to be used for the heading and the words "unfit for babies" in the declarations set out above shall be not less than one-quarter of an inch in height (or, if the gross weight of the tin or other receptacle does not exceed twelve ounces, one-eighth of an inch in height), and that to be used for the remainder of the said declarations shall be not less than one-eighth of an inch in height (or, if the gross weight of the tin or other receptacle does not exceed twelve ounces, one-sixteenth of an inch in height). 3. The label shall in addition bear the name and address of the manufacturer of the dried milk or of the dealer or merchant in the United Kingdom for whom it is manufactured, 45 4. The label shall be securely affixed to the tin or other receptacle so as to be clearly visible. If there is attached to the tin or other receptacle a label bearing the name, trade mark, or design representing the brand of the dried milk, the prescribed declaration shall be printed as part of such label. 5. There shall not be placed on any tin or other receptacle containing dried milk— (a) any comment on, explanation of, or reference to either the statement of equivalence contained in the prescribed declaration or the words "partly skimmed," "machine-skimmed," "skimmed," or "unfit for babies " : or (6) any instructions as to dilution, unless either— (i) the fluid produced in accordance with such instructions would contain not less milk fat and not less milk solids than milk, partly skimmed milk, or skimmed milk as defined in Rule 1 of this Schedule, as the case may require ; or (ii) such instructions clearly specify that the fluid so prgduced is not of equivalent composition to milk, partly skimmed milk, or skimmed milk, as the case may be. 6. Wherever the word " Milk " appears on the label of a tin or other receptacle of dried partly skimmed or skimmed milk as the description or part of the description of the contents, it shall be immediately preceded or followed • by the words "Partly skimmed," "Machine-skimmed," or " Skimmed," as the case may require. CIRCULAR 325. This Circular was issued in July, 1922, calling attention to the case of a Milk Vendor who was prosecuted for selling milk deficient in fat, and on the case coming before the Court, it was shewn that the Vendor had held a good record for a number of years and that during that period constant tests had given uniformly satisfactory results. It was further shewn that special circumstances existed to account for the milk being deficient in fat on the occasion of the test on which the prosecution was based. As soon as the Local Authority became aware of the facts of the case they withdrew the prosecution. The Minister of Health expressed the opinion that it is extremely undesirable that a prosecution should be based 46 upon the results of an isolated test when other tests of the particular milk supply have proved satisfactory and suggested for the consideration of the local authority, that in such cases prosecutions should be instituted only where a series of tests have shewn repeated default. In May, 1923, the Minister of Health issued Circular No. 399, withdrawing Circular No. 325 on the grounds that it had been widely misunderstood and to some extent misrepresented, with the result that it has not produced the effect which was intended. CIRCULAR 462. This Circular was issued by the Minister of Health in December, 1923, and deals with the sampling of milk sold in sealed bottles and of prescribed medicines. In view of the increasing practice of selling milk in sealed bottles it is desirable that the attention of sampling officers should be drawn to the difficulty which is sometimes found in dividing a sample of bottled milk so as to secure the uniform distribution of the milk fat throughout the three parts of the sample. Where the cream has risen freely in the bottle or where some of it adheres to the sides it may be found useful to decant the milk into a larger vessel and to return a small quantity in order to rinse out the bottle before the final mixing and division are effected. The Minister desires to recommend to the consideration of the Council the following suggestions which he has received from the Society of Public Analysts with regard to the sampling of prescribed medicines :— (i) That the inspector be instructed, prior to dividing the sample into three parts, to mark, in the presence of the vendor, the 47 height the contents reach in the bottle in which the medicine is originally supplied to him by the vendor. That the bottle so marked be submitted to the Analyst in order to enable him to determine the total quantity of medicine supplied. (ii) That the Analyst and the Medical Officer of Health be both consulted as to the type of prescription it is desirable to use for the purpose of checking the accuracy of dispensing, and that, in the event of any substantial inaccuracies being disclosed by analysis both these officers be consulted as to the desirability of instituting proceedings. The object of the first suggestion is to enable the Analyst to ascertain the total quantity of each of the ingredients (including the water or other " vehicle ") present in the medicine. If he receives only a portion of the sample, representing an unknown fraction of the whole, he' is only able to ascertain the relative percentages of the several ingredients; but if he is also provided with information as to the total quantity of the medicine dispensed he can then deduce the total amount of each of the ingredients as supplied by the Chemist. These particulars will obviously be of importance to the Council in considering what action they should take in regard to a medicine which has been inaccurately dispensed. The Minister believes that the second suggestion is in accordance with the practice which is already largely adopted by Local Authorities. It is clearly desirable that, where a sample of medicine is taken for the purpose of checking the accuracy of dispensing, it should be so chosen as to be capable of accurate analysis. It is also desirable in considering whether or not proceedings should be taken under the Sale of Food and Drugs Acts that proper regard should be paid both to the degree of accuracy obtainable in the analysis of the article in question and to the margin of error allowable in ordinary dispensing operations. 48 CERTIFICATION OF CERTAIN FOOD PRODUCTS FOR EXPORT TO THE DOMINIONS. In view of the requirements of the Food Laws in operation in the Dominions, 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 the Dominions, 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. 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 49 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 Authorities are prepared to accept. 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. b. Number of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. Milk 0 0 Cream 5 1 Nature of preservative in each case in Column (b), and action taken under the Regulations in regard to it. Sample No. 269.—Cream contained a preparation of boric acid equivalent to 0.29 per cent. of crystallised boric acid. Vendors explanation accepted by the Council. 50 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. (1) Correct statements made 7 (2) Statements incorrect 0 (3) Percentage of preservative found in each sample:— Percentage Sample stated on No- Statutory label 250 0.23% or 16.1 grains of Boric Acid per pound 0.4 252 0.25% or 17.5 grains of Boric Acid per pound 0.4 268 0.33% or 23.1 grains of Boric Acid per pound 0.4 338 0.4% or 28.0 grains of Boric Acid per pound 0.4 394 0.06% or 4.2 grains of Boric Acid per pound 0.4 424 0.24% or 16.8 grains of Boric Acid per pound 0.4 496 0.2% or 14.0 grains of Boric Acid per pound 0.4 (b) Determination made of milk fat in cream sold as preserved cream. (1) Above 35 per cent. 7 (2) Below 35 per cent. 0 Total 7 (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 case No. 269 the explanation 51 given was considered satisfactory. All samples of milk taken for analysis under the Sale of Food and Drugs Acts are examined for preservatives. During the year no sample was found to contain preservative. 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 87. ANNUAL REPORT OF THE PUBLIC ANALYST. Mr. P. A. Ellis Richards, F.I.C., F.C.S. Year ended 31st December, 1923. During the twelve months ended on that date 626 samples were submitted to me for examination. Of these, 600 were purchased 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 509 were reported as genuine. 37 as adulterated, whilst 54 were of inferior quality. TABLE I. Samples received. Genuine. Inferior Adulterated. Total. Quarter ending March 31st 126 12 12 150 ,, ,, June 30th 121 26 3 150 ,, ,, Sept. 30th 127 10 13 150 ,, ,, Dec. 31st 135 6 9 150 Totals 509 54 37 600 The percentage of adulteration was 6.1 as compared with 6.6 last year. The percentage of articles of inferior quality, 52 where actual adulteration could not be certified, was 9.0 this year and 6.3 last year. In Table II. 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. Summonses issued. Penalties imposed. Genuine. Inferior. Adulterated. £ s. d Borax 14 12 — 2† — — Boric Ointment 3 3 — — — Butter 43 41 — 2 1 10 6 Castor Oil 6 6 — — — — Chocolates 3 3 — — — — Citric Acid 4 4 — — — —. Cocoa 25 21 — 4† — — Coffee 4 4 — - — — Flour, self-raising 4 4 — — — — Glauber's salt 2 2 — — — — " Grape Nuts " 1 1 — — — — " Instant Postum " 1 1 — — — — Jam 1 1 — — — — Lemonade Powder 3 3 — — — — Lime Juice Cordial 1 — — 1* — — Liquorice Powder 1 1 — — — — Margarine 1 1 — — — — Marmalade 1 1 — — — — Meat and Fish Pastes 7 7 — — — — Meat Pie 3 3 — — — — Milk 435 359 54 22 18 21 9 6 „ Condensed 1 1 — — - — „ Dried 1 1 — — - — ,, Separated 1 1 — — - — Olive Oil 11 9 — 2 2 8 3 0 Peas 1 — — 1* — — Pineapple 1 1 — — — — Prawns 2 2 — — — — Prescription 2 2 — . — — — Salad Oil 2 2 — — — — Salmon 4 4 — ' - — — Sausages 9 6 — 3* — — Tomatoes 1 1 — — — — Treacle 1 1 — — — — Totals 600 509 54 37 21 30 3 0 * Informal sample. † Cautionary letter to Vendor. 53 Milk.—During the year 435 samples of milk were examined and of these 359 were reported as genuine, 54 as inferior, and 22 as adulterated. The following Table shows the nature and extent of the adulteration:— TABLE III. No. Adulteration Certified. Penalties Imposed. 1 Fat abstracted 22 per cent. Warranty proved. Case dismissed. 2 ,, ,, 8 ,, Fined £2. 3 ,, ,, 7 ,, Case dismissed. 4 ,, ,,4.5 ,, Case dismissed. Warranty proved. 5 ,, ,, 3 ,, No proceedings. 6 ,, ,, 2 ,, Cautionary letter to Vendor. 7 Added Water 31 „ Warranty proved. Case dismissed. 8 ,, ,, 8 ,, Fined £1 and £1 1s. costs. 9 ,, ,, 7 ,, Fined and £1 1s. costs. 10 ,, ,, 6 ,, Fined £1 and £1 1s. costs. 11 ,, ,, 6 ,, Fined £2 and 10s. 6d.. costs. 12 ,, ,, 5 ,, Fined £1 and £1 1s. costs. 13 ,, ,, 5 ,, Warranty proved. Case dismissed. 14 ,, ,, 4.5 ,, £2 2s. costs. 15 ,, ,, 3 ,, £2 2s. costs. 16 ,, ,, 3 ,, 10s. 6d. costs. 17 ,, ,, 1 ,, No action. 18 ,, ,, 1 ,, No action. 19 Coloured with Annatto Fined £1 and 10s. 6d. costs. 20 ,, ,, ,, Fined £1 and 10s. 6d. costs. 21 ,, ,, ,, Fined £1 and 10s. 6d. costs. 22 ,, ,, ,, Fined 10s. and 10s. 6d. costs. The percentage of adulteration for the year in the case of milk is 5.0 as compared with 3.9 for the preceding year. Prosecutions were instituted in the case of most of the adulterated samples and the penalties inflicted amounted to £21 9s. 6d. 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:— 54 TABLE IV. Samples received. Fat. Non-fatty Solids. Water. Quarter ending March 31st 3.65% 8.87% 87.48% „ „ June 30th 3.54% 8.89% 87.57% „ „ September 30th 3.63% 8.88% 87.49% „ „ December 31st 3.88% 8.88% 87.24% Average for the year 3.67% 8.88% 87.45% A sample of dried milk, one of separated milk, and one of condensed milk were also analysed and were found to be genuine. Butter, Margarine, etc.—Forty-three samples of butter and one of margarine were analysed and all of these were found to be genuine, with the exception of two samples sold as butter which were found to consist entirely of margarine. Cocoa and. Chocolates.—Twenty-five specimens of cocoa and three of chocolates were examined and were found to be genuine, with the exception of four of the cocoas. The latter contained traces of arsenic, ranging from l-130th to l-80th of a grain of arsenious oxide per pound. Meat and Fish Preparations.— Seven samples of meat and fish pastes, four of salmon two of prawns, nine of sausages and three of meat pie were examined. Of these, three were found to contain boron preservative, the amounts found being 18.2 grains, 17.5 grains and 13.3 grains per pound, the results being expressed in terms of crystallised boric acid. Preserved Fruits and Vegetables.—Of one sample each of peas, pineapple/ tomatoes, jam and marmalade, only the first 55 was found to be adulterated. This contained a preparation of copper equivalent to 0.9 grains of crystallised sulphate of copper per pound. Salad and Olive Oils.— Of eleven specimens of olive oil, two were found to contain forty and thirty per cent. of oil other than olive oil, having the characters of arachis oil. Two salad oils were returned as genuine. Lime Juice Cordial.— A sample of this article contained salicylic acid to the amount of 3.5 grains per pint and was therefore reported as adulterated. Drugs. The total number of drugs analysed during the year was thirty-two and only two of these were adulterated. The latter were specimens of borax which were found to contain ten parts of arsenious oxide per million. This is exactly twice the limit of the British Pharmacopoeia. In addition to the foregoing, the following samples on analysis were found to be genuine:— Coffee 4 samples. „ Grape Nuts „ 1 sample. „ Instant Postum „ 1 sample. Lemonade Powder 3 samples. Self-raising Flour 4 samples. Treacle 1 sample. The Public Health (Milk and Cream) Regulations.— Five samples of cream and seven of preserved cream were examined under these Regulations during the year. Adulteration was reported in the case of a cream which contained 0.29 per cent. of boric acid. All of the preserved creams contained boric acid, but in no case was the limit of 0.4 per cent. exceeded. 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. 56 TABLE V. No. Infringement or Adulteration. Action Taken. 1 Margarine exposed for sale and not marked in accordance with the Margarine Acts. Letter of Warning. 2 Borax containing 10 parts of Arsenious Oxide per 1,000,000. Letter of Warning. 3 Olive Oil containing 40% Arachis Oil Legal Proceedings; Fined £5 and £2 2s. costs. 4 Olive Oil containing 30% Arachis Oil Legal Proceedings; Summonsdismissed on payment of £1 1s. costs. 5 Margarine exposed for sale and not marked in accordance with the Margarine Acts. Legal Proceedings; Case dismissed on payment of 10s. 6d. costs. 6 *Cocoa containing 1 /90th grain Arsenious Oxide per lb. Letter of Warning. 7 *Cocoa containing 1 /130th grain Arsenious Oxide per lb. Letter of Warning. 8 *Cocoa containing l/80th grain Arsenious Oxide per lb. Letter of Warning. 9 *Cocoa containing l/100th grain Arsenious Oxide per lb. Letter of Warning. 10 Vendor's name and address not on milk cans or barrow. Legal Proceedings; Fined £2. *The Manufacturers withdrew all the stores of Cocoa in the Borough. 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. 57 Licensed Slaughterhouses.— At the annual licensing 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 repeat 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 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. 58 The following table gives a summary of the work relating to milk premises, slaughterhouses and ice cream premises:— PREMISES. NUMBER OF PREMISES. Number of inspections. 1923. Number of notices 1923. Number of prosecutions, 1923. On register at end of 1922 Added in 1923. Removed in 1923. On register at end of 1923. Milk premises 81 3 — 84 1901 13 1 Slaughter-houses 7 — — 7 258 2 nil. Ice Cream premises 114 25 10 129 219 5 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 49 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. 59 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 notices 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 S. N. Lockwood * 1 Masbro Road W. A. Macklen * 67 Ditto G. Teague * 87 Ditto Not in use * 6 Beaconsfield Terrace Not in use † * 98 Blythe Road A. Schofield * 47 Milson Road W. Warwick No. 2 DISTRICT. † 65 Bridge Road Mrs.. 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 A. Hayes 88 Queen Street Not in use 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 * Underground † Factory 60 No. 4 DISTRICT. Address. Name. 18 Black Lion Lane B. Samels 93 Ditto G. Banham † * 102 Dailing 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 * 108 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 No. 7 DISTRICT † * 126 Uxbridge Road E. Jackson † * 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 N. A. Carrington * 2 Hunt Street Not in use 1Q4 Latimer Road Ditto * Underground † Factory. 61 UNSOUND FOOD. During the year no seizure was made A pig's head was purchased by a woman in Bradmore Market in October, from a stall and brought to the Town Hall the following day. The head was diseased and was submitted to a Justice of the Peace, condemned and destroyed. An endeavour was made to trace the stallholder but without result, he not being a regular vendor in the Market. The following is a list of unsound food condemned during the year:— Commodity. Condition. Result. 6 stone of Whiting Decomposed. Surrendered. 31 Rabbits ditto ditto 1 bundle (4 boxes) Tomatoes ditto ditto 1 pony of Beef (6 st. 2 lb.) ditto ditto 14 lbs. of Cods' Roes ditto ditto 2 boxes of Tomatoes ditto ditto 18 boxes of Apples (each 1 bushel) ditto ditto 6 stone of Haddocks ditto ditto 1 box (11 stone) Cat Fish ditto ditto Split Peas, approximate 50 lbs. Damaged. ditto Tapioca (Med.) „ 90 „ ditto ditto Tapioca (P.) „ 90 „ ditto ditto Haricot Beans „56 „ ditto ditto Blue Peas „ 50 „ ditto ditto Butter Beans „ 56 „ ditto ditto Dutch Peas „ 59 „ ditto ditto Pearl Barley „ 42 „ ditto ditto Rolled Oats „ 42 „ ditto ditto Sago „ 41 „ ditto ditto 7 stone of Skate Decomposed. ditto 1 box of Kippers ditto ditto PREVALENCE AND CONTROL OVER INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 935 cases reported as due to notifiable infectious diseases 62 in the Borough, against 1,197 in the previous year. The number of cases of Tuberculosis notified was 274 against 295 in the previous year. There were also reported 840 cases of infectious diseases that were not notifiable, against 1,865 in the previous year; 347 of these were Measles, 136 Whooping Cough, and 363 Chicken Pox. TABLE IV. Cases of Infectious Disease notified during the year 1923. 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) 233 8 65 132 14 14 ­ ­ 93 114 26 226 Erysipelas 31 2 ­ 5 3 7 10 4 17 9 5 19 Scarlet Fever 245 4 82 127 19 13 ­ ­ 109 96 40 240 Typhus Fever ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ Enteric Fever 14 ­ 1 4 3 4 2 ­ 9 2 3 12 Relapsing Fever (R) Continued Fever (C) ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ Puerperal Fever 13 ­ ­ ­ 5 8 ­ ­ 4 8 1 13 Cerebro-Spinal Meningitis 3 1 1 ­ ­ 1 ­ ­ 3 ­ ­ 3 Polio-myelitift 4 ­ 3 ­ 1 ­ ­ ­ 1 2 1 3 Encephalitis Lethargica 6 ­ ­ ­ 1 4 1 ­ 4 2 ­ 6 Ophthalmia Neonatorum 28 28 ­ ­ ­ ­ ­ ­ 13 9 6 8 Pulmonary Tuberculosis 211 ­ 1 15 52 92 45 6 105 73 33 59 Other forms of Tuberculosis 63 3 13 23 11 9 3 1 32 27 4 18 Anthrax ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ Pneumonia 84 4 6 8 14 22 28 2 32 33 19 27 Malaria ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ Dysentery ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ Trench Fever ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ ­ Totals 935 50 172 314 123 174 89 13 422 375 138 634 Deaths from the Seven Principal Zymotic Diseases.—The total number of deaths of residents registered from the seven principal zymotic diseases was 71, against 158 in the previous year. The deaths of residents last year from these diseases were equal to 48 per 1,000 of the total deaths of resident registered and were at the rate of 0.5 deaths per 1,000 persons 63 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, 1914 to 1923. Year. Smallpox. Measles. Scarlet Fever. Diphtheria and i Membranous Croup. Whooping Cough. Enteric Fever. Diarrhœa and Cholera. Total. 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 1923 0 6 2 20 10 2 31 71 Average last 10 yrs 0 26 6 21 18 3 48 122 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was 51 below the average number registered in the last ten years. Smallpox.-No case of Smallpox was notified in the Borough during the year, against no case in the previous year. 64 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.—Two hundred and thirty-three cases were reported as due to Diphtheria or Diphtheritic Membranous Croup, against 440 cases in the previous year. Two hundred and twenty-six cases were treated at the Isolation Hospitals and 7 at the homes of the patients. Twenty deaths were registered. The mortality rate on the cases reported was 8.6 per cent. It will be observed that there is a considerable decrease in the number of cases of Diphtheria, as compared with the previous year. 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 I am 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. 66 Chart shewing the number of cases of Diphtheria notified week by week in the Borough during the year 1923. 66 Chart shewing the number of cases of Scarlet Fever notified week by week in the Borough during the year 1923. 67 Scarlet Fever.—Two hundred and forty-five cases were notified as due to Scarlet Fever, against 496 in the previous year. Two hundred and forty cases were treated at the Isolation Hospitals, and 5 at the homes of the patients. Two deaths were registered. The mortality rate on the Cases reported was 0.8 per cent. Enteric Fever.—Fourteen cases were reported as due to Enteric Fever, against 14 cases in the previous year. Six cases were treated at the Isolation Hospitals of the Metropolitan Asylums Board, one at the West London Hospital, one at St. George's Hospital, two at St. Marylebone Infirmary, one at the Fulham Infirmary, one at St. George's Hospital, and two at the homes of the patients. Two deaths were registered. The mortality rate on the cases reported was 14.3 per cent. Erysipelas.—Thirty-one cases were reported as due to Erysipelas, against 39 cases in the previous year. Twelve cases were treated at the homes of the patients. Twelve at Fulham Infirmary, 5 at St. Marylebone Infirmary, 1 in the Hospital of the Metropolitan Asylums Board, and 1 at Kensington Infirmary. No death was registered. The mortality rate on the cases reported was 0 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.—No case was reported as due to Continued Fever, against one case in the previous year. Puerperal Fever.—Thirteen cases were reported as due to Puerperal Fever, against nine cases in the previous year. Three of the cases were treated at Kensington Infirmary, 8 68 at the Fulham Infirmary, 1 at St. Marlebone Infirmary, and 1 at "Parkside" Maternity Home. Five deaths were registered. The mortality rate on the cases reported was 38.5 per cent. Cerebro-Spinal Meningitis.—Three cases of Cerebro-Spinal Meningitis were reported, against 4 in the previous year. One case was removed to the West London Hospital, 1 to St. Marylebone Hospital and 1 to St. Mary's Hospital. One death was registered. The mortality rate on the cases reported was 50 per cent. Acute Polio-myelitis.—Four cases were reported as due to Polio-myelitis, against 3 cases in the previous year. Two cases were treated at the West London Hospital, 1 at Paddington Green Hospital and 1 at home. One death (non-parishioner) was registered. Encephalitis Lethargica.—Six cases were reported as due to Encephalitis Lethargica, against 1 in the previous year. Two cases were treated at St. Marylebone Infirmary, 1 at the National Hospital, 1 at Acton Hospital, 1 at the West Loudon Hospital, and 1 at the Hospital for Epilepsy and Paralysis. Three deaths were registered. Ophthalmia Neonatorum.—Twenty-eight cases were reported as due to Ophthalmia Neonatorum, against 35 in the previous year. Eight cases were treated at Hospitals, 20 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. 69 Glanders.—No case was reported as due to Glanders, as against one case in the previous year. Measles and German Measles.—Three hundred and forty-seven cases of Measles and German Measles were notified against 1,284 in the previous year. Three hundred and twenty-five cases were treated at the homes of the patients, and 22 in the Hospitals of the Metropolitan Asylums Board. Six deaths were registered. 70 Whooping Cough.—One hundred and thirty-six cases of Whooping Cough were reported, against 357 in the previous year. Ten deaths were registered. As this is not a notifiable disease, the mortality 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. 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. 71 Chicken Pox.—Three hundred and sixty-three cases of Chicken Pox were reported, against 224 in the previous year. In every case the premises were visited by one of your Inspectors and the parents advised as to the precautions necessary. Pneumonia.—Eighty-four cases of Pneumonia, 18 Influenzal Pneumonia and 66 Primary Pneumonia, were notified during the year. The majority of the patients were treated at home. Twenty-six 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. Ninety-nine 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.—No case was reported, against 4 in the previous year. Dysentery.—No case of Dysentery was reported, against no case in the previous year. Trench Fever.—No case of Trench Fever was reported, against no case in the previous year. Influenza.—During the year 18 deaths from Influenza occurred, as compared with 70 in the previous year. 72 TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1914 to 1923. 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. 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 0 2428 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 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 8 0 0 20 0 57 0 168 763 225 4 1 0 0 53 6 04 165 20 9 1 2610 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 1 154 4 0 0 3062 1923 0 215 233 0 14 0 0 13 0 31 0 363 347 136 3 0 0 0 28 4 6 84 0 0 0 1507 Average for 10 years. 0 489 256 0 12 0 0 9 0 58 0 277 956 215 6 0 0 0 37 4 2 70 13 1 0 2405 * Not Notifiable †Notifiable during years 1916—1919. ‡Notifiable from 1st March 1919 73 Wrong Diagnosis.—Fifty-eight 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 18 cases of Diphtheria and 29 oases of Scarlet Fever, and 1 case of Encephalitis Lethargica. Cleansing of Verminous Persons.—Provision has now been made for the cleansing of verminous persons, the Council having erected a Cleansing Station in Scotts Road, Shepherd's Bush. Negotiations are taking place and it is hoped that arrangements will be made for the cleansing of school children to commence early in 1924. Children attending the L.C.C. Schools and requiring cleansing are dealt with at the Cleansing Stations at Sedlescombe Road, Fulham, and Blechynden Mews, Kensington. Age Periods. Number of Notifications on Form "A" Notifications on Form "B" Number of Notifications on Form "C" Primary Notifications. Total Notifications on Form "A" Primary Notifications. Total Notifications on Form "B" Poor Law Institutions. Sanatoria. 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. Under 5. 5 to 10 10 to 15 Total Pri. Not. Pulmonary, Males ... ... 3 5 9 10 22 26 21 10 5 111 162 ... ... 1 1 2 25 103 Pulmonary, Females ... 1 1 3 14 15 20 17 7 1 1 83 113 ... 1 1 2 3 8 62 Non-Pulmonary, Males 2 6 6 3 2 3 3 ... ... 1 1 27 245 31 334 ... 4 1 5 8 5 10 ... 19 Non-Pulmonary, Females 1 7 2 2 ... 5 2 3 2 ... ... 24 28 ... ... ... ... ... 14 Tuberculosis.—Two hundred and seventy-four cases of Tuberculosis were reported during the year; 211 of which were Pulmonary and 63 being other forms of Tuberculosis, against 295 cases in the previous year. 74 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 twenty-seven deaths from Pulmonary Tuberculosis were registered, against 142 in the previous year, representing a death-rate of 0.9 per 1,000, compared with 1.1 in 1922. 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. I append figures for the years 1920, 1921, 1922 and 1923 shewing the interval between notification and death of tuberculous persons. 1920. 1921. 1922. 1923. 1. Total number of deaths from Tuberculosis in the Borough 157 173 162 145 2. The number of cases notified at death 11 8 17 . 11 3. The number of cases notified within one month of death (excluding above) 26 29 20 21 4. The number of cases notified within three months of death (excluding above) 28 29 20 18 5. The number of cases notified within six months of death (excluding above) 16 9 16 13 75 I submit a report on the work carried out at the Tuberculosis Dispensary. Tuberculosis Officer's Report for 1923. The notifications of fresh cases of all forms of Tuberculosis in the Borough during the year 1923 numbered 274, a decrease of 20 as compared with 1922. The deaths numbered 145, 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 1923 145 274 New Patients. During the year 590 patients attended at the Tuberculosis Dispensary for examination for the first time. Of these, 189 were under the age of 15 and 401 were adults. Males comprised 267, females 323. Diagnosis. Found to have Pulmonary Tuberculosis 141 Found to have other forms of Tuberculosis 36 Shewing no evidence of Tuberculosis 413 Total Attendances and Examinations. The total attendances of persons for purposes of examination, observation and treatment, numbered 3,688. 76 This includes not only the new patients for 1923, but also persons who have continued attendance from previous years. Physical examinations were carried out in 1,484 instances. The number of insured persons under Domiciliary treatment, with Dispensary supervision, on 31st December was 254. Sputum Examination. Five hundred and forty-three specimens of sputum and other pathological products were examined bacteriologically. Ninety-one shewed the presence of Tubercle Bacilli, while 452 proved negative. Institutional Treatment. The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homes), under the London County Council's Scheme, numbered 156. 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 460 To the Ministry of Pensions 285 To the local War Pensions Committee 107 To General Practioners and Hospitals 303 Home Visitation. The Tuberculosis Officer made 179 visits to homes of patients for the purpose of examination, and investigation of the home conditions. In addition he met local practitioners in consultation at the homes of patients on 30 occasions, and at their surgeries on 33 occasions. 77 The Nurses visit the tuberculous population on notification and thereafter at intervals of six months or less, as may appear advisable. During the year 3,347 such visits were made. Since the resignation, in January, 1922, of the CareCommittee 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 160. These enquiries form the basis upon which the Tuberculosis Care-Committee makes its decision in the assessing of individual cases. During the year 147 Home-Enquiry Schedules were submitted to the Committee. Tuberculosis Care-Committee. The Committee met on 20 occasions during the year. There were submitted by the Staff 169 applications for residential treatment. The Committee decided in 107 of these cases that no payment should be required in respect of such treatment. In the remaining 62 assessments of varying amounts were made. In 77 instances, reconsideration of these assessments was rendered necessary at subsequent meetings, mainly by changes in the family circumstances. Fifty-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 £212 12s. 9d. 78 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 AfterCare 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. 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. 79 As in the ease 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 Hospitals. 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. 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, 80 CANCER. In August the Ministry of Health issued a Memorandum on Cancer for the guidance of Local Authorities, in view of the great and increasing amount of suffering and death due to that disease in this country, the public concern which is evinced by its prevalence, the failure so far to find a preventative or cure for it, and the inquiries made by local public health authorities as to the steps which they can usefully take to disseminate information with regard to it amongst the inhabitants of their districts. The Memorandum summarises in non-technical terms our present knowledge with regard to the cause and incidence of cancer, and to offer for the consideration of local health authorities some suggestions which it is hoped may be useful to them in their efforts to inform public opinion on this important subject. I do not consider it advisable to set out the whole of the Memorandum but only to refer to the word of caution of the Minister under the heading of propaganda. Much caution is obviously needed in announcements to the public on Cancer in order to avoid over-statement, the making of promises which are not warranted by evidence, or the production of needless and mischievous apprehension of cancer. If all this is realised, knowledge of some of the main facts of cancer (negative as well as positive) such as are indicated in this Circular, may usefully be spread through the ordinary agencies of public health departments, notably by instruction at Welfare Centres, by midwives and maternity nurses, and by social welfare workers. It need hardly be added that it is important for the Medical Officer of Health in advising on these matters to enlist the counsel and assistance of other medical men, whether specialists or general practitioners, in his area. 81 EXHUMATION AND RE-INTERMENT OF BODIES. St. Mary's Catholic Cemetery, Harrow Road. During the year licences were granted by the Secretary of State for the exhumation and removal of the bodies of 27 persons from the catacombs or graves in St. Mary's Cemetery. Twenty-one were bodies of Belgian soldiers and were removed to Belgium, one removed to Manila, Phillipine Islands, one to France, one to United States, one to the Argentine Republic, one to St. Marylebone Cemetery, Finchley, and one reinterred in St. Mary's Cemetery, Harrow Road. 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. 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 82 other the success of the work accomplished in the interests of Maternity and Child Welfare :— Number of Births registered during the year 2 537 Corrected Number of Births 2,701 These figures represent a Birth-rate per 1,000 of the population of the Borough of 20.2 Corrected Number of Deaths of Infants under one year, of whom 54 died under one week 173 Legitimate Infants—162, or 63 per 1 000 Births. Illegitimate Infants—11, or 85 per 1,000 Births. Infant Mortality Rate per 1,000 Births 64 The work undertaken under this heading in the Borough during the year 1923 falls into three categories :— 1. Activities directly initiated by the Borough Council-. (а) 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. (b) Day Nurseries. 3. Activities of independent Voluntary Agencies : (а) Rescue Homes. (b) Convalescent Treatment for Invalid Children 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. 83 The visits paid are enumerated in detail below :— First visits 2,357 Re-visits (under 1 year) 1,814 Re-visits (1 to 5 years) 1,110 Out and removals 2,037 Special visits 309 Ophthalmia 44 Pneumonia 5 Puerperal Fever 12 Ante-natal, first visits 333 Ante-natal, re-visits 31 Visits to Stillbirths 49 Visits to Infant Deaths 134 Total 8,235 Number of Consultations at Infant Welfare Centres, attended by Health Visitors 436 Number of Committee Meetings of Voluntary Associations attended 55 Number of Insanitary Conditions reported by Health Visitors and dealt with by Sanitary Inspectors 34 The feeding of the 2,357 infants visited was found to be as follows :— Breast-feeding 2,119 Artificial feeding 158 Mixed feeding 80 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. The following table gives the number of births and deaths of infants and the rate per 1,000 births during the past 18 years, the year of the appointment of the first Health Visitor:— 84 Year. Births. Deaths of Infants. Deaths of infants per 1000 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 1923 2701 173 64 It will be observed that the infant death-rate has decreased from 71 to 64 per 1,000. This figure is the 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. Although the Infant Mortality figure is the lowest in the history of the Borough, it appears to me to be considerably higher than it should be when compared with other Metropolitan Boroughs. Hammersmith is nineteenth on the list of twenty-eight, and the mortality rate is 4 per 1,000 higher than the average for the whole of London. From the following table it will be seen that the infant mortality rates of the London Boroughs varies from 42 in Hampstead to 82 in Shoreditch. It is to be expected that the figure for a wealthy Borough such as Hampstead would be considerably better than that of 85 Shoreditch and Hammersmith, but I would draw attention tc the low figures in boroughs where the inhabitants are living under similar and worse conditions than Hammersmith, notably Hackney, Battersea and Poplar. The mortality figure for Hammersmith should at least be not higher than that for the whole of London. Reference to the table will show the marked decrease in the mortality rates in London and the various boroughs as compared with the figures of eighteen years ago. This is largely due to improved sanitary conditions but, in my opinion, it is principally due in the more recent years to the intensive work carried out in some boroughs undei various Maternity and Child Welfare Schemes, both voluntary and municipal. Where the fuller schemes are established even in boroughs such as Hackney and Poplar, the mortality rate has dropped in an extremely satisfactory way. I have pointed out on several occasions that the staff of Health Visitors is small and needs increasing to at least double its present number. The Borough has an acreage of 2,282 and this has to be covered by your three Health Visitors, an area of 700 acres per Health Visitor. It is impossible to work such a large area efficiently. Too much time is wasted in walking from house to house. The number of births in Hammersmith last year was 2,701, of which 95 per cent. were visited. This is too large a number, giving 900 to each Health Visitor; it being more than double the number of births which the Ministry of Health recommends as being a maximum for which one Health 86 Visitor should be responsible. Even 400 per visitor spread over so large an area as 700 acres is, in my opinion, too many. This number in a smaller and more compact district could possibly be efficiently visited and supervised. The appointment of more Health Visitors is, in my opinion, an urgent matter, if the infant mortality is to be reduced and the lives of the children saved. INFANTILE MORTALITY—HEALTH VISITORS. Boroughs. Number of Births, 1923. Infant Death Rate. Health Visitors. 1905. 1923. Municipal. Voluntary. Total. County of London 91,662 129 60 — — — Hampstead 1,238 94 42 3 3 Lambeth 6,242 115 43 5 22 27 Lewisham 3,297 92 43 6 — 6 Woolwich 2,867 102 43 7 — 7 Stoke Newington 960 122 46 3 — 3 City of Westminster 1,752 114 47 4 5 9 Battersea 3,434 131 50 8 3 11 Wandsworth 5,474 119 53 5 7 12 Camberwell 5,657 124 57 3 9 12 Chelsea 1,015 117 58 1 2 3 Hackney 4,433 129 58 9 3 12 Deptford 2,428 122 59 6 — 6 City of London 111 149 60 No information. Greenwich 2,119 119 60 5½ — 5½ Poplar 4,256 153 60 6 12 18 Finsbury 1,845 127 61 6 3 9 St. Pancras 4,367 135 63 4 20 24 Stepney 5,913 141 63 10 13 23 Fulham 3,123 144 64 5 l½ 6½ Hammersmith 2,701 135 64 3 2 5 St. Marylebone 1,657 88 66 6 6 12 Islington 7,117 125 66 7 ? 7 Southwark 4,558 148 68 11 5 16 Bethnal Green 2,880 151 69 9 — 9 Paddington 2,617 123 69 2 6 8 Kensington 3,121 144 70 9 9 18 Bermondsey 3,020 148 76 8 5 13 Holborn 593 92 79 1⅔ — l⅔ Shoreditch 2,864 167 82 5 2 7 87 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 20 per week during the year. The total expenditure during the year was approximately £320. The distribution of milk has entailed no increase of the administrative staff or additional expense to the Council. 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.—I 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 Supervisors : Dr. Llewellyn Jones and Dr. Butler. 88 " Parkside " Maternity Home. Period Ended 29th December, 1923. 1. Total number of cases admitted 395 2. Average duration of stay 15½ days 3. No of eases delivered by— (a) Midwives 365 (b) Doctors 28 (Two abortions.) 4. Number of cases in which medical assistance was sought by the midwife, with reasons for requiring assistance :— (a) Ante-natal. All patients attend antenatal clinic. (b) During labour— Secondary uterine inertia (forcep deliverie ) 10 Placenta praevia 2 Ante-partum hæmorrhage 1 Post-partum hæmorrhage 1 Ruptured perineum 1 (c) After labour— Visited daily by physician. (d) For infant— Visited daily by physician. Total 15 5. Number of cases notified as puerperal sepsis, with result of treatment in each case— Complete recovery 1 89 6. Number of cases in which temperature rose above 100.4 for twenty-four hours, with rise of pulse rate 2 One patient suffering from endocarditis. 7. Number of cases notified as ophthalmic neonatorium, with result of treatment in each case 1 Eyes quite clear. 8. Number of cases of " inflammation of the eyes," however slight 5 9. Number of infants not entirely breast-fed while in the Institution, with reasons why they were not breast-fed— Supplementary feeding— Insufficient breast milk 5 Bottle fed— Twin l Mother suffering from acute pulmonary tuberculosis 1 Albuminaria 1 Endocarditis 1 — 4 Total 9 10. Number of maternal deaths, with causes— Cerebral embolism following ante-partum hæmorrhage and placenta praevia 1 11. Number of foetal deaths (stillborn or within ten days of birth) and their causes, and the results of the post-mortem examination (if obtainable)— Stillbirths 3 Blood test of parent in each case positive. 90 Deaths- Premature 4 Twins 3 Ante-partum hæmorrhage 1 — 8 Total 11 Voluntary Work Aided by Borough Council. Infant Welfare Centres.—There are four 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. The Latymer Road Mission Welfare Centre held two sessions weekly: infant consultations and weighings and mothers' classes. This Welfare Centre is on the borders of the Borough and serves both Kensington and Hammersmith. The College Park Clinic was a branch of the Hammersmith Infant Welfare Centre, but is now carried on under the auspices of Presbyterian Church, Ponsard Road. Infant consultations are held weekly. This Centre also serves Willesden. 91 Day Nurseries.—Three Day Nurseries in the Borough— Princess Christian, Princess Mary Adelaide, the Latymer Road Mission Creche—were in great demand where mothers were compelled to work for the support of the family. These nurseries received grants-in-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. 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 36 Dental Treatment 5 Total 49 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. 92 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 13 9 13 - 13 Ophthalmia Neonatorum 28 35 28 11 |8 Epidemic Diarrhoea* 31 18 - - - Measles & German Measles (under 5)† 101 391 101 2 8 Whooping Cough (under 5)† 47 153 47 - 1 Poliomyelitis (under 5) 3 - 3 - - *Summer Diarrhœa.—As tliis 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 28, against 35 in the previous year. The analysis of the final reports received is as follows :— Eyes satisfactory 27 Infants died 1 Total 28 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. 93 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 74 Negative results 340 414 Blood from cases of suspected Fever— Widal or Typhoid reaction obtained 2 Widal or Typhoid reaction not obtained 5 7 Urine from cases of Tuberculosis— Positive 0 Negative 1 1 Anthrax—Examination of Shaving Brushes— Anthrax bacillus found 0 Anthrax bacillus not found 1 1 Sputa from cases of suspected TuberculosisTubercle bacillus found 103 Tubercle bacillus not found 502 605 Total examinations 1,028 94 Disinfection.—The following table shews the amount of disinfection carried out by your Council during the year; all bedding and articles of clothing, &e., being removed to the Council's Disinfecting Station, for the purpose of disinfection. Beds 407 Mattresses 636 Pillows 1,569 Bolsters 398 Blankets 1,668 Sheets 832 Rugs 679 Articles of clothing 2,459 Rooms 864 Sundries 325 Total 9,837 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 fifty-three applications were received for certificates under the above Act. In forty-five cases the certificates were granted, and eight applications were refused. Five certificates were granted to owners who had carried out the work specified satisfactorily. 95 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 289 bodies were removed to the Mortuary in Fulham Palace Road. There were 240 brought to the Mortuary by order of the Coroner, and 49 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. Twenty-seven Certificates were granted during the year, under Section 48 (2) of age Public Health (London) Act, 1891, with regard to newly erected houses having a proper and sufficient water supply; 5 on the housing estate of the Borough Council, and 22 in other parts of the Borough. HOUSING CONDITIONS. Statistics. Year ended 30th December, 1923. 1.—General. (1) Estimated population 133,600 (2) General death-rate 11.0 (3) Death-rate from tuberculosis 1.17 (4) Infantile mortality 64 (5) Number of dwelling-houses of all classes (estimated) 18,481 (6) Number of working-class dwelling-houses (estimated) 12,000 (7) Number of new working-class houses erected 27 96 2.—Unfit Dwelling-houses. I.— Inspection. (1) Total number of dwelling-houses inspected for Housing defects (under Public Health or Housing Acts) 6,924 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 312 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (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 3,232 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 Nil (2) Number of dwelling-houses which were rendered fit— (a) By owners Nil (b) By Local Authority in default of owners Nil 97 (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 3,232 (2) Number of dwelling-houses in which defects remedied— (a) By owners 3,372 (b) By Local Authority in default of owners 1 (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 3 (2) Number of dwelling-houses in respect of which Closing Orders were made 6 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil (4) Number of dwelling-houses in respect of which demolition orders were made 2 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 2 Meteorology. The average mean temperature registered in London during the year was 50.3 degrees Fahrenheit. The highest air temperature registered being 92 degrees, in July. The lowest air temperature was 23 degrees in November. The total amount of rainfall was 24,0 inches.