HAM 65 Annual Report OF THE Medical Officer of Health OF THE BOROUGH OF HAMMERSMITH FOR THE YEAR 1925 Metchim & Son, Westminster and City. INDEX. Page Introduction 2 Statistics for the Year 1925 4 Natural and Social Conditions of the District. Population 4 Marriages 5 Births 5 Chart—Diarrhœa 6 Deaths 7 Deaths of Infants 7 Summer Diarrhœa 7 Hospital Treatment—Zymotic Enteritis 7 Danger from Flies 7 Deaths of Illegitimate Children 8 Infantile Mortality (Table III) 8 Deaths of Aged Persons 8 Statistics (Table I) 9 Deaths in Institutions 9 Deaths (Various Causes—Table II) 11 Table—Whole of London—Comparison 12 Poor Law Relief 13 Out-door Medical Relief 13 General Provision of Health Services in the Borough. Hospitals 13 Institutional Treatment for Unmarried Mothers 13 Ambulance Facilities 14 Clinics and Treatment Centres 14 Attendances at Infant Welfare Centres 15 Day Nurseries 15 School Clinics 16 Tuberculosis Dispensary 16 Treatment Centre for Venereal Diseases 16 Staff of the Public Health Department 16 Professional Nursing in the Home 18 General 18 Infectious Diseases 18 Midwives 18 Chemical Work 18 Page Sanitary Circumstances of the Borough. Closet Accommodation 18 Scavenging 18 Cesspools 19 Notices 19 Summonses 20 Factories and Workshops—Inspection of 22 House to House 24 Houses Let m Lodgings 24 Rat and Mice (Destruction) Act, 1919 24 Smoke Abatement 25 Controlled Premises and Occupations 25 Ice Cream Vendors 26 Schools 26 Housing. Housing Conditions 27 Housing and Town Planning 28 Newly Erected Houses 28 Statistics 29 Food. Milk Supply 30 Milk (Special Designations) Order, 1923 31 Milk and Dairies Consolidation Act, 1915 32 Preservatives, &c., in Food 36 Public Health Regulations, 1925 38 Certification of Certain Food Products for Export 45 Public Health (Milk and Cream) Regulations, 1912 and 1917 46 Milk (Mothers and Children) Order, 1919 48 Sale of Food and Drugs Acts 48 Condensed Milk 50 Butter and Margarine 50 Coffee and Cocoa 51 Meat and Fish Preparations 51 Jam and Marmalade 51 Lemon Cheese 51 Desiccated Coconut 51 Rice 51 Lime Juice Cordial, &c. 51 Drugs 52 Meat 53 Public Health (Meat) Eegulations, 1924 53 Stalls 54 Shops, Stores, &c. 54 Transport and Handling 57 Licensed Slaughterhouses 57 Page Food—continued. Markets 58 Fried-fish Shops 59 Bakehouses 59 Unsound Food 61 Food Surrendered 61 Food Poisoning 62 Prevalence and Control over Infectious Diseases. Infectious Diseases 62 Bacteriology 63 Zymotic Diseases 64 Smallpox 65 Cholera 65 Plague 65 Chart—Diphtheria 66 Diphtheria and Diphtheritic Membraneous Croup 67 Antitoxin 67 Scarlet Fever 67 Enteric Fever 67 Erysipelas 67 Typhus Fever 67 Relapsing Fever 67 Chart—Scarlet Fever 68 Continued Fever 69 Puerperal Fever 69 Cerebro- Spinal Meningitis 69 Acute Polio-myelitis 69 Encephalitis Lethargica 69 Ophthalmia Neonatorum 69 Anthrax 69 Hydrophobia 69 Babies Order, 1919 69 Measles—Chart 70 Glanders 70 Measles and German Measles 70 Whooping Cough 70 Chart—Whooping Cough 71 Chicken Pox 71 Pneumonia 71 Malaria 72 Dysentery 72 Trench Fever 72 Influenza 72 Wrong Diagnosis 72 Cleansing of Verminous Persons 72 Page Prevalence and Control over Infectious Diseases—continued. Tabular Statement—Zymotic Diseases 73 Disinfection 74 Tuberculosis 74 Tuberculosis Officer's Report 76 Tuberculosis Dispensary 77 Institutional Treatment 78 Clinical Reports 78 Home Visitation 78 Tuberculosis Care Committee 78 Public Health (Prevention of Tuberculosis) Regulations, 1925 80 Cancer 82 Exhumation and Re-interment of Bodies 83 Health Week. Exhibition, Baby Competitions and Lectures 84 Maternity and Child Welfare. Statistics 85 Health Visitors—Work of 85 Feeding of Infants—Statistics 86 Table—Births, Deaths, and Infant Death Rate 86 Chart—Infantile Mortality Rate 87 Maternal Mortality 87 Milk (Mothers and Children) Orders, 1918-1919 87 " Parkside " Maternity Home—Statistics 88 Voluntary Work. Infant Welfare Centres 90 Day Nurseries 90 Rescue Homes 90 Convalescent Treatment of Invalid Children 90 Treatment and Nursing—Children under School Age 90 (a) Operations, (b) Minor Ailments, (c) Dental Treatment. Infectious Diseases of Mothers, and Children under five years of age—Tabular Statement 91 Ophthalmia Neonatorum 92 Sanitary Administration. Staff 92 Rent Restrictions Acts 92 Rag Flock Act 92 Public Mortuary 93 Meteorology 93 ANNUAL REPORT OF THE Medical Officer of Health OF THE BOROUGH OF HAMMERSMITH For the Year 1925. 2 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 1925. 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 11.9 is 0.5 lower than the rate for the previous year, whilst the infantile mortality rate has been reduced from 72 per 1,000 births to 65 per 1,000 births—only 1 per 1,000 greater than the lowest rate recorded in 1923. This figure is very satisfactory and is undoubtedly the result of the work carried out under the maternity and child welfare scheme of the Borough. The efforts of your Council have been, as in the past, considerably augmented by those of the Voluntary Societies engaged in this branch of the Public Health Services of the Borough. With regard to infectious diseases the total number notified was below the average. The housing condition of the Borough is not of a very satisfactory nature and it is to be regretted that a very 3 considerable amount of overcrowding still exists. The Council's Housing Scheme is practically completed, but up to the present no improvement in housing conditions has resulted in the congested areas. During the year, 3,658 Intimation Notices and 1,037 Statutory Notices were served. I am, Ladies and Gentlemen, Your obedient Servant, J. B. HOWELL, Medical Officer of Health. 4 STATISTICS FOR THE YEAR 1925. General Statistics. Area 2,282.5 acres Population (1925) 134,500 Population Census (1901) 112,239 (1911) 121,521 (1921) 130,287 Natural increase, i.e., excess of births over deaths 743 Density of population 58.9 persons per acre Marriages registered 1,127 Number of inhabited houses (1921) 17,402 Number of families or separate occupiers (1921) 33,263 Rateable value (1925) £970,187 Sum represented by a penny rate, 1925 £4,042 Vital Statistics. Births (legitimate) 2,232 ,, (illegitimate) 119 Deaths (corrected) 1,604 birth rate 17.5 death rate 11.9 Number of women dying in, or in consequence of childbirth from sepsis 6 from other causes 7 Deaths of infants under one year of age per 1,000 births 65 Legitimate, 63 Illegitimate, 101 Deaths from measles (all ages) 6 Deaths from whooping cough (all ages) 32 Deaths from diarrhœa (under 2 years of age) 30 NATURAL AND 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, showing an increase during the 10 years of 9,282. The Census of 1921 shows 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. 5 At the time of the last Census part of the Defence Force, which was mobilised as an emergency, was in camp on Wormwood Scrubbs. The estimated population adopted by the RegistrarGeneral is 134,500, but I believe this number to be below the actual population of the Borough. Since the Census was taken, over thirteen 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 2,351, whilst the corrected number of deaths of residents was 1,608, thus showing a natural increase of population by excess of births over deaths of 743. The area of the Borough is 2,282.5 acres, there being 58.9 persons to the acre, showing an increase as compared with the previous year of 0.1 persons per acre. Marriages.—The number of marriages registered during the year was 1,127, the marriage rate being 17. Births.—During the year 2,178 births were registered in the Borough. Adding 304 births which occurred outside the Borough, transferred by the Registrar-General as belonging to Hammersmith, and deducting 131 births which occurred in the Borough, and transferred to other districts by the Registrar-General, the corrected number of births for the year was 2,351. On the estimated population, i.e., 134,500, the corrected number of births registered was equal to an annual rate of 17.5 births per 1,000 persons living. The Birth-rate for the year is 0.4 per 1,000 less than the rate for the previous year which was 17.9. The Birth-rate in London on the estimated population, i.e., 4,612,000, was equal to an annual rate of 18 births per 1,000 persons living. Notification of Births Act, 1907. Births registered 2,178 Corrected number of births 2,351 Notification Received from Midwives. Doctors. Lying-in Hospitals. Poor Law Institutions. Parents. M.O.H.'s. 1,020 519 587 84 27 10 Total notifications received, 2,247. 6 The following Chart shows the number of deaths from Diarrhoea per 100,000 inhabitants, 1906-1925. 7 Deaths.—During the year 1,034 deaths (476 males, 558 females) were registered in the Borough, as compared with 1,123 in the previous year. Adding 733 deaths of residents of this Borough which occurred in general hospitals and other public institutions, and 23 deaths of residents transferred by the Registrar-General as having occurred in various parts of England, and deducting 157 deaths of non-residents and 29 transferable deaths which occurred in the Borough, the corrected number of deaths of residents registered was 1,604. On the estimated population, i.e., 134,500, the corrected number of deaths of residents was equal to an annual rate of 11.9 deaths per 1,000 persons living. The death-rate in London on the estimated population, i.e., 4,612,000, was equal to an annual rate of 11.7 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 153, as compared with 173 in the previous year. The number of deaths of infants under one year of age was equal to 65 per 1,000 of the corrected births and to 95 per 1,000 of the corrected deaths. The number of deaths of infants under one year of age, residents in London, was equal to 67 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, 2 per 1,000 less in this Borough than in London. Summer Diarrhoea.—The number of deaths from Diarrhoea was 35, being 20 more than in the previous year. Of these 28 were of children under one year of age. Hospital Treatment.—Zymotic Enteritis.—The arrangements made by the Metropolitan Asylums Board for the provision of a number of beds for the treatment of zymotic enteritis was continued. The provision is limited and cases are admitted on the recommendation of the Medical Officer of Health after consultation with the Medical Practitioner in attendance on the patient. One case was admitted to Hospital. 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. 8 Deaths of Illegitimate Children.—The corrected number of deaths of illegitimate infante under one .year of age was 12 or at the rate of 101 per 1,000 illegitimate births. It is interesting to note the very great difference between the death-rate of legitimate and illegitimate infante. The former being 63 per 1,000 whilst the latter is 101 per 1,000, a difference of 38 per 1,000. The following table on infantile mortality has been prepared in accordance with the direction of the Ministry of Health. TABLE III. Infantile Mortality during the year 1925. Nett Deaths from stated causes at various ages under one year of age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total uuder 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 45 6 5 4 60 26 28 18 21 153 Uncertified — - - - - - - - - - Small-pox - - - - - — — - - — Chicken-pox — - - - - - - -1 1 2 Measles — - - - - - - - - - Scarlet Fever — - - - - - - - - - Whooping Cough — - - — - 1 5 2 4 12 Diphtheria and Croup — - - - - - - - - - Erysipelas — - - - - - - - - - Tuberculous Meningitis — - - - - - - - - - Abdominal Tuberculosis — - - - - - - - - - Other Tuberculous Diseases — — — - — — - — — - Meningitis (not Tuberculous) - - - - - - 1 - 1 2 Convulsions 1 1 - — 2 - 1 - - 3 Laryngitis — - - - - - - - - - Bronchitis - 2 - - 2 1 3 - 1 7 Pneumonia (all forms) - - - - - 6 7 5 10 28 Diarrhœ - - - 1 1 - 1 - - 2 Enteritis — — 2 — 2 6 10 5 3 26 Gastritis - - - - - - - - - - Syphilis — — — — - 1 - - - 1 Rickets - - - - - - - - - - Suffocation, overlaping 3 — — — 3 - - 1 - 4 Injury at Birth 1 — — — 1 - - - — 1 Atelectasis 1 - - - 1 - - - - 1 Congenital Malformations 4 - - - 4 1 - - - 5 Premature Birth 25 2 - 1 28 2 - 1 - 31 Atrophy, Debility & Marasmus 5 - 3 2 10 4 1 - - 15 Other causes 5 1 - - 6 4 1 1 1 13 Totals 45 6 5 4 60 26 28 18 21 153 Nett Births in the Yea Legitimate 2232 Illegitimate 119 Nett Deaths in the Year of: Legitimate Infants 141 Illegitimate Infants 12. Deaths of Aged Persons The corrected number of deaths of residents at 65 years of age and upwards registered during the year was 665, against 625 in the previous year. These deaths were equal to 4.6 per 1,000 of the total persons living, and 390 per 1,000 of the total deaths of residents registered. 9 Of the 665 deaths of residents at 65 years of age and upwards it is interesting to note that of these, 136 died between the ages of 65 and 70, 330 between 70-80, 177 between 80-90, and 22 between 90-100. Statistics.—The following table gives the statistics of the Borough during 1925 and the previous five years, in the form prescribed by the Ministry of Health: — TABLE I. Vital Statistics of Whole District during 1925 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. Number. Rate. of Non-residents registered in the District. of Residents not registered in the District. 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 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 91 202 669 245 88 1634 12.7 1922 134400 2564 2758 20.5 1223 91 196 705 196 71 1733 12.9 1923 133600 2571 2701 20.2 981 7.3 125 649 173 64 1473 11.0 1924 134200 2199 2399 17.9 1123 8.4 173 718 173 72 1668 12.4 1925 134500 2178 2351 17.5 1034 7.7 186 756 153 65 1604 11.9 Area of District in acres (land and inland water) 2,282.5 Total population of all ages 130,287 Total families or occupiers 33,263 At Census of 1921 (cf Census Vol. 5.) Deaths of Residents.—Belonging to the Borough, occurring in Public Institutions, &c., in districts outside, during the year 1925 :— FEVER HOSPITALS. Western Hospital 15 Northern Hospital 1 Grove Hospital 4 North-Western Hospital 3 Southern Hospital 1 — Total 24 MENTAL HOSPITALS. Hanwell Hospital 19 Springfield Hospital 3 Tooting Bee Hospital 20 Colney Hatch Hospital2 City of London Hospital 1 Glaybury Hospital 1 Dartford Heath Hospital 1 Colindale Hospital 3 Leavesden Hospital 2 Horton Hospital 2 Long Grove Hospital 2 Downs Hospital 1 Banstead Hospital 4 — Total 61 10 GENERAL HOSPITALS. Samaritan Free Hospital 1 Hampstead General Hospital 2 St. Luke's Hospital 9 St. George's Hospital 15 Children's Hospital, Great Ormond Street 11 St. Mary's Hospital 12 Queen Charlotte's Hospital 6 Cancer Hospital 5 St. Columba's Hospital 1 National Hospital for Diseases of Heart 5 Mount Vernon Hospital 1 University College Hospital 4 Royal Chest Hospital 2 Middlesex Hospital11 German Hospital 1 St. Joseph's Hospital 1 St. Peter's Hospital 1 London Hospital 1 Acton Hospital 2 Victoria Hospital 1 Guy's Hospital 2 St. James' Hospital 1 Chiswick Hospital 1 Willesden Hospital 1 Brompton Hospital 2 Charing Cross Hospital 1 Freemasons' Hospital 1 St. Bartholomew's Hospital 1 St. Mark's Hospital, City Road 1 Total 103 OTHER INSTITUTIONS. St. Marylebone Hospital 348 Fulham Hospital 82 Kensington Hospital 20 Chelsea Hospital 12 Westminster Hospital 9 St. George's Home, Milman Street 5 Columbia Hospital 1 Hospital for Epilepsy and Paralysis 1 St. Thomas's Home 1 Ministry of Pensions Hospital, Orpington 3 Royal Hospital 2 French Hospital 2 Spring Hospital, Church Road 1 St. Josephus Hospital 1 Edmonton Epileptic Colony 2 St. Andrew's Hospital, Dollis Hill 1 St. John's Home, 32, Worple Road 1 St. Joseph's Home 1 Camberwell House 1 Peckham House 1 Infants' Hospital, Vincent Square 1 Chelsea Hospital for Women 2 New End Hospital 4 St. Peter and St. Paul's Receiving Homes 1 West End Hospital, Gloucester Gate 1 Total 503 VARIOUS. 4, King's Road 1 On way to, and near St. Bartholomew's Hospital 2 30, Twickenham Road 2 53, Carrow Gate Road 1 96, Sibley Grove 1 11, Avenue Crescent 1 49, Beaumont Street 2 Harrow Road 1 41, Gillingham Street, Pimlico 1 50, Thisker Road 1 65, Oxford Road 1 On way to Fulham Hospital 1 On way to Charing Cross Hospital 1 9, Chatham Road 1 Lonsdale Road 1 Palladium Theatre, Argyll Street 1 54, Sefton Street 1 164, St. John's Hill 1 16b, Charlotte Street 1 46, Ousley Road, Balham 1 On way to St. Mary's Hospital 1 Twyford Lodge, Acton Lane 5 61, The Grove, Vauxhall 1 River Thames 1 9, Orme Court, Paddington 1 Between Western Avenue and Acton Hospital 1 28, Twickenham Road 1 11, Randolph Crescent 1 25, Thornton Hill 1 The Cloisters. Bromley 1 50, Kingston Hill 1 Arthway House 1 2a, Bow Road 2 18, Thavies Inn 1 Total 42 11 TABLE II. Causes of, and ages at Death during the Year 1925. 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. Wards. 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 All Causes Certified 1604 153 36 26 56 84 172 412 665 250 319 272 93 276 276 118 238 Uncertified 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Enteric Fever 3 0 0 0 0 0 1 2 0 0 0 0 0 2 1 0 0 Small-pox 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Measles 6 2 0 1 3 0 0 0 0 0 2 0 1 0 3 0 0 Scarlet Fever 3 0 0 1 1 1 0 0 0 0 0 0 0 1 1 1 0 Whooping Cough 32 12 14 5 1 0 0 0 0 3 7 5 2 4 9 2 0 Diphtheria and Croup 12 0 0 5 6 1 0 0 0 1 0 0 0 1 9 1 1 Influenza 34 1 0 0 0 6 7 8 12 4 6 5 2 9 4 4 1 Erysipelas 3 0 0 0 0 0 0 2 1 0 2 0 0 0 1 0 0 Phthisis(PulmonaryTuberculosis) 124 0 0 0 1 35 40 38 10 22 24 21 8 24 20 5 3 Disemminated Tuberculosis 3 0 1 1 0 1 0 0 0 0 0 0 1 2 0 0 2 Tuberculosis Meningitis 8 0 1 2 2 1 1 1 0 1 0 1 0 4 2 0 3 Other Tuberculous Diseases 3 0 0 0 0 0 2 0 1 0 0 - 0 1 2 0 0 3 Cancer, malignant disease 215 0 0 0 1 4 21 101 88 31 40 47 14 37 33 13 39 Rheumatic Fever 7 0 0 0 3 2 0 0 2 2 1 2 1 0 1 0 5 Meningitis 9 2 1 0 2 1 1 2 0 0 2 2 0 2 2 1 1 Organic Heart Disease 169 1 0 0 6 4 19 42 97 31 39 25 10 34 24 6 6 Bronchitis 115 7 1 0 0 0 2 24 81 26 23 21 3 11 19 12 5 Pneumonia (all forms) 134 28 12 4 4 1 12 25 48 18 22 17 10 28 28 11 16 Other Diseases of the Respiratory Organs 17 1 0 0 1 1 1 4 9 3 4 2 1 3 3 1 5 Diarrhœa and Enteritis 35 28 2 1 1 0 0 2 1 4 8 4 3 2 6 8 5 Appendicitis and Typhlitis 12 0 0 0 3 1 1 4 3 1 2 3 0 3 3 0 16 Cirrhosis of Liver 8 0 0 0 0 0 0 6 2 2 1 0 1 2 2 0 0 Alcoholism 1 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 Nephritis and Bright's Diseese .. 59 0 0 0 5 2 6 19 27 10 10 9 3 14 9 4 6 Puerperal Fever 6 0 0 0 0 0 6 0 0 0 1 3 0 1 1 0 0 Other Accidents and Diseases of Pregnancy and Parturition 7 0 0 0 0 1 6 0 0 0 1 2 0 2 1 1 0 Congenital Debility and Malforniation,including Prematnre Birth 51 51 0 0 0 0 0 0 0 5 8 6 1 7 11 3 16 Violent Deaths, excluding Suicide 45 1 2 2 4 6 8 11 11 12 13 7 3 5 4 1 25 Suicide 12 0 0 0 0 0 4 6 2 0 3 2 0 4 2 1 1 Other defined diseases 471 19 2 4 12 16 33 115 270 73 100 88 28 72 77 3 79 Diseases ill-defined or unknown .. 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 1604 153 36 26 56 84 172 412 665 250 319 272 93 276 276 118 238 SubEntries included in above figures. Cerebro-Spinal Meningitis 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Encephalitis Lethargica 4 0 0 1 1 0 0 2 0 0 0 2 0 0 2 0 1 The following table shows the Death Rates of the seven Wards of the Borough. 12 This rate is calculated on the estimated population of each Ward. Ward. Estimated Population. No. of Deaths. Death Rate. No. 1 River 17,661 250 14.2 No. 2 Brook Green 25,843 319 12.3 No. 3 The Grove 22,971 272 11.8 No. 4 St. Stephens 9,240 93 10.1 No. 5 Starch Green 22,797 276 12.1 No. 6 Wormholt 23,852 276 11.6 No. 7 College Park and Latimer 12,136 118 9.7 LONDON AND THE METROPOLITAN BOROUGHS. Cities and Boroughs. Estimated population to the middle of year. 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 4,602,000 18.0* 0.7 11.7* 67* West Districts. Paddington 147,100 15.9 0.4 12.1 72 Kensington 179,600 15.8 0.5 13.2 78 Hammersmith 134,500 17.5 0.7 11.9 65 Fulham 163,700 16.9 0.5 10.7 76 Chelsea 64,820 14.4 0.4 13.6 69 City of Westminster 139,600 10.7 0.4 12.3 69 North Districts. St. Marylebone 106,100 14.1 0.5 11.6 63 Hampstead 88,040 12.0 0.2 10.2 55 St. Pancras 215,900 17.9 0.8 12.7 72 Islington 339,200 19.4 0.4 12.3 63 Stoke Newington 53,190 15.8 0.34 11.2 61 Hackney 228,300 17.9 0.5 10.9 65 Central Districts. Holborn 43,315 12.2 0.4 12.5 63 Finsbury 77,560 22.6 0.8 13.6 60 City of London 13,340 7.5 0.5 11.8 60 East Districts. Shoreditch 107,300 24.6 1.2 13.3 88 Bethnal Green 119,800 21.9 1.3 12.0 81 Stepney 255,370 21.2 0.9 11.9 73 Poplar 168,500 22.7 0.9 11.7 75 South Districts. Southwark 189,000 21.2 0.9 13.1 77 Bermondsey 123,000 23.4 0.8 12.6 78 Lambeth 311,100 24.6 0.5 12.1 45 Battersea 172,100 18.5 0.4 10.5 58 Wandsworth 340,900 14.3 0.3 10.4 52 Camber well 275,400 17.7 0.5 11.1 65 Deptford 115,900 18.8 0.8 12.1 63 Greenwich 103,936 18.8 0.6 11.2 70 Lewisham 185,600 15.6 0.3 10.3 55 Woolwich 140,740 18.3 0.4 10.8 55 *These provisional figures are taken from a table furnished by the Registrar-General. Other figures supplied by Medical Officer of Health of borough concerned. 13 POOR LAW RELIEF. I am indebted to the Clerk of the Guardians who has kindly furnished me with the following information, so that I might comply with the request of the Minister of Health to supply particulars of the extent to which hospital and other forms of gratuitous medical relief are utilised. The figures are probably of small value in consequence of the occupation of the Hammersmith Hospital by the Ministry of Pensions, and persons were treated on behalf of this parish in the following Poor Law Hospitals. The weekly rate of maintenance at 31st December, 1925, is shown against each Institution:— No. of persons treated. Weekly Rate of Maintenance. Brentford 1 35/- Camberwell 1 45/6 City of London 14 29/6 Chelsea 63 38/- Fulham 656 44/5 Hampstead 10 48/9 Holborn 2 45/6 Kensington 155 39/5 Lambeth 1 45/6 Paddington 3 52/6 St. Marylebone 1,660 42/9 City of Westminster 34 35/- Willesden 12 49/- 2,612 Out-door Medical Relief.—The average number of persons treated weekly by the District Medical Officers during the year ended 31st December, 1925, was 111. GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. HOSPITALS. "Parkside" Maternity Home, Ravenscourt Park, W.6.— 20 beds. This Home was opened by the Council in 1919, for the reception of Maternity Cases. The Ministry of Health contributes one-half the cost. West London Hospital.—This is a general hospital, supported by voluntary contributions, situate in Hammersmith Road, and having accommodation for 225 beds (including cots and private wards). INSTITUTIONAL TREATMENT FOR UNMARRIED MOTHERS. St. Margaret's Hostel, 466, Uxbridge Read, W.12.— Accommodation for 10 mothers and their infants. This hostel 14 is conducted by a voluntary society towards which the Ministry of Health contributes. Hammersmith and Chiswick Refuge for Friendless Girls, 36, Glenthorne Road, W.6.-—Accommodation for 8 mothers and their infants. Supported by voluntary subscriptions. AMBULANCE FACILITIES. Infectious Cases—Provision for the removal of infectious cases is made by the Metropolitan Asylums Board. Non-Infectious and Accident Cases.—Ambulances for the removal of non-infectious cases are provided by the Metropolitan Asylums Board, on payment of a small fee. Ambulances for accident cases are provided by the London County Council. CLINICS AND TREATMENT CENTRES. Hammersmith Infant Welfare Association. Maternity and Child Welfare Centres. 48, Glenthorne Road.—Three Infant Clinics held weekly. Ante-Natal clinic held weekly. Victoria Hall, Becklow Road.—Two Infant Clinics held weekly. Tenants' Institute, Old Oak Lane.—Two Infant Clinics held weekly. St. Matthew's Parochial Hall, Blythe Road.—One Infant Clinic held weekly. Women's League of Service, 161, Sulgrave Road.—Two Infant Clinics held weekly. Ante-Natal Clinic and Dental Clinic held weekly. Dinners to expectant and nursing mothers daily. Presbyterian Church Hall, Ponsard Road.—One Infant Clinic held weekly. Latymer Road Mission, Blechynden Street.—One Infant Clinic held weekly. 15 SCHEDULE OF ATTENDANCES AT THE INFANT WELFARE CENTRES. Address of Clinic. No. of Clinics held. New Cases. Attendances. Mothers. Children. Mothers. Children. Antenatal. Postnatal. Under 1 yr. 1-5 yrs. Antenatal. Postnatal. Under 1 yr. 1-5 yrs. 48, Glenthorne Road 41 111 88 - - 299 166 - - 48, Glenthorne Road 156 - - 441 32 - - 5337 1915 Victoria Mission Hall, Becklow Road 102 - - 237 19 - - 2948 958 St. Matthew's Hall, Blythe Road. 51 - - 160 12 - - 2276 732 Tenants' Institute, Old Oak Estate 14 30 21 - - 69 38 - - Tenants' Institute 52 - - 155 27 - - 2065 731 161, Sulgrave Road 47 42 24 - - 130 84 - - 161, Sulgrave Road 100 - - 161 29 - - 1950 961 Latymer Road Mission 42 - - 42 10 - — 868 579 Presbyterian Hall, Ponsard Road, College Park 38 - - 51 9 — — 723 161 643 183 133 1247 138 498 288 16167 6037 Ante-Natal Clinics 102 Infant Consultations 541 643 The above Centres are conducted by Voluntary Associations supported by voluntary contributions, donations, &c., to which the Council contributes. DAY NURSERIES. Latymer Road Day Nursery.—Provides accommodation for 50 children. Princess Christian Day Nursery, Goldhawk Road.-Provides accommodation for 45 children in winter and 50 in summer. The above nurseries are conducted by Voluntary Associations, supported by voluntary contributions, to which the Council contributes. b 16 SCHOOL CLINICS. L.C.C. Hammersmith School Treatment Centre, 103, Shepherd's Bush Road. The above Centre is provided by the London County Council. Children under school age are dealt with at this Centre by arrangement with the Hammersmith Nursing Association on a basis of a Capitation fee. TUBERCULOSIS DISPENSARY. Hammersmith Tuberculosis Dispensary, Ravenscourt Park. The above Dispensary is provided by the Borough Council. Grants are received from the Ministry of Health and the London County Council. TREATMENT CENTRE FOR VENEREAL DISEASES. West London Hospital, Hammersmith Road. The above Centre is provided under the scheme of the London County Council. STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF THE YEAR 1925. 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) 11902 J. C. Turner 1920 C. M. White 1920 †Miss Cole 1923 R. J. Daw 1923 A, H. Johns 1925 17 Sanitary Inspectors. Year of Appointment †S. Addison 1901 §*F. Q. Barry 1919 †J. S. Cromack 1899 §*A. Hayes 1910 §†H. Neighbour 1901 §*P. W. Pottier 1919 §*W. Rigby 1919 §*L. W. Burrell 1924 Vacant — 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 Cameron (Nurse Visitor) 1924 "□║Miss Murphy (Nurse Visitor) 1924 ¶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. b 2 18 Grants are received by the Council in respect of the Medical Officer of Health, the Tuberculosis Officer, the Sanitary Inspectors, the Health Visitors, the Dispensary Nurses, the Dispenser and Secretary, and Miss Cole. PROFESSIONAL NURSING IN THE HOME. General.—The Hammersmith District Nursing Association provides nurses in all cases for general nursing, upon application being made to the Nightingale Shore Home, 10, Mall Road. Patients are expected to make payments to the Nursing Association in accordance with their means, but no patient is refused the services of a nurse on account of inability to pay- Infectious Diseases.—Arrangements have been made by the Borough Council with the District Nursing Association to provide nurses in case of measles, ophthalmia neonatorum, pneumonia, &c., at a fee of 1s. per visit. When necessary two or three visits are paid daily. Midwives.—The London County Council is the supervising authority under this heading. The Borough Council employs a district midwife in connection with "Parkside" Maternity Home. I am informed by Dr. F. N. Kay Menzies, the County Medical Officer of Health, that 33 midwives gave notice of their intention to practice in the Borough during 1925. Chemical Work.—This is carried out by the Public Analyst, a report on which is included in a later part of this report. 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 been installed, and are provided with proper covers. The horse-drawn vehicles are only covered when the van has been loaded. 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 19 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 no cesspool has been found. General Sanitary Administration—The general sanitary condition of the Borough has been improved to some extent. Whilst a large number of notices has been served during the year it is still very obvious that the overcrowded conditions have not been relieved to any great extent. These conditions 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 have provided many houses, but overcrowded conditions still exist in the Borough. Notices.-The following table shows the number of visits paid by the Inspectors and the Preliminary Notices served and complied with during the year:— Number of Inspections. Number of Notices Served. Number of Notices complied with. Infectious Diseases 3,216 427 430 Complaints 3,590 2,107 2,211 Bakehouses 836 24 23 Outworkers 145 3 3 Houses let in lodgings 9 — — House to House 1,013 520 444 Housing and Town Planning Act 265 156 150 Factories and Workshops, &c. 2,111 82 50 Slaughterhouses 447 2 2 Milk Vendors 2,022 7 7 Ice Cream Vendors 235 — — Smoke 25 14 14 Food 7,228 23 21 Miscellaneous 19,980 393 301 41,022 3,658 3,656 During the year 1,037 Statutory Notices were served and 996 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:— 20 SUMMONSES—YEAR 1925. Situation of Premises Nature of Offence No. of Summonses Result of Proceedings 8 Milson Road Failing to comply with Statutory Notices. 4 (1) Withdrawn. (2) Withdrawn. Work done. 10s 6d. costs. (3) Withdrawn. (4) Withdrawn. 46a Ormiston Road ditto 2 Withdrawn. Work done. £1 1s. costs. 17 North Pole Road ditto 1 Order made. 14 days. 15 Rayleigh Road ditto 1 Order made. 14 days. 22 Netherwood Road ditto 1 Order made. 21 days. Penalty 40/- 91 Rayleigh Road ditto 1 Withdrawn. Work done. 10s. 6d. costs. 144 Sinclair Road Failing to comply with Statutory Notice. 2 (1) Withdrawn. Work done. £2 2s. costs. (2) Order made. 14 days. 7 Wolverton Gardens ditto 3 (1) Order made. 14 days. 10s. 6d. costs. (2) Withdrawn. (3) Withdrawn. 10s. 6d. costs. 94 Queen Street ditto 1 Withdrawn. Work done. 10s. 6d. costs. 81 Rayleigh Road ditto 1 Withdrawn. Work done. 2 Milson Road ditto i Withdrawn. Work done. 92 Masbro Road ditto 2 Withdrawn. Work done. 10s. 6d. costs. 78 Rayleigh Road ditto 1 Order made. 14 days. 49 Benbow Road ditto 1 Withdrawn. Work done. 17 North Pole Road ditto 1 Adjourned. 21 days. 152 Goldhawk Road ditto 1 Withdrawn. Work done. 114 Sinclair Road ditto 1 Order made. 21 days. £1 1s. costs. 70 Rayleigh Road ditto 1 Order made. 21 days. £1 1s. costs. 74 Rayleigh Road ditto 1 Order made. 21 days. 22 Harelock Road ditto 2 Withdrawn. Work done. £1 1s. costs. 100 Rayleigh Road ditto 1 Withdrawn. 57 Gayford Road ditto 1 Dismissed. £3 3s. costs. 38 Stebbing Street ditto 1 Withdrawn. 72 Rayleigh Road ditto 1 Withdrawn. Work done. 49 Hunt Street ditto 1 Withdrawn. Work done. 7 Anley Road ditto 2 (1) Order made. 21 days. (2) Withdrawn. Work done. 9 Ingersoll Road ditto 6 Withdrawn. Work done. 100 Rayleigh Road ditto 1 Order made. 21 days. 78 Rayleigh Road ditto 1 Withdrawn. Work done. 7 Letchford Gardens ditto 1 Order made. 14 days. £1 1s. 21 Summonses—continued. Situation of Premises Nature of Offence No. of Summonses Result of Proceedings 122 Uxbridge Road Failure to comply with Statutory Notice. 1 Withdrawn. Work done. £1 1s. costs. 109a Adelaide Road ditto 1 Withdrawn. Work done. £1 1s. costs. 15 Saunders Road ditto 2 (1) Order made. 14 days. (2) Penalty £1 17 North Pole Road ditto 1 Order made. 14 days. 1 Letchford Gardens ditto 1 Withdrawn. Work done. 116 King Street Removal of of- fensive matter during pro- hibited hours. 1 Fined £1. (E. Stannard, 2, Bedding Corner, Mitchara, Surrey). Goldhawk Road, corner Cathnor Rd. (G. Ritchie, 134, Merton Road, Wimbledon). ditto 1 Fined £1. 7 Letchford Gardens Failing to comply with Statutory Notice. 1 Withdrawn. Work done. 84 Ravleigh Road ditto 1 Withdrawn. Work done. 48 Stebbing Street ditto 1 Adjourned 14 days. 27 Worlidge Street ditto 2 Withdrawn. Work done. 24 Milson Road ditto 2 Withdrawn. Work done. 19 Alexandra Road ditto 1 Withdrawn. Work done. 73 Cobbold Road ditto 3 (1) Penalty 10s. 6d. (2) Order made. 14 days. Penalty £2. (3) Withdrawn. Work done. 207 Latimer Road ditto 1 Withdrawn. Work done. 123 King Street (A. Dangertield) Depositing for purpose of sale or of preparation for sale 2 shoulders of lamb—7 pieces of beef and 2 pieces of black pudding — 10 pieces of pork and 3 pieces of beef, being unfit for food of man. 3 (1) Fined £10. (2) Fined £10. (3) Fined £10. £21 costs. 123 King Street (A. Dangerfield) Unlawfully seling half a pigs' head, the same being unfit for food of man. 1 Adjourned—sine die. 1 Raynham Road Failing to comply with Statutory Notice. 1 Order made. 14 days. Penalty £2. 20 Melina Road ditto 1 Withdrawn. 17 North Pole Road ditto 1 Withdrawn. Work done 22 Factories and Workshops, etc.—During the year 82 notices were served in reference to insanitary conditions and defects found to exist during the inspection of the factories, workshops and workplaces in the Borough, and during the same period 50 notices were complied with. During the previous year there were 93 notices served and 96 complied with. The following is a list of the Factories and Workshops upon the Register: — Restaurants, Hotels, &c 155 Bakehouses (15 not in use as Bakeries) 63 Bootmakers 48 Motor and Cycle Makers 16 Dressmakers and Milliners. 97 Laundries 80 Outworkers 275 Letterpress Printers and Bookbinders 19 Electrical and Mechanical Engineers 23 Smiths, Wheelwrights and Coaclibuilders 28 Tailors 56 Builders, Carpenters and Joiners 38 Miscellaneous 418 Total 1,315 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. 1.—inspection of factories, workshops and workplaces. Premises Number of Inspections Writ ten Notices Prosecutions Factories (including Factory Laundries) 959 37 1 Workshops (including Workshop Laundries) 565 31 4 Workplaces (other than outworkers' premises included in Part 3 of this report) 587 14 4 Total 2,111 82 9 23 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars Number of Defects Number of Prosecutions Pound Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts— Want of Cleanliness 20 19 — — Want of Ventilation 6 6 — — Overcrowding 1 1 — — Want of Drainage of Floors 1 1 — — Other Nuisances 31 31 — — Sanitary Accommodation insufficient 17 17 — — unsuitable or defective 23 22 — — not separate for sexes 2 2 — — Offences under the Factory find Workshop Act Illegal occupation of underground bakehouse (S. 101) - - - - Other offences (excluding offences relating to out-work which are included in Part 3 of this report) 2 2 - - Total 103 101 — — 3.—HOME WORK. Nature of Work Outworkers' List, Section 107 Outwork in Unwholesome premises, Sec. 108 Outwork in Infected Premises Sees. 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 inspection of Lists Failing to send Lists Instances Notices served Prosecutions Instances Orders made (Sec. 110) Prosecutions (Sec. 109,110) Lists Outworkers Lists Outworkers Contrac- Workmen Contrac- Workmen 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Wearing apparel— (1) making, etc. 34 11 64 5 12 6 .. .. .. 3 3 .. .. .. .. (2) cleaning and washing .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Furniture and upholstery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. TOTALS 34 11 64 5 12 6 .. .. .. 3 3 .. .. .. •• 24 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year N umber Bakehouses 33 Dressmakers 87 Laundries 31 Others 289 Total number of workshops on Register 440 House to House.—As a result of the house to house visitation 1,013 inspections were made, 520 notices served, and 444 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. 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) 9 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but tot under the Factory and Workshop Act, 1901 (S.5) Notified by H.M. Inspector 8 Reports (of action taken) sent to H.M. Inspector 8 Other ... 1 Underground bakehouses (S.101)— Certificates granted during year .. - In use at the end of the year ... 33 25 During the year several 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 result have been obtained. Old buildings often provide ideal accommodation for rats; hollow partitions, space between floors and ceilings and under basement flooring being used for nesting. It is a difficult matter to rid such premises of rats. Generally speaking some improvement has been made, but it appears to me that no great advance will result until systematic attack is made upon the rodents in their chief breeding grounds, the sewers. Throughout the Borough, and I have no doubt throughout the whole of London, there exist old brick sewers swarming with rats, from which they emerge at night and enter dwellings and other premises. Smoke Abatement.—During the year observations were kept in reference to black smoke emitted from the various factories, laundries, bakehouses, &c., situate in and adjoining the Borough. Fourteen 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. Netting Hill & Kensington Electric Light Co., Wood Lane. Public Baths, Lime Grove. Central London Railway, Wood Lane. Glen Laundry, Landor Road. Carpet Beating Works, Glenthorne Road. Waring & Gillows, Cambridge Road. Post Office Savings Bank, Blythe Road. Kensington Palace Laundry, Springvale Terrace. Laundry rear of 123, Latimer Road. L.M.S. Railway Laundry, Scrubbs Lane. PREMISES AND OCCUPATIONS WHICH CAN BE CONTROLLED BY BYE-LAWS AND REGULATIONS. The following premises and occupations have been kept under constant inspection throughout the year, and action taken where found to be necessary:— Fried Fish Vendors. Milk Vendors. Ice Cream Vendors. Slaughterhouses. Full particulars and remarks regarding these premises are to be found in another part of the report. 26 Ice Cream Vendors.—The London County Council, after considering the views of the various Borough Councils on tne question of compulsory registration of ice cream vendors, decided that the powers already possessed by local sanitary authorities in London, were sufficient to protect the public from danger arising from the consumption of ice cream. I am 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. During the year an inspection was made of all the ice cream vendors in the Borough. The premises, in the majority of cases, were found to be satisfactory, but in some cases it was necessary for action to be taken regarding their condition. Many premises are not suitable for the handling of so easily contaminated a food as ice cream, and there is often a lack of personal cleanliness about the vendors. In a few cases the premises are used for making the cream only, it being sold from barrows in the street, but generally speaking it is sold at the premises at which it is made. The selling of this commodity from barrows is, in my opinion, very undesirable as the 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. 27 HOUSING. The housing conditions in Hammersmith are far from ideal, and although approximately 1,040 houses have been erected in the Borough since 1920, very little, if any, reduction in the overcrowded conditions has resulted. The cost of building these so-called working class dwellings has been so great that the economic rents charged are higher than the people for whom they were intended can afford to pay- Many of the tenants have sub-let part of the houses, and there is a danger that overcrowding may result, and the health of the inhabitants suffer as in other overcrowded parts of the Borough. It is impossible for the average man earning from 55s. to 70s. per week, to pay the rents demanded. In most cases there are 3 or 4 children, which adds to this difficulty. The London County Council declines to accept tenants when their financial position does not justify their being accepted as tenants of State assisted accommodation. I am continually receiving letters from inhabitants asking me to assist them to obtain houses. In all such cases inquiries are made and referred with observations to the London County Council or Borough Council. In my previous Report, I set out some of the cases which had been brought to my notice during 1924. Many more cases of equal urgency have been the subject of inspection and report. In three cases it has been necessary for Closing Orders to be made under the Housing Act, in respect to basement rooms being used for sleeping purposes. A further case of a man and wife with 7 children living in two basement rooms, and a further child expected, is one of the many. In several cases 4, 5 and even 6 persons are living in one room. The building of houses has been carried.on with such dilatoriness, that it has been impossible to deal even with the urgent cases. At the present moment there are 1,800 cases on the waiting list. There are many hundreds of families who now occupy the same accommodation as they did many years ago. It may 28 be that the accommodation was sufficient for their former needs and health, but families have increased, with the result that they are now overcrowded and are unable to obtain increased accommodation. Proper housing is the basis of good health, and it is therefore absolutely essential that the building of houses be expedited as much as possible, and that due regard be paid to the accommodation provided being within the reach of those people most in need of it. 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. Fifty Certificates were granted during the year under Section 48 (2) of the Public Health (London) Act. 1891, with regard to newly erected houses having a proper and sufficient water supply. Since the War, 1,438 houses have been erected in the Borough, by the London County Council, the Hammersmith Borough Council and by private enterprise, for which Certificates have been granted (details as under). Newly Erected Houses. Certificates granted with regard to water supply under Section 48 (Sub-sec. 2) of the Public Health (London) Act, 1891. Year. L.C.C. Estate. H.B.G. Estate. Private Houses. 1920 188 18 Nil 1921 169 166 Nil 1922 384 354 Nil 1923 Nil 5 22 1924 Nil 42 40 1925 Nil Nil 50 Totals 741 585 112 The premises have provided accommodation for approximately 7,190 persons, but despite this fact overcrowding is still in evidence. At the moment of writing I am informed that there are 1,800 applications for houses still to be dealt with. 29 As I have already said in previous reports, overcrowding is probably the greatest factor in the propagation of all infectious diseases. If the Housing conditions were ideal it is probable that all our infectious diseases would be very materially lessened and chronic infections such as Tuberculosis disappear. Better housing is the first step towards a healthier nation and a reduction of the expenditure of such vast sums of money in the prevention and treatment of disease. Statistics.—Year ended 31st December, 1925. 1.—General. (1) Estimated population 134,500 (2) General death-rate 11.9 (3) Death-rate from tuberculosis 0.9 (4) Infantile mortality 65 (5) Number of dwelling-houses of all classes mated) 18,613 (6) Number of working-class dwelling-houses (estimated) 12,000 (7) Number of new working-class houses erected 50 2.—Unfit Dwelling-houses. II.—Inspection. (1) Total number of dwelling-houses inspected for Housing defects (under Public Health or Housing Acts) 5,891 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910, or the Housing Consolidated Regulations, 1925 265 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 3,749 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 30 III.— Action under Statutory Powers. (.A) Proceedings under Section 3 of the Housing, Act, 1925— (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 (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 3,154 (2) Number of dwelling-houses in which defects remedied— (a) By owners 3,220 (b) By Local Authority in default of owners — (C) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925— (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 3 (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 1 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 5 INSPECTION AND SUPERVISION OF 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. 31 During the year 355 samples of milk were taken and submitted to the Public Analyst for analysis, the results of which are shown in a latter part of this report. No samples were examined for the presence of Tubercle Bacilli. This work is carried out by the County Council and their investigations show 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 not necessary to serve a notice requiring the suspension of the sale of milk under the Dairies, Cowsheds and Milkshops Order. In two cases where infectious diseases occurred at the houses of milk roundsmen, arrangements were made with the employers to suspend the roundsmen for a period of seven days. Milk (Special Designations) Order, 1923. The following is a list of the licences issued during the year under the Milk (Special Designations) Order, 1923:— Description. Number. (1) Producers' Licences to use the designation "Grade A " Nil (2) Dealers' Licences to use the designation "Certified" 11 (3) Dealers' Licences to use the designation " Grade A (Tuberculin Tested) "— (a) Bottling Establishments Nil (b) Shops 9 (4) Dealers' Licences to use the designation "Grade A"— (a) Bottling Establishments Nil (b) Shops 1 (5) Dealers' Licences to use the designation " Pasteurised"— (a) Pasteurising Establishments 1 (b) Shops 8 c 32 Milk and Dairies Consolidation Act, 1915. In July, 1925, the Minister of Health issued a circular drawing the attention of the Council to the Milk and Dairies (Consolidation) Act, 1915, which came into operation on the ist September, 1925. Section 21 (1) of the Act provided that it should come into operation on such date, not being later than the expiration of one year after the termination of the war, as the Local Government Board might by order appoint. Section 1 of the Milk and Dairies (Amendment) Act, 1922, enacted that the 1915 Act, notwithstanding anything contained therein, should not come into operation before the 1st September, 1925. Although it was the evident intention of the 1922 Act that the 1915 Act should come into operation on the date mentioned, the Minister is advised that it is not certain that this is effected automatically by the Act itself. He has therefore deemed it advisable, in order to remove any possible doubt, to make an Order formally appointing the 1st September, 1925, as the date of commencement of the Act. The 1915 Act repeals and re-enacts a number of provisions contained in the Contagious Diseases (Animals) Acts and the Sale of Food and Drugs Acts with regard to Milk and Dairies. It also reproduces a number of amendments and new provisions which were contained in the Milk and Dairies Act, 1914, the operation of which was deferred. Sections 1 and 2 of the 1915 Act include provisions for the making and enforcement of Milk and Dairies Orders, extending the list of purposes for which similar Orders could be made under the Contagious Diseases (Animals) Act, 1878. It is proposed as soon as possible to make an Order under the new powers, but in pursuance of the proviso to Section 21 (3), the Dairies, Cowsheds and Milk-shops Orders of 1885, 1886 and 1899, and the Regulations made by Local Authorities under Article 13 of the Order of 1885 will, until altered or revoked, continue in force as if made under the new Act. Sections 3, 4 and 5 and the First Schedule contain provisions similar in effect to those which are contained in a number of Local Acts for stopping the supply of milk which is likely to cause tuberculosis. In the Local Acts the power of stopping the supply is given to the Local Authority for the consuming area and the prohibition only applies to that area. Under the General Act the duty of enforcement is placed on the Council of the County or County Borough in which the cows are kept, and any Order made by them will prohibit the sale of the affected milk in any area. Section 4 requires the Medical Officer of Health of the County or County Borough to make the necessary investigations on receipt of a notice 33 from any other Medical Officer of Health. Section 21 (3) provides that as from the expiration of one year after the commencement of the Act the Local Act provisions shall be repealed. The Minister of Agriculture and Fisheries has made an Order (the Tuberculosis Order of 1925) providing for the slaughter of bovine animals affected with certain specified forms of tuberculosis and for the payment of compensation in respect of animals so slaughtered. The Order will come into operation on the same day as the Act and it will be the duty of the Local Authority, when in the exercise of their powers under the Act they discover the presence in a herd of an animal to which the Order applies, to cause it to be slaughtered in pursuance of the Order, or if they are not themselves the Authority for the purposes of the Diseases of Animals Acts, to report the matter to that Authority for the appropriate action. Further information as to the Tuberculosis Order is contained in the Circular Letter issued by the Ministry of Agriculture and Fisheries under the Reference No. T.A. 19848/C.L. Sections 6 and 7 re-enact provisions contained in the Sale of Food and Drugs Act, 1899. Section 8, in conjunction with Section 14, enlarges the power of the Officers of the Local Authority to take samples of milk, and such samples may under the Act be taken at any time before the milk is delivered to the consumer. Except by the direction of the Minister, samples may only be taken in the area for which the Officer acts, but an Authorised Officer of one Authority may by notice require the Medical Officer or other Authorised Officer of another Authority, being a Sale of Food and Drugs Acts Authority, to take samples of milk within the area of his Authority. Where such a notice is given, the Authority whose officer requires samples to be taken will be liable to defray the expenses incurred, and for the purposes of the Sale of Food and Drugs Acts the sample will be deemed to have been taken within the area of the officer giving the notice. Section 9 in conjunction with the Third Schedule amends the provisions of the Sale of Food and Drugs Acts with regard to the warranty defence. Where such a defence is pleaded by a purveyor of milk a sample from a corresponding milking must be taken in the course of transit or delivery to the purveyor, and if the owner of the cows so requests, a further sample must be taken at the dairy at which the cows are kept. The warranty defence will not be available where the sample in respect of which the proceedings are taken is a mixture of milk obtained from more than one seller or consignor. Power c 2 34 is also given to the Local Authority of the District in which the first sample was taken, instead of or in addition to taking proceedings against the purveyor, to take proceedings against the seller or consignor. Attention may also be drawn to the definition of the expression "dairy" in Section 19 (1) of the Act. It will be observed that the expression does not include a shop from which milk is not supplied otherwise than in the properly closed and unopened receptacles in which it was delivered to the shop. I append Section 8, Sub-sections 3, 4 and 5, together with Section 9 and the Third Schedule, which are of considerable importance. SECTION 8. (3 The medical officer of health or any other officer authorised for the purpose by a local authority within the area of which milk from any dairy situate outside that area is being sold or exposed or kept for sale, may by notice in writing require the medical officer of health or other authorised officer of any other local authority, being an authority for the purposes of the Sale of Food and Drugs Acts, 1875 to 1907, to take samples of the milk at that dairy or in the course of transit from that dairy to the area of the first-mentioned local authority. (4) Upon receipt of such notice it shall, subject to the provisions of Sub-section 1 of this section, be the duty of the medical officer of health or other authorised officer of the other authority as soon as practicable to take samples and to forward, for analysis or bacteriological examination, to the officer who gave the notice a part of any sample so taken, and in taking a sample the officer shall, if so required by the notice, comply with the provisions of the Sale of Food and Drugs Acts, 1875 to 1907, which relate to the division of samples into parts. The authority requiring the samples to be taken shall be liable to defray any reasonable expenses incurred, the amount whereof shall in default of agreement be settled by the Local Government Board. For the purpose of the Sale of Food and Drugs Acts, 1875 to 1907, the sample shall be deemed to have been taken within the area of the officer who gave the notice, and proceedings under those Acts may be taken either before a court having jurisdiction within the district for which that officer acts or before a court having jurisdiction in the place where the sample was actually taken. (5) In any proceedings under the Sale of Food and Drugs Acts, 1875 to 1907, or this Act, the production of a certificate of the officer who took the sample under this section that the provisions of this section, as to the manner in which samples are to be dealt with, were complied with shall be sufficient evidence of compliance, unless the defendant requires that officer to be called as a witness. SECTION 9. (1) The provisions of the Sale of Food and Drugs Acts, 1875 to 1907, in reference to the taking of samples of milk, and any proceedings in connexion therewith shall be amended in accordance with the provisions contained in the Third Schedule to this Act. (2) So much of any contract, made after the thirteenth day of August nineteen hundred and fourteen, whether made before or after the 35 passing of this Act, as requires a purveyor of milk on a sample of his milk being taken under the Sale of Food and Drugs Acts, 1875 to 1907, to send to the person from whom he procured the milk any part of such sample or to give such person notice that a sample has been so taken, shall be null and void. THIRD SCHEDULE. Amendment of Sale of Food and Drogs Acts. (1) Where, under the Sale of Food and Drugs Acts, 1875 to 1907, a sample of milk is procured from a purveyor of milk, he shall, on being required to do so by the person by whom or on whose behalf the sample was taken, state the name and address of the seller or consignor from whom he received the milk. 12) The local authority in whose district the sample was taken may take or cause to be taken one or more samples of milk in course of transit or delivery from such seller or consignor. Within sixty hours after the sample of milk was procured from the purveyor he may serve on the local authority a notice stating the name and address of the seller from whom he recevied the milk and the time and place of delivery to the purveyor by the seller or consignor of milk from a corresponding milking and requesting them to take immediate steps to procure, as soon as practicable, a sample of milk in the course of transit or delivery from the seller or consignor to the purveyor, unless a sample has been so taken since the sample was procured from the purveyor, or within twenty-four hours prior to the sample being procured from the purveyor, and where a purveyor has not served such notice as aforesaid, he shall not be entitled to plead a warranty as a defence in any such proceedings: Provided that the purveyor shall not have any such right to require that such a sample shall be taken in cases where the milk, from which the sample procured from the purveyor was taken, was a mixture of milk obtained by the purveyor from more than one seller or consignor. If a purveyor has served on the local authority such a notice as aforesaid, and the local authority have not procured a sample of milk from the sellor or consignor in accordance with the foregoing provisions, no proceedings under the Sale of Food and Drugs Acts, 1875 to 1907, shall be taken against the purveyor in respect of the sample of milk procured from him. (3) Any sample of milk so taken in the course of transit or delivery shall be submitted for analysis to the analyst to whom the sample procured from the purveyor is or was submitted. (4) If proceedings are taken against the purveyor of milk, a copy of the certificate of the result of the analysis of every sample so taken in the course of transit or delivery shall be furnished to the purveyor, and every such certificate shall, subject to the provisions of section twentyone of the Sale of Food and Drugs Act, 1875, be sufficient evidence of the facts stated therein, and shall be admissible as evidence on any question whether the milk sold by the purveyor was sold in the same state as he purchased it. (5) The local authority of the district in which the first-mentioned sample was taken may, instead of, or in addition to, taking proceedings against the purveyor of milk, take proceedings against the seller or consignor. (6) If a sample of milk of cows in any dairy is taken in course of transit or delivery from that dairy, the owner of the cows may, within sixty hours after the sample of milk was procured, serve on the local authority a notice requesting them to take immediate steps to procure 36 as soon as practicable a sample of milk from a corresponding milking of the cows, and the foregoing provisions shall apply accordingly : Provided that the person taking the sample shall be empowered to take any such steps at the dairy as may be necessary to satisfy him that the sample is a fair sample of the milk of the cows when properly and fully milked. Preservatives, &c., in Food. In August, 1925, the Minister of Health forwarded for the information of the Authority a copy of the Public Health (Preservatives, &c., in Food) Regulations, 1925, which were based on the recommendations of the Departmental Committee on the Use of Preservatives and Colouring Matters in Food. The Regulations provide for the prohibition of the impor tation and sale of articles of food to which preservatives and other specified substances have been added. The provisions as to importation contained in Part III of the Regulations will be enforced by the Officers of Customs and Excise and by the Port and other Sanitary Authorities responsible for the administration of the Public Health (Imported Food) Regulations, 1925. The Regulations in terms give co-ordinate jurisdiction to the Officers of Customs and Excise and to the Local Authorities and their officers, but it has been arranged with the Commissioners of Customs and Excise that so far as meat and fish and their products are concerned, the enforcement will normally be left to Local Authorities and their officers, and that the Officers of Customs and Excise will normally enforce the Regulations so far as they apply to other articles of food. Local Authorities are not precluded from taking action with regard to such other articles, but in order to avoid any duplication it is desirable that wherever they propose to take samples of any such article or to initiate proceedings in connection with its importation they should notify the local Officer of Customs and Excise. Under Article 9 (3) an officer of a Local Authority must in certain circumstances obtain the consent of the Officer of Customs and Excise before taking a sample. One of the recommendations of the Departmental Committee was, that any prohibitions or limitations imposed by Regulations should bind the Courts in proceedings taken under the Sale of Food and Drugs Acts. The Committee went on to say:— "If this were done, traders and the public generally would know what was permissible and what was not, and there would be no conflict of expert evidence on the question whether the amount of preservative or colouring matter was or was not injurious to health. The only point at issue would normally be whether the preservative or colouring matter found in the food, or the amount of it, was in contravention of the Regulations. A change in the law in this 37 direction would, we feel sure, be appreciated both by Local Authorities and by traders." The Minister is entirely in agreement with the view of the Committee, but it has not been practicable up to the present to introduce legislation to give effect to this recommendation. The Minister commends the matter, however, to the consideration of Local Authorities and suggests that proceedings should not be taken under the Sale of Food and Drugs Acts in respect of the addition of preservatives to food except where such addition would be contrary to the provisions of the Regulations. In this connection Local Authorities will no doubt have regard to the fact that in conformity with the recommendation of the Committee, the Regulations have been framed so as to allow time for the adjustment of methods and processes, and the clearance of existing stocks, before they come into operation. Representations have been made to the Minister that a Local Authority, before instituting proceedings under the Regulations, should give the person concerned an opportunity of furnishing an explanation. This suggestion has been made mainly on the ground that, especially during the early period of operation of the Regulations, difficulties may occur which would be satisfactorily cleared up by administrative action and would not justify the institution of legal proceedings. The Minister is in general agreement with the suggestion, but he thinks that the matter is one that can properly be left to the discretion of Local Authorities and he has, therefore, decided not to include in the Regulations any specific provision on this point. Representations have also been made that a retailer should be entitled, as in the case of the Sale of Food and Drugs Acts, to plead the defence of warranty. The Minister feels that the proposal is equitable in principle but he is advised that, in view of the statutory powers under which the Regulations are made, it is not possible to include a suitable provision to give effect to it in the Regulations. Attention may, however, be drawn to Article 7 which empowers a Local Authority instead of, or in addition to, taking proceedings against a retailer, to take proceedings against the manufacturer or wholesaler by whom the article was previously sold. It is suggested that this provision might be used with advantage in many cases where an article of food is sold in a sealed container bearing the name and address of the manufacturer or of the wholesale dealer responsible for its distribution. In connection with this matter reference may be made to the terms of Article 14 which enables the officers of the Local Authority to make any necessary enquiries as to the origin of an article to which the Regulations apply. 38 I append the Regulations as made by the Minister of Health:— Public Health, England. The Public Health (Preservatives, etc., in Food) Regulations, 1925, dated August 4, 1925, made by the Minister of Health. The Minister of Health, in the exercise of the powers confererd upon him by the Public Health Act, 1875, the Public Health (London) Act, 1891, the Public Health Act, 1896, the Public Health (Regulations as to Food) Act, 1907, and the Butter and Margarine Act, 1907, and of every other power enabling him in that behalf, hereby makes the following Regulations, with the consent of the Commissioners of Customs and Excise, so far as they apply to the Officers of Customs and Excise, that is to say:— PART I. General. 1. These Regulations may be cited as the Public Health (Preservatives, &c., in Food) Regulations, 1925, and shall come into operation on the 1st day of January, 1927: Provided that— (i) the Regulations shall come into operation on the 1st day of January, 1928, so far as they relate to butter and cream and to the revocation of such of the provisions of the Public Health (Milk and Cream) Regulations, 1912, and the Public Health (Milk and Cream) Regulations, 1912, Amendment Order, 1917, as relate to cream; and (ii) so far as the Regulations prohibit the sale of an article of food containing any preservative which is necessarily introduced by the use in its preparation of preserved bacon, ham, margarine or butter, they shall come into operation on the 1st day of July, 1927, in the case of bacon, ham and margarine, and the 1st day of July, 1928, in the case of butter. 2.— (1) In these Regulations unless the context otherwise requires— "The Minister " means the Minister of Health; "Local Authority" means any local authority authorised to appoint an analyst for the purposes of the Sale of Food and Drugs Acts, 1875 to 1907, and "public analyst" means an analyst so appointed; "Officer of Customs and Excise" includes any person acting under the authority of the Commissioners of His Majesty's Customs and Excise; " Food " means food or drink intended for human consumption; "Cream" means that portion of milk rich in milk-fat which has been separated by skimming or otherwise and is intended for human consumption; "Preservative" means any substance which is capable of inhibiting, retarding or arresting the process of fermentation, acidification, or other decomposition of food or of masking any of the evidences of putrefaction: but does not include common salt (sodium chloride), saltpetre (sodium or potassium nitrate), sugars acetic acid or vinegar, alcohol or potable spirits, herbs, hop extract, spices and essential oils used for flavouring purposes, or any Bubstance added to food by the process of curing known as smoking; 39 "Thickening substance" means sucrate of lime, gelatine, starch paste or any other substance, which when added to cream is capable of increasing its viscosity but does not include cane or beet sugar; " Spulphur dioxide " includes sulphites, and " benzoic acid includes benzoates; "Sell" includes expose or offer for sale or deposit in any place for purposes of sale, and "sale" shall be construed accordingly; "Importer" includes any person who, whether as owner, consignor or consignee, agent or broker, is in possession of or in anywise entitled to the custody or control of any article of food brought from a place situate outside Great Britain, Ireland, the Channel Islands and the Isle of Man; and " import " shall be construed accordingly; (2) Percentages shall be calculated by weight. (3) Sulphites shall be calculated as sulphur dioxide (SO2) and benzoates as benzole acid (C6H5C00H). (4) The Interpretation Act, 1889, applies to the interpretation of these Regulations as it applies to the interpretation of an Act of Parliament. PART II. Sale of Artici.es of Food and Preservatives. 3. The Local Authority and every officer of a Local Authority authorised in writing by the Authority shall enforce and execute this Part of these Regulations, and for this purpose shall make such enquiries and take such other steps as may seem to them or him to be necessary for securing the due observance of this Part of the Regulations in the district of the local authority. 4.—(1) No person shall manufacture for sale or sell any article of food which contains any added preservative or any of the colouring matters specified in Part II of the First Schedule to these Regulations : Provided that— (i) any article of food specified in Part I of the said Schedule may contain preservative of the nature and in the proportion therein specified; (ii) where an article of food specified in Part I of the said Schedule is used in the preparation of any other article of food, the latter article may contain any preservative necessarily introduced by the use of the former article, but the total proportion of any one preservative contained in any article of food specified in that Part of the Schedule shall not exceed the proportion therein specified. (2) A person who sells any of the articles of food specified in paragraph 1 of the Second Schedule to these Regulations which contains any preservative shall cause such article at the time when it is exposed or offered for sale by retail or delivered to any purchaser, broker or agent to be labelled in accordance with the Rules set out in that Schedule: Provided that— (i) this provision shall not apply where the article of food is exposed or offered for sale by retail or delivered to a customer in a hotel, restaurant or other such place for consumption on the premises; and (ii) when the article is exposed or offered for sale by retail it shall be a sufficient compliance with this requirement if a notice to the effect that the article contains preservative is exhibited 40 in a conspicuous position so as to be easily readable by a purchaser. (3) No person shall sell cream which contains any thickening sub. stance. 5. — (1) No person shall sell any article which is recommended in any mark or label placed thereon or on its receptacle or container for use as a preservative of, or colouring matter for, any article of food or is described or referred to in any such mark or label in terms likely to lead to its being so used,— (i) if such use would be contrary to these Regulations; or (ii) if in the case of a preservative, it is not labelled in accordance with the Rules set out in the Second Schedule to these Regulations. (2) No person shall on or in connection with the sale of any article or in any advertisement, circular or notice relating thereto recommend it for use as a preservative of, or colouring matter for, any article of food, or describe or refer to it in terms likely to lead to its being so used, if such use would be contrary to these Regulations. (3) No person shall sell any article which is recommended in any such mark or label as aforesaid for use as a thickening substance for cream or is described or referred to in any such mark or label in terms likely to lead to its being so used, and no person shall on or in connection with the sale of any article or in any advertisement circular or notice relating thereto recommend it for use as a thickening substance for cream or describe or refer to it in terms likely to lead to its being so used 6.—(1) Any officer authorised by the Minister and any officer of the Local Authority acting in the execution of these Regulations shall have power to enter at all reasonable times any premises where articles to which these Regulations apply are prepared, packed, labelled or stored. (2) The officer may take samples of any such article or of any substance used or capable of being used in the preparation of any such article and of any labels designed to be affixed to any such article or to any package or other receptacle containing such article, but shall if so required make reasonable payment for any samples so taken. (3) Where a sample is taken of an article to which these Regulations apply, the Sale of Food and Drugs Act, 1875 to 1907, shall apply as if the officer were an officer authorised to procure samples thereunder; and where an analysis is required for the purposes of these Regulations, 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, shall apply. 7. Where it appears to any authority or officer whose duty it is to enforce these Regulations that an article has been sold within the district of the authority contrary to the provisions of Article 4 or 5 of these Regulations, the authority or officer may, instead of or in addition to taking proceedings against the seller, take proceedings against any previous seller of the article notwithstanding that the sale by such previous seller took place outside the district of the authority, and for the purpose of any such proceedings the sale by the previous seller shall be deemed to have taken place within the district of the authority and the proceedings may be taken either before a Court having jurisdiction within that district or before a Court having jurisdiction in the place where the sale actually took place. 41 PART III. Importation of Articles of Food. 8.—(1) Subject to any directions given by the Commissioners of Customs and Excise after consultation with the Minister, the Officers of Customs and Excise shall have power to enforce and execute this Part of these Regulations and may take such samples as may be necessary of consignments of imported articles to which these Regulations apply. (2) Where an Officer of Customs and Excise takes a sample for the purpose of analysis he shall send the sample or a portion thereof to the Government Chemist, and either the officer or the Government Chemist shall send a portion of the sample to the importer. 9.—(1) The following authorities and any officers authorised by them in writing shall also have power to enforce and execute this Part of these Regulations, namely :— (a) Where the article of food is landed from a ship or aircraft in a place which is not within the jurisdiction of a Port Sanitary Authority, or where the article is imported in a vehicle and the Customs examination of that vehicle is deferred with the consent of the Commissioners of Customs and Excise until the vehicle reaches a place outside such jurisdiction, the Council of the Borough (including the City of London and a Metropolitan Borough) or Urban or Rural District in which such place is situated. (b) In every other case, the Port Sanitary Authority. (2) Every officer authorised as aforesaid may take such samples as may be necessary of consignments of imported articles to which these Regulations apply, and where he takes a sample for the purpose of analysis he shall send the sample or a portion thereof to a public analyst and either the officer or the analyst shall send a portion of the sample to the importer. (3) Where the duties of an Officer of Customs and Excise with regard to the examination of a cargo or consignment comprising an article of food have not been wholly discharged, a sample of that article shall not be taken without his consent, but every officer of Customs and Excise shall afford such facilities as the circumstances require for the taking of samples in pursuance of this Article. 10. If in any case the Commissioners of Customs and Excise or a Port Sanitary Authority or other authority executing this Part of these Regulations 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. 11.—(1) No person shall import into England or Wales any article of food intended for sale which contains any added preservative or any of the colouring matters specified in Part II of the First Schedule to these Regulations : Provided that— (i) any article of food specified in Part I of the said Schedule may contain preservative of the nature and in the proportion therein specified; (ii) where an article of food specified in Part I of the said Schedule is used in the preparation of any other article of food, the latter article may contain any preservative necessarily introduced by the use of the former article, but the total proportion of any one preservative contained in any article of food 42 specified in that Part of the Schedule shall not exceed the proportion therein specified. (2) No person shall import into England or Wales any cream intended for sale which contains any thickening substance. PAET IV. Miscellaneous. 12. The provisions of these Regulations with respect to prohibiting any preservative or colouring matter or thickening substance in articles of food and requiring the labelling of certain articles of food and of articles sold as preservatives shall not apply in the case of any article which is intended to be exported or re-exported or in the case of butter intended for use as ships' stores. 13.—(1) 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. (2) In any proceedings under these Regulations, where the fact that any article has been dealt with contrary to these Regulations has been proved, if the respondent desires to rely upon the exceptions or provisions contained in these Regulations with reference to such article being sold for consumption on the premises or being intended for export or re-export or for use as ships' stores it shall be incumbent upon him to prove that the article was so sold or was intended for export or re-export or for use as ships' stores. 14. A person shall, if so required, give to any officer of Customs and Excise or of any local authority who is acting in the execution of these Regulations all reasonable assistance in his power, and shall, in relation to anything within his knowledge, furnish any such officer with all information which he may reasonably require for the purposes of these Regulations including information as to the persons from whom or places from which any article to which these Regulations apply has been obtained and to whom and to which it has been consigned or otherwise disposed of. 15. The Public Health (Milk and Cream) Regulations, 1912, the Public Health (Milk and Cream) Regulations, 1912. Amendment Order, 1917, and so much of the Public Health (Imported Food) Regulations, 1925, as relates to paragraph (f) of the First Schedule thereto are hereby revoked, but without prejudice to any proceedings begun or other action taken in pursuance of any of those Regulations. THE FIRST SCHEDULE. Part I.—Articles of Food which may contain Preservative and Nature and Proportion of Preservative in each case :— The articles of food specified in the first column of the following table may contain the preservative specified in the second column in proportions not exceeding the number of parts (estimated by weight) per million specified in the third column :— 43 Food. Preservative. Parts per Million. 1. Sausages and sausage meat containing raw meat, cereals and condiments Sulphur dioxide 450 2. Fruit and fruit pulp, not dried: (a) Strawberries and raspberries Do. 2,000 (b) Other fruit Do. 1,500 3. Dried Fruit: (a) Apricots, peaches, nectarines, apples and pears Do. 2,000 (b) Raisins and sultanas Do. 750 4. Unfermented grape juice and nonalcoholic wine made from such grape juice if labelled in accordance with the rules contained in the Second Schedule to these Regulations. Benzoic acid 2,000 5. Other non-alcoholic wines, cordials and fruit juices, sweetened or unsweetened. Either Sulphur dioxide 360 or Benzoic acid 600 6. Jam (including fruit jelly prepared in the way in which jam is prepared, but not including marmalade made from citrous fruits). Sulphur dioxide 40 7. Candied peel Do. 100 8. Sugar (including solid glucose) Do. 70 9. Corn syrup (liquid glucose) Do. 450 10. Gelatine Do. 1,000 11. Beer Do. 70 12. Cider Do. 200 13. Alcoholic wines Do. 450 Either Sulphur 70 14. Sweetened mineral waters dioxide or Benzoic acid 120 15. Brewed ginger beer Benzoic acid 120 16. Coffee extract Do. 450 17. Pickles and sauces made from fruit or vegetables. Do. 250 I'art II.—Colouring Matters which may not be added to Articles of Food. 1. Metallic Colouring Matters. Compounds of any of the following metals:— Cadmium, Copper, Arsenic, Mercury, Antimony, Lead, Chromium, Zinc. 2. Vegetable Colouring Matter. Gamboge. u 3. Coal Tar Colours. Number in Colour Index of Society of Dyers and Colourists, 1924. Name. Synonyms. 7 Picric Acid Carbazotic Acid Saffron Substitute ; Dinitrocresol. 8 Victoria Yellow 9 Manchester Yellow Naphthol Yellow; Martius Yellow. 12 Aurantia Imperial Yellow. 724 Aurine Rosolic Acid; Yellow Coralline. THE SECOND SCHEDULE. Labelling of Articles of Food containing Preservative and of Preservatives. 1. The articles of food containing preservatives to which the Rules as to labelling set out in this Schedule apply are sausages, sausage-meat, coffee extract, pickles and sauces, and (where the proportion of benzoic acid exceeds 600 parts per milliom) grape juice and wine. 2.— (1) Where any of the said articles of food contains preservative it shall bear a label on which is printed the following declaration or such other declaration substantially to the like effect as may be allowed by the Ministe:— (a) CONTAIN(S) PRESERVATIVE. (2) The declaration shall be completed by inserting at (a) the word "This" or "These," followed by the name of the food as used in paragraph 1 of this Schedule. (3) In the case of grape juice or wine to which these Rules apply there shall be added to the declaration the words "and is not intended for use as a beverage." 3.—(1) An article sold as a preservative shall bear a label on which is printed the following declaration or such other declaration substantially to the like effect as may be allowed by the Minister:— THIS PRESERVATIVE CONTAINS (a) PER CENT. OF SULPHUR DIOXIDE. (2) Where the article contains benzoic acid the words "Benzoic Acid '' shall be substituted for the words " Sulphur Dioxide." (3) The declaration shall be completed by inserting at (a) in words and figures, excluding fractions (e.g. "seventy (70)") the true percentage of the sulphur dioxide or benzoic acid present in the article. 4. The prescribed declaration shall in each case be printed in dark block type upon a light coloured ground within a surrounding line and 45 no other matter shall be printed within such surrounding line. The type used shall be not less than one-eighth of an inch in height, or, in the case of grape juice or wine to which these Eules apply, one-sixteenth of an inch in height. 5. The label shall be securely affixed to the article or be part of or securely affixed to the wrapper or container, and in any case shall be so placed as to be clearly visible. If the article bears a label containing the name, trade mark, or design representing the brand of the article or the name and address of the manufacturer or dealer the prescribed declaration shall be printed as part of such label. 6. No comment on or explanation of the prescribed declaration (other than any direction as to use in the case of a preservative) shall be placed on the label or on the wrapper or container. Given under the Official Seal of the Minister of Health this Fourth day of August in the year One thousand nine hundred and twenty-five. Note.—The Public Health Act, 1896, provides by Sub-section (3) of Section 1 that if any person wilfully neglects or refuses to obey or carry out, or obstructs the execution of any regulations made under any of the enactments mentioned in that Act, he shall be liable to a penalty not exceeding £100, and, in the case of a continuing offence, to a further penalty not exceeding £50 for every day during which the offence continues. The power of making regulations under the Public Health Act, 1896, and the enactments mentioned in that Act, is enlarged by the Public Health (Regulations as to Food) Act, 1907. The Butter and Margarine Act, 1907, provides by Sub-section (3) of Section 7 that any person who manufactures, sells, or exposes or offers for sale or has in his possession for the purpose of sale, any butter, margarine or milk-blended butter which contains a preservative prohibited by a Regulation under the Section or an amount of a preservative in excess of the limit allowed by any such Regulation shall be guilty of an offence under the Act. Under Section 11 of the Act any person guilty of an offence under the Act is liable for a first offence to a fine not exceeding £20 and for a second offence to a fine not exceeding £50, and for a third or any subsequent offence to a fine not exceeding £100, and in cases where imprisonment can be inflicted under Section 17 of the Sale of Food and Drugs Act, 1899, to such imprisonment as is authorised by that Section. By Section 5 of the Butter and Margarine Act, 1907, the importation of butter, margarine, or milk-blended butter which contains a preservative prohibited by any Regulation made under the Act, or an amount of a preservative in excess of the limit allowed by any such Regulation, is made an offence under Section 1 of the Sale of Food and Drugs Act, 1899. Certification of Certain Food Products for Export to the Dominions. In view of the requirements of the Food Laws in operation in the Dominions, the 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 continued. 46 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 post-mortem 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 ante- mortem and post-mortem by an Officer of the Local Authority for which he himself acts; or (b) That the animals were slaughtered in a public abattoir under official veterinary inspection; or he must be furnished by the applicant with a declaration signed by a qualified veterinary surgeon, appointed by the firm with the approval of the Certifying Officer, to the effect that an ante-mortem and postmortem 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 acountry 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 and Cream) Regulations, 1912 and 1917. The following statement shows the action taken under the Public Health (Milk and Cream) Regulations, 1912 and 1917:- 1. Milk and Cream not Sold as Preserved Cream. a. Number of samples examined for the presence of a preservative. b. Number in which a preservative was reported to be present. Milk 0 0 Cream 3 0 Nature of preservative in the case of Column (6), and action taken under the Regulations in regard to it Nil. 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 9 (2) Statements incorrect 0 (3) Percentage of preservative found in each sample:— Percentage Sample No. stated on Statutory label. 1622 0.29 per cent. or 20.3 grains of Boric Acid per pound 0.4 1623 0.28 per cent. or 19.6 grains of Boric Acid per pound 0.4 1624 0.28 per cent. or 19.6 grains of Boric Acid per pound 0.4 1626 0.28 per cent. or 19.6 grains of Boric Acid per pound 0.4 1650 0.22 per cent. or 15.4 grains of Boric Acid per pound 0.5 1661 0.22 per cent. or 15.4 grains of Boric Acid per pound 0.4 1777 0.23 per cent. or 16.1 grains of Boric Acid per pound 0.4 1780 0.30 per cent. or 21.0 grains of Boric Acid per pound 0.4 1778 Contained no preservative 0.4 (b) Determination made of milk fat in cream sold as preserved cream:— (1) Above 35 per cent 9 (2) Below 35 per cent 0 Total 9 (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 not been observed Two. (d) Particulars of each case in which the Regulations have not been complied with and action taken:— (1) Sample 1622.—Words " Not suitable for infants and invalids " omitted from label. Letter of warning. (2) Sample 1659.—Label stated " preserved cream containing Boric Acid not exceeding 0.5 per cent." Words "Not suitable for infants and invalids" omitted from label. Letter of warning. 48 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. 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 SALE OF FOOD AND DRUGS ACTS. Year ended 31st December, 1925. During the twelve months 615 samples were submitted for examination. Of these, 600 were purchased by Inspector Pottier under the provisions of the Sale of Food and Drugs Acts, and 12 under the Public Health (Milk and Cream) Regulations; and in addition 3 samples of water were submitted by the Borough Engineer. 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 550 were reported as genuine, 16 as adulterated, whilst 34 were of inferior quality. TABLE I. Samples received. Genuine. Inferior. Adulterated. Total. Quarter ending March 31st 128 16 6 150 „ ,, June 30th 137 11 2 150 „ „ Sept. 30th 142 4 4 150 „ „ Dec. 31st 143 3 4 150 Totals 550 34 16 600 The percentage of adulteration was 2.7 as compared with 5.7 last year. The percentage of articles of inferior quality where actual adulteration could not be certified was 5.7 this year and 9.7 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. 49 TABLE II. Article. No. of Samples examined. Result of Examination. Summonses Issued. Penalties Imposed. Genuine. Inferior Adulterated. Ammoniated tincture of Quinine 2 2 — — — — Baking Powder 4 4 — — — — Boric Ointment 6 4 - 2* — — Butter 74 72 1 1† — — Camphorated Oil 6 5 — 1* — — Castor Oil 4 4 — — — — Citric Acid 3 3 — — - — Cocoa 19 19 — — — — Coconut, desiccated 3 3 — — — — Coffee 9 9 — — — — Compound Liquorice Powder 2 2 — — — — Cornflour ... 1 1 - - — — Cream of Tartar 6 6 — - — — Epsom Salt 2 2 — - — — Ginger, ground 4 4 — — - — Glauber's Salt 3 3 — — — — Gregory's Powder 4 3 — 1* — — Herrings in Tomato Sauce 1 1 - - — — Jam 4 4 — — — — Lard 8 8 — — - — Lemonade Powder 4 4 — — - — Lemon Cheese 1 1 — — — — Lemon Squash, crystallised 1 1 - — — - Lime Juice 3 - - 3* - - Margarine 5 5 — — — — Marmalade 2 2 — — — — Meat and Fish Paste??? 2 2 — — — — Mercury Nitrate Ointment 1 1 — - — — Mercury Oxide Ointment 1 1 - — - — Milk 355 316 33 6 4 £1 1s. 0d. „ Condensed 16 16 — — -— — Mustard 3 3 — — — — Olive Oil 7 7 — — — — Pepper 6 6 — — — — Prawns 1 1 — — — — Rice 4 4 — — — — Sugar, Demerara 2 2 — — — — Sulphur, Milk of 5 5 — — - — Tomatoes, canned 2 2 — -— — — Tomato Sauce 1 1 — — — — Vinegar 5 5 — — — — White Precipitate Ointment 2 2 — — - - Zinc Ointment 6 4 -— 2* — — Totals 600 550 34 16 4 £1 1s. 0d. * Informal samples. † No prosecution, but cautionary letter sent to vendor. 50 Milk.—During the year 355 samples of milk were examined, and of these, 316 were reported as genuine, 33 as inferior, and 6 as adulterated. The following Table shows the nature and extent of the adulteration:— TABLE III. No. Adulteration Certified. Penalties Imposed. 1 Fat abstracted 27 per cent. Summons dismissed—warranty proved. 2 „ „14 „ „ „ „ „ „ 3 „ „9 „ „ „ „ „ „ 4 „ „6 „ „ £1 1s. 0d. costs. 5 Added Water 2 „ „ No prosecution—adulteration too small. 6 2 „ „ „ „ The percentage of adulteration in the case of milk is 1.7 as compared with 5.0 last year. The following Table gives the average composition of the milk calculated on the total number of samples taken in the Borough during the four quarters of the year:— TABLE IV. Fat. Non-fatty Solids. Water. Per cent. Per cent. Per cent. Quarter ending March 31st 3.60 8.84 87.56 „ „ June 30th 3.54 8.88 87.58 „ „ Sept. 30th 3.65 8.90 87.45 „ ,, Dec. 31st 3.86 9.15 86.99 Average for the year 3.66 8.94 87.40 Condensed Milk.—Sixteen condensed milks were specially examined with a view to ascertaining whether or no they complied with the requirements of the new Regulations. They were all found to fulfill these requirements, both in respect of the amount of fat and non-fatty solids present and in regard to the composition of the milk yielded on dilution to the extent indicated on the labels of the tins. Butter and Margarine.—Seventy-four samples of butter were analysed, and of these, 1 was inferior and 1 adulterated. The inferior butter contained the maximum allowance of water—16 per cent.—whilst the adulterated sample contained 0.4 per cent. in excess of this limit. In no case was the limit for boron preservative exceeded. 51 Five margarines were also examined and were reported genuine. Cocoa and Coffee.—Nineteen specimens of cocoa and 9 of coffee were all passed as genuine. Arsenic was specially tested for in the cocoas, but with negative results. Meat and Fish Preparations.-Two samples of meat and fish pastes, 1 of prawns, and 1 of herrings in tomato sauce were examined during the year and in no case could preservatives be found. The specimen of herrings in tomato sauce was commendably free from traces of tin. Jam and Marmalade.—Four jams and 2 marmalades were returned as genuine. Tests for metallic contamination and for traces of arsenic gave negative results. Lemon Cheese.—The single specimen of this article analysed was found to be genuine. During the last few years there has been a large increase in the consumption of lemon cheese by the public. Originally it consisted of lemon, eggs, butter and sugar, whilst nowadays it is frequently prepared from oil of lemon, margarine substituted for butter, glucose in the place of sugar, with eggs practically absent. Preservatives, which are certainly undesirable, are also frequently present. Although there is no legal standard for this article of food, the matter is under discussion at the present time. Desiccated Coconut.—Three samples were submitted for examination and were found to be of genuine quality, none of them containing added sugar, which had been found us an adulterant on a previous occasion. Rice.—Four samples of rice were examined with a view to ascertaining whether or no they had been " polished " by talc, and, if so, whether the amount retained by the grains was an excessive amount. Two samples were found to be unpolished, whilst the remaining 2 showed a small amount of added siliceous matter, not exceeding the limit of 0.5 per cent. Lime Juice Cordial, etc.—All the three samples of this article were found to contain preservative and were therefore 52 reported as adulterated. In one case a quarter of a grain of sulphur dioxide together with two grains of salicylic acid per pint were found, and in the other two cases salicylic acid to the extent of 6.5 grains and 3.9 grains per pint respectively. In addition to these, four lemonade powders and one "crystallised" lemon squash were examined and were returned as genuine. Drugs.—The total number of drugs analysed during the year was fifty-three, and of these six were found not to comply with the requirements of the British Pharmacopoeia. Two boric ointments were deficient in boric acid to the extent of 12 per cent. and 9.5 per cent. respectively; two zinc ointments were deficient in zinc oxide to the extent of 6.5 per cent. and 4.0 per cent. respectively; one Gregory's powder was 9.0 per cent. deficient in magnesium oxide, and one camphorated oil was found to contain 14.3 per cent. of water and 0.02 per cent. of lime. The adulteration in the last case was traced to the sample having been supplied in a bottle that had previously contained lime-water. The following samples were also analysed and were found to be genuine:— Baking Powder 4 samples. Cornflour 1 sample. Ground Ginger 4 samples. Lard 8 ,, Mustard 3 „ Olive Oil 7 ,, Pepper 6 ,, Sugar, Demerara2 „ Tomatoes, Canned2 ,, Tomato Sauce 1 sample. Vinegar 5 samples. The following table shows the action taken on adulterated samples (other than milk and cream), and other infringements of the Sale of Food and Drugs Acts:— 53 TABLE V. Sample No. Article. Offence. Where heard and date. Result. 1179 Milk 9% fat abstracted W. L. Police Court 27/2/25 Summons dismissed. Warranty defence upheld. 1180 Milk 14 %fat abstracted W. L. Police Court 27/2/25 Summons dismissed. Warranty defence upheld. 1197 Milk 2% added water No action Adulteration insufficient. 1281 Boracic Ointment 5% deficient in Boric Acid Informal sample Letter of warning. 1292 Milk 6% fat abstracted K.P.S. 24/4/25 £1 1s. costs. 1304 Butter 0'4% excess of water - Letter of warning. 1388 Milk 27% fat abstracted K.P.S. 7/7/25 Summons dismissed. Warranty defence. 1446 Lime Juice ¼gr. Sulphur Dioxide and 2grs. Salicylic Acid per pint Informal sample No action. 1478 Gregory's Powder Deficient in Magnesium Oxide to extent of 9% Informal sample No action. 1592 Camphorated Oil Contained foreign ingredients, water 14.3% Calcium Hydrate 0.02% No action - 1616 Lime Juice 6.5grs. Salicylic Acid per pint No action Adulteration insufficient. 1618 Lime Juice 3.9grs. Salicylic Acid per pint No action Adulteration insufficient. 1671 Milk 2% added water No action Adulteration insufficient. 1756 Zinc Ointment 6.5% deficient in Zinc Oxide Informal sample — 1758 Zinc Ointment 4% deficient in Zinc Oxide Informal sample — 1762 Boracic Ointment 12% deficient in Boric Acid Informal sample - 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. Public Health (Meat) Regulations, 1924. The Public Health (Meat) Regulations, 1924, came into operation on the 1st day of April, 1925. 54 They provided for the giving of notice to the Local Authority by Licensees of slaughterhouses of their intention to slaughter an animal at least three hours before the time of slaughtering. This is an important section and enables arrangements to be made for the inspection of all carcases of animals slaughtered in the local slaughterhouses. Meat Marking.—Provision is made in the Regulations for the stamping of all carcases so examined on payment of a fee, but up to the present, no request has been received for this to be done. Stalls.—It is provided that a person selling meat or exposing or offering meat for sale from any stall shall— (a) shall keep his name and address legibly painted or inscribed on such stall in some conspicuous position; (b) shall cause such stall (if not placed in an enclosed and covered market place) to be suitably covered over and to be screened at the sides and back thereof in such a manner as to prevent mud, filth or other contaminating substance being splashed or blown from the ground upon any meat on the stall; (c) shall cause every counter, slab, vessel or other article on or in which meat is placed for sale and all knives and other implements used in connection with the meat to be thoroughly cleansed after use and to be kept at all times in a cleanly condition; (d) shall take all such steps as may be reasonably necessary to guard against the contamination of the meat by flies; (e) shall not place or cause to be placed any meat on, or within eighteen inches of the ground or floor, unless the meat is placed in a closed cupboard or other adequately protected space not less than nine inches from the ground or floor; (/) shall cause all trimmings, refuse and rubbish to be placed in properly covered receptacles kept for the purpose apart from any meat intended for sale. Shops, Stores, etc.—It is further provided that— (1) The occupier of any room in which any meat is sold or exposed for sale or deposited for the purpose of sale or of preparation for sale or with a view to future sale, and any person who knowingly lets any room or suffers any room 55 to be occupied for such purpose shall cause the following provisions to be complied with:— (a) No urinal, water-closet, earth-closet, privy, ashpit or other like sanitary convenience shall be within such room or shall communicate directly therewith, or shall be otherwise so placed that offensive odours therefrom can penetrate to such room; (b) No cistern for supply water to such room shall be in direct communication with or directly discharge into such sanitary convenience; (c) No drain or pipe for carrying off faecal or sewage matter shall have any inlet or opening within such room unless it is efficiently trapped; (d) No such room shall be used as a sleeping place, and, so far as may be reasonably necessary to prevent risk of the infection or contamination of any such meat as aforesaid, no sleeping place shall communicate directly with such room; (e) Except in the case of a room used as a cold store, adequate means of ventilation shall be provided. (2) The occupier of any such room shall not cause or suffer any refuse or filth whether solid or liquid to be deposited or to accumulate therein except so far as may be reasonably necessary for the proper carrying on of the trade or business. (3) Such occupier shall cause the walls and ceiling of such room to be whitewashed, cleansed or purified as often as may be necessary to keep them in a proper state. (4) Such occupier and every other person engaged in such room shall observe due cleanliness in regard to such room and all articles, apparatus and utensils therein. (5) The occupier of any such room— (a) shall take all such steps as may be reasonably necessary to guard against the contamination of the meat therein by flies and shall cause the meat to be so placed as to prevent mud, filth or other contaminating substance being splashed or blown thereon; (5) shall not permit any gut-scraping, tripe-cleaning or household washing to be carried on therein; (c) shall cause every counter, slab, vessel or other article on or in which meat is placed for sale and all knives and other implements used in connection with the meat to be thoroughly cleansed after use and to be kept at all times in a cleanly condition; (d) shall cause all trimmings, refuse and rubbish to be placed in properly covered receptacles kept for the purpose apart from any meat intended for sale. 56 By the passing of these Regulations, it was anticipated that it would be possible to cause retailers of meat to protect it from contamination by means of the provision of glass windows. For this purpose, I arranged a meeting with the representatives of the Meat Retailers' Association. It was felt that, apart from the cost, the protection of the meat in shops by means of the provision of windows, was one of the first steps to be taken under the Regulations. At the same time it was realised that difficulties would be met with in the case of the stalls in the Borough, and one felt that nothing should be done which would be likely to cause an increase in the price of meat sold at these establishments or to place restrictions upon the stallholders which might be the means of their being unable to carry on their business. However, the Minister of Health issued Circular No. 604 in June, following the receipt of a large number of communications both from local authorities and others, as to the proper interpretation of the statutory provisions of the Public Health (Meat) Regulations. The Minister pointed out that the legal interpretation of the Regulations could only be decided by the Courts, but he thought that it might be useful to set out for the information of local authorities, the intention of the Ministry and the construction, which, as he was advised, could properly be given to the provisions in question. Article 2 (1) (Definition of Meat).—The Minister's intention in making the Regulations was that, apart from the special case of bacon and ham, they should apply to what is ordinarily known as butcher's meat, that is to say the raw and untreated edible parts of the carcases of slaughtered cattle, swine, sheep and goats. Questions have been raised whether the Regulations apply to rabbits, poultry, fish, butter, margarine and cheese. It is clear that the definition of meat would not include these articles, and the Minister thinks that local authorities might also properly treat cooked meat, lard, sausages and other preparations of or containing meat as outside the scope of the Regulations. Article 20 (5) (a).—It was not contemplated that this provision should be construed as requiring all butchers' shops to be provided with glass fronts, and the precautions which it may be reasonable to require under this provision must depend on the circumstances of individual cases. It seems to the Minister that in its enforcement the corresponding provisions of Article 19 (5) and (d) should be borne in mind 57 and that the same general standard of freedom from contamination should be aimed at both for shops and for stalls. The steps necessary to protect meat against contamination must depend on the circumstances of the shop or stall in relation to the sources of possible contamination and also on the conditions under which trade is carried on. In no circumstances, however, should meat be allowed to project outside the limits of the wall or screen of the shop or stall, where it would be especially exposed to contamination from the street, and it should be kept as far within those limits as is practicable. Where meat has to be kept near to an open window the general rule should be that it should be covered with clean muslin or other suitable material, but local authorities will no doubt realise that, when a brisk trade is being carried on, this precaution may have to be suspended so that meat may be readily accessible. In view of this circular, it was impossible to ask the retailers to provide windows, and the Regulations were thus rendered practically unworkable in this respect. As a matter of interest, I have summarised the shops and stalls under the following headings:— Glass Fronts. Glass Fronts. Open. No meat exposed outside. Shut. No meat exposed outside. Open. Meat exposed outside. Shut. Meat exposed outside. No Glass Fronts. Shops 7 36 17 2 14 Stalls - - 1 - 5 Transport and Handling.—The section covering this question has done much to improve the conditions under which meat is handled and transported. It has not been necessary to take action in the Borough under this heading, although proceedings have been instituted with success elsewhere. 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 Licences. 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 licences. 58 At the Special Session at the London County Council the seven licences were granted. I have repeatedly expressed the opinion that the time had arrived when Public Abattoirs should be established so as to make it possible for all the meat to be inspected before leaving the slaughterhouse. The following is a list of the licensed slaughterhouses in the Borough:— Premises. Name of Licencee. 185 Uxbridge Road John Mullet Allwright 40 Goldhawk Road Andrew G. Hedges 138 Goldhawk Road George Langstone Moore 247 Goldhawk Road Arthur William Godfrey 55 Dalling Road Arthur Clapson 65 King Street John Garton Jenkins 341 King Stroet Stanley Brooks Midwinter The Slaughterhouses are visited as often as possible. The Dairies, Milkshops, Ice Cream Vendors, Restaurants and Food Shops have been kept under systematic inspection bv vour Inspectors. The following tables gives a summary of the work relating to milk premises, slaughterhouses and ice cream premises:— PREMISES. NUMBER OF PREMISES. Number of inspecions 1925 Number of notices 1925 Number of prosecutions 1925 On register in 1920. On register at end of 1924 Added in 1925 Re- moved in 1925 On register at end of 1925 Milk premises 128 86 4 4 86 2022 7 nil Slaughterhouses 7 7 — — 7 447 2 nil Ice Cream premises 234 131 65 27 169 235 — 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. 59 Many of the stalls in the Railway Approach Market are constructed so as to form lock-ups when business for the day is finished and thereby provide a means of storage for all unsold food. In other instances, Bradmore and Norland Markets, wheelbarrows form the structure, and these are wheeled to and from the markets, morning and evening, the food being stored under various conditions. During the year special inspections have been made of the premises where the food was stored. Fried-fish Shops.—The fried-fish shops are regularly and constantly inspected for the purpose of ensuring conformity with the Bye-laws made by the London County Council. At the same time a careful look-out is kept on the condition of the fish. Bakehouses The 48 bakehouses in use in the Borough have been regularly inspected during the year. Twenty-four notices were served relating to various defects, 23 being complied with. It was not necessary to apply for any summonses against Bakers whose bakehouses were found not to be in conformity with the Act, as they readily complied with the requirements of the 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 Not in use * 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 Exors. of Mary Luff 2 Crisp Road Mrs. 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 F. Hayes 88 Queen Street Not in use * Underground † Factory 60 No. 3 DISTRICT. Address. Name. * 77 Brackenbury Road A. Gardner † 1TheGrove 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 28 King Street (rear of) L. E. Jolly No. 4 DISTRICT. 1G Black Lion Lane Not in use 93 Ditto G. Banham †* 102 Dalling Road Plumridge Bros. * 192 Ditto Not in U6e † 1 Eyot Gardens J. R. Chibnad, Ltd. † 258 King Street Miller & Son †316 Ditto B. Samels † 348 Ditto . W. Langrebe †* 11 Lamington Street EL A. Roberts, Ltd. 10 Upper Mall Not in use 7 St. Peters Road E. Marlow No. S DISTRICT. †* 128 Askew Road G. Ingle † 74 Ditto J. Auer †* 1C7 Ditto F. Keber † 104 Ditto D. Miller 121 Ditto Not in use 41 Gayford Road Ditto No. 6 DISTRICT. †* 74 Goldhawk Road H. Crisp * 106 Ditto Bowman and Baker 166 Ditto N. Carrington * 242 Ditto S. T. Stoneman †* 75 Uxbridge Road B. Samels †* 125 Ditto A. B. Hemmings * 55 Melina Road J. Tame No. 7 DISTRICT. †* 126 Uxbridge Road F. E Olliver †* 216 Ditto H. Bamford † 410 Ditto A. Hauser 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 104 Latimer Road Ditto * Underground † Factory 61 UNSOUND FOOD. A half of a pig's head, purchased from Dangerfields, of No. 123, King Street, was brought to the Town Hall and was found on examination to be unsound and unfit for the food of man. An inspection of the premises was immediately made, when the following meat was seized:— 10 pieces of Pork 10 pieces of Beef 2 shoulders of Black Pudding Total weight 36 1bs 2 pieces of Black Pudding; The meat was submitted to the Magistrate at the West London Police Court, who condemned same and gave an order for its destruction. A summons was issued against Mr. Dangerfield, which was heard at the West London Police Court, when fines amounting to £30 with 20 guineas costs were imposed, The following is a list of unsound food condemned during the year:— Commodity. Condition. Result. 1 box of Skate (5 stone) Decomposed Surrendered 22 small boxes and 3 bushels of Tomatoes ditto ditto 1 box Plaice ditto ditto 2 boxes of Roe (2 stone) ditto ditto 1 bag of Winkles ditto ditto 4 boxes of smoked Codlings ditto ditto 16 boxes of Tomatoes ditto ditto 10 stone (approx.) smoked Codlings ditto ditto 2 bags of Potatoes ditto ditto 6 handles of Mushrooms ditto ditto 4 boxes of Coal Fish ditto ditto 1 barrel of Crabs ditto ditto 1 sack of Winkles ditto ditto 17 tins of "Maiden" Brand of Condensed Milk ditto ditto 1 box Lemon Sole (6 stone) ditto ditto 1 margarine of fresh Herrings ditto ditto 2 bags of Winkles ditto ditto 5 boxes of Kippers ditto ditto 53 lbs. of Grapes ditto ditto 2 bags of King Edward Potatoes ditto ditto 62 FOOD POISONING. In June, my attention was called to the death of a resident of the Borough, who had been attended by a medical practitioner—the death being certified as ptomaine poisoning. A post-mortem was ordered and inquest held. It appeared that the deceased, who was a dairyman (unemployed for some time), had visited Hampstead Heath on the Monday prior to his death. On returning home, he stated that he had been sick several times, although he had not eaten anything. He remained in bed the next day, suffering from acute diarrhoea and sickness. A doctor was called in, but the deceased died about 10 o'clock on the Wednesday morning. At the post-mortem, specimens were prepared by Dr. Bronte and submitted to the Ministry of Health for bacteriological examination. The report on the bacteriological examination was as follows:— "Bacilli belonging to the aertryck group have been cultivated from all the tissues (spleen liver and kidney) and from stomach contents, from the small intestine and from the cæcum." Following this report, enquiries were made as to the food eaten by the deceased. It was found that he had partaken of food with his family and at his lodgings, but it was impossible to find out what food he had eaten elsewhere, and no further official action could be taken in the matter. An inquest was held, and the verdict of death from food poisoning was recorded. PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 745 cases reported as due to notifiable infectious diseases in the Borough, against 760 in the previous year. The number of cases of Tuberculosis notified was 265 against 296 in the previous year. There were also reported 1,633 cases cf infectious diseases that were not notifiable, against 1,969 in the previous year; 658 of these were Measles, 573 Whooping Cough, and 402 Chicken Pox. 63 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 62 Negative results 544 606 Blood from cases of suspected Fever— Widai or Typhoid reaction obtained 2 Widal or Typhoid reaction not obtained 5 7 Urine from cases of Tuberculosis— Positive 0 Negative 1 1 Sputa from cases of suspected Tuberculosis— Tubercle bacillus found 141 Tubercle bacillus not found 540 681 Total examinations 1,295 One sample of cocoa was submitted for examination. 64 TABLE IV. Cases of Infectious Disease notified during the year 192S. Notifiable Disease Number of Cases Notified Total cases notified in each Ward Total Cases Removed to Hospital At all Ages Under 1 1 & under 5 Years 5& under 15 Year* 10 & under 25 ears 25 & under 45 Years 40& under 65 Years 65 & and upwards 5th Centre North Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera(C) Plague(P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 208 5 72 96 20 15 .. .. 35 36 17 11 20 68 21 205 Erysipelas 47 1 3 3 13 19 8 6 7 4 2 9 12 7 26 Scarlet Fever 290 5 97 156 24 8 .. .. 55 40 47 24 41 58 25 274 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 9 1 .. 1 1 3 3 .. .. 1 .. .. 3 5 .. 8 Relapsing Fever (R) Continued Fever (C) Puerperal Fever 15 .. .. .. 3 12 .. .. 5 2 2 2 3 1 .. 13 Cerebro-Spinal Meningitis 1 .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. 1 Polio-myelitis 2 .. 1 1 .. .. .. .. .. .. .. .. .. 1 1 .. Encephalitis Lethargica 9 .. .. 1 2 3 3 .. 1 1 3 .. 1 3 .. 3 Ophthalmia Neonatorum 21 21 .. .. .. .. .. .. 4 5 2 1 4 4 1 4 Pulmonary Tuberculosis 220 .. 2 6 67 101 37 7 30 41 36 15 37 43 18 .. Other forms of Tuberculosis 45 .. 6 14 13 11 2 .. 2 6 10 5 10 9 3 .. Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 142 4 22 20 23 37 22 14 16 41 15 12 28 24 6 51 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. 1 Trench Fever .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 1010 36 200 299 156 204 86 29 155 180 136 72 156 229 82 - Deaths from the Seven Principal Zymotic Diseases.—The total number of deaths of residents registered from the seven principal zymotic diseases was 91 against 88 in the previous year. The deaths of residents last year from these diseases were equal to 57 per 1,000 of the total deaths of residents registered and were at the rate of 0.7 deaths per 1,000 persons living. The following table shows the deaths of residents registered from the seven principal zymotic diseases which occurred in the ten years, 1916 to 1925. 65 Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Enteric Fever. Diarrhœa and Cholera. Total. 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 1928 0 6 2 20 10 2 31 71 1921 0 35 4 17 16 1 15 88 1925 0 6 3 12 32 3 35 91 Average last 10 yrs. 0 22 4 21 19 2 40 108 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was 17 below the average number registered in the last ten years. Notifiable Diseases (other than Tuberculosis) during the year 1928. DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths. Diphtheria 208 205 12 Erysipelas 47 26 3 Scarlet Fever 290 274 3 Enteric Fever 9 8 3 Puerperal Fever 15 13 6 Cerebro-Spinal Meningitis 1 1 - Polio-myelitis 2 - - Encephalitis Lethargica 9 3 4 Ophthalmia Neonatorum 21 4 - Pneumonia 142 51 134 Dysentery 1 1 - Totals 745 586 165 Smallpox No case of Smallpox was notified in the Borough during the year, against no case in the previous year. Cholera.—No case was reported as due to Cholera, against no case in the previous year. Plague No case was reported as due to Plague, against no case in the previous year. 66 Chart showing the number of cases of Diphtheria notified week by week in the Borough during the year 1925. 67 Diphtheria and Diphtheritic Membranous Croup—Two hundred and eight cases were reported as due to Diphtheria or Diphtheritic Membranous Croup against 267 cases in the previous year. Two hundred and five cases were treated at the Isolation Hospitals and three at the homes of the patients. Twelve deaths were registered. The mortality rate on the cases reported was 5.8 per cent. 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. It is to be regretted that more use is not made of this provision, as I am convinced some of the mortality from this disease would be avoided if greater use were made of the free supply of Anti-toxin supplied by the Council. No difficulty was experienced in removing cases to Hospital, the accommodation available being adequate for the number of cases. Scarlet Fever.—Two hundred and ninety eases were notified as due to Scarlet Fever, against two hundred and fortythree in £he previous year. Two hundred and seventy-four cases were treated at the Isolation Hospitals, and sixteen at the homes of the patients. Three deaths were registered. The mortality rate on the cases reported was 1.0 per cent. Enteric Fever—Nine cases were reported as due to Enteric Fever, against six cases in the previous year. Six cases were treated at the Isolation Hospitals of the Metropolitan Asylums Board, two at St. Marylebone Infirmary, and one at the home of the patient. Three deaths were registered. The mortality rate on the cases reported was 33 per cent. Erysipelas.—Forty-seven cases were reported as due to Erysipelas, against thirty-five cases in the previous year. Twenty-one cases were treated at the homes of the patients, eight at Fulham Hospital, thirteen at St. Marylebone Hospital and five at Kensington Hospital. Three deaths were registered. The mortality rate on the cases reported was 6.4 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 Belapsing Fever, against no case in the previous year. 68 Chart showing the number of cases of Scarlet Fever notified week by week in the Borough during the year 1925. 69 Continued Fever.—No case was reported as due to Continued Fever, against no case in the previous year. Puerperal Fever—Fifteen cases were reported as due to Puerperal Fever, against twelve cases in the previous year. Seven cases were treated at St. Marylebone Hospital, three at St. Mary Abbot's Hospital, two at the Isolation Hospital of the Metropolitan Asylums Board, one at the Fulham Infirmary, and two at the homes of the patients. Six deaths were registered. The mortality rate on the cases reported was 40 per cent. Cerebro-Spinal Meningitis.—One case of Cerebrospinal Meningitis was reported against seven in the previous year. The case was removed to the Metropolitan Asylums Board Hospital. No death was registered. Acute Polio-myelitis.—Two cases were reported as due to Polio-myelitis, against five cases in the previous year. The cases were treated at home. No death was registered. Encephalitis Lethargica.—Nine cases were reported as due to Encephalitis Lethargica, against thirteen in the previous year. Two cases were treated at the West London Hospital, one case was treated in the Isolation Hospital of the Metropolitan Asylums Board and six cases were treated at the homes of the patients. Four deaths were registered. The mortality rate on the cases reported was 44.4 per cent. Ophthalmia Neonatorum.—Twenty-one cases were reported as due to Ophthalmia Neonatorum, against sixteen in the previous year. Three cases were treated at the Metropolitan Asylums Board Hospital, 1 at St. Mary Abbot's Hospital, and seventeen 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. 70 The following Chart shows the number of Deaths from Measles per 100,000 inhabitants, 1906-1925. Glanders.—No case was reported as due to Glanders, as against no case in the previous year. Measles and German Measles.—Six hundred and fifty- eight cases of Measles and German Measles were notified against thirteen hundred and sixty-one in the previous year. Six hundred and thiry-four cases were treated at the homes of the patients, and twenty-four in the Hospitals of the Metropolitan Asylums Board. Six deaths were registered. Whooping Cough.—Five hundred and seventy-three cases of Whooping Cough were reported, against two hundred and ninety-seven in the previous year. 71 Thirty-two 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. The following Chart shows the number of Deaths from Whooping-Cough per 100,000 inhabitants, 1906-1925. Chicken Pox Four hundred and two cases of Chicken Pox were reported, against three hundred and eleven 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 One hundred and forty-two cases of Pneu monia (thirty-three Influenzal Pneumonia and one hundred and nine Primary Pneumonia) were notified during the year. The majority of the patients were treated at home. 72 Fifty-one cases were treated at various institutions. All cases were made the subject of enquiry by your lady Sanitary Inspector or 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. One hundred and thirty-four 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 one case in the previous year. Dysentery.—One case of Dysentery was reported, against one case in the previous year. The case was treated at the Isolation Hospital of the Metropolitan Asylums Board. Trench Fever.—No case of Trench Fever was reported, against no case in the previous year. Influenza.—During the year thirty-four deaths from Influenza occurred, as compared with fifty-six in the previous year. Wrong Diagnosis.—Sixty-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. Diphtheria 31 Scarlet Fever 27 Measles 6 Enteric Fever 2 Cerebro-Spinal Meningitis 1 Encephalitis Lethargica 1 Total... 68 Cleansing of Verminous Persons.—The Medicinal Baths in Scotts Road, Shepherd's Bush, provide for the treatment of cases of Scabies, Impetigo and the cleansing of verminous persons, etc. Negotiations were completed and arrangements made with the London County Council for the cleansing of school children to commence as and from the 1st April, 1924. 73 TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1916 to 1925. Year. Smallpox. Scarlet Fever. Diphtheria or Diphtheritic Croup. Typhus Fever. Enteric Fever. Simple Continued Fever. Relapsing Fever. Puerperal Fever. Cholera. Erysipelas. Plague. Chickenpox. a Measles, b a Whooping Cough, a Cerebro-Spinal Fever. Anthrax. Glanders. Hydrophobia. Ophthalmia Neonatorum. Acute Polio-Myelitis. Encephalitis Lethargica. Pneumonia. c Malaria. c Dysentery. c Trench Fever. c Total. 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 0 185 238 0 9 0 0 6 0 74 0 188 786 150 6 1 0 0 0 36 8 3 141 95 3 0 1927 1920 1 726 380 0 8 0 0 20 0 57 0 168 763 225 4 1 0 53 6 4 165 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 3062 1507 2729 2378 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 1923 0 245 233 0 14 0 0 13 0 31 0 363 347 136 3 0 0 0 28 4 6 84 0 0 0 1924 0 243 267 0 6 0 0 12 0 35 0 311 1361 297 7 0 0 0 16 5 13 154 1 1 0 1925 0 290 208 0 9 0 0 15 0 47 0 402 658 573 1 0 0 0 21 2 9 142 0 1 0 Average for 10 years. 0 407 272 0 10 0 0 10 0 47 0 288 1047 257 5 0 0 0 35 3 4 99 13 2 0 2499 a Not Notifiable. b Notifiable during the years 1916—1919. c Notifiable from 1st March, 1919. 74 It was not then possible for all Hammersmith school children to be sent to Scotts Road, a large number of them being treated at the Kensington Medicinal Baths and at the London County Council Station in Seddlescombe Road, Fulham. This was due to the fact that the London County Council had previously entered into an agreement with Kensington prior to the opening of the Hammersmith Baths. This agreement came to an end in March when arrangements were made for all Hammersmith children to be dealt with at your Council's station. I append figures showing the numbers dealt with during the year. School Children— Scabies 120 Impetigo 22 Verminous Cases 2,445 Adults— Scabies 10 Impetigo — Verminous Cases 70 Other conditions 10 The County Council pay the sum of two shillings in respect of each child cleansed, except in cases of scabies or impetigo in which case the payment is at the rate of 1s. for each bath given. The amounts received from the London County Council during the year was £244 10s. 0d. in respect of cleansings and £7 2s. 0d. in respect to scabies cases and impetigo. DISINFECTION. The following table shows the amount of disinfection carried out by your Council during the year; all bedding and articles of clothing, &c., being removed to the Council's Disinfecting Station, for the purpose of disinfection. Beds 443 Mattresses 656 Pillows 1,720 Bolsters 493 Blankets 1,697 Sheets 859 Bugs 749 Articles of Clothing 2,306 Booms 991 Sundries 287 Total 10,201 Tuberculosis. Tuberculosis—Two hundred and sixty-five cases of tuberculosis were reported during the year; two hundred and twenty of which were Pulmonary and forty-five being other 75 forms of Tuberculosis, against two hundred and ninety-six cases in the previous year. The following table shows the number of notifications received during the year:— Age Periods. Notifications on Form "A" Notifications on Form "B" Number of Notifications on Form "C" Number of Primary Notifications. Total Notifications on Form "A" No.ol 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 Prim. Not. Under 5 5 to 10 10 to 15 Total J Prrim. Not. Pulmonary. Males .. .. 1 2 10 15 37 29 20 6 5 125 265 174 356 .. .. 1 1 1 1 1 18 89 215 Pulmonary, .. 2 1 9 19 93 15 20 8 3 9 95 126 .. .. .. .. .. 11 61 Non-Pulmonary, Males .. 3 2 1 4 1 2 .. .. .. .. 13 19 .. .. .. .. .. .. 14 ary, Females .. 2 6 5 5 3 7 2 2 .. .. 32 37 .. .. .. .. .. .. 22 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-four deaths from Pulmonary Tuberculosis were registered, against one hundred and fortyseven in the previous year, representing a death-rate of 0.9 per 1,000, compared with 1.1 in 1924. See page 76 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 1920-1925, showing the interval between notification and death of tuberculous persons. 1920. 1921. 1922. 1923. 1924. 1925. 1. Total number of deaths from Tuberculosis in the Borough 157 173 162 145 170 138 2. The number of eases notified at death 11 8 17 11 10 13 3. The number of cases notified within one month of death (excluding above) 26 29 20 21 23 18 4. The number of cases notified within three months of death (excluding above) 28 29 20 18 20 13 5. The number of cases notified within six months of death (excluding above) 16 9 16 13 16 18 76 The following table has been prepared, giving particular of new cases of tuberculosis and of deaths from tuberculosi during 1925:- Age Periods. New Cases. Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. 0 - - - - - - - - 1 — 2 3 2 1 1 1 1 5 1 1 2 6 - - - 2 10 2 2 1 5 — 1 1 - 15 10 19 4 5 6 14 2 - 20 15 23 1 3 7 10 - 25 37 15 2 7 8 13 2 1 35 29 20 — 2 9 10 - - 45 20 8 — 2 15 7 — - 55 6 3 - - 8 7 - - 65 and upwards 5 2 — — 7 3 1 — Totals 125 95 13 32 61 66 7 4 See page 75 I submit a report on the work carried out at the Tuberculosis Dispensary. Tuberculosis Officer's Report for the Year 1925. During the year sessions have been held regularly at the Dispensary for the examination and treatment of patients at the following times:— Mondays, 10 a.m. Women and Children. Tuesdays, 1.30 p.m. School Children. Tuesdays, 6 p.m. Men. Thursdays, 6 p.m. Women. Saturdays, 10 a.m. Schoolchildren. Special appointments are held daily to suit the convenience of those who cannot attend at the stated hours and in cases where the consultation is likely to be a lengthy one. The notification of fresh cases of Tuberculosis in the Borough during the year numbered 265, a decrease of 31 as compared with 1924. At the end of 1925 there were 1,280 persons living in the Borough whose names were entered in the register as suffering with the disease. Some of these had been notified many years before and had been well and free from symptoms for years subsequent to notification. 77 It has been the practice to remove from the register the names of persons who were found to be showing no evidence of the disease, had been free from symptoms for a long period and who expressed a wish that that should be done. Such procedure had been carried out in a limited number of cases but until the end of 1924 there was no official sanction for it. At the end of that year the Ministry of Health signified that "denotification" was desirable under certain provisos which the Minister laid down. By this means the record of the prevalence of the disease in the Borough has been brought up to date. Tuberculosis Dispensary. The record of the year's work of the Dispensary is as follows:— New Patients. During the year 605 persons attended for examination for the first time. Of these 215 were under the age of fifteen and 390 were adults. Males and females attended in almost equal numbers, viz., 314 and 291. Of the total, 247 were referred to the Dispensary by local Practitioners for the purpose of consultation, while 193 were "contacts" of persons suffering with Tuberculosis and 44 were discharged ex-Service men who attended for reports on the instruction of the Ministry of Pensions. Diagnosis. Found to have Pulmonary Tuberculosis 155 Found to have other forms of Tuberculosis 34 Showing no evidence of Tuberculosis 416 Patients from Previous Years. Six hundred and fifty-two persons who had attended the Dispensary in previous years presented themselves during 1925. Of these, 430 were adults, and included 107 ex-Service men, while 222 were children. Some of these made regular visits for the purpose of treatment. The majority, however, came for examination or for advice only, at varying intervals of time. Total Attendances and Examinations. The total attendances of persons for the purpose of examination, observation or treatment, numbered 3,462, and physical examinations were carried out in 1,684 instances, i.e., in 48.5 per cent. of the total attendances. The number of insured persons under domiciliary treatment with Dispensary supervision on 31st December is estimated at 396. 78 Sputum Examinations. Five hundred and fifty-seven specimens of sputum and other pathological products were examined bacteriologically. One hundred and twenty-two showed the presence of Tubercle Bacilli, while 435 proved negative. Institutional Treatment. The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homes), under the London County Council's Scheme, numbered 172. 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 535 To the Ministry of Pensions 55 To the local War Pensions Committee 171 To General Practitioners and Hospitals 499 Home Visitation. The Tuberculosis Officer made 155 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 26 occasions. The Nurses visit the tuberculous population on notifica tion and thereafter as far as possible at intervals of six months or less, as may appear advisable. During the year 4,205 such visits were made. In addition to the ordinary health visits paid by them the Dispensary Nurses undertake duties in connection with the investigation of the social circumstances of the households in which the patients belong. The result of these enquiries are submitted to the Tuberculosis Care Committee and form the basis upon which the Committee makes its decision in the assessment of individual cases. During the year 207 HomeEnquiry Schedules were submitted to the Committee. Tuberculosis Care Committee. This Committee is formed of representatives of the following bodies: the Borough Council, the County Council, the Board of Guardians, the Red Cross Society, the United Services Fund, the Charity Organisation, the Invalid Children's Aid Association, the Labour Exchange, and the local Medical Practitioners, and meets on the first and third Wednesday in 79 each month for the purpose of considering how patients and their households can best be helped and the amount of contribution, if any, which should be collected towards the cost of institutional treatment under the London County Council Tuberculosis Scheme. The Committee met on 22 occasions during the year. There were submitted by the staff 221 applications for residential treatment, an increase of 11 compared with 1923. The Committee decided in 130 of these cases that no payment should be required in respect of such treatment. In the remaining 91, assessments of varying amounts were made. In 56 instances, reconsideration of these assessments was rendered necessary at subsequent meetings, mainly by changes in the family circumstances. Thirty-four 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 £227 18s. 6d. These monies are handed over to the Borough Accountant who transfers them to the County Council. The staff consist of the Tuberculosis Officer, Dr. Govan, two Nurses, Dispenser and Clerk, and' Secretary (part time) to the After Care Committee. There are no residential institutions in the Borough with beds available for the treatment of Pulmonary 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 to the Tuberculosis Officer on patients under domiciliary treatment at three monthly intervals. f 80 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. No special methods of diagnosis are in use. Doubtful cases, upon which a further opinion is required necessitating more elaborate investigation than the equipment of the Dispensary will permit, are referred to the West London Hospital or to the London County Council for admission to one of its institutions. 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 has made provision in the 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. 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. PUBLIC HEALTH (PREVENTION OF TUBERCULOSIS) REGULATIONS, 1925. In July the Minister of Health, in the exercise of the powers conferred on him by the Public Health Act, 1875, the Public Health (London) Act, 1891, the Public Health Act, 1896, and the Public Health (Regulations as to Food) Act, 1907, made the following regulations:— 1. These Regulations may be cited as the Public Health (Prevention of Tuberculosis) Regulations, 1925, and shall come into operation forthwith. 2. In these regulations— The expression "local authority" means, as the case may be, the Common Council of the City of London, the Council of a Metropolitan Borough, the Council of a Municipal Borough or other Urban District or the Council of a Rural District; 81 The expression "milk" means milk (including cream, skimmed milk and separated milk), intended for sale for human consumption; The expresion "dairy" includes any farm, cowshed, milk store, milk shop, or other place from which milk is supplied on, or for, sale, but does not include a shop or other place in which milk is sold for consumption on the premises only. 3. The local authority shall enforce and execute 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. 4. No person who is aware that he is suffering from tuberculosis of the respiratory tract shall enter upon any employment or occupation in connection with a dairy which would involve the milking of cows, the treatment of milk, or the handling of vessels used for containing milk. 5. Notwithstanding anything contained in the Public Health (Tuberculosis) Regulations, 1912, if a local authority, on the report in writing of their Medical Officer of Health, are satisfied that a person residing in their district who is engaged in any such employment or occupation as aforesaid is suffering from tuberculosis of the respiratory tract and is in an infectious state, they may by notice in writing signed by the Clerk or the Medical Officer of Health require such person to discontinue his employment or occupation on or before the date specified in the notice, such date being not less than seven days after the service of the said notice, and such person shall thereupon comply with the said notice. A notice issued by the local authority under these regulations shall be in the form set forth in the Schedule hereto. 6.—(1) If any person deems himself aggrieved by a requirement of a local authority under these regulations, he may, within fourteen days after the service of notice of the requirement, appeal to a court of summary jurisdiction and shall in that event give written notice to the Clerk to the local authority of his intention to appeal and the ground thereof. (2) The court may make such order in the matter as may seem equitable to them, and may award costs, which shall be recoverable summarily as a civil debt, and the order so made shall be binding and conclusive. (3) Upon the hearing of an appeal under this article the court shall have power with the consent of the appellant to direct that he be examined by a registered medical practitioner nominated by the court. 7. The provisions of section 308 of the Public Health Act, 1875, (which relates to compensation for damages sustained by reason of the exercise of the powers of the Act) shall apply to any person who sustains any damage by reason of the exercise of any of the powers of these legulations in relation to any matter as to which he is not himself in default. SCHEDULE. The Public Health (Prevention of Tuberculosis) Regulations, 192,1. To of The , being satisfied on the report of their Medical Officer of Health that you are engaged in an employment or occupation involving the milking of cows, the treatment of milk, or the handling of vessels used for containing milk in connection with a dairy, and that you are suffering from tuberculosis of the f 2 82 respiratory tract and are in an infectious state, hereby give you notice that you are required on or before the day of 19 to discontinue such employment or occupation. Dated this day of 19 Signature of Clerk or Medical Officer of Health Note-—Any person sustaining damage by reason of the exercise by a local authority of any of the powers of these regulations, and not being himself in default, is entitled under section 308 of the Public Health Act, 1875, as applied by these regulations, to receive full compensation from the local authority. Any claim which you desire to make should be addressed in writing to the Clerk to the Council. You are entitled, within fourteen days after the service of this notice, to appeal to a court of summary jurisdiction against the local authority's decision requiring you to discontinue your employment. If you intend to appeal you must give notice in writing to the Clerk to the Council of your intention and of the ground of the appeal. Given under the Official Seal of the Minister of Health this Thirtyfirst day of July, in the year One thousand nine hundred and twenty-five. (l.s.) A. B. Maclachlan, Assistant Secretary, Ministry of Health. Note.—The Public Health Act, 1896, provides by sub-section (3) of section 1 that if any person wilfully neglects or refuses to obey or carry out, or obstructs the execution of , any regulations made under any of the enactments mentioned in that Act he shall be liable to a penalty not exceeding £100, and, in the case of a continuing offence to a further penalty not exceeding £50 for every day during which the offence continues. The power of making regulations under the Public Health Act, 1896, and the enactments mentioned in that Act, is enlarged by the Public Health (Regulations as to Food) Act, 1907. It was not necessary to take action under these Regulations relating to Tuberculous employees in the Milk trade. CANCER. During the year the Ministry of Health issued three circulars known as Cancer II, Cancer III and Cancer IV, for the guidance of Local Authorities supplementing the information contained in the circular known as Cancer I and issued in August, 1923. Cancer II relates to the effects of radium and X rays upon normal and cancerous tissues. Cancer III relates to Cancer of the breast and the results of surgical operation in connection therewith. Cancer IV is a review on the main lines which experimental Cancer research has followed in recent years and of the broad conclusions, negative as well as positive, which seem to be deducible up to now from the several branches of this work. 83 Cancer is not an incurable disease providing it is attended to in its earlier stages. Doctors are very often, in fact, in most cases, terribly handicapped by the reluctance of patients to seek early advice. Often the consultation of a doctor is delayed until the disease is too far advanced for treatment. It is therefore imperative that a doctor be consulted, should any deviation from the normal health occur. Cancer caused 215 deaths. Carcinoma was the form of Cancer to which 176 deaths were attributed; sarcoma and epithelioma were assigned cause of 15 deaths; 24 deaths were certified as due to cancer or malignant disease without further definition. The parts of the body which were affected in each case are shown in the following table:— Deaths from Cancer, 1925. Males. Females. Buccal Cavity 19 2 Liver and Pancreas 6 6 Alimentary Canal 46 41 Female Genital Organs — 25 Breast — 25 Prostrate and Bladder 12 4 Other and Unspecified Organs 17 12 Total 100 115 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 nine persons from the catacombs or graves in St. Mary's Cemetery. Seven of the bodies were re-interred in St. Mary's Cemetery, Harrow Road, one was removed for re-interment in Brompton Cemetery and one to Peru. The following conditions were attached to the licences:— (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 ever the coffin, the soil, or any matter that may tie offensive. In those cases where the remains were removed to other countries, it was required that they be placed in a lead lined shell which shall be hermetically sealed. 84 Whilst in other cases the remains were contained in well pitched shells and entirely surrounded by four inches of newly made vegetable charcoal in powder. The work of removal and re-interrnent was carried out in accordance with the conditions and under the supervision of the Sanitary inspector on my behalf. HEALTH WEEK. During Health Week an Exhibition was held together with Baby Competitions and Lectures. The Baby Competitions were held in three classes as under:— One for males under 1 year of age, One for females under 1 year of age, and One for males and females between X1and 2 years of age. The Exhibition was arranged in the Concert Room at the Town Hall. The following is a list of the exhibits:— Hammersmith and District Nursing Association, West London Hospital, British Social Council of Hygiene, Women's League of Service, Hammersmith Infant Welfare Association, Princess Christian Day Nursery, Exhibit by the Health Visitors, and Exhibit from Parkside Maternity Home. A Clinic under the auspices of the Hammersmith Infant Welfare Association was also held in the Council Chamber. In the evenings lectures were given on the following subjects: Tuberculosis, Ante-natal Care, Care of the Children, Health and Happiness, and Venereal Diseases. The Baby Competitions were a great success, there being 150 entries of boys under 1 year of age, 122 entries of girls under 1 year of age and 109 entries of boys and girls between 1 and 2 years. The Exhibition and Lectures were not well attended. The Ministry of Health whilst being in favour of Health Week does not support Baby Competitions, and as a result no grant was received from them towards this particular part of the programme. This is to be regretted, as such competitions induced many mothers to come to the Exhibition who would otherwise not have done so. Lady Bull, Sir Henry Simpson, K.C.V.O., and The Mayor, Alderman Marshall Hays, J.P., L.C.C., assisted by opening the Exhibition, distributing the prizes and giving short addresses to the mothers. 85 MATERNITY AND CHILD WELFARE. The figures tabulated below, indicate in some measure the extent of the ground to be covered on the one hand, and on the other the success of the work accomplished in the interests of Maternity and Child Welfare:— Number of Births registered during the year 2,178 Corrected Number of Births 2,351 These figures represent a Birth-rate per 1,000 of the population of the Borough of 17.5 Corrected Number of Deaths of Infants under one year, of whom 45 died under one week 153 Legitimate Infants—141, or 63 per 1,000 Births. Illegitimate Infants—12, or 101 per 1,000 Births. Infant Mortality Kate per 1,000 Births 65 The work undertaken under this heading in the Borough during the year 1925 was continued on similar lines to previous years. 1. Activities directly initiated, by the Borough Council-. (a) Provision of three Health Visitors, as in former years. (b) Provision of a Maternity Home. (c) Supply of Free Milk to necessitous Mothers and Young Children. (d) Treatment and Nursing of Children under School Age. 2. Activities of Voluntary Agencies in receipt of grants- in-aid from the Borough Gowncil: (a) Infant Welfare Centres. (b) Day Nurseries. 3. Activities of independent Voluntary Agencies: (a) 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. The visits paid are enumerated in detail below:— First visits 2,040 Re-visits (under 1 year) 2,149 Re-visits (1 to 5 years) 1,072 Out and removals 1,882 Special visits 468 Ophthalmia 25 Puerperal Fever 15 Ante-natal, first visits 399 Ante-natal, re-visits 38 Visits to Stillbirths 53 Visits to Infant Deaths 140 Cerebro-Spinal Meningitis 1 Encephalitis Lethargica 5 Poliomyelitis 2 Total 8,289 86 Number of Consultations at Infant Welfare Centres, attended by Health Visitors 440 Number of Committee Meetings of Voluntary Associations attended 52 Number of Insanitary Conditions reported by Health Visitors and dealt with by Sanitary Inspectors ... 65 The feeding of the 2,078 infants visited was found to be as follows:— Breast-feeding 1,832 Artificial feeding 126 Mixed feeding 82 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 20 years, the year of the appointment of the first Health Visitor:— 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 1924 2399 173 72 1925 2351 153 65 It will be observed that the infant death-rate has decreased from 72 to 65 per 1,000. 87 The activities of those who have been engaged in Infant Welfare Work continues to be carried on with enthusiasm by both voluntary and municipal workers. Hammersmith is fourteenth on the list of the twenty-eight Boroughs, and the mortality rate is 2 per 1,000 lower than the average for the whole of London. The infant mortality rates of the London Boroughs varies from 45 in Lambeth to 88 in Shoreditch. The following Chart shows the Infantile Mortality rate for the years 1903-1925. MATERNAL MORTALITY. Milk (Mothers and Children) Orders, 1918-1919.—Under these orders the Council has continued to supply milk to 88 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 21 per week during the year. The total expenditure during the year was approximately £350. 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. "PARKSIDE" 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. Fry and Dr. Jones. Period ending 31st December, 1925. (l) Number of Cases in the Home on 1st January, 1925. 10 (2) Total Number of Cases admitted during 1925. 383. (3) Average duration of stay. 14½ days. (4) No. of Cases delivered (a) by Midwives. 370. (b) by Doctors. 11. 89 (5) No. of Cases in which Medical Assistance was sought by the Midwife with reasons for requiring assistance. All patients medically examined in Ante-natal Clinic. Result of Examination. (a) Ante-natal. (a) 1 Contracted Pelvis, transferred to Middlesex Hospital. 3 Inductions. 1 Albuminuria (acute). 1 Pyelitis of pregnancy. (b) During labour. (b) 6 Uterine enertia. 1 Ante-Partum Hsemorrhage. 1 Post „ ,, 1 Breech Presentation. 2 Occipito-posterior unreduced. 2 Ruptured perineum. (c) After labour. (c) All patients seen daily by visiting physician. (d) For infant. (d) Ditto. (6) No. of Cases notified as Puerperal sepsis with result of treatment in each case. NIL. (7) No. of Cases in which temperature rose above 100.4 for 24 hours with rise of pulse rate. 9. 2 Severe coughs. 3 Following difficult labours (forceps deliveries). 2 Normal Deliveries, prolonged labour. 1 Pyelitis of pregnancy. 1 Abortion. (8) Number of cases of Pemphigus Neonatorum. NIL. (9) No. of Cases notified as Ophthalmia Neonatorum with the result of treatment ill each case. NIL. (10) ) No. of cases of " Inflammation of the Eyes " however slight. 1. (11) ) No. of Infants not entirely breastfed while in the Institution with reasons why they were not breastfed. 8. 4 Entirely breast fed. 1 death of mother. 3 mothers suffering from Pulmonary Tuberculosis. 4 Partial, insufficient breast milk. (12 ) No of Maternal Deaths, with causes. 2. 1 placenta Praevia, Ante-partum hæmorrhage, ruptured uterus. 1 admitted with septic pneumonia, seventh month of pregnancy undelivered. (13 ) No. of Foetal deaths (a) stillborn, and (b) within 10 days of birth and their causes, and the result of the post-mortem examination if obtainable. 11. 7 Premature births. 2 Blood tests "Positive." 1 with ascites (Syphilitic.) 1 with malformation of head. 4 Full term births. 2 Breech presentations. 1 Macerated fœtus (induction case). 1 normal fcetus. 2 Vertex presentations, Normal condition of fcetus. 90 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. Day Nurseries.—Two day Nurseries in the Borough— Princess Christian, the Latymer Road Mission Creche—were in great demand where mothers were compelled to work for the support of the family. These nurseries received grantsin-aid from the Council. Independent Voluntary Agencies. Rescue Homes.—There were three Homes open in the Borough throughout the year for the reception of Unmarried Mothers and their Children; the total accommodation available for such cases was 37 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 91 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 2 Minor Ailments 22 Dental Treatment 4 Total 28 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. 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 to Hospital. Puerperal Fever 15 12 15 - 13 Ophthalmia Neonatorum 21 16 21 13 4 Epidemic Diarrhœa* 35 15 — — 1 Measles & German Measles (under5)† 201 511 201 2 12 Whooping Cough (under 5)† 327 173 327 - 25 Poliomyelitis (under 5) 2 5 2 — — *Summer Diarrhoea.—As this is not a notifiable disease the figures available are those of deaths which were registered as having been due to this cause. †Not notifiable diseases. 92 Ophthalmia Neonatorum.—The number of cases reported was twenty-one, against sixteen in the previous year. The analysis of the final reports received is as follows:— Cases. Vision unimpaired. Vision Impaired. Total Blindness. Deaths. Notified. Treated. At Home. In Hospital. 21 17 4 21 — — — 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. 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, &c. Increase of Rent and Mortgage Interest Restrictions Act, 1920-1923.—During the year thirty-three applications were received for certificates under the above Act. In twenty-six cases the certificates were granted, six applications were refused, and two held over on request of applicant. Five certificates were granted to owners who had carried out the work specified satisfactorily, three being refused. Rag Flock Act, 1911.—The Rag Flock Regulations, 1912.—No action was taken under these regulations during the year under review. 93 Public Mortuary.—During the year four hundred and thirty bodies were removed to the Mortuary in Fulham Palace Road. There were two hundred and seventy-six brought to the Mortuary by order of the Coroner, and one hundred and fifty-four were received for accommodation and convenience of burial. METEOROLOGY. The average mean temperature registered in London during the year was 50.5 degrees Fahrenheit. The highest air temperature registered being 90 degrees, in July. The lowest air temperature was 21 degrees in December. The total amount of rainfall was 23.4 inches.