HAM 22 ANNUAL REPORT of the Medical Officer of Health of the BOROUGH OF HAMMERSMITH For the Year 1926 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 1926. 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 11.4 is 0.5 lower than the rate for the previous year, whilst the infantile mortality rate is 66 per 1,000 births—1 per 1,000 greater than the rate for the previous year. This figure is fairly satisfactory and is undoubtedly the result of the work carried out under the maternity and child welfare scheme of the Borough, but greater efforts should be made to improve matters still further. 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. 3 The housing condition of the Borough is not of a very satisfactory nature and it is to be regretted that a very considerable amount of overcrowding still exists. In spite of the large number of houses completed no improvement in housing conditions has resulted in the congested areas. The delay in proceeding with the Southern Housing Scheme is to be regretted. During the year, 3,322 Intimation Notices and 953 Statutory Notices were served. I am, Ladies and Gentlemen, Your obedient Servant, J. B. HOWELL, Medical Officer of Health 4 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1926. Area 2,282.5 acres. Population (1926) 134,400 Population Census (1901) 112,239 ,, ,, (1911) 121,521 ,, ,, (1921) 130,287 Natural increase, i.e., excess of births over deaths 653 Density of population 58.9 persons per acre Marriages registered 1,161 Number of inhabited houses (1921) 17,402 Number of families or separate occupiers (1921) 33,263 Rateable value (1926) £1,045,646 Sum represented by a penny rate, 1926 £4,160 Vital Statistics. Births (legitimate) 2,069 ,, (illegitimate) 119 Deaths (corrected)1,535 birth rate 16.3 death rate 11.4 Number of women dying in, or in consequence of childbirth from sepsis 3 from other causes 4 Deaths of infants under one year of age per 1,000 births 66 Legitimate, 63 Illegitimate, 109 Deaths from measles (all ages) 24 Deaths from whooping cough (all ages) 11 Deaths from diarrhoea (under 2 years of age) 24 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, showirg 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 134,400, but I believe this number to be below the actual population of the Borough. Since the Census was taken, over sixteen hundred houses have been built by the London County Council and the Borough Council, in the northern part of the Borough. It is probable, therefore, that the estimate of the Registrar-General is considerably below the actual population. The corrected number of births registered was 2,188, whilst the corrected number of deaths of residents was 1,535, thus showing a natural increase of population by excess of births over deaths of 653. The area of the Borough is 2,282.5 acres, there being 58.9 persons to the acre. Marriages.—The number of marriages registered during the year was 1,161, the marriage rate being 17. Births.—During the year 2,001 births were registered in the Borough. Adding 335 births which occurred outside the Borough, transferred by the Registrar-General as belonging to Hammersmith, and deducting 148 births which occurred in the Borough, and transferred to other districts by the Registrar-General, the corrected number of births for the year was 2,188. On the estimated population, i.e., 134,400, the corrected number of births registered was equal to an annual rate of 16.3 births per 1,000 persons living. The Birth-rate for the year is 1.2 per 1,000 less than the rate for the previous year which was 17.5. The Birth-rate in London on the estimated population. i.e., 4,615,400, was equal to an annual rate of 17.1 births per 1,000 persons living. Notification of Births Act, 1907. Births registered 2,001 Corrected number of births 2,188 Notification Received from Midwives. Doctors. Lying-in Hospitals. Poor Law Institutions. Parents. M.O.H.'s. 1,038 437 429 99 25 10 Total notifications received, 2,038. 6 The following Chart shows the number of deaths from Diarrhoea per 100,000 inhabitants, 1907-1926. 7 Deaths.—During the year 1,174 deaths (567 males, 607 females) were registered in the Borough, as compared with 1,034 in the previous year. Adding 535 deaths of residents of this Borough which occurred in general hospitals and other public institutions, and 21 deaths of residents transferred by the Registrar-General as having occurred in various parts of England, and deducting 169 deaths of non-residents and 26 transferable deaths which occurred in the Borough, the corrected number of deaths of residents registered was 1,535. On the estimated population, i.e., 134,400, the corrected number of deaths of residents was equal to an annual rate of 11.4 deaths per 1,000 persons living. The death-rate in London on the estimated population, i.e., 4,615,400, was equal to an annual rate of 11.6 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 144, as compared with 153 in the previous year. The number of deaths of infants under one year of age was equal to 66 per 1,000 of the corrected births and to 94 per 1,000 of the corrected deaths. The number of deaths of infants under one year of age, residents in London, was equal to 64 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 greater in this Borough than in London. Summer Diarrhoea.—The number of deaths from Diarrhoea was 26, being 9 less than in the previous year. Of these 18 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. No case was admitted to hospital from this Borough. 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 infants under one year of age was 13 or at the rate of 109 per 1,000 illegitimate births. It is interesting to note the very great difference between the death-rate of legitimate and illegitimate infants. The former being 63 per 1,000 whilst the latter is 109 per 1,000, a difference of 46 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 1926. 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 under 4 Weeks. 4 Weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths. under 1 Year ALL Certified CAUSES. Uncertified 42 9 9 8 68 20 23 23 10 144 — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — Measles — — — — — — 2 3 3 8 Scarlet Fever — — — — — — — — — — Whooping Cough — — — — 1 1 — 1 4 1 7 Diphtheria and Croup — — — — — — 1 — 1 2 Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — 1 — 1 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — 1 — 1 Meningitis (not Tuberculous) — — — — — — — — 1 1 Convulsions 1 — — — 1 2 2 — — 5 Laryneiitis — — — — — — — — — — Bronchitis — — — — — 2 — — — 3 Pneumonia (all forms) — — 1 — 1 2 3 4 3 13 Diarrhœa — — — — — 1 3 — — 4 Enteritis 1 — — 1 2 4 6 3 — 15 Gastritis — — — — — — — — — — Syphilis — — — — — 2 1 — — 3 Rickets — — — — — — — — — — Suffocation. overlying — 1 — — 1 1 — — — 2 Injury at Birth — 1 — — 1 — — — — 1 Atelectasis 5 — — — 5 — — — — 5 Con genital Malformations 2 — 2 2 6 1 — — — 7 Premature Birth 23 1 5 1 30 2 — — — 32 Atrophy, Debility & Marasmus 7 3 1 2 13 1 2 2 — 18 Other causes 3 3 — 1 7 2 2 5 — 16 Totals 42 9 9 8 68 20 23 23 10 144 Nett Births in the Year: Legitimate, 2069; Illegitimate. 119. Nett Deaths in the Year ok : Legitimate Infants, 131 ; Illegitimate Infants, 13. Deaths of Aged Persons.-The corrected number of deaths of residents at 65 years of age and upwards registered during the year was 650, against 665 in the previous year. These deaths were equal to 4.9 per 1,000 of the total persons living, and 433 per 1,000 of the total deaths of residents registered. 9 Of the 650 deaths of residents at 65 years of age and upwards it is interesting to note that of these, 164 died between the ages of 65 and 70, 288 between 70-80, 169 between 80-90, and 28 between 90-100 and 1 of 100. Statistics.—The following table gives the statistics of the Borough during 1926 and the previous five years, in the form prescribed by the Ministry of Health:— TABLE I. Vital Statistics of Whole District during 1926 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 1920 136200 3150 3312 24.3 1073 7.9 161 646 219 66 1558 11.4 1921 131500 2599 2779 21.1 1167 9.1 202 669 245 88 1634 12.7 1922 134400 2564 2758 20.5 1223 9.1 196 705 196 71 1733 12.9 1923 133600 2571 2701 20.2 981 7.3 125 649 173 64 1473 11.0 1924 134200 2199 2399 17.9 1123 8.4 173 718 173 72 1668 12.4 1925 134500 2178 2351 17.5 1034 7.7 186 766 153 65 1604 11.9 1926 134400 2001 2188 16.3 1174 8.7 195 656 144 66 1535 11.4 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 (of. Census Vol. 5.) Deaths of Residents.—Belonging to the Borough, occurring in Public Institutions, &c., in districts outside, during the year 1926:— FEVER HOSPITALS. North Western Hospital 3 Western Hospital 14 Grove Hospital 3 London Fever Hospital 2 South Western Hospital 1 Northern Hospital 2 24 MENTAL HOSPITALS. Colney Hatch Hospital 5 Horton Hospital 5 West Park Hospital 2 Hanwell Hospital 12 Long Grove Hospital 7 Tooting Bee Hospital 20 Cone Hill Hospital I Springfield Hospital 2 Colindale Hospital 4 London County Hospital 1 City of London Hospital 1 Fountain Hospital (Temporary) 1 61 10 GENERAL HOSPITALS. St. Bartholomew's Hospital 5 Charing Cross Hospital 4 St. George's Hospital 8 Willesden Hospital 3 King Edward VII Memorial Hospital 3 St. Mary's Hospital 9 Royal Waterloo Hospital 1 Loudon Hospital 1 Hospital of SS. John and Elizabeth 3 Hampstead General Hospital 1 Victoria Hospital 4 Queen's Hospital 2 St. Thomas s Hospital 3 Putney Hospital 1 St. Margaret's Hospital, 25, Leighton Road 1 Middlesex Hospital 5 Hounslow Hospital 1 St. Luke's Hospital 9 University College Hospital 4 Westminster Hospital 3 Acton Hospital 1 St. Vincent's Orthopaedic 1 Battersea General Hospital 1 74 OTHER INSTITUTIONS. St. Marylebone Hospital 190 Fulham Hospital 38 Kensington Hospital 25 French Hospital 1 German Hospital 1 Samaritan Free Hospital 3 Consumption Hospital 1 Manor Institution 1 Cancer Hospital 5 Children's Hospital 5 Central London Ophthalmic Hospital 1 Chelsea Hospital for Women 3 Queen Charlotte's Hospital 5 Metropolitan Ear, Nose and Throat Hospital 1 Royal Chest Hospital 1 Brompton Hospital 1 St. Joseph's Hospice 3 Grove Park Hospital 3 Infants' Hospital, Vincent Square 3 Hospital for Epilepsy and Paralysis 2 St. George's Home, Milman Street 3 Hospital for Women 2 Home and Hospital for Jews 1 Osterley Nursing Home 1 British Home for Incurables 1 Hackney Branch Institution 1 St. Mary's Nursing Home 1 303 VARIOUS. St. George's Home, Milman Street 1 On way to Fulham Hospital 1 Metropolitan Station, Baker Street 1 41, Cale Street 12 369, Fulham Road 2 la, Shepherdess Walk 1 Taken dead to St. Bartholomew's Hospital 1 129, St. John's Road 1 South Kensington Station, Metropolitan and District Railway 1 184, Drammond Street 1 2a, Bow Road 12 Great West Road 1 73, Cornwall Gardens 1 Fulham Palace Road, Fulham 1 Opposite 841, Harrow Road 1 29, Wimpole Street 1 Twyford Abbey. West, Twyford 1 Twyford Lodge, Arton Lane 2 112, Havcrstock Hill 1 12, The Grove, Highgate 1 Workworth House, Twickenham 2 249, Queen's Road 1 28, Kings Avenue 1 1, Ladbroke Square 1 30, Twickenham Road 1 19, Rose Road, Croydon 1 77a, Highgate Hill 1 Camberwell House 1 129a, Fulham Palace Road 1 Ormonde Gate, Chelsea (in street) 1 On way to Charing Cross Hospital 1 6, Colosseum Terrace, St. Pancras 1 25, Upham Park Road, wick 1 50, Kingston Hill 1 Station Road, Barnes 1 Falcon P. House, Kilburn 1 385, High Road, Chiswick 2 14G, Ifield Road, Kensington 1 River Thames, Barnes Bridge 2 38, Filmer Road, Fulham 1 92, Redeliffe Gardens 1 127, Ladbroke Road 1 29, North Side, Wandsworth Common 1 Gt. Central Railway Station, L. & N. E. Railway 1 285, Harrow Road 1 On way to Kensington Hospital 1 73 11 TABLE II. Causes of, and ages at, Death during the Year 1926. METROPOLITAN BOROUGH OF HAMMERSMITH. Causes op 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 age*. Under 1 year. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and upwards. Wards. 1 2 3 4 5 6 7 1 2 3 4 6 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 All Causes Certified 1535 144 32 20 14 3 18 13 38 111 120 390 650 234 317 284 83 243 236 138 461 Uncertified 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Enteric Fever 0 0 0 0 0 0 0 0 0 0 0 0 ii 0 0 0 0 0 0 1 Small-pox 0 0 0 0 0 0 0 0 0 0 0 0 (i 0 0 0 0 0 0 0 0 Measles 24 8 8 6 3 0 0 0 0 0 0 0 0 4 2 4 1 6 4 3 0 Scarlet Fever 2 0 1 0 0 0 0 0 1 0 0 1 (1 1 0 1 0 0 0 0 0 Whooping Cough 11 7 0 2 0 0 0 1 1 0 0 0 0 2 1 1 1 3 1 2 0 Diphtheria and Croup 14 2 1 3 3 1 3 1 0 0 0 0 0 2 2 4 1 2 1 2 0 Influenza 23 3 0 0 0 0 0 0 0 3 2 7 1 1 9 4 0 2 2 5 4 Erysipelas 2 0 0 0 0 0 0 0 0 0 0 2 0 1 0 0 0 1 0 0 0 Phthisis (Pulmonary Tuberculosis) 127 0 0 1 0 1 0 1 12 53 26 30 3 24 19 22 10 16 30 6 23 Disseminated Tuberculosis 3 1 0 0 0 0 0 0 1 1 0 0 1 1 1 | 0 0 0 o 0 Tuberculosis Meningitis 5 1 1 1 1 0 0 0 1 0 0 0 1 0 1 2 0 2 0 0 5 Other Tuberculous Diseases 7 0 0 0 0 0 0 0 3 1 2 1 0 1 1 1 1 0 2 1 3 Cancer, malignant disease 217 0 0 0 0 0 0 0 1 3 10 91 109 24 49 48 13 32 36 15 88 Rheumatic Fever 6 0 0 0 0 0 1 1 1 1 0 1 1 1 3 1 0 1 0 0 1 Meningitis 4 1 1 0 0 0 1 0 0 1 0 0 t 0 1 1 1 1 0 0 3 Organic H eart D isease 184 0 0 0 1 0 0 1 3 4 8 53 114 31 27 40 12 37 25 12 30 Bronchitis 111 3 1 1 0 0 0 0 0 2 5 18 81 21 20 18 4 15 20 13 15 Pneumonia(allforms) 105 13 11 4 1 1 4 0 1 5 8 29 28 17 19 21 2 16 12 18 28 Other Diseases of the Respiratory Organs 15 1 0 0 0 0 0 0 0 3 0 5 6 3 3 4 1 2 1 1 4 Diarrhœa and Enteritis 26 18 4 0 0 0 0 0 0 0 0 2 1 2 6 2 0 6 6 4 5 Appendicitis and Typbilitis 7 0 0 0 0 0 0 1 1 1 1 2 1 2 1 2 0 2 0 0 14 Cirrhosis of Liver 7 0 0 0 0 0 0 0 0 0 3 3 1 1 3 1 0 0 2 0 2 Alcoholism 0 0 0 0 u 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Nephritis and Bright's Disease 47 0 0 0 I 0 1 0 1 4 4 22 6 19 6 3 4 6 3 9 Puerperal Fever 3 0 0 0 0 0 u 0 0 2 1 0 0 0 0 1 0 1 1 0 0 Other Accidents and Diseases of Pregnancy and Parturition 4 0 0 0 0 0 0 0 0 2 2 0 i) 0 0 1 1 1 1 0 3 Congenital Debility and Malformation, including Premature Birth 58 58 0 0 0 0 0 0 0 0 0 0 1 6 10 9 1 11 11 10 11 Violent Deaths, excluding Suicide .. 52 1 1 0 0 0 6 1 2 8 4 10 19 7 10 10 5 9 8 1 45 Suicide 18 0 0 0 0 0 0 0 0 3 1 10 4 1 6 0 4 2 5 0 5 Other defined diseases 453 27 3 3 4 0 2 6 9 14 25 110 250 75 104 79 22 71 62 40 162 Diseases ill-defined or unknown 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 1535 144 32 20 14 3 18 13 38 111 120 390 650 231 317 284 83 243 236 138 461 Encephalitis Letharica 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 12 This rate is calculated on the estimated population of each Ward. Ward. Estimated Population. No. of Deaths. Death Rate. No. 1 River 17,647 234 13.3 No. 2 Brook Green 26,823 317 12.3 No. 3 The Grove 22,954 284 12.4 No. 4 St. Stephens 9,233 83 8.9 No. 6 Starch Green 22,780 243 10.7 No. 6 Wormholt 23,834 236 9.9 No. 7 College Park and Latimer 12,129 138 11.4 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 4,605,000 17.1* 0.61 11.6* 64* West Districts. Paddington 146,700 15.3 0.8 12.6 86 Kensington 180,000 15.1 0.6 12.8 60 Hammersmith 134,400 16.3 0.6 11.4 66 Fulham 164,300 16.2 0.6 10.8 64 Chelsea 64,820 13.3 0.7 12.5 64 City of Westminster 138,400 11.3 0.44 11.6 59.7 North Districti. St. Marylebone 105,800 12.7 0.5 11.9 81 Hampstead 87,580 12.3 0.23 10.6 60 St. Pancras 216,800 16.7 0.8 12.4 76 Islington 339,200 19.0 0.5 12.0 66 Stoke Newington 53,080 16.0 0.8 10.7 48 Hackney 228,500 17.2 0.46 10.8 59 Central Districts. Holborn 43,200 12.38 0.5 121 90 Finsbury 77.560 21.4 0.67 12.9 66 City of London 13,230 7.1 0.07 10.4 66 East Districts. Shoreditch 106,400 23.5 0.6 12.2 66 Bethnal Green 119,600 20.9 0.84 11.6 70 Stepney 256,100 19.4 0.79 11.5 65 Poplar 169,000 21.6 0.9 11.4 70 South Districts. Southwark 188,600 20.2 0.9 12.7 70 Bermondsey 123,100 19.6 0.76 12.1 60 Lambeth 311,000 17.9 0.5 11.6 38.4 Battersea 171,900 17.3 0.7 11.4 61.6 Wandsworth 342,100 14.1 0. 10.37 64 Camber well 275,400 16.6 ??? 14.0 70 Deptford 115,700 18.2 0.7 11.3 56 Greenwich 104,300 17.7 0.4 10.8 61 Lewisham 187,800 15.3 0.2 10.0 40 Woolwich 141,900 17.4 0.3 10.2 43 *These provisional figures are taken from a table furnished by the Registrar-General. Other figures supplied by Medical Officers of Health. 13 GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. HOSPITALS. "Farkside" Maternity Home, Ravenscourt Park, W.6.— This Home consisted of 20 beds and was opened by the Council in September, 1919, for the reception of maternity cases. In September, arrangements were completed with the Hammersmith Board of Guardians for the transfer of the Home to a Special Ward, consisting of 14 beds, at the Hammersmith Hospital, Du Cane Road, W.12. As a result, the Home at Ravenscourt Park was closed on the 30th September, 1926. 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 Road, W.12.— Accommodation for 10 mothers and their infants. This hostel is conducted by a voluntary society towards which the Minis try 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. Maternity Cases.—The London Ambulance Service provided by the London County Council is available for the conveyance of women to "Parkside" Maternity Home, Du Cane Road, W.12, between the hours of 11 p.m. and 8 a.m. CLINICS AND TREATMENT CENTRES. Hammersmith Infant Welfare Association. B 14 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 Clinic 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. 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 32 174 55 — — 377 144 — — 48, Glenthorne Road 152 — — 385 47 — — 5257 1744 Victoria Mission Hall, Becklow Road 98 — — 173 17 — — 2219 964 St. Matthew's Hall, Blythe Road 46 — — 135 24 — — 1774 661 Tenants' Institute, Old Oak Estate 19 34 22 — — 90 32 — — Tenants' Institute 49 — — 138 26 — — 2190 627 161, Sulgrave Road 38 52 12 — — 130 76 — — 161, Sulgrave Road 88 — — 150 21 — — 1959 923 Latymer Road Mission 42 — — 29 10 — — 667 601 Presbyterian Hall, Ponsard Road 47 — — 74 5 — — 921 436 611 260 89 1084 150 597 252 14987 5956 Ante-Natal Clinics 89 Infant Consultations 522 611 15 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. 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. B 2 16 STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF THE YEAR 1926. Medical Officer of Health and Administrative Tuberculosis Officer. Year of Appointment J. B. Howell, M.R.C.S., L.R.C.P., D.P.H. 1914 Tuberculosis Officer. R. Govan, M.A., M.D., Ch.B., D.P.H. 1918 Clerical Staff. *A. H. Wilmot (Chief Clerk) 1902 J. C. Turner 1920 C. M. White 11920 †Miss Cole 1923 R. J. Daw 1923 A. H. Johns 1925 Sanitary Inspectors. †S. Addison 1901 §*F. Q. Barry 1919 §*†P. T. Bayes 1926 §*W. J. Godden 1926 §*A. Hayes 1910 §*E. J. Nether 1926 §*P. W. Pottier 1919 §*W. Rigby 1919 §*L. W. Burrell 1924 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 17 Tuberculosis Dispensary Staff. Year of Appointment Mrs. 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. 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. 18 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 provided a district midwife in connection with "Parkside" Maternity Home. This service was discontinued as and from the 30th September. I am informed by Dr. F. N. Kay Menzies, the County Medical Officer of Health, that 34 midwives gave notice of their intention to practice in the Borough during 1926. Chemical Work.—This is carried out by the Public Analyst, a summary of 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 are provided with proper covers. The horse-drawn vehicles are only covered when the van has been loaded. These are of the high-loading type and require the use of ladders to deposit the refuse in the carts. The method is oldfashioned, wasteful and insanitary. Tt should be abolished and a modern low-loading type of vehicle used. Throughout the Borough, there are quite a number of ashpits. This means of depositing house refuse is not only out of date, but in the majority of cases leads to nuisances arising. In all cases which come before the Public Health Department, the owners are advised to close the same, and provide proper metal receptacles in accordance with the L.C.C. Bye-laws. 19 Cesspools.—During the year one cesspool was found and closed. 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 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 2,646 364 367 Complaints 3,801 2,041 1.863 Bakehouses 736 15 14 Outworkers 161 7 7 Houses let in lodgings — — — House to House 529 161 284 Housing and Town Planning Act 214 113 106 Factories and Workshops, &c. 1,839 43 38 Slaughterhouses 510 1 1 Milk Vendors 1,577 6 6 Ice Cream Vendors 224 — — Smoke 103 13 13 Food 6,622 39 41 Poultry Slaughterhouses 56 I 2 Drainage 2,288 152 153 Miscellaneous 14,708 366 347 35,914 3,322 3,242 During the year 953 Statutory Notices were served and 900 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 1926. Situation of Premises Nature of Offence No. of Summonses Result of Proceedings 340, King Street Failing to comply with Statutory Notices. 1 Order made. 14 days. Fine £5 and £1 costs. 16, Saunders Road ditto 1 Penalty £2. 63, Porten Road ditto 1 Withdrawn. Work done. 3, Porten Road ditto 2 Withdrawn. Work done. 48, Worbeck Road ditto 1 Withdrawn. Work done. 13, Avenue Road ditto 1 Withdrawn. Work done. 57, Wendell Road ditto 1 Wit hdrawn. Work done. 36, Hetley Road ditto 1 Withdrawn. Work done. 10s. 6d. costs. 1, Raynham Road ditto 1 Adjourned 14 days. Fined £10. 3, Letchford Gardens ditto 3 Withdrawn. Work done. 18. Rayleigh Road ditto 1 Adjourned 14 days. 1, West wick Gardens ditto 1 Adjourned 14 days. 37, Yeldbam Road ditto 1 Order made. 14 days. Fined £2. 340, King Street (William Saunders) Failing to comply with Closing Order 1 Order made for Compliance . Suspended 28 days. 104, Gayford Road Failing to comply with Statutory Notice. 1 Withdrawn. Work done. 31, Milson Road ditto 1 Order made. 7 days. 25, Maclise Road Failing to deposit drainage plans 1 Withdrawn. Requirements complied with. 340, King Street Failing to comply with Statutory Notice. 5 (1) Order made. 28 days. (2) Order made. 28 days. (3) Fined £1. (4) Fined £1. (5) Order made. 28 days. 77, Tunis Road ditto 1 Withdrawn. Work done. 1, Devonshire Villas ditto 1 Order made. 28 days. 24, Gayford Road ditto 3 Withdrawn. Work done. 28, Gayford Road ditto 1 Withdrawn. Work done. 17a, Netherwood Road ditto 1 Withdrawn. Work done. 4, Kinnear Road ditto 2 Withdrawn. Work done. 197, Dalling Road ditto 1 Order made. 28 day?. 30, Mardale Street ditto 2 Withdrawn. Work done. 27, Leffern Road ditto 1 Withdrawn. Work done. 10s. 6d. costs. 36b, Richmond Road ditto 1 Withdrawn. Work done. 10s. 6d. costs. 3, Hunt Street ditto 2 Withdrawn. Work done. 6. Hunt Street ditto 3 Withdrawn. Work done. 31, Milson Road ditto 2 (1) Withdrawn. Work done. (2) Withdrawn. Work done. 10s 6d. costs. 45, Railway Cottages ditto 1 Withdrawn. Work done. 10s. 6d. costs. 127, Percy Road ditto 1 Withdrawn. Work done. 21 Summonses—continued. Situation of Premises Nature of Offence No. of Summonses Result of Proceedings 8, Furber Street Failing to comply with Statutory Notice. 1 Order made. 14 days. 18, Rockley Road ditto 1 Order made. 14 days. 75, Becklow Road ditto 1 Withdrawn. Work done. 60, Bassein Park Road ditto 1 Withdrawn. Workdone. 1, Rockley Road ditto 1 Order made. 14 days. 197, Dalling Road ditto 1 Adjourned—sine die. (Council, by arrangement agreeing to do work). 48, Warbeck Road ditto 1 Withdrawn. Workdone. £1 1s. costs. 6, Letchford Gardens ditto 1 Withdrawn. Work done. 1a, Porten Road ditto 2 (1) Summons dismissed. (2) Withdrawn. Work done. 12, Lockton Street ditto 4 (1) Withdrawn. Work done. (2) Withdrawn. Work done. (3) Withdrawn. Work done. (4) Order made. 14 days. Fined £2. 7, Rigeley Road ditto 2 Order made. 28 days. 9, Rigeley Road ditto 1 Order made. 28 days. 11, Rigeley Road ditto 2 (1) Order made. 28 days. (2) Withdrawn. Work done. 8, Mall Road ditto 1 Order made. 7 days. £1 costs. 47, Granville Garder s ditto 2 (1) Order made. 28 days. 10s. 6d. costs. (2) Order made. 28 days 2, Masbro Road ditto 1 Withdrawn. Work done. 50, Rednall Terrace ditto 1 Withdrawn. Work done. 106, Rayleigh Road ditto 1 Order made. 21 days. Fined £3. 20, Fielding Road ditto 1 Withdrawn. Work done. £1 1s. costs. 47, Shepherd's Bush Road (Nurse A. Williams, 47, Shepherd's Bush Road) Failing to notify a birth. 1 Fined £1. £3 3s. costs. 59, Macfarlane Road (Nurse M. Pickett, 70, Pennard Road) ditto 1 Fined £1. £2 2s. costs. 49, Stowe Road (Nurse M. Pickett, 70, Pennard Road) ditto 1 Fined £1. £2 2s. costs 82, Rayleigh Road (Nurse A. Ilberry, 1, Hemlock Road) Failing to notify a case of Ophthalmia Neonatorum. 1 Summons dismissed. 22 Summonses—continued. Situation of Premises Nature of Offence No. of Summons. Result of Proceedings 34, Kenmont Gardens (Dr. W. McElroy, 725, Harrow Road) Failing to notify a birth. 1 Fined £1 1s. £5 5s. costs. 40, Goldhawk Road, (A. Tudgay, 44, Sydford Road, Queen's Road, Paddington. W.) Failing to use a Humane Killer for slaughtering animals. 1 Fined £2. 375, King Street (E. Stannard, 2, Beddington Corner, Mitcham, Surrey) Removal of offensive matter during prohibited hours. 1 Fined £3. 123, King Street Depositing for 2 Fined £20. (A. Dangerfield) purpose of sale or of preparation for sale, certain meat, being unfit for the food of man. Failing to take requisite steps to prevent contamination of meat by flies. 1 Fined 10s. 83, Rayleigh Road Failing to comply with Statutory Notice. 1 Withdrawn. Work done 1, Rockley Road ditto 1 Withdrawn. Work done. 20, Maclise Road ditto 2 (1) Order made. 28 days. 10s. 6d. costs. (2) Order made. 28 days. 32, Hazlitt Road ditto 2 Order made. 28 days. 340, King Street ditto 6 Adjourned 21 days. 340, King Street Failing to 1 Adjourned—sine die. (William Saunders) ply with Closing Order. 56a, Ormiston Road Failing to comply with Statutory Notice. 1 Order made. 7 days. 48a. Oaklands Grove ditto 1 Older made. 21 days. 25, Banim Street ditto 1 Withdrawn. Work done. 24, Ponsard Road ditto 1 Adjourned 14 days. 7, Letchford Gardens ditto 1 Adjourned 14 days. 2, Masbro Road Failing to abate overcrowding. 1 Order made. 28 days. 35, Galloway Road Failing to comply with Statutory Notice. 1 Withdrawn. Work done. 165, Goldhawk Road ditto 1 Withdrawn. Work done Factories and Workshops, etc.—During the year 43 notices were served in reference to insanitary conditions and defects 23 found to exist during the inspection of the factories, workshops and workplaces in the Borough, and during the same period 38 notices were complied with. During the previous year there were 82 notices served and 50 complied with. The following is a list of the Factories and Workshops upon the Register:— Restaurants, Hotels, &c. 162 Bakehouses (15 not in use as Bakeries) 63 Bootmakers 51 Motor and Cycle Makers 17 Dressmakers and Milliners 78 Laundries 59 Outworkers 277 Letterpress Printers and Bookbinders 19 Electrical and Mechanical Engineers 38 Smiths, Wheelwrights and Coach builders 36 Tailors 48 Builders, Carpenters and Joiners 54 Miscellaneous 358 Total 1,260 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 Adminis (ration 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 Written Notices Prosecutions Factories (including Factory Laundries) 925 16 — Workshops (including Workshop Laundries) 486 19 — Workplaces other than outworkers' premises included in Part 3 of this report) 428 8 — Total 1,839 43 — 24 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts— — Want of Cleanliness 15 16 — — Want of Ventilation 12 12 — — Overcrowding — — — — Want of Drainage of Floors 1 1 — Other Nuisances 19 19 — — Sanitary Accommodation insufficient — — — — unsuitable or defective 16 16 — — not separate for sexes 1 1 — — Offences under the Factory and 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 66 67 — —— 3.—HOME WORK. Nature of Work Outwork in Unwholesome premises, Sec. 108 Outwork in Infected Premises Secs. 109, 110 Instances Notices served Prosecutions Instances Orders made (Sec. 110) Prosecutions (Sec. 109. 110) Wearing apparel— (1) making, etc. 5 5 — 1 — — (2) cleaning and washing — — — — — — Furniture and upholstery — — — — — — Totals 5 5 — 1 — — 25 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year Number Bakehouses 33 Dressmakers 109 Laundries 25 Others 275 Total number of workshops on Register 442 5.—OTHER MATTERS. Class Number Matters notified to H M. Inspector of FactoriesFailure to affix Abstract of the Factory and Workshop Act 1901 (S. 133) 2 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act, 1901 (S.5) Notified by H.M. Inspector 12 Reports (of action taken) sent to H.M. Inspector 12 Other — Underground bakehouses (S.101)— Certificates granted during year — In use at the end of the year 30 House to House.—As a result of the house to house visitation 529 inspections were made, 161 notices served, and 284 complied with. It is important that this work should be systematically parried out. Houses Let in Lodgings.—During the year no new houses were registered. Rats and Mice (Destruction) Act, 1919.—During the year the Rats and Mice (Destruction) Act, 1919, continued in operation, the District Inspectors being responsible for its administration in their respective districts. Section I places the responsibility of ridding the premises of the pest upon the occupier, but this is somewhat difficult when dealing with tenement houses containing in some cases three or more families. During the year 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 results have been obtained. 26 Old buildings often provide ideal accommodation for rats; hollow partitions, space between floors and ceilings and under basement flooring being used for nesting. It is a difficult matter to rid such premises of rats. Generally speaking some improvement has been made, but it appears to me that no great advance will result until systematic attack is made upon the rodents in their chief breeding grounds, the sewers. Throughout the Borough, and I have no doubt throughout the whole of London, there exist old brick sewers swarming with rats, from which they emerge at night and enter dwellings and other premises. Smoke Abatement.—During the year observations were kept in reference to black smoke emitted from the various factories, laundries, bakehouses, &c., situate in and adjoining the Borough. Thirteen 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. Notting 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. Swan Laundry, Blythe Road. Ivy House Sanitary Laundry, Becklow Road. H.B.C. Electricity Works, Fulliam Palace Road. Thompson & Norris, Worple Way, Acton. C. A. Vandervell, Larden Road. King's Theatre, Hammersmith Road. 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. 27 Ice Cream Vendors.—The compulsory registration of ice cream vendors has been the subject of enquiry for some years past. I submitted a report to the Public Health Committee in June, 1921, when, following the approval of my recommendations, the London County Council was asked to include a clause in a General Powers Bill, which would provide for such compulsory registration. Compulsory registration of all premises where ice cream is manufactured, stored or sold, is required to ensure that the manufacture or storage is carried out under proper conditions. Under present legislation, it is not necessary for any person to obtain permission to manufacture or sell, and it is a matter of great difficulty to keep the register required by the London County Council (General Powers) Act. During the past year, in this Borough, twelve additional premises were placed on the register, but it is certain that others have been used for manufacturing and have not yet been discovered. More often than not, these premises are discovered by accident. This must be so, failing a systematic inspection of the whole of the Borough. During the same period many businesses have changed hands. It is not necessary, at present, for the new owner to notify the change, and it has been found that premises kept in proper condition at the time of registration—have become far from satisfactory under the new ownership. It cannot be too strongly pointed out that the sale of this commodity, made or sold under insanitary conditions, may prejudicially affect the health of those persons partaking of it. The question is again becoming the subject of discussion, and a further request has been made to the London County Council, through the Society of Medical Officers of Health, for powers to secure compulsory registration. 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 inform the Divisional Superintendent. 28 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. HOUSING. Overcrowding in the congested areas of the Borough is still as acute as described in the last annual report. In 1926, approximately 202 houses were erected, all by private enterprise. Altogether 1,640 houses have been completed since 1920, but in spite of this, there appear to be as many applicants for housing accommodation as existed a year ago. It frequently happens that families consisting of man, wife and several children are found to be occupying one or two rooms. This often leads to offences against the Bye-Laws of the London County Council, with regard to indecent occupation, where people of opposite sex sleep in the same room. This is bound to cause a sense of moral degradation and unhappiness amongst the families concerned. Many Notices for overcrowding have been served on these people during the year. A notable and praiseworthy attempt at housing for the working classes is nearing completion on the site of the Convent of the Good Shepherd, Fulham Palace Road. Here, the Peabody Donation Fund are erecting a complete lay-out of blocks of dwellings and cottages with 1, 2, 3 and 4 rooms with domestic conveniences for about 280 families. The layout has been well conceived, distribution of accommodation is excellent, and from an architectural point of view it is splendid in every way. There are central baths and washhouses with a constant supply of hot water. In these buildings the family washing is done, near to, but outside the house, and must be a great boon to the occupiers. There is an excellent series of baths which must add to the general cleanliness and health of the people. The only criticism one can offer is that the lighting is done by gas instead of electricity. This, in my opinion, is to be regretted. On the whole one cannot but admire the Peabody Donation Fund for the erection of these buildings and the Architect for the lay-out and general design. 29 It is an example which might very well be followed generally, when dealing with the rehousing of large numbers in small areas near to their occupation. Before the next annual report is published, it is to be hoped that the Southern Improvement Scheme for the re-housing of the people will have been commenced on somewhat similar lines. 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. Two hundred and two Certificates were granted during the year under Section 48 (2) of the Public Health (London) Act, 1891, with regard to newly erected houses and flats having a proper and sufficient water supply. Since the War, 1,640 houses and flats 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.C. 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 1926 Nil Nil 202 Totals 741 585 314 The premises have provided accommodation for approximately 8,200 persons, but despite this fact overcrowding is still in evidence. At the moment of writing I am informed that there are upwards of 2,000 applications for houses still to be dealt with. c 30 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, 1926. 1.—General. (1) Estimated population 134,400 (2) General death-rate 11.4 (3) Death-rate from tuberculosis 1.1 (4) Infantile mortality 66 (5) Number of dwelling-houses of all classes (estimated) 18,815 (6) Number of working-class dwelling-houses (estimated) 12,000 (7) Number of new working-class houses erected 202 2.—Unfit Dwelling-houses II.—Inspection. (1) Total number of dwelling-houses inspected for Housing defects (under Public Health or Housing Acts) 6.110 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 214 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (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 2,754 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 31 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 2,754 (2) Number of dwelling-houses in which defects remedied— (a) By owners 2,697 (6) 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 Nil (2) Number of dwelling-houses in respect of which Closing Orders were made Nil (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 Nil (5) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil c 2 32 INSPECTION AND SUPERVISION OF FOOD. Milk Supply.—In the Borough of Hammersmith, very large quantities of milk arrive daily at the L. M. & S. railway station at Willesden Junction, from farms in all parts of the country. Much of this milk is transferred by trains to other parts of London and the suburbs. The remainder is conveyed by motor lorries to the premises of local dairymen and wholesale dealers. Periodical inspections are made at the station to ensure, as far as possible, that the milk is not unnecessarily exposed to contamination. The new design of churn which is coming largely into use is helping to this end, and the provisions of the Milk and Dairies Order, 1926, prohibiting the opening of any churn or vessel in any railway van or on any railway station, should further safeguard the milk at this stage of its journey from the cow to the consumer. The majority of small traders in this Borough obtain their supplies of milk from wholesale dealers, who deliver by lorry to the traders' premises. The greater part of the milk is delivered in closed churns, but when small quantities are required, the milk is measured out of a churn on the lorry into hand cans. The opening of the churns in the streets renders the milk liable to contamination by dirt and dust from the roadway. The hands of the carmen who have to measure out the supplies are often far from clean, due to the handling of the churns, &c., and often come into actual contact with the milk. In some towns in the North of England, regulations are in force to prohibit the transfer of milk from one vessel to another in the open streets. Similar regulations applied to London would be of assistance. One of the big difficulties with regard to a clean milk supply in London has been with regard to the premises of the small trader. A few years ago a systematic investigation was made in the Borough of Hammersmith, as a result of which, fifty-four premises were removed from the register of milkshops. From many "general" or chandlers' shops at which milk was retailed, coal or coal blocks, firewood, hearthstone, soap, greengrocery (potatoes, onions, &c.), paraffin oil, pickles, vinegar and other dirty, dusty and strong-smelling goods were sold. Many of the shops were in a dirty condition, and even when the shopkeeper was a clean and careful person, the crowded condition of the shop, and the fact of the floor being permanently lumbered up with boxes, barrels, firewood, &c., effectually prevented proper cleanliness. 33 It is now the practice in this Borough, before consideration is given to an application for permission to sell milk, to require a written undertaking from the applicant that he will not sell any of these articles. The premises used for the sale of milk must be efficiently lighted and ventilated, and must not communicate directly with any room used for sleeping or with any water-closet. The floor of the shop must be kept clear, so as to allow of effectual cleansing, and all vessels containing milk must, at all times, be kept properly covered. Frequent inspections are made to see that these regulations are complied with. The delivery of milk to the consumer in glass bottles has, of recent years, greatly increased, and in such cases the Milk and Dairies Order requires that the bottles shall be filled in the dairy. The present state of legislation, however, still permits milk to be retailed in the streets from hand-cans. These hand-cans must of necessity, be opened for varying periods whilst the milk is being measured out, and thus expose the milk to contamination from manure and dirt from the roadway. The question of cleanliness of milk bottles is one which receives special attention in this Borough. In a number of cases the washing of bottles has been found to be carried out in a casual manner, and constant supervision is necessary to ensure clean bottles. The ideal milk supply would be one produced under ideal conditions and bottled at the farm, as is the case with "certified" milk. The cost of transport to the towns would, perhaps, prevent the adoption of such a system on a large scale. Although not attaining our ideal, the system in operation at one dairy in this Borough has much to commend it. All milk to this dairy is delivered direct from the farms to a private railway siding on the premises. From the time of its arrival until it leaves the premises in bottles, the milk is subjected to the minimum of exposure and handling. After pre-heating, the milk is passed through a series of pipes to a number of centrifugal clarifiers. From these it is conveyed by a further series of pipes to "Pasteurizing" plant of the "Holding" type, from whence, after cooling, it is passed to numerous automatic bottle-filling machines. After every batch of milk has been dealt with, the whole of the plant, including all pipes, is thoroughly cleansed with boiling water. In use at these premises are some of the largest bottlewashing machines in the world. An average of 40,000 gallons of milk per day are dealt with at this dairy. Although much still requires to be done before a satisfactory milk supply is assured, considerable improvement has been made during recent years in the milk supplies of London. 34 The latest Milk and Dairies Order, if properly carried out, will undoubtedly make for a cleaner and purer supply, but constant inspection and supervision is necessary to ensure that the regulations are complied with. During the year 315 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. During the year, it was not necessary to serve a notice requiring the suspension of the sale of milk under the Dairies, Cowsheds and Milkahops 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" 6 (3) Dealers' Licences to use the designation "Grade A (Tuberculin Tested)"— (a) Bottling Establishments Nil (b) Shops 6 (4) Dealers' Licences to use the designation "Grade A"— (a) Bottling Establishments Nil (b) Shops Nil (5) Dealers' Licences to use the designation "Pasteurised"— (a) Pasteurising Establishments 1 (b) Shops 8 Milk and Dairies Order, 1926. Public Health (Imported Milk) Regulations, 1926. In July the Minister of Health forwarded for the information of the Authority a copy of the Milk and Dairies Order, 1926, made under Section 1 of the Milk and Dairies (Consolidation) Act, 1915, and a copy of the Public Health (Imported Milk) Regulations, 1926, made under the Public Health (Regulations as to Food) Act, 1907, and Sections 8 (1) of the Milk and Dairies (Amendment) Act, 1922. 35 The Milk and Dairies Order, 1926. The Order revokes the Dairies, Cowsheds and Milkshops Orders of 1885, 1886 and 1899, so far as they relate to England and Wales, and all Regulations made thereunder by Local Authorities. The main provisions of those Orders and Regulations are replaced in the present Order by provisions similar in general purpose but modified in accordance with the development of modern hygienic knowledge so as to lay greater stress on cleanliness in all operations connected with the production and handling of milk (including the care of the cow) than upon the structure of buildings. The most important of the new provisions of the Order are those relating to the health and inspection of cattle, and to the handling, conveyance and distribution of milk. The former provisions are contained in Part IV of the Order and are supplementary to the sections of the Act (Sections 3, 4 and 5), which involve the inspection of cattle, and they will accordingly be administered by the Authorities upon whom is laid the duty of enforcing those sections, i.e., the Councils of Counties and County Boroughs. In connection with the general arrangements for the administration of the Act and the Tuberculosis Order the Minister desires to remind Local Authorities of the convenience and economy of having the same Veterinary Surgeons available for both purposes, as mentioned by the Ministry of Agriculture and Fisheries in their Circular of the 15th July. 1925. In a few cases where Veterinary Officers have been appointed by Sanitary Authorities for the purposes of the administration of the existing Dairies, Cowsheds and Milkshops Orders, the question whether these officers should be transferred to the County Council at the commencement of the new Order should be considered at an early date by the Authorities concerned. The remainder of the Order is enforceable by Sanitary Authorities. In connection with the administration of Part VIII (relating to the conveyance and distribution of milk) it may be observed that the officers of County Councils in the exercise of their duties under the Sale of Food and Drugs Acts will have opportunities for observing the conditions under which milk is consigned by rail (including the condition and marking of churns), and it is suggested that, where they have reason to suspect any contravention of the provisions of the Order, they should notify the responsible Sanitary Authority. Except with regard to registration, specific provisions have not been inserted in the Order for the mutual exchange of assistance and information between County Councils and Sanitary Authorities, but the Minister feels sure that all Authorities and their officers will realise the importance of co-operation in the administration of the Order 36 without any specific duty in this respect being imposed on them. Public Health (Imported Milk) Regulations, 1926. The Regulations require the registration by Port and Riparian Sanitary Authorities of persons receiving imported milk and give power to the registering Authorities, similar to that conferred by Section 2 of the Milk and Dairies (Amendment) Act, 1922, in regard to retailers, to refuse registration or to remove a person from the register if the requirements of the Regulations in regard to the condition of the milk are not complied with. These requirements, viz., freedom from tubercle bacilli and a limitation of the bacterial content, are, as the Minister is advised, such as can suitably be applied to milk which has been submitted to a pasteurising or other heating process which is a commercial necessity for imported milk. Milk and Dairies, England. The Milk and Dairies Order, 1926, dated July 6, 1926, made under the Milk and Dairies (Consolidation) Act, 1915 (5 & 6 Geo. 5. c. 66). The Minister of Health in pursuance of his powers under the Milk and Dairies (Consolidation) Act, 1915, and with the concurrence of the Minister of Agriculture and Fisheries, hereby orders as follows:— PART I. Short Title, Operation, Interpretation, &c. 1. This Order may be cited as the Milk and Dairies Order, 1926, and shall come into operation on the 1st day of October, 1926: Provided that— (i) Articles 12 (1), 13 (1) and 25 shall not apply to any building in use as a cowshed or dairy on the 1st day of October, 1926, until a period of eighteen months has elapsed after the service of a notice by the sanitary authority drawing the attention of the occupier thereto, and in the case of Article 25 no such notice shall be given before the 1st day of April, 1928; (ii) Article 24 shall not come into operation until the 1st day of April, 1927; and (iii) Articles 27 and 29, shall not come into operation until the 1st day of October, 1928. 2.—(1) In this Order, unless the contrary intention appears:— "Infectious disease" means dysentery and any infectious disease to which the Infectious Disease (Notification) Act, 1889 (a) applies; "The Act" means the Milk and Dairies (Consolidation) Act, 1915; "Cowkeeper" means any person who keeps one or more cows for the purpose of the supply of milk; "Milk" means milk intended for sale for human consumption or for use in the manufacture of products for sale for human consumption, and includes cream, skimmed milk and separated milk; 37 "Dairy" includes any farm, cowshed, milk store, milk shop or other place from which milk is supplied on or for sale, or in which milk is kept or used for purposes of sale or manufacture into butter, cheese, dried milk or condensed milk for sale, and, in the case of a purveyor of milk who does not occupy any premises for the sale of milk, includes the place where he keeps the vessels used by him for the sale of milk, but does not include a shop from which milk is not supplied otherwise than in properly closed and unopened receptacles in which it was delivered to the shop or a shop or other place in which milk is sold for consumption on the premises only. "Registered premises" means any building or other premises required to be registered under the provisions of this Order. (2) The Interpretation Act, 1889, applies to the interpretation of this Order or in relation to the revocation of any Order or Regulation by this Order, as it applies to the interpretation of an Act of Parliament. 3. Part IV of this Order shall be enforced and executed by the council of the county or county borough and the remainder of the Order by the sanitary authority: Provided that, where the Minister of Health has made an Order under Sub-section (4) of Section 3 of the Act with respect to a non-county borough, Part IV of this Order shall be enforced and executed by the council of such borough as if the borough were a county borough. 4. Every cowkeeper and dairyman shall take all practicable steps to make the provisions of this Order known to every person in or about any registered premises in his occupation so far as such provisions impose any duties or restrictions on such person and so far as they relate to the processes carried out by such person. PART II. Revocation of Orders and Deculations. 5. The Dairies, Cowsheds and Milk-shops Order of 1885, the Dairies, Cowsheds and Milk-shops Amending Order of 1886, and the Dairies, Cowsheds and Milk-shops Order of 1890, so far as they relate to England and Wales, and any regulations made by local authorities in England and Wales under the said Orders are hereby revoked. PART III. Registration and Noticfs. 6.—(1) Every sanitary authority shall keep registers of all persons carrying on in their district the trade of cowkeeper or dairyman and of all farms and other premises within their district which are used as dairies. (2) Subject to the provisions of Section 2 of the Milk and Dairies (Amendment) Act, 1922, or of any other statutory enactment, the sanitary authority, on (he application of any person proposing to carry on in their district the trade of cowkeeper or dairyman or to use any farm or other premises in the district as a dairy, shall register such person or such premises. (3) Subject as aforesaid, no person shall carry on the trade of cowkeeper or dairyman or use any premises as a dairy unless he and any such premises are registered in pursuance of this article. (4) The sanitary authority shall immediately after the commencement of this Order inform the county council of the particulars of registration then in force of cowkcepers and their premises, and they shall as soon as may be inform the county council of all alterations made in the registers. 38 7. Before commencing to use as a cowshed or as a place for the keeping of milk a building not previously used for that purpose the occupier shall give one month's notice in writing to the sanitary authority of his intention so to do. PART IV. Health and Inspection of Cattle. 8. Every county council and county borough council shall cause to be made such inspections of cattle as may be necessary and proper for the purposes of the Act and of this Order. 9. Where a veterinary inspector gives notice to a cowkeeper of his intention to make an inspection of cattle for the purposes of the Act or of this Order the cowkeeper shall not allow any cow to be removed from the registered premises without the consent of the inspector until the inspection has been made or a period of forty-eight hours has elapsed from the receipt of the notice. 10. A veterinary inspector making the inspection of cattle in pursuance of the Act or of this Order may require any cow to be milked in his presence and may take samples of the milk and may require that the milk from any particular teat shall be kept separate, and he may take separate samples thereof. 11. The following diseases affecting cows, in addition to the diseases specified in Section 5 of the Act, shall be diseases for the purposes of that section, namely:— Any comatose condition; Any septic condition of the uterus; Any infection of the udder or teats, which is likely to convey disease; Provided that, where an officer of a local authority gives a notice under the section with regard to any of the diseases set out in this article:— (1) The notice shall forthwith be withdrawn as soon as the officer or the authority is satisfied that the cow is no longer in an infective condition; and it shall in any case cease to operate at the expiration of such period not exceeding five days as may be specified therein, but without prejudice to the right of the officer to give a further notice or notices with a like limitation of duration; and (2) The local authority shall, if required so to do by the person receiving such notice, afford him an opportunity to appear before them for the purpose of applying for the withdrawal of the notice and shall consider any written representations made by him for the same purpose. PART V. General Provisions for Securing the Cleanliness of Dairies, &c., and for Protecting Milk against Infection and Contamination. 12.—(1) Every cowshed and every building used for keeping milk, other than a cold store, shall be provided with a sufficient number of windows or other openings suitably placed and communicating directly with the external air. The windows or permanent openings shall be such as to secure that the building is sufficiently lighted during the hours of daylight and the openings provided for ventilation shall be kept in proper order and so used as to secure that the air in the building is kept in a fresh and wholesome condition (2) Every such building in which milking or any other process is carried on during the hours of darkness shall also be provided with 39 such lamps or other means of artificial lighting as will enable any such process to be conducted in a good and proper light. 13.—(1) All registered premises shall be provided with a supply of water suitable and sufficient for the requirements of this Order. (2) Every receptacle used for the storage or conveyance of water shall be emptied and cleansed from time to time as often as may be necessary to prevent the pollution of the water and to maintain it in a suitable condition for the purpose for which it is required. (3) The water supply used for the watering of cows shall, as far as reasonably possible, be protected against contamination caused by the drainage of foul water. 14. The following provisions shall apply for the purpose of preventing contamination or infection of milk:— (1) Milk shall not be deposited or kept in any place where it is liable to become contaminated or infected. In particular it shall not be deposited or kept— (i) in any room used as a kitchen, scullery, living-room or sleeping-room; or (ii) in any room or part of a building which communicates directly by door, window or otherwise with,— (а) any water-closet, earth-closet, privy, cesspool or receptacle for ashes or other refuse; or (b) any room which is used as a sleeping-room or any room which is occupied by a person suffering from an infectious disease, or which, having been so occupied, has not been subsequently properly disinfected; or (iii) in any room or part of a building in which there is any direct inlet to a drain which is not efficently trapped; Provided that the foregoing provisions shall not be deemed to prohibit the deposit or keeping of milk intended for use in the manufacture of butter, cream or cheese in a room used as a kitchen. (2) Vessels containing milk shall be properly covered or the milk shall be otherwise effectively protected from dust, dirt, flies or other sources of contamination; (3) No foul or noxious matter or soiled bed or body clothing shall be conveyed through any part of a building used for the keeping or storage of milk. 15. Every person engaged in the milking of cows or the distribution or measuring of milk or otherwise having access to the milk or to the churns or other milk receptacles shall keep his clothing and person in a cleanly condition. 16. A person shall not carry out any process of cooling, bottling, sterilising or pasteurising milk or any other process connected with milk, or keep any appliances connected with any such process, in a cowshed or in any place where the milk or appliances would be liable to contamination arismg from any cowshed, stable or manure-heap, or otherwise. 17.—(1) Every person having access to the milk or to the churns or other milk receptacles in or about any registered premises, as soon as he becomes aware that any member of his household is suffering from any infectious disease, shall immediately notify the occupier of such premises of the fact and the occupier shall immediately notify the 40 medical officer of health of the district in which the premises are situate unless notification has already been given to that officer. (2) Where the medical officer of health of any sanitary district becomes aware that any such person is suffering from an infectious disease or has recently been in contact with a person so suffering he shall forthwith notify the occupier of such premises of the fact, and where the council of such sanitary district are not the registering authority for the locality in which the premises are situate he shall also notify the medical officer of health of the registering authority. 18.—(1) Where the medical officer of health of a sanitary district is in possession of evidence that any person is suffering from infectious disease caused by the consumption of milk supplied within the district from any registered premises or that the milk at any registered premises within the district has been infected with such disease, he may by a notice in writing to the occupier of such premises specifying such evidence require, if the premises are within the district, that no milk from such premises (or, if the notice so provides, no milk received at such premises from any specified source) shall be sold for human consumption or used in the manufacture of products for human consumption, or, if the premises are without the district, that no such milk shall be sold for human consumption within the district. (2) Any such notice shall operate for such period not exceeding twenty-four hours as may be specified therein from the time of the receipt of the notice but may be renewed for a further period or periods of twenty-four hours. The notice shall forthwith be withdrawn as soon as the medical officer of health is satisfied that the milk is no longer likely to cause infectious disease. (3) Where the medical officer of health serves such a notice he shall forthwith report the matter to the sanitary authority, and if the premises are within the district he shall forthwith endeavour to ascertain the causes of the infectious condition of the milk. (4) Where the milk in respect of which a notice is given under this article is obtained from any registered premises without the district, the medical officer of health shall forthwith send a copy of the notice to the mediial officer of health of the sanitary district from which the milk is obtained. (5) No person shall sell milk for human consumption or use milk of sell milk for use in the manufacture of products for human consumption contrary to the terms of a notice given by the medical officer of health under this article. (6) Where any person sustains any damage or loss by reason of a notice issued under this article he shall be entitled to full compensation from the sanitary authority in case it shall appear that no infectious disease was in fact caused by the consumption of milk from the premises to whose occupier the notice was addressed or as the case may be that no milk at such premises had been infected with such disease. Any dispute as to the right to or the amount of such compensation shall be settled by arbitration in the same manner as provided by the Public Health Act, 1875, and any sum awarded as compensation shall be recoverable as a civil debt: Provided that if the compensation claimed does not exceed twenty pounds it may at the option of either party instead of being settled as hereinbefore provided be settled by and recoverable before a Court of Summary Jurisdiction. 19.—(1) Where the medical officer of health of the registering authority by reason of such notification or otherwise suspects that any of the persons in or about any registered premises who have access to the milk or to the churns or other milk receptacles is suffering from an infectious disease or has recently been in contact with any person so suffering or is in such a condition that there is a danger of his trans- 41 mitting an infectious disease he may give notice to the occupier of such premises that he considers it necessary to make an examination of any or all of such persons; and where he gives such notice, the said occupier and every person concerned shall give to the medical officer of health all reasonable facilities for making such examination. (2) Where from the result of any such examination or otherwise the medical officer of health is of opinion that the employment of any such person is likely to lead to the spread of infectious disease, the medical officer of health may give notice in writing to that effect to the occupier of the registered premises and to the person concerned requiring that, during a period to be specified in such notice, the person to whom the notice relates shall not milk cows or handle vessels used for containing milk or in any way take part in the production, distribution or storage of milk. (3) A person to whom any such notice relates and any other person who is suffering from an infectious disease or has recently been in contact with a person so suffering shall not milk cows or handle vessels used for containing milk or in any way take part in the production, distribution or storage of milk until the expiry of the period, mentioned in the notice or, as the case may be, until all danger of the communication of infectious disease by means of the milk has ceased. (4) No cowkeeper or dairyman shall allow any person to whom any such notice relates, or any other person who is so suffering or has recently been in contact as aforesaid, to milk cows or handle vessels used for containing milk or in any way to take part in the production, distribution or storage of milk, until the expiry of the period mentioned in the notice or, as the case may be, until all danger of the communication of infectious disease by means of the milk has ceased. 20. No person shall keep any swine or poultry in any cowshed or room in which cows in milk are kept or milked or in which milk or milk utensils are kept or in any room or shed communicating directly therewith. 21. Every cowkeeper or dairyman shall cause all vessels (including the lids of such vessels) and appliances used or intended to be used by him for containing, measuring or stirring milk, or for any other purpose for which they may be brought into contact with milk, to be kept at all times in a state of thorough cleanliness. For this purpose— (i) Every such vessel, lid and appliance shall be thoroughly washed as soon as may be after use, and shall be cleansed and scalded with boiling water or steam before it is used again. (ii) No oxidising or preservative agent shall be used in the ing of any such vessel or appliance. (iii) Every such vessel, lid and appliance, when not in use shall be stored in a clean place and shall be protected from dust and dirt. (iv) No such vessel or appliance shall be used for containing, measuring or applying any process or treatment to any article other than milk or milk products: Provided that the requirements set out in paragraphs (i) and (ii) shall not apply to mechanical milkers and similar appliances used in milking which are efficiently cleansed so that all trace of any substance used in the cleansing is removed before they are brought into contact with milk. 42 PART VI. Special Provisions applicable to Cowkeepers. 22.—(1) Every cowkeeper shall cause every part of the interior of every cowshed in his occupation to be thoroughly cleansed from time to time, as often as may be necessary to secure that such cowshed shall be at all times reasonably clean and sweet. (2) He shall cause the ceiling or interior of the roof and the walls of every such cowshed to be properly lime-washed or sprayed with lime or otherwise disinfected twice at least in every year, that is to say, once during April or May and once during September or October, and at such other times as may be necessary: Provided that this requirement shall be deemed to be satisfied as regards any part of such ceiling or walls which is properly painted or varnished or constructed or covered with tiles or other smooth washable material if that part is properly washed from time to time as often as may be necessary to keep it clean. (3) He shall cause all dung and other offensive matter to be removed from any cowshed in his occupation in which cows are milked at least once in every day. (4) He shall not cause any dung or offensive matter to be so placed as to render uncleanly the access to any cowshed or milk room. 23. Every cowkeeper shall cause the following precautions to be taken in connection with the milking of cows, viz.:— (i) The milking shall be carried out in a good and proper light whether in the daytime or in the hours of darkness. (ii) Before milking is begun, all dirt in or around the flanks, udder and teats of each cow shall be removed, and the udder and teats shall be cleansed by being thoroughly rubbed with a clean damp cloth. (iii) The hands of the milker shall be thoroughly washed and dried before milking and shall throughout the milking be kept clean, free from contamination and, as far as practicable, dry. (iv) All milking stools shall be kept thoroughly clean. (v) As soon as possible after milking, the milk of each cow shall be removed from the cowshed to a suitable milk room or shall be placed in a covered receptacle. (vi) No dry bedding or other dusty matter shall be moved in the cowshed during the milking or within half an hour before the milking commences, except so far as may be necessary for the removal of dung. 24.—(1) Every cowkeeper shall, without any delay other than that caused by any process of straining or centrifugalisation to which it may be subjected, cause the milk to be cooled to a temperature not more than five degrees Fahrenheit higher than the temperature of the water supply available for cooling : Provided that this requirement shall not apply— (i) where the milk is delivered by road without delay to a ing station provided with adequate facilities for cooling milk to a temperature not exceeding fifty-five degrees Fahrenheit; or (ii) where the milk is used for the manufacture of butter, cream, cheese or other miik products at the premises where it is produced or is supplied to some other person for this purpose; or 43 (iii) where the cowkeeper sells the milk to the consumer and either delivers it at the premises where it is produced or dispatches it at least twice a day on the day of production; or (iv) where the cowkeeper sells the milk to some other purveyor at the premises where it is produced for delivery to the consumer immediately after milking. (2) Every person who receives at a collecting station milk which has not previously been cooled shall forthwith cause it to be cooled to a temperature not exceeding fifty-five degrees Fahrenheit unless he uses it in the preparation or manufacture of butter, cream, cheese or other milk products and every person who purchases for re-sale milk which has not previously been cooled shall cause it to be cooled forthwith to a temperature not exceeding fifty-five degrees Fahrenheit unless he uses it as aforesaid or delivers it to the consumer immediately after milking. 25. Every cowkeeper shall cause the floor of every cowshed in his occupation to be constructed of such material and in such manner as to render it practicable to remove all liquid matter which may fall thereon, and he shall cause such cowshed to be provided with channels of rendered concrete or other durable and impervious material so constructed as to prevent as far as reasonably practicable the soiling of the cows and so as to receive all such liquid matter and to convey it to a suitable drain or other place of disposal outside such cowshed. PART VII. Special Provisions Applicable to Buildings used for the Sale, &g., of Milk. 26. The following provisions shall apply to any building or part of a building which is used for the sale of milk or in which milk is kept or used for the purpose of sale or manufacture into butter, cheese, dried milk or condensed milk for sale:— (1) The occupier shall cause the interior and the furniture and fittings therein to be thoroughly cleansed from time to time as often as may be necessary to secure the maintenance of reasonable cleanliness, and in particular the floors shall be thoroughly cleansed with water at least once in every day. (2) Except in the case of a building or part of a building which is used for the sale of milk by retail the occupier shall cause the floor to be constructed of rendered concrete or other durable and impervious material and to be so sloped as to ensure the removal of all liquid matter which may fall thereon, and to be provided with channels so constructed, sloped and placed as to receive all such liquid matter and to convey it to a suitable drain or other place of disposal outside the building. PART VIII. Conveyance and Distribution of Milk, Churns, &c. 27. A person shall not use, or cause to be used, for the reception, measurement, storage or delivery of milk any churn, vessel or other receptacle, the interior surface of which is incapable of being readily cleansed. 28. Every person who purchases milk for the purposes of his trade or business, and empties and returns the churns or other receptacles in which the milk is delivered to him, shall cause all such churns and receptacles, other than bottles, to be thoroughly cleansed and securely closed before they leave his custody or control. 44 29. Every person shall cause every churn, vessel or other receptacle, other than bottles, in which he despatches milk by rail or road to comply with the following requirements, viz.:— (1) The name and address of the owner shall be permanently marked on the churn, vessel or other receptacle or on a plate or plates of metal properly soldered or otherwise securely affixed thereto. (2) The churn, vessel or other receptacle shall be provided with a lid without openings, which shall be so constructed and fitted as effectively to prevent the access to the milk of dirt, dust or rain water or the return to the interior of the receptacle of any milk which may have been splashed above the lid. 30. Every person shall cause every churn, vessel or other receptacle used by him for the conveyance of skimmed or separated milk or for containing such milk at any time when it is exposed for sale to be marked with the words "Skimmed Milk" or "Separated Milk," as the case may require, in large and legible type. 31.—(1) Except in pursuance of any statutory authority in that behalf, no person shall open any churn, vessel or other receptacle containing milk or transfer milk from one receptacle to another in any railway van or on any railway station: Provided that this article shall not be deemed to prohibit the purchaser or his agent when taking delivery of the milk from opening a churn, vessel or other receptacle containing milk or transferring the milk to another receptacle so far as such opening or transfer may be necessary for the purpose of checking and sampling the milk. (2) Where a person delivers milk in bottles he shall cause every such bottle to be filled and closed on registered premises; and no person shall remove or tamper with the disc or other device used for closing the bottle at any time after it has left such premises and before it is delivered to the consumer. 32. Every person engaged in the conveyance or distribution of milk shall use all practicable precautions for preventing the milk from being unnecessarily exposed to heat and from being contaminated by dirt, dust, rain water or otherwise. 33. The interior of every vehicle used for the conveyance of milk shall be at all times kept clean. No live animal or any article likely to contaminate the milk shall be conveyed in the vehicle at the same time as milk and no vehicle which has been used for the conveyance of offensive matter shall be used for the conveyance of milk until the vehicle has been thoroughly cleansed and purified. Given under the Official Seal of the Minister of Health this Sixth day of July, in the year One thousand nine hundred and twenty-six. l.s. E. B. Cross, Assistant Secretary, Ministry of Health. The Minister of Agriculture and Fisheries hereby concurs in the making of the above order. H. E. Dale, Assistant Secretary, Ministry of Agriculture and Fisheries. Note.—The Milk and Dairies (Consolidation) Act. 1915, provides by sub-section (3) of section 1 that if any person is guilty of a contravention of, or non-compliance with the provisions of any Milk and Dairies Order, he shall be guilty of an offence against the Act. Sub-section (1) of section 18 of that Act provides that if any person commits an offence against the Act he shall be liable on summary 45 conviction to a fine not exceeding in the case of a first offence five pounds and in the case of a second or subsequent offence fifty pounds, and if the offence is a continuing offence to a further fine not exceeding forty shillings for each day during which the offence continues. The Public Health (Imported Milk) Regulations, 1926, dated July 6, 1926, made by the Minister of Health. The Minister of Health, in the exercise of the powers conferred 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 Section 8 of the Milk and Dairies (Amendment) Act, 1922, and of every other power enabling him in that behalf, hereby makes the following Regulations, that is to say:— 1. These Regulations may be cited as the Public Health (Imported Milk) Regulations, 1926, and shall come into operation on the 1st day of January, 1927. 2.—(1) In these Regulations, unless the context otherwise requires— "The Minister" means the Minister of Health. "Sanitary Authority" means a Port Sanitary Authority, and the Conncil of a Borough or Urban or Rural District which includes or abuts on any part of a Customs port which part is not within the jurisdiction of a Port Sanitary Authority. "District" means the District of a Sanitary Authority, and in the case of a Sanitary Authority other than a Port Sanitary Authority, include the waters of any Customs port abutting on any part of their district so far as such waters are not within the district of a Port Sanitary Authority. "Milk" means milk (including skimmed milk and separated milk but not including condensed or dried milk) which is intended for sale for human consumption or for use in the manufacture of products for human consumption. "British Islands" means Great Britain and Ireland, the Channel Islands, and the Isle of Man. "Imported Milk" means milk imported into England or Wales from any place situated outside the British Islands. (2) The Interpretation Act, 1889, applies to the interpretation of these Regulations as it applies to the interpretation of an Act of Parliament. 3.—(1) Every Sanitary Authority shall enforce and execute these Regulations and shall keep a Register of persons to whom milk imported into their district may be consigned. (2) Any Officer of the Sanitary Authority duly authorised in that behalf, may take a sample of any milk imported into the district. 4. No person shall receive any milk consigned to him from any place outside the British Islands unless he is registered under these Regulations by the Sanitary Authority into whose district the milk is imported. 5. All imported milk shall be in such condition that, on a sample being taken within the district of a Sanitary Authority, the milk shall be found to contain not more than 100,000 bacteria per cubic centimetre and to be free from tubercle bacilli. 6.—(1) If the Sanitary Authority are satisfied that any milk imported into their district does not comply with the provisions of these Regulations, they may serve upon the person to whom the milk was consigned a notice to appear before them not less than seven days after the date of the notice, to 6how cause why they should not, for reasons to be specified in the notice, remove him from the register, either absolutely or in respect of any specified source of supply, and if he fails to show D 46 cause to their satisfaction accordingly they may remove him from the register. (2) Any person aggrieved by any such decision of the Sanitary Authority as aforesaid may, within twenty-one days, appeal to a Court of Summary Jurisdiction and that Court may require the Sanitary Authority not to remove him from the register. (3) The Sanitary Authority, or such person as aforesaid, may appeal from the decision of the Court of Summary Jurisdiction to the next practicable Court of Quarter Sessions, and that Court may confirm, vary or reverse the Order of the Court of Summary Jurisdiction. (4) The decision of a Sanitary Authority to remove any person from the register shall not have effect until the expiration of the time for appeal to a Court of Summary Jurisdiction, nor if any such appeal is brought until the expiration of seven days after the determination thereof, nor if notice of appeal to Quarter Sessions is given within such seven days until such appeal is finally determined unless such appeal ceases to he prosecuted. (5) Where, in pursuance of the foregoing provisions of this Article, a person is removed from the register of a Sanitary Authority, the Sanitary Authority shall report the facts to the Minister, and if the Minister on consideration of such facts is of opinion that that person should be removed from the register of any other Sanitary Authority or should not be included in such register either absolutely or in respect of any specified source of supply he may direct such Sanitary Authority so to remove such person from the register or to refuse so to register him as the case may be and such Sanitary Authority shall forthwith comply with the Minister's direction. 7. A person shall, if so required, give to any officer of a Sanitary Authority 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 he may reasonably require for the purpose of these Regulations. Given under the Official Seal of the Minister of Health this Sixth day of July, in the year One thousand nine hundred and twenty-six. (l.s.) R. B. Cross, 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, as amended by the Milk and Dairies (Amendment) Act, 1922. Public Health (Preservatives, &c., in Food) Amendment Regulations, 1926. In December the Minister of Health referred to Circular 606, dated the 11th August, 1925, and forwarded for the information of the Authority a copy of the Public Health (Preservatives, &c., in Food) Amendment Regulations, 47 1926, which postpone the operation of the Public Health (Preservatives, &c., in Food) Regulations, 1925, so far as certain foods are concerned, and make certain minor alterations in those Regulations. 2. The dates on which the principal Regulations as now amended will come into operation are as follows:— (1) All foods except those specified below 1st January, 1927. (2) Bacon, ham, egg yolk and articles of food containing preservative necessarily introduced by the use in their preparation of preserved margarine 1st July, 1927. (3) Butter, cream and articles of food containing preservative necessarily introduced by the use in their preparation of preserved bacon, preserved ham, preserved egg yolk or preserved cream 1st January, 1928. (4) Articles of food containing vative necessarily introduced by the use in their preparation of preserved butter 1st July, 1928. 3. A number of communications have been received from various trade interests, representing that, owing to the exceptional industrial conditions or other causes, it has not been possible for retailers completely to clear their old stocks before the date on which the Regulations operate. In view of the time which has elapsed since the original Regulations were made and the desirability of avoiding further elaboration in regard to the dates of their application to particular commodities, the Minister has not felt justified in acceding to the requests for further postponement. Local Authorities, however, will probably consider it desirable to refrain from instituting legal proceedings during the next few months where they are satisfied that reasonable efforts have been made to clear old stocks and that further consignments will conform with the Regulations. 4. The arrangements with the Commissioners of Customs and Excise which are referred to in the second paragraph of Circular 606 have now been so modified as to provide that it will normally be left to Local Authorities to enforce the Regulations as regards imports of fresh fruit (not including pulp) in addition to the articles (meat and fish and their products) specified in that paragraph. I append the regulations as made by the Minister. d 2 48 The Public Health (Preservatives, &c., in Food) Amendment Regulations, 1926, dated December 10, 1926, made by the Minister of Health. The Minister of Health, in the exercise of the powers conferred 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:— 1. These Regulations may be cited as the Public Health (Preservatives, &c., in Food) Amendment Regulations, 1926. 2. The Public Health (Preservatives, &c., in Food) Regulations, 1925, shall be amended as follows:— (1) For the proviso to Article 1 there shall be substituted the following proviso,— "Provided that— (i) the Regulations shall come into operation on the 1st day of July, 1927, so far as they relate to bacon, ham and egg yolk, and 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 margarine, preserved egg yolk, preserved bacon, preserved ham, preserved cream, or preserved butter, they shall come into operation on the following dates, viz.— (a) the 1st day of July, 1927, where the preservative has been so introduced by the use of preserved margarine; (b) the 1st day of January, 1928, where the preservative has been so introduced by the use of preserved bacon, preserved ham, preserved egg yolk or preserved cream; and (c) the 1st day of July, 1928, where the preservative has been so introduced by the use of preserved butter." (2) In the definition of "preservative" contained in Article 2 (1) the word "glycerine" shall be inserted after the word "vinegar." (3) For Article 4 (2) there shall be substituted the following paragraph:— "(2) The following provisions shall have effect with respect to any of the articles of food mentioned in paragraph 1 of the Second Schedule to these Regulations which contains any preservative specified in Part I of the 49 First Schedule as permissible in the case of such article, that is to say— (a) A person who exposes or offers any such article for sale by retail shall at the time when it is so exposed or offered either cause the article to be labelled in accordance with the Rules set out in said Second Schedule, or cause a notice to the effect that the article contains preservative to be exhibited in a conspicuous place so as to be easily readable by a customer; and (b) A person who sells any such article shall cause it to be labelled in accordance with the said Rules at the time when it is delivered to any purchaser, agent or broker: Provided that,— (i) Neither the requirement mentioned in paragraph (a) nor that mentioned in paragraph (b) shall apply where the article 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) The requirement mentioned in paragraph (b) shall not apply where the article is sold by retail and delivered to the purchaser at the vendor's premises or stall if such a notice as is mentioned in paragraph (a) is there exhibited as provided in that paragraph." (4) The words "in the case of butter" shall be omitted from Article 12. (5) In Part I of the First Schedule for the items numbered 2, 6 and 7 there shall be substituted the following items,— Food. Preservative. Parts per Million. 2. Fruit and fruit pulp, (not dried) for conversion into jam or crvstallised glace or cured fruit as defined in items 6 and 7: (a) Cherries Sulphur dioxide 3,000 (b) Strawberries and Raspberries Do. 2,000 (c) Other fruit Do. 1,500 6. Jam (including marmalade and fruit jelly prepared in the way in which jam is prepared) Do. 40 7. Crystallised glace or cured fruit (including candied peel) Do. 100 7a Fruit pulp not otherwise specified in this Schedule Do. 350 (6) In paragraph 5 of the Second Schedule the words "on and after the 1st day of July, 1927," shall be inserted after the word ''shall" in the fifth line of that paragraph. 3. Copies of the Public Health (Preservatives, &c., in Food) Regulations, 1925, printed under the authority of His Majesty's Stationery Office, may be printed with any additions, omissions or substitutions directed to be made by these or any other amending regulations, but with a footnote in each instance referring to such amending regulations; 50 and the principal regulations so printed may be cited as the Public Health (Preservatives, &c., in Food) Regulations. Given under the Official Seal of the Minister of Health this Tenth day of December, in the year One thousand nine hundred and twenty-six. (l.s.) R. B. Cross, Assistant Secretary, Ministry of Health. The Commissioners of Customs and Excise hereby consent to the foregoing Regulations so far as they apply to the Officers of Customs and Excise. A. J. Dyke. C. B. Grylls. Sale of Food and Drugs Acts, &c. In December the Minister of Health issued a Circular stating that, it had been represented to the Minister that a few public analysts in reporting on a sample of milk which is found to be deficient both in milk-fat and in other milksolids word their certificates in such a way as to imply that the double offence of the abstraction of fat and the addition of water has been committed, whatever the relative degrees of the two deficiencies. After consultation with the Society of Public Analysts the Minister recommends that in such a case the certificate, while following the general form set out in the Schedule to the Sale of Food and Drugs Act, 1875, should be so worded as to show how much, if any, of the deficiency of milk-fat is presumed to be due to abstraction, allowance being made for the effect of the added water. A new edition of Memorandum 36/Foods has been prepared, embodying in a revised form the matter contained in the previous issue of the memorandum, together with that contained in a number of official circulars. The object of the present edition is to consolidate and bring up to date the principal recommendations of a permanent character which have previously been made as to the procedure of Local Authorities and their officers in the administration of the Sale of Food and Drugs Acts and other legal provisions of a similar character. Procedure under the Sale of Food and Drugs Acts, &c. Memo. 36/Foods. (January, 1927.) (Composition and Description of Food and Drugs.) I.—Legal Provisions. 1. The principal legal provisions relating to the composition and description of food and drugs (apart from provisions as to poisons and other special drugs) in force on the 1st January, 1927, are:— (a) The Sale of Food and Drugs Acts, 1875 to 1907, viz.:— Sale of Food and Drugs Act, 1875. 51 Sale of Food and Drugs Act Amendment Act, 1879. Margarine Act, 1887. Sale of Food and Drugs Act, 1899. Butter and Margarine Act, 1907. (b) Legislation amending and supplementing the Sale of Food and Drugs Acts, viz.:— Section 10 of the Licensing Act, 1921 (dilution of spirits). Milk and Dairies (Consolidation) Act, 1916. Section 4 of the Milk and Dairies (Amendment) Act, 1922. Section 23 of the Finance Act, 1921 (sending samples to Government Chemist). (c) Orders and Regulations made under the Sale of Food and Drugs Acts, viz.:— Order as to Registration of Margarine Factories, etc., 1900. Order as to Registration of Butter Factories, etc., 1907. Regulation as to Competency of Analysts, 1900. Sale of Milk Regulations, 1901 and 1912. Sale of Butter Regulations, 1902. (d) Regulations made under the Public Health (Regulations as to Food) Act, 1907, viz.:— Public Health (Milk and Cream) Regulations, 1912 and 1917*. Public Health (Condensed Milk) Regulations, 1923. Public Health (Dried Milk) Regulations, 1923. Public Health (Preservatives, &c., in Food) Regulations, 1925 and 1926. 2. Most of the legal provisions cited above are enforced and executed by Sale of Food and Drugs Acts Authorities, and it is convenient that they should be treated for the purpose of administration and report as constituting a single group of laws for securing the purity of food. II.—Action and Reports of Local Authorities. 3. The Local Authority is required by statute to send copies of the Public Analyst's Quarterly Reports to the Ministry, and in order to facilitate the work of the Department the reports should be sent every quarter as soon as they are received. 4. The Ministry also desire to receive information respecting the action taken by Local Authorities in regard to each sample not reported as genuine by the Public Analyst, showing what legal proceedings have been instituted and the result of such proceedings. Particulars should be given of any prosecutions of an exceptional character, especially in connection with the adulteration of milk or with the application of any new legislation or Regulations. Where prosecution has not been considered advisable the Ministry should be furnished with a brief statement of the circumstances which have determined the decision, and the precise action which has been taken. The information should be given either on a copy of the Analyst's report or otherwise in such a form as to ensure the identification of the relative sample. 5. Where proceedings in respect of offences committed in any quarter are pending at the time of sending in the report for that quarter, the necessary information as to the result of the proceedings should be transmitted to the Ministry as early as practicable. 6. The Ministry desire to be furnished with particulars of offences other than adulteration, e.g., contravention of the labelling requirements of the Regulations mentioned in paragraph 1 (d) of this Memorandum or of the provisions of the Margarine Act, 1887, or the Butter and Margarine Act,, 1907, obstructing officers in the discharge of their duty, or refusing to sell. As regards such offences information as to the * Revoked as from 1st January, 1928. 52 action taken should be given on the same lines as that asked for above with regard to adulterated samples. 7. The Ministry would also be glad to be informed of all cases in which samples have been submitted to the Public Analyst, or any other action has been taken with regard to the composition of description of food, otherwise than under the legal provisions referred to in paragraph 1 of this Memorandum (e.g., under the Public Health Acts, the Bread Acts or the Merchandise Marks Acts). 8. The Ministry should be furnished with copies of any annual or special reports made to the Authority by the Public Analyst on the general working and administration of the Sale of Food and Drugs Acts and similar matters, or the results of special investigations as to particular foods. The Ministry should also be supplied with a copy of any reports on like matters which may be made by the Medical Officer of Health or any other officer of the Authority. They would be glad to receive such copies as soon as the reports have been submitted to the Authority. 9. In many instances information is given by Public Analysts showing the composition of each sample of milk analysed. This information is valuable, and where it is available the Ministry desire to receive a copy. III.—Appointment of Public Analysts. 10. When the appointment of a Public Analyst is submitted for the Minister's approval, particulars of the appointment should be given on the official form. 11. If the person appointed does not already hold an appointment as Public Analyst it is necessary for him to provide satisfactory documentary evidence of competence in analytical chemistry, therapeutics and microscopy. 12. The Minister will ordinarily accept as sufficient evidence of competence in all three subjects the diploma of Fellowship or Associateship of the Institute of Chemistry of Great Britain and Ireland, together with a certificate granted by the Institute after an examination conducted by them, in the Chemistry (including microscopy) of Food and Drugs and Water. 13. Where a registered medical practitioner is appointed as a public analyst his medical diploma is ordinarily accepted as sufficient evidence of competence in therapeutics and microscopy, but he is required to furnish evidence of competence in analytical chemistry. 14. Where a candidate for the office of Public Analyst does not possess the specific evidences of competence mentioned above, it is necessary for him to produce documentary evidence that he has attained an equivalent standard of competence in each of the three specified subjects. A personal testimonial is of no value as evidence of competence unless it is given by a person who is himself a recognised expert of high standing in the subjects in question end testifies to his personal knowledge of the proficiency of the candidate in these subjects. IV.—Collection and Disposal of Samples. 15. The quantity of any article purchased should be sufficient to enable a satisfactory analysis to be made of each of the three portions into which the sample is divided, but should not be so large as to attract special attention. In any case of doubt the Public Analyst should be consulted as to the quantity required. 16. The three portions should be made as nearly equal as possible. 17. Tn the case of such an article as milk care should be taken to secure an even distribution of the constituent parts of the sample before 53 it is divided. Where milk is sold in bottles it may be useful for this purpose to pour the milk into a larger vessel, and then return a small quantity to rinse out the bottle before the final mixing. 18. The bottles used for liquids should have a narrow neck and should be filled as nearly as possible, since if the samples are shaken in transit the use of bottles much too large for the contents may result in a separation of some of the constituents of the liquids. 19. Such bottles should be closed with new and sound cork stoppers fitting so tightly as to secure the contents with no aid from the wax used for sealing. The sealing should be carried out in such a way as to prevent any attempt to remove the cork. It is, therefore, recommended that the cork should be slit down to a quarter of its length and string drawn through and securely fastened round the neck, the ends afterwards being carried to the top of the cork and sealed thereon. 20. Samples of solid fatty substances such as butter, margarine, lard or dried milk, in which it is important that the proportions of fat and water should be accurately estimated, should be placed without paper (since paper acts as an absorbent) in a dry, wide-mouthed, stoppered bottle, or earthenware jar. It is an advantage to use a screw-capped bottle, provided with a cork-lined metal lid, having a mouth as nearly as possible of the full width of the bottle. The sample can be placed in such a bottle without pressure, and can be easily removed by the Analyst. 21. All bottles should have rounded sides in order to give security to the samples in transit. 22. The labels used should be printed in triplicate, and bear serial numbers so as to avoid any confusion. The vendor should be given an opportunity of verifying the identity of the labels used for the three portions of the samples. 23. In all cases where a screw-capped bottle or any receptacle which cannot conveniently be sealed is used it should be labelled with the necessary particulars, and enclosed in an envelope of stout paper secured at the ends with the Official seal. The serial number and other particulars should be placed both on the bottle and on the envelope. 24. Where cows are milked under the supervision of the sampling officer and a sample of the milk is taken immediately afterwards, the part submitted to the Public Analyst should be marked "Appeal to Cow Sample," or in some other distinctive manner to indicate the circumstances in which it was taken. 25. When a sample of a prescribed medicine is taken, the height of the contents in the bottle supplied by the vendor should be marked in his presence prior to the division of the sample. The bottle so marked should be submitted to the Analyst in order to enable him to determine the total quantity of medicine supplied. 26. The retained portion of any perishable article should be kept at an equable and cool temperature in a dark place. V.—Public Analyst's Reports. 27. The Analyst is required by Statute to make Quarterly Reports, and these should be made up to the last day of March, June, September and December respectively. 28. The Analyst should record in his reports the results of the examination of all samples of food and drugs sent to him for the purposes of the Sale of Food and Drugs Acts, &c., including those taken without the prescribed formalities and the special samples of milk (some of which may be taken outside the area for which he is appointed) under the Milk and Dairies (Consolidation) Act, 1915. 54 29. It is desirable for the sake of uniformity that every report should contain the following particulars (preferably in tabular form):— (1) Name or description of article. (2) Number of samples of each article examined classified as (a) formal, (b) informal, and (c) private samples; together with (d) total. (3) Numbers of samples of each article regarded as adulterated, below standard, or otherwise not complying with prescribed requirements, also classified as in (2). (4) Totals of (2) and (3) for all articles. The following particulars should be given as to the samples regarded as adulterated, &c.:— (1) Serial number of the sample. (2) Name or description of article. (3) Whether a formal, informal, or private sample. (4) Nature of the adulteration or irregularity. 30. It is desirable that articles of food which experience shows to be likely to contain preservatives should be examined for preservatives. An indication of the samples which have been so examined should be given under the heading of "Observations" in the main statement of the Report. 31. The Analyst is required to specify in his report the sum paid to him in respect of each analysis. In most cases this can most conveniently be given by a general statement as to the terms of his remuneration. APPENDIX. Suggested Form of Analyst's Quarterly Report. Sale of Food and Drugs Acts, &c. Report of the Public Analyst for the of upon the Articles analysed by him during the quarter ended the Analyses. Article. Number examined. Number adulterated, &c. Formal. Informal. Private. Total. Formal. Informal. Private. Total. Total Adultered Samples, &c. Serial Number. Article. Whether Formal, Informal or Private. Nature of adulteration or irregularity. Observations. The sum paid in respect of each analysis was (Signed) (Date) Ministry of Health, Whitehall, London, S.W.1. 55 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. 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 antemortem and post-mortem by an Officer of the Local Authority for which he himself acts; or (b) That the animals were slaughtered in a public abattoir under official veterinary inspection; or he must be furnished by the applicant with a declaration signed by a qualified veterinary surgeon, appointed by the firm with the approval of the Certifying Officer, to the effect that an ante-mortem and 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 a country whose certificates the Authorities are prepared to accept. If the information obtained by the Certifying Officer is not, in his view, satisfactory, certification is to be withheld and the Certifying Officer must inform the Ministry forthwith. The Certifying Officer will supply the Ministry of Health with such information as may be required in regard to the methods of inquiry, inspection and certification which have been adopted. 56 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 6 1 Nature of preservative in the case in Column (b), and action taken under the Regulations in regard to it One. Contained 0.22 per cent. or 15.4 grains of boric acid per lb. Case at present under consideration by Committee. 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 6 (2) Statements incorrect 0 (3) Percentage of preservative found in each sample:— Sample No. Percentage stated on Statutory label. 236 0.32 per cent. or 22.4 grains of Boric Acid per lb. 0.4 330 0.29 per cent. or 20.3 grains of Boric Acid per lb. 0.4 331 0.21 per cent. or 14.7 grains of Boric Acid per lb. 0.4 332 0.26 per cent. or 18.2 grains of Boric Acid per lb. 0.4 386 0.40 per cent. or 28.0 grains of Boric Acid per lb. 0.4 390 0.37 per cent. or 25.9 grains of Boric Acid per lb. 0.4 (b) Determination made of milk fat in cream sold as preserved cream:— (1) Above 35 per cent 6 (2) Below 35 per cent 0 Total 6 (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 Nil (d) Particulars of each case in which the Regulations have not been complied with and action taken Nil. 3. Thickening Substances. Any evidence of their addition to cream or preserved cream. Action taken where found Nil. 57 4. Other Observations. In all cases where a contravention of the Regulations has occurred, the Council has, in accordance with Article G 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, 1926. During the twelve months 613 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 1 sample of Dried Milk was submitted. 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 553 were reported as genuine, 23 as adulterated, whilst 24 were of inferior quality. Table I. Samples received. Genuine. Inferior. Adulterated. Total Quarter ending March 31st 138 6 6 150 „ „ June 30th 135 12 3 150 „ „ Sept. 30th 139 3 8 150 „ „ Dec. 31st 141 3 6 150 Totals 553 24 23 600 The percentage of adulteration was 3.8 as compared with 2.7 last year. The percentage of articles of inferior quality where actual adulteration could not be certified was 4.0 this year and 5.7 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. 58 Table II. Article. No. of Samples examined. Result of Examination. Summonses Issued. Penalties Imposed. Genuine. Inferior Adulterated. Almonds, ground 2 2 — — — — Arrowroot 3 3 — — — — Aspirin Tablets 3 3 — — — — Baking Powder 2 2 — — — — Barley 2 2 — — — — Boric Ointment 2 2 — — — — Brawn 1 1 — — — — Butter 55 53 — 2* — — Camphorated Oil 6 6 — — — — Caraway Seeds 2 2 — — — — Castor Oil 4 4 — — — — Citrate of Magnesia 3 3 — — — — Citric Acid 2 2 — — — — Cocoa 15 15 — — — — Coffee 11 11 — — — — Cornflour 1 1 — — — — Cream of Tartar 4 4 — — — — Curry Powder 2 2 — — — — Dripping, Beef 2 2 — — — — Eucalyptus Oil 3 3 — — — — Ginger 4 4 — — — — Gregory's Powder 2 2 — — — — Jam 7 7 — — — — Jelly Crystals 1 1 — — — — Lard 8 8 — — — — Lemonade Powder 3 3 — — — — Lemon Cheese 2 2 — — — — Liquorice Powder 2 2 — — — — Magnesia, calcined 2 2 — — — — Margarine 5 5 — — — — Marmalade 5 5 — — — — Meat and Fish Pastes 10 8 — 2† — — Meat Pie 7 4 — 3† — — Milk 315 285 24 6 3 £11 11 6 ,, Condensed 19 19 — — — — ,, Separated 1 1 — — — — „ Skimmed 1 1 — — — — Mustard 5 8 — 2* — — Oatmeal 1 1 — — — — Olive Oil 7 7 — — — — Ox-tail Soup 1 1 — — — — Pea Flour 2 2 — — — — Peas 5 3 — 2* — — Pepper 6 6 — — — — Prawns 1 1 — — — — Rice 3 3 — — — — Rum and Coffee 1 1 — — — — Carried forward 551 510 21 17 3 £11 11 6 * Informal samples. † Adulteration insufficient. 59 Milk.—During the year 315 samples of milk were examined, and of these, 285 were reported as genuine, 24 as inferior, and 6 as adulterated. Four samples were taken in course of delivery by the Inspector for the Borough of Kensington, following instructions from the vendor of a milk which had been reported as adulterated. These were found to be quite different in composition from that of the adulterated sample and were all reported genuine. In addition to the above one separated and one skimmed milk were passed as genuine. The following Table shows the nature and extent of the adulteration:— Table III. No. Adulteration Certified. Penalties Imposed. 1 Fat abstracted 35 per cent. £5 0 0 fine and 10s. 6d. costs. 2 „ „ 24 „ „ £2 0 0 „ ., 30s. 6d. costs. 3 „ „ 14 „ „ £2 0 0 „ „ 10s. 6d. costs. 4 „ „ 5 „ „ Vendor warned. 5 Added Water 2 „ „ „ „ 6 „ „ 1 „ „ No action—adulteration insufficient. The percentage of adulteration in the case of milk is 1.9 as compared with 1.7 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 3.54 8.86 87.60 „ ,, June 30th 3.75 8.87 87.58 „ „ Sept. 30th 3.79 8.98 87.23 „ „ Dec. 31st 3.86 8.97 87.17 Average for the year 3.68 8.92 87.40 Condensed Milk.—Nineteen condensed milks were specially examined with a view to ascertaining whether or no they somplied 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. 60 Butter and Margarine and Lard.—Fifty-five samples of butter were analysed, and of these, 2 were found to contain water in excess of the permitted maximum. In one instance the excess was 1.8 per cent. and in the other 0.5 per cent. Five margarines and eight lards were also examined and were reported genuine. In the butters and margarines no case was found in which the limit for boron preservation was exceeded. Cocoa and Coffee.—Fifteen specimens of cocoa and eleven of coffee were all passed as genuine. Arsenic was specially tested for in the cocoas, but with negative results. Meat and Fish Preparations.—Fifteen samples of sausages, 10 meat and fish pastes, 7 of meat pies, 2 of beef dripping, 1 of brawn, 1 of oxtail soup, 1 of prawns and 1 of beef suet were examined during the year. Of these, 2 fish pastes, 3 meat pies and 2 sausages were found to contain boron preservative, the amounts found varying between 14 grains and 1.4 grains per pound, expressed in terms of crystallised boric acid, and, in the case of the meat pies, on the meat portion only. Conserves, Vegetables, &c.—Seven specimens of jam, 2 of lemon cheese, 5 of marmalade, and 1 of tomato ketchup were reported genuine, whilst of 5 samples of peas, 2 contained a preparation of copper and were therefore reported adulterated. The amounts found, expressed in terms of crystallised sulphate of copper, were 1.4 grains and 1.5 grains per pound of peas. Farinaceous Foods, &c.—The following varied assortment of farinaceous and leguminous foodstuffs was submitted during the year for analysis, and in no case was adulteration or deficiency detected:— Arrowroot 3 samples. Barley 2 „ Cornflower 1 sample. Oatmeal 1 „ Pea flour 2 samples. Bice 3 „ Sago 2 „ Semolina 2 „ Tapioca 1 sample. The specimens of rice were examined for "polishing" by talc, but with negative results. 61 Condiments, Spices, &c.—Of 2 samples of caraway seeds, 2 of curry powder, 4 of ginger, 5 of mustard, 6 of pepper and 3 of vinegar, only 2 were reported adulterated. These were both mustard which contained 30 per cent. of starch coloured with turmeric. Spirits.—Thirteen samples of whisky were examined for compliance or otherwise with the provisions of the Licensing Act, 1921, and one was found to be 52.4 degrees under proof. The Act provides that no spirits may be sold of strength lower than 35 degrees under proof. Drags.—The total number of drugs analysed during the year was 39, and of these 3 were found not to comply with the requirements of the British Pharmacopoeia. One zinc ointment was deficient in zinc oxide to the extent of 3.3 per cent., whilst 2 samples of milk of sulphur were found to contain 43.5 per cent, of calcium sulphate. This form of adulteration was rather common in the past, but is seldom met with at the present time. The occurrence of calcium sulphate is due to the manufacturers employing sulphuric acid in place of hydrochloric acid in the preparation of the milk of sulphur. The presence of such a large percentage of calcium sulphate, which is virtually plaster of Paris, is certainly undesirable in a drug which may be taken internally. The following samples were also analysed and were found to be genuine :— Almonds, ground 2 samples. Baking powder 2 ,, Jelly crystals 1 sample. Lemonade powder 3 samples. Olive Oil 7 ,, Bum and coffee 1 sample. Sugar, demerara 5 samples. No traces of arsenic, lead or copper were found in the baking powders and lemonade powders. The specimen of jelly crystals was found to be normal in its setting properties, indicating the presence of a suitable quantity of gelatine. E 62 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:— Table V. Sample No. Article. Result of Analysis. Date of Prosecution. Result. Remarks. 1794 Milk 147% fat abstracted K P.S. 16/2/26 Fine, £2— Costs, 10/6 — 1828 Whisky 52.4 degrees under proof K.P.S. 30/3/26 Summons dismissed — 1835 Tinned Peas 1.4 grs. Cryst. Sulp. of Copper per lb. — — Informal sample. 1839 Liver Sausage 12.6 grs.Cryst. Boric Acid per lb. No action — Adulteration insufficient. 1877 Butter 0.5% excess of water — — Informal sample. Official sample genuine. 1881 Milk 35% fat abstracted K.P.S. 20/4/26 Fine, £5— Costs, 10/6 — 1946 Milk 5% fat abstracted Letter of warning — 18 Salmon and Shrimp Paste 1.4 grs. Cryst. Boric Acid per lb. No action — Adulteration insufficient. 81 Milk 2% added water Letter of warning — 94 Meat Pie 11.6grs. Boric Acid per lb. No action — Adulteration insufficient. 97 Fish Paste 4.9 grs. Boric Acid per lb. No action — Adulteration insufficient. 109 Mustard 30% foreign Starch — — Informal sample. Official sample genuine. 149 Milk of Sulphur 43.5%Calcium Sulphate — — Infor nal sample. See 173. 173 Milk of Sulphur 43.5%Calcium Sulphate K.P.S. 19/10/26 Fine, £2— Costs, 10/6 — 184 Milk 24% fat abstracted K.P.S. 2/11/26 Fine, £2— Costs, £ 1 10/6 — 207 Sausages 14 grs. Boric Acid per lb. No action — Adulteration insufficient. 232 Mustard 30% foreign Starch — Informal sample. 270 Meat Pie 1.4 grs. Boric Acid per lb. No action — Adulteration insufficient. 271 Meat Pie 14 grs, Boric Acid per lb. No action — Adulteration insufficient. 277 Tinned Peas 1.5 grs. Cryst. Sulp. of Copper per lb. — — Informal sample. 309 Milk 1% added water No action — Adulteration insufficient. 336 Zinc Ointment Slightly deficient in Zinc Oxide — — Informal sample. 389 Butter 1.8% excess water — — Informal sample. Official sample taken. 387 Cream 0.22% or 15.4 grs. Boric Acid per lb. Proceedings pending — All other adulterated samples were informal and upon these no action could be taken. 63 Meat.—With regard to meat inspection, this important commodity is kept under supervision by the Inspectors in charge of the districts. Public Health (Meat) Eegulations, 1924. The Public Health (Meat) Regulations, 1924, came into operation on the 1st day of April, 1925. The provision of these Regulations, regarding the giving of notice to the local authority of the times of slaughter, has enabled arrangements to be made for the inspection cf all carcases of animals slaughtered in the local slaughterhouses. The following is a list of Unsound Food found During the Inspection of the Carcases of Animals Slaughtered in the Local Slaughterhouses. Description. Disease. Approx mate Weight. Bullock's lungs Tuberculosis 7 lbs. Bullock's liver Abscess 18 „ Bullock's liver Distoma Hepaticum 15 „ Bullock's liver Distoma Hepaticum 13 ., Bullock's liver Distoma Hepaticum 14 ,, Bullock's lungs Tuberculosis 7 ,, Bullock's liver Distoma Hepaticum 21 .. Sheep's pluck Strongylus Kufescens 3 ,, Sheep's pluck Strongylus Rufescens. 3 „ Carcase and offal of Sheep Emaciation 32 ,, Pig's pluck Pneumonia and Cirrhosis of Liver. 6 „ Pig's head Tuberculosis 5 ,, Carcase and offal of Pip Dropsy 68 „ Carcase and offal of Heifer Bruised and Fevered 6 cwts. Pig's head Tuberculosis 4 lbs. Pig's mesentery Tuberculosis ½lb. Bullock's head Actinomycosis 14 lbs. Bullock's lungs Pleurisy 7 ,, Bullock's liver Distoma Hepaticum 7 ,, Sheep's liver Stronguli Rufescens 2 „ Bullock's liver Distoma Hepaticum 28 „ Pig's head Tuberculosis 4 „ Pig's collars. Tuberculosis 8 „ Bullock's liver Distoma Hepaticum 6 ,, Bullock's liver Distoma Hepaticum 5 ,, Bullock's head Tuberculosis 14 „ Bullock's tongue Tuberculosis 7 „ Pig's head Tuberculosis 4½ ,, Pig's liver Milk Spots 2 ,, Leg of Mutton Abscess 5½ „ Pig's head Tuberculosis 3½ „ Pig's collars Tuberculosis 6 „ The protection of meat and the provision of glass fronts to shops has been a question to which some careful study has E 2 64 been given, as it is not possible to deal with stalls and shops on the same lines. In most cases the owners of butcher shops have readily complied with the suggestions made for the protection of the meat, but in the case of stalls, the provision of glass fronts is impracticable. Side screens are used and as much protection is called for as is considered reasonable, due regard being paid to the circumstances of each individual case. No application has been received for the stamping of carcases examined by the Sanitary Inspectors. Licensed Slaughterhouses—At the annual licensing of slaughterhouses in October, 1 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 their licences. At the Special Session at the London County Council the seven licences were granted. I have repeatedly expressed the opinion that the time has 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 Licences. 185 Uxbridge Road John Mullet Allwright 40 Goldhawk Road Andrew G. Hedges 138 Goldhawk Road William Henry Keith and Henry George Larkin 247 Goldhawk Road Arthur William Godfrey 55 Dalling Road Arthur Clapson 65 King Street Richard Norman Hammett 341 King Street Stanlev 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 by your Inspectors. 65 The following table gives a summary of the work relating to milk premises, slaughterhouses and ice cream premises :— PREM1SES. NUMBER OF PREMISES. Number of inspecions 1924 NT umber of uotices 192 d Number of prosecutions 1926 On register in 1920. On register at end of 1924 Added in 1926 Removed in 1926 On register at end of 192t> Milk premises 128 86 2 4 84 1,577 6 nil Slaughterhouses 7 7 — — 7 510 1 nil Ice Cream premises 234 169 11 12 171 224 — 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. 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 47 bakehouses in use in the Borough have been regularly inspected during the year. Fifteen notices were served relating to various defects, 14 being complied with. It was not necessary to apply for any summonses against Bakers whose bakehouses were found not to be in conformity with the Act, as they readily complied with the requirements of the notices served. 66 The following is a list of bakehouses in the Borough :— No. 1 DISTRICT. Address. Name. †* C.ndby 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 G. Teague * 67 Ditto G. Dunsby * 87 Ditto Not in use * 6 Bcaconsfield Terrace Not in use †* 98 Blythe Road A. Schofield * 47 Milson Road W. Warwick No. 2 DISTRICT. †* 65 Bridge Road Misses Bass 2 Crisp Road Mis. 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 * 91 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 No. 3 DISTRICT. * 77 Brackenbury Road A. Gardner † 1 The Grove Palmer's Stores, Ltd. †* 33 Glenthorne Road K. 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. 16 Black Lion Lane Not in use 93 Ditto .. G. Banham †* 102 Dalling Road Plumridge Bros. * 192 Ditto Not in use † 1 Eyot Gardens J. R. Chibnall, Ltd. † 258 King Street Miller & Son † 316 Ditto B. Samels † 348 Ditto W. Langrebe †* 11 Laming ton Street U. A. Roberts, Ltd. 10 Upper Mall Not in use 7 St. Peters Road E. Marlow * Underground † Factory 67 Address. Name. No. 5 DISTRICT. †* 128 Askew Road G. Ingle † 74 Ditto J. Auer †* 167 Ditto H. Yates † 104 Ditto P. Miller 121 Ditto Not in use 41 Gayford Road Ditto No. 6 DISTRICT. †* 74 Goldhawk Road H. Crisp * 106 Ditto F. J. Drake 166 Ditto N. Carrington * 242 Ditto Plumridge Bros. †* 75 Uxbridge Road B. Samels †* 125 Ditto A. B. Hemmings * 55 Melina Road J. Tame No. 7 DISTRICT. †* 126 Uxbridge Road Not in use †* 216 Ditto H. BamforJ † 410 Ditto A. Hauser No. 8 DISTRICT. †* 831 Harrow Road H. T. Rogers †* 39 St. Ann's Road E. Tomlin †* 16 North Pole Itoad H. Allinson †* 32 Norland Road N. A. Carrington * 2 Hunt Street Not in use 104 Latimer Road Ditto * Underground † Factory UNSOUND FOOD. Following a complaint regarding two shoulders of lambs purchased from Messrs. Dangerfield's of No. 123, King Street, an inspection of the premises was made, when the following meat was seized :— 3 pieces of Eeef, weighing 86 lbs. 4 pieces of Mutton, weighing 51 lbs. 1 piece of Liver, weighing 1½ lbs. 4 pieces of Pickled Beef, weighing 12 lbs. All this meat was decomposing and unfit for the food of man, the pickled beef also being flyblown. 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, when he was fined £20 with 20 guineas costs. 68 A further summons was issued against Mr. Dangerfield for failing to comply with the Public Health (Meat) Regulations, in that he did not take reasonable precautions to prevent contamination of the meat by flies. A fine of 10s. was imposed. On inspection of the premises in the occupation of Messrs. John Best, Ltd., 5, Bradmore Lane, a half a pig's head was found to be affected with tuberculosis—tubercular lesions being present in the lymphatic gland. This was seized and taken to the Magistrate at the West London Police Court, who condemned same and gave an Order for its destruction. A summons was issued against Messrs. Best, Ltd., when a fine of 40s. was imposed. The following is a list of unsound food condemned during the year:— Commodity. Comdition. Result. 1 Carrel of "Baldwin" Apples Decomposed Surrendered 1 Case of Fresh Herrings ditto ditto 2 Stone of Soles ditto ditto 2 Boxes of Catfish (each 6 stone) ditto ditto 12 Sheep's Plucks ditto ditto 1 Box of Skate ditto ditto 6 Boxes of Red Hanepoot Giapes ditto ditto 5 Stone of Small Plaice ditto ditto 5 Basket' of Cherries ditto ditto 6 Boxes of " Star " Brand Fish Fi lets ditto ditto 1 Box of Coal Fish ditto ditto ½ Sack of Whelks ditto ditto 20 Boats of Cherries ditto ditto 1 Box of Mackerel ditto ditto Portions of Hind Quarter of Peef 18 lbs ditto ditto 15 Chickens ditto ditto 6 Cases (300) Lemons ditto ditto 4 Boxes of Codling ditto ditto 7 Boxes of Fillet (46 lbs) ditto ditto 7 Boxfs of Kippers ditto ditto 4½ Bushels of William Pears ditto ditto Entire Carcase md Offal of a Heifer (6 cwt) ditto ditto 3 Boxes of Catfish (12 stone) ditto ditto 8 Stone of Cod ditto ditto 2 Boxes of Smoked Haddock ditto ditto 5 Boxes of Haddock ditto ditto 2 Bags of Whelks ditto ditto Carcase of Pig (8 stone 4 lbs). ditto ditto 1 Bag of Mussels ditto ditto 3 Bags of Pears Saturated with of ditto 1 Pig's head and 2 Collars Decomposed ditto 69 FOOD POISONING. No case of food poisoning was brought to my notice during the year under review. PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 716 cases reported as due to notifiable infectious diseases in the Borough, against 745 in the previous year. The number of cases of Tuberculosis notified was 278 against 265 in the previous year. There were also reported 1,150 cases of infectious diseases that were not notifiable, against 1,633 in the previous year; 712 of these were Measles, 148 Whooping Cough, and 290 Chicken Pox. BACTERIOLOGY. The Bacteriological work is carried out by Dr. Ehvorthy 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 cai ries out the examination. The following bacteriological examinations were made on behalf of the Council:— Material from cases of suspected Diphtheria— True Diphtheria bacillus isolated 104 Negative results 538 642 Blood from cases of suspected Fever— Widal or Typhoid reaction obtained 4 Widal or Typhoid reaction not obtained 2 6 Stools and Urine from cases of suspected Fever— Para Typhoid B. Positive 0 Para Typhoid B. Negative 1 1 Sputa from cases of Suspected Tuberculosis— Tubercle bacillus found 130 Tubercle bacillus not found 488 618 Examination of Feathers for Anthrax— Positive 0 Negative 1 1 Total examinations 1,268 70 Cases of Infectious Disease notified during the year 1926. Table IV. Notifiable disease Number op Cakes Notified Total cases notified in each Ward Total Casks Bhmovedto Hospital At all Ages Under 1 1 & under 5 Years 5 & under 15 Years 15 & under 25 Years 25 &Aiuuder 45 Years 15 & uuder 65 Years 65 and upwards S'th 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) 254 10 76 129 28 10 1 .. 39 50 44 12 33 45 31 251 Erysipelas 29 1 .. 3 8 8 7 2 4 4 7 2 3 8 1 19 Scarlet Fever 276 1 73 170 15 15 2 .. 30 56 45 22 38 66 19 267 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. En' eric Fever 8 .. 1 3 1 3 .. .. .. 2 1 1 .. 4 .. 6 Relapsing Fever (R) Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 7 .. .. .. 2 5 .. .. 2 .. 1 .. 2 2 .. 7 Puerperal Pyrexia 10 .. .. .. 3 7 .. .. .. 4 .. .. 2 4 .. 9 Cerebro-Spinal Meningitis 1 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Polio-myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 4 .. .. 1 1 1 1 .. .. 2 1 .. .. 1 .. 4 Ophthalmia Neonatorum 24 24 .. .. .. .. .. .. 7 4 3 1 3 3 3 10 Anthrax 1 .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. 1 Pneumonia 102 2 12 14 18 29 17 10 14 24 12 8 21 15 8 39 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Trench Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 716 39 162 320 77 78 28 12 96 148 114 46 102 148 62 614 Tuberculosis Pulmonary Tuberculosis 210 .. 3 8 53 89 51 6 39 41 42 11 22 32 23 Other forms of Tuberculosis 68 1 5 33 16 9 2 2 8 14 8 8 11 18 1 Totals . 278 1 8 41 69 98 53 8 47 55 50 19 33 50 24 Deaths from the Seven Principal Zymotic Diseases.—The total number of deaths of residents registered from the seven principal zymotic diseases was 80 against 91 in the previous year. The deaths of residents last year from these diseases were equal to 51 per 1,000 of the total deaths of residents registered and were at the rate of 0.6 deaths per 1,000 persons living. l'he following table shows the deaths of residents registered from the seven principal zymotic diseases which occurred in the ten years, 1917 to 1926 :— 71 Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. l'nteric Fever. Diarrhoea and Cholera. Total. 1917 0 39 1 11 12 6 45 114 1918 0 44 3 6 28 4 31 116 1919 0 9 2 19 10 1 69 110 1920 0 16 7 35 12 1 35 106 1921 0 0 16 24 10 3 73 126 1922 0 36 11 49 40 4 18 158 1923 0 6 2 20 10 2 31 71 1921 0 35 4 17 16 1 15 88 1925 0 6 3 12 32 3 35 91 1926 0 24 2 14 11 0 28 80 Average last 10 yrs. 0 21 5 20 18 2 38 106 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was 26 below the average number registered in the last ten years. Notifiable Diseases (other than Tuberculosis) during the year 1926. DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths. Diphtheria 254 251 14 Erysipelas 29 19 2 Scarlet Fever 276 267 2 Enteric Fever 8 6 — Puerperal Fever 7 7 2 Puerperal Pyrexia 10 9 — Cerebro-Spinal Meningitis 1 1 — Encephalitis Lethargica 4 4 — Ophthalmia Neonatorum 24 10 — Pneumonia 102 39 105 Anthrax 1 1 — Totals 716 614 125 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. 72 73 Diphtheria and Diphtheritic Membranous Croup.—Two hundred and fifty-four cases were reported as due to Diphtheria or Diphtheritic Membranous Croup against 208 cases in the previous year. Two hundred and fifty-one cases were treated at the Isolation Hospitals and three at the homes of the patients. Fourteen deaths were registered. The mortality rate on the cases reported was 5.5 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 seventy-six cases were notified as due to Scarlet Fever, against two hundred and ninety in the previous year. Two hundred and sixty-seven cases were treated at the Isolation Hospitals, and nine at the homes of the patients. Two deaths were registered. The mortality rate on the cases reported was 0.7 per cent. Enteric Fever.—Eight cases were reported as due to Enteric Fever, against nine cases in the previous year. Six cases were treated at the Isolation Hospitals of the Metropolitan Asylums Board, one at the Victoria Hospital for Children, and one at the home of the patient. No death was registered. Erysipelas.—Twenty-nine cases were reported as due to Erysipelas, against forty-seven cases in the previous year. Ten cases were treated at the homes of the patients, one at Fulham Hospital, seven at St. Marylebone Hospital, two at Kensington Hospital, one at St. Luke's Hospital, one at St. Stephen's Hospital, one at the University College Hospital and three at the Hammersmith Hospital. Two deaths were registered. The mortality rate on the cases reported was 6.9 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 Pielaps- ing Fever, against no case in the previous year. 74 75 Continued Fever.—No case was reported as due to Continued Fever, against no case in the previous year. PUERPERAL FEVER AND PUERPERAL PYREXIA. In August the Minister of Health forwarded copies of the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, which came into operation on the 1st October, 1926. NOTIFICATION. Puerperal Fever has been notifiable throughout the country since the Infectious Disease (Notification) Extension Act, 1899, came into force. Experience has shown, however, that for a variety of reasons notification of this disease has been far from complete, with the result that not only are the statistics relating to the disease inaccurate and misleading (particularly as regards incidence and fatality rate), but measures for the prevention and effective treatment of the condition have been seriously hampered. The main reason for the comparative failure to notify is to be found in the fact that Puerperal Fever is ill defined and is not a specific disease comparable with Scarlet Fever or Diph-. theria. There is frequently, therefore, a genuine doubt as to the correct diagnosis. The term moreover bears a connotation which may be thought to imply some slur upon the patient or medical attendant, and this may possibly act as a deterrent to notification of a doubtful case. In any event, it is certain that many cases are not notified at all and that severe cases are often notified only when it is too late for effective action to be taken; and it is therefore important to modify the existing arrangements for the notification of Puerperal Fever by requiring the prompt notification of this morbid process as soon as symptoms suggestive of septic infection become manifest, in order that adequate nursing and treatment can be ensured and the spread of infection to others prevented. The Minister consulted the Section of Obstetrics and Gynaecology of the Royal Society of Medicine in this matter, and a representative committee appointed by the Section submitted a report in February, 1925, upon which the enclosed Regulations are based. The Minister is advised that it will ultimately be desirable to replace the term "Puerperal Fever" by the term " Puerperal Pyrexia, " the latter being defined in terms which involve no theory as to causation, but without legislation amending the Infectious Disease (Notification) Acts it is not practicable to substitute "Puerperal Pyrexia" for 76 peral Fever " as a disease notifiable under those Acts. The Regulations therefore, while prescribing new forms for the notification of cases of Puerperal Fever, also require the notification of cases of Puerperal Pyrexia (as defined in the Regulations) in addition to the present notification of Puerperal Fever.under the Infectious Disease (Notification) Acts, thus placing an obligation upon medical practitioners to notify all cases of Pyrexia during the puerperium irrespective of the cause to which the fever may be attributed. It is recognised that this requirement will lead to a great increase in the number of notifications and that many cases so reported will be relatively trivial in degree, but the great importance of securing adequate treatment in the early stages of Puerperal infection is regarded as outweighing any objection to the notification of a certain amount of minor illness which gives no cause for anxiety. Reports received on inquiries recently carried out in regard to the occurrence of Puerperal infecfion in connection with various Maternity Institutions in different parts of the Country, lead the Minister to think that Pyrexia during the puerperium is not infrequently looked upon as a comparatively unimportant incident, and that proper precautions to prevent the spread of infection are at times neglected with disastrous results. He desires to take this opportunity of impressing upon all those concerned with administration or treatment in Maternity Institutions that the presence of infection, however slight in degree, in a patient or in a member of the staff should be considered as liable to give rise to an outbreak of virulent infection and should be dealt with accordingly. Article 3 of the Regulations requires the Local Authority to cause notice to be given to all medical practitioners resident or practising within the District of the Authority of the duties imposed upon them by the Regulations, and Article 4 requires the Authority also to supply practitioners with copies of the notification forms which are prescribed in the Schedules to the Regulations. In this connection, it will be desirable to explain that the effect of Articles 7 and 8 is merely to require medical practitioners when notifying a case of Puerperal Fever under the Infectious Disease (Notification) Act, 1889, or under Section 55 of the Public Health (London) Act, 1891, to use the form prescribed in Part I or Part II, as the case may be, of the First Schedule to the present Regulations, instead of the forms contained in the Schedules to the Public Health (Notification of Infectious Disease) Regulations, 1918. The attention of practitioners should also be specially called to the definition of " Puerperal Pyrexia " and to the fact that the notification forms enable practitioners, when notifying a case of either Puerperal 77 Fever or Puerperal Pyrexia, to indicate whether any assistance in dealing with the case is desired. It will be observed that Article 13 of the Regulations requires the Medical Officer of Health of any Local Authority in London, who receives a notification of a case of Puerperal Pyrexia, to send a copy of the notification within twelve hours after its receipt, to the Metropolitan Asylum Managers. This requirement already applies to notifications of cases of Puerperal Fever by virtue of Section .55 (4) of the Public Health (London) Act, 1891, and in this connection I am to draw the attention of Metropolitan Borough Councils to Circular 622 which was issued on the 14th September, 1925, and to suggest that the attention of medical practitioners in London should again be drawn to the special arrangements described in that Circular which have been made by the Metropolitan Asylum Managers for the treatment of cases of Puerperal Fever. FACILITIES FOR TREATMENT. It will be realised that if the more complete notification is to have practical value it should be supplemented by the provision, when necessary, of facilities for assistance in diagnosis and for the treatment of patients who are not able to secure adequate treatment for themselves. These facilities can most readily be provided by the Local Authorities which are administering schemes under the Maternity and Child Welfare Act, 1918, and it will be observed that provision is made in Article 5 of the Regulations by which these Authorities will receive prompt information of cases arising in the districts of Sanitary Authorities which do not administer such schemes. Maternity and Child Welfare Authorities are empowered, with the sanction of the Minister, to make provision for the special treatment of women suffering from Puerperal Pyrexia, for consultation with an obstetric specialist, for skilled nursing, or for institutional treatment; and it is important that these Authorities and their Medical Officers of Health should do all that is possible to meet the requests of medical practitioners for special assistance for women suffering from Puerperal Pyrexia which is, or is likely to be, serious in character, in order that maternal mortality and morbidity from this cause may be so far as possible prevented. If special assistance from the Local Authority is desired, the Medical Officer of Health should ask the medical practitioner to supply him with further information which might include some or all of the following points: — 1. Conditions in the patient, if any, prior to the labour which might have been factors in producing the F 78 pyrexia, e.g., septic foci, vaginal discharge, carious teeth, (fee. 2. The names of all persons who have made internal examinations, including the name of the person who delivered the patient: their occupations and professional qualifications (if any). 3. Day and hour of commencement of labour or miscarriage. 4. The clinical course of labour or miscarriage, mentioning any special means used to assist labour, e.g., obstetrical operations or manual removal of placenta; and any injuries incurred by the patient. 5. The duration of labour and time of termination of labour or miscarriage. 6. The clinical history subsequent to delivery, including the amount and character of lochia; copy of temperature chart, Ac. 7. The time of the onset and the probable cause of pyrexia. 8. Any cases of specific fevers, erysipelas, puerperal pyrexia, or other possible forms of sepsis, visited recently by doctor or other attendant, giving dates. I append the Regulations as made by the Minister of Health :— PUBLIC HEALTH, ENGLAND. The Minister of Health in exercise of the powers conferred on him by the Public Health Act, 1875, the Infectious Disease (Notification) Act, 1889, the Public Health (London) Act, 1891, and of every other power enabling him in that behalf hereby makes the following Hegulations PART I. General. 1. These Regulations may be cited as the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, and shall come into operation on the 1st day of October, 192fi. 2.—(1) In these Regulations, unless the contrary intention appears :— " Local authority " means the common council of the City of London, the council of a metropolitan borough, the council of a municipal borough or other urban district, the council of a rural district, or a port sanitary authority. " Medical officer of health " means medical officer of health of a local authority; " Medical practitioner " means any person for the time being registered under the Medical Acts; The Minister " means the Minister of Health; " The Infectious Disease (Notification) Acts " means the Infectious Disease (Notification) Acts, 1889 to 1899. and includes Section 55 of the Public Health (London) Act, 1891, and any provisions relating to the notification of infectious disease contained in any local Act or Order made thereunder. 79 (2) The Interpretation Act, 1889, shall apply to the interpretation of these regulations as it applies to the interpretation of an Act of Parliament. 3. The local authority shall enforce and execute these Regulations in their district and shall forthwith cause notice to be given to all medical j ractitioners resident or practising within the district of the duties thereby imposed upon them. 4. For the purposes of these Regulations the local authority shall provide and maintain a sufficient supply of printed copies of the appropriate forms set out in (he Schedules to these Regulations, and shall as soon as practicable after these Regulations come into operation, and afterwards from time to time when application is made to them, furnish printed copies of the said forms to every medical practitioner resident or practising within the district. 5. The medical officer of health of the authority shall forward a copy of every notification received by him under Part II or Part III of these Regulations to the medical officer of health of the administrative county within which the district is situate within 24 hours after the receipt of the notification. 6. Where a woman is an inmate of any building, ship, vessel, boat, tent, van, shed, or similar structure belonging to His Majesty the King, nothing in these Regulations shall be construed as requiring a notification to be transmitted to a medical officer of Health in respect of that woman in any case not falling within the provisions of paragraph (b) of Section 5 of the Local Government (Emergency Provisions) Act, 1916 (as made permanent bv the Expiring Laws Act, 1925, and as applied to the Royal Air Force by the Air Force (Application of Enactments) (No. 2) Order, 1918. PART II. Puerperal Fever. 7. The form of certificate contained in Part I of the First Schedule to these Regulations shall be the form for the purpose of any notification of puerperal fever to be given by a medical practitioner to the medical officer of health of a municipal borough or of any other urban district or of a rural district or of a port sanitary district (other than the London port sanitary district) under Sub section (1) (b) of Section 3 of the Infectious Disease (Notification) Act, 1889, and the form of certificate contained in Part II of the said Schedule shall be the form for the purpose of any notification of puerperal fever to be given by a njedical practitioner to the medical officer of health of the City of Loudon, of the London port sanitary district or of a metropolitan borough under Sub-section (1) (6) of Section 55 of the Public Health (London) Act, 1891. 8. In so far as they relate to puerperal fever the Public Health ^Notification of Infectious Disease) Regulations, 1918, are hereby revoked but without prejudice to any right, obligation or liability acquired, accrued or incurred thereunder. PART m. Puerperal Pyrexia. 9. In this Part of these Regulations the expression " puerperal pyrexia " means any febrile condition (other than a condition which is required to be notified as puerperal fever under the Infectious Disease (Notification) Acts) occurring in a woman within 21 days after childbirth or miscarriage >n which a temperature of 100.4° Fahrenheit (38° Centigrade) or more has been sustained during a period of 24 houre or has recurred during that period. 10. Subject to the provisions of this Part of these Regulations every medical practitioner, on first becoming aware that a woman upon whom p 2 80 tie is in professional attendance is suffering from puerperal pyrexia, shail forthwith make and sign a notification of the case in the form contained in the Second Schedule to these Regulations, and shall transmit the notification to the medical officer of health of the district within which the place of residence of the patient is situate at the date of notification. 11. A notification to be transmitted to the medical officer of health in pursuance of this Part of these Regulations shall be addressed to that officer and may be transmitted by being delivered to him or by being delivered at his office or residence, or may be sent by prepaid letter post addressed to him at his office or at his residence. The notification shall either be enclosed in a sealed envelope or shall be folded in such manner that during its transmission the particulars of the notification cannot be observed. 12.—(1) The local authority shall pay to every medical practitioner a fee of two shillings and sixpence for each notification duly made, signed and transmitted by him under this Part of these Regulations if the case occurs in his private practice, and of one shilling if the case occurs in his practice as medical officer of any public body or of any institution. (2) Every fee shall be paid as soon as practicable after the end of the quarter during which the notification was sent, and the local authority shall not require before payment an account of fees claimed under these Regulations. (3) The said fees shall in each case be deemed to cover all expenses, including the cost of transmission. 13. The provisions of Sub-section (4) of Section 55 of the Public Health (London) Act, 1891, shall apply to any notification received by a medical officer of health of any local authority in the Administrative County of London, in pursuance of this Part of these Regulations, in like manner as the provisions of the sub-section apply to a certificate received by a medical officer of health under the said section. I submitted a report to the Maternity and Child Welfare Committee on the recommendations of the Ministry, in regard to the facilities for treatment, pointing out that— Skilled Nursing is already provided under an agreement with the Hammersmith District Nursing Association. Institutional Treatment for cases of Puerperal Fever is provided by the Metropolitan Asylums Board at the North Western Hospital, Hampstead, and the South Western Hospital, Stockwell. I understand that the Metropolitan Asylums Board will arrange for the admission of cases of Puerperal Pyrexia in the same manner. Obstetric Specialist.—It will be necessary for the Council to make arrangements for the services of an Obstetric Specialist, and I recommend accordingly. The Maternity and Child Welfare Committee decided, subject to the approval of the Ministry of Health, to appoint a Rota of Consulting Obstetricians whose services will be at the disposal of general practitioners in cases of difficulty or abnormality, upon the following terms:— (1) The patient must be a resident of Hammersmith. (2) The medical practitioners immediately notify the Medical Officer of Health that they have called in the 81 services of one of the consultants, giving the name and address of the patient, date of call, the reason and the result. (3) The Borough Council pay the consulting obstetrician a fee of three guineas when called in to give advice, but in such cases as require operative assistance a fee of five guineas will be paid. (4) Contributions, by the patient, will be considered in each individual case. The following Rota of Consultants has been approved for submission to the Minister of Health:— Barrett, Lady Florence Elizabeth, M.D., M.S., 31, Devonshire Place, W.l. Forsdike, Sidney, M.D., F.R.C.S., 82, Harley Street, W.l. Goodwin, Aubrey, M.D., F.R.C.S., 72, Wimpole Street, W.l. Williams, Leslie Herbert Worthy, M.D., F.R.C.S. Puerperal Fever.—Seven cases were reported as due to Puerperal Fever, against fifteen cases in the previous year. Three cases were treated at the Isolation Hospital of the Metropolitan Asylums Board, one at St. Marylebone Hospital, one at St. Mary Abbot's Hospital, one at the Fulham Infirmary, and one at the Mothers' Hospital. Two deaths were registered. The mortality rate on the cases reported was 28.6 per cent. Puerperal Pyrexia.—Ten cases were reported as due to Puerperal Pyrexia. Two cases were treated at the isolation hospitals of the Metropolitan Asylums Board, 3 at the Hammersmith Hospital, 2 at Queen Charlotte's Hospital, 1 at the Mothers' Hospital, 1 at St. George's Hospital, and 1 at the home of the patient. Cerebro-Spinal Meningitis.—One case of Cerebro-Spinal Meningitis was reported against one in the previous year. The case was treated at the Fulham Hospital. No death was registered. Acute Polio-myelitis.—No cases were reported as due to Polio-myelitis, against two cases in the previous year. Encephalitis Lethargica.—Four cases were reported as due to Encephalitis Lethargica, against nine in the previous year. One case was treated at the Middlesex Hospital, 1 at the London Jewish Hospital, 1 at Queen Square Nerve Hospital and 1 at the Chatham Naval Hospital. No death was registered. 82 OPHTHALMIA NEONATORUM. In August the Ministry of Health issued new Regulations in regard to the Notification and Treatment of Ophthalmia Neonatorum. The Minister of Health stated that he has had under consideration the question of revising the Public Health (Ophthalmia Neonatorum) Regulations, 1914, under which an obligation rests upon a certified midwife to notify any case in which she has reasonable grounds for supposing that a child upon whom she is in attendance, or whom she is called in to visit in the course of her practice, is suffering from Ophthalmia Neonatorum, unless the case has already been notified by a medical practitioner. It has been represented that the system of dual notification by medical practitioners and midwives has in some instances resulted in complete failure to notify; and that the fact that, under the Rules of the Central Midwives Board, a midwife is required to call in medical help for any inflammation of, or discharge from, the eyes, however slight, and to send notice thereof to the Local Supervising Authority, has tended to confuse midwives as to their duty under the Regulations. The Minister has, therefore, decided to issue amended Regulations under which the duty of notifying a case of Ophthalmia Neonatorum is placed solely upon the medical practitioner in attendance upon the case, while at the same time an obligation is laid upon the Medical Officer of Health of a Local Sanitary Authority to forward a copy of every notification which he receives under the Regulations to the County Medical Officer of Health within 24 hours after the receipt of the notification. 2. It will be observed that Article 4 of the Regulations requires the Borough Council forthwith to cause notice to be given to all medical practitioners resident or practising within the Borough of the duties imposed on them by the Regulations, and it would be desirable to include in the notice an intimation that in future midwives will not be required to notify cases of Ophthalmia Neonatorum. It is also suggested that the London County Council should send a similar intimation to all midwives practising in the area of the administrative County, and at the same time should make it clear that, in accordance with the rules of the Central Midwives Board, midwives are still required (1) to summon medical assistance in all cases, however, slight, of inflammation of, or discharge from, the eyes of a child, and (2) to send notice immediately to the Local Supervising Authority that such assistance has been sought. Further, it will be seen that under Article 9 of the Regulations it will be necessary for the Borough Medical Officer of Health to send a copy of every notification which he receives 83 under these Regulations to the Metropolitan Asylums Board within 12 hours after the receipt of the notification. 3. It is clearly important that, for districts in which the Local Supervising Authority under the Midwives Acts are not also the Maternity and Child Welfare Authority and the Local Sanitary Authority, there should be definite arrangements between those Authorities as to the precise steps to be taken wherever inflammation of, or discharge from, the eyes is reported by a midwife, or when Ophthalmia Neonatorum is notified by a medical practitioner, with a view to obviating any delay in the treatment of the child. Whilst prevention of the occurrence of Ophthalmia Neonatorum should be the first aim, adequate provision should be made for such cases of this disease as occur, by visiting and nursing in the home and by hospital treatment where necessary; and the Minister is of opinion that the appropriate Authority to carry out these measures is the one entrusted with the scheme for Maternity and Child Welfare in the district. 4. It is understood that the London County Council, on receipt of a copy of the notice sent by a midwife calling in medical help for inflammation of, or discharge from, the eyes of a child, arrange for an immediate visit to the home of the patient by the Inspector of Midwives, and that an intimation of the case, giving such particulars as may be considered necessary, is sent by the County Medical Officer of Health to the appropriate Borough Medical Officer of Health as soon as possible after the visit of the Inspector of Midwives, indicating whether supervision of the case by a Health Visitor is considered desirable during the lying-in period. If such supervision is needed, the Borough Medical Officer of Health should arrange for a Health Visitor to visit the child and report to him as to whether the recommendations of the Inspector of Midwives are being carried out and whether any further measures appear to be necessary. 5. In notified cases of Ophthalmia Neonatorum, it is suggested that, if the patient was originally attended by a medical practitioner, the Borough Medical Officer of Health should ascertain personally from the practitioner whether nursing or other assistance is needed and should arrange for the provision of such assistance. If a midwife was originally in attendance, the Borough Medical Officer of Health will already be in touch with the case through the Inspector of Midwives. 6. It has been represented to the Minister that in cases in which midwives call in medical help for inflammation of, or discharge from, the eyes of an infant, there is often objection on the part of the mother or her husband if the Local Supervising Authority attempt to recover the fee paid by them to 84 the medical practitioner who answers the call, and that in consequence some midwives are reluctant to call in medical help for this condition. It appears to the Minister to be important that nothing should be done which would be likely to deter midwives from promptly seeking medical aid in all cases of inflammation of, or discharge from, the eyes, however slight, and he suggests that the London County Council should consider whether they should not refrain in future from exercising their power of recovery under Section 14 (4) of the Midwives Act, 1918, in this class of case. I append the Regulations as made by the Minister. Public Health, England. Prevention of Epidemic, Endemic or Infectious Diseases. The Public Health (Ophthalmia Neonatorum) Regulations, 1926, dated July 31, 1926, made by the Minister of Health. The Minister of Health, in exercise of the powers conferred upon him by the Public Health Act, 1875, the Public Health (London) Act, 1891, and the Public Health Act, 1896, and of every other power enabling him in that behalf, hereby makes the following regulations :— 1. These regulations may be cited as the Public Health (Ophthalmia Neonatorum) Regulations, 1926, and shall come into operation on the 1st day of October, 1926. 2.—(1) In these regulations, unless the contrary intention appears:— " Local authority " means 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; "Medical officer of health" means medical officer of health of a local authority; "Medical practitioner" means any person for the time being registered under the Medical Acts; "Ophthalmia neonatorum" means a purulent discharge from the eyes of an infant commencing within twenty-one days from the date of its birth; "The Minister" means the Minister of Health; "The Infectious Disease (Notification) Acts" means the Infectious Disease (Notification) Acts, 1889 to 1899, and includes Section 55 of the Public Health (London) Act, 1891, and any provisions relating to the notification of infectious disease contained in any local Act or Order made thereunder. (2) The Interpretation Act, 1889, shall apply to the interpretation of these regulations as it applies to the interpretation of an Act of Parliament. 3. The Public Health (Ophthalmia Neonatorum) Regulations, 1914, and, so far as they relate to ophthalmia neonatorum, the Notification of Infectious Disease (London) Regulations, 1920, are hereby revoked, but without prejudice to any right, obligation, or liability acquired, accrued or incurred thereunder. 4. The local authority shall enforce and execute these regulations in their district and shall forthwith cause notice to be given to all medical practitioners resident or practising within the district of the duties thereby imposed upon them. 85 5.— (1) Subject to the provisions of these regulations every medical practitioner, on first becoming aware that a child upon whom he is in professional attendance is suffering from ophthalmia neonatorum, shall forthwith make and sign a notification of the case in the form prescribed for the purpose of certificates under the Public Health (Notification of Infectious Disease) Regulations, 1918, at the same time stating in writing, either on the form or on a separate sheet attached to the form, the date of birth of the child, the name and address of the parent or other person, if any, having charge of the child, and the date of the onset of the disease, and shall transmit the notification and statement to the medical officer of health of the district within which the place of residence of the parent or other person, if any, having charge of the child is situate at the date of notification: Provided that a medical practitioner shall not be required to notify a case of ophthalmia neonatorum under these regulations if the case is notifiable or has been notified under the Infectious Disease (Notification) Acts. (2) Every medical practitioner who transmits to a medical officer of health a notification of a case of ophthalmia neonatorum under the Infectious Disease (Notification) Acts shall at the same time state in writing, either on the form or on a separate sheet attached to the form, the date of birth of the child, the name and address of the parent or other person, if any, having charge of the child, and the date of the onset of the disease. 6. A notification to be transmitted to a medical officer of health in pursuance of these regulations shall be addressed to that officer and may be transmitted by being delivered to him or by being delivered at bis office or residence, or may be sent by prepaid letter post addressed to him at his office or at his residence. The notification shall either be enclosed in a sealed envelope or shall be folded in such manner that during its transmission the particulars of the notification cannot be observed. 7.— (1) The local authority shall pay to every medical practitioner a fee of two shillings and sixpence for each notification duly made, signed and transmitted by him under these regulations if the case occurs in his private practice, and of one shilling if the case occurs in his practice as medical officer of any public body or of any institution. (2) Every fee shall be paid as soon as practicable after the end of the quarter during which the notification was sent, and the local authority shall not require before payment an account of fees claimed under these regulations. (3) The said fees shall in each case be deemed to cover all expenses, including the cost of transmission. 8. The medical officer of health of the local authority shall forward a copy of every notification received by him under these regulations to the medical officer of health of the administrative county within which the district is situate within twenty-four hours after the receipt of the notification. 9. The provisions of sub-section (4) of section 55 of the Public Health (London) Act, 1891, shall apply to any notification received by a medical officer of health of any local authority in the Administrative County of London, in pursuance of these regulations, in like manner as the provisions of the sub-section apply to a certificate received by a medical officer of health under the said section. 10. Where a child is an inmate of any building, ship, vessel, boat, tent, van, shed, or similar structure belonging to His Majesty the King, nothing in these regulations shall be construed as requiring a notification to be transmitted to a medical officer of health in respect of that child in any case not falling within the provisions of paragraph (b) of section 5 of the Local Government (Emergency Provisions) Act, 1916 (as made permanent by the Expiring Laws Act, 1926), and as applied 86 to the Royal Air Force by the Air Force (Application of Enactments) (No. 2) Order, 1918. Given under the Official Seal of the Minister of Health this Thirtyfirst day of July, in the year One thousand nine hundred and twenty-six. 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. Ophthalmia Neonatorum. — Twenty - four cases were reported as due to Ophthalmia Neonatorum, against twentyone in the previous year. Ten cases were treated at the Metropolitan Asylums Board Hospital, and fourteen at home. In the majority of cases treated at home arrangements were made for a nurse to attend the patient. Anthrax.—One case of Anthrax was notified during the year, against no case in the previous year. The patient, a youth of 15 years, first observed a pimple on his left chin on the 3rd September, which gradually grew larger, and on the 6th September was admitted to the West London Hospital, the case being diagnosed as Anthrax. He was treated with Sclavo Serum and make a complete recovery. The patient was employed as a General Hand at the Feather Mills, and it is possible that he was infected at these premises. I inspected the factory and saw many bales of feathers. I had two of the bales opened; one from Tientsin and the other from Canton, and I took a sample of feathers from each. The feathers were extraordinarily foul and dusty and the smell was distinctly unpleasant. The feathers were submitted to Dr. Ehvorthy, Pathologist at the West London Hospital, whom it may be remembered first discovered the connection between infected shaving brushes and Anthrax. He reported that "Anthrax bacilli were not obtained from the washings of either of these samples. Other pathogenic spore-bearing organisms were present in large numbers. Animals inoculated lived long enough to have shown B. Anthracis in spleen, blood, &c., but cultures failed to show them." He observed that "this somewhat limited examination must not be taken as an indication that the bales, from which the samples were taken, were anthrax spore free nor that the 87 factory had not been infected from bales previously worked with. In both samples the sludge was extraordinarily foul." His negative findings did not prove that the feathers were not infected. Of course, it is realised that if the feathers were generally infected, cases of Anthrax of the Pneumonic form would occur. I made inquiries as to this and found no evidence in support. From the general health point of view, the occupation must, in my opinion, be very unhealthy, owing to the large amount of dust, and that of a very objectionable kind. No precautions appeared to be taken by the workers for their protection against inhalation of dust. I was informed by the manager that they objected to wearing masks for this purpose. Many of the workers looked unhealthy, coughed a good deal and appeared to be bronchitic. I think the wearing of masks should be compulsory in this and similar dusty occupations. Although the Anthrax bacillus was not found by the Pathologist, spore-bearing organisms of the bacillus of malignant (Edema and the bacillus Welchii were very plentiful, and killed the animals used in the experiment. Hydrophobia.—No case was reported as duo to Hydrophobia, as against no case in the previous year. Rabies Order, 1919.—No case of Rabies in dogs occurred in the Borough. Glanders.—No case was reported as due to Glanders, as against no case in the previous year. Measles and German Measles.—Seven hundred and twelve cases of Measles and German Measles were notified against six hundred and fifty-eight in the previous year. Six hundred and sixty-two cases were treated at the homes of the patients, and fifty in the Hospitals of the Metropolitan Asylums Board. Twenty-four deaths were registered. Whcoping Cough.—One hundred and forty-eight cases of Whooping Cough were reported, against five hundred and seventy three in the previous year. Eleven 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. 88 I have received, as heretofore, information as to cases from the Head Teachers of the Schools of the London County Council. The following Chart shows the number of Deaths from Measles per 100,000 inhabitants, 1907-1928. The homes of the patients were visited by your Inspectors, and the parents advised as to the precautions that should be taken. 89 The following Chart shows the number of Deaths from Whooping-Cough per 100,000 inhabitants, 1907-1926. Chicken Pox.—Two hundred and ninety cases of Chicken Pox were reported, against four hundred and two in the previous year. In every case the premises were visited by one of your Inspectors and the parents advised as to the precautious necessary. 90 Pneumonia.—One hundred and two cases of Pneumonia (twenty-one Influenzal Pneumonia and eighty-one Primary Pneumonia) were notified during the year. The majority of the patients were treated at home. Thirty-nine cases were treated at various institutions. All cases were made the subject of inquiry 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 five 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.—No case of Dysentery was reported against one case in the previous year. Trench Fever.—No case of Trench Fever was reported, against no case in the previous year. Influenza.—During the year twenty-three deaths from Influenza occurred, as compared with thirty-four in the previous year. Wrong Diagnosis.—Forty-five cases of infectious disease were removed to the Hospitals of the Metropolitan Asylums Board and subsequently returned home in consequence of the patients being found not to be suffering from the disease stated on the certificates, or any other notifiable disease— Diphtheria 27 Scarlet Fever 17 Enteric Fever 1 Total 45 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. 91 TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1917 to 1926. Year. Smallpox. Scarlet Fever. Diphtheria or Diphtheritic Croup. Typhus Fever. Enteric Fever. Simple Continued Fever. Relapsing Fever. Puerperal Fever. Cholera. Erysipelas. Plague. Chicken pox. 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. 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 36 8 3 141 95 3 0 1927 1920 0 726 380 0 8 0 0 20 0 57 0 168 763 225 4 1 0 0 53 6 4 165 20 9 0 2610 1921 1 1358 443 0 4 1 0 12 0 51 0 193 38 101 2 0 0 0 44 3 5 151 6 3 1 2415 1922 0 496 440 0 14 1 0 9 0 39 0 224 1284 357 4 0 0 0 35 0 1 154 4 0 0 3062 1923 0 245 233 0 14 0 0 13 0 31 0 363 347 136 3 0 0 0 28 4 6 84 0 0 0 1507 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 2729 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 2378 1926 0 276 254 0 8 0 0 17 0 29 0 290 712 148 1 1 0 0 24 0 4 102 0 0 0 1866 Average for 10 years. 0 413 276 0 11 0 0 11 0 45 0 288 977 251 5 0 0 0 34 3 5 109 13 2 0 2443 a Not Notifiable. b Notifiable during the years 1916—1919. e Notifiable from 1st March. 1919. 92 I append figures showing the numbers dealt, with during the year. School Children— Scabies 105 Impetigo 33 Verminous Cases 2,438 Adults— Scabies 13 Impetigo — Verminous Cases 69 Children under School age— Verminous Cases 6 Scabies 2 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 £243 16s. 0d. in respect of cleansings and £6 18s. 0d. in respect of 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 423 Mattresses 603 Pillows 1,603 Bolsters 408 Blankets 1,758 Sheets 892 Quilts 755 Articles of Clothing 2,604 Sundries 381 Total 9,427 Rooms 954 Tuberculosis. Tuberculosis.—Two hundred and seventy-eight cases of tuberculosis were reported during the year; two hundred and ten of which were Pulmonary and sixty-eight being other forms of Tuberculosis, against two hundred and sixty-five cases in the previous year. 93 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. of 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 90 30 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 Prim. Not Pulmonary. Male .. 2 .. 4 7 14 23 33 9 32 8 4 127 276 174 359 .. .. .. .. 2 .. 2 34 104 200 Pulmonary. Female .. 1 2 2 8 24 24 7 4 2 83 113 .. .. .. .. 2 12 59 Non-Pulmon- ary, Male 1 3 10 9 5 1 3 2 1 .. 1 36 38 .. .. .. .. .. .. 22 Non-Pulmonary, Females .. 2 8 4 7 3 4 .. 1 .. 1 30 34 .. 1 1 2 .. 2 15 The following table shows the number of new cases of tuberculosis coming to the knowledge of the Medical Officer of Health or Chief (Administrative) Tuberculosis Officer during the period from the 3rd January, 1926, to the 1st January, 1927, otherwise than by notification on Form A or Form B under the Public Health (Tuberculosis) Regulations, 1912:— Age periods. 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 Cases. Pulmonary Males — — — — — 1 3 1 2 — — 7 ,, Females 1 1 _ — 1 1 — — — — 4 Non-pulmonary ,, Males — 1 — — — — — — — — — 1 ,, Females — — 1 — 1 — — — — — — 2 In all cases notified the nurses visited and obtained all the necessary information. Any insanitary conditions found to exist were referred to the Sanitary Inspectors. One hundred and twenty-seven deaths from Pulmonary Tuberculosis were registered, against one hundred and twentyfour in the previous year, representing a death-rate of 0.9 per 1,000, compared with 0.9 in 1925. 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. 94 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 1920-1926. showing the interval between notification and death of tuberculous Persons. 1920. 1921. 1922. 1923. 1924. 1925. 1926. 1. Total number of deaths from Tuberculosis in the Borough 157 173 162 145 170 138 142 2. The number of cases notified at death 11 8 17 11 10 13 8 3. The number of cases notified within one month of death (excluding above) 26 29 20 21 23 18 30 4. The number of cases notified within three months of death (excluding above) 28 29 20 18 20 13 20 5. The number of cases notified within six months of death (excluding above) 16 9 16 13 16 18 12 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1926:— Ago Periods. New Cases. Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M, F. M. F. M. F. 0 — — 1 — — 1 — 1 1 2 1 3 2 1 i 1 2 5 — 2 10 8 — — — — 10 4 2 9 4 — 1 — — 15 7 8 5 7 4 9 1 3 20 14 24 1 3 9 12 — — 25 23 24 3 4 24 11 1 35 33 9 2 — 19 7 1 45 32 7 1 1 13 7 1 — 55 8 4 — — 7 2 — 65 and upwards 4 2 1 1 2 1 — — Totals 127 83 36 30 79 52 3 8 I submit a report on the work carried out at the Tuberculosis Dispensary. 95 Tuberculosis Officer's Report for the Year 1926. 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. School Children. 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 278, an increase of 13 as compared with 1925. At the end of 1925 there were 1,302 persons living in the Borough whose names were entered in the Medical Officer of Health's 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. 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:— On 1st January, 1926, the number of patients on the Dispensary Register was 824. During the year 11 definite cases of the disease were transferred from other areas into the Hammersmith district and 66 moved out of this district or were lost sight of. Sixtyfive were written off the register as being cured cases who had previously been notified as suffering with tuberculosis. New Patients. During the year 509 persons attended for examination for the first time. Of these 172 were under the age of fifteen and 337 were adults. Males and females attended in almost equal numbers, viz., 252 and 257. G 96 Of the total, 180 were referred to the Dispensary by local Practitioners for the purpose of consultation, while 93 were "contacts" of persons suffering with Tuberculosis and 66 were discharged ex-Service men who attended for reports on the instruction of the Ministry of Pensions. Diagnosis. Found to have Pulmonary Tuberculosis 138 Found to have other forms of Tuberculosis 47 Showing no evidence of Tuberculosis 324 Patients from Previous Years. Six hundred and eleven persons who had attended the Dispensary in previous years presented themselves during 1926. Of these, 465 were adults, and included 147 ex-Service men, while 146 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 2,850, and physical examinations were carried out in 1,610 instances, i.e., in 56.5 per cent. of the total attendances. The names of 454 persons were written off the register as being nontuberculous, and the total number on the Dispensary register on 31st December, 1926, was estimated at 686. Sputum Examinations. Five hundred and thirteen specimens of sputum and other pathological products were examined bacteriologically. One hundred and six showed the presence of Tubercle Bacilli, while 407 proved negative. Institutional Treatment. The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homes), under the London County Council's Scheme, numbered 185. 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 540 To the Ministry of Pensions 146 To General Practitioners and Hospitals 450 97 Home Visitation. The Tuberculosis Officer made 188 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 31 occasions. The Nurses visit the tuberculosis population on notification and thereafter as far as possible at intervals of six months or less, as may appear advisable. During the year 3,942 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 206 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 Hoard of Guardians, the Red Cross Society, the United Services Fund, the Charity Organisation Society, the Invalid Children's Aid Association, the Labour Exchange and the Local Medical Practitioners, and meets on the first and third Wednesday in 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's Tuberculosis Scheme. The Committee met on 21 occasions during the year. There were submitted by the staff 232 applications for residential treatment, an increase of 11 compared with 1925. The Committee decided in 154 of these cases that no payment should be required in respect of such treatment. In the remaining 78, assessments of varying amounts were made. In 83 instances, reconsideration of these assessments was rendered necessary at subsequent meetings, mainly by changes in the family circumstances. Thirty 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 £269 0s. 6d. G 2 98 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 Londoi 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. 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. Thirty-four cases were dealt with in this way during the year. Arrangements exist for the provision of Finsen Light treatment, and artificial pneumothorax. Seventeen attendances were made at the West London Hospital for the purpose of the latter. 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. 99 No definite arrangements for the provision of nursing exists, but advantage is taken of the services of the District Nursing 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. Application was made to the Borough Council by a patient who had just returned from a sanatorium for a chalet to enable him to carry out the open-air treatment in his back garden. The Council purchased one and granted the loan of it to him, and excellent use has been made of it. 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 continues in many instances. CANCER. During the year the Ministry of Health issued a further circular known as Cancer V for the guidance of Local Authorities supplementing the information contained in the circulars known as Cancer I, Cancer II, Cancer III, Cancer IV. Cancer V relates to cancer of the breast, and the results of surgical operation in connection with this condition. It supplements the information already given in Cancer III, by incorporating additional and more exact data which has since been obtained. This has established the previous conclusions on a firmer basis of fact, and has demonstrated that the results secured by complete operation at an early stage are even better, in terms of length of subsequent healthy life, than had been demonstrated. Intensive efforts on a wide scale are now being devoted to the search for the cause or causes of malignant disease, and it is earnestly hoped that they will result in furnishing humanity with some direct means of controlling the disease through the application of preventive measures. Cancer caused 217 deaths. Carcinoma was the form of Cancer to which 188 deaths were attributed; sarcoma and epithelioma were assigned cause of 12 deaths; 17 deaths were certified as due to cancer or malignant disease without further definition. 100 The parts of the body which were affected in each case are shown in the following table:— Deaths from Cancer, 1926. Males. Females. Buccal Cavity 4 2 Liver and Pancreas 9 12 Alimentary Canal 57 39 Female Genital Organs — 33 Breast — 25 Prostrate and Bladder 11 3 Other and Unspecified Organs 16 6 Total 97 120 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. Two of the bodies were re-interred in St. Mary's Cemetery, Harrow Road, one was removed for re-interment in Brompton Cemetery, London, one was removed to Peru for re-interment in the Cementerio General, Lima, one was removed to the Irish Free State for re-interment in Dublin, one was removed to Chile, and one was removed to Venezuela. The remains of a person who died in Madeira in May, 1921, were interred at the Kensal Green Roman Catholic Cemetery. 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 be 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. 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. 101 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. Owing to the difficulty of obtaining the Town Hall during October, it was decided to hold a Health Exhibition in May, 1927. 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 2,001 Corrected Number of Births 2,188 These figures represent a Birth-rate per 1,000 of the population of the Borough of 16.3 Corrected Number of Deaths of Infants under one year, of whom 42 died under one week 144 Legitimate Infants—141, or 63 per 1,000 Births. Illegitimate Infants—12, or 109 per 1,000 Births. Infant Mortality Rate per 1,000 Births 66 The work undertaken under this heading in the Borough during the year 1926 was continued on similar lines to previous years. 1. Activities directly initiated by the Borough Councd : (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 Councd : (а) Infant Welfare Centres. (б) Day Nurseries. 3. Activities of independent Voluntary Agencies : (а) llescue Homes. (б) 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. 102 I have advised the Council that the number of Health Visitors is too small. It is impossible for three Health Visitors to adequately visit and keep under observation over 2,000 new babies each year, and also keep in touch with all children up to the age of five years. A large proportion of deaths of children under 1 year occur in the first few weeks, and it is during this period that the advice of the Health Visitors is most essential. As I have already said it is impossible to carry on with the present staff. The visits paid are enumerated in detail below:— First visits 1,905 Re-visits (under 1 year) 2,230 Be-visits (1 to 5 years) 1,345 Out and removals 2,090 Special visits 424 Ophthalmia, first visits 23 Ophthalmia Be-visits 8 Puerperal Fever 7 Puerperal Pyrexia 5 Ante-natal, first visits 422 Ante-natal, re-visits 64 Visits to Stillbirths 56 Visits to Infant Deaths 130 Cerebro-Spinal Meningitis — Encephalitis Lethargica 6 Poliomyelitis — Epidemic Diarrhoea 1 Total 8,716 Number of Consultations at Infant Welfare Centres, attended by Health Visitors 430 Number of Committee Meetings of Voluntary Associations attended 42 Number of Insanitary Conditions reported by Health Visitors and dealt with by Sanitary Inspectors 41 The feeding of the 2,078 infants visited was found to be as follows:— Breast-feeding 1,685 Artificial feeding 142 Mixed feeding 78 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. 103 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 1926 2188 144 66 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. 104 The infant mortality rates of the London Boroughs varies from 38 in Lambeth to 90 in Holborn. The following Chart shows the Infantile Mortality rate for the years 1903-1926. MATERNAL MORTALITY. Milk (Mothers and Children) Orders, 1918-1919.—Under these orders the Council has continued to supply milk to necessitous cases, each case being investigated, especially as to the financial position, before a supply is granted. 6,044 lbs. of dried milk and 100 quarts of raw milk were distributed during the year. The number of applications for free milk has averaged 22 per week during the year. The total expenditure during 105 the year was approximately £380. 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. During the year the Council decided to transfer "Parkside" Maternity Home from Ravenscourt Park to the Hammersmith Hospital, 150, Du Cane Road. The transfer took place in September, all patients having booked for admission following the 16th September were duly notified and were admitted to the Home in Du Cane Road. I append figures for the period 1st January, 1926, to 30th September 1926, and for the period 1st October, 1926, to 31st December, 1926:— Name of Institution.—"Parkside" Maternity Home, Ravenscourt Park Number of Beds.—20. Figures for the Period from 1st January, 1928, to 30th September, 1926. Information Required. Particulars. (1) Number of Cases in the Home on 1st January. 8. (2) Number of Cases admitted during 1996. 267. (3) Average duration of stay 15½ days. (4) No. of Cases delivered by (a) Midwives 256. (b) Doctors 9. 106 Information Required. Particulars. (5) No. of Cases in which medical assistance was sought by the midwife with reasons for requiring assistance (a) Ante-natal All cases examined by Medical Officer in Ante-natal Clinic. (b) During labour 20. Prolonged labour 3 Shoulder presentation 1 Unreduced occipito posterior. 2 Placenta pravia 1 Partially adherent placenta 1 Post-partum Haemorrhage 1 Ruptured perineums 10 Extended breech 1 (c) After labour All patients visited daily by Medical Officer. No. of ruptured perineums which required suture 10. (d) For infant All patients visited daily by Medical Officer. (6) No. of Cases notified as (a) Puerperal fever Nil. (b) Puerperal pyrexia (i.e., rise of temperature to 100.4°F. or its recurrence within that period) with result of treatment in each case. Nil. (7) No. of Cases of Pemphigus Neonatorum. Nil. (8) No. of Cases notified as Ophthalmia Neonatorum with result of treatment in each case. Nil. (9) No. of Cases of "Inflammation of the Eyes" however slight. Nil. (10) No. of Infants not entirely breastfed while in the Institution with reasons why they were not breastfed. 3. Supplementary feeds only. Insufficient breast milk. (11) No. of Maternal deaths with causes. 1. Acute Toxemia of pregnancy. (12) No. of Foetal deaths (a) Stillborn 9. Abortion 1 Premature 2 Macerated foetus 1 Induced abortions 2 Placenta pravia 1 Toxemia of pregnancy 2 (b) Within 10 days of birth and their causes and the results of their postmortem examinations if obtainable. 6. Premature 4 Haemorrhage 1 Twin 1 107 Name of Institution.—"Parkside" Maternity Home. Address.—150, Ducane Road, W.12. Figures for the Period from 1st October to 31st December, 1926. Number of Beds.—14. Information required. Particulars. (1) Number of Cases in the Home on the 1st January, 1926 (2) Number of Cases admitted during 1926. 68. (3) Average duration of stay 15½ days. (4) Number of Cases delivered by (a) Midwives 67. (b) Doctors 1. (5) No. of Cases in which Medical Assistance was sought by the Midwife, with reasons for,requiring assistance (a) Ante-natal 1 Case of Albuminuria. (b) During labour 3. a. Antepartum Hsemorrhage. b. Placenta retained for over an hour, with considerable loss between 2nd and 3rd stage of labour. c. Complicated breech presentation. All patients are seen daily by the Doctor. (c) After labour 4. a. Accelerated pulse rate and blanching immediately after delivery. b. Uiseof temperatureon2ndday. c. Kiseof temperatureon 3rd day. d. Rise of temperature on 5th day. (d) For Infant 19 ruptured perineums required sutures. 13 required 1 stitch. 6 required 2 stitches. 2. a. Frail infant with incessant vomiting after food. b. White asphyxia. (6) No. of Cases notified as (a) Puerperal fever Nil. (b) Puerperal pyrexia (i.e., rise of temperature to 100.4° F. or its recurrence within that period) with the result of treatment in each case. 3. All three cases recovered rapidly with no complications. 108 Information Required. Particulars. (7) No. of Cases of Pemphigus Neonatorum. Nil. (8) No. of Cases notified as Ophthalmia Neonatorum with result of treatment in each case. Nil. (9) No. of Cases of "Inflammation of the Eyes," however slight. Nil. (10) No. of Infants not entirely breastfed while in the Institution with reasons why they were not breastfed. 5. Cases of rise of temperature 3 Congenital pyloric obstruction 1 Alternate breast and bottle feeds as the mother had one breast excised for carcinoma 1 (11) No. of Maternal deaths with causes. 1. Ante-partum hæmorrhage, due to Placenta Pravia. Child not born, was dead for some time in utero. (12) No. of Foetal deaths (a) Stillborn 1. (b) Within 10 days of birth and their causes, and the results of the pjst-mortem examination if obtainable. Stillborn—complicated breech. No post-mortem. 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. 109 The College Park Clinic was a branch of the Hammersmith Infant Welfare Centre, but is now carried on under the auspices of the 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 clemand 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 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 4 Minor Ailments 27 Dental Treatment 3 Total 34 . 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 110 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 7 15 7 — 7 Puerperal Pyrexia 10 — 10 1 9 Ophthalmia Neonatorum 24 21 24 10 10 Epidemic Diarrhoea *26 35 — 4 — Measles & German Measles (under 5)† 201 201 201 8 41 Whooping Cough (under 5)† 52 327 52 1 5 Poliomyelitis (under 5) — 2 — — — * Summer Diarrhoea.—As this is not a notifiable disease the figures available are those of deaths which were registered as having been due to this cause. t Not notifiable diseases. Ophthalmia Neonatorum.—The number of cases reported was twenty-four, acrainst twenty-one 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. 24 14 10 23 1 — — 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 111 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-eight applications were received for certificates under the above Act. In thirty-two cases the certificates were granted, six applications were refused. Fourteen certificates were granted to owners who had carried out the work specified satisfactorily, three being refused. Rag Flock Act, 1911.—The Rao Flock Regulations, 1912.—No action was taken under these regulations during the year under review. Public Mortuary.—During the year four hundred and two bodies were removed to the Mortuary in Fulham Palace Road. There were two hundred and seventy-eight brought to the Mortuary by order of the Coroner, and one hundred and twenty-four were received for accommodation and convenience of burial. METEOROLOGY. The average mean temperature registered in London during the year was 51.1 degrees Fahrenheit. The highest air temperature registered being 88 degrees, in September. The lowest air temperature was 16 degrees in January. The total amount of rainfall was 28.1 inches. INDEX. Page Introduction 2 Statistics for the Year 1926 4 Natural and Social Conditions of the District. Population 4 Marriages 5 Births 6 Chart—Diarrhœa 6 Deaths 7 Deaths of Infants 7 Summer Diarrhoea 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 General Provision of Health Services in the Borough. Hospitals 13 Institutional Treatment for Unmarried Mothers 13 Ambulance Facilities 13 Clinics and Treatment Centres 13 Maternity and Child Welfare Centres 14 Attendance at Infant Welfare Centres 14 Day Nurseries 15 School Clinics 15 Tuberculosis Dispensary 15 Treatment Centre for Venereal Diseases 15 Staff of the Public Health Department 16 Professional Nursing in the Home 17 General 17 Infectious Diseases 18 Midwives 18 Chemical Work 18 Page Sanitary Circumstances of the Borough. Closet Accommodation 18 Scavenging 18 Cesspools 19 General Sanitary Administration 19 Notices 19 Summonses 20 Factories and Workshops—Inspection of 23 House to House 25 Houses Let in Lodgings 25 Eats and Mice (Destruction) Act, 1919 25 Smoke Abatement 26 Controlled Premises and Occupations 26 Ice Cream Vendors 27 Schools 27 Housing. Housing Conditions 28 Housing and Town Planning 29 Newly Erected Houses 29 Statistics 30 Food. Milk Supply 32 Milk (Special Designations) Order, 1923 34 Milk and Dairies Order, 1926 34 Imported Milk Regulations, 1926 45 Preservatives, Ac., in Food 46 Public Health Regulations, 1926 46 Sale of Food and Drugs Acts—Procedure 50 Certification of Certain Food Products for Export 55 Public Health (Milk and Cream) Regulations, 1912 and 1917 56 Milk (Mothers and Children) Order, 1919 57 Sale of Food and Drugs Acts 57 Condensed Milk 59 Butter and Margarine 60 Cocoa and Coffee 60 Meat and Fish Preparations 60 Conserves, Vegetables, &c. 60 Farinaceous Foods, &c. 60 Condiments, Spices, &c 61 Spirits 61 Drugs 61 Meat 63 Public Health (Meat) Regulations, 1924 63 Licensed Slaughterhouses 64 Markets 65 Page Poor—continued. Fried-fish Shops 65 Bakehouses 65 Unsound Food 67 Food Surrendered 68 Food Poisoning 69 Prevalence and Control over Infectious Diseases. Infectious Diseases 69 Bacteriology 69 Zymotic Diseases 70 Smallpox 71 Cholera 71 Plague 71 Chart—Diphtheria 72 Diphtheria and Diphtheritic Membranous Croup 73 Anti-toxin 73 Scarlet Fever 73 Enteric Fever 73 Erysipelas 73 Typhus Fever 73 Relapsing Fever 73 Chart—Scarlet Fever 74 Continued Fever 75 Puerperal Fever 75 Cerebro-Spinal Meningitis 81 Acute Polio-myelitis 81 Encephalitis Lethargica 81 Ophthalmia Neonatorum 82 Anthrax 86 Hydrophobia 87 Babies Order, 1919 87 Glanders 87 Measles and German Measles 87 Whooping Cough 87 Measles—Chart 88 Chart—Whooping Cough 89 Chicken Pox 89 Pneumonia 90 Malaria 90 Dysentery 90 Trench Fever 90 Influenza 90 Wrong Diagnosis 90 Cleansing of Verminous Persons 90 Tabular Statement—Zymotic Diseases 91 Page Prrvalence and Control over Infectious Diseases—continued. Disinfection 92 Tuberculosis 92 Tuberculosis Officer's Report 95 Tuberculosis Dispensary 95 Institutional Treatment 96 Clinical Reports 96 Home Visitation 97 Tuberculosis Care Committee 97 Cancer 99 Exhumation and Re-interment of Bodies 100 Health Week 101 Maternity and Child Welfare Statistics 101 Health Visitors—Work of101 Feeding of Infants—Statistics 102 Table—Births, Deaths, and Infant Death Rate 103 Chart—Infantile Mortality Rate 104 Maternal Mortality 104 Milk (Mothers and Children) Orders, 1918-1919 104 "Parkside" Maternity Home—Statistics 105 Voluntary Work. Infant Welfare Centres 108 Day Nurseries 109 Rescue Homes 109 Convalescent Treatment of Invalid Children 109 Treatment and Nursing—Children under School Age 109 (a) Operations. (b) Minor Ailments, (c) Dental Treatment. Infectious Diseases of Mothers, and Children under five years of age—Tabular Statement 110 Ophthalmia Neonatorum 110 Sanitary Administration. Staff 110 Rent Restrictions Acts 111 Rag Flock Act 111 Public Mortuary 111 Meteorology 111