HAM 67 Annual Report OF THE Medical Officer of Health OF THE Borough of Hammersmith FOR THE YEAR 1927 INDEX. Page Introduction 2 Statistics fob the Year 1927 4 Natural and Social Conditions of the District. Population 1 Marriages 5 Births 5 Chart—Diarrhoea 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 10 Deaths (Various Causes—Table II) 12 Table—Whole of London—Comparison 13 General Provision of Health Services in the Borough. Hospitals 11 Institutional Treatment for Unmarried Mothers 11 Ambulance Facilities 15 Clinics and Treatment Centres 15 Maternity and Child Welfare Centres 15 Attendance at Infant Welfare Centres 16 Day Nurseries 16 School Clinics 17 Tuberculosis Dispensary 17 Treatment Centre for Venereal Diseases 17 Staff of the Public Health Department 17 Professional Nursing in the Home 19 General 19 Infectious Diseases 19 Midwives 19 Chemical Work 19 Pagt Sanitary Circumstances op the Borough. Closet Accommodation 19 Scavenging 19 Cesspools 20 General Sanitary Administration 20 Notices 20 Summonses 21 Milk and Dairies Order, 1926 24 Ice Cream 25 Factories and Workshops—Inspection of 25 House to House 28 Houses Let in Lodgings 28 Rats and Mice (Destruction) Act, 1919 28 Smoke Abatement 29 Controlled Premises and Occupations 29 Ice Cream Vendors 30 Schools 30 Housing. Housing Conditions 30 Housing and Town Planning 31 Newly Erected Houses 31 Statistics 32 Food. Milk Supply 34 Certification of Certain Food Products for Export 36 Public Health (Milk and Cream) Regulations, 1912 and 1917 ... 37 Milk (Mothers and Children) Order, 1919 38 Sale of Food and Drugs Acts 38 Milk 40 Condensed Milk 41 Butter and Margarine 41 Cocoa and Coffee 41 Meat and Fish Preparations 41 Conserves, Vegetables, &c. 41 Condiments, Spices, &c. 42 Spirits 42 Drugs 42 Meat 44 Licensed Slaughterhouses 45 Markets 46 Fried-fish Shops 47 Bakehouses 47 Unsound Food 49 Food Surrendered 50 Food Poisoning .51 Page Prevalence and Control over Infectious Diseases. Infectious Diseases 51 Bacteriology 51 Zymotic Diseases 52 Smallpox 53 Cholera 53 Plague 53 Chart—Diphtheria 54 Diphtheria and Diphtheritic Membranous Croup 55 Anti-toxin 55 Scarlet Fever 55 Enteric Fever 55 Erysipelas 55 Typhus Fever 55 Relapsing Fever 55 Chart—Scarlet Fever 56 Continued Fever 57 Puerperal Fever 57 Puerperal Pyrexia 57 Cerebro-Spinal Meningitis 57 Acute Polio-myelitis 57 Encephalitis Lethargica 57 Ophthalmia Neonatorum 57 Anthrax 57 Hydrophobia 57 Rabies Order, 1919 57 Glanders 57 Measles and German Measles 57 Whooping Cough 58 Measles—Chart 58 Chart—Whooping Cough 59 Chicken Pox 59 Pneumonia 59 Malaria 60 Dysentery 60 Trench Fever 60 Influenza 60 Wrong Diagnosis 60 Cleansing of Verminous Persons 60 Tabular Statement—Zymotic Diseases 61 Disinfection 62 Tuberculosis 62 Tuberculosis Officer's Report 65 Tuberculosis Dispensary 65 Institutional Treatment 66 Page Prevalence and Control over Infectious Diseases—continued. Clinical Reports 67 Home Visitation 67 Tuberculosis Cure Committee 67 Exhumation and Re-interment of Bodies 69 Health Week 70 Maternity and Child Welfare. Statistics 70 Health Visitors—Work of 71 Feeding of Infants—Statistics 72 Table—Births, Deaths, and Infant Death Rate 72 Chart—Infantile Mortality Rate 73 Maternal Mortality 73 Milk (Mothers and Children) Orders, 1918-1919 74 " Parkside " Maternity Home—Statistics 74 Voluntary Work. Infant Welfare Centres 76 Day Nurseries 76 Rescue Homes 76 Convalescent Treatment of Invalid Children 77 Treatment and Nursing—Children under School Age 77 (a) Operations, (b) Minor Ailments. (c) Dental Treatment.. Infectious Diseases of Mothers, and Children under five years of age—Tabular Statement 77 Ophthalmia Neonatorum 78 Sanitary Administration. Staff 78 Kent Restrictions Acts 78 Rug Flock Act 79 Public Mortuary 79 ANNUAL REPORT of the Medical Officer of Health of the BOROUGH OF HAMMERSMITH For the Year 1927 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 1927. 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 13.0 is 1.6 greater than the rate for the previous year, whilst the infantile mortality rate is 61 per 1,000 births—the lowest rate recorded in the Borough. The latter is very 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 at all satisfactory and a considerable amount of overcrowding still exists. In spite of the large number of houses completed little improvement in housing conditions has resulted in the congested areas. During the year, 3,261 Intimation Notices and 1,200 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, 1927. Area 2,282.5 acres. Population (1927) (estimated) 132,800 Population Census (1901) 112,239 (1911) 121,521 (1921) 130,287 Natural increase, i.e., excess of births over deaths 348 Density of population 58.2 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 (1927) £1,059,446 Sum represented by a penny rate, 1927 £4,414 Vital Statistics. Births (legitimate) 1,948 ,, (illegitimate) 128 Deaths (corrected) 1,728 Number of women dying in, or in consequence of childbirth birth rate 15.0 death rate 13.0 from sepsis 3 from other causes 4 Deaths of infants under one year of age per 1,000 births 61 Legitimate, 54 Illegitimate, 172 Deaths from measles (all ages) 2 Deaths from Whooping cough (all ages) 4 Deaths from diarrhoea (under 2 years of age) 28 Population.—According to the Census of 1901, the population of the Borough was then 112,239. By the Census of 1911 the population was 121,521 showing an increase during the 10 years of 9,282. The Census of 1921 shows the population of the Borough to be 130,287, being an increase in the 10 years of 8,766. In this report the rates are calculated on the estimated population up to the middle of the year. 5 At the time of the last Census part of the Defence Force, which was mobilised as an emergency, was in camp on Wormwood Scrubbs. The estimated population adopted by the RegistrarGeneral is 132,800, but I believe this number to be below the actual population of the Borough. Since the Census was taken, over two thousand one 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 2,076, whilst the corrected number of deaths of residents was 1,728, thus showing a natural increase of population by excess of births over deaths of 348. The area of the Borough is 2,282.5 acres, there being 58.2 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 1,892 births were registered in the Borough. Adding 372 births which occurred outside the Borough, transferred by the Registrar-General as belonging to Hammersmith, and deducting 94 births which occurred in the Borough, and transferred to other districts by the Registrar-General, the corrected number of births for the year was 2,076. On the estimated population, i.e., 132,800, the corrected number of births registered was equal to an annual rate of 15.6 births per 1,000 persons living. The Birth-rate for the year is 0.7 per 1,000 less than the rate for the previous year which was 16.3. The Birth-rate in London on the estimated population, i.e., 4,541,000, was equal to an annual rate of 16.1 births per 1,000 persons living. Notification of Births Act, 1907. Births registered 1,798 Corrected number of births 2,076 Notification Keceived fbom Midwives. Doctors. Lying-in Hospitals. Poor Law Institutions. Parents. M.O.H.'s. 988 426 526 44 23 24 Total notifications received, 2,031. 6 The following Chart shows the number of deaths from Diarrhoea per 100,000 inhabitants, 1908-1927. 7 Deaths.—During the year 1,581 deaths were registered in (lie Borough, as compared with 1,174 in the previous year. Adding 341 deaths of residents of this Borough which occurred in general hospitals and other public institutions, and 36 deaths of residents transferred by the Registrar-General as having occurred in various parts of England, and deducting 204 deaths of non-residents and 26 transferable deaths which occurred in the Borough, the corrected number of deaths of residents registered was 1,728 (862 males, 866 females). On the estimated population, i.e., 132,800, the corrected number of deaths of residents was equal to an annual rate of 13.0 deaths per 1,000 persons living. The death-rate in London on the estimated population, i.e., 4,541,000, was equal to an annual rate of 11.9 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 126, as compared with 144 in the previous year. The number of deaths of infants under one year of age was equal to 61 per 1,000 of the corrected births and to 73 per 1,000 of the corrected deaths. The number of deaths of infants under one year of age, residents in London, was equal to 59 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 28, being 2 greater than in the previous year. Of these 20 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.—There was a marked diminution in the number of flies during the summer months and it was not thought necessary to distribute leaflets on the danger therefrom. 8 Deaths of Illegitimate Children.—The corrected number of deaths of illegitimate infants under one year of age was 22 or at the rate of 172 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 54 per 1,000 whilst the latter is 172 per 1,000, a difference of 118 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 1927. 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 1 year. Total Deaths under 1 Year. ALL CAUSES. Certified 41 6 — 7 54 16 34 9 13 126 Uncertified — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — — — — — Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — — — — — — Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — — 1 1 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Meningitis (not Tuberculous) — — — — — — — — 1 1 Convulsions 1 l — — 2 — 2 — — 4 Laryngitis — — — — — — — — — — Bronchitis 1 — — — 1 1 1 — 1 4 Pneumonia (all forms) 1 — — — 1 5 11 6 5 28 Diarrhœa — — — 2 2 — 1 — — 3 Enteritis — — — 1 1 2 11 1 2 17 Gastritis — — — — — — — — — — Syphilis — — — 1 1 — 1 — — 2 Rickets — — — — — — — — — — Suffocation, overlying 1 — — 1 2 — — 1 — 3 Injury at Birth — — — — — — — — — — Atelectasis 2 — — — 2 — — — — 2 Congenital Malformations 4 l — — 5 — 1 — — C Premature Birth 20 l — 1 22 5 2 — 1 30 Atrophy, Debility & Marasmus 5 2 — 1 8 1 3 1 — 13 Other causes 6 1 — — 7 2 1 — 2 12 Totals 41 6 — 7 54 16 34 9 13 126 Nett Births in the Year: Legitimate. 1948; Illegitimate. 128. Nett Deaths in the Year of: Legitimate Infants, 104; Illegitimate Infants, 22. Deaths of Aged Persons.—The corrected number of deaths of residents at 65 years of age and upwards registered during the year was 769, against 650 in the previous year. These deaths were equal to 5.8 per 1,000 of the total persons living, and 445 per 1,000 of the total deaths of residents registered. 9 Statistics.—The following table gives the statistics of the Borough during 1927 and the previous five years, in the form prescribed by the Ministry of Health: — TABLE I. Vital Statistics of Whole District during 1927 and Previous Years. Year. m«o£ qoua jo aippim pa^utDiisa uorjBindoj Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. •jaqmnji pa^oajjootifx Nett. Number. Rate. •jou^sid >([) ui paj<vjsi3aj -i1U9p!S0J-U0j!l JO vpui.ja ui paa^si3aa }ou s^uapiean jo Under 1 Year of Age. At all Ages. w Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1921 131500 2599 2779 211 1167 91 202 669 245 88 1634 12-7 1922 134400 2564 2758 20*5 1223 9-1 196 705 196 71 1733 12-9 1928 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 175 1034 7-7 186 756 153 65 1604 11.9 1926 134400 2001 2188 16-3 1174 8*7 195 556 144 66 1535 11-4 1927 132800 1789 2076 15*6 1581 11.9 230 377 126 61 1728 130 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 0e *IO A snsuaQ 70) IZ6I jo snsuaQ 10 Deaths of Residents.—Belonging to the Borough, occurring in Public Institutions, &c., in districts outside, during the year 1927 :— FEVER HOSPITALS. Western Hospital 9 North Western Hospital 3 Northern Hospital 2 — Grove Hospital 1 15 MENTAL HOSPITALS. West Park Hospital 1 Metropolitan Asylum, Leavesden 2 Hanwell Hospital 2 Tooting Bee Hospital 35 Fountain Temporary Hospital 2 Coluey Hatch Hospital 6 Cane Hill Hospital 2 Horton Hospital 4 Banstead Hospital 1 Colindale Hospital 10 Coulsdon Hospital 1 66 GENERAL HOSPITALS. Grove Park Hospital 8 Maudsley Hospital, Denmark Hill 1 Middlesex Hospital 14 Samaritan Free Hospital 1 Queen Mary's Hospital, Stratford 3 New End Hospital 2 Royal Hospital, Richmond 1 St. Paul's Hospital 1 Battersea General Hospital 2 Royal Free Hospital 4 Hospital of St. John and Elizabeth 3 Kensington General Hospital 1 National Hospital 2 St. George's Hospital 10 Acton Hospital 3 St. Anthony Hospital, Cheam 1 Charing Cross Hospital 3 Westminster Hospital 3 Hounslow Hospital 1 St. Mary's Hospital 5 University College 2 Wellhouse Hospital, Barnet 1 St. Thomas's Hospital 2 St. Luke's Hospital 5 London Hospital 1 St. Margaret's Hospital 1 Guy's Hospital 1 Manor House Hospital 1 Victoria Hospital 1 King's College Hospital 2 French Hospital 1 St. Bartholomew's Hospital 4 91 OTHER INSTITUTIONS. Infants' Hospital, Vincent Square 3 Royal Chest Hospital 1 St. George's Home, Millman Street 3 National Hospital for Diseases of the Heart 1 Homeopathic Hospital, Gt. Cancer Hospital 5 Ormond Street 1 Children's Hospital, Gt. Ormond Street 6 28, Marloes Road 9 Invalids' Home 1 Darenth Training Colony 1 Manor Certified Institution, Epsom 1 12, Exmoor Street 27 Epileptic Colony, Silver Street 2 Chelsea Hospital for Women 2 Queen Charlotte's Hospital 4 Seamen's Hospital 1 Throat Hospital 1 Lambeth Hospital 1 St. Joseph's Hospice 2 Consumption Hospital 4 Hospital for Epilepsy 3 103, St. Dunstan's Road 12 1, Uxbridge Road, Southall 12 Brompton Hospital 1 104 11 VARIOUS. 87, St. George's Square, Westminster 2 Warkworth House, Isleworth 1 la, Manor Road, Ilford 2 14, Comeragh Road 1 8, Arterberry Road, Wimbledon 1 198, Cromwell Road 1 2, Colham Mill Road 1 13, Hinde Street 1 1, Northumberland Street 3 River Thames 3 41, Cale Street 4 The Grove, Horton Lane, Epsom 2 6, Devonshire Terrace 1 In ambulance near St. Bartholomew's Hospital 1 22a, Devonshire Street 1 58, Sirdar Road 1 2, Grove Road, Richmond 1 302, Fulham Palace Road 1 17, Manchester Street 1 285, Harrow Road 1 2, Church Road, Ilford 1 The Terrace, St. Pancras 1 57, Campden Hill Road 1 7, Knaresborough Place 1 1, West Bark Road, Epsom 1 385, High Road, Brentford 1 Peckham House 1 1, Lad broke Grove 1 4, Dorset Square 1 9, St. Alban's Villas 1 19, Bentinck Street 1 14, Church Street, Hampton 1 On way to 103, St. Dunstan's Road 1 2 & 3, Beaumont Street 1 Electric Chamber, Holland Park Avenue 1 Regents Canal, near Grove Road 1 25, Norfolk Square 1 20, Pembridge Crescent 1 Bridge Street Railway Footbridge 1 38, Compayne Gardens 1 Hundred Acres, Banstead 1 St. John's Home, 32, Worple Road 1 Opposite 1084 Harrow Road 1 18, Thavies Inn 1 21, Bentinck Street 1 73, Oxford Road, Gunnersbury 1 High Street, Acton 1 Pond Wood, Epsom 1 Chiswick High Road 1 369, Fulham Road 1 In Street near Huntspill St., Garratt Lane 1 36, Aubert Park, Highbury 1 No. 3 Pond, Parliament Hill Fields 1 Foreshore, River Thames, off Battersea Park 1 65 50, Kingston Hill 1 12 TABLE II. Causes of, and Ages at, Death during the Year 1927. METROPOLITAN BOROUGH OF HAMMERSMITH. Causes of Death. Sex. All Ages. 0— 1— —2 5— 15— 25— 45— 65— 75— All Causes M 862 81 19 11 24 33 98 275 178 143 F 866 46 15 12 17 32 95 201 189 259 1 Enteric Fever M .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. 2 Small-pox M .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. 3 Measles M 1 .. 1 .. .. .. .. .. .. .. F 1 .. l .. .. .. .. .. .. .. 4 Scarlet Fever M .. .. .. .. .. .. .. .. .. .. F 1 .. 1 .. .. .. .. .. .. .. 5 Whooping Cough M 2 .. l 1 .. .. .. .. .. .. F 2 .. .. 1 1 .. .. .. .. .. 6 Diphtheria M 6 .. 1 2 3 .. .. .. .. .. F 5 .. .. .. .. .. .. .. 1 .. 7 Influenza M 24 .. .. .. .. .. 2 10 9 1 F 27 .. 1 .. 1 1 4 6 6 8 8 Encephalitis Lethargica M 1 .. .. .. .. .. 1 .. .. .. F .. .. .. .. .. .. .. .. .. .. 9 Meningococcal Meningitis M .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. .. .. .. .. 10 Tuberculosis of respiratory system M 96 .. .. .. .. 14 34 37 8 2 F 63 .. 1 .. .. 13 29 15 3 1 11 Other Tuberculous Diseases M 13 1 1 3 3 .. 4 .. 1 .. F 10 .. 3 4 1 2 .. .. .. .. 12 Cancer, malignant disease M 80 .. .. .. .. .. 2 30 27 21 F 126 .. .. .. .. 1 10 48 40 27 13 Rheumatic Fever M .. .. .. .. .. .. .. .. .. .. F 2 .. .. .. .. .. .. .. 2 .. 14 Diabetes M 7 .. .. .. .. .. .. .. 3 .. F 13 .. .. .. .. 1 1 6 4 1 15 Cerebral Hemorrhage, &c. M 34 .. .. .. .. l 2 11 11 9 F 59 .. .. .. .. .. .. 19 21 19 16 Heart Disease M 127 .. .. .. 3 3 8 49 37 27 F 124 .. .. .. 2 5 5 36 36 40 17 Arterio-sclerosis M 29 .. .. .. .. .. 1 9 7 12 F 23 .. .. .. .. .. .. 2 3 18 18 Bronchitis M 62 2 1 .. .. .. 1 18 19 21 F 72 2 .. .. 1 .. .. 10 20 39 19 Pneumonia (all forms) M 78 19 9 4 1 1 3 19 10 12 F 51 8 6 2 3 1 5 13 7 6 20 Other Respiratory Diseases M 11 .. .. .. .. .. 1 5 3 2 F 16 1 .. 1 .. .. .. 3 1 7 21 Ulcer of Stomach or Duodenum M 10 .. .. .. .. .. 1 8 1 .. F 9 .. .. .. .. 1 1 6 1 .. 22 Diarrhoea, &c. M 22 16 .. .. .. .. .. 1 .. .. F 6 4 .. .. .. .. .. .. .. .. 23 Appendicitis and Typbilitis M 8 .. .. .. .. .. .. .. .. .. F 5 .. .. .. .. .. 4 1 .. .. 24 Cirrhosis of Liver M 7 .. .. .. .. .. 1 5 1 .. F 3 .. .. .. .. .. 2 1 .. .. 25 Acute and Chronic Nephritis M 31 .. .. .. .. l 3 14 7 9 4 F 19 .. .. .. .. .. 2 4 4 26 Puerperal Sepsis M .. .. .. .. .. .. .. .. .. .. F 3 .. .. .. .. .. 3 .. .. .. 27 Other Accidents and Diseases of Pregnancy and Parturition M F 4 4 28 Congenital Debility and Malformation, Premature Birth M 31 30 .. .. .. .. .. 1 .. .. F 21 21 .. .. .. .. .. .. .. .. 29 Suicide M 7 .. .. .. .. l 2 4 .. .. F 4 .. .. .. .. .. 2 1 1 .. 30 Other deaths from violence M 50 2 .. .. 5 2 14 13 3 10 9 4 F 33 5 .. .. 4 1 8 4 7 31 Other defined diseases M 125 11 2 1 5 13 37 20 28 F 163 4 2 1 2 4 16 24 30 80 32 Causes ill-defined or unknown M .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. Total 1,728 127 34 23 41 65 193 476 367 402 12 This rate is calculated on the estimated population of each Ward. Ward. Estimated Population. No. of Deaths. Death Rate. No. 1 River 17,437 282 16.2 No. 2 Brook Green 25,515 350 13.7 No. 3 The Grove 22,681 331 14.6 No. 4 St. Stephens 9,123 121 13.3 No. 5 Starch Green 22,509 263 11.7 No. 6 Wormholt 23,550 242 10.3 No. 7 College Park and Latimer 11,985 139 11.6 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 West Districts. 4,541,000 161 — 11.9 59 Paddington 142,700 15.5 0.5 13.5 79 Kensington 176,700 15.0 0.36 13.8 66 Hammersmith 132,800 15.6 0.3 13.0 61 Fulham 161,900 15.1 0.2 11.3 66 Chelsea 63,690 13.4 0.4 14.1 76 City of Westminster 136,500 10.0 0.5 12.3 69 North Districts. St. Marylebone 103,500 13.2 0.4 11.3 59 Hampstead 86.160 11.9 0.2 12.2 51 St. Pancras 213.200 15.5 0.4 12.3 62 Islington 334.300 18.3 0.38 12.3 53 Stoke Newington ... 52,130 14.0 0.27 12.2 66 Hackney 224,700 15.7 0.46 11.6 64 Central Districts. Holborn 42,209 11.96 0.14 12.5 38 Finsburv 75,500 19.2 0.5 13.4 50 City of London 13,010 8.7 0.23 11.5 105 East Districts. Rhoreditch... 105,700 20.6 0.7 12.6 74 Bethnal Green 119,900 19.6 0.6 11.1 58 Stepney 251,580 18.1 0.5 11.6 68 Poplar 167,000 19.8 0.6 11.8 66 South Districts. Southwark 184,250 19.0 0.8 13.4 61 Bermondsey 121,000 18.5 0.37 12.9 67 Lambeth 307,700 16.2 0.39 12.4 51 Battersea ... 169,000 16.6 0.3 12.2 54 Wandsworth 342,700 13.53 0.25 11.3 5! Camberwell 271,100 15.6 — 11.4 52 Deptford 113,800 16.8 0.3 11.5 58 Greenwich ... 101,920 16.2 0.3 10.8 53 Lewisham ... 188,600 15.1 0.15 11.0 46 Woolwich ... 140.770 15.9 0.2 10.6 42 * The provisional figures relating to London were supplied by the Registrar-General. Other figures supplied by Medical Officers of Health. b 14 GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. HOSPITALS. " Parkside " Maternity Home, 150, Du Cane Road, W.12. —This Home consists of 14 beds for the reception of maternity cases. 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). Hammersmith Hospital, Du Cane Road, W.12.—This Hospital is under the control of the Board of Guardians. The present accommodation is as follows :— Hospital Beds 399 Maternity Beds 14 Resident Medical Officers 4 Visiting Consultants 2 Institution Beds 575 It is proposed in the near future to make certain alterations in the allocation of this accommodation, which will be as follows: — Hospital Beds 471 Maternity Beds 14 Resident Medical Officers 4 Visiting Consultants 2 Institution Beds 455 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. 15 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. Maternity and Child Welfare Centres. 48, Glenthorne Road.—Three Infant Clinics held weekly. Ante-Natal clinic held weekly. Victoria Hall, Becklow Road.—Two Infant Clinice held weekly. St. Catherine's Hall, Old Oak Estate.—One Infant Clinic held weekly. St. Matthew's Parochial Hall, Blyth-e Road.—Two Infant Clinics 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. This Clinic was closed in June. Presbyterian Church Hall, Ponsard Road.—One Infant Clinic held weekly. Latymer Road Mission, Blechynden Street.—One Infant Clinic held weekly. b 2 1C 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 49 172 90 — — 498 136 — — 18, Glenthorne Road 153 — — 361 63 — — 6669 1590 Victoria Mission Hall, Becklow Road 100 — — 159 16 — — 2417 533 St. Matthew's Hall, Blythe Road 76 — — 256 47 — — 3273 531 St. Catherine's Hall, Old Oak Estate 37 64 20 — — 319 45 — — do. 50 — — 170 16 — — 2625 435 161, Sulgrave Road 21 39 12 — — 98 27 — — 161, Sulgrave Road (Closed 30th June, 1927.) 25 — — 93 27 — — 956 307 Latymer Road Mission 45 — — 31 9 — — 568 482 Presbyterian Hall, Ponsard Road 51 — — 80 5 — — 1061 302 "Parkside," Ante-natal Clinic 35 94 — — — 222 — — — Total 642 369 122 1155 183 1137 208 17569 4180 Ante-Natal Clinics 142 Infant Consultations 500 642 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. 17 SCHOOL CLINICS. L.C.C. Hammersmith School Treatment Centre, 103, Shepherd's Bush Road. The above Centre is provided by the London County Council. Children under school age are dealt with at this Centre by arrangement with the Hammersmith Nursing Association on a basis of a Capitation fee. TUBERCULOSIS DISPENSARY. Hammersmith Tuberculosis Dispensary, Ravenscourt Park. The above Dispensary is provided by the Borough Council. Grants are received from the Ministry of Health and the London County Council. TREATMENT CENTRE FOR VENEREAL DISEASES. West London Hospital, Hammersmith Road. The above Centre is provided under the scheme of the London County Council. STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF THE YEAR 1927. Medical Officer of Health and Year of Administrative Tuberculosis Officer. Appoiniment 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 1920 †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 §*F. W. Mason 1926 †§*E. J. Nether 1926 §*P. W. Pottier 1919 §*W. Rigby 1919 18 Lady Sanitary Inspector. Year of Appointment †*Miss M. M. Hawkins 1923 Health Visitors. "║□†*Miss R. A. Henry 1916 "║Miss D. G. Johnson 1922 ║□*Miss A. M. M. Willcox 1916 Tuberculosis Dispensary Staff. □||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. 19 PROFESSIONAL NURSING IN THE HOME. General.—The Hammersmith District Nursing Association provides nurses in all cases for general nursing, upon application being made to the Nightingale Shore Home, 10, Mall Road. Patients are expected to make payments to the Nursing Association in accordance with their means, but no patient is refused the services of a nurse on account of inability to pay. Infectious Diseases.—Arrangements have been made by the Borough Council with the District Nursing Association 10 provide nurses in cases 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. I am informed by Dr. F. N. Kay Menzies, the County Medical Officer of Health, that 24 midwives gave notice of their intention to practise in the Borough during 1927. 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. Throughout the Borough, there are quite a number of ashpits. This means of depositing house refuse is not only cut 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. 20 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. Notices Served. Notices complied Infectious Diseases 2,051 340 282 Complaints 3,820 2.039 2.236 House to House 365 90 62 Housing and Town Planning Act 95 29 14 House to House Consolidated Regulations 237 94 89 Food (other than Restaurants) 4,234 40 41 Restaurants, &c. 510 20 14 Markets 1,592 1 1 Slaughterhouses 591 1 1 Poultry Slaughterhouses 30 — — Bakehouses 704 15 15 Milk Vendors 1,530 5 8 Ice Cream Vendors 905 2 2 Factories 1,187 36 34 Workshops 612 38 36 Workplaces 465 22 17 Outworkers 199 7 6 Public Urinals 2,457 16 13 Smoke Observations 129 29 29 Drainage 3,747 13 4 Miscellaneous 4,095 131 85 Re-visits 12,674 293 256 Total 41,529 3 261 3,245 During the year 1,200 Statutory Notices were served and 1,148 complied with. In several instances it was necessary to take proceedings in order to enforce compliance with Notices served. 21 The following table shows the result of proceedings taken:— SUMMONSES—YEAR 1927. Situation of Premises Nature of Offence No. of Summonses Result of Proceedings 25, Rayleigh Road Failing to comply with Statutory Notice. 1 Order made. 14 days. 57, Porten Road ditto 1 Order made. 14 days. 31, Clifton Street ditto 1 Withdrawn. Work done. 70, St. Stephens Avenue ditto 1 Withdrawn. Work done. 72, Thorpebank Road ditto 1 Fined £1. 114, Netherwood Roat ditto 1 Withdrawn. Work done. 5, Bradmore Lane (John Best, Ltd., 119-120, London Wall, E.G.2) Depositing for purpose of sale or of preparation for sale one half pig's head being unfit for the food of man 1 Fined £2. 1, Devonshire Villas Failing to comply with Statutory Notice. 1 Withdrawn. Work done. 7, Letchford Gardens ditto 1 Order made. 14 days, 15s. cost. 340, King Street ditto 1 Fined £1. 98, Queen Street ditto (Failing to abate overcrowding) 2 1. Order made. To be abated forthwith. 2. Adjourned sine die. 30, Station Road Failing to comply with Statutory Notice 1 Order made. 14 days. 36, Redmore Road ditto 1 Withdrawn. Work done. 18, Camden Gardens Contravention of Hammersmith Borough Council Bye-laws re Nuisance by Dogs 1 Fined 10s, 363, King Street Failing to comply with Statutory Notice 1 Withdrawn. Work done. 76, Rayleigh Road ditto 1 Order made. 14 days. 37, Godolphin Road ditto 1 Order made. 14 days. 14, Kenmont Gardens ditto 2 1. Order made. 14 days, and fined £1. 2. Fined £1. 70, Rayleigh Road ditto (Failure to abate overcrowding) 1 Older made. To be abated in 6 weeks. 10, Goodwin Road Failing to comply with Statutory Notice 1 Withdrawn. Work do . 10s. 6d. costs. 22 Summonses—continued. Situation of Premises Nature of Offence No. of Summonses Result of Proceedings 74, Rayleigh Road Failing to comply with Statutory Notice 1 Order made. 7 days. Fined £2. 3, Iffley Road ditto 1 Fined £1. 34, Boundary Road ditto 2 Withdrawn. Work done. Caravan on land between 143/5, Percy Road (Failing to abate overcrowding) 1 Order made. To be abated in 14 days. 261, Latimer Road Failing to comply with Statutory Notice 1 Fined £1. 340, King Street ditto 6 1. Fined £3. 2. Fined £3. 3. Fined £3. 4. Fined £3. 5. Fined £1. 6. Fined £1. 1, Iffley Road ditto 2 Withdrawn. Work done 46 Stebbing Street ditto (Failing to abate overcrowding) 1 Fined 10s. 56A, Sinclair Road Failing to comply with Statutory Notice. 1 Order made, 7 days. 104b, Sinclair Road ditto 1 Order made. 14 days. Fined £1. 27, Porten Road ditto 1 Withdrawn. Work done. 13, Ravenscourt Square ditto 1 Withdrawn. Work done. 338, King Street Failing to comply with Closing Order 1 Withdrawn. Premises vacated. 2, Upper Mall Failing to comply with Statutory Notice 2 1. Fined £2. 2. Withdrawn. 2, Masbro Road ditto (Failing to abate overcrowding) 1 Withdrawn. Complied with. 91d, Coningham Road Failing to comply with Statutory Notice 1 Order made. 14 days. 88, Galloway Road ditto 1 Order made. 14 days. 57, Minford Gardens ditto 2 Withdrawn. Work done. 46, Boundary Road ditto 1 Fined £1. Bradmore Lane Market Depositing for purpose of sale certain fish being unfit for the food of man 2 1. Fined £15 and £10 10s. cost. 2. Dismissed. 21, Masbro Road Failing to comply with Statutory Notice 1 Withdrawn. Work done. 10s. 6d. costs. 23 Summonses—continued. Situation of Premises Nature of Offence No. of Summonses Result of Proceedings 50, Bridge Road Failing to comply with Statutory Notice. 2 1. Fined 10s. 2. Withdrawn. Work done. 261, Latimer Road ditto 1 Withdrawn. Work done. 48,Brackenbury Road ditto 1 Withdrawn. Complied (Falling to abate overcrowding.) with. 135, The Grove ditto 1 Withdrawn. Complied with. 84, Rayleigh Road ditto 1 Order made. 7 days. 34, Southbrook Street ditto 3 1. Fined 5s. 2. Withdrawn. Work done. 3. Withdrawn. Work done. 5, Bradmore Lane (John Best, Ltd., 119-120, London Wall, E.C.) Depositing for purpose of sale or of preparation for sale, certain meat, being unfit for the food of man. 3 1. Fined £25. 2. Dismissed. 3. Dismissed. 5, Hazlitt Mews Failing to comply with Statutory Notice. 1 Withdrawn. Work done. 58, Masbro Road ditto 1 Order made. 14 days. 132, Blythe Road ditto 2 Withdrawn. Work done. 98, Queen Street (Failing to abate overcrowding). 1 Overcrowding abated. Adjourned sine die, with liberty to apply. 7, Letchford Gardens Failing to comply with Statutory Notice. 1 Order made. 14 days, and fined £1. 47, Railway Arches ditto 1 Withdrawn. Work done. 21, Porten Road ditto 2 1. Withdrawn. Work done. £2 2s. costs. 2. Withdrawn. Work done. 14, Manchester Road ditto 1 Withdrawn. Work done. 10s. 6d. costs. 54, Manchester Road ditto 1 Withdrawn. Work done. 10s. 6d. costs. 20, Hunt Street ditto 1 Fined £2. 26, Porten Road ditto 3 1. Order made. 14 days, and 10s. 6d. costs. 2. Withdrawn. Work done. 10s. 6d. costs. 3. Withdrawn. Work done. 31, Stebbing Street ditto 1 Withdrawn. Work done. 10s. 6d. costs. 24 Summonses—continued. Situation of Premises Nature of Offence No. of Summonses Result of Proceedings 25, Porten Road Failing to 3 1. Order made. 14 days. ply with Statutory Notice 10s. 6d. costs. 2. Order made. 14 days. 10s. 6d. costs. 3. Withdrawn. Work done. 7, Rigeley Road ditto 1 Withdrawn. Work done. 1, Hazlitt Mews ditto 2 1. Order made. 14 days. 2. Withdrawn. Work done. 23, Abdale Road ditto 1 Withdrawn. Work done. 78, Rayleigh Road ditto 1 Order made. 14 days. 10s. 6d. costs. 5, Havelock Road ditto 1 Order made. 14 days. 10s. 6d. costs. 41, Minford Gardens ditto 1 Withdrawn. Work done. 15, Chapel Street ditto 1 Nuisance at present abated. Adjourned sine. die. 58, Masbro Road ditto 1 Fined £1. MILK AND DAIRIES ORDER, 1926. Name and Address Nature of Offence No. of Summonses Result of Proceedings 71, Blythe Road (D. Rees) Bottling Milk in Blythe Road 1 Fined £1. 73, Masbro Road (J. Jones) Bottling Milk in Shepherd's Bush Road 2 1. Withdrawn. 2. Fined £1. 7, Shepherd's Bush Road (D. Rogers) Bottling Milk in Shepherd's Bush Road 2 1. Withdrawn. 2. Fined £1 10s. 7, Shepherd's Bush Road (D. Rogers) Bottling Milk in Roseford Gardens 2 1. Withdrawn. 2. Fined £1. 23c, Aldensley Road (H. W. Ellis) Bottling Milk at the corner of Glenthorne Road and Leamore Street 1 Fined £1. « 25 Milk and Dairies Order—continued. Name and Address Nature of Offence No. of Summonses Result of Proceedings 73. Masbro Road (J. Jones) Bottling Milk in Milson Road 2 1. Fined £1. 2. Fined £1. 175, Holland Road (W. Collins) Bottling Milk in Saunders Road 2 1. Fined £2. 2. Fined £1. 98, Adelaide Road (J. Williams & Son) Bottling Milk at the corner of Keith Grove and Uxbridge Road 2 1. Fined £1. 2. Fined £1. 7, Shepherd's Bush Road (D. D. W. Rogers) Bottling Milk in Devonport Road 2 1. Fined £4. 2. Fined £1. 16, Black Lion Lane (C. A. W.Wheeler) Exposing Milk without protective covering 1 Fined £2. ICE CREAM. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1902. Name and Address Nature of Offence No. of Summonses Result of Proceedings 75, Silchester Road (Andre E. Spossito) Omission of proper precautions re sale of ice cream 1 Fined £2. Factories and Workshops, etc.—During the year 96 notices were served in reference to insanitary conditions and defects found to exist during the inspection of the factories, workshops and workplaces in the Borough, and during the same period 87 notices were complied with. 26 During the previous year there were 43 notices served and 38 complied with. The following is a list of the Factories and Workshops upon the Register:— Restaurants, Hotels, &c. 166 Bakehouses (15 not in use as Bakeries) 64 Bootmakers 55 Motor and Cycle Makers 53 Dressmakers and Milliners 97 Laundries 67 Outworkers 296 Letterpress Printers and Bookbinders 18 Electrical and Mechanical Engineers 41 Smiths, Wheelwrights and Coachbuilders 40 Tailors 54 Builders, Carpenters and Joiners 37 Miscellaneous 426 Total 1,414 The whole of these premises have been under a systematic inspection by your Inspectors and numerous improvements have been carried out under their supervision. The following tables have been prepared in accordance with the form prescribed by the Home Office on the Administration of the Factory and Workshops Act, 1901, in connection with Factories, Workshops, Workplaces and Homework. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 1,187 36 — Workshops (including Workshop Laundries) 612 38 — Workplaces (other than outworkers' premises included in Part 3 of this report) 465 22 — Total 1,264 96 27 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 56 50 — — Want of Ventilation 3 3 — — Overcrowding 2 o — — Want of Drainage of Floors — — — — Other Nuisances 36 34 Sanitary Accommodation insufficient 5 2 unsuitable or defective 34 28 not separate for sexes 4 4 — — 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) Total 140 123 — — 3.—HOME WORK. Nature of Work Outwork in Unwholesome premises, Sec. 108 Outwork in Infected Premises Sees. 109, 110 Instances Notices served Prosecutions Instances Orders made (Sec. 110) Prosecutions (Sec. 109, 110) Wearing apparel— (1) making, etc 4 4 — — — — (2) cleaning and washing — — — — — — Furniture and upholstery — — — — — — Totals 4 4 — — — — 28 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year Number Bakehouses 33 Dressmakers 88 Laundries 28 Others 278 Total number of workshops on Register 427 5.—OTHER MATTERS. Class Number Matters notified to H M. Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Act 1901 (S. 133) 12 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 (8. 5) Notified by H.M. Inspector 7 Reports (of action taken) sent to H.M. Inspector 7 Other 5 Underground bakehouses (S.101)— Certificates granted during year — In use at the end of the year 46 House to House.—As a result of the house to house visitation 365 inpections were made, 90 notices served, and 62 complied with. It is important that this work should be systematically carried out. Houses Let in Lodgings.—During the year no new houses were registered. Rats and Mice (Destruction) Act, 1919.—During the year the Rats and Mice (Destruction) Act, 1919, continued in operation, the District Inspectors being responsible for its administration in their respective districts. Section I places the responsibility of ridding the premises of the pest upon the occupier, but this is somewhat difficult when dealing with tenement houses containing in some cases three or more families. During the year 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. 29 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. Waring & Gillows, Cambridge Road. Post Office Savings Bank, Blythe Road. Kensington Palace Laundry, Springvale Terrace. Balmoral Laundry, Becklow Road. H.B.C. Electricity Works, Fulham Palace Road. 104, Askew Road. Metropolitan Water Board, Standish Road. Kensington Destructor Works. Lorne House Laundry, Becklow Road. 34, Goldhawk Road. 67, Becklow Road. 6, Wendell Road. Devon Dyeing and Cleaning Co., Wharf Road Gaumont Co., Lime Grove. 271a, King Street. 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. c 30 Ice Cream Vendors.—For some years past I have reported on the advisability of compulsory registration of ice cream vendors. It is satisfactory to note that the London County Council (General Powers) Act, 1928, contains provisions for this 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. 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 information he obtains from the School Medical Officers. HOUSING. The housing problem is one that shows very little, if any, improvement, the congested areas of the Borough remaining as overcrowded as reported a year ago. During the year 523 houses have been erected by the County Council and private enterprise and approximately 200 are in course of erection and nearing completion. In spite of this, however, it has not made any appreciable difference to the overcrowding of the Borough. Unfortunately, only a small percentage of the houses erected by the County Council have been allotted to local residents. It has been said that the housing schemes of the County Council have supplied sufficient accommodation for all the needs of London and that there is in fact something like 600 or 700 houses empty on one of the County Council Estates. It is perfectly true that a large number of houses have been erected but it does not help the local situation to erect houses at points where they are inaccessible for the local workers. Some families have made the attempt to reside at Becontree, but have found it impossible owing to the cost of and the time taken up in travelling. Another difficulty is that the rents in many cases make it prohibitive for the average working man with a wage varying from 50s. to 60s. per week. 31 The whole situation is very depressing and letters are received almost daily begging for assistance in obtaining accommodation. Many of the people are living in basement rooms, five persons to a room, whilst in one case where a notice has been served for overcrowding, a family of 10 are living in one room. Many notices have been served for overcrowding and indecent occupation under the Bye-laws of the London County Council owing to the housing shortage. In the great majority of cases it is not the fault of the occupier, as it is usually found that they have not been able to find other accommodation. The situation is all the more depressing as there appears to be no immediate prospect of improving or alleviating the dreadful conditions of overcrowding. The health of the people living under these circumstances must necessarily suffer. The whole question is one that demands considerable thought in an endeavour to provide housing accommodation in districts near to the work and at a rental within the means of the people most in need of such accommodation. 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. Negotiations are proceeding to acquire the sites for the Southern Housing Scheme and it is hoped to commence rebuilding during 1928. Five hundred and twenty-three 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, 2,163 houses and flats ihave 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. II.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 1927 284 Nil 239 Totals 1,025 585 553 c 2 32 The premises have provided accommodation for approximately 10,815 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. 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, 1927. 1.—General. (1) Estimated population 132,800 (2) General death-rate 13.0 (3) Death-rate from tuberculosis 1.4 (4) Infantile mortality 61 (5) Number of dwelling-houses of all classes (estimated) 19,000 (6) Number of working-class dwelling-houses (estimated) 12,250 (7) Number of new working-class houses erected 523 2.—Unfit Dwelling-houses. II.—Inspection. (1) Total number of dwelling-houses inspected for Housing defects (under Public Health or Housing Acts) 5,871 (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 237 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 7 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 3,232 33 II —Remedy of defects without service of formal notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers ... Nil III.—Action under Statutory Powers. (A) Proceedings under Section 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 (6) By Local Authority in default of owners Nil (3) Number of dwelling-houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close Nil (B) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3,232 (2) Number of dwelling-houses in which defects remedied— (a) By owners 3,216 (b) By Local Authority in default of owners Nil (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 4 (2) Number of dwelling-houses in respect of which Closing Orders were made 7 (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 34 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 great difficulties with regard to a clean milk supply in London has been with regard to the premises of the small trader. The delivery of milk in sealed bottles has practically become almost universal and is a further step in the prevention of contamination of the milk. The Milk and Dairies Order requires that the bottles shall be filled in the dairy. During the year, reports have been submitted to the Public Health Committee relating to the filling of bottles in the street. In such cases summonses have been issued and a penalty imposed. The latest Milk and Dairies Order, if properly carried out, will undoubtedly make for a cleaner and purer supply, but 35 constant inspection and supervision is necessary to ensure that the regulations are complied with. During the year 344 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 Milkshops Order. In two cases where infectious diseases occurred at the houses of milk roundsmen, arrangements were made with the employers to suspend the roundsmen for a period of seven days. Milk (Special Designations) Order, 1923. The following is a list of the licences issued during the year under the Milk (Special Designations) Order, 1923:— Descrivtion. Number. (1) Producers' Licences to use the designation "Grade A " Nil (2) Dealers' Licences to U6e the designation "Certified" 6 (3) Dealers' Licences to use the designation " Grade A (Tuberculin Tested) "— (a) Bottling Establishments (b) Shops Nil 7 (4) Dealers' Licences to use the designation "Grade A"— (a) Bottling Establishments (b) Shops Nil Nil (5) Dealers' Licences to use the designation " Pasteurised"— (a) Pasteurising Establishments (b) Shops 1 7 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 36 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 hi3 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. 37 Public Health (Milk and Cream) Regulations, 1912 and 1917. I beg to present a statement in the form prescribed by the Ministry of Health with reference to the administration of the Public Health (Milk and Cream) Regulations, 1912 and 1917. 1. Milk and Cream not Sold as Preserved Cream. a. b. Number of samples examined for Number in which a preservative the presence of a preservative. was reported to be present. Milk 0 0 Cream 8 0 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 pre servatives were correct:— (1) Correct statements made 4 (2) Statements incorrect 0 (3) Percentage of preservative found in each sample:— Percentage Sample No. stated on Statutory label. 962 0.30 per cent. or 21 grains of Boric Acid per lb 0.4 983 0.19 per cent. or 13.3 grains of Boric Acid per lb. 0.4 985 0.25 per cent. or 17.5 grains of Boric Acid per lb. 0.4 986 0.23 per cent. or 16.1 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. 4 (2) Below 35 per cent. 0 Total 4 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article 5 (1) and the proviso in Article 5 (2) of the Regulations have 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. 38 4. Other Observations. All samples of milk taken for analysis under the Sale of Foods 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 74. SALE OF FOOD AND DRUGS ACTS. Year ended 31st December, 1926. During the twelve months 612 samples were submitted to the Public Analyst 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. 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, 538 were reported as genuine, 19 as adulterated, whilst 43 were of inferior quality. Table I. Samples received. Genuine. Inferior. Adulterated. Total. Quarter ending March 31st ... 132 12 6 150 „ ,, June 30th 126 18 6 150 „ „ Sept. 30th 132 13 6 150 „ „ Dec. 31st 148 0 2 150 Totals 538 43 19 600 The percentage of adulteration was 31 as compared with 3.8 last year. The percentage of articles of inferior quality where actual adulteration could not be certified was 71 this year and 4 0 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. 39 Table II. Article. No. of Samples examined. Result of Examination. Summonses Issued. Penalties Imposed. Genuine. Inferior. Adull erated. Arrowroot 1 1 — — — — Aspirin Tablets 4 4 — — — — Baking Powder 1 1 — — — — Boric Ointment 3 3 — — — — Brawn 2 2 — — — — Butter 41 40 — 1 — — Camphorated Oil 6 6 — — — — Castor Oil 5 5 — — — — Chocolate 4 4 — — — — Citrate of Magnesia 2 2 — — — — Citric Acid 1 1 — — — — Cocoa 16 16 — — — — Coffee 10 10 — — — — Crayfish 1 1 — — — — Cream of Tartar 4 4 — — — — Eucalyptus Oil 3 3 — — — — Fruit Salad 1 1 — — — — Glauber Salt 3 3 — — — — Jam 2 2 — — — — Lard 8 8 — — — — Lemon Cheese 1 1 — — — — Lemon Squash 2 2 — — — — Margarine 11 11 — — — — Marmalade 2 2 — — — — Meat and Fish Pastes 11 11 — — — — Meat Pie 6 6 — — — — Milk 344 296 39 9 2 £10 2 0 ,, Condensed 20 20 — — — — Mincemeat 3 3 — — — — Mustard 5 4 1 — — — Olive Oil 5 5 — — — — Peas 3 3 — — — — Pepper 6 6 — — — — Prawns X 1 — — — — Sausages 31 28 — 3 1 £3 3 0 Seidlitz Powder 2 2 — — — — Sugar, Demerara 2 2 — — — — Sulphur, Milk of 8 7 — 1 — — Tincture of Iodine 2 — 2 — — Tomatoes 1 1 — — — — Vinegar 2 2 — — — — Whiskj 11 6 3 2 — — Zinc Ointment 3 2 — 1 — — Totals 600 538 43 19 3 £13 5 0 40 Milk. During the year 344 samples of milk were examined and of these 296 were reported as genuine, 39 as inferior, and 9 as adulterated. Particulars of the samples reported against are given in the following Table: — Table III. No. Adulteration Certified. Penalties Imposed. 1 Added Water 2'7 per cent, and Fat abstracted 8'2 per cent. No action—see note below. 2 Added Water 5 „ „ 3 „ „ 4 6 ,, ,, 4 „ „ 33 „ „ 5 „ „ 3.5 „ „ Vendor warned. 6 „ „ 2 „ „ No action. 7 Fat abstracted 13 „ „ Kine £3 and costs 10s. 6d. 8 „ „ 7 „ „ „ £5 „ „ £1 11s. 6d. 9 „ „ 2 ,, „ Vendor warned. Following the report on Nos. 1 and 2 above, "appeal" samples were taken by the Inspector for Wilts County Council, and these also fell below the legal limit for non-fatty solids (see Nos. 3 and 4). Further inquiries elicited the fact that the cows yielding this milk had been fed in a way that would probably cause this deficiency of non-fatty solids. An "appeal" sample arising out of No. 7 proved to be genuine. The percentage of adulteration in the case of milk is 2 6 as compared with l-9 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 3.66 8.85 87.49 „ „ June 30th 3.50 8.84 87.66 „ „ Sept. 30th 3.63 8.84 87.53 „ ,, Dec. 31st 3.93 8.91 87.16 Average for the year 3-68 8-86 87'46 41 Condensed Milk. Twenty condensed milks were specially examined for compliance or otherwise with the requirements of the new Regulations. They were all found to fulfil 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. Butter, Margarine and Lard. Forty-one samples of butter were analysed and of these one was found to contain 118 per cent, of water, i.e., 2 per cent, in excess of the permitted maximum. Eleven margarines and eight lards were also examined and were reported genuine. In the butters and margarine where boron preservative was found the limit was not exceeded. Cocoa and Coffee. Sixteen specimens of cocoa and ten of coffee were passed as genuine. Tests for arsenical contamination in the cocoas gave negative results. Meat and Fish Preparations. The following meat and fish preparations were examined during the year:— Brawn 2 samples. Crayfish 1 sample. Meat and fish paste 11 samples. Meat pie 6 „ Prawns 1 sample Sausages 31 samples. With the exception of four samples of sausages these proved to be free from preservatives. In one case the sausages were sold with notice as to the presence of preservative and hence were passed as genuine. The preservative found here was sulphur dioxide—176 parts per million—an amount well below the limit of 450 parts per million. In another a small proportion of boric acid was found—0'7 grain per pound— and in the remaining two sulphur dioxide occurred to the extent of 89 parts per million and 315 parts per million respectively, and in both these instances no notice was given in regard to preservative at the time of purchase. Conserves, Vegetables, Fruits, &c. Two specimens of jam, two of marmalade, three of peas, one of fruit salad, one of tomatoes, one of lemon cheese and 42 three of mincemeat were examined and in no case were preservatives, colouring matter, or metallic contamination detected. Condiments, Spices, Ac. Of five samples of mustard, six of pepper and two of vinegar, one of the mustards was reported inferior on account of its containing traces,—not exceeding 1 per cent.—of starch coloured with turmeric. The vinegars were free from arsenic and mineral acids. Spirits. Eleven samples of whisky were analysed and of these three were reported inferior on account of their containing the minimum of proof spirit and two were adulterated. The latter were respectively 35'7 and 36 degrees under proof. Drugs. The total number of drugs analysed during the year was forty-six and of these four were found not to comply with the requirements of the British Pharmacopoeia. Two specimens of strong tincture of iodine were found to contain an excess of iodine—11*8 grammes and 10'5 grammes of iodine respectively per 100 millilitres, the amount required by the Pharmacopoeia being 10 grammes. This year we had another instance of milk of sulphur adulterated with calcium sulphate to the extent of 44 4 per cent. The sample referred to was taken informally and when a formal sample was purchased by the Inspector the correct article was supplied. A sample of zinc ointment was deficient in zinc oxide. It contained only 13'5 per cent, instead of the 15 per cent, required by the Pharmacopoeia. The following miscellaneous samples proved to be genuine:— Arrowroot 1 sample. Baking powder 1 „ Chocolate 4 samples. Lemon squash 2 „ Olive oil 5 „ Sugar, Demerara 2 „ Tests for arsenic, lead and copper in the baking powder gave negative results and the specimens of lemon squash proved to be free from preservatives and metallic contamination. 43 TABLE V. 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:— Sample No. Article. Offence. Remarks. Result. 447 Beef Sausages 89 pts. SO2 per million parts sausage Letter of warning 471 Whisky 35.7 degrees under proof Letter of warning 494 Milk 2% added water No action. Adulteration insufficient 527 Butter 18% of water Informal sample (Official sample genuine) 629 Milk 5.7 added water Samples taken in 530 Milk 2.7% added water' and 8.2% deflcient in fat courseof delivery "Appeal to cow" lodged 555 Milk 3.3% added water "•Appeal to cow" samples 556 Milk 4.6% added water 576 Beef Sausages 7/10th. grn. Boric Acid per lb. Informal sample (Official sample genuine). 590 Milk 2% deficient in fat Letter of warning 627 Milk 7% fat abstracted K.P.S. 5/7/27 Penalty £5 Costs £1 11 6 665 Milk 13% fat abstracted K.P.S. 26/7/27 Penalty £3 Costs 10/6 817 Milk 3.5% added water Letter of warning 822 Strong Tincture of Iodine 11.8 grs. of Iodine per 100 millilitres Letter of warning 836 Strong Tincture of Iodine 10.5 grs. of Iodine per 100 millilitres Letter of warning 837 Milk of Sulphur 44.47% Calcium Sulphate Informal sample. (Official sample genuine). 852 Whisky 36 degrees under proof Letter of warning 894 Sausages 315 pts. SO2 per million K.P.S. 20/12/27 Costs £3 3 970 Zinc Ointment 13.5% Zinc Oxide Informal sample All other adulterated samples were informal and upon these no action could be taken. 44 Meat.—With regard to meat inspection, this important commodity is kept under supervision by the Inspectors in charge of the districts. Public Health (Meat) Regulations, 1924. The Public Health (Meat) Regulations, 1924, came into operation on the 1st day of April, 1925. 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 of 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. ximate Weight. Sheep's liver Bacterial Necrosis 2 lbs. Sheep's liver Distoma Hepaticum 3 „ Half Bullock's liver Distoma Hepaticum 7 „ Bullock's mesentery Tuberculosis 12 „ Bullock's mesentery Tuberculosis 13 „ Half Bullock's liver Distoma Hepaticum 7 „ Bullock's head Actinomycosis 24 „ Half Bullock's liver Distoma Hepaticum 6 „ Bullock's head Tuberculosis 24 „ Bullock's mesentery Tuberculosis 12½ „ Bullock's liver Abscesses 14 „ Half Bullock's liver Distoma Hepaticum 6 „ Sheep's lungs Abscesses 14 „ Bullock's liver Distoma Hepaticum 14 „ Bullock's liver Distoma Hepaticum 13½ „ Carcase and offal of Calf Tuberculosis 19 stone Bullock's liver Distoma Hepaticum 14 lbs. Half Bullock's liver Distoma Hepaticum 6½ „ Bullock's head Actinomycosis 25 „ Sheep's lungs Strongylus Rufescens 1½ „ 8 Sheep's lungs Stiongylus Rufescens 13„ Bullock's lungs Tuberculosis 7 „ Bullock's mesentery Tuberculosis 12 „ Bullock's liver Distoma Hepaticum 12 „ Hiilf Bullock's liver Distoma Hepaticum 6 ,, Half Bullock's liver Distoma Hepaticum 6 „ Half Bullock's liver Distoma Hepaticum 6 „ Bullock's liver Distoma Hepaticum 14 „ Sheep's lungs Bpllock's lungs Septic Pneumonia 1½ „ Tuberculosis 7 „ Bullock's liver Multiple Abscesses 14 „ Bullock's lungs Distoma Hepaticum 7 „ Half Bullock's liver Distoma Hepaticum 4 „ Half Bullock's liver Distoma Hepaticum 5 „ 45 Ta b l e—continued. Description. Disease. Approximate Weight. Heifer's liver Cavernous Angioma 14 lbs. Half Bullock's liver Distoma Hepaticum 6 „ Sheep's liver Distoma Hepaticum 2 „ Sheep's liver Distoma Hepaticum 2 „ Sheep's liver Distoma Hepaticum 2 „ Sheep's liver Distoma Hepaticum 2 „ 2 Sheep's livers Distoma Hepaticum 4 „ Sheep's liver Distoma Hepaticum 2 „ Sheep's liver Parasitic 2 „ 2 Sheep's livers Parasitic 4 „ Bullock's lungs Tuberculosis 7 „ Sheep's liver Parasitic 2 „ 4 Forequarters Beef Tuberculosis 84 stone 2 lbs. 1 Rump Tuberculosis 1 Head Actinomycosis 1 Tongue Actinomycosis 15 stone 2 Lungs Tuberculosis 1 Heart Peritonitis 1 Spleen Tuberculosis 1 Spleen Pericardii,is 2 Messenteries Tuberculosis Caul Fat Tuberculosis 1 Liver Tuberculosis The protection of meat and the provision of glass fronts to shops has been a question to which some careful study har 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, I received notices from seven licensees of their intention to make application to the London County Council for the renewal of their licences. In all cases these premises were found to be, as far as your Council's requirements were concerned, in a satisfactory condition. No opposition was offered to the renewal of their licences. D 46 At the Special Session at the London County Council the seven licences were granted. The following is a list of the licensed slaughterhouses in the Borough :— Premises. Name of Licencee. 185 Uxbridge Road John Mullet Allwright 40 Goldhawk Road Andrew G. Hedges 138 Goldhawk Road 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 Stanley Brooks Midwinter The Slaughterhouses are visited as often as possible. The Dairies, Milkshops, Ice Cream Vendors, Restaurants and Pood Shops have been kept under systematic inspection by your Inspectors. The following table gives a summary of the work relating to milk premises, slaughterhouses and ice cream premises :— PREMISES. NUMBER OP PREMISES. Number of inspections 1927 Number of notices 1927 Number of prosecutions 1927 On register in 1920. On register at end of 1926 Added in 1927 Removed in 1927 On register at end of 1927 Milk premises 128 84 8 6 86 1,530 5 nil Slaughterhouses 7 7 — — 7 591 1 nil Ice Cream premises 234 171 30 30 171 205 — 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 47 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. Street Trading.—The London County Council (General Powers) Act, 1927, made provision for the Licensing of Street Traders which came into operation on the 1st November, 1927. This Act provided that " it shall not be lawful for any person to sell or expose or offer for sale any article or thing from or upon any barrow cart stall or other receptacle occupying a stationary position at a place in the carriageway or footway of any street in any metropolitan borough without a licence from the borough council authorising him so to do." Provided that this section shall not apply to any person selling or exposing or offering for sale any article or thing from or upon any barrow cart stall or other receptacle which he ordinarily moves from place to place in pursuit of and while conducting-his trade. During the year 148 licences were issued to street traders. 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 46 bakehouses in use in the Borough have been regularly inspected during the year. Fifteen notices were served relating to various defects, 15 being complied with. It was not necessary to apply for any summonses against Bakers whose bakehouses were found not to be in conformity with the Act, as they readily complied with the requirements of the notices served. The following is a list of bakehouses in the Borough :— No. 1 DISTRICT. Address. Name. †*Cadby Hall, Hammersmith Road J. Lyons & Co. *7 Shepherd's Bush Road Not in use *13 Shepherd's Bush Green Not in use *60 Richmond Road S. N. Lockwood *1 Masbro Road G. Teague *67 Ditto G. Dunsby *87 Ditto Not in use *6 Beaconsfield Terrace Not in use †*98 BIythe Road A. Schofield *47 Milson Road Not in use. *Underground. †Factory. D 2 48 Address. Name No. 2 DISTRICT. †65 Bridge Road Not in use 2 Crisp Road Mrs. C. R. Gottig *82 Great Church Lane 'J'. Pen-in †Great Church Lane Fullers, Ltd †*134 Shepherd's Bush Road F. Olliver †*84 Ditto F. R. Ries *94 Ditto Not in use *75 Blythe Road 1". Olliver *31 Goldhawk Road F. Olliver †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 E. VVinstone †*1 Aldensley Road H. A. Roberts, Ltd. †*85 The Grove A. W. Painter *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 Diito Nut in use †1 Eyot Garden J. R. Chibnall, Ltd. †258 King Street Miller & Son †316 Ditto B. Samels †348 Ditto W. Langrebe †* 11 Lamington Street H. A. Roberts, Ltd. 10 Upper Mall Not in use 7 St. Peters Road E. Gent No. S DISTRICT. †*128 Askew Road G. Ingle † 74 Ditto J. Auer †107 Ditto H. Yates †104 Ditto D. Miller 121 Ditto Not in use 41 Gay ford Road Ditto *Underground †Factory 49 Address. Kame. No. 6 DISTRICT. †*74 Goldliawk Road H. Crisp †88 Ditto G. Burnett *106 Dilto F. k. A. Posford 166 Ditto N. Carrington *242 Ditto Plum ridge 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 Road H. Allinson †*32 Norland Road N. A. Carrington *2 Hunt Street Not in use 104 Latimer Road Ditto *Underground †Factory UNSOUND FOOD. A summons was issued, following the seizure of half a pig's head from the premises of Messrs. J. Best, Ltd., 5, Bradmore Lane, which was diseased and unfit for the food of man. The meat was submitted to the Magistrate at the West London Police Court, who condemned the same and gave an Order for its destruction. On the hearing of the summons, the Magistrate imposed a penalty of £2. Two boxes of cod fish (weighing about 8 stones each) were submitted by a vendor in Bradmore Market for examination. The fish were found to be in a decomposing condition and unfit for the food of man. An inspection of the stallholder's premises was made when two boxes of ling (weighing about 6 stones each) were also found to be unfit for the food of man. The fish, which had been purchased from Messrs. Leleu & Morris, of Billingsgate, at 7 o'clock in the morning, was submitted to a Justice of the Peace, who condemned the same and gave an Order for its destruction. 50 A summons was issued against Messrs. Leleu &, Morris, when the Magistrate impoesd a tine of £15 and £10 10s. Od. costs. During an inspection of the premises of Messrs. J. Best, Ltd., 5, Bradmore Lane, Hammersmith, the following meat was seized :— 4 pieces of Pork (weighing 8 lbs.). 4 pieces of Mutton (weighing 5£ lbs.) 1 Pig's Liver. The pieces of pork and mutton were decomposing, unsound and unfit for the food of man. The pig's liver was affected with tuberculosis in the hepatic gland. The meat was submitted to the Magistrate at the West London Police Court, who condemned the same and gave an Order for its destruction. Three summonses were issued against Messrs. J. Best, Ltd., when the Magistrate imposed a fine of £25 in the first summons—the remaining summonses being dismissed. The following is a list of unsound food condemned during the year:— Commodity. Condition. Result. 1 Box of Haddocks (6 stone approx.) Decomposed Surrendered Carcase and Offal of Calf ditto ditto 2 Stone of Skate ditto ditto 1 Box of Fresh Herrings ditto ditto 24 Chickens ditto ditto 2 Boxesot CodFish(16 stone approx.) ditto ditto 2 Boxes of Ling (12 stone approx.) ditto ditto 1 Box of Lemon Soles (6stoneapprox.) ditto ditto 108 Bags of Beetroot ditto ditto 200 Bags of Beetroot ditto ditto 56 lbs. of Meat (Mutton, Beef and Veal) ditto ditto 16 Boxes of Smoked Haddocks (15 stone) ditto ditto 2½ Stone of Skate ditto ditto 1 Case (176) of Oranges ditto ditto 10S Twopenny packets of Shredded Beef Suet ditto ditto 14 Stone of Meat (Necks of Mutton, Veal and Beef Pieces) ditto ditto 2f cwts. of Russian Apples 4 Forequarters and 1 Rump of Beef ditto ditto (84 stone), and Offal (15 stone) ditto ditto 1 Pig's Head and 2 Collars (2 stone 1 lb.) ditto ditto 51 FOOD POISONING. No case of food poisoning was brought to my notice during the year under review. PREVALENCE OP, AND CONTROL OVER INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 931 cases reported as due to notifiable infectious diseases in the Borough, against 716 in the previous year. The number of cases of Tuberculosis notified was 279 against 278 in the previous year. There were also reported 412 cases of infectious diseases that were not notifiable, against 1,150 in the previous year; 60 of these were Measles, 83 Whooping Cough, and 269 Chicken Pox. BACTERIOLOGY. The Bacteriological work is carried out by Dr. Elworthy at the West London Hospital, and I append figures with regard thereto. Sputa from cases of suspected Tuberculosis is examined in the majority of cases by the Tuberculosis Officer, but, in a few instances Dr. Elworthy carries out the examination. The following bacteriological examinations were made on behalf of the Council:— Material from cases of suspected Diphtheria— True Diphtheria bacillus isolated 199 Negative results 1,007 1,206 Blood from cases of suspected Fever— Widal or Typhoid reaction obtained 1 Widal or Typhoid reaction not obtained 6 7 Sputa from cases of Suspected Tuberculosis Tubercle bacillus found 144 Tubercle bacillus not found 521 665 Examination of Feathers for Anthrax— Positive 1 Negative 3 4 Total examinations 1,882 52 Cases of Infectious Disease notified during the year 1927. TABLE IV. Notifiable disease Number op Oases Notified Total cases notified in each Ward Cases Removed to Hospital At all Ages Under 1 1 & unuer 5 Years 5 & under 15 Year* 15 & under 25 Years 25 $ under 45 Years 45 & unde 65 Years 65 and upwards 8th Centre North Ward 1 «v»rd 2 »Vard 3 Ward 4 Ward 5 Ward 6 Ward 7 Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 368 4 66 235 38 22 2 1 80 54 30 30 69 70 35 366 Erysipelas 41 2 2 1 3 11 16 6 5 3 4 4 7 11 7 22 Scarlct Fever 312 2 16 184 32 17 1 .. 41 57 32 2 46 107 20 296 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 11 .. .. 2 3 3 3 .. 2 .. 4 .. 1 4 .. 11 Relapsing Fever (R) Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 7 .. .. .. 2 6 .. .. 2 1 .. 1 1 2 .. 6 Puerperal Pyrexia 22 .. .. .. 7 15 .. .. 1 2 2 4 6 5 2 16 Cerebro-Spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Polio-myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 4 .. 2 1 .. .. 1 .. .. .. 2 .. 1 1 .. 3 Ophthalmia Neonatorum 16 16 .. .. .. .. .. .. 3 2 4 2 .. 2 1 9 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 145 5 14 18 19 63 28 8 24 21 30 6 20 28 16 80 Malaria 2 .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. Dysentery 3 1 2 .. .. .. .. .. .. 2 1 .. .. .. .. 3 Trench Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 931 30 162 441 104 128 61 15 168 142 110 56 153 231 81 812 Tuberculosis. Pulmonary Tuberculosis 226 .. 4 11 46 104 52 9 28 48 35 13 24 50 28 Other forms of Tuberculosis 51 .. 6 20 14 9 3 1 6 e 5 5 8 12 12 Totals 279 .. 10 31 60 13 55 [ 10 33 54 40 18 32 62 40 Deaths from the Seven Principal Zymotic Diseases-The total number of deaths of residents registered from the seven principal zymotic diseases was 46 against 80 in the previous year. The deaths of residents last year from these diseases were equal to 27 per 1,000 of the total deaths of residents registered and were at the rate of 0.3 deaths per 1,000 persons, living. The following table shows the deaths of residents registered from the seven principal zymotic diseases which occurred in the ten years, 1918 to 1927:— 53 Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Enteric Fever. Diarrhœa and Cholera. Total. 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 8 12 32 3 35 91 1926 0 24 2 14 11 0 28 80 1927 0 2 1 11 4 0 28 46 Average last 10 yrs. 0 18 5 21 17 2 36 99 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was 43 below the average number registered in the last ten years. Notifiable Diseases (other than Tuberculosis) during the year 1927. DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths. Diphtheria 368 366 11 Erysipelas 41 22 — Scarlet Fever 312 296 1 Enteric Fever 11 11 — Puerperal Fever 7 6 3 Puerperal Pyrexia 22 16 — Cerebro-Spinal Meniugitis — — — Encephalitis Lethargica 4 3 — Ophthalmia Neonatorum 16 9 — Pneumonia 145 80 139 Anthrax — — — Totals 926 809 154 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. 54 The Chart hereunder shows the number of cases of Diphtheria notified week by week during the year. 55 Diphtheria and Diphtheritic Membranous Croup.—Three hundred and sixty-eight cases were reported as due to Diphtheria or Diphtheritic Membranous Croup against 254 cases in the previous year. Three hundred and sixty-six cages were treated at the Isolation Hospitals and two at the homes of the patients. Eleven deaths were registered. The mortality rate on the cases reported was 3.0 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 us# 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.-—Three hundred and twelve cases were notified as due to Scarlet Fever, against two hundred and seventy-six in the previous year. Two hundred and ninety-six cases were treated at the Isolation Hospitals, and sixteen at the homes of the patients. One death was registered. The mortality rate on the cases reported was 0.3 per cent. Enteric Fever.—Eleven cases were reported as due to Enteric Fever, against eight cases in the previous year. Six cases were treated at the Isolation Hospitals of the Metropolitan Asylums Board, 3 at the West London Hospital, one at the Victoria Hospital for Children, and one at St. George's Hospital. No death was registered. Erysipelas.—Forty-one cases were reported as due to Erysipelas, against twenty-nine cases in the previous year. Nineteen cases were treated at the homes of the patients, five at St. Marylebone Hospital, fourteen at the Hammersmith Hospital, two at the West London Hospital and one at the Metropolitan Asylums Board Hospital. No death was registered. 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 Eelapsing Fever, against no case in the previous year. 56 The Chart hereunder shows the number of cases of Scarlet Fever notified week by week during the year. 57 Continued Fever.—No case was reported as due to Continued Fever, against no case in the previous year. Puerperal Fever.—Seven cases were reported as due to Puerperal Fever, against seven 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, and one at the University College Hospital. Three deaths were registered. The mortality rate on the cases reported was 43 per cent. Puerperal Pyrexia.—Twenty-two cases were reported as due to Puerperal Pyrexia against ten in the previous year. Six cases were treated at the isolation hospitals of the Metropolitan Asylums Board, 1 at the Hammersmith Hospital, 7 at Queen Charlotte's Hospital, 1 at the Mothers' Hospital, 1 at Charing Cross Hospital, and 6 at the homes of the patients. In three cases of Puerperal Pyrexia Medical Practitioners availed themselves of the services of the Obstetric Specialists provided for in the scheme adopted by the Council in 1926. Cerebro-Spinal Meningitis.—No case of Cerebro-Spinal Meningitis was reported against one in the previous year. Acute Polio-myelitis.—No cases were reported as due to Polio-myelitis, against none in the previous year. Encephalitis Lethargica.—Four cases were reported as due to Encephalitis Lethargica, against four in the previous year. Three cases were treated in the Hospitals of the Metropolitan Asylums Board and one at the home of the patient. Ophthalmia Neonatorum.—Sixteen cases were reported as due to Ophthalmia Neonatorum, against twenty-four in the previous year. Seven cases were treated at the Metropolitan Asylums Board Hospital, 1 at St. George's Hospital, 1 at Queen Charlotte's Hospital, and 7 at home. In the majority of cases treated at home arrangements were made for a nurse to attend the patient- Anthrax.—No case of Anthrax was notified during the year, against one case in the previous year. Hydrophobia.—No case was reported as due to Hydrophobia, as against no case in the previous year. Rabies Order, 1919.—No case of Babies 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.—Sixty cases of Measles and German Measles were notified against seven hundred and twelve in the previous year. Fifty cases were treated at the homes of the patients, and ten in the Hospitals of the Metropolitan Asylums Board. Two deaths were registered. 58 Whooping Cough.—Eighty-three cases of Whooping Cough were reported, against one hundred and forty-eight in the previous year. Four deaths were registered. As this is not a notifiable disease, the mortality rate on the cases reported is of no value, as doubtless a very large number of cases occurred which were not known of in the Public Health Department. I have received, as heretofore, information as to cases from the Head Teachers of the Schools of the London County Council. The following Chart shows the number of Deaths from Measles pej 100,000 inhabitants, 1908-1927. 59 The homes of the patients were visited by your Inspectors, and the parents advised as to the precautions that should be taken. The following Chart shows the number of Deaths from Whooping-Cough per 100,000 inhabitants, 1908-1927. Chicken Pox.—Two hundred and sixty-nine cases of Chicken Pox were reported, against two hundred and ninety in the previous year. In every case the premises were visited by one of your Inspectors and the parents advised as to the precautions necessary. Pneumonia.—One hundred and forty-five cases of Pneumonia (forty-nine Influenzal Pneumonia and ninety-six Primary Pneumonia) were notified during the year. The majority of the patients were treated at home. Eighty 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 60 was found necessary to arrange for a nurse to visit and attend to the wants of (he patients. This was done by arrangement with the Hammersmith District Nursing Association. One hundred and thirty-nine deaths were registered. From the above figures it may be assumed that a good many cases have occurred, of which no information has been received by your Public Health Department. Malaria.—Two cases were reported, against no <ase in the previous year. Dysentery.—Three cases of Dysentery were reported against no case in the previous year. Trench Fever.—No case of Trench Fever was reported, against no case in the previous year. Influenza.—During the year fifty-one deaths from Influenza occurred, as compared with twenty-three 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 10 Scarlet Fever 7 Enteric Fever 1 Total 24 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. 61 TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1918 to 1927. Year. Smallpox. Scarlet Fever. Diphtheria or Diphtheritic Croup. Typhus Fever. Enteric Fever. Simple Continued Fever. Relapsing Fever. Puerperal Fever. Puerperal Pyrexia, d Cholera. Erysipelas. Plague. Chickenpox. a Measles, b a Whooping Cough, a Cerebro-Spinal Fever. Anthrax. Glanders. Hydrophobia. Ophthalmia Neonatorum. Acute Polio-Myelitis. Encephalitis Lethargica. Pneumonia, e Malaria, e Dysentery, c Trench Fever, c Total. 1918 0 177 146 0 15 0 0 8 0 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 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 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 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 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 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 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 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 10 0 29 0 290 712 148 1 1 0 0 24 0 4 102 0 0 0 1866 1927 0 312 368 0 11 0 0 7 22 0 41 0 269 60 83 0 0 0 0 16 0 4 145 2 3 0 1343 Average, for 10 years. 0 431 297 0 10 0 0 12 2 0 44 0 290 767 240 4 0 0 0 31 3 5 124 13 2 0 2275 a Not Notifiable. b Notifiable during the years 1916—1919. c Notifiable from 1st March, 1919. d Notifiable from 1st October, 1926. 62 I append figures showing the numbers dealt with during the year. School Children— Scabies 69 Impetigo 98 Verminous Cases 2,486 Other conditions 1 Adults— Scabies 12 Impetigo — Verminous Cases 106 Children under School-age— Scabies 1 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 £248 14s. 0d. in respect of cleansings and £8 7s. 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 462 Mattresses 727 Pillows 1,509 Bolsters 481 Blankets 1,835 Sheets 1,071 Quilts 856 Articles of Clothing 2,734 Sundries 328 Total 9,063 Rooms 1,046 Tuberculosis. Tuberculosis.—Two hundred and seventy-nine cases of tuberculosis were reported during the year; two hundred and twenty-six of which were Pulmonary and fifty-three being 63 other forms of Tuberculosis, against two hundred and seventyeight cases in the previous year. The following table shows the number of notifications received during the year:— Age Periods. Notifications on Form "a" Notifications on Form "B" Number of Notifications on Form "C" Number of Primary Notifications. Total Notifications on Form "A" No.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 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total Prim. Not. Under 5 5 to 10 10 to 15 Total Prime, Not. Pulmonary. Males .. 1 3 1 6 11 18 32 32 6 7 117 180 383 .. .. 1 1 6 1 8 20 94 Pulmonary, Females .. 3 3 1 13 16 25 29 12 9 2 106 143 .. — .. 2 3 13 67 Non-Pulmonary, Males .. 4 8 5 5 .. 1 3 1 .. 1 28 34 .. .. .. .. .. 1 22 Non-Pulmonary, Females .. 2 l 3 2 7 5 .. 2 .. .. 22 26 .. 2 1 3 4 4 10 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 2nd January, 1927, to the 31st December, 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 — — — — — 3 5 6 5 5 1 25 Females — — — — 1 — 3 2 6 — 1 13 Non-pulmonary Males 1 3 4 2 — — — — — — 1 11 »» Females — 4 3 1 — — — 1 — —0 1 10 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. e 2 61 One hundred and fifty-eight deaths from Pulmonary Tuberculosis were registered, against one hundred and twentyseven in the previous year, representing a death-rate of 1.2 per 1,000, compared with 0.9 in 1926. The following table shows the number of cases of Tuberculosis remaining on the Registers of Notifications on the 31st December, 1927:— Pulmonary. Non-Pulmonary. Total Cases. Males. Females. Total. Males. Females. Total. 505 427 932 166 191 357 1,289 The notification of cases of Tuberculosis by medical practitioners is, unfortunately, not carried out as required by the Regulations, that is within 48 hours of the same coming to their knowledge. There are undoubtedly many difficulties attending the notification of this disease, but the efforts of Local Authorities, and the money spent in combating this disease are to a large extent rendered nugatory. I append figures for the years 1920-1927, showing the interval between notification and death of tuberculous persons. 1920. 1921. 1922. 1923. 1924. 1925. 1926. 1927. 1. Total number of deaths from Tuberculosis in the Borough 157 173 162 145 170 138 0142 182 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 25 4. The number of cases notified within three months of death (excluding above) 28 29 20 18 20 13 20 23 5. The number of cases notified within six months of death (excluding above) 16 9 16 13 16 18 12 18 65 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1927:— Age Periods. New Cases. Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. 0 — — — — — — 1 — 1 1 3 4 2 — 1 1 3 5 4 4 13 4 1 1 6 5 15 17 29 5 9 14 13 — 2 25 50 54 4 5 34 29 4 45 38 14 1 2 37 15 — — 65 and upwards 7 2 1 . — 10 4 1 — Totals 117 106 28 22 96 63 13 10 I submit a report on the work carried out at the Tuberculosis Dispensary. Tuberculosis Officer's Report for the Year 1927. 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. Tuberculosis Dispensary. The record of the year's work of the Dispensary is as follows:— On 1st January, 1927, the number of patients on the Dispensary Register was 686. During the year 26 definite cases of the disease wre transferred from other areas into the Hammersmith district and 46 moved out of this district or were lost sight of. Twenty- 66 five were written off the register as being cured cases who had previously been notified as suffering with tuberculosis. New Patients. During the year 696 persons attended for examination for the first time. Of these 255 were under the age of fifteen and 441 were adults. Males and females attended in almost equal numbers, viz., 333 and 363. Of the total, 173 were referred to the Dispensary by local Practitioners for the purpose of consultation, while 174 were " contacts " of persons suffering with Tuberculosis and 56 were discharged ex-Service men who attended for reports on the instruction of the Ministry of Pensions. Diagnosis. Found to have Pulmonary Tuberculosis 159 Found to have other forms of Tuberculosis 28 Showing no evidence of Tuberculosis 509 Patients from Previous Years. Four hundred and forty-four persons who had attended the Dispensary in previous years presented themselves during 1927. Of these, 336 were adults, and included 102 ex-Service men, while 108 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 2,625, and physical examinations were carried out in 1,503 instances, i.e., in 57.25 per cent, of the total attendances. The names of 507 persons were written off the register as being nontuberculous, and the total number on the Dispensary register on 31st December, 1927, was estimated at 744. Sputum Examinations. Five hundred and seven specimens of sputum and other pathological products were examined bacteriologically. One hundred and ten showed the presence of Tubercle Bacilli, while 397 proved negative. Institutional Treatment. The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homes), under the London County Council's Scheme, numbered 201. 67 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 503 To the Ministry of Pensions 114 To General Practitioners and Hospitals 415 Home Visitation. The Tuberculosis Officer made 158 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 34 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 4,547 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 198 HomeEnquiry Schedules were submitted to the Committee. Tuberculosis Care Committee. This Committee is formed of representatives of the following bodies: the Borough Council, the County Council, the Board of Guardians, the Red Cross Society, the United Services Fund, the Charity Organisation 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 233 applications for residential treatment, an increase of 1 compared with 192G. The Committee decided in 169 of these cases that no payment should be required in respect of such treatment. In the remaining 64 assessments of varying amounts were made. In 80 instances, reconsideration of these assessments was 68 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 .£283 13s. 6d. These monies are handed over to the Borough Accountant who transfers them to the County Council. The staff consist of the Tuberculosis Officer, Dr. Govan. two Nurses, Dispenser and Clerk, and Secretary (part time) to the After Care Committee. There are no residential institutions in the Borough with beds available for the treatment of Pulmonary Tuberculosis. Close co-operation exists between the West London Hospital to which the Dispensary is affiliated. Cases of non-tuberculous chest diseases and "surgical tuberculosis" are admitted if a bed is available for surgical procedure. Admissions to Brompton and other special hospitals for diagnosis and treatment are arranged through the London County Council. Children found to be suffering with tonsils and adenoids, bad dental conditions, and minor ailments are reported to the District Organiser of the London County Council, who arranges for the attendance of the children at the School Clinic for treatment. Certain medical practitioners send reports to the Tuberculosis Officer on patients under domiciliary treatment at three monthly intervals. 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. 69 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. 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 patients suffering from Tuberculosis. 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 congested parts of the Borough. Housing difficulties still exist, and overcrowding continues in many instances. 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 to Peru for re-interment, two were re-interred in the Terrace Catacomb, St. Mary's Cemetery, Kensal Green, one was removed for re-interment at Mount Vernon Cemetery, Liberton, Edinburgh, and one was removed to France for re-interment at Vincennes. 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. 70 (2) That freshly made ground lime be freely sprinkled over the coffin, the soil, or any matter that may be offensive. In those eases where the remains were removed to other 3ountries, 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. 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. The Health Exhibition held in May proved to be an outstanding success, and afforded a very efficient means of propaganda work. Twenty-eight stalls were erected in the Large Hall in which various exhibits and demonstrations in clean foods, health and cleanliness, hygiene, dental work, labour-saving devices, diseased and unsound foods, <&c., were given. Cooking demontrations were held twice daily and lectures wth films were given each afternoon and evening. Six hundred school children visited the Exhibition by arrangement with the School Authorities, when lectures and demonstrations were given at certain selected stalls. They were afterwards shown a film on the care of teeth. I am of opinion that this exhibition provided a very efficient means of instruction and enlightenment of the public. 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 1,798 Corrected Number of Births 2,076 These figures represent, a Birth-rate per 1,000 of the population of the Borough of 15.6 Corrected Number of Deaths of Infants under one year, of whom 41 died under one week 1.26 Legitimate Infants—104 or 54 per 1,000 Births. Illegitimate Infants—22, or 172 per 1,000 Births. Infant Mortality Rate per 1,000 Births 61 The work undertaken under this heading in the Borough during the year 1927 was continued on similar lines to previous years. 71 1. Activities directly initiated by the Borough Council: (a) Provision of three Health Visitors, as in former years. (b) Provision of a Maternity Home. (c) Supply of Free Milk to necessitous Mothers and Young Children. (d) Treatment and Nursing of Children under School Age. 2. Activities of Voluntary Agencies in receipt of grants- in-aid from the Borough Council: (a) Infant Welfare Centres. (b) Day Nurseries. 3. Activities of independent Voluntary Agencies: (a) Rescue Homes. (b) Convalescent Treatment for Invalid Children. Health Visitors.—Three Health Visitors were engaged, as in former years, in visits of enquiry to Births, Infant Deaths, cases of Ophthalmia Neonatorum, Puerperal Fever, and other diseases of mothers and young children; they have also taken an active part in the work of the Voluntary Infant Welfare Centres. 1 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 weks, and it is during this period that the advice of the Health Visitors is most essential. The visits paid are enumerated in detail below:— First visits 1,844 Re-visits (under 1 year) 1,800 Re-visits (1 to 5 years) 820 Out and removals 1,861 Special visits 272 Ophthalmia, first visits 15 Ophthalmia Re-visits 8 Puerperal Fever 7 Puerperal Pyrexia 20 Ante-natal, first visits 334 Ante-natal, re-visits 65 Visits to Stillbirths 26 Visits to Infant Deaths 99 Cerebro-Spinal Meningitis — Encephalitis Lethargica 4 Poliomyelitis 2 Epidemic Diarrhœa 1 Total 7,178 72 Number of Consultations at Infant Welfare Centres, attended by Health Visitors 413 Number of Committee Meetings of Voluntary Associations attended 16 Number of Insanitary Conditions reported by Health Visitors and dealt with by Sanitary Inspectors 39 The feeding of the 1,844 infants visited was found to be as follows:— Breast-feeding 1,618 Artificial feeding 160 Mixed feeding 66 Every effort is made by the Health Visitors to encourage mothers to breast-feed their infanta, and also to induce them to attend the Consultations at the Infant Welfare Centres, so that both mother and child may be kept under observation during the most critical months of the child's life. The following table gives the number of births and deaths of infants and the rate per 1,000 births since 1906, 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 1927 2076 126 61 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. 73 The infant mortality rates of the London Boroughs varies from 38 in Holborn to 105 in the City of London. The following Chart shows the Infantile Mortality rate for the years 1903-1927. MATERNAL MORTALITY. In 1924 I reported on the subject of Maternal Mortality, since when the position has changed very little. A Committee has now been formed by the Ministry of Health to go into the question and to advise as to the best course of action to be adopted to deal with this important problem. In this connection it has been suggested that every Maternal death should be inquired into by a qualified medical practitioner and evidence collected as to the probable cause. 74 This question is one which calls for careful investigation. In addition to the deaths at the time of and as a result of childbirth there are many more cases of serious illness from the same causes which do not prove to be fatal. These surviving mothers often become permanent invalids as a result. In my opinion the inquiry suggested by the Ministry should be extended so as to include all cases of serious illness arising from childbirth. 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. 5,118 lbs. of dried milk and 60 quarts of raw milk were distributed during the year. The number of applications for free milk has averaged 18 per week during the year. The total expenditure during the year was approximately £320. The distribution of milk has entailed no increase of the administrative staff or additional expense to the Council. The distribution of this free milk has been an inestimable boon, and has, without doubt, contributed very largely to the improved condition of the children generally. By this means the Public Health Department and the Maternity and Infant Welfare Centres are able to keep in close contact with these cases, and at the same time mothers have been able to obtain a proper supply of milk for their children which they could not have done otherwise. The arrangements whereby the Infant Welfare Centres are supplied with dried milk for distribution has been continued. The mothers attend the Centre and obtain their supplies on presenting an order issued from the Public Health Department, thus encouraging the mothers to attend the Centres where they can obtain advice both with regard to themselves and their children. "PARKSIDE" MATERNITY HOME. I append figures for the year 1927:— Name of Institution.—"Parkside" Maternity Home, Hammersmith Hospital, 150, Du Cane Road, W.12. Number of Beds.—14. 75 Information Required. (1) No. of Cases in the Home on 1st January, 1927. (2) No of cases admitted during 1927. (3) Average duration of stay. (4) No of cases delivered (a) by Midwives. (b) by Doctors. (5) No. of Cases in which medical assistance was sought by the midwife with reasons for requiring assistance (a) Ante-natal (b) During labour (c) After labour (d) For infant (6) No. of Cases notified as (a) Puerperal fever (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. (7) No. of Cases of Pemphigus Neonatorum. (8) No. of Cases notified as Ophthalmia Neonatorum with the result of treatment in each case. (9) No. of Cases of "Inflammation of the Eyes" however slight. (10) No. of Infants not entirely breastfed while in the Institution with reasons why they were not breastfed. Particulars. 8. 201. 14 days. 186. 15. Dr. Jenkins in attendance at all Ante-natal Clinics. 1. Hydramnics 1. Eslamptic 4. Delayed 1st and 2nd stages =8 2. Adherent Placenta 1. Haemorrhage 7th day. 1. Blue Asphyxia. 11. Stillbirths. Nil. Nil. Nil. Nil. Nil. 1. Artificial feeding on 13th day owing to persistent cracked nipple. 1. Due to debility of mother. 1. Mother returning to work immediately after leaving Home. 76 Information Required. Particulars. (11) No. of Maternal deaths, with Nil. causes. (12) No. of Fœtal deaths (a) Stillborn (b) Within 10 days of birth and their causes and the results of their postmortem examinations if obtainable. (a) 11. (b) 9 days. Congenital Maldevelopment (twin pregnancy). 12 hours. Congenital debility (triple pregnancy). 45 minutes. Inanition, congenital debility. 4 days. Congenital debility. 1 day. Congenital debility (twin pregnancy). 1 day. Congenital debility (twin pregnancy). 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 closed its Centre at the end of June. The Latymer Road Mission Welfare Centre held two sessions weekly: infant consultations and weighings and mothers' classes. This Welfare Centre is on the borders of the Borough and serves both Kensington and Hammersmith. The College Park Clinic 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 demand where mothers were compelled to work for the support of the family. These nurseries received grantsin-aid from the Council. Independent Voluntary Agencies. Rescue Homes—There were three Homes open in the Borough throughout the year for the reception of Unmarried 77 Mothers and their Children; the total accommodation available for such cases was 37 beds. 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:— Operation for Tonsils and Adenoids 7 Minor Ailments 40 Dental Treatment 8 Total 55 In addition arrangements were made, as before, with the Hammersmith District Nursing Association for the services of a nurse when required, to ensure adequate attention in cases of Ophthalmia Neonatorum, Pneumonia and Measles. Infectious Diseases of Mothers and Children Under Five Years of Age. Statistics showing the incidence of all infectious diseases during the year are included in the general report, but in so far as they relate particularly to diseases of parturient women and children under five years of age, are tabulated below:— Disease. No. of Cases Notified. Previous Year. No. of Cases Visited. No. of Cases Nursed. No. of Cases Removed to Hospital. Puerperal Fever 7 7 7 — 6 Puerperal Pyrexia 22 10 20 — 16 Ophthalmia Neonatorum 16 24 15 7 9 Epidemic Diarrhœa *28 26 1 1 — Measles & German Measles (under 5)+ 22 201 22 1 8 Whooping Cough (under 5)† 40 52 40 — 21 Poliomyelitis (under 5) 1 — — — *Summer Diarrhœa.—As this is not a notifiable disease the figures available are those of deaths which were registered as having been due to this cause. †Not notifiable diseases. 78 Ophthalmia Neonatorum.—The number of cases reported was sixteen, against twenty-four 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. 16 7 9 15* — — 1 *One case did not return to this Borough following discharge from Hospital. All notified cases of diseases of parturient women and children under five years of age are visited immediately, and arrangements made for the attendance of a nurse where required. SANITARY ADMINISTRATION. Staff.—There are nine male Sanitary Inspectors and one lady Sanitary Inspector. Eight of the male Inspectors are employed as District Inspectors, being responsible for all matters excepting the taking of samples under the Sale of Food and Drusis 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-two applications were received for certificates under the above Act. In thirty-one cases the certificates were granted, one application was refused. Eight certificates were granted to owners who had carried out the work specified satisfactorily, three being refused. 79 Rag Flock Act, 1911.—The Rag Flock Regulations, 1912.—No action was taken under these regulations during the year under review. Public Mortuary.—During the year three hundred and thirty-two bodies were removed to the Mortuary in Fulham Palace Road. There were two hundred and seventy four brought to the Mortuary by order of the Coroner, and fiftyeight were received for accommodation and convenience of burial.