HAM 23 AC..4347 pp 48 111-113 Metropolitan Borough of Hammersmith ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1931. INDEX. page Introduction 2 Staff of the Public Health Department 4 Statistics for the Year 1931 7 Natural and Social Conditions of the District. «- Population 8 Marriages 8 Births 8 Deaths 9 Deaths of Infants 10 Chart—Diarrhoea 10 Slimmer Diarrhcea 11 Hospital Treatment—Zymotic Enteritis 11 Danger from Flies 11 Deaths of Illegitimate Children 11 Infantile Mortality (Table III) 12 Deaths of Aged Persons 12 Statistics (Table I) 13 Deaths in Institutions 13 Deaths (Various Causes—Table II) (Wards) 16 Table—Whole of London—Comparison 17 Professional Nursing in the Home. Nursing 18 Midwives 18 Laboratory Facilities 18 General Provision of Health Services in the Borough. Hospitals (Public) 19 Hospitals (Voluntary) 20 Institutional Treatment for Unmarried Mothers 22 Maternal Mortality 23 Ambulance Facilities 24 Maternity and Child Welfare Centres 25 Clinics and Treatment Centres 25 Day Nurseries 26 School Clinics 26 Tuberculosis Dispensary 26 Rheumatism Advisory Clinic 27 Treatment Centre for Venereal Diseases 27 Sanitary Circumstances of the Borough. Closet Accommodation 28 Scavenging 28 Fouling of Footpaths by Dogs 28 General Sanitary Administration 29 Notices 30 Page Summonses. Public Health Acts 31 Public Health (London) Act, 1891—Unsound Food 35 Hammersmith Borough Council By laws—Dogs 35 Milk and Dairies Order, 1926 36 London County Council (General Powers) Act, 1928 37 Factory and Workshop Act, 1901 37 Factories and Workshops—Inspection of 38 House to House 40 Smoke Abatement 40 Bats and Mice (Destruction) Act, 1919 41 Controlled Premises and Occupations 42 Tenement Houses 42 Houses Let in Lodgings 42 Housing Act, 1925—Section 18 42 Vans 42 Ice Cream Vendors 43 Schools 44 Bag Flock Acts, 1911 and 1928 44 Housing. Statistics 45 General Housing Conditions 48 Supply of Houses—Overcrowding 51 Newly Erected Houses 53 Inspection and Sopehvision op Food. Food Supplies 55 Milk Supply 55 Milk (Special Designations Order, 1923 56 Certification of Certain Food Products for Export 56 Public Health (Meat) Begulations, 1924 58 Inspection of Carcases of Animals slaughtered in Looal Slaughterhouses 58 Licensed Slaughterhouses 59 Markets 60 Street Trading 60 Fried-fish Shops 61 Bakehouses 61 Unsound Food 63 Food Surrendered 65 Food Poisoning 65 Clinical and Bacteriological Examination of Food 66 Inspbotion and Supervision of Food—continued. Page Food and Drugs Adulteration Act, 1928 66 Milk 68 Condensed Milk 68 Cream 68 Butter, Margarine and Lard 68 Meat and Fish Preparations 69 Conserves, Vegetables, Fruits, &c 69 Cocoa, Coffee and Tea 69 Farinaceous Foods 70 Condiments, Spices, Ac 70 Cordials, Wines, Spirits, Ac 70 Drugs 70 Miscellaneous Articles 70 Pkkvalencb and Control oveb Infectious Diseases. Infectious Diseases 72 Bacteriology 72 Zymotic Diseases 73 Notifiable Diseases 74 Smallpox 75 Cholera 75 Plague 75 Diphtheria and Diphtheritic Membranous Croup 75 Anti-toxin 75 Scarlet Fever 75 Enteric Fever 76 Erysipelas 76 Typhus Fever 76 Relapsing Fever 76 Continued Fever 76 Puerperal Fever 76 Puerperal Pyrexia 76 Chart—Diphtheria 77 Chart—Scarlet Fever 78 Cerebro-Spinal Meningitis 79 Acute Polio-myelitis 79 Encephalitis Lethargica 79 Ophthalmia Neonatorum 79 Anthrax 79 Hydrophobia 79 Babies Order, 1919 79 Glanders 79 Measles and German Measles 80 Measles—Chart 80 Whooping Cough 80 Chart—Whooping Cough 81 Chicken Pox 81 Prevalence and Control over Infectious Diseases—continued. Pag* Pneumonia 82 Malaria 82 Dysentery 82 Influenza 82 Wrong Diagnosis 82 Psittacosis 83 Cleansing of Verminous Persons 83 Tabular Statement—Zymotic Diseases 84 Disinfection 85 Vaccination 85 Vaccination Returns 87 Public Health (Smallpox) Regulations, 1917 89 Tuberculosis 89 Public Health (Prevention of Tuberculosis) Regulations, 1925 92 Tuberculosis Dispensary 92 Tuberculosis Care Committee 100 Prevention of Blindness 103 Exhumation and Re-interment of Bodies 103 Health Education. Propaganda 104 Maternity and Child Welfare. Statistics 105 Health Visitors—Work of 106 Feeding of Infants—Statistics 107 Table—Births, Deaths, and Infant Death Rate 107 Schedule of Attendances at Infant Welfare Centres 108 Chart—Infantile Mortality Rate 109 Artificial Light Treatment 109 Light Treatment Centre 110 Milk (Mothers and Children) Orders, 1918-1919 110 " Parkside " Maternity Home—Statistics 114 Voluntary Work. Infant Welfare CentreB 116 Day Nurseries 116 Rescue Homes 116 Convalescent Treatment of Invalid Children 116 Treatment and Nursing—Children under School Age 117 (a) Operations. (6) Minor Ailments, (c) Dental Treatment. Infectious Diseases of Mothers, and Children under five years of age—Tabular Statement 117 Ophthalmia Neonatorum 118 Sanitary Administration. Staff 118 Rent Restrictions Acts 119 Public Mortuary 119 ANNUAL REPORT OF THE Medical Officer of Health or THE BOROUGH OF HAMMERSMITH For the Year 1981. Metchim &-Son Westminster and City 98734 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 1981. 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 death-rate of 12.2 is 0.5 per thousand greater than the rate for the previous year. The infantile mortality rate is 68 per 1,000 births. The lowest rate was 61 per 1,000 births in 1927. " Parkside " Maternity Home continues to be a great boon to those mothers who have no suitable accommodation in their own homes. The number of confinements in 1981 amounted to 207 compared with 201 for 1927, 257 in 1928, 841 in 1929, and 294 in 1930. It will be observed that the number of cases admitted during the year is lower than in previous years. This is due to the reduction in the accommodation. During the year arrangements were made with the authorities of Queen Charlotte's Hospital for the reception of Hammersmith cases into " Invermead," Goldhawk Eoad. Ten beds have been allocated for the women booked through the Council. During the year 130 cases were admitted, 114 to " Invermead," and 16 to Queen Charlotte's Hospital, Marylebone Eoad. The 16 cases were admitted to Queen Charlotte's Hospital, on the report of the ante-natal doctor, as being abnormal or difficult cases. 3 In view of the large number of women attending the ante-natal Clinics, it was found necessary to provide additional sessions. Arrangements were made through the Hammersmith Infant Welfare Association for an additonal Clinic to be held on Friday morning at the Centre in Glenthorne Road. The Council undertook the financial responsibility in connection with this additional Clinic. It is an obligation on every expectant mother booked for " Parkside " or " Invermead " to attend at least once. Usually two, three or more attendances are made. 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 for the past ten years. This is accounted for by the decrease in the number of cases of scarlet fever, diphtheria and measles. There is still a considerable amount of overcrowding in spite of the large number of houses erected in the Borough by the Borough Council, the London County Council and by private enterprise. During the year 5,027 Intimation Notices and 2,008 Statutory Notices were served. The special house-to-house inspection has continued throughout the year, although it has been somewhat delayed owing to changes in the temporary staff. Two thousand two hundred and forty-seven houses have been inspected, resulting in the service of one thousand nine hundred and sixty-seven notices. I am, Ladies and Gentlemen, Your obedient Servant, J. B. HOWELL, Medical Officer of Health. 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF THE YEAR 1931. Medical Officer of Health and year of Administrative Tuberculosis Officer. appoitment J. B. Howell, M.R.C.S., L.R.C.P., D.P.H. 1914 Assistant Medical Officer of Health and Tuberculosis Officer. g. I. Davies, M.D., B.S., M.R.C.S., L.R.C.P., D.P.H 1930 Consultant Gynaecologists. Lady Florence Elizabeth Barrett, M.D., M.S. S. Forsdike, M.D., F.R.C.S. A. Goodwin, M.D., F.R.C.S. L. H. W. Williams, M.D., F.R.C.S. Public Vaccinators (Part time). D. F. Durward, M.R.C.S., L.R.C.P. A. R. Dale, M.R.C.S., L.R.C.P. J. W. Brash, M.R.C.S.. L.R.C.P. J. S Dockrill, B.A..M.B., B.Ch., B.A.O., D.P.H. P. E. F. Frossard, M.R.C.S., L.R.C.P. Public Analyst (Part time). P. A. Ellis Richards. F.I.C., F.C.S. Pathologist. R. R. Elworthy, M.D., M.R.C.P., M.R.C.S., D.P.H. Ante-natal Clinics. Naomi Dancy, M.B., B.S., M.R.C.S., L.R.C.P. A. A. Renshaw, M.D., M.B., Ch.B. Clerical Staff. *A. H. Wilmot (Chief Clerk) 1902 J. C. Turner 1920 C. M. White 1920 fMiss E. Cole 1923 A. H. Johns 1925 F. G. Holland (Vaccination Officer) 1929 E. F. Yorke 1931 T. J. Hares (Temporary) 1930 5 Year of Appointment Sanitary Inspectors. §*F. Q. Barry 1919 = §*P. T. Bayes 1926 †§*W. J. Godden 1926 §*A. Hayes 1910 §øG. W. Herrick 1929 ±°†§*F. W. Mason 1926 †§*E. J. Nether 1926 §*P. W. Pottier (Food and Drugs Inspector) 1919 = §*W. Rigby 1919 Temporary Sanitary Inspectors. øE. Saphier 1930 øW. C. Turner 1931 Lady Sanitary Inspector. ‡*Miss M. M. Hawkins 1923 Health Visitors. "| |*†Miss R. A. Henry 1916 | |*Miss A. M. M. Willcox 1916 "||Miss D. G. Johnson 1922 ∆"| |HQMiss C. M. Henniker 1929 Tuberculosis Dispensary Staff. □| |Mrs. Cameron (Nurse Visitor) 1924 "□| |QHMiss Murphy (Nurse Visitor) 1924 Miss Rees (Dispenser and Secretary) 1918 A. Pullin (Porter) 1918 Medicinal Baths and Disinfecting Staff. A. H. S. Hutchinson (Superintendent) 1928 Mrs. Manners 1924 G. Langley (Disinfector) 1900 Mortuary Keeper. E. W. Mackay 1929 6 †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). °Royal Sanitary Institute (Smoke Certificate). Apothecaries' Hall Certificate. øCert. Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. =Smoke Abatement Cert. L.C.C. School of Engineering. ± Diploma, Institute of Hygiene. ∆Diploma in Nursing, London University. 7 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1931. Area 2,282.5 acres Population (1981) (estimated) 135,100 Population Census (1901) 112,289 (1911) 121,521 (1921) 130,295 (1931) 185,521 Natural increase, i.e., excess of births over deaths 421 Density of population 59.2 persons per acre Marriages registered 1,209 Number of inhabited houses 1931 17,402 Number of families or separate occupiers (1921) 88,263 Rateable value (1931) £1,137,121 Sum represented by a penny rate, 1931 £4,603 Vital Statistics. Births (legitimate) 1,915 ,, (illegitimate) 158 birth rate 15.3 Stillbirths. 39 death rate 12.2 Deaths (corrected) 1,652 Number of women dying in, or in from sepsis 2. consequence of childbirth from other causes 5 Deaths of infants under one year of age per 1,000 births 68 Legitimate, 64. Illegitimate, 114. Deaths from measles (all ages') 0 Deaths from whooping cough (all ages) 7 Deaths from diarrhoea (under 2 years of age) 19 8 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 130,295, being an increase in the 10 years of 8,774. The Census of 1931 shows the population of the Borough to be 135,521, being an increase in the 10 years of 5,226. In this report the rates are calculated on the estimated population adopted by the Registrar-General, i.e., 185,100. The corrected number of births registered was 2,078, whilst the corrected number of deaths of residents was 1,652, thus showing a natural increase of population by excess of births over deaths of 421. The area of the Borough is 2,282.5 acres, there being 59.2 persons to the acre. Marriages.—The number of marriages registered during the year was 1,209, the marriage rate being 18. Births.—During the year 1,954 births were registered in the Borough. Adding 450 births which occurred outside the Borough, transferred by the Registrar-General as belonging to Hammersmith, and deducting 831 births which occurred in the Borough, and transferred to other districts by the Registrar-General, the corrected number of births for the year was 2,073. On the estimated population, i.e., 135,100, the corrected number of births registered was equal to an annual rate of 15.3 births per 1,000 persons living. 9 The Birth-rate for the year is 0.6 per 1,000 less than the rate for the previous year, which was 15.9. The Birth-rate in London on the estimated population, i.e., 4,377,000, was equal to an annual rate of 15.0 births per 1,000 persons living. Notification of Births Act, 1907. Births notified 3,013 Corrected number of births 2,073 Notification Received from Midwives. Doctors. Lying-in Hospitals. Poor Law Institutions. Parents. M.O.H.'s. 951 179 833 36 6 8 Total notifications received, 2,013. Deaths. —During the year 1,567 deaths were registered in the Borough, as compared with 1,757 in the previous year. Adding 343 deaths of residents of this Borough which occurred in general hospitals and other public institutions, and 30 deaths of residents transferred by the Registrar-General as having occurred in various parts of England, and deducting 261 deaths of non-residents and 27 transferable deaths which occurred in the Borough, the corrected number of deaths of residents was 1,652 (802 males, 765 females). On the estimated population, i.e., 135,100, the corrected number of deaths of residents was equal to an annual rate of 12.2 deaths per 1,000 persons living. The Death-rate in London on the estimated population, i.e., 4,877,000, was equal to an annual rate of 12.4 deaths per 1,000 persons living. 10 Deaths of Infants.—The corrected number of deaths of residents under one year of age registered during the year was 140, as compared with 140 in the previous year. The number of deaths of infants under one year of age was equal to 68 per 1,000 of the corrected births and to 85 per 1,000 of the corrected deaths. The number of deaths of infants under one year of age, residents in London, was equal to 65 per 1,000 of the total registered births. The following Chart shows the number of deaths from Diarrhoea per 100,000 inhabitants, 1912-1931. 11 The mortality rate of infants under one year of age was, as compared with the total births registered, 3 per 1,000 greater in this Borough than in London. Summer Diarrhoea.—The number of deaths from Diarrhoea was 23, being 1 less than in the previous year. Nineteen were children under one year of age. Hospital Treatment.—Zymotic Enteritis.—The arrangements made by the London County Council 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. Deaths of Illegitimate Children.—The corrected number of deaths of illegitimate infants under one year of age was 18 or at the rate of 114 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 64 per 1,000 whilst the latter is 114 per 1,000, a difference of 50 per 1,000. 12 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 1931. 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 46 7 7 7 67 21 25 19 8 140 Uncertified - - - - - - - - - - Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - — — — — 2 — — 2 Diphtheria and Croup - - - - - - - - - - Erysipelas - - - - - — — - - — Tuberculous Meningitis - - - - - - - 3 - 3 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not Tuberculous) - — 1 1 1 — 3 1 6 Convulsions - 1 - - 1 - — - - 1 Laryngitis — — — — — — — — — — Bronchitis - — — — 1 2 — - 3 Pneumonia (all forms) 1 1 1 3 6 8 6 6 29 Diarrhoea - — - — - — 1 — 1 Enteritis - 1 1 1 3 3 8 2 16 Gastritis - - - - - - - - - - Syphilis - — - - - - - - - - Rickets - - - - - - - - - - Suffocation, overlying - - - 1 1 3 - - - 4 Injury at Birth 8 - 1 - 9 - - - - 9 Atelectasis 5 1 - 6 - - — - 6 Congenital Malformations 3 2 2 — 7 3 - 1 — 11 Premature Birth 22 — 3 2 27 — — - - 27 Atrophy, Debility & Marasmus 2 — — — 2 4 1 1 — 8 Other causes 5 1 — 1 7 — 4 2 1 14 Totals 46 7 7 7 67 21 25 19 8 140 Deaths of Aged Persons.—The corrected number of deaths of residents at 65 years of age and upwards registered during the year was 725, against 698 in the previous year. These deaths were equal to 5.4 per 1,000 of the total persons living, and 439 per 1,000 of the total deaths of residents registered. Nett Births in the Year: Legitimate, 1915; Illegitimate. 158 nett Deaths ix the Year of : Legitimate Infants, 122; Illegitimate Infants, 18. 13 Statistics. —The following table gives the statistics of the Borough during 1931 and the previous five years, in the form prescribed by the Ministry of Health:— TABLE I. Vital Statistics of Whole District during 1931 and Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. of Non-residents registered in the District. of Residents not registered in tht District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate 1 2 3 4 6 6 7 8 9 10 11 12 13 1922 134400 2564 2758 20•5 1223 9•1 196 705 196 71 1733 12•9 1923 133600 2571 2701 20•2 981 7•3 125 649 173 64 1473 11•0 1924 134200 2199 2399 17•9 1123 8•4 173 718 173 72 1668 12•4 1925 134500 2178 2351 17•5 1034 7•7 186 756 153 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 13•0 1928 136300 1938 2258 16•6 1449 10•6 222 326 156 69 1553 11•4 1929 136900 1869 2162 15•8 1767 12•8 222 340 133 62 1875 13•7 1930 136900 1962 2173 15•9 1387 10•1 219 436 140 64 1604 11•7 1931 135100 1954 2073 15•3 1567 11•6 288 373 140 68 1652 12•2 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 Deaths of Residents.—Belonging to the Borough, occurring in Public Institutions, &c., in districts outside, during the year 1981:— FEVER HOSPITALS. South Eastern Hospital 1 Western Hospital 8 Grove Hospital 2 — 11 MENTAL HOSPITALS. Hundred Acres, Ranstead 3 Brentwood L.C.C. Colony 1 Tooting Bee Hospital 15 la, Manor Road, Ilford 1 Horton Hospital 10 Fountain Hospital 1 31 At Census of 1921 (cf. Census Vol. 5.) 14 GENERAL HOSPITALS. Victoria, Hospital 3 Queen Mary's Hospital, Chislehuret 5 St. Paul's Hospital 1 Samaritan Free Hospital 1 National, Queen Square 2 S. Mary's Hospital 8 St. Thomas's Hospital 3 St. Columba's Hospital 2 Acton Hospital 2 Middlesex Hospital 5 St. Luke'e Hospital 5 North Wimbledon Hospital 1 St. George's Hospital 6 King's College Hospital 2 St. Margaret's Hospital, St. Pancras 2 Princess Louise Hospital 5 Royal Free Hospital 1 Miller Hospital, Greenwich 1 1 loyal Waterloo Hospital 1 Guy's Hospital 2 Homoeopathic Hospital, Gt. Ormond Street 1 Putney Hospital 1 Florence Nightingale Hospital 1 Rattersea Hospital 1 King Edward VII Hospital 2 North Middlesex Hospital 1 Paddington Hospital 1 Westminster Hospital 1 Hospital of St. John and St. Elizabeth 1 Elizabeth Garrett Anderson Hospital 1 St. Bartholomew's Hospital 2 St. Joseph's Hospital 1 London Temperance Hospital 1 Hospital for Women, Chelsea 1 Freemasons' Hospital 1 Manor House Hospital, Golders Green 1 76 OTHER INSTITUTIONS. 12, Exmoor Street 77 28. Marloes Road 36 103, St. Dunstan's Road 8 Lambeth Hospital 4 1, Uxbridge Road, Norwood 15 Brompton Hospital 3 St. Stephen's Home, 15, Church Street, Edmonton 1 St. Mary's Nursing Home 1 Central Home, Leyton 1 Catholic Nursing Institute 1 Queen Charlotte's Hospital 10 Cancer Hospital, Chelsea 8 Children's Hospital, Paddington 1 Colindale Hospital 2 The Infirmary, Friern Barnet 2 Children's Hospital, Gt. Ormond Street 2 Royal Chest Hospital, City Road 1 Duchess Nursing Home, St. Marylebone 1 Evalina Hospital 1 Chest Hospital, Bethnal Green 1 93, Sydney Street, Chelsea 6 Isolation Hospital, Coppetts Road, Hornsey 1 183 15 VARIOUS. Biver Thames 4 385, High Road, Chiswick 1 164, St. John's Hill 2 302, Fulham Palace Road 1 285. Harrow Road 3 4, Earls Court Road 1 34, Nottingham Place 1 1, Ladbroke Square 3 250, Kings Road, Chelsea 1 Warkworth House, Twickenham Road 1 24, Underworth Street, Stepney 1 On way to Middlesex Hospital 1 1, West Park Road 4 20, Glazbury Road 1 50, Weymouth Street 1 Junction of St. Marks Road and Cambridge Gardens 1 The Grove, Epsom 1 268, Gloucester Terrace 1 28, Arlington Park Mansions 1 On way to Paddington Hospital 1 Clonmore Street, Wandsworth 1 4, Dorset Square 1 369,F'ulham Road 2 37, Holloway Street, Hounslow 1 8, Blenheim Road, Acton 2 On way to Charing Cross Hospital 1 11, Bichmond Boad, Hackney 1 High Street, Stratford 1 Buckfields, Chessington Boad, Chessington 1 42 Causes of, and Ages at, Death during the year 1931 METROPOLITAN BOROUGH OF HAMMERSMITH. CAUSES OF DEATH. Sex. All Ages. 0- 1- 2 - 5- 15- 25 - 35- 45- 55- 65- All Causes M 825 77 14 7 14 38 33 57 118 149 177 F 827 63 17 6 18 29 44 54 75 110 l62 1 Typhoid and Paratyphoid Fever M .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. 2 Measles M .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. 3 Scarlet Fever M 1 .. .. .. 1 .. .. .. .. .. .. F 1 .. .. .. 1 .. .. .. .. .. .. 4 Whooping Cough M 4 .. 3 1 .. .. .. .. .. .. .. F 3 2 1 .. .. . .. .. .. .. .. 5 Diphtheria M 3 .. 1 1 1 .. .. .. .. .. .. F 3 .. 2 .. 1 .. .. .. .. .. .. 6 Influenza M 12 1 .. .. .. 1 .. 1 2 3 2 . F 15 1 1 .. .. 1 .. 1 2 1 3 7 Encephalitis Lethargica M 1 .. .. .. .. .. .. .. 1 .. .. F 1 .. .. .. .. .. 1 .. .. .. .. 8 Cerebo-spinal Fever M 3 1 .. .. .. 2 .. .. .. .. .. F 3 1 .. .. .. 1 1 .. .. .. .. 9 Tuberculosis of Respiratory System M 66 .. .. .. .. 13 9 13 20 8 3 F 43 .. .. .. 1 12 11 9 6 4 .. 10 Other Tuberculous Diseases M 11 2 .. .. 2 5 .. 1 1 .. .. F 7 1 .. 1 2 .. 2 .. 1 .. .. 11 Syphilis M 2 .. .. .. .. .. .. 1 .. 1 .. F 3 .. .. .. .. .. 1 1 i .. .. 12 General Paralysis of the insane, tabes dorsalis . M 13 .. .. .. .. .. .. 1 4 4 2 F 3 .. .. .. .. .. .. 1 1 1 .. 13 Cancer, malignant disease.. \[ 104 .. .. .. .. .. 2 9 20 33 29 F 125 .. .. 1 .. .. 1 11 16 32 32 14 Diabetes M 9 .. .. .. .. 2 .. .. 1 2 2 F 7 .. .. .. .. .. 2 .. 1 1 1 15 Cerebral Haemorrhage, &c. M 29 .. .. .. .. .. .. .. 3 6 14 F 49 .. .. .. .. .. .. 1 3 11 17 16 Heart Disease M 173 .. .. 1 .. 2 3 6 9 38 61 F 182 .. .. .. .. 4 6 7 8 34 44 17 Aneurism M 3 .. .. .. .. .. .. .. .. 2 1 F 1 .. .. .. .. .. 1 .. .. .. .. 18 Other circulatory diseases M 40 .. .. .. .. .. 1 2 2 4 16 F 28 .. .. .. .. .. .. .. 2 2 12 19 Bronchitis M 45 1 .. .. .. .. .. 2 12 6 9 F 48 2 .. .. .. 1 .. .. 1 3 10 20 Pneumonia (all forms) M 67 19 7 1 .. 2 2 4 10 13 6 F 65 11 12 2 4 1 2 3 4 5 13 21 Other Respiratory Diseases M 11 .. .. .. .. .. 2 1 3 1 2 F 6 1 .. .. .. .. 1 .. 2 1 .. 22 Peptic Ulcer M 8 .. .. .. .. .. .. 3 2 1 2 F 4 .. .. .. .. .. .. .. 2 1 1 23 Diarrhoea, &c. M 13 10 2 .. .. .. .. .. .. .. 1 F 10 7 .. .. .. .. 1 .. .. 1 1 24 Appendicitis M 4 .. .. .. 1 .. 2 1 .. .. .. F 10 .. .. .. 1 2 .. 4 2 .. 1 25 Cirrhosis of Liver M 4 .. .. .. .. .. .. 2 1 1 .. F 6 .. .. .. .. .. .. 1 2 1 2 26 Other Diseases of Liver, &c. M 3 .. .. .. .. .. .. .. .. 2 1 F 2 .. .. .. .. .. .. .. 1 .. 1 27 Other Digestive Diseases M 11 2 .. 1 1 .. 1 .. 2 2 2 F 20 1 .. 2 1 1 1 1 4 2 5 28 Acute and Chronic Nephritis M 18 .. .. .. .. .. 1 4 5 1 3 F 19 .. .. .. .. 1 1 .. 4 3 3 29 Puerperal Sepsis F 2 .. .. .. .. .. .. 2 .. .. .. 30 Other Puerperal Causes F 2 .. .. .. .. .. 1 1 .. .. .. 31 Congenital Debility, Premature Birth, Malformations, &c. M 34 34 .. .. .. .. .. .. .. .. .. F 29 29 .. .. .. .. .. .. .. .. .. 32 Senility M 16 .. .. .. .. .. .. .. .. .. 3 F 36 .. .. .. .. .. .. .. .. .. 4 33 Suicide M 15 .. .. .. .. 2 3 1 4 2 2 F 8 .. .. .. .. 1 1 3 1 2 .. 34 Other violence M 36 1 1 1 3 5 4 1 7 6 3 F 24 3 .. .. 3 2 2 .. 1 .. 1 35 Other defined diseases M 65 6 .. 1 5 4 3 4 9 13 13 F 62 4 1 .. 4 2 8 8 10 5 8 36 Causes ill-defined, or unknown M 1 .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. 17 This rate is calculated on the estimated population of each Ward. Ward. Estimated Population. No. of Deaths. Death Rate. No. 1 River 17,741 280 15.8 No. 2 Brook Green 26,958 277 10.7 No. 3 The Grove 23,076 279 12.1 No. 4 St. Stephens 9,281 119 12.8 No. 5 Starch Green 22,891 259 10.9 No. 6 Wormholt 23,960 303 12.2 No. 7 College Park and Latimer 12,193 135 11.0 LONDON AND METROPOLITAN BOROUGHS. Cities and Boroughs. Estimated population to the middle of year 1929. Births. Annual rate per 1,000 persons living. Death- rate per 1,000 living. Infantile Mortality rate per 1,000 births. West Districts. Paddington 140,300 14.8 13.1 87 Kensington 174,800 14.2 14.0 76 Hammersmith 135,100 15.3 12.2 68 Fulham 151,200 15.1 12.3 67 Chelsea 57,220 12.8 14.1 42 City of Westminster 115,600 10.2 13.9 75 North Districts. St. Marylebone 97,620 12.4 12.4 65 Hampstead 87,740 11.2 11.7 60 St. Pancras 195,600 15.1 13.3 68 Islington 324,600 16.3 12.6 64 Stoke Newington 51,380 15.2 12.7 54 Hackney 217,000 15.5 11.4 60 Central Districts. Holborn 34,470 10.2 14.3 74 Finsbury 70,120 18.0 14.0 62 City of London 10,808 5.6 12.5 81 East Districts. Shoreditch 98,260 17.1 12.5 74 Bethnal Green 109,200 16.8 12.5 88 Stepney 225,800 17.5 13.1 78 Poplar 156,300 17.5 12.4 77 Smith District. Southwark 172,900 16.9 14.0 61 Bermondsey 112,400 17.4 12.5 57 Lambeth 295,900 15.3 12.7 60 Battersea 159,800 15.5 12.1 57 Wandsworth 353,200 12.3 11.3 59 Camber well 252,100 14.7 11.9 56 Deptford 107,200 16.3 12.0 53 Greenwich 100,640 15.0 11.4 64 Lewisham 220,800 14.1 10.2 49 Woolwich 142,600 15.1 11.6 59 The figures were supplied by the Medical Officers of Health. 18 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. Nursing.—The arrangements made by the Borough Council with the District Nursing Association to provide nurses in cases of measles, ophthalmia neonatorum, pneumonia, &c., continued throughout the year. When necessary two or three visits are paid daily. The Council made a grant to the Nursing Association of £200 per annum, for the nursing of all cases approved by the Medical Officer of Health. The amount being divisible as follows:— Maternity and Child Welfare Nursing £125 Public Health Regulations £75 Midwives.—The London County Council is the supervising authority under this heading. I am informed by the County Medical Officer of Health that 32 midwives gave notice of their intention to practise in the Borough during 1981. Laboratory Facilities.—The chemical analysis of food is carried out by the Public Analyst (Mr. P. A. Ellis Richards). The bacteriological examination of food is carried out by Dr. Elworthy. The work of the bacteriological laboratory consists mainly of the examination of throat swabs for diphtheria baccilli and the examination of sputa for tubercle bacilli. 19 The former are examined by Dr. Elworthy, Pathologist of the West London Hospital, and the latter by Dr. Davies, Assistant Medical Officer of Health and Tuberculosis Officer. Throat swabs and sputum containers are supplied free on application to the Public Health Department to all medical practitioners practising in the Borough. In addition other bacteriological investigations are undertaken when required. GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. HOSPITALS—PUBLIC. "Parkside" Maternity Home, 150, Du Cane Road, W.12.—This Home consists of a ten-bedded ward in the Hammersmith Hospital for the reception of maternity cases booked through the Hammersmith Borough Council. Name :—Hammersmith Hospital. Situation:—Du Cane Road, Shepherd's Bush, W.12. Purpose:—General. No of available beds :—386 If used by persons resident outside the area, in what proportion :—Yes. Varies with demands. Management:—London County Council. No. of beds available for each sex for the following services:— M. F. General Medical 116 172 Children 52 Maternity - 12 Tuberculosis 30 — Chronic sick — Other:—Staff beds 4 20 Facilities available for:— (1) Operative Surgery.—2 Operating theatres. (2) X-Ray.—Efficient modern apparatus. (3) Dental.—Dentist attends once a week. Fully equipped dental room. (4) Ophthalmic.—Ophthalmic Surgeon attends when required. (5) Massage.—3 Masseurs employed. Arrangements for pathological work:—Sent out to Charing Cross Hospital, Pathological Department; West London Hospital Laboratory and London County Council Laboratories. No. of patients during 1931 :—Admissions = 3,430. Is the hospital provision for the area adequate?—No. HOSPITALS—VOLUNTARY. Name:-West London Hospital. Situation:—Hammersmith Road, W.6. Purpose:—General Hospital for treatment of sick poor as In and Out-patients. No. of available beds:—234. If used by persons resident outside the area, in what proportion :—80 per cent, were from districts other than Hammersmith or Shepherd's Bush. Management:—Voluntary Agency. No. of beds available for each sex for the following services:— M. F. General Medical 25 26 General Surgical 59 60 Children 21 Venereal Diseases 4 4 Ear, Nose and Throat 4 3 Skin Diseases 2 2 Other (Private Wing) (Mixed) 26 Facilities available for:— (1) Operative Surgery.- 2 Major Operation Theatres. 2 Minor (2) X-Ray.—Radiographic and Radiotherapeutic ratus. (3) Dental.—Clinics held twice weekly in Out-patients' Department. (4) Ophthalmic.—Three afternoons a week in patients' Department. (5) Massage.—Department open daily. 21 Arrangements for pathological work:—Pathological and Bio-chemical Laboratories. Wo. of patients during 1931:—3,850 In-patients and 37,722 out-patients and 361,384 out-patients attendances. Is the hospital provision for the area adequate1—There is always an average of about 215 patients waiting for admission. Name:—Queen Charlotte's Maternity Hospital. Situation:—Ravenscourt Square and Goldhawk Road. Purpose:—Maternity and Puerperal Fever and Pyrexia. No. of available beds:—30 Puerperal Fever and 20 ordinary Maternity. If used by persons resident outside the area, in what proportion:—Yes, but accommodation used chiefly by residents of St. Marylebone, Paddington, Kensington, Hammersmith, Fulham, Willesden, St. Pancras, Hampstead. &c. Management:—Voluntary Agency. No. of beds available for each sex for the following services:— F. Maternity 20 Puerperal Fever and Pyrexia 30 Facilities available for:— (1) Operative Surgery.— (2) X-Ray.— (3) Dental.— (4) Ophthalmic.— (5) Massage.— So far as necessary in connection with the above cases. Arrangements for pathological work :—A Research Laboratory at Ravenscourt Square in connection with the Isolation Block. No. of patients during 1931 :—358 at "Invermead," 229 at Isolation Block. Is the hospital provision for the area adequate?—Used partly as an overflow from the main hospital in Marylebone. There is great need for additional maternity beds. 22 Name :—St. John's Hospital for Skin Diseases. Situation:—262, Uxbridge Road, W.12. Purpose:—For Skin Diseases. No. of available beds:—40. If used, by persons resident outside the area, in what proportion:—Mostly outside area. Management:—Voluntary Agency. No. of beds available for each sex for the following services:— M. F. Skin Diseases 19 21 Facilities available for:— (1) Operative Surgery.—Nil. (2) X-Ray. — X-Ray Out-patients' Department at Leicester Square. Artificial Sunlight Room here. (3) Dental.—Hon. Dental Surgeon. (4) Ophthalmic.—Sent to various hospitals. (5) Massage.—Not necessary. Arrangements for pathological work.—At Out-Patients' Department, 49, Leicester Square, W.C.2. No. of patients during 1931:—218 in-patients, 11,971 outpatients. Is the hospital provision for the area adequate?—No. The In-patients' Department has recently been enlarged and now serves the purpose. INSTITUTION 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 Ministry of Health contributes. Hammersmith and Chiswick Refuge for Friendless Girls, 36, Glenthorne Road, W.6.—Accommodation for 8 mothers and their infants. Supported by voluntary subscriptions. 23 MATERNAL MORTALITY. Consultants.—The provision of the services of four Consulting Obstetricians whose services are at the disposal of general practitioners in cases of difficulty or abnormality, was continued upon the following terms:— (1) That the patient must be a resident of Hammersmith. (2) The medical practitioners immediately notify the Medical Officer of Health that they have called in the services of the Consultants, giving the name and address of the patient, date of call, the reason and the result. (3) The Borough Council pay the fees of the Consultant, but where the financial position justifies it, the patient will be asked to pay a portion or the whole of the fee. This service was arranged in the hope that it might be of some assistance in preventing maternal mortality. During the year a Consultant was called in on one occasion. Maternal Deaths.—During the year seven maternal deaths occurred, two from Puerperal Sepsis and five from other accidents and diseases of pregnancy and parturition. Special enquiry was made and particulars obtained in accordance with the form presented by the Committee appointed by the Ministry of Health. The reports contain full information as to— (1) Previous pregnancies, with particulars of complications, if any. (2) Ante-natal care, including number of consultations and examination of urine, with the result. 24 (3) Summary of the case. (4) Comments of Medical Practitioner in charge. (5) Comments of Medical Investigator. (6) Comments of Medical Officer of Health. Special information is obtained in cases of abortion, toxaemias of pregnancy, haemorrhage, difficult labour and puerperal sepsis. The number of Maternal Deaths during the past twelve years is as follows:- Year. Number of Deaths Number of Births. Maternal Death Rate. Puerperal Sepsis. Other Accidents of Pregnancy. 1920 6 5 3,312 3.3 1921 2 10 2,779 4.3 1922 4 5 2,758 3.3 1923 5 3 2,701 3.0 1924 4 4 2,399 3.3 1925 6 7 2,351 5.5 1926 3 4 2,188 3.2 1927 3 4 2,076 3.4 1928 5 5 2,258 4.4 1929 5 2 2,162 3.3 1930 4 5 2,173 4.1 1931 2 5 2,073 3.4 It will be observed that the Maternal Mortality has remained almost stationary. AMBULANCE FACILITIES. Infectious Cases.—Provision for the removal of infectious cases is made by the London County Council. Non-Infectious and Accident Cases.—Ambulances for the removal of non-infectious cases are provided by the London County Council, on payment of a small fee. 25 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, and "Invermead," Goldhawk Road, between the hours of 11 p.m. and 8 a.m. An ambulance service is also available for "Parkside" and "Invermead" cases between the hours of 8 a.m. and 11 p.m. by arrangement with the London County Council. MATERNITY AND CHILD WELFARE CENTRES. Hammersmith Infant Welfare Association. 48, Glenthorne Road.—Three Infant Clinics held weekly. Two Ante-Natal Clinics held weekly. Victoria Hall, Becklow Road.—Two Infant Clinics held weekly. Old Oak Infant Welfare Centre, Western Avenue.—Two Infant Clinics held weekly. Two Ante-natal Clinics held weekly. St. Matthew's Parochial Hall, Blythe Road.—Two Infant Clinics held weekly. Presbyterian Church Hall, Ponsard Road.—One Infant Clinic held weekly. Latymer Road Mission, Blechynden Street.—One Infant Clinic held weekly. 26 DAY NURSERIES. Latymer Road Day Nursery.—Provides accommodation for 50 children. Princess Christian Day Nursery, Goldhawk Road.— Provides accommodation for 45 children in winter and 50 in summer. The above nurseries are conducted by Voluntary Associations, supported by voluntary contributions, to which the Council contributes. SCHOOL CLINICS. L.C.C. Hammersmith School Treatment Centre, 103, Shepherd's Bush Road. L.C.C. School Treatment Centre, Old Oak Welfare Centre, Western Avenue. The above Centres are provided by the London County Council. Children under school age are dealt with at these Centres by arrangement with the Hammersmith Nursing Association on a basis of a Capitation fee. Dental Clinic.—A Dental Clinic is held at the Old Oak Welfare Centre by the London County Council for the treatment of school children. 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. 27 RHEUMATISM ADVISORY CLINIC. Princess Louise Kensington Hospital for Children. The Council continued the grant to the above Hospital of £150 per annum. £50—out-patient treatment. £100—in-patient treatment. During the year G8 Hammersmith patients were treated at the Clinic, 20 being admitted as in-patients and 48 as out-patients. New patients, 1931 49 Old patients, 1931 19 Total number of attendances, 1931 143 TREATMENT CENTRE FOR VENEREAL DISEASES. West London Hospital, Hammersmith Road. The above centre is provided under the scheme of the London County Council. 28 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 horse-drawn vehicles. Throughout the Borough, there are quite a number of ashpits. This means of depositing house refuse is not only out of date, but in the majority of cases leads to nuisances arising. In all cases which come before the Public Health Department, the owners are advised to close the same, and provide proper metal receptacles in accordance with the L.C.C. Bye-laws FOULING OF FOOTPATHS BY DOGS. In September, 1922, the Council obtained approval of the following Bye-law for the good rule and government of the Borough in pursuance of Section 28 of the Municipal Corporation Act. 1882, and Section 16 of the Local Government Act, 1888. NUISANCE BY DOGS. No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. 29 PENALTY. Any person offending against the foregoing Bye-law shall be liable to a penalty not exceeding forty shillings. This Bye-law shall cease to be in force after the 1st day of September, 1924, unless a Bye-law confirming and continuing its provision has been duly made and come into force before that date. This Bye-law ceased to be in force on the 1st September, 1924. In May, 1926, the Council deemed it advisable to again bring into operation this Bye-law, and that the Bye-law should be made a permanent one. Leaflets have been distributed and posters exhibited calling attention to the Bye-law. The Sanitary Inspectors were instructed to report any breach of the Bye-law observed. Representations were made to the Home Office, and in February, 1928, arrangements were made for the Police to report to the Council such offences against the Bye-law as come to their notice in the course of their ordinary duties. During the year under review seven summonses were taken, when fines of 10s. were imposed in five cases, and 5s. in one case, and one case being dismissed with caution. Sanitary Inspection of the Area.—The general sanitary condition of the Borough has been improved to some extent. Eighty-nine notices have been served during the year regarding overcrowded conditions. These are found in the course of inspection, but it is difficult to take effective action owing to the shortage of accommodation. The Housing schemes of the London County Council and 30 Borough Council have provided many houses, but overcrowded conditions still exist. Notices.—The following table shows the number of visits paid by the Inspectors and the Preliminary Notices served and complied with during the year:— Number of Inspections. Notices Served. Notices complied with Infectious Diseases 4,196 205 223 Complaints 4,148 1,975 1,992 House to House 2,247 1,967 1,435 Housing Acts 6 — — House to House Consolidated Regulations 152 68 35 Food (other than Restaurants) 3,729 50 57 Restaurants, &c. 636 29 28 Markets 1,446 1 1 Slaughterhouses 326 — — Poultry Slaughterhouses 34 1 1 Bakehouses 400 15 22 Milk Vendors 1,075 17 18 Ice Cream Vendors 256 — - Factories 589 26 21 Workshops 242 25 16 Workplaces 211 15 11 Outworkers 146 3 3 Public Urinals 1,033 6 6 Smoke Observations 77 25 25 Drainage 5,513 46 49 Miscellaneous 3,195 103 68 Re-visits 15,659 450 487 Total 45,316 5,027 4,498 During the year 2,008 Statutory Notices were served and 1,777 complied with. In several instances it was necessary to take proceedings in order to enforce compliance with Notices served. 31 The following table shows the result of proceedings taken:— SUMMONSES—YEAR 1931. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 40, Cathnor Road Failing to comply with Statutory Notice 5 1. Withdrawn. £1 1s. costs 2. Withdrawn. £1 1s. costs 3. Withdrawn. £1 1s. costs 4. Withdrawn. £1 1s. costs 5. Withdrawn. £1 1s. costs 49, Cathnor Road ditto 1 Withdrawn. £1 1s. costs 178, Dalling Road ditto 1 Order suspended 1 month 219, Latimer Road ditto 2 1. Fined 10s. 2. Order made 14 days 73, Cobbold Road ditto 3 1. Withdrawn. Work done 2. Withdrawn. Work done 3. Withdrawn. Work done 25, Godolphin Road ditto 2 1. Withdrawn 2. Withdrawn 80, Cathnor Road ditto 1 Held over 15, Rayleigh Road ditto 1 Combined abatement and prohibition order 3, Barb Mews ditto 1 Withdrawn. Work done. £1 1s. costs 49, Milson Road ditto 1 Fined £5 20, Batoum Gardens ditto 1 Withdrawn. Work done. £1 1s. costs 17, North Pole Road ditto 3 1. Order made 28 days 2. Order made 28 days 3. Fined 10s. 22, Norland Road North ditto 2 1. Withdrawn. Work done 2. Withdrawn. Work done 30, Olaf Street Dwellings ditto (overcrowding) 1 Withdrawn. Abated 20, Thornfield Road ditto 1 Withdrawn. Abated 119, Godolphin Road ditto 1 Withdrawn. Abated 106, Great Church Lane ditto 1 Order made 21 days 15, Sinclair Gardens ditto 2 1. Withdrawn 2. Withdrawn 32 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses Result of Proceedings. 150, Sinclair Road Failing to comply with Statutory Notice 1 Withdrawn 12, Agate Road ditto 3 Dismissed 49, Great Church Lane ditto 1 Withdrawn. Work done 7, Theresa Mews ditto 1 Order made 21 days 18, Rayleigh Road ditto 1 Withdrawn. Abated 178, Dalling Road ditto 1 Fined £1 48, Tunis Road ditto (overcrowding) 2 Order made 21 days Coningham Villa, Boscombe Road ditto 3 1. Withdrawn. Work done 2. Withdrawn. Work done 3. Order made 28 days 3, Wellington Road ditto 1 Withdrawn. Abated 26, Montgomery Street ditto 2 Withdrawn. Work done. 10s. 6d. costs 22, Montgomery Street ditto 1 Withdrawn. Work done 17, Montgomery Street ditto 2 Withdrawn. Work done 385, Goldhawk Road ditto 1 Withdrawn. Work done 32, Cathnor Road ditto 1 Withdrawn. Work done 41, Devonport Road ditto 1 Order made 14 days 5, Alexandra Road ditto 1 Withdrawn. Abated. 10s. 6d. costs 127, Sulgrave Road ditto 1 Withdrawn. Work done. 6s. 8d. costs 37, Maclise Road ditto 1 Withdrawn. Abated. 10s. 6d. costs 30, Mardale Street ditto (overcrowding) 2 Withdrawn. Abated 27, Maclise Road ditto 1 Withdrawn. Work done 2, Masbro Road ditto 1 Order made 14 days. 10s. 6d. costs 261, Latimer Road ditto (overcrowding) 2 Order made 21 days 67, Blythe Road ditto 1 Order made 14 days. 10s. 6d. costs 73, Blythe Road ditto 1 Withdrawn. Abated. 10s. 6d. costs 12, Agate Road ditto 1 Order made 14 days 68, Goldhawk Road Failing to deposit plans relating to drainage work 2 Dismissed on payment of costs 33 Summonses-continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 301, King Street Failing to comply with Statutory Notice 1 Withdrawn. Work done 173, Goldhawk Road ditto 1 Order made 21 days 80, Cathnor Road ditto 1 Withdrawn. Abated 82, Cathnor Road ditto 1 Held over 9, Goodwin Road ditto 2 1. Withdrawn. Work done. 10s. 6d. costs 2. Fined £5. £1 1s. costs 92, Woodstock Road ditto 1 Order made 14 days 46, Norland Gardens ditto 2 1. Fined £1. 2. Withdrawn. Work done 323, Latimer Road ditto 1 Withdrawn. Abated 325, Latimer Road ditto 2 1. Withdrawn. Work done 2. Withdrawn 193, Askew Road ditto 1 Withdrawn. Work done Hebron Road (rear of) ditto 1 Order made 7 days. Fined £2 24, Hume Road ditto 1 Order made 7 days 38, Cathnor Road ditto 1 Complied with. Fined £1 38, Leffern Road ditto 1 Order made 7 days 9, Leffern Road ditto 1 Withdrawn 77, Yeldham Road ditto 2 Withdrawn. Work done. 13s. 4d. costs 67, Blythe Road ditto 2 1. Order made 14 days 2. Fined £2 84, Rayleigh Road ditto 1 Fined £3 55, Vespan Road ditto 1 Withdrawn. Abated 5, Perrers Road ditto 1 Withdrawn. Abated 6, West wick Gardens ditto 1 Order made 14 days. 5s. costs 5, Richmond Gardens ditto 2 1. Order made 14 days 2. Fined 10s. 9, Alexandra Road ditto 1 Withdrawn. Work done 2, Masbro Road ditto 1 Withdrawn. Abated. 10s. 6d. costs. 24, Porten Road ditto 1 Order made 21 days 3, Girdlers Road ditto 2 1. Fined £2 2. Fined £2 74, Cathnor Road ditto 1 Order made 7 days 43, Cathnor Road ditto 1 Order made 14 days. Fined £1 52, Waldo Road ditto 1 Order made 28 days 20, Manchester Road ditto 1 Order made 14 days 34 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 81, Davisville Road Failing to comply with Statutory Notice 1 Withdrawn. Abated 1, Southerton Road ditto 1 Order made 14 days 51, Porten Road ditto 1 Order made 14 days Porten Houses ditto 1 Order made 14 days 83, Milson Road ditto 2 1. Order made 14 days 2. Fined 20s. 10, Wharf Road ditto 1 Withdrawn. Work done 17, Southerton Road ditto 2 1. Withdrawn. Work done 2. Order made 28 days 57, Yeldham Road ditto 1 Withdrawn. Abated 49, Askew Road ditto 2 Withdrawn. Abated 165, Askew Road ditto 1 Order made 14 days. 10s. 6d. costs 14, Southbrook Street ditto 3 1. Fined £1 2. Order made 21 days 3. Order made 21 days 8, Wood Street ditto 1 Withdrawn. Work done 76, Stowe Road ditto 3 1. Fined £1 2. Fined £1 3. Order made 14 days 25, Godolphin Road ditto 2 Withdrawn. Abated 57, Uxbridge Road ditto 1 Withdrawn. Work done 9, Davisville Road ditto 2 1. Withdrawn. Work done 2. Withdrawn. Work done. 10s. 6d. costs 31, Ceylon Road ditto 2 1. Order made 14 days 2. Fined £1. 7s. 6d. costs 15, Paradise Row ditto 1 Adjourned 52a, Rayleigh Road ditto 1 Withdrawn. Work done 22, Havelock Road ditto 1 Order made 21 days. Fined £1 24, Havelock Road ditto 2 1. Order made 21 days. Fined £1 2. Withdrawn. Work done 28, Southbrook Street ditto 1 Adjourned 38, Ravenscourt Park Mansions ditto 1 Adjourned 9, Rigeley Road ditto 1 Adjourned 81, Davisville Road ditto 1 Withdrawn. Work done 35 PUBLIC HEALTH (LONDON) ACT, 1891.—UNSOUND FOOD. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. T. Walton (London), Limited, 11, Hanover Court, W.C.2 Exposing for sale walnuts unfit for food of man —Metropolitan Railway Station 1 Dismissed. £7 7s. costs J. Alexander & Sons, Limited, 55, King Street, W.6 Exposing for sale 133 lemons unfit for food of man 1 Fined £5. £2 2s. costs T. Walton (London), Limited, 11, Hanover Court, W.C.2 Exposing for sale raspberries unfit for food of man—Metropolitan Railway Station 1 Fined £2 Stanley V. Gill, 10, Latimer Road, W.11 Exposing for sale pears unfit for food of man— Shepherd's Bush Market 1 Fined 10s. Stanley V. Gill, 10, Latimer Road, W.11 Exposing for sale pears unfit for food of man— Norland Market 1 Fined 10s. HAMMERSMITH BOROUGH COUNCIL BY-LAWS—DOGS. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Miss Ivy Broadribb, 19, Askew Road, W.I2 Contravention of By-law re nuisance by dogs in Askew Road 1 Fined 5s. Mrs. Helen Green, 1, Rayleigh Road, W.14 ditto 1 Dismissed with caution Addison Gardens Rose Payne, 35, Netherwood, Road, W.14 ditto 1 Fined 10s. Shepherd's Bush Road Mrs. E. Daniel, "Vevey," Keymer, Sussex ditto 1 Fined 10s. Blythe Road Mrs. A. Dickinson, 42, Shepherd's Bush Road ditto 1 Fined 10s. Shepherd's Bush Road Mrs. E. Reynolds, 16, Gwendwr Road, W.14 ditto 1 Fined 10s. Colet Gardens Albert Skinner, 75, Masbro Road, W.14 ditto 1 Fined 10s. Blythe Road 36 LONDON COUNTY COUNCIL (GENERAL POWERS) ACTS. Name and Address. Nature of Procedings. No. of Summonses. Result of Proceedings. Eduardo Pini, 68, Goldhawk Road Food deposited for sale in unclean kitchen— 68, Goldhawk Road 1 Fined £1. Costs £1 1s. ditto Failing to protect ice cream from contamination 1 Fined £1 ditto Failing to register premises for sale of ice cream 1 Fined £1 ditto Selling ice cream with dirty utensils—68, Goldhawk Road 1 Fined £1 ditto Food deposited for sale in unclean kitchen— 68, Goldhawk Road 1 Fined £1 A. B. Hemmings, & Co., Ltd., 200, Fulham Road, S.W.10 Underground bakehouse, due cleanliness not observed—125, Uxbridge Road 1 Fined £1. £2 2s. costs MILK AND DAIRIES (CONSOLIDATION) ACT, 1915. MILK AND DAIRIES ORDER, 1926. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mrs. G. F. Marvin Filling milk bottle in Yeldham Road 1 Fined £1 PUBLIC HEALTH (LONDON) ACT, SECTION 55— INFECTIOUS DISEASES. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Dr. David West, 1, Raynham Road, W.6 Failing to notify infectious disease 1 Withdrawn on payment of costs £1 11s. 6d. 37 LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1928. During the year it was found necessary to apply to the Court for Orders for the removal of five persons who were unable to devote to themselves proper care and attention and living under insanitary conditions. The Court made an Order in each case for their removal to the Hammersmith Institution. Factories, Workshops and Workplaces.— During the year 66 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 48 notices were complied with. During the previous year there were 65 notices served and 68 complied with. The following is a list of the Factories, Workshops and Workplaces upon the Register:— Restaurants, Hotels, &c. 150 Bakehouses (22 not in use as Bakeries) 67 Bootmakers 53 Motor and Cycle Makers 37 Dressmakers and Milliners 71 Laundries 68 Outworkers 196 Letterpress Printers and Bookbinders 19 Electrical and Mechanical Engineers 87 Smiths, Wheelwrights and Coachbuilders 58 Tailors 46 Builders, Carpenters and Joiners 41 Miscellaneous 348 Total 1,241 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. 38 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 589 26 — Workshops (including Workshop Laundries) 242 25 — Workplaces (other than outworkers' premises included in Part 3 of this report) 211 15 - Total 1,042 66 - 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 44 28 - - Want of Ventilation 4 4 — — Overcrowding — — — — Want of Drainage of Floors 4 4 - - Other Nuisances 32 30 - - Sanitary Accommodation insufficient 4 6 - - unsuitable or defective 19 9 - - not separate for sexes 2 1 — - Offences under the Factory and Workshop Act Illegal occupation of underground bakehouse (S. 101) - - - - Other offences (excluding offences relating to out-work which are included in Part 3 of this report) - - - - Total 109 82 — - 39 3.—HOME WORK. Nature of Work Outwork in Unwholesome premises, Sec. 108 Outwork in Infected Premises Secs. 109, 110 Instances Notices served Prosecutions Instances Orders made (Sec. 110) Prosecutions (Secs. 109, 110) Wearing apparel— (l) making, etc. 3 3 — — — — (2) cleaning and washing — — — — — — Furniture and upholstery — — — — — — Totals 3 3 — — — — 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year Number Bakehouses 33 Dressmakers 99 Laundries 21 Outworkers 325 Others 281 Total number of workshops on Register 759 5.—OTHER MATTERS. Class Number Matters notified to H.M. Inspector of FactoriesFailure to affix Abstract of the Factory and Workshop Act 1901 (S. 133) 5 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act, 1901 (S.5) Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspector 1 Other — Underground bakehouses (S.101)— Certificates granted during year — In use at the end of the year 26 40 House to House.—As a result of the house to house visitation 2,247 inspections were made, 1,967 notices served, and 1,485 complied with. The special house-to-house inspection of certain streets in the borough continued throughout the year. The two temporary Sanitary Inspectors inspected 2,247 houses. This work has not proceeded as quickly as it was anticipated owing to the resignation of the two Inspectors appointed, and the consequent periods which elapsed before the appointment of their successors. In order to facilitate the inspection of the houses scheduled by the Council for house-to-house inspection, arrangements were made for the notices to be followed up by the District Sanitary Inspectors. In many instances overcrowding and the illegal occupation of underground rooms was observed and dealt with. 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. Twenty-five 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:— Swan Laundry, Blythe Road. H.B.C. Electricity Works, Fulham Palace Road. Kensington Palace Laundry, Spring Vale Terrace. Victoria Laundry, 10, Great Church Lane. 84, Shepherd's Bush Road. 134, Shepherd's Bush Road. Ice Drome, Brook Green Road. Balmoral Laundry, Becklow Road. Lome House Laundry, Becklow Road. 98, Goldhawk Road. Roesiters Laundry, Becklow Road. Nazareth House, Hammersmith Road. Manbre & Garton, Winslow Road. 12, Goldhawk Road. 124, Askew Road. J. Alexander & Son, Shepherd's Bush Market. Popular Fisheries, Fulham Palace Road. Shepherd's Bush Pavilion, Shepherd's Bush Green. Post Office, Blythe Road. 41 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. 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. National Rat Week was held in November, as in previous years. The Ministry of Agriculture and Fisheries again urged local authorities to take action, and arrangements were made for the baiting of the sewers, through the agency of the Borough Engineer and Surveyor's Department. Fifty-six lbs. of rat poison was laid in sewer manholes. The Borough Engineer and Surveyor reports that in most cases the poison had disappeared. Traces of where 42 rats had been were discernible, and in some manholes dead rats were found lying on benching near where the poison had been placed. 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. Tenement Houses.—As a result of house to house inspection 673 premises have been registered as tenement houses under the London County Council By-laws relating to tenement houses. Houses Let in Lodgings.—During the year no new houses were registered. HOUSING ACT, 1925, SECTION 18. Ten notices were served under the Regulations in respect of underground sleeping rooms. VANS. There are four caravans at the rear of No. 261, Latimer Road, used for living and sleeping purposes by eleven persons. 43 The average cubic capacity available for each person is 154 c. ft. There are no regulations applicable to vans in this Borough on the question of overcrowding, and it is therefore difficult to deal with them from this point of view. These are under constant supervision. In Britannia Yard, off Wharf Road, there is one large caravan in which two adults sleep. A large wooden shed is used as a kitchen. No nuisance has been observed at the time of inspection. In the Car Park opposite the White City Stadium there is always one large caravan occupied by two adults. Other vans park on this ground from time to time usually for short periods only. No nuisance has been observed at the time of inspection. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1928. Ice Cream Vendors.—Section 29 requires all premises used for sale, storage or manufacture of ice cream, to be registered with the Sanitary Authority, and imposes penalties for use of any premises without being so registered. Premises which are required to be registered under Factory and Workshop Acts and premises used as a hotel, restaurant or club are exempt. The Act gives no power to the Sanitary Authority to refuse to register or to remove any premises from the register. Proceedings must be taken under the London County Council (General Powers) Act, 1902, for breach of special regulations. 44 ICE CREAM VENDORS. Registered under L.C.C. (G.P.) Act, 1928 127 Restaurants 18 Factories 8 148 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. Rag Flock Acts, 1911 and 1928.—There are three factories in the Borough on which rag flock is used. The premises are kept under regular inspection. No samples were taken during the year under review. 45 HOUSING. Statistics.—Year 1981. 1. Inspection of dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 10,591 (b) Number of inspections made for the purpose 23,775 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 144 (b) Number of inspections made for the purpose 260 (8) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 4,467 2.—Remedy of defect during the year 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 46 3.—Action under Statutory Powers during the year :— (A) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1980 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (B) Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 4,467 (2) Number of dwelling-houses in which defects were remedied after services of formal notices :— (a) By owners 5,401 (b) By Local Authority in default of owners Nil (C) Proceedings under Sections 19 and 21 of the Housing Act, 1980 :— (1) Number of dwelling-houses in respect of which demolition orders were made Nil (2) Number of dwelling-houses. demolished in pursuance of demolition orders Nil (D) Proceedings under Section 20 of the Housing Act, 1980 :— (1) Number of separate tenements or underground rooms in respect of which closing orders were made 5 47 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit 1 (E) Proceedings under Section 8 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 after service of formal notices:— (a) By owners Nil (b) By local authority in default of owners Nil (8) Number of dwelling-houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close Nil (F) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925 :— (1) Number of dwelling-houses in respect of which closing orders were made Nil (2) Number of dwelling-houses in respect of which closing orders were determined, the dwelling-houses having been rendered fit Nil (8) Number of dwelling-houses in respect of which demolition orders were made Nil (4) Number of dwelling-houses demolished in pursuance of demolition orders Nil 48 General Housing Conditions. — The houses in the Borough are mainly occupied by the artisan class. They are mostly houses of three and four stories let in flats and rooms. The water closet accommodation, whilst conforming with the standard laid down for tenement houses, cannot be considered satisfactory, as in many instances two or more families use the same water closet. These premises were originally occupied by one family. The rents charged for flats and rooms have increased considerably, so much so that I find on investigation that families are called upon to pay exhorbitant rents, in many cases as much as 50 per cent, of the earnings being paid in this direction. This compares with 16 per cent, to 17 per cent, of the family income paid for rent in pre-war days. This occurs in both Decontrolled and Controlled houses. In the former, the owners have increased the rents of the houses or let the various floors in flats at higher rentals, whilst in the latter, the Superior Tenant has let rooms, both furnished and unfurnished, at rentals which enable them to retain two or three rooms rent free, and in many cases receive more rent than that paid to the owner. It is realised that tenants could make application to the Courts under the Rent and Mortgage Interest Restrictions Act, 1920-28, for an apportionment of rent in accordance with the Standard Rent, but through fear of ejection and unpleasant consequences refuse to take such action. The result is that the spending power for food, clothing, etc., is so greatly reduced as to have a serious effect on the health of the family. I refer more particularly to this part of the question in a later part of my report— see page 11T. I submit particulars of a few of the cases which have been brought to my knowledge and extracted from the reports of the officers of the Public Health Department. 49 Houses let by Owners. "A" Owner lives on premises, keeps two rooms for own occupation. Lets Top flat for 25/- per week. ,, Hall floor ,, 25/- per week. ,, One room ,, 10/6 per week. ,, One room ,, 10/- per week. ,, One room ,, 11/- per week. Total rent from lettings 81/6 per week. This house is freehold. Gross value £60 per annum. " B " Owner not living on premises. Lets Basement for 20/- per week. ,, Hall floor ,, 23/6 per week. ,, First floor ,, 20/- per week. ,, Top floor ,, 16/- per week. Total rent from lettings 79/6 per week. This house was originally let for 25/- per week. (Lower flat, 13/-, upper flat 12/-). " C " Owner not living on premises. Lets Basement front room for 18/6 per week. ,, Basement back room ,, 18/6 per week. ,, Ground floor front room ,, 17/6 per week. ,, Ground floor back room ,, 22/- per week. ,, First floor front room and kitchen ,, 22/- per week. First floor back room ,, 18/6 per week. Top floor front (South) „ per week. ,, Top floor back (North) „ „ Top floor front (North) „ 14 per week. ,, Top floor back (South) „ Total rent from lettings 163/6 per week. Thjs house is rated at £70 exclusive. 50 Letting by Superior Tenant. " D " Superior tenant retains three rooms. Lets four rooms for 30/- per week. ,, two rooms ,, 15/- per week. ,, one room ,, 20/- per week. ,, one room ,, 15/- per week. Total rent from lettings 80/- per week. Superior tent pays rent of £75 per annum, plus rates. " E Superior tenant retains three rooms. Lets one room for 10/- per week. ,, two rooms „ 12/- per week. Total rent from lettings 22/- per week. Superior tenant pays rent of 20/- per week. F " Superior tenant retains four rooms. Lets two rooms for 9/3 per week. ,, two rooms ,, 15/- per week. Total rent from lettings 24/3 per week. Superior tenant pays rent of 21/2 per week. " G " Superior tenant retains two rooms. Lets one room for 9/6 per week. ,, two rooms ,, 13/9 per week. ,, two rooms ,, 12/3 per week. ,, one room (F) ,, 17/6 per week. „ one room (F) ,, 12/6 per week. „ two rooms ,, 9/- per week. Total rent from lettings 74/6 per week. Superior tenant pays 30/- per week, plus rates. 51 H " Superior tenant retains two rooms. Lets one room (F) for 7/- per week. ,, one room (F) ,, 6/- per week. ,, one room (F) ,, 8/- per week. ,, one room (F) ,, 8/- per week. Total rent from lettings 29/- per week. Superior tenant pays 19/4 per week. " I " Superior tenant retains two rooms. Lets three rooms for 14/- per week. ,, one room (F) ,, 12/- per week. ,, one room (F) ,, 18/- per week. ,, one room (F) ,, 6/- per week. Total rent from lettings 45/- per week. Superior tenant pays 25/- per week. The above are only a few of the cases recored in the Department, but will suffice to show that the rents charged by both owners and superior tenants have been very greatly increased in the past few years. Supply of Houses—Overcrowding.—For the past five years I have commented upon the overcrowding that exists in the Borough owing to the housing shortage. Hundreds of applications for houses remain on the waiting list of the Council despite the fact that the list has been closed for a very long time. Applications are being received in the Public Health Department daily. These are investigated, particulars obtained and a report sent to the Town Clerk for submission to the appropriate Committee. The question is one of considerable difficulty and anxiety inasmuch as action must be taken to deal with cases found to be legally overcrowded. These are fortunately in the minority. 52 Action has been taken in some cases where the officers have been satisfied that the occupiers have not made any endeavour to find other accommodation. It appears in some cases that the tenants do not desire to obtain other accommodation as it would mean an increase of rent. There are, however, very many cases in which, although not legally overcrowded, the families are living under conditions prejudicial to their health—the standard laid down as to cubic capacity being a very low one. Experience shows that parents with children have the greatest difficulty in obtaining better accommodation. Those who are responsible for the letting of vacant rooms or houses are not willing to accept them as tenants. Some large families have been refused accommodation on the County Council Estates as the rent they would be called upon to pay would mean too great a strain on the family resources. Special consideration should be given to these cases and every endeavour made to provide houses and/or flats for their accommodation. Fitness of Houses :— (a) No difficulties have been experienced under the Public Health Act or under the Housing Acts. (b) Certain houses have been scheduled for annual inspection under the Housing Consolidated Regulations. Two temporary Sanitary Inspectors are engaged on house-tohouse inspection of a list of streets, approximately 6,000 houses. (c) The water supply is through the Metropolitan Water Board. Very few houses have not an adequate internal water supply. (Notices are served where necessary under the London County Council (General Powers) Act, 1907, in the case of tenement houses.) 58 (d) In two instances blocks of cottages have common sanitary accommodation. These are being dealt with under the Council's Housing Schemes. Unhealthy Areas. 5. A list of unhealthy areas has been prepared in connection with which it is proposed to take action during the next five years either as Clearance or Improvement Areas or by Closing Orders. By-laws. 6. No special difficulties have been experienced in the enforcement of the by-laws relating to houses and houses let in lodgings. Newly-Erected Houses.—Good progress has been made in the Southern Housing Scheme. This scheme includes the demolition of a large insanitary area and the erection on the site of a number of blocks of working-class dwellings. These dwellings are similar to those erected by the Peabody Donation Fund, but with one important improvement, namely, they will be lighted by electricity, whereas those of the Peabody Trust are lighted by gas. Fifty-seven 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, 3,611 houses and flats have been erected in the Borough, by the London County Council, the Hammersmith Borough Council and by private enterprise, for which Certificates have been granted (details as under). 54 Certificates granted with regard to water supply under Section 48 (Sub-sec. 2) of the Public Health (London) Act, 1891. Year. L.C.C. Estate. H.B.C. Estate. Private Enterprise. 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 1928 500 Nil 187 1929 1 60 297 1930 Nil 56 90 1931 Nil 21 36 Totals 1,726 722 1,163 The premises have provided accommodation for approximately 18,055 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. 55 INSPECTION AND SUPERVISION OF FOOD. FOOD SUPPLIES. The supervision of the food supplies of the community is one of the most important duties which devolve upon the Public Health Service. On food, more than any other factor, does the health of a nation depend and, therefore, special care must be exercised to ensure that the purity of supplies to the consumer is above suspicion. Milk Supply.—During the year 346 samples of milk were taken and submitted to the Public Analyst for analysis, the results of which are shown in a later 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, the employers were advised to suspend the roundsmen for a period of seven days. 56 Milk (Special Designations) Order, 1923. The following is a list of the licences issued during the year under the Milk (Special Designations) Order, 1923:— Description. Number. (1) Producers' Licences to use the designation "Grade A" Nil (2) Dealers' Licences to use the designation "Certified" 7 (3) Dealers' Licences to use the designation "Grade A (Tuberculin Tested)"— (a) Bottling Establishments 2 (b) Shops 12 (4) Dealers' Licences to use the designation "Grade A"— (a) Bottling Establishments Nil (b) Shops 1 (5) Dealers' Licences to use the designation " Pasteurised"— (a) Pasteurising Establishments 3 (b) Shops 6 Certification of Certain Food Products for Export to the Dominions. In view of the requirements of the Food Laws in operation in the Dominions, the system of certification for food products which are derived from the flesh of cattle, sheep, swine or goats, or from game or poultry, and are prepared or packed in England and Wales for export to the Dominions, has been continued. The Certifying Officer—usually the Medical Officer of Health—is required to keep himself informed, by personal inquiry and in other available ways, as to:— (1) The sanitary condition, structure and character of premises on which the food products are prepared, stored or packed, with special regard to the possibility of contamination of the food products at any stage. 57 (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 fiom which the products are prepared have been subjected to an ante-mortem and post-mortem veterinary inspection and found free from disease and suitable for human food. Where the products are prepared from animals slaughtered in the United Kingdom, the Certifying Officer before certifying as to Veterinary examination must be satisfied :— (a) That the animals were subjected to veterinary examination ante- mortem and post-mortem by an Officer of the Local Authority for which he himself acts; or (b) That the animals were slaughtered in a public abattoir under official veterinary inspection; or he must be furnished by the applicant with a declaration signed by a qualified veterinary surgeon, appointed by the firm with the approval of the Certifying Officer, to the effect that an ante-mortem and post mortem examination was made by him and that the animals so examined were found free from disease. Where the products are prepared from material imported into the United Kingdom from overseas, the Certifying Officer must satisfy himself that the material was accompanied by a certificate as to ante-mortem and post-mortem veterinary inspection signed by an Official of the National Government of the country of origin, being a country whose certificates the Authorities are prepared to accept. If the information obtained by the Certifying Officer is not. in his view, satisfactory, certification is to be withheld and the Certifying Officer must inform the Ministry forth with. The Certifying Officer will supply the Ministry of Health with Buch information as may be required in regard to the methods of inquiry, inspection and certification which have been adopted. Meat.—With regard to meat inspection, this important commodity is kept under supervision by the Inspectors in charge of the districts. 58 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. I append the number of animals slaughtered and examined in the slaughterhouses during the year. Lambs 551 Sheep 405 Calves 12 Beasts 15 Pigs 102 Total 1,085 The following is a list of Unsound Food found during the Inspection of the Carcases of Animals Slaughtered in the Local Slaughterhouses. Description. Disease. Approximate Weight. 2 Lamb's livers Fluke 2¾ lbs. 1 Lamb's liver Strongylus Rufescens 1½ ,, 1 Lamb's lungs Congestion 1½ „ 1 Sheep's liver Strongylus Rufescens 2½ „ 1 Bullock's spleen Congestion 2¼ ,, 1 Lamb's liver Strongylus Rufescens 1½ ,, 1 Lamb's lungs ,, 1½ ,, 1 Lamb's lungs Congestion 1½ ,, 1 Lamb's liver Cavernous Angioma 1½ ,, 1 Heifer's head Tuberculosis 24 ,, 1 Heifer's lungs ,, 8 „ 1 Pig's head and collar ,, 9 „ 1 Pig's heart Pericarditis ¼ .. 3 Pig's messenteries Tuberculosis 2¼ „ 1 Heifer's spleen Congestion 2 „ 1 Heifer's liver Distoma Hepaticum 14 „ 1 Bullock's liver Multiple Abscesses 14 „ 2 Pig's livers Milk Spots 6 „ 59 The protection of meat and the provision of glass fronts to shops has been a question to which some careful study has 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. At the Special Session at the London County Council the licences were granted. The following is a list of the slaughterhouses in the Borough:— Premises. Name of Licensee 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 Dairies, Milkshops, Ice Cream Vendors, Restaurants and Food Shops have been kept under systematic inspection by your Inspectors. 60 The following table gives a summary of the work relating to milk premises, slaughterhouses and ice cream premises:— PREMISES. NUMBER OF PREMISES. N amber of inspections 1931 Number of notices 1931 Numbei of prosecutions 1931 On register in 1920. On register at end of 1930 Added in 1931 Removed in 1931 On register at end of 1931 Milk premises 128 103 15 1 117 1,075 17 nil Slaughterhouses. 7 7 — — 7 326 nil nil Poultry Slaughterhouses. — 2 — — 2 34 1 nil Ice Cream premises 162 132 28 26 127 256 nil 3 Markets.—There are three markets in the Borough, situate in Bradmore Lane, Approach Road and Norland Road. These markets have been the subject of much inspection during the year, both by the District Inspector concerned and the Inspector carrying out the requirements of the Food and Drugs Acts. Many of the stalls in the Railway Approach Market are constructed so as to form lock-ups when business for the day is finished and thereby provide a means of storage for all unsold food. In other instances, Bradmore and Norland Markets, wheelbarrows form the structure, and these are wheeled to and from the markets, morning and evening, the food being stored under various conditions. 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 61 tacle 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 120 licences were issued to street traders. All premises used for the storage of food, clothing, &c., are inspected and reported upon by the Sanitary Inspectors. Notices are served where the conditions are not satisfactory, and the licences are withheld until the necessary works have been carried out. Tteports on storage premises in adjoining boroughs have been obtained through the Medical Officers of Health, whilst reports on similar premises in this Borough have been furnished to the Medical Officers of Health concerned. 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.—One new bakehouse was opened during the year, whilst the use of one bakehouse was discontinued. The 45 bakehouses in use in the Borough have been regularly inspected during the year. Fifteen notices were served relating to various defects, and complied with. It was necessary to apply for a summon against a Baker whose bakehouse was found not to be in conformity with the Act. 62 The following is a list of bakehouses in the Borough:— Address. Name. No. 1 DISTRICT. † 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 C. W. Tompkins * 1 Masbro Road W. A. Maclen * 67 Ditto G. Dunsby * 87 Ditto Not in use * 6 Beaconsfield Terrace Not in use †* 98 Blythe Road Miss Schofield * 47 Uilson Road Not in use No. 2 DISTRICT. † 65 Bridge Koad Not in use 2 Crisp Road Mrs. C. R. (iottig * 82 Great Church Lane 13. Galey †Great Church Lane Fullers, Ltd †* 134 Shepherd's Bush Road F. Oii?er †* 84 Ditto F. R. Ries †* 94 Ditto Not in use * 75 Blythe Road F. Olivei * 31 Goldhawk Road F. Oliver † 213 Hammersmith Road F. Hayes 88 Queen Street Not in use No. 3 DISTRICT. * 77 Brackenbury Koad Not in use †1 The Grove Palmer's Stores, Ltd. †* 33 Glenthorne Road Plumridge Bros. †* 1 Aldensley Road H. A. Roberts, Ltd. †* 85 The Grove R. Pearson * 17 Kilmarsh Road Not in use 70 Glenthorne Road Ditto 24 Bradmore Park Road T. Miller † 28 King Street (rear of) L. E. Jolly No. 4 DISTRICT. 16 Black Lion Lane Not in use 93 Ditto . G. Banham †* 102 Dalling Road Plumridge Bros. * 192 Ditto Not in use † 1 Eyot Gardens J. It. Chibnall, Ltd, †t 258 King Street Miller & Son †f 316 Ditto B. Samels †f 348 Ditto Not in use †f* 11 Laiuington Street H. A. Roberts, Ltd 10 Upper Mall Not in use 7 St. Peters Road E. Gent la, Hammeremith Terrace ... Mrs. JackBon * Underground. + Factory. 68 Address. Name. No. 8 DISTRICT. †* 128 Askew Road G. Ingle † 74 Ditto J. Auer †* 167 Ditto F. J. Lockwood † 104 Ditto D. Miller 121 Ditto Not in use 41 Gavford Road Ditto No. 6 DISTRICT. †* 74 Goldliawk Road H.Crisp † 88 Ditto H. Crisp * 106 Ditto F. 4: A. Posford 166 Ditto H. & G. Curran * 242 Ditto Plumridge Bros. †* 75 Uxbridge Road Not in use †* 125 Ditto A. B. Hemmings Ltd. * 55 Melina Road J Tame No. 7 DISTRICT. †* 216 Uxbridge Road L. W. Jenkins † 410 Ditto A. Hauser No. 8 DISTRICT. †* 126 Uxbridge Road Not in use †* 132 Ditto Not in use †* 831 Harrow Road H. T. Rogers †* 39 St. Ann's Road E. Tomlin †* 16 North Pole Road G. Glanville †* 32 Norland Road N. Stone * 2 Hunt Street Not in use 104 Latimer Road Ditto Sunya House, Scrubs Lane Bee Bee Biscuits Ltd. * Underground †Factory UNSOUND FOOD. A quantity of walnuts (15 lbs. 9 ozs.) were seized from a fruiterer's shop, Hammersmith Metropolitan Railway, and submitted to the Magistrate at the West London Police Court, who condemned them as unfit for food and gave an Order for their destruction. The summons was dismissed with £7 7s. Od. costs. In May, 188 lemons were seized from a fruiterers in Queen Street, Hammersmith, and submitted to the Magistrate at the West London Police Court, who condemned the same and gave an Order for their destruction. 64 A summons was issued, when the Magistrate imposed a fine of £5 and £2 2s. 0d. costs. In July, seven baskets of raspberries, each containing 2 lbs., were seized from a fruiterer's shop, Hammersmith Metropolitan Railway Station, and submitted to the Magistrate at the West London Police Court, who condemned the same and gave an Order for their destruction. A summons was issued, when a penalty of £2 was imposed. In October, four bushels of pears were seized, two bushels from a stall in Norland Market and two bushels from a stall in Shepherds Bush Market. Both stalls were owned by the same man. The pears were submitted to a Justice of the Peace, who condemned the same and gave an Order for their destruction. Two summonses were issued, when fines of 10s. were imposed in each case. In September, the Sanitary Inspector reported that whilst inspecting a butcher's shop in King Street, a consignment of six pigs arrived by carrier. The carcases were deposited in the food preparation room at the rear of the shop, weighed and hung up. He examined the pigs and in two of them found tubercle deposits in the sub-maxillary glands. The heads were seized and submitted to a Magistrate, who condemned the same and gave an Order for their destruction. The carman who delivered the carcases stated they had been slaughtered at a farm near Newbury, where there was a licensed slaughterhouse, but did not know whether or not they had been examined by an Inspector of the local authority. A communication was accordingly addressed to the Medical Officer of Health for the District informing him of the facts and inquiring if notice of intention to slaughter had been given under the Public Health (Meat) Regula- 65 tions, 1924, and whether the carcases had been inspected prior to removal from the slaughterhouse. It transpired that the pigs had been slaughtered in a licensed slaughterhouse in which large numbers of " porkers " are killed for the London market. They had been killed within the notified hours of regular slaughtering, but were not seen by the Sanitary Inspector. No notice was given under Section 9 of the Public Health (Meat) Regulations, 1924, as the slaughtermen stated they saw no signs of disease in any of the pigs slaughtered that day. The glands of the carcases are not cut into as a routine procedure; diseased glands, unless obviously enlarged, would not be detected. It appears that the inspection of carcases in rural areas is not regularly carried out, owing to the large areas the Sanitary Inspectors have to cover. The position is one, therefore, that calls very strongly for the provision of public abattoirs with the prohibition of slaughtering elsewhere. Many difficulties would probably have to be surmounted in the establishment of such a system, but, nevertheless, every possible step should be taken to prevent diseased meat from reaching the public. The following is a list of unsound food condemned during the year:— Commodity. Condition. Result. 45 tins Clotted Cream Decomposed Surrendered 40 lbs. Skate ditto ditto 41 lbs. Walnuts ditto ditto 1 box Haddocks ditto ditto 1 trunk Haddocks ditto ditto 1 box Sprats (about 2½ stone) ditto ditto 16 Turkeys (97 lbs.) ditto ditto Turkeys (81 lbs.) ditto ditto FOOD POISONING. No case of food poisoning was brought to my notice during the year. 66 CLINICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. The clinical examination of food is carried out by the Public Analyst at the Laboratories, Royal Dental Hospital, Leicester Square. Six hundred and twelve samples taken under the Sale of Food and Drugs Acts were examined during the year. Over 50 per cent. of the articles analysed were milk samples. The bacteriological examination of food is carried out by the Pathologist of the West London Hospital. In the case of food poisoning specimens are sent to the Ministry of Health. FOOD AND DRUGS (ADULTERATION) ACT, 1928. Year ended 31st December, 1931. During the twelve months 612 samples of food and drugs were submitted for examination. The number of adulterated samples is one more than that of last year, whilst the number of inferior samples, where actual adulteration could not be certified, was 19 this year as against 32 in 1930. In Table I are given the numbers of samples received under the Food and Drugs (Adulteration) Act during the several quarters of the year, together with the numbers classified as genuine, inferior and adulterated. Of the total number examined 585 were reported as genuine, 8 as adulterated, whilst 19 were of inferior quality. Table I. Samples received. Genuine. Inferior. Adulterated. Total.  Quarter ending March 31st 144 4 2 150 „ „ June 30th 142 8 Nil 150 „ „ Sept. 30th 141 6 3 150 „ „ Dec. 31st 158 1 3 162 Totals 585 19 8 612 67 In Table II will be found a statement of the number and nature of the various articles examined during the year. Table II. Article. No. of Samples examined. Result of Examination. Genuine. Inferior Adulterated.   Amnion. Quinine 4 4 - - Aspirin Tablets 3 3 — — Barley 1 1 — — Brawn 6 6 — — Butter 48 47 — 1 Camphorated Oil 4 3 — 1 Castor Oil 4 4 — — Cheese 1 — 1 — Cheese and Tomato Paste 1 1 — — Chicken Roll 1 1 — — Chicken and Ham Roll 1 1 — — Cocoa 11 11 — — Coffee 3 3 — — Confectionery 4 4 — — Cream 12 12 — — Epsom Salts 4 4 — — Eucalyptus Oil 4 4 — — Fish Paste 8 8 — — Fruit, dried 14 13 — 1 Fruit, tinned 4 4 — — Herring Roes 1 1 — — Honey 2 2 — — Jam 5 5 — — Lard 8 8 — — Lemon Cheese 2 2 — — Lemon Squash 2 2 — — Margarine 12 12 — — Marmalade 5 5 — — Meat Paste 3 3 — — Pie 2 2 — — Milk 346 324 18 4 „ Condensed 23 23 — — Mincemeat 2 2 — — Olive Oil 8 8 — — Pepper 6 6 — — Rice 5 5 — — Sago 1 1 — — Sauce 2 2 — — Sausages 17 17 — — Seidlitz Powder 2 2 — — Semolina 2 2 — — Tea 4 4 — — Veal and Ham Loaf 1 1 — — Vegetables, tinned 6 6 — — Vinegar, Malt 1 1 — — Whisky 6 4 — 1 Wine Jelly 1 1 — — Totals 612 585 19 8 68 Milk. During the year 846 samples of milk were examined and of these, 824 were reported as genuine, 18 as inferior and 4 as adulterated. All of the inferior samples were poor in fat, whilst those adversely reported upon contained added water, the amounts found being 3, 2, 1, and 1 per cent. respectively. 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 III. Fat. Non-fatty Solids. Water. Per cent. Per cent. Per cent.  Quarter ending March 31st 3·71 8·85 87·44 „ „ June 30th 3·78 8·89 87·33 „ „ Sept. 30th 3·72 8·84 87·44 „ „ Dec. 31st 3·80 8·86 87·34 Average for the year 3·75 8·86 87·39 These figures represent milk of fair average quality for the whole year. Condensed Milk. Twenty-three condensed milks were specially examined for compliance or otherwise with the requirements of the Condensed Milk Regulations. They were all found to fulfil these requirements, both in respect of composition and in regard to the volume of milk yielded on dilution. Cream. Four samples of cream and eight of tinned cream analysed during the year were all free from preservatives, colouring matter and other foreign substances. The tinned samples were free from metallic contamination. Butter, Margarine, Lard. Forty-eight samples of butter, twelve of margarine and eight of lard were examined. All of these proved to be 69 genuine with the exception of a butter, which contained 16.2 per cent. of water, i i.e., 0.2 per cent, above the maximum allowed. Meat and Fish Preparations. The meat and fish preparations examined this year comprised the following :— Brawn 6 samples Chicken Boll 1 sample Chicken and Ham Boll 1 ,, Fish Paste 8 Bamples Herring Roes 1 sample Meat Paste3 samples Meat Pie 2 „ Sausages 17 „ Veal and Ham Loaf 1 sample All of these were genuine, preservatives being absent from all except one sample of sausages, which contained 128 parts per million of sulphur dioxide, an amount within the permitted limit. A specimen of anchovy paste was sealed by the manufacturers in an unusual way. Over the paste was a layer of paraffin wax. with a paper seal pasted over the glass container. This form of seal is undesirable inasmuch as the wax does not stick tightly to the glass and thus does not form an efficient barrier against bacterial contamination ; moreover, particles of the paraffin wax may become detached and eaten. Conserves, Vegetables, Fruit, &c. The samples falling under this head number forty, and include tinned peas, tinned tomatoes, tinned fruit, dried fruit, jam, marmalade, lemon cheese, mincemeat and honey. The tinned articles were commendably free from metallic contamination, and preservatives were absent from all but four cases of dried fruit. In these, amounts of sulphur dioxide preservatives were found respectively equal to 256, 706, 1.198 and 2,607 parts of sulphur dioxide per million. The last is 607 parts per million in excess of the maximum allowance for the article—dried apricots—and this sample was therefore reported adulterated. Cocoa, Coffee, Tea. Eleven specimens of cocoa, three of coffee and four of tea were genuine. Tests for arsenical contamination in the cocoas gave negative results. 70 Farinaceous Foods. A specimen of barley, five of rice, one of sago and two of semolina were genuine. Two rices showed evidence of " polishing " with talc, but the amount of foreign mineral matter did not exceed the limit of 0.5 per cent. usually allowed. Condiments, &c. Eight specimens of olive oil, six of pepper, two of sauce and one of malt vinegar were examined, and in no case was adulteration detected. Cordials and Spirits. Two samples of lemon squash contained sulphur dioxide within the permitted limit of 850 parts per million, the amount found being 64 parts per million in each case. Of five samples of whisky, one was 35.3 degrees under proof, i.e., 0.3 degree more than the limit of dilution permitted by the Act, and was on this account reported adulterated. Of those passed as genuine, three reached the limit of dilution and only one was reasonably well above strength. Drugs. The drugs examined during the year included the following:— Ammoniated Quinine 4 samples Aspirin Tablets 3 ,, C&mphorated Oil 4 „ Castor Oil 4 ,, Epsom Salte 4 „ Eucalyptus Oil 4 ,, Seidlitz Powder 2 „ All of these complied with the requirements of the British Pharmacopoeia with the exception of one specimen of camphorated oil. The latter contained only 19.5 per cent, of camphor in place of the 20 per cent, of the Pharmacopoeia formula. Miscellaneous Articles. Of the articles enumerated in Table II not already dealt with in detail only a few require special mention. Among these was a sample of cream cheese reported inferior on 71 account of its containing only 22.5 per cent. of fat, whereas cream cheese should contain at least 40 per cent. of fat, though there is no legal standard for this at present. Four samples of sweets were passed as genuine. One of these was reputed to have caused sickness in children who had eaten some of it, and was specially examined for metallic and other poisonous substances. Nothing of a toxic nature could be found, and it is probable that the coconut present in it was somewhat rancid. A sample of a proprietary brand of "wine jelly" gave evidence of the presence of a small amount of alcohol. This might have been due to the actual addition of wine, or merely to spirit present in any fruit essence used for flavouring the jelly. In addition to articles taken under the Food and Drugs (Adulteration) Act a sample of water from the First Class Swimming Bath at Lime Grove was analysed. This complied with the specifications as to purity. The following Table shows the action taken on adulterated samples and other infringements of the Sale of Food and Drugs Act:- Table IV. Sample No. Article. Adulteration. Action. Result.  868 Milk 3 % added water Letter of warning 996 do. 2 % added water do. — 173 do. 1 % added water do. 271 Butter 16·2 % water do. — 311 Apricots (dried) 2,607 parts of Sulphur dioxide per million do. — 329 Milk 1 % added water do. — 457 Camphorated Oil Contained only 19·5 % Camphor do. — 479 Whiskey 35·3* under proof do. — 72 PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 1,515 cases reported as due to notifiable infectious diseases in the Borough, against l,196 in the previous year. There were also reported 442 cases of infectious diseases that were not notifiable, against 2,124 in the previous year; 178 of these were Measles, and 264 Whooping Cough. The increase in the number of notifiable cases is due to notification of Chickenpox. The number of cases of Tuberculosis notified was 239 against 250 in the previous year. BACTERIOLOGY. The following bactoriological examinations were made on behalf of the Council:- Material from cases of suspected Diphtheria— True Diphtheria bacillus isolated 132 Negative results 1,308 Sputa from cases of suspected Tuberculosis— Tubercle bacillus found 74 Tubercle bacillus not found 407 Blood from cases of suspected Fever— Widal or Typhoid reaction obtained Widal or Typhoid reaction not obtained 6 Stools (for Tuberculosis), Negative 5 Urine (8.5.31 and 28.9.31) 5 Spleen 1 Grand Total 1,934 73 Cases of Infectious Diseases notified during the year 1931. TABLE IV. Notifiable Disease Number of Cases Notified Total cases notified in each Ward Total Cases Removed to Hospital  At all Ages Under 1 1 & under 5 Years 5 &, under 15 Years 15 & under 25 Years 25 & under 45 Years 45 & under 65 Years 65 and upwards S'th Centre North Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Smallpox 49 .. 9 27 3 9 .. 1 .. .. .. .. 45 4 .. 49 Choler. (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 228 6 76 108 25 11 2 .. 33 41 31 11 45 36 31 228 Erysipelas 48 2 2 3 6 12 14 9 4 2 5 3 9 18 7 24 Scarlet Fever 280 1 86 150 31 11 1 .. 25 28 55 12 32 71 57 273 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 1 .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 Relapsing Fever (R) Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 5 .. .. .. .. 5 .. .. .. 3 1 .. .. 1 .. 4 Puerperal Pyrexia 30 .. .. .. 20 10 .. .. 7 2 8 4 3 4 2 24 Cerebro-Spinal Meningitis 9 3 2 .. 3 1 .. .. 3 2 1 .. 2 1 .. 9 Polio-myelitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 2 .. .. 1 .. 1 .. .. .. .. .. .. 1 .. 1 2 Ophthalmia Neonatorum 13 13 .. .. .. .. .. .. 4 .. 1 2 1 3 2 8 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 141 10 20 12 18 39 28 14 18 22 23 6 23 28 21 70 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery 2 .. 1 1 .. .. .. .. .. .. .. .. .. 2 .. 2 TOTALS Tuberculosis. Pulmonary Tuberculosis 183 .. .. 5 53 78 44 3 20 40 19 10 30 41 20 Other forms of Tuberculosis 56 2 8 15 14 10 7 .. 14 7 10 1 6 16 2 TOTALS 239 2 8 20 67 88 51 3 34 47 29 11 36 60 22 Deaths from the Seven Principal Zymotic Diseases.— The total number of deaths of residents registered from the seven principal zymotic diseases was 88 against 89 in the previous year. The deaths of residents last year from these diseases were equal to 23 per 1,000 of the total deaths of residents registered and were at the rate of 0.3 deaths per 1,000 persons living. 74 The following table shows the deaths of residents registered from the seven principal zymotic diseases which occurred in the ten years, 1922 to 1981:— Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Enteric Fever. Diarrhœa and Cholera. Total.  1922 0 36 11 49 40 4 18 158 1923 0 6 2 20 10 2 31 71 1924 0 35 4 17 16 1 15 88 1925 0 6 3 12 32 3 35 91 1926 0 24 2 14 11 0 28 80 1927 0 2 1 11 4 0 28 46 1928 0 23 3 5 5 2 33 71 1929 0 2 0 5 41 2 19 69 1930 0 31 3 21 9 1 24 89 1931 0 0 2 6 7 0 23 38 Average last 10 yrs. 0 16 3 17 17 2 25 80 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was equal to the average number registered in the last ten years. Notifiable Diseases (other than Tuberculosis) during the year 1931. DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths.  Smallpox 49 49 - Diphtheria 228 228 Erysipelas 48 24 — Scarlet Fever 280 273 Enteric Fever 1 1 Puerperal Fever 5 4 2 Puerperal Pyrexia 30 24 2 Cerebro-Spinal Meningitis 9 9 6 Encephalitis Lethargica 2 2 2 Ophthalmia Neonatorum 13 8 — Pneumonia 141 70 132 Malaria — — — Dysentery 2 2 — Poliomyelitis — — — Chicken pox 707 18 — Totals 1,515 712 150 75 Smallpox.—The epidemic of smallpox reported in my previous Annual Report continued during the months of January and February. During this period 49 cases were notified. The infection continued to be of a mild character and no deaths resulted therefrom. No further cases have occurred in the Borough, although the epidemic has continued in the East part of London in a lesser degree. Many suspicious cases have been visited on the request of medical practitioners, but on investigation proved to be chickenpox. Cholera.—No case was reported as due to Cholera, against no case in the previous year. Plague.—No case was reported as due to Plague, against no case in the previous year. Diphtheria and Diphtheritic Membranous Croup.— Two hundred and twenty-eight cases were reported as due to Diphtheria or Diphtheritic Membranous Croup against 284 cases in the previous year. All cases were treated at the Isolation Hospitals. Six deaths were registered. The mortality rate on the cases reported was 2.6 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. No difficulty was experienced in removing cases to Hospital, the accommodation available being adequate for the number of cases. Scarlet Fever.—Two hundred and eighty cases were notified as due to Scarlet Fever, against four hundred and ninety-eight in the prevous year. Two hundred and seventy-three cases were treated at the Isolation Hospitals, 76 and seven at the homes of the patients. Two deaths were registered. The mortality rate was 0.7 per cent. Enteric Fever.—One case was reported as due to Enteric Fever, against six cases in the previous year. The case was treated at the Hammersmith Hospital. No death was registered. Erysipelas.—Forty-eight cases were reported as due to Erysipelas, against sixty-three cases in the previous year. Twenty-four cases were treated at the homes of the patients, seven at the Hammersmith Hospital, seven at St. Charles' Hospital, three at the London County Council Isolation Hospitals, two at the West London Hospital, one at St. Stephen's Hospital, one at the Fulham Hospital, one at the Hospital for Sick Children, one at St. John's Hospital, and one at St. Mary's 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 Relapsing Fever, against no case in the previous year. Continued Fever.—No case was reported as due to Continued Fever, against no case in the previous year. Puerperal Fever.—Five cases were reported as due to Puerperal Fever, against ten cases in the previous year. Two cases were treated at the London County Council Hospitals, two at Queen Charlotte's Hospital, and one at the home of the patient. Two deaths were registered. The mortality rate on the cases reported was 40 per cent. Puerperal Pyrexia.—Thirty cases were reported as due to Puerperal Pyrexia against twenty-six in the previous year. Two cases were treated at the Isolation Hospital of the London County Council, two at St. Mary Abbots Hospital, fifteen at Queen Charlotte's Hospital, two at St. George's Hospital, one at St. Pancras Hospital, one at the City of London Maternity Hospital, one at St. Marylebone Hospital, and six at the homes of the patients. The Chart hereunder shows the number of cases of Diphtheria notified week by week during the year. The Chart hereunder shows the number of cases of Scarlet Fever notified week by week during the year. 79 In one case a medical practitioner availed himself of the services of the obstetric specialists provided for in the scheme adopted by the Council in 1926. Cerebro-Spinal Meningitis.—Nine cases of Cerebrospinal Meningitis were reported against three cases in the previous year. Three cases were treated at the Isolation Hospitals of the London County Council, three at the Hammersmith Hospital and three at the West London Hospital. Acute Polio-myelitis.—No case was reported as due to Polio-myelitis, against one case in the previous year. Encephalitis Lethargica.—Two cases were reported as due to Encephalitis Lethargica, against four in the previous year. The two cases were treated in the Isolation Hospitals of the London County Council. Ophthalmia Neonatorum.—Thirteen cases were reported as due to Ophthalmia Neonatorum, against fourteen in the previous year. Seven cases were treated at St. Margaret's Hospital, one at Hammersmith Hospital, and five at the homes of the patients. In the cases treated at home arrangements were made for a nurse to attend the patient. Sixteen cases of slight inflammation of eyes were reported by the Inspector of Midwives of the London County Council. These cases were visited by the Health Visitors and action taken where necessary. Anthrax.—No case of Anthrax was notified during the year, against no case in the previous year. Hydrophobia.—No case was reported as due to Hydrophobia, as against no case in the previous year. Rabies Order, 1919.—No case of Rabies in dogs occurred in the Borough. Glanders.—No case was reported as due to Glanders, as against no case in the previous year. 80 Measles and German Measles.—One hundred and seventy-eight cases of Measles and German Measles were notified against fourteen hundred and eighty-six in the previous year. Thirty-three cases were treated in the Hospitals of the London County Council. No death was registered. The following Chart si.ows the number oF Deaths from Measles per 100.000 inhabitants, 1912-1931. Whooping Cough.—Two hundred and sixty-four cases of Whooping Cough were reported, against two hundred and six in the previous year. Seven deaths were registered. Sixty cases were removed to hospital, two hundred and four being treated at home. I have received, as heretofore, information as to cases from the Head Teachers of the Schools of the London County Council. 81 The following Chart shows the number of Deaths from Whooping-Cough per 100,000 inhabitants, 1912-1931 The homes of the patients were visited by your Inspectors, and the parents advised as to the precautions that should be taken. Chicken Pox.—Seven hundred and seven cases of Chicken Pox were reported, against four hundred and thirty-two in the previous year. Eighteen cases were removed to hospital. In every case the premises were visited by one of your Inspectors and the parents advised as to the precautions necessary. In view of the prevalence of smallpox and the mild form thereof, the Council made representations to the Ministry of Health pointing out the advisability of making Chicken Pox notifiable. The Ministry of Health issued an Order known as the Hammersmith (Chicken Pox) Regulations, 1981, dated 20th February, 1931, requiring the notification of Chicken 82 Pox in any person not under ten years of age and any person under ten years of age who had not been vaccinated. The Regulations came into force on the 2nd March, 1931. Pneumonia.—One hundred and forty-one cases of Pneumonia (forty-two Influenzal Pneumonia and ninetynine Primary Pneumonia) were notified during the year. Seventy cases were treated at various institutions. All cases were made the subject of inquiry by your lady Sanitary Inspector or Health Visitors, and in many cases it was found necessary to arrange for a nurse to visit and attend to the wants of the patients. This was done by arrangement with the Hammersmith District Nursing Association. One hundred and thirty-two deaths were registered. From the above figures it may be assumed that a good many cases have occurred, of which no information has been received by your Public Health Department. Malaria.—No case was reported, against no case in the previous year. Dysentery.—Two cases of Dysentery were reported against no case in the previous year. The two cases were removed to the Isolation Hospitals of the London County Council. Influenza.—During the year twenty-seven deaths from Influenza occurred, as compared with fourteen in the previous year. Wrong Diagnosis.—Thirty-two cases of infectious disease were removed to the Hospitals of the London County Council and subsequently returned home in consequence of the patients being found not to be suffering 83 from the disease stated on the certificates, or any other notifiable disease— Diphtheria 19 Scarlet Fever 13 Total 32 Psittacosis.—No case of psittacosis was reported in the Borough during the year. Cleansing of Verminous Persons.—The Medicinal Baths in Scotts Boad, Shepherd's Bush, provide for the treatment of cases of Scabies, Impetigo and the cleansing of verminous persons, &c. I append figures showing the numbers dealt with during the year. School Children— Scabies 181 Impetigo 73 Verminous Cases 2,407 Other conditions — Adults— Scabies 76 Verminous Cases 113 Other conditions 6 Children under School-age— Scabies 17 Verminous Oases 2 Other conditions 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 ls. for each bath given. The amounts received from the London County Council during the year was £240 14s. 0d. in respect of cleansings and £10 2s. 0d. in respect of scabies cases and impetigo. TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1922 to 1931. 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. Chicken pox. f Measles, b a Whooping Cough, a Cerebro-Spinal Fever. Anthrax. Gland rs. Hydrophobia. Ophthalmia Neonatorum. Acute Polio-Myelitis. Encephalitis Lethargica. Pneumonia, c Malaria, c Dysentery, c Trench Fever.e Total.  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 1758 1928 0 337 380 0 8 0 0 7 18 0 52 0 114 631 45 3 0 0 0 21 3 3 130 5 1 0 1929 0 409 249 0 4 0 0 9 15 0 74 0 87 237 113 3 0 0 0 13 0 3 232 0 1 0 1452 1930 21 498 384 0 6 0 0 10 26 0 63 0 432 1486 206 3 0 0 0 14 1 4 166 0 0 0 3320 1931 49 280 228 0 1 0 0 5 30 0 48 0 707 178 264 9 0 0 0 13 0 2 141 0 2 0 1957 Average for 10 years. 7 339 301 0 8 0 0 10 12 0 46 0 320 695 222 3 0 0 0 20 2 5 145 1 1 0 2137 a Not .Notifiable. b Notifiable during the vears 1916—1919. e Notifiable from 1st March 1919 to 31/12/1927. c Notifiable from 1st March. 1919. d Notifiable from 1st October, 1926. f Notifiable from 2nd March, 1931. 85 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 purposes of disinfection. Beds 397 Mattresses 897 Pillows 1,854 Bolsters 657 Blankets 2,905 Sheets 967 Quilts 823 Articles of Clothing 3,214 Sundries 123 Total 11,737 Rooms 792 Vaccination.—The Minister of Health, in exercise of his powers under the Vaccination Acts, 1867 to 1898, and the Vaccination Act, 1907, issued an Order dated 3rd January, 1980, to be cited as the Vaccination Order, 1980, which came into operation on the 1st day of April, 1980. The duties under the Vaccination Acts and the Vaccination Order were transferred to the Borough Council on the 1st April, 1930, and were undertaken by the Public Health Department. The Return for 1980 shows that 1,085 Infants were vaccinated, this being 58.28 per cent, of the Births, and compares favourably with 5617 per cent, in 1929. At the close of 1931, 1,809 cases had been dealt with, leaving 445 cases outstanding in the Vaccination Register for that year. During January and February, the Public Vaccinators were called upon to offer vaccination to smallpox contacts. Four hundred and thirty-one certificates of successful vaccination were received. Two hundred and twenty-three related to persons over 14 years of age, and 208 to children between three and fourteen years of age. 86 Proceedings under Section 81 of the Vaccination Act, 1867, were instituted in 46 cases, and resulted as follows:— Magistrate's Order for Vaccination (including Costs) 24 Adjourned sine die 3 Not served by Police (for various reasons) 5 Withdrawn (vaccinated prior to hearing) 14 46 Subsequently, penalties were imposed in four cases for non-compliance with the Magistrate's Order. In February the Council decided to alter the Public Vaccinator's Districts following a report which I submitted calling attention to the large increase in population in District No. 8, due to the number of houses erected on the Wormholt and Old Oak Estates. The Council decided, subject to the approval of the Minister of Health to divide the Borough into the following districts for the performance of vaccination, namely:— No. of Vaccination Limits of Vaccination District. District. 1 That part of the Borough comprising Ward No. 1 (River) and Ward No. 3 (The Grove and Ravenscourt), with the exception of Queen Charlotte's Hospital, 341, Goldhawk la That part of Ward No. 3 (The Grove and Ravens court) comprising Queen Charlotte's " Invermead " Auxiliary Hospital, 341, Goldhawk Koad. 2 That part of the Borough comprising Ward No. 4 (St. Stephen's) and Ward No. 5 (Starch Green), with the exception of the Hammersmith Receiving Home for Children, 206, Goldhawk Road. 2a That part of Ward No. 5 (Starch Green) comprising the Hammersmith Receiving Home for Children, 206, Goldhawk Road. 3 That part of the Borough comprising Ward No. 2 (Brook Green and St. Matthew's); the portion of Ward No. 6 (Wormholt) situate to the east of a line drawn southwards along the centre of Scrubs Lane from a point where the L.M.S. Railway (West London Line) crosses under that lane to and along the centre of Wood Lane to Uxbridge Road; and that portion of Ward No. 7 (College Park and Latymer) situate to the south of the Great Western Railway. 4 That part of the Borough comprising the remainder of Ward No. 6 (Wormholt), with the exception of the Hammersmith Hospital, Du Cane Road. 4a That part of Ward No. 6 (Wormholt), comprising the Hammersmith Hospital, Du Cane Road. 5 That part of the Borough comprising the remainder of Ward No. 7 (College Park and Latymer). VACCINATION RETURNS. RETURN FOR 1930. Registration Sub-Districts comprised in the Vaccination Officers' District Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st Dec., 1930 Number of these Births duly entered by 31st January, 1932, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1932, remained unentered in the " Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1931. neither duly entered in the "Vaccination Register" (columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the "Report Book" (columns 8, 9 and 10 of this Return Number of Certificates of Successful Primary Vaccination of children under 14 years received during the calendar year 1931 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate during the calendar year 1931 Col. 1 Col. II Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received Col. v Dead, Unvaccinated Postpone ment by Medical Certificate Removal to Districts, the Vaccination Officer of which has been duly apprised Removal to Places unknown or which cannot be reached; and Cases not having been found Successfully Vaccinated Insusceptible of Vaccination Had SmallPox 1 2 3 4 5 6 7 8 9 10 11 12 13  1. North Hammersmith 1,140 613 7 — 365 54 5 10 56 30 1,624 513 2. South Hammersmith 693 404 2 — 182 24 4 17 51 9 3. "Invermead" 127 68 — — 22 5 — 31 1 — 1,960 1,085 9 — 569 83 9 58 108 39 1,624 513 87 88 Table showing Work of Vaccination Officer from 1st January to 31st December, 1931. No. of Vaccination Certificates received from— No. of Insusceptibility Certificates. Total No. of Certificates. No. of Declarations of Conscientious Objection. No. of Postponement Certificates Received. No. of Cases Removed Inwards. No. of Cases Removed Outwards. No. of "Q" Notices Sent. No. of "K" Notices Served. No. of Children Died Unvaccinated. No. of Visits of Vaccination Officer. No. of Cases Removed and not Traced. Nos. entered on "H" Lists to Public Vaccinators. No. of Cases remaining to be dealt with. N umbers on Birth Lists Received from Registrars  Dr. Durward. Dr. Dale. Dr. Harrison. Dr. frossard. Dr. Dockrill. Dr. Brash. Other Doctors. Dr. Durward. Dr Dale. Dr. Harrison. Dr. Frossard. Dr. Dockrill. Dr. Brash. North 31 556 45 79 123 13 197 8 1052 369 99 — 45 815 124 37 250 25 26 168 57 74 118 14 191 973 South 166 40 15 95 5 — 154 3 478 206 64 — 54 529 96 27 134 22 167 19 18 93 3 — 129 636 Queen Charlotte's Hospital 5 7 - 15 11 - 144 1 183 62 3 - 201 269 3 10 9 10 8 7 2 19 5 - 76 345 Removed Inwards 14 41 9 54 5 2 43 — 168 — 30 300 — 120 47 0 53 17 48 36 21 59 37 4 49 300 Above 14 years of age 46 223 3 6 - - - - 278 - - - - - - - - - - - - - - - - - Total 262 867 72 249 144 15 538 12 2159 637 196 300 300 1733 270 74 446 74 289 230 98 245 163 18 445 2254 89 Public Health (Smallpox) Regulations, 1917. No primary vaccinations or revaccinations were performed by your Medical Officer of Health during the year, under the above regulations. Tuberculosis. Tuberculosis.—Two hundred and thirty-nine cases of tuberculosis were reported during the year; one hundred and eighty-three of which were Pulmonary and fifty-six being other forms of Tuberculosis, against two hundred and fifty cases in the previous year. PART I. Summary of Notifications during the period from the 28th December, 1930, to the 2nd January, 1932. Age Periods Formal Notifications Number of Primary Notifications of new cases of Tuberculosis' Total Notifications  0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages) Pulmonary Males — — — 3 9 12 32 17 20 11 3 107 175 Pulmonary Females — — — 2 13 19 20 9 9 4 — 76 109 Non-pulmonary Males 1 3 4 5 4 1 — 4 2 2 — 26 32 Non-pulmonary Females 1 5 6 — 6 3 6 — 1 2 — 30 35 90 PART II. Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age Periods 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total  Pulmonary Males - — — 1 — 1 6 3 3 3 — 17 Pulmonary Females — — — 2 1 1 6 1 — 2 — 13 Non-pulmonary Males 2 — 2 - 1 1 1 1 — — — 8 Non-pulmonary Females 1 - - — 1 — 1 - — — — 3 The source or sources from which information as to the abovementioned cases was obtained should be stated below :— Source of Information No. of Cases Pulmonary Nonpulmonary  Death Returns from local Registrars 4 2 transferable deaths from Registrar General 1 3 Posthumous notifications 1 1 "Transfers" from other areas (other than transferable deaths) 24 5 Other Sources, if any (specify) — — PART III. Notification Register. Pulmonary Non-pulmonary Total Cases  Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December, 1931, on the Registers of Notifications 449 375 824 171 203 374 1,198 Number of cases removed from the Register(s) during the year by reason, inter alia, of: — 1. Withdrawal of notification 1 1 2 — — — 2 2. Recovery from the disease 12 18 30 13 15 28 58 3. Death 68 50 118 6 4 10 128 91 In all cases notified the nurses visited and obtained all the necessary information. Any insanitary conditions found to exist were referred to the Sanitary Inspectors. One hundred and nine deaths from Pulmonary Tuberculosis were registered, against one hundred and thirtytwo in the previous year, representing a death-rate of 0.8 per 1,000 compared with 0.9 in 1930. The notification of cases of Tuberculosis by medical practitioners is, unfortunately, not carried out in all cases 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 some extent rendered nugatory. In all cases where failure to notify occurs, the attention of the medical practitioner is called to the fact and his observations requested. The majority of the non-notified cases are tuberculous meningitis, the diagnosis being made at the post mortem. It has not been deemed necessary to take any further action as the explanations have been considered satisfactory. A append figures for the years 1920-31, showing the interval between notification and death of tuberculous persons. 1920. 1921. 1922. 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1. Total number of deaths from Tuberculosis in the Borough 157 173 162 145 170 .138 142 181 135 149 153 127 2. The number of cases notified at death 11 8 17 11 10 13 8 - 7 3 7 2 3. The number of cases notified within one month of death (excluding above) 26 29 20 21 23 18 30 25 17 32 18 16 4. The number of cases notified within three months of death (excluding above) 28 29 20 18 20 13 20 23 13 18 21 14 5. The number of cases notified within six months of death (excluding above) 16 9 16 13 16 18 12 18 9 8 9 14 92 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1931:— Age Periods. New Cases. Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. 0 - - 1 1 - - 2 1 1 — — 3 5 — - - 1 5 3 2 9 6 — 1 2 2 15 21 32 5 9 13 12 5 — 25 49 29 4 6 22 20 1 2 45 31 13 4 3 28 10 1 1 65 and upwards 3 — — 3 — — — Totals 107 76 26 30 66 43 11 7 The ratio of non-notified tuberculous deaths to the total tuberculous deaths is 1 to 6. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not found necessary to take action under these regulations during the year under review. Tuberculosis Dispensary. I submit a report on the work carried out at the Tuberculosis Dispensary during the year under review. Sessions have been held regularly at the Dispensary for the examination and treatment of patients at the following times :— Mondays, 10.30a.m. Women and Children. Tuesdays, 1.30 p.m. Old Patients only. Tuesdays, 5.30 p.m. Men and Women (Workers only). Thursdays, 5.30 p.m. Men and Women (Workers only). Saturdays, 10 a.m. School Children. New Patients may attend at any of the Sessions. 93 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. On 1st January, 1981, the number of patients on the Dispensary Register was 905. During the year 36 definite cases of the disease were transferred from other areas into the Hammersmith district and 191 moved out of this district or were lost sight of. Seventy-five were written off the register as being cured cases who had previously been notified as suffering with tuberculosis. New Patients. During the year 660 persons attended for examination for the first time. Of these 214 were under the age of fifteen and 446 were adults. Males and females attended in almost equal numbers, viz., 311 and 849. Of the total 176 were referred to the Dispensary by local practitioners for the purpose of consultation and 199 were " contacts " of persons suffering with Tuberculosis. Patients attended the Dispensary on the recommendation of other patients, at the request of various voluntary societies, after discharge from hospitals and sanatoria, on the advice of general practitioners practising in the Borough or on their own initiative. Diagnosis. Found to have Pulmonary Tuberculosis 128 Found to have other forms of Tuberculosis 44 Showing no evidence of Tuberculosis 488 94 Total. Attendances and Examinations. The total attendances of persons for the purpose of examination, observation or treatment, numbered 2,285 and physical examinations were carried out in 1,924 instances, i.e., in 84 per cent, of the total attendances. The names of 498 persons were written off the register as being non-tuberculous, and the total number on the Dispensary register on 81st December, 1981, was estimated at 768. Sputum Examinations. Three hundred and ninety-three specimens of sputum and other pathological products were examined bacteriologically. Sixty-one showed the presence of Tubercle Bacilli, while 882 proved negative. Institutional Treatment. The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homest, under the London County Council's Scheme, numbered 173. Others have entered Infirmaries through the agency of the local Public Assistance Committee, and Convalescent Homes through that of the local Invalid Children's Aid Association. Clinical Reports. To the London County Council, numbered 630 To the Ministry of Pensions 45 To General Practitioners and Hospitals 685 Home Visitation. The Tuberculosis Officer made 197 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 56 occasions. 95 Return showing the work of the Dispensary during the year 1931. Diagnosis Pulmonary Non-pulmonary Total Adults Childr'n Adults Childr'n Adults Childr'n m. f. m. f. m. f. m. f. m. f. m. f. A—New Cases examined during the year (excluding contacts)- (a) Definitely tuberculous 63 53 1 — 6 15 10 7 69 68 11 7 (b) Diagnosis not completed — — — — - - — — 1 1 — — (c) Non-tuberculous - - - - - - - - 102 1()7 52 43 B.—Contacts examined during the year:- (a) Definitely tuberculous 5 4 1 1 1 1 4 5 5 2 5 (b) Diagnosis not completed — — — — — — — — 1 - - (c) Non-tuberculous - - - - - - - - 21 66 48 46 C.—Cases written off the Dispensary Register as:— (a) Recovered 12 13 5 2 5 11 16 11 17 24 21 13 (6) Non-tuberculous (including any such cases previouslydiagnosed and entered on the Dispensary Register as tuber- culous) - - - - - - - - 126 178 100 89 D.—Number of Cases on Dispensary Register on December 31st:- (a) Definitely tuberculous 293 232 13 25 43 62 50 42 336 294 63 67 (b) Diagnosis not completed - — — — — — — — 1 2 — - 1. Number of cases on Dispensary Register on January 1st 905 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in prevous years 36 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight or 191 4. Cases written off during the year as Dead (all causes) 79 5. Number of attendances at the Dispensary (including contacts) 2,285 6. Number of Insured Persons under Domiciliary Treatment on the 3l8t December 321 7. Number of consultations with medical practitioners (a) Personal 56 (b) Other 176 8. Number of visits by losis Officers to homes (including personal consultations) 197 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 5,038 3,474 Dispensary 11,564 Town Hall 10. Number of (a) Specimens of sputum, &c., examined, 393 150 Doctors 1 243 Dispensary (b) X-ray examinations made, in connection with dispensary work 82 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (ft) above Nil 12. Number of " T.B. plus " cases on Dispensary Register on December 31st 348 96 PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1931 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the return relates Previous to 1926 1926 1927 1928 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 23 7 3 10 1 1 1 2 2 - 2 2 1 - - 1 F. 6 4 2 - 6 3 2 — — 2 4 1 - - 1 6 - - - - Children 8 - - — - 3 - — — - 2 - — — - - — — — — Disease not Arrested Adults M. 27 6 20 7 33 5 6 6 4 16 2 6 10 5 21 3 9 2 3 14 F. 29 — 7 — 7 6 1 6 2 9 6 2 2 - 4 — 4 3 2 9 Children 6 — — — — — — — — — 1 — — — — 2 — — — — Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 99 17 32 7 56 18 10 12 6 28 17 9 14 5 28 13 14 5 5 24 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 11 1 - - 1 2 — - - - - - - - - - - - - - F. 15 2 2 2 1 - - 1 - - - - - - - - - - Children 7 - - - - 3 - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 32 5 3 2 10 13 9 8 1 18 23 7 13 5 25 26 18 17 3 38 Dead Adults M. 3 3 6 4 5 15 13 33 1 4 10 29 43 2 3 13 9 25 F. 4 — 3 4 7 3 4 2 11 17 4 2 5 12 19 5 17 5 4 26 Children 2 — — — — — — — - - 2 — 1 - 1 2 - — — — Total written off Dispensary Register 71 8 9 9 26 27 19 25 25 69 30 13 29 46 88 35 38 35 16 89 Grand Totals 170 25 41 16 82 45 29 37 31 97 47 22 43 51 116 48 52 40 21 113 97  1929 1930 1931 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - Children — — — — — — — — — — — — — — — Disease not Arrested Adults M. 11 11 7 2 20 20 6 13 2 21 17 19 18 4 41 F. 14 12 11 2 25 22 12 9 1 22 20 10 18 3 31 Children 6 — — — — 5 1 1 — 2 — — — — — Condition not ascertained during the year - - - - - - - - - - - - - - 72 Total on Dispensary Register at 31st December 31 23 18 4 45 47 19 23 3 45 40 29 36 7 - (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 15 8 7 1 16 9 5 7 — 12 2 1 5 — 6 Dead Adults M. 9 6 11 9 26 7 6 8 9 23 3 - 3 - 3 F. 4 - 4 5 9 7 3 7 5 15 2 - 1 1 2 Children - — - - - - - - - - - — - - - Total written off Dispensary Register 28 14 22 15 51 23 14 22 14 50 7 1 9 1 11 Grand Totals 59 37 40 19 96 70 33 45 17 95 47 30 45 8 83 98 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1931 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the return relates Previous to 1926 1926 1927 1928 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 2 2 - 4 1 1 - - - - - 1 - - 1 2 F. 3 — — 2 5 — 1 — 3 4 — — — - - 1 — - — 1 Children 4 — — 2 6 2 — — 4 6 1 1 — — 2 1 1 — 1 3 Disease not Arrested Adults M. - - - — - 1 - - 1 2 2 - - 1 3 3 1 2 6 F. — — 2 — 2 — 1 1 1 3 4 1 - - 5 1 - - 2 3 Children 3 — — 4 7 1 1 1 4 7 1 - — — 1 4 — 3 5 12 Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 12 - 4 8 24 5 3 2 13 23 8 2 - 1 11 11 1 4 11 27 Transferred to Pulmonary (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 3 - 2 - 5 - - - - - - - - - - - - - - - F. 2 1 1 4 8 — 2 — 1 3 - - - - - - - - - - Children 7 1 1 13 22 — — — 3 3 — — — 2 2 — - — — — Lost sight of, or otherwise removed from Dispensary Register 14 _ 3 15 32 8 - - 5 13 5 1 3 5 14 - - 1 4 5 Dead Adults M 2 2 1 - - - 1 - - 1 - 1 F. - - - - - - - - 1 1 - - - - - - - - - - Children — — — — — — 1 1 — 2 — — — — — — - — — — Total written off Dispensary Register 26 2 7 32 67 10 3 1 10 24 6 1 3 7 17 — — 2 4 6 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 38 2 11 40 91 15 6 3 23 47 14 3 3 8 28 11 1 6 15 33 99  1929 1930 1931 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 2 _ _ - 2 _ - - - F. 1 — - 2 3 - - - - - - - - - - Children — — 1 — 1 - — — — — — — - — — Disease not Arrested Adults M. 2 - 4 - 6 6 1 2 3 12 4 — — 1 5 F. 1 1 — 2 4 6 2 3 5 16 5 5 1 5 16 Children 2 - 1 5 8 7 - - 11 18 7 3 2 9 21 Condition not ascertained during the year - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 8 1 6 9 24 19 3 6 19 46 16 8 3 15 42 Transferred to Pulmonary (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 1 - 4 3 8 3 - - - 3 2 - - 1 3 Dead Adults M. — — — — — 1 — 1 — 2 — — — —- — F. — — — — — — 1 — 1 — — — — — Children - - - - - - - - - - - - - - - Total written off Dispensary Register 1 - 4 3 8 4 - 2 - 6 2 - - 1 3 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 9 1 10 12 32 23 3 7 19 52 18 8 3 16 45 100 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 5,088 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 inquiries 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 143 Home-Inquiry 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 local Public Assistance Committee, 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 15 occasions during the year. There were submitted by the staff 148 applications for residential treatment, a decrease of 53 compared with 1930. The Committee decided in 100 of these cases that no payment should be required in respect of such treatment. In the remaining 48 assessments of varying amounts were made. In 58 instances, reconsideration of these assessments was rendered necessary at subsequent meetings, mainly by changes in the family circumstances. 101 Fifty-six patients were referred for help to other agencies including the local branch of the British Red Cross Society, the United Services Fund, the 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 £170 16s. 6d. These monies are handed over to the Borough Treasurer, who transfers them to the County Council. The staff consists of the Tuberculosis Officer, Dr. G. I. Davies, two Nurses and Dispenser-Secretary. 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. The staff of the Hospital has invariably taken a kindly interest in the patients referred to them by the Dispensary. 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. 102 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. Eighty-two cases were dealt with in this way during the year. One hundred and thirty-six attendances were made at Brompton Hospital for artificial pneumothorax. During the year, a clinic for refills for those Borough cases undergoing treatment by artificial pneumothorax, has been organised at the Hammersmith Hospital, Du Cane Boad. These refills are controlled by X-ray examinations and the clinic is under the supervision of the Tuberculosis Officer. The success of this clinic is now well established, and all future cases referred from institutions will be carried out at the above Hospital. In the working of this Hospital clinic, our thanks are due to the Medical Superintendent and the Staff for their valuable support and co-operation. 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. 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. 103 PREVENTION OF BLINDNESS. Blind Persons Act, 1920. It was not found necessary to refer any case of blindness to the London County Council under the scheme for the education and training of the blind. 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 four persons from the catacombs or graves in St. Mary's Cemetery. One of the bodies was forthwith transported to Spain, one body was reinterred in St. Mary's Cemetery, Harrow Road, and two were conveyed to Mexico for reinterment. The following conditions were attached to the licences:— (1) That the removal be effected with due care and attention to decency early in the morning. (2) That freshly made ground lime be freely sprinkled over the coffin, the soil, or any matter that may be offensive. In the cases where the remains were removed to Spain and Mexico it was required that they be contained in a lead-lined shell, hermetically sealed. The work of removal and re-interment was carried out in accordance with the conditions and under the supervision of the Sanitary Inspector on my behalf. 104 PUBLIC BATHS. The Public Swimming Baths in Lime Grove and the Open-air Swimming Bath in Bloemfontein Road, are provided with aeration and filtration plants, whereby the water is continuously filtered, aerated and chlorinated. The water is pumped from a point at the deepest part of the Baths, passed under pressure to gravel filters, then into a chamber or tank where it is aerated, and afterwards chlorinated before returning to the Baths. During the year samples of the water were submitted for chemical and bacteriological examination. The reports showed the water, which had been in use for several months, to be of a very high standard of purity, there being no sediment or B. Coli present, PUBLIC WASH-HOUSES. The public wash-houses in Scotts Road form part of the building comprising the indoor Swimming Baths, Lime Grove. These wash-houses are very well patronised, and provide a means of clothes washing for many families living in tenement houses without washing accommodation. They are open ordinary week-days from 8 a.m. to 8 p.m., except Saturdays, when they are available from 8 a.m. to 3 p.m. PROPAGANDA. During the year " Better Health," a monthly Health Journal, published under the auspices of the Society of Medical Officers of Health, was distributed. One thousand copies of this Journal being distributed monthly to the Schools and Infant Welfare Centres. The Journal is welcomed by the School Teachers as a great help in the teaching of Hygiene. 105 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 1,954 Corrected Number of Births 2,073 These figures represent a Birth-rate per 1,000 of the population of the Borough of 15.3 Corrected Number of Deaths of Infants under one year, of whom 46 djed under one week 140 Legitimate Infante 122, or 64 per 1,000 Births. Illegitimate Infante—18, or 114 per 1,000 Births. Infant Mortality Bate per 1,000 Births 68 The work undertaken under this heading was continued on similar lines to previous yeajrs. 1. Activities directly initiated by the Borough Council: (а) Provision of four Health Visitore. (b) Provision of Maternity Homes. (c) Provision of Ante-Natal Clinics. (d) Supply of Fresh Milk to necessitous Mothers and Young Children. 2. Activities of Voluntary Agencies in receipt of grants- in-aid from the Borough Council: (a) Infant Welfare Centres. (b) Day Nurseries. (c) Treatment and Nursing of Children under School Age. (d) Rheumatism Clinic. 8. Activities of independent Voluntary Agencies : (a) Bescue Homes. (b) Convalescent Treatment for Invalid Children. 106 Health Visitors—Visits. The Health Visitors were engaged, as in former years, in visits of enquiry to Births, Infant Deaths, cases of Ophthalmia Neonatorum, Puerperal Fever, and other diseases of mothers and young children; they have also taken an active part in the work of the Voluntary Infant Welfare Centres. The visits paid are enumerated in detail below:— First visits 1,873 Re-visits (under 1 year) 2,690 Re-visits (1 to 5 years) 2,119 Out 2,926 Removals 622 Special visits 702 Ophthalmia first visits 12 Ophthalmia re-visits 11 Puerperal Fever 5 Puerperal Pyrexia 27 Ante-natal, first visits 585 Ante-natal, re-visits 180 Visits to stillbirths 31 Visits to Infant Deaths 108 Measles 16 Encephalitis Lethargica 2 Pneumonia 8 Chickenpox 22 Total 11,939 Number of Consultations at Infant Welfare Centres, attended by Health Visitors 705 Number of Committee Meetings of Voluntary Associations attended 10 Number of Insanitary Conditions reported by Health Visitors and dealt with by Sanitary Inspectors 44 107 The feeding of the 1,873 infants visited was found to be as follows:— Breast-feeding 1,636 Artificial feeding 159 Mixed feeding 78 Every effort is made by the Health Visitors to encourage mothers to breast-feed their infants, and also to induce them to attend the Consultations at the Infant Welfare Centres, so that both mother and child may be kept under observation during the most critical months of the child's life. 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 1928 2258 156 69 1929 2162 133 62 1930 2173 140 64 1931 2073 140 68 108 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. Schedule of Attendances at Infant Welfare Centres. Address of Clinic. No. of Clinics New Cases. Attendances. Mothers. Children. Mothers. Children. Antenatal. Postnatal. Under 1 yr. Over 1 yr. Antenatal. Postnatal Under 1 yr. Over 1 yr.  48, Glenthorne Road 148 — — 379 29 — — 4654 1 48, Glenthorne Road 76 435 39 — — 1192 78 — — Victoria Mission Hall, Becklow Road 98 — — 235 11 — — 2650 313 St. Matthew's Hall, Blythe Road 98 — — 258 32 — — 3060 1390 Old Oak Centre, The Curve, Western Avenue 98 — — 264 46 — — 3662 1032 Old Oak Centre, The Curve, Western Avenue 102 283 25 — — 1168 47 — — Latymer Road Mission Blechynden Street 49 — 67 10 — — 654 609 Presbyterian Hall, College Park 49 — — 35 4 — — 491 394 Total 718 718 64 1238 132 2360 125 15171 5388 Ante-natal Clinics 178 Infant Consultations 540 718 The above Centres are conducted by Voluntary Associations supported by voluntary contributions, donations, &c., to which the Council contributes. The infant mortality rates of the London Boroughs varies from 42 in Chelsea to 88 in Bethnal Green. 109 The following Chart shows the Infantile Mortality rate for the years 1903 1931. ARTIFICIAL LIGHT TREATMENT. The provision of artificial light treatment for children up to 5 years of age suffering from marasmus and rickets was continued at the Hammersmith Hospital. During the year 41 patients received treatment—the total attendances being 582. 110 LIGHT TREATMENT CENTRE. Staff.—One Medical Officer, Head Masseuse and two assistants. Clinic.—Light room in Electrotherapeutic Department, other rooms arranged for Radiant Heat, Massage and Ionisation, &c. Sessions.—Days and hours are arranged according to number and type of patients. Types of Lamps—(a) Percy Hall mercury vapour Lamp, (b) Murray Levick type of infra-red lamp. During the period of the year twenty-five children were referred to the Light Treatment Centre and three hundred and twenty-six exposures were given. The following is a summary of the cases treated. Number. Disease. 14 Debility. 27 Rickets. 41 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. 12,657 lbs. of dried milk and 858 quarts of raw milk and 54 tins of Nestle's were distributed during the year. The number of applications for free milk has averaged 44 per week during the year. The total expenditure during the year was approximately ,£820. The amount of milk distributed during the year increased 111 by 5,402 lbs. of dried milk, 809 quarts of raw milk and 54 tins of Nestles, at an increased cost of ,£800. Many more persons made application for milk grants owing to unemployment. 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. Nutrition of Children.—I have referred in a previous art of this report to the high rents charged for flats and rooms. My attention has been called by the officers of the Department to the very serious effect upon the health of parents and the nutrition of children, resulting from so much of the family income being paid in rent. Applications for free milk under the Maternity and Child Welfare Schemes have considerably increased and the Council has been called upon to increase the amount of money spent in this direction. 112 The majority of applicants are unemployed and in receipt of out-of-work pay. Others are employed but come within the scale after deduction of rent. The applicants are parents of families ranging from one to Bix, seven or eight children. These families are compelled to pay high rents owing to the refusal of owners and agents to let rooms to people with children. Consequently, the amount available for providing food, etc., is greatly reduced, resulting in parents and children being underfed and improperly nourished. The following cases recorded in the Department afford ample evidence of the position of some of these families. OUT OF WORK. Rooms Income. Rent. Net Inc. Average per head.  s. d. s. d. s. d. s. d. 1. M & W. 4,3, 9 mos. 2 29 3 17 6 11 9 2 4 2. ,, 6,4,1 month 4 29 3 25 0 13 3 2 8 (1 let) 9 0 3. ,, 6,4,1 2 29 3 19 6 9 9 1 11 4. ,, 2, (1 expected) 1 23 3 13 6 11 8 3 11 5. ,, 7, 6, 5, 4 mos. 1 31 3 15 0 16 3 2 8 6. ,, 1, 2 mos. 3 27 3 18 0 9 3 2 4 7. ,, 12,10,3,2 2 31 3 20 0 11 3 1 11 8. ,, (1 expected) 2½, 1 yr. 4 mos. 3 27 3 21 0 6 3 1 7 9. ,, 6½, 3 3 27 3 21 0 6 3 1 7 10. ,, 10, 10, 3, 9 mos. 4 31 3 20 0 11 3 1 10 11. ,, 2½ (1 expected) 1 16 0 16 0 — - (Help from parents) EARNING. 12. ,, 8, 3, 2 2 & S. 46 8 20 0 26 8 5 4 13. ,, 4, 6 mos. 3 31 0 20 0 11 0 2 9 14. ,, 4, 2, 1, 1 month 3 48 6 21 0 27 6 5 6 15. ,, 11, 7, 6, 4, 3 3 50 0 24 0 26 0 3 8 16. ,, 12, 10, 6, 3½, 3 mos. 4 60 0 30 0 30 0 4 3 It will be seen that the rents paid in nearly all the above eases are over 50 per cent. of the income : the net 113 income ranging from 1s. 7d. per head to 5s. 6d. per head for food, clothing, etc. I quote the following which appeared in " The Lancet " under the pen of Dr. G. P. Growden, M.Sc., M.R.C.S. Eng., in an article on " The Minimum Cost of Physiologically Adequate Diets for Working-Class Families":— " Information has been collected from various sources in order to determine the minimum cost of providing an adequate, well-balanced, varied, and physiologically sound diet per unit man-value per week, and, with this figure as a basis, the minimum cost of adequate food per week for families of varying size has been calculated. The sum of 7s. per week per man-value appears to be the absolute minimum of expenditure on food under the best possible conditions of household management and economic purchasing by the mother at the present time." It is therefore seen that the amount of money left in many of these families, after paying present day rent, is insufficent to provide a physiologically adequate diet to maintain the health of the family. Circumcisions.—During the year the Hammersmith Infant Welfare Association decided to discontinue the Circumcision Session. Arrangements were made for these cases to be referred by the Medical Officers at the Infant Welfare Centres to the West London Hospital. This scheme commenced in October, 1931. Seventeen cases were dealt with during the quarter ending December, 1931. The Council pays a fee of 2s. 6d. per case to the Hospital Authorities. 114 " PARKSIDE " MATERNITY HOME. I append figures for the year 1981 :— Name of Institution.—" Parkside " Maternity Home, Hammersmith Hospital, 150, Du Cane Road, W.12. Number of Beds.— 10 :— Information Required. Particulars.  (1) No of cases admitted during the year. 207. (2) Average duration of stay 14 days. (3) No of cases delivered by— (a) Midwives 200. (b) Doctors 7. (4) No. of cases in which Medical Assistance was sought by a Midwife in emergency. 10. (5) No. of cases notified as— (a) Puerperal fever — (b) Puerperal pyrexia (i.e., rise of temperature to 100·4°F. for 24 hours, or its recurrence within that period). - (6) No. of cases of Pemphigus Neonatorum. — (7) No. of Infants not entirely breastfed while in the Institution. 11. (8) No. of cases notified as Ophthalmia Neonatorum. — (9)—(a) No. of Maternal deaths 1. (b) Cause of death in each case Shock following expression of placenta. Retained products: labour (full term) chronic myocarditis. (10)—(a) No. of Fœtal deaths— (i) Stillborn 5. (ii) Within 10 days of birth. 7. (b) Cause of death in each case, and results of postmortem examination (if obtainable). 1. Cerebral Hæmorrhage; tentorial tear. 2. Cerebral Hæmorrhage. 3. Pulmonary Atelectasis. 4. Broncho-Pneumonia. 5. Haemorrhage from Cord. 6. Pulmonary Atelectasis 7. Cerebral Hæmorrhage, tentorial tear. 115 Queen Charlotte's Auxiliary Hospital, "Invermead," Goldhawk Road, W.12, 10 beds reserved for smith Borough Council cases. Information Required Particulars. (1) No. of cases admitted during the year (April to December). 114 to Invermead. 16 to Q.C.H. Marylebone Road. 130 (2) Average duration of stay 14·8 days. (3) Number of cases delivered by— (a) Midwives 108 Invermead plus 13 at Q.C.H. = 121 (b) Doctors 6 Invermead plus 3 at Q.C.H. = 9 (4) No. of cases in which Medical Assistance was sought by a Midwife in emergency. 10. (5) No. of cases notified as — (a) Puerperal Fever — (b) Puerperal pyrexia (i.e. rise of temperature to 100·4°F. for 24 hours, or its recurrence within that period). 2. (6) No. of cases of Pemphigus Neonatorum. — (7) No. of Infants not entirely breastfed while in the Institution. 7. (8) No. of cases notified as Ophthalmia Neonatorum. — (9)—(a) No. of Maternal deaths (b) Cause of death in each case — (10)—(a) Number of Fœtal deaths— (i) Stillborn 5 (ii) Within 10 days of birth 4 (including twins). (b) Cause of death in each case, and results of postmortem examination (if obtainable). Prematurity. 116 Voluntary Work Aided by Borough Council. Infant Welfare Centres.—There are three 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 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 part of Willesden. Day Nurseries.—Two day Nurseries in the BoroughPrincess Christian, the Latymer Road Mission Crechecontinue in great demand where mothers are compelled to work for the support of the family. These nurseries received grants-in-aid from the Council. Independent Voluntary Agencies. Rescue Homes.—There were three Homes open in the Borough throughout the year for the reception of Unmarried Mothers and their Children; the total accommodation available for such cases was 87 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. 117 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 — Minor Ailments 16 Dental Treatment 1 Total 17 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 5 9 5 - 4 Puerperal Pyrexia 30 24 30 1 24 Ophthalmia Neonatorum 12 14 12 2 7 Epidemic Diarrhæa *19 19 - - - Measles & German Measles (under 5)* 63 555 63 14 24 Whooping Cough (under 5)† 129 92 129 - 49 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. 118 Ophthalmia Neonatorum.—The number of cases reported was twelve, against fourteen 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. 5.2.31 - 1 1 - - - 24.3.31 — 1 1 — — - 1.4.31 — 1 1 — — 1* 20.4.31 1 — 1 — — - 24.4.31 — 1 1 — — - 27.4.31 1 — 1 — — - 18.6.31 1 — 1 — — - 17.7.31 — 1 1 — — - 7.10.31 — 1 1 — — - 4.11.31 — 1 1 — — - 9.11.31 1 — 1 — — - 28.11.31 - 1 1 — — - 4 8 12 — — 1 * a. Meningocele, b. Spina Bifida. Ophthalmia Neonatorum. All notified cases of diseases of parturient women and children under five years of age are visited immediately, and arrangements made for the attendance of a nurse where required. SANITARY ADMINISTRATION. Staff.—There are nine male Sanitary Inspectors and one lady Sanitary Inspector. Eight of the male Inspectors are employed as District Inspectors, being responsible for all matters excepting the taking of samples under the Sale of Food and Drugs Acts and the inspection of Ice Cream Vendors, for which the Special Inspector is responsible. The Special Inspector also inspects the Markets. The Lady Inspector inspects Factories, &c., where females are employed, makes enquiries into cases of measles, whooping cough, chicken pox, &c. 119 Two temporary Sanitary Inspectors were employed for the purpose of making house-to-house inspections of special roads approved by the Public Health Committee. Increase of Rent and Mortgage Interest Restrictions Act, 1920-1923.—During the year twenty-nine applications were received for certificates under the above Act. In twenty-five cases the certificates were granted, four applications were refused. Nine certificates were granted to owners who had carried out the work specified satisfactorily, two being refused. Public Mortuary.—One hundred and ninety-three bodies were removed to the Mortuary in Fulham Palace Road during the year. Hammersmith— Admitted by order of Coroner 156 Admitted by order of Police 13 Admitted on application of undertakers for accommodation 18 187 Bodies admitted from other Boroughs :— Fulham 2 Chelsea 4 Total 193 No. of P. M. examinations conducted :— Hammersmith cases 137 Fulham cases 2 139 No. of Inquests held :— Hammersmith cases 105 Fulham cases 68 Chelsea cases 82 Total Inquets held 255