CI AC 4347 HAM 24 Metropolitan Borough of Hammersmith. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1932. 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 9 Chart—Diarrhœa 10 Summer Diarrhœa 11 Hospital Treatment—Zymotic Enteritis 11 Danger from Flies 11 Deaths of Illegitimate Children 11 Infant Mortality for 1932 12 Deaths of Aged Persons 12 Statistics 13 Deaths of Residents 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 21 Maternity and Child Welfare Centres 25 Clinics and Treatment Centres 25 Day Nurseries 25 School Clinics 26 Tuberculosis Dispensary 26 Rheumatism Advisory Clinic 26 Treatment Centre for Venereal Diseases 27 Sanitary Circumstances of the Borouoh. Closet Accommodation 27 Scavenging 27 Fouling of Footpaths by Dogs 27 Nuisance by Dogs 27 Penalty28 General Sanitary Administration 28 Inspections 29 Notices 30 Page Summonses. Public Health Acts 31 Hammersmith Borough Council By-laws—Dogs 36 Vaccination Act, 1871, Section 7 36 Milk and Dairies Order, 1926 36 Public Health (London) Act, 1891—Dnsound Food 37 Factory and Workshop Act, 1901 37 London County Council (General Powers) Act, 1928 38 Factories and Workshops—Inspection of 39 House to House 41 Smoke Abatement 41 Bats and Mice (Destruction) Act, 1919 42 Controlled Premises and Occupations 42 Tenement Houses 43 Houses Let in Lodgings 43 Housing Act, 1925—Section 18 43 Vans 43 Ice Cream Vendors 43 Schools 44 Bag Flock Acts, 1911 and 1928 44 Housing. Statistics 45 General Housing Conditions 48 Supply of Houses—Overcrowding 48 Newly Erected Houses 49 Inspection and Supervision op Food. Food Supplies 51 Milk Supply 52 Milk (Special Designations) Order, 1923 52 Certification of Certain Food Products for Export 53 Public Health (Meat) Begulations, 1924 54 Inspection of Carcases of Animals slaughtered in Looal Slaughterhouses 55 Licensed Slaughterhouses 55 Markets 56 Street Trading 57 Fried-fish Shops 58 Bakehouses 58 Unsound Food 60 Food Surrendered 61 Clinical and Bacteriological Examination of Food 61 Food and Drugs Adulteration Act, 1928 62 Milk 64 Condensed Milk 65 Cream 65 Butter, Margarine and Lard 65 Inspection and Sofbbvision of Food—continued. Page Cheese 65 Meat and Fish Preparations 66 Conserves, Vegetables, Fruits, &C. 66 Cocoa, Coffee and Tea 66 Farinaceous Foods 66 Condiments, &c.66 Cordials and Spirits 66 Drugs 67 Prevalence and control over infectious diseases. Infectious Diseases 69 Bacteriology 69 Zymotic Diseases 70 Notifiable Diseases 71 Smallpox 72 Cholera 72 Plague 72 Diphtheria nnd Diphtheritic Membranous Croup72 Anti-toxin 72 Scarlet Fever 72 Chart—Diphtheria 73 Chart—Scarlet Fever 74 Enteric Fever 75 Erysipelas 75 Typhus Fever 75 Relapsing Fever 76 Continued Fever 75 Puerperal Fever 75 Puerperal Pyrexia 75 Cerebro-Spinal Meningitis 76 Acute Polio-myelitis 76 Encephalitis Lethargica 76 Ophthalmia Neonatorum 76 Anthrax 76 Hydrophobia 76 Babies Order, 1919 76 Glanders 76 Measles and German Measles 77 Measles—Chart 77 Whooping Cough 77 Chart—"Whooping Cough 78 Chicken Fox 78 Pneumonia 79 Malaria 79 Dysentery 79 Foo4 Poisoning 9 Influenza. 79 Wrong Diagnosis 79 Prevalencb and Contbol over Infectious Diseases—continued. Page Psittacosis 80 Cleansing of Verminous Persons 80 Tabular Statement—Zymotic Diseases 81 Disinfection 82 Vaccination 82 Vaccination Returns 83 Public Health (Smallpox) Regulations, 1917 85 Tuberculosis 85 Public Health (Prevention of Tuberculosis) Regulations, 1925 88 Tuberculosis Dispensary 88 Tuberculosis Care Committee 96 Report on Tuberculosis Work at Hammersmith Hospital 97 X-Ray Work 99 Artificial Pneumothorax Treatment 99 Prevention of Blindness100 Exhumation and Re-interment of Bodies101 Public Baths 101 Health Education. Propaganda 102 Maternity and Child Welfare Statistics 103 Health Visitors—Work of 104 Feeding of Infants—Statistics 105 Table—Births, Deaths, and Infant Death Rate 105 Schedule of Attendances at Infant Welfare Centres 106 Chart—Infantile Mortality Rate 107 Artificial Light Treatment 107 Light Treatment Centre 108 Milk (Mothers and Children) Orders, 1918-1919 108 Nutrition of Expectant Mothers 109 Nutrition of Children 110 Grant-Aided Midwifery Service 113 Circumcisions 114 " Parkside " Maternity Home—Statistics 115 " Invermead " Maternity Home—Statistics 116 Voluntary Work. Infant Welfare Centres 117 Day Nurseries 117 Rescue Homes 117 Convalescent Treatment of Invalid Children 117 Treatment and Nursing—Children under School Age 118 (a) Operations. (6) Minor Ailments, (e) Dental Treatment. Infectious Diseases of Mothers, and Children under five years of age—Tabular Statement 118 Ophthalmia Neonatorum 119 Sanitary Administration. Staff 119 Rent Restrictions Acts 120 Public Mortuary 120 Cremation 121 Metropolitan Borough of Hammersmith. ANNUAL REPORT of the Medical Officer of Health for the YEAR 1932. 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 1982. 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 included directly or indirectly relate to the Public Health of the Borough. The death-rate of 12.8 is 0.6 per thousand greater than the rate for the previous year. The infantile mortality rate is 66 per 1,000 births. The lowest rate was 61 per 1,000 births in 1927. " Parkside and " Invermead " Maternity Homes continue to be a great boon to those mothers who have no suitable accommodaton in their own homes. The number of confinements in 1982 amounted to 416. It is an obligation on every expectant mother booked tor " Parkside " or " Invermead " to attend the antinatal centre 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 above the average for the past ten years. 3 This is accounted for by the increase in the number of cases of scarlet fever 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. The special house-to-house inspection was discontinued in May. During the year a survey of the Public Health Services of the Borough was carried out by the Medical Officers of the Ministry of Health, and a report thereon was forwarded in November, 1982. The report stated that " the Council are maintaining a reasonable standard of efficiency and progress in the discharge of their functions relating to public health." The Minister thought it desirable, however, to draw attention to certain points. These points have been considered by the appropriate Committees, and suitable action has been taken in regard to some; others are still under discussion. 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 1982. Medical Officer of Health and Year of Administrative Tuberculosis Officer. Anpoinlment J. B. Howell, M.R.C.S., L.R.C.P., D.P.H. 1914 Deputy 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 Gynecologists. 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. Froesard, 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 †Miss E. Cole 1923 A. H. Johns 1925 F. G. Holland (Vaccination Officer) 1929 E. F. Yorke 1931 T. J. Hares 1932 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 (appointment terminated May, 1932) 1930 øW. C. Turner (appointment terminated May, 1932) 1931 Lady Sanitary Inspector. ║⁪⁪⁪”*Mis8 E. M. Cross 1932 Health Visitors. ˝║†*Miss R. A. Henry 1916 ║*Miss A. M. M. Willcox 1916 ˝||Miss D. G. Johnson 1922 ∆˝║Miss C. M. Henniker 1929 Tuberculosis Dispensary Staff. ║Mrs. Cameron (Nurse Visitor) 1924 ˝║Miss Murphy (Nurse Visitor) 1924 ¶Miss N. Rees {Dispenser and Secretary) '1918 Miss V. Day {Junior Clerk) '1932 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). *Wert. Sanitary Inspectors Examination Board. Cert. Central Midwives Board. §Ceri- 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. ADiploma in Nursing, London University. 7 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1932. Area 2,282.5 acres Population (1982) (estimated) 138,700 Population Census (1901) 112,239 „ „ (1911) 121,521 „ „ (1921) 180,295 „ „ (1981) 185,521 Natural increase, i.e., excess of births over deaths 226 Density of population 58.6 persons per acre Marriages registered 1,235 Number of inhabited houses 1981 17,402 Number of families or separate occupiers (1921) 33,263 Rateable value (1982) £1,144,018 Sum represented by a penny rate, 1982 £4,650 Vital Statistics. Births (legitimate) 1,807 ,, (illegitimate) 183 birth rate 14.5 Stillbirths 71 death rate 12.8 Deaths (corrected) 1,714 Number of women dying in, or in from sepsis 3. consequence of childbirth from other causes 4. Deaths of infants under one year of age per 1,000 births 66 Legitimate, 60. Illegitimate, 150. Deaths from measles (all ages) 29 Deaths from whooping cough (all ages) 6 Deaths from diarrhoea (under 2 years of age) 26 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 ;he Borough to he 180,295, 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., 133,700. The corrected number of births registered was 1,940, whilst the corrected number of deaths of residents was 1,714, thus showing a natural increase of population by excess of births over deaths of 226. The area of the Borough is 2,282.5 acres, there being 58.6 persons to the acre. Marriages.—The number of marriages registered during the year was 1,235, the marriage rate being 18. Births.—During the year 1,795 births were registered in the Borough. Adding 396 births which occurred, outside the Borough, transferred by the Registrar-General as belonging to Hammersmith, and deducting 251 births which occurred in tihe Borough, and transferred to other districts by the Registrar-General, the corrected number of births for the year was 1,940. On the estimated population, i.e., 133,700, the corrected number of births registered was equal to an annual rate of 14.5 births per 1,000 persons living. The Rirth-rate for the year is 0.8 per 1.000 less than the rate for the previous year, which was 15.8. The Birth-rate in London on the estimated population, i.e., 4,357,000, was equal to an annual rate of 14.2 births per 1,000 persons living. 9 Notification of Births Act, 1907. Births notified 2,112 Corrected number of births 1,940 Notification Received from Midwives. Doctors. Lying-in Hospitals. Poor Law Institutions. Parents. M.O.H.'s. 919 171 338 172 5 7 Total notifications received, 2,112. Deaths.—During the year 1,465 deaths were registered in the Borough, as compared with 1,567 in the previous year. Adding 52'2 deaths of residents of this Borough which occurred in general hospitals and other public institutions, and 21 deaths of residents transferred by the Registrar-General as having occurred in various parts of England, and deducting 279 deaths of non-residents and 15 transferable deaths which occurred in the Borough, the corrected number of deaths of resdents was 1,714 (868 males, 846 females). On the estimated population, i.e., 188,700, the corrected number of deaths of residents was equal to an annual rate of 12.8 deaths per 1,000 persons living. The Death-rate in London on the estimated population, i.e., 4,857,000, was equal to an annual rate of 12.8 deaths per 1,000 persons living. Deaths of Infants.—The corrected number of deaths of residents under one year of age registered during the year was 129, as compared with 140 in the previous year. The number of deaths of infants under one year of age was equal to 66 per 1,000 of the corrected births and to 75 per 1,000 of the corrected deaths. The number of deaths of infants under one year of age, residents in London, was equal to 66 per 1,000 of the total registered births. 10 The following Chart shows the number of deaths from Diarrhoea per 100,000 inhabitants, 1911-1932. 11 The mortality rate of infants under one year of age was, as compared with the total births registered, the same in this Borough as in London. Summer Diarrhoea.—The number of deaths from Diarrhoea was 26, being 8 more than in the previous year. Twenty 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 20 or at the rate of 150 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 60 per 1,000 whilst the latter is 150 per 1,000, a difference of 90 per 1,000. 12 The following table on infantile mortality has been prepared in accordance with the direction of the Ministry of Health. INFANT MORTALITY 1932. Infantile Mortality during the year 1932. 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 Week?. 4 Weeks, and under 3 months. 3 months an 3 under 6 months. 6 months and under 9 months. 9 months and under 1 year. Total Deaths under 1 Year. ALL CAUSES. Certified 40 8 5 4 57 24 15 16 17 12?) Uncertified — — — — — — — — — — Small-pox — — — — — — — — — — Chicken-pox — — — — — — — — — — Measles — — — — — — — 2 1 3 Scarlet Fever — — — — — — — — — — Whooping Cough — — — — — — — 1 2 3 Diphtheria and Croup — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — 1 — 1 Abdominal Tuberculosis — — — — — — — 1 — 1 Other Tuberculous Diseases — — — — — — — — — — Meningitis (not T.B.) — — — — — — 1 1 2 4 Convulsions — 1 — — 1 1 — — — 2 Laryngitis — — — — — — — — — — Bronchitis — 1 — — 1 5 9 — 1 9 Pneumonia (all forms) — 1 — — 1 4 7 5 6 23 Diarrhœa — — — — — 1 — 1 — 2 Enteritis — — 2 — 2 3 5 3 5 18 Gastritis 1 — — — 1 — — — — 1 Syphilis — — — — — — — — — — Rickets — — — — — — — — — — Suffocation, overlying — — — — — 1 — — — 1 Injury at Birth — — — — — — — — — — Atelectasis 6 — — — 6 — — — — 6 Congenital Malformations 1 1 — 2 4 2 — — — 6 Premature Births 29 4 3 1 37 2 — — — 39 Atrophy, Debility & Marasmus Other causes — — — 1 1 4 — — — 5 3 — — — 3 1 — 1 — 5 Totals 40 8 5 4 57 24 15 16 17 129 Nett Births in the Yeab : Legitimate, 1807; Illegitimate. 133. Nett Deaths in the Year OP: Legitimate Infanta, 109 Illegitimate Infants, 20. Deaths of Aged Persons.—The corrected number of deaths of residents at 65 years of age and upwards registered during the year was 759, against 725 in the previous year. These deaths were equal to 5.7 per 1,000 of the total persons living, and 423 per 1,000 of the total deaths of residents registered. 13 Statistics.—The following table gives the statistics of the Borough during 1982 and the previous ten years :— Vital Statistics of Whole District during 1932 and Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. of Non-residents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate 1 2 3 4 5 6 7 9 10 11 12 13 1922 134400 2564 2758 20.5 1223 9.1 196 705 196 71 1733 12.9 1928 133600 2571 2701 20.2 981 7.3 125 649 173 64 1473 11.0 1924 134200 2199 2399 17.9 1123 8.4 173 718 173 72 1668 12.4 1925 134500 2178 2351 17.6 1034 7.7 186 756 153 65 1604 11.9 1926 134400 2001 2188 16.3 1174 8.7 195 55f 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 136910 1869 2162 15.8 1757 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 1932 133700 1795 1940 14.5 1465 10.9 294 543 129 66 1714 12.8 Deaths of Residents.—Belonging to the Borough, occurring in Public Institutions, &c., in districts outside, during the year 1982 :— FEVER HOSPITALS. Acton Isolation Hospital 1 Brook Hospital, Woolwich 2 Grove Hospital, Tooting 6 Joyce Green Hospital 1 Northern Hospital 2 North-Western Hospital 2 Park Hospital, Lewisham 2 South-Eastern Hospital 1 South-Western Hospital 2 Western Hospital 21 40 MENTAL HOSPITALS. Tooting Bee Hospital 13 1, West Park Road 4 The Hospital, Cane Hill 5 1, Uxbridge Road, Hanwell 17 Horton Hospital 7 The Forest, Hook Road 2 Hundred Acres, Banstead 4 Edmonton Colony 3 la, Manor Road. Ilford 1 63, Christchurch Road 1 1, Bexley Lane 1 Metropolitan Hospital, Caterham 1 69 14 GENERAL HOSPITALS. Acton Hospital 5 Grove Park, Bromley 8 Westminster Hospital 1 St. Thomas's Hospital 3 Chiswick Hospital 1 Hospital for Women, Chelsea 1 Guy's Hospital 1 National Hospital, Queen Square 3 Manor House Hospital, Golder's Green 3 St. Bartholomew's Hospital 4 Golden Square Throat, Nose and Ear Hospital 1 Consumption Hospital, Brompton 4 Princess Louise Hospital 4 Queen Mary's Hospital, West Ham 1 St. John's Hospital, Twickenham 1 Home & Hospital for Jewish Incurables 1 Nursing Home, Penton Road, Staines 1 1, The Terrace, St. Pancras 1 Middlesex Hospital Annexe 1 St. John's Hospital, Morden Hill, Lewisham 2 Infants' Hospital, Vincent Square 3 Middlesex Hospital 4 Royal Ear Hospital 1 St. George's Hospital 12 St. Mary's Hospital 12 Colindale Hospital, Hendon 2 London Hospital 1 St. Luke's Hospital 3 II, Grange Park 1 Boyal Waterloo Hospital 1 Children's Hospital, Gt. Ormond Street 1 Samaritan Free Hospital for Women 1 St. Andrew'8 Hospital 1 Hospital of St. John and St. Elizabeth 2 Queen Charlotte's Hospital 1 University College Hospital 6 St. Mary's Nursing Home 1 Cancer Hospital 4 Charing Cross Hospital 3 St. Joseph's Hospice for the Dying 2 St. Mary's Hospital, Chiswick 1 20, Glazbury Boad 2 National Hospital for Diseases of the Heart 2 Empire Nursing Home, Westminster 1 Victoria Hospital for Children, Tite Street 1 Twyford Lodge, Acton Lane 1 Children's Hospital, Padding- ton Green 1 Grove Park Hospital, Lewisham 1 18, Bentinck Street 1 385, High Road, Chiswick 1 Radium Institute 1 Homoeopathic Hospital 1 Queen Mary's Hospital, Car- shalton 1 Invalids' Home, Highbury 1 Battersea General Hospital 1 King Edward's Hospital, Ealing 1 122 OTHER INSTITUTIONS. Fulham Hospital 5 369, Fulham Road 10 103, St. DunBtan's Road 15 48, Constance Road, S.E.5 1 250, King's Road, Chelsea 1 The Infirmary, Friern Barnet 2 Redhill House, Edgware 1 30, Twickenham Road, Isleworth 2 28, Marloes Road 143 12, Exmoor Street 80 93, Sydney Street 7 285, Harrow Road 8 1, Northumberland Street 3 Lambeth Hospital 1 4, King's Road, St. Pancras 2 la, Shepherdess Walk 1 Bancroft House, Bancroft Road 1 283 15 VARIOUS. 42, Drewstead Road, Wandsworth 1 54, Mount Pleasant Road, Willesden 1 On Foreshore of River Thames by Bishop's Park 1 In River Thames near Price's Wharf, Battersoa 1 80, Hendon Lane, Finchley 1 In Ambulance at Acton Hospital 1 12, Foubert's Place, Westminster 1 33, Hanworth Road, Sunbury 1 On the way to 28, Marloes Road 1 107, Nightingale Lane, Wandsworth 1 124, Baron's Court Road 1 24, Underwood Street 1 River Thames 1 In garden of Baring Hall Hotel, Lewisham 1 4, Colwith Road, Fulham 1 On the way to Middlesex Hospital 1 29, North Side, Wandsworth 1 On the way to St. George's Hospital 1 18 TABLE II. Causes of, and Ages at, Death during the Year 1932. METROPOLITAN BOROUGH OF HAMMERSMITH. Causes of Death.. Sex. All Ages. 0— 1- 2— 5— 15- 25— 35- 45- 55- 65- 75- All Causes M 868 74 15 18 31 33 47 47 107 170 181 145 F 846 55 10 21 14 34 37 44 71 127 170 263 1 Typhoid and Paratyphoid Fever M .. .. .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. .. .. .. 1 .. .. 2 Measles M 14 1 5 .. .. .. .. .. .. .. .. F 15 2 7 4 2 .. .. .. .. .. .. .. 3 Scarlet Fever M 3 .. .. 1 2 .. .. .. .. .. .. .. F 1 .. .. .. 1 .. .. .. .. .. .. .. 4 Whooping Cough M 2 1 1 .. .. .. .. .. .. .. .. .. F 4 2 .. 2 .. .. .. .. .. .. .. .. 5 Diphtheria M 4 .. .. 3 1 .. .. .. .. .. .. .. F 4 .. .. 3 1 .. .. .. .. .. .. .. 6 Influenza M 21 .. .. .. .. .. 2 1 7 2 3 6 F 22 .. .. .. .. .. .. 1 .. 5 7 9 7 Encephalitis Lethargien M 1 .. .. .. .. .. .. .. .. .. 1 .. F .. .. .. .. .. .. .. .. .. .. .. .. 8 Cerebo-spinal Fever M 6 1 .. .. 1 1 .. 2 1 .. .. .. F 2 2 .. .. .. .. .. .. .. .. .. .. 9 Tuberculosis of Respiratory System M 85 .. 1 .. 2 13 20 13 16 13 7 .. F 50 .. .. .. 1 19 11 5 5 4 5 .. 10 Other Tuberculous Diseases M 14 .. 1 2 3 2 2 1 1 1 .. .. F 7 1 .. 1 .. .. 1 2 2 .. .. .. 11 Syphilis M 2 .. .. .. .. .. .. .. .. 2 .. .. F 3 .. .. .. .. .. .. .. 2 1 .. .. 12 General Paralysis of the insanetabes dorsalls . M 5 .. .. .. .. .. .. 1 4 .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 13 Cancer, malignant disease. M 92 .. .. .. .. 1 4 2 11 37 26 11 F 114 .. .. .. 1 2 2 7 20 34 27 21 14 Diabetes M 9 .. .. .. .. .. .. 1 1 .. 6 1 F 6 .. .. .. .. .. .. .. .. .. 6 .. 15 Cerebral Haemorrhage, &c,. M 26 .. .. .. .. .. .. .. 1 6 14 5 F 28 .. .. .. .. .. .. .. 1 9 9 9 16 Heart Disease M 189 .. .. .. .. 1 1 8 22 49 51 57 F 214 .. .. .. .. 4 5 6 11 25 63 100 17 Aneurysm M 1 .. .. .. .. .. .. .. .. .. 1 .. F 3 .. .. .. .. .. 1 .. .. 1 .. 1 18 Other circulatory diseases F 38 .. .. .. .. 1 .. 1 1 5 17 13 F' 48 .. .. .. .. .. .. 1 7 10 12 18 19 Bronchitis M 41 6 1 .. .. .. .. 2 6 8 10 8 F 39 3 .. 2 .. .. 1 .. 2 1 11 19 20 Pneumonia (all forms) M 47 17 .. .. 2 2 2 2 9 5 6 2 F 67 6 3 2 .. 1 1 5 9 11 14 15 21 Other Respiratory Diseases F 8 .. .. .. .. 1 2 1 2 .. 1 1 F 7 .. .. .. .. 1 .. 1 .. 1 1 3 22 Peptic Ulcer M 15 .. .. .. .. 1 2 .. 5 5 1 1 F 2 .. .. .. .. .. .. .. .. 2 .. .. 23 Diarrhœa, &c. M 15 12 1 .. 1 .. .. .. .. .. 1 .. F 11 8 .. 2 .. .. .. 1 .. .. .. .. 24 Appendicitis M 7 .. .. .. .. .. .. .. 3 1 .. .. F 2 .. .. .. .. .. 1 1 .. .. .. .. 25 Cirrhosis of Liver M 3 .. .. .. .. .. .. .. 1 .2 .. .. F 2 .. .. .. .. .. .. .. 1 .. 1 .. 26 Other Diseases of Liver, &c. M 3 .. .. .. .. .. 1 .. 1 .. l .. F 5 .. .. .. .. .. .. 2 .. 1 l 1 27 Other Digestive Diseases M 14 1 .. 1 1 1 .. 1 3 1 4 I F 13 .. .. 1 1 .. .. .. 2 1 2 6 28 Acute and Chronic Nephritis M 24 .. .. .. .. 2 2 2 1 6 5 6 F 20 .. .. .. .. 1 1 l 1 5 3 8 29 Puerperal Sepsis F 3 .. .. .. .. .. 3 .. .. .. .. .. 30 Other Puerperal Causes F 4 .. .. .. .. 1 1 2 .. .. .. .. 31 Congenital Debility, Premature Birth, Malformations, &c. M 33 12 .. .. .. .. .. .. 1 .. .. .. F 30 29 1 32 senility M 11 1 1 9 F 43 .. .. .. .. .. .. .. .. .. 2 41 33 Suicide M 13 .. .. .. .. 1 .. 2 3 3 4 .. F 5 .. .. .. .. .. 2 1 .. 1 .. 1 34 other violence M 33 1 .. 3 5 1 5 .. 3 5 4 6 F 15 l .. 2 3 2 .. .. 1 3 .. 3 35 Other defined diseases M 89 1 2 2 13 3 4 7 4 18 17 18 F 56 l .. 2 4 3 7 8 6 11 6 8 36 Causes ill-defined or unknown M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Total 1,714 129 25 39 45 67 84 91 178 297 351 408 17 This rate is calculated on the estimated population of each Ward. Ward. Estimated Population. No. of Deaths. Death Rate. No. 1 River 17,557 264 15.0 No. 2 Brook Green 25,689 309 12.0 No. 3 The Grove 22,837 277 12.1 No. 4 St. Stephens 9,184 132 14.4 No. 5 Starch Green 22,654 286 12.5 No. 6 Wormholt 23,712 311 13.3 No. 7 College Park and Latimer 12,067 135 11.2 LONDON AND METROPOLITAN BOROUGHS. Cities and Borocghs. Estimated population. Births. Annual rate per 1,000 persons living. Deathrate per 1,000 living. Infantile Mortality rate per 1,000 births. West Districts. Paddington 143,600 13.8 13.3 107 Kensington 183,500 12.9 13.6 98 Hammersmith 133,700 14.5 12.8 g6 Fulham 149,600 14.3 12.4 58 Chelsea 59,430 11.9 12.9 52 City of Westminster 126,400 9.1 12.3 66 North Districts. St. Marylebone 96,430 11.0 12.4 87 Hampstead 90,130 10.9 11.6 54 St. Pancras 194,000 13.8 13.1 69 Islington 324,600 15.3 12.4 68 Stoke Newington 51,680 15.0 12.9 53 Hackney 214,200 14.5 11.5 54 Central Districts. Holborn 36,440 9.6 14.2 72 Finsburv 69.030 16.0 13.4 81 City of London — 6.5 10.2 46 En.it Districts. shoreditch 95,800 17.5 12.3 80 Bethnal Green 106,300 15.4 12.0 69 Stepney 223.000 16.7 12.3 62 I'orilar 152,400 17.2 12.1 63 South Districts. South wark 168,900 16.2 13.1 72 Bermondsey 110,100 16.6 12.0 56 Lambeth 292,300 14.7 12.5 56 Battersea 157,000 14.8 12.1 58 Wandsworth 353,300 11.9 11.6 62 Camberwell 248.000 14.6 12.0 65 Deptford 105,100 15.9 12.2 65 Greenwich 99,590 14.7 11.8 80 Lewisham 221,500 12.7 10.2 54 Woolwich 146,900 14.0 11.1 60 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 .£250 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 £125 Midwives.—The London County Council is the supervising authority under this heading. I am informed by the County Medical Officer of Health that 80 midwives gave notice of their intention to practise in the Borough during 1932. 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 bacilli 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, Deputy 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 Eoad, 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.—Yes. (2) X-ray.—Yes. (3) Dental.—Yes. (4) Ophthalmic.—Yes. (5) Massage.—Yes. 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 1932 :—Admissions = 3,354 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 :—72 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 24 25 General Surgical 63 53 Children 26 Venereal Diseases 4 4 Ear, Nose and Throat 2 3 Skin Diseases 2 2 Other (Private Wing) (Mixed) 26 Facilities available for:— . - 2 Major Operation Theatres. (1) Operative Surgery.— 2 Minor ,, ,, (2) X-Rav.—Diagnostic and Therapeutic Departments. (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. No. of -patients during 1932.—3,764 In-patients and 36,563 out-patients and 347,510 out-patients attendances. Is the hospital provision for the area adequate?—There is always an average of about 300 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. Management:—Voluntary Agency. No. of beds available for the following services:— Maternity 20 Puerperal Fever and Pyrexia 30 Nurseries for 30 babies. Facilities available for:— (1) Operative Surgery — Fully equipped Theatre, Anaesthetising and Recovery Rooms. (2) X-Ray—By arrangement with St. Mary's Hospital. (3) Dental—No Dental Clinic, but services of Hospital Hon. Dental Surgeon available. (4) Ophthalmic—No Ophthalmia Clinic, but services of Hospital Hon. Ophthalmic Surgeon available. (5) Massage—By outside masseuse. No. of patients during 1932 :—360 at " Invermead," 251 at Isolation Block. Isolation Block: — (а) 7 per cent. Hammersmith patients, 93 per cent. resident outside area. Auxiliary Hospital :— (b) 52 per cent. Hammersmith patients, 48 per cent. resident outside area. Name:-St. John's Hospital for Skin Diseases. Situation:—262, Uxbridge Road, W.12. Purpose:—For Skin Diseases. No. of available beds:—40. 22 If used by persons resident outside the area, in what proportion:—Mostly outside area. Management —The Board of Management for St. John's Hospital for Diseases of the Skin. 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. (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 1932:—305 in-patients, 11,704 outpatients. Is the hospital provision for the area adequatel— The In-patients' Department has recently been enlarged and now serves the purpose. Name:- Freemasons' Hospital. The Freemasons' Hospital adjoining Ravenscourt Park is nearing completion, and will be opened for the reception of patients in October. The building is of modern architecture and design, and will provide accommodation for 180 to 200 patients. Whilst this hospital may be described as a private insti¬tution, the treatment of patients therein will relieve the calls upon the voluntary hospitals. 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. 23 Hammersmith and Chiswick Refuge for Friendless Girls, 36, Glenthorne Road, W.6.—Accommodation for 8 mothers and their infants. Supported by voluntary sub¬scriptions. 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 abnor¬mality, was continued upon the following terms: — (1) That the patient must be a resident of Hammer¬smith. (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. (8) The Borough Council pay the fees of the Consul¬tant, 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, three from Puerperal Sepsis and four 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 complica¬tions, if any. 24 (2) Ante-natal care, including number of consultations and examination of urine, with the result. (3) Description of Labour and Puerperium. (4) Remarks of Medical Officer of Health. Special information is obtained in cases of abortion, toxaemias of pregnancy, hæmorrhage, difficult labour and puerperal sepsis. The number of Maternal Deaths during the past thirteen 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 1930 5 4 2 5 2,162 2,173 3.3 4.1 1931 2 6 2,073 3.4 1932 3 4 1,940 3.6 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. Ambulances for accident cases are provided by the London County Council. 25 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 Bond.—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. DAY NURSERIES. Latymer Road Day Nursery.—Provides accommoda¬tion 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. 26 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 the basis of a capitation fee. Dental Clinics.—Dental Clinics are held at the Old Oak Welfare Centre and 103, Shepherd's Bush Road, 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 (see page 88). Grants are received from the Ministry of Health and the Loudon County Council. 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 65 Hammersmith patients were treated at the Clinic, 11 being admitted as in-patients and 54 as out-patients. New patients, 1932 27 Old patients, 1932 38 Total number of attendances, 1932 193 27 TREATMENT CENTRE FOR VENEREAL DISEASES. West London Hospital, Hammersmith Road. The above centre is provided under the scheme of the London County Council. 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 govern¬ment of the Borough in pursuance of Section 23 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. 28 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 con¬tinuing its provision has been duly made and come into force before that date. This Bye-law ceased to be in force on the 1st Septem¬ber, 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 four summonses were taken, when fines of 10s. were imposed in two cases and 5s. in two cases. Sanitary Inspection of the Area.—The general sani¬tary condition of the Borough has been improved to some extent. Ninety-three 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 29 Borough Council have provided many houses, but overcrowded conditions still exist. Inspections.—The following table shows the number of visits made in each district under the various inspection head :— NUMBER OF INSPECTIONS MADE DURING 1932. Cause of Inspection. Districts. 1 2 3 4 5 6 7 8 Lady Sanitary Inspector Food and Drugs Inspector House to House Inspectors Total. Infectious Disease 102 172 160 140 149 124 287 159 1,890 4 .. 3,187 Complaints 425 480 501 479 373 600 192 450 577 2 4,079 Houses let In Lodgings 10 .. .. .. .. .. .. .. .. .. .. 10 * House to House 12 4 24 18 12 7 14 62 .. .. 1,124 1,277 Housing and Town Planning Act .. .. .. .. .. .. .. .. .. .. .. .. House to House Consolidated Regulations 5 39 32 60 27 5 2 10 .. .. .. 180 Food (other than Restaurants and Eating Houses) 316 362 239 452 173 198 655 331 .. 1,313 .. 4,039 Restaurants and Eating Houses 82 135 73 49 12 35 127 81 .. 158 .. 752 Markets 17 20 278 36 11 260 33 262 .. 546 .. 1,463 Slaughterhouses 2 .. 171 157 .. 15 .. .. .. 10 .. 355 Poultry Slaughterhouses .. 12 .. .. .. .. .. .. .. 6 .. 18 Bakehouses 62 51 37 108 62 72 25 36 .. 61 .. 514 Milk Vendors 268 137 44 153 93 20 61 99 .. 410 .. 1,285 Ice Cream Vendors 1 14 2 .. 1 .. 218 .. 236 Factories (including Factory Laundries) 60 26 51 80 21 67 44 134 113 .. .. 596 Workshops (including Workshop Laundries) 36 36 12 53 2 14 14 21 157 .. .. 345 Workplaces (other than Outworkers) 17 3 54 71 1 7 16 21 99 .. .. 289 Outworkers 8 6 .. 2 1 3 8 .. 280 .. .. 308 Public Urinals 79 122 97 44 153 106 74 162 59 .. .. 896 Smoke Observations .. 9 .. 1 20 29 2 39 .. .. .. 100 Drainage 971 1,656 778 642 602 448 434 605 .. .. 67 6,203 Miscellaneous 244 275 82 461 158 211 707 236 420 528 .. 3,322 Re-visits 1,841 1,404 2,155 1,850 2,306 2,613 1,298 1,953 453 .. 434 16,307 Totals 4,558 4,963 4,788 4,858 4,176 4,835 3,993 4,661 4,048 3,256 1,625 45,761 30 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 3,187 254 217 Complaints 4.079 1,693 1.856 House to House 1,277 1,234 2,426 Housing Acts — — 1 House to House Consolidated Regulations 180 69 90 Food (other than Restaurants) 4.039 62 69 Restaurants, &c. 752 34 28 Markets 1,463 — — Slaughterhouses 355 — — Poultry Slaughterhouses 18 1 1 Bakehouses 514 18 13 Milk Vendors 1,285 12 14 Ice Cream Vendors 236 1 1 Factories 596 39 40 Workshops 345 24 29 Workplaces 289 21 17 Outworkers 308 8 6 Public Urinals 896 10 11 Smoke Observations 100 14 14 Drainage 6,203 47 38 Miscellaneous 3,322 109 66 Re-visits 16,307 533 551 Total 45,761 4,184 5,475 During the year 1,655 Statutory Notices were served and 1,606 complied with. In several instances it was necessary to take proceed¬ings in order to enforce compliance with Notices served. 31 The following table shows the result of proceedings taken:— SUMMONSES—YEAR 1932. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 33, Lena Gardens Failing to comply with Statutory Notice 2 1. Withdrawn. 10s. 6d. costs 2. Withdrawn. 10s. 6d. costs 152, Sulgrave Road ditto 2 1. Withdrawn. 10s. 6d. costs 2. Withdrawn 10, Boundary Road ditto 1 Fined £3 6, King's Parade ditto 2 Withdrawn 55, Westville Road ditto 1 Withdrawn 62, Percy Road ditto 1 Order made 14 days 30, Mardale Street ditto 4 1. Order made 28 days 2. Order made 28 days 3. Order made 28 days 4. Fined £2 65a, Adelaide Road ditto 1 Order made 21 days 3, Iffley Road ditto 1 Order made 21 days. 3s. costs 5, Iffley Road ditto 1 Order made 21 days 24, Havelock Road ditto 2 1. Order made 21 days 2. Fined £2. 41, Hadyn Park Road ditto 1 Withdrawn 39, Hadyn Park Road ditto 4 Withdrawn 56, Nasmyth Street ditto 1 Order made 21 days. 2s. costs 14, Southbrook Street ditto 2 1. Fined £2 10s. 2. Fined £2 10s. 32, Tunis Road ditto 2 Withdrawn. Nuisance abated. 13s. 4d. costs 81, Davisville Road ditto 1 Withdrawn 9, Alexandra Road ditto 1 Order made 14 days 68, Tunis Road ditto 2 1. Order made 14 days 2. Fined 10s. 12, Southbrook Street ditto 1 Withdrawn 32, Southbrook Street ditto 1 Withdrawn 44, Hadyn Park Road ditto 3 Withdrawn 46, Hadyn Park Road ditto 3 Withdrawn 48, Hadyn Park Road ditto 2 Withdrawn 32 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summons Result of Proceedings. 52b, Addision Gardens 56, Chancellors Road Failing to comply with Statutory Notice Failing to deposit plans relating to drainage work 1 1 Fined 10s. Fined 10s. ditto Failing to give notice to Sanitary Authority I Fined 10s. 165, The Grove Failing to deposit plans relating to drainage work 1 Fined 10s. ditto Failing to give notice to Sanitary Authority 1 Fined 10s. ditto Construction of Soilpipe 1 Fined 10s. ditto Non-compliance with bye-laws in constructing w.c. 1 Fined 10s. 1, Southerton Road Failing to comply with Statutory Notice 1 Withdrawn 27, Lena Gardens ditto 1 Order made 7 days 4, Lena Gardens ditto 3 Withdrawn 15, Sinclair Gardens ditto 1 Order made 7 days. 10s. costs 150a, Latimer Road ditto 2 1. Order made 7 days 2. Fined £2 48, Warbeck Road ditto 1 Order made 14 days. 62, Percy Road ditto 1 £1 1s. costs 9, Goodwin Road ditto 1 Order made 7 days 49, Cathnor Road ditto 1 Withdrawn. 84, Cathnor Road ditto 2 £1 Is. costs 3, Bulwer Street ditto 1 Withdrawn. 10s. 6d. costs 117, Becklow Road ditto 1 Withdrawn 14, Boundary Road ditto (overcrowding) 2 Order made for abate¬ment in 28 days 4, Letchford Gardens ditto 1 Withdrawn 42, Hadyn Park Road ditto 3 Withdrawn 77, Sinclair Road ditto 1 Withdrawn 8, Netherwoodj Road ditto 1 Withdrawn 27, Southerton Road Unlawful construction of drain 1 Fined £1 49, Milson Road Failing to comply with Statutory Notice 1 Fined £2 33 Summonses—continued. Situation of Premises. Nature of Offence. No of Summonses. Result of Proceedings. 78, Cathnor Road Failing to comply with Statutory Notice 3 Withdrawn. £2 12s. 6d. costs 82, Cathnor Road ditto 1 84, Cathnor Road ditto 1 47, Southerton Road ditto 1 Order made 14 days 17, Southerton Road ditto 1 Withdrawn 62, Percy Road ditto 1 Fined £1. 10s. 6d. costs 47, Gayford Road ditto 4 Withdrawn. £4 costs 49, Gayford Road ditto 3 Withdrawn 51, Gayford Road ditto 5 Withdrawn 53, Gayford Road ditto 2 Withdrawn 55, Gayford Road ditto 2 Withdrawn 57, Gayford Road ditto 2 Withdrawn 9, Godolphin Road ditto 1 Order made 14 days 1, Rose Cottages ditto 1 Withdrawn 18, Rayleigh Road ditto 1 Order made 14 days. 10s. 6d. costs. 69, Shepherd's Bush Road ditto 1 Withdrawn Gloucester House, Bolingbroke Road ditto 1 Withdrawn 22, Rayleigh Road ditto 3 1. Fined 10s. 2. Order made 14 days 3. Fined 10s. 80, Cathnor Road ditto 1 Order made 7 days 77, St. Ann's Road ditto 1 Withdrawn. 5s. costs 60, Fulham Palace Road ditto 2 Withdrawn. 10s. 6d. costs Arthur Boshier, Windmill Road, Sunbury, Middx. Removal of offensive matter during prohibited hours 1 Fined £2 33, Caithness Road Unlawful construction of drain 1 Fined £2 ditto Failing to give notice to Sanitary Authority 1 Fined 10s. 27, Southbrook Street Failing to comply with Statutory Notice 1 Withdrawn 1 Order made 3 days. Fined £1 8, Letchford Gardens ditto 60, Westville Road ditto 1 Order made 14 days. Is. costs 26, Cathnor Road ditto 1 Withdrawn. £2 2s. costs 28, Cathnor Road ditto 1 36, Cathnor Road ditto 1 47, Cathnor Road ditto 1 34 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. Orchard Studios Failing to deposit plans relating to drainage work 1 Fined 10s. ditto Failing to give notice to Sanitary Authority 1 Fined 10s. ditto Non-compliance with bye-laws— constructing W.C. 1 Fined 10s. ditto Non-compliance with bye-laws— ventilation to W.C. 1 Fined 10s. 33, Paddenswiek Road Failing to deposit plans relating to drainage work 1 Fined 10s. ditto Failing to give notice to Sanitary Authority 1 Fined 10s. ditto Unlawful construction of waste pipe 1 Fined 10s. ditto Non-compliance with drainage bye-laws— junction of drains 1 Fined 10s. ditto Non-compliance with bye-laws entrance to W.C. 1 Fined £2 and £2 2s. costs 6, Warbeck Road Failing to comply with Statutory Notice 4 1. Order made 14 days 2. Order made 28 days 3. Order made 14 days 4. Withdrawn 13, Goodwin Road ditto 1 Order made 14 days 15, Goodwin Road ditto 1 Order made 14 days 19, Goodwin Road ditto 1 Order made 14 days. 10s. 6d. costs 18, Rayleigh Road ditto 1 Order made 14 days 9, Goodwin Road ditto 1 Order made 14 days 11, Goodwin Road ditto 1 Order made 14 days 491, Latimer Road ditto 1 Order made 7 days 17, North Pole Road ditto 1 Order made 3 days 52, Waldo Road ditto 1 Withdrawn 80, Cathnor Road ditto 1 Withdrawn 9, Godolphin Road ditto 1 Fined £1 49a, Goldhawk Road ditto 4 Withdrawn 14, Camden Gardens ditto 1 Order made 14 days. Fined £1 85 Summonses—continued. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. 48, Warbeck Road Failing to comply with Statutory Notice 1 Order made 14 days Caravan Yard, ditto 1 Order made 7 days 37, Greenside Road ditto 2 Order made 28 days 38, Overstone ditto 2 1. Fined £1 2. Order made 28 days 106, Rayleigh Road ditto 1 Adjourned 10, Hunt Street ditto 1 Order made 14 days 12,Hunt street 1 Order made 14 days 102/4, Latimer road ditto 1 Adjourned 28, Keith Grove ditto 1 Order made 14 days HAMMERSMITH BOROUGH COUNCIL BYE-LAWS—DOGS. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Miss D. Cohen, 20, Percy Road Contravention of Bye-law re nuisance by dogs in Askew Road 1 Fined 5s. Mr. Arthur Chapman, 32, Rayleigh Road ditto The Broadway I Fined 10s. Miss Marie Wittenburg, 20, Fielding Road ditto Blythe Road 1 Fined 10s. Miss Jean Symons, 53, Sterne Street ditto Brook Green Road 1 Fined 5s. PUBLIC HEALTH (LONDON) ACT, 1891, SECTION 55— INFECTIOUS DISEASES. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Dr. David West, 1, Raynharn Road, W.6. Failing to notify cases of infectious disease 4 1. Fined £1. 10s. 6d. costs 2. Fined £1. 10s. 6d. 3. Fined 10s. 6d. costs 4. Withdrawn 36 VACCINATION ACT, 1871. SECTION 7. Name and Address Nature of Offence. No. of Summonses. Result of Proceedings. Dr. David West 1, Raynham Road, W.6. Failing to deliver certificate to parent 1 Fined £1. 10s. 6d. costs MILK & DAIRIES (CONSOLIDATION) ACT, 1915. MILK & DAIRIES ORDER, 1926. MILK & DAIRIES (AMENDMENT) ACT, 1922. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mr. Charles Neal, 6, Barb Mews Filling milk bottle in Faroe road 1 Fined £1 Mr. Sydney Blackie, 2, Goldhawk Mews Selling milk to which colouring matter had been added— 1 Withdrawn Mr. Thos. L. Davies, 2, Goldhawk Mews Sterndale Road Selling milk to which colouring matter had been added—• Iffley Road 1 Withdrawn Mr. Henry Jesse Rhodes (alias John King), 12, Milson Road Selling milk to which colouring matter had been added— Milson Road 1 Dismissed LONDON COUNTY COUNCIL (GENERAL POWERS) ACTS. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mr. L. Bondonno, 14, Uxbridge Road Unfit premises used for sale, &c., of food for human consumption 14, Uxbridge Road 1 Fined £1. 10s. costs 37 PUBLIC HEALTH (LONDON) ACT, 1891.- -UNSOUND FOOD. Name and Address. Nature of Offence. No. of Summonses Result of Proceedings. Mr. Arthur Selley, 50, Market Extension, W.12. Exposing for sale cheeses unfit for food of man 1 Fined £3. £2 2s. costs J. Alexander & Sons, 55, King Street, W.6 Exposing for sale 1Jlbs. of raspberries unfit for food of man— 11, Queen Street 1 Fined £5 J. Alexander & Sons, 55, King Street, W.6. Depositing for purpose of sale 3 lbs of raspberries unfit for food of man— 11, Queen Street 1 Fined £5 Mr. Joseph Ferstein, 95, Uxbridge Road, W.12. Depositing for purpose of sale confectionery unfit for food of man 1 Fined £5. £1 Is. costs FACTORY AND WORKSHOP ACT, 1901, Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mr. Fredk. R. Clifford, 75, Uxbridge Road, W.12. Unfit underground bakehouse 2 1. Order made 21 days Fined £1 2. Order made 21 days Fined £1 38 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 84 notices were served in reference to insanitary con¬ditions and defects found to exist during the inspection of the factories, workshops and workplaces in the Borough, and during the same period 86 notices were complied with. During the previous year there were 66 notices served and 48 complied with. The following is a list of the Factories, Workshops and Workplaces upon the Register:— Restaurants, Hotels, &c 225 Bakehouses (23 not in use as Bakeries) 69 Bootmakers 55 Motor and Cycle Makers 14 Dressmakers and Milliners 31 Laundries 52 Outworkers 229 Letterpress Printers and Bookbinders 21 Electrical and Mechanical Engineers 141 Smiths, Wheelwrights and Coachbuilders 46 Tailors 39 Builders, Carpenters and Joiners 43 Miscellaneous 285 Total 1,250 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. 39 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 596 39 — Workshops (including Workshop Laundries) 345 24 — Workplaces (other than outworkers' premises included in Part 3 of this report) 289 21 — Total 1,230 84 — 2.—DEFECTS FOUND IN FACTORIES, WORK¬SHOPS AND WORKPLACES. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuitmtcet under the Public Health Acts— Want of Cleanliness 34 33 _ — Want of Ventilation 1 1 — Overcrowding 2 2 — — Want of Drainage of Floors — Other Nuisances 17 17 Sanitary (insufficient 1 1 — — Accommo( unsuitable or defective 46 36 — 1 dation ( not separate for sexes 3 2 — — Offences under the Factory and Workshop Act Illegal occupation of underground house (S. 101) — — — — Other offences — — — (excluding offences relating to out-work which are included in Part 3 of this report) Total 104 92 — 1 40 3.—HOME WORK. Nature of Work Outwork in Unwholesome premises, Sec. 108 Outwork in Infected Premises Sees. 109, 110 Instances Notices served Prosecutions Instances Orders made (Sec. 110) Prosecutions (Secs. 109, 110) Wearing apparel— (1) making, etc. 6 6 — — — — (2) cleaning and washing — — — — — — Furniture and upholstery — — — — — — Totals 6 6 — — — — 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year Number Bakehouses ... ... ... ... 27 Dressmakers ... ... ... ... 27 Laundries ... ... ... ... 15 Outworkers ... ... ... ... 229 Others ... ... ... ... 246 Total number of workshops on Register 544 5.—OTHER MATTERS. Class Number Matters notified to H.M. Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Act 1901 (S. 133) 1 Action taken in matters ferred 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 8 Reports (of action taken) sent to H.M. Inspector 8 Other Underground bakehouses (S. 101)— _ Certificates granted during year In use at the end of the year 27 41 House to House.—As a result of the house to house visitation 1,277 inspections were made, 1,234 notices served, and 2,426 complied with. The special house-to-house inspection of certain streets in the borough continued until the end of May, when the services of the temporary Inspectors were dispensed with. The two temporary Sanitary Inspectors inspected 1,277 houses. 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. Smoke Abatement.—During the year observations were kept in reference to black smoke emitted from the various factories, laundries, bakehouses, &c., situate in and adjoining the Borough. Fourteen Intimation Notices were served. No summons was taken out. Reports were submitted to the Public Health Com¬mittee in reference to the observations made as regards the following:— H.B.C. Electricity Worke, Fulham Palace Road. Victoria Laundry, 10, Great Church Lane. 134, Shepherd's Bush Road. Olympia, Hammersmith Road. Balmoral Laundry, Becklow Road. Lome House Laundry, Becklow Road. ',18, Goldhawk Road. Glen Laundry, Landor Road. Manbro & Garton, Winslow Road. 12, Goldhawk Road. Shepherd's Bush Pavilion, Shepherd's Bush Green. 43, Fulham Palace Road. Builder's Yard, adjoining 118, Askew Road. 104, Askew Road. Mildmay Sanitary Laundry, 4, Wendell Road. G. Wimpey & Co., Wood Lane. Wellesley House Laundry, 6, Wendell Road. 69, Becklow Road. 70, Uxbridge Road. Railway Sidings, Wood Lane. Patent Steam Carpet Beating Co., Latimer Road. Fry's Yard, Scrubs Lane. 42 Rats and Mice (Destruction) Act, 1919.—During the year the Eats and Mice (Destruction) Act, 1919, con¬tinued in operation, the District Inspectors being responsible for its administration in their respective districts. Section I places the responsibility of ridding the pre¬mises 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. 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 reported that 80 per cent, of the poison had been taken. 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. 43 Tenement Houses.—As a result of house to house inspection 594 premises have been registered under the London County Council Bye-laws relating to tenement houses. Houses Let in Lodgings.—During the year no new houses were registered. HOUSING ACT, 1925, SECTION 18. Seven 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. 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 there¬fore 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 also one large caravan occupied by two adults. Other vans park on this ground from time to time. 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 regis¬tered. 44 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. ICE CREAM VENDORS. Registered under L.C.C. (G.P.) Act, 1928 138 Restaurants 20 Factories 8 156 Schools.—The sanitary condition and water supply of the Schools is a matter which requires very little atten¬tion from the Public Health Department. The super¬vision 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 1932. 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) 11,521 (b) Number of inspections made for the purpose 27,828 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 177 (b) Number of inspections made for the purpose 242 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 7 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,360 2.—Remedy of defects 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 28 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 3,360 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 4,986 (b) By Local Authority in default of owners Nil (C) Proceedings under Sections 19 and 21 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which demolition orders were made 8 (2) Number of dwelling-houses demolished in pursuance of demolition orders Nil (8 demolished 1933) (D) Proceedings under Section 20 of the Housing Act, 1930 :— (1) Number of separate tenements or underground rooms in respect of which closing orders were made 4 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 Nil (E) Proceedings under Section 3 of the Housing Act, 1925 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit 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 became operative Nil (2) Number of dwelling-houses in respect of which closing orders were determined, the dwelling-houses having been rendered fit 1 (3) Number of dwelling-houses in respect of which demolition orders became operative 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. Supply of Houses—Overcrowding.—Overcrowding still 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 received in the Public Health Department 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. 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. 49 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. The services of the two temporary Sanitary Inspectors engaged on house-to-house inspection of a list of streets was discontinued in May, 1932. (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.) Unhealthy Areas. No action has been taken with regard to the list of properties recommended to be dealt with either as Clearance or Improvement Areas or by Closing Orders. Bye-laws No special difficulties have been experienced in the enforcement of the bye-laws relating to houses and houses let in lodgings. Newly-Erected Houses.—Progress continued to be 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 50 will be lighted by electricity, whereas those of the Peabody Trust are lighted by gas. Forty 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, 3,651 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). Certificates granted with regard to water supply under Section 48 (Sub-sec. 2) of the Public Health (London) Act, 1891. Private Year. L.C.C. Estate. H.B.C. Estate. Enterprise. 1920 188 18 Nil 1921 169 166 Nil 1922 884 854 Nil 1923 Nil 5 22 1924 Nil 42 40 1925 Nil Nil 50 1926 Nil Nil 202 1927 284 Nil 289 1928 500 Nil 187 1929 1 60 297 1980 Nil 56 90 1981 Nil 21 36 1982 Nil 89 1 Totals 1,726 761 1,164 The premises have provided accommodation for approximately 18,255 persons, but despite this fact overcrowding is still in evidence. At the moment of writing there are upwards of 2,000 applications for houses still to be dealt with. 51 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. The health of a nation depends more upon its food supplies than any other factor and, therefore, special care must be exercised to ensure that the purity thereof is above suspicion. The London County Council (General Powers) Act, 1932, provides for the registration of premises used or proposed to be used— (1) for the sale or the manufacture for the purpose of sale of ice-cream or other similar commodity or the storage of ice-cream or other similar commodity intended for sale; or (2) for the preparation or manufacture of sausages or potted pressed pickled or preserved meat fish or other food intended for sale. If a sanitary authority is satisfied that any premises registered or sought to be registered with them pursuant to this section are unsuitable for the purpose for which they are registered or sought to be registered, they may serve upon— (a) the person on whose application the premises were registered or the occupier of the premises; or (b) the person applying for such registration; (as the case may be) a notice to appear before them not less than seven days after the date of the notice to show cause why the sanitary authority should not for reasons to be specified in the notice remove the premises from the register or refuse to register the premises (as the case may be), and if he fails to show cause to their satisfaction accordingly they may remove the premises from the register or refuse to register the premises (as the case may be). 52 Any person aggrieved by the decision of the sanitary authority may appeal to a Court of Summary Jurisdiction, and, if then not satisfied, to a Court of Quarter Sessions. The Act does not apply to any premises used as a Club, Hotel or Restaurant. 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. Milk (Special Designations) Order, 1923. The following is a list of the licences issued during the year under the Milk (Special Designations) Order, 1928:— 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 8 r 53 Certification of Certain Food Products for Export to the Dominions. In view of the requirements of the Food Laws in opera¬tion in the Dominions, the system of certification for food products which are derived from the flesh of cattle, sheep, swine or goats, or from game or poultry, and are prepared or packed in England and Wales for export to the Dominions, has been continued. The Certifying Officer—usually the Medical Officer of Health—is required to keep himself informed, by personal inquiry and in other available ways, as to:— (1) The sanitary condition, structure and character of premises on which the food products are prepared, stored or packed, with special regard to the possibility of contamination of the food products at any stage. (2) The cleanliness and wholesomeness of the methods employed in preparing, storing or packing the food products. (3) The precautions taken to avoid the utilisation for food purposes of diseased, unsound or unwholesome material in any portion of the premises: and arrangements for the safe disposal of any material which, on account of disease, unsoundness, unwholesomeness, or for any other reason, is unfit for human food. In the case of products derived from cattle, sheep, swine, or goats, the Certifying Officer must also satisfy himself that the animals from which the products are prepared have been subjected to an ante-mortem and post-mortem veterinary inspection and found free from disease and suitable for human food. Where the products are prepared from animals slaughtered in the United Kingdom, the Certifying Officer before certifying as to Veterinary examination must be satisfied :— (a) That the animals were subjected to veterinary examination 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. 54 Where the products are prepared from material imported into the United Kingdom from overseas, the Certifying Officer must satisfy himself that the material was accompanied by a certificate as to ante-mortem and post-mortem veterinary inspection signed by an Official of the National Government of the country of origin, being a country whose certificates the Authorities are prepared to accept. If the information obtained by the Certifying Officer is not, in his view, satisfactory, certification is to be withheld and the Certifying Officer must inform the Ministry forthwith. The Certifying Officer will supply the Ministry of Health with such information as may be required in regard to the methods of inquiry, inspection and certification which have been adopted. Meat.—With regard to meat inspection, this impor¬tant commodity is kept under supervision by the Inspectors in charge of the districts. Public Health (Meat) Regulations, 1924. The Public Health (Meat) Regulations, 1924, came into operation on the 1st day of April, 1925. The provision of these Regulations, regarding the giv¬ing 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 728 Sheep 275 Calves 61 Beasts 86 Pigs 515 Total 1,615 No application has been received for the stamping of carcases examined by the Sanitary Inspectors. 55 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. 1 Sheep's carcase and Offal Caseous Lymphadenitis 59 lbs. 1 Bullock's mesentery Tuberculosis 12 „ 8 Bullocks' livers Distoma Hepaticum 120 „ 1 Cow's liver Cavernous Angioma 12 „ 1 Bullock's liver „ 14 „ 1 Bullock's spleen Congestion 1½ 1 Heifer's liver Multiple Abscesses 14 „ 1 Heifer's lungs Tuberculosis 7 „ 1 Heifer's liver Distoma Hepaticum 14 „ 1 Heifer's liver Tuberculosis 14 „ 7 Heifers' mesenteries „ 84 „ 1 Calf's lungs „ 2½ „ 1 Calf's liver „ 3½ „ 6 Sheeps' livers Distoma Hepaticum 13 „ 3 Sheeps' livers Strongulus Ruftscens 6 „ 1 Sheep's heart Pericarditis ½ „ 6 Sheeps' lungs Strongulus Rufesccns 9 „ 1 Lamb's liver „ 1½ „ 2 Lambs' lungs „ 2 „ 8 Lambs' lungs Congestion 8 „ 4 Pigs' loins Haemorrhage 28 „ 4 Pigs' heads and collars Tuberculosis 50 „ 4 Pigs' heads „ 24 „ 5 Pigs' lungs Congestion 8 „ 3 Pies' livers Cirrhosis 7 „ 1 Pig's liver Cavernous Angioma 3 „ 24 Pigs' livers Milk Spots 70 „ 1 Pigs' spleen Tuberculosis ¼ „ 1 Pig's spleen Pericarditis ¼ „ 1 Pig's spleen Congestion ¼ „ 12 Pigs' mesenteries Tuberculosis 10 „ 3 Lambs* livers Distoma Hepaticum 5½ „ 2 Lambs' livers „ 3½ „ 1 Lamb's liver „ 1½ „ 1 Sheep's carcase and Offal Pneumonia and Peritonitis 80 „ 1 Lamb's liver Distoma Hepaticum 1½ „ 1 Sheep's liver „ 1¾ „ 3 Lambs' livers „ 5¾ „ 18 Sheeps' livers „ 25 „ 12 Sheeps' livers „ 20 „ Licensed Slaughterhouses.—At the annual licensing of slaughterhouses in October, I received notices from five 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. 56 The following is a list of the licensed slaughterhouses in the Borough:— Premises. Name of Licensee 185 Uxbridge Road John Mullet Allwright 40 Goldhawk Road Andrew G. Hedges 247 Goldhawk Road Arthur William Godfrey 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. The following table gives a summary of the work relating to milk premises, slaughterhouses and ice cream premises:— PREMISES. NUMBER OF PREMISES. Number of inspections 1932 Number of notices 1932 Number of proseutions 1932 On register in 1920. On register at end of 1931 Added in 1932 Removed in 1932 On register at end of 1932 Milk premises 128 117* 19 6 130 1,285 12 — Slaughterhouses. 7 7 — 2 5 355 - - Poultry Slaughterhouses. — 2 - — 2 18 1 - Ice Cream premises 162 127 22 16 133 236 1 - Markets.—There are three markets in the Borough, situate in Bradmore Lane, Approach Boad and Norland Boad. 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 Bailway Approach Market are constructed so as to form lock-ups when business for 57 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 being stored in premises which are inspected and approved. 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 recep¬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 offer¬ing 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 138 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. Reports 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 constantly inspected for the purpose of ensuring 58 formity 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.—Two new bakehouses were opened during the year. The 46 bakehouses in use in the Borough have been regularly inspected during the year. Eighteen notices were served relating to various defects, and complied with. It was necessary to apply for a summons against a Baker whose bakehouse was found not to be in conformity with the Act. The following is a list of bakehouses in the Borough:— Address. Name. No. 1 DISTRICT. †Cadby Hall, Hammersmith Road J. Lyons & Co. †* 60 Richmond Road C. W. Tompkins * 1 Masbro Road W. A. Maclcn †* 67 Ditto G. Dunsby †* 98 Blythe Road Miss Schofield † Ceylon Road Brook Green Electric Bakery Ltd. No. 2 DISTRICT. * 82 Great Church Lane E. Galey † Great Church Lane Fullers, Ltd †* 134 Shepherd's Bush Road F. Oliver †* 84 Ditto F. R. Ries * 75 Blythe Road F. Oliver * 31 Goldhawk Road F. Oliver † 213 Hammersmith Road F. Hayes No. 3 DISTRICT. †* 33 Glenthorne Road Plumridge Bros. †* 1 Aldensley Road H. A. Roberts, Ltd. †* 85 The Grove R. Pearson 24 Bradmore Park Road T. Miller † 28 King Street (rear of) L. E. Jolly † Blacks Road Palmers Stores Ltd. No. 4 DISTRICT. 93 Black Lion Lane G. Banham †*102 Dalling Road Plumridge Bros. †1 Eyot Gardens J. R. Chibnall, Ltd. †258 King Street Miller & Son † 316 Ditto B. Samels †* 11 Lamington Street H. A. Roberts, Ltd 7 St. Peters Road E. Gent la, Hammersmith Terrace Mrs. Jackeon * Underground. † Factory. 59 Address. Name. No. 3 DISTRICT. †* 128 Askew Road G. Ingle † 74 Ditto J. Auer †* 167 Ditto F. J. Lockwood † 10J Ditto D. Miller No. 6 DISTRICT. †* 74 Goldhawk Road H. Crisp † 88 Ditto H. Crisp †* 106 Ditto F. & A. Posford † 166 Ditto H. & G. Curran †* 242 Ditto Plumridge Bros. †* 125 Uxbridge Road A. B. Hemmings Ltd. * 56 Melina Road J Tame †* 75, Uxbridge Road F. R. Clifford No. 7 DISTRICT. †*216 Uxbridge Road L. W. Jenkins †410 Ditto A. Hauser No. 8 DISTRICT. †* 831 Harrow Road H. T. Rogers †* 39 St. Ann's Road E. Tomlin †* 16 North Pole Road G. Glanville †*32 Norland Road N. Stone †Sunya House, Scrubs Lane Bee Bee Biscuits Ltd. The following is a list of registered bakehouses in the Borough not now in use :— * 7 Shepherd's Bush Road 70 Glenthorne Road * 13 Shepherd's Bush Green 16 Black Lion Lane * 87 Masbro Road * 192 Dalling Road * 6 Beaconsfield Terrace † 348 King Street * 47 Milson Road 10 Upper Mall† 65 Bridge Road 121 Askew Road 2 Crisp Road 41 Gay ford Road * 94 Shepherd's Bush Road †* 126 Uxbridge Road 88 Queen Street †* 132 Uxbridge Road * 77 Brackenbury Road * 2 Hunt Street † 1 The Grove 104 Latimer Road * 17 Kilmarsh Road * Underground † Factory 60 UNSOUND FOOD. In March, a quantity of cheeses were seized from a shop in the Shepherd's Bush Market. The cheeses were wrapped in metal foil and were exposed on a stall in front of the shop. They appeared to be old, the wrappings were badly tarnished and the cheeses misshapen. The Public Analyst reported that the sample submitted to him contained a compound of tin equivalent to 0.2 per cent., i.e., 14 grains per pound, of tin. The cheeses were submitted to a Justice of the Peace who condemned them as unfit for food, and gave an Order for their destruction. The weight of the cheeses was 14½ lbs. A summons was issued, when the Bench imposed a fine of £3 with 2 guineas costs. In July, 1½ lbs. of raspberries were seized from a shop in Queen Street, which were covered with a green mould and in an advanced state of decomposition. Two baskets of raspberries which were under a shelf in the shop were also seized. The raspberries were submitted to a Justice of the Peace, who condemned them as being unfit for food, and gave an Order for their destruction. A summons was issued for exposing for sale, when a fine of £5 was imposed. A further summons was issued for depositing for the purpose of sale, when a fine of £5 was imposed. In September, a quantity of chocolates were seized from a shop in Uxbridge Road. The chocolates showed evidence of an extensive attack by weevils, and, on several, living maggots were found. Maggots were also found in the boxes. 61 The chocolates consisted of chocolate-covered whipped cream walnuts, nut assorted chocolates and hazel nut fondants. All were submitted to a Justice of the Peace who condemned them, and gave an Order for their destruction. A summons was issued, when a fine of £'5 was imposed with 1 guinea costs. The following is a list of unsound food condemned during the year:— Commodity. Condition. Result. 77 lbs. Apples Decomposed Surrendered 2 cwt. Canadian Apples ditto ditto 20 cases Australian Apples (9 cwt. 3 qrs.) ditto ditto 1 box Pears (46 lbs.) ditto ditto 1 box Soft Roes ditto ditto 73 2-lb. boxes Mixed Fish ditto ditto 28 1-lb. boxes Mixed Fish ditto ditto 1 box Dog Fish (1 cwt.) ditto ditto 13 Imported Cock Turkeys (120 lbs.) ditto ditto 10 Cod ditto ditto 13 boxes Grapes (180 lbs.) ditto ditto 48 bags Beetroot (1 ton 1 cwt.) ditto ditto 8 boxes Tomatoes ditto ditto 1 box Onions (1 cwt. 1 qr.) ditto ditto 5 boxes Apples (2 cwt.) ditto ditto 21 trays Peaches (about 168 lbs.) ditto ditto 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. 62 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, 1932. During the twelve months 612 samples of food and drugs were submitted to me for examination. Of this number 554 were reported as genuine, 18 as adulterated, whilst 40 were of inferior quality. The numbers for adul¬terated and inferior samples are both over double those of last year, the corresponding figures being then 8 and 19. It is to be regretted that the article responsible for these increases is milk, and that the adulteration shows also a large increase in regard to its amount in many cases. In Table I are given the total 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. Table I. Samples received. Genuine. Inferior. Adulterated. Total. Quarter ending March 31st 139 7 4 150 „ „ June 30th 126 20 4 150 „ „ Sept. 30th 131 11 8 150 „ „ Dec. 31st 158 2 2 162 Totals 554 40 18 612 In Table II will be found a statement of the number and nature of the various articles examined during the year, together with particulars of the prosecutions which were instituted. 63 Table II. Article. No. of Samples examined. Result of Examination. Summonses Issued. Penalties Imposed. Genuine. Inferior. Adulterated. Almonds, ground 3 3 - - - - Ammon, Quinine 4 4 — - - - „ „ Tablets 1 1 — — - - Aspirin Tablets 3 3 — - - - Boric Ointment 2 2 — — - - Butter 42 42 - — - - Camphorated Oil 4 4 — — - - Castor Oil 3 3 — — — - Cheese 7 4 1 2 2 £5 2 0 Citrate of magnesia 3 3 — — — — Cocoa 10 10 — - - - Coffee 5 5 — - — - Confectionery 3 3 — — — — Cordials 4 4 — — - — Cream 12 12 — — — — Epsom Salt 1 1 — — — — Eucalyptus Oil 2 2 — — — — Fish Paste 9 7 — 2 — - „ tinned 1 1 — — — - Fruit, dried 8 8 — - — - „ tinned 8 8 — - — - Glauber Salt 3 3 — - — - Jam 7 7 — - — — Lard 7 7 — - — - Lemon Cheese 1 1 — - — - Margarine 7 7 — — — — Marmalade 4 4 — - — - Marshmallow Cream 1 1 — - - - Meat Paste 2 2 - - — - „ Pie 2 2 — — — - ,, potted or tinned 9 9 — — — — Milk 347 294 39 14 7 £10 14 6 ,, Condensed 26 26 - — — - Mincemeat 2 2 — — — - Olive Oil 8 8 - — — - Pepper 2 2 — — — — Rice 3 3 — — — — Rissoles 1 1 - — — — Sauce, tomato 2 2 — — — - Sausages 20 20 — — — — Seidlitz Powder 2 2 — — — — Semolina 2 2 - - — - Tea 5 5 - - — — Vegetables, tinned 6 6 — — — — Vinegar 4 4 — — — — Whisky 1 1 — — — — Zinc Ointment 3 3 — — — — Totals 612 554 40 18 9 £15 16 6 64 Milk. During the year 347 samples of milk were examined and of these, 294 were reported as genuine, 39 as inferior and 14 as adulterated, thirty of the inferior samples were poor in fat, 1 in non-fatty solids, and 8 in both fat and non-fatty solids. Particulars of the adulterated milks are given in Table III. Table III. No. Adulteration Certified. 1 Fat abstracted 24 per cent. 2 „ „ 24 „ „ 3 „ „ 7 „ „ 4 „ „ 6 „ „ 5 „ „ 5 „ „ 6 „ „ 1 „ „ 7 Added Water 8 „ „ 8 „ „ 3 „ „ 9 „ „ 1 „ „ 10 „ „ 1 „ „ 11 „ „ 1 „ „ 12 Coloured with annatto 13 „ „ „ 14 „ „ „ The following Table gives the average composition of the milk calculated on the total number of samples taken in the Borough during the four quarters of the year:— Table IV. Fat. Non-fatty Solids. Water. Per cent. Per cent. Per cent. Quarter ending March 31st 3.58 8.80 87.59 „ „ June 30lh 3.58 8.78 87.64 „ Sent. 30th 3.70 8.75 87.55 „ „ Dec. 31st 3.97 8.86 87.17 Average for the year 3.71 8.80 87.49 These figures represent milk of good average quality for the whole year. 65 Condensed Milk. Twenty-six 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. Six samples of cream and six 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-two samples of butter, seven of margarine and seven of lard were examined, and all of these proved to be of genuine composition in regard to the fat and to contain no excess of water. Cheese. Seven specimens of cheese were submitted for analysis during the year, and of these one was reported inferior and two adulterated. The latter were of the tin-foil wrapped type and contained excessive amounts of tin. The generally accepted maximum limit for tin in foodstuffs is two grains per pound, whereas these contained 14 grains and 4.9 grains respectively; that is, seven times the limit in the one case and nearly two and a-half times times in the other. Both of these were purchased from the same vendor, the remaining stock being seized and condemned. Two other tin-foil wrapped cheeses contained no tin. The sample reported inferior was a so-called cream cheese. Analysis proved it to contain only 10 per cent. of fat, whereas cheese made from cream should contain not less than 40 per cent, of fat. In the absence of a legal standard no action was taken here. 66 Meat and Fish Preparations. Of the forty-four meat and fish preparations examined this year only two specimens of anchovy paste were adversely reported upon. These both contained 0.8 per cent. of extraneous mineral matter having the characters of a ferruginous earth. Conserves, Vegetables, Fruit, &c. Under this heading are included tinned fruit and vegetables, dried fruit, jam, marmalade, mincemeat and lemon cheese—in all, thirty-six samples. The tinned articles were free from all but traces of tin, and in no case was preservative detected except where it is allowed, and in these the amounts found fell within the permitted limit. Cocoa, Coffee, Tea. Ten specimens of cocoa, five of coffee and five of tea were genuine. Tests for arsenical contamination in the cocoas gave negative results. Farinaceous Foods. Three samples of rice and two of semolina were genuine. The rices showed no evidence of " polishing " with talc. Condiments, &c. Eight specimens of olive oil, two of pepper, two of tomato sauce and four of vinegar were examined and in no case was adulteration detected. Two of the vinegars were sold as malt vinegar and had the characters of such, whilst all showed no trace of metallic or arsenical con¬tamination and had a satisfactory content of acetic acid. Cordials and Spirits. A sample each of lemon squash, lime juice, orange squash, close cordial and whisky proved on analysis to 61 be genuine. In the lime juice and orange squash 198 and 224 parts respectively of sulphur dioxide per million were found, but these amounts are within the permitted limit. The whisky was satisfactory in regard to its alcoholic strength. Drugs. A fairly representative selection of drugs comprising twelve different articles was sampled during the year. All of these complied with the requirements of the British Pharmacopoeia. It may, be mentioned that a new edition of the British Pharmacopoeia has been issued and is now in force. All official drugs have to comply with the requirements there set forth, which include various modifications and amendments in the case of certain drugs. In addition to the articles taken under the Food and Drugs (Adulteration) Act, a sample of milk powder was analysed. This complied with the maker's specifications as to composition and volume of milk yielded on solution. 89 The following Table shows the action taken on adulterated samples and other infringements of the Sale of Food and Drugs Act:— Sample No. Article. Analyst's Report. Court. Date of Hearing. Result of Proceedings. Other Action. Table V. 552 Milk 6 per cent. fat abstracted K.P.S. 22-3- 32 Fined £1 0s. 0d. Costs 10s. 6d. - 586 Anchovy Paste Contained 0.8 per cent extraneous mineral matter having the characters of a ferruginous earth - - - - 616 Cheese 4.9 grains of tin per lb. K.P.S. 3-5-32 Fined £3 0s. 0d. Costs £2 2s. 0d. Seized as "unwholesome" under Sec. 47, P.H. (Lond.) Act 622 do. 14 grains of tin per lb. 646 Anchovy Paste Contained 0.8 per cent extraneous mineral matter having the characters of a ferruginous earth - - - - 660 Milk 24 per cent. fat abstracted K.P.S 21-6-32 Fined £2 10s. 0d. Costs £2 2s. 0d. - 662 do. 24 per cent. fat abstracted Fined £2 10s. 0d. Costs £2 2s. 0d. 774 do. 7 per cent. fat abstracted — — - Warning Letter 793 do. 5 per cent. fat abstracted — — — do. 794 do. 1 per cent. fat abstracted — — — do. 800 do 1 per cent. added water — — — do. 802 do. do. - - - do. 811 do. do. — — — do. 919 do. Contained artificial colouring matter having characters of annatto K.P.S. 15-11-32 Summons withdrawn — 921 do. do. do. do. do. — 924 do. do. do. do. Summons dismissed — 988 do. 3 per cent. added water - - — Warning Letter 15 do. 8 per cent added water K.P.S. 7-2-33 Summons dismissed Warranty upheld - 69 PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 1,487 cases reported as due to notifiable infectious diseases in the Borough, against 1,515 in the previous year. There were also reported 1,918 cases of infectious diseases that were not notifiable, against 442 in the previous year: 1,588 of these were Measles, and 330 Whooping Cough. The number of cases of Tuberculosis notified was 228 against 239 in the previous year. BACTERIOLOGY. The following bacteriological examinations were made on behalf of the Council:— Material from cases of suspected Diphtheria- True Diphtheria bacillus isolated 89 Negative results 989 Sputa from cases of suspected Tuberculosis— Tubercle bacillus found 102 Tubercle bacillus not found 407 Blood from oases of suspected Fever— Widal or Typhoid reaction obtained 2 Widal or Typhoid reaction not obtained 1 Stools, Negative 2 Urine 1 Spleen 1 Grand Total 1,654 70 Cases of Infectious Disease notified during the year 1932. 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 4 & under 65 Years 65 and upwards 8'th Centre North Ward | Ward 2 Ward 3 Ward ; 4 Ward 5 Ward ' 6 W ard Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 192 6 72 89 12 11 1 1 38 17 19 3 32 40 43 192 Erysipelas 51 4 3 3 3 17 11 10 6 9 10 2 10 7 7 35 Scarlet Fever 594 3 169 354 ii 2b 5 67 76 114 31 85 171 50 576 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 4 .. 1 1 1 .. 1 .. .. .. 1 .. .. 1 2 3 Relapsing Fever (R) Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. 2 .. .. .. 1 .. .. .. 1 .. 2 Puerperal Pyrexia 29 .. .. .. 15 14 .. .. 5 4 5 2 6 3 4 28 8 2 1 .. 1 3 1 .. 2 1 1 .. 1 1 2 8 Polio-myelitis 1 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Encephalitis Lethargica 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 1 Ophthalmia Neonatorum 19 19 .. .. .. .. .. .. 4 4 4 .. 2 5 .. 10 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 178 2 30 34 16 44 38 14 23 27 23 10 22 55 18 79 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 Food Poisoning 2 .. .. .. .. 2 .. .. .. .. .. .. 1 .. 1 .. Chickenpox 405 15 73 296 16 5 .. ... 34 25 37 14 144 130 21 i3 TOTALS 1487 52 349 777 101 124 58 26 180 165 214 62 303 415 148 949 Tuberculosis. Pulmonary Tuberculosis 183 0 1 10 53 73 38 8 35 33 26 14 24 36 15 Other forms of Tuberculosis . 45 2 2 14 10 7 10 .. 2 7 9 4 13 6 4 TOTALS 228 2 3 34 63 80 48 8 37 40 35 18 37 42 19 Deaths from the Seven Principal Zymotic Diseases.— The total number of deaths of residents registered from the seven principal zymotic diseases was 74 against 38 in the previous year. The deaths of residents last year from these diseases were equal to 48.2 per 1,000 of the total deaths of residents registered and were at the rate of 0.5 deaths per 1,000 persons living. 71 The following table shows the deaths of residents registered from the seven principal zymotic diseases which occurred in the ten years, 1923 to 1982:— Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Enteric Fever. Diarrhoea and Cholera. Total. 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 21 89 1931 0 0 2 6 7 0 23 38 1932 0 29 4 8 6 1 26 74 Average last 10 yrs. 0 17 2 12 14 1 26 72 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was two above the average number registered in the last ten years. Notifiable Diseases (other than Tuberculosis) during the year 1932. DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths. Diphtheria 192 192 8 Erysipelas 51 35 — Scarlet Fever 594 576 4 Enteric Fever 4 3 1 Puerperal Feve 2 2 3 Puerperal Pyrexia 29 28 — Cerebro-Spinal Meningitis 8 8 8 Encephalitis Lethargica 1 1 — Ophthalmia Neonatorum 19 10 — Pneumonia 178 79 114 Dysentery 1 1 — Poliomyelitis 1 1 — Chickenpox 405 13 — Food Poisoning 2 - - Totals 1,487 949 138 72 Smallpox.—No case of smallpox was reported during the year, although this disease has been prevalent in the east part of London. Several suspicious cases which have been visited on the request of medical practitioners have 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.— One hundred and ninety-two cases were reported as due to Diphtheria or Diphtheritic Membranous Croup against two hundred and twenty-eight cases in the previous year. All cases were treated at the Isolation Hospitals. Eight deaths were registered. The mortality rate on the cases reported was 2.6 per cent. The cases were fairly evenly distributed throughout the Borough. • 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.—Five hundred and ninety-four cases were notified as due to Scarlet Fever, against two hundred and eighty in the previous year. Five hundred and seventy-six cases were treated at the Isolation Hospitals, and eighteen at the homes of the patients. This is the highest number of cases reported since 1921, when thirteen hundred and fifty-eight cases were notified. Four deaths were registered. The mortality rate was 0.7 per cent. 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. 75 Enteric Fever.—Four cases were reported as due to Enteric Fever, against one case in the previous year. Two cases were treated at the London County Council Hospitals, one at the Hammersmith Hospital and one at the home of the patient. One death was registered. Erysipelas.—Fifty-one cases were reported as due to Erysipelas, against forty-eight cases in the previous year. Sixteen cases were treated at the homes of the patients, eleven at the Hammersmith Hospital, nine at St. Charles' Hospital, seven at St. Mary Abbotts Hospital, two at the London County Council Isolation Hospitals, two at the West London Hospital, two at St. Stephen's Hospital, and two at the Fulham Hospital. Sixteen cases were treated at the homes of the patients. 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.—Two cases were reported as due to Puerperal Fever, against five cases in the previous year. One case was treated at the London County Council Hospital, and one at Queen Charlotte's Hospital. Puerperal Pyrexia.—Twenty-nine cases were reported as due to Puerperal Pyrexia against thirty in the previous year. Fifteen cases were treated at St. Mary Abbotts Hospital, four at Queen Charlotte's Hospital, four at Hammersmith Hospital, three at the London County Council Hospitals, one at St. Stephen's Hospital, and one in a Private Nursing Home. One case remained at home. 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. 76 Cerebro-Spinal Meningitis.—Eight cases of Cerebrospinal Meningitis were reported against nine cases in the previous year. Two cases were treated at the Isolation Hospitals of the London County Council, two at St. Charles' Hospital, one at the Hammersmith Hospital, one at Paddington Green Children's Hospital, one at St. Mary's Hospital and one at St. George's Hospital. Acute Polio-myelitis.—One case was reported as due to Polio-myelitis, against two cases in the previous year. The case reported was treated at the West London Hospital. Encephalitis Lethargica.—One case was reported as due to Encephalitis Lethargica, against two in the previous year. The case reported was treated in one of the Isolation Hospitals of the London County Council. Ophthalmia Neonatorum.—Nineteen cases were reported as due to Ophthalmia Neonatorum, against thirteen in the previous year. Eight cases were treated at St. Margaret's Hospital, one at the University College Hospital, one at Queen Charlotte's Hospital, and nine at the homes of the patients. In the cases treated at home arrangements were made for a nurse to attend the patient. Twenty-nine 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. 77 Measles and German Measles.—Fifteen hundred and eighty-eight cases of Measles and German Measles were notified against one hundred and seventy-eight in the previous year. Two hundred and eighty-five cases were treated in the Hospitals of the London County Council. Twenty-nine deaths were registered. The following Chart shows the number of Deaths from Measles per 100,000 inhabitants, 1913-1932. Whooping Cough.—Three hundred and thirty cases of Whooping Cough were reported, against two hundred and sixty-four in the previous year. Six deaths were registered. Forty cases were removed to hospital. I have received, as heretofore, information as to cases from the Head Teachers of the Schools of the London County Council. 78 The following Chart shows the number of Deaths from Whooping-Cough per 100,000 inhabitants, 1913-1932. The homes of the patients were visited by your Inspectors, and the parents advised as to the precautions that should be taken. Chicken Pox.—Four hundred and five cases of Chicken Pox were reported, against seven hundred and seven in the previous year. Thirteen 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. The Order known as the Hammersmith (Chicken Pox) Regulations, 1931. dated 20th February, 1931, requiring the notification of Chicken Pox in any person not under ten years of age and any person under ten years of age who had not been vaccinated continued in force. 79 Pneumonia.—One hundred and seventy-eight cases of Pneumonia (forty-seven Influenzal Pneumonia and one hundred and thirty-one Primary Pneumonia) were notified during the year. Seventy-nine cases were treated at various institutions. All cases were made the subject of inquiry by your lady Sanitary Inspector or Health Visitors, and in many cases it was found necessary to arrange for a nurse to visit, advise and assist in the nursing of the patients. This was done by arrangement with the Hammersmith District Nursing Association. One hundred and fourteen deaths were registered. Malaria.—No case was reported, against no case in the previous year. Dysentery.—One case of Dysentery was reported against two cases in the previous year. Food Poisoning.—Two cases of Food Poisoning were reported under Section 7 of the London County Council (General Powers) Act, 1932. Influenza.—During the year forty-three deaths from Influenza occurred, as compared with fourteen in the previous year. Wrong Diagnosis.—Thirty-four 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 from the disease stated on the certificates, or any other notifiable disease— Diphtheria 13 Scarlet Fever 21 Total 34 80 Psittacosis.—No case of psittacosis was reported in the Borough during the year. Cleansing of Verminous Persons.—The Medicinal Baths in Scotts Road. Shepherd's Bush, provide for the treatment of cases of Scabies, Impetigo and the cleansing of verminous persons, &c. I append figures showing the numbers dealt with during the year. School Children— Scabies 186 Impetigo 84 Verminous Cases 2,175 Other conditions — Adults— Scabies 159 Verminous Cases 118 Other conditions 2 Children under School-age— Scabies 15 Verminous Cases — 1 Other conditions — The County Council pay the sum of two shillings in respect of each child cleansed, except in cases of scabies or impetigo in which case the payment is at the rate of 1s. for each bath given. The amounts received from the London County Council during the year was £217 10s. Od. in respect of cleansings and £13 6s. Od. 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 1923 to 1932. Year. Smallpox. Scarlet Fever. Diphtheria or Diphtheritic Croup. Typhus Fever. Enteric Fever. Simple Continued Fever. Relapsing Fever. Puerperal Fever. Puerperal Pyrexia. d Cholera. Erysipelas. Plague. Chickenpox. f Measles. b a Whooping Cough. a Cerebro-Spinal Fever. Anthrax. Glanders. Hydrophobia. f Ophthalmia Neonatorum. Acute Polio-Myelitis. Encephalitis Lethargica. Pneumonia. e Malaria. c Dysentery. c Trench Fever. e Food Poisioning. g. Total. 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 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 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 0 2378 1926 0 276 254 0 8 0 0 17 10 0 29 0 290 712 148 1 0 0 0 24 0 4 102 0 0 0 0 1866 1927 0 312 368 0 11 0 0 7 22 0 41 0 269 60 83 0 1 0 0 16 0 4 145 2 3 0 0 1343 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 0 1758 1929 0 109 249 0 4 0 0 9 15 0 74 0 87 237 113 3 0 0 0 13 0 3 232 0 1 0 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 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 0 1957 1932 0 594 192 0 4 0 0 2 29 0 51 0 405 1588 330 8 0 0 0 19 1 1 178 0 1 0 2 3405 Average for 10 years 7 348 276 0 7 0 0 10 15 0 47 0 338 726 219 4 0 0 0 18 2 5 147 1 1 0 0 2171 a Not Notifiable. b Notifiable during the years 1916—1919. e Notifiable from 1st March, 1919, to 31/12/1927. c Notifiable from 1st March, 1919. f Notifiable from 2nd March, 1931. d Notifiable from 1st October, 1926. g. Notifiable from 12th July, 1932. 82 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 481 Mattresses 882 Pillows 2,261 Bolsters 683 Blankets 3,326 Sheets 1,069 Quilts 1,056 Articles of Clothing 3,530 Sundries 147 Total 13,435 Booms 973 Vaccination.—The duties under the Vaccination Acts and the Vaccination Order were carried out by the Public Health Department. The Return for 1931 shows that 1.092 Infants were vaccinated, this being 55.9 per cent. of the Births, and compared with 58.28 per cent. in 1930. 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. 88 VACCINATI ON RETURNS. RETURN FOR 1931. 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 Successfully Vaccinated Col. II Col IV. Number in respect of whom Certifl cates 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 Insusceptible of Vaccination Had SmallPox 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Hammersmith 972 520 6 — 315 44 7 13 52 15 2. South Hammersmith 634 376 2 — 152 30 3 16 49 6 1,852 546 3. "Invermead " 345 188 — — 71 11 — 44 20 11 1,951 1,084 8 — 538 85 10 73 121 32 1,852 546 Table showing Work of Vaccination Officer from 1st January to 31st December, 1932. 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. Nob. entered on *'H " Lists to Public Vaccinators. Dr. Durward. Dr. Dale. Dr. frossard. Dr. Dockrill. Dr. Brash. Dr. Phillips. Dr. Barnes Other Doctors. Dr. Durward. Dr Dale. Dr. Frossard. Dr. Dockrill. Dr. Brash. Total North 22 185 105 140 10 — — 127 5 594 341 60 - 34 739 76 37 201 25 24 129 92 114 14 373 South 134 24 118 2 — — — 144 5 427 152 52 — 41 480 67 27 144 22 126 8 122 1 — 257 Queen Charlotte's Hospital 28 38 19 13 3 117 _ 218 91 15 - 73 287 9 10 30 10 36 29 17 15 - 97 Removed Inwards 30 43 46 18 — — 10 35 - 182 — 24 260 — 101 41 — 45 — 35 38 68 32 1 174 Above 14 years of age — 9 — 2 — — — — — 11 — — — — — — — — — — — — — — — Total 214 299 288 175 10 3 10 423 10 1432 584 151 260 148 1607 193 74 420 57 221 204 299 162 15 901 85 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 twenty-eight cases of tuberculosis were reported during the year, one hundred and eighty-three of which were Pulmonary and forty-five being other forms of Tuberculosis, against two hundred and thirty-nine cases in the previous year. PART I. Summary of Notifications during the period from the 3rd January, 1932, to the 31st December, 1932. Age Periods Formal Notifications Total Notifications Number of Primary Notifications of new cases of Tuberculosis 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all aees) Pulmonary Males — 1 1 3 5 11 32 16 15 16 4 104 150 Pulmonary Females - - 1 5 14 23 16 9 2 5 4 79 120 Non-pulmonary Males 1 1 6 3 4 4 3 1 2 2 - 27 37 Non-pulmonary Females 1 1 2 3 1 1 2 1 6 — — 18 20 86 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- 26- 35- 45- 55- 65- Total Pulmonary Males - 2 2 1 - 2 6 4 7 - 2 26 Pulmonary Females - — — 1 1 2 5 2 2 - 2 15 Non-pulmonary Males - 3 2 2 1 - 2 - - - - 10 Non-pulmonary Females - - 2 3 1 - 2 1 - — — 9 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 from local Registrars 8 3 Death Returns transferable deaths from 1 Registrar General 3 3 Posthumous notifications 4 2 "Transfers" from other areas (other than transferable deaths) 26 11 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, 1932, on the Registers of Notifications 420 341 761 166 201 367 1,128 Number of cases removed from the Register(s) during the year by reason, inter alia, of:— 1. Withdrawal of notification - 2. Recovery from the disease 3 6 9 7 3 10 19 3. Death 92 54 146 13 2 15 161 87 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 thirty-five deaths from Pulmonary Tuberculosis were registered, against one hundred and nine in the previous year, representing a death-rate of 1.0 per 1,000 compared with 0.8 in 1981. 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. I append figures for the years 1920-32, showing the interval between notification and death of tuberculous persons. 1920. 1921. 1922. 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1. Total number of deaths from Tuberculosis in the Borough 157 173 162 145 170 138 142 181 135 149 153 127 156 2. The number of cases notified at death 11 8 17 11 10 13 8 7 3 7 2 6 3. The number of cases notified within one month of death (excluding above) 20 29 20 21 23 18 30 25 17 32 18 16 21 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 17 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 15 88 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1932:— Age Periods. New Cases. Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. 0 - - 1 1 - - 1 1 1 1 — 1 1 1 — 3 1 5 4 6 9 5 2 1 3 - 15 16 37 8 2 13 19 2 - 25 48 25 4 3 33 16 3 3 45 31 7 4 6 29 9 2 2 65 and upwards 4 4 - — 7 6 — — Totals 104 79 27 18 85 50 14 7 The ratio of non-notified tuberculous deaths to the total tuberculous deaths is 1 to 9. 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, 10.30 a.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. 89 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, 1932, the number of patients on the Dispensary Register was 763. During the year 55 definite cases of the disease were transferred from other areas into the Hammersmith district and 110 moved out of this district or were lost sight of. Sixteen were written off the register as being cured cases who had previously been notified as suffering with tuberculosis. New Patients. During the year 607 persons attended for examination for the first time. Of these, 183 were under the age of fifteen and 424 were adults. Males and females attended in almost equal numbers, viz., 298 and 314. Of the total 223 were referred to the Dispensary by local practitioners for the purpose of consultation and 230 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 22 Showing no evidence of Tuberculosis 457 90 Total Attendances and Examinations. The total attendances of persons for the purpose of examination, observation or treatment, numbered 2,690 and physical examinations were carried out in 1,874 instances, i.e., in 69 per cent. of the total attendances. The names of 459 persons were written off the register as being non-tuberculous, and the total number on the Dispensary Register on 31st December. 1932. was estimated at 749. Sputum Examinations. Four hundred and seventy-two specimens of sputum and other pathological products were examined bacteriologically. Eighty-seven showed the presence of Tubercle Bacilli, while 385 proved negative. Institutional Treatment. The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homes), under the London County Council's Scheme, numbered 158. 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 687 To the Ministry of Pensions 22 To General Practitioners and Hospitals 756 Home Visitation. The Tuberculosis Officer made 143 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 55 occasions. 91 Return showing the work of the Dispensary during the year 1932. Diagnosis Pulmonary Non-pulmonary Total Grand 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 65 51 3 4 5 6 7 3 70 57 10 7 144 (b) Diagnosis not completed — — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 87 92 34 20 223 B.—Contacts examined during the year:- (a) Definitely tuberculous 2 3 — — 1 — — — 3 3 — — 6 (b) Diagnosis not completed — — — — — — — — — 1 — — 1 (c) Non-tuberculous - - - - - - - - 33 78 56 56 223 C.—Cases written off the Dispensary Register as :— (a) Recovered - 5 2 1 2 1 4 1 2 6 6 2 16 (b) Non-tuberculous (including any such cases previouslydiagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 121 172 190 76 459 d.-number of Cases on Dispensary Register on December 31st:- (a) Definitely tuberculous 289 223 14 23 39 72 50 38 328 295 64 61 748 (b) Diagnosis not completed — — — — — — — — — 1 — — 1 1. Number of cases on Dispensary Register on January 1st 763 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in prevous years 55 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 110 4. Cases written off during the year as Dead (all causes) 91 5. Number of attendances at the Dispensary (including contacts) 2,690 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 296 7. Number of consultations with medical practitioners:— (а) Personal 229 (б) Other 223 8. Number of visits by Tubercu- losis Officers to homes (including personal consultations) 284 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4,101 2,729 Dispensary 1,372 Town Hall 10. Number of :— (a) Specimens of sputum, Ac., examined, 472 87 plus 385 negative (b) X-ray examinations made, in connection with dispensary work 107 11. Number of "Recovered" cases restored to Dispensary Register, and included in A (a) and A (b) above Nil 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 297 92 93 PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1932 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 Children M. 21 8 4 — 12 — 1 — — 1 3 — 2 — 2 2 1 — — 1 F. 6 3 3 — 6 3 2 — — 2 — 1 — — 1 5 — — — — 5 — — — — 3 — — — — 1 — — — — — — — — — Disease not Arrested Adults Children M. 28 5 17 5 27 4 5 5 4 14 2 4 8 4 16 1 9 1 2 12 F. 27 — 7 — 7 6 1 5 2 8 8 2 — — 2 — 5 4 — 9 4 — — — — — — — — — 1 — — — — 1 — — — — Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 91 16 31 5 52 16 9 10 6 25 15 7 10 4 21 9 15 5 2 22 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults Children M. 11 1 1 2 — — — — — — — — — — — — — — F. 15 3 — — 3 2 1 — — 1 4 — — — — — — — — — 9 — — — — 3 — — — — 1 — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 42 5 5 2 12 14 10 9 1 20 23 9 17 6 32 30 18 18 3 39 Dead Adults Children M. 1 1 4 5 10 5 5 16 13 34 1 4 12 29 45 2 3 14 11 28 F. 4 — 3 4 7 3 4 2 I 1 17 4 2 6 12 19 5 17 7 6 30 2 — — — — — — — — — 2 — 1 — 1 2 — — — — Total written off Dispensary Register 84 10 12 11 33 29 20 27 25 72 35 15 35 47 97 39 38 39 20 97 Grand Totals 175 26 43 16 85 45 29 37 31 97 50 22 45 51 118 48 53 44 22 119 1929 1930 1931 1932 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults Children M. — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Disease not Arrested Adults Children M. 10 8 5 13 19 3 5 8 13 15 9 4 28 12 16 20 4 40 F. 10 10 5 2 17 16 7 1 2 10 14 8 14 3 25 11 13 16 1 30 4 — — — — 4 1 1 — 2 3 1 — — 1 5 1 2 — 3 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 24 18 10 2 30 39 11 7 2 20 30 24 23 7 54 28 30 38 5 73 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults Children M. — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 24 11 8 2 21 16 8 15 — 23 7 4 9 — 13 6 2 3 1 6 Dead Adults Children M. 9 7 13 10 30 7 9 14 12 35 6 2 10 1 13 1 3 2 6 11 F. 5 1 9 5 15 8 6 9 5 20 4 3 6 1 10 2 2 2 1 5 — — — — — — — — — — — — — — — — — — — — Total written off Dispensary Register 38 19 30 17 66 31 23 38 17 78 17 9 25 2 36 9 7 7 8 22 Grand Totals 62 87 40 19 96 70 34 95 19 98 47 33 48 9 90 37 37 45 13 95 94 SO NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1932 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 Children M. 1 — — — 1 1 — — — 1 1 — — — 1 1 — — 1 2 F. 2 — — 4 6 — — 3 3 — — — — — — — — — — 3 — — 2 5 2 — — 3 5 1 1 — — 2 1 — — 1 Disease not Arrested Adults Children M. — — — — — 1 — — 2 3 1 — — 1 2 2 1 1 1 5 F. — — — 4 6 — 1 1 1 3 4 1 — — 5 2 — 1 ?, 5 3 — — — 3 — 1 1 3 5 1 — — — 1 3 — 2 4 9 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 9 — 2 10 21 4 2 2 12 20 8 2 — 1 11 9 1 4 8 22 Transferred to Pulmonary . (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults| Children M, 3 8 6 1 — — — 1 — — — — — — — — — — F. 2 1 1 4 8 — 3 — 1 4 — — — — — — — — —- — 7 1 1 13 22 — — — 5 5 — — — 2 2 1 — — 2 3 Lost sight of, or otherwise removed from Dispensary Register 17 — 4 15 86 9 — — 5 14 5 1 3 5 15 1 — 2 6 9 Dead Adults Children M. 1 — — — 1 2 — — — 2 1 — — — — — — 1 — 2 F. — — — — — — — — 1 1 — — — — — — — — — — — — — — — — 1 1 — 2 — — — — — — — — — — Total written off Dispensary Register 30 2 9 32 73 12 4 1 12 29 6 1 3 8 18 3 — 3 8 14 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 39 2 11 42 94 16 6 3 24 49 14 3 3 9 29 12 1 7 16 36 1929 1930 1931 1932 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults Children M. 2 — — — 2 — — — — — — — — — — — — — — — F. 1 — — 2 3 — — — — — — — — — — — — — — — 1 — 1 1 3 — — — — — — — — — — — — — — — Disease not Arrested Adults Children M. 1 2 3 4 2 2 8 4 1 5 2 1 3 6 F. 3 1 — 2 6 3 2 2 6 13 5 4 1 5 15 4 — — 3 7 1 — — 4 5 7 — — 10 17 8 3 2 7 20 8 1 — 3 12 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 9 1 3 9 22 14 2 4 18 38 17 7 3 13 40 14 2 — 9 25 Transferred to Pulmonary (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults Children M. — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 1 — 7 5 13 8 1 2 11 3 1 — 3 7 — — Dead Adults Children M. 1 — — 1 1 — 1 — 2 — — — — — F. — — — — — — — 2 — 2 — — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — Total written off Dispensary Register 2 — 7 5 14 9 1 3 2 15 3 1 — 3 7 — — — — — Grand Totals of (a) and (6) (excluding those transferred to Pulmonary). 11 1 10 14 36 23 3 7 20 53 20 8 3 16 47 14 2 — 9 25 96 The Nurses visit the tuberculosis population on notification and thereafter as far as possible at intervals of six months or less, as may appear advisable. During the year 4,101 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 171 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 every three weeks on Thursday 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 16 occasions during the year. There were submitted by the staff 172 applications for residential treatment, an increase of 29 compared with 1931. The Committee decided in 141 of these cases that no payment should be required in respect of such treatment. In the remaining 81 assessments of varying amounts were made. In 30 instances, reconsideration of these assessments was rendered necessary at subsequent meetings, mainly by changes in the family circumstances. 97 One hundred and eight 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. The Societies have co-operated with the work of the Care Committee and given very valuable assistance. Collection of payments, on behalf of the London County Council, has been made by the Dispensary to the amount of £185 7s. 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, Dispenser-Secretary and Junior Clerk. Report on Tuberculosis Work at Hammersmith Hospital Tuberculosis work is carried out in a special ward, C. 5, set aside for this purpose. Male pulmonary and surgical cases are admitted through the usual sources. It is to be regretted that no female ward exists in the hospital for tuberculosis, as it is an obvious fact, that more female cases from the Borough would accept local hospital treatment in preference to such treatment outside the Borough. Weekly visits are made to the hospital by the Borough Tuberculosis Officer in the capacity of Advisory Physician for tuberculosis, and all doubtful chest cases are seen by him. In this way co-operation between the hospital and the dispensary is established, and found to be valuable to both institutions. 98 Specialised treatment, such as artificial pneumothorax, gas replacements, phrenic evulsion and sanocrysin, is carried out on suitable pulmonary cases, whilst plaster work and orthopaedic corrections form part of the routine of suitable surgical cases. In connection with this specialised treatment an outpatient clinic has been organised for the Borough cases needing artificial pneumothorax refills, this latter being conducted by the Tuberculosis Officer and the work is under X-ray control. The Medical Officer of the ward has arranged for continuation of sanocrysin injections to discharged cases. In carrying out the specialised treatment an attempt is therefore being made to raise the classification of the patients to the pre-sanatorium stage, and various mendations to sanatoria are made from time to time. Cases of surgical tuberculosis and non-tuberculous chest diseases are admitted to suitable hospitals. 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. 99 X-Ray Work. Dispensary cases requiring further investigation are referred to the X-ray department of the London County Council Hospital at Du Cane Road, W.12. Films of the chest and other regions are taken, and delivered to the dispensary to be filed as permanent records of the respective cases. The Tuberculosis Officer makes his own reports on these skiagrams. This new scheme has proved a great saving in time to both the dispensary staff and the patient, whilst the interval between attendance and active treatment is greatly reduced. Artificial Pneumothorax Treatment. On 31st December the previous arrangements existing between the Borough Council and the Brompton Hospital for the above treatment were cancelled. All Borough cases in need of the continuation of this treatment are now referred to a special clinic at the London County Council Hospital, Du Cane Road. This clinic was organised by the Public Health Department with the help of the hospital staff, and the work is carried out by the Tuberculosis Officer in the minor operating theatre, X-ray control being suitably carried1 out. This refill clinic is arranged from 2.30 p.m. to 5 p.m. on Wednesday afternoons, but all new cases returning from Sanatorium are requested to report in the first instance to the Tuberculosis Officer at the Dispensary, Ravenscourt Park, so that arrangements may be made for refills. Close co-operation exists between the London County Council sanatoria and the dispensary, and full details of previous refills are sent by the medical superintendents to the dispensary. 100 The number of cases in the Borough now receiving this form of treatment is 14. It has been realised that certain cases may not be able to attend at the time stated above, but suitable times may be made by arrangement with the Tuberculosis Officer, and the treatment will he carried out at the dispensary. 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. Home nursing is provided through the District Nursing Association. 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. 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. 101 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 body was forthwith transported to Ireland for reinterment, and three bodies were re-interred in St. Mary's Cemetery, Harrow Road: 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 case where the remains were removed to Ireland 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. 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. 102 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 pathogenic bacteria present. PUBLIC WASH-HOUSES. The public wash-houses in Scotts Boad 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. 108 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 1,795 Corrected Number of Births 1,940 These figures represent a Birth-rate per 1,000 of the population of the Borough of 14.5 Corrected Number of Deaths of Infants under one year, of whom 40 died under one week 129 Legitimate infants 109, or 60 per 1,000 Births. Illegitimate Infants 20, or 150 per 1,000 Births. Infant Mortality Rate per 1,000 Births 66 The work undertaken under this heading was continued on similar lines to previous years. 1. Activities directly initiated by the Borough Council: (a) Provision of four Health Visitors. (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 grantsin-aid from the Borough Council: (a) Infant Welfare Centres (b) Day Nurseries. (c) Treatment and Nursing of Children under School Age. (d) Rheumatism Clinic. 3. Activities of independent Voluntary Agencies : (а) Rescue Homes. (b) Convalescent Treatment for Invalid Children. 104 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:— District. Total. No. 1. No. 2. No. 3. No. 4. Number of Births notified 362 611 510 369 1,852 Visits. First visits 309 584 475 357 1,725 Re-visits (under 1 year) 348 385 523 655 1,911 Re-visits (1-5 years) 433 260 279 420 1,392 Out 459 706 637 583 2,385 Removals 78 100 120 106 404 Special visits 92 105 94 285 576 Ophthalmia—First visits 2 10 — 2 14 Ophthalmia—Re-visits 1 — — — 1 Puerperal Fever 1 — — 1 2 Puerperal Pyrexia 1 7 7 3 18 Ante-natal—First visits 144 164 180 99 587 Ante-natal—Revisits 57 18 33 44 152 Stillbirths 13 10 12 7 42 Infant Deaths 26 35 17 20 98 Measles 73 87 129 91 380 Pneumonia 12 15 6 13 46 Encephalitis Lethargica — 1 — — 1 Chickenpox 55 3 7 10 75 Whooping Cough 3 10 2 18 33 Total visits 2,107 2,500 2,521 2,714 9,842 Attendances at Infant Welfare Centres 143 150 196 156 645 Attendances at Committee Meetings Voluntary Associations — 9 — — 9 Number of insanitary conditions reported 4 4 19 19 46 105 The feeding of the 1,725 infants visited was found to be as follows:— Breast-feeding 1,508 Artificial feeding 127 Mixed feeding 90 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 1932 1940 129 66 106 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. Total Attendances. Mothers. Children. Mothers. Children. Antenatal. Postnatal. Under 1 yr. Over 1 yr. Antenatal. Postnatal. Under 1 yr. Over l yr. 48, Glenthorne Road 151 — — 389 41 — — 5119 2116 48, Glenthorne Road 101 471 45 — — 1565 63 — — Victoria Mission Hall, Becklow Road 100 — — 227 19 — — 3194 1129 St. Matthew's Hall, Blythe Road 103 — — 284 47 — — 4375 1263 Old Oak Centre 100 — — 268 42 — — 4309 811 The Curve, West Way 98 250 27 — — 1168 46 — — Latymer Road Mission Blechynden Street 50 — — 54 14 — — 676 535 Presbyterian Hall, College Park 50 — — 44 8 — — 560 351 Total 753 721 72 1266 171 2733 109 18233 6205 Ante-natal Clinics 201 Infant Consultations 552 753 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 varied from 46 in the City of London to 107 in Paddington. 107 The following Chart shows the Infantile Mortality rate for the years 1903-1932. 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. 108 During the year 24 patients received treatment—the total attendances being 475. The following is a summary of the cases treated. Number. Disease. 11 Debility. 18 Rickets. 24 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. 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. 18,526 lbs. of dried milk and 1,684 quarts of raw milk and 100 tins of Nestle's were distributed during the year. The number of applications for free milk has averaged 63 per week during the year. The total expenditure during the year was approximately £1,200. 109 The amount of milk distributed during the year increased by 5,869 lbs. of dried milk, 825 quarts of raw milk and 46 tins of Nestles, at an increased cost of approximately £390. 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. The Nutrition of Expectant Mothers.—It is essential that the expectant mother should be well nourished if the growing baby is to be properly supplied with materials for building up bones, muscles and teeth which are forming slowly all through the nine months before birth. Fresh natural foods are what the mother needs most for herself and her baby; milk, eggs and butter, fruit and vegetables (especially greens, green salad, carrots, swedes and tomatoes) are all important for her health. The scheme for the supply of milk to expectant and nursing mothers under the Maternity and Child Welfare Act, 1918. provides that milk may be supplied in necessitous cases to expectant mothers in the last three months of pregnancy. 110 At the 82nd week of pregnancy most of the foetal parts are developed or laid down—it is then too late to give them a good start by the provision of milk. Many expectant mothers are undernourished, and no provision is made for the supply of milk during the first six months of pregnancy. The early period of pregnancy is equally as important if not more so than the later. It is then that the feetus commences to lay down bone deposits and the formation of muscles and teeth, and it is during this stage that the mother should have sufficient nourishment. It should therefore be possible for the Maternity and Child Welfare authorities to supply milk or dinners to expectant mothers in the early stages of pregnancy. Nutrition of Children.—In last year's report I referred to the evidence of malnutrition in children, which was attributed by the parents to the small amount of money left for food for the family after paying the present-day rents. An inspection of school children belonging to '21 families of the unemployed was carried out by Mr. Somerville Hastings, F.R.C.S., L.C.C., and results published in the Lancet dated 25th March, 1933. "Evidence of malnutrition was found in 28 per cent., whilst 76 per cent. were below the average weight of children of the same age in the elementary schools" Those selected for investigation were the elder children of the same families whose pre-school members were referred to as suffering from malnutrition in my annual report. An anomalous position has now arisen! We find that children living in the slums have better health than the children living under better housing conditions existing on the municipal estates. 111 The explanation is quite simple—the amount of money left to provide food is considerably greater in the slums than that which remains after paying increased rents of the better housing accommodation. This shows that the provision of food is even more important than the provision of good environmental surroundings. Much has been written and said on this subject, and one is led to speculate as to how the housewife has managed to feed her family on her diminished net income. The capacity of housewives for economical working varies enormously. It has been said by some observers that the housewife knows best how to lay out the money she has economically, and other observers have stated that she is appallingly ignorant on the subject and very wasteful. My experience shows that both may be right. Some mothers are extraordinarily thrifty, make the utmost use of every farthing, and buy food that gives good nutritional value. I set out a budget of one of these where the sum of nineteen shillings and threepence remains for the housewife to feed herself, husband and three children. On the other hand some mothers buy cooked or tinned foods, which are very dear, and sausages, which though savoury and make an easy meal, have very little food value. One mother was giving her baby of 14 months tinned salmon, as she " could not afford anything else." It is true this woman was of low mental standard. Another mother, receiving money from the Labour Exchange, was found to be buying English meat. Whilst this is very patriotic of those who can afford it, it is bad management for those who cannot. Others buy new bread notwithstanding the fact that bread left over can be bought cheaper in the early 112 ing at bakers' shops. New bread is not of the same economic value as bread not so recently baked. One cannot but observe that the instruction of girls in the purchasing of foods of good nutritional value and the proper cooking of these foods into appetising meals would be more advantageous to families than much which is taught in schools at the present time. BUDGET. Husband and wife (expectant mother) and 3 children (10), (8), (5). Money from Labour Exchange, 29s. 3d. : Rent, 10s. (two rooms); net income, 19s. 3d. s. d. s. d. Brought forward 9 9 Milk 4 0 Meat, target of mutton 1 0 Bread 2 11 ½ lb. of butter 5 Potatoes 1 0 ½ lb. of marg. 4 Vegetables 6 ½ lb. lard 3 Coal, 1 cwt. 2 7 3 lbs. flour 4½ Oil 1 0 1 lb. dates 2½ Soap and matches 6 ½ b. tea 5 Fish 4 2 lbs. sugar 4½ Eggs 5 Beans 3½ Bacon 3 Milk (skimmed) 2 Rice 3½ 9 9 Total 17 7½ Balance 1s. 7½d. MEALS. Breakfast.—Bread and margarine, tea, sometimes jam. Dinners.—(*Target of mutton—Dinners for 3 days.) 1st Day.—*Ribs roasted, potatoes and greens. 2nd Day.—* Rolled and roasted, potatoes and greens. 3rd Day.—*Stewed, dumplings, potherbs, potatoes. Pastry. 4th Day.—Fish, potatoes, pudding made from chopped dates. 5th Day.—Eggs and rice, potatoes, pudding. 6th Day.—Bacon and bread fried in gravy, pudding. 7th Day.—Beans, potatoes and greens, pudding (suet) Teas.—Bread and margarine, tea, sometimes jam. Children have tea at 6 p.m. Go to bed at 6.30 p.m. Target of Mutton (4 or 5 lbs.) bought in market on Saturday night for 1s. Bread.—Stale bread 2½d. per loaf; 2 loaves daily. Sometimes a little cheese bought out of balance. All children's clothes made out of old clothes. Mother repairs children's shoes. Can buy an old motor tyre for 2d. or 3d. at the rag fair. Strips the tyre and uses rubber for soles and heels. Fish.—Boiled and made into fishcakes, as it goes further. 113 Grant-aided Midwifery Service, Queen Charlotte's Hospital.—During the year the Midwives practising in the Borough complained to the Ministry of Health that their work was being largely taken away from them owing to the small fee charged by the district services of Queen Charlotte's Hospital. The complaint was referred by the Ministry to the London County Council as the Midwives' Supervising Authority for investigation. A conference was held at the County Hall between representatives of the London County Council, Queen Charlotte's Hospital and the Midwives', to which I was invited. The Chairman of the Central Public Health Committee presided. After some considerable discussion the matter was left in my hands to investigate, and if possible, find a satisfactory way out of the difficulty. I had several interviews with the Hospital Authorities and the Midwives separately, and some conferences of both parties were held in my room. Finally it was agreed that the Hospital should charge those mothers who could afford to pay, the same fee as would be charged by the Midwives, and adopt a method of assessing the others according to income, following the practice of the Public Health Department for the assessment of cases admitted to "Parkside" and "Invermead" Maternity Homes, but modified to suit district work. One cannot but sympathize with the Midwives in their complaint at their diminishing practice. This, however, seems almost inevitable as the entrance of Queen Char lotte's Charity into the Borough is not the only factor affecting the position. The loss is due as much to the falling Birth Rate as to any other factor. In 1920 the total births in Hammersmith amounted to 3,312, since when it has steadily fallen to 1,940 in 1932, a loss of 1,372 births in a year, sufficient to give full-time employment to about 10 midwives. 114 There is also an increasing tendency on the part of mothers to enter Maternity Institutions for their confinements. In the year 1931, 337 cases were confined in Institutions provided by this Council, which number was increased to 417 in 1982. In addition 258 mothers were confined in other institutions in 1931 and 358 in 1932, making 595 institutional births in 1931 and 775 in 1932. In 1932, 40 per cent. of the births took place in institutions compared with only 7 per cent. in 1917. The Midwives also complain that they are deprived of some work by the employment of the "handy woman" when a doctor is engaged. Some of the latter, but not all, insist on the assistance of a qualified Midwife. It appears that the combination of factors mentioned above is likely to continue, and the amount of work left for the practising Midwives lessened thereby. 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. Seventyseven cases were dealt with during the year ending December, 1932. The Council pays a fee of 2s. fid. per case to the Hospital Authorities. 115 "PARKSIDE" MATERNITY HOME. I append figures for the year 1932 :— 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. 214. (2) Average duration of stay 14 days. (3) No of cases delivered by— (a) Midwives 201. (1 B.B.A.) (b) Doctors 12. (4) No. of cases in which Medical Assistance was sought by a Midwife in emergency. 14. (5) No. of cases uotified 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). 1 (6) No. of cases of Pemphigus Neo natorum. 5 (7) No. of Infants not entirely breast fed while in the Institution. 12. (8) No. of cases notified as Ophthalmia Neonatorum. — (9)—(a) No of Mat ernal deaths (b) Cause of death in each case — (10)—(a) No. of Foetal deaths— (i) Stillborn 8. (ii) Within 10 days of birlh. 8. (b) Cause of death in each case, and results of postmortem examination (if obtainable). 1. P.M. Pulmonary Atelectasis. 2. Prematurity, 30 weeks. 3. do. 25 ,, 4. Atelectasis ; tentorial. hæmaturia. 5. Atelectasis : prematurity. 6. Atelectasis of the lungs. 7. Prematurity. Prematurity. 116 Queen Charlotte's Auxiliary Hospital, "Invermead," Goldhawk Road, W.12, 10 beds reserved for Hammersmith Borough Council cases. Information Required. Particulars. (1) No. of cases admitted during the year (April to December). 202. (2) Average duration of stay 14•2 days. (3) Number of cases delivered by— (a) Midwives 172. (b) Doctors 30. (4) No. of cases in which Medical Assistance was sought by a Midwife in emergency. - (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. 10. (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 7. (ii) Within 10 days of birth 2. (b) Cause of death in each case, and results of postmortem examination (if obtainable). Prematurity and Pyloric Stenosis White Asphyxia. 117 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 Borough— Princess Christian, the Latymer Road Mission Creche— continue 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 37 beds. Convalescent Treatment of Invalid Children.—This work was carried on by the Invalid Children's Aid Association; the majority of children assisted are of school age, and a considerable number were sent to Convalescent Homes by the good offices of the Association during the year. 118 Treatment and Nursing of Children under School Age. —The treatment of children under five years of age was continued at the School Clinic. During the year the cases dealt with were as follows:— Operation for Tonsils and Adenoids — Minor Ailments 17 Dental Treatment — 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 2 5 2 - 2 Puerperal Pyrexia 29 30 18 2 28 Ophthalmia Neonatorum 19 12 19 5 10 Epidemic Diarrhœa 26 19 - - - Measles & German Measles (under 5)† 718 63 718 76 210 Whooping Cough (under 5)† 178 129 178 37 Poliomyelitis (under 5) 1 — 1 — 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. 119 Ophthalmia Neonatorum.—The number of cases reported was nineteen against thirteen 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. 8.1.32 1 - 1 - - - 9.1.32 — 1 1 - — — 22.1.32 — 1 1 - — — 10.3.32 — 1 1 - — — 29.3.32 1 — 1 - — — 4.4.32 1 — 1 - — — 22.4.32 — 1 1 - — — 4.5.32 1 — 1 - — — 2.7.32 — 1 1 - — — 6.7.32 — 1 1 - — — 22.7.32 — 1 1 - — — 25.7.32 1 — 1 - — — 28.7.32 1 1 - - - 2.8.32 1 1 - — — 19.9.32 — 1 1 - — — 3.10.32 1 — 1 - — — 7.11.32 1 — 1 - — — 19.12.32 — 1 1 - — — 24.12.32 — 1 — - — 1* 8 11 18 — — 1 * Prematurity. Ophthalmia Neonatorum. Gonococcal 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. 120 The Lady Inspector inspects Factories, &c., where females are employed, makes enquiries into cases of measles, whooping cough, chicken pox, &c. Two temporary Sanitary Inspectors were employed for the purpose of making house-to-house inspections of special roads approved by the Public Health Committee. This service was discontinued at the end of May. Increase of Rent and Mortgage Interest Restrictions Act, 1920-1923.—During the year twenty-six applications were received for certificates under the above Act. In twenty-three cases the certificates were granted, three applications were refused. Twelve certificates were granted to owners who had carried out the work specified satisfactorily. Public Mortuary.—Three hundred and four bodies were removed to the Mortuary in Fulham Palace Road during the year. Hammersmith— Admitted by order of Coroner 160 Admitted by order of Police 11 Admitted on application of undertakers for accommodation 31 202 Bodies admitted from other Boroughs :— Fulham 33 Chelsea 69 102 Total 304 No. of P.-M. examinations conducted: — Hammersmith cases 101 Fulham cases 23 Chelsea cases 16 Total P.M.'s 140 No. of Inquests held :— Hammersmith cases 122 Fulham cases 91 Chelsea cases 75 Total Inquests held 288 121 Cremation.—The burial of the dead has for centuries past, in the great majority of cases, been carried out by laying the remains in cemeteries. The cemeteries are scattered throughout the country and occupy much land in the midst of residential quarters. The law provides that no ground not already used as or appropriated for a cemetery shall be used for burials within the distance of 100 yards from any dwelling-house without the consent of the owner, lessee and occupier of such dwelling-house, but there is no law to prevent the building of dwelling-houses close to an established burial ground. It has been suggested that cemeteries are unhealthy; whether that be so or not, the modern method of disposing of the dead by cremation is being adopted much more frequently than in the past. This method is one that commends itself to all sanitarians, and I have no doubt that ultimately cremation will be universal. The filling up of open spaces, which are often valuable sites and would provide accommodation for hundreds of houses, is a question that must sooner or later receive the attention of those responsible for the well-being of this country. The advantages of cremation are both sanitary and economical. Cremation is the best method of disposal of the dead. Regard to the common welfare is a powerful incentive to cremation. No one can ponder upon cremation without realising how much preferable it is to that of earth burial. The necessity of maintaining a grave is dispensed with. The practice of burying several bodies in a common grave is most objectionable, especially when it is remembered that the remains bear no relation to one another. 122 This is done where the relatives are poor and unable to purchase a grave space. The cost of cremation, as a whole, is much cheaper, and if generally adopted, would obviate the necessity of this unfortunate practice. There are a number of crematoria established throughout the country, several of which are within easy reach of London. One at Ilford is established by the Corporation of the City of London, and others privately owned are at Woking and Golders Green.