AC 4347 HAM25 Metropolitan Borough of Hammersmith. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1933. INDEX. Page Introduction 2 Staff of this Public Health Department. 6 Statistics for the Year 1933 9 Natural and Social Conditions of the District. Births 10 Chart—Diarrhœa 12 Diarrhœa 13 Deaths 11 Deaths of Infants 11 Deaths of Illegitimate Children 13 Deaths of Aged Persons 14 Deaths of Residents 15 Deaths (Various Causes—Table II) 18 Hospital Treatment—Zymotic Enteritis 13 Infant Mortality for 1933 14 Marriages 10 Population 10 Statistics 15 Table—Whole of London—Comparison 19 Professional Nursing in the Home. General 20 Midwives 20 Nursing 20 Laboratory Facilities 20 General Provision of Health Services in the Borough. Ambulance Facilities 26 Day Nurseries 28 Hospitals (Public) 21 Hospitals (Voluntary) 22 Institutional Treatment for Unmarried Mothers 25 Maternal Mortality 25 Maternity and Child Welfare Centres 26 Rheumatism Advisory Clinic 29 School Clinics 28 Treatment Centre for Venereal Diseases 29 Tuberculosis Dispensary 28 Sanitary Circumstances of the Borough. Closet Accommodation 29 Fouling of Footpaths by Dogs 30 Hammersmith Borough Council By-laws—Dogs 36 Inspections 31 Notices 32 Public Health Acts 37 Sanitary Inspection of Area 30 Scavenging 29 Summonses. Page Controlled Premises and Occupations 42 Factory and Workshop Act, 1901 37 Factories and Workshops—Inspection of 39 House to House 42 Houses Let in Lodgings 43 Housing Act, 1925—Section 18 44 Ice Cream Vendors 44 London County Council. (General Powers) Act, 1928 39 Rag Flock Acts, 1911 and 1928 45 Rats and Mice (Destruction) Act, 1919 42 Schools 45 Smoke Abatement 42 Tenement Houses 43 Vans 44 Housing. General Housing Conditions 48 Newly Erected Houses 49 Statistics 46 Supply of Houses—Overcrowding 48 Inspection and Supervision of Food. Bakehouses 59 Butter, Margarine and Lard 66 Certification of Certain Food Products for Export 52 Cheese 66 Chemical and Bacteriological Examination of Food 61 Cocoa, Coffee and Tea 67 Common Lodging Houses 56 Condensed Milk 65 Cordials, Wines and Spirits 68 Condiments, &c. 67 Conserves, Vegetables, Fruits, &c. 67 Cow Houses 56 Cream 65 Drugs 68 Farinaceous Foods 67 Food and Drugs Adulteration Act, 1928 62 Food Supplies 50 Food Surrendered 61 Fried-fish Shops 58 Housing Act, 1930 38 Inspection of Carcases of Animals slaughtered in Local Slaughter. houses 53 Knackers' Yards 56 Markets 57 Milk Supply 51 Milk (Special Designations) Order, 1923 52 Inspection and Supervision of Food—continued. Page Meat and Fish Preparations 66 Milk 64 Offensive Trades—Slaughterers of Poultry 57 Public Health (Meat) Regulations, 1924 52 Seamen's Lodging Houses Slaughterhouses and Knackers' Yards 56 Street Trading 58 Unsound Food 61 Prevalence and Control over Infectious Diseases. Acute Polio-myelitis 79 Anthrax 72 Anti-toxin 75 Artificial Pneumothorax Treatment 102 Bacteriology 72 Cerebro-Spinal Meningitis 78 Chicken Pox 81 Cholera 75 Cleansing of Verminous Persons 82 Continued Fever 78 Diphtheria and Diphtheritic Membranous Croup 75 Diphtheria—Chart 76 Disinfection 84 Dysentery 82 Encephalitis Lethargica 79 Enteric Fever 78 Erysipelas 78 Food Poisoning 82 Glanders 79 Hydrophobia 79 Influenza 82 Malaria 81 Measles and German Measles 79 Measles—Chart 80 Notifiable Diseases 73 Ophthalmia Neonatorum 79 Plague 75 Pneumonia 81 Public Health (Smallpox) Regulations, 1917 87 Public Health (Prevention of Tuberculosis) Regulations, 1925 90 Puerperal Fever 78 Puerperal Pyrexia 78 Psittacosis 82 Rabies Order, 1919 79 Relapsing Fever 78 Report on Tuberculosis Work at Hammersmith Hospital 100 Scarlet Fever 75 Scarlet Fever—Chart 77 Smallpox 75 Prevalence and Control over Infectious Diseases—continued. Page Tabular Statement—Zymotic Diseases 83 Tuberculosis 87 Tuberculosis Dispensary 90 Typhus Fever 78 Vaccination 84 Vaccination Returns 85 Whooping Cough 81 Whooping Cough—Chart 80 Wrong Diagnosis 82 X-Ray Work 101 Zymotic Diseases 73 Prevention of Blindness 104 Exhumation and Re-interment of Bodies 104 Public Baths 105 Health Education. Public Wash-houses 106 Propaganda 106 Infant Life Protection 106 Maternity and Child Welfare Artificial Light Treatment 114 Chart—Infantile Mortality Rate 113 Circumcisions 115 Feeding of Infants—Statistics 111 Health Visitors—Work of 110 "Invermead" Maternity Home—Statistics 117 Light Treatment Centre 114 Milk (Mothers and Children) Orders, 1918-1919 114 "Parkside" Maternity Home—Statistics 116 Schedule of Attendances at Infant Welfare Centres 112 Sessions 114 Staff 114 Table—Births. Deaths, and Infant Death Rate 111 Types of Lamps 114 Voluntary Work. Convalescent Treatment of Invalid Children 120 Day Nurseries 120 Infant Welfare Centres 118 Infectious Diseases of Mothers, and Children under five years of age—Tabular Statement 121 Ophthalmia Neonatorum 122 Rescue Homes 120 Treatment and Nursing—Children under School Age 118 (a) Operations. (6) Minor Ailments. (c) Dental Treatment. Sanitary Administration. Staff 122 Rent Restrictions Act 122 Public Mortuary 123 Metropolitan Borough of Hammersmith. ANNUAL REPORT of the Medical Officer of Health for the YEAR 1933. 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 1988. 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 12.9 is 0.1 per thousand greater than the rate for the previous year. The infantile mortality rate is 65 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 accommodation in their own homes. The number of confinements in 1933 amounted to 460. It is an obligation on every expectant mother booked for "Parkside" or "Invermead" to attend the antinatal centre at least once. Usually two, three or more attendances are made. The Council has received notice to terminate the agreement relating to the use of "Parkside" for the admission of maternity cases, during the coming year, owing to the proposed establishment of a Post-Graduate School at the Hammersmith Hospital. Arrangements will be made to provide the services at some other Institution. 3 The efforts of your Council have been, as in the past, considerably augmented by those of the Voluntary Societies engaged in this branch of the Public Health Services of the Borough. With regard to infectious diseases, the total number notified was below the average for the past 10 years. This was due to the decrease in the number of cases of measles. Towards the end of the year the number of cases of scarlet fever and diphtheria increased with the result that the hospital accommodation available was overtaxed. In November two children died from diphtheria, one before the arrival of the doctor and the other whilst awaiting the report of the pathologist on a swab. The coroner held an inquest on the former. Delay in the diagnosis of cases of diphtheria is often followed with fatal results. If the clinical evidence is such as to give reasonable grounds for assuming the case to be positive it is imperative that antitoxin should be immediately administered, even if the patient is to be removed to hospital. If the clinical evidence is not conclusive and it is necessary to take a swab, antitoxin should be administered at once and not delayed until the report is received from the pathologist. In connection with this I considered it advisable to arrange for an address to be given on this question to the medical practitioners practising in the Borough. Through the courtesy of Sir Frederick Menzies, K.B.E., the Chief Medical Officer of the London County Council. 4 Dr. Rolleston, the Medical Superintendent of the Western Fever Hospital, gave an address on "Infectious Diseases" more particularly with regard to diphtheria and scarlet fever. The meeting was very well attended, about 50 doctors being present. After Dr. Rolleston's talk questions were invited and a general discussion followed. At the conclusion thanks were accorded by those present to the lecturer for his address and to the Public Health Department for making the arrangements. The hope was expressed that similar meetings should be held in the future, and as closer co-operation between medical practitioners and the Public Health Department has always been, in my opinion, very desirable, it is my intention to arrange similar gatherings at suitable intervals. The chair was taken by Alderman Dr. W. H. Burnhill, Chairman of the Public Health Committee. In pursuance of the Transfer of Powers (London) Order, 1933, the undermentioned services were transferred from the London County Council to the Metropolitan Borough Councils as and from 1st April, 1933:— Public Health Services. 1. Licensing, inspection and supervision of seamen's lodging houses. 2. Registration, licensing, inspection and regulation of common lodging houses. 8. Licensing of dairymen to use premises as cow- horses. 5 4. Licensing and inspection of slaughter-houses and knackers' yards. 5. Sanctioning of establishment or enlargement of premises used for offensive trades. Maternity and Child Welfare Services. 1. Infant life protection under Part I of Children Act, 1908, amended by Part 5 of the Children and Young Persons Act, 1932. The Council is now the authority responsible for the registration and supervision of foster mothers and foster children. I am, Ladies and Gentlemen, Your obedient Servant, J. B. HOWELL, Medical Officer of Health. 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF THE YEAR 1933 Medical Officer of Health and Year of Administrative Tuberculosis Officer. Appointment 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 Gynæcologists. 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 J. A. Johnson, M.B., B.Ch. 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., 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 T. J. Hares 1930 E. F. Yorke 1931 Miss M. Holmes 1933 7 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 Lady Sanitary Inspector. II”*Miag E. M. Cross 1932 Health Visitors. "II†*Miss R. A. Henry 1916 II*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 8 †Cert. Royal Sanitary Institute (Inspector). *Cert. 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. ∆Diploma in Nursing, London University. 9 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1933. Area 2,282.5 acres Population (1933) (estimated) 131,400 Population Census (1901) 112,239 „ „ (1911) 121,521 „ „ (1921) 130,295 „ „ (1931) 135,521 Natural increase, i.e., excess of births over deaths 137 Density of population 57.6 persons per acre Marriages registered 1,245 Number of inhabited houses 1931 17,402 Number of families or separate occupiers (1921) 33,263 Rateable value (1933) £1,148,584 Sum represented by a penny rate, 1933 £4,680 Vital Statistics. Births (legitimate) 1,706 ,, (illegitimate) 121 birth rate 13.9 Stillbirths 66 death rate 12.9 Deaths (corrected) 1,690 Number of women dying in, or in from sepsis 6. consequence of childbirth from other causes 2. Deaths of infants under one year of age per 1,000 births 65 Legitimate, 58. Illegitimate, 157. Deaths from measles (all ages) 3 Deaths from whooping cough (all ages) 5 Deaths from diarrhœa (under 2 years of age) 27 10 Population.—According to the Census of 1901, the population of the Borough was then 112,239. By the Census of 1911 the population was 121,521 showing an increase during the 10 years of 9,282. The Census of 1921 shows the population of the Borough to be 130,295, being an increase in the 10 years of 8,774. The Census of 1931 shows the population of the Borough to be 135,521, being an increase in the 10 years of 5,226. In this report the rates are calculated on the estimated population adopted by the Registrar-General, i.e., 131,400. The corrected number of births registered was 1,827, whilst the corrected number of deaths of residents was 1,690, thus showing a natural increase of population by excess of births over deaths of 137. The area of the Borough is 2,282.5 acres, there being 57.6 persons to the acre. Marriages.—The number of marriages registered during the year was 1,245, the marriage rate being 19. Births.—During the year 1,682 births were registered in the Borough. Adding 413 births which occurred, outside the Borough, transferred by the Registrar-General as belonging to Hammersmith, and deducting 268 births which occurred in the Borough, and transferred to other districts by the Registrar-General, the corrected number of births for the year was 1,827. On the estimated population, i.e., 131,400, the corrected number of births registered was equal to an annual rate of 13.9 births per 1,000 persons living. The Birth-rate for the year is 0.6 per 1,000 less than the rate for the previous year, which was 14.5. The Birth-rate in London on the estimated population, i.e., 4,298,600. was equal to an annual rate of 13.2 births per 1,000 persons living. 11 Notification of Births Act, 1907. Births notified 2,004 Corrected number of births 1,827 Notification Received from Midwives. Doctors. Lying-in Hospitals. Poor Law Institutions. Parents. M.O.H.'s. 806 124 878 188 4 4 Deaths.—During the year 1,500 deaths were registered in the Borough, as compared with 1,465 in the previous year. Adding 506 deaths of residents of this Borough which occurred in general hospitals and other public institutions, and 24 deaths of residents transferred by the Registrar-General as having occurred in various parts of England, and deducting 322 deaths of non-residents and 18 transferable deaths which occurred in the Borough, the corrected number of deaths of residents was 1,690 (849 males, 841 females). On the estimated population, i.e., 131,400, the corrected number of deaths of residents was equal to an annual rate of 12.9 deaths per 1,000 persons living. The Death-rate in London on the estimated population. i.e., 4,298,600, was equal to an annual rate of 12.2 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 119, as compared with 129 in the previous year. The number of deaths of infants under one year of age was equal to 65 per 1,000 of the corrected births. The number of deaths of infants under one year of age, residents in London, was equal to 59 per 1,000 of the total registered births. 12 The following Chart shows the number of deaths from Diarrhœa per 100,000 inhabitants, 1911-1933. 13 The mortality rate of infants under one year of age was six per thousand greater in this Borough than in London. Diarrhœa.—The number of deaths from diarrhœa was 27, being 1 more than in the previous year. Nineteen were children under one year of age. Hospital Treatment.—Zymotic Enteritis.—The arrangements made by the London County Council for the provision of a number of beds for the treatment of zymotic enteritis was continued. Deaths of Illegitimate Children.—The corrected number of deaths of illegitimate infants under one year of age was 20 or at the rate of 157 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 58 per 1,000 whilst the latter is 157 per 1,000, a difference of 99 per 1,000. 14 The following table on infantile mortality has been prepared in accordance with the direction of the Ministry of Health. INFANT MORTALITY 1933. Infantile Mortality during the year 1933. Nett Deaths from stated causes at various ages under one year of age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks. and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 1 year. Total Deaths under 1 Year.  ALL Certified 32 10 6 1 49 19 22 21 8 119 CAUSES. Uncertified - - - - - - - - - - Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - - 1 2 1 4 Diphtheria and Croup - - - - - - - - - - Erysipelas - - - - - - - - 1 1 Tuberculous Meningitis - - - - - - - - - 1 Abdominal Tuberculosis - - - - - - - -1 - 1 Other Tuberculous Diseases - - - - - - - - - - Meningitis (not T.B.) - - - - - 1 - 1 1 3 Convulsions - - - - - - - - - - Laryngitis - - - - - - - - - - Bronchitis - — 1 - 1 1 - 1 - 3 Pneumonia (all forms) 2 2 - - 4 5 7 6 - 22 Diarrhœa - - - - - - - - - - Enteritis - - - - - 3 5 5 5 18 Gastritis - - - - - - 1 - - 1 Syphilis - - - - - 1 - - - 1 Rickets - - - - - - - - - - Suffocation, overlying - - - - - - - - - - Injury at Birth 3 - - - 3 - - - - - Atelectasis 3 1 - - - - - - - - Congenital Malformations 3 - 1 1 5 - 2 - - 7 Premature Births 18 7 2 - 27 - - 1 - 33 Atrophy, Debility & Marasmus 2 - 1 - 3 3 - 1 - 7 Other causes 1 - 1 - 2 2 4 2 - 10 Totals 32 10 6 1 49 19 22 21 8 119 Nett Births in the Year: Legitimate, 1706; Illegitimate. 121. Nett Deaths in the Year of: Legitimate Infants, 99; 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 799, against 759 in the previous year. These deaths were equal to 6.1 per 1,000 of the total persons living, and 473 per 1,000 of the total deaths of residents registered. 15 Statistics.—The following table gives the statistics of the Borough during 1933 and previous years:— Vital Statistics of Whole District during 1933 and Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. of Non-residents registered in the District. of Residents not registered in the District. Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1922 134400 2564 2758 20.5 1223 9.1 196 705 196 71 1733 12.9 1923 133600 2571 2701 20.2 981 7.3 125 649 173 64 1473 11.0 1924 134200 2199 2399 17.9 1123 8.4 173 718 173 72 1668 12.4 1925 134500 2178 2351 17.5 1034 7.7 186 756 153 65 1604 11.9 1926 134400 2001 2188 16.3 1174 8.7 195 556 144 66 1535 11.4 1927 132800 1789 2076 15.6 1581 11.9 230 377 126 61 1728 13.0 1928 136300 1938 2258 16.6 1449 10.6 222 326 156 69 1553 11.4 1929 136900 1869 2162 15.8 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 1933 131400 1??? 82 1827 13.9 1500 11.4 340 530 119 65 1690 12.9 Deaths of Residents.—Belonging to the Borough, occurring in Public Institutions, &c., in districts outside, during the year 1933:— FEVER HOSPITALS. Grove Hospital, Tooting 5 Brook Hospital, Woolwich 1 Western Hospital, Fulham 15 North-Western Hospital 1 South-Eastern Hospital 1 23 MENTAL HOSPITALS. Tooting Bee Hospital 7 1, West Park Road 2 1, Uxbridge Road, Southall 30 Horton Hospital 6 The Forest, Hook Road 1 Hundred Acres, Banstead 7 The Grove, Horton Lane 4 Camberwell House 2 Fountain Mental Hospital 1 Springfield House, Tooting 1 1a, Manor Road, Ilford 1 — 62 16 GENERAL HOSPITALS. Acton Hospital 3 Chiswick Hospital 3 Consumption Hospital 3 Princess Louise Hospital 1 Middlesex Hospital Annexe 3 Infants' Hospital, Vincent Square 2 St. Luke's Hospital, Padding- ton 6 Children's Hospital, Great Ormond Street 2 Queen Charlotte's Hospital 9 20, Glazbury Road 1 Empire Nursing Home, Westminster 1 Invalid's Home, Highbury 1 St. Margaret's Nursing Home, St. Pancras 1 St. Mark's Hospital, Finsbury 1 Jewish Home of Rest 2 7, Knaresborough Place 2 69, Hornsey Lane 1 Italian Hospital, Queen Square 1 The Grange, Morden 1 83, Mattock Lane, Ealing 1 Ewell Grove Nursing Home 1 Mount Vernon Hospital, Ruislip 1 Westminster Hospital 2 Golden Square Throat, Nose & Ear Hospital 1 Home and Hospital for Jewish Incurables 1 St. George's Hospital 12 St. Mary's Hospital, Padding- ton 6 11, Grange Park 1 St. Andrew's Hospital 1 Cancer Hospital 6 St. Joseph's Hospice for the Dying 2 Victoria Hospital for Children 2 302, Fulham Palace Road 2 Queen Mary's Hospital, Putney 1 Royal Free Hospital 1 National Temperance Hospital. St. Pancras 2 Queen Mary's Hospital, Chislehurst 2 25, Leinster Square 2 Downs Hospital, Sutton 1 Chest Hospital, Bethnal Green 1 Chelsea Hospital for Women 2 St. Thomas' Hospital 1 University College Hospital 3 Battersea General Hospital 1 Charing Cross Hospital 1 1, Ladbroke Square 1 St. Mary's Nursing Home, Chiswick 1 Colindale Hospital 2 National Hospital for Diseases of the Heart 2 52, Grange Park 1 4, Sydenham Road, Croydon 1 St. Peter's Hospital 1 111 PUBLIC INSTITUTIONS. Fulham Hospital 21 Redhill House, Edgware 1 28, Marloes Road 127 93, Sydney Street 12 1, Northumberland Street 1 la. Shepherdess Walk 1 2a, Woolwich Road 1 St. James' Hospital, Balham 1 390. High Street, Lewisham 1 2, Grove Road, Richmond 1 369, Fulham Road 20 30, Twickenham Lane 3 12. Exmoor Street 79 285, Harrow Road 6 Lambeth Hospital 2 Twyford Lodge, Acton 2 26, Wolverton Avenue, Kingston 2 2a, Bow Road 1 282 17 VARIOUS. 64, Bulstrode Avenue, Hounslow 1 30, Clyde Road, Beddington 1 4, Bristol Gardens, Paadington 1 4, Devonshire Road 1 In Brentford and Chiswick Ambulance outside Chiswick Hospital 1 27, Cumberland Park, Acton 1 16, Swaffield Road, Wandsworth 1 385, High Road, Chiswick 1 21, Longton Grove, Lewisham 1 On the way to St. Thomas Hospital 1 30, Summerhouse Avenue, Hounslow 1 185, Wornington Road, Kensington 1 26. Eastcote Road, Harrow 1 264, Queen's Road, Battersea 1 On the way to St. George's Hospital 1 Gt. Marlborough Street Police Court 1 14, Penzance Place, Kensington 1 20a, Rossetti Gardens Mansions, Chelsea 1 Lessness Hurst Woods, Abbey Wood 1 10, Bull's Cross, Enfield 1 7, Rathgar Avenue, Ealing 1 112, Chatsworth Crescent, Hounslow 1 46, Rosebery Avenue, Hounslow 1 On Foreshore of the River Thames 1 In River Thames at Chiswick 1 In River Thames off Middle- ton's Wharf, Wapping 1 In River Thames at Mortlake 1 In River Thames off Wandsworth Gas Works 1 28 TABLE II. Causes of, and Ages at, Death during the Year 1933. METROPOLITAN BOROUGH OF HAMMERSMITH. Causes of death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Causes M 849 62 7 14 19 33 41 52 100 183 181 157 F 841 57 3 6 14 37 42 43 69 109 195 266 1 Typhoid and Paratyphoid Fever M 1 .. .. .. .. 1 .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 2 Measles M 3 .. .. 1 1 .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 3 Scarlet Fever M 2 .. .. .. 1 .. .. .. .. .. .. .. F 2 .. .. .. 2 .. .. .. .. .. .. .. 4 Whooping Cough M 2 2 .. .. .. .. .. .. .. .. .. .. F 3 2 .. 1 .. .. .. .. .. .. .. .. 5 Diphtheria M 6 .. .. 3 3 .. .. .. .. .. .. .. F 8 .. .. 3 5 .. .. .. .. .. .. .. 6 Influenza M 26 .. .. .. 1 .. 2 .. .. 7 6 7 F 38 .. .. .. .. .. .. 4 4 3 10 17 7 Encephalitis Lethargica M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 8 Cerebo-spinal Fever M 2 1 .. .. 1 .. .. .. .. .. .. .. F 2 .. .. .. 1 .. .. .. 1 .. .. .. 9 Tuberculosis of Respiratory System M 82 .. .. .. 1 7 13 19 23 15 4 .. F 56 .. .. .. .. 16 20 8 2 6 2 2 10 Other Tuberculous Diseases M 9 2 1 1 2 1 1 .. 1 .. .. .. F 3 .. .. .. .. 2 .. 1 .. .. .. .. 11 Syphilis M 4 .. .. .. .. .. .. .. 2 2 .. .. F 3 1 .. .. .. 1 .. .. 1 .. .. .. 12 General Paralysis of the insane. tabes dorsalis M 9 .. .. .. .. .. .. 1 3 5 .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 13 Cancer, malignant disease M 114 .. .. .. .. 2 3 5 13 33 38 20 F 117 .. .. .. .. 1 2 9 19 27 29 30 14 Diabetes M 4 .. .. .. .. 1 .. .. .. 1 .. .. F 11 .. .. .. .. .. .. .. 1 4 5 1 15 Cerebral Hæmorrhage, &c. M 18 .. .. .. .. .. .. 1 2 5 5 5 F 38 .. .. .. .. .. .. 3 3 7 11 14 16 Heart Disease M 199 1 .. .. 1 2 2 5 20 44 62 62 F 210 .. .. .. .. 3 8 4 7 18 66 104 17 Aneurysm M 10 .. .. .. .. .. .. .. 2 6 2 .. F 2 .. .. .. .. .. .. .. .. .. 2 .. 18 Other circulatory diseases M 44 .. .. .. .. .. .. .. 2 10 19 13 F 37 • • .. .. .. .. .. .. 3 9 9 16 19 Bronchitis M 24 .. .. .. .. 1 .. 1 2 7 3 10 F 33 .. .. .. .. .. .. .. 2 2 4 25 20 Pneumonia (all forms) M 60 15 3 3 .. 2 7 2 2 10 12 4 F 53 7 1 1 1 .. 1 3 4 9 9 17 21 Other Respiratory Diseases M 7 .. .. .. .. .. .. .. 2 3 1 1 F 15 1 .. .. .. 2 1 1 1 3 3 3 22 Peptic Ulcer M 13 .. .. .. .. .. 1 2 4 4 2 .. F 11 .. .. .. .. .. .. .. 1 1 6 3 23 Diarrhœa, &c. M F 9 18 7 12 .. 1 .. .. .. 1 .. .. 1 1 .. .. .. 1 .. .. 1 1 .. 1 24 Appendicitis M 5 .. .. .. .. .. 1 1 1 2 1 1 F 3 .. .. .. .. 1 1 .. 1 .. .. .. 25 Cirrhosis of Liver M 1 .. .. .. .. .. .. .. .. 1 .. .. F 4 .. .. .. .. .. .. 1 .. 3 .. .. 26 Other Diseases of Liver, &c. M 1 .. .. .. .. .. .. .. .. 1 .. .. F 3 .. .. .. .. .. .. .. .. .. 3 .. 27 Other Digestive Diseases M 22 5 1 3 2 1 2 .. 1 1 5 1 F 14 1 .. .. 1 1 .. 1 1 1 5 3 28 Acute and Chronic Nephritis M 25 1 .. .. .. 2 2 .. 5 4 7 4 F 18 .. .. .. .. 1 1 1 3 3 4 4 29 Puerperal Sepsis F 6 .. .. .. .. 3 1 2 .. .. .. .. 30 Other Puerperal Causes F 2 .. .. .. .. 1 1 .. .. .. .. .. 31 Congenital Debility, Premature Birth, Malformations, &c. M 24 24 .. .. .. .. .. .. .. .. .. .. F 31 30 .. .. .. 1 .. .. .. .. .. .. 32 Senility M 11 .. .. .. .. .. .. .. .. .. 1 10 F 21 .. .. .. .. .. .. .. .. .. 4 17 33 Suicide M 11 .. .. .. .. .. 1 1 2 3 2 2 F 12 .. .. .. .. .. 2 2 4 3 1 .. 34 Other violence M 42 .. .. 1 6 9 4 6 5 4 5 2 F 20 .. .. i .. .. 1 2 1 2 7 6 35 Other defined diseases M 59 4 1 l 1 3 1 8 5 15 6 14 F 46 3 1 .. 3 4 1 1 9 8 13 3 36 Causes ill-defined, or unknown M .. .. .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. .. .. .. .. 1 .. Total 1,690 119 10 20 33 70 83 95 169 292 376 423 19 This rate is calculated on the estimated population o: each Ward. Ward. Estimated Population. No. of Deaths. Death Rate. No. 1 River 17,255 276 16.0 No. 2 Brook Green 25,248 239 13.4 No. 3 The Grove 22,446 294 13.1 No. 4 St. Stephens 9,028 117 12.9 No. 5 Starch Green 22,265 257 11.5 No. 6 Wormholt 23,305 289 12.4 No. 7 College Park and Latimer 11,853 118 9.9 LONDON AND METROPOLITAN BOROUGHS. Cities and Boroughs. Estimated population. Births. Annual rate per 1,000 persons living. Deathrate per 1,000 living. Infantile Mortality rate per 1,000 births. County of London 4,298,600 13.2 12.2 59 West Districts. Paddington 141,900 13.4 13.4 85 Kensington 181,100 12.0 12.9 72 Hammersmith 131,400 13.9 12.9 65 Fulham 148,200 13.1 13.0 65 Chelsea 58,850 10.6 13.6 78 City of Westminster 126,300 8.7 12.4 68 North Districts. St. Marylebone 94,080 9.7 12.2 56 Hampstead 90,380 9.6 11.0 38 St. Pancras 190,900 13.6 13.7 58 Islington •319,100 •14.4 *12.4 63 Stoke Newington 51,120 12.6 12.3 46 Hackney 214,300 14.0 11.5 51 Central Districts. Holborn 36,050 9.5 13.5 70 Finsbury 66,640 15.1 12.8 50 City of London 9,830 7.7 10.9 65 East Districts. Shoreditch 93,550 16.0 13.0 74 Bethnal Green 104,200 14.3 12.5 66 Stepney 219,100 15.1 12.9 65 Poplar 149,300 15.4 12.4 54 South Districts. Southwark 164,700 14.2 13.9 63 Bermondsey 107,300 14.0 12.5 61 Lambeth 289,000 13.6 13.1 63 Battersea 154,000 14.7 12.5 49 Wandsworth 350,200 10.9 11.5 50 Camberwell 243,700 13.3 12.3 49 Deptford 102,800 14.8 12.1 54 Greenwich 97,830 13.7 11.9 66 Lewisham 221,100 12.2 10.2 39 Woolwich 146,200 12.6 11.2 62 •The estimated population is that of 1932 and the rates are calculated on this figure. 20 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 make 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 82 midwives gave notice of their intention to practise in the Borough during 1988. Laboratory Facilities. The chemical analysis of food is caried 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. 21 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. (Typhoid, cerebro-spinal meningitis, milk counts, &c.) GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. HOSPITALS—PUBLIC. "Parkside" Maternity Home, 150, Du Cane Road, W.12.—This Home consists of a ten-bedded ward in the Hammersmith Hospital for the reception of maternity cases booked through the Hammersmith Borough Council. Name :—Hammersmith Hospital. Situation:—Du Cane Road, Shepherd's Bush, W.12. Purpose:—General. No. of available beds:—366. If used by persons resident outside the area, in what proportion :—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 36 Maternity — 12 Tuberculosis 30 — Chronic sick — — 22 Facilities available for:— (1) Operative Surgery.—Yes. (2) X-ray.—Yes. (3) Dental.—Yes. (4) Ophthalmic.—Yes. (5) Massage.—Yes. Arrangements for pathological work:—Small laboratory, and specimens sent to other laboratories. No. of patients during 1933 :—Admissions = 3,837. 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:—235. If used by persons resident outside the area, in what proportion:—73 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 23 24 General Surgical 45 42 Children 28 Venereal Diseases 4 4 Ear, Nose and Throat (1 Children) 2 3 Skin Diseases (1 Children) 1 1 Other (Private Wing) (Mixed) 55 Facilities available for:— 12 Major Operation Theatres. (1) Operative Surgery.—2 Minor (2) X-Ray.—Diagnostic and Therapeutic Departments. (3) Dental.—Clinics held twice weekly in Out-patients' Department. (4) Ophthalmic.—Three afternoons a week in Out- patients' Department. (5) Massage.—Department open daily. 23 Arrangements for pathological work:—Pathological and Bio-chemical Laboratories. No. of patients during 1933.—3,920 In-patients and 39,633 out-patients and 312,713 out-patients' attendances. Is the hospital provision for the area adequate?—There is always an average of about 250 patients waiting for admission. Name:—Queen Charlotte's Maternity Hospital. Situation:—Ravenscourt Square and Goldhawk Road. Purpose:— (a) *Treatment of and research into Puerperal Sepsis. (b) †Normal Maternity, auxiliary to Queen Chaelotte's Hospital. (e) Ante-natal Clinics and District Midwives' Home. No. of available beds:—30 Puerperal Fever and 20 ordinary Maternity. If used by persons resident outside the area, in what proportion:— (a) *5 per cent. Hammersmith Residents. (b) †50 ,, ,, ,, 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) Xt-Ray—By arrangement with St. Mary's Hospital. (3) Dental—No Dental Clinic, but services of Hon. Dental Surgeon available. (4) Ophthalmic—No Ophthalmia Clinic, but services of Hon. Ophthalmic Surgeon available. (5) Massage—By outside masseuse. Arrangements for pathological work:—All pathological work done in the "Bernhard" Baron Memorial Research Laboratories" adjacent, under the Hospital's Director of Research and staff of 7 fully trained research workers. No. of patients during 1933:—361 Maternity, 289 Puerperal Sepsis. 24 Name:—St. John's Hospital for Skin Diseases. Situation:—262, Uxbridge Road, W.12. Purpose :—For Skin Diseases. No. of available beds :—40. If used by persons resident outside the area, in what proportion:—Mostly outside area. Management :—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 1933:—336 in-patients. Is the hospital provision for the area adequate?— Yes. Name —Royal Masonic Hospital. The Royal Masonic Hospital provides accommodation for paying patients, primarily of limited means, being Freemasons, their wives and dependent children. The number of beds available will be 180—200, one-third being for General Medical and two-thirds for General Surgical services. Approximately one-third for females. There are two sections for children of 20 beds in all. The Hospital is being opened up gradually and 150 beds will be in use in June, 1934. Four theatres have been provided for operative Surgery. Facilities are also available for X-Ray, Dental, Ophthalmic and Surgery. Special arrangements have been made for pathological work. 25 INSTITUTION TREATMENT FOR UNMARRIED MOTHERS. St. Margaret's Hostel, 466, Uxbridge Road, W.12.— Accommodation for 10 mothers and their infants. This hostel is conducted by a voluntary society towards which the Ministry of Health contributes. Hammersmith and Chiswick Refuge for Friendless Girls, 36, Glenthorne Road, W.6.—Accommodation for 8 mothers and their infants. Supported by voluntary 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 abnormality, was continued upon the following terms:— (1) That the patient must be a resident of Hammersmith. (2) The medical practitioners immediately notify the Medical Officer of Health that they have called in the services of the Consultants, giving the name and address of the patient, date of call, the reason and the result. (3) The Borough Council pay the fees of the Consultant, but where the financial position justifies it, the patient will be asked to pay a portion or the whole of the fee. During the year a Consultant was called in on three occasions. 26 Maternal Deaths.—During the year eight maternal deaths occurred, six from Puerperal Sepsis and two from other accidents and diseases of pregnancy and parturition. Special enquiry was made and particulars obtained in accordance with the form presented by the Committee appointed by the Ministry of Health. The reports contain full information as to— (1) Previous pregnancies, with particulars of complications, if any. (2) Ante-natal care, including number of consultations and examination of urine, with the result. (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 fourteen years is as follows:— Year. Number of Deaths Number of Births. Maternal Death Rate. Puerperal Sepsis. Other Accidents of Pregnancy. 1920 6 5 3,312 3·3 1921 2 10 2,779 4·3 1922 4 5 2,758 3·3 1923 5 3 2,701 3·0 1924 4 4 2,399 3·3 1925 6 7 2,351 5·5 1926 3 4 2,188 3·2 1927 3 4 2,076 3·4 1928 5 5 2,258 4·4 1929 5 2 2,162 3·3 1930 4 5 2,173 4·1 1931 2 5 2,073 3·4 1932 3 4 1,940 3·6 1933 6 2 1,827 4·4 It will be observed that the Maternal Mortality has remained almost stationary. 27 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. Maternity Cases.—The London Ambulance Service provided by the London County Council is available for the conveyance of women to "Parkside" Maternity Home, Du Cane Road. W.12, and "Invermead," Goldhawk Road, between the hours of 11 p.m. and 8 a.m. An ambulance service is also available for "Parkside" and "Invermead" cases between the hours of 8 a.m. and 11 p.m. by arrangement with the London County Council. MATERNITY AND CHILD WELFARE CENTRES. Hammersmith Infant Welfare Association. 48, Glenthorne Road.—Three Infant Clinics held weekly. Two Ante-Natal Clinics held weekly. Victoria Hall, Becklow Road.—Two Infant Clinics held weekly. Old Oak Infant Welfare Centre, Western Avenue.—Two Infant Clinics held weekly. Two Ante-natal Clinics held weekly. St. Matthew's Parochial Hall, Blythe Road.—Two Infant Clinics held weekly. Presbyterian Church Hall, Ponsard Road.—One Infant Clinic held weekly. Latymer Road Mission, Blechynden Street.—One Infant Clinic held weekly. 28 DAY NURSERIES. Latymer Road Day Nursery.—Provides accommodation for 50 children. Princess Christian Day Nursery, Goldhawk Road.— Provides accommodation for 45 children in winter and 50 in summer. The above nurseries are conducted by Voluntary Associations, supported by voluntary contributions, to which the Council contributes. SCHOOL CLINICS. The L.C.C. Hammersmith School Treatment Centre, 103, Shepherd's Bush Road, is provided by the Hammersmith District Nursing Association, who receive grants from the London County Council. L.C.C. School Treatment Centre, Old Oak Welfare Centre, Western Avenue. This centre is held in the Borough Council Clinic, who receive a rental for the use thereof. Children under school age are dealt with by arrangement with the Hammersmith Nursing Association. 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 90). Grants are received from the Ministry of Health and the London County Council. 29 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 56 Hammersmith patients were treated at the Clinic, 5 being admitted as in-patients and 51 as out-patients. New patients, 1933 21 Old patients, 1933 35 Total number of attendances, 1933 215 TREATMENT CENTRE FOR VENEREAL DISEASES. West London Hospital, Hammersmith Road. The above centre is provided under the scheme of the London County Council. This centre is open night and day. 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. 30 FOULING OF FOOTPATHS BY DOGS. In September, 1922, the Council obtained approval of the following Bye-law for the good rule and government of the Borough in pursuance of Section 28 of the Municipal Corporation Act, 1882, and Section 16 of the Local Government Act, 1888. 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. Any person offending against the foregoing Bye-law shall be liable to a penalty not exceeding forty shillings. During the year under review three summonses were taken, when fines of 5s. were imposed in two cases and 10s. in one case. Sanitary Inspection of the Area.—During the year 42,901 inspections were made by the Sanitary Inspectors. Seventy 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 Borough Council have provided many houses, but overcrowded conditions still exist. The people are still suffering from the oppressive rents which they are called upon to pay often for poor accommodation, and the consequent reduction of the money available for providing essential needs. I consider the question of high rents one of the most important factors affecting public health at the present time. 31 Inspections.—The following table shows the number of visits made in each district under the various inspection head:— NUMBER OF INSPECTIONS MADE DURING 1933 Cause of Inspection. Districts. 1 2 3 4 5 6 7 8 Ladv Sanitary Inspector Food and Drugs Inspector Total. Infectious Disease 173 249 120 132 210 234 338 218 1,051 9 2,734 Complaints 609 560 502 500 457 519 220 452 415 4 4,238 Tenement Houses 48 2 3 .. .. 14 .. 35 .. .. 102 House to House 75 53 152 62 150 39 95 143 .. .. 769 Housing and Town Planning Act 46 155 48 62 6 38 31 42 .. 70 498 House to House Consolidated Regulations 13 36 26 33 24 .. 11 12 .. •• 155 Food (other than Restaurants and Eating Houses) 185 432 364 460 163 215 762 537 .. 1,461 4,579 Restaurants and Eating Houses 108 95 110 19 20 64 104 85 .. 93 698 Markets 22 29 287 36 27 247 23 279 .. 540 1,490 Slaughterhouses 5 21 200 161 12 85 6 9 .. 37 536 Poultry Slaughterhouses .. 15 .. .. .. .. .. .. .. 2 17 Bakehouses 47 31 32 66 52 79 27 27 .. 36 397 Milk Vendors 211 123 54 161 84 34 54 102 .. 286 1,109 Ice Cream Vendors .. 10 2 1 .. 2 .. 1 .. 166 182 Factories (Including Factory Laundries) 55 35 39 59 4 45 21 130 47 •• 435 Workshops (including Workshop Laundries) 38 13 39 30 3 23 18 11 58 .. 233 Workplaces (other than Outworkers) 1 12 63 56 2 17 6 21 23 .. 201 Outworkers 7 2 2 2 1 2 9 .. 106 .. 131 Public Urinals 74 134 115 56 159 160 159 206 16 .. 1,079 Smoke Observations 8 17 6 .. 10 18 19 67 .. .. 145 Drainage 924 1,776 775 485 459 624 817 776 .. .. 6,636 Miscellaneous 251 205 99 511 195 166 705 200 197 474 3,003 Re-visits 1,607 1,174 1,585 1,540 1,975 1,801 1,056 1,484 153 .. 12,375 Infant Life Protection .. .. .. .. .. .. .. .. 1,156 .. 1,156 Common Lodging Houses .. .. 3 .. .. .. .. .. .. .. 3 Totals 4,507 5,179 4,626 4,432 4,013 4.426 4,481 4,837 3,222 3,178 42,901 32 Notices.—The following table shows the number of Preliminary Notices served and complied with during the year:- Notices Served. Notices complied with Infectious Diseases 340 283 Complaints 1,816 1,763 House to House 475 705 Housing Acts — — House to House Consolidated Regulations 72 57 Food (other than Restaurants) 29 37 Restaurants, &c. 32 26 Markets — — Slaughterhouses — — Poultry Slaughterhouses — — Bakehouses 14 16 Milk Vendors 18 15 Ice Cream Vendors - — Factories 24 24 Workshops 28 27 Workplaces 16 15 Outworkers 1 1 Public Urinals 5 8 Smoke Observations 4 4 Drainage 34 26 Miscellaneous 99 81 Re-visits 339 417 Total 3,346 3,505 During the year 1,129 Statutory Notices were served and 1,125 complied with. In many instances it was necessary to take proceedings in order to enforce compliance with Notices served. 33 The following table shows the result of proceedings taken:— SUMMONSES—YEAR 1933. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 73, Cobbold Road Failing to comply with Statutory Notice 1 Order made 14 days 18, Rowan Road ditto 1 Order made 28 days 17, North Pole Road ditto 1 Withdrawn 37, Cromwell Grove Non-compliance with bye-laws in constructing waste pipe 1 Fined 5s. ditto Failure to give notice 1 Fined 5s. 50, Sinclair Road Failure to deposit plans 1 Fined £2 28, Gratton Road Non-compliance with bye-laws in constructing soilpipe 1 Fined 10s. ditto Construction of water-closets 1 Fined 10s. 30, Gratton Road Non-compliance with bye-laws in constructing waste stack 1 Fined 10s. ditto Construction of waste pipe 1 Fined 10s. ditto ditto 1 Fined 10s. 28 & 30, Gratton Road Failure to deposit plans 1 Fined 10s. 27, Southerton Road Failing to comply with Statutory Notice 1 Order made 14 days 17, Shepherd's Bush Road ditto 3 1. Withdrawn 2. Order made 21 days 3. Order made 21 days 37, Devonport Road ditto 2 Withdrawn Watts Yard, Norland Gardens ditto 1 Order made 28 days 18, Southbrook Street ditto 1 Order made 14 days 2, Richford Street ditto 1 Withdrawn 4, Richford Street ditto 3 Withdrawn 13, Goodwin Road ditto 2 1. Order made 14 days 2. Order made 14 days 17, Goodwin Road ditto 2 1. Order made 14 days 2. Order made 14 days 34 Summonses—continued. Situation of Premises. Mature of Offence. No. of 1 Summonses. Result of Proceedings. 9, Goodwin Road Failing to comply with Statutory Notice 1 Fined £2 11, Goodwin Road ditto 1 Fined £1 15, Goodwin Road ditto 1 Fined £1 48, Warbeck Road ditto 1 Fined £2 27, Southerton Road ditto 1 Fined £2 12, Shepherd's Bush Green Construction of water-closets 1 Withdrawn 10s. 6d. costs ditto Construction of soilpipes 1 Withdrawn 10s. 6d. costs ditto Failure to deposit plans 1 Withdrawn 10s. 6d. costs ditto Failure to give notice 1 ditto Non-compliance with bye-laws in constructin; waste pipe 1 Withdrawn 13s. 4d. costs 491, Latimer Road Failing to comply with Statutory Notice 1 Withdrawn 9, Glenthorne Road ditto 1 Withdrawn 83, Shepherd's Bush Road ditto 3 1. Order made 21 days 2. Order made 21 days 3. Order made 21 days 10s. 6d. costs each 3, Richmond Gardens ditto 1 Order made 14 days 5, Richmond Gardens ditto 1 Fined 10s. 6, Letchford Gardens ditto 4 Withdrawn 20, Aynhoe Road ditto 2 1. Order made 21 days 2. Fined 10s. 85, Shepherd's Bush Road ditto 1 Order made 21 days 2, Cannon Court ditto (overcrowding) 3 1. Order made 14 days 2. Order made for abatement in 28 days 3. ditto 54, The Grove Failing to comply with Statutory Notice 2 1. Order made 14 days 2. Order made 14 days 84, Cathnor Road ditto 1 Order made 21 days and fined £10 59, Boscombe Road ditto (overcrowding) 2 1. Fined £1 2. Withdrawn. 78, Goldhawk Road Construction of waste pipe 1 Fined £1 35 Summonses—continued. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. 78, Goldhawk Road Re-construction of waste pipe 1 Fined £1 ditto Failure to give notice 1 Fined f 1 Factory at G.W. Railway Sidings, Wood Lane Nuisance from smoke 1 Prohibition Order and £2 2s. costs 85, Shepherd's Bush Road Failing to comply with Statutory Notice 1 Withdrawn 6s. 8d. costs 20, Aynhoe Road ditto 1 Withdrawn 10s. 6d. costs 36, Cathnor Road ditto 1 Withdrawn 48, Becklow Road ditto 1 Withdrawn 32, Becklow Road ditto 1 Withdrawn. 50, Becklow Road ditto 1 Fined £1 21, Addison Court Gardens ditto 2 1. Withdrawn 2. Fined £1 90, Coningham Road ditto 1 Withdrawn 11, Goodwin Road ditto 1 Withdrawn 7, Shepherd's Bush Green Failure to deposit plans 1 Fined £1 178, Dalling Road Failure to give notice 1 Fined 10s. ditto Construction of waste pipe 1 Fined 10s. 10, Lockton Street Failing to comply with Statutory Notice 3 1. Fined £1 2. Order made 14 days and fined £1 3. ditto 4, Cambridge Road ditto 1 Withdrawn 78 Goldhawk Road ditto 1 Withdrawn 11, Norland Gardens ditto 1 Prohibition Order and 10s. costs 9, Goodwin Road ditto 1 Order made 14 days 19, Goodwin Road ditto 1 Order made 14 days 69, St. Stephen's Avenue Failure to deposit plans 1 Fined £1 and £1 1s. costs 16, Iffley Road Failing to comply with Statutory Notice 1 Order made 28 days 0, Studland Street ditto (overcrowding) 1 Order made for abate- ment in 21 days 40, Caithness Road Construction of soilpipe 1 Fined 10s. ditto Failure to give notice 1 Fined 10s. ditto Unlawful repair of drain 1 Fined 10s. Blenheim Villa Failing to comply with Statutory Notice 2 1. Order made 14 days 2. Fined 5s. 36 Summonses—continued. Situation of Premises. Nature of Offence. No of Summonses. Result of Proceedings. 6, Westwick Gardens Failing to comply with Statutory Notice 1 10s. costs 40, Milson Road ditto 2 Withdrawn. 13s. 4d. costs 94, Glenthorne Road ditto 1 Order made 14 days 30, Gratton Road ditto 2 Withdrawn. 10s. costs 59, Waldo Road ditto 2 1. Order made 14 days 2. Fined 10s. 61, Waldo Road ditto 1 Order made 14 days 19, Goodwin Road ditto 1 Withdrawn 14, Thornfield Road ditto 1 Order made 7 days 16, Masbro Road ditto 1 Fined 10s. 55, Roxwell Road ditto 1 Withdrawn 73, Vespan Road ditto 1 Withdrawn HAMMERSMITH BOROUGH COUNCIL BYE-LAWS—DOGS. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mr. J. H„ Chiswick Contravention of Bye-law re nuisance by dogs in King Street 1 Fined 10s. Mr. A. B., Hammersmith ditto Goldhawk Road 1 Fined 5s. Miss P. C., Hammersmith ditto Goldhawk Road 1 Fined 5s. PUBLIC HEALTH (MEAT) REGULATIONS, 1924. Name and Address. Nature of Offence. No. of Summonses Result of Proceedings. Mesrs. P & S., Ltd., London Stall insufficiently screened— 31, Norland Road 1 Fined £5 and £1 costs 37 PUBLIC HEALTH (LONDON) ACT, 1891,—SECTION 55. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Dr. D. W., Shepherd's Bush Failing to notify a case of infectious disease 1 Fined £2 VACCINATION ACT, 1871—SECTION 7. Name and Address Nature of Offence. No. of Summonses. Result of Proceedings. Dr. D. W., Shepherd's Bush Failing to deliver certificate to parent 1 Fined £1 and £1 1s. costs Dr. W. H., Shepherd's Bush ditto 1 Fined £1 FACTORY AND WORKSHOP ACT, 1901, Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Messrs. A. B. H., Ltd., Fulham Unfit underground bakehouse—125, Uxbridge Road 1 Fined £2 LONDON COUNTY COUNCIL (GENERAL POWERS) ACTS. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Messrs. A. B. H., Ltd., Fulham Underground bakehouse, due cleanliness not observed—125, Uxbridge Road 1 Fined £2 and £5 5s. costs 38 HOUSING ACT, 1930. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. 135, Blythe Road Basement room being used contrary to Closing Order 1 Withdrawn 3, Cannon Place Application for possession under Demolition Order 1 Order to vacate in 4 weeks 39 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 four 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 68 notices were served in reference to insanitary conditions and defects found to exist during the inspection of the factories, workshops and workplaces in the Borough, and during the same period 66 notices were complied with During the previous year there were 84 notices served and 86 complied with. The following is a list of the Factories, Workshops and Workplaces upon the Register:— Restaurants, Hotels, &c. 167 Bakehouses (23 not in use as Bakeries) 67 Bootmakers 41 Motor and Cycle Makers 25 Dressmakers and Milliners 32 Laundries 50 Outworkers 128 Letterpress Printers and Bookbinders 20 Electrical and Mechanical Engineers 74 Smiths, Wheelwrights and Coachbuilders 22 Tailors 18 Builders, Carpenters and Joiners 33 Miscellaneous 285 Total 962 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. 40 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 485 24 - Workshops (including Workshop Laundries) 233 28 — Workplaces (other than outworkers' premises included in Part 3 of this report) 201 16 - Total 869 68 — 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts— Want of Cleanliness 36 32 — - Want of Ventilation 2 2 — — Overcrowding — — — — Want of Drainage of Floors 2 2 — — Other Nuisances 23 24 — 1 Sanitary Accommodation insufficient 5 4 - - unsuitable or defective 28 28 — — not separate for sexes 3 4 — — Offences under the Factory and Workshop Act Illegal occupation of underground bakehouse (S. 101) - - - - Other offences (excluding offences relating to out-work which are included in Part 3 of this report) - - - - Total 99 96 — 1 41 3.—HOME WORK. Outwork in Unwholesome premises, Sec. 108 Outwork in Infected Premises Secs. 109, 110 Nature of Work Instances Notices served Prosecutions Instances Orders made (Sec. 110) Prosecutions (Sees. 109, 110) Wearing apparel— (1) making, etc. 1 1 — — — — (2) cleaning and washing — — — — — — Furniture and upholstery — — — — — — Totals 1 1 — — — — 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year Number Bakehouses 25 Dressmakers 28 Laundries 12 Outworkers 128 Others 62 Total number of workshops on Register 255 5.—OTHEE 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 referred by H M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act, 1901 (S.5) Notified by H.M. Inspector 7 Reports (of action taken) sent to H.M. Inspector 7 Other — Underground bakehouses (S.101)— Certificates granted during year — In use at the end of the year 27 42 House to House.—As a result of the house to house visitation 769 inspections were made, 475 notices served, and 705 complied with. Smoke Abatement.—During the year observations were kept in reference to black smoke emitted from the various factories, laundries, bakehouses, &c., situate in and adjoining the Borough. Four Intimation Notices were served. No summons was taken out. Reports were submitted to the Public Health Committee in reference to the observations made as regards the following:— H.B.C. Electricity Works, Fulham Palace Road. Victoria Laundry, 10, Great Church Lane. 110, Uxbridge Road. 216, Uxbridge Road. Lome House Laundry, Becklow Road. Cadby Hall, Hammersmith Road. Glen Laundry, Landor Road. Kensington Palace Laundry, Springvale Terrace. Gaumont British Film Studios. Shepherd's Bush Pavilion, Shepherd's Bush Green Devon Dye Works, Wharf Road. Kensington B.C. Destructor. G. Wimpey & Co., Wood Lane. Royal Chiswick Laundry, British Grove. 6, Stamford Brook Road. 125, Uxbridge Road. Patent Steam Carpet Beating Co., Latimer Road. JohnBon Matthey, Askew Road. Swan Laundry, Blythe Road. Ivy House Laundry, Latimer Road. London Wholesale Dairies Land, Wood Lane. 75, Uxbridge Road. Rats and Mice (Destruction) Act, 1919.—During the year the Rats and Mice (Destruction) Act, 1919, continued in operation, the District Inspectors being responsible for its administration in their respective districts. Section I places the responsibility of ridding the 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. 43 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 pre vious years. The Ministry of Agriculture and Fisheries again urged local authorities to take action, and arrange ments 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 75 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. Tenement Houses.—As a result of house to house inspection 181 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. 44 HOUSING ACT, 1925, SECTION 18. Five 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 persona. 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 registered. Premises which are required to be registered under Factory and Workshop Acts and premises used as a hotel, restaurant or club are exempt. The Act gives no power to the Sanitary Authority to refuse to register or to remove any premises from the register. 45 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 161 Restaurants 20 Factories 3 184 Schools.—The sanitary condition and water supply of the Schools is a matter which requires very little attention from the Public Health Department. The supervision of the schools is in the hands of the London County Council, but combined action has been taken when and where required, with a view to preventing the spread of infectious disease. An arrangement exists whereby cases of Measles, Whooping Cough and Chicken Pox are notified by the Head Teacher to the Medical Officer of Health, at the same time as they inform the Divisional Superintendent. These cases are followed up, and the premises are inspected with a view to any insanitary conditions being remedied. This form of co-ordination is carried out as well 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. 46 HOUSING. Statistics.-Year 1933. 1.—Inspection of dwelling-houses during the year :— (1) (a.) Total number of dwelling-houses inspected for housing defects (under Public Health on Housing Acts) 7,115 (b) Number of inspections made for the purpose 19,796 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 136 (b) Number of inspections made for the purpose 299 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 11 (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 2,841 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 3.—Action under Statutory Powers during the year:— (A) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 4 47 (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 2,841 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 2,967 (b) By Local Authority in default of owners 4 (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 7 (2) Number of dwelling-houses demolished in pursuance of demolition orders 6 (D) Proceedings under Section 20 of the Housing Act, 1980:— (1) Number of separate tenements or underground rooms in respect of which closing orders were made 1 (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 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. 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. (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. A list of properties, recommended to be dealt with either as Clearance or Improvement Areas or by Closing Orders, has been submitted to the Borough Council. Bye-laws. No special difficulties have been experienced in the enforcement of the bye-laws relating to houses and houses let in lodgings. 49 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. Fifty-two Certificates were granted during the year under Section 48 (2) of the Public Health (London) Act, 1891, with regard to newly erected houses and flats having a proper and sufficient water supply Since the War, 3,703 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. Year. L.C.C. Estate. H.B.C. Estate. Private Enterprise. 1920 188 18 Nil 1921 169 166 Nil 1922 384 354 Nil 1923 Nil 5 22 1924 Nil 42 40 1925 Nil Nil 50 1926 Nil Nil 202 1927 284 Nil 239 1928 500 Nil 187 1929 1 60 297 1930 Nil 56 90 1931 Nil 21 36 1982 Nil 39 1 1933 Nil 32 20 Totals 1,726 793 1,184 The premises have provided accommodation for approximately 18,515 persons, but despite this fact overcrowding is still in evidence. 50 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. It is imperative that all persons engaged in the handling of food should pay strict attention to cleanliness, and with this object in view arrangements were made for notices to be exhibited in the lavatories of premises where food is prepared and / or sold. The proprietors of the various stores and shops, in almost every instance, gave their approval and arranged for the notices to be displayed in the staff water closets. In a few cases the firms arranged for posters embodying the terms of the notice to be affixed in the lavatory apartments. The notice was printed on cardboard and glazed, the wording being as follows :— Hammersmith Borough Council Public Health Department. AS HANDLERS OF FOOD you should always WASH YOUR HANDS after using a W.C. 51 Pears.—During the course of inspection the attention of the Sanitary Inspectors was called to some pears which had apparently been sprayed and showed the presence of a green powder deposit. The Public Analyst reported the presence of copper compound on the skins of the pears, i.e., a preparation of copper equivalent to 0.02 grains of copper per pound of pear. The vendors were advised to surrender the pears which was willingly done in every case. Food Premises.—'Seventy-seven premises were registered under the London County Council (General Powers) Act, 1932, for the preparation or manufacture of sausages or potted, pressed, pickled or preserved meat, fish, or other food intended for sale. Milk Supply.—During the year 345 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 cases where infectious disease occurs in the families of milk roundsmen, the employers are advised to suspend the roundsmen for a period of seven days. 52 Milk (Special Designations) Order, 1923. The following is a list of the licences issued during the year under the Milk (Special Designations) Order, 1923:— Description. Number. (1) Producers' Licences to use the designation "Grade A" Nil (2) Dealers Licences to use the designation "Certified" 5 Supplementary Licence 1 (3) Dealers' Licences to use the designation "Grade A (Tuberculin Tested)"— (a) Bottling Establishments 2 (b) Shops 8 (c) Supplementary Licences 2 (4) Dealers' Licences to use the designation "Grade A"— (a) Bottling Establishments Nil (b) Shops Nil (5) Dealers' Licences to use the designation "Grade A— Pasteurised" 1 (6) Dealers' Licences to use the designation ''Pasteurised"— (a) Pasteurising Establishments 3 (b) Shops 5 (c) Supplementary Licences 2 Certification of Certain Food Products for Export to the Dominions. No application was received for the certification of food products for export to the Dominions. Meat.—With regard to meat inspection, this important commodity is kept under supervision by the Inspectors in charge of the districts. Most of the shops are now provided with glass fronts resulting in an improvement of the condition of the meat for sale. Public Health (Meat) Regulations, 1924. The Public Health (Meat) Regulations, 1924, came into operation on the 1st day of April, 1925. 53 The provision of these Regulations, regarding the giving of notice to the local authority of the times of slaughter, has enabled arrangements to be made for the inspection of all carcases of animals slaughtered in the local slaughterhouses. I append the number of animals slaughtered and examined in the slaughterhouses during the year. Lambs 583 Sheep 627 Calves 46 Beasts 21 Pigs 1,623 Total 2,900 No application has been received for the stamping of carcases examined by the Sanitary Inspectors. 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. Inspector Rigby 4 Pigs' heads Tuberculosis 20 lbs. 1 Pig's ribs Pleurisy 8 „ 2 Pigs' plucks Tuberculosis 18 „ 2 Pigs' livers Milk Spots 7 „ 2 Pigs' lungs and hearts Pleurisy and Pericarditis 5½ „ 2 Pigs' fats Tuberculosis 1¼ 1 Pig's lungs Congestion 2 „ 2 Pigs' heads Tuberculosis 10 „ 2 Pigs' livers Milk Spots 7„ Entire pig carcasc and offal Tuberculosis 110 „ Inspector Mason Entire carcase, organs and offal of 1 Sow Tuberculosis 360 lbs. Entire carcase, organs and offal of 2 Pigs ,, 134 „ 4 Pigs' long forequarters ,, 120 „ 54 Description. Disease. Approximate Weight. Inspector Mason —cont. 10 Pigs' heads Tuberculosis 52 lbs. 2 Pigs' livers ,, 7½ ,, 1 Pig's spleen ,, 4 ozs. 8 Pigs' plucks ,, 36 lbs. 12 Pigs' mesenteries ,, 12½ ,, 9 Pigs' livers Cirrhosis 31 „ 2 Pigs' spleens Melanosis 8 ozs. 1 Pig's foot Actinomycosis 2½ lbs 2 Pigs' kidneys Nephritis 1 ,, 9 pairs Pigs' lungs Congestion 18¼ ,, 1 Sheep's liver Distoma Hepaticum 2 „ Inspector Godden 3 Beasts' lungs Tuberculosis 42 lbs. 1 Beast's head ,, 24 „ 3 Beasts' livers Distoma Hepaticum 60 „ 2 Beasts' mesenteries Tuberculosis 32 „ 1 Beast's tongue Actinomycosis 7 „ 1 Pig's carcase Tuberculosis 60 „ 1 Pig's ribs and middle „ 12 „ 1 Pig's ribs „ 8 „ 1 Pig's head and collar „ 8 „ 16 Pigs' heads „ 96 „ 1 Pig's head Abscess 6 „ 1 Pig's knuckle Arthritis 1½ „ 1 Pig's belly Haemorrhages 8 ,, 32 Pigs' mesenteries Tuberculosis 32 „ 5 Pigs' hearts Pericarditis 2 „ 2 Pigs' spleens Tuberculosis ½ ,, 7 Pigs' livers Cirrhosis 14 „ 4 Pigs' livers Tuberculosis 8 „ 19 Pigs' livers Milk Spots 38 „ 1 Pig's liver Bacterial Necrosis 2 „ 9 Pigs' plucks Tuberculosis 40 „ 14 Pigs' lung9 Congestion 28 „ 7 Pigs' lungs Pneumonia 14 ,, 4 Pigs' lungs Pleurisy 8 „ 1 Pig's lungs Tuberculosis 2 ,, 1 Sheep's liver Distoma Hepaticum 2 „ 5 Sheeps' livers Strongulus Rufescens 10 „ 6 Lambs' lungs ,, 6 „ 1 Lamb's lungs Congestion 1 „ Inspector Barry 5 Sheeps' livers Distoma Hepaticum 8¾ lbs. Shoulder of Lamb Injury 2¾ „ I Lamb's liver Distoma Hepaticum 1½ ,, 1 Sheep's liver Cirrhosis 1¾ ,, 2 Pigs' heads Tuberculosis 11 ,, 2 Pigs' mesenteries ,, 55 Description. Disease. Approximate Weight. Inspector Hayes 9 Pigs' lungs Tuberculosis 18 lbs. 2 Pigs' livers Bacterial Necrosis 4 ,, 1 Pig's fat Tuberculosis 1 „ Inspector Bayes 57 Pigs' heads Tuberculosis 285 lbs. 56 Pigs' messenteries ,, 30 „ 4 Pigs' plucks ,, 24 „ 1 Pig's liver ,, 3½ ,, 8 entire pigs' carcases and organs ,, 578 „ Part of Pig's loin „ 3 „ 39 Pigs' livers Cirrhosis 175,, 24 pairs Pigs' lungs Pleurisy 48 „ 2 Pigs' livers Peritonitis 7 „ 1 Pig's liver Abscess 3½ ,, 2 Pigs' spleens Congestion ½ ,, 1 Pig's spleen Melanosis ¼ ,, 9 Pigs' hearts Pericarditis 6¾ ,, 2 Pigs' kidneys Cystic ½ ,, Part of Pig's loin Abscess 1 ,, 24 Sheeps' livers Distoma Hepaticum 50 „ 1 Sheep's flank Peritonitis ¼ ,, 1 Sheep's spleen Inflammation 3 ozs. 1 Sheep's liver Cystic 3 lbs. Entire carcase and organs of 1 sheep Dropsical 50 „ Inspector Nether 6 Pigs' livers Milk Spots 21 lbs. 2 Pigs' plucks Milk Spots and Congestion 12 „ Inspector Herrick 2 Sheeps' livers Distoma Hepaticum 4 lbs. 2 pairs Pigs' lungs Congestion 3½ ,, Inspector Pottier 1 Pig's liver Echinococcus 4 lbs. 1 Pig's head Tuberculosis 5 „ 2 Pigs' mesenteries ,, 2 „ 1 Pig's pluck ,, 4½ ,, 2 pairs Pigs' lungs ,, 4 ,, 56 Transfer of Powers (London) Order, 1933. Seamen's Lodging Houses.—There are no seamen's lodging houses in the Borough. Common Lodging Houses.—There is one common lodging house known as Jubilee Chambers situate in more Lane, Hammersmith. Application for the renewal of the licence was received from Mr. William George Parker, residence Jubilee House, Hammersmith. The application was approved and a licence issued dated the 1st July, 1933. The maximum number of lodgers who may be received at any one time into this house is 244. Cow Houses.—There are no cow houses in the Borough. Slaughterhouses and Knackers' Yards.—There are live slaughterhouses in the Borough. Applications were received from five licensees for the renewal of their licences. 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 George Hedges 247 Goldhawk Road Arthur William Godfrey 65 King Street Richard Norman Hammett 341 King Street Stanley Brooks Midwinter Knackers' Yards.—There are no knackers' yards in the Borough. 57 Offensive Trades—Slaughterers of Poultry.—There are two authorised slaughterers of poultry in the Borough:— Premises. Name of Occupier. 109, Shepherd's Bush Road Solomon Shockett Arch No. 204.Wells Road, Goldhawk Road Hyman Fisher 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 1933 Number of notices 1933 Number of prosecutions 1933 On register in 1920. On register at end of 1932 Added in 1933 Removed in 1933 On register at end of 1933 Milk premises 128 130 14 2 142 1,109 18 — Slaughterhouses. 7 5 — — 5 536 — — Poultry Slaughterhouses. — 2 — — 2 17 — — Ice Cream premises 162 133 37 9 161 182 — — Markets.—There are three markets in the Borough, situate in Bradmore Lane, Approach Road and Norland Road. These markets have been the subject of much inspection during the year, both by the District Inspector concerned and the Inspector carrying out the requirements of the Food and Drugs Acts. Many of the stalls in the Railway Approach Market are constructed so as to form lock-ups when business for 58 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 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 receptacle occupying a stationary position at a place in the carriageway or footway of any street in any metropolitan borough without a licence from the borough council authorising him so to do." Provided that this section shall not apply to any person selling or exposing or offering for sale any article or thing from or upon any. barrow cart stall or other receptacle which he ordinarily moves from place to place in pursuit of and while conducting his trade. During the year 121 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 59 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.—The 44 bakehouses in use in the Borough have been regularly inspected during the year. Fourteen 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 Hoad J. Lyons & Co. †* 60 Richmond Road C. W. Tompkins * 1 Masbro Road W. A. Maclen †* 67 Ditto G. Dunsby †* 98 Blythe Road Miss Schofield †Ceylon Road Brook Green Electric Bakery Ltd. No. 2 DISTRICT. * 82 Great Church Lane E. Galer †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 F. Becker 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 †*]02 Dalling Road Plumridge Bros. †1 Eyot Gardens J. R. Chibnall, Ltd. † 258 King Street Miller & Son † 316 Ditto F. Watkins †* 11 Lamington Street H. A. Roberts, Ltd 7 St. Peters Road E. Gent * Underground. † Factory. 60 Address. Name. No. 5 DISTRICT. †* 128 Askew Road G. Ingle †74 Ditto J. Auer 167 Ditto F. J. Lockwood †10-1 Ditto D. Miller No. 6 DISTRICT. †* 74 Goldhawk Road H. Crisp †* 106 Ditto F. & A. Posford † 166 Ditto E. G. Robinson †* 242 Ditto Plumridge †* 125 Uxbridge Road A. B. Hemmings Ltd. * 55 Melina Road E. J. West †* 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 10 Black Lion Lane * 87 Masbro Road * 192 Dalling Road * 6 Beaconsfield Terrace † King Street * 47 Milson Road 10 Upper Mall † 65 Bridge Road 121 Askew Road 2 Crisp Road 41 Gayford Road * 94 Shepherd's Bush Road †* 126 Uxbridge Road 88 Queen Street †*132 Uxbridge Road * 77 Brackenbury Road * 2 Hunt Street †l The Grove 104 Latimer Road * 17 Kilmareh Road * Underground † Factory 61 UNSOUND FOOD. No seizure of unsound food was made during the year. The following is a list of unsound food condemned during the year:— Commodity. Condition. Result. 1 doz. tins Sardines in Tomatoes. Unsound and Unfit for food Surrendered 1 tub Grapes (40 lbs.) ditto ditto 1 Imported Ox Liver (8 lbs.) ditto ditto 30 boats Tomatoes ditto ditto Quantity of Eels (48 lbs.) ditto ditto 1 box Cod Fish (50 lbs.) ditto ditto 31 boxes Apples (14 cwt.) ditto ditto 1 box Kippers ditto ditto 3 stone Filleted Cod ditto ditto 11 cases Pears ditto ditto 2 boxes Pears ditto ditto 23 Pears ditto ditto 12 bags Walnuts ditto ditto 1 box Pig's Kidneys (30 lbs.) ditto ditto 91 lbs. Spanish Chestnuts ditto ditto CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. The chemical examination of food is carried out by the Public Analyst at the Laboratories, Royal Dental Hospital, Leicester Square. Six hundred and twelve samples taken under the Sale of Food and Drugs Acts were examined during the year. Over 50 per cent. of the articles analysed were milk samples. The bacteriological examination of food is carried out by the Pathologist of the West London Hospital. In the case of food poisoning specimens are sent to the Ministry of Health. 62 Report of Public Analyst. FOOD AND DRUGS (ADULTERATION) ACT, 1928. Year ended 81st December, 1938. During the twelve months 612 samples of food and drugs were submitted to me for examination. Of this number 567 were reported as genuine, 14 as adulterated, whilst 81 were of inferior quality. These numbers for adulterated and inferior samples are both somewhat smaller than those of last year, the corresponding figures being then 18 and 40, but are still much in excess of the figures for some years preceding 1982. The observation made in last year's report to the effect that the article responsible for the increase in defective samples is milk unfortunately still remains true. The adulteration of articles other than milk has this year been of a rather gross nature. Later on in this report mention is made of some labelled in such a way as to lead the ordinary purchaser to assume that they are even better than the article they are made to resemble; examples of this are to be found in the two cream substitutes and the so-called " lemon-squash." The selling of inferior articles under trade names, and sometimes wilful misdescription, would seem to be on the increase. 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. Period. Genuine. Inferior. Adulterated. Total. Quarter ending March 31st 139 7 4 150 ,, „ June 30th 130 18 2 150 ,, ,, Sept. 30th 143 2 5 150 ,, ,, Dec. 31st 155 4 3 162 Totals 567 31 14 612 In Table II will be found a statement of the number and nature of the various articles examined during the year with particulars of the results of analysis. 63 Table II. Article. No. of Samples examined. Result of Examination. Genuine. Inferior. Adulterated.  Ammnniated Quinine 8 6 2 Aspirin Tablets 3 3 — — Baking Powder 2 2 — — Borax 1 1 — — Boric Ointment 3 3 — — Brawn 6 6 — — Butter 37 37 — — Camphorated Oil 2 2 — — Castor Oil 2 2 — — Cheese 8 8 — — Chicken and Ham Roll 1 1 — — Chicken and Ham Rissoles 1 1 — — Cocoa 7 7 — — Coffee 5 5 — — Coffee and Chicory 1 1 — — Cordials 6 5 — 1 Cream 12 12 — — Cream substitutes 2 2 — — Eucalyptus Oil 3 3 — — Fish Cakes 2 2 — — „ Paste 5 5 — — „ tinned 5 4 — 1 Flour, self-raising 3 3 — — Fruit, dried 7 7 — — „ tinned 7 7 — — Galantine 2 2 — — Glucose 1 1 — — Honey 2 2 — — Iodine, tincture 4 3 — 1 Jam 4 4 — — Jelly 3 3 — — Lard 8 8 — — Lemonade Crystals 1 1 — — Lemon Cheese 5 5 — — „ Saline 1 1 — — Magnesia 1 1 — — ,, , carbonate of 2 2 — „ , citrate of 3 3 — — Malt, milk and egg beverage 1 1 — — Margarine 6 6 — — Marmalade 4 4 — — Meat Paste 1 1 — — „ Pie 10 10 — — Milk 321 283 31 7 „ Condensed 24 24 — — Mincemeat 3 3 — — Mint, dried 1 l — — „ Sauce 2 2 — — Olive Oil 6 6 — — Pears 1 — — 1 64 Table II—continued. Article. No. of Samples examined. Result of Examination. Genuine. Inferior. Adulterated.  Pepper 3 3 — - Rice 4 4 — — Hum Essence ] 1 — — Sandwich Spread 1 1 — — Sausages 14 14 — — Seidlitz Powder 2 2 — — Semolina 1 1 — Sponge Cakes 2 2 — — Syrup of Figs 3 3 — — Tapioca 1 1 _ — Tea 4 4 — — Tomato Puree 1 1 Veal and Ham Cutlets 1 1 — — Vegetables, tinned 8 8 — Vinegar 5 5 — — Whisky 1 1 — Wine 1 1 — — Zinc Ointment 3 2 — 1 Totals 6l2 567 31 14 Milk. During the year 821 samples of milk were examined and of these 288 were reported as genuine, 31 as inferior and 7 as adulterated. Twenty-seven of the inferior samples were poor in fat and four in both fat and non-fatty solids. Three of the adulterated samples had fat abstracted—14, 7 and 6 per cent, respectively—whilst four contained small amounts of added water ranging from 1 to 2.5 per cent. The following Table gives the average composition of the milk calculated on the total number of samples taken in the Borough during the four quarters of the year:— Table III. Fat. Non-fatty Solids. Water. Per cent. Per cent. Per cent.  Quarter ending March 31st 3.60 8.80 87.60 „ „ June 30th 3.56 8.77 87.67 „ „ Sept. 30th 3.81 8.76 87.43 „ „ Dec. 31st 3.86 8.83 87.31 Average for the year 3.71 8.79 87.50 65 These figures represent milk of fair average quality for the whole year, and are practically the same as those for 1932. Condensed Milk. Twenty-four 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 and Cream Substitutes. 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 specimens were free from metallic contamination. Two cream substitutes were submitted for analysis and these were found to contain no preservatives or other injurious substances and were therefore reported genuine. They were labelled in such a way as not to come within the definition of artificial cream. One of them appeared to have been made from milk and butter and was therefore a genuine artificial cream; the other contained a fat other than butter fat, but in view of the fact that it was not sold as artificial cream no action could be taken against the vendor. The labels on these two specimens are interesting as examples of contracting out of the Act in the first case and of an attempt, in the second case, at making an inferior article appear as good as, or even better than, the food it is made to resemble. Statements on the labels are here reproduced:— 1. " Made of equal weights of pure fresh dairy milk and fresh dairy butter. Contains no other ingredients whatever and although free from preservatives can be kept for days. " As the Authorities object to the sale of this mixture of pure milk and butter except under the definition of ' Artificial Cream ' (which in our 66 opinion wrongly describes the article) we have in this instance added a small percentage of honey which, while not affecting its nature, relieves it of the stigma of being sold under the definition artificial." In this instance it will be noticed that the first paragraph declares the ingredients to be only milk and butter, whereas the second paragraph contradicts this by disclosing the addition of honey. 2. "Is pure fresh Grade A (II) dairy milk enriched with a highly refined and very digestible fat. High vitamin content." Butter, Margarine, Lard. Thirty-seven samples of butter, six of margarine and eight of lard were examined, and all of these proved to be of genuine composition in regaxd to the fat and to contain no excess of water and no preservatives. Cheese. Eight specimens of cheese, all of the tin-foil wrapped kind, were submitted for analysis during the year and were genuine. No metallic contamination could be detected, a satisfactory state of affairs in view of the two cases of cheese found last year containing respectively 14 grains and 4.9 grains of tin per pound, that is, seven times the usually accepted limit in the one case and nearly two and a half times in the other. Meat and Fish Preparations. Of the forty-eight meat and fish preparations examined this year only one, a sample of sardines in tomato, was adversely reported upon. This contained 4.5 grains of tin per pound, an amount 2.5 grains per pound in excess of the limit. 67 Conserves, Vegetables, Fruit, &c. Under this heading are included tinned fruit and vegetables, fresh fruit, dried fruit, jam, marmalade, mincemeat, lemon cheese and honey—in all, thirty-three 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 limits. In only one instance—a sample of pears—was adulteration detected. Here the presence of copper was reported, the amount found being 0.02 of a grain per pound of fruit. The copper compound was concentrated on the skin and therefore it was assumed that it came from the use of a spray on the growing fruit. The consignment was surrendered by the vendor and destroyed. Cocoa, Coffee, Tea, &c. Seven specimens of cocoa, five of coffee, one of coffee and chicory, and four of tea were genuine. Tests for arsenical contamination in the cocoas gave negative results. A sample of malt, milk and egg beverage gave evidence of the presence of all three of the named constituents and contained nothing extraneous; it was therefore passed as genuine. Farinaceous Foods. Four samples of rice, one of semolina, one of tapioca, and three of self-raising flour were genuine. The rices showed no evidence of polishing with talc and the " raiser " in the flours was of satisfactory composition, no excess of calcium sulphate being found. Condiments, &c. Six specimens of olive oil, three of pepper, five of vinegar, two of mint sauce and one of dried mint were examined and in no case was adulteration detected. One of the vinegars was sold as malt vinegar and had the 68 characteristics of such, whilst all showed no trace of metallic or arsenical contamination and had a satisfactory content of acetic acid. Cordials, Wines and Spirits. Of six fruit cordials, one whisky, one wine and one lemonade crystals, only one was adulterated. This was a sample sold as lemon squash, consisting of a crystalline powder containing 3.7 per cent. of citric acid with sugar, colouring matter and lemon flavouring 96.3 per cent. It had, therefore, the composition of the article usually sold as " lemonade crystals," but in view of the low amount of citric acid present was a poor specimen even of that. Drugs. Forty-two specimens of drugs comprising sixteen different articles were taken during the year. Four failed to comply with the requirements of the British Pharmacopoeia. Two samples of ammoniated tincture of quinine were deficient in ammonia to the extent of 44 per cent. and 20 per cent. respectively; a sample of strong tincture of iodine consisted of the weak tincture; and a sample of zinc ointment was deficient in zinc oxide, there being present only 14 per cent. in place of the required 15 per cent. A new Act, the Poisons and Pharmacy Act, 1983, received the King's signature on June 28th last. It is divided into three parts; the first relating to pharmacy and pharmacists, the second to poisons generally and the third to miscellaneous matters. Parts II and III affect the work of Local Authorities and of Public Analysts appointed by them. Part II of the Act is designed to control the sale of poisons. An Advisory Committee, to be known as the Poisons Board, is to draw up a Poisons List consisting of 69 two parts, the first of which shall comprise substances which may be sold only by authorised sellers of poisons, and the second of which shall contain substances which may be sold only by authorised sellers of poisons or by those whose names are in a list kept by a Local Authority of persons entitled to sell poisons included in this second part. It is intended to restrict the second part to articles which are in common use, such as those used for sanitary, domestic, industrial, agricultural or horticultural purposes, or as vermin killers. Section 18 of the Act deals with prohibitions and regulations with respect to the sale of poisons, and with labelling of poisons. Section 20 deals with exemption with respect to sales wholesale and to certain persons, including medical practitioners, registered dentists or veterinary surgeons, Government Departments or Officers of the Crown requiring the article for the purpose of the public service, or any Local Authority requiring the article in connection with the exercise of any statutory powers, or persons or institutions engaged in scientific education or research. Section 21 defines the conditions under which Local Authorities may enter the names of persons other than authorised sellers of poisons in the list of those who may sell the poisons included in the second part of the Poisons List and gives power of refusal to enter the name of any person for any sufficient reason relating to him or his premises. Among the provisions of Part TIT of the Act are the following:— Sub-section 5: "A document purporting to be a certificate signed by a Public Analyst or person appointed by the Secretary of State to make analyses for the purpose of this Act, stating the results of an analysis made by him, shall be admissible in any proceedings under this Act as evidence of the matters stated therein, but either party may require the person bv whom the analysis was made to be called as a witness." 70 Section 29 defines a Public Analyst as one appointed under the Food and Drugs (Adulteration) Act, 1928. This Act repeals, wholly or in part, the Arsenic Act of 1851; the Pharmacy Acts of 1852, 1868, 1869 and 1898; the Poisons and Pharmacy Act of 1908; and the Dangerous Drugs and Poisons (Amendment) Act of 1923. In July of 1933 the Minister of Health and the Secretary of State for Scotland directed that the work of the Departmental Committee on Food Law, suspended in September, 1931, be resumed, with the following altered terms of reference :— " To consider whether it is desirable that the law relating to the composition and description of articles of food should be altered so as to enable definitions or standards to be prescribed, or declarations of composition to be required, for articles of food other than liquid milk; and if so to recommend what alterations of the law are required." A Memorandum dealing with antimony poisoning due to the use of enamelled vessels was issued by the Ministry of Health in February of last year. The Memorandum draws attention to the dangers to health arising from the use of low-grade enamelled vessels for the preparation or storage of food or drink and refers to the ready solution of antimony from the enamel by citric, tartaric, acetic and other acids present in foods. Three outbreaks of antimony poisoning at Newcastle-on-Tyne in 1928, Folkestone in 1929, and London in 1932, are mentioned and the cause of these referred to the use of enamelled pails and jugs used for preparing lemonade. In addition to the articles taken under the Food and Drags (Adulteration) Act I have analysed nine samples of swimming-bath water submitted by the Medical Officer of Health. 71 The following Table shows the action taken on terated samples and other infringements of the Sale of Food and Drugs Act:- Table IV. Sample No. Article. Analyst's Report. Result. 107a Sardines in Tomato 4½ grains tin per lb. Stock seized and destroyed 184 Milk 2·5 per cent.added water Warning letter 189 Strong Tincture of Iodine Consisted of weak tincture of iodine Warning 244 Milk 14 per cent.fat abstracted Warning letter 286 Zinc Ointment 14 per cent. zinc oxide in place of 15 per cent. Warning 334 Milk 7 per cent. fat abstracted Warning letter 419 Pears ·02 of grain of copper per lb. Stock surrendered and destroyed 429 Lemon Squash Consisted of a crystaline powder citric acid 3·7 per cent. Sugar and lemon flavouring 96·3 per cent. No action. Vendors, in liquidation 444 Milk 1 per cent.added water Warning letter 473 do. 6 per cent. fat abstracted do. 549 do. 1 per cent. added water do. 581 Ammoniated Tincture of Quinine 44 per cent. deficient in ammonia Warning 587 do. 20 per cent. deficient in ammonia do. 681 Milk 2 per cent. added water Warning letter 72 PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 1,827 cases reported as due to notifiable infectious diseases in the Borough, against 1,487 in the previous year. There were also reported 618 cases of infectious diseases that were not notifiable, against 1,918 in the previous year; 299 of these were Measles, and 319 Whooping Cough. The number of cases of Tuberculosis notified was 216 against 228 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 118 Negative results 1,297 Sputa from cases of suspected Tuberculosis— Tubercle bacillus found 104 Tubercle bacillus not found 456 Blood from cases of suspected Fever— Widal or Typhoid reaction obtained 5 Widal or Typhoid reaction not obtained 1 Urine 1 Grand Total 1,982 73 Cases of Infectious Disease notified during the year 1933 Table V. 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 15 Years 45 & under 65 Years 65 and upwards S'th Centre North Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 241 8 62 136 23 10 2 .. 47 29 18 27 37 42 41 236 Erysipelas 97 3 3 6 8 30 35 12 10 14 13 6 19 26 9 68 Scarlet Fever 895 7 202 582 57 45 2 .. 134 124 99 91 137 226 84 876 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 8 .. .. 4 1 3 .. .. .. 2 4 .. .. 2 .. 7 Relapsing Fever (R) Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 9 .. .. .. 3 6 .. .. 2 1 2 1 1 2 .. 7 Puerperal Pyrexia 33 .. .. .. 11 22 .. .. 3 5 2 2 6 11 4 28 Cerebro-Spinal Meningitis 6 .. 2 1 3 .. .. .. 1 1 1 .. 1 2 .. 6 Polio-myelitis 4 .. 2 2 .. .. .. .. .. .. 1 .. 1 1 1 3 Encephalitis Lethargica 1 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 Ophthalmia Neonatorum 10 10 .. .. .. .. .. .. 3 1 1 1 1 2 1 2 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 179 4 18 28 20 52 40 17 18 27 20 11 24 51 28 105 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery 3 .. 2 1 .. .. .. .. .. 1 .. .. .. 2 .. 3 Food Poisoning 8 .. .. 1 3 .. 4 .. .. .. .. 1 2 5 .. .. Chickenpox 333 11 121 184 12 4 1 .. 52 20 36 12 72 80 61 30 TOTALS 1827 44 412 945 141 172 84 29 270 225 197 152 301 453 229 1,372 Tuberculosis. Pulmonary Tuberculosis 185 .. 1 3 48 73 55 5 21 40 34 12 18 43 17 Other forms of Tuberculosis 31 1 2 8 10 5 4 1 3 13 .. 2 4 6 3 TOTALS 216 1 3 11 58 78 59 6 24 53 34 14 22 49 20 Deaths from the Seven Principal Zymotic Diseases.— The total number of deaths of residents registered from the seven principal zymotic diseases was 54 against 74 in the previous year. The deaths of residents last year from these diseases were equal to 31.9 per 1,000 of the total deaths of residents registered and were at the rate of 0.4 deaths per 1,000 persons living. 74 The following table shows the deaths of residents registered from the seven principal zymotic diseases which occurred in the ten years, 1924 to 1933:— Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Mcm branous Croup. Whooping Cough. Enteric Fever. Diarrhœa and Cholera. Total. 1924 0 35 4 17 16 1 15 88 1925 0 6 3 12 32 3 35 91 1926 0 24 2 14 11 0 28 80 1927 0 2 1 11 4 0 28 46 1928 0 23 3 5 5 2 33 71 1929 0 2 0 5 41 2 19 69 1930 0 31 3 21 9 1 24 89 1931 0 0 2 6 7 0 23 38 1932 0 29 4 8 6 1 26 74 1933 0 3 4 14 5 1 27 54 Average last 10 yrs. 0 15 3 11 14 1 26 70 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 vears. Notifiable Diseases (other than Tuberculosis) during the year 1933. DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths. Diphtheria 241 236 14 Erysipelas 97 68 — Scarlet Fever 895 876 4 Enteric Fever 8 7 1 Puerperal Fever 9 7 8 Puerperal Pyrexia 33 28 — Cerebro-Spinal Meningitis 6 6 4 Encephalitis Lethargica 1 1 — Ophthalmia Neonatorum 10 2 — Pneumonia 179 105 113 Dysentery 3 3 — Poliomyelitis 4 3 — Chickenpox 333 30 — Food Poisoning 8 — — Totals 1,827 1,372 144 75 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.— Two hundred and forty-one cases were reported as due to Diphtheria or Diphtheritic Membranous Croup against one hundred and ninety-two cases in the previous year. Two hundred and thirty-six cases were treated at the Isolation Hospitals and five at the homes of the patients. Fourteen deaths were registered. The mortality rate on the cases reported was 5.8 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.—Eight hundred and ninety-five cases were notified as due to Scarlet Fever, against five hundred and ninety-four in the previous year. Eight hundred and seventy-six cases were treated at the Isolation Hospitals, and nineteen 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 0.4 per cent. The Chart hereunder show* 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 78 Enteric Fever.—Eight cases were reported as due to Enteric Fever, against four cases in the previous year. Five cases were treated at the London County Council Hospitals, two at the Hammersmith Hospital and one at the home of the patient. One death was registered. Erysipelas.—Ninety-6even cases were reported as due to Erysipelas, against fifty-one cases in the previous year. Twenty-nine cases were treated at the homes of the patients, and sixty-eight in various hospitals. 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.—Nine cases were reported as due to Puerperal Fever, against two cases in the previous year. Two cases were treated at the London County Council Hospitals and five at Queen Charlotte's Hospital. Two cases were treated at the homes of the patients. Six deaths were registered from Puerperal Sepsis and two from other accidents and diseases of pregnancy. Puerperal Pyrexia.—Thirty-three cases were reported as due to Puerperal Pyrexia against twenty-eight in the previous year. Twenty-two cases were treated at the London County Council Hospitals, one at St. George's Hospital, five at Queen Charlotte's Hospital and five at the homes of the patients. Cerebro-Spinal Meningitis.—Six cases of Cerebro-Spinal Meningitis were reported against eight cases in the previous year. Four cases were treated at the Isolation Hospitals of the London County Council, one at St. Charles' Hospital, and one at the West London Hospital. Four deaths were registered. 79 Acute Polio-myelitis.—Four cases were reported as due to Polio-myelitis, against one case in the previous year. Two cases were treated at Princess Louise Hospital, one at Gt. Ormond Street Hospital, and one at the home of the patient. Encephalitis Lethargica.—One case was reported as due to Encephalitis Lethargica, against one in the previous year. The case reported was treated at Victoria Hospital. Ophthalmia Neonatorum.—Ten cases were reported as due to Ophthalmia Neonatorum, against nineteen cases in the previous year. Two cases were treated at London County Council Hospitals, and eight at the homes of the patients. In the cases treated at home arrangements were made for a nurse to attend the patients. Twenty-two 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. There was no impairment of vision in any case. Anthrax.—No case of Anthrax was notified during the year, as 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. Measles and German Measles.—-Two hundred and ninety-nine cases of Measles and German Measles were notified against fifteen hundred and eighty-eight in the previous year. Fifty-seven cases were treated in the Hospitals of the London County Council. Three deaths were registered. 80 81 Whooping Cough.—Three hundred and nineteen cases of Whooping Cough were reported, against three hundred and thirty in the previous year. Five deaths were registered. Fifty-nine 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. The homes of the patients were visited by your Lady Inspectors, and the parents advised as to the precautions that should be taken. Chicken Pox.—Three hundred and thirty-three cases of Chicken Pox were reported, against four hundred and five in the previous year. Thirty 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. Pneumonia.—One hundred and seventy-nine cases of Pneumonia (sixty-nine Influenzal Pneumonia and one hundred and ten Primary Pneumonia) were notified during the year. One hundred and five 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 thirteen deaths were registered. Malaria.—No case was reported, as against no case in the previous year. 82 Dysentery.—Three cases of Dysentery were reported against one case in the previous year. Food Poisoning.—Eight cases of Food Poisoning were reported under Section 7 of the London County Council (General Powers) Act, 1932. Influenza.—During the year sixty-four deaths from Influenza occurred, as compared with forty-three in the previous year. Wrong Diagnosis.—Fifty-seven 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 22 Scarlet Fever 35 Total 57 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 153 Impetigo 205 Verminous Cases 1,845 Adults— Scabies 89 Verminous Cases 97 Children under School-age— Scabies 39 Verminous Cases 2 Adults—Non-Hammersmith— Scabies 19 Verminous Cases 2 TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1924 to 1933. 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. Ophthalmia Neonatorum. Acute Polio-Myelitis. Encephalitis Lethargica. Pneumonia. c Malaria. c Dysentery. c Trench Fever.e Food Poisioning. g. Total. 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 0 409 249 0 4 0 0 9 15 0 74 0 87 237 113 3 0 0 0 13 0 3 232 0 1 0 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 1933 0 895 241 0 8 0 0 9 33 0 97 0 333 299 319 6 0 0 0 10 4 1 179 0 3 0 8 2445 Average for 10 years 7 413 277 0 6 0 0 9 18 0 54 0 335 721 238 4 0 0 0 17 2 4 157 1 1 0 1 2265 a Not Notifiable. b Notifiable during the years 1916—1919. c Notifiable from 1st March, 1919. d Notifiable from 1st October. 1926. e Notifiable from 1st March, 1919, to 31/12/1927. f Notifiable from 2nd March, 1931. g. Notifiable from 12th July, 1932. 84 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 £188 4s. Od. in respect of cleansings and £15 9s. Od. in respect of scabies cases and impetigo. The non-Hammersmith cases of scabies and verminous conditions were dealt with, as the district in which the persons were resident have not provided medicinal baths. A charge of two shillings in respect of each bath given is made and is paid by the responsible Authority. 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 587 Mattresses 1,037 Pillows 2,892 Bolsters 685 Blankets 3,307 Sheets 1,734 Quilts 1,508 Articles of Clothing 4,768 Sundries 206 Total 16,724 Rooms 1,382 Vaccination. The duties under the Vaccination Acts and the Vaccination Order were carried out by the Public Health Department. The Return for 1932 shows that 980 Infants were vaccinated, this being 57.0 per cent. of the Births and compared with 55.9 per cent. in 1931. Proceedings under Section 7 of the Vaccination Act, 1871, were instituted in two cases, and resulted as follows :— (1) Fined £1 and £1 1s. 0d. costs. (2) Fined £1. 85 VACCINATION RETURNS. RETURN FOR 1932. 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., 1932 Number of these Births duly entered by 31st January, 1934, in Columns I, II, IV and V of the "Vaccination Register " (Birth List Sheets), viz.: Number of these Births which on 31st January, 1934, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1934. 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 1933 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 1933 Col. 1 Successfully Vaccinated Col.II Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received Col. V Dead, Unvaccinated Postpone ment by Medical Certificate Removal to Districts, the Vaccination Officer of which has been duly apprised Removal to Places unknown or which cannot be reached; and Cases not having been found Insusceptible of Vaccination Had SmallPox 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Hammersmith 882 461 4 — 292 43 6 11 55 10 922 457 2. South Hammersmith 555 307 6 — 143 18 7 10 57 7 3. "Invermead" 354 202 — — 89 11 1 26 20 5 1,791 970 10 — 524 72 14 47 12 22 922 457 Table showing Work of Vaccination Officer from 1st January to 31st December, 1933. No. of Vaccination Certificates received from— No. of Insusceptibility Certificates. Total No. of Certificates. No. of Declarations of Conscientious Objection. No. of Postponement Certificates. No. of Cases Removed Inwards. No. of Cases Removed Outwards. No. of "Q" Notices Sent. No. of "k" Notices Served. No. of Children Died Unvaccinated. No. of Visits of Vaccination Officer. No. of Cases Removed and not Traced. Nos. entered on "H" Lists to Public Vaccinators. Dr. Durward. Dr. Dale. Dr. Frossard. Dr. Johnson. Dr. Dockill. Dr. Brash. Dr. Phillips. Dr. Barnes Other Doctors. Dr. Durward. Dr Dale. Dr. Frossard. Dr. Johnson. Dr. Dockrill. Dr. Brash. Total North 19 78 7 29 64 7 — — 100 1 305 251 32 — 36 495 31 18 132 21 19 82 7 29 66 7 210 South 73 5 15 38 17 — — — 109 1 258 130 41 — 23 351 48 25 93 24 79 5 15 38 17 — 154 Queen Charlotte's Hospital 24 24 1 10 5 2 — — 112 2 180 76 11 77 214 6 8 26 8 24 15 10 1 5 2 57 Removed Inwards 46 28 10 34 29 3 — — 29 — 179 — 19 286 — 79 36 1 46 — 46 28 10 34 29 3 150 Above 14 years of age 6 4 — 2 2 — — — — — 14 — — — — — — — — — — — — — — — — Total 168 139 33 113 117 12 — — 350 4 936 457 103 286 136 1139 121 52 297 53 168 130 42 102 117 12 571 87 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 sixteen cases of tuberculosis were reported during the year, one hundred and eighty-five of which were Pulmonary and thirty-one being other forms of Tuberculosis, against two hundred and twenty-eight cases in the previous year. PART I. Summary of Notifications during the period from the 1st January, 1933, to the 31st December, 1933. 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 ages) Pulmonary Males — — — 2 7 9 19 22 28 15 1 103 165 Pulmonary Females — 1 — 1 11 21 20 12 7 5 4 82 105 Non-pulmonary Males 1 1 4 1 3 1 - 1 1 1 — 14 18 Non-pulmonary Females — 1 3 — 2 4 3 1 2 - 1 17 19 88 PART II. Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age Periods 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary Males — - 1 1 - 1 4 12 6 1 1 27 Pulmonary Females — — — 3 — 7 10 2 - 2 — 24 Non-pulmonary Males 1 3 2 — — 1 — 1 1 - — 9 Non-pulmonary Females — — - 1 — 1 - - - — - 2 No. of Cases Source of Information Pulmonary pulmonary from local Registrars 4 1 Death Returns transferable deaths from Registrar General 3 — Posthumous notifications 7 6 " Transfers " from other areas (other than transferable deaths) 37 4 Other Sources, if any — - 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, 1933, on the Registers of Notifications 404 323 727 144 185 329 1,056 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 10 11 21 13 11 24 45 3. Death 84 60 144 11 5 16 160 89 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 forty-eight deaths from Pulmonary Tuberculosis were registered, against one hundred and thirty-five in the previous year, representing a death-rate of 1.0 per 1,000 compared with 1.0 in 1932. 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. 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 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 1920-33, showing the interval between notification and death of tuberculous persons. 1920. 1921. 1922. 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1. Total number of deaths from Tuberculosis in the Borough 157 173 162 145 170 138 142 181 135 149 153 127 156 150 2. The number of cases notified at death 11 8 17 11 10 13 8 – 7 3 7 2 6 13 3. The number of cases notified within one month of death (excluding above) 26 29 20 21 23 18 30 25 17 32 18 16 21 17 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 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 16 90 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1933:— Age Periods. New Cases. Deaths. Pulmonary NonPulmonary Pulmonary NonPulmonary M. F. M. F. M. F. M. F. 0 – – 1 – – – 2 – 1 — 1 1 1 — — 2 – 5 2 1 5 3 1 — 2 – 15 16 32 4 6 7 16 1 2 25 41 32 1 4 32 28 1 1 45 43 12 2 2 38 8 1 — 65 and upwards 1 4 — 1 4 4 – – Totals 103 82 14 17 82 56 9 3 The ratio of non-notified tuberculous deaths to the total tuberculous deaths is 1 to 18. 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. 1 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 Childien. Tuesdays, 5.30 p.m. Men and Women (Workers only). Thursdays, 5.30 p.m. Men and Women (Workers only). Fridays, lO.30 a.m. Men, Women and Children. Saturdays, 10 a.m. School Children. New Patients may attend at any of the Sessions. 91 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, 1933, the number of patients on the Dispensary Register was 749. During the year 52 definite cases of the disease were transferred from other areas into the Hammersmith district and 129 moved out of this district or were lost sight of. Forty-four were written off the register as being cured cases who had previously been notified as suffering with tuberculosis. New Patients. During the year 746 persons attended for examination for the first time. Of these, 227 were under the age of fifteen and 519 were adults. Males and females attended in almost equal numbere, viz., 330 and 416. Of the total 355 were referred to the Dispensary by local practitioners for the purpose of consultation and 342 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 158 Found to have other forms of Tuberculosis 25 Showing no evidence of Tuberculosis 563 92 Total Attendances and Examinations. The total attendances of persons for the purpose of examination, observation or treatment, numbered 2,393 and physical examinations were carried out in 2,331 instances, i.e., in 98 per cent, of the total attendances. The names of 568 persons were written off the register as being non-tuberculous, and the total number on the Dispensary Register on 81st December, 1933, was estimated at 715. Sputum Examinations. Four hundred and seventy-nine specimens of sputum and other pathological products were examined bacteriologically. Seventy-nine showed the presence of Tubercle Bacilli, while 400 proved negative. Institutional Treatment. The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homes), under the London County Council's Scheme, numbered 200. Others have entered Convalescent Homes through the following agencies:—The local Children's Aid Association, the local Charity Organisation Society, and the local branch of the United Services Fund. Clinical Reports. To the London County Council, numbered 682 To the Ministry of Pensions 13 To General Practitioners and Hospitals 821 Home Visitation. The Tuberculosis Officer made 226 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 69 occasions. 93 Return showing the work of the Dispensary during the year 1933. 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 79 67 1 1 5 11 2 4 84 78 3 5 170 (b) Diagnosis not completed - — — — — — — — 1 — 1 2 (c) Non-tuberculous - - - - - - - - 88 99 26 19 232 B.—Contacts examined during the year:- (a) Definitely tuberculous 4 5 - 1 — 1 2 - 4 6 2 1 13 (b) Diagnosis not completed — — — — — — — - - - - - (c) Non-tuberculous - - - - - - - - 33 126 88 82 329 C.—Cases written off the Dispensary Register as:— (a) Recovered 13 10 — 3 2 4 9 3 15 14 9 6 44 (b) Non-tuberculous (including any such cases previouslydiagnosed and entered on the Dispensary Register as tuber- culous) - - - - - - - - 121 226 114 101 562 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 276 224 11 22 38 68 40 34 314 292 51 56 713 (b) Diagnosis not completed - - - — - — — — 1 — 1 - 2 1. Number of cases on Dispensary Register on January 1st 749 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in prevous years 52 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 129 4. Cases written off during the year as Dead (all causes) 97 5. Number of attendances at the Dispensary (including contacts) 2,393 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 317 7. Number of consultations with medical practitioners:- (a) Personal 226 (b) Other 355 8. Number of visits by losis Officers to homes (including personal consultations) 295 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4,369 10. Number of:— (а) Specimens of sputum, &c., examined 479 (b) X-ray examinations made, in connection with dispensary work 196 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 314 95 PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 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 1929 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 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) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 14 5 4 1 10 - 1 1 - 2 3 - 1 - 1 - - - - - - - - - - F. 4 1 — — 1 1 2 - — 2 1 1 - - 1 2 - - - - 2 - - - - Children 6 — — — - 3 - — — - 1 - — — - - — — — - - — — — — Disease not Arrested Adults M. 16 3 8 2 13 5 5 4 4 13 1 4 7 2 13 1 9 2 1 12 9 7 4 1 12 F. 6 1 5 — 6 4 1 5 2 8 5 2 — — 2 — 2 2 - 4 4 9 3 2 14 Children — — — — — — — — — — 1 — - — — 1 — — — — 3 - - - - Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 46 10 17 3 30 13 9 10 6 25 12 7 8 2 17 4 11 4 1 16 18 16 7 3 26 1 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 17 1 1 2 2 1 - 1 - 1 3 1 - - 1 - - - - - F. 18 3 2 — 5 4 1 — — 1 5 — — — — 1 — 1 — 1 - Children 12 — — — — 3 — — — — 1 — — — — — — — — - — — — — — Lost sight of, or otherwise removed from Dispensary Register 76 12 15 4 31 16 10 10 1 21 24 9 18 6 33 31 20 18 3 41 28 13 11 2 26 Dead Adults M. 2 1 4 5 10 5 5 16 13 34 1 4 12 31 47 2 3 15 13 31 10 7 13 10 30 F. 4 — 5 4 9 3 4 2 11 17 4 2 5 12 19 6 18 9 6 33 5 2 9 5 16 Children 2 - — — — - - - - - 2 - 1 - 1 2 - - - - - - - - - Total written off Dispensary Register 131 17 27 13 57 33 20 28 25 73 38 15 37 49 101 45 42 43 22 107 43 22 33 17 72 Grand Totals 177 27 44 16 87 46 29 38 31 98 50 22 45 51 118 49 53 47 23 123 61 38 40 20 98 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults 1930 1931 1932 1933 M. 1 - - - - - - - - - - - - - - - - - - - F. 1 - - - - - - - - - - - - - - - - - - - Children — — — — — — — — — — — — — — — — — — — — Disease not Arrested Adults M. 14 1 4 - 5 12 10 8 5 23 12 10 16 3 29 17 11 24 3 38 f. 14 1 3 3 7 13 6 14 3 23 10 9 16 1 26 20 13 25 4 42 Children 4 1 1 - 2 2 1 - - 1 4 1 2 - 3 1 - 1 - 1 Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 34 3 8 3 14 28 17 22 8 47 26 20 34 4 58 38 24 50 7 81 (b) Not now on Dispensary a Register and reasons for removal therefrom. Discharged as Recovered Adults M. - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 21 11 15 26 10 4 13 _ 17 8 4 8 2 14 1 1 1 2 4 Dead Adults M. 8 10 17 12 39 6 7 12 1 20 2 5 8 10 23 3 2 15 7 24 F. 9 8 10 5 23 4 4 8 1 13 3 4 6 1 11 1 1 5 3 9 Children - - - - - - - - - - 1 — - - - 1 — — — — Total written off Dispensary Register 38 29 42 17 88 20 15 33 2 50 14 13 22 13 48 6 4 21 12 37 Grand Totals 72 32 50 20 102 48| 32 55 10 97 40 33 56 17 106 44 28 71 19 118 97 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1933 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 1929 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 Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M 1 - - - 1 1 - - 1 1 - - - - - 1 - - 2 3 2 - - - 2 F 2 - - 1 3 - - - 3 3 - - - - - - - - - - 2 - - 2 4 Children 2 - - - 2 2 — — 2 4 — — — — — 1 — — 2 3 1 — 1 2 4 Disease not Arrested Adults M - - 2 - 2 - - - 2 2 - - - - - 2 1 1 1 5 - - 2 - 2 F - 2 4 6 — 1 1 1 3 2 — — — 2 - - 1 2 3 1 1 - 2 4 Children 1 — — — 1 — 1 1 — 2 2 — — — 2 1 — 2 — 3 1 — — — 1 Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 6 - 4 5 15 3 2 2 8 15 4 - - - 4 5 1 4 7 17 7 1 3 6 17 Transferred to Pulmonary (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 3 - 3 - 6 1 1 1 1 2 - - - - - - - - - F 2 1 1 5 9 - 3 — 1 4 1 1 — — 2 — — — — — — — — •— — Children 8 1 1 15 25 — — — 7 7 — 1 — 2 3 2 — — 4 6 — — — 2 2 Lost sight of, or otherwise removed from Dispensary Register 20 - 4 18 42 10 — - 7 17 8 1 3 5 18 3 — 2 6 11 2 — 7 6 15 Dead Adults M 1 - - - 1 2 - - - 2 1 - - 1 1 1 - 2 1 - - - 1 F. - - - - - - - - 1 1 - - - - - - - - - 1 - - - 1 Children — — — — — 1 1 — 2 — — — — 1 — — — 1 - — — — — Total written off Dispensary Register 34 2 9 38 83 13 4 1 16 34 11 3 3 9 26 7 — 3 10 20 4 — 7 8 19 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 40 2 13 43 98 16 6 3 24 49 15 3 3 9 30 12 1 7 17 37 11 1 10 14 36 1930 1931 1932 1933 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - Children - — — 2 2 - - - - - - - - - - - - - - - Disease not Arrested Adults M. 3 — 2 1 6 4 - - 1 5 2 1 - 3 6 1 - 2 - 3 F. 3 1 2 b 11 5 1 1 5 12 4 — — 2 6 6 1 - 4 11 Children 6 — — 7 13 7 3 2 5 17 8 1 — 2 11 1 3 1 4 9 Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 12 1 4 15. 32 16 4 3 11 34 14 2 - 7 23 8 4 3 8 23 Transferred to Pulmonary (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. - - - - - - - - - - - - - - - - - - - - F. — — — 1 1 - - - - - - - - - - - - - - - Children — — — 1 1 - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 10 1 — 3 14 4 3 5 12 1 2 3 - 1 1 2 Dead Adults M. 1 - 1 - 2 - - - - - - - - - - - - - 1 1 F. — 1 2 - 3 — 1 — — 1 — — — — — — - - - - Children - - - - - - - - - - - - - - - - - - - - Total written off Dispensary Register 11 2 3 5 21 4 4 — 5 13 1 — 2 3 1 2 Grand Totals of (a) and (6) (excluding those transferred to Pulmonary). 23 3 7 20 53 20 8 3 16 47 15 2 - 9 26 8 4 4 10 26 98 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 4,369 such visits were made. In addition to the ordinary health visits paid by them, the Dispensary Nurses submit reports to the London County Council on the home conditions of patients recommended for Institutional Treatment. During the year 240 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 London County Council, the local Public Assistance Committee, the Red Cross Society, the District Nursing Association, the Charity Organisation Society, the Invalid Children's Aid Association, the Labour Exchange and the Local Medical Practitioners. The Committee meets every three weeks on Thursday for the purpose of considering how patients and their households can best be helped and for the purpose of making assessments towards the cost of institutional treatment under the London County Council's Tuberculosis Scheme. This work has increased during the past-year, as it was arranged by the London County Council, from the 1st April, 1933, that all cases of Tuberculosis should be treated under their scheme, and assessed by the local Tuberculosis Care Committees. Previously, the Tuberculous cases admitted to the London County Council's General Hospitals, were dealt with by the Public Assistance Committee. During the year, 181 hospital cases were added to the list of cases for consideration by the Tuberculosis Care Committee. The Committee met on 16 occasions during the year. 99 There were submitted by the staff 230 applications for residential treatment, an increase of 58 compared with 1932. The Committee decided in 177 of these cases that no payment should be required in respect of such treatment. In the remaining 53 assessments of varying amounts were made. In 50 instances, reconsideration of these assessments was rendered necessary at subsequent meetings, mainly by changes in the family circumstances. During the year assistance was rendered to patients through the following agencies:— Invalid Children's Aid Association 15 Charity Organisation Society 31 British Red Cross Society 27 School Care Committee 18 Public Assistance Committee 51 Mayor's Fund 2 United Services Fund 14 Royal Naval Benevolent Society 2 Collection of payments, on behalf of the London County Council, has been made by the Dispensary to the amount of £199 6s. 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. In November, 1933, the members of the Tuberculosis Care Committee visited Frimley Sanatorium, and Burrow Hill Colony Sanatorium, with a view to ascertaining the line of treatment adopted for patients. A full report of these visits was submitted to the Public Health Committee and the Borough Council. Nursing Comforts. The Hammersmith Borough Council has set aside an annual grant of £15, for the use of the Tuberculosis Care 100 Committee, in supplying nursing comforts and appliances to necessitous cases, in pre- and post-sanatorium stages. These comforts and appliances are given out to patients on loan, and returned to the Dispensary after use, for disinfection and further distribution. The articles consist of rubber ring cushions, bed rests, aluminium and rubber hot-water bottles, air cushions and bed pans. These articles will be supplied on loan, to any tuberculous patient brought to our notice through the usual sources, and in this respect the co-operation of the Borough Medical Practitioners, Hospitals and other Associations is requested. 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 a fact that more female patients would accept hospital treatment if it was available in the Borough. Weekly visits are made to the Hospital by the Borough Tuberculosis Officer in the capacity of Consultant 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. 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. 101 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 recommendations 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. 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. 102 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. It is anticipated that in the near future the Dispensary will be equipped with its own X-ray plant, and that it will be operated by the Tuberculosis Officer. This will not only facilitate the easier and more rapid aid to diagnosis, but will also bring the dispensary service into the category of a modern unit. The total number of X-rays and reports made by the Tuberculosis Officer for the year was 180. Artificial Pneumothorax Treatment. 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 carried 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. The number of cases in the Borough now receiving this form of treatment is 21. 108 The total number of refills performed by the Tuberculosis Officer either in the Hospital clinic or in the dispensary, for the year 1933 was 178. Previously a charge of 10s. 6d. per refill was payable by the Hammersmith Borough Council to Brompton Hospital for this treatment, so that under the new organisation an equivalent sum had been saved. 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. Cases that are unable to attend at the Hospital clinic are treated at the dispensary by special appointment with the Tuberculosis Officer, and X-ray control is carried out at the Hospital at suitable times. Two such cases attended the dispensary during 1933, and the total number of their refills being 10. Home nursing is provided through the District Nursing Association. " Sanocrysin Treatment." Injections for sanocrysin, and the allied gold salts, are carried out at the Dispensary, either on the recommendation for continuation of treatment by Medical Superintendents of Sanatoria, or when the Tuberculosis Officer considers such treatment to be indicated for dispensary patients. The total number of sanocrysin injections made during the year was 20. According to the dosage used, these injections cost about 1s. per injection, as against a charge of 3s. made by outside Institutions, thus representing a saving of 2s. per injection, when carried out at the Dispensary. 104 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 maximum incidence of tuberculosis is tending to change from the more congested parts of the Borough, to the new estate areas. The reasons for this are twofold :— (1) The rents of the new estates are higher, and the added requirements of better environment leave less money for food—an indication that nutrition is of more importance than housing. (2) Preferential consideration for housing in the new estates is given on the grounds of ill-health, and particularly for tuberculosis, therefore one finds the influx of a population of already diminished resistance and a percentage of tuberculous patients from this and other Boroughs. PREVENTION OF BLINDNESS. Blind Persons Act, 1920. It was not found necessary to refer any case of blindness to the London County Council under the scheme for the education and training of the blind. EXHUMATION AND RE-INTERMENT OF BODIES. St. Mary's Catholic Cemetery, Harrow Road. During the year licences were granted by the Secretary of State for the exhumation and removal of the bodies of two persons from the catacombs or graves in St. Mary's Cemetery. One body was forthwith removed to Golders Green for the purpose of cremation, and one body was re-interred in St. Mary's Cemetery, Kensal Green. 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. 105 (2) That freshly made ground lime be freely sprinkled over the coffin, the soil, or any matter that may be offensive. 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. 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. Bacteriologically the water was of a high standard, but complaints were received of irritation of the eyes. This was due to over-chlorination or to the use of too much alum ferric for precipitation purposes. The open-air bath at Bloemfontein Road was badly contaminated with a growth of green algae. This was so bad that it became impossible to see the bottom of the bath. The bath had to be emptied and fresh water introduced. When the bathing season was over the bath was emptied, cleansed of all growth of algae attached to the sides and bottom of the bath. The bath was then sprayed with an even suspension of white cement with the object of providing, as far as possible, a smooth surface which it was hoped would lead to a diminution of the algae growth, and a white surface instead of the grey cement giivng a better reflection. The result of this experiment will be watched with interest. 106 PUBLIC WASH-HOUSES. The public wash-houses in Scotts Road form part of the building comprising the indoor Swimming Baths, Lime Grove. These wash-houses are very well patronised, and provide a means of clothes-washing for many families living in tenement houses without washing accommodation. They are open ordinary week-days from 8 a.m. to 8 p.m., except Saturdays, when they are available from 8 a.m. to 3 p.m. PROPAGANDA. During the year "Better Health," a monthly Health Journal, published under the auspices of the Society of Medical Officers of Health, was distributed. One thousand copies of this Journal being distributed monthly to the Schools and Infant Welfare Centres. The Journal is welcomed by the School Teachers as a great help in the teaching of Hygiene. INFANT LIFE PROTECTION. Children and Young Persons Acts, 1908-1932. On the 1st April, 1988, the duties relating to Infant Life Protection were transferred from the London County Council to the Metropolitan Borough Councils. The sections of the Acts under the jurisdiction of the Borough Council relate to :— (1) Notices to be given by persons receiving infants, under the age of nine, for reward. (2; Appointment and powers of inspection to visit any infants referred to in any notice given. (8) Persons prohibited from receiving children for reward. 107 (4) Powers of local authority to prevent overcrowding. (5) Removal of infants kept in unsuitable premises or by unsuitable persons. (6) Notices to be given to Coroner in the case of a death of any infant respecting which notice is required to be given under this Part of the Act. (7) Avoidance of policies of life insurance of infants kept for reward. (8) Prohibition of anonymous advertisements offering to take care of infants. (9) Provisions of notices to be given under this Part of the Act. (10) Prosecution of offences and application of fines. (11) Local authorities and expenses. (12) Exemptions. At the time of the transfer of this work there were 121 foster-mothers and 143 foster-children in the Borough. The records relating thereto were transferred by the London County Council together with the papers relating to foster-mothers who had been previously registered but had not, at the time of transfer, children in their care. The work of inspection has been carried out by the lady sanitary inspector. Action was taken under Section 67, Part IV, of the Childrens and Young Persons Act, 1932, with respect to a foster-child in the care of an unregistered foster-mother. The foster-mother, a person who, by reason of old age. ignorance, &c., was unfit to have care of the child. A Magistrate's Order directing the removal of the infant to an Institution was obtained, and the child removed. 108 A summary of the work carried out during the nine months under review follows :— FOSTER MOTHERS. No. of Foster Mothers on Register April 1st, 1933 (Taken over from L.C.C.) 132 ,, ,, „ „ December 30th, 1933 151 „ „ „ Recommended for Registration 35 ,, Applications for Registration received but not Recommended 10 No. of Foster Mothers removed from Register:— (1) Lack of accommodation 4 (2) Removed from Borough 9 (3) Adopted Children 2 FOSTER CHILDREN. No. of Foster Children on Register April 1st, 1933 (Taken over from L.C.C.) 147 „ „ ,, „ December 30th, 1933 141 ,, „ „ received by Foster Mothers 103 ,, „ ,, moved from Foster Mothers:— (1) To Foster Mothers 31 (2) To Parents or Guardians 45 (3) To Institutions 17 (4) Died 2 (5) To Foster Mother out of District 1 (6) Adopted 2 „ Children removed from Borough with Foster Mother 10 ,, Foster Children who have reached the age of 9 years during the Year 1 VISITS. No. of visits to new Foster Mothers 59 „ „ Registered Foster Mothers 840 Verification Visits 17 Special Visits 78 Outs 162 Total Visits 1,156 109 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 1,682 Corrected Number of Births 1,827 These figures represent a Birth-rate per 1,000 of the population of the Borough of 13.9 Corrected Number of Deaths of Infants under one year, of whom 40 died under one week 119 Legitimate infants 99, or 58 per 1,000 Births. Illegitimate Infants 20, or 157 per 1,000 Births. Infant Mortality Rate per 1,000 Births 65 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 Milk to necessitous Mothers and Young Children. 2. Activities of Voluntary Agencies in receipt of grants- in-aid from the Borough Council: (a) Infant Welfare Centres. (b) Day Nurseries. (c) Treatment and Nursing of Children under School Age. (d) Rheumatism Clinic. 3. Activities of independent Voluntary Agencies : (a)Rescue Homes. (b) Convalescent Treatment for Invalid Children. 110 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 Visits. 347 640 520 303 1,810 First visits 325 615 455 289 1,684 Re-visits (under 1 year) 590 513 556 750 2,409 Re-visits (1-5 years) 667 398 581 698 2,344 Out 544 846 814 875 3,079 Removals 107 280 243 189 819 Special visits 70 148 94 297 609 Ophthalmia-Neonatorum 1st visits 2 4 2 2 10 Ophthalmia- „ Re-visits — — — 2 2 Puerperal Fever 1 3 2 1 7 Puerperal Pyrexia 7 3 3 5 18 Ante-natal—First visits 129 213 187 117 646 Ante-natal—Re-visits 64 23 43 29 159 Stillbirths 8 14 24 4 50 Infant Deaths 8 50 29 19 106 Measles — — 1 1 2 Pneumonia 6 — — 2 8 Encephalitis Lethargica — — — 1 1 Chickenpox — — 1 2 3 Whooping Cough 1 3 1 5 10 Polio-Myelitis — — 1 2 3 Total visits 2,529 3,113 3,037 3,290 11,969 Attendances at Infant Welfare Centres 149 150 202 154 655 Attendances at Committee Meetings Voluntary Associations - 9 — — 9 Number of insanitary conditions reported 1 7 9 15 32 111 The feeding of the 1,684 infants visited was found to be as follows:— Breast-feeding 1,456 Artificial feeding 142 Mixed feeding 86 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 1933 1827 119 65 112 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. Mother*. Children. Antenatal. Postnatal. Under 1 yr. Over 1 yr. Antenatal. Postnatal. Under 1 yr. Over l yr. 48, Glenthorne Road 103 470 20 — — 1510 21 — — 48, Glenthorne Road 152 — — 379 61 — — 6640 2370 Victoria Mission Hall, Becklow Road 100 — — 176 25 — — 3007 1103 St. Matthew's Hall, Blythe Road 103 — — 269 32 — — 4192 1507 Old Oak Centre 103 264 26 — — 1179 43 — Westway 100 — — 237 35 — — 3935 461 Latymer Road Mission Blechynden Street 49 — — 52 10 — — 796 688 Presbyterian Hall, College Park 50 — — 43 4 — — 886 492 Totals 760 734 46 1156 167 2689 64 19456 6621 The above Centres are conducted by Voluntary Associations supported by voluntary contributions, donations &c., to which the Council contributes. Ante-natal Clinics 206 Infant Consultations 554 760 113 The infant mortality rates of the London Boroughs varied from 38 in Hampstead to 85 in Paddington. 114 ARTIFICIAL LIGHT TREATMENT. The provision of artificial light treatment for children up to 5 years of age suffering from marasmus and rickets was continued at the Hammersmith Hospital. During the year 22 patients received treatment—the total attendances being 261. The following is a summary of the cases treated. Number. Disease. 7 Debility. 15 Rickets. 22 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 Tonisation, &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 supplv milk to necessitous cases, each case being investigated, especially as to the financial position, before a supply is granted. 115 17,976 lbs. of dried milk and 1,230 quarts of raw milk and 24 tins of Nestle's were distributed during the year. The number of applications for free milk has averaged 61 per week during the year. The total expenditure during the year was approximately £966. The amount of milk distributed during the year decreased by 550 lbs. of dried milk, 454 quarts of raw milk and 76 tins of Nestles, at a decreased cost of approximately £234. The distribution of this free milk continues to be 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. Circumcisions.—During the year sixty-four cases were referred by the Medical Officers at the Infant Welfare Centres to the West London, Hospital. The Council pays a fee of 2s. 6d. per case to the Hospital Authorities. 116 " PARKSIDE" MATERNITY HOME. I append figures for the year 1933 :— 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. 242. (2) Average duration of stay 14 days. (3) No of cases delivered by— (a) Midwives 224. (b) Doctors 18. (4) No. of cases in which Medical Assistance was sought by a Midwife in emergency. 14. (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). 7 (6) No. of cases of Pemphigus Neonatorum. — (7) No. of Infants not entirely breastfed while in the Institution. 8. (8) No. of cases notified as Ophthalmia Neonatorum. — (9)—(a) No. of Maternal deaths 4. (b) Cause of death in each case 1. Acute œdema of lungs; mitral Stenosis; pregnancy. 2. Pulmonary Embolism; femoral thrombosis; parturition. 3. Acute Pulmonary Tuberculosis. 4. Uræmia ; pregnancy; sepsis Puerperal. (Westminster Case.) (10)—(a) No. of Infant deaths— (i) Stillborn 7. (ii) Within 10 days of birth. 4. (b) Cause of death in each case. 1. 2 days Prematurity. 2. 4 days Birth debility. 3. 12 hours Cerebral hæmorrhage. 4. 8 days Prematurity. 117 Queen Charlotte's Auxiliary Hospital, "Invermead," Goldhawk Road, W.12, 10 beds reserved for Hammersmith Borough Council cases. Information Required. Particulars. Invermead, Goldhawk Road. Queen Charlotte's, Marylebone Road. (!) No. of cases admitted during the year. 203. 16. (2) Average duration of stay 14 days. 19 days. 3) Number of cases delivered by— (a) Midwives 187. 9. (b) Doctors 15. 6. (c) B.B.A. 1. — (4) No. of cases where Medical Assistance was sought by a Midwife in emergency. 16. — (5) No. of cases notified as — (a) Puerperal Fever 1. 1. (b) Puerperal Pyrexia. — — (6) No. of cases of Pemphigus Neonatorum. — — (7) No. of Infants not entirely breastfed while in the Institution. 12. 2. (8) No. of cases notified as Ophthalmia Neonatorum. — — (9) No. of Maternal deaths — — (10)—(a) No. of Infant deaths— (i) Stillborn 7. 2. (if) Within 10 days of birth 2. — (b) Cause of death in each case. 1.Infant had attacks of extreme Cyanosis. was born in state of Blue Asphyxia. Left side of chest breath sounds impaired. 2. Intercranial Hemorrhage. Fifteen patients booked for "Invermead" were admitted to Queen Charlotte's Hospital, Marylebone Road, on the advice of the Medical Officers in charge of the antenatal clinic. 118 Voluntary Work Aided by Borough Council. Infant Welfare Centres.—There are three Voluntary Societies for the promotion of Infant Welfare in the Borough. The first Infant Welfare Centre in Hammersmith was opened in January, 1911, by "The Hammersmith School for Mothers and Babies Welcome," at No. 1, Shaftesbury Road East. The Centre was urgently needed, and in 1912 there were 132 babies on the register with an average attendance of 50 per week. The need for further centres was fulfilled by !he opening of new branch centres at Becklow Road in July, 1914, at the Presbyterian Church Hall, College Park, and Great Church Lane in 1915, and St. Matthew's Parochial Church Hall, Blythe Road in June, 1916. In 1917 the Association moved its headquarters to No. 48, Glenthorne Road and became known as "The Hammersmith Infant Welfare Association." A more complete scheme of Infant Welfare work was organised, which included an Ante-natal Clinic and a Toddlers' Clinic. The branch clinic at Great Church Lane was closed and three-weekly consultations were held at 48, Glenthorne Boad. In 1920 a second weekly session was started at Becklow Boad Branch Centre and the Latymer Boad Mission opened an Infant Welfare Centre in Blechvnden Street, Notting Hill. A further branch centre was opened under the auspices of the Hammersmith Infant Welfare Association at St. Michael's Church Hall. Old Oak Estate, in 1921, with one weekly session which was increased to two the following year. In 1922 the Association decided to close down the Centre held at the Presbyterian Church Hall, Ponsard Road, College Park, owing to the poor attendance. The Centre was subsequently reopened by the Presbyterian Church Committee and is still being carried on. 119 The average attendances for the various centres are as follows :— Hammersmith Infant Welfare Centres 51 , Latymer Mission 30 College Park Centre 27 In the latter centre 40 per cent. only are residents of the Borough of Hammersmith, the remainder being residents of the Borough of Willesden. In 1930 the Centre now know as the Old Oak Centre and situate in Westway was opened by the Rt. Hon. Arthur Greenwood, P.C., M.P. (Minister of Health). The Centre serves the districts known as Old Oak and Wormholt and replaces the Centre at St. Michael's Hall. There are six Centres in the Borough, four under the auspices of the Hammersmith Infant Welfare Association, one under the management of the Latymer Road Mission and the College Park Centre, held at the Presbyterian Church Hall, Ponsard Road. The Borough Council makes grants to all the Associations responsible for their management. Twelve sessions, one for toddlers and eleven for infants are held weekly. The work of the Centres has been of inestimable value. They are closely associated with and form an important part of the Maternity and Child Welfare Scheme of the Borough Council. Ante-Natal Clinics.—Four Ante-Clinics with modern equipment, are provided for expectant mothers booked to enter the Council's Maternity Homes ("Parkside" and "Invermead"). In addition expectant mothers who have engaged a doctor or midwife are seen when required and reports furnished. Should any abnormality be discovered the patient is referred to the Obstetric Ward of the Hammersmith or Queen Charlotte's Hospitals for observation and treatment. It was hoped that the midwives would take advantage of the facilities provided and send their patients to the 120 Clinic for ante-natal examination, but the attendance from this source is disappointing. This is probably due to the fact that the Borough Council, which is the Maternity and Child Welfare Authority, is not the supervising authority under the Midwives Act. This function unfortunately remains in the hands of the London County Council, which leads to overlapping, divided authority and consequent lack of efficiency. Ante-natal supervision is insisted upon in fell cases booked for " Parkside " and " Invermead." Speaking generally the Borough Council Ante-natal Clinics at one time considered unnecessary by the expectant mothers are gradually but surely becoming popular. In addition the popularity amongst the mothers to have their confinements in an Institution continues to increase. During the year 44 per cent. of the births visited by the Health Visitors took place in institutions. This compares with a figure of approximately 5 per cent. in 1920. Day Nurseries.—Two day Nurseries in the Borough— Princess Christian, the Latymer Boad Mission Creche— continued at the School Clinics. During the year the cases to work for the support of the family. These nurseries received grants 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 during the year. Treatment and Nursing of Children under School Age. —The treatment of children under five years of age was 121 continued at the School Clinics. During the year the cases dealt with were as follows :—. Operation for Tonsils and Adenoids 1 Minor Ailments 26 Dental Treatment — Total 27 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 9 2 6 7 Puerperal Pyrexia 33 29 18 — 28 Ophthalmia Neonatorum 10 19 10 7 2 Epidemic Diarrhœa* 20 26 - 6 - Measles & German Measles (under 5)† 83 718 83 2 36 Whooping Cough (under 5)† 167 178 167 4 53 Poliomyelitis (under 5) 2 1 2 — 2 * Summer Diarrhoea.—As this is not a notifiable disease the figures available are those of deaths which were registered as having been iue to this cause, t Not notifiable diseases. 122 Ophthalmia Neonatorum.—The number of cases reported was ten against nineteen in the previous year. The analysis of the final reports received is as follows :— Notified. Cases. Vision unimpaired. Vision Impaired. Total Blindness. Deaths. Treated. At Home. In Hospital. 14.1.38 — 1 1 — — — 25.1.33 1 — 1 — — — 1.5.33 1 — 1 — — — 14.6.33 1 — 1 — — — 29.6.33 1 — 1 — — — 13.7.33 — 1 1 — — — 10.7.33 1 — 1 — — — 28.9.33 1 — 1 — — — 14.10.33 1 — 1 — — — 29.11.33 1 — 1 — — — 8 2 10 — — — All notified cases of diseases of parturient women and children under five years of age are visited immediately, and arrangements made for the attendance of a nurse where required. SANITARY ADMINISTRATION. Staff.—There are nine male Sanitary Inspectors and one lady Sanitary-Inspector. Eight of the male Inspectors are employed as District Inspectors, being responsible for all matters excepting the taking of samples under the Sale of Food and Drugs Acts and the inspection of Ice Cream Vendors, for which the Special Inspector is responsible. The Special Inspector also inspects the Markets. The Lady Inspector inspects Factories, &c., where females are employed, and makes enquiries into cases of measles, whooping cough, chicken pox, &c. Increase of Rent and Mortgage Interest Restrictions Act, 1920-1933.—During the year twenty-five applications 123 were received for certificates under the above Act. In twenty-one cases the certificates were granted, four applications were refused. Five certificates were granted to owners who had carried out the work specified satisfactorily. Public Mortuary.—Three hundred and seventy-eight bodies were removed to the Mortuary in Fulham Palace Road during the year. Hammersmith— Admitted by order of Coroner 161 Admitted by order of Police 11 Admitted on application of undertakers for accom- modation 25 Admitted on order of Medical Superintendent, Hammersmith Hospital 1 — 198 Bodies admitted from other Boroughs :— Fulham 74 Chelsea 106 — 180 378 No. of P.-M. examinations conducted :— Hammersmith cases 103 Fulham cases 20 Chelsea cases 26 Total P.M.'s 149 No. of Inquests held :— Hammersmith cases 120 Fulham cases 73 Chelsea cases 106 Total Inquests held 299