C.I. AC 4347 M HAM 26 Metropolitan Borough of Hammersmith. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1934. INDEX Page Introduction 2 Staff of the Public Health Departmen 4 Statistics for the Year 1934 7 Natural and Social Conditions of the District. Births 8 Chart—Diarrhœa 11 Diarrhoea 12 Deaths 9 Deaths of Infants 10 Deaths of Illegitimate Children12 Deaths of Aged Persons 13 Deaths of Residents (Outlying)14 Deaths (Various Causes) 17 Hospital Treatment—Zymotic Enteritis 12 Infant Mortality for 1934 13 Marriages 8 Population 8 Statistics 14 Stillbirths9 Table—Whole of London—Comparison 18 Professional Nursing in the Home. General 19 MidwiveB ... ... .. ... ... 19 Nursing19 Laboratory Facilities 19 General Provision of Health Services in the Borough. Ambulance Facilities . 26 Day Nurseries 27 Hospitals (Public) 20 Hospitals (Voluntary) 21 Institutional Treatment for Unmarried Mothers 24 Maternal Mortality 25 Maternity and Child Welfare Centres 26 Rheumatism Advisory Clinic 28 School Clinics 27 Treatment Centre for Venereal Diseases 28 Tuberculosis Dispensary 27 Sanitary Circumstances of the Borough. Closet Accommodation 28 Fouling of Footpaths by Dogs 29 Hammersmith Borough Council By-laws—Dogs29 Inspections 30 Notices Sanitary Inspection of Area 29 Scavenging 28 Page Summonses32 Controlled Premises and Occupations. Factory and Workshop Act, 1901 36 Factories and Workshops—Inspection of 37 House to House 39 Houses Let in Lodgings 41 Housing Act, 1926—Section 18 41 Ice Cream Vendors 42 London County Council (General PowerS) Act, 1928 42 Bag Flock Acts, 1911 and 1928 43 Bats and Mice (Destruction) Act, 1919 40 Schools 43 Smoke Abatement Tenement Houses 41 Vans 42 Housing. General Housing Conditions 46 Newly Erected Houses 47 Statistics 44 Supply of Houses—Overcrowding 46 Inspection and Supervison op Food. Bakehouses 54 Butter, Margarine and Lard 67 Certification of Certain Food Products for Export 49 Chees 68 Chemical and Bacteriological Examination of Food 57 Cocoa, Coffee and Tea 69 Composition and Description of Food 73 Condensed Milk 66 Cordials, Wines and Spirits 70 Con69 Conserves, Vegetables, Fruits, Ac-68 Cream 66 Drugs 70 Farinaceous Foods 69 Food and Drugs Adulteration Act, 1928 62 Food Supplies 48 Fried-fish Shops 54 Inspection of Carcases of Animals slaughtered in Local Slaughterhouses 49 Knackers' Yards 52 Markets Fish Preparations 68 Milk 65 Milk Supply 48 Milk (Special Designations) Order, 1923 49 Inspection and Supervision op Food—continued. Page Offensive Trades—Slaughterers of Poultry 52 Slaughterhouses and Knackers' Yards 52 Street Trading 53 Unsound Food &7 Transfer of Powers (London) Order, 1933. Common Lodging Houses 51 Seamen's Lodging Houses 51 Cowhouses 52 Prkvalbnce and Control over Infectious Diseases. Acute Polio-myelitis 83 Anthrax 84 Anti-toxin 80 Artificial Pneumothorax Treatment 108 Bacteriology 77 Cerebro-Spinal Meningitis 83 Chicken Pox 84 Cholera 79 Cleansing of Verminous Persons 87 Continued Fever 83 Diphtheria and Diphtheritic Membranous Cronp 79 Diphtheria—Chart 81 Disinfection 89 Dysentery 86 Encephalitis Letbargica 83 Enteric Fever 80 Erysipelas 80 Food Poisoning 86 Glanders 84 Hydrophobia 84 Influenza 86 Malaria 86 Measles and German Measles 84 Measles—Chart 86 Notifiable Diseases 79 Nursing Comforts 105 Ophthalmia Neonatorum 83 Plague 79 Pneumonia 86 Public Health (Smallpox) Regulations, 1917 82 Public Health (Prevention of Tuberculosis) Regulations, 1925 95 Puerperal Fever Puerperal Pyrexia Psittacosis Rabies Order, 1919 Relapsing Fever Report on Tuberculosis Work at Hammersmith Hospital Sanocrysin Treatment 109 Preevalencb and Contbol over Infectious Diseases—continued. Page Scarlet Fever 80 Sosrlet Fever—Chart 82 Smallpox 79 Tabular Statement—Zymotic Diseases 88 Tuberculosis 92 Tuberculosis Dispensary 96 Typhus Fever80 Vaccination 89 Vaccination Returns 0 Whooping Cough Whooping Cough—Chart 86 Wrong Diagnosis 86 X-Ray Work 108 Zymotic Diseases 78 Prevention of Blindness110 Exhumation and Re-interment of Bodies 110 Public Baths 110Swimming Pool l Public Wash-houses 112 Pbofaoanda 112 Infant Life Protection 112 Maternity and Child Welfare Ante-natal Clinics 123 Chart—Infantile Mortality Rate 117 Circumcisions11 9 Cod Liver OilO118 Feeding of Infants—Statistics11K Health Visitors—Work of 115 " Invermead " Maternity Home—Statistics 121 Milk (Mothers and Children) Orders, 1918-1919 118 " Parkside " Maternity Home—Statistics 120 Schedule of Attendances at Infant Welfare Centres 122 Sessions 123 Table—Births, D eaths, and Infant Death Rate 116 Voluntary Work. Convalescent Treatment of Invalid Children 124 Infant Welfare Centres 123 Infectious Diseases of Mothers, and Children under five years of age—Tabular Statement *thalmia Neonatorum 126 Rescue Homes124 Treatment and Nursing—Children under School Age 124 (a) Operations, (6) Minor Ailment6. (c) Dental Treatment. Sanitary Administration. Staff 126 Rent Restrictions Act126 Public Mobtuaby 127 Metropolitan Borough of Hammersmith. ANNUAL REPORT of the Medical Officer of Health for the YEAR 1934. 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 my Annual Report for the Year 1934. 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 relate to the Public Health of the Borough. The death-rate of 12.9 is the same as for the previous year. The infantile mortality rate has increased from 65 to 77 per 1,000 births. This is the highest rate recorded since 1921. The lowest rate was 61 per 1,000 births in 1927. Generally speaking there was an increase in the rates of nearly every London Borough. The rate for the County of London increased from 59 to 67 per 1,000 births. " Parkside " Maternity Home was closed during the year and Hammersmith mothers were admitted to St. Mary Abbots Hospital, Marloes Road, Kensington. It is proposed to provide accommodation of approximately 50 beds for maternity cases at the British Post-graduate Medical School, Hammersmith Hospital. 3 A certain number of beds will be set aside for abnormal cases. The School is most efficiently equipped and it is hoped that Hammersmith mothers will readily seek admission. The efforts of your Council have been, as in the past, considerably augmented by those of the Voluntary Societies engaged in this branch of the Public Health Services of the Borough. With regard to infectious diseases, the total number notified was above the average for the past 10 years. This was due to the biennial epidemic of measles and to an increase in the number of cases of diphtheria. Diphtheria has been prevalent throughout the whole of the year and the highest number of cases was recorded in the Borough. The Council has now approved a scheme for immunisatior and it is to be hoped that the residents of the Borough will take advantage of the opportunity of having their childreD protected from this dreaded disease. I am, Ladies and Gentlemen, Your obedient Servant, J. B. HOWELL, Medical Officer of Health. 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF THE YEAR 1934. Medical Officer of Health and year of Appointment Administrative Tuberculosis Officer. J. B. Howell, M.R.C.S., L.R.C.P., D.P.H. 1914 Deputy Medical/ Officer of Health and Tuberculosis Officer. G. I. Davies, M.D., B.S., M.R.C.S., L.R.C.P., D.P.H 1930 Consultant Gynecologists. Lady Florence Elizabeth Barrett, M.D., M.S. S. Forsdike, M.D., F.R.C.S. A. Goodwin, M.D., F.R.C.S. L. H. W. Williams, M.D., F.R.C.S. Public Vaccinators (Part time). D. F. Durward, M.R.C.S., L.R.C.P. A. R. Dale, M.R.C.S., L.R.C.P. J. W. Brash, M.R.C.S.. L.R.C.P. J. S. Dockrill, B.A., M.B., B.Ch., B.A.O., D.P.H. M. M. Townsend, L.R.C.P., L.R.C.S. Public Analyst (Part time). F. E. Edwards, F.I.C., F.C.S. Pathologist. R. R. Elworthy, M.D., M.R.C.P., M.R.C.S., D.P.H. Bacteriologist. F. H. Teale, M.D., F.R.C.P. Ante-natal Clinics. Naomi Dancy, M.B., B.S., M.R.C.S., L.R.C.P. A. A. Renshaw, M.D., Ch.B, 5 Year of Appointment Clerical Staff. *A H. Wilmot (Chief Clerk) 1902 J. C. Turner 1920 † Miss E. Cole 1923 A. H. Johns 1925 F. G. Holland 1929 T. J. Hares 1930 E. F. Yorke 1931 Misa M. Holmes 1933 Sanitary Inspectors. §*F. Q. Barry 1919 = §*P. T. Bayes 1926 †§*W. J. Godden 1926 §*A. Hayes 1910 §øG. W. Herrick 1929 ±°t§*F- W. Mason 1926 †§*E. J. Nether 1926 §*P. W. Pottier (Food and Drugs Inspector) 1919 = §*W. Rigby 1919 Lady Sanitary Inspector and Infant Life Protection Visitor. Miss E. M. Cross 1932 Health Visitors. Miss R. A. Henry 1916 Miss A. M. M. Willcox 1916 "Miss D. G. Johnson 1922 Miss C. M. Henniker 1929 Tuberculosis Dispensary Staff. Mrs. Cameron (Nurse Visitor) 1924 Miss Murphy (Nurse Visitor) 1924 Miss N. Rees (Dispenser and Secretary) 1918 Miss V. Day (Junior Clerk) 1932 A. Pullin (Porter) 1918 6 Year of Appointment. Medicinal Baths and Disinfecting Staff. A. H. S. Hutchinson (Superintendent) 1928 Mrs. Manners 1924 G. Langley (Disinfector) 1900 Mortuary Keeper. D. A. Mackay 1929 †Cert. Royal Sanitary Institute (Inspector). *Cert. Sanitary Inspectors Examination Board. ⁪⁪⁪⁪⁪Cert. Central Midwives Board. §C«r< Royal Sanitary Institute (Meat and other foods). \\Trained Nurse. "Cert. Royal Sanitary Institute (Health Visitor). °Royal Sanitary Institute (Smoke Certificate). ^[Apothecaries' Hall Certificate. ipCert. Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. =Smoke Abatement Cert. L.C.C. School of Engineering + Diploma, Institute of Hygiene. ADiploma in Nursing, London University. 7 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1934. Area 2,282.5 acres Population (1983) (estimated) 131,400 Population Census (1901) 112,289 „ „ (1911) 121,521 „ „ (1921) 130,295 „ „ (1931) 135,521 Natural increase, i.e., excess of births over deaths 115 Density of population 56.6 persons per acre Marriages registered 1,301 Number of inhabited houses 1931 17,402 Number of families or separate occupiers (1921) 33,268 Rateable value (1934) £1,156,738 Sum represented by a penny rate, 1934 £4,676 Vital Statistics. Births (legitimate) 1,674 Birth rate 13.8 ,, (illegitimate) 109 Stillbirths 63 Rate per 1,000 (live and still) births 34 Deaths (corrected) 1,668 Death rate 12.9 Adjusted death rate 13.3 Deaths from puerperal causes:- Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 4 2.2 Other puerperal causes 5 2.7 Total 9 4.9 Deaths of infants under one year of age per 1,000 birth 77 Legitimate, 72. Illegitimate, 147. Deaths from measles (all ages) 35 Deaths from whooping cough (all ages) 19 Deaths from diarrhoea (under 2 years of age) 22 8 Population.—According to the Census of 1901, the population of the Borough was then 112,239. By the Census of 1911 the population was 121,521 showing an increase during the 10 years of 9,282. The Census of 1921 shows the population of the Borough to be 130,295, being an increase in the 10 years of 8,774. The Census of 1981 shows the population of the Borough to be 185,521, 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., 129,170. The corrected number of deaths registered was 1,788, whilst the corrected number of deaths of residents was 1,668, thus showing a natural increase of population by excess of births over deaths of 115. The area of the Borough is 2,282.5 acres, there being 56.6 persons to the acre. Marriages.—The number of marriages registered during the year was 1,801, the marriage rate being 20. Births.—During the year 1,551 births were registered in the Borough. Adding 512 births which occurred, outside the Borough, transferred by the Registrar-General as belonging to Hammersmith, and deducting 280 births which occurred in the Borough, and transferred to other districts by the Registrar-General, the corrected number of births for the year was 1,788. On the estimated population, i.e., 129,170, the corrected number of births registered was equal to an annual rate of 13.8 births per 1,000 persons living. The Birth-rate for the year is 0.1 per 1,000 less than the rate for the previous year, which was 18.9. The Birth-rate in London on the estimated population, i.e., 4,230,200, was equal to an annual rate of 18.2 births per 1,000 persons living. 9 Notification of Births Act, 1907. Births notified 2,032 Corrected number of births 1,783 Notification Received from Midwives. Doctors. Lving in Hospitals and Nursing Homes. L.C.C. Institutions. Parents. M.O.H.'s. 733 125 897 269 1 7 Stillbirths.—'Sixty-three stillbirths were allocated to this Borough. Forty-four were registered in the Borough, of which number six were outward transfers. Twenty-five were born outside the Borough and were transferred by the Registrar-General. Deaths.—During the year 1,859 deaths were registered in the Borough, as compared with 1,500 in the previous year. Adding 631 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 329 deaths of non-residents and 17 transferable deaths which occurred in the Borough, the corrected number of deaths of residents was 1,668 (813 males, 855 females). On the estimated population, i.e., 129,170, the corrected number of deaths of residents was equal to an annual rate of 12.9 deaths per 1,000 persons living. Populations of all areas are not similarly constituted as regards the proportions of their sex and age group components, and their crude death rates fail as true comparative mortality indexes in that their variations are not due to mortality alone but arise also from differences in the popu lation constitution, the two elements being combined in indistinguishable proportions. 10 An adjusting factor has been supplied by the RegistrarGeneral, and this when applied to the Hammersmith death rate gives a rate of 18.3, a figure which is directly comparable with the contemporaneous crude death rate for the country as a whole or with the mortality of any other local area, the crude death rate of which should be similarly modified with its own factor for the purpose. The comparability factor for Hammersmith is 1.08. The Death-rate in London on the estimated population, i.e., 4,280,200, was equal to an annual rate of 11.9 deaths per 1,000 persons living. Deaths of Infants.—The corrected number of deaths of residents under one year of age registered during the year was 187, as compared with 119 in the previous year. The number of deaths of infants under one year of age was equal to 77 per 1,000 of the corrected births. The number of deaths of infants under one year of age, residents in London, was equal to 67 per 1,000 of the total registered births. The mortality rate of infants under one year of age was ten per thousand greater in this Borough than in London. A large proportion of the deaths (50), equal to 36 per cent., died in the first month, and of these thirty-three occurred in the first week, practically all of which may be ascribed to pre-natal causes. This points out the necessity for greater attention to and control of the expectant mother if these deaths are to be avoided. Enteritis was responsible for the deaths of 21 babies and pneumonia 26. These may be very properly ascribed to lack of knowledge on the part of the mother in the problems of infant feeding and " mothering." 11 The following Chart shows the number of deaths from Diarrhoea per 100.000 inhabitants, 1911-1934. 12 It calls for intensive propaganda and the education in feeding, clothing and general care of those responsible for the nursing and upbringing of the very young. Diarrhoea.—The number of deaths from diarrhoea was 27, being the same as in the previous year. Twenty-one 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 16 or at the rate of 147 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 72 per 1,000 whilst the latter is 147 per 1,000, a difference of 75 per 1,000. 13 The following table on infantile mortality has been prepared in accordance with the direction of the Ministry of Health. INFANT MORTALITY, 1934. Infantile Mortality during the year 1934. 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 vear. Total Deaths under 1 Year. ALL CAUSES. Certified 33 7 5 5 50 26 27 19 15 137 Uncertified. - - - - - - - - - - Small-pox - - - - - - - - - - Chicken-pox — — — — — — — — — — Measles — — — — — — — — 4 4 Scarlet Fever — — — — — — — — — — Whooping Cough - — — — - — — 4 — 4 Diphtheria and Croup - - — - - — — - 1 1 Erysipelas - — - - - - — - - - Tuberculous Meningitis - - - - - - - 1 - 1 Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not T.B.) - - - - - 1 - 1 - 2 Convulsions — — — - — - 2 1 - 3 Laryngitis - - - - - - - - - - Bronchitis — — - - - 2 2 - - 4 Pneumonia(all forms) — 2 1 2 5 4 10 2 5 26 Diarrhœa — — — — — — 1 2 - 3 Enteritis - - - - - 3 6 6 3 18 Gastritis — — - - - - - - - - Syphilis — — — — — — — — — — Rickets — — — — — - — 1 — 1 Suffocation — — — — - 1 1 - 1 3 Injury at Birth — — 1 - 1 - — - - 1 Atelectasis 3 - - - 3 - - - - 3 Congenital Malformations 3 2 - 1 6 4 2 - - 13 Premature Births 26 2 3 - 31 4 - — — 35 Atrophy, Debility & Marasmus — — - 1 1 4 1 - — 6 Other causes 1 1 - 1 3 3 2 — 1 9 Totals 83 7 5 5 50 26 27 19 15 137 Nett Births in the Year: Legitimate, 1674; Illegitimate. 109. Nett deaths in the Year of: Legitimate Infants, 121; Illegitimate Infants, 16. Deaths of Aged Persons.—The corrected number of deaths of residents at 65 years of age and upwards registered during the year was 783, against 799 in the previous year. These deaths were equal to 6.1 per 1,000 of the total persons living, and 469 per 1,000 of the total deaths of residents registered. 14 Statistics.—The following table gives the statistics of the Borough during 1984 and previous years:— Vital Statistics of Whole District during 1934 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 1928 133600 2571 2701 20·2 981 7·3 125 649 173 64 1473 11·0 1924 134200 2199 2399 17·9 1123 8·4 173 718 173 72 1668 12·4 1925 134500 2178 2351 17·5 1034 7·7 186 756 153 65 1604 11·9 1926 184400 2001 2188 16·3 1174 8·7 195 556 144 66 1535 11·4 1927 132800 1789 2076 15·6 1581 11·9 230 377 126 61 1728 13·0 1928 136300 1938 2258 16·6 1449 10·6 222 326 156 69 1553 11·4 1929 136900 1869 2162 15·8 1767 12·8 222 340 133 62 1875 13·7 1930 136900 1962 2173 15·9 1387 10·1 219 436 140 64 1604 11·7 1931 135100 1954 2073 15·3 1667 11·6 288 373 140 68 1652 12·2 1932 133700 1795 1940 145 1465 10·9 294 543 129 66 1714 12·8 1933 131400 1682 1827 13·9 1500 11·4 340 630 119 65 1690 12·9 1934 129170 1551 1783 13·8 1359 16.5 346 655 137 77 1668 12·9 Deaths of Residents.—Belonging to the Borough, occurring in Public Institutions, &c., in districts outside, during the year 1984:- FEVER HOSPITALS. Western Hospital, Fulham 33 Grove Hospital, Tooting 12 North-Western Hospital, Hampstead 5 North-Eastern Hospital, Tottenham 1 South-Eastern Hospital, New Cross 3 Park Hospital, Lewisham 1 Joyce Green Hospital, Dartford 1 Eastern Hospital, Homerton 2 Staines Joint Isolation Hospital, Staines 1 South-Western Hospital, Stockwell 5 64 15 MENTAL HOSPITALS. Tooting Bec Hospital 10 1, Uxbridge Road, Southall 18 Horton Hospital, Epsom 7 Springfield House, Tooting 1 Hundred Acres, Banstead 4 The Grove, Horton Lane 2 1, West Park Road, Epsom 2 Netherne, Merstham 1 The Hospital, Cane Hill 3 49 Fountain Mental Hospital 1 GENERAL HOSPITALS, NURSING HOMES, & c. 7, Knaresborough Place, Kensington 2 Hospital for Tropical Diseases St. Pancras 1 St. Luke's Hospital, Paddington 3 Princess Beatrice Hospital, Kensington 2 University College Hospital St. Pancras 2 St. Bartholomew's Hospital, City of London 1 St. Mary's Hospital, Paddington 6 National Hospital for Diseases of the Heart 1 St. George's Hospital 6 London Hospital, Stepney 1 Infants' Hospital, Westminster 3 Wembley Hospital 1 High Wood Hospital, Brentwood 1 Invalids' Home, Highbury 20, Devonshire Place, 1 1, Ladbroke Grove 1 St. Marylebone 1 Westminster Hospital 1 Golden Square Ear, Nose and Throat Hospital 1 Guy's Hospital 2 Consumption Hospital, Brompton 2 German Hospital, Hackney 1 North Lodge Nursing Home, Maidenhead 1 King's College Hospital, Camberwell 1 Torbay Hospital, Torquay 1 21, Mansion Mews, Kensington 1 Bridgwater Hospital 1 Royal Waterloo Hospital, Lambeth 2 Grove House Nursing Home, Norwich 1 Cancer Hospital 1 East Surrey Hospital, Redhill 1 Manor House Hospital, Hendon 1 King Edward VII Hospital, Windsor 1 Queen Charlotte's Hospital 7 8, Beaumont Street, St. Marylebone 1 Queen Mary's Hospital, Chislehurst 2 St. Mary's Nursing Home, Brentford 2 Willesden General Hospital 2 Acton Hospital 3 Charing Cross Hospital 1 Metropolitan Hospital, Caterham 1 Battersea General Hospital 3 Princess Louise Hospital 7 St. John and St. Elizabeth's Hospital, St. Matylebone 2 National Hospital, Queen Square 4 Prince of Wales' General Hospital, Tottenham 1 French Hospital, Westminster 1 Jewish Home of Rest, Wandsworth 1 Children's Hospital, Hampstead 2 Cotswold Sanatorium, Cranham, Glos. 1 1, Sherbroke Road, Fulham 1 Metropolitan Hospital, Hackney 1 General Hospital, Birmingham 1 Royal Hospital, Richmond 1 Preston Hall, Aylesford 1 Middlesex Hospital 4 Bishopsbourne Convalescent Home, Broadstairs 1 Chiswick Hosnital 1 Putney Hospital 1 Hill End Hospital, St. Albans 1 Colindale Hospital 1 Royal Victoria Hospital, Boscombe 1 69, Hornsey Lane, Hornsey 1 2, Fitzjohn Avenue, Hampstead 1 Downs Hospital for Children, Sutton 1 St. Andrew's Hospital, Willesden 1 Seamen's Hospital, Greenwich 1 St. Benedict's Hospital, Wandsworth 8 St. Joseph's Hospice for the Dying, Hackney 1 30, Silverdale, Lewisham 1 136 16 PUBLIC INSTITUTIONS. 26, Marines Boad 109 369, Fulham Road 17 Fulham Hospital 39 Hillingdon County Hospital 1 Lambeth Hospital 14 93, Sydney Street, Chelsea 15 285, Harrow Road 8 Archway Hospital, Islington 1 The Infirmary, Friern Barnet 2 Middlesex County Council 1 46, Ousley Road Balham 1 129, St. John's Road, Islington 1 4, King's Boad, St. Pancras 6 164, St. John's Hill, Battersea 2 1, Northumberland Street, St. Marylebone 2 182, Westmorland Road, Walworth 5 2a, Bow Road, Poplar 1 73a, Devons Road, Poplar 2 Guildford House, Guildford 1 12, Exmoor Street 142 370 VARIOUS. In the River Thames at Barnes 1 10, Fairfax Road, Chiswick 1 On the Way to Charing Cross Hospital 2 17, Upper Addison Gardens, Kensington 1 On the Way to Princess Louise Hospital 1 19, Churchfield Road, Acton 1 On the Foreshore of the River Thames at Barnes 2 On the Way to St. Mary's Hospital, Paddington 1 On the Local Down Line at Waterloo Junction Station, Lambeth 1 6, St. Mary'b Road. Ealing 1 100, West Hill, Wandsworth 1 River Thames, near Cherry Orchard Road, E. Molesey 1 On the Way to Middlesex Hospital 1 In Ambulance on the Way to Acton Hospital 1 1, Somerset Road, Ealing 1 11, Seymour King's Buildings, Kensington 1 29, North Side, Wandsworth In a Field near Tanfield Stud 1 Queen's Road Station (C.L.R.) 1 Farm, Golf's Oak, Hertfordshire 1 73, Oxford Road, Chiswick 1 In the River Thames at Fulham 1 "Belmont," Lower Bourne, Porlock 1 Great North Road 1 The Broads, Medstead, Alton 1 11, St. Ja.mes' Street, Monmouth 1 "Ashdene," Springfield Road, Poole 1 Bird's Cafe, Clevedon 1 46, Alexandra Road, Worthing 1 Colnbrook Bye-Pass Road, Iver, Bucks 1 The Cottage on the Common, Chiselborough 1 36 Liverpool Street Station (L.N.E.R.) 1 Causes of, and Ages at, Death during the Year 1934. Causes of Death. Sex. All Ages. 0- 1- 2- 5- 15- 25- 35- 45- 55- 65- 75- All Causes M 813 72 26 15 23 28 31 59 88 154 172 150 F 855 65 14 21 18 38 30 50 61 97 210 251 1 Typhoid and Paratyphoid Fever M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 2 Measles M 22 2 14 4 2 .. .. .. .. .. .. .. F 13 2 4 6 1 .. .. .. .. .. .. .. 3 Scarlet Fever M 1 .. .. .. 1 .. .. .. .. .. .. .. F 3 .. .. .. 2 1 .. .. .. .. .. .. 4 Whooping Cough M 8 .. 3 4 1 .. .. .. .. .. .. .. F 11 4 3 4 .. .. .. .. .. .. .. .. 5 Diphtheria M 10 .. 1 5 4 .. .. .. .. .. .. .. F 15 1 1 7 6 .. .. .. .. ... .. .. 6 Influenza M 4 l .. 1 .. .. .. 1 1 .. .. .. F 5 .. .. .. .. .. 1 1 .. .. 1 2 7 Encephalitis Lethargica M 1 .. .. .. .. 1 .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 8 Cerbo-spinal Fever M 3 1 2 .. .. .. .. .. .. .. .. .. F 3 1 .. 1 .. .. .. 1 .. .. .. .. 9 Tuberculosis of Respiratory System M 64 .. 1 .. 1 10 10 12 16 10 4 .. F 51 .. .. .. 1 23 11 5 5 3 3 .. 10 Other Tuberculous Diseases M 5 .. .. .. .. 3 .. .. 1 .. 1 .. F 4 l .. .. .. 1 .. 1 1 .. .. .. 11 Syphilis M 1 .. .. .. .. .. .. 1 2 .. .. 1 F 1 .. .. .. .. .. .. 1 .. .. .. .. 12 General Paralysis of the insane, tabes dorsalis M 7 .. .. .. .. .. .. 3 .. 4 .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 13 Cancer, malignant disease M 112 .. .. .. .. 1 .. 9 11 35 31 25 F 123 .. .. .. 1 .. .. 9 19 21 51 22 14 Diabetes M 6 .. .. .. .. .. .. 2 .. 2 1 1 F 5 .. .. .. .. .. .. .. .. .. 5 .. 15 Cerebral Hemorrhage, & c. M 14 •• .. .. .. .. .. .. 1 4 4 5 F 52 .. .. .. .. .. 2 1 3 8 17 21 16 Heart Disease M 168 .. .. .. 3 .. 3 5 18 33 57 49 F 210 .. .. .. 1 3 1 8 11 30 59 97 17 Aneurysm M 7 .. .. .. 1 .. .. .. 1 4 1 .. F 4 .. .. .. .. 1 1 .. 1 .. .. 1 18 Other circulatory diseases M 30 .. .. .. .. .. .. .. 1 10 5 14 F 46 .. .. .. .. .. .. 1 1 6 13 25 19 Bronchitis M 32 2 .. .. .. .. 1 3 2 7 8 9 F 38 2 .. .. .. .. 1 2 .. 2 7 24 20 Pneumonia (all forms) M 57 13 4 1 1 1 3 5 6 11 7 5 F 44 13 4 1 1 2 1 .. .. 5 9 8 21 Other Respiratory Diseases M 11 .. .. .. .. 1 1 .. 2 4 3 .. F 4 .. .. .. .. .. .. 2 .. 2 .. 22 Peptic Ulcer M 7 .. .. .. .. .. .. 1 2 2 1 1 F 4 • • .. .. .. .. .. 1 1 .. 1 1 23 Diarrhoea, & c. M 15 14 .. .. .. .. .. .. 1 .. .. .. F 12 7 1 .. .. .. .. .. .. 2 1 1 24 Appendicitis M 6 .. .. .. 1 1 1 1 .. 1 1 .. F 3 .. .. .. 1 1 .. 1 .. .. .. .. 25 Cirrhosis of Liver M 4 .. .. .. .. .. .. .. .. 1 3 .. F 1 .. .. .. .. .. .. 1 .. .. .. .. 26 Other Diseases of Liver, & c. M 4 .. .. .. .. .. .. 1 .. 1 1 l F 10 .. .. .. .. .. 1 1 1 1 5 1 27 Other Digestive Diseases M 15 .. .. .. 2 1 1 1 3 1 4 2 F 20 .. .. .. 1 1 1 .. 2 3 4 8 28 Acute and Chronic Nephritis M 22 .. .. .. .. 2 .. .. 2 4 .. 8 F 21 .. .. 1 .. .. 1 3 3 2 4 7 29 Puerperal Sepsis F 4 .. .. .. .. 1 3 .. .. .. .. .. 30 Other Puerperal Causes F 5 .. .. .. .. .. 2 3 .. .. .. .. 31 Congenital Debility, Premature Birth, Malformations, & c. M 34 34 .. .. .. .. .. .. .. .. .. .. F 26 26 .. .. .. .. .. .. .. .. .. .. 32 Senility M 10 .. .. .. .. .. .. .. .. .. 1 9 33 Suicide F 25 .. .. .. .. .. .. .. .. .. 4 21 M 14 .. .. .. .. 1 .. 1 4 5 3 .. 34 Other violence F 7 .. .. .. .. 2 .. .. 2 1 1 1 M 40 1 .. .. 4 3 7 7 2 6 7 3 F 21 5 1 .. 1 2 .. 2 3 1 3 3 35 Other defined diseases M 76 4 1 .. 2 3 4 6 7 9 23 17 F 64 3 .. 1 2 .. 4 6 8 12 20 8 36 Causes ill-defined, or unknown M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Total 1,668 137 40 36 41 66 61 109 144 251 382 401 18 This rate is calculated on the estimated population of each Ward. Ward. Estimated Population. No. of Deaths. Death Rate. No. 1 River 16,962 281 16·5 No. 2 Brook Green 24,820 325 13·1 No. 3 The Grove 22,065 268 12·2 No. 4 St. Stephens 8,875 114 12·8 No. 5 Starch Green 21,887 253 11·6 No. 6 Wormholt 22,909 295 12·9 No. 7 College Park and Latimer 11,662 132 11·3 LONDON AND METROPOLITAN BOROUGHS. Cities and Boroughs. Estimated Resident population (mid-1934). Live Births (rate). Death rate: Infantile Mortality per 1,000 births. Crude. Adjusted. County of London 4,230,200 13·2 11·9 - 67 West Districts. Paddington 139,790 13·7 12·4 12·3 95 Kensington 179,080 12·3 13·3 12·5 93 Hammersmith 129,170 13·8 12·9 13·3 77 Fulham 145,400 13·7 12·6 12·7 59 Chelsea 58,160 10·8 13·4 11·4 65 City of Westminster 124,050 9·4 11·8 12·1 66 North Districts. St. Marylebone 92,320 9·0 12·7 12·6 61 Hampstead 90,000 10·4 11·3 10·6 53 St. Pancras 187,540 13·1 12·8 13·2 65 Islington 314,200 14·7 11·8 11·9 62 Stoke Newington 50,620 13·7 11·5 11·0 61 Hackney 211,120 14·2 11·7 12·2 56 Central Districts. Holborn 36,000 8·6 12·2 ? 71 Finsbury 64,970 15·1 13·4 14·6 51 City of London 9,660 6·8 10·5 11·6 121 East Districts. Shoreditch 90,630 16·1 13·1 14·4 84 Bethnal Green 102,060 14·3 11·8 13·3 73 Stepney 214,990 15·3 12·3 14·3 87 Poplar 146,370 15·5 12·3 13·7 62 South Districts. Southwark 159,930 14·9 13·5 14·4 77 Bermondsey 105,060 14·8 12·4 14·1 64 Lambeth 283,900 14·2 12·8 12·7 63 Battersea 150,870 14·3 12·5 12·3 61 Wandsworth 345,250 11·0 11·2 10·4 57 Camber well 238,360 13·2 12·3 12·3 67 Deptford 101,380 15·8 13·1 13·6 68 Greenwich 97,250 13·7 12·2 12·5 87 Lewisham 222,180 12·2 10·0 10·1 43 Woolwich 145,520 13·7 11·3 12·0 63 19 PROFESSIONAL NURSING IN THE HOME. General.—The Hammersmith District Nursing Association provides nurses in all cases for general nursing, upon application being made to the Nightingale Shore Home, 10, Mall Road. Patients are expected to make payments to the Nursing Association in accordance with their means, but no patient is refused the services of a nurse on account of inability to pay. 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 83 midwives gave notice of their intention to practise in the Borough during 1934. Laboratory Facilities. The chemical analysis of food is carried out by the Public Analyst (Mr. F. E. Edwards). The bacteriological examination of food is carried out by Dr. F. H. Teale, of the University College Hospital Medical School. 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. 20 The former are examined by Dr. R. 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. This Home was closed in July. 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:—N o. 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 — — 21 Facilities available for:— (1) Operative Surgery.—Yes (2) X-ray.—Yes. (3^ Dental.—Yes. (4) Ophthalmic.—Yes. (5) Massage.—Yes. Arrangements for pathological work:—Specimens sent to L.C.C. Group laboratories. No. of patients during 1934:—Admissions = 3,021. HOSPITALS- VOLUNTARY. Name West London Hospital. Situation:—Hammersmith Road, W.6. Purpose:—General Hospital for treatment of sick poor as In and Out-patients. No. of available beds:—234. If used by persons resident outside the area, in what proportion:—The area served is widespread. Management:—Board of Management. No. of beds available for each sex for the following services:— M. F. General Medical 23 24 General Surgical 63 53 Children, (Mixed) 30 Venereal Diseases 4 4 Ear, Nose and Throat (1 Children) 2 3 Skin Diseases (1 Children) 1 1 Other (Private Wing) (Mixed) 26 Facilities available for:— 2 Major Operation Theatres. (1) Operative Surgery.— 2 Minor (2) X-Rav.—Diagnostic and Therapeutic Departments. (3) Dental.—Clinics held twice weekly in Out-patients' Department. (4) Ophthalmic.—Three afternoons a week in Out- patients' Department. (5) Massage.—Department open daily. 22 Arrangements for pathological work:—Pathological and Bio-chemical Laboratories. No. of patients during 1934:— 4,055 in-patients and 41,937 out-patients. Is the hospital provision for the area adequate?—There is always an average of about 200 patients waiting for admission. Name:—Queen Charlotte's Maternity Hospital. Situation:—Ravenscourt Square and Goldhawk Road. Purpose:— (а) *Treatment of and research into Puerperal Sepsis. (б) tNormal Maternity, auxiliary to Queen Charlotte's Hospital. (c) 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:— (а) *5 per cent. Hammersmith Residents. (б) †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) X-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 1934:—422 Maternity, 278 Puerperal Sepsis. 23 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 S"kin. No. of beds available for each sex for the followiny 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 1934 :—335 in-patients. Is the hospital provision for the area adequatet— 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. 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. 24 INSTITUTION TREATMENT FOR UNMARRIED MOTHERS. St. Margaret's Hostel, 466, Uxbridge Road, W.12.— Accommodation for 10 mothers and their infants. This hostel is conducted by a voluntary society towards which the Ministry of Health contributes. Hammersmith and Chiswick Refuge for Friendless Girls, 36, Glenthorne Road, W.6.—Accommodation for 8 mothers and their infants. Supported by voluntary subscriptions. Jewish Hostel for Girls, Charcroft House, Roseford Gardens, W.12.—Accommodation, 19 beds and 13 cots. This hootel is conducted by a voluntary society towards which the London County Council contributes. 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. 25 Maternal Deaths.—During the year nine maternal deaths occurred, four from Puerperal Sepsis and five from other accidents and diseases of pregnancy and parturition. Special enquiry was made and particulars obtained in accordance with the form piesented 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 fifteen years is as follows: — Year. Number of Deaths Number of live 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 6 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 6 2,073 3·4 1932 3 4 1,940 3·6 1933 6 2 1,827 4·4 1934 4 5 1,783 5·0 26 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, Glenthorpe 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, Westway.—Two Infant Clinics held weekly. Two Ante-natal Clinics held weekly. St. Matthew's Parochial Hall, Wythe 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. 27 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, 108, 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, Westway. 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 Boad, 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 96). Grants are received from the Ministry of Health nnd the London County Council. 28 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 59 Hammersmith patients were treated at the Clinic, 14 being admitted as in-patients and 45 as out-patients. New patients, 1984 16 Old patients, 1984 29 Total number of attendances, 1934 175 TREATMENT CENTRE FOR VENEREAL DISEASES. West London Hospital, Hammersmith Boad. 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 tar 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 29 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 23 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 five summonses were taken, when fines of 10s. were imposed in four cases and one being withdrawn. Sanitary Inspection of the Area.—During the year 48,462 inspections were made by the Sanitary Inspectors. Fifty-six 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. 80 Inspections.—The following table shows the number of visits made in each district under the various inspection head:— NUMBER OF INSPECTIONS MADE DURING 1934. Cause of Inspection. Districts. 1 2 3 4 5 6 7 8 Lady Sanitary Inspector Food and Drugs Inspector Total. Infectious Disease 241 224 161 131 138 240 350 219 1,455 4 3,163 Complaints 494 478 458 540 518 652 363 643 314 20 4,480 Tenement Houses 22 2 .. .. .. .. .. 20 .. .. 44 House to House 36 15 99 71 82 23 33 166 .. .. 525 Housing and Town Planning Act 58 14 6 .. 51 .. .. .. .. .. 129 House to House Consolidated Regulations 7 78 .. 64 4 .. 25 2 .. .. 180 Food (other than Restaurants and Eating Houses) 136 372 365 444 136 182 665 277 .. 1,323 3,900 Restaurants and Eating Houses 80 95 92 47 20 66 107 83 .. 110 700 Markets 27 27 293 52 22 135 37 273 .. 581 1,447 Slaughterhouses 2 1 154 120 .. 17 .. .. .. 7 301 Poultry Slaughterhouses .. 10 .. .. .. .. .. .. .. 5 15 Bakehouses 53 47 41 85 41 54 17 29 .. 59 426 Milk Yendors 128 131 66 139 109 28 61 66 .. 399 1,127 Ice Cream Vendors .. 6 1 .. .. 2 .. .. .. 211 220 Factories (including Factory Laundries) 57 55 32 29 17 76 21 114 8 .. 409 Workshops (including Workshop Laundries) 11 18 22 47 34 10 6 33 15 .. 196 Workplaces (other than Outworkers) 46 32 71 33 3 5 4 44 1 .. 239 Outworkers .. 7 6 .. 4 .. 11 .. 22 .. 50 Public Urinals 95 217 93 50 172 211 135 159 8 .. 1,135 Smoke Observations .. 5 .. 30 18 98 6 19 .. .. 176 Drainage 1,155 1,540 949 603 619 526 573 580 .. .. 6,545 Miscellaneous 204 421 128 441 247 271 846 214 85 493 3,350 Re-visits 1,760 1,099 1,644 1,885 1,978 2,075 1,151 1,771 70 .. 13,333 Infant Life Protection .. .. .. .. .. .. .. .. 1,345 .. 1,345 Common Lodging Houses .. .. 27 .. .. .. .. .. .. .. 27 TOTALS 4,612 4,794 4,708 4,811 4,213 4,671 4,411 4,712 3,318 3,212 43,462 31 Notices.—The following table shows the number of Preliminary Notices served and complied with during the year:— Notices Served. Notices complied with. Infectious Diseases 401 388 Complaints 2,158 2,158 House to House 333 265 House to House Consolidated Regulations 49 63 Food (other than Restaurants) 59 53 Restaurants, &c 22 24 Bakehouses 10 13 Milk Vendors 8 12 Ice Cream Vendors 1 1 Factories 31 28 Workshops 17 24 Workplaces 21 19 Outworkers 5 5 Public Urinals 2 4 Smoke Observations 9 — Drainage 36 28 Miscellaneous 117 85 Re-visits 401 392 Common Lodging Houses 2 2 Tenement Houses 2 2 Housing and Town Planning — 7 Infant Life Protection — 1 Total 3,684 3,574 \ During the year 1,855 Statutory Notices were served and 1,260 complied with. In many instances it was necessary to take proceedings in order to enforce compliance with Notices served. 32 The following table shows the result of proceedings taken:- SUMMONSES-YEAR 1934. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 27, Hetley Road Failing to comply with Statutory Notice 1 Withdrawn 9, Godolphin Road ditto 2 Order made 14 days 91c, Coningham Road ditto 1 Order made 14 days 4, Lockton Street ditto 2 Withdrawn 28, Letchford ditto 4 1. Order made 14 days Gardens 2. Fined £2 3. Fined £2 4. Fined £2 ditto ditto 4 1. Fined £1 2. Fined £1 3. Fined £1 4. Withdrawn 9, Alexandra Road ditto 2 1. Withdrawn 2. Order made 14 days £1 Is. Od. costs 2, Souldern Road ditto 1 W ithdrawn 30, Stebbing Street ditto 1 Withdrawn 124, Emlyn Road ditto 1 Withdrawn 50, Loftus Road ditto 1 Order made 14 days 17a, St. Paul's Mansions ditto 1 Withdrawn 102, Devonport Road ditto 2 Withdrawn 9, Hume Road ditto 1 Withdrawn. 10s. 6d costs 8, Montgomery Street ditto 1 Withdrawn. 10s. 6d. costs 67, Shepherd's Bush Road ditto 1 Order made 14 days. 4s. costs 170, Coningham Road ditto 3 1. Fined £1 2. Fined £1 3. Fined £1 13, Goodwin Road ditto 1 Order made 14 days 10, Hunt Street ditto 1 Order made 21 days 2, Marryat Street ditto 1 Withdrawn 36, Shaftesbury Road Failing to give notice 2 1. Fined 10s. 2. Fined 10s. 38, Overstone Road Failing to comply with Statutory Notice 1 Order made 14 days. 10s 6d. costs 35, Hetley Road ditto 2 Withdrawn 23, Woodstock Road ditto 1 Withdrawn. 10s. 6d. costs 15, Sinclair Gardens Failing to give notice 1 Adjourned sine die ditto Failing to deposit plans 1 Adjourned sine die 33 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 15, Sinclair Gardens Failing to give notice 1 Adjourned sine die ditto Failing to deposit plans 1 Adjourned sine die 17, Goodwin Road Failing to comply with Statutory Notice 1 Fined £1 Land, rear of Hythe Road ditto 2 1. Order made 14 days 2. Withdrawn 32, Hazlitt Road Failing to give notice 1 Fined £2 ditto Failing to deposit plans 1 Fined £2 ditto Construction of waste pipe 1 Fined £2 34, Hazlitt Road Failing to give notice 1 Fined £2 ditto Failing to deposit plans 1 Fined £2 ditto Construction of waste pipe 1 Fined £2 33, Aynhoe Road Failing to comply with Statutory Notice 2 Withdrawn 4, Wells Road ditto 4 Withdrawn 9, Grove Mews ditto 1 Closing Order made. £2 2s. Od. costs 10, Grove Mews ditto 1 Closing Order made. £2 2s. Od. coste 11, Grove Mews ditto 1 Closing Order made. £2 2s. Od. costs 16, Marryat Street ditto 1 Withdrawn 11, Chapel Street ditto 1 Withdrawn 46, Manchester Road Failing to give notice 1 Fined £2 ditto Failing to deposit plans 1 Fined £2 ditto Construction of waste pipe 1 Fined £2 ditto Failing to give notice 1 Withdrawn ditto Failing to deposit plans 1 Withdrawn ditto Construction of waste pipe 1 Withdrawn 9, Tadmor Street Failing to comply with Statutory Notice 1 Withdrawn 389, Goldhawk Road ditto 1 Withdrawn 34 Summonses—continued. Situation of Premises. Nature of Offence. No of Summonsee. Result of Proceedings. 391, Goldhawk Road Failing to comply with Statutory Notice 1 Withdrawn 38, Cathnor Road Failing to deposit plans 1 Fined £2 12, Leysfield Road Failing to comply with Statutory Notice Withdrawn. 10s. 6d. costs College House, Sussex Place ditto 1 Order made 7 days 40, Cathnor Road ditto 1 Withdrawn. 10s. 6d. costs 43, Cathnor Road ditto 2. 1. Withdrawn. 10s. 6d. costs. 2. Withdrawn. 10s. 6d. costs. 78, Cathnor Road ditto 2 1. Withdrawn. 10s. 6d. costs. 2. Order made 7 days. 10s. 6d. costs 84, Cathnor Road ditto 1 Withdrawn. 10s. 6d. costs 12, Melina Road Failing to deposit plans 1 Withdrawn. 10s. 6d. costs 16, Porten Road Failing to comply with Statutory Notice 1 Withdrawn. 10s. 6d. costs 38, Overstone Road ditto 1 Order made 7 days 31, Had™ Park Flats ditto 2 Withdrawn 13, Goodwin Road ditto 2 1. Order made 14 days 2. Withdrawn 10, Elric Street ditto 1 Withdrawn 27, Hunt Street ditto 1 Order made 14 days. 10s. 6d. costs 16, Manchester Road ditto 1 Withdrawn. 10s. 6d. costs. 29, Waldo Road ditto 1 Order made 14 days 24 & 24a, Pavilion Terrace ditto 1 Fined £1. £1 Is. costs 123, Brackenbury Road ditto 1 Withdrawn. 10s. 6d. costs 79, Sinclair Road ditto 1 Withdrawn. 10s. costs 16 Hadyn Park ditto Withdrawn Flats 76, Stowe Road ditto 1 Fined £1. 10s. 6d. costs 17, Goodwin Road ditto 3 1. Fined £1 1s. 2. Order made 14 days 3. Order made 14 days 85 Summonses—continued. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. 92, Devonport Road Failing to comply with Statutory Notice 1 Adjourned 13, Goodwin Road ditto 1 Fined £5. £1 Is. costs 6, Warbeck Road ditto 1 Withdrawn 38, Overstone ditto 1 Fined £5. £1 Is. costs 15, Mardale Street ditto 1 Withdrawn HAMMERSMITH BOROUGH COUNCIL BYE-LAWS—DOGS. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mr. W. D. V., Hammersmith Contravention of Bye-law re nuisance by dogs in Paddengwick Road 1 Withdrawn Mr. J. G., Hammersmith ditto Blythe Road 1 Fined 10s. Mr. E. V., Fulham ditto The Broadway 1 Fined 10s. Mr. E. E., Hammersmith ditto Beauclerc Road 1 Fined 10s. Mr. P. V., ditto Great Church Lane 1 Fined 10s. MILK AND DAIRIES ORDER, 1926. Name and Address. Nature of Offence. No. of Summonses Result of Proceedings. Mr. A. H. B„ Hammersmith Selling skimmed milk in vessels not properly labelled 1 Fined 10s. Mr. H. J. B., ditto Withdrawn Wimbledon ditto Filling milk botin Agate Road 1 Fined 10s. Mr. C. D„ Hammersmith Filling milk bottles in Blythe Road 1 Fined 10s. Mr. A. H. B„ Hammersmith Filling milk bottles in The Grove 1 Fined 10s. 86 FACTORY AND WORKSHOP ACT, 1901, Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mr. T. E. O., Shepherd's Bush Unfit bakehouse, 31, Goldhawk Road 1 Order made 14 days. Fined £1 10s. £2 2s. coats 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 six persons who were unable to devote to themselves proper care and attention and living under insanitary conditions. They were removed to Institutions of the L.C.C. Factories, Workshops and Workplaces. — During the year 69 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 71 notices were complied with. During the previous year there were 68 notices served and 66 complied with. The following is a list of the Factories, Workshops and Workplaces upon the Register:— Restaurants, Hotels, &c. 213 Bakehouses (23 not in use as Bakeries') 67 Bootmakers 40 Motor and Cycle Makers 11 Dressmakers and Milliners 28 Laundries 50 Outworkers 118 Letterpress Printers and Bookbinders 20 Electrical and Mechanical Engineers 92 Smiths, Wheelwrights and Coachbuilders 36 Tailors 28 Builders, Carpenters and Joiners 26 Miscellaneous 223 Total 946 87 The "whole of these premises have been under a systematic inspection by your Inspectors. The following tables have been prepared in accordance with the form prescribed by the Home Office on the Administration of the Factory and Workshops Act, 1901, in connection with Factories, Workshops, Workplaces and Homework. 1— INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 409 31 - Workshops (including Workshop Laundries) 196 17 - Workplaces (other than outworkers' premises included in Part 3 of this report) 239 21 - Total 844 69 - 88 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 37 48 - - Want of Ventilation - - - Overcrowding - - - - Want of Drainage of Floors 5 5 - - Other Nuisances 28 29 - - Sanitary Accommodation insufficient - 1 - - unsuitable or defective 24 24 - - not separate for sexes 4 4 - - Offences under the Factory and Workshop Act Illegal occupation of underground bakehouse (S. 101) - - - - Other offences (excluding offences relating to out-work which are included in Part 3 of this report) - - - - Total 98 111 - - 3.-HOME WORK. Nature of Work Outwork in Unwholesome premises, Sec. 108 Outwork in Infected Premises Sees. 109, 110 Instances Notices served Prosecutions Instances Orders made (Sec. 110) Prosecutions (Secs. 109, 110) Wearing apparel- (1) making, etc. - - - - - - (2) cleaning and washing - - - - - - Furniture and upholstery - - - - - - Totals - - - - - - 89 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year Number Bakehouses 25 Dressmakers 22 Laundries 10 Outworkers 118 Others 157 Total number of workshops on Register 332 5.—OTHER MATTERS. Class Number Matters notified to H M. Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Act 1901 (S. 133) 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 9 Reports of action taken sent to H.M. Inspector 9 Other 1 Underground bakehouses (S.101)— Certificates granted during year — In use at the end of the year 27 House to House.—As a result of the house to house visitation 525 inspections were made, 888 notices served, and 265 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. Nine Intimation Notices were served. No summons was taken out. 40 Reports were submitted to the Public Health Committee in reference to the observations made as regards the following:— H.B.C. Electricity Worke, Fulham Palace Road. Glen Laundry, Landor Road. Gaumont British Film Studios. Shepherd's Bush Pavilion, Shepherd's Bush Green G. Wimpey & Co., Wood Lane. 6, Stamford Brook Road. 125, Uxbridge Road. Swan Laundry, Blythe Road. Ivy House Laundry, Latimer Road. Metropolitan Water Board Works. Purewite Laundry, Gayford Road. Destructor, 15, Pennard Road. Fullers, Ltd., Great Church Lane. Atlas Laundry, Wendell Road. Balmoral Laundry, 67, Becklow 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 premises of the pest upon the occupier, but this is somewhat difficult when dealing with tenement houses containing in some cases three or more families. During the year several complaints were received with regard to rat infestation of premises. In each case an inspection was made and advice and instructions given. A supply of poison was given where necessary and in most cases satisfactory results have been obtained. National Rat Week was held in November, as in previous years. The Ministry of Agriculture and Fisheries again urged local authorities to take action, and arrangements were made for the baiting of the sewers, through 41 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 60 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 44 premises have been registered under the London County Council Bye-laws relating to tenement houses. Houses Let in Lodgings.—During the year no new houses were registered. HOUSING ACT, 1925, SECTION 18. One notice was served under the Regulations in respect of underground sleeping rooms. 42 VANS. There are five caravans at the rear of No. 261, Latimer Road, used for living and sleeping purposes by twenty persons. The average cubic capacity available for each person is 100 c. ft. There are no regulations applicable to vans in this Borough on the question of overcrowding, and it is therefore difficult to deal with them from this point of view. These are under constant supervision. In Britannia Yard, off Wharf Road, there is one large caravan in which two adults sleep. A large wooden shed is used as a kitchen. No nuisance has been observed at the time of inspection. In the Car Park opposite the White City Stadium there is 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. 48 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 155 Restaurants 22 Factories 4 181 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. 44 HOUSING. Statistics.—Year 1934. 1.—Inspection of dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,741 (b) Number of inspections made for the purpose 21,185 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 90 (b) Number of inspections made for the purpose 292 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 (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 8,089 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 H.—Action under Statutory Powers during the year:— (A) Proceedings under Sections 17, 18 and 28 of the Housing Act, 1980:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil 45 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners 4 (b) By Local Authority in default of owners Nil (B) Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3,089 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 3,006 (b) By Local Authority in default of owners Nil (C) Proceedings under Sections 19 and 21 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which demolition orders were made 1 (2) Number of dwelling-houses demolished in pursuance of demolition orders 5 (D) Proceedings under Section 20 of the Housing Act, 1930 :— (1) Number of separate tenements or ground rooms in respect of which closing orders were made Nil (2) Number of separate tenements or ground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit Nil 46 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 tenement houses, &c. 47 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, 3,778 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. L.C.C. Estate. H.B.C. Estate Private Enterprise. Year. 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 1932 Nil 39 1 1933 Nil 32 20 1934 112 Nil 163 Totals 1,638 793 1,347 The premises have provided accommodation for approximately 18,890 persons, but despite this fact overcrowding is still in evidence. 48 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. Food Premises.—Nine 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 315 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. 49 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 7 (c) Supplementary Licences 2 (4) Dealers' Liccnces to use the designation "Grade A"— (a) Bottling Establishments Nil (b) Shops 1 (5) Dealers' Licences to use the designation "Grade A— Pasteurised" Nil Supplementary Licence 1 (6) Dealers' Licences to use the designation " Pasteurised''— (a) Pasteurising Establishments 4 (b) Shops 12 (c) Supplementary Licences 4 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. Public Health (Meat) Regulations, 1924. The Public Health (Meat) Regulations, 1924, came into operation on the 1st day of April, 1925. The provision of these Regulations, regarding the giving of notice to the local authority of the times of 50 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 284 Sheep 218 Calves 6 Beasts 7 Pigs 354 Total 869 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 Slaughterhouse*. Description. Disease. Approximate Weight. Inspector Rigby 3 sets Pigs' lungs Congestion 5 lbs. Inspector Mason 1 Ox liver Cirrhosis 16 lbs. 1 Pig's liver ,, 3 „ 2 sets Pigs' lungs Congestion 4 ,, Inspector Godden 1 Heifer's liver Distoma Hepaticum 20 lbs. 2 Heifers' lungs Tuberculosis 28 „ 5 Lambs' livers Distoma Hepaticum 10 2 Lambs' lungs Stronguli . 2 „ Pig's loins Hæmorrhage 7 „ 1 Pig's head Tuberculosis 6 „ 1 Pig's spleen Enlarged ½ " 1 Pig's liver Hæmorrhage 2 „ 5 Pigs' livers Milk Spots 10 „ 4 Pigs' mesenteries Tuberculosis 4 „ 10 Pigs' lungs Congestion 20 „ 1 Pig's pluck Tuberculosis 4½ 51 Description. Disease. Approximate Weight. Inspector Barry Pig's head Tuberculosis 4 lbs. 1 Pig's mesentery " ¾ „ Carcases and offal of 3 Pigs " 26 stones 1 Lamb's liver Distoma Hepaticum 1¼ lbs. Inspector Bayes 5 Pigs' heads Tuberculosis 30 lbs. 9 Pigs' mesenteries " 9 " 1 Pig's pluck " 4½ " 1 Pig's spleen ,, ... ... ¼ " 1 pair Pig's lungs Pleurisy 2 „ 1 Pig's kidney Nephritis ¼ 2 Pigs' spleens Congestion ½ 1 Pig's heart Pericarditis 6 ozs. 2 Sheeps' livers Parasitic 4 lbs. 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 Bradmore 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, 1934. The maximum number of lodgers who may be received at any one time into this house is 244. 52 Cow Houses.—There are no cow houses in the Borough. Slaughterhouses and Knackers' Yards.—There are four slaughterhouses in the Borough. Applications were received from four 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 65 King Street Richard Norman Hammett 341 King Street Stanley Brooks Midwinter Knackers' Yards.—There are no knackers' yards in the Borough. 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. 53 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 1934 Number of notices 1934 Number of prosecutions 1934 On register in 1920. On register at end of 1933 Added in 1934 Removed in 1934 On register at end of 1934 Milk premises 128 142 21 2 167 1,127 8 — Slaughterhouses. 7 5 — 1 4 301 — — Poultry Slaughterhouses. — 2 — — 2 15 — — Ice Cream premises 162 161 6 12 155 220 1 — Markets.—There are three markets in the Borough, situate in Bradmore Lane, Approach Road and Norland Road. These markets have been the subject of much inspection during the year, both by the District Inspector concerned and the Inspector carrying out the requirements of the Food and Drugs Acts. Many of the stalls in the Railway Approach Market are constructed so as to form lock-ups when business for the day is finished and thereby provide a means of storage for all unsold food. In other instances, Bradmore and Norland Markets, wheelbarrows form the structure, and these are 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. 54 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 132 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 ensurine conformity with the Bve-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. Ten notices were served relating to various defects, and complied with. 55 The following is a list of bakehouses in the Borough:— Address. Name. No. 1 DISTRICT. Cad by Hall, Hammersmith Road... J. Lyons & Co. 60 Richmond Road C. W. Tompkins 1 Masbro Road W. A. Maclcn 67 Ditto G. Dunsby 98 Blythe Road Miss Schofield Ceylon Road Brook Green Electric Bakery Ltd. No. 2 DISTRICT. 82 Great Church Lane E. 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 102 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 56 Address. Name. No. 6 DISTRICT. 128 Askew Road G. Ingle 74 Ditto J. Auer 167 Ditto F. J. Lockwood 104 Ditto D. Miller No. 6 DISTRICT. 74 Goldhawk Road H. Crisp 106 Ditto F. & A. Posford 166 Ditto F. R. Ries 242 Ditto Plumridge 125 Uxbridge Road A. B. Hemmings Ltd. 56 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 16 Black Lion Lane 87 Masbro Road 192 Dalling Road 6 Beaconsfield Terrace 348 King Street 47 Milson Road 10 Upper Mall 65 Bridge Road 121 Askew Road 2 Crisp Road 41 Gayford Road 94 Shepherd's Bush Road 126 Uxbridge Road 88 Queen Street 132 Uxbridge Road 77 Brackenbury Road 2 Hunt Street 1 The Grove 104 Latimer Road 17 Kilmarsh Road Underground Factory 57 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.[/### 4 boxes Filleled Haddock (34 lbs.) Unsound and Unfit for food Surrendered 1 Chicken (3 lbs.) ditto ditto 1 Chicken(3¾ lbs. ditto ditto 1 Chicken (3½ lbs.) ditto ditto 3 Chickens (9 lbs.) ditto ditto 2 Chickens ditto ditto 11 Chickens (40 lbs.) ditto ditto 3 Chickens ditto ditto 1 Chicken (2 lbs.) ditto ditto 3 Chickens (8 lbs.) ditto ditto 1 Cooked Chicken ditto ditto 1 Chicken (2½ lbs) ditto ditto 1 Chicken (3½ lbs.) ditto ditto 1 Chicken (2¾ lbs.) ditto ditto 2 Chickens (6 lbs.) ditto ditto 7 Chickens ditto ditto 2 Chickens (5½ lbs.) ditto ditto 1 Chicken (3½ lbs.) ditto ditto 3 barrels Apples (237 lbs.) ditto ditto 16 lbs. Apples ditto ditto 42 lbs. Kingston Cod Fillets ditto ditto 1 box Cod (4 stone) ditto ditto 2 Chickens (4½ lbs.) ditto ditto 35 Rabbits' Carcases ditto ditto Portions of Frozen Rabbits (14 lbs.) 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 University College Hospital Medical School and the West London Hospital. In the case of food poisoning specimens are sent to the Ministry of Health. 58 RESULTS OF SAMPLES OF MILK SUBMITTED FOR BACTERIOLOGICAL EXAMINATION. Total Count B. Coli Microscopic Examination Ordinary Sample No. 1 Milk 560,000 per c.c. — in 1/100th Centrifugalised deposit contained marked excess of leucocytes and squames 2 4,400,000 „ - in 1/1000th Centrifugalised deposit contained decided excess of leucocytes, some squames, and traces of detritus 3 6;800.000 „ in 1/10000th „ 4 172,666 ,. in 1/100th — 5 205,000 ,. in 1/100th — 6 9,270 ,. in 1/10th — „ 7 14.300 ., in 1/10th — 8 147.333 „ in 1/100th — 9 3,400,000 ., in 1/100th — „ 10 252,600 „ in 1/100th — " 11 2,400,000 „ in 1/1000th — These samples although not sold as " pasteurised were said to have been treated in accordance with the requirements of the Milk (Special Designations) Order 1923, for pasteurised milk Pasteurised Milk Sample No. 12 14.966 per c.c. in 1/10th Centrifugalised deposit contained slight excess of leucocytes and squames, and traces of detritus „ 13 6,633 „ — in 1/10th Centrifugalised deposit contained a few leucocytes and squames, and a minute trace of detritus „ 14 10,180 „ in 1/10|th — .. 15 9,733 „ — in 1/10th — „ 16 3,760 „ — in 1/10th — 17 8,733 „ — in 1/10th — Grade A T.T. Sample No.18 5,766 per c.c. — in 1/100th Centrifugalised deposit contained only a few leucocytes and squames Orade A Pasteurised Sample No. 19 155 per c.c. — in 1 c.c. Centrifugalised deposit very small and contained only a few leucocytes 59 Presence of Tubercle Bacilli. Guinea-pigs were inoculated with milk from samples 1, 2, 12, 13, 18 and 19, but in each case failed to show any evidence of a tuberculous infection on post-mortem examination. BACTERIOLOGICAL EXAMINATION OF SAMPLES OF GRADED MILKS. The Milk (Special Designations) Order, 1923, lays down certain conditions under which graded milks may be sold, and these include a requirement that, on a sample being taken at any time before delivery to the consumer, the milk shall contain not more than a prescribed number of bacteria per cubic centimetre. The requirements for the various grades of milk are as follow :— Maximum No. of bacteria Coliform Bacillus, per c.c. Certified Milk 30,000 Absent in l/10th c.c. Grade A and Grade A (T.T.) 200,000 ,, l/100th ,, Grade A (Pasteurised) 30,000 „ l/10th „ Pasteurised 100,000 — The Order provides, further, that a licensing authority, if they are satisfied that any of the conditions upon which a licence is granted are not being complied with, may suspend or revoke the licence. It is my considered opinion that most of the reports now received with regard to the bacteriological examination of milk are unreliable. The question of sampling and examination of graded milks is one to which I have given considerable attention in the past and, in support of my view, I would draw your attention to the following facts. Some time ago I became dissatisfied with the results of the examination of samples, which, at that time, were being submitted to one of the largest laboratories specialising in 60 this work in the country. I therefore decided to send test samples to another laboratory. Two churns of milk were selected upon delivery at each of two hospitals in Hammersmith and duplicate samples taken from each. The same methods were adopted for each sample. Bottles, sterilized under exactly similar conditions in the laboratory, were used for each of the samples. They were immediately packed on ice and four were submitted to the usual laboratory and four to another well-known institution. Sample "A" was reported by one laboratory to contain 39,850 bacteria per c.c. (well within the prescribed limit) and by the other 144,000 per c.c. (nearly 50 per cent. above the legal maximum). The other three reports all showed similar variation. In July I had further tests made with startling results. A quart bottle of pasteurised milk was taken and, after being thoroughly shaken, divided into six parts. Sterile bottles were used and every precaution taken during the division. Two of these bottles were submitted to each of three laboratories. The following table gives particulars of the reports received :— No. of sample Temp. No. of Presence of B. Coli (24 hrs.) „ Bacteriologist on bacteria Sample arrival per c.c. 1/10 1/100 1/1,000 1/10,000 1 No. 1 Laboratory 13˚'C 9,270 +- - - 2 No. 1 „ 13°C 14,300 +- - - 3 No. 2 „ ll'C 147,333 - - - 4 No. 2 „ 11˚0 3,400,000 - - 6 No. 3 „ 14˚0 36,000 +- - - 6 No. 3 „ 14*0 47,000 +- - - It will be seen that one report gives a bacterial count of 9,270 per c.c. and another 3,400,000 per c.c. for the same milk and that the results obtained by one laboratory vary from 147,000 to 3.400,000. Other tests have been made and the above figures are typical of the results obtained. 61 In view of these facts I think it must be agreed that, to withdraw a licence upon such unreliable data, would be most unjust. In Memo. 39/Foods, the Ministry of Health set out a suggested technique for the bacteriological examination of graded milks. If this is properly carried out the results should be reasonably comparable. I can only assume that, in making their examinations, bacteriologists do not faithfully and carefully carry out the suggested procedure. Unless every stage, from the composition of media to uniform heating in the incubators is standardised, the results must vary. There is one point in the Ministry's suggested technique to which I would draw attention. In paragraph 12 it is stated that the original sample and each dilution must be shaken 25 times, each shake being an up and down motion, with an excursion of about one foot. This shaking is, of course, to distribute the organisms in the sample evenly, and, secondly, to break up any bacterial aggregates which may have been formed. Most samples of graded milks are submitted to the bacteriologist in the bottle in which the milk is sold, and as such bottles are usually entirely filled with milk, it is unlikely that any proper mixing is obtained by shaking unless the milk is first transferred to a larger bottle. Again, the vigour with which the shaking is conducted may makg an appreciable difference to the final count. I suggest that more uniform results would be obtained by the use of a mechanical shaker, working at a standard speed. Reviewing the position as it now stands. I am of opinion that little value can be placed upon the reports received and that until a more standard practice is adopted by bacteriologists, both time and money are being wasted in submitting milk samples for examination. 62 Report of Public Analyst. FOOD AND DRUGS (ADULTERATION) ACT, 1928. Year ended 81st December, 1934. Of the total of 612 samples of food and drugs submitted for analysis 550 were genuine, 38 were inferior and 24 adulterated. It is much to be regretted that the slight improvement recorded last year has not been maintained. The figures for inferior and adulterated samples show increases over those for 1933 of 7 and 10 respectively. The increase in inferior samples is due to poor quality milk, whilst the increase in the figure for adulteration is due to the sale in the Borough of so-called cream confectionery containing no real cream and to very defective specimens of iodine ointment. In the last available (1933-1934) Report of the Ministry of Health the percentage of adulterated or defective samples for the whole country is given as 5.5 whereas in our Borough the percentage is 3.9. In Table I are given the total numbers of samples received under the Food and Drugs (Adulteration) Act as recorded in my quarterly Statutory Reports to the Ministry of Health, with the numbers classified as genuine, inferior and adulterated. Table I. Period. Genuine. Inferior. Adulterated. Total. 1st quarter 123 21 6 150 2nd 134 8 8 150 3rd 93 7 4 104 4th „ 200 2 6 208 Totals 550 38 24 612 In Table II the percentages of genuine, inferior and adulterated samples are compared for the last ten years. It will be seen from this that the year under review is one of the worst within the period. 63 Table II. Year. Genuine. Inferior. Adulterated. 1925 91.6 5.7 2.7 1926 92.1 40 3.9 1927 89 7 7.2 3.1 1928 892 6.5 4 3 1929 93.5 5.4 1.1 1930 93.6 5'3 l.l 1931 95.6 31 1.3 1932 90.6 65 3.0 1933 92.6 51 2.3 1931 899 6 2 3.9 Average for ten years 91 9 5.4 2*7 The number and nature of the various articles examined during the year are set out in Table III. Particulars of prosecutions instituted and penalties imposed are given under the separate headings which follow this Table. Table III. Article. No. of SampleB examined. Result of Examination. Genuine. Inferior. Adulterated/###] Almonds, ground 2 2 Ammnniated Tincture of Quinine 2 2 — Aspirin Tablets 4 4 — Black Pudding 1 1 — Boric Ointment 2 2 — — Brawn 1 1 — Butter 31 31 — Camphorated Oil 5 5 — — Castor Oil ... 4 4 — Cheese ... 4 4 — Chicken and Ham Roll 3 3 — Chicken Roll 1 1 — Citrate of Magnesia 5 5 — Cocoa 7 7 — Coffee 3 3 — Coffee and Chicory 1 1 — — Coffee and Chicory Extraet 1 1 ■— Cream 12 12 — — Cream Confectionery 11 4 7 Epsom Salt 2 2 — Eucalyptus Oil 2 2 — Fish Paste 5 5 — „ tinned 2 2 — Fruit, cordials 4 4 — Fruit, dried 6 6 — „ tinned 5 5 — 64 Table III—continued. Article. No. of Samples examined. Result of Examination. Genuine. Inferior. Adulterated. Ginger, ground 3 Glauber's Salt 2 — Golden Syrup 1 I — Glucose Barley Mints 1 1 — Iodine ointment 1 5 ,, phenolated 1 1 — — ,, tincture, weak 3 — Jam ... ... 7 7 — Jelly 3 — Ketchup, tomato 1 1 — Lard ... 7 7 — Lemonade Powder 1 1 — Margarine ... ... ... 10 10 — Marmalade 3 — — Meat Paste .. 4 4 — „ Bie a 3 — Milk 315 270 38 7 „ Condensed 19 19 — — ,, Skimmed — — 2 Mincemeat 4 4 — — Olive Oil 4 4 — — Orange Curd 1 1 — — Paraffin, liquid z 2 — — Pepper 5 — — Petroleum Jelly 1 — — Raisins 2 2 — — Rice 3 3 — — Sausages 18 16 — 2 Sauce, taint 1 1 — — „ tomato 2 2 — — Scotch rarebit t 1 — Seidlitz Powder 2 2 — — Semolina ... ... 5 5 — — Sponge Cakes ... 3 3 — — Suet 1 1 — — Sugar 3 — — Sultanas o 2 — — Syrup of Figs 2 — — Tea 4 4 — — Tomato Puree .. 1 — — 1 Veal and Ham Cutlets 1 — — „ jellied i 1 — „ loaf • 1 — Vegetables, tinned 7 1 7 — — Vinegar ... ._ 7 — — " Vitacup" ... .„ 1 1 — — Wine .. ... „ 5 5 — — Zinc Ointment ._ ... 4 4 — — Totals (512 550 38 24 65 The articles which demand special consideration are dealt with in the matter which follows. Milk. During the year a total of 315 milks were analysed, of which 270 were genuine, 38 genuine but of inferior quality, and 7 adulterated. Of the inferior samples 35 were poor in fat and 3 in both fat and non.fatty solids. Four of those adulterated contained small amounts of added water and 3 were deficient in fat to the extent of 9, 13 and 14 per cent, respectively of the minimum laid down by the Sale of Milk Regulations, 1901. The following Table gives the average composition of the milk samples for each month and for the whole year. By setting out the results month by month, instead of quarterly as was done formerly, one can compare more closely and more interestingly the results with those for other districts and with the published results such as those of H. D. Richmond and other observers, which are based on very many thousands of analyses spread over many years. Table IV. Month. No. of Samples. Fat average (per cent.). Non.fatty solids Average (per cent.). January 22 3.55 8.74 February 36 3.51 8.82 March 17 3.63 8.75 April 20 3.42 8.73 May 49 3.64 8.78 June 23 3.77 8.75 July 34 3.66 8.82 August.. 17 3.48 8 76 September 13 3.51 8.85 October 42 3.62 8.82 November 14 3.82 8.87 December 28 3.76 8.78 Whole year 315 3.61 8.79 The above figures represent milk of fair average quality. 66 For a number of years it has been the custom to classify genuine milks as of good, fair or poor quality according to the fat content. The limits adopted are :— Fat 3.0 per cent, up to 3.3 per cent.—Poor quality. Fat over 3.3 ,, ,, 3.8 ,, —Fair ,, ,, 3.8 ,, —Good ,, The following Table shows the numbers so classified in each quarter:— Table V. Period. Good quality. Fair quality. Poor quality. 1st quarter 8 62 21 2nd „ 9 60 8 '3rd „ 17 43 7 4th „ 20 51 2 Whole year ... 64 216 38 Condensed Milk. Nineteen condensed milks were examined for compliance or otherwise with the requirements of the Condensed Milk Regulations. All were found to fulfil these requirements, both in respect of composition and of volume of milk yielded on dilution according to the statements on the tins. Eight were sold as full cream and 11 as skimmed condensed milk. Cream and Cream Confectioner?. Four samples of cream and eight of tinned cream were analysed during the year and all of these proved to be genuine. Two of the creams were sold as " half-price " cream and '' coffee '' cream and were found to contain only 24.0 per cent, and 24.7 per cent, respectively of fat. Of the tinned creams two bore on the tin a statement as to the fat, content and analysis verified the figures given. 67 Seven specimens out of a total of eleven of various types of cream confectionery were reported adulterated on account of the use of cream substitutes as a filling material. Proceedings were instituted in respect of four samples and convictions were obtained in each case, the total of penalties inflicted amounting to £12 2s. 0d. It has been the custom for a number of years in the trade to use substances resembling cream as a filling for certain types of confectionery and the view of your Analyst is that no exception can be taken to this custom provided that no claim, actual or implied, is made that the substances so used are cream. The use of such terms as " cream buns " or " cream sponge sandwich " are calculated to deceive the purchaser and it is a very debatable point as to how far the word cream can legimately be employed in the generic sense instead of the specific sense. There is no doubt, however, that the very large majority of purchasers of this confectionery buy it under the impression that the cream filling really is cream. In the cases already quoted the articles were sold as " real cream " buns, cakes, &c., hence there could be no two views as to whether deception was intended or not. It would certainly appear that the former reluctance of Local Authorities to prosecute vendors of this fictitious cream confectionery has recently been taken advantage of, for not only is there a much larger quantity of such produce now on the market, but some vendors of it have become bolder and to deceive the purchaser more completely have descended to the use of such terms as " real cream." Others, again, use such names as " creamy buns " for their produce and thus avoid prosecution whilst still artfully practising the same deception. Butter, Margarine, Lard and Suet. Thirty-one samples of butter, ten of margarine, seven of lard and one of beef suet were analysed and found to be genuine, no excess of water or addition of foreign fat being 68 detected. Tests for preservatives gave negative results. The suet bore on the packet a statement that no starch was present and this was verified. Cheese, &c. Four cheeses of the tin-foil wrapped class showed no metallic contamination and the absence of preservatives. A sample of " Scotch rarebit," similarly packed, was also genuine, the ingredients being cheese with tomato and celery flavouring. The question of standards for milk fat in cheese has for a long time been under discussion. In July, 1933, the Agricultural Produce (Grading and Marking) (Cheshire Cheese) Regulations, 1933. came into force. These prescribe a minimum of 45 per cent, of milk fat in the moisturefree article, so that for at least one type of cheese we have now an official standard for the fat content. Meat and Fish Preparations. Of the forty-one meat and fish preparations specified in Table III only two were adversely reported upon. Both of these were sausage in which preservative—sulphur dioxide —was found, the amounts being 350 and 150 parts per million respectively. No declaration of the presence of preservative as required by the Preservatives Regulations was made when the purchase took place. In the few instances where the articles were sold in tins the absence of any significant proportion of poisonous metals such as tin, lead and copper was proved. Vegetables, Fruit, Conserves, &c. Table III contains thirty-eight samples in ten different varieties falling under the above heading. These were all genuine with the exception of one specimen of tomato puree which contained copper to the extent of twelve parts per million. 69 Seven specimens of jam and three of marmalade conformed to the standards of the Food Manufacturers' Federation. These standards permitted in jam the use of fruit pulp, glucose, colouring matter, pectin and certain organic acids, but required minima of 68.5 per cent. of soluble solids and 42 per cent. of fruit. By the Agricultural Produce (Grading and Marking) (Jam) Regulations, 1934, which came into operation for National Mark Jam on the 29th June last, a much higher standard is set. These Regulations require minima of 55 per cent, of fruit and 68.5 per cent, of soluble solids, the use of fresh fruit anl refined sugar only, without glucose, colouring matter, acids, or setting material such as pectin, with the proviso that to strawberry, raspberry, blackberry, loganberry and cherry jams there may be added '' any other substance which occurs as a natural constituent of the fruit." The reference here is doubtless to the acidity and pectin, in which the fruits specified are somewhat deficient. Cocoa, Coffee, Tea, &c. During the year seven specimens of cocoa, three of coffee, one of coffee and chicory, one of coffee and chicory extract, four of tea and one of "Vitacup" were examined and all were passed as genuine. The last named was a proprietary beverage containing cocoa, milk. malt and eggs. The coffee and chicory was found to contain 65 per cent. of coffee and 35 per cent. of chicory, so that the article was correctly named and was not merely chicory flavoured with coffee. Tests on the cocoas for arsenical contamination were negative. Farinaceous Foods. Three samples of rice and five of semolina upon analysis proved to be genuine. No evidence of polishing with talc was given by the rice samples. Condiments, Spices, &c. Three samples of ground ginger, one of tomato ketchup, four of olive oil, five of pepper, one of mint sauce, two of tomato sauce and seven of vinegar were all passed as genuine. The acetic acid content of the vinegars was in no 70 case below the suggested limit of 4 per cent., and they contained no preservatives, arsenic, lead or copper. Cordials, Wines and Spirits. Two specimens of lemon squash, two of grape fruit squash and five of wine upon analysis proved to be genuine. Two of the fruit cordials contained sulphur dioxide perservative, but the amount present in each case was below the permitted limit. No samples of spirits were received this year. Drugs. Table III contains forty-nine drugs in a very varied assortment of seventeen varieties. The majority satisfied the requirements of the British Pharmacopoeia and in the few instances where the articles were not Pharmacopoeia preparations other criteria of purity were complied with. From the last edition of the Pharmacopœia iodine ointment was omitted. Possibly because of this omission there have appeared on the market various preparations, outwardly similar, which are either entirely devoid of free or combined iodine, or which contain but a trace. It may be useful to remark here that the British Pharmacopoeia is frequently invoked in the Courts as a work whose requirements are " standards." In point of fact the standards of the Pharmacopoeia are not absolute standards, but very important presumptive ones readily accepted by magistrates and very difficult for the defence to put aside. The Pharmacopoeia is not the only work to which appeal may be made, though it is the chief. Others are the "British Pharmaceutical Codex," Squire's" Companion to the British Pharmacopoeia," and Martindale's "Extra Pharmacopoeia." Beference may sometimes be necessary to previous issues of the Pharmacopoeia, where drugs, not included in the current issue, are still in use. An important official example of this procedure is afforded by the Dangerous Drugs Acts and Begulations, wherein are specified drugs and preparations of the last but one (1914) edition and even so far back as the edition of 1898. 71 Moreover, the Analyst may put forward standards of his own, based upon his experience in the analysis of a number of samples of a particular drug or preparation and may, of course, quote any of the above works in support of his view. Of six samples of iodine ointment analysed during the year no less than five were condemned. Two were ointments of a very different type, made from methyl salicylate (oil of wintergreen) and petroleum jelly, with the addition of a dark brown colouring matter to make them resemble iodine ointment. In the remaining three instances traces only of iodine or potassium iodide were present, whereas the Pharmacopoeia of 1914 and the Pharmaceutical Codex of 1923 and 1934 require 4 per cent. of each. There is no doubt that the sale of these preparations is to the prejudice of the purchaser, inasmuch as iodine ointment is used as an antiseptic dressing for minor injuries such as cuts, abrasions, sprains and the like. The virtue of the Pharmacopoeia preparation lies in the free iodine present and it has been shown that for any antiseptic action to be exhibited the iodine must be in the free condition. Moreover, the potassium iodide is not less essential, for its function is to prevent to a large extent the combination of the iodine with the fatty base of the ointment. All the five samples under discussion contained a petroleum jelly base in place of the base of glycerin and prepared lard required by the British Pharmacopoeia. This substitution in the base is one to which exception would probably not have been taken by your Analyst, inasmuch as various preparations of iodine with a petroleum jelly base have been on the market for some years, and, indeed, are quoted in the Pharmaceutical Codex. It is satisfactory to record that the Courts upheld the contentions of the Council's Officers and legal representatives. In three cases fines and costs totalling £76 19s. 0d. were imposed. At the time of writing this Beport it would seem that the vendors are considering taking the case further. In addition to samples submitted under the various Acta and Regulations, one sample of water from the Swimming Bath at Lime Grove was submitted by the Medical Officer of Health for examination. 72 Sample no. Article. Analyst's Beport. Result of Proceedings. Other Information. Table VI. 737 Milk Contained 1 5 per cent. of added water - Informal sample 738 do. do. 2 per cent. do. Summones dismissed on From same milk 739 Skimmed Milk do. 2.3 per cent. do. on payment of 10s. 6d. Vendor as informal 740 do. do. 3.2 per cent. do. costs in each case sample No. 737 754 Milk 9 per cent, fat abstracted — Letter of warning 845 do. Contained 1 per cent. of added water - do. 882 do. 14 per cent. fat abstracted Summons dismissed Warranty defence upheld 953 "Real Cream " Tarts Contained a filling consisting of a substance other than real Cream — Informal sample 954 do. Gateaux do. - do. 955 do. Trifle do. - do. 962 do. Tarts do. Fined £2 10 0 From same vendor as formal sample No. 953. 963 do. Cookies do. Fined £2 10 0 964 do. Gateaux do. Dismissed under Probation of Offenders Act. £2 2 0 costs From same Vendor as informal samples Nos. 955 and 954 985 do. Chocolate Eclairs do. Fined £5 0 0 — 49 Milk 13 per cent, fat abstracted — Letter of warning 55 do. 2 percent, added water — do. 98 Sausages Contained 350 parts ol S.O2. per million — Informal sample (official sample genuine) 99 do. do. 150 parts do. — do. 174 Iodine Ointment 100 per cent, deficient in free iodine and 100 per cent. deficient in potassium iodide - Informal sample 195 do. 100 per cent. deficient in free iodine and 100 per cent. deficient in potassium iodide Fined £110 From same Vendor as informal sample No. 174 Costs £1 1 0 196 do. 100 per cent. dificient in free iodine and 99.25 per cent. deficient in potassium iodide Fined £110 - Costs £110 204 do. 98.5 per cent. deficient in free iodine and 100 per cent. deficient in potassium iodide - Informal sample 209 do. 98.5 per cent. deficient in free iodine and 100 per cent. deficient in potassium iodide Fined £15 0 0 From same Vendors as informal sample No. 204 Costs £5 5 0 266 Tomato Puree Contained 12 parts of copper per million - Letter of warning 73 COMPOSITION AND DESCRIPTION OF FOOD. Of the total number of samples submitted during the year to the Public Analyst for analysis. 3.9 per cent. were reported to be adulterated. The corresponding figure for the year 1923 was 6.1 per cent., whilst in 1921 it was 8.5 per cent. These figures would seem to indicate a considerable improvement in the quality of the foodstuffs now offered for sale to the public, and there has, in fact, been a substantial reduction in the amount of adulteration of food as practised even a few years ago. This may be accounted for to some extent by the fact that an increasing number of articles are supplied to retailers "prepacked" and by the increasing number of shops now owned by the large "multiple shops" firms. The sale of milk in bottles has undoubtedly resulted in a decrease in the amount of adulteration of that commodity. The increased activities of local authorities, however, is probably the chief factor which has brought about the result. Many more samples are now being taken and the dishonest trader is coming to realise that adulteration does not pay. During the year under review the report of a Departmental Committee on the Composition and Description of Food has been issued. This report contains some very useful suggestions, and it is to be hoped that a number of the recommendations put forward will shortly find their way to the Statute Book. The main question considered by the Committee was 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. The answer of the Committee was in the affirmative, but they did not consider that the case for the extension of standards and definitions to all articles of food had been made out. At the present time, except for a very few articles, such as milk and butter, no standard of composition exists. Difficulty is often experienced as to what is actually "the 74 nature, substance or quality" of an article demanded. Trade practice varies considerably in different parts of the country and it is left to the Courts to fix a standard to which an article should attain in each case. In many other countries, notably America, Australia and New Zealand, definite standards are laid down by the Governments, below which no article may be sold. The absence of legal standards allows many articles of inferior quality to be sold and as a consequence the consumer suffers considerable loss. Not only, however, is this prejudicial to the purchaser but it is unfair to the more conscientious trader. In their report the Committee states: "We think the main thing to be aimed at is that the public, when buying an important article of food, should know what they are getting." At the present time the public often do not know what they are getting. As an example, the only legal definition of cream is " that portion of milk rich in milk fat which has been separated by skimming or otherwise." There is no requirement as to the percentage of fat which it shall contain. This may be 60 per cent. or may be as low as 10 per cent., but it may all be described and sold as cream. Recently many dairies have been widely advertising for sale what they describe as "economy cream," "half-price cream" or "coffee cream." How many purchasers of this cream know what they are getting for their money? Analysis of samples taken in the Borough show that the average fat content is about 24 per cent. The percentage of fat in ordinary cream is about 50. Some firms are now describing the latter as "double cream," a description which, to my mind, is very misleading. "Ordinary" cream should contain this percentage of fat. To call an article "double cream" implies that it is twice as good as normal. A sample of tinned cream examined recently was labelled "Rich thick cream, Superior quality," and it was further stated to be "highly concentrated. Actually it contained 19 per cent. of fat. 75 If cream of varying quality is to be sold, a declaration of the amount of fat which it contains should be required to be stated upon the label or a definite minimum should be prescribed for each designation. The public will then know what they are getting. The Committee recommend that power be given to the Ministry of Health to prescribe standards for any article of food for which it can be shown that such standards are necessary, but that no standards shall be laid down without giving the manufacturers and other persons concerned the fullest opportunity of hearing what is proposed to be done and submitting their views on the proposal. Although there has been a decrease in the number of samples reported to be adulterated, there has, in my opinion, been a growing tendency to describe many articles of food, &c., by misleading statements as to their nature in advertisements and on labels. As an instance, labels on pots of jam frequently include such wording as " improved by the addition of other fruit juices." This declaration on the jar is sufficient to cover the makers in law and allows an inferior article to be sold. Again, in the case of certain " tonic wines," advertisements frequently make exaggerated claims as to the benefits to be derived from their consumption, which it would be very difficult to establish as facts. A big advertising campaign has recently been undertaken in support of the sale of what are described as "iodine lockets." According to such advertisements the mere fact of wearing one of these lockets around the neck or in the pocket is sufficient to cure or ward off every ailment from which man has been known to suffer. It would appear that a law making it compulsory that every member of the community should wear one of these lockets would solve all the problems of the Public Health Service. The Departmental Committee have considered the question of advertisements and labels of foodstuffs and in their report they state that they agree with the principle of the following recommendation put before them. 76 "It is our opinion that any attempt to control by Statute statements about the composition of food will be stultified unless it is legally enacted that, for the purpose of evidence as to the nature, quality and substance demanded of a food, specific claims made in advertisements shall be deemed to be part of the package label. Though it is theoretically true that the purchaser is expected to examine the label of a product before he completes its purchase, it is a matter of common knowledge that the vast majority of purchasers do not do so. The description on which they have been induced to buy the product is in a large number of cases only that contained in the advertisements, and we hold very strongly that progress in the standardisation and description of food will be seriously hampered until this matter is dealt with." Presumably any alteration in the law will be by amendment of the Food and Drugs (Adulteration) Act and will apply to both food and drugs. Legislation along the lines recommended should go a long way to protect the public and prevent their exploitation. PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 1,861 cases reported as due to notifiable infectious diseases in the Borough, against 1.827 in the previous year. There were also reported 1,606 cases of infectious diseases that were not notifiable, against 618 in the previous year; 1,334 of these were Measles, and 272 Whooping Cough. The number of cases of Tuberculosis notified was 215 against 216 in the previous year. 77 BACTERIOLOGY. The following bacteriological examinations were made on behalf of the Council:— Material from oases of suspected Diphtheria— True Diphtheria bacillus isolated 220 Negative results 1,371 Sputa from cases of suspected Tuberculosis— Tubercle bacillus found 56 Tubercle bacillus not found 475 Blood from cases of suspected Fever— Widal or Typhoid reaction obtained — Widal or Typhoid reaction not obtained 1 Stools (for Food Poisoning) (negative) 1 Spleen 1 Grand Total 2,125 Cases of Infectious Disease notified during the year 1934 Notifiable Disease Number of Cares Notified Total cases notided in each Ward Total Cases Removed to Hospita l. At all Ages Under 1 1 & under 5 Years 5 & under 15 Years 15 & under 25 Years 25 & under 45 Years 45 & under 65 Years 65 and upwards S'th Centre North Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 549 5 164 323 36 20 1 .. 65 115 58 26 72 145 68 544 Erysipelas 79 1 2 8 6 14 34 14 9 10 12 4 16 18 10 51 Scarlet Fever 609 1 156 354 50 45 3 .. 79 85 85 29 114 161 56 577 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 1 .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. 1 Relapsing Fever (R) Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. 1 1 .. .. .. 1 .. .. 1 .. .. 2 Puerperal Pyrexia 22 .. .. .. 5 17 .. .. 3 3 5 .. 4 5 2 20 Cerebro-spinal Meningitis 6 1 2 .. 1 2 .. .. .. .. 1 1 .. 1 3 6 Polio-myelitis 1 .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. 1 Encephalitis Lethargica 1 .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. 1 Ophthalmia Neonatorum 11 11 .. .. .. .. .. .. 2 2 3 1 1 1 1 3 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 154 8 29 25 15 27 33 17 14 37 16 3 28 36 20 78 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Food Poisoning 4 .. .. .. .. 3 1 .. 2 .. .. 1 .. 1 .. .. Chickenpox 422 8 100 304 8 1 1 .. 18 92 74 21 58 116 43 31 TOTALS 1861 35 453 1015 123 130 74 31 193 345 254 86 294 186 203 1,315 Tuberculosis. Pulmonary Tuberculosis 184 .. 1 9 66 62 42 4 37 35 32 15 20 29 16 Other forms of Tuberculosis 31 1 2 8 6 9 2 3 6 6 5 .. 5 7 2 TOTALS 215 1 3 17 72 71 44 7 43 41 37 15 25 36 18 78 Deaths from the Seven Principal Zymotic Diseases.— The total number of deaths of residents registered from the seven principal zymotic diseases was 100 against 54 in the previous year. The deaths of residents last year from these diseases were equal to 60 per 1,000 of the total deaths of residents registered and were at the rate of 0.8 deaths per 1,000 persons living. The following table shows the deaths of residents registered from the seven principal zymotic diseases which occurred in the ten years, 1925 to 1934:— Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Enteric Fever. Diarrhoea and Cholera. Total. 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 1934 0 25 4 25 19 0 27 100 Average last 10 yrs. 0 14 3 12 14 1 27 71 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was twenty-nine above the average number registered in the last ten years. 79 Notifiable Diseases (other than Tuberculosis) during the year 1934 DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths. Diphtheria 549 544 25 Erysipelas 79 51 — Scarlet Fever 609 577 4 Enteric Fever 1 1 — Puerperal Fever 2 2 9 Puerperal Pyrexia 22 20 — Cerebro-Spinal Meningitis 6 6 6 Encephalitis Lethargica 1 1 — Ophthalmia Neonatorum 11 3 — Pneumonia 154 78 106 Dysentery — — — Poliomyelitis 1 1 — Chickenpox 422 31 — Food Poisoning 4 — — Total 1,861 1,315 150 Smallpox.—No case of smallpox was reported during the year. Cholera.—No case was reported as due to Cholera, against no case in the previous year. Plague.—No case was reported as due to Plague, against no case in the previous year. Diphtheria and Diphtheritic Membranous Croup.— Five hundred and forty-nine cases were reported as due to Diphtheria or Diphtheritic Membranous Croup against two hundred and forty-one cases in the previous year. Five hundred and forty-four cases were treated at the Isolation Hospitals and five died at the homes of the patients. Twenty-five deaths were registered. The mortality rate on the cases reported was 4.6 per cent. The cases were fairly evenly distributed throughout the Borough. Diphtheria is a disease which calls for prompt action by both the parent and medical practitioner. 80 Parents often delay calling in a doctor when children are ill. Any child who complains of a sore throat should be immediately seen by a doctor and removed to hospital when the clinical evidence is such as to give reasonable grounds for assuming the case to be positive. If the clinical evidence is not sufficient and it is necessary to take a swab, anti-toxin should be administered at once and not delayed until the report is received from the Pathologist. 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.—Six hundred and nine cases were notified as due to Scarlet Fever, against eight hundred and ninetyfive in the previous year. Five hundred and seventy-seven cases were treated at the Isolation Hospitals, and thirty-two at the homes of the patients. Four deaths were registered. The mortality rate was 0.7 per cent. Enteric Fever.—One case was reported as due to Enteric Fever, against eight cases in the previous year. The case registered. It was not possible to trace the source of infection. Erysipelas.—'Seventy-nine cases were reported as due to Erysipelas, against ninety-seven cases in the previous year. Twenty-eight cases were treated at the homes of the patients, and fifty-one in various hospitals. Typhus Fever.—No case was reported as due to Typhus Fever, against no case in the previous year. 83 Relapsing Fever.—No case was reported as due to Relapsing Fever, against no case in the previous year. Continued Fever.—No case was reported as due to Continued Fever, against no case in the previous year. Puerperal Fever.—Two cases were reported as due to Puerperal Fever, against nine cases in the previous year. One case was treated at a London County Council Hospital and one at Queen Charlotte's Hospital. Four deaths were registered from Puerperal Sepsis and five from other accidents and diseases of pregnancy. Puerperal Pyrexia.—Twenty-two cases were reported as due to Puerperal Pyrexia against thirty-three in the previous year. Three cases were treated at the London County Council Hospitals, ten at Queen Charlotte's Hospital, two at the homes of the patients, and seven at various other hospitals. Cerebro-Spinal Meningitis.—Six cases of Cerebro-Spinal Meningitis were reported against six cases in the previous year. Four cases were treated at the Isolation Hospitals of the London County Council, one at Hammersmith Hospital and one at the Princess Louise Hospital. Six deaths were registered. Acute Polio-myelitis.—One case was reported as due to Polio-myelitis, against four cases in the previous year. The case was treated at the West London Hospital. Encephalitis Lethargica.—One case was reported as due to Encephalitis Lethargica, against one in the previous year. The case reported was treated at St. Charles Hospital. Ophthalmia Neonatorum.—Eleven cases were reported as due to Ophthalmia Neonatorum, against ten cases in the previous year. Three cases were treated at London County Council Hospitals, and eight at the homes of the patients. In the cases treated at home arrangements were 84 made for a nurse to attend the patients. Sixteen cases of slight inflammation of eyes were reported by the Inspector of Midwives of the London County Council. These cases were visited by the Health Visitors and action taken where necessary. 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.—One thousand three hundred and thirty-four cases of Measles and German Measles were notified against two hundred and ninety-nine in the previous year. Three hundred and thirteen cases were treated in the Hospitals of the London County Council. Twenty-five deaths were registered. Whooping Cough.—Two hundred and seventy-two cases of Whooping Cough were reported, against three hundred and nineteen in the previous year. Nineteen deaths were registered. Seventy-one cases were removed to hospital. The homes of the patients were visited by your Lady Inspector, and the parents advised as to the precautions that should be taken. Chicken Pox.—Four hundred and twenty-two cases of Chicken Pox were reported, against three hundred and thirty-three in the previous year. Thirty-one cases were removed to hospital. 86 In every case the premises were visited by your Lady Inspector 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 fifty-four cases of Pneumonia (sixty-one Influenzal Pneumonia and ninety-three Primary Pneumonia) were notified during the year. Seventy-eight 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 six deaths were registered. Malaria.—No case was reported, as against no case in the previous year. Dysentery.—No case of Dysentery was reported against three cases in the previous year. Food Poisoning.—Four cases of Food Poisoning were reported under Section 7 of the London County Council (General Powers) Act, 1932. Influenza.—During the year nine deaths from Influenza occurred, as compared with sixty-four in the previous year. Wrong Diagnosis.—Seventy-eight 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 87 from the disease stated on the certificates, or any other notifiable disease— Diphtheria 46 ScarletFever 32 Total 78 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 91 Impetigo 297 Verminous Cases 1,870 Adults— Scabies 100 Verminoufi Cases 9 Other Conditions 2 Children under School-age— Scabies 23 Verminous Cases 4 Adults—Non-Hammersmith Scabies 17 Other Conditions 31 Common Lodging-houses- Scabies 3 Verminous 69 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. TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1925 to 1934. 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. 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 1934 0 609 549 0 1 0 0 2 22 0 79 0 422 1334 272 6 0 0 0 11 1 1 154 0 0 0 4 3467 Average for 10 years 7 450 305 0 6 0 0 8 21 0 58 0 346 718 23 4 0 0 0 16 1 3 157 1 1 0 1 2339 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. 89 The amount received from the London County Council during the year was £187 0s. 0d. in respect of cleansings and £19 3s. 0d. 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 140 Mattresses 504 Pillows 2,931 Bolsters 699 Blankets 3,289 Sheets 1,843 Quilts 1,625 Articles of Clothing 4,526 Sundries 262 Total .15,819 Rooms 1,336 Vaccination. The duties under the Vaccination Acts and the Vaccination Order were carried out by the Public Health Department. The Return for 1933 shows that 924 Infants were vaccinated, this being 57.0 per cent. of the Births and compared with 57.0 per cent. in 1982. No proceedings under the Vaccination Acts were instituted. 90 VACCINATION RETURNS. RETURN FOR 1933. 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., 1933 Number of these Births duly entered by 31st January, 1935, in Columns I, II, IV and V of the "Vaccination Register " (Birth List Sheets), viz.: Number of these Births which on 31st January, 1935, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1935. 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 1934 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 1934 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 788 416 1 — 285 29 1 10 40 6 1,144 543 2. South Hammersmith * 525 295 1 — 142 33 — 5 46 3 3. "Invermead" 367 209 2 - 121 11 — 5 19 — * 1,682 920 4 — 548 73 1 20 105 9 1,144 543 * One Birth occurring in 1931 and one in 1896 Registered in 1933 not counted for Vaccination Acts. Number of Copies of Certificates sent to other Vaccination Officers—157. Table showing Work of Vaccination Officer from 1st January to 31st December, 1934. 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. Johnson. Dr. Townsend. Dr. Dockrlll. Dr. Brash. Dr. Phillips. Dr. Barnes Other Doctors. Dr. Darward. Dr Dale. Dr. Johnson. Dr. Townsend. Dr. Dockrill. Dr. Brash. Total North 26 125 19 37 95 5 — — 105 5 417 259 46 — 38 471 56 31 9 17 23 96 16 29 96 7 267 South 91 18 22 49 2 — — — 116 — 298 165 33 — 55 350 66 8 5 13 86 7 17 61 1 — 172 Queen Charlotte's Hospital 27 34 — 27 20 — — — 136 1 245 119 9 — 122 248 15 9 3 7 32 31 12 12 17 1 105 Removed Inwards 33 39 — 52 30 1 — — 29 — 184 — 20 248 — 74 44 8 1 40 31 28 5 47 17 — 128 Above 14 years of age 3 7 — 2 1 — — — — — 13 — — — — — — — — — — — — — — — — Total 180 223 41 167 148 6 — — 386 6 1157 543 108 248 215 1143 181 56 18 77 172 162 50 149 131 8 672 92 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 fifteen cases of tuberculosis were reported during the year, one hundred and eighty-four of which were Pulmonary and thirty-one being other forms of Tuberculosis, against two hundred and sixteen cases in the previous year. PART I. Summary of Notifications during the period from the 1st January, 1934, to the 31st December, 1934. 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 — 1 2 3 11 13 20 18 18 15 1 102 148 Pulmonary Females - — 1 3 19 23 17 7 7 2 3 82 102 Non-pulmonary Males 1 1 2 - - 1 4 — - 1 2 12 13 N on-pulmonary Females - 1 3 3 — 5 5 — - 1 1 19 23 93 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 7 9 11 5 - 35 Pulmonary Females — — — — 1 4 3 6 2 - — 16 Non-pulmonary Males — 3 3 3 2 2 1 2 — - - 16 Non-pulmonary Females 1 2 4 6 2 — 1 1 1 - — 17 Source of Information No. of Cases Pulmonary Nonpulmonary Death Returns from local Registrars 4 2 transferable deaths from Registrar General 5 5 Posthumous notifications 5 — "Transfers" from other areas (other than transferable deaths) 37 26 Other Sources, if any (specify) - - PART III. Notification Register. Pulmonary Non-pulmonary Total Cases Males Females Total Males Females Total Number of cases of Tuberculosis remaining at the 31st December, 1934, on the Registers of Notifications 427 309 736 142 192 334 1,070 Number of cases removed from the Registers) during the year by reason, inter alia, of:— 1. Withdrawal of notification 2 — 2 — — — 2 2. Recovery from the disease 10 11 21 8 3 11 32 3. Death 70 54 124 7 5 12 136 94 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 fifteen deaths from Pulmonary Tuberculosis were registered, against one hundred and forty-eight in the previous year, representing a death-rate of 0.9 per 1,000 compared with 1.0 in 1933. 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 thftir 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 1920-34, showing the interval between notification and death of tuberculous persons. 1920. 1921. 1922. 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1. Total number of deaths from Tuberculosis in the Borough 157 173 162 145 170 138 142 181 135 149 153 127 156 150 124 2. The number of cases notified at death 11 8 17 11 10 13 8 _ 7 3 7 2 6 13 5 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 21 4. The number of cases notified within three months of death (excluding above) 28 29 20 18 20 13 20 23 13 18 21 14 17 17 9 5. The number of cases notified within six months of death (excluding above) 16 9 16 13 16 18 12 18 9 8 9 11 15 16 11 95 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1984 :— Age Periods. New Cases. Deaths. Respiratoiy NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0 — — 1 — — — — 1 1 1 — 1 1 1 — — — 5 5 4 2 6 1 1 — — 15 24 42 1 5 10 23 3 1 25 38 24 4 5 22 16 — 1 45 33 9 1 L 1 26 8 1 1 65 and upwards 1 3 2 1 7 — 1 — Totals 102 82 12 19 67 48 5 4 The ratio of non-notified tuberculous deaths to the totai tuberculous deaths is 1 to 8. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not found necessary to take action under these regulations during the year under review. 96 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 Children. Tuesdays, 5.30 p.m. ... Men and Women (Workers only). Wednesdays, 2.30 p.m. ... Artificial Pneumothorax refill clinic. Thursdays, 5.30 p.m. ... Men and Women (Workers only). Fridays, 10.30 a.m. ... Men, Women and Children. Saturdays, 10 a.m. ... School Children. New Patients may attend at any of the Sessions. 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, 1984, the number of patients on the Dispensary Register was 715. During the year 76 definite cases of the disease were transferred from other areas into the Hammersmith district and 93 moved out of this district or were lost sight of. Thirty were written off the register as being cured cases who had previously been notified as suffering with tuberculosis. New Patients. During the year 750 persons attended for examination for the first time, 825 males and 425 females. Of these, 288 were under the age of fifteen and 517 were adults. Of the total 241 were referred to the Dispensary by local practitioners for the purpose of consultation and 896 were " contacts " of persons suffering with Tuberculosis. Patients attend 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. 97 Diagnosis. Found to have Pulmonary Tuberculosis 156 Found to have other forms of Tuberculosis 27 Showing no evidence of Tuberculosis 567 Total Attendances and Examinations. The total attendances of persons for the purpose of examination, observation or treatment, numbered 3,108 and physical examinations were carried out in 2,880 instances, i.e., in 77 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 31st December, 1934, was 759. Sputum Examinations. Five hundred and one specimens of sputum and other pathological products were examined bacteriologically. Fifty showed the presence of Tubercle Bacilli, while 450 proved negative. Institutional Treatment. The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homest, under the London County Council's Scheme, numbered 219. 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. 98 Clinical Reports. To the London County Council, numbered 627 To the Ministry of Pensions 6 To General Practitioners and Hospitals 842 Home Visitation. The Tuberculosis Officer made 241 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 130 occasions. The Nurses visit the tuberculosis population on notification and thereafter as far as possible at intervals of six months or less, as may appear advisable. During the year 4,147 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. Dr. G. I. Davies, the Deputy Medical Officer of Health and Tuberculosis Officer, gave an informal address on the "Modern Aspects of Tuberculosis" with its early diagnosis to medical practitioners practising in the Borough. The meeting was fairly well attended and the address was followed by questions and a general discussion. At the conclusion, thanks were accorded to Dr. Davies for his lecture. This meeting was arranged to secure the closer co-operation of medical practitioners in the campaign against tuberculosis. The Chair was taken by the Medical Officer of Health. 99 Return showing the work of the Dispensary during the year 1934. Diagnosis Pulmonary Non-pulmonary Total Grand Total Adults Children Adults Children Adults Children m. f. m. f. m. f. m. f. m. f. m. f. a —New Cases examined during the year (excluding contacts:- (a) Definitely tuberculous 71 57 2 2 5 10 3 3 76 67 5 5 153 (b) Diagnosis not completed — — — — — — — — — — 1 1 (c) Non-tuberculous — — — — — — — — 68 92 25 15 200 B.—Contacts examined during the years:- (a) Definitely tuberculous 8 13 2 1 1 — 2 3 9 13 4 4 20 (b) Diagnosis not completed — — — — — — — — — — — — — (e) Non-tuberculous — — — — — — — — 63 129 75 99 366 C.—Cases written off the Dispensary Register as:— (a) Recovered 6 8 2 2 1 3 6 2 7 11 8 4 30 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as culous) — — — — — — — — 132 221 101 114 568 D.—Number of Cases on Dispensary Register on December 31st:- (a) Definitely tuberculous 300 222 11 22 49 67 45 42 349 289 56 64 758 (b) Diagnosis not completed — — — — — — — — — — — 1 1 1. Number of cases on Dispensary Register on January 1st 715 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in prevous years 76 3. Number of cases transferred to other are is, cases not desiring further assistance under the scheme, and cases "lost sight of" 93 4. Cases written off during the year as Dead (all causes) 91 5. Number of attendances at the Dispensary (including contacts) 3,103 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 337 7. Number of consultations with medical practitioners:— (a) Personal 241 (b) Other 518 8. Number of visits by losis Officers to homes (including personal consultations) 371 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4,147 10. Number of:— (a) Specimens of sputum, &c., examined 501 (b) X-ray examinations made, in connection with dispensary work 141 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 342 PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 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 S Total (Class T.B. plua) (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 14 5 2 1 8 — 1 1 — 2 3 1 — 1 1 — — — — — — — — F. 4 1 — — 1 — 2 — — 2 — 1 — — 1 2 1 — — 1 — 1 — — 1 Children 5 — — — — 1 — — — — 1 — — — — — — — — — 1 — — — Disease not Arrested Adults M. 11 2 9 2 13 5 3 2 1 6 1 4 3 2 9 — 6 — 2 8 5 7 5 1 13 F. 4 — 4 — 4 5 1 3 1 5 4 — — — — 1 l 1 — 2 2 6 3 2 11 Children — — — — — — — — — — 1 — — — — 1 — — — — 1 — — — — Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 38 8 15 3 20 11 7 6 2 15 10 5 4 2 11 5 8 1 2 11 9 14 8 3 25 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 17 1 3 — 4 2 — — — — 1 — 2 — 2 3 3 — — 3 1 — — — — F. 19 3 2 — 5 5 1 — — 1 6 — — — — 1 — 1 — 1 4 1 — — 1 Children 13 — — — — — — — — — — — — — — — — — — — 1 — — — — Lost sight of, or otherwise removed from Dispensary Register 85 14 17 5 30 16 12 13 5 30 25 10 18 6 34 31 20 19 3 42 31 13 12 2 27 Dead Adults M. 3 1 4 5 10 5 5 17 13 35 1 5 15 31 51 2 4 16 13 33 10 7 13 10 30 F. 4 — 7 4 11 3 4 2 11 17 4 3 5 12 20 6 18 10 6 34 5 3 9 5 17 Children 2 — — — — — — — — — 2 — 1 — 1 2 — — — — — — — — — Total written off Dispensary Register 143 19 33 14 66 36 22 32 29 83 40 18 41 49 108 45 45 40 22 113 52 24 34 17 75 Grand Totals 181 27 48 17 92 47 29 38 31 98 50 23 45 51 119 50 53 47 23 124 61 38 42 20 100  1930 1931 1932 1933 1934 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adult M. 2 — 2 — 2 — — 1 — 1 — — — — — — — — — — — — — — — Children F. — — — — — 2 — — — — — — — — — — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — Disease not Arrested Adult M. 12 1 1 — 2 11 10 7 5 22 7 6 18 3 27 12 5 22 5 32 16 18 24 12 54 Children F. 11 — 4 3 7 10 6 11 1 18 10 5 12 1 18 12 9 21 1 31 21 12 18 2 32 3 1 1 — 2 1 1 — — 1 4 1 2 — 3 1 — 1 — 1 4 — 1 — 1 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 29 2 8 3 13 24 17 19 6 42 21 12 32 4 48 25 14 44 6 64 41 30 43 14 87 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adult M. — — — — — — — — — — — — — — — — — — — — — — — — — Children F. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 28 12 17 — 29 11 4 15 1 20 10 6 12 2 20 5 5 15 2 22 2 — 1 2 3 Dead M. 8 10 20 12 42 8 8 12 1 21 5 7 9 10 26 6 5 17 8 30 2 1 — 8 9 Children F. 10 8 10 5 23 5 4 10 2 10 3 7 8 1 16 3 3 9 6 18 3 — 6 7 13 — — — — — 1 — — — — 1 — — — — 1 — — — — 2 — — — — Total written off Dispensary Register 40 30 47 17 94 25 16 37 4 57 19 20 29 13 52 15 13 41 16 70 9 1 7 17 25 Grand Totals 75 32 55 20 107 49 33 56 10 99 40 32 61 17 110 40 27 85 22 134 50 31 50 31 112 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1934 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. 2 — — — 2 1 — — — 1 — — — — — 1 — — 1 2 2 — — — 2 F. 2 — — 1 3 — — — 2 2 — — — — — — — — — — 2 — — 1 3 Children 1 — — — 1 2 — — 2 4 — — — — — 1 — — 1 2 1 — 1 1 3 Disease not Arrested Adults M. — — 3 — 3 — — — 2 2 — — — — — 2 1 1 1 5 1 — 2 — 3 F. — — 2 5 7 — 1 1 1 3 2 — — — 2 — — 1 2 3 — 1 —_ 3 3 Children 1 — — 1 2 — — 1 — 1 — — — — — 2 — 2 — 4 1 — 1 — 2 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 6 — 5 7 18 3 1 2 7 13 2 — — — 2 6 1 4 5 16 7 1 4 4 16 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 — — — 1 1 — — — — — F. 2 1 1 5 9 — 3 — 2 5 1 1 — — 2 — — — — — — — — 1 1 Children 9 1 1 15 26 — 1 — 7 8 2 1 — 2 5 2 — — 6 8 — — — 2 2 Lost sight of, or otherwise removed from Dispensary Register 20 — 4 18 42 10 — — 7 17 8 1 3 3 18 3 — 2 6 11 2 — 7 7 16 Dead Adults M. 1 — — — 1 2 — — _ 2 1 — — — 1 1 — 1 — 2 1 — — — 1 F. — 1 — — 1 — — — 1 1 — — — — — — — — — — — — — — 2 — — — — — — 1 1 — 2 — — — — — 1 — — — 1 — — — — — Total written off Dispensary Register 35 3 9 38 85 13 5 1 17 36 13 3 3 9 28 7 — 3 13 23 5 7 10 22 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 41 3 14 45 103 16 6 24 49 15 3 3 9 30 13 1 7 18 39 12 1 11 14 38  1930 1931 1932 1933 1934 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — 1 1 — — — — — — — — — — — — — — — — — — — — Children 1 — — 2 3 — 1 — — 1 — — — — — — — — — — — — — — — Disease not Arrested Adults M. 3 2 1 6 4 — — 1 5 3 1 — 4 8 1 — 3 — 4 3 — 3 — 6 F. 2 — 1 3 6 5 — 1 4 10 2 — — 2 4 5 1 — 5 11 3 2 1 3 9 Children 4 — — 7 11 6 1 2 4 13 8 1 — 7 16 1 3 1 5 10 4 1 — 9 14 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 10 — 3 14 27 15 2 3 9 29 13 2 — 13 28 7 4 4 10 25 10 3 4 12 29 Transferred to Pulmonary (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — F. 1 — — 1 2 — — — — — — — — — — — — — — — — — — — — Children — — — 2 2 1 — — — 1 — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 12 2 — 4 18 5 4 — 7 16 3 — — 2 5 1 — 1 2 4 — — — 1 1 Dead Adults M. 1 — 1 — 2 — — — — — — — — — — — — — 1 1 — — — — — F. — 1 3 — 4 — 2 — — 2 — — — — — — — — — — — — 1 — 1 Children — — — — — — — — — — — — — — — — — — — — — — — 1 1 Total written off Dispensary Register 14 3 4 7 28 6 6 — 7 19 3 — — 2 5 1 — 1 3 5 — — 1 2 3 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 24 3 7 21 55 21 8 3 16 48 16 2 — 15 33 8 4 5 13 30 10 3 5 14 32 104 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 London Insurance Committee and the Local Medical Practitioners. The Committee met on 16 occasions during the year. For some years past it has been felt that patients have been reluctant to enter sanatoria because of their being called upon to make contributions towards the cost of their maintenance. The question has been the subject of discussion by the Public Health Committee and representations have been made to the London County Council and the Metropolitan Boroughs Standing Joint Committee recommending the admission of patients to sanatoria free of cost. The decision of the London County Council in August last to provide sanatorium treatment free of charge to patients is a further step in the advancement of the campaign against Tuberculosis. During the year two hundred and forty-one applications for residential treatment were submitted to the London County Council. Particulars of the financial position of the family are taken in each case so that suitable help can be rendered to necessitous cases. One hundred and thirty-nine cases were referred for assistance to the following agencies:— Invalid Children's Aid Association 20 Charity Organisation Society 14 British Red Cross Society 21 School Care Committee 11 Public Assistance Committee 52 Mayor's Fund 2 United Services Fund 10 Royal Naval Benevolent Society 2 Metropolitan Society for the Blind 1 Jewish Board of Guardians 2 Welfare Centre 2 Country Holiday Fund 2 105 Collection of payments, on behalf of the London County Council, up to August amount to £143 3s. 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. Nursing Comforts. The Hammersmith Borough Council has set aside an annual grant of £15, for the use of the Tuberculosis Care 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. &c. These articles are 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. Home nursing is provided by the District Nursing Association. The following Table shows the number of articles owned by the Borough Council as Nursing Comforts, and also the number of patients who have been granted the use of these articles. 106 Nursing Comforts. Articles. Quantity owned by the Borough Council. Number of Patients to whom Loaned. Number still on Loan. Bed Rests 10 12 7 Rubber Rings 3 10 2 Air Rings 3 3 2 Rubber Hot-Water Bottles 4 3 3 Bed Pans 6 1 1 Ice Bags 4 1 — Air or Water Bed 1 1 — Inhalers 6 — — Air Cushion 1 — — Aluminium Hot-Water Bottles 6 — — Bronchitis Kettles 6 — — Feeding Cups 6 — — Bed Sheets 2 — — Water Cushion 1 — — Repairs to Surgical Appliances. During the year four repairs were carried out to surgical appliances for necessitous patients. These repairs were arranged by the Dispensary and financial assistance was given from the Nursing Comforts Fund at the recommendation of the Tuberculosis After-Care Committee. In some cases the patients were able to pay for these necessary alterations themselves, but were advised by the Tuberculosis Officer and arrangements made by him to the manufacturers as to the special requirements. Report on Tuberculosis Work at the Hospital. During the year all Tuberculosis cases were transferred from the Hammersmith Hospital to St. Charles Hospital in the Borough of Kensington. Two wards, G.3 and H.3, have been allocated for the reception of male cases and Ward B.3 for female cases. These wards are used for Hammersmith patients and for those recommended from other Metropolitan Boroughs. 107 It is a regrettable fact that no hospital beds are available in the Borough of Hammersmith for Tuberculous patients, as more cases would accept hospital treatment if provided in their own 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, gab replacements, phrenic evulsion and sanocrysin, is carried out on suitable pulmonary cases, whilst plaster work and orthopaedic corrections form part of the routine of suitable surgical cases. In 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. 108 X-Ray Work. Dispensary eases requiring further investigation are referred to the X-ray department of the London County Council Hospital at Du Cane Road, W.12. Films of the chest and other regions are taken, and delivered to the Dispensary to be filed as permanent records of the respective cases. The Tuberculosis Officer makes his own reports on these skiagrams. This new scheme has proved a great saving in time to both the dispensary staff and the patient, whilst the interval between attendance and active treatment is greatly reduced. 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 141. Artificial Pneumothorax Treatment. All Borough cases in need of the continuation of this treatment are dealt with at a special refill clinic at the Dispensary on Wednesday afternoons. Workers unable to attend the afternoon session are dealt with at the evening clinic on Tuesdays at 7 p.m. 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 17. The total number of refills performed by the Tuberculosis Officer in the dispensary for the year 1934 was 228. 109 Previously a charge of 10s. 6d. per refill was payable by the Hammersmith Borough Council to Brompton Hospital for this treatment, so that an equivalent sum has been saved. The success of this clinic is now well established, and all future cases referred from institutions will be dealt with at the dispensary. X-ray control is carried out at the Hammersmith Hospital. "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. One sanocrysin injection was made during the year. 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. 110 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 three persons from the catacombs or graves in St. Mary's Cemetery. One body was removed to the Langney Cemetery near Eastbourne for re-interment, and two bodies were reinterred 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. (2) That freshly made ground lime be freely sprinkled over the coffin, the soil, or any matter that may be offensive, and in the case of the body removed to Eastbourne—the remains be contained in a wellpitched shell, and entirely surrounded by four inches of newly-made vegetable charcoal in powder. 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. 111 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. Bacteriologically the water was of a high standard, but some bathers complained of irritation of the eyes following bathing at the Lime Grove Baths. A sample of water was submitted to the Public Analyst, who reported the absence of free chlorine. During the winter months when the open-air bath at Blomfontein Road was closed, certain work was carried out with a view to preventing the growth of algae, from which considerable trouble had been experienced during the previous summer season. The whole of the inside of the bath was sprayed with an even suspension of white cement, so as to fill up all cracks and crevices and provide a smooth surface and one to which it would be less likely that the algae "spores" would adhere. During the summer season little or no trouble was experienced from algae. This may have been the result of the work which had been done to the bath, but other factors, such as difference in weather conditions, more extensive use of the water purification plant, &c., may have contributed to the improvement. SWIMMING POOL. A swimming pool was opened in "Playlands," Wood Lane, in August. The water was treated with a "Sterilizing and Cleansing Fluid." A sample was taken and submitted for bacteriological examination, which was reported to be satisfactory. 112 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. At the end of the year there were 122 foster-children in the care of 117 foster-mothers. The Lady Sanitary Inspector is responsible for visiting the homes of all foster-children. During the year 83 foster-mothers were removed from the register for various reasons and 49 new foster-mothers were registered. Twenty applications for registration were not approved. 113 A summary of the work carried out during the twelve months under review follows:— FOSTER-MOTHERS. No. of Foster-Mothers on Register December 31st, 1934 117 ,, ,, ,, Recommended for Registration 49 No. of Foster-Mothers removed from Register 83 (1) Lack of accommodation 7 (2) Removed from Borough 12 (3) Adopted Children 3 (4) Unsuitable 3 (5) 9 years of age 4 (6) Tuberculosis Contact 1 (7) Temporarily approved 2 (8) No further Foster-Children required 51 ,, Applications for Registration received but not Recommended 20 FOSTER-CHILDREN. No. of Foster Children on Register December 31st. 1934 122 „ „ ,, received by Foster-Mothers 140 ,, „ ,, moved from Foster-Mothers 159 (1) To Foster-Mothers 44 (2) To Parents or Guardians 59 (3) To Institutions 36 (4) Adopted 4 ,, Children removed from Borough with Foster-Mother 11 ,, Foster-Children who have reached the age of 9 years during the Year 5 VISITS. No. of visits to new Foster-Mothers 63 „ „ Registered Foster-Mothers 969 Verification Visits 7 Special Visits 112 Outs 194 Total Visits 1,345 114 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 1,551 Corrected Number of Births 1,783 These figures represent a Birth-rate per 1,000 of the population of the Borough of 13.8 Corrected Number of Deaths of Infants under one year, of whom 33 died under one week 137 Legitimate Infants 121, or 72 per 1,000 Births Illegitimate Infants 16, or 147 per 1,000 Births. Infant Mortality Bate per 1,000 Births 77 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: (а) Infant Welfare Centres. (b) Day Nurseries. (e) 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. (c) Homes for Unmarried Mothers and their Children. 115 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 338 628 476 311 1,753 Visits. First visits 278 577 436 301 1,592 Re-visits (under 1 year) 607 751 798 790 2,946 Re-visits (1-5 years) 847 311 608 688 2,454 Out 728 968 891 913 3,500 Removals 172 183 230 187 772 Special visits 130 152 90 300 672 Ophthalmiar-Neonatorum 1st visits 1 3 2 3 9 Ophthalmia ,, Re-visits — — — 3 3 Puerperal Fever — 1 1 — 2 Puerperal Pyrexia 3 5 3 4 15 Ante-natal—First visits 185 231 205 135 756 Ante-natal—Re-visits 73 33 43 54 203 Stillbirths 9 13 14 9 45 Infant Deaths 20 36 32 25 113 Measles 60 57 72 93 282 Pneumonia 3 6 2 6 17 Encephalitis Lethargica — 1 — 3 4 Chickenpox 14 9 2 15 40 Whooping Cough 13 1 5 12 31 Polio-Myelitis 1 — — — 1 Cerebro Spinal Meningitis 1 1 1 4 7 Total visits 3,145 3,334 3,435 3,550 13,464 Attendances at Infant Welfare Centres 98 101 152 80 431 Attendances at Ante-Natal Clinics 56 51 48 52 207 Attendances at Committee Meetings Voluntary Associations — 9 — — 9 Number of insanitary conditions reported 2 7 29 32 70 116 The feeding of the 1,592 infants visited was found to be as follows:— Breast-feeding 1,877 Artificial feeding 128 Mixed feeding 87 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 1934 1783 137 77 117 The infant mortality rates of the London Boroughs varied from 43 in Lewisham to 121 in the City of London. 118 Milk (Mothers and Children) Orders, 1918-1919.— Under these Orders the Council has continued to supply milk to necessitous cases, each case being investigated, especially as to the financial position, before a supply is granted. 18,192 lbs. of dried milk and 1,477 quarts of raw milk and '28 tins of Nestle's were distributed during the year. The number of applications for free milk has averaged 47 per week during the year. The total expenditure during the year was approximately £691. The amount of dried milk distributed during the year decreased by 4,784 lbs., raw milk increased by 247 quarts and Nestle's by four tins. There was a decreased cost of approximately £275. 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. Cod Liver Oil.—During the year arrangements were made whereby mothers could obtain small quantities of cod liver oil for their children. This was provided free to those mothers who were receiving free milk under the Maternity and Child Welfare Act. 119 The Medical Officers of the Clinics report that many children have greatly benefited since this provision was made. Circumcisions.—During the year fifty-eight 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. 120 "PARKSIDE" MATERNITY HOME. Name of Institution.—" Parkside " Maternity Home, Hammersmith Hospital, 150, Du Cane Road, W.12. (Home closed July, 1934.) Number of Beds.— 10: — Information Required. Particulars. (1) No of cases admitted during the year. 140. (2) Average duration of stay 14 days. (3) No of cases delivered by— (a) Midwives 129 and 1 born before admission. (b) Doctors 10. (4) No. of cases in which Medical Assistance was sought by a Midwife in emergency. 4. (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). 1. (6) No. of cases of Pemphigus Neonatorum. — (7) No. of Infants not entirely breastfed while in the Institution. 5. (8) No. of cases notified as Ophthalmia Neonatorum. — (9)—(a) No of Maternal deaths Nil. (b) Cause of death in each case (10)—(a) No. of Infant deaths— (i) Stillborn 4. (ii) Within 10 days of birth. 2. (b) Cause of death in each case. 1. 8 hours. P.M. held. Atelectasis. 2. 5½ hours. Microcephaly and immaturity; albuminuria and hyperpyesia of mother. 121 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 Charlottes Marylebone Road (1) No. of cases admitted during the year. 259. 20, (2) Average duration of stay 13•4 days. 15•7 days. (3) Number of cases delivered by— (a) Midwives 251. 16. (b) Doctors 8. 4. (c) B.B.A - - (4) No. of cases where Medical Assistance was sought by a Midwife in emergency. - 6. (5) No. of cases notified as — (a) Puerperal Fever 3. 1. (b) Puerperal Pyrexia. 2. — (6) No. of cases of Pemphigus Neonatorum. — — (7) No. of Infants not entirely breastfed while in the Institution. 36. 2. (8) No. of cases notified as Ophthalmia Neonatorum. — — (9) No. of Maternal deaths - 2. 1. P.M. Septic pneumonia. 2. P.M. Endocarditis. (10)—(a) No. of Infant deaths— (i) Stillborn 2. 3. (ii) Within 10 days of birth 9. 2. (b) Cause of death in each case. 1. Congenital heart. 2. Premature. 3. Premature. 4. Baby got much mucus in lung, soft head with large caput occiput cyanosed. 5. Premature. 6. Baby malformed Bilateral talipes carcaneous. Hydrocephalus (mild). Spina bifida. 7. P.M. Lungs but partially expanded. Everything else apparently normal except ossification of skull bones. 8 and 9. Premature twins. 1. Premature. 2. Premature. 26 weeks. Twenty 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. 122 Voluntary Work Aided by Borough Council. Infant Welfare Centres.—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. Schedule of Attendances at Infant Welfare Centres. Address of Clinic. No. of Clinics New Cases. Total Attendances. Mothers. Children. M others. Children. Antenatal. Postnatal. Under 1 yr. Over l yr. Antenatal. Postnatal. Under 1 yr. Over l yr. 48, Glenthorne Road 102 412 20 - - 1496 22 - - 48, Glenthorne Road 153 — — 354 46 — — 5416 2336 Victoria Mission Hall, Becklow Road 99 - - 202 17 - - 2824 916 St. Matthew's Hall, Blythe Road 103 - - 236 40 - - 2804 639 Old Oak Centre 102 303 29 — — 1209 47 — — Westway 100 — — 270 46 — — 3766 1240 Latymer Road Mission Blechynden Street 50 — 46 14 569 680 Presbyterian Hall, College Park 51 - - 36 2 — — 588 500 Totals 760 755 49 1144 165 2705 69 15967 6111 Ante-natal Clinics 204 Infant Consultations 556 760 123 The average attendances for the various centres are as follows:— Hammersmith Infant Welfare Centres 44 Latymer Mission 25 College Park Centre 21 In the latter centre 40 per cent. only are residents of the Borough of Hammersmith, the remainder being residents of the Borough of Willesden. Infant Welfare Centres. 48, Glenthorne Boad, W.6. Tuesdays, Thursdays and Fridays, 1.45 p.m. New Cases, 1.80 p.m. Toddlers' Clinic, alternate Wednesdays, 10.30 a.m. Victoria Hall, Becklow Road, W.12. Mondays, 1.30 p.m.; Wednesdays, 1.45 p.m. Old Oak Centre, The Curve, Westway, W.12. Mondays and Thursdays. 1.45 p.m. fit. Matthew's Parish Hall, Blythe Road, W.14. Tuesdays and Thursdays, 2 p.m. Presbyterian Church Hall, Ponsard Boad, N.W.10. Wednesdays, 2 p.m. Latymer Road Mission. Blechynden Street, W.ll. Tuesdays, 2 p.m. Ante-Natal Clinics. 48, Glenthorne Boad, W.6. Wednesdays, 2 p.m.; Fridays, 10.80 a.m. Old Oak Centre, The Curve, Westway, W.12. Wednesdays and Fridays, 2 p.m. Four Ante-Natal Clinics 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. 124 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 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 all 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 42 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. Independent Voluntary Agencies. Rescue Homes.—There were three Homes open in the Borough throughout the year for the reception of Unmarried Mothers and their Children; the total accommodation available for such cases was 87 beds. Convalescent Treatment of Invalid Children.—This work was carried on by the Invalid Children's Aid Association; the majority of children assisted are of school age, and a considerable number were sent to Convalescent Homes during the year. Treatment and Nursing of Children under School Age. —The treatment of children under five years of age was 125 continued at the School Clinics. During the year the cases dealt with were as follows:— Operation for Tonsils and Adenoids 1 Minor Ailments 28 Dental Treatment - Total 24 In addition arrangements were made, as before, with the Hammersmith District Nursing Association for the services of a nurse when required, to ensure adequate attention in cases of Ophthalmia Neonatorum, Pneumonia and Measles. Infectious Diseases of Mothers and Children Under Five Years of Age. Statistics showing the incidence of all infectious diseases during the year are included in the general report, but in so far as they relate particularly to diseases of parturient women and children under five years of age, are tabulated below:— Disease. No. of Cases Notified. Previous Year. No. of Cases Visited. No. of Cases Nursed. No. of Cases Removed to Hospital. Puerperal Fever 2 2 2 - 2 Puerperal Pyrexia 22 33 22 - 20 Ophthalmia Neonatorum 11 10 11 3 3 Epidemic Diarrhæa* 30 20 - 1 - Measles & German Measles (under 5)† 628 83 628 63 240 Whooping Cough (under 5)† 153 167 153 10 61 Poliomyelitis (under 5) 1 2 1 - 1 * Summer Diarrhcea.—As this is not a notifiable disease the figures available are those of deaths which were registered as having been due to this cause. † Not notifiable diseases. 126 Ophthalmia Neonatorum.—The number of cases reported was eleven against ten in the previous year. The analysis of the final reports received is as follows:— Cases. Vision unimpaired. Vision Impaired. Total Blindness. Removed from District. Still under Treatment. Deaths. Notified. Treated. At Home. In Hospital. 26.2.34 1 1 10.3.34 1 — 1 — — — — — 27.3.34 1 — 1 — — — — — 4.6.34 1 — 1 — — — — — 16.7.34 — — 1 — — — — — 7.8.34 1 — 1 — — — — — 22.8.34 — 1 1 — — — — — 15.9.34 1 — 1 — — — — — 24.9.34 1 — — — — 1 — — 27.9.34 1 — 1 — — — — — 5.12.34 — 1 — — — — 1 — 8 3 8 — — 2 1 — All notified cases of diseases of parturient women and children under five years of age are visited immediately, and arrangements made for the attendance of a nurse where required. SANITARY ADMINISTRATION. Staff.—There are nine male Sanitary Inspectors and one lady Sanitary Inspector. Eight of the male Inspectors are employed as District Inspectors, being responsible for all matters excepting the 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 127 were received for certificates under the above Act. In all cases the certificates were granted. Seven certificates were granted to owners who had carried out the work specified satisfactorily. Public Mortuary.—Four hundred and thirty-nine bodies were removed to the Mortuary in Fulham Palace Road during the year. Public Mortuary.—Four hundred and thirty-nine bodies were removed to the Mortuary in Fulham Palace Road during the year. Hammersmith— Admitted by order of Coronor 160 Admitted by order of Police 13 Admitted on application of undertakers for accommodation 32 205 Bodies admitted from other Boroughs:— Fulham 108 Chelsea 126 234 No. of P.-M. examinations conducted:— Hammersmith cases 155 Fulham cases 53 Chelsea cases 62 Total P.M.'s 270 No. of Inquests held:— Hammersmith cases 112 Fulham cases 83 Chelsea cases 118 Total Inquests held 313 During the year the Council had before them the question of the keeping of bodies at the Public Mortuary. The Council's Mortuary, which was built many years ago, was provided with Charcoal Chambers. The Mortuary Keeper called attention to the difficulty experienced in keeping the bodies and stated that the abnormal warm weather had emphasized the necessity for the installation of a refrigeration plant for the purpose of arresting the decomposition thereof. 128 The Council has now installed a refrigeration plant which provides accommodation for twelve bodies. The installation consists of two chambers, one of which is known as a one-chamber compartment and provides accommodation for nine bodies, and a separate chamber for special caseB requiring extra low temperature with a capacity for three bodies.