C.1 AC 4347 M HAM 27 Metropolitan Borough of Hammersmith. ANNUAL REPORT OF THE Medical Officer of Health FOR THE YEAR 1935. INDEX Page Introduction 2 Staff of the Public Health Department 4 Statistics fob the Year, 1935 7 Natural and Social Conditions of the District. Births 3 Chart—Diarrhoea 12 Diarrhoea 11 Deaths 9 Deaths of Infants 10 Deaths of Illegitimate Children 14 Deaths of Aged Persons 14 Deaths of Residents (Outlying) 15 Deaths (Various Causes) 18 Hospital Treatment—Zymotic Enteritis 14 Infant Mortality for 1935 11 Marriages 8 Population 8 Statistics 15 Stillbirths 9 Table—Whole of London—Comparison 19 General Provision of Health Services in the Borough. Ambulance Facilities 20 Hospitals (Public) 23 Hospitals (Voluntary) 24 Laboratory Facilities 20 Professional Nursing in the Home— General 21 Nursing 21 Rheumatism Advisory Clinic 22 School Clinics 21 Treatment Centre for Venereal Diseases 23 Tuberculosis Dispensary 22 Treatment and Nursing—Children under School Age 23 (a) Operations. (6) Minor Ailments, (c) Dental Treatment. Maternity and Child Welfare. Ante-natal Clinics 35 Chart—Infantile Mortality Rate 30 Circumcisions 32 Cod Liver Oil 31 Convalescent Treatment of Invalid Children 36 Day Nurseries 40 Domiciliary Midwifery Service 41 Feeding of Infants—Statistics 28 Health Visitors—Work of 28 Infectious Diseases of Mothers, and Children under five years of age—Tabular Statement 36 Page Institutional Treatment for Unmarried Mothers 38 "Invermead" Maternity Home—Statistics 33 Maternity Services—Reorganisation of 40 Maternal Mortality 38 Midwives 40 Milk (Mothers and Children) Orders, 1918-1919 31 Ophthalmia Neonatorum 37 Schedule of Attendances at Infant Welfare Centres 34 Sessions—Infant Welfare Centres 35 Table—Births, Deaths, and Infant Death Hate 29 Infant Life Protection 43 Sanitary Circumstances of the Borough. Closet Accommodation 45 Common Lodging Houses 59 Fouling of Footpaths by Dogs 45 Hammersmith Borough Council By-laws—Dogs 45 Inspections 47 Notices 48 Sanitary Inspection of Area 46 Scavenging 45 Seamen's Lodging Houses 59 Summonses 49 London County Council (General Powers) Act, 1928. Persons Living under Insanitary Conditions 43 Factories and Workshops—Inspection of 54 House to House 57 Houses Let in Lodgings 59 Ice Cream Vendors 43 Bag Flock Acts, 1911 and 1928 61 Bats and Mice (Destruction) Act, 1919 58 Schools 60 Smoke Abatement 57 Tenement Houses 59 Vans 60 Housing. Closing Orders 66 General Housing Conditions 64 Newly Erected Houses 65 Statistics 61 Supply of Houses—Overcrowding 64 Survey—Housing Act, 1935 63 Slum Clearance 66 Inspection and Supervision of Food. Bakehouses 73 Butter, Margarine, Lard and Suet 87 Certification of Certain Food Products for Export 68 Page Cheese 87 Chemical and Bacteriological Examination oi Food 77 Cocoa, Coffee and Tea 89 Condensed Milk 84 Cordials, Wines and Spirits 92 Condiments, &c 90 Conserves, Vegetables, Fruits, &c 88 Cream 84 Drugs 93 Farinaceous Foods 90 Food and Drugs Adulteration Act, 1928 99 Food Supplies 67 Ice Cream Vendors 76 Ins Markets 71 Meat and Fish Preparations 88 Milk 82 Milk Supply 67 Milk (Special Designations) Order, 1923 68 Miscellaneous Samples 93 Offensive Trades—Slaughterers of Poultry 71 Samples—Adulterated 94 Slaughterhouses 70 Street Trading 72 Sugar, Sweets and Jellies 91 Soups 88 Unsound Food 76 Prevalence and Control over Infectious Diseases. Acute Polio-myelitis 110 Anthrax 111 Anti-toxin 101 Artificial Pneumothorax Treatment 136 Bacteriology 98 Cerebro-Spinal Meningitis 110 Chicken Pox 111 Cholera 101 Cleansing of Verminous Persons 114 Continued Fever 110 Diphtheria 101 Diphtheria—Chart 108 Diphtheria Immunisation 102 Disinfection 115 Dysentery 113 Encephalitis Lethargica 110 Enteric Fever 107 Page Erysipelas 107 Food Poisoning 113 Glanders 111 Hydrophobia 111 Influenza 113 Malaria 113 Measles and German Measles 111 Measles—Chart 112 Notifiable Diseases 116 Nursing Comforts 133 Ophthalmia Neonatorum 110 Plague 101 Pneumonia 113 Public Health (Smallpox) Regulations, 1917 119 Public Health (Prevention of Tuberculosis) Regulations, 1925 123 Puerperal Fever 110 Puerperal Pyrexia 110 Psittacosis 111 Rabies Order, 1919 111 Relapsing Fever 110 Report on Tuberculosis Work at Hammersmith Hospital 135 Sanocrysin Treatment 137 Scarlet Fever 107 Scarlet Fever—Chart 109 Smallpox 101 Tabular Statement—Zymotic Diseases 116 Tuberculosis 119 Tuberculosis Care Committee 132 Tuberculosis Dispensary 123 Typhus Fever 107 Vaccination 115 Vaccination Returns 117 Whooping Cough Ill Whooping Cough—Chart 112 Wrong Diagnosis 113 X-Ray Work 136 Zymotic Diseases 99 Prevention of Blindness 137 Sanitary Administration. Staff 139 Increases of Rent and Mortgage Interest Restrictions Acts, 1920-23 139 Exhumation and Re-interment of Bodies 140 Public Baths 140 Public Wash-houses 141 Propaganda 141 Shops Act, 1934 141 Public Mortuary 144 Metropolitan Borough of Hammersmith. ANNUAL REPORT of the Medical Officer of Health for the YEAR 1935. 2 Pcblio 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 1935. 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 11.9 being 1.0 less than the previous year. The infantile mortality rate has decreased from 77 to 70 per 1,000 births. The lowest rate was 61 per 1,000 births in 1927. Generally speaking there was a decrease in the rates of nearly every London Borough. The rate for the County of London decreased from 67 to 58 per 1,000 births. The infantile mortality rate of the Borough is very unsatisfactory—the rate being 12 per thousand greater than the average for London. In 23 Boroughs the infantile mortality rate ranges between 43 and 69—there being only 5 Boroughs with a higher mortality rate than Hammersmith. This question is therefore one which calls for careful consideration. In my opinion the Health Visiting staff of this Council is too small and home visitation, as a consequence, is not being carried out as efficiently as it should be. This is a very important part of the Health Visitors' work and it is essential that provision should be made for this to be carried out. During the year your Council decided to cancel the arrangements made for the admission of maternity cases to "Invermead," as it was felt that the provisions made, for the reception and treatment of maternity cases at the Hammersmith Hospital, were such that Hammersmith mothers should be encouraged to seek admission thereto. 8 Maternal deaths were reduced to two, one following an abortion at three months. The rate was equal to 1.1. A satisfactory reduction. The rate for the whole country being 3.93. The efforts of your Council have been, as in the past, considerably augmented by those of the Voluntary Societies engaged in this branch of the Public Health Services of the Borough. With regard to infectious diseases, the total number notified was below the average for the past 10 years. This was due to the decrease in number of cases of measles, diphtheria and scarlet fever. The scheme for immunisation of children against diphtheria has been in operation since February, and it is satisfactory to record that 1,170 children have been dealt with under the scheme. The housing survey which was carried out during the year has brought to light a definite amount of overcrowding. An account appears in the later pages of this report. For some years very little house-to-house inspection has been carried out owing to the increased duties placed upon the Department by Legislation. As a result, the general housing conditions of the Borough are unsatisfactory. The majority of houses are let in tenements and there are many streets needing inspection. This can only be accomplished by the appointment of additional Sanitary Inspectors so that a systematic house-to-house inspection can be put into operation. I desire to express my appreciation of the kindness and consideration shown to me by the Chairman and members of the Public Health and Maternity and Child Welfare Committees, and to record my thanks to the members of the staff for their loyal co-operation. 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 1935. MEDICAL OFFICER OF HEALTH Administrative Officer for Tuberculosis, and Maternity and Child Welfare. Vaccination Officer. J. B. Howell, M.R.C.S., L.R.C.P., D.P.H. Year of Appointment 1914 Tuberculosis Officer and Deputy Medical Officer of Health. G. I. Davies, M.D., B.S., M.R.C.S., L.R.C.P., D.P.H 1930 Consultant Gynæcologists. Lady Florence Elizabeth Barrett, M.D., M.S. S'. Forsdike, M.D., F.R.C.S. A. Goodwin, M.D., F.R.C.S. L. H. W. Williams, M.D., F.R.C.S. Public Vaccinators (Part time). D. F. Durward, M.R.C.S., L.R.C.P. A. R. Dale, M.R.C.S., L.R.C.P. J. W. Brash, M.R.C.S.. L.R.C.P. J. S. Dockrill, B.A., M.B., B.Ch., B.A.O., D.P.H. 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. Elworthv, M.D., M.R.C.P., M.U 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. Colo 1923 A. H. Johns 1925 F. G. Holland 1929 T. J. Hares 1930 E. F. Yorke 1931 Miss V. Steadman 1935 Sanitary Inspectors. §*A. Hayes 1910 §*F. Q. Barry 1919 = §*W. Rigby 1919 §*P. W. Pottier (Food and Drugs Inspector) 1919 †§*E. J. Nether 1926 = §*P. T. Bayes 1926 + §*W. J. Godden 1926 °†§*F. W. Mason 1926 §ǿG. W. Herrick 1929 Lady Sanitary Inspector and Infant Life Protection Visitor. ||□"ǿMiss E. M. Cross 1932 Health Visitors. "||□†*Miss R. A. Henry 1916 ||□*Miss A. M. M. Willcox 1916 "||Miss D. G. Johnson 1922 ǿ"||□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. §Cert- Royal Sanitary Institute (Meat and other foods). || Trained Nurse. "Cert. Royal Sanitary Institute (Health Visitor). °Royal Sanitary Institute (Smoke Certificate). ¶Apothecaries' Hall Certificate. ǿCert. Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. = Smoke Abatement Cert. L.C.C. School of Engineering 7 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1935. Area 2,282.5 acres Population (1933) (estimated) 131,400 Population Census (1901) 112,239 (1911) 121,521 (1921) 130,295 (1931) 135,521 Natural increase, i.e., excess of births over deaths 353 Density of population 56.1 persons per acre Marriages registered 1,375 Number of inhabited houses 1931 17,402 Number of families or separate occupiers (1921) 33,268 Rateable value (1935) £1,223,277 Sum represented by a penny rate, 1935 £4,702 Vital Statistics. Births (legitimate) 1,738 Birth rate 14.7 ,, (illegitimate) 139 Stillbirths 72 ( Rate per 1,000 (live and still) births 37 Deaths (corrected) 1,524 Death rate 11.9 Adjusted death rate 12.3 Deaths from puerperal causes:- Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 0.5 Other puerperal causes 1 0.5 Total 2 1.0 Deaths of infants under one year of age per 1,000 births 70 Legitimate, 66. Illegitimate, 115. Deaths from measles (all ages) 0 Deaths from whooping cough (all ages) 7 Deaths from diarrhoea (under 2 years of age) 28 8 Population.—According to the Census of 1901, the population of the Borough was then 112,239. By the Census of 1911 the population was 121,521 showing an increase during the 10 years of 9,282. The Census of 1921 shows the population of the Borough to be 130,295, being an increase in the 10 years of 8,774. The Census of 1931 shows the population of the Borough to be 135,521, being an increase in the 10 years of 5,226. In this report the rates are calculated on the estimated population adopted by the Registrar-General, i.e., 128,100. The corrected number of births registered was 1,877, whilst the corrected number of deaths of residents was 1,524, thus showing a natural increase of population by excess of births over deaths of 353. The area of the Borough is 2,282.5 acres, there being 56.1 persons to the acre. Marriages.—The number of marriages registered during the year was 1,875, the marriage-rate being 21. Births.—During the year 1,774 births were registered in the Borough. Adding 438 births which occurred, outside the Borough, transferred by the Registrar-General as belonging to Hammersmith, and deducting 335 births which occurred in the Borough, and transferred to other districts by the Registrar-General, the corrected number of births for the year was 1,877. On the estimated population, i.e., 128.100, the corrected number of births registered was equal to an annual rate of 14.7 births per 1,000 persons living. The Birth-rate for the year is 0.9 per 1,000 greater than the rate for the previous year which was 13.8. The Birth-rate in London on the estimated population, i.e., 4,185,200, was equal to an annual rate of 13.3 births per 1,000 persons living. 9 Notification of Births Act, 1907. Births notified 2,235 Corrected number of births 1,877 Notification Received from Midwives. Doctors. Lying in Hospitals and Nursing Homes. L.C.C. Institutions. Parents. M.O.H.'s. 725 89 697 697 — i 27 Stillbirths.—Seventy-two stillbirths were allocated to this Borough. Fifty-eight were registered in the Borough, of which number nine were outward transfers. Twenty-three were born outside the Borough and were transferred by the Registrar-General. Deaths.—During the year 1,347 deaths were registered in the Borough, as compared with 1,359 in the previous year. Adding 560 deaths of residents of this Borough which occurred in general hospitals and other public institutions, and 23 deaths of residents transferred by the Registrar-General as having occurred in various parts of England, and deducting 395 deaths of non-residents and 11 transferable deaths which occurred in the Borough, the corrected number of deaths of residents was 1,524 (786 males, 738 females). On the estimated population, i.e., 128,100, the corrected number of deaths of residents was equal to an annual rate of 11.9 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 population 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 deathrate gives a rate of 12.2, 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., 4,185,200, was equal to an annual rate of 11.4 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 131, as compared with 137 in the previous year. The number of deaths of infants under one year of age was equal to 70 per 1,000 of the corrected births. The number of deaths of infants under one year of age, residents in London, was equal to 58 per 1,000 of the total registered births. The mortality rate of infants under one year of age was twelve per thousand greater in this Borough than in London. A large proportion of the deaths (52), equal to 40 per cent., died in the first month, and of these forty-three occurred in the first week, practically all of which may be ascribed to natal and pre-natal causes. 11 This points out the necessity for greater attention to and control of the expectant mother and better obstetrics if these deaths are to be avoided. Enteritis was responsible for the deaths of 27 babies and pneumonia 18. These may be very properly ascribed to lack of knowledge on the part of the mother in the problems of infant feeding and "mothering." The following table shows the deaths of infants under one year of age and the cause:— INFANT MORTALITY, 1935. Infantile Mortality during the year 1935. 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 undar 4 Weeks. 4 Weeks, and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 1 year. Total Deaths under 1 Year. ALL CAUSES. Certified 43 5 1 3 52 28 26 19 6 131 Uncertified - - - - - - - - - - Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - - 1 3 1 5 Diphtheria and Croup - - - - - - - 1 - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not T.B.) - - - - - - 2 - - 2 Convulsions - 1 - - 1 1 - - - 2 Laryngitis - - - - - - - - - - Bronchitis 1 - - - 1 1 2 - - 4 Pneumonia (all forms) - 1 - 1 2 7 4 4 1 18 Diarrhoea - - - - - - - - - - Enteritis - - - 2 2 7 11 7 1 28 Gastritis - - - - - - - - - - Syphilis - 1 - - 1 - 1 - - 2 Rickets - - - - - - - - - - Suffocation, Overlying - - - - - - - - - - Injury at Birth 5 - - - 5 - - - - 5 Atelectasis 6 - - - 6 - - - - 6 Congenital Malformations 3 - - - 3 1 1 1 1 7 Premature Births 20 1 1 - 22 2 1 - - 25 Atrophy, Debility & Marasmus 4 - - - 4 4 2 - 1 11 Other causes 4 1 - - 5 5 1 3 1 15 Totals 43 5 1 3 52 28 26 19 6 131 Nett Births in the Year: Legitimate. 1738; Illegitimate. 139 Nett Deaths in the Year of: Legitimate Infanta, 115; T'legitimate Infants, 16. 12 The following table gives the births and infant deathrates in England and Wales, London and Hammersmith and the wards of the Borough for the year 1985:— District. 1935. No. of Births. No. of Deaths of Children under 1 year of age. Infant Mortality Rate. England and Wales 598,756 34,089 57 London 55,780 3,229 58 The Borough 1,877 131 70 North Hammersmith 1,035 76 73 South Hammersmith 842 55 65 WARDS River 157 10 64 Brook Green 403 25 62 Grove 282 20 71 St. Stephen's 190 11 58 Starch Green 320 27 84 Wormholt.. 385 30 78 Latimer and College Park 140 8 57 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 80. Twenty-eight were children under one year of age. 18 The following Chart shows the number of deaths from Diarrhoea per 100,000 inhabitants, 1911-1934. 14 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 115 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 66 per 1,000 whilst the latter is 115 per 1,000, a difference of 49 per 1,000. Deaths of Aged Persons.—The corrected number of deaths of residents at 65 years of age and upwards registered during the year was 705, against 783 in the previous year. These deaths were equal to 5.5 per 1,000 of the total persons living, and 463 per 1,000 of the total deaths of residents registered. 15 Statistics.—The following table gives the statistics of the Borough during 1935 and previous years:— Vital Statistics of Whole District during 193S 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 Birth-. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1922 134400 2564 2758 20.5 1223 9.1 196 705 196 71 1733 12-9 1923 133600 2571 2701 20.2 981 7.3 125 649 173 64 1473 11.0 1924 134200 2199 2399 17.9 1123 8.4 173 718 173 72 1668 12.4 1925 134500 2178 2351 17.5 1034 7.7 186 756 153 65 1604 11.9 1926 134400 2001 2188 16.3 1174 8.7 195 556 144 66 1535 11.4 1927 132800 1789 2076 15.6 1581 11.9 230 377 126 61 1728 13.0 1928 136300 1938 2258 16.6 1449 10.6 222 326 156 69 1553 11.4 1929 136900 1869 2162 15.8 1757 12.8 222 340 133 62 1875 13.7 1930 136900 1962 2173 15.9 1387 10.1 219 436 140 64 1604 11.7 1931 135100 1954 2073 15.3 1567 11.6 288 373 140 68 1652 12.2 1932 133700 1795 1940 14.5 1465 10.9 294 543 129 66 1714 12.8 1933 131400 1682 1827 13.9 1500 11.4 340 530 119 65 1690 12.9 1934 129170 1551 1783 13.8 1359 10.5 346 655 137 77 1668 12.9 1935 128100 1774 1877 14.7 1347 10.5 406 583 131 70 1524 11.9 Deaths of Residents.—Belonging to the Borough, occurring in Public Institutions, &c., in districts outside, during the year 1985 :— FEVER HOSPITALS. Western Hospital, Fulham ... 11 South Western Hospital, Stockwell 2 North-Eastern Hospital, Tottenham 1 17 Grove Hospital, Tooting 3 16 MENTAL HOSPITALS. 1, West Park Road, Epsom 8 Horton Hospital, Epsom 7 1, Bexley Lane, Dartford 1 Darenth Training Colony 1 Tooting Bec Hospital 6 1, Uxbridge Road, Southall 12 The Hospital, Coulsdon 1 Leavesden Mental Hospital, Watford 3 The Grove, Horton Lane, Epsom 4 Brentwood Mental Hospital 1 The Hospital, Chartham 1 51 GENERAL HOSPITALS, NURSING HOMES, &c. St. George's Hospital 6 Elizabeth Garrett Anderson Hospital 1 Cancer Hospital 3 Grove Park Hospital, Chislehurst 2 Infants' Hospital, Westminster 3 St. Bartholomew's Hospital, City of London 1 Middlesex Hospital 3 Queen Mary's Hospital, Chislehurst 1 Old Court, Hangar Lane, Ealing 1 All Saints' Hospital, Southwark 1 Queen Charlotte's Hospital, St. Marylebone 3 Radium Institute, Riding House Street 1 20, Glazbury Road, Fulham 2 Royal Hospital, Richmond 2 Brompton Hospital 1 Catholic Nursing Institute, Southwark 1 53, Barrowgate Road, Chiswick 1 Italian Hospital 1 National Sanatorium, Benenden, Cranbrook 1 Sunny Lodge, Mount Park, Harrow 1 Royal Free Hospital, St. Pancras 1 Victoria Hospital, Chelsea 3 77 Bromley Road, Beekenham 1 Guy's Hospital, Southwark 1 St. Mary's Hospital, Paddington 4 Acton Hospital 2 Northern Hospital, Southgate 4 St. Joseph's Hospital, Chiswick 1 St. Luke's Hospital Paddington 3 Putney Hospital, Wandsworth 1 Charing Cross Hospital 2 West End Hospital, St. Pancras 2 Children's Hospital, Great Ormond Street 5 High Wood Hospital, Brentwood 1 Sheffield Street Hospital, Westminster 1 9, Chiswick Lane 1 53, Castlebar Road, Ealing 1 Municipal Hospital, Bournemouth 1 St. Luke's Hospital, Lowestoft 1 General Hospital. Harrogate 1 Children's Hospital, Paddington Green 1 London Jewish Hospital, Stepney Green 1 Homoeopathic Hospital, Great Ormond Street. 2 Cromwell House, Highgate 1 National Hospital for Diseases of the Heart 1 National Hospital, Queen Square 2 Colindale Hospital 3 Princess Louise Hospital, Kensington 9 153, Lower Clapton Road, Hackney 1 Queen Mary's Hospital, Wandsworth 2 Gordon Hospital, Westminster 1 Royal Victoria Hospital, Folkestone 1 Metropolitan Hospital, Hackney 1 King Edward's Memorial Hospital, Ealing 1 Chollacott Nursing Home, Lowestoft 1 25, Carlton Road, Wandsworth 1 Royal Naval Hospital, Plymouth 1 Chiswick Hospital 1 Metropolitan Hospital, Caterham 1 106 17 PUBLIC INSTITUTIONS. '28, Marloes Road, Kensington 108 2a, Bow Road, Poplar 4 Fulham Hospital 22 St. Peter's Hospital, Stepney 1 Warkworth House, Heston 2 The Grove, Shardlow 1 Lambeth Hosptal 4 Lewisham Hospital 1 '250, King's Road, Chelsea 1 93, Sydney Street, Chelsea 11 26, Wolverton Avenue, Kingston 1 73a, Devons Road, Poplar 1 Redhill House, Hendon 1 St. Stephen's Hospital, Chelsea 14 la, Shepherdess Walk, Shoreditch 1 164, St. John's Hill, Battersea 4 '2a, Woolwich Road, Greenwich 1 182, Westmoreland Road Southwark 1 The Infirmary, Friern Barnet l 12, Exmoor Street, Kensington 169 St. Pancras Hospital 6 Paddington Hospital 9 372 Hillingdon County Hospital 2 17, Wellhouse Lane, Barnet 1 VARIOUS. 173, Sandycombe Road, North Sheen 1 46, Winchester Avenue, Kingsbury 1 101, Firs Avenue, Cranford 1 353, Lillie Road, Fulham 1 47, Powis Square, Kensington 1 Hendon Way, near Hendon Central 1 On way to St. Mary's Hospital, Paddington 2 On the way and near Homoeopathic Hospital 1 64, Holland Park 1 309, Preston Old Road, Blackburn 1 Lancaster Court Hotel, 66, Lancaster Gate 1 Hever House, Marine Parade, Hastings 1 Brookiands, Slough Road, Datchet 1 In the River Thames at Eton, Bucks 1 Stoketon Cottage, Salt ash 1 Homewood, Pirton Road, Hitchin 1 On the way to and near Princess Beatrice Hospital 1 Columbine, Old Fort Road, Shoreham by Sea 1 On the way and near to Middlesex Hospital 1 In the Ambulance, Hounslow Hospital 1 In River Thames, off Grosvenor Road 1 River Thames 1 1101, Queensmill Road, Fulham 1 On the way and near to 12, Exmoor Street 1 Found dead on towpath of River Thames at Barnes 2 River Tees, near Teesport, Grangetown 1 In River Thames at Barnes 1 H.M. Prison, Wandsworth 1 17, Labworth Road, Canvey Island 1 Devonshire Bow Mews, Devonshire Street, W.l 1 The River Thames. The Flam, Cockmarsh, Cookham 1 "Dungog," Curlyon Road, Beaconsfield 1 Main Line, L.M.S. Railway, near No. 1 Signal Box, Edgeley Station, Stockport 1 London-Oxford Road, Denham, Bucks 1 Floating in River Thames, off Dawney's Wharf, Battersea 1 37 18 Causes of, and Ages at, Death during the Year 1935. CAUSES OF DEATH. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Causes M 786 85 7 10 23 28 35 50 97 152 148 151 F 738 46 2 3 12 34 26 39 67 103 147 259 1 Typhoid and Paratyphoid Fever M .. .. .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. .. .. 1 .. .. .. .. 2 Measles M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 3 Scarlet Fever M 2 .. .. .. 2 .. .. .. .. .. .. .. F 1 .. .. .. .. .. .. 1 .. .. .. .. 4 Whooping Cough M 2 1 1 .. .. .. .. .. .. .. .. .. F 5 4 1 .. .. .. .. .. .. .. .. .. 5 Diphtheria M 6 .. .. 3 3 .. .. .. .. .. .. .. F 6 1 .. 2 2 1 .. .. .. .. .. .. 6 Influenza M 2 .. .. .. .. 1 .. .. .. .. 1 .. F .. .. .. .. .. .. .. .. .. 2 .. 4 7 Encephalitis Lethargica M 1 .. .. .. .. .. .. 1 .. .. .. F 3 .. .. .. .. .. .. 1 .. .. 2 .. 8 Cerebo-spinal Fever M 1 1 .. .. .. .. .. .. .. .. .. .. F 1 1 .. .. .. .. .. .. .. .. .. .. 9 Tuberculosis of Respiratory System M 62 .. .. .. .. 12 13 11 15 9 2 .. F 48 .. .. .. .. 20 11 10 5 2 .. .. 10 Other Tubercu- lous Diseases M 6 .. .. 2 1 2 .. 1 .. .. .. .. F 3 .. .. .. 1 1 1 .. .. .. .. .. 11 Syphilis M 6 2 .. .. .. .. .. .. 1 3 .. .. F 3 .. .. .. .. .. .. .. 1 2 .. .. 12 General Paralysis of the insane, tabes dorsalis M 8 .. .. . .. .. .. 2 1 4 1 .. F .. .. .. .. .. .. .. .. .. .. .. .. 13 Cancer, malignant disease M 117 .. .. .. .. .. 1 7 20 37 38 14 F 99 .. .. .. .. .. 1 6 16 29 26 21 14 Diabetes M 8 .. .. .. .. .. .. 3 .. 2 .. 3 F 7 .. .. .. .. .. .. .. .. 2 3 2 15 Cerebral Haemorrhage, &c. M 25 .. .. .. .. .. .. .. 2 6 11 6 F 34 .. .. .. .. .. .. .. 1 6 11 16 16 Heart Disease M 147 .. .. 1 2 .. 1 7 19 24 41 52 F 213 .. .. .. 2 1 4 6 15 23 60 102 17 Aneurysm M 7 .. .. .. .. .. .. .. 3 4 .. .. F 4 .. .. .. .. 1 .. 1 .. 1 1 .. 18 Other circulatory M 42 .. .. .. .. 1 .. 1 1 9 12 18 F 47 .. .. .. .. .. .. .. 3 4 11 29 19 Bronchitis M 36 3 .. .. .. .. 1 2 6 9 6 9 F 17 .. .. .. .. .. .. 1 .. 2 2 12 20 Pneumonia (all forms) M 49 11 4 1 1 .. 1 4 3 8 10 6 F 38 7 1 .. 1 1 1 2 8 5 4 8 21 Other Respiratory Diseases M .. .. .. .. .. 1 1 .. .. 1 1 .. F 8 .. .. .. .. 1 .. .. .. .. 4 3 22 Peptic Ulcer M 13 .. .. .. .. .. 2 1 5 1 2 2 F 6 .. .. .. .. .. .. .. 1 2 2 1 23 Diarrhoea, &c. M 21 21 .. .. .. .. .. .. .. .. .. .. F .. 7 .. .. .. .. .. .. .. .. .. .. 24 Appendicitis M 9 .. .. 1 1 .. 1 1 2 2 .. 1 F 7 .. .. .. 1 1 .. .. 2 2 1 .. 25 Cirrhosis of Liver M 6 .. .. .. .. 1 .. .. 1 2 1 1 F 2 .. .. .. .. .. .. .. 1 .. 1 .. 26 Other Diseases of Liver, &c. M 1 .. .. .. .. .. .. .. .. 1 .. .. F 3 .. .. .. .. .. .. .. 1 1 .. 1 27 Other Digestive Diseases M 16 3 1 1 1 .. 1 2 1 2 2 2 F 16 5 .. .. 1 .. .. 1 3 2 .. 4 28 Acute and Chronic Nephritis M 18 1 .. .. 2 1 .. 1 2 5 3 3 F 12 .. .. 1 1 1 .. .. 1 4 1 3 29 Puerperal Sepsis F 1 .. .. .. .. .. .. 1 .. .. .. .. 30 Other Puerperal Causes F 1 .. .. .. .. .. 1 .. .. .. .. .. 31 Congenital Debility, Premature Birth, Malformations, &c. M 40 37 .. .. 1 .. 1 .. .. 1 .. .. F 17 17 .. .. .. .. .. .. .. .. .. .. 32 Senility m 11 .. .. .. .. .. .. .. .. .. .. 11 F 34 .. .. .. .. .. .. .. .. .. 2 32 33 Suicide M 11 .. .. .. .. .. 2 .. 3 3 3 .. F 10 .. .. .. .. .. 1 1 1 5 2 .. 34 Other violence M 42 1 .. .. 7 7 6 1 4 5 4 7 F 25 2 .. .. 1 3 2 .. 1 2 6 8 35 Other defined diseases M 63 4 1 .. 2 .. .. .. .. .. 10 15 F 51 2 .. .. 2 3 4 7 7 6 8 12 36 Causes ill-defined, or unknown M 1 .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Total 1,524 131 9 13 35 62 61 89 164 255 295 410 19 This rate is calculated on the estimated population of each Ward. Ward. Estimated Population. No. of Deaths. Death Rate. No. 1 River 16,899 226 13.4 No. 2 Brook Green 24,537 315 12.8 No. 3 The Grove 21,882 266 12.2 No. 4 St. Stephens 8,802 111 12.6 No. 5 Starch Green 21,706 233 10.7 No. 6 Wormholt 22,719 263 11.6 No. 7 College Park and Latimer 11,655 110 9.5 LONDON AND METROPOLITAN BOROUGHS. Cities and Boroughs. Estimated Resident population (mid-1935). Live Births rate per 1,000 population. Death rate per 1,000 population : Infantile Mortality rate per 1,000 lire births. Crude. Adjusted. County of London 4,185,200 13.3 11..4 - 58 West Districts. Paddington 138,600 14.2 12.1 12.0 71 Kensington 178,300 12.4 12.1 11.3 79 Hammersmith 128.100 14.7 11.9 12.3 70 Fulham 113,600 13.8 11.6 11.7 51 Chelsea 57,320 10.2 12.6 10.7 60 City of Westminster 124,400 8.3 11.5 11.8 72 North Districts. St. Marylebone 92,200 9.7 11.8 11.7 56 Hampstead 90,600 11.0 11.2 10.5 49 St. Pancras 185.300 13.3 12.0 12.2 63 Islington 308,170 14.9 — 11.0 52 Stoke Newington 50,210 13.9 11.1 10.6 51 Hackney 210,600 14.0 10.6 11.1 48 Central Districts. Holhorn 35,400 7.7 11.9 12.7 89 Finsbury 63,100 14.7 12.6 13.7 59 City of London 9,360 7.6 11.0 12.2 113 East Districts. Shoreditch 88,400 14.0 11.3 12.4 52 Bethnal Green 99,910 14.4 10.3 11.6 51 Stepney 211.500 14.3 11.3 12.8 63 Poplar 143,700 15.4 11.0 12.3 46 South Districts. South wark 156,100 14.8 — 12.4 66 Bermondsey 102,700 14.5 11.7 13.3 69 Lambeth 279,900 13.7 12.2 12.0 59 Battersea 148,200 14.2 12.0 11.9 65 Wandsworth 343,300 11.0 11.0 10.2 55 Camberwell 234,400 13.4 11.8 11.8 60 Dcptford 99,500 14.4 11.1 11.5 52 Greenwich 96,600 13.9 10.8 11.0 59 Lewisham 223,000 12.5 9.9 10.0 43 Woolwich 146,400 14.0 10.2 10.8 44 20 GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. 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. 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.) 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. 21 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 Maternity Homes. 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 Eoad. 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 SCHOOL CLINICS. The L.C.C. Hammersmith School Treatment Centre, 108, Shepherd's Bush Road, is provided by the Hammer— smith District Nursing Association, who receive grants from the London County Council. 22 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 Road, by the London County Council for the treatment of school children. TUBERCULOSIS DISPENSARY. Hammersmith Tuberculosis Dispensary, Ravenscourt Park. The above Dispensary is provided by the Borough Council (see page 123). Grants are received from the Ministry of Health and the London County Council. RHEUMATISM ADVISORY CLINIC. Princess Louise Kensington Hospital for Children. The Council discontinued the grant to the above Hospital from the 31st March, 1935. During the year 52 Hammersmith patients were treated at the Clinic, 13 being admitted as in.patients and 39 as out.patients. Total number of attendances, 1935 144. 23 TREATMENT CENTRE TOR VENEREAL DISEASES. West London Hospital, Hammersmith Road. The above centre is provided under the scheme of the London County Council. This centre is open night and day. Treatment and Nursing of Children under School Age. —The treatment of children under five years of age was continued at the School Clinics. During the year the cases dealt with were as follows :— Operation for Tonsils and Adenoids — Minor Ailments 13 Dental Treatment — Total 18 HOSPITALS—PUBLIC. Name Hammersmith Hospital. Situation:—Du Cane Road, Shepherd's Bush, W.12. Purpose:—General. No. of available beds:—360. If used by persons resident outside the area, in what proportion:—No. Management:—London County Council. No. of beds available for each sex for the following services:— M. F. General Medical 75 78 General Surgical 78 55 Children — — Maternity — 43 Tuberculosis 3 3 Chronic sick — — Gynaecological — 25 24 Facilities available for:— (1) Operative Surgery.—Yes. (2) X.ray.—Yes. (3) Dental.—Yes. (4) Ophthalmic.—Yes. (5) Massage.—Yes. Arrangements for pathological work:—Own laboratories, British Post.graduate Medical School. No. of patients during 1935Admissions = 4,663. 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 24 24 General Surgical 63 53 Children, (Mixed) 31 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:— I 2 Major Operation Theatres. (1) Operative Surgery.—Minor (2) X.Ray.—Diagnostic and Therapeutic Departments. (3) Dental.—Clinics held twice weekly in Out.patients' Department. (4) Ophthalmic.—Three afternoons a week in Out— patients' Department. (5) Massage.—Department open daily. 25 Arrangements for pathological work:—Pathological and Bio.chemical Laboratories. No. of patients during 1934:—4,381 in.patients and 42,192 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:—llavenscourt Square and Goldhawk Itoad. Purpose:— (а) *Treatment of and research into Puerperal Sepsis. (б) fNormal 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:— (a) *5 per cent. Hammersmith Residents. (b) +45 „ „ „ 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) XhRay—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 1935 :—354 Maternity, 289 Puerperal Sepsis. 26 Name :—St. John's Hospital for Skin Diseases. Situation:—262, Uxbridge Road, W.12. Purpose :—For Skin Diseases. No. of available beds —40. If used by persons resident outside the area, in what proportion:—Mostly outside area. Management:—The Board of Management for St. John's Hospital for Diseases of the Skin. No. of beds available for each sex for the following services:— M. F. Skin Diseases l9 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, 5, Lisle Street. No. of patients during 1935:—299 in.patients. Is the hospital provision for the area adequatei— Yes. \ Name —Royal Masonic Hospital. The Royal Masonic Hospital provides accommodation for paying patients, primarily of limited means, being Free— masons, their wives and dependent children. The number of beds available is 145 to be increased to 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. Five 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. No. of patients during 1935 :—1,579. 27 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 1,774 Corrected Number of Births 1,877 These figures represent a Birth.rate per 1,000 of the population of the Borough of 14.7 Corrected Number of Deaths of Infants under one year, of whom 43 died under one week 131 Legitimate Infants 115, or 66 per 1,000 Births. Illegitimate Infants 16, or 115 per 1,000 Births. Infant Mortality Rate per 1,000 Births 70 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 Ante.Natal Clinics. (c) Supply of Milk to necessitous Mothers and Young Children. (d) Provision of Consultants. (e) Provision of Maternity Outfits. 2. Activities of Voluntary Agencies in receipt of grants. in.aid from the Borough Council: (a) Infant Welfare Centres. (b) Day Nurseries. (c) Treatment and Nursing of Children under School Age. (d) Rheumatism Clinic. 8. Activities of independent Voluntary Agencies : (а) Rescue Homes. (б) Convalescent Treatment for Invalid Children (c) Homes for Unmarried Mothers and their Children. Health Visitors—Visits. The Health Visitors were engaged, as in former years, in visits of enquiry to Births, Infant Deaths, cases of 28 Ophthalmia Neonatorum, Puerperal Fever, and other diseases of mothers and young children; they have also taken an active part in the work of the Voluntary Infant Welfare Centres. The visits paid are enumerated in detail below:— . District. Total No. 1. No. 2. No. 3. No. 4. Number of Births notified Visits. 312 677 756 371 2,110 First visits 312 565 435 358 1,670 Re.visits (under 1 year) 880 900 1,078 944 3,802 Re.visits (1.5 years) 600 320 457 647 2,024 Out 738 1,126 844 1,033 3,741 Removals 142 138 205 206 691 Special visits 191 176 32 292 691 Ophthalmia.Neonatoium 1st visits 3 1 — — 4 Ophthalmia. „ Re.visits —. — — — — Puerperal Fever — — 2 — 2 Puerperal Pyrexia 2 2 6 4 14 Ante.natal—First visits 125 254 156 168 703 Ante.natal—Re.visits 93 40 40 61 234 Stillbirths 10 22 10 14 56 Infant Deaths 18 31 32 20 101 Measles 1 — — 1 2 Pneumonia 1 — — 3 4 Encephalitis Lethargica — 1 1 — 2 Chickenpox 1 — 1 4 6 Whooping Cough 13 9 7 9 38 Polio.Myelitis — — 1 — 1 Cerebro Spinal Meningitis Epidemic Diarrhcea 1 1 — 2 4 Total visits 3,131 3,586 3,307 3,766 13,790 Attendances at Infant Welfare Centres 115 107 153 63 438 Attendances at Ante.Natal Clinics 51 54 51 53 209 Attendances at Committee Meetings — 10 — — 10 Voluntary Associations Number of insanitary conditions reported — 11 12 18 41 Schick Test Clinics 15 2 2 19 The feeding of the 1,670 infants visited was found to be as follows:— Breast.feeding 1,465 Artificial feeding 123 Mixed feeding 89 29 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 Inliants. 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 1935 1877 131 70 30 The infant mortality rates of the London Boroughs varied from 113 in the City of London to 48 in Lewisham. The following Chart shows the Infantile Mortality rate for the years 1903.1935. 31 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. 11,104 lb. of dried milk and 5,611 quarts of raw milk and 8 tins of Nestle's were distributed during the year. The number of applications for free milk has averaged 44 per week during the year. The total expenditure during the year was approximately £664. The amount of dried milk distributed during the year decreased by 2,088 lb., raw milk increased by 4,184 quarts, and Nestle's decreased by twenty tins. There was a decreased cost of approximately £27. 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 Tnfant 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 other— wise. The arrangements whereby the Tnfant Welfare Centres are supplied with dried milk for distribution has been con— tinued. 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. 32 The Medical Officers of the Clinics report that many children have greatly benefited since this provision was made. Circumcisions.—During the year arrangements were made for cases to be referred by the Medical Officers of the Infant Welfare Centres to the Hammersmith Hospital instead of the West London Hospital. Thirty.five cases were referred to the West London Hospital. Fifty.two cases were referred to the Hammersmith Hospital. A fee of 2s. 6d. was paid to the West London Hospital, but no charge will be made by the London County Council in respect of the cases dealt with at Hammersmith Hospital. 33 Queen Charlotte's Auxiliary Hospital, " Invermead," Goldhawk Road, W.12, 10 beds reserved for Hammer— smith Borough Council cases. (Discontinued July, 1935) Information Required. Particulars. Invermead, Queen Charlottes Goldhawk Road. Marylebone Road (1) No. of cases admitted during the year. 159. 37. (2) Average duration of stay 14.4 days. 13 "6 days. (3) Number of cases delivered by— (a) Midwives 148. 28. (b) Doctors 7. 9. (c) B.B.A — — (4) No. of cases where Medical Assistance was sought by a Midwife in emergency. 4. — (5) No. of cases notified as — (a) Puerperal Fever 2. (b) Puerperal Pyrexia. — — (6) No. of cases of Pemphigus Neo— natorum. — — (7) No. of Infants not entirely breast— fed while in the Institution. 19. 4. (8) No. of cases notified as Oph— thalmia Neonatorum. — — (9) No. of Maternal deaths — — (10)—(a) No. of Infant deaths— (i) Stillborn 4. 5. (ii) Within 10 days of birth 3. 1. (b) Cause of death in each case. 1. Had five convul— sions, became ex— tremely cyanosed, collapsed and died. 2. Premature. 3. Premature. 1. P.M.Atelectasis Cerebral CEdema. Thirty.seven patients booked for " Invermead " were admitted to Queen Charlotte's Hospital, Marylebone Eoad, on the advice of the Medical Officers in charge of the antenatal clinic. 34 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 o! Attendances at Infant Welfare Centres. Address of Clinic. No. of Clinics New Cases. Total Attendances. Mothers. Children. Mothers. Children. Antenatal. Postnatal. Under 1 yr. Over 1 yr. Antenatal. Postnatal. Under 1 yr. Over 1 yr. 48, Glenthorne Road 101 404 17 1460 19 48, Glenthorne Road .. 152 — — 388 30 — — 5783 1907 Victoria Mission Hall, Becklow Road 98 205 22 3070 1066 ESt. Matthew's Hall, Blythe Road 102 292 52 4406 1158 Old Oak Centre 101 247 30 — — 896 54 Westway 98 — — 287 41 — — 4109 1263 Latymer Road Mission Blechynden Street ... 49 55 17 763 636 Presbyterian Hall, College Park 48 — — 27 7 — — 475 310 Totals 749 651 47 1254 169 2356 73 18606 6340 Ante.natal Clinics 202 Infant Consultations 547 749 35 The average attendances for the various centres are as follows :— Hammersmith Infant Welfare Centres ... 34 Latymer Mission 25 College Park Centre 22 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 Road, W.6. Tuesdays, Thursdays and Fridays, 1.45 p.m. New Cases, 1.30 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. St. Matthew's Parish Hall, Blvthe Road, W.14. Tuesdays and Thursdays, 2 p.m. Presbyterian Church Hall, Ponsard Road, N.W.10. Wednesdays, 2 p.m. Latymer Road Mission, Blechynden Street, W.l 1. Tuesdays, 2 p.m. Ante.Natal Clinics. 48, Glenthorne Road, W.6. Wednesdays, 2 p.m.; Fridays, 10.30 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. 36 Any expectant mother being resident in the Borough may attend. Reports are furnished to hospitals, doctors and midwives in respect of their respective patients. Should any abnormality be discovered patients are advised to attend 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 continues to be 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. Convalescent Treatment ol Invalid Children.—This work was carried on by the Invalid Children's Aid Assosiation; the majority of children assisted are of school age, and a considerable number were sent to Convalescent Homes during the year. 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 : 37 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 Ophthalmia 19 22 14 — 19 Neonatorum Epidemic 11 11 11 1 8 Diarrhcea* 30 30 — 1 — Measles & German Measles (under 5)+ 13 628 13 — 8 Whooping Cough (under 5)t 167 163 167 1 59 Poliomyelitis (under 5) 2 1 2 — 2 * Summer Diarrhcea.—As this is not a notifiable disease the figures available are those of deaths which were registered as having been Jue to this cause. I Not notifiable diseases Ophthalmia Neonatorum.—The number of cases reported was eleven against eleven in the previous year. The analysis of the final reports received is as follows :— Cases. Vision unimpaired. Vision Impaired. Total Blindness. Removed from Dis trict. Still under Treatment. Deaths. Notified. Treated. At Home. In Hospital. 30.1.35 1 — 1 — — — — — 9.3.35 i 1 — — — — — 1.4.35 — i 1 — — — — — 18.6.35 1 — 1 — — — — — 22.6.35 — 1 1 — — — — — 28.6.35 — 1 — — — 1 — — 1.11.35 — 1 1 — — — — — 15.11.35 — 1 1 — — — — 25.11.35 — 1 — — — 1 — — 12.12.35 — 1 1 — — — — — 21.12.35 — 1 — — — — 1 — 2 9 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. 38 INSTITUTIONAL TREATMENT FOR UNMARRIED MOTHERS. St. Margaret's Hostel, 466, Uxbridge Road, W.12.— Accommodation for 10 mothers and their infants. This hostel is conducted by a voluntary society towards which the 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 sub— scriptions. Jewish Hostel for Girls, Charcroft House, Roseford Gardens, W.12.—Accommodation, 19 beds and 18 cots. This hoatel 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 Hammer— smith . (2) The medical practitioners immediately notify the Medical Officer of Health that they have called in the services of the Consultants, giving the name and address of the patient, date of call, the reason and the result. (8) The Borough Council pay the fees of the Consultant, but where the financial position justifies it, the patient will be asked to pay a portion or the whole of the fee. No consultant was called in during the year. 39 Maternal Deaths.—During the year two maternal deaths occurred, one from Puerperal Sepsis and one 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. (8) Description of Labour and Puerperium. (4) Remarks of Medical Officer of Health. Special information is obtained in cases of abortion, toxaemias of pregnancy, haemorrhage, difficult labour and puerperal sepsis. The number of Maternal Deaths during the past fifteen years is as follows Year. Number of Deaths Number of live Births. Maternal Death Rate. Puerperal Sepsis Other Accidents of Pregnancy. 1920 6 6 3,312 3.3 1N1 2 10 2,779 4.3 11122 4 5 2,758 33 1923 5 3 2,701 3.0 1924 4 4 2,399 3.3 1925 6 7 2,351 5.5 1926 3 4 2.188 3.2 1927 3 4 2,076 3.4 1928 5 5 2,258 4.4 1929 5 2 2,162 3.3 1930 4 5 2,173 4.1 1931 2 5 2,073 3.4 1932 3 4 1,940 3.6 1933 6 2 1,827 4.4 1W 4 5 1,783 5.0 1935 1 1 1,877 1.1 40 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. Midwives. The London County Council is the supervising authority under this heading. I am informed by the County Medical Officer of Health that 41 midwives gave notice of their intention to practise in the Borough during 1935. Reorganisation of Maternity Services. In July, I submitted a report relating to the additional obstetric and other services available as a result of the opening of the British Post.Graduate School at Hammer— smith Hospital and the effect of these on the services for which the Council is responsible. In view of the exceptional facilities available at the Hospital, the installation of the very latest equipment and the ready co.operation of the medical, surgical and obstetric 41 units, it was confidently anticipated that practically all Hammersmith mothers wishing to be confined in an institution would seek admission for their confinement. Six part.time medical officers were engaged on Maternity and Child Welfare work at the Infant Welfare Centres in the Borough, and although the doctors were experienced and capable there were many disadvantages in this part. time service. For these reasons and having regard to the relatively high maternal and infant death.rates, I recommended that the services provided at the Infant Welfare Centres and the Ante.natal Clinics should be re.organised. Whole.time officers are better able to secure co.operation between the Council and the Voluntary Organisations devoted to Public Health, Social and Maternity and Child Welfare work. On my recommendation the Council decided to appoint two Assistant Medical Officers for Maternity and Child Welfare work. In view of the provision of this service by the Borough Council, the annual grants to the Voluntary Associations were revised and approved by the Ministry of Health. The Assistant Medical Officers will commence their duties on the 1st April, 1986. I have also been in touch with Sir Frederick Menzies, the Chief Medical Officer for the London County Council, and Professor Young, of the Post.Graduate Medical School 42 at Hammersmith Hospital, and suggested that the services of the Hospital Staff shall be placed at the disposal of the Midwives and Medical Practitioners in cases of abnormality or difficulty. This proposal was well received, and it is hoped to complete a scheme whereby this may be put into operation. Domiciliary Midwifery Service. Following the Report of the Midwifery Services Committee appointed by the Joint Council of Midwifery to consider the whole question of the remuneration of the midwives as bearing on the efficiency of the midwifery service, &c. I recommended the Council to immediately proceed to make provision for a Domiciliary Midwifery Service. I pointed out that this could be done very conveniently by arrangement with the Hammersmith District Nursing Association, which was already responsible for carrying out domiciliary nursing for the Council under the Public Health Acts and Maternity and Child Welfare Scheme. As a result, the Council has entered into an agreement with the Hammersmith District Nursing Association for the services of a properly trained midwife to attend cases booked for home confinements. The midwife also attends the Council's Ante.natal Clinics where expectant mothers are kept under observation. She will thereby be in close touch with her patients from the early stages of pregnancy until delivery. This arrangement will also relieve the Health Visitors from attending two Ante.natal Clinics. This service will come into operation on 1st April, 1936. 43 INFANT LIFE PROTECTION. Children and Young Persons Acts, 1908.1932. At the end of the year there were 104 foster.children in the care of 97 foster.mothers. Fourteen foster.mothers were on the register but without foster children at end of year. The Lady Sanitary Inspector is responsible for visiting the homes of all foster.children. During the year 47 foster.mothers were removed from the register for various reasons and 41 new foster.mothers were registered. Twenty.one applications for registration were not approved. A summary of the work carried out during the twelve months under review follows :— FOSTER.MOTHERS. No. of Foster.Mothers on Register December 31st, 1935 111 >t (( „ Recommended for Registration 41 No. of Foster.Mothers removed from Register _47 (1) Removed from Borough 6 (2) Adopted Children 2 (3) Unsuitable 1 (4) 9 years of age 10 (5) Temporarily approved 3 (6) No further Foster.Children required 24 (7) Illness of Foster Mothers 1 ,, Applications for Registration received but not Recom— mended 21 44 FOSTER.CHILDREN. No. of Foster Children on Register December 31st, 1936 104 „ „ ,, received by Foster.Mothers 129 ,, „ „ moved from Foster.Mothers 147 (1) To Foster.Mothers . 33 (2) To Parents or Guardians 62 (3) To Institutions 31 (4) Adopted 4 „ Children removed from Borough with Foster.Mother 4 ,, Foster.Children who have reached the age of 9 years during the Year 12 „ Died . 1 VISITS. No. of visits to new Foster.Mothers 44 „ „ Registered Foster.Mothers 1180 Verification Visits 14 Special Visits 63 Outs 269 Total Visits 1,550 45 SANITARY CIRCUMSTANCES OF THE BOROUGH. Closet Accommodation.—There are as far as is known no privies in the Borough, all houses being provided with proper water-closets on the water carriage system. Scavenging.—The arrangements for the removal and disposal of house refuse include the use of both motor and horse-drawn vehicles. Throughout the Borough, there are quite a number of ashpits. This means of depositing house refuse is not only out of date, but in the majority of cases leads to nuisances arising. In all cases which come before the Public Health Department, the owners are advised to close the same, and provide proper metal receptacles in accordance with the L.C.C. Bye-laws FOULING OF FOOTPATHS BY DOGS. In September, J 922, 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. 1332, and Section 16 of the Local Government Act, 1333. 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. 46 Any person offending against the foregoing Bye-law shall be liable to a penalty not exceeding forty shillings. During the year under review seven summonses were taken, when fines of 10s. were imposed in four cases. £1 in one case, £2 in one case, and one case being dismissed on payment of 2s. costs. Sanitary Inspection of the Area.—During the year 43,634 inspections were made by the Sanitary Inspectors. Fifty-seven 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 over— crowded conditions still exist. 47 Inspections.—The following table shows the number of visits made in each district under the various inspection head :— NUMBER OF INSPECTIONS MADE DURING 1935. Cause of inspection. Districts. 1 2 3 4 5 6 7 3 Lady Sanitary Inspector Food and Drugs Inspector Total. Infectious Disease 100 127 30 32 235 166 133 102 322 3 1,916 Complaints 602 590 525 623 504 717 436 603 393 ... 5,053 Tenement Houses 20 1 •• .. .. 3 ... ... ... ... 24 House to House 31 19 46 44 41 7 60 53 ... ... 306 Housing Acts 124 64 94 103 35 1 .. 2 ... ... 473 House to House Consolidated Regulations 35 15 ... ... 12 ... •• 11 ... ... 73 Shops Act, 1934 42 127 31 50 23 127 29 133 ... ... 572 Food (other than Restaurants and Eating Houses) 46 291 197 363 146 102 553 261 ... 1,333 3,357 Restaurants and Eating Houses 44 74 56 43 17 43 122 66 ... 103 573 Markets 36 36 236 65 32 196 29 294 ... 610 1,534 Slaughterhouses ... ... 94 57 ... 3 ... •• ... 1 155 Poultry Slaughterhouses .. ... 10 ... ... ... ... ... ... ... 2 12 Bakehouses 11 41 34 51 52 36 22 13 ... 54 319 Milk Vendors 67 123 61 131 75 26 42 73 ... 447 1,040 Ice Cream Vendors .. 4 1 ... ... ... ... ... ... 199 204 Factories (including Factory Laundries) 54 59 23 36 16 37 29 135 59 ... 443 Workshops (including Workshop Laundries) 14 25 .. 34 5 14 14 23 54 •• 133 Workplaces (other than Outworkers) 5 19 21 29 1 6 3 34 47 •• 165 Outworkers ... 1 ... 1 ... ... ... ... 106 .. 103 Public Urinals 125 223 59 34 123 210 132 151 12 ... 1,074 Smoke Observations ... 39 1 3 16 32 ... 12... ... 153 Drainage 1,160 1,454 1,161 997 793 642 631 617 ... ... 7,455 Miscellaneous 163 497 40 379 190 216 325 131 52 445 2,993 Re-visits 2,209 1,222 1,301 1,314 1,519 1,917 1,572 2,276 31 ... 13,911 Infant Life Protection ... ... ... ... ... ... ... ... 1,550 ... 1,550 Common Lodging Houses ... ... 23 ... ... ... ... ... ... ... 23 Totals 4,339 5,066 4,034 ,4,954 3,390 4,556 4,742 5,065 3,131 3,257 43,634 48 Notices.—The following table shows the number of Preliminary Notices served and complied with during the year :— Notices Served. Notices complied with. Infectious Diseases 241 329 Complaints 2,443 167 2.295 House to House 266 House to House Consolidated Regulations 13 30 Food (other than Restaurants) 36 35 Restaurants, &c. 2<5 22 Bakehouses 13 10 Milk Vendors 5 5 Ice Cream Vendors — Factories 19 19 Workshops 13 12 Workplaces 19 24 Outworkers 1 1 Public Urinals 4 3 Smoke Observations 16 — Drainage 67 43 Miscellaneous 107 64 Re-visits 502 439 Common Lodging Houses 1 1 Tenement Houses 3 4 Housing Acts — 3 Infant Life Protection 3 3 Shops Act, 1934 112 31 Markets 1 — Total 3,330 3,699 During the year 1,393 Statutory Notices were served and 1,221 complied with. In many instances it was necessary to take proceedings in order to enforce compliance with Notices served. 49 The following table shows the result of proceedings taken:— SUMMONSES—YEAR 1935. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 5, Elric Street Failing to comply with Statutory Notice 2 Withdrawn. 10s. 6d. costs 25, Stamford Brook Road ditto 1 Withdrawn. 10s. 6d. costs 2, Chester Terrace ditto 1 Withdrawn. 10s. 6d. costs 96, Devonport Road ditto 1 W ithdrawn 13, Somerset Place ditto Withdrawn. 10s. 6d. costs 23, Letchford Gardens ditto 1 Order made 14 days 24, Rowan Road ditto Construction of waste pipe Failing to give notice 1 Fined 10s. 1 Fined 10s. 43, Woodstock Road Failing to comply with Statutory Notice 1 Withdrawn. 10s. 6d. costs 124, Beck low Road ditto 2 Withdrawn 37, Davisville Road ditto 3 Withdrawn 9, Goodwin Road ditto 3 1. Fined £1 2. Order made 14 days 3. Fined £1 11, Goodwin Road ditto 4 1. Fined £1 2. Fined £1 3. Fined £1 4. Fined £1 13, Goodwin Road ditto 1 Fined £1 15, Goodwin Road ditto 1 Fined £1 Goldhawk Road Unlawful removal of offensive mat— ter 1 Dismissed 2, Olaf Street Dwellings Failing to comply with Statutory Notice 1 Order made 7 days 205, Latymer Road ditto 2 1. Withdrawn 2. Order made 14 days 207, Latymer Road ditto 1 Withdrawn 49, Netherwood Road Construction of waste pipe 1 Withdrawn. 10s. 6d. costs 37, Poplar Grove ditto 1 Withdrawn ditto ditto 1 Withdrawn ditto Failing to give notice 1 Fined 10s. 72, RayleighRoad Failing to comply with Statutory Notice 1 Withdrawn. 10s. 6d. costs 50 Summonses—continued. Situation of Premises. Nature of Offence. No. of Sum— monses. Result of Proceedings. 77, Cobbold Road Failing to comply with Statutory Notice 1 Withdrawn 29, Southbrook Street ditto 1 Withdrawn 12, Hetton Street ditto 1 Withdrawn 17, Goodwin Road ditto 3 1. Fined £3 2. Fined £3 3. Fined £3 19, Goodwin Road ditto ] Order made 14 days 93, Goldhawk Road ditto 2 1. Withdrawn. 10s. 6d. costs 2. Withdrawn. 10s. 6d. costs 45, Stebbing Street ditto 2 Withdrawn 93, Goldhawk Road ditto 1 Withdrawn 2, Loris Road Construction of waste pipe 1 Withdrawn ditto Failing to give notice 1 Withdrawn 64, RayleighRoad Failing to comply with Statutory Notice 2 1. Order made 23 days 2. Fined £1 1, Adie Road ditto 2 1. Withdrawn. 10s. 6d. costs 2. Withdrawn. 10s. 6d. costs 21, Oaklands Grove Failing to give notice Fined 10s. ditto Construction of waste pipe Fined 10s. Goldhawk Road Unlawful removal of offensive mat— ter 1 Fined £1 ditto ditto 1 Dismissed with a caution. Case proved J 60, Percy Road Failing to comply with Statutory Notice Withdrawn 64, Wendell Road ditto 1 Withdrawn 9, Goodwin Road ditto Withdrawn 19, Goodwin Road ditto 1 Withdrawn 120, Uxbridge Road ditto 1. Order made 14 days 2. Fined £2 35, Richmond Road Failing to give notice 1 Withdrawn. 10s. 6d. costs ditto Construction of waste pipe 1 Withdrawn. 10s. 6d. costs 51 Summonses—continued. Situation of Premises. Nature of Offence. No of Summouse?. Result of Proceedings. Goldhawk Road Unlawful removal of offensive mat— ter 2 1. Fined 10s. 2. Fined 10s. 45, Maclise Road Failing to comply with Statutory Notice Withdrawn 21, Oakland* Grove ditto 1 Fined £2 3, Hanover Cottages ditto 1 Withdrawn. 5s. costs 22, Havelock Road ditto 1. Order made 14 days 2. Fined 10s. 2, Sinclair Road Failing to deposit plans Fined 5s. 4, Sinclair Road ditto 1 Fined 5s. 2, Olaf Street Dwellings Failing to comply with Statutory Notice Fined 33s. 43, Gratton Road ditto Order made 14 days 375, Latymer Road Preventing owner from obeying Sanitary Notice Withdrawn on defen— dants undertaking to allow work to proceed 96, Rayleigh Road Failing to comply with Statutory Notice Order made 14 days 12, Cromwell Grove Failing to give notice 1 Fined 10s. ditto Construction of waste pipe 1 Fined 10s. 55, Milson Road Failing to comply with Statutory Notice 2 1. Fined £2 2. Fined £2 64, Rayleigh Road ditto 1 Order made 14 days 17, Shepherd's Bush Green ditto 1 Withdrawn 57, Milson Road ditto 1 Withdrawn Askew Road Unlawful removal of offensive matter 1 Dismissed with caution Uxbridge Road ditto 1 Fined 10s. ditto ditto 1 Dismissed with caution Ducane Road ditto 2 1. Dismissed with caution 2. Fined 5s. Westway ditto 2 1. Dismissed with caution 2. Fined 5s. King Street ditto 2 1. Fined 5s. Westway ditto 1 2. Fined 5s. Fined 5s. 15, Fielding Road Failing to comply with Statutory Notice 1 Fined £2 10s. 52 Summonses—continued. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. 37, Richmond Gardens Failing to deposit plans 1 Withdrawn. 10s. 6d. costs 96, Rayleigh Road ditto 1 Withdrawn. 10s. 6d. costs 20, Lena Gardens Failing to comply with Statutory Notice 1 Order made 21 days Fined £2 Shepherd's Bush Road Unlawful removal of offensive mat— ter 2 1. Fined 10s. 2. Summons not pro— ceeded with on recommendation of Bench 31, Lena Gardens Failing to comply with Statutory Notice 6 Withdrawn. 10s. 6d. costs 2. Withdrawn 3. Withdrawn. 10s. 6d. costs. 4. Withdrawn 5. Withdrawn 203, Latymer Road ditto 1 Fined 5s. 205, Latymer Road ditto 1. Order made 14 days 2. Fined 10s. 15, Hume Road Construction o f drain 1 Fined 10s. ditto Failing to deposit plans 1 Fined 10s. 64, Rayleigh Road Failing to comply with Statutory Notice 1 Fined £2 160, Percy Road Letting rooms in verminous con— dition 1 Fined £2 34, Southbrook Street ditto Fined £2 ditto Failing to comply with Statutory Notice 1 W ithdrawn Coningham Villa, Boscombe Road Failing to deposit plans 1 Fined £1 39, Hetley Road ditto 1 Fined £1 la, Redan Street Failing to comply with Statutory Notice 1 Order made 7 days 16, Raynham Road ditto 1 Withdrawn. 113, Sinclair Road ditto 1 Withdrawn. 10s. 6d. costs 12, Rayleigh Road ditto 1 Order made 14 days. Goldhawk Road Unlawful removal of offensive matter 2 Dismissed with caution 17, Rayleigh Road Failing to comply with Statutory Notice 1 Withdrawn. 10s. 6d. costs 53 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 9, Goodwin Road Failing to comply with Statutory Notice 1 Fined £1 13, Goodwin Road ditto 2 1. Fined £1 2. Order made 14 days 26, Hunt Street ditto 1 Order made 7 days 19, Goodwin Road ditto 1 Order made 14 days HAMMERSMITH BOROUGH COUNCIL BYE-LAWS—DOGS. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings Mrs. P. A., Hammersmith Contravention of Bye-law re nuis— ance by dogs in Goldhawk Road I Fined 10a. Miss M. K. S., Fulham ditto Hammersmith Road 1 Fined 10s. Mr. R. C., Hammersmith ditto Bloemfontein Road 1 Dismissed under the P.O.A. on payment of 2s. costs Miss K. C„ Acton ditto Askew Road 1 Fined £1 Mr. G. H., Osterley ditto The Grove I Fined £2 Mr. D. R„ ditto 1 Fined 10s. Hammersmith Mr. F. M.. Glenthorne Road ditto 1 Fined 10s. Hammersmith Uxbridge Road MILK AND DAIRIES ORDER, 1926. Name and Address. Nature of Offence. No. of Summonses Result of Proceedings. Mr. H. C. D„ Fulham Filling milk bottle in Elm Grove 1 Fined £1 Mr. G. J., Kensington Filling milk bottle in Sussex Place 1 Fined 6s. ditto Unlawfully carrying on trade as dairyman in the Borough without being registered 1 Withdrawn by consent to enable Council to proceed against employers Messrs. D. G. D. & Son, Fulham ditto 1 Dismissed with a caution under the P.O.A. 54 INFANT LIFE PROTECTION. Name and Address. Nature of Offence. No. of Sum— monses. Result of Proceedings. Mrs. T., Hammersmith Failure to register infant with local authority 1 Fined £1 HOUSING ACT. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 135, Blythe Road Underground room used for sleeping purposes contrary to Closing Order 1 Adjourned sine die. On recommendation of Bench an undertaking was given by Defendant not to permit use of room for these purposes. 10s. 6d. costs. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1923. During the year it was found necessary to apply to the Court for Orders for the removal of three 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 51 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 55 notices were complied with. During the previous year there were 69 notices served and 71 complied with. 55 The following is a list of the Factories, Workshops and Workplaces upon the Register:— Restaurants, Hotels, &c 193 Bakehouses (27 not in use as Bakeries) 67 Bootmakers 36 Motor and Cycle Makers 3 Dressmakers and Milliners 24 Laundries 44 Outworkers 122 Letterpress Printers and Bookbinders 20 Electrical and Mechanical Engineers 39 Smiths, Wheelwrights and Coachbuilders 21 Tailors 19 Builders, Carpenters and Joiners 23 Miscellaneous 227 Total 393 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. Number of Premises Inspections Written Notices Prosecutions Factories (including Factory Laundries) 443 19 — Workshops (including Workshop Laundries) 133 13 — Workplaces (other than outworkers ' premis. s included in Part 3 of this report) 165 19 — Total 796 51 — 56 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to h.m. Inspector Nuisances ujider the Public Health Acts— Want of Cleanliness 20 23 — — Want, of Ventilation 2 2 — — Overcrowding — — — — Want of Drainage of Floors 1 1 — — Other Nuisances 19 19 — — Sanitary (insufficient 5 4 — — A ccommo- -! unsuitable or defective 16 13 — — dation ( not separate for sexes — — — — Offences under the Factory and Workshop Act Illegal occupation of underground bake— house (S. 101) — — — — Other offences (excluding offences relating to out-work which are included in Part 3 of this report) — — — — Total 63 67 — — 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) cutions (Sees. 109, 110) Wearing apparel— (1) making, etc. 1 1 — — — — (2) cleaning and washing — — — — — — Furniture and upholstery Totals 1 1 — — — — 57 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year Number Bakehouses 26 Dressmakers 22 Laundries 7 Outworkers 122 Others 139 Total number of workshops on Register 316 5.—OTHER MATTERS. Class Number Matters notified to H M. Inspector of FactoriesFailure to affix Abstract of the Factory and Workshop Act 1901 (S. 133) — Action taken in matters re— ferred by H M. Inspector as remediable under the Notified by H.M. Inspector 7 Public Health Acts, but rot under the Factory and Workshop Act, 1901 (S.5) Reports of action taken sent to H.M. Inspector 7 Other — Underground bakehouses (S.101)— Certificates granted during year In use at the end of the year 25 House to House.—As a result of the house to house visitation 306 inspections were made, 1G7 notices served, and 266 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. Sixteen Intimation Notices were served. No summons was taken out. 53 Reports were submitted to the Public Health Committee in reference to the observations made as regards the following:— H.B.C. Electricity Works, Fulham Palace Road. Glen Laundry, Landor Road. Gaumont British Film Studios. Shepherd's Bush Pavilion, Shepherd's Bush Green Victoria Laundry, Becklow Road. Dubilier Condenser Co., Goldhawk Road. New Ideal Studios, River Terrace. Swan Laundry, Blythe Road. London Wholesale Dairies, Wood Lane. Cromwell Grove Sewer Extension Works. Purewite Laundry, Gayford Road. Destructor, 15, Pennard Road. Fullers, Ltd., Great Church Lane. Sulgrave Road, Sewer Extension Works. Balmoral Laundry, 67, Becklow Road. Waring & Gillow, Cambridge Road. Civic Pipe Co., Fulham Palace Road. Stonsell & Gregory, Askew Road. Rats and Mice (Destruction) Act, 1919. -During the year the Rats and Mice (Destruction) Act, 1919, con— tinued in operation, the District Inspectors being responsible for its administration in their respective districts. Section I places the responsibility of ridding the pre— mises of the pest upon the occupier, but this is somewhat difficult when dealing with tenement houses containing in some cases three or more families. During the year several complaints were received with regard to rat infestation of premises. In each case an inspection was made and advice and instructions given. A supply of poison was given where necessary and in most cases satisfactory results have been obtained. National Rat Week was held in November, as in previous years. The Ministry of Agriculture and Fisheries again urged local authorities to take action, and arrangements were made for the baiting of the sewers, through the agency of the Borough Engineer and Surveyor's Department. 59 Fifty-six lbs. of rat poison was laid in sewer manholes. The Borough Engineer and Surveyor reported that 50 por 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 43 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. 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, 1935. The maximum number of lodgers who may be received at any one time into this house is 244. 60 VANS. There are three caravans in the yard side of 261, Latimer Road, used for living and sleeping purposes by six adults and six children. The average cubic capacity for each person is 100 c. ft. Regular inspections have been made, but owing to the absence of special regulations and the fact that these vandwellers are of the lowest gypsy-type, any improvements in the sanitary conditions effected are of short duration. In Britannia Yard, Wharf Road, there is one large .caravan in which two adults sleep, a separate van being used as a kitchen. No nuisance has been observed during inspections. In the National Car Park opposite the White City Stadium there is one large caravan occupied by the caretaker and his wife. Other vans park here from time to time. During the time of the Olympia Fun Fair there were nine caravans occupied by twenty-three people. This site is a good one and the occupiers are of the showman type with well-fitted caravans. No nuisance has been observed during inspections. 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 61 remedied. This form of co-ordination is carried out as well as possible under the present conditions. Rag Flock Acts, 1911 and 1923.—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. HOUSING. Statistics.—Year 1935. 1.—Inspection of dwelling-houses during the year :— (1) (a) Tolal number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) ... 7,329 (b) Number of inspections made for the purpose 21,770 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regula— tions, 1925 43 (b) Number of inspections made for the purpose 35 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 11 (4) Number of dwelling-houses (exclusive of those referred to under the preced— ing sub-head) found not to be in all respects reasonably fit for human habitation 3.123 2.—Remedy of defects during the year without service of formal notices :— Number of defective dwelling-houses ren— dered fit in consequence of informal action by the Local Authority or theii officers Nil 62 3.—Action under Statutory Powers during the year : — (A) Proceedings under Sections 17, 13 and 23 of the Housing Act, 1930 :— (1) Number of dwelling-houses in reBpect of which notices were served requiring repairs 1 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 1 (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 3.123 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 3,365 (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 3 (2) Number of dwelling-houses demolished in pursuance of demolition orders 1 (D) Proceedings under Section 20 of the Housing Act, 1930 :— (1) Number of separate tenements or under— ground rooms in respect of which closing orders were made 3 (2) Number of separate tenements or under— ground rooms in respect of which closing orders were determined, thp tenement or room having been ren— dered fit Nil 63 Housing Act, 1935—Housing Survey.—During the year a survey of the Borough was carried out in accordance with the provisions of the Housing Act, 1935. This was made with a view to ascertaining what dwellinghouses were overcrowded on the standard laid down in the Act and the preparation and submission to the Minister of Health, through the London County Council, a report showing the result of the inspection and the number of new houses required in order to abate the overcrowding disclosed. To ensure, as far as possible, that the survey for the County of London was carried out in a uniform manner, the County Council arranged a code of instructions for the staff engaged on the work and for the forms used in connection with the survey to be supplied to the Metropolitan Borough Councils. The overcrowding standard laid down in the Act consists of two parts. Section 2 (1) (a) provides that a dwelling-house shall be deemed to be overcrowded if the accommodation is such that any two persons being 10 years old or more, of opposite sexes and not being persons living together as husband and wife must sleep in the same room. Section 2 (1) (b), in conjunction with Tables I and II in the First Schedule to the Act, fixes, in relation to the number and size of the rooms in any dwelling-house, the maximum number of persons, irrespective of sex, who may be permitted to sleep in that house at one time. The maximum permitted number in the case of each dwelling is the number ascertained by reference to Table I or Table II in the First Schedule, whichever number is the less. These tables are as follows :— TablEI. Table II. No. of Permitted No. Permitted No. Rooms. of Persons. Size of Koom. of Persons. 1 2 110 sq. ft. or over 2 2 3 90 sq. ft. or over but 3 5 under 110 sq. ft 1½ 4 7½ 70 sq. ft. or over but 5 10 under 90 sq. ft. 1 and two persons extra for each 60 sq. ft. or over but additional room. No room under under 70 sq. ft. ½ 50 sq. ft. is counted. Under 50 sq. ft. Nil 64 For the purpose of determining the number of persons in a family, a child under 1 year of age is not counted and a child between the ages of 1 year and 10 years counts as ^ a person. Only rooms normally used in the locality for sleeping or living purposes are counted as rooms, so that sculleries, bathrooms, &c., are not taken into account in determining the permitted number of persons. The survey fell into two stages, the first being a preliminary enumeration to ascertain the number of persons in each family, the number of children under 10 years of age and the number of rooms occupied. The second stage of the survey consisted of the measurement of the floor area of all the rooms in the house in which a doubtful case or doubtful cases of overcrowding had been disclosed by the preliminary enumeration. The survey has disclosed that of the 35,236 families in respect of which particulars were obtained, 1.723 (about 4.9 per cent.) are living in overcrowded conditions. 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. 65 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. 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 43 (2) of the Public Health (London) Act, 1391. with regard to newly erected houses and flats having a proper and sufficient water supply Since the War, 3,967 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). 66 Certificates granted with regard to water supply under Section 43 (Sub-sec. 2) of the Public Health (London) Act, 1391. Private Year. L.C.C. Estate. H.B.C. Estate. Enterprise. 1920 133 13 Nil 1921 169 166 Nil 1922 334 354 Nil 1923 Nil 5 22 1924 Nil 42 40 1925 Nil Nil 50 1926 Nil Nil 202 1927 234 Nil 239 1923 500 Nil 137 1929 1 60 297 1930 Nil 56 90 1931 Nil 21 36 1932 Nil 39 1 1933 Nil 32 20 1934 112 Nil 163 1935 Nil Nil 139 Totals 1,638 793 1,536 The premises have provided accommodation for approximately 19,335 persons, but despite this fact overcrowding is still in evidence. HOUSING ACT, 1925, SECTION 13. Three closing orders were made in respect of under— ground rooms. 67 The property involved consists of two shops with living accommodation attached and 34 houses and outbuildings, comprising an area of 1.311 acres. The houses are two storeys in height and many are old, damp, worn out and badly arranged. The Council decided to declare the area a Clearance Area under the Act. The number of persons of the working classes in occupation of the buildings was 155, of whom 131 were in occupation of houses in the Clearance Area, and 24 in occupation of houses on the additional lands. On the 14th October, 1935, an inquiry was held at the Town Hall by A. Archer Betham, Esq., F.R.I.B.A., for the purpose of receiving evidence of any persons interested in the matter. Following the report of the Inspector, the Minister of Health confirmed with modifications the compulsory purchase order made by the Council in respect of properties in the Area and the additional land required for development purposes and issued his order entitled " The Hammersmith (Becklow Place) Housing Confirmation Order, 1936." One dwelling and a small number of outbuildings used as stables, &c., are excluded from the Clearance Area but remain in the Order as added lands purchasable by the Council. Argyle Place Area.—In October, 1935, I submitted an official representation with respect to the area known as Argyle Place Area. The property involved consists of 3 houses and outbuildings, comprising an area of .092 acres. Four of the houses are two storeys in height and consist of four rooms each, 63 while the remainder are three-storey dwellings of only one room on each floor. The properties are old, badly arranged, congested, dilapidated, dark, ill ventilated and lacking in reasonable sanitary facilities. The Council decided to declare the Area a Clearance Area under the Act. The number of persons of the working classes in occupation of the buildings was 30. Hanover Cottages Area.—An official representation was submitted in October, 1935, with respect to the area known as Hanover Cottages Area. The property involved consists of 31 dwelling-houses, one of which has been converted into two lock-up shops with a flat above, and covers an area of .466 acres. The houses forming the area, which are all of a two-storey type, are congested and have very little air space. In all the houses there is evidence of rising dampness; and with few exceptions there is dampness in the upper-floor rooms due to the defective condition of the roofs, rainwater pipes and brickwork The Council decided to declare the area a Clearance Area under the Act, that the owners should be required to demolish the properties on the Area, and that the Council should impose suitable restrictions and con— ditions with regard to the user of the land when cleared of buildings. The number of persons of the working classes in occupation of the buildings was 164. 69 The following areas have been represented and action pending. Terrace Court. Nob. 1, 2, 3 and 4. Coleman's Buildings. Nos. 1, 2, 3, 4, 5 and 6. Mulberry Place. Nos. 3 and 9. Brittania Court. Nos. 4, 5, 6, 7, 3, 9, 10, 11, 12, 13 and 14. Bergham Mews. Nos. 1, 2, 3, 4, 5, 6, 7, 3, 9, 10, 11, 12, 13, 14, 15, 16, 17, 13 and 19. Bannister's Cottages. Nos. 1, 2, 3, 4, 5, 6, 7, 3, 9, 10, 11, 12, 13, 14, 15, 16, 17, 13 and 19. Uxbridge Road. Nos. 416, 413, 420 and 422. 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 the arrangements made for notices to be exhibited in the lavatories of premises where food is prepared and/or sold were continued. Food Premises.—Two premises were registered under the London County Council (General Powers) Act, 1932, 70 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 407 samples of milk were taken and submitted to the Public Analyst for analysis, the results of which axe shown in a later part of this report. 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" ... 6 Supplementary Licence 1 (3) Dealers' Licences to use the designation "Grade A (Tuberculin Tested) "— (a) Bottling Establishments 3 (b) Shops 7 (c) Supplementary Licences 3 (4) Dealers' Licences to use the designation "Grade A"— (a) Bottling Establishments Nil (b) Shops 1 (5) Dealers' Licences to use the designation " Grade A— Pasteurised" 1 Supplementary Licence 1 (6) Dealers' Licences to use the designation " Pasteurised"— (a) Pasteurising Establishments 6 (b) Shops 12 (c) Supplementary Licences 5 71 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 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. Lamb 61 Sheep 57 Calves – Beasts 11 Pigs 248 Total 877 72 No application has been received for the stamping of carcases examined by the Sanitary Inspectors. The Following is a list of Unsound Food found during the Inspection of the Carcases of Animals Slaughtered in the Local Slaughterhouses Description. Disease. Approximate Weight. Inspector Godden 1 Pig's carcase and complete set of Pig's offal Tuberculosis 6 stones 8 Pigs' mesenteries Tuberculosis 9 lbs. 1 Pig's lungs Pleurisy 2 „ 3 Pigs' lungs Pneumonia 6 „ 1 Pig's liver Cirrhosis 2 „ 2 Pigs' livers Milk Spots 4 „ 3 Pigs' heads Tuberculosis 18 „ 1 Pig's pluck Tuberculosis 4½ 4 Pigs' hearts Pericarditis 1 lb. 1 bullock's liver Distoma Hepaticum 20 lbs. Slaughterhouses.—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 78 Offensive Trades—Slaughterers of Poultry.—There are two authorised slaughterers of poultry in the Borough:— Premises. Name of Occupier. 109, Shepherd's Bush Road Solomon Shockett Arch No. 204, Wells Road, Goldhawk Road Hyman Fisher The Dairies, Milkshops, Ice Cream Vendors, Restaurants and Food Shops have been kept under systematic inspection by your Inspectors. The following table gives a summary of the work relating to milk premises, slaughterhouses and ice cream premises:— PREMISES. NUMBER OP PREMISES. Number . of inspections 1935 Number of notices 1935 Number of prosecutions 1935 On register in 1920. On register at end of 1934 Added in 1935 Removed in 1935 On register at end of 1935 Milk premises 128 167 14 10 163 1,040 5 – Slaughterhouses. 7 4 – – 4 155 – – Poultry Slaughterhouses. – 2 – – 2 12 – – Ice Cream premises 162 155 33 5 183 204 – – Markets.—There axe 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. 74 In other instances, Bradmore and Norland Markets, wheelbarrows form the structure, and these are stored in premises which are inspected and approved. Street Trading—The London County Council (General Powers) Act, 1927, made provision for the Licensing of Street Traders which came into operation on the 1st November, 1927. This Act provided that "it shall not be lawful for any person to sell or expose or offer for sale any article or thing from or upon any barrow cart stall or other receptacle occupying a stationary position at a place in the carriageway or footway of any street in any metropolitan borough without a licence from the borough council authorising him so to do." Provided that this section shall not apply to any person selling or exposing or offering for sale any article or thing from or upon any barrow cart stall or other receptacle which he ordinarily moves from place to place in pursuit of and while conducting his trade. During the year 114 licences were issued to street traders. All premises used for the storage of food, clothing, &c., are inspected and reported upon by the Sanitary Inspectors. Notices are served where the conditions are not satisfactory, and the licences are withheld until the necessary works have been carried out. Reports on storage premises in adjoining boroughs have been obtained through the Medical Officers of Health, whilst reports on similar premises in this Borough have been furnished to the Medical Officers of Health concerned. Fried-fish Shops.—The fried-fish shops are constantly inspected for the purpose of ensuring conformity with the Bye-laws made by the London County Council. At the same time a careful look-out is kept on the condition of the fish. 75 Bakehouses.—The 40 bakehouses in use in the Borough have been regularly inspected during the year. Thirteen notices were served relating to various defects. The following is a list of bakehouses in the Borough:— Address. Name. No. 1 DISTRICT. † Cadby Hall, Hammersmith Road J. Lyons & Co. †* 60 Richmond Road C. W. Tompkins * 1 Masbro Road W. A. Maelen † 67 Ditto G. Dunsby †* 98 Blythe Road Miss Schofield 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. Recker 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 7 St. Peters Road E. Gent * Underground. † Factory. 76 Address. Name. No. 5 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 † *242 Ditto Plumridge † * 125 Uxbridge Road A. B. Hemmings Ltd. * 55 Melina Road E. J. West †* 75, Uxbridge Road F. R. Clifford No. 7 DISTRICT. † * 216 Uxbridge Road L. W. Jenkins † 410 Ditto A. Hauser No. 8 DISTRICT. †* 831 Harrow Road H. T. Rogers † * 39 St. Ann's Road E. Tomlin †* 16 North Pole Road G. Glanville †* 32 Norland Road N. Stone † Sunya House, Scrubs Lane Bee Bee Biscuits Ltd. The following is a list of registered bakehouses in the borough not now in use:— * 7 Shepherd's Bush Road 70 Glenthorne Road * 13 Shepherd's Bush Green 16 Black Lion Lane * 87 Masbro Road * 192 Dalling Road * 6 Beaconsfield Terrace † 348 Ring 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 † Ceylon Road † * 11 Lamington Street † * 106 Goldhawk Road † 166 Goldhawk Road * Underground † Factory 77 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. 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 183 Restaurants 22 Factories 5 210 78 UNSOUND FOOD. No seizure of unsound food was made during the year. The following is a list of unsound food condemned during the year:— Commodity Condition. Result. 1 box Filleted Cod (1 stone) Unsound and Unfit for food Surrendered 7 ¾ doz. tins Cherries ditto ditto 4 ½ bushels Apples ditto ditto 2 boxes Pears + 55 Pears ditto ditto 1 Imported Chicken (2¼ lbs.) ditto ditto 5 boxes Pears (2 cwts.) ditto ditto 11 boxes Pears (3 cwts.) ditto ditto 1 wing Skate (14 lbs.) ditto ditto 1 Chicken ditto ditto 4 Chickens ditto ditto 5 tins Cherries ditto ditto 2 tins Grape Fruit ditto ditto 1 tin Pears ditto ditto 1 tin Apricots ditto ditto 1 tin Grape Fruit ditto ditto 1 Chicken (3 lbs. 12 ozs.) ditto ditto 4 tins Cherries ditto ditto 2 tins Apricots ditto ditto 1 Chicken ditto ditto 1 Guinea Fowl ditto ditto 3 Chickens ditto ditto 2 Ducks ditto ditto 5 Chickens ditto ditto 2 Chickens ditto ditto 1 tin Ham (12½ lbs.) ditto ditto 2½ bags Dutch New Potatoes ditto ditto 1 thick flank Chilled Beef (1 stone 4 lbs.) ditto ditto 2 Chickens (7½ lbs.) ditto ditto 3 Fowls (11¼ lbs.) ditto ditto 1 Duck (4½ lbs.) ditto ditto 1 Chicken (3 lbs.) ditto ditto 1 Fowl ditto ditto 1 box Haddock ditto ditto 2 stones Lemon Soles (28 lbs.) ditto ditto 16 bags Walnuts ditto ditto 6 ½-bushel baskets Plums ditto ditto 1 tin Ham (11 lb3.) ditto ditto 12 Babbits ditto ditto 15 lbs. Meat trimmings and small pieces ditto ditto 79 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. Eight hundred 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. 80 ANNUAL REPORT 1935, BACTERIOLOGICAL EXAMINATION OF MILK. Sample No. Milk. Total count. B. Coli. Microscopic examination. 101 Pasteurised 150,800 Neg 1/10 – 102 do. 930,600 Pos. 1/10 – 103 do. 71,860 Pos. 1/10 – 104 do. 30,950 Neg. 1/10 – *{ 105 Raw milk 1,132,000 Pos. 1/1000 Few acid fast bacteria present 106 Pasteurised 33,000 Pos. 1 /10 No acid fast bacteria seen 107 do. (bottled) 274,000 Pos. 1/100 do. *{ 108 Raw milk 4,390,000 Pos. 1/1000 – 109 Pasteurised 36,300 Pos. 1/1000 – 110 do. (bottled) 221,400 Pos. 1/1000 – 111 Grade "A" T.T. 5,110 Neg. 1/100 – 112 Grade "A" Pasteurised 140 Neg. 1/10 – 113 Pasteurised 5.840 Neg. 1/10 – 114 Grade "A" T.T. 6,670 Neg. 1/100 – †ll5 Undesignated 42,700 Neg. 1/10 Guinea pig inoculation showed no evidence of tubercular lesions 116 Pasteurised 258 000 Neg. 1/10 do. 117 do. 57,200 Pos. 1/10 do. 118 do. 20,500 Pos. 1/10 do. 119 do. 510,300 Pos. 1/10 do. 120 do. 93,260 Pos. 1/10 do. *{ 121 Grade "A " T.T. 2,810 Neg. 1/100 – 122 do. (bottled) 1,740 Neg. 1/100 – 123 Pasteurised 49,400 Pos. 1/10 – 124 do. 41,400 Pos. 1/10 – * Same milk. †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. 81 Presence of Tubercle Bacilli. Guinea-pigs were inoculated with milk from samples 115, 116, 117, 118, 119 and 120, but in each case failed to show any evidence of a tuberculous infection on post-mortem examination. Extract from Report of Public Analyst. FOOD AND DRUGS (ADULTERATION) ACT, 1928 Year ended 31st December, 1935. Eight hundred samples of food and drugs were submitted for analysis by the Council's Sampling Officers, and of these 724 were genuine, 39 inferior and 37 adulterated. The percentage of inferior samples is therefore 4.9 and of adulterated samples 4.6. The last figure does not differ greatly from that of 5.3 per cent. given in the last available Report of the Ministry of Health (1934-1935). This figure for the whole country shows a reduction of 0.2 per cent. as compared with the preceding year, whereas in our Borough there has been an increase of 0.7 per cent. An examination of Tables I and II, however, will reveal the fact that for 1935 the combined percentages of inferior and adulterated samples is 9.5; that is to say, nearly one sample in ten is either adulterated or suspect. Furthermore, reference to Table II shows that the position now in regard to adulteration is worse than in any of the preceding ten years. For the last three years the increase has been progressive. An increase in any one year would give cause for comment, but the fact that the position has gone from bad to worse during the last few years and that the use of false or deceptive labels on foodstuffs is greatly on the increase is disquieting. Many examples of false labels will be found later in this Report. 82 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 of those classified as genuine, inferior and adulterated. Table I. Period. Genuine. Inferior. Adulterated. Total. 1st quarter 165 21 14 200 2nd „ 170 16 14 200 3rd „ 197 2 1 200 4th „ 192 – 8 200 Whole year 724 39 37 800 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 appreciably worse than any within the period. Table II. Year. Genuine. Inferior. Adulterated. 1926 91.6 5.7 2.7 1927 89.7 7.2 3.1 1928 89.2 6.5 4.3 1929 93.5 5.4 1.1 1930 93.6 5.3 1.1 1931 95.6 3.1 1.3 1932 90.5 6.5 3.0 1933 92.6 5.1 2.3 1934 89.9 6.2 3.9 1935 90.5 4.9 4.6 Average for ten years 91.7 5.4 2.9 88 The number and nature of the various articles analysed during the year are set out in full in Table III below. Table III. Article. No. of Samples examined. Result of Examination. Genuine. Inferior. Adulterated . "Active Mineral Salts " 1 1 – – Almonds, ground 2 2 – – Ammoniated Tincture of Quinine 2 2 – – Aspirin Tablets 4 4 – – Barley 1 1 – – Beef Suet 2 2 – – Boric Ointment 3 3 – – Brawn 2 2 – – Butter 37 37 – – Camphorated Oil 5 4 – 1 Castor Oil 3 3 – – Caviare 2 2 – – Cheese 8 8 –' – Citrate of Magnesia 2 2 – – Cocoa 11 11 – – Coffee 2 2 – – Coffee and Chicory 5 4 – 1 Coffee and Chicory Extract 3 3 – – Cordials 3 3 – – Cream 4 3 1 – Cream (tinned) 12 7 2 3 ., Confectionery 3 2 – 1 Custard 1 1 – – Custard (" real egg") 1 1 – – Epsom Salt 1 1 – – Eucalyptus Oil 2 2 – – Fish Paste 14 14 – – „ (tinned or bottled) 14 12 2 – Friar's balsam 3 3 – – Fruit dried) 13 13 – – „ (tinned) 10 10 – – Ginger Wine Essence 1 1 – – Glauber's Salt 2 2 – – Glycerin 3 3 – – „ of Thymol 2 2 – – Grape Juice 1 1 – – Green Pea Soup 1 1 – – Ham and Beef Rissoles 1 1 – – Honey 3 3 – – Iodine Cream 1 – – 1 „ Tincture 2 2 – – Jam 6 6 – – Jelly Cream 1 1 – – „ (Table) 2 2 – – Lard 7 7 – – Lemonade Powder 2 2 – – Lemon Curd 2 2 – – 84 Table III—continued. Article. No. of Samples examined. Result of Examination. Genuine. Inferior. Adulterated. Liquid Paraffin 2 2 – – Margarine 8 8 – – Marmalade 5 5 – – Meat Paste 2 2 – – „ Pie 6 6 – – Milk 407 364 33 10 ,, Condensed 27 26 – 1 Mincemeat 4 4 – – Mustard 2 1 1 – Olive Oil 1o 10 – – Orangeade Powder 1 1 – – Parrish's Food 4 4 – – Pepper 4 4 – – Rice 5 4 – 1 Sauce 5 4 – 1 Sausages 18 16 – 2 Seidlitz Powder 4 4 – – Semolina 2 2 – – Sherry Trifle 1 1 – – Spice (ground) 2 2 – – Sugar (icing) 3 1 – 2 „ (pudding) 3 3 – – Sultana pudding 1 1 – – Sweets 2 2 – – Syrup of Figs 4 3 – 1 Tea 6 6 – – Tomato Juice 1 1 – – „ Paste 1 1 – – „ Soup 6 4 – 2 „ (tinned) 4 4 – – Vegetables (tinned) 9 9 – – Vinegar 8 – – 8 „ (malt) 4 4 – – Whisky 11 9 – 2 Wine (raisin) 1 1 – – Zinc Ointment 4 4 – – Totals 800 724 39 37 Milk. In the first quarter of the year nine adulterated milks were reported; all of these were from a single source. In the second quarter only one was reported against and in the remaining half-year none at all. If, therefore, we leave out of account the actual number of milks adulterated, we 85 may say that only two sources produced a defective supply, which is very satisfactory. The nine adulterated milks mentioned all came from one farmer. They constituted part of a batch of 19 taken in course of delivery. The farmer was able to prove to the satisfaction of the Court that he had not, nor had any of his servants, tampered with the milk; the summonses were accordingly dismissed. Table IV, below, gives the average composition of milk for each month and for the whole year. Table IV. Month. No. of Samples. Fat average (per cent.). Non-fatty solids Average (per cent.) January 26 3.8 8.77 February 42 3.37 8.78 March 25 3.5 8.8 April 36 3.46 8.79 May 34 3.63 8.9 June 19 3.6 8.95 July 35 3.59 8.78 August 40 3.66 8 87 September 30 3.91 8.83 October 41 3.75 8.9 November 28 3.93 8.9 December 52 3.99 8.86 Whole year 407 3.68 8.84 These figures represent good quality milk for the months September, November and December and fair quality for the rest of the year. The following Table shows the number of milks classified as being of good, fair or poor quality in each quarter of the year, omitting, of course, the adulterated samples. 86 Table V. Period. Good quality. Fair quality. Poor quality. 1st quarter 12 80 21 2nd „ 14 71 12 3rd „ 43 77 – 4th „ 21 46 – Whole year 90 274 33 Condensed Milk. Since the coming into force of the Condensed Milk Regulations of 1923 and 1927 no adulterated samples of this article have been discovered in our Borough until this year. One of the 27 examined had a fat content of only 8.87 per cent. in place of the 9.0. per cent. required by the Regulations. The deficiency was, however, not considered large enough to warrant a prosecution of the vendor. Cream and Cream Confectionery. One of three specimens of cream confectionery was certified to be adulterated as the filling did not consist of cream. Owing to conflicting decisions given by magistrates recently in this type of offence against the Act, this Borough, in common with others, has not felt justified in taking proceedings. This seems to be a case where the permanent Board under the Ministry of Health suggested by the Society of Public Analysts to consider standards and definitions would decidedly be of use. In such cases the lack of standards operates to the disadvantage of the consumer who used to buy this type of article under the name of French or Vienna pastry and may be forgiven for imagining that the change of name to cream pastry really means that there is cream present in the filling. 87 A sample of cream, one of "coffee" cream and one of "half-price" cream were genuine. In the "coffee" cream there was 30.9 per cent. of fat and in the "halfprice" cream 29.9 per cent. The use of such names as these by the trade raises an interesting question as to what is to be done with cream poor in fat sold with no qualifying label or notice and at the price of ordinary cream. If one firm sells cream at a low price, is another to be permitted to sell a similar article at full price? A "double" cream was reported inferior on account of its fat content being as low as 47.7 per cent. In the Report of the Reorganisation Commission for Milk the following standards were suggested:— Breakfast Cream 12 per cent. butter fat. Single Cream 25 ,, ,, ,, Double Cream 50 ,, ,, ,, This sample did not satisfy even the very low standard here suggested. Some milks, admittedly freak ones, taken in Hammersmith, have been found to be richer in fat than "breakfast" cream. Reorganisation might very well be attempted upon a higher plane than this; the requirement for fat in each grade should be about 20 per cent. higher. "Single" cream, by which the ordinary purchaser would doubtless understand cream as ordinarily sold by averageclass dairies, would then have to contain, say, 45 per cent. of fat, a quite ordinary figure which is frequently exceeded. The Commission's "double" cream is nothing more than ordinary cream under a high-sounding title. Good Devonshire clotted cream with upwards of 60 per cent. of fat would presumably present the Commission with a problem in nomenclature. The tinned creams examined this year have been a trouble to report upon. In the majority of cases very careful consideration has had to be given to the labels on the tins. 88 One labelled "Pure Thick English Cream" contained 32.6 per cent. of fat and might well be taken as an example for others with somewhat similar labels to follow, especially in view of the declaration of tinners that it is impossible to put up cream with over 25 to 27 per cent. of fat owing to separation upon sterilisation. This sample was reported genuine, as also were six others whose labels bore no very extravagant claims to richness, though in regard to some it was found necessary to comment upon the somewhat deceptive character of the labels. Two samples of the same brand, one formal and the other informal, were reported adulterated as the fat found was only 20 per cent. and 18.5 per cent. respectively. Both were labelled "Pure Thick Cream—superior quality—a highly concentrated and rich cream." A rich cream, even without being highly concentrated, should contain at least 50 per cent. of fat. Another tinned cream was reported adulterated as the label declared the presence of 25 per cent. of fat, whereas only 24 per cent. was found. Two were reported inferior; in one, labelled "West Country Brand—Pure Thick British Cream," the fat was only 21.6 per cent., whilst in the other, labelled "Pure Thick Danish Cream," only 20.5 per cent. of fat was present. The Milk and Cream Regulations, 1912, prohibited the use of boron preservative in cream containing less than 35 per cent. of fat. In the Artificial Cream Act, 1929, cream is defined as "that portion of natural milk rich in milk fat which has been separated by skimming or otherwise." Beyond this standard and definition we have nothing to guide us in assessing the quality of cream. Very great care has to be taken in the interpretation of descriptive labels on tinned cream. The use of the word "thick" would probably be defended by manufacturers on the ground that the meaning was merely that the cream had been rendered 89 thick in consistency by the process of sterilisation it had undergone. On the other hand, the use of such descriptive words as "rich," "concentrated" and the like where the cream contains only 20 per cent. or thereabouts of fat constitutes false description and warrants a prosecution. Butter, Margarine, Lard and Suet. Thirty-seven samples of butter, eight of margarine, seven of lard and two of beef suet were genuine. The last-named contained no excess of starch, and no excess of water occurred in any of the others. Cheese. A variety of cheeses were analysed during the year and of those wrapped in tin foil it is satisfactory to record that no metallic contamination was found. In five cases an estimation of the fat content was called for; these were Stilton, Cheshire, or Cheddar cheeses, and the results showed no deficiency in this constituent. In the Report for 1934 it was pointed out that standards have been laid down for fat in Cheshire cheese. During 1935 other standards were produced for Stilton, Cheddar, Caerphilly and cream cheeses. These standards all have to do with National Mark produce. In the 1934 Report it was mentioned that a Departmental Committee had pronounced in favour of standards. None have so far been prescribed by the Ministry of Health upon the strength of the Departmental Committee's Report. It seems a pity that standards have not been adopted for the protection of the consumer and for the guidance of Local Authorities and their Officers, as well as judges and magistrates. The want of standards has been felt for a long time in respect of cream, vinegar and not a few other foods, and many prosecutions for rather gross adulteration have failed for the want. Even manufacturers seem to be pressing in the matter; it has been reported in the Press that negotiations are taking place between the Ice Cream Association and the Milk Marketing Board to secure a legal definition and standard for ice cream. 90 Meat and Fish Preparations. Only two of the total of 59 meat and fish preparations were reported adulterated; these were two sausages in which 96 and 230 parts respectively of sulphur dioxide per million were found, no notice of the presence of preservative having been given at the time of purchase. Two samples of fish were classed as inferior on account of the presence of metals. In one of them (tinned sardines) there was five parts of lead per million and in the other (tinned sild) there was four-fifths of a grain of tin pier pound. In a specimen of tinned fish roes just over half a grain of tin was discovered, but this amount was not deemed to be sufficient to warrant calling it inferior. Vegetables, Fruit, Conserves, &c. All the samples falling under this heading were genuine. Those sold in tins were commendably free from metallic contamination, only one canned tomatoes being found to contain tin; here the amount was one grain per pound. A sample sold as tomato paste was a proprietary brand of nut food flavoured with tomato. One jam consisted of a mixture not commonly met with—melon and pineapple— and was sold canned. Vegetable Soups. Of six specimens of tomato soup two were certified to be adulterated. These contained copper to the extent of 50 and 14 parts per million respectively. A label on one of the packets indicated, under a guarantee of £1,000, that the tablet of soup contained over one pound of tomatoes and no colouring matter or preservative. The makers are probably not aware that copper is listed as one of the prohibited metallic colouring matters. An attempt to determine the amount of material derived from tomato was made; on the portion left after determining the copper present only sufficient work could be done to indicate that the statement on the label was probably not incorrect. 91 A sample of green pea soup was genuine. It bore a label stating that "This soup contains valuable protein food," which probably has helped its sale among the unsophisticated, who might think that something much more valuable than ordinary cheap green pea flour was present. The statement is not false, but is merely of the catch-penny type. The occurrence of copper in tomato products seems to be more frequent than formerly. It may be due to the practice of spraying the growing tomato plant with copper fungicides, or more likely, perhaps, to preparation in copper vessels. However the metal gets in, its presence is contrary to the provisions of the Public Health (Preservatives, &c., in Food) Regulations. Ingenious defences of this contravention of the Regulations have in the past been put forward, based on the known natural occurrence of relatively large amounts of copper in certain crustacea and of small amounts in such fruits as the tomato. It has been said that minute amounts of copper are actually necessary for health in the human subject. That is no reason, however, why we should regard kindly the practice of manufacturers in giving us this extra copper, since it is possible to have too much of a good thing and the ordinary person would no doubt prefer to take his daily minute trace of copper in the way that unassisted nature gives it him. Copper is a cumulative poison and therefore undesirable in the relatively massive doses in which it occurs in these tomato preparations. Cocoa, Coffee, Tea, &c. Eleven samples of cocoa, two of coffee and six of tea were reported genuine. All the cocoas were specially examined for arsenic, but with negative results. Of five specimens of coffee and chicory one was reported adulterated on account of the presence of an excessive proportion of chicory—72 per cent.—whilst the other samples were genuine, the chicory therein being under 50 per cent. In the view of your Analyst such a high 92 proportion of chicory as 72 per cent. is excessive and not in conformity with ordinary custom in the trade. Three coffee and chicory extracts were found to be genuine. In two cases, since it was said that the price of each was very low, it was considered advisable to extend the analysis with a view to determining not only the presence of some extract of coffee, but also the proportion of coffee to chicory used in their manufacture. The results were satisfactory, inasmuch as the proportions of coffee to chicory indicated were approximately 8 to 10 in the one case and 10 to 12 in the other. Farinaceous Foods. A sample of barley was genuine, but one of rice contained 0.08 per cent, of extraneous mineral matter having the characters of talc, this being evidence of the practice of "facing." The amount found was, however, well below the limit of 0.5 per cent. recommended in Dr. Hamill's report to the Local Government Board, so that no action was taken. A sample labelled "Extra Creamy Custard" bore on the tin, in small print, the words "Not prepared with eggs" and had the composition of the article usually sold as custard powder, that is to say, it consisted of starch coloured and flavoured. My report called attention to the deceptive character of the label. Condiments, Spices, &c. Falling under this heading are ten specimens of olive oil, four of malt vinegar, eight of table vinegar, four of pepper, two of mustard, two of ground spice and five of sauce. Of the last-named three were mint sauce, two of which were sold with labels claiming that they were prepared with 98 malt vinegar. The claim was substantiated by the results of analysis in one case, but in the other the vinegar portion was found not to have the characters of malt vinegar and it was therefore certified to be adulterated. One of the mustards was found to contain a small proportion of starch and turmeric, but no exception could be taken to this as it was sold as a mixed article. The other contained a small amount of turmeric and was merely reported inferior as it is not usual to regard the colouring of mustard with turmeric as adulteration. All the table vinegars were reported adulterated as they were found to consist of artificial vinegar. In three of them the amount of acetic acid was respectively 46, 26.5 and 4 per cent. deficient; these were therefore artificial vinegar adulterated with water. It is satisfactory to record that the Court upheld your Analyst's opinion that table vinegar should consist of a superior article, such as malt vinegar, and not of artificial vinegar, which is merely acetic acid diluted with water and coloured with caramel. Pines totalling £10 2s. 6d. were imposed. Sugar, Sweets and Jellies. Of six samples of sugar two were found to be adulterated, one with 2 per cent, of starch and the other with 1.14 per cent, of rancid fat; this last also contained a few dead flies. It was afterwards learned that the presence of the starch was notified on the label of the original container and that the contamination with rancid fat was to be accounted for by the vendor having kept the sugar in packets in a tin alongside packets of ground almonds. Three were brown sugar of the Barbados type and were submitted in view of the fact that elsewhere such sugar had been found to contain appreciable quantities of sand. It appears, however. that the cases where sand was discovered were isolated ones and the trouble is said to have been due to malice on 94 the part of native employees in the works. None of those submitted to me contained sand. Three table jellies were certified to be genuine. One was sold as "jelly cream" and was said to contain milk. Apparently some milk was present, but only sufficient to give the jelly a slight opalescence. Two specimens of sweets sold as "Bubbly Gums" and "Bobby Gums" were free from injurious constituents and so were reported genuine. They were submitted for analysis following complaints that they had caused sore throat in children. They were sweets of the chewing gum type and directions on the wrappers were given to the effect that after all the sugary material had been chewed out of them the residual gum could be used for blowing bubbles by pressing against the teeth and blowing air into it. This absurd proceeding seems to have attracted children sufficiently to lead to a rather brisk sale of the sweets. According to my information the children pass the gum from one to another; hence, although there is nothing in the sweets themselves to cause sore throat, the disgusting and dangerous use to which they are put is quite sufficient to propagate much more serious diseases. Cordials, Wines, Spirits, &c. Four fruit cordials, one ginger wine essence, two lemonade powders, one orangeade powder, and one nonalcoholic raisin wine were genuine, but of eleven whiskies two were adulterated. The latter had strengths of 40.64 and 37.65 degrees under proof, whereas the Act requires spirits to be not more than 35 degrees under proof. The proof strengths reported indicate that the samples were whisky of the minimum legal strength to which had been added approximately 9 per cent. of water in the one case and 4 per cent. in the other. Proceedings in respect of these resulted in fines and costs totalling £4 2s. 0d. being imposed. 95 DRUGS. Fifty-four drugs in the very varied assortment exhibited in Table III were analysed during the year. All were genuine with the exception of one white iodine cream, one syrup of figs and one camphorated oil. The white iodine cream bore a label stating that the content of potassium iodide was 2 per cent., whereas analysis proved it to contain only 1 per cent, of this salt. The syrup of figs contained 750 parts per million of salicylic acid and the camphorated oil was deficient of 50 per cent, of the amount of camphor required by the British Pharmacopoeia formula. A sample sold as " Active Mineral Salts " had the following composition indicated on its label:— Sodium Sulphate 22 per cent. Magnesium Sulphate 75 Sodium Chloride 2 Tartaric Acid 1 Analysis disclosed some variation from this formula but not greater than would be allowable for error in dispensing. Miscellaneous Samples. Two specimens of ground almonds were genuine, as also was a sultana pudding mixture. A sherry trifle was found to contain some small proportion of wine and a " real egg " custard—a confection of the custard tart type— contained some egg. In addition to the samples taken under the Food and Drugs (Adulteration) Act, analyses were made at the request of the Medical Officer of Health and an English full-cream milk powder, a specimen of water from the Lime Grove First-Class Swimming Bath, and a sample of the salt used in this Bath. 96 L6 Table VI. Article. Identification No. given to sample in Quarterly Report. Result of Analyses. Legal proceedings under the Sale of Food and Drugs Act. Course when no proceedings are taken. Remarks. Fines. £ s. d. C08t8. £ 8. d. Milk 378 382 16% fat abstracted 4% — — 385 9% Appe al to cow defen ce upheld — — 386 7% — 388 2% 390 11% Summon s dismissed 394 3% _ 395 10% _ Sausages 403 Contained 96 pts. per million of sulphur dioxide Warning Offence was really in not displaying a notice as to the presence of preservative do. 470 Contained 230 pts. per million of sulphur dioxide Warning Mint Sauce 477 The vinegar portion had not the characteristics of malt vinegar whereas the label claimed that it had been prepared with malt vinegar Informal sample. Official sample genuine — Tinned Cream 490 Contained only 18.5% fat. Label declared contents to be " Pure thick cream. A highly concentrated and ilch cream." — — No action — Iodine Cream 491 Contained only 1% of potassium iodide whereas label declared 2°/„ Referred for action to be taken against wholesalers Milk 514 9% fat abstracted — Letter of warning — Tinned Cream 536 Label described contents as pure thick concentrated and rich cream. Sample contained only 20% fat. A rich cream should contain not less than 50% of fat. Sample therefore was 60% deficient in fat No aotion Table Vinegar 606 100% artificial vinegar and deficient in acetic acid to extent of 26.5% Informal sample. See official sample No. 631 630 100% artificial vinegar 2 10 0 10 6 — 631 100% artificial vinegar and 46% deficient in acetic acid 5 0 0 10 6 650 100% artificial vinegar Informal sample. See o fficia1 sample No. 721 98 Table VI—continued. Article. Identification No. given to sample in Quarterly Report. Result of Analyses. Legal proceedings under the Sale of Food and Drugs Act. Course when no proceedings are taken. Remarks. Fines. £ s. d. Costs. £ s. d. Table Vinegar 656 100% artificial vinegar — — — Informal sample. See official sample No. 720 Milk 683 2% fat abstracted — — No action. Adultera tion insufficient — Condensed Milk 690 Contained only 8.87% — No action fat whereas Con- densed milk regula- tions require 9% Tinned Cream 693 Contained only 24% — — No action butter fat whereas label declared 25% French Coffee 704 Contained 72% chicory — — No action Table Vinegar 720 100% artificial vinegar — — Letter of warning — 721 100% artificial vinegar and 4% deficient in acetic acid Summons dismissed " Warrants " defence upheld 722 100% artificial vinegar Dismissed underP.O.A. 1 11 6 — — Cream Buns 724 Filling consisted of a — No action substance other than cream Tomato Soup 872 Contained 14 parts per million of copper Informal sample Whisky 986 37.65 degrees under proof Dismissed with cautio 2 0 0 1 1 0 110 — — 987 40.64 degrees under — proof Syrup of Figs 19 Contained a preparation of salicylic acid equivalent to 750 pts. of salicylic acid per million Vendor warned.Stock withdrawn from sale Tomato Soup 77 Contained 50 pts. of copper per million Manufacturers warned. Remainder of stock withdrawn from sale Icing Sugar 78 79 Contained 2% of starch Contained 1.14% oi rancid fat — No action Vendor warned — Camphorated Oil 99 60% deficient in camphor Informal sample Official sampl genuine Rice 106 Contained not less than — 0.08% of extraneous mineral matter No action 99 100 PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 999 cases reported as due to notifiable infectious diseases in the Borough, against 1,861 in the previous year. There were also reported 679 cases of infectious diseases that were not notifiable, against 1,606 in the previous year; 45 of these were Measles, 812 Whooping Cough and 322 Chickenpox. The number of cases of Tuberculosis notified was 201 against 215 in the previous year. BACTERIOLOGY. The following bacteriological examinations were made ou behalf of the Council:— Material from cases of suspected Diphtheria— Positive results 155 Negative results 1,330 Sputa from cases of suspected Tuberculosis Tubercle bacillus found 87 Tubercle bacillus not found 487 Blood from cases of suspected Fever— Widal or Typhoid reaction obtained — Widal or Typhoid reaction not obtained 1 Stools 2 Grand Total 1,963 101 Cases of Infectious Disease notified during the year 193d. Notifiable Disease Number of CASES Notified Total cases notified in each Ward Total Cases Removed to Hospital At all Ages Age Periods Under 1 1 dc under 5 Years 5 & under 15 Years 15& under 25 Years 25 & under 45 Years 45 <fc under 65 Years 66 and upwards S'th Centre North Ward 1 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Smallpox ......... ... ... ...... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 333 5 102 184 17 21 4 36 50 36 16 85 67 43 331 50 1 1 4 16 22 6 6 5 8 3 11 14 3 30 Scarlet Fever 349 3 113 167 30 32 4 57 34 38 22 81 94 23 336 Typhus Fever Enteric Fever Relapsing Fever (R) Continued Fever (C) 5 ... ... ... 2 3 ...... 1 1 1 2 5 Puerperal Fever ... ... ... ... ... ... ... ... ... ... 2 Puerperal Pyrexia 19 8 11 ... ... 1 ... ... 2 6 3 1 19 Cerebro-Spinal Meningitis ... 1 ... ... ... 1 2 2 2 ... ... ... ... ... 1 1 ... 2 2 ... ... 2 1 ... 1 ... ... 1 Ophthalmia Neonatorum 11 11 ... ... ...... ... ...... 3 ... 1 1 4 9 ... ... ... ... ... ... Pneumonia 88 4 9 10 2b 28 3 7 23 13 4 6 23 12 31 Dysentery 14 1 3 I 6 3 10 2 1 5 9 3 2 2 1 1 2 1 3 3 1 Chickenpox 113 4 29 69 8 1 1 1 19 12 21 3 19 32 7 7 TOTALS 999 30 259 133 88 118 60 11 132 143 123 54 211 242 94 781 Tuberculosis. Pulmonary Tuberculosis 170 2 50 76 37 5 33 33 27 2 24 40 11 Other forms of Tuberculosis .. 31 - 1 12 10 7 1 3 8 1 3 14 2 TOTALS .. 201 1 14 60 83 38 5 36 41 27 3 27 54 13 Deaths from the Seven Principal Zymotic Diseases.— The total number of deaths of residents registered from the seven principal zymotic diseases was 49 against 100 in the previous year. The deaths of residents last year from these diseases were equal to 82 per 1,000 of the total deaths of residents registered and were at the rate of 0.3 deaths per 1,000 persons living. 102 The following table shows the deaths of residents registered from the seven principal zymotic diseases which occurred in the ten years, 1926 to 1935 :— Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Enteric Fever. Diarrhcea and Cholera. Total. 1926 0 24 2 14 u 0 28 80 1927 0 0 1 11 4 0 28 46 1928 0 23 3 5 5 2 33 71 1929 0 2 0 5 41 2 19 69 1930 0 31 3 21 9 1 21 89 1931 0 0 2 6 7 0 23 38 1932 0 29 4 8 6 1 26 74 1933 0 3 4 14 5 1 27 54 1934 0 25 4 25 19 0 27 100 1935 0 0 3 12 7 1 28 49 Average last 10 yrs. 0 14 3 12 11 1 26 67 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was eighteen below the average number registered in the last ten years. Notifiable Diseases other than Tuberculosis) during the year 1935 DISEASE. 1 Total cases notified. Cases admitted to Hospital. Total deaths. Diphtheria 333 381 12 Erysipelas 50 30 — Scarlet. Fever 349 336 3 Enteric Fever 5 5 1 Puerperal Feve 2 2 1 Puerperal Pyrexia 19 19 — Cerebro-Spinal Meningitis 2 2 2 Encephalitis Letliargica 2 1 4 Ophthalmia Neonatorum 11 9 — Pneumonia 88 31 87 Dysentery 14 5 — Poliomyelitis 2 2 — Chickenpox 113 8 Food Poisoning 9 1 — Totals 999 782 110 103 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 wa6 reported as due to Plague, against no case in the previous year. Diphtheria and Diphtheritic Membranous Croup.— Three hundred and thirty-three cases were reported as due to Diphtheria or Diphtheritic Membranous Croup against five hundred and forty-nine cases in the previous year. Three hundred and thirty-one cases were treated at the Isolation Hospitals and two were treated at home. Twelve deaths were registered. The mortality rate on the cases reported was 8.7 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. 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. 104 Diphtheria Immunisation. In January, I submitted a further report on the question of Diphtheria Immunisation recommending the Council to make arrangements through the medical practitioners for the immunisation of children between the ages of one and twelve years. A scheme was submitted to the Council providing as follows :— (1) That arrangements be made for children to be Schick tested and immunised. (2) The appointment of an immunising expert at a fee of £2 2s. Od. per session. (8) All Schick testing to be performed by the Council's expert. (4) That medical practitioners be invited to co-operate in the scheme of immunisation. Arrangements were made to submit the scheme to a meeting of local doctors who decided to co-operate with the Council on the terms and conditions set out hereunder :— The Council of the Borough of Hammersmith to pay a fee of ten shillings to a medical practitioner who undertakes the immunisation of a Hammersmith child against Diphtheria :— 1. The medical practitioner's name must be on a list prepared by the Medical Officer of Health. 2. The Council will not pay a fee in respect of any child under the age of one year or over the age of twelve years. 8. The Council will not pay a fee unless the Medical Officer of Health is satisfied that the parent or guardian cannot reasonably be expected to afford a private fee for this treatment. (Note for guidance : If the wageearner of the family is entitled to National Health Insurance Benefit or has an income which would entitle him to benefit if he were insurable, or is 105 unemployed, the Medical Officer of Health will generally regard the case as one for which the Council should pay; but where the family is in better circumstances the Medical Officer of Health will, unless there are exceptional conditions, regard the family as one able to pay a fee to the doctor.) 4. Before immunising a child, the medical practitioner must obtain the written consent of the parent or guardian. 5. The child must be given three immunising injections at not less than fortnightly intervals. 6. The immunising agent selected by the medical practitioner must be approved by the Medical Officer of Health and obtained from a firm licensed under the Therapeutic Substances Acts. 7. Each dose of the immunising agent must be contained in a separate sealed glass ampoule. In no circumstances will the Council pay a fee in respect of the immunisation of a child by a preparation from a container holding more than one dose. 8. The medical practitioner will enter the particulars of each immunising dose on a record card provided by the Council. When this record is completed and returned to the Public Health Department the Medical Officer of Health will, in appropriate cases, forward particulars of the cases to the Borough Treasurer, in order that the fees due may be paid each quarter. 9. In every case the medical practitioner must place before the parent or guardian the significance of the Schick test and advise that this should be applied to children over five years of age. If the parent or guardian decides to forego the Schick test before immunisation, it may be omitted. The medical prac- 106 titioner must urge in every case that the Schick should be applied three months after the immunising injections have been given. 10. If the parent or guardian desires the Schick test to be performed before immunisation, the medical practitioner must refer the child to the Council's immunisation expert. The medical practitioner will also endeavour to arrange for every child to visit the immunisation expert three months after the last injection. 11. The technique to be employed in connection with Diphtheria immunisation work must be that prescribed by the Council's immunisation expert. 12. The fee of ten shillings to be paid by the Council in respect of each child immunised in accordance with these rules will be the limit of the Council's liability in connection with Diphtheria immunisation, and the cost of purchasing the immunising agent must be borne by the medical practitioner, who will also be responsible for any subsequent medical attention necessary and for any other liability which may result. The council will also pay a fee of 2s. 6d. in the case of a child sent by a medical practitioner to the Clinic to have a preimmunisation Schick test and found to be negative. IB. The Medical Officer of Health may examine any child before, during or after the administration of the immunising doses, and all records kept by the medical practitioner in respect of Diphtheria immunisation must be open to his inspection. 14. An expert in Diphtheria immunisation work will be appointed who will prescribe the technique to be followed in respect of those cases for which the Council is prepared to pay a fee. He will also undertake ALL Schick testing which may be necessary, or desired. 107 15. Most children under one year of age are immune from Diphtheria and it is therefore not considered necessary to immunise them. After the age of twelve years the risk of contracting Diphtheria diminishes rapidly and the Council does not propose, at present, to pay fees in respect of persons over this age. In these circumstances, if a medical practitioner desires to immunise infants under twelve months or persons over twelve years of age, it will be necessary for him to arrange for a private fee to be paid for his services and for the services of the immunisation expert, if desired. 16. As the majority of children between the ages of one and five years are susceptible to Diphtheria, it is not essential to apply the Schick test, and immunisation can be recommended immediately (except in the case of those who have had Diphtheria). 17. A medical practitioner should not undertake immunisation until the appropriate facts have been placed before the parent or guardian. 18. If the Schick test after the immunising injections have been given, proves positive, the expert will advise the medical practitioner to give further injections, and on evidence being produced that these have been given, the Council will agree to pay an additional fee of ten shillings, subject, however, to the limitation of liability indicated under heading (12) above. 19. Arrangements will be made for children to be Schick tested and immunised at the Infant Welfare Centres at West way and 48, Glenthorne Road. 20. The Council, by means of the usual health propaganda channels, will bring to the notice of Hammersmith residents the fact that Diphtheria can be prevented and that those who desire security for their children should apply to their own family doctor. 108 The following are the particulars of the work done under the scheme since the date of its inception in February to the end of the year :— Number of children immunised by medical practitioners 1,170 Number of children who did not complete the three doses 18 Number of children who were immunised without a pre-Schick 1,184 Schick Testing Clinic. Number of Clinics held 22 Pre-Schick tests. Positive 57 Negative (4 to be re-Schick tested) 22 No reading (failure to attend)1 Post-Schick tests. Positive 6 Negative 546 No reading 19 Refusals or non-attendances 75 Removed—address unknown 38 Removed—information sent on to M.O.H. concerned 18 Additional doses recommended by the Immunisation Expert 4 (2 had one—2 had two) 109 Fees paid to medical practitioners. £ s. d. 1,170 at 10s 585 0 0 7 at 6s. 8d. 2 6 8 10 at 3b. 4d. 1 18 4 18 at 2s. 6d 2 5 0 £591 5 0 Scarlet Fever.—Three hundred and forty-nine cases were notified as due to Scarlet Fever, against six hundred and nine in the previous year. Three hundred and thirtysix cases were treated at the Isolation Hospitals, and thirteen at the homes of the patients. Three deaths were registered. The mortality rate was 0.9 per cent. Enteric Fever.—Five cases were reported as due to Enteric Fever, against one case in the previous year. The cases were treated in various hospitals. It was not possible to trace the source of infection. Erysipelas.—Fifty cases were reported as due to Erysipelas, against seventy-nine cases in the previous year. Twenty cases were treated at the homes of the patients, and thirty in various hospitals. Typhus Fever.—No case was reported as due to I'yphus Fever, against no case in the previous year. 112 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 two cases in the previous year. Both cases were treated at a London County Council Hospital. One death was registered from Puerperal Sepsis and one from other accidents and diseases of pregnancy. Puerperal Pyrexia.—Nineteen cases were reported as due to Puerperal Pyrexia against twenty-two in the previous year. One case was treated at a London County Council Hospital, three at Queen Charlotte's Hospital and fifteen at various other hospitals. Cerebro-Spinal Meningitis.—Two cases of Cerebro-Spinal Meningitis were reported against six cases in the previous year. One case was treated at Hammersmith Hospital and one at St. Charles Hospital. Two deaths were registered. Acute Polio-myelitis.—Two cases were reported as due to Polio-myelitis, against one case in the previous year. Both cases were treated at a London County Council Isolation Hospital. Encephalitis Lethargica.—Two cases were reported as due to Fncephalitis Lethargica, against one in the previous year. One case was treated at the London Homoeopathic Hospital and one was treated at home. Ophthalmia Neonatorum.—Fleven cases were reported as due to Ophthalmia Neonatorum, against eleven cases in the previous year. Seven cases were treated at London County Council Hospitals, two at Hammersmith Hospital and two at the homes of the patients. In the cases treated 113 at home arrangements were made for a nurse to attend the patients. Two cases of slight inflammation of eyes were reported by the Inspector of Midwives of the London County Council. These cases were visited by the Health Visitors and action taken where necessary. There was no impairment of vision in any case. Anthrax.—No case of Anthrax was notified during the year, as against no case in the previous year. Hydrophobia.—No case was reported as due to Hydrophobia, as against no case in the previous year. Rabies Order, 1919.—No case of Rabies in dogs occurred in the Borough. Glanders.—No case was reported as due to Glanders, as against no case in the previous year. Measles and German Measles.—Forty-five cases of Measles and German Measles were notified against one thousand three hundred and thirty-four in the previous year. Fourteen cases were treated in the Hospitals of the London County Council. No death was registered. Whooping Cough.—Three hundred and twelve cases of Whooping Cough were reported, against two hundred and seventy-two in the previous year. Seven deaths were registered. Seventy 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 thirty-five cases of Chicken Pox were reported, against four hundred and twenty-two in the previous year. Twenty-six cases were removed to hospital. 115 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, 1981, 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 until the first of July, 1985. Pneumonia.—Eighty-eight cases of Pneumonia (twentyseven Influenzal Pneumonia and sixty-one Primary Pneumonia) were notified during the year. Thirty-one 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. Eighty-seven deaths were registered. Malaria.—No case was reported, as against no case in the previous year. Dysentery.—Fourteen cases of Dysentery were reported against no case in the previous year. Food Poisoning.—Nine cases of Food Poisoning were reported under Section 7 of the London County Council (General Powers) Act, 1932. Influenza.—During the year eight deaths from Influenza occurred, as compared with nine in the previous year. Wrong Diagnosis.—Fifty-six cases of infectious disease were removed to the Hospitals of the London County Council and subsequently returned home in consequence of the patients being found not to be suffering from the 116 disease stated on the certificates, or any other notifiable disease— Diphtheria 28 Scarlet Fever 28 Total 66 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 116 Impetigo 262 Verminous Cases 1,889 Adults— Scabies 105 Verminous Cases 10 Other Conditions — Children under School-age— Scabies 13 Verminous Cases 13 School Children—Non-Hammersmith— Scabies 17 Impetigo 2 Verminous 115 Adults—Non-Hammersmith— Scabies 15 Other Conditions 9 Common Lodging-houses— Scabies 4 VerminouB 62 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 Is. for each bath given. 117 The amount received from the London County Council during the year was £'200 8s. Od. in respect of cleansings and 1119 lis. Od. in respect of scabies and cases and impetigo. The non-Hammersmith cases of scabies and verminous conditions were dealt with, as the districts 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. Beds153 Mattresses 497 Pillows ,999 Bolsters 573 Blankets 1,968 Sheets 1,160 Quilts 1,069 Articles of Clothing 4,813 Sundries 273 Total 12,505 Booms 836 Vaccination. The duties under the Vaccination Acts and the Vaccination Order were carried out by the Public Health Department. The Return for 1984 shows that 870 Infants were vaccinated, this being 56.0 per cent, of the Births and compared with 57.0 per cent, in 1938. No proceedings under the Vaccination Acts were instituted. TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1926 to 1935. 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. / Measles, b a Whooping Cough, a Cerebro-Spinal Fever. Anthrax. Glanders. Hydrophobia. Ophthalmia Neonatorum. Acute Polio-Myelitis. Encephalitis Lethargica. Pneumonia, e Malaria, e Dysentery, c Trench Fever.# Food Poisioning. g. Total. 1926 0 276 254 0 8 0 0 17 10 0 29 0 290 712 148 i 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 1929 0 337 380 0 8 0 0 7 18 0 52 0 114 631 45 3 0 0 0 21 3 8 130 5 1 0 0 1758 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 1931 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 49 280 228 0 1 0 0 6 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 1088 330 8 0 0 0 19 1 1 178 0 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 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 1935 0 349 333 0 5 0 0 2 19 0 50 0 435 45 312 2 0 0 0 11 2 2 88 0 14 0 9 1678- A verage for 10 years 7 457 318 0 6 0 0 7 21 0 59 0 349 C57 209 4 0 0 0 15 I 3 152 1 2 0 2 2269 a Not Notifiable. h Notifiable during the years 1916—1919. e Notifiable from 1st March, 1919. d Notifiable from 1st October. 1926. e Notifiable from 1st March, 1919, to 31/12/1927. / Notifiable from 2nd March, 1931, to 1/7/35. g. Notifiable from 12th July, 1932. 119 VACCINATION RETURNS. RETURN FOR 1934. Registration Sub-Districts comprised in the Vaccination Officers' District Number of Births returned in the " Birth List Sheets " a registered from 1st January to 31st Dec., 1934 Number of these Births duly entered by 31st January, 1930, in Columns I, II, IV and V of the " Vaccination Register " (Birth List Sheets), viz.: Number of these Births which on 31st January, 1936, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1936. neither duly entered in the " Vaccination Register " (columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for In the "Re port 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 1935 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 1935[ 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 19 13/###] 1. North Hammersmith 673 351 1 — 226 40 7 9 30 9 2. South Hammersmith 482 276 1 — 144 11 2 8 28 12 1,177 543 3. " Invermead " *395 243 — — 100 15 — 19 15 2 *1,550 870 2 470 66 9 36 73 23 1,177 543 * Including one " overtime" registration of birth. Number of Copies of Certificates sent to other Vaccination Officers—193. 120 Table showing Work of Vaccination Officer from 1st January to 31st December, 1935. 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. of11 Q " Notices Sent. No. of " K " Notices Served. No. of Children Died Unvaccinated. No. of Cases Removed and not Traced. Nos. entered on 'H " Lists to Public Vaccinators. Dr. DurwarJ. Dr. Dale. Dr. Townaend. Dr. Dockrlll. Dr. Brash. Dr. Phillips. Dr. Barnes Other Doctors. Dr. Durward. Dr Dale. Dr. Townsend. Dr. Dockrlll. Dr. Brash. Total North 10 128 36 87 12 — — 49 3 325 198 36 — 36 372 45 18 15 15 108 31 70 12 236 South 90 13 91 4 — — — 85 4 287 157 21 — 87 327 43 21 9 106 3 93 1 — 203 Hammersmith Hospital.. 12 11 20 9 1 — — 23 1 77 78 2 — 64 153 1 21 16 24 25 18 36 1 104 Queen Charlotte's Hospital 21 23 33 24 1 — — 160 2 264 109 4 — 235 172 13 9 19 23 24 25 20 — 92 Removed Inwards S3 53 72 27 4 — — 25 3 237 1 33 404 — 94 36 14 37 55 56 91 37 7 246 Above 14 years of age 7 9 8 1 —— — — — — — — —— — — — —— — — —— — — — — Total 193 237 260 152 18 — — 342 13 1215 543 96 404 422 1118 138 83 96 223 216 258 164 20 881 121 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 one cases of tuberculosis were reported during the year, one hundred and seventy of which were Pulmonary and thirty-one being other forms of Tuberculosis, against two hundred and fifteen cases in the previous year. PART I. Summary of Notifications during the period from the 1st January, 1935, to the 31st December, 1935. Age Periods Formal Notifications Total NotifIcations Number of Primary Notifications of new cases of Tuberculosis 0- 1- 6- 10- 15- 20- 25- 35- 45- 55- 65- Total (all aues) Pulmonary Males — — 7 14 20 21 17 11 4 94 128 Pulmonary Females — — 2 11 18 00 ** 7 7 2 1 76 90 Non-pulmonary Males 1 3 4 3 3 2 1 — — 17 21 Non-pulmonary Females — 3 2 2 2 3 1 1 — — 14 14 12'2 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- 16- 20- 25- 35- 45- 55- 65- Total Pulmonary Males — 1 1 6 11 6 4 1 2 32 Pulmonary Females — — — 4 6 9 7 2 2 — 30 Non-pulmonary Males 2 4 4 1 2 1 — — 1 15 Non-pulmonary Females — 3 3 2 1 2 2 — — — 13 Source of Information No. of Cases Pulmonary Nonpulmonary Death Returns from local Registrars 5 3 transferable deaths from Registrar General 2 2 Posthumous notifications 9 2 " Transfers" from other areas (other than transferable deaths) 46 21 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, 1935, on the Registers of Notifications 417 307 724 146 189 335 1,059 N umber of cases removed, from the Register(s) during the year by reason, inter alia of:— 1. Withdrawal of notification 2 2 4 — 1 1 5 2. Recovery from the disease 14 12 26 5 3 8 34 3. Death 66 49 115 7 4 11 126 123 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 ten deaths from Pulmonary Tuberculosis were registered, against one hundred and fifteen in the previous year, representing a death-rale of 0.9 per 1,000 compared with 0.9 in 1984. The notification of cases of Tuberculosis by medical practitioners is, unfortunately, not carried out in all cases as required by the Regulations, that is within 48 hours of the same coming to their knowledge. In all cases where failure to notify occurs, the attention of the medical practitioner is called to the fact and his observations requested. The majority of the non-notified cases are tuberculous meningitis, the diagnosis being made post mortem. It has not been deemed necessary to take any further action as the explanations have been considered satisfactory. I append figures for the years 1920-85, showing the interval between notification and death of tuberculous persons. 1920. 1921. 1922. 1923. 1924. 1925. 19-5. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1. Total number of deaths from Tuberculosis in the Borough 157 173 102 145 170 138 142 181 135 149 153 127 156150 124 119 2. The number of cases notified at death 11 8 17 11 10 13 8 — 7 3 7 2 6 13 5 11 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 11 II 4. The number of cases notified within three months of death (excluding above) 28 29 20 18 20 13 20 23 13 18 21 ! 4 17 17 9 8 5. The number of cases notified within six months of death (excluding above) 16 9 16 13 16 18 12 18 » 8 9 11 15 16 11 11 124 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1985 :— Age Periods. New Oases. Deaths. Respiratory NonRespiratory Respiratoiy NonRespiratory M. F. M. F. M. F. M. F. 0 — — — — — — — — 1 1 — — — 2 — 5 — 2 7 5 — — 1 1 15 21 29 6 4 12 20 2 2 25 41 35 3 4 24 21 1 — 45 28 9 — — 24 7 — — 65 and upwards 4 1 — — 2 — — — Totals 94 76 17 14 62 48 6 3 The ratio of non-notified tuberculous deaths to the total tuberculous deaths is 1 to 10. The following table indicates the reduction in the number of cases and deaths from Tuberculosis and the efforts made throughout the country are clearly reflected thereby :— Year. No. of Cases notified. No. of Deaths. No. of Oases on Dispensary Register. No. o f Cases on Register of Notifications. Pulmonary. NonPulmonary. Total. 1916 283 57 340 210 — — 1917 335 82 417 230 — — 1918 330 44 374 230 — — 1919 313 52 365 170 — — 1920 284 75 359 157 — — 1921 260 51 311 173 — — 1922 246 49 295 162 1923 211 63 274 145 1924 200 56 256 170 1,426 1925 220 46 265 138 1,280 1926 210 68 278 142 824 1,302 1927 226 53 279 182 686 1,289 1928 205 56 261 135 744 1,308 1929 217 63 280 149 818 1,334 1930 196 54 250 153 803 1,293 1931 183 56 239 127 905 1,198 1932 183 45 228 156 763 1,128 1933 185 31 216 150 749 1,056 1934 184 31 215 124 715 1,070 1935 170 31 201 119 759 1,059 125 Average number of cases notified for the 10 years 1916-1925 (inclusive) = 826. Average number of cases notified for the 10 years 1926-1985 (inclusive) = 245. Average number of deaths for the 10 years 1916-1925 (inclusive) = 178. Average number of deaths for the 10 years 1926-1935 (inclusive) = 144. Public Health (Prevention of Tuberculosis) Regulations, 1925. It was not found necessary to take action under these regulations during the year under review. Tuberculosis Dispensary. I submit a report on the work carried out at the Tuberculosis Dispensary during the year under review. Sessions have been held regularly at the Dispensary for the examination and treatment of patients at the following times :— Mondays, 10.30 a.m. Women and Children. Tuesdays, 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. Hammersmith Hospital. Thuisdays. 3 p.m. X-Ray Clinic. 126 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, 1935, the number of patients on the Dispensary Register was 759. During the year 64 definite cases of the disease were transferred from other areas into the Hammersmith district and 64 moved out of this district or were lost sight of. Twenty-nine were written off the register as being cured cases who had previously been notified as suffering from tuberculosis. New Patients. During the year 869 persons attended for examination for the first time, 407 males and 462 females. Of these, 295 were under the age of fifteen and 574 were adults. Of the total 212 were referred to the Dispensary by local practitioners for the purpose of consultation and 478 were " contacts " of persons suffering from 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. 127 Diagnosis. Found to have Pulmonary Tuberculosis ... 148 Found to have other forms of Tuberculosis 28 Showing no evidence of Tuberculosis ... 698 Total Attendances and Examinations. The total attendances of persons for the purpose of examination, observation or treatment, numbered 2,489 and physical examinations were carried out in 2,838 instances, i.e., in 96 per cent, of the total attendances. The names of 696 persons were written off the register as being non-tuberculous, and the total number on the Dispensary Register on 81st December, 1985, was 805. Sputum Examinations. Five hundred and twenty specimens of sputum and other pathological products were examined bacteriologically. Seventy-one showed the presence of Tubercle Bacilli, while 449 proved negative. Institutional Treatment. The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homes), under the London County Council's Scheme, numbered 284. 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. 128 Clinical Reports. To the London County Council, numbered 582 To the Ministry of Pensions 8 To General Practitioners and Hospitals952 Home Visitation. The Tuberculosis Officer made 212 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 88 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 3,719 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. 129 Return showing the work of the Dispensary during the year 1935. Diagnosis Pulmonary Non-pulmonary Total Grand Total Adults Childr'n Adults Childr'n Adults Childr'n m. f. M. f. m. f. M. f. m. f. m. f. a —New Casks examined during the year (excluding (a) Definitely tuberculoid .. 73 53 — 6 9 1 5 79 02 1 5 147 (6) Diagnosis not completed _ ?, 1 3 (c) Non-tuberculous .. — — — — — — — — 81 93 40 27 241 B.—Contacts examined during the year (a) Definitely tuberculous .. 8 13 1 2 8 13 3 _ 24 _ (c) Non-tuberculous .. — — — — — — — — 83 152 110 109 454 C.—Cases written off the Dispensary Register as (a) Recovered 11 8 — 4 1 1 3 1 12 9 3 5 29 (ft) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuber- — — — — — — — — 104 245 150 137 696 D.—Number of Cases on Dispensary Register on (a) Definitely tuberculous .. 321 232 12 10 52 70 40 53 373 302 68 69 802 (b) Diagnosis not completed — — — — — 2 1 3 1. Number of cases on Dispensary Register on January 1st 759 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) .. 300 2. Number of caees transferred from other areas and cases returned after discharge under Head 3 in previous years 3. Number of cases transferred to 64 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 3,719 other areas, cases not desiring further assistance under the scheme, and cases " lost sight of 64 10. Number of:— (a) Specimens of sputum, Ac examined 520 4. Cases written off during the year as Dead (all causes) 98 (6) X-ray examinations made, in connection with dispensary work 211 5. Number of attendances at the Dispensary (including contacts) 2,439 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (6) above Nil 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 343 7. Number of consultations with medical practitioners:— (a) Personal 212 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 879 (6) Other 566 PULMONARY TUBERCULOSIS Supplementary Annual Return showing in summary form (a) the condition at the end of 1935 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 rceord made during the year to which the return relates Previous to 1926 1926 1927 1928 1929 1930 Class T.Bf 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 Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.b. plus) (a) Remaining on Dispensary Register on 31st December. Disease Adults Arre8ted Children M. 13 4 3 1 8 1 1 2 2 1 — 1 1 — — — — — — 1 — 1 2 — — — — F. 4 1 — 1 — 2 1 — 3 1 1 — — 1 2 2 1 1 1 2 — — — — 1 — — — — — — _ — — — — 1 — — 1 — — — — Disease not Adults Arrested Chi]dren M. 13 3 10 2 15 4 3 1 1 5 4 3 2 9 4 1 _ 5 2 5 4 1 10 4 2 1 3 F. 2 1 4 — 5 5 1 1 2 — — —- — — 1 1 2 5 3 ? 10 7 2 4 6 — — — - — — — — 1 — — — — — — 1 3 1 1 2 Condition not ascertained during the year — — — —— — — — — — — — —— —— — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 34 9 17 3 29 10 7 3 2 12 4 5 4 2 11 1 6 2 8 6 11 8 3 22 18 3 4 4 11 (b) Not now on Dis; ensary Register and reasons for removal therefrom. Discharged Adults as Recovered Children m 18 1 3 4 2 3 2 2 3 4 4 3 1 1 4 F. 19 3 2 — 5 5 1 1 — 2 8 — — 3 1 — 1 5 2 — 2 1 15 — — — — — — — — — — — — —— —— — — — — — — — —— — — — — Lost sight of, or otherwise removed from Dispensary Register 88 16 17 5 38 17 12 13 5 30 26 10 18 6 34 31 21 19 3 43 31 13 13 2 28 29 13 18 — 31 Dead Adults Children M 3 1 4 6 11 5 5 18 13 36 1 5 15 31 51 2 5 16 15 36 12 8 13 10 31 9 11 ?? 1? 45 F. 4 7 4 11 3 4 3 11 18 4 3 5 12 20 6 18 11 6 35 5 3 9 5 17 12 8 11 f> 24 2 — — — — — — 2 1 1 2 — — — — — —— — —— — — — — Total written off Dispensary Register 149 21 33 15 69 37 22 35 29 86 46 18 41 49 108 48 48 47 24 119 57 27 35 17 79 55 32 51 17 100 Grand Totals 183 30 50 18 98 47 29 38 31 98 50 23 45 51 119 49 54 49 24 127 63 38 43 20 101 73 35 55 21 111 1931 1932 1933 1934 1935 (a) Remaining on Dispensary Register on 31st December. Disease Adults Arrested Children M 2 2 2 1 — — — —— — — — — — — — — — — — — — — — F 2 1 —— — — — — — — — — — — —— — — — — — —— — — 1 — — — — — — — — — — — — — — — — — — — Disease not Adults Arrested Children M. 7 11 7 5 23 6 7 13 2 22 11 4 18 4 26 7 13 23 g 44 25 14 30 1 45 F. 10 5 10 — 15 8 4 1 14 13 7 lb 22 10 4 20 2 26 16 20 18 2 40 — 1 — — 1 4 1 2 — 1 — 1 — 1 4 — — — — 1 Condition not ascertained during the year — — — — — —— — — — — — — — — — — — — — —— — — — Total on Dispensary Register at 31st December 22 18 19 5 42 19 12 25 3 40 25 11 34 4 49 21 17 43 10 70 42 34 48 3 85 (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Adults Recovered Children M — — — —— — — — — — — — — — — — — — — — — — —— — F. — — — — — — — — — —— — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —— — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 11 5 18 1 24 11 6 16 2 24 5 6 19 2 27 6 4 5 2 11 1 1 5 2 8 Dead Adults Children M. 8 8 12 1 21 5 8 13 11 32 6 5 22 9 36 5 3 5 13 21 1 2 6 6 14 F. 5 4 11 3 18 6 8 9 1 18 4 5 13 7 25 6 3 13 7 23 1 1 4 5 1 — — — 1 — — — 1 — — — 2 — 1 ~ 1 — — — Total written off Dispensary Register 25 17 41 5 63 23 22 38 14 74 16 16 54 18 88 19 10 24 22 56 3 3 12 12 27 Grand Totals 47 35 60 10 105 42 34 63 17 114 41 27 88 22 137 40 27 67 32 126 45 37 60 15 112 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1935 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 1930 Bones and Joints Additional Other Organs Peripheral Glandsl 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 Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Rem lining on Dispensary Register on 31st December. Disease Adults Arrested ciiildren M. 2 — — — 2 1 — — 1 1 1 2 1 1 F. 2 — — 1 3 2 2 2 — 1 3 — 1 1 1 — — — 1 2 — — 2 4 — — — — — 1 — — — 1 2 — 1 1 4 1 — — 2 3 Disease not Adults Arrested chi,drei M. 3 _ 3 o 2 1 1 2 1 1 4 1 2 3 3 . 2 1 6 F. — — 2 5 *7 — 1 1 1 3 2 — — 2 1 2 3 1 2 3 2 3 5 — — — — — 1 — 1 — 2 — — ~ — — — 2 — 2 — — 1 2 3 6 — — 7 13 Condition not ascertained during the year — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 5 - 5 6 16 4 1 2 7 14 2 - - 1 3 4 1 4 3 12 6 1 4 6 17 12 2 14 28 Transferred to Pulmonary (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged Adults as Recovered Children M 3 3 6 1 — — — 1 1 — 1 2 1 1 1 1 F. 2 1 1 5 9 3 — 2 5 1 1 2 — — 1 1 1 1 1 3 9 1 1 16 27 — 1 — 7 8 2 1 — 2 5 3 — — 8 11 — — — 2 2 — — — 2 2 Lost sight of, or otherwise removed from Dispensary Register M. 21 4 19 44 10 — — 7 17 8 1 3 6 18 3 2 7 12 2 7 7 16 12 2 5 19 1 1 2 — — 9 1 1 1 1 2 1 1 1 1 2 Dead ADULT Children F. 1 — 1 — — 1 1 — — — — — - 2 — — — 2 1 3 — 4 — — - — — 1 1 — 2 — — — — — 2 — — 2 — ~~ — — — — — — Total written off Dispensary Register 36 3 9 40 88 13 5 1 17 36 13 3 3 •J 28 9 — 3 16 28 6 7 10 23 14 3 5 30 Grand Totals of (a) and (6) (excluding those transferred to Pulmonary) 41 3 14 46 104 17 6 3 50 15 3 3 10 31 13 1 7 19 40 12 1 11 16 40 26 3 7 22 L. 58 1031 1932 1933 1934 1935 (a) Remaining on Dispensary Register on 31st December. Disease Adults Arrested children m. — — — — — — — — — — — — — — — — — —— — — — — — — F. 1 1 2 1 1 4 1 — — — 1 — — — — — — — — — — — — — — Disease Adults not Arrested children m 4 2, 6 1 8 4 1 2 3 4 1 3 8 4 2 6 F 5 1 4 10 1 ?. 3 3 4 7 2 2 1 3 8 3 3 — 2 8 5 1 1 5 12 7 1 — 7 15 1 3 1 5 10 4 1 11 16 2 3 — 3 8 Condition not ascertained during the year — — — — — — — — — — — — — — — —— — — — —— — — — — Total on Dispensary Register at 31st December 15 4 3 12 34 9 2 - 12 23 5 3 3 9 20 10 4 4 14 32 9 6 7 22 Transferred to Pulmonary (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Adults Recovered children m. — — — — — — — — — — — — — — — — — — — — — —- — — — F — — — — — — — — — — — — — — —— — — — — — ——— — — — 1 — — — — — — — — — — — — — — — — — — — — — —— Lost sight of, or otherwise re moved from Dispensary Register 6 4 — 8 18 6 — — 4 10 8 1 1 3 8 1 — - 1 2 — — 1 1 Dead Adults Children M — — — — 1 — — — 1 — 1 1 2 F — 2 2 — — — 1 — 1 — 1 — — 1 — — — — — —— — — — — — — — — —— — 1 1 — — — — — Total written off Dispensary Register 7 6 — 8 21 7 — — 4 11 3 1 2 4 10 1 — 1 2 4 — 1 1 — 2 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 22 10 3 20 55 16 2 - 16 34 8 4 5 13 30 11 4 5 16 36 9 7 1 7 24 134 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 12 occasions during the year. The London County Council are now providing free clothing, dental treatment and spectacles to suitable cases undergoing sanatorium treatment. A Sale of Christmas Seals was organised for the first time by the members of the Tuberculosis Care Committee under the auspices of the National Association for the Prevention of Tuberculosis. The Sale proved a great success, £126 17s. 7d. was collected with a net result of £97 8s. Od. This is known as the Tuberculosis After-Care Committee Fund " and is used to assist suitable patients in matters not provided for under other schemes. Extra nourishment is provided by the Borough Council to patients before entering institutions and on discharge. „ This grant is made by the Borough Council under the Public Health (Prevention and Treatment of Disease) Act, 1913. The suitability of the patients for participating in this grant rests with the Tuberculosis Officer after consideration of the clinical and social features of the case. 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. 135 Eighty-two cases were referred for assistance to the following agencies:— Invalid Children's Aid Association 8 Charity Organisation Society 1 Unemployment Assistance Board 4 School Care Cohimittee 10 Public Assistance Committee 44 Mayor's Fund 2 United Services Fund 12 South Street Mission 1 Metropolitan Society for the Blind.. 1 Jewish Board of Guardians 1 Welfare Centre 2 Friends of the Poor 1 In addition, clothing was supplied to six patients from the Dispensary sources. The staff consists of the Tuberculosis Officer, Dr. 6. 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 preand 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 onr 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. 136 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. • Nursing Comforts. Articles. Quantity owned by the Borough Council. Number of PatientB to whom Loaned. Number still on Loan. Bed Rests 10 13 4 Rubber Rings 3 3 — Air Rings 6 11 4 Rubber Hot-Water Bottles 15 0 10 Bed Pans 6 8 3 Ice Bags 4 2 — Air or Water Bed 2 — — Inhalers 20 7 — Air Cushion 1 — — Aluminium Hot-Water Bottles 3 3 3 Bronchitis Kettles 6 — — Feeding Cups 6 1 1 Bed Sheets 2 — — Water or Air Cushions 3 1 — Camp Bed 1 — — Iron Bedsteads with Mattress 3 1 1 Urinals 5 3 1 Invalid Chaiis 2 1 1 Repairs to Surgical Appliances. During the year two 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. Other cases or those requiring new appliances were referred to one of the voluntary associations. 137 Report on Tuberculosis Work at the Hospital. All. Tuberculosis cases are now treated at 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. 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, gas replacements, phrenic evulsion and sanocrysin, is carried out on suitable pulmonary cases, whilst plaster work and orthopaedic corrections form part of the routine of suitable surgical cases. In 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. 138 Certain medical practitioners send reports to the Tuberculosis Officer on patients under domiciliary treatment at three-monthly intervals. The majority fail to do so, but in these cases no difficulty has been experienced in securing the attendance at the Dispensary of the patients themselves for examination purposes. X-Ray Work. Dispensary cases requiring further investigation are referred to the X-ray department of the London County Council Hospital at Du Cane Road, W.12. Films of the chest and other regions are taken, and delivered to the Dispensary to be filed as permanent records of the respective cases. This 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. The total number of X-rays and reports made by the Tuberculosis Officer for the year was 211. 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 15. The total number of refills performed by the Tuberculosis Officer in the dispensary for the year 1935 was 212. 139 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. Fifty-four sanocrysin injections were made during the year. PREVENTION OF BLINDNESS. Blind Persons Act, 1920. If 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. 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 carries out the duties in relation to Infant Life Protection, 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-four applications were received for certificates under the above Act. In twenty-three cases the certificates were granted. 140 Nine certificates were granted to owners who had carried out the work specified satisfactorily. 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 seven persons from the catacombs or graves in St. Mary's Cemetery. One body was removed to the churchyard at Winkfield for re-interment, and six bodies were re-interred in St. Mary's Cemetery, Kensal Green. The following conditions were attached to the licences:— (1) That the removal be effected with due care and attention to decency early in the morning. (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 Winkfield—the remains be conveyed to the churchyard and be there re-interred, provided that if any of the wooden shells in which the coffins are contained shall be found to be decayed the coffin shall be placed in a new wooden shell prior to removal. 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 Boad, are provided with aeration and filtration plants, whereby the water is continuously filtered, aerated and chlorinated. The water is pumped from a point at the deepest part of the Baths, passed under pressure to gravel filters, then 141 into a chamber or tank where it is aerated, and afterwards chlorinated before returning to the Baths. Samples of water were periodically submitted for bacteriological examination and found to be of a high standard. 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 8 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. Booklet—" Family Meals and Catering."—This booklet is issued by the British Medical Association and contains information as to the vitamins in various dishes and on the preparation and cooking of meals containing full nourishing values. The Council, on the recommendation of the Maternity and Child Welfare Committee, decided to distribute copies of the booklet to all mothers attending the Infant Welfare Centres and Ante-natal Clinics. SHOPS ACT, 1934. This Act contains provisions for (1) regulating the hours of employment of persons under the age of 18 years 142 employed about the business of a shop, and (ii) securing improved arrangements for the health and comfort of shop workers generally. The Act came into operation on the 30th December, 1934. The provisions relating to the hours of employment are to be administered by the local authorities under the Shops Act, and by the local authorities responsible for the regulation of street trading (i.e., in both instances in London, the London County Council). As regards the arrangements for the health and comfort of any workers generally, while the enforcement of the provisions as to lighting of shops, washing facilities and facilities for meals, rests with the Shops Act authorities, the provisions as to ventilation and temperature of shops and as to sanitary conveniences in shops are to be administered by the sanitary authorities (i.e., in London, the Metropolitan City and Borough Councils). The Act applies to three classes of premises : retail shops, wholesale shops and warehouses. Ventilation and Temperature.—It is provided by Section 10 that in every part of a shop in which persons are employed about the business of a shop— (i) There must be provided suitable and sufficient means of ventilation and sufficient ventilation must be maintained. (ii) There must be provided suitable and sufficient means to maintain a reasonable temperature and a reasonable temperature must be maintained. " Employment about the business of a shop " is a very wide term and includes any employment in the service of an occupier which is ancillary to the business carried on in the shop, e.g., cleaning and maintenance work. Sanitary Conveniences.—Section 10 (2) of the Act provides that in every shop, unless it is specifically exempted, there must be provided and maintained suitable and sufficient sanitary conveniences. These conveniences have to be available for the use of persons employed "in or 143 about the shop." This is intended to cover employment in the shop itself and in the immediate vicinity. Sanitary conveniences must be provided in the shop unless a certificate of exemption is granted by the local authority, i.e., the Borough Council. Such certificate may be granted only where the authority are satisfied that by reason of restricted accommodation or other special circumstances affecting the shop, it is reasonable that such certificate should be in force, and that suitable and sufficient sanitary conveniences are otherwise conveniently available. If the local authority ceases to be satisfied that the necessary conditions are fulfilled, they must withdraw the certificate, but it is provided that an occupier may appeal to the County Court against the withdrawal. In the event of failure to comply with the provisions above mentioned, the authority must serve notice upon the owner or occupier requiring him to carry out such work as may be necessary within a specified time in default of which summary proceedings may be taken against him. Enforcement.—For the purposes of the enforcement of the provisions for which sanitary authorities are responsible, Sanitary Inspectors of the Borough Council have the power of entry and inspection conferred by Section 119 of the Factory and Workshop Act, 1901. Although Shops Act authorities are not responsible for the provisions of the Act relating to ventilation, temperature and sanitary conveniences in shops, it is nevertheless the duty of Shops Act Inspectors (L.C.C. officers) to take a note of and, if necessary, to report to the sanitary authority any contravention of these provisions, and for that purpose the Shops Inspectors have the power of entry and inspection referred to above. During the year ninety-one shops were inspected. Thirty notices were served requiring the provision of water closet accommodation, forty-one notices were served requiring the provision of suitable and sufficient means to 144 maintain a reasonable temperature and eight notices were served relating to the provision of suitable and sufficient means of ventilation. In twenty-four cases the Council granted a certificate of exemption where satisfactory arrangements had been made for the shop assistants to use conveniences in the same building or elsewhere in the immediate vicinity. Public Mortuary.—Three hundred and seventy-seven bodies were admitted to the Mortuary in Fulham Palace Road during the year. H ammersmith— Admitted by order of Coroner 136 Admitted by order of Police 19 Admitted on application of undertakers lor accommodation 37 192 Bodies admitted from other Boroughs :— Fulham 74 Chelsea 111 186 No. of P.-M. examinations conducted :— Hammersmith oases 109 Fulham cases 43 Chelsea cases 63 Total P.M.'s 215 No. of Inquests held :— Hammersmith cases 112 Fulham cases 55 Chelsea cases 94 Total Inquests held 261 The installation of a refrigeration plant for the purpose of arresting decomposition of the bodies has proved very successful.