65891 HAM 28 INDEX Page Introduction 2 Staff of the Public Health Department 5 Statistics for the Year, 1936 8 Natural and Social Conditions of the District. Births 9 Cancer 11 Deaths 10 Deaths of Aged Persons 11 Deaths of Residents (Outlying) 12 Deaths (Various Causes) 15 Marriages 9 Population 9 Statistics 12 Table—Whole of London—Comparison 16 General Provision of Health Services in the Borough. Ambulance Facilities 17 Hospitals (Public) 20 Hospitals (Voluntary) 21 Laboratory Facilities 17 Professional Nursing in the Home— General 18 Nursing 18 Bheumatism Advisory Clinic 19 School Clinics 19 Treatment Centre for Venereal Diseases 20 Tuberculosis Dispensary 19 Treatment and Nursing—Children under School Age 20 Minor Ailments. Maternity and Child Welfare. Accouchement Outfits and Maternity Bags 43 Ante-natal Clinics 40 Births—Notification 28 Centres—Infant Welfare 35 Chart—Infantile Mortality Rate 30 Circumcisions 34 Cod Liver Oil 39 Consultants 44 Convalescent Treatment 48 Day Nurseries 47 Deaths of Infants 28 Deaths—Premature 31 Deaths in Institutions 32 Deaths—Illegitimate 33 Page Diarrhœa—Chart 34 Dinners 39 Domiciliary Midwifery Service 42 Feeding of Infants—Statistics 26 Health Visitors—Work of 25 Home Helps 45 Hospital Treatment—Zymotic Enteritis 33 Infantile Mortality 29 Infectious Diseases of Mothers and Children under five years of age—Tabular Statement 46 Infective Enteritis and Pneumonia 31 Institutional Treatment for Unmarried Mothers 42 Massage and Remedial Exercises Clinic 36 Maternity Services—Reorganisation of 24 —Facilities for Confinement 41 Maternal Mortality 38 Midwives 45 Milk (Mothers and Children) Orders, 1918-1919 38 Ophthalmia Neonatorum 47 Schedule of Attendances at Infant Welfare Centres 36 Sessions—Infant Welfare Centres 35 Stillbirths 28 Table—Births, Deaths, and Infant Death Rate 27 Child Life Protection 49 Sanitary Circumstances of the Borough. Closet Accommodation 51 Common Lodging Houses 64 Fouling of Footpaths by Dogs 51 Inspections 52 Notices 53 Sanitary Inspection of Area 51 Scavenging 51 Seamen's Lodging Houses 64 Summonses 53 Persons Living under Insanitary Conditions 59 Factories and Workshops—Inspection of 59 House to House 62 Houses Let in Lodgings 64 Rag Flock Acts, 1911 and 1928 65 Rats and Mice (Destruction) Act, 1919 62 Schools 65 Smoke Abatement 62 Tenement Houses 63 Vans 64 Housing. Eradication of Bed Bug 70 General Housing Conditions 69 Newly Erected Houses 70 Statistics 65 Survey—Overcrowding 68 Slum Clearance 72 Page Inspection and Supervision of Food. Bacteriological Examination of Milk 93 Bakehouses 86 Butter, Margarine 110 Certification of Certain Food Products for Export 82 Cheese 110 Chemical and Bacteriological Examination of Food 89 Cocoa, Coffee and Tea 114 Condensed Milk 108 Cordials, Wines and Spirits 114 Condiments, &c. 112 Confectionery 112 Conserves, Vegetables, Fruits, &c. 112 Cream 109 Drugs 115 Farinaceous Foods 114 Food and Drugs Adulteration Act, 1928 101 Food Supplies 81 Fried Fish Shops 86 Ice Cream Vendors 88 Inspection of Carcases of Animals slaughtered in Local Slaughterhouses 83 Markets 85 Meat and Fish Preparations 110 Milk 104 Milk Supply 81 Milk (Special Designations) Order, 1936 82 Offensive Trades—Slaughterers of Poultry 84 Public Health (Meat) Regulations, 1924 83 Samples—Adulterated 40 Slaughterhouses 84 Street Trading 85 Unsound Food 89 Prevalence and Control over Infectious Diseases. Acute Polio-myelitis 134 Anthrax 135 Anti-toxin 128 Artificial Pneumothorax Treatment 164 Bacteriology 125 Cerebro-Spinal Meningitis 134 Chicken Pox 138 Cholera 128 Cleansing of Verminous Persons 143 Continued Fever 134 Diphtheria 128 Diphtheria-Chart 132 Diphtheria Immunisation 129 Disinfection 141 Dysentery 140 Encephalitis Lethargica134 Enteric Fever131 Page Erysipelas 131 Food Poisoning 140 Glanders 135 Hydrophobia 135 Infectious Diseases 126 Influenza 140 Malaria 140 Measles and German Measles 135 Measles—Chart 139 Notifiable Diseases 127 Nursing Comforts 161 Ophthalmia Neonatorum 134 Plague 128 Pneumonia 140 Public Health (Smallpox) Regulations, 1917 147 Public Health (Prevention of Tuberculosis) Regulations, 1925 151 Puerperal Fever 134 Puerperal Pyrexia 131 Psittacosis 140 Rabies Order, 1919 135 Relapsing Fever 134 Report on Tuberculosis Work at Hammersmith Hospital 163 Sanocrysin Treatment 165 Scarlet Fever 130 Scarlet Fever—Chart 133 Smallpox 128 Special Investigation—Tuberculosis 165 Tabular Statement—Zymotic Diseases 127 Tuberculosis 147 Tuberculosis Care Committee 160 Tuberculosis Dispensary 151 Typhus Fever 131 Vaccination 144 Vaccination Returns 145 Whooping Cough 138 Whooping Cough—Chart 139 Wrong Diagnosis 140 • X-Ray Work 164 Zymotic Diseases 126 Prevention of Blindness 168 Sanitary Administration. Staff 168 Increases of Rent and Mortgage Interest Restrictions Acts, 1920-23 168 Exhumation and Re-interment of Bodies 169 Public Baths 169 Public Wash-houses 171 Propaganda 171 Shops Act, 1934 173 Pharmacy and Poisons Act 172 Public Mortuary 174 Zotofoam Baths 170 Metropolitan Borough of Hammersmith. ANNUAL REPORT of the Medical Officer of Health for the YEAR 1936. 2 Public Health Department, Town Hall, Hammersmith, W.6. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hammersmith. Ladies and Gentlemen,—I beg to present my Annual Report for the Year 1936. The report deals with the vital statistics, and with the work carried out under the direction of your Council during the year. The statistical tables included relate to the Public Health of the Borough. The death-rate of 12.5 being 0.6 greater than the previous year. There were three maternal deaths as compared with two in the previous year. The rate was equal to 1.5, whereas the rate for the whole country was 3.6. The infantile mortality rate has decreased from 70 to 60 per 1,000 births; the lowest rate recorded in the Borough. The rate for the County of London increased from 58 to 66 per 1,000 births. It is very gratifying to be able to report this decrease in the number and rate of infant deaths. It is perhaps significant that this should occur immediately following the appointment of two whole-time Assistant Medical Officers. This is all the more encouraging as the reduction has taken place during a year when infantile rates for the whole of London has increased. 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. During the year the new services provided by the Council, i.e., the provision of a domiciliary midwifery service, 3 provision of Home Helps have been put in operation, and it is hoped that Hammersmith mothers will take advantage of them. Diphtheria Immunisation. The scheme for immunisation of children against diphtheria continued throughout the year; 557 children have been dealt with. It is to be regretted that the number of children immunised dropped from 1,170 to 557. The present method necessitates three injections. It is found in quite a number of cases that children refuse to have the second and/or third injection. I propose in the coming year to submit a revised scheme which will provide for the immunisation by what is known as the one-shot method. It is interesting to note the decrease in the number of cases of diphtheria (p. 142). Tuberculosis. Tuberculosis is a disease which has for years occupied the attention of the Public Health authorities throughout the country. Since the War greater provision has been made for the treatment and segregation of tuberculous patients by the establishment of Tuberculosis Dispensaries, Sanatoria and the provision of beds in hospitals. As a result there has been a considerable decrease in the number of cases and deaths from tuberculosis. In the Tuberculosis section of this report I have included a table showing the figures relating to this disease since the year 1917. It will be seen that the number of cases and deaths have dropped approximately 50 per cent. during the past twenty years. 4 During the past two years the Tuberculosis Officer has carried out a special investigation (p. 165) on the question of the reliability of diagnosis. This work shows that quite a large number of cases are diagnosed and notified as Tuberculosis which, on further investigation, are found to have been notified on insufficient evidence and are not suffering from this disease. This is a matter of great importance and deserves consideration. It is to be hoped that the passing of the Housing Act will result in better housing, and that the prosperity of the country will continue, so that the people can obtain a plentiful supply of good food. These two important factors, together with an abundant supply of fresh air, must play a very great part in the further reduction of this disease. During the year a considerable amount of time has been spent in the supervision of the Milk Distributing Depots established in the Borough. Experiments have been earned out in relation to the bacteriological examination of milk and the pasteurisation of milk : a full report on this work is included in the appropriate section. With regard to infectious diseases, the total number notified was above the average for the past 10 years. This was due to the increase in number of cases of measles. It is my pleasure, once again, 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. 5 STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF THE YEAR 1936. MEDICAL OFFICER OF HEALTH Administrative Officer for Tuberculosis, and Maternity and Child Welfare. Vaccination Officer. year of Appointment 1914 J. R. Howell, M.R.C.S., L.R.C.P., D.P.H. Tuberculosis Officer and Deputy Medical Officer of Health. G. I. Davies, M.D., R.S., M.R.C.S., L.R.C.P., D.P.H 1930 Assistant Medical Officers (M. and C.W.). Mary I. Adams, M.B., B.Ch., B.A.O., D.P.H 1936 Naomi Dancy, M.B., B.S., M.R.C.S., L.R.C.P 1936 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. G. Waller, M.R.C.S., L.R.C.P. Bacteriologist. F. H. Teale, M.D., F.R.C.P. 6 Year of Appointment Clerical Staff. *A H. Wilmot (Chief Clerk) 1902 J. C. Turner 1920 †Miss E. Cole 1923 A. H. Johns 1925 F. G. Holland 1929 T. J. Hares 1930 E. F. Yorke 1931 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 §ØG. W. Herrick 1929 Lady Sanitary Inspector and Infant Life Protection Visitor. "║□⁫⁪"ØMiss E. M. Cross 1932 Health Visitors. "║□†*Miss R. A. Henry 1916 ║□*Miss A. M. M. Willcox 1916 "||Miss D. G. Johnson 1922 ΔØ"║□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 (Temporary Junior Clerk-) 1932 A. Pullin (Porter) 1918 7 Year of Appointment Medicinal Baths and Disinfecting Staff. A. H. S. Hutchinson (Superintendent) 1928 Mrs. Manners 1924 C. Langley (Disinfector) 1900 Mortuary Keeper. D. A. Mackay 1929 †Cert. Royal Sanitary Institute (Inspector). *Cert. Sanitary Inspectors Examination Board. □Cert. Central Midwives Board. §Ceri. Royal Sanitary Institute (Meat and other foods). ║Trained Nurse. "Cert. Royal Sanitary Institute (Health Visitor). °Royal Sanitary Institute (Smoke Certificate). ¶Apothecaries' Hall Certificate. ØCert. Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. =Smoke Abatement Cert. L.C.C. School of Engineering. ΔDiploma in Nursing, London University. 8 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1936. Area 2,282.5 acres Population (1986) (estimated) 127,700 Population Census (1901) 112,239 „ „ (1911) 121,521 „ „ (1921) 180,295 „ „ (1931) 135,521 Natural increase, i.e., excess of births over deaths 325 Density of population 55.9 persons per acre Marriages registered 1,411 Number of inhabited houses 1931 17,402 Number of families or separate occupiers (1921) 33,263 Rateable value (1936) £1,231,945 Sum represented by a penny rate, 1936 £4,948 Vital Statistics. Births (legitimate) 1,784 Birth rate 15·1 ,, (illegitimate) 138 Stillbirths 58 Rate per 1,000 (live and still) births 29 Deaths (corrected) 1,597 Death rate 12·5 Adjusted death rate 12·9 Deaths from puerperal causes:- Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 0·5 Other puerperal causes 2 1·0 Total 3 1·5 9 Deaths of infants under one year of age per 1,000 births 60 Legitimate, 60. Illegitimate, 65. Deaths from cancer (all ages) 249 Deaths from measles (all ages) 15 Deaths from whooping cough (all ages) 7 Deaths from diarrhoea (under 2 years of age) 25 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., 127,700. The corrected number of births registered was 1,922, whilst the corrected number of deaths of residents was 1,597, thus showing a natural increase of population by excess of births over deaths of 325. The area of the Borough is 2,282.5 acres, there being 55.9 persons to the acre. Marriages.—The number of marriages registered during the year was 1,411, the marriage-rate being 22 Births.—During the year 2,266 births were registered in the Borough. Adding 309 births which occurred, outside the Borough, transferred by the Registrar-General as belonging to Hammersmith, and deducting 653 births which occurred in the Borough, and transferred to other districts by the Registrar-General, the corrected number of births for the year was 1,922. On the estimated population, i.e., 127,700, the corrected number of births registered was equal to an annual rate of 15.1 births per 1,000 persons living. 10 The Birth-rate for the year is 0.4 per 1,000 greater than the rate for the previous year which was 14.7. The Birth-rate in London on the estimated population, i.e., 4,141,100, was equal to an annual rate of 13.6 births per 1,000 persons living. There has been a considerable increase in the number of births notified under the Notification of Births Act, i.e., 2,584. This is due to the increase in the accommodation provided at the Hammersmith Hospital. As a result the number of births registered in the Borough was 2,266 as against 1,774 in the previous year. This increase means additional work in the department both in respect to records, transferring information to other districts, &c. Deaths.—During the year 1,399 deaths were registered in the Borough, as compared with 1,347 in the previous year. Adding 609 deaths of residents of this Borough which occurred in general hospitals and other public institutions, and 30 deaths of residents transferred by the Registrar-General as having occurred in various parts of England, and deducting 427 deaths of non-residents and 14 transferable deaths which occurred in the Borough, the corrected number of deaths of residents was 1,597 (806 males, 791 females). On the estimated population, i.e., 127,700, the corrected number of deaths of residents was equal to an annual rate of 12.5 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. An adjusting factor has been supplied by the RegistrarGeneral, and this when applied to the Hammersmith deathrate gives a rate of 12.9, a figure which is directly comparable with the contemporaneous crude death-rate for the 11 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 1.03. The Death-rate in London on the estimated population, i.e., 4,141,100, was equal to an annual rate of 12.5 deaths per 1,000 persons living. Deaths of Aged Persons.—The corrected number of deaths of residents at 65 years of age and upwards registered during the year was 789, against 705 in the previous year. These deaths were equal to 6.2 per 1,000 of the total persons living, and 494 per 1,000 of the total deaths of residents registered. Cancer.—There were 249 deaths from Cancer, and of this number, 224 occurred in persons over the age of 45 years. These deaths were equal to 1.96 per 1,000 of the population. The following table shows the number of deaths from Cancer under the various age groups during the past 10 years:- Year. Total Deaths. Sex. All Ages. 1- 2— 5— 15— 25— 45— 65— 75— 1927 206 M 80 - - - - 2 30 27 21 F 126 — — — 1 10 48 40 27 1928 207 M 104 1 — — 1 6 43 32 21 F 103 - — — — 10 48 30 15 1929 231 M 110 — 1 — — 2 51 40 16 F 121 — - 1 3 7 44 40 26 1930 213 M 106 — — — — 7 51 31 17 F 107 — 1 — — 9 48 24 25 1931 229 M 104 — — — — 11 53 29 11 F 125 — 1 — — 12 48 32 32 1932 206 M 92 — - — 1 6 48 26 11 F 114 — — 1 2 9 54 27 21 1933 231 M 114 - — — 2 8 46 38 20 F 117 — — — 1 11 46 29 30 1934 235 M 112 — - — 1 9 46 31 25 F 123 — — 1 - 9 40 51 22 1935 216 M 117 — — — — 8 57 38 14 F 99 — — — — 7 45 26 21 1936 249 M 111 — — 1 2 5 48 42 13 F 138 — — — 3 14 53 38 30 The average number of deaths for the ten years is 222. In all cases where death occurs from Cancer the Lady Sanitary Inspector visits and offers disinfection. 12 Statistics.—The following table gives the statistics of the Borough during 1936 and previous years :— Vital Statistics of Whole District during 1936 and Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. of Non-residents registered in the District. of Residents not registered in the District Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13  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 1936 127700 2266 1922 15.1 1399 10.9 441 639 116 60 1597 12.5 Deaths of Residents.—Belonging to the Borough, occurring in Public Institutions, &c., in districts outside, during the year 1986 :— MENTAL HOSPITALS. 1, West Park Road, Epsom 3 The Forest, Hook Road, Epsom 1 Horton Hospital, Epsom 7 1, Uxbridge Road, Southall 18 Stone House 1 Tooting Bee Hospital 18 Leavesden Mental Hospital 1 Bethlem Royal Hospital, Croydon 1 Daren th Training Colony, Lartford 1 Hundred Acres, Banstead 5 Fountain Hospital, Wandsworth 1 The Grove, Hbrton Lane, Epsom 1 Mental Hospital, Shenley 1 59 13 GENERAL HOSPITALS, NURSING HOMES, &c. German Hospital, Hackney 1 National Hospital for Diseases of the Heart 1 General Lying-in Hospital, Lambeth 1 Seamen's Hospital, Greenwich 1 Royal Northern Hospital, Islington 2 Royal Hospital for Incurables, Putney 1 Mount Vernon Hospital, North- wood 2 Royal Free Hospital 1 All Saints' Hospital, South- wark 1 Heatherwood Hospital. Ascot 1 Brompton Hospital Sanatorium, Frimley 1 Stoneycrest Nursing Home, Hindhead 1 Grove Park Hospital, Chisle- hurst 1 Beckenham Hospital 1 East Anglian Sanatorium, Nay- land 1 1. Rutland Park, Sheffield 1 Guy's Hospital 1 Queen Mary's Hospital, Chisle- hurst 1 Marillac Sanatorium, Brentwood 1 Surrey County Sanatorium, Busbridge 1 Children's Hospital, Great Ormond Street 1 Queen Charlotte's Hospital 1 Royal Victoria Hospital, Bournemouth 1 Princess Beatrice Hospital, Kensington 1 Victoria Hospital, Chelsea 3 Northants Sanatorium, Hollo- well 1 Petworth Cottage Hospital 1 Redoubt Nursing Home, Eastbourne 1 114 Princess Louise Hospital, Kensington 18 Willesden General Hospital 1 Acton Hospital 5 Colindale Hospital 1 Putney Hospital 1 20, Devonshire Place, St. Mary- lebone 1 University College Hospital 3 St. Luke's Hospital, Paddington 4 Charing Cross Hospital 3 Brompton Hospital 1 Convent Farm, Wandsworth 1 Moorfields Hospital 1 King Edward Memorial Hospital, Ealing 2 National Temperance Hospital, St. Pancras 1 30, Porchester Square, Paddington 1 Children's Hospital, Paddington 3 Royal Hospital, Richmond 1 Middlesex Hospital 2 7, Knaresborough Place, Kensington 2 Home of Compassion, Thames Ditton 1 St. Joseph's Hospice for the Dying 2 102, City Road, Finsbury 1 Atkinson Morley's Convalescent Hospital, Wimbledon 1 Homœopathic Hospital, Great Ormond Street 4 Elizabeth Garrett Anderson Hospital 1 St. Thomas's Hospital 3 St. George's Hospital 1 38. Nevern Square, Kensington 1 St. Mary's Hospital, Paddington 7 Memorial Hospital, Finchley 1 St. Bartholomew's Hospital 1 St. Paul's Hospital, Endell Street, Holborn 2 Westminster Hospital 1 Wembley Hospital 1 20, Glazburv Road, Fulham 1 1, Ladbroke Square 1 FEVER HOSPITALS. North-Western Hospital, Hamp- stead 2 Southern Hospital, Dartford 1 39 South-Western Hospital 5 Western Hospital, Fulham 18 Orchard Hospital, Dartford 1 London Fever Hospital 1 Grove Hospital, Tooting 11 14 PUBLIC INSTITUTIONS. 46, Ouseley Road, Battersea 4 93, Sydney Street, Chelsea 26 The infirmary, Friern Barnet 1 9, Northumberland Street 1 West Middlesex Hospital, Heston 2 Lambeth Hospital 5 Park Lane, Harefield 1 New End, Hampstead 2 Redhill House, Edgware 1 9, Dartmouth Park Hill, St. Panoras 1 2, Horsham Road, Dorking 1 386 2a, Bow Road, Poplar 3 28, Marloes Road, Kensington 100 4, King's Road, St. Pancras 7 Fulham Hospital 50 164, St. John's Hill, Battersea 1 204, Hoxton Street 2 Twvford Lodge, Willesden 2 230, Homerton High Street, Hackney 1 Whipps Cross Hospital 1 la, Shepherdess Walk, Shore- ditch 1 Alden Hey Hospital, Liverpool 1 12, Exmoor Street, Kensington 96 285, Harrow Road, Paddington 48 369, Fulham Road 29 VARIOUS. River Thames, off Blake's Wharf 1 8, Ray Street, Finsbury 1 River Thames, off Victoria Embankment 1 43, Denham Drive, Ilford 1 On the way to Westminster Hospital 1 River Thames at Brentford 1 Howell's Comer, Kingsfold, Warnham, Horsham 1 Little Pookewell, Rolvenden 1 Forest Hill, Oxford 1 8, Norbiton Avenue, Kingston 1 83, Woodlands Park Road, Northfields, Birmingham 1 205, Conyers Road, Newcastle- upon-Tyne 1 27 On the way to and near 28, Marloes Road 1 Ealing Common Station 1 On the way to Charing Cross Hospital 1 River Thames, off Tate Gallery 1 C.A.V. Bosch Works, Worple Way, Acton 1 On the way and near to 285, Harrow Road 1 28, Wolverton Avenue, Kingston 1 G.W.R. Station, Dawlish East 1 Rosedpne, Abbotswood 1 47, High Street, Weybridge 1 Malt House Farm, Chalk, nr. Gravesend 1 Clifton Lodge, Marine Parade, Clacton 1 West End Cottages, Kingsclere 1 171. Littlechurch Road, Packing 1 On fie way to St. Mary's Hospital, Paddington 1 15 Causes of, and Ages at, Death during the Year 1936. Causes of death. Sex. All Ages. 0— 1— 2- 5 — 15- 25— 35— 45— 55- 65— 75-  All Causes M 806 76 9 6 14 29 28 44 85 159 204 152 F 791 40 10 16 14 17 36 43 72 110 184 249 1 Typhoid and Paratyphoid Fever M .. .. .. .. .. .. .. .. .. .. .. .. F 2 .. .. .. .. 1 .. .. 1 .. .. .. 2 Measles |M 5 2 1 2 .. .. .. .. .. .. .. .. F 10 2 3 4 1 .. .. .. .. .. .. .. 3 Scarlet Fever M .. .. .. .. .. .. .. .. .. .. .. .. F 3 .. 1 1 .. .. .. 1 .. .. .. .. 4 Whooping Cough M 1 1 •• .. .. .. .. .. .. .. .. .. F 6 4 1 1 .. .. .. .. .. .. .. .. 5 Diphtheria M 2 .. .. .. 2 .. .. .. .. .. .. .. F 3 1 1 1 .. .. .. .. .. .. .. .. 6 Influenza M 9 2 .. .. .. .. 1 1 1 1 3 .. V 6 .. .. .. .. 1 .. .. 1 1 2 1 7 Encephalitis Lethargica M .. .. .. .. .. .. .. .. .. .. .. .. F 2 .. .. .. .. 1 .. .. .. .. .. 1 8 Cerebo-spinal Fever S 1 1 .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. 1 .. .. .. .. .. .. 9 Tuberculosis of Respiratory System M 68 .. .. .. .. 13 12 .. 16 13 4 l F 31 .. .. .. 1 3 11 7 3 5 1 .. 10 Other Tuberculous Diseases M 11 .. .. 2 .. 3 1 2 .. 2 1 .. F 6 1 .. 2 1 .. 2 .. .. .. .. .. 11 Syphilis M 5 .. .. .. .. .. .. .. 1 2 2 .. F 1 .. .. .. .. .. 1 .. .. .. .. .. 12 General Paralysis of the insnne. tabes dorsalis .. M 8 .. .. .. .. .. .. .. 5 2 .. 1 F 3 .. .. .. .. .. .. .. 1 1 1 .. 13 Cancer, malignant disease.. M 111 .. .. .. 1 2 2 3 9 39 42 13 F 138 .. .. .. .. 3 3 11 26 27 38 30 14 Diabetes M 5 .. .. .. 1 .. .. .. .. 3 1 .. F 12 .. .. .. .. .. 1 .. .. 3 5 3 15 Cerebral Haemorrhage, &c. M 22 .. .. .. .. .. .. 1 1 4 9 6 7 F 40 .. .. .. .. .. .. 4 3 7 12 14 16 Heart Disease M 184 .. .. .. l 1 2 5 8 32 72 63 F 215 .. .. .. 2 1 4 5 11 25 64 103 17 Aneurysm M 5 .. .. .. .. .. .. .. 1 2 2 .. F 7 .. .. .. .. 1 .. 1 2 2 .. 1 18 Other circulatory diseases M 38 .. .. .. .. .. .. 2 3 7 12 14 F 35 .. .. .. .. .. .. 1 1 4 13 16 19 Bronchitis M 42 2 .. .. 1 .. 1 1 5 9 9 14 F 23 2 .. .. .. .. .. .. 5 2 6 8 20 Pneumonia (all forms) M 67 15 4 1 .. .. 2 6 12 14 9 4 F 43 6 2 2 .. .. 1 1 6 6 9 10 21 Other Respiratory Diseases M 6 .. .. .. .. .. .. .. 2 .. 3 .. F 8 .. .. 1 .. .. .. 2 .. 2 2 1 22 Peptic Ulcer M 16 .. .. .. .. .. 1 3 4 4 2 2 F 3 .. .. .. .. .. .. .. .. 1 2 .. 23 Diarrhœa, &c. M 18 17 .. .. .. .. .. .. .. 1 .. .. F 7 6 1 .. .. .. .. .. .. .. .. .. 24 Appendicitis M 4 .. .. .. 1 .. .. 1 .. 1 1 .. F 4 .. .. .. 1 .. .. .. 1 1 1 .. 25 Cirrhosis of Liver M 3 .. .. .. .. .. .. .. 1 .. .. 2 F .. .. .. .. .. .. .. .. .. .. .. .. 26 Other Diseases of Liver, &c. M 1 .. .. .. .. .. .. .. •• .. 1 .. F 4 .. .. .. .. .. 1 .. .. 1 2 .. 27 Other Digestive Diseases M 9 3 .. .. .. .. .. 1 1 l .. 3 F 10 .. .. .. 1 .. .. 1 1 4 .. 3 28 Acute and Chron ic Nephritis M 17 .. .. .. .. 2 1 .. 1 2 6 5 F 20 .. .. .. .. .. 1 1 3 3 6 6 29 Puerperal Sepsis F 1 .. .. .. .. .. .. 1 .. .. .. .. 30 Other Puerperal Causes F 2 .. .. .. .. .. 2 .. .. .. .. .. 31 Congenital Debility, Premature Birth, Malformation, &c M 26 25 .. .. .. 1 .. .. .. .. .. .. F 17 17 .. .. .. .. .. .. .. .. .. .. 32 Senility M 9 .. .. .. .. .. .. .. .. .. 2 7 F 33 .. .. .. .. .. .. .. .. .. 3 30 33 Suicide M 11 .. .. .. .. .. .. 3 2 4 2 .. 34 Other violence . F 8 .. .. .. .. .. 1 1 3 3 .. .. M 39 3 1 1 4 6 2 3 7 7 2 3 35 Other defined diseases F 24 .. .. 2 1 2 1 .. 2 1 7 8 M 62 5 3 .. 3 1 3 3 5 9 19 11 F 63 1 1 2 6 3 7 6 2 11 10 14 36 Causes ill-defined, or unknown M 2 .. .. .. .. .. .. .. .. .. .. 2 F .. .. .. .. .. .. .. .. .. .. .. .. Total 1,597 116 19 22 28 46 64 87 157 269 388 401 16 .This rate is calculated on the estimated population of each Ward. Ward. Estimated Population. No. of Deaths. Death Rate.  No. 1 River 16,846 259 15.4 No. 2 Brook Green 24,460 310 12.7 No. 3 The Grove 21,814 278 12.8 No. 4 St. Stephens 8,774 107 12.2 No. 5 Starch Green 21,638 232 10.7 No. 6 Worruholt 22,648 304 13.4 No. 7 College Park and Latimer 11,519 107 9.3 LONDON AND METROPOLITAN BOROUGHS. Cities and Borodghs. Estimated Resident population (mid-1936). Live Births rate per 1,000 population. Death rate per 1,000 population : tile Mortality rate per 1,000 lire births. Crude. Adjusted. County of London 4.141.100 13.6 12.5 - 66 West Districts. Paddington 139.200 13.8 13.0 12.8 72 Kensington 176,100 12.7 12.5 11.7 73 Hammersmith 127.700 15.1 12.5 12.9 60 Fulham 141,300 14.9 12.6 12.7 64 Chelsea 56,500 11.3 13.7 11.6 53 City of Westminster 124,100 8.5 11.1 11.4 66 North Districts. St. Marylebone 92,400 9.8 12.6 12.5 75 Hampstead 90,700 10.4 10.2 9.6 66 St. Pancras 183.900 13.0 13.5 13.8 79 Islington 304,100 15.2 12.4 12.6 61 Stoke Newington 50,350 13.7 11.4 10.9 45 Hackney 209,100 14.4 12.0 12.6 63 Central Districts. Holborn 34.850 8.3 12.0 12.8 62 Finsbury 60.800 13.8 14.0 15.3 81 City of London 9,100 7.5 11.4 12.7 147 East Districts. Shoreditch 85.400 14.9 12.8 14.1 75 Bethnal Green 96,900 13.5 12.7 14.3 98 Stepney 207.800 14.7 12.6 14.7 100 Poplar 140,300 15.0 12.5 13.8 72 South Districts. Southwark 152,200 14.8 13.1 — 59 Bermondsey 100,400 15.4 12.8 14.6 60 Lambeth 277.500 13.9 12.5 12.4 59 Battersea 145,500 14.6 13.1 13.0 59 Wandsworth 343,000 11.5 11.8 11.0 58 Camberwell 229.300 13.9 12.6 12.6 59 Deptford 98,900 15.7 12.2 12.6 50 Greenwich 95,900 13.8 11.4 11.6 49 Lewisham 224,000 13.0 10.8 10.9 55 Woolwich 146,500 13.8 11.2 11.8 59 17 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. G. Waller, 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. 18 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 Road. Patients are expected to make payments to the Nursing Association in accordance with their means, but no patient is refused the services of a nurse on account of inability to pay. Nursing.—The arrangements made by the Borough Council with the District Nursing Association to provide nurses in cases of measles, ophthalmia neonatorum, pneumonia, &c., continued throughout the year. When necessary two or three visits are paid daily. The Council make a grant to the Nursing Association of £250 per annum, for the nursing of all cases approved by the Medical Officer of Health. The amount being divisible as follows:— Maternity and Child Welfare Nursing £125 Public Health Regulations £125 SCHOOL CLINICS. The L.C.C. Hammersmith School Treatment Centre, 103, Shepherd's Bush Road, is provided by the Hammersmith District Nursing Association, who receive grants from the London County Council. 19 L.C.C. School Treatment Centre, Old Oak Welfare Centre, Westway. This centre is held in the Borough Council Clinic, who receive a rental for the use thereof. Children under school age are dealt with by arrangement with the Hammersmith Nursing Association. Dental Clinics.—Dental Clinics are held at the Old Oak Welfare Centre and 103, Shepherd's Bush Boad, by the London County Council for the treatment of school children. TUBERCULOSIS DISPENSARY. Hammersmith Tuberculosis Dispensary, Ravenscourt Park. The above Dispensary is provided by the Borough Council (see page 151). Grants are received from the Ministry of Health and the London County Council. RHEUMATISM ADVISORY CLINIC, HAMMERSMITH HOSPITAL. Since the Council discontinued the grant to the Princess Louise Kensington Hospital for Children arrangements have been made for Hammersmith children to attend the Bheumatism Advisory Clinic at the Hammersmith Hospital. In certain cases children are sent for institutional treatment to Carshalton. 20 TREATMENT CENTRE FOR VENEREAL DISEASES. West London Hospital, Hammersmith Road. The above centre is provided under the scheme of the London County Council. This centre is open night and day. 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 :— Minor Ailments 6 HOSPITALS—PUBLIC. Name:- Hammersmith Hospital. Situation:—Du Cane Road, Shepherd's Bush, W.12. Purpose:—General. No. of available beds :—559. If used by persons resident outside the area, in what proportion:—Yes.—5 per cent. Management:—London County Council. No. of beds available for each sex for the following services:— M. F.  General Medical 75 78 General Surgical 150 82 Children — — Maternity — 77 (Excl. 4 Laoour Beds.) Tuberculosis 3 3 Chronic sick 72 29 Gynæcological — 25 Puerperal Pyrexia — 10 21 Facilities available for:— (1) Operative Surgery.—Yes. (2) X-ray.—Yes. (3) Dental.—Yes. (4) Ophthalmic.—Yes. (5) Massage.—Yes. Arrangements for pathological work: —Own laboratories, British Post-graduate Medical School. No. of patients during 1936 :—Admissions = 6,227. 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.—241. 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 26 26 General Surgical ... 64 59 Children 17 — Venereal Diseases ... 4 4 Ear, Nose and Throat ... (1 Children) 2 5 Skin Diseases ... ... (1 Children) 1 2 Others (Private Wing) ... (Mixed) 26 Others (Casualty) .. ... (Mixed) B Facilities available for:— 2 Major Operation Theatres. (1) Operative Surgery.—2 Minor (2) X-Ray.—Diagnostic and Therapeutic Departments. (3) Dental.—Clinics held twice weekly in Out-patients' Department. (4) Ophthalmic.—Three afternoons a week in patients' Department. (5) Massage.—Department open daily. 22 Arrangements for pathological work:—Pathological and Bio-chemical Laboratories. No. of patients during 1936:—4,441 in-patients and 43,302 out-patients and casualties. Is the hospital provision for the area adequate—There is always an average of about 200 patients waiting for admission. Name:—Queen Charlotte's Maternity Hospital. Situation:—Ravenscourt Square and Goldhawk Road. Purpose:— (а) *Treatment of and research into Puerperal Sepsis. (б) †Normal 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) Isolation Block :—98 per cent, outside. (b) Invermead :—88 per cent, outside. Management:—Voluntary Agency. No. of beds available for the following services:— Maternity 20 Puerperal Fever and Pyrexia 30 Nurseries for 30 babies. Facilities available for:— (1) Operative Surgery — Fully equipped Theatre, Anaesthetising and Recovery Rooms. (2) X-Ray—By arrangement with St. Mary's Hospital. (3) Dental—No Dental Clinic, but services of Hon. Dental Surgeon available. (4) Ophthalmic—No Ophthalmia Clinic, but services of Hon. Ophthalmic Surgeon available. (5) Massage—By outside masseuse. Arrangements for pathological work:—All pathological work done in the "Bernhard Baron Memorial Research Laboratories "adjacent, under the Hospital's Director of Research and staff of 7 fully trained research workers. No. of patients during 1936 424 Maternity (50 Hammersmith patients), 332 Puerperal Sepsis (2 Hammersmith patients). 23 Name :—St. John's Hospital for Skin Diseases. Situation:—262, Uxbridge Road, W.12. Purpose —For Skin Diseases. No. of available beds :—40. If used by persons resident outside the area, in what proportion:—Mostly outside area. Management :—The Board of Management for St. John's Hospital for Diseases of the S"kin. No. of beds available for each sex for the following services:— M. F.  Skin Diseases 19 21 Facilities available for:— (1) Operative Surgery.—Nil. (2) X-Ray.—X-Ray Out-patients' Department at 5, Lisle Street, Leicester Square, W.C.2. (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, W.C.2. No. of patients during 1936 :—328 in-patients; 13,584 new out-patients. is the hospital provision for the area adequate1—Yes. Name —Royal Masonic Hospital. The Royal Masonic Hospital provides accommodation for paying patients, primarily of limited means, being Freemasons, their wives and dependent children. The number of beds available 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 Massage and a well-equipped Electro-Therapy Department. Special arrangements have been made for pathological work. No. of patients during 1936:—1,609. 24 MATERNITY AND CHILD WELFARE SERVICES. In July, 1935, I recommended a reorganisation of the existing Maternity and Child Welfare Services so as to coordinate the work of this department and secure greater co-operation between the Borough Council as the Local Authority and Voluntary Organisations. The Council appointed two whole-time women Assistant Medical Officers to act under my direction, and on 1st April, 1936, these two Officers took over the work formerly carried on by six doctors, who devoted part of their time to the Maternity and Child Welfare Clinics in the Borough. As far as can be judged in the short period under review, the new scheme has proved to be excellent in every way. The Medical Officers are now in close touch with the Medical Officer of Health, the administrative Public Health staff and the voluntary organisations. There is promise of great improvement in the health of the mothers and young children following the changes made. 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 2,266 Corrected Number of Births 1,922 These figures represent a Birth-rate per 1,000 of the population of the Borough of 15.1 Corrected Number of Deaths of Infants under one year, of whom died under one week 116 Legitimate Infants 107, or 60 per 1,000 Births. Illegitimate Infants 9, or 65 per 1,000 Births. Infant Mortality Bate per 1,000 Births 60 25 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) Provision of Toddlers' Clinics. (d) Supply of Milk to necessitous Mothers and Young Children. (e) Provision of Consultants. (/) Provision of Maternity Outfits. (7) Provision of Home Helps. (h) Provision of Domiciliary Midwifery Service. 2. Activities of Voluntary Agencies in receipt of grants- in-aid from the Borough Council : (a) Infant Welfare Centres. (i>) Day Nurseries. (c) Treatment and Nursing of Children under School Age. (d) Rheumatism Clinic. (e) Massage and Remedial Exercises. 3. Activities of independent Voluntary Agencies : (a) Rescue Homes. (b) 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. Ante-natal Visits, cases of Ophthalmia Neonatorum, Puerperal Fever, and other diseases of mothers and young children; they have also taken an active part in the work of the Voluntary Infant Welfare Centres. 26 The visits paid are enumerated in detail below:— District. Total.  No. 1. No. 2. No. 3. No. 4. Number of Births notified Visits. 363 656 496 351 1,866 First visits 339 566 456 332 1,693 Re-visits (under 1 year) 680 947 968 1,108 3,703 Re-visits (1-5 years) 586 488 788 914 2,776 Out 691 1,312 1,134 1,426 4,563 Removals 136 202 275 206 819 Special visits 140 111 87 145 483 Ophthalmia-Neonatorum 1st visits 1 2 1 1 5 Ophthalmia-Neonatorum Re-visits - - - - - Puerperal Fever — 1 2 2 5 Puerperal Pyrexia 1 2 5 4 12 Ante-natal—First visits 205 305 234 188 932 Ante-natal—Re-visits 58 24 17 46 145 Stillbirths 10 14 15 9 48 Infant Deaths 20 43 14 31 108 Measles 18 9 5 29 61 Pneumonia 3 3 6 Encephalitis Lethargica — — 2 2 Chickenpox 1 2 1 1 5 Whooping Cough 5 1 — 3 9 Polio-Myelitis 1 1 Cerebro Spinal Meningitis 2 2 - - 4 Epidemic Diarrhœa 1 — — 3 4 Total visits 2,894 4,032 4,005 4,453 15,384 Attendances at Infant Welfare Centres 108 100 150 65 423 Attendances at Ante-Natal Clinics 40 33 39 66 178 Attendances at Committee Meetings Voluntary Associations - 1 — — 1 Number of insanitary conditions reported 6 9 11 28 54 Schick Test Clinics 13 — 15 — 28 The feeding of the 1,693 infants visited was found to be as follows:— Breast-feeding 1,452 Artificial feeding 136 Mixed feeding 105 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 27 observation duriiig the most critical months of the child's life. The number of children under one year who need visiting does not permit sufficient revisits being made to children under a year nor to those over one year and under five with the present staff of Health Visitors. Such supervision is necessary if the number of preventable defects found when the child enters school are to be recognised and prevented or treated effectively. It is gratifying to know that the Council has approved the appointment of three additional Health Visitors to begin duty on 1st April, 1937. 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:— Y ear. Births. Deaths of Infants. Deaths of Infants per 1000 births.  1906 3112 430 138 1907 3029 362 117 1908 3204 383 120 1909 2995 360 120 1910 2906 329 99 1911 2929 434 146 1912 2880 259 90 1913 2951 314 103 1914 2935 276 94 1915 2708 277 102 1916 2605 222 85 1917 2278 251 110 1918 2014 210 104 1919 2296 228 99 1920 3312 219 66 1921 2779 245 88 1922 2758 196 71 1923 2701 173 64 1924 2399 173 72 1925 2351 153 65 1926 2188 144 66 1927 2076 126 61 1928 2258 156 69 1929 2162 133 62 1930 2173 140 64 1931 2073 140 68 1932 1940 129 66 1933 1827 119 65 1934 1783 137 77 1935 1877 131 70 1936 1922 116 60 28 Notification of Births Act, 1907. Births notified 2,584 Corrected number of births 1,922 Notification Received fbom Midwives. Doctors. Lying in Hospitals and Nursing Homes. L.C.C. Institutions. Parents. M.O.H.'s.  705 54 653 1,127 3 42 Stillbirths.—Fifty-eight stillbirths were allocated to this Borough. Seventy were registered in the Borough, of which number nineteen were outward transfers. Seven were born outside the Borough and were transferred by the Registrar-General. Deaths of Infants.—The corrected number of deaths of residents under one year of age registered during the year was 116, as compared with 131 in the previous year. The number of deaths of infants under one year of age was equal to 60 per 1.000 of the corrected births. The number of deaths of infants under one year of age, residents in London, was equal to 66 per 1,000 of the total registered births. The mortality rate of infants under one year of age was six per thousand less in this Borough than in London. 29 The following table shows the deaths of infants under one year of age and the cause :— INFANT MORTALITY, 1936. Infantile Mortality during the year 1936. Nett Deaths from stated causes at various ages under one year of age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks, and under 3 months. 3 months ani under 6 months. 6 months and under 9 months. 9 months and under 1 year. Total Deaths under 1 Year.  ALL Certified CAUSES. Uncertified 35 5 2 1 43 14 20 15 24 116 - - - - - - - - - - Small-pox - — — — — — — — — Chicken-pox - - - - - - - - - - Measles - - - - - - — 2 2 4 | Scarlet Fever - - - - - - - - - Whooping Cough — — — — 2 3 5 - - - - - - - _ 1 1 Influenza.. - - - - - - - 1 1 Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - -— 1 — 1 Abdominal Tuberculosis - — — — — — - — — Other Tuberculoses Diseases - - - - - - - - - - Meningitis (not T.B.) - — — — — 1 — 1 1 3 Laryngitis - — — - — — — Bronchitis - — 3 3 — — 6 Pneumonia (all forms) 1 1 3 6 4 8 22 Infective Gastro Enteritis - - - - — 4 4 6 4 18 Syphilis - - - - - - - - - — Rickets - - - - - - - - - - Suffocation, Overlying - - - - - - - - - - Injury at Birth 8 — 8 — — 8 Atelectasis 2 - 2 — — — 2 Congenital Malformations 10 2 — 1 13 2 1 — 1 17 Premature Births 11 1 1 - 13 — — — 13 Otitis Media — 2 1 1 4 Violence 1 _ 1 — — 1 2 Icterus Neonatorum — 1 1 — 2 — — — — 2 Hæmorrhage of the Newborn.. 3 — — — 3 — — — — 3 Other causes - - - - - 1 2 — 1 4 Totals 35 5 2 1 43 14 20 15 24 116 Nett Births in the Year: Legitimate, 1784; Illegitimate. 138 Nett Deaths in the Year of: Legitimate Infants, 107; Illegitimate Infants, 9. 80 The infant mortality rates of the London Boroughs varied from 147 in the City of London to 45 in Stoke Newington. 31 A large proportion of the deaths, 43, equal to 37 per cent., died in the first month, and of these 35 occurred in the first week. Practically all of these may be ascribed to ante-natal or intra-natal causes. These facts point to the necessity of greater attention to and control of the expectant mother; and on taking into consideration the increase of deaths due to injury at birth the need for greater skill in obstetrics is obvious. The Number of Deaths from Prematurity has fallen from 20 to 11, and this is probably due to the fact that a greater number of the expectant mothers attend the ante-natal clinics regularly and to the better feeding resulting from the decrease in unemployment. Infective Enteritis and Pneumonia still claim by far the greatest number of victims. Pneumonia accounted for 22 deaths and infective enteritis for 18. These may be very properly ascribed to lack of knowledge on the part of the mother in the problems of infant feeding and management, which indicates the necessity for more frequent home visiting and greater educational measures. 32 The following table gives the births, infant deaths and infantile mortality rates in England and Wales, London and Hammersmith and the wards of the Boroughs for the year 1986:- District. 1936. No. of Births. No. of Deaths of Children under 1 year of age. Infant Mortality Rate. England and Wales 605,292 35,712 59 London 56,273 3,714 66 The Borough 1,922 116 60 North Hammersmith 1,037 71 68 South Hammersmith 842 45 53 WARDS River 178 2 11 Brook Green 374 32 86 Grove 290 11 38 St. Stephen's 173 15 87 Starch Green 304 17 56 Wormholt 425 22 52 Latimer and College Park 135 17 126 Ward unknown 44 - - On investigation of the infant deaths of other wards it is found that a like small proportion of attendances at Infant Welfare Centres had been made. This fact again points to the necessity of increasing the number of visits to infants under one year and also to the great value of tact and powers of persuasion in the Health Visitor to overcome the prejudice which still abounds in certain parts of the Borough towards " clinics." Deaths in Institutions.- Of 116 infant deaths in the Borough only 19 took place at home, and the remaining 97 in institutions. On careful enquiry into the latter cases 33 it was found that certain of them were admitted for one disease and died of another. In two cases children were admitted for domestic reasons, both in perfectly good health, and died of gastro enteritis. These deaths should not have occurred, and call for better nursing in the Institutions. Illegitimate Deaths.—The corrected number of deaths of illegitimate infants under one year of age was 9 or at the rate of 65 per 1,000 illegitimate births. It is gratifying to note that the great disparity between death rates of legitimate and illegitimate infants has lessened markedly this year, as can easily be seen by comparison with previous years:- 1934. 1935. 1936. Legitimate Deaths 72 per 1,000 66 per 1,000 60 per 1,000 Illegitimate Deaths 147 per 1,000 115 per 1,000 65 per 1,000 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. 34 The following Chart shows the number of deaths from Diarrhcea per 100,000 inhabitants, 1911-1936. Circumcisions.—Cases are referred by the Assistant Medical Officers to the Hammersmith Hospital. During the year 94 circumcisions were carried out. 35 IInfant Welfare Work.—There are six Infant Welfare Centres in the Borough, all under the auspices of voluntary organisations. Four are under the management of the Hammersmith Infant Welfare Association, who also provide a Massage and Remedial Exercises Clinic for mothers and children in South Hammersmith; one is organised by the Latymer Road Mission, and one by a voluntary committee at Ponsard Road, College Park. The Borough Council makes grants-in-aid to all these voluntary associations. In addition a Municipal (Toddlers) Clinic is held weekly at the Old Oak Centre, and in all 12 Infant Welfare Clinics are held weekly at which the Borough Council's Medical Officers, and the Health Visitors for the various districts, attend. Infant Welfare Centres. 48, Glenthorne Road, W.6. Mondays and Fridays, 2 p.m. Thursdays, 10 a.m. Toddlers, Wednesdays, 10 a.m. Victoria Hall, Becklow Road, W.12. Mondaiys, 2 p.m. Wednesdays, 2 p.m. Old Oak Centre, The Curve, Westway, W.12. Mondays and Thursdays, 2 p.m. Toddlers, Wednesdays, 2 p.m. Milson Road School, Milson Road, W.14. Tuesdays 2 p.m. Thursdays, 2 p.m. St. Peter's Church Hall, Ponsard Road, N.W.10. Wednesdays, 10 a.m. Latymer Road Mission, Bleehynden Street, W.ll. Tuesdays, 2 p.m. 36 Massage and Remedial Exercises Clinic. 48, Glenthorne Road, W.6. Mondays and Thursdays, 2 p.m. The work of the Centres has been of inestimable value. They are closely associated with and form an important part of the Maternity and Child Welfare Scheme of the Borough Council. Schedule of Attendances at Infant Welfare Centres. Address of Clinic. No. of Clinics New Cases. Total Attendances. Mothers. Children. Mothers. Children. Antenatal. Postnatal. Under 1 yr. Over 1 yr. Antenatal. Postnatal. Under 1 yr. Over 1 yr. 48, Glenthorne Road 101 326 10 - - 1126 12 - - 48, Glenthorne Road 202 - - 348 44 - - 5314 2347 Victoria Mission Hall, Becklow Road 101 - - 220 26 - - 3346 776 St. Matthew's Hall, Blythe Road 103 - - 282 46 - - 4253 1171 Old Oak Centre 99 169 33 - - 526 53 - - West way 101 - - 267 63 - - 4165 1034 Latymer Road Mission 27 15 2 - - 49 4 - - Blechynden Street 50 - - 74 14 - - 1048 519 Presbyterian Hall, College Park 52 - - 49 18 - - 631 406 Totals 836 510 45 1240 211 1701 69 18757 6253 Ante-natal Clinics 217 Infant Consultations 619 836 The average attendances for the various Centres are as follows:- Hammersmith Infant Welfare Centres 44 Latymer Mission 81 College Park Centre 20 In the latter Centre 50 per cent. only are residents of the Borough of Hammersmith, the remainder being residents of the Borough of Willesden. 37 Although the average attendance of infants at the Hammersmith Infant Welfare Centres was only 44, yet the numbers at the Glenthorne Road and Becklow Road Centres have on many occasions been so great as to have rendered the Clinics inconvenient for the mothers and very tiring for the staff. On receiving this information the Council at once decided to secure the use of a suitable hall in the centre of the Borough to relieve the congestion at these Centres and to lessen the distances the mothers have to travel. Such a Hall was found in St. Thomas's Church, at the junction of Godolphin and Thornfield Boads; and it is proposed to inaugurate an I.W.C. there in May, 1937. At all these Clinics mothers are given advice on the upbringing of their children in good health by proper feeding, &c., and the prevention of malnutrition and disease. The children are seen by the Doctor when they first attend, and as far as possible at regular intervals afterwards. Health talks are given and attendance is encouraged for the sake of acquiring knowledge in child welfare. During the year a Health Week was held and lectures were given on subjects of interest to mothers. Much appreciation was expressed by those who attended the lectures. In North Hammersmith the infants are fairly well nourished, but many are markedly anæmic. Rickets occurs rarely, and when it does so it is mild in type. This is probably due to the far greater possibility of obtaining sunlight in the north than in the south. The provision of free or very cheap cod-liver oil no doubt is of great assistance in this respect. The chief problem is that of the very high rents and the resultant insufficiency of money left for food. In north-east Hammersmith, more especially in the Latymer Road area, bad housing, lack of air and sun coupled with ignorance and prejudice, are the chief difficulties to be overcome. This probably accounts for the 38 high infantile mortality rate in this ward of 116 per 1,000 births. In Central and South Hammersmith mild rickets, anaemia, malnutrition, chest conditions and the so-called common cold are still too frequently seen in children who attend the Centres. Many children and mothers who attend the clinics in South Hammersmith have derived much benefit from the Massage and Remedial exercise clinic held twice weekly at 48, Glenthorne Road. In 1935 over 800 treatments were given to women and children, and in 1936 over 1,000 treatments. There is a very long waiting list. Whilst breast feeding is the rule in the early weeks and months, later the number of babies who for various reasons are artificially fed increases considerably in spite of the supply of free milk to necessitous nursing mothers and the supply of free cod liver oil. The latter is being granted in necessitous cases for children in receipt of free milk. 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. 9,882 lbs. of dried milk and 13,491 quarts of raw milk were distributed during the year. The number of applications for free milk has averaged 47 per week during the year. The total expenditure during the year was approximately £826 10s. 3d. The amount of dried milk distributed during the year decreased by 1.222 lbs., raw milk increased by 7,880 quarts. There was an increased cost of approximately £162 10s. 3d. The distribution of this free milk continues to be an inestimable boon, and has, without doubt, contributed very 39 largely to the improved condition of the children generally. By this means the Public Health Department and the Maternity and Infant Welfare Centres are able to keep in close contact with these cases, and at the same time mothers have been able to obtain a proper supply of milk for their children which they could not have done otherwise. The distribution of dried milk continued to be made through the Infant Welfare Centres. The mothers attend with their babies and obtain their supplies on presenting an order issued from the Public Health Department. This encourages 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. Those above the scale were supplied with small quantities at cost price. The Medical Officers of the Clinics report that many children have greatly benefited since this provision was made. Dinners.—The problem of the supply of free dinners for necessitous expectant and nursing mothers was very seriously considered by the Maternity and Child Welfare Committee in view of the fact that the under-nourishment of pregnant women is known to be a predisposing cause of antemia and septicemia. The Invalid Kitchens of London were approached in this matter, and they agreed to find a suitable house in a central position in the Borough. Such a place was found at 47. Melina Boad. and rooms on the ground floor were rented. These premises will be ready for use in May, 1937. 40 The Second Feathers Club in Norland Gardens was also approached, and they agreed also to supply dinners for a fixed price. This Centre will start to cater for necessitous Borough cases after 1st April, 1937. Ante-Natal Clinics. There are three ante-natal clinics in the Borough, two in North Hammersmith and one in South Hammersmith. They are held at the following Centres :- 48, Glenthorne Boad, W.6. Tuesdays, 6. p.m. Fridays, 10 a.m. Old Oak Centre, The Curve, West way, W.12. Mondays, 6 p.m. Fridays, 2 p.m. Latymer Road Mission, Blechynden Street, W.ll. Thursday, 10 a.m. The Medical Officers who attend these clinics are the Borough Council's Assistant Medical Officers. The Municipal Midwife and Health Visitors also attend. Any expectant mother being resident in the Borough may attend. Reports are furnished to hospitals, doctors and midwives in respect of their respective patients. 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. 41 MATERNITY SERVICES. Facilities for Confinement. 1. Hospital Facilities. The excellent facilities existing at Hammersmith Hospital Post-Graduate Medical School for maternity cases in 1935 have been available again for Hammersmith mothers. Information regarding the provision for expectant mothers here is becoming better known, and as a result increasing numbers are taking advantage of it. In 1919 only 6 per cent. of Hammersmith mothers were confined in Institutions. In 1936 this had increased to 58 per cent., and there is not the least doubt that having experienced the comfort of the Hospital the numbers seeking admission will increase. During 1936 there were 803 Hammersmith cases confined in Hammersmith Hospital. Early in the year I conferred with the Hospital Staff, and a policy of co-operation was agreed upon to facilitate the admission of Borough ante-natal clinic cases wishing to book at Hospital for confinement. Any abnormal or complicated cases are at once transferred to Hammersmith Hospital for the necessary in- or out-patient treatment, and continue to attend the hospital, where the most up-to-date treatment, equipment and consultative opinion of the medical, surgical, obstetric and special units is available, and readily given. 2. Queen Charlotte's Auxiliary Hospitals, Invermead, Goldhawk Road. (a) This hospital provides 20 beds for normal cases. No beds are actually reserved for Borough Council cases, but during the year 86 mothers residing in Hammersmith were confined in Invermead. (b) Queen Charlotte's Hospital Auxiliary Hospital for Treatment and Investigation of Puerperal Sepsis, Ravenscourt Square. This Hospital contains 30 beds. 42 During the past year Dr. Leonard Colebrook, the Honorary Director of the Research Laboratories of Queen Charlotte's Hospital, Hammersmith, has obtained considerable success in the treatment of Puerperal Sepsis by the use of a new drug known as Protonsil. This drug has been the means of greatly reducing the mortality from a formerly very fatal infection. 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 subscriptions. Jewish Hostel for Girls, Charcroft House, Roseford Gardens, W.12.—Accommodation, 19 beds and 13 cots. This hostel is conducted by a voluntary society towards which the London County Council contributes. DOMICILIARY MIDWIFERY SERVICE. 1. Municipal Midurife. On 1st April, 1936, the Municipal Midwife appointed by the Borough Council under arrangement with the Hammersmith District Nursing Association commenced duties. During the year this service has been available, and mothers desiring the services of the Municipal Midwife have increased in number. 43 Only those cases are undertaken who can safely and suitably be confined in their homes. The Municipal Midwife visits and reports on the home of those desiring her services before the case is actually booked, and fees are charged in accordance with a scale of income approved by the Council. The attendance of the Municipal Midwife at ante-natal clinics in the Borough affords opportunities of seeing the patients and having periodic reports concerning their health and general condition. Fifteen cases were attended by the municipal midwife in 1936. 2. Queen Charlotte's Hospital District Nurses, Longthorpe Lodge, Goldhawk Road, W.12. These nurses book and attend cases during confinement and the puerperium in their homes in the district . Number of cases attended in 1936 191 Ante-natal and post-natal clinics are held in connection with these district cases. Supply of Accouchement Outfits and Maternity Bags. —Accouchement Outfits with all necessary equipment for necessitous cases of confinement are available for women resident in the Borough. These outfits may be obtained on application at the Public Health Department, Broadway Chambers, Hammersmith, W.6, between 9 a.m. and 5 p.m., and on Saturdays before 12 noon. Or in emergency at the Hammersmith District Nursing Association, 10, Mall Boad, W.6, between 7 a.m. and 10 p.m., and at Hammersmith Hospital, Ducane Boad, Shepherd's Bush, at any time. Number of outfits used in 1936, 19. Maternity Bags, filled with all necessities for the confinement and lying-in period of the mother and for the baby, are also supplied by the Borough Council for necessitous cases who have booked the Municipal Midwife for confinement on recommendation of the Medical Officer of Health. 44 Three bags are available. These are kept at the Hammersmith District Nursing Association, 10, Mall Road, W.6. Consultants.—The provision of the services of four Consulting Obstetricians whose services are at the disposal of general practitioners in cases of difficulty or abnormality, was continued upon the following terms:— (1) That the patient must be a resident of Hammersmith. (2) The medical practitioners immediately notify the Medical Officer of Health that they have called in the services of the Consultants, giving the name and address of the patient, date of call, the reason and the result. (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. 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 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 sympathetically received, and it is hoped to complete a scheme whereby this may be put into operation. Midwives. The London County Council is the local Supervising Authority and I am informed by the Chief Medical Officer that 53 Midwives notified their intention to practice during the year in this area. 45 AUXILIARY HOME SERVICES. Service of Home Helps.—During the year a service of Home Helps was inaugurated to help with the work of the home during the mother's confinement at home. Women approved by the Medical Officer of Health attend for a specified number of hours each day, according to the needs in the home, and are paid at a rate fixed by the Borough Council. The families are assessed according to a scale of income fixed by the Council. This service in no way interferes with the duties and responsibilities of the midwife, the home help's duties being the care of the children, marketing, the cooking and serving of meals, cleaning and washing. The home help only attends for two weeks immediately following the confinement. Exceptional circumstances and urgent cases, on application, receive the special consideration of the Maternity and Child Welfare Committee. Since the service began in April, 1936, 16 applications have been received for home helps. Home helps have been supplied, and in three cases home helps have been cancelled owing to the mothers being confined in Hospital. Maternal Deaths.—During the year there were three maternal deaths. One from acute nephritis, one from septicaemia, and one from eclampsia. Special enquiry was made by the Medical Officer of Health in each case in accordance with the Ministry of Health's requirements which aim at the prevention of maternal deaths. The maternal death rate for the Borough of Hammersmith was 1.5 and compares with 1.9 for the whole of London. 46 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 1922 4 5 2,758 3.3 1923 5 3 2,701 3.0 1924 4 4 2,399 3.3 1925 6 7 2.351 5.5 1926 3 4 2,188 3.2 1927 3 4 2,076 3.4 1928 5 5 2,258 4.4 1929 5 2 2,162 3.3 1930 4 5 2,173 4.1 1931 2 5 2,073 3.4 1932 3 4 1,940 3.6 1933 6 2 1,827 4.4 1934 4 5 1,783 5.0 1935 1 1 1.877 1.1 1936 1 2 1.922 1.6* * The Maternal Death rate calculated on the total (live and still) births is 1.5. 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 : Disease. No. of Cases Notified. Previous Year. No. of Cases Visited. No. of Cases Nursed. No. of Cases Removed to Hospital. Puerperal Fever 9 2 9 - 9 Puerperal Pyrexia 21 19 21 - 21 Ophthalmia N eonatorum 4 11 4 2 2 Epidemic Diarrhoea* 25 30 4 1 - Measles & German Measles (under 5)† Whooping Cough 586 13 586 - 213 (under 5)† 112 167 112 1 38 Poliomyelitis (under 5) 2 2 1 1 1 * Summer Diarrhœa.—As this is not a notifiable disease the figures available are those of deaths which were registered as having been due to this cause. † Not notifiable diseases. 47 Ophthalmia Neonatorum.—The number of cases reported was four 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 District. Still under Treatment. Deaths. Notified. Treated. At Home. In Hospital. 6.3.36 1 - Yes - - - - - 2].3.36 - 1 ,, - - - - - 29.5.36 - 1 ,, - - - - - 2.6.36 1 - ,, - - - - - Totals 2 2 4 - - - - - 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. DAY NURSERIES. There are two day nurseries in the Borough. Both are conducted by Voluntary Associations, supported by voluntary contributions, to which the Council contributes. The Latymer Road Day Nursery accommodates 65 children : 30 of nursery school age, between 2 and 5 years; 15 toddlers between 1 and 2 years; and 20 children under 1 year. The Princess Christian Day Nursery, Goldhawk Road, provides accommodation for 45 in winter and 50 in summer. This last year some new treatment was carried out in order to try and check epidemics which are likely to occur when any large body of children are congregated together. In April, 1986, a single case of measles arose in each Day Nursery, and in order to stop the spread of infection, immunising serum was given to all the children in both Day Nurseries whose parents were willing to have them inoculated. 48 These children numbered 22. Six parents refused treatment for their children and in each of the six cases the child developed measles. Two of them had severe attacks. Of the 22 immunised, only two contracted the disease and both of them had very mild attacks. This method of protection has proved to be extremely valuable, and I propose to continue its use when necessary. In November, 1936, one case of diphtheria arose in the Day Nursery at Latymer Road. Five parents of Hammersmith children attending there were anxious to have their children immunised. The oneshot method was adopted and a post-Schick test was carried out later. In each case the child was proved to be satisfactorily immunised. There has been no other infection in either Day Nursery. CONVALESCENT HOME TREATMENT OF INVALID CHILDREN. The service given by the Invalid Children's Aid Association in former years was continued. The Borough Council continued their grant in aid of £25 to the Association. The Assistant Medical Officers refer necessitous cases direct from the Infant Welfare Clinics to the Association's Hammersmith Secretary, who is most helpful in finding suitable homes for the children at the seaside or in the country, and undertakes all arrangements for transport. During the year. 19 children were sent to convalescent homes for periods varying from two weeks to six months, compared with seven in 1985. On return the children are medically examined and a report sent about their condition to the Association. It is found the children invariably derive much benefit from the treatment. CONVALESCENT HOME TREATMENT FOR NURSING MOTHERS AND YOUNG CHILDREN. Strong representation has been frequently made to me by the Assistant Medical Officers that there were 49 able numbers of nursing mothers and young children who were debilitated and in need of convalescent treatment. It became apparent also that certain mothers would be unable to take advantage of it were they not able to take two children with them. Thus it was decided that in addition to the grant of £75 per annum to the Zachary Merton Trust Home at Rustington (which grant enables the Council to fill one bed and one cot all the year round), a further sum of £25 should be available for the convalescence of mothers with a baby and toddler. CHILD LIFE PROTECTION. Public Health (London) Act, 1936. At the end of the year there were 94 foster-children in the care of 83 foster-mothers. Five 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 54 foster-mothers were removed from the register for various reasons and 26 new foster-mothers were registered. Fourteen 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 83 „ „ „ Recommended for Registratior 26 No. of Foster-Mothers removed from Register 54 (1) Removed from Borough 15 (2) Adopted Children 1 (3) Unsuitable 5 (4) 9 years of age 8 (5) Temporarily approved 5 (6) No further Foster-Children required 16 (7) Illness of Foster Mothers 3 (8) Lack of accommodaion 1 ,, Applications for Registration received but not Recommended 14 50 FOSTER-CHILDREN. No. of Foster Children on Register December 31st, 1936 •• 94 „ ,, „ received by Foster-Mothers •• 115 ,, ,, ,, moved from Foster-Mothers 105 (1) To Foster-Mothers 21 (2) To Parents or Guardians 49 (3) To Institutions 34 (4) Adopted 1 ,, Children removed from Borough with Foster-Mother .. 10 ,, Foster-Children who have reached the age of 9 years during the Year •• 10 VISITS. No. of visits to new Foster-Mothers 43 „ ,, Registered Foster-Mothers 1052 Verification Visits 17 Special Visits 25 Outs 270 Total Visits 1,407 There is a definite shortage of foster-mothers in the Borough and it is often difficult to place children. The standard of the home and all that pertains thereto is rightly kept very high, and although there is no marked shortage of applicants yet few of them are suitable for "registration." Children's Out-Patient Department and Wards. Bepresentation has already been made to the L.C.C. concerning the urgent need for the provision of out-patient facilities and beds for children in the Hammersmith Hospital. At present sick children have to be taken to Hospitals outside the Borough where it is difficult for the Department to keep in touch and the mothers find it difficult to visit. 51 SANITARY CIRCUMSTANCES OF THE BOROUGH. Closet Accommodation.—There are as far as is known no privies in the Borough, all houses being provided with proper water-closets on the water carriage system. Scavenging.—The arrangements for the removal and disposal of house refuse include the use of both motor and horse-drawn vehicles. Throughout the Borough, there are quite a number of ashpits. This means of depositing house refuse is not only out of date, but in the majority of cases leads to nuisances arising. In all cases which come before the Public Health Department, the owners are advised to close the same, and provide proper metal receptacles in accordance with the L.C.C. Bye-laws. FOULING OF FOOTPATHS BY DOGS. In September, 1922, the Council obtained approval of the following Bye-law for the good rule and government of the Borough in pursuance of Section 23 of the Municipal Corporation Act, 1882, and Section 16 of the Local Government Act, 1888. No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. Any person offending against the foregoing Bye-law shall be liable to a penalty not exceeding forty shillings. During the year under review ten summonses were taken, when fines of £1 were imposed in two cases, 10s. in six cases, 5s. in one case, and one case dismissed with a caution. Sanitary Inspection of the Area.—During the year 46,810 inspections were made by the Sanitary Inspectors. 52 Inspections.-The following table shows the number of visits made in each district under the various inspection head:- NUMBER OF INSPECTIONS MADE DURING 1936. Cause of Inspection. Districts. 1 2 3 4 5 6 7 8 Lady Sanitary Inspector Food and Drugs Inspector Total. Infectious Disease 80 93 83 44 80 86 118 84 1294 3 1,965 Complaints 712 706 623 560 635 653 650 492 285 •• 5,316 Tenement Houses •• •• •• •• •• •• •• •• •• •• •• House to House •• 8 •• 7 7 20 22 14 •• •• 78 Housing Acts 187 136 368 204 555 190 11 120 •• 6 1,777 House to House Consolidated Regulations •• •• •• 47 10 •• •• •• •• •• 57 Shops Act, 1934 127 260 140 224 180 128 83 85 •• •• 1,227 Food (other than Restaurants and Eating Houses) 155 189 281 224 22 260 216 358 •• 1,657 3,362 Restaurants and Eating Houses 74 147 42 89 31 21 13 75 •• 86 578 Markets 156 226 92 110 24 144 32 64 •• 630 1,578 Slaughterhouses •• •• 16 71 •• 51 •• •• •• 8 146 Poultry Slaughterhouses •• 1 2 •• •• •• •• •• •• 2 5 Bakehouses 30 60 25 46 14 21 44 25 •• 51 316 Milk Vendors 29 45 115 78 47 61 90 72 •• 450 987 Ice Cream Vendors •• 1 3 •• •• •• •• •• •• 166 170 Factories (including Factory Laundries) 73 53 30 64 61 40 18 42 32 •• 413 Workshops (including Workshop Laundries) 13 10 6 23 5 16 •• 5 41 •• 119 Workplaces (other than Outworkers) 34 26 8 72 1 26 4 12 29 •• 212 Outworkers •• 5 1 •• •• •• •• 1 71 •• 78 Public Urinals 95 292 247 177 108 63 154 68 4 •• 1,208 Smoke Observations 5 34 6 2 16 2 12 7 •• •• 84 Drainage 1,137 881 1,400 728 686 883 468 444 •• •• 6,627 Miscellaneous 324 337 254 119 299 285 440 704 30 528 3,320 Re-visits 1,998 1,663 1,708 1,497 1,649 2,157 2,247 2,355 124 •• 15,398 Infant Life Protection •• •• •• •• •• •• •• •• 1,407 •• 1,407 Common Lodging Houses •• •• 2 11 •• 1 •• •• •• •• 14 Pharmacy and Poisons Act 18 29 37 21 12 70 6 25 •• •• 218 Diphtheria Immunisation •• •• •• •• •• •• •• •• 146 •• 146 Cancer •• •• •• •• •• •• •• •• 4 •• 4 Totals 5,247 5,202 5,589 4,418 4,442 5,178 4,628 5,052 3,467 3,587 46,810 53 Notices.—The following table shows the number of Preliminary Notices served and complied with during the year Notices Served. Notices complied with. Infectious Diseases 148 154 Complaints 2,443 2,401 House to House 25 93 House to House Consolidated Regulations 21 23 Food (other than Restaurants) 44 44 Restaurants, &c. 42 39 Bakehouses 16 17 Milk Vendors 12 8 Factories 35 30 Workshops 10 9 Workplaces 20 13 Outworkers 1 2 Public Urinals 9 9 Smoke Observations 22 — Drainage 32 33 Miscellaneous 94 80 Re-visits 479 466 Common Lodging Houses 1 1 Housing Acts 16 16 Child Life Protection 6 6 Shops Act, 1934 223 161 Total 3,699 3,605 During the year 1,479 Statutory Notices were served and 1,235 complied with. The following table shows the result of proceedings taken:— SUMMONSES-YEAR 1936. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 116, Iffley Road Failing to comply with Statutory Notice 2 Withdrawn 142, The Grove ditto 2 Withdrawn 9, Alexandra Road ditto 1 Order made 14 days 90, Sinclair Road ditto 1 Order made 21 days 54 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 81, Sterndale Road Unlawful repair of drain 1 Fined £2 28, Clifton Street Failing to comply with Statutory Notice 5 1. Order made 21 days 2. Order made 14 days 3. Fined £2 4. Fined £5 5. Fined £2 32, Gratton Road ditto 1 Order made 14 days 2, Rayleigh Road ditto 1 Order made 21 days 116, Addison Gardens Failing to give notice 2 Withdrawn ditto Failure to deposit plans 1 Withdrawn 135, Percy Road Failing to comply with Statutory Notice 1 Withdrawn 109, Goldhawk Road ditto 1 Order made 14 days 111, Goldhawk Road ditto 1 Order made 14 days 28, Clifton Street ditto 2 1. Fined £2 2. Fined £2 2, Souldern Road ditto 7 1. Order made 14 days 2. Fined £1 10s. 3. Fined £1 10s. 4. Dismissed 5. Fined £1 10s. 6. Fined £1 10s. 7. Fined £1 10s. 31, Worlidge Street ditto 3 1. Withdrawn. 10s. 6d. costs 2. Withdrawn. 10s. 6d. costs 3. Withdrawn 10s. 6d. costs 19, Clifton Road ditto 1 Older made 14 days 74, St. Elmo Road ditto 2 1. Order made 14 days 2. Fined 10s. 28, Clifton Street ditto 5 Withdrawn 33, Leffern Road ditto 1 Dismissed 15, Fielding Road ditto 1 Withdrawn 83, Shepherd's Bush Road ditto 2 1. Withdrawn. 10s. 6d. costs 2. Withdrawn. 10s. 6d. costs 85, Hammersmith Bridge Road ditto 3 1. Withdrawn. 14s. costs 2. Withdrawn. 14s. costs 3. Withdrawn. 14s. costs 15, Benbow Road ditto 1 Withdrawn 55 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 15, Emlyn Road Failing to comply with Statutory Notice 1 Withdrawn 17, Emlyn Road ditto 1 Withdrawn 122, Shepherd's Bush Road ditto 1 Order made 21 days 74, St. Elmo Road ditto 2 1. Withdrawn. 10s. 6d. costs 2. Withdrawn. 10s. 6d. costs 60, Addison Gardens ditto 1 Withdrawn. 10s. 6d. costs 139, Askew Road ditto 1 Order made 8 weeks 1, Oaklands Grove Carrying on offensive trade 1 Adjourned sine die Uxbeidge Road Unlawful removal of offensive matter 2 1. Fined 10s. 2. Fined 10s. 109, Goldhawk Road Failing to comply with Statutory Notice 1 Fined £1 1, Leysfield Road ditto 2 1. Fined 5s. 2. Fined 10s. 393, Goldhawk Road ditto 1 Order made 28 days The Lawn Unlawful removal of offensive matter 4 1. Fined 10s. 2. Dismissed 3. Fined 10s. 4. Fined 10s. 391, Goldhawk Road Failing to comply with Statutory Notice 1 Order made 28 days 385, Goldhawk Road ditto 1 Order made 28 days 387, Goldhawk Road ditto 1 Order made 28 days 389, Goldhawk Road ditto 1 Order made 28 days 138, The Grove ditto 3 1. Order made 14 days 2. Fined 10s. 3. Order made 14 days and fined 10s. 90, Sinclair Road ditto 1 Order made 21 days 109, Adelaide Road ditto 3 1. Order made 14 days 2. Order made 14 days 3. Fined 10s. 100, Gayford Road ditto 2 Withdrawn 109, Goldhawk Road ditto 1 Fined £4 17s. 6d. 111, Goldhawk Road ditto 1 Fined £1 29, Goldhawk Road Construction of waste pipe 1 Fined 10s. 56 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 29, Goldhawk Road Failing to give notice 1 Fined 10s. 122, Iffley Road Construction of waste pipe 1 Withdrawn. 10s. 6d. costs ditto Failing to give notice 1 Withdrawn. 10s. 6d. costs 184, The Grove Construction of waste pipe 1 Fined 5s. ditto Failing to give notice 1 Fined 5s. 182, Blythe Road Construction of waste pipe 1 Fined £1 ditto Failing to give notice 1 Fined £1 2, Souldern Road Failing to comply with Statutory Notice 1 Fined £1 183, Askew Road ditto 1 Withdrawn 9, Thornfield Road ditto 1 Order made 7 days 4, Leffern Road ditto 4 1. Fined £1 2. Fined £1 3. Fined £1 4. Order made 14 days 25, Coningham Road ditto 1 Adjourned sine die. 10s. 6d. costs 60, Masbro Road ditto 1 Withdrawn. 10s. 6d. costs 78, Overstone Road ditto 1 Withdrawn. 10s. 6d. costs Goldhawk Road Unlawful removal of offensive matter 2 1. Fined 5s. 2. Fined 5s. 69, Banim Street Failing to comply with Statutory Notice 3 1. Fined 10s. 2. Dismissed 3. Withdrawn. 10s. 6d. costs 107, Adelaide Road ditto 4 1. Order made 14 days 2. Dismissed 3. Order made 14 days 4. Order made 14 days 109, Adelaide Road ditto 2 1. Dismissed 2. Fined £l 162, Blythe Road ditto 1 Order made 7 days. 182, Blythe Road ditto 1 Withdrawn 35, Coningham Road ditto 2 1. Order made 14 days 2. Dismissed 15, Richford Street ditto 3 Withdrawn 84, Loftus Road ditto 1 Order made 7 days. 10s. 6d. costs 86, Loftus Road ditto 1 Withdrawn. 10s. 6d. costs 57 Summonses- continued. Situation of Premises. Nature of Offence. No of Summonses. Result of Proceedings. 27, Adelaide Road Failing to comply with Statutory Notice 1 Withdrawn. 10s. 6d. costs 31, Coningham Rood ditto 1 Withdrawn. 10s. 6d. costs 36, Woodstock Road ditto 1 Withdrawn. 10s. 6d. costs 23, Askew Road ditto 1 Withdrawn. 10s. 6d. costs 10, Southerton Road ditto 2 1. Order made 7 days 2. Undertaking given. 10s. 6d. costs 24, Richford Street ditto 1 Withdrawn. 10s. 6d. costs 3, Benbow Road ditto 2 1. Order made 21 days Fined £1 2. Order made 21 days Fined £1 58, Askew Crescent ditto 1 Withdrawn. 10s. 6d. costs Shepherd's Bush Road Unlawful removal of offensive matter 2 1. Dismissed 2. Fined 10s. The Lawn ditto 1 Fined 10s. Goldhawk Road ditto 1 Fined 5s. King Street ditto 1 Fined 10s. King Street ditto 2 1. Fined 5s. 2. Fined 5s. 33, Iffley Road Application for warrant of entry 1 Warrant granted SHOPS ACT, 1934. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 39, Fulham Palace Road Failing to comply with Statutory Notice re ventilation 1 Withdrawn. 10s. 6d. costs ditto Failing to comply with Statutory Notice re temperature 1 Withdrawn 10s. 6d. costs 58 PUBLIC HEALTH (LONDON) ACT—UNSOUND FOOD. Name and Address. Nature of Offence. No. of Summonses Result of Proceedings. Mr. J. G., Bradmore Lane Market Exposing for sale fish roes unfit for food of man 2 1. Fined £2 2. Fined £2 M. & S., Ltd., King Street, Hammersmith Sale of unsound smoked salmon for food of man 1 Dismissed ditto Sale of unsound veal and ham pie for food of man 1 Dismissed MERCHANDISE MARKS ACT, 1926. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mr. S. G., Hammersmith Failure to label imported apples and tomatoes 3 1. Fined 10s. 2. Fined 10s. 3. Fined 10s. HAMMERSMITH BOROUGH COUNCIL BYE-LAWS—DOGS. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mrs. L. S. H., Hammersmith Contravention of Bye-law re nuisance by dogs in Goldhawk Road 1 Dismissed with a caution Mr. C. C., Hammersmith ditto Goldhawk Road 1 Fined 10s. Mrs. E. C., Richmond ditto Hammersmith Road 1 Fined 10s. Mr. W. P., Hammersmith ditto Ravenscourt Park 1 Fined 10s. Miss D. M., Hammersmith ditto Stronsa Road 1 Fined 10s. Mr. G. R., Hammersmith ditto Uxbridge Road 1 Fined 10s. Mr. P. A. S., Hammersmith ditto Sussex Place 1 Fined 10s. Mr. G. R., Hammersmith ditto Sulgrave Road 1 Fined £1 Mr. C. C., Hammersmith ditto Brook Green Road 1 Fined £1 Mr. H. B., Fulham ditto Colet Gardens 1 Fined 5s. 59 Removal of Diseased or Infirm Persons to Hospitals or Institutions. PUBLIC HEALTH (LONDON) ACT, 1936, Sec. 224. During the year it was found necessary to apply to the Court for Orders for the removal of two persons who were unable to devote to themselves proper care and attention and living under insanitary conditions. They were removed to Institutions of the London County Council. Factories, Workshops and Workplaces.— During the year 65 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 52 notices were complied with. During the previous year there were 51 notices served and 55 complied with. The following is a list of the Factories, Workshops and Workplaces upon the Register:— Restaurants, Hotels, &c. 194 Bakehouses (28 not in use as Bakeries) 67 Bootmakers 85 Motor and Cycle Makers 16 Dressmakers and Milliners 23 Laundries 44 Outworkers 105 Letterpress Printers and Bookbinders 18 Electrical and Mechanical Engineers 83 Smiths, Wheelwrights and Coachbuilders 22 Tailors 22 Builders, Carpenters and Joiners 26 Miscellaneous 182 Total 837 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, 60 in connection with Factories, Workshops, Workplaces and Homework. 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises Number of Inspections Written Notices Prosecutions Factories (including Factory Laundries) 413 35 — Workshops (including Workshop Laundries) 119 10 — Workplaces (other than outworkers' premises included in Part 3 of this report) 212 20 — Total 744 65 — 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts— Want of Cleanliness 21 17 Want of Ventilation 1 1 — — Overcrowding — — Want of Drainage of Floors 5 5 — Other Nuisances 15 11 Sanitary Accommodation insufficient 2 2 — — unsuitable or defective 38 31 — — not separate for sexes — — — — Offences under the Factory and Workshop Act Illegal occupation of underground bakehouse (S. 101) — — Other offences (excluding offences relating to out-work which are included in Part 3 of this report) — — — — Total 83 68 — — 61 3.—HOME WORK. Nature of Work Outwork in Unwholesome Premises, Sec. 108 Outwork in Infected Premises, Secs. 109, 110 Instances Notices served Prosecutions Instances Orders made (Sec. 110) Prosecutions (Secs. 109, 110) Wearing apparel— (1) making, etc. — — — — — — (2) cleaning and washing — — Furniture and upholstery — — — — — — Totals — — — — — — 4.—REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year Number Bakehouses 26 Dressmakers 21 Laundries 7 Outworkers 105 Others 125 Total number of workshops on Register 284 5.—OTHER MATTERS. Class Number Matters notified to H.M. Inspector of Factories— Failure to affix Abstract of the Factory and Workshop Act 1901 (S. 133) — Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act, 1901 (S.5) Notified by H.M. Inspector 5 Reports of action taken sent to H.M. Inspector 5 Other Underground bakehouses (S.101)— Certificates granted during year — In use at the end of the year 24 62 House to House.—As a result of the house to house visitation 78 inspections were made, 25 notices served, and 98 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. Twenty-two Intimation Notices were served. No summons was taken out. Reports were submitted to the Public Health Committee in reference to the observations made as regards the following:— H.B.C. Electricity Works, Fulham Palace Road. Glen Laundry, Landor Road. Gaumont British Film Studios. Shepherd's Bush Pavilion, Shepherd's Bush Green Victoria Laundry, Becklow Road. Kensington Palace Laundry, Springvale Terrace. Factory, 8/10, Dalling Road. Swan Laundry, Blythe Road. London Wholesale Dairies, Wood Pane. Bakehouse, 74, Goldhawk Road. Purewite Laundry, Gayford Road. Destructor, 15, Pennard Road. Fullers, Ltd., Great Church Lane. Easiwork, Ltd., Woodstock Road. Balmoral Laundry, 67, Becklow Road. Darby Laundry, Gayford Boad. 120, Galloway Road. Bakehouse, 51, Aldensley Road. Rats and Mice (Destruction) Act, 1919.— During the year the Eats and Mice (Destruction) Act, 1919, continued in operation, the District Inspectors being responsible for its administration in their respective districts. Section I places the responsibility of ridding the premises of the pest upon the occupier, but this is somewhat difficult when dealing with tenement houses containing in some cases three or more families. 63 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 Eat Week was held in November, as in previous years. The Ministry of Agriculture and Fisheries again urged local authorities to take action, and arrangements were made for the baiting of the sewers, through the agency of the Borough Engineer and Surveyor's Department. Fifty-six lbs. of rat poison was laid in sewer manholes in 270 roads in the Borough. The Borough Engineer and Survyeor reported that owing to abnormal rains, which surcharged the sewers and washed the bait away, it is difficult to estimate the amount taken by rats. It could be assumed that 50 per cent. was 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.—No premises have been registered under the London County Council Bye-Laws relating to tenement houses. 64 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 more Lane, Hammersmith. Application for the renewal of the licence was received from Mr. William George Parker, residence Jubilee House, Hammersmith. The application was approved and a licence issued dated the 1st July, 1936. The maximum number of lodgers who may be received at any one time into this house is 244. VANS. There are three caravans in the yard at the side of 261, Latimer Boad, used for living and sleeping purposes by five adults and three children. The average cubic capacity for each person is 100 c. ft. Begular 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 Boad, there is one caravan in which two adults sleep. 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. 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. 65 Schools.—The sanitary condition and water supply of the Schools is a matter which requires very little attention from the Public Health Department. The supervision of the schools is in the hands of the London County Council, but combined action has been taken when and where required, with a view to preventing the spread of infectious disease. An arrangement exists whereby cases of Measles, Whooping Cough and Chicken Pox are notified by the Head Teacher to the Medical Officer of Health, at the same time as they inform the Divisional Superintendent. These cases are followed up, and the premises are inspected with a view to any insanitary conditions being remedied. Rag Flock Acts, 1911 and 1928.—There are three factories in the Borough in which rag flock is used. The premises are kept under regular inspection. No samples were taken during the year. HOUSING. Statistics.—Year 1936. 1.—Inspection of dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,936 (b) Number of inspections made for the purpose 23,737 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 41 (b) Number of inspections made for the purpose 57 66 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 43 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,029 2.—Remedy of defects during the year without service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers Nil 3.—Action under Statutory Powers during the year:— (A) Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (B) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3,029 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 3,042 (b) By Local Authority in default of owners 1 67 (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 43 (2) Number of dwelling-houses demolished in pursuance of demolition orders 3 (D) Proceedings under Section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which closing orders were made Nil (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit 1 Housing Act, 1935—Overcrowding Survey:— (a) (i) Number of dwellings overcrowded at the end of the year 1,728 (ii) Number of families dwelling therein 1,728 (iii) Number of persons dwelling therein 8,079 (b) Number of new cases of overcrowding reported during the year Nil (c) (i) Number of cases of overcrowding relieved during the year 35 (ii) Number of persons concerned in such cases 231 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil 68 (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report Nil Housing Act, 1935—Overcrowding Survey.—Section 6 of the Housing Act, 1935, provides that " as from the expiration of six months from the appointed day, every rent book or similar document used in relation to a dwelling-house by or an behalf of the landlord shall contain a summary, in the prescribed form, of the provisions of Sections 2, 3 and 5 of this Act, and a statement of the permitted number of persons in relation to the house." Six months after the appointed day, it is the duty of the Authority, upon the application of the landlord, or of the occupier of a dwelling-house, to inform the applicant, in writing, the number of persons constituting the permitted number in relation to the house. It is necessary, in order to be in a position to supply this information, and to check that a house is not overcrowded, that every room in each house in the Borough should be measured. A scheme was prepared and submitted to the Council which provided for carrying out this work, necessitating the engagement of a temporary staff consisting of two sanitary inspectors, ten measurers and five clerks. Subsequently the London County Council intimated that the appointed day for the Borough for the purpose of Sections 3, 4, 8 and 68 of the Housing Act, 1935, had been fixed as the 1st July, 1937. It is the duty of the Local Authority to see that existing cases of overcrowding are abated as soon as possible and that no new cases arise, except for special reasons and under conditions set out in temporary licence. Arrangements have been made for:— (1) The measuring of the rooms in working-class houses for the purpose of ascertaining the permitted number for each working-class dwelling, and for the furnishing of this 69 information to landlords for insertion in the prescribed form of notice in rent-books. (2) The installation of a system providing for a complete record of all existing overcrowded families and of the action taken to deal with them, of new cases as they arise by reason of births or the growing up of children and of cases licensed by the Authority. (8) The dissemination of information to the public concerning their new duties and responsibilities and the date from which these operated, and the preparation of pamphlets for distribution to inquirers. When dealing with cases of overcrowding the Local Authority must do so with discretion and sympathy. "The object of the Act is to help such people and not to injure them." The measuring of the houses commenced in January, 1937. and the results will be reported upon in my Annual Report for that year. 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. Fitness of Houses:— (a) No difficulties have been experienced under the Public Health Act or under the Housing Acts. (h) 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.) 70 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. Eradication of Bed Bugs. Number of Council houses found to be infested 4 Number of other houses found to be infested 209 Number of Council houses disinfested 4 Number of other houses disinfested 24 In all cases a notice is served, calling attention to the infestation. Methods Employed. Removal of all woodwork, use of blow lamp, spray with insecticide. Bedding disinfested in Council's disinfector. The belongings of tenants removing to Council houses are disinfested by hydrocyanic acid gas. This Council has an arrangement whereby the Kensington Borough Council carries out this work at a cost of £8 7s. 6d. per van load. Newly-Erected Houses.—Progress continues 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. Three hundred and one Certificates were granted during the year under Section 95 (2) of the Public Health (London) Act, 1936, with regard to newly-erected houses and flats having a proper and sufficient water supply. 71 Since the War, 4,268 houses and flats have been erected in the Borough, by the London County Council, the Hammersmith Borough Council and by private enterprise, for which Certificates have been granted (details as under). Certificates granted with regard to water supply under Section 95 (Sub-sec. 2) of the Public Health (London) Act, 1936. Year. L.C.G. Estate. H.B.C. Estate Private Enterprise. 1920 188 18 Nil 1921 169 166 Nil 1922 384 354 Nil 1923 Nil 5 22 1924 Nil 42 40 1925 Nil Nil 50 1926 Nil Nil 202 1927 284 Nil 289 1928 500 Nil 187 1929 1 60 297 1930 Nil 56 90 1931 Nil 21 36 1932 Nil 39 1 1933 Nil 32 20 1934 112 Nil 163 1935 Nil Nil 189 1936 Nil Nil 301 Totals 1,638 793 1,837 The premises have provided accommodation for approximately 21,340 persons, but despite this fact overcrowding is still in evidence. HOUSING ACT, 1930, SECTION 20. One closing order made in respect of underground rooms was determined. 72 HOUSING ACT, 1930—SLUM CLEARANCE. Becklow Place Clearance Area.—In January, 1986, the Minister of Health confirmed, with modifications, the Compulsory Purchase Order made by the Council in June, 1935, in respect of the properties in the Becklow Place Area with the additional lands required for development purposes, and issued an Order entitled "The Hammersmith (Becklow Place) Housing Confirmation Order, 1986." One dwelling and a small number of outbuildings, used as stables, etc., were excluded from the clearance area but remained in the Order as added lands purchasable by the Council. Argyle Place Area.—In May, 1936, the Minister of Health confirrmed, without modification, the Clearance Order made by the Council in respect of the properties in the Argyle Place Area, and issued an Order entitled ''The Hammersmith (Argyle Place) Housing Confirmation Order, 1986." Hanover Cottages Area.—In May, 1936, the Minister of Health confirmed, with modification, the Clearance Order made by the Council in respect of the properties in the Hanover Cottages Area, and issued his Order entitled "The Hammersmith (Hanover Cottages) Housing Confirmation Order, 1936." One property (No. 1, Hanover Cottages) was excluded from the Clearance Area. Terrace Court Area.—In March, 1936, I submitted an official representation with respect to the Area known as the Terrace Court Area. The area was .06 acres in extent and comprised four brick-built dwelling-houses. One was a three-storey building with two rooms on the ground floor, two on the first floor and one on the second floor, and was old, dilapidated, badly arranged, and damp throughout. 73 The remaining three dwellings were two-storey buildings with two rooms on the ground floor, and two rooms on the first floor. Each of these properties was old and was in a bad state of repair generally, and there was considerable rising dampness. The Council decided that the area should be declared a clearance area under the Act, that the owners should be required to demolish the properties in the area, and that the Council should impose suitable restrictions and conditions 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 according to a recent count was 14. In August, 1936, the Minister of Health issued an Order confirming the Clearance Order made by the Council entitled "The Hammersmith (Terrace Court) Housing firmation Order, 1936." Mulberry Place Area.—In March, 1936, I submitted an official representation with regard to the area known as the Mulberry Place Area. The area was .10 acres in extent and comprised two dwelling-houses and outbuildings. The houses adjoined and were brick-built, two-storey dwellings. There was rising dampness in each of the properties, which were badly arranged internally. The Council decided that the area should be declared a clearance area under the Act, that the owners should be required to demolish the properties in the area, and that the Council should impose suitable restrictions 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 according to a recent count was 11. In August, 1936, the Minister of Health issued an Order confirming the Clearance Order made by the Council, 74 entitled "The Hammersmith (Mulberry Place) Housing Confirmation Order, 1936." Coleman's Buildings Area.—In March, 1936, I submitted an official representation with respect to the area known as the Coleman's Buildings Area. The area was .07 acres in extent and comprised six brick-built, two-storey dwellings, five with two rooms on the ground floor and two on the first floor, and one with three rooms on the ground floor and three on the first floor. The premises were old and worn out, with rising dampness in each of the houses and dampness from defective roofs, gutters and brickwork, and all were badly lighted, illventilated and congested. The Council decided that the area should be declared a clearance area under the Act, that the owners should be required to demolish the properties in the area, and that the Council should impose suitable restrictions and conditions 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 according to a recent count was 27. In August. 1936, the Minister of Health issued an Order confirming the Clearance Order made by the Council, entitled "The Hammersmith (Coleman's Buildings) Housing Confirmation Order, 1936." Britannia Court Area.—In March, 1936, I submitted an official representation with respect to the area known as the Britannia Court Area. The area was .13 acres in extent and comprised 11 twostorey, brick-built terraced dwelling-houses, with two rooms and a scullery on the ground floor and two on the upper floor. The properties were old, damp and badly arranged internally; and the area was congested. Other defects included settlements in walls and sagged roofs. 75 The Council decided that the area should be declared a clearance area under the Act, that the owners should be required to demolish the properties in the area, and that the Council should impose suitable restrictions and conditions 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 according to a recent count was 42. In August, 1936, the Minister of Health issued an Order confirming the Clearance Order made by the Council, entitled "The Hammersmith (Britannia Court) Housing Confirmation Order, 1936." Bannisters Cottages Areas.—In June, 1936,1 submitted official representations with respect to two areas known as the Bannisters Cottages (Nos. 1 and 2) Areas. The areas were situated on the north side of Uxbridge Boad between Adelaide Boad and Willow Yale. A roadway running through the areas from Uxbridge Boad to a building in Willow Yale formed a cul-de-sac. The areas were .93 acres in extent, and comprised 22 brick-built, two-storey buildings; 14 consisted of two rooms and wash-house, six of four rooms and wash-house, one of four rooms (one of which was a combined kitchen and washhouse), and one of four rooms and outhouse which consisted of wash-house and kitchen. The buildings were old and worn out, much of the brickwork was bulged, settled or crumbled, and much of the rendering and pointing was defective. There-was rising dampness in every house, and dampness from defective roofs, rain-water guttering and brickwork; the lighting and ventilation was generally bad, and none of the houses was provided with means of artificial lighting; the woodwork generally was decayed, and a large number of other insanitary conditions existed. The Council decided that the areas should be declared clearance areas under the Act, that the owners should 76 be required to demolish the properties in the areas, and that the Council should impose suitable restrictions and conditions 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 according to a recent count was 72. In November, 1936, the Minister of Health issued Orders confirming the Clearance Orders made by the Council, entitled "The Hammersmith (Bannisters Cottages No. 1) Housing Confirmation Order, 1936" and "The Hammersmith (Bannisters Cottages No. 2) Housing Confirmation Order, 1936." Berghem Mews Area.—In May, 1936, I sumitted an official representation with respect to the area known as the Berghem Mews Area. The area was .31 acres in extent and comprised 19 brickbuilt buildings; the upper floor in each case was used for human habitation. The ground floor in one instance was used as a workshop, and in the other 18 properties, for garage purposes. The area was congested; the premises were ill-lit and ill-ventilated, and were badly arranged internally; most of the drainage system was old and defective; and there was evidence of structural weakness in all of the properties. The Council decided that the area should be declared a clearance area under the Act, that the owners should be required to demolish the properties in the area, and that the Council should impose suitable restrictions and conditions 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 according to a recent count was 78. In November, 1936, the Minister of Health issued an Order confirming the Clearance Order made by the 77 Council, entitled "The Hammersmith (Berghem Mews) Housing Confirmation Older, 1936." With regard to this Order, the Minister, having taken into account the report of the Inspector, directed that a payment under Section 64 of the Housing Act, 1935, be made in respect of Nos. 1-8 (inclusive), .Berghem Mews. An appeal has been lodged and is, at the moment, pending. Rose and Crown Lane Area.—In November, 1936, I submitted an official representation with respect to the area known as the Rose and Crown Lane Area. The area is .17 acres in extent and comprises 21 properties; 20 are wholly two-storey brick-built dwellings and one is a three-storey brick-built building used as a dwelling, with the ground-floor front room used as a barber's shop. The buildings are old and worn out, much of the brickwork is bulged and settled, there is rising dampness in every house, and dampness from defective roofs, rainwater guttering and brickwork; the woodwork is decayed and a large number of other insanitary conditions exist. The premises are badly lighted and ventilated, and the area is congested and lacking in air space. The Council decided that the area should be declared a clearance area under the Act, that the owners should be required to demolish the properties in the area, and that the Council should impose suitable restrictions and conditions 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 according to a recent count is 63. Action pending. Wescombe Cottages Area.—In November, 1936, I submitted an official representation with respect to the area known as the Wescombe Cottages Area. The area is 78 situated on the north side of King Street, and is approached therefrom by a narrow roadway. A number of the properties face on to Bradmore Grove. The area is .73 acres in extent and comprises 32 properties, three of which are still occupied as dwelling-houses, the others being vacant. All the properties are old and worn out, badly lighted and ventilated, and with rising dampness; much of the brickwork is settled and defective, and much of the pointing of the brickwork is defective. The area as a whole is congested. In a letter (6/11/86) the London County Council intimates that it does not itself intend to deal with the area as a clearance area or part of a clearance area under the Housing Act, 1930. The Council decided that the area should be declared a clearance area under the Act, that the owners should be required to demolish the properties in the area, and that the Council should impose suitable restrictions and conditions 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 according to a recent count is nine. Action pending. Edwin Cottages Area.—In November, 1936, I submitted an official representation with respect to the area known as the Edwin Cottages Area. The area is .02 acres in extent and comprises two brickbuilt, two-storey dwellings. The buildings are old and worn out; the brickwork is defective; there is rising dampness in both of the houses, which are badly lighted; the drains are defective and other insanitary conditions exist. In addition, the area is lacking in air space. In a letter (6/11/36) the London County Council intimates that it does not itself intend to deal with the area 79 as a clearance area or part of a clearance area under the Housing Act, 1930. The Council decided that the area should be declared a clearance area under the Housing Act, 1930, that the owners should be required to demolish the properties in the area, and that the Council should impose suitable restrictions and conditions 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 according to a recent count is nine. Action pending. Montagu Street Area.—In November, 1936, I submitted an official representation with respect to the area known as the Montague Street Area. The area is .07 acres in extent and comprises seven brickbuilt, two-storey dwellings. The buildings are old and worn out; the brickwork in part is defective; there is rising dampness in every house and dampness from rainwater guttering, roofs, and brickwork; the lighting and ventilation is generally bad; the woodwork generally is decayed and a large number of other insanitary conditions exist. The area is lacking in air space at the rear. In a letter (6/11/36) the London County Council intimates that it does not itself intend to deal with the area as a clearance area or part of a clearance area under the Housing Act, 1930. The Council decided that the Area should be declared a clearance area under the Housing Act, 1930, that the owners should be required to demolish the properties in the area, and that the Council should impose suitable restrictions and conditions 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 according to a recent count is 26. Action pending. 80 The following table gives particulars of the Clearance Areas dealt with during the past two years:— Name of Area Date of Declaration Action taken by Council No. of Premises on Site No. of Persons Living on Site Position at end of 1936 1. Becklow Place June, 1935 Compulsory Purchase Order 34 179 Order confirmed with modifications. Premises not yet demolished. 2. Argyle Place October, 1935 Clearance Order 8 30 Order cenfirmed. Premises not yet demolished. 3. Terrace Court March, 1936 Clearance Order 4 14 Order confirmed. Premises not yet demolished. 4. Bannisters Cottages June, 1936 Clearance Order 23 76 Order confirmed. Premises not yet demolished. 5. Coleman's Buildings March, 1936 Clearance Order 6 27 Order confirmed. Premises not yet demolished. 6. Hanover Cottages October; 1935 Clearance Order 30 164 Order confirmed. Premises not yet demolished. 7. Mulberry Place March, 1936 Clearance Order 2 11 Order confirmed. Premises not yet demolished. 8. Britannia Court March, 1936 Clearance Order 11 42 Order confirmed. Premises not yet demolished. 9. Rose and Crown Lane November, 1936 Clearance Order 21 63 Order not yet confirmed. 10. Wescombe Cottages November, 1936 Clearance Order 33 9 Order not yet confirmed.. 11. Montagu Street November, 1936 Clearance Order 7 26 Order not yet confirmed. 12. Edwin Cottages November, 1936 Clearance Order 2 9 Order not yet confirmed. 13. Berghem Mews May, 1936 Clearance Order 19 78 Order not yet confirmed, pending Appeal by Owners. 81 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. 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.—No premises were registered under for Public Health (London) Act, 1936, 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 414 samples of milk were taken and submitted to the Public Analyst for analysis, the results of which are shown in a later part of this report. 82 Milk (Special Designations) Order, 1936. The following is a list of the licences issued during the year under the Milk (Special Designations) Order, 1986:— 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 2 (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 16 (c) Supplementary Licences 6 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. 88 Public Health (Meat) Regulations, 1924. The Public Health (Meat) Regulations, 1924, came into operation on the 1st day of April, 1925. The provision of these Regulations, regarding the giving of notice to the local authority of the times of slaughter, has enabled arrangements to be made for the inspection of all carcases of animals slaughtered in the local slaughterhouses. I append the number of animals slaughtered and examined in the slaughterhouses during the year. Lambs 57 Sheep 87 Calves 7 Beasts 13 Pigs — Total 164 No application has been received for the stamping of carcases examined by the Sanitary Inspectors. The following is a list of Unsound Food found during the Inspection of the Carcases of Animals Slaughtered in the Local Slaughterhouse. Description. Disease. Approximate Weight. Inspector Mason 1 set of Sheep's lungs Strongulus Rufescens 2½ lbs. Inspector Godden 1 Bullock's liver Distoma Hepaticum 20 lbs. 1 Bullock's lungs Congestion 14 „ 2 Sheeps' lungs Stronguli 3 „ 1 Calt's liver Abscess 3¼ „ 84 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 Offensive Trades—Slaughterers of Poultry.—There are two authorised slaughterers of poultry in the Borough:— Premises. Name of Occupier. 109, Shepherd's Bush Road Solomon Shockett Arch No. 204. Wells Road, Goldhawk Road Hyman Fisher The Dairies, Milkshops, Ice Cream Vendors Restaurants and Food Shops have been kept under systematic inspection by your Inspectors. The following table gives a summary of the work relating to milk premises, slaughterhouses and ice cream premises:— PREMISES. NUMBER OF PREMISES. Number of inspections 1936 Number of notices 1936 Number of prosecutions 1936 On register in 1920. On register at end of 1935 Added in 1936 liemoved in 1936 On register at end of 1936 Milk premises 128 163 19 9 173 987 12 - Slaughterhouses. 7 4 - - 4 146 - - Poultry Slaughter- - 2 - - 2 5 - - Ice Cream premises 162 183 24 21 186 170 - - 85 Markets.—There are three markets in the Borough, situate in Bradmore Lane, Approach Road and Norland Road. These markets have been the subject of much inspection during the year, both by the District Inspector concerned and the Inspector carrying out the requirements of the Food and Drugs Acts. Many of the stalls in the Railway Approach Market are constructed so as to form lock-ups when business for the day is finished and thereby provide a means of storage for all unsold food. In other instances, Bradmore and Norland Markets, wheelbarrows form the structure, and these are stored in premises which are inspected and approved. Street Trading.—The London County Council (General Powers) Act, 1927, made provision for the Licensing of Street Traders which came into operation on the 1st November, 1927. 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 108 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. 86 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. Bakehouses. —The 39 bakehouses in use in the Borough have been regularly inspected during the year. Sixteen 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. * 1 Masbro Road W. A. Maclen †* 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. Becker 24 Bradmore Park Road T. Miller † 28 King Street (rear of) L. E. Jolly † Blacks Road Palmers Stores Ltd. * Underground. Factory 87 Address. Name. 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 Acton Bakeries 7 St. Peters Road E. Gent No. 6 DISTRICT. †* 128 Askew Road G. Ingle †74 Ditto J. Auer †* 167 Ditto Stamford Hill Bakeries, Ltd. † 104 Ditto D. Miller No. 6 DISTRICT. †* 74 Goldhawk Road H. Crisp †* 242 Ditto Plumridge, Bros. †* 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 Beaconsfleld Terrace † 348 King Street * 47 Milson Road 10 Upper Mall † 65 Bridge Road 121 Askew Road 2 Crisp Road 41 Gayford Road * 94 Shepherd's Bush Road †* 126 Uxbridge Road 88 Queen Street †* 132 Uxbridge Road * 77 Blacken bury Road * 2 Hunt Street † 1 The Grove 104 Latimer Road * 17 Kilmarsh Road † Ceylon Road †* 11 Lamington Street †* 106 Goldhawk Road †* 60 Richmond Road † 166 Goldhawk Road * Underground † Factory 88 PUBLIC HEALTH (LONDON) ACT, 1936. Ice Cream Vendors.—Section 187 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 above Act for breach of special regulations. ICE CREAM VENDORS. Registered under Public Health (London) Act, 1936 186 Restaurants 22 Factories 5 213 89 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. 6 boxes Peaches (15 per box) Unsound and Unfit for food Surrendered 3 boxes Peaches (18 per box) ditto ditto 91 boxes Peaches (18 per box) ditto ditto 7 boxes Pears ditto ditto 1 box Mackerel ditto ditto 2 Chickens ditto ditto 3 Chickens ditto ditto 3 Chickens ditto ditto 3 boxes Pears ditto ditto 123 cwts. Potatoes ditto ditto 2 Fowls (5½ lbs.) ditto ditto 2 Ducks (10 lbs.) ditto ditto 2 Chickens ditto ditto 2 boxes Fillets of Cod ditto ditto 1 Chicken ditto ditto 2 stones of Skate ditto ditto 2 boxes Filleted Haddock ditto ditto 9 bushels Pears ditto nitto 1 box Mackerel ditto ditto CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. The chemical examination of food is carried out by the Public Analyst at the Laboratories, Royal Dental Hospital, Leicester Square. 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. 90 The bacteriological examination of food is carried out by the Pathologists 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. On 20th January I received information that a sample of milk sold by a retail dairyman in Carshalton and supplied by a Hammersmith wholesale dairy, as wholesalers, had been submitted to examination, and that the report on such examination stated that blood, pus and streptococci were present. This sample had been taken by the Beddington and Wallington Urban District Council, within whose area the milk was being sold. As a consequence of this Report a sample was taken by the Carshalton Urban District Council upon delivery of milk to the retailer. The report on this sample stated that blood and pus were not apparent. Films from the cream and deposit showed a large number of miscellaneous microorganisms, including streptococci (long and short chains). The milk in each of these cases had not been sold under a "special designation," but had, in fact, been "processed" (i.e., heated to about 140° F. for 30 minutes). Enquiries were at once instituted in an endeavour to trace the source of infection. The bulk of milk received at the depot is dispatched by road from the Company's Creameries at Chippenham, Malmsbury and Savernake in Wiltshire and Chepstow in Monmouthshire in motor delivery tanks. Each tank contains milk from a large number of farms. In addition to these tanks, milk is received in churns direct from the farms. Samples from each of the road tanks were submitted by the wholesalers for bacteriological examination, and the report on milk from Chippenham, Malmsbury and Chepstow stated that microscopical examination of the centrifugalised deposit showed that all were free from pus, short-chain streptococci and from an excessive amount of 91 cellular elements. The report on the milk from Savernake, however, stated that microscopical examination showed the presence of some pus, a few short-chain streptococci and a noticeable amount of cellular elements. The report added that a veterinary inspection of the farms producing the milk was advisable with a view to discovery of the offending cows and their removal from the herd until the trouble ceased. I immediately communicated the facts to the Medical Officer of Health of the Wiltshire County Council, and on the night of 23rd January samples were taken by the Inspector from road tanks from Chippenham, Malmsbury (2), Savernake and Chepstow upon their arrival at various times at the depot in Hammersmith. Samples were also taken from a churn of milk from a farm in the Savernake district. This milk was suspected by the Company to be the cause of the trouble, and had been excluded from the Savernake tank. Each sample was divided into two parts, one of which was submitted to the Council's bacteriologist and one to a laboratory carrying out similar work by the Company. The reports differed materially in respect of the same sample, and the figures are set out in the table attached. On 24th January I received from the Medical Officer of Health of St. Marylebone a copy of a report on a. sample of "pasteurised" milk which had been supplied by the same wholesaler. This report stated that on microscopic examination there were numerous pus cells and a few lymphocytes. The stained film contained a few streptococci. The Bacteriologist stated:— "This sample of pasteurised milk fulfils the Ministry requirements as to bacterial content. This sample contained some 10 B. Coli per c.c., which acounts for the acid reaction and is a finding unusual in good pasteurised milk. Note also the high content of pus, which is undesirable." Upon enquiry, the Manager of the wholesale dairy stated that the milk in this case had been received from 92 the Chepstow Creamery and had been treated in accordance with the requirements of the Milk (Special Designations) Order. He produced a report on a sample which had been taken from the same consignment and submitted to the Company's bacteriologist. This report stated: "The total bacterial count is low and the absence of B.Coli from one-tenth c.c. is very satisfactory. It satisfies the Ministry of Health requirement for pasteurised milk (total count not exceeding 100.000 bacteria per c.c.)." The facts were communicated to the Medical Officers of Health for the counties of Monmouth and Gloucester, from both of which areas milk is supplied to Chepstow. Samples were taken by the Inspector in Hammersmith of Chepstow milk after both ''pasteurising'' and ''processing.'' Identical samples were also submitted by the wholesaler to two different laboratories. The reports from all three bacteriologists showed all the samples to be satisfactory in regard to both total bacterial count and B. Coli. One of the wholesaler's laboratories reported that on microscopic examination a few streptococci were found in each sample, but the other two laboratories failed to identify these organisms. It will be seen that the Council's bacteriologist found streptococci in milk from Chippenham, but no other creamery, and that the wholesaler's bacteriologist found these organisms in milk from Chepstow and Savernake, but not from Chippenham. On 12th February I received information from the Medical Officer of Health of the Wiltshire County Council that the Veterinary Officer had visited a number of farms supplying milk to the wholesaler, and that at one farm, out of a total of 41 cows in milk, no less than six were found to be affected with mastitis. A prohibition was immediately placed on the use of milk from any of these cows. It was further stated that the majority of these cows must have been giving bad 93 milk for some considerable time, and there is no doubt that the milk from this farm must have been contaminated with a considerable quantity of pus and mastitis organisms. The Medical Officer of Health for Monmouthshire reported that examination of samples showed that on the whole milk from that district was fairly satisfactory, but that further investigation was being made. I am of opinion that the facts as set out strongly confirm the case, which I have put forward on previous occasions, for the compulsory pasteurisation of all milk. In no other way can a safe supply be assured. BACTERIOLOGICAL EXAMINATION OF MILK. In my Annual Report for 1934 I called attention to the unsuitability of the plate count as a standard for grading milk, and drew attention to the unreliability of reports on the bacteriological examination of samples. I set out in some detail the results of certain tests which I had had carried out, and showed that reports from different laboratories of the examination of samples of milk taken from one bottle gave figures varying from 9.270 to 3,400,000 per c.c., and that the results obtained by one laboratory varied from 147.000 to 3,400.000 for the same milk. In October, 1935, Professor G. S. Wilson's valuable report, "The Bacteriological Grading of Milk," was issued by the Medical Research Council. In this book, which sets out the results of three years of investigation, the plate count is severely criticised. "Even under favourable conditions, with the method standardised as far as possible, the experimental error is very large, and on any one count an allowance of ± 90 per cent. may have to be made. Even this margin of error will not include all results. . . . . It is therefore recommended that the plate count should be discontinued as a method of grading ordinary raw milk. . . . .The quantitative expression of the results in figures extending over a wide range affords 94 a fictitious appearance which leads, not only in laymen, but even in public health officials, to a wholly unjustifiable feeling of confidence in their value. . . . . For pasteurised milk, with the possible exception of Grade A pasteurised, the plate count is not recommended. The actual count on pasteurised milk is determined by so many factors independent of the efficiency of the processing that the results bear little relation to any important quality of the milk." Of the coliform test Professor Wilson states:—"With the possible exception of its employment on empirical grounds for certified milk there seems, therefore, to be no justification for the use of either the coliform test or the coli-aerogenes ratio test in the grading of raw milk. For pasteurised milk, on the other hand, the coliform test may be of some value. It may serve as an index of the efficiency of the processing, if performed on freshly pasteurised milk, or as an index of the subsequent contamination or exposure to unsuitable temperatures, if performed on the bottled milk at the time of delivery to the consumer. The experimental error of the test is, however, very large, and on this account the results should preferably be reported, not in absolute numbers, but as above or below an arbitary standard." In spite of these recommendations the plate count has been retained for pasteurised milk in the Milk (Special Designations) Order, 1936, but no provision has been made for the coliform test and, for raw graded milk, the coliform test has been retained although the plate count has been replaced by the methylene blue test. In addition to the variation in laboratory reports there are other factors which minimise the value of the plate count. A general enumeration of the total bacterial content of a sample of milk is of little value from the public health point of view. It gives no indication of the presence or absence of pathogenic organisms and, therefore, although it may afford some indication of the cleanliness and keeping quality of the milk, provides little information with regard to its safety. 95 I have for many years advocated the pasteurisation of all milk which, if carried out in the manner laid down in the "Special Designations" Order, will destroy pathogenic organisms and render the milk safe for humantion. An increasing number of consumers is coming to rely upon pasteurised milk as a safe milk. Unfortunately, much of the milk now labelled and described as "pasteurised" is, in fact, nothing of the kind. A number of pasteurising plants are defective in design or construction, and frequently they are inefficiently operated. As a result the milk treated in them is not satisfactorily pasteurised. The legal bacterial standard of 100,000 bacteria per millilitre is of no value whatever as a control of the efficiency of pasteurisation. It is possible, without much difficulty, to attain such a standard at any reasonably well-conducted farm, especially during the winter months, without resort to heating the milk at all. As Professor Wilson has pointed out the best bacteriological control of the efficiency of the pasteurising process is the coliform test, but this test has its limitations. B. Coli should not be present in appreciable numbers in properly pasteurised milk immediately after pasteurisation, but their absence does not necessarily demonstrate efficient pasteurisation. What is required, therefore, is a reliable test which will establish whether the milk has been treated in accordance with the requirements of the Milk (Special Designations) Order, i.e., that it has been retained at a temperature of not less than 145° and not more than 150° F. for at least 30 minutes. Details of a test which, it is claimed, will meet these conditions has been published by Professor Kay of the Institute for Research in Dairying, Reading. The test is based upon the fact that the enzyme phosphatase, which is a constant constituent of raw milk, is almost completely destroyed when the milk is held for a period of half an hour at the minimum temperature required by the regulations for officially pasteurised milk. 96 The presence of phosphatase, which is readily detected, is, therefore, evidence that the milk has not been properly treated. If the required temperature is not attained or is not maintained for the requisite period, the enzyme survives in greater or lesser amounts. It is said that milk which has been heated at 143.5° F. or which has been treated at 145° F. for 20 minutes, or milk containing as little as 0.25 per cent. of raw milk in properly pasteurised milk, can be detected by this method. It has been calculated that over 40 per cent. of the milk sold as "pasteurised" in London is processed in the Borough of Hammersmith, and it is, therefore, obvious that a test such as this, if efficient and reliable, would be of great value in the control of pasteurisation. In view of experience with the bacteriological examination of samples it was decided to make some experiments to check the value and reliability of the test. For this purpose a sample, consisting of one pint, was taken from a churn containing 17 gallons of milk which had been pasteurised in accordance with official requirements. This sample was divided into four parts and submitted to four different laboratories for examination. The reports from three of these laboratories stated that the milk had been satisfactorily pasteurised. At the same time, a further sample was taken from the churn after a half pint of raw (T.T.) milk had been added to it. The contents of the churn, therefore, consisted of 17 gallons, less 1 pint of pasteurised milk, plus half a pint of raw milk, i.e., 0.87 per cent. of raw milk. A third sample was prepared by adding to 9½ pints of milk, from which the second sample was taken, a further ½ pint of raw milk. The percentage of raw milk in this case was, therefore, 5.35. The samples were submitted to each of the laboratories without any indication as to the nature of the contents. The reports on the samples are set out on the attached table A. 97 Table A. No. Designation. Laboratory A. Laboratory B. Laboratory C. Laboratory D. 139 Pasteurised (From churn containing 17 gallons) 2.1 Lovibond blue units Satisfactory 1.0 Lovibond blue units Satisfactorily pasteurised 2.1 Lovibond blue units Satisfactorily pasteurised 1.5 Lovibond blue units In my opinion this milk has been properly pasteurised 140 Milk from above churn to which ½ pt. raw (T.T.) milk had been added (17 gallons - 1 pt. pasteurised + ½ pt. raw = .37% raw) 3.4 Lovibond blue units Slight error in technique of pasteurisation 4.3 Lovibond blue units Result, suggests inadequate temperature or holding period or admixture with small quantity of raw milk 4.6 Lovibond blue units Unsatisfactory, and probably contains a little unpasteurised milk 141 From 9½ pts. of above milk (140) to which ½ pt. of raw (T.T.) milk had been added (5.35% raw) 10+ Lovibond blue units Raw or grossly underheated Over 30 Lovibond blue units Grossly underheated or contains a quantity of raw milk. This milk may not have been heated Over 20 Lovibond blue units It is probably unpasteurised milk 98 From these results it will be seen that three of the laboratories detected the addition of the raw milk, and that, apart from a slight variation in the figures of the stated number of blue units, the results were comparable. Laboratory "D" is one which carries out the analysis of milk samples for the "trade" at a very low charge, and it would appear that those responsible for the examination of the samples in question had little or no knowledge of the test or that the technique employed in carrying out the examination was unsatisfactory. A number of samples have also been submitted to both the phosphatase test and bacteriological examination, and it is interesting to note that in many cases where the phosphatase test has been positive, i.e., the milk had not been properly pasteurised, the plate count has been reported to be well within the maximum limit prescribed by the Milk (Special Designations) Order and would have been passed as satisfactory had it not been for the new test. In no instance has a sample, reported negative to the phosphatase test, given a bacterial count in excess of the standard. The results so far obtained point to the test being of great value, and it has been adopted as a routine measure in the control of pasteurisation in Hammersmith. The following table (B) sets out the results of samples taken during the year:— 99 Table B.—PHOSPHATASE TESTS. Sample No. Designation Report Lovibond Blue Units P. 101 Pasteurised Saisfactorily pasteurised 2.1 P. 102 „ „ 2.0 P. 103 „ „ 1.9 P. 104 „ „ 2.2 P. 105 „ „ 2.3 P. 106 „ „ 1.8 P. 107 „ Incorrectly pasteurised or admixed with small quantity of raw milk 3.1 P. 108 „ Satisfactorily pasteurised 2.1 P. 109 „ Raw or grossly underheated 10 + P. 110 „ Satisfactorily pasteurised 2.2 P. 111 * Ordinary „ 1.8 P. 112 Pasteurised Slight error in pasteurising technique 2.7 P. 113 „ Satisfactorily pasteurised 2.1 P. 114 „ „ 2.3 P. 115 „ „ 2.1 P. 116 „ „ 2.0 P. 117 „ „ 1.6 P. 118 „ „ 1.4 P. 119 „ „ 1.5 P. 120 „ „ 1.5 * Although not sold as such this milk had, in fact, been pasteurised. loo BACTERIOLOGICAL EXAMINATION OF MILK. No. Class of Milk. Total count. B. Coli. Microscopic examination. 1 Raw (from tank) 481,000 per c c. + in l/1000th c.c. Numerous pus cells and some long chain streptococci 2 do. 256,000 „ + in l/1000th c.c. A small number of pus cells 3 do. 197,000 „ + in l/1000th c.c. A few leucocytes 4 do. 157,000 „ + in 1/1000th c.c. do. 5 do. 189,000 „ + in l/1000th c.c. do. 6 Raw (from churn) 298,000 „ + in l/1000th c.c. do. 7 Pasteurised (from churn) 4,030 „ - in l/10th c.c. A small number of leucocytes 8 do. 32,500 „ - in 1 /10th c.c. do. 9 Pasteurised (bottle) 58,000 „ + in 1/10th c.c. A few leucocytes. No acid fast bacteria 10 do. 16,300 „ + in 1/10th c.c. Some leucocytes. No acid fast bacteria 11 do. 52,000 + in 1 /10th c.c. Some leucocytes. No acid fast bacteria 12 do. 46,200 „ + in l/10th c.c. Some leucocytes. No acid fast bacteria 13 Pasteurised ( from churn ) 3,340 - in l/10th c.c. — 14 do. 2,930 - in l/10th c.c. — 15 do. 3,970 - in 1/10th c.c. - 16 do. 4,490 „ - in l/10th c,c. — 17 do. 2,760 - in 1/10th c.c. — 101 FOOD AND DRUGS (ADULTERATION) ACT, 1928. Extract from Report of the Public Analyst for the Year ended 31st December, 1936. Eight hundred samples of food and drugs were submitted for analysis by the Council's Sampling Officers, and of these a total of eighty-seven, or a percentage of 10.9, were reported upon adversely. This represents an increase of 1.4 per cent. over the preceding year, the increase being due to the greater number of samples of inferior quality where actual adulteration could not be certified. The number adulterated is exactly the same as in 1935. Reference to Table II will reveal that although the percentage of samples not genuine fell in the years immediately after the passing of the Food and Drugs Act of 1928, the average for the last five years is 9.5 per cent. It is to be hoped that the changes in the law relating to food and drugs foreshadowed in the concluding parts of this Report will lead to a fall in this figure, for the present position cannot be regarded as at all satisfactory. The present-day trend toward somewhat gross misdescription of food and drugs receives due comment in this Report. The many examples quoted will show clearly the need for vigilance in this matter. In Table I are set out the total numbers of samples examined under the Food and Drugs (Adulteration) Act as recorded in my Statutory Quarterly Reports to the Ministry of Health, together with the numbers of those classified as genuine, inferior and adulterated. Table I. Period. Genuine. Inferior. Adulterated. Total. 1st quarter 121 6 3 130 2nd „ 157 27 12 196 3rd „ 139 10 11 160 4th „ 296 7 11 314 Whole year 713 50 37 800 (Percentages) 89·1 6·3 4·6 102 In Table II the percentages of genuine, inferior and adulterated samples are compared for the last ten years. From this it will be seen that 1936 shows an appreciable advance in inferior samples, whilst those adulterated show no diminution as compared with the high figure for 1935. Table II. Year. Genuine. Inferior. Adulterated. 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 2·3 193 + 89.9 6.2 3·9 1935 90.5 4.9 4·6 1936 89.1 6.3 4·6 Average for ten years 91.4 5.7 2·9 The number and nature of the various articles analysed during the year under the Act are set out fully in Table III below:— Table III. Article. No. of Samples examined. Result of Examination. Genuine. Inferior Adulterated. Ammoniated Tincture of Quinine 2 1 - 1 Aspirin Tablets 3 3 — — Baking Chocolate 1 1 — — Beef-steak Pudding (tinned) 1 I — — "Betacream" 1 1 — — Blackcurrant Pastilles 2 2 — — Butter 44 44 — — Camphorated Oil 4 4 — — Cheese 8 7 — 1 Chicken and Ham Galantine 1 1 — — „ „ Roll 3 3 — — Chocolate Confectionery 8 3 — 5 Syrup 1 1 - — 108 Table III—continued. Article. No. of Samples examined. Result of Examination. Genuine. Inferior. Adulterated. Citrate of Magnesia 3 3 - - Cocoa 9 9 - - Coffee 7 7 - — Coffee and Chicory 1 1 — — Coffee and Chicory Extract 3 3 — — Cornflour 1 1 — - Cream 14 7 2 5 ,, Confectionery 5 2 — 3 Dairy Table Cream 1 — — 1 Eucalyptus Oil 3 3 — — Fish Paste 7 7 — — „ (tinned) 13 8 2 3 Friar's Balsam 3 3 — — Fruit (dried) 8 8 — — „ (tinned) 11 9 1 1 Halibut Liver Oil Pastilles 1 1 — — Honey 4 4 — — Iodine Ointment 1 — — 1 „ Paint 1 — — 1 ,, Tincture 6 6 — — Jam 8 8 — — Jelly (Mint) 1 1 - — ,, (Table) 3 3 — — Lard 9 9 — — Lemonade Powder 3 3 — — Lemon Barley Powder 2 2 — — „ Essence 1 1 — — Margarine 11 11 — — Marmalade 6 6 — — Meat Paste 5 5 — — ,, Pies 9 9 — — Milk 414 364 44 6 ,, Condensed 24 24 — — „ Gums 1 1 — — Mincemeat 5 5 — — Mint Creams 2 2 — — „ Sauce 2 2 — — Mustard 4 4 — — Olive Oil 6 6 — — Orange Curd 2 2 — — „ Squash 1 1 — — Paraffin (Liquid) 4 4 — — Parrish's Chemical Food 2 1 — 1 „ „ „ Pastilles 1 1 — — Pepper 2 2 — — Raspberry Roly-Poly (tinned) 1 1 — — Rice 3 2 — 1 Rissoles 1 1 — — 104 Table III—continued. Article. No. of Samples examined. Result of Examination. Genuine. Inferior. Adulterated. Sal Volatile 4 3 1 Sandwich Spread 2 2 - — Sausages 15 14 - 1 Scotch Eggs 1 1 - — Seidlitz Powder 2 1 - 1 Semolina 3 3 - — Sodium Bicarbonate 1 1 - — Strawberry Syrup 2 2 - — Suet 3 3 - — Sugar 7 6 - 1 Syrup of Figs 3 2 - 1 Tea 5 5 - — Tomato Sauce 4 4 - — ,, Soup 4 3 - 1 Vegetables (tinned) 9 9 - — Vinegar 9 9 - — Whisky 6 6 - — White Milk Chocolate 1 — - 1 Wine 2 1 1 — Yeast Tablets 1 1 - — Zinc Ointment 2 2 - — Totals 800 713 50 37 In the section which follows the analyses of these articles are discussed, as well as the new forms of adulteration encountered and the numerous instances of false or misleading labelling. This is followed by brief references to new Orders or Regulations which have lately been issued. Milk. Three of the six adulterated milks contained extraneous water, the amounts found being 6, 3 and 2 per cent., respectively. The others were deficient in fat to the extent of 12, 10 and 2 per cent., respectively, of the minimum limit laid down in the Sale of Milk Regulations, 1901. The 44 samples classified as inferior were all of poor quality in regard to their fat content. The rather high proportion of samples poor in fat (over 10 per cent.) is 105 indicative of the need for constant supervision, but I think it may be said that the efficient inspection that the milk supply of our Borough receives has led in recent years to a welcome decrease in adulteration of this essential food. Table IV, below, shows the average composition of milk as sold in the Borough month by month and for the whole year. Table IV. Month. No. examined. Fat (per cent.). Non-fatty solids (per cent.). January 20 4.20 8.86 February 37 3.75 8.83 March 32 3.52 8.82 April 27 3.60 8.82 May 29 3.48 8.83 June 26 3.23 8.83 July 27 3.51 8.71 August 37 3.58 8 68 September 37 3.69 8.80 October 46 3.80 8.90 November 25 3.91 8.86 December 71 3.83 8.86 Whole year 414 3.67 8.82 The following Table shows the numbers of milks classified as of good, fair and poor quality in each quarter of the year, omitting, of course, the adulterated ones:— Table V. Period. Good quality. Fair quality. Poor quality. 1st quarter 8 75 6 2nd ,, 6 50 23 16 72 10 4th 59 78 5 Whole year 89 275 44 106 The sale as pasteurised milk of raw milk, inadequately heated milk, or pasteurised milk that has been contaminated with raw milk, has lately been receiving attention in various parts of the country and in the Metropolis. Complaints regarding the quality of the milk supplied to school-children under the "Milk in Schools" scheme; a recent outbreak of typhoid fever in the country which seems to have been traced to an infected milk supply; and many other considerations which are too lengthy to deal with here, all render the inspection both of pasteurising plant and the milk supply a matter of urgent necessity. This Borough was one of the first to initiate measures designed to deal with this matter, and during the past year inspections of plant and the testing of the milk for efficiency of pasteurisation have been carried out. Until recently inspection of plant was the only method of ensuring a good product, but we have now a chemical test by means of which we can judge the quality of pasteurised milk; this is known as the phosphatase test, and depends upon the fact that under the conditions obtaining in pasteurisation properly carried out an enzyme naturally occurring in milk, called phosphatase, is destroyed. In carrying out the test, traces of phosphatase are sought for by delicate chemical means and as a result one is enabled to express an opinion as to the efficiency or otherwise of the pasteurising process. Recently the test has undergone an extensive survey at the hands of its originators and of other investigators, which resulted in an interesting paper being published in the Journal of the Society of Public Analysts, to which Journal your Analyst also contributed a short note dealing with the same subject. In these, all the conditions of the test have been subjected to a searching enquiry, and it has been shown that in skilled hands the test is capable of detecting 0.3 per cent., or even less, of raw milk in pasteurised milk and to give practically infallible indications of inadequate heating. 107 In Circular 1533, issued in connection with the Milk (Special Designations) Order, 1986, the Minister of Health refers to this test in the following terms:— " The Minister is advised that there is evidence that milk subjected to the pasteurising process may in fact be improperly pasteurised on account of the pasteurising plant being imperfect in design and construction, or improperly and inefficiently operated and controlled. It has also been asserted that in cold weather milk which has not been through the pasteuriser at all may be sold as ' Pasteurised,' Improperly pasteurised milk has not the advantage, which pasteurisation is designed to secure, of the destruction of pathogenic bacteria, and the Minister is therefore pleased to learn that a test for pasteurised milk (the phosphatase test) has recently been devised. A detailed description of this test and its method of operation is given in the Journal of Dairy Research (Vol. VI, No. 2, p. 191, 1935). Present experience of the test shows that a positive result, i.e., the demonstration of the presence of phosphatase in the milk, is conclusive evidence that the milk has not been properly pasteurised or that milk which has not been pasteurised has been added to it. A negative result, i.e., failure to demonstrate the presence of phosphatase, does not necessarily indicate that the milk has been properly pasteurised, as it may not be possible to demonstrate indubitably the presence of phosphatase in milk which has been heated to slightly below the pasteurising temperature or for a slightly less period than 30 minutes, or to which a small proportion of raw milk has gained access. Nevertheless, it is claimed that even relatively small errors in pasteurisation technique, e.g.. heating at 143°F. instead of 145°, or heating for 20 instead of 30 minutes at 145°, or the addition of 0.3 per cent. (or even less) of raw milk to the pasteurised bulk may be detected by this test. 108 The test accordingly gives promise of being of great value in so far as a positive result indicates that the milk has not been properly pasteurised, and its application will no doubt enable Local Authorities to deal with cases in which it is suspected that raw milk is being sold as ' Pasteurised ' and may also facilitate the detection of defects in the pasteurising apparatus or in its working." Of the 20 samples submitted to the phosphatase test during the year under review (or, rather, a part of the year), 17 were reported as satisfactory, though of these 2 reached the limiting value in the test; in one indications were obtained of a slight error in the technique of pasteurisation, one was improperly pasteurised, and one was raw milk or milk that had been grossly underheated. These results can only be regarded as indicative of need for improvement in the supply. Under the Milk (Special Designations) Orders, if the Council are not satisfied that a vendor is selling properly pasteurised milk they may exercise their discretion in refusing to issue him a licence to sell such milk, or may revoke a licence already issued. Apart from any considerations regarding the relative merits of raw and pasteurised milk, it should be obvious that a purchaser requiring and paying for pasteurised milk is prejudiced if he is served with raw or inadequately heated milk; in a sense, therefore, a new form of adulteration has arisen—the mixing of raw milk with pasteurised milk, or, what amounts in effect to the same thing, inadequate heating. Condensed Milk. All the 24 condensed milks analysed during the year satisfied the requirements of the Condensed Milk Regulations in regard to both composition and volume of milk yielded on dilution—the " equivalent pints " value. Six of these were sold as full-cream and 18 as machineskimmed. 109 Cream, &c. five fresh creams were genuine, but one bottled cream was reported inferior as it was sold as " double " cream and should therefore have contained a minimum of 50 per cent. of fat, whereas only 47.6 per cent. was found. This deficiency is, however, not serious in an article such as cream where a tendency to separation exists; therefore the deficiency was considered too small to warrant returning the sample as adulterated. Two " half-price " creams were genuine, the fat content being 24.0 and 24.2 per cent. respectively. Of six tinned creams five were reported against. One contained only 23.1 per cent. of fat, but as no claims to richness occurred in the label it was only reported inferior. Three others were reported adulterated, the fat content being only 20.0, 19.9 and 23.0 per cent., respectively, whilst extravagant claims regarding their quality were printed in the labels. Two were described as " rich " and the other as " pure thick Devonshire cream—rich English cream." This last was guaranteed to contain a minimum of 23 per cent. of butter fat and the amount found by analysis was the bare minimum. The fifth sample was reported adulterated because it contained 1 per cent. of cane sugar; the label on this was false and contradictory, the following statements occurring therein :— Guaranteed absolutely pure—absolutely free from preservatives or other foreign substances. A small percentage of cane sugar is added to bring out the full rich flavour of the cream." It will be noted that the second sentence contradicts the first, for cane sugar is a foreign ingredient in cream. The absurdity of a full rich flavour " which requires " bringing out " by a sweetening agent should be apparent, but the guile of the packers in using the word " rich " to describe only the flavour—not the quality—would probably 110 escape the notice of the ordinary person. As a matter of fact the cream was of poor quality, the fat therein being only 22.8 per cent. A specimen of '' Betacreem '' gave analytical results consistent with the composition declared by the makers—a reconstituted cream containing a small proportion of eggyolk—and was therefore reported genuine. It was said to be intended for use in filling cream confectionery and was a much better class of article for this purpose than is usually encountered. A sample sold as " Dairy Table Cream " was found to consist merely of chocolate-flavoured blancmange powder and was reported adulterated. There was no cream or milk powder in it and in my opinion the name used is a glaring example of a type of misdescription all too frequently met with at the present time. Cheese. Of eight cheeses only one was adulterated; this was a Cheddar cheese which contained only 40.4 per cent. of fat calculated on the moisture-free sample, whereas in my opinion it should have contained a minimum of 45 per cent. Two others were kinds for which standards exist under the National Mark Scheme; though not sold with this mark, (hey complied with the requirements for fat content. Butter, Margarine, &c. All the samples of butter, margarine, lard and suet examined this year were genuine. There were no preservatives in any of them, no excess water in the butters and margarines, none at all in the lards, and no excess of starch in the suets. Meat and Fish Preparations. Of the total of 56 meat and fish preparations analysed during the year, 2 were reported inferior and 4 adulterated. 111 The inferior samples were both canned fish in which 1.1 grains of tin per pound were found. The accepted limit for tin in foodstuffs is two grains per pound, any excess over this amount being regarded as unnecessary and potentially injurious. Two other canned fish contained amounts of tin above this limit—both had 3.3 grains per pound—and in another 0.5 grain of tin as well as 15 parts of lead per million were discovered. These three were reported adulterated. No excess of sulphur dioxide was found in those sausages which were sold as preserved, but one other was reported adulterated on account of the finding therein of 110 parts of sulphur dioxide per million, no declamation of its presence being made on sale as required by the Preservatives Regulations. One sample of sausages was sold canned but in this no tin was found. The search for poisonous metals in food and drugs, always a major part of the work of Public Analysts, is becoming intensified at the present time owing to a variety of reasons, among which is their somewhat more frequent occurrence than was the case formerly, and also the desire for the suppression of all avoidable excess of lead, which is considered more dangerous than most metals owing to its cumulative poisonous action. The ever-greater variety of foodstuffs that are now canned may be one contributory cause of the increase of this form of adulteration; curious examples in this report are to be found in tinned beef-steak pudding, raspberry roly-poly and sausages—all foods which do not seem to be worth canning—and in last year's report, tinned jam. Other causes may be unduly long keeping in stock by retailers and carelessness in manufacture, as well as the increasing use of tomatoes with tinned fish. Tomatoes seem, from my experience, to be specially liable to act on tin containers. Though due care is no doubt exercised by the majority of packers, it would appear that retailers are not sufficiently aware that long keeping of canned goods 112 is not advisable from the point of view of public health. Many packers guard against this by such means as are within their power, but they cannot in all cases ensure that their produce will be sold within a reasonable time and it would seem that action against the vendor is called for in cases where metallic contamination is excessive. Successful prosecutions for excessive tin or lead have been recorded in this Borough and others. The sample sold under the name of " Scotch eggs " consisted of a hard-boiled egg within a thin layer of meat paste, the whole apparently being fried or baked in breadcrumbs. Vegetables, Fruit, Conserves, &c. All the conserves examined during the period under review were genuine. In those cases where jam was sold as full fruit standard analyses disclosed no deficiency. Nine samples of canned vegetables were free from metallic contamination, but of 11 tins of fruit 2 were adversely reported upon, both being tomatoes containing tin in one case 1.1 grains per pound and in the other 2.1 grains per pound. The first was reported inferior and the other adulterated. Eight specimens of dried fruit were examined, all being genuine. Five contained sulphur-dioxide preservative, but in amounts under the permitted limit. Condiments, Spices, Sauces, Soups, &c. All the samples falling under this heading were genuine, with the exception of one of tomato soup which was contaminated with copper to the extent of 40 parts per million. Confectionery, &c. Eleven preparations of chocolate were submitted for analysis, of which no less than six were adulterated. A specimen of white milk chocolate was found to have been 118 prepared from cocoa butter with milk and sugar (probably added as sweetened condensed milk) with no fat-free cocoa matter whatever. Chocolate, whether for drinking or eating, has always been made from cocoa, not merely the fat of cocoa, and in my opinion such a preparation as the one under discussion is not entitled to be called chocolate. Cocoa butter is a fat rather difficult of digestion and my information is that this white milk chocolate has not been a successful introduction owing to its having caused biliousness in children. A chocolate syrup and a baking chocolate were genuine. The latter was apparently intended for use in the coating of home-made chocolate confectionery. Of eight samples of chocolate confectionery five were returned as adulterated; in four of them no cocoa whatever could be detected, whilst in the other only 1 per cent. of dry fat-free cocoa matter was present. Two of these were chocolate-coated confectionery and curiously enough contained no cocoa at all where one would expect to find a reasonable amount, namely, the chocolate coating. The standard for the minimum content of fat-free cocoa matter in this class of confectionery adopted by most analysts is 4 per cent. and in the better-class article much more than this is usually found. From reports of cases taken to Court in different parts of the country it appears that a preparation is sold to bakers for making this confection which contains no cocoa matter, but is merely a sweetened and vanilla-flavoured solution of a brown colouring-matter. The use of cocoa in the small proportion required would be by no means an expensive matter and the substitution of this preparation for it seems a particularly mean kind of offence. Proceedings taken against vendors of this type of confectionery resulted in substantial fines being imposed. Such was also the case with samples of cream confectionery which analysis revealed to contain fillings other than real cream, 114 though resembling cream in appearance. Of a total of five samples no less than three were so adulterated. A sample of icing sugar was adulterated with 1.04 per cent. of starchy matter. It is understood that subsequent enquiry at the retailer's shop established that this fact was admitted on the label of the container from which it was sold. Cocoa, Coffee, Tea, &c. All the samples of cocoa, coffee and tea were genuine, as also were one of coffee and chicory and three of coffee and chicory extract. The coffee and chicory mixture, sold under the name of " French coffee," contained only 50 per cent. of coffee and was therefore rather a poor specimen. It bore the following misleading label:— " This coffee is roasted and ground on the Continental principle. Sold as a mixture of extra fine coffee and chicory. It is more stimulating and refreshing than any other coffee Even the name " French coffee " is misleading, for no such name is recognised in France,' and, moreover, in that country admixture with chicory constitutes adulteration. Farinaceous Foods. A sample of cornflour and three of semolina were genuine, but of three of rice one was reported adulterated on account of " facing " with talc, as indicated by the finding of 0.06 per cent. of extraneous mineral matter. Cordials, Wines, Spirits, &c. Three specimens of lemonade powder, two of lemon barley powder, one each of lemon essence and orange squash, two of strawberry syrup, six of whisky and one of ginger wine 115 were genuine, but a raisin wine was reported inferior as it consisted merely of a coloured and flavoured sugar solution and contained '200 parts of benzoic acid per million, this preservative being permitted in such an article. This sample is typical of the sort of stuff that is sometimes sold as " British wine." Drugs. A large selection of drugs—47 in 19 varieties—were analysed during the year and of these seven failed to satisfy the requirements of the British Pharmacopoeia or the British Pharmaceutical Codex. An ammoniated tincture of quinine was deficient in ammonia to the extent of 16 per cent. of the correct amount; this is not a serious deficiency in view of the volatility of the ammonia. An iodine ointment was 100 per cent. deficient in iodine and 90 per cent. deficient in potassium iodide and in my opinion was worthless for the purposes for which iodine ointment is used. In a previous report reference was made to the dangers attendant upon the use of such preparations, which possess none of the antiseptic properties of the real article. Another iodine preparation—iodine paint—contained only 1.01 per cent. of iodine in place of the 2 per cent. which, in my opinion, is the minimum quantity which should have been used to render the preparation at all effective for the purposes for which it is intended. A sample of Parrish's chemical food was found to consist entirely of compound glycerin of thymol, a substitution which probably represents the result of gross carelessness on the part of the chemist who sold it. Fortunately, compound glycerin of thymol is not poisonous, but when taken in mistake for Parrish's chemical food is not only worthless as a tonic, but is likely seriously to impair the digestion. A spirit of sal volatile was 19 per cent. deficient in ammonia and 12 per cent.deficient in carbon dioxide. 116 A compound syrup of figs contained 100 parts of salicylic acid per million; in a preparation largely used for children and invalids this preservative is undesirable. A specimen of Seidlitz powder was found to be deficient in the content of tartaric acid in the white packet to the extent of 20 per cent., whilst the blue packet contained the correct quantities of sodium bicarbonate and Rochelle salt, but contained saccharine as a foreign ingredient. The label on this was misleading in that it represented the sample to be " an improvement on the B.P. formula." NEW ACTS, ORDERS AND REGULATIONS. The Milk (Special Designations) Order, 1936, came into operation on 1st June last. Reference was made to a draft of this Order in my last Annual Report, but some important alterations were made in the draft by the Minister of Health after consideration of the representations made to him. The new Order has two main objects—to transfer from the Minister to Local Authorities the duty of granting licences to producers of certain graded milks and to improve and simplify the special designations in the Orders of 1923 and 1934. The designations previous to the present Order were " Certified," " Grade A (Tuberculin Tested)," "Grade A" and " Pasteurised." The existence of so many grades did not give a clear indication to the consumer of the nature of the milk purchased. Therefore, the grades are now reduced to three—" Tuberculin Tested," " Accredited " and " Pasteurised." Tuberculin Tested " has replaced the previously existing designations " Certified " and " Grade A (Tuberculin Tested)," the chief characteristic of which was that both milks came from herds which had been subjected to a 117 stringent test for the absence of tubercle. The new designation indicates this characteristic more clearly. This milk may, if desired, be pasteurised, and where this is done it must be sold as " Tuberculin Tested Milk (Pasteurised)." It will have the double security of tuberculin testing (as a safeguard against tuberculosis) and pasteurisation (as a safeguard against all milk-borne disease). " Accredited " milk has replaced the former " Grade A" milk. It is raw milk from cows which are regularly inspected by a veterinary surgeon, but which are not tuberculin tested. " Pasteurised " milk is, as before, milk which has been held at a temperature of 145 to 150 degrees F. for 30 minutes. In regard to the examination of these milks the " plate count " test in relation to raw " Tuberculin Tested " and Accredited " milks has been susperseded by a colour test called the " methylene blue " test recommended by the Medical Research Council, The test for coliform bacilli is not altered. A circular was sent to Local Authorities explaining the new order and calling their attention to the new chemical test—the phosphatase test—for determining whether or not milk has been properly pasteurised. The Pharmacy and Poisons Act, 1933, together with the Rules made under it came into full effect on 1st May, 1936, and replaced all the existing legislation relating to the sale, supply, storage and transport of poisons. The Act established a Poisons Board with the duty of preparing a list—known as the Poisons List—of the substances to which the Act shall apply. The list now issued is divided into two parts; in Part I are those substances the sale of which is restricted to the premises of "authorised sellers of poisons," and in Part II are those poisons in 118 common use which may be sold from the premises of ' listed sellers of Part II poisons," i.e., persons registered with their Local Authority for the purpose, as well as from the premises of " authorised sellers of poisons." It is the duty of the Local Authority, by means of inspection and otherwise, to secure compliance by listed sellers of Part II poisons, and other persons not being authorised sellers of poisons, with the provisions of the Act and Rules relating to Part II poisons. An Inspector of a Local Authority has power at all reasonable times to enter any premises, on which a listed seller carries on business, and any other premises on which the Inspector has reasonable cause to suspect that a breach of the law has been committed in respect of any poisons included in Part II of the Poisons list. He has further powers to make such examination and enquiry, and to do such other things, including the taking of samples, as may be necessary for the purposes of the inspection. The actual provisions of the Act and Rules are very comprehensive and quite beyond the scope of this Report, but the principal changes effected in so far as concerns shopkeepers who are registered by their Local Authority as " listed sellers " are :— (a) The sale of certain poisonous preparations used in agriculture and horticulture is now permitted to any trader who is registered for the purpose. (b) Traders so registered are now permitted to sell carbolic disinfectant containing up to 60 per cent. of phenols, whereas formerly the sale of liquids containing more than 3 per cent. of phenols was restricted to chemists' shops. (c) The sale of ammonia of over 5 per cent. strength, sulphuric acid, nitric acid, and a few other poisonous substances, which hitherto was unrestricted, 119 is now restricted to registered traders. The sale of caustic soda and caustic potash is controlled for the first time. Another important piece of legislation passed during the year is the Public Health (London) Act. This now embodies the Rag Flock Act and Regulations. Several Regulations were added to the already long list by the Minister of Agriculture and Fisheries during 1986 under the Agricultural Produce (Grading and Marking) Act, 1928 ; among the articles for which standards are prescribed are Lancashire, Leicester and Wensleydale cheeses, eggs, fruit juice syrups, malt extracts and malt flours, plums and canned vegetables. In regard to coming legislation, Sir Kingsley Wood is reported in the Press to have said, in a written reply to Mr. Bull:— The Committee on the Consolidation of Local Government and Public Health law is at present considering the consolidation and revision of the food law and 1 hope it will be possible to introduce legislation to give effect to their recommendations in the course of the present year. This will provide a convenient opportunity for dealing with the question of definitions of articles of food and similar matters." 120 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. Costs. £ s. d. Rice 134 Contained 0.06% of extraneous mineral matter having the characteristics of talc. — No action — Icing Sugar 135 Contained 1.04% of farinaceous matter — — No aotion — Tomato Soup .. 136 Contained 40 pts. ot copper per million — — Warning letter Stock withdrawn and destroyed Milk 282 12% deficient in fat Dismissed under P.O.A. 10 6 — Tinned Herrings . 294 Contained 3.3 grains of tin per pound — — Informal sample See No. 343 Tinned Tomatoes 300 Contained 2.1 grains of tin per pound — — No action. Insufficient adulteration Compound Syrup 326 Contained 100 pts. of — — Vendor warned of Figs salicylic acid per million Tinned "Rich" 328 Contained only 20% of — — — Informal sample. See No. 342 Suppliers agreed to alter wording on label Cream fat Tinned "Rich" 342 Contained only 19.9% — — Warning Cream of fat • Tinned Herrings in Tomato Sauce 343 Contained 3.3 grains of tin per pound 3 0 0 2 2 0 " 121 Tinned Sardines 345 Contained 15 parts of lead per million and 0.5 grain of tin per pound. - - No action — Milk 358 10% deficient in fat. — — Letter of warning Sedlitz Powder 401 The white packet contained only 2.0 grammes of tartaric acid in place of the 2.5 grammes required. The blue packet contained a mixture of sodium bicarbonate and Rochelle salt in the proportions required but was sweetened with saccharine, the latter being a foreign ingredient in Sedlitz powder. — — Vendor warned White Milk 421 Contained no fat-free No action - Chocolate cocoa matter. Milk 432 2% deficient in fat. — Letter of warning Letter of warning . Contained 3% of extraneous water. — — — " 513 Contained 2% of ex- — — Letter of warning traneous water. ft 528 Contained 6% of extraneous water. i — — Letter of warning . — Spirit of Sal Volatile 555 19% deficient in ammonia and 12% deficient in carbon Informal sample. 122 123 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. Parrish's Chemical Food 565 Consisted entirely of compound Glycerin of Thymol — — No action Bottle wrongly labelled. Vendor warned Tinned Cream 575 Contained 1% of cane — — No action — Tinned "Rich Devonshire" 582 sugar Contained only 23% of fat — — No action — Cream Ammoniated Tinc- 609 16% deficient in am- _ - Warning ture of Quinine Iodine Paint 615 monia Contained only 1% of Iodine — — No action — Real Cream Doughnuts 617 The filling consisted of a substance resembling but was not, in - - - I n formal sample. See Nos. 635 & 636 Chocolate Cup Cakes 618 fact, real cream Contained no cocoa in either the chocolatecoloured pastry — — - Informal sample See No. 634 Iodine Ointment 626 portion or in the "chocolate" coating 100% deficient in iodine and 96% deficient in potassium iodide - — Stock withdrawn from sale — Chocolate Cup Cakes 634 Contained less than 4% of dry fat-free cocoa 2 2 0 2 2 0 - Fresh Cream Doughnuts 635 matter. Filling consisted of a substance resembling cream but having the characters of margarine fat. 2 2 0 1 1 0 - — Butter Cream Doughnuts 636 Filling consisted of a substance resembling cream but having the characters of mar- 2 2 0 1 1 0 - — Chocolate Buns 644 garine fat. Contained no cocoa. — — Letter of warning sent to all Bakers and Confectioners Letter of warning sent to all Bakers Informal sample „ Shells 647 Contained no cocoa. — — Informal sample Roll 648 Contained no cocoa. — — and Confectioners Letter of warning sent to all Bakers and Confectioners Letter of warning Informal sample Pork Sausages 722 Contained 110 parts of sulphur dioxide per — — — Dairy Table Cream 725 million. Consisted not of cream, but of chocolateflavoured blancmange powder. - - No action — fZl 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. Cheddar Cheese 727 Contained only 40.4% of fat instead of 45% — — No legal standard Adulteration considered insufficient — Tinned Cream 884 Contained 23.5% butter fat. Label declared 25% - - for further action No action. Adulteration insufficient — 125 PREVALENCE OF, AND CONTROL OVER INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 658 cases reported as due to notifiable infectious diseases in the Borough, against 999 in the previous year. There were also reported 1,899 cases of infectious diseases that were not notifiable, against 679 in the previous year; 1,372 of these were Measles, 234 Whooping Cough and 293 Chickenpox. The number of cases of Tuberculosis notified was 196 against 201 in the previous year. BACTERIOLOGY. The following bacteriological examinations were made on behalf of the Council:— Material from cases of suspected Diphtheria— Positive results 49 Negative results 807 Sputa from cases of suspected Tuberculosis Tubercle bacillus found 62 Tubercle bacillus not found 472 Blood from cases of suspected Fever— Widal or Typhoid reaction obtained Widal or Typhoid reaction not obtained 1 Stools (positive = 2, negative = 1) 3 Urine (negative) 8 Grand Total 1,397 126 Cases of Infectious Disease notified during the year 1936. Notifiable Disease Number of Oases Notified Total cases notified in each Ward Total Cases Removed to Hospital At all Ages AGE PERIODS Under 1 1 & under 5 Years 5 & under 15 Years 15 & under 25 Years 25 & under 45 Years 45 & under 65 Years 65 and upwards 8th Centre North Ward 1 Ward 2 Ward 3 Ward 4 Ward 5 Ward 6 Ward 7 Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (c )plague (p) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 130 6 45 56 10 13 .. .. 22 18 10 7 26 32 15 129 Erysipelas 38 .. .. 3 4 3 20 8 4 11 6 1 5 8 3 25 Scarlet Fever 335 2 91 17 7 38 24 2 1 4/ 5/ 39 7 74 76 35 321 Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 13 .. 2 3 4 2 2 .. .. 3 2 3 3 2 .. 13 Relapsing Fever (R) Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 9 .. .. .. 3 6.. .. .. 1 3 1 1 1 1 9 Puerperal pyrexia 21 .. .. .. 10 11 .. .. 3 3 4 3 4 3 1 21 Cerebro-Spinal Meningitis .. 6 1 2 .. 2 1 .. .. 3 2 .. .. .. 1 .. 6 Polio -myelites 2 .. 1 1 .. .. .. .. 1 .. .. .. .. 1 .. 1 Encephlities .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 4 4 .. .. .. .. .. .. 2 1 1 .. .. .. .. .2 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 83 3 13 18 7 18 20 4 14 17 11 2 9 26 5 36 Malaria 2 .. .. .. .. 1 1 .. .. .. 1 .. .. 1 .. .. Dysentery 14 3 8 1 1 1 .. .. 2 4 2 .. 2 .. 4 13 Food Poisoning 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. TOTALS 658 19 162 259 79 81 45 13 99 117 80 24 124 150 64 577 Tuberculosis. Pulmonary Tuberculosis 156 .. 1 6 48 60 36 5 26 27 24 11 18 38 12 Other forms of Tuberculosis 40 .. 9 12 7 9 2 1 6 11 5 6 4 5 3 TOTALS 196 .. 10 18 55 69 38 6 32 38 29 17 22 43 15 Deaths from the Seven Principal Zymotic Diseases.— The total number of deaths of residents registered from the seven principal zymotic diseases was 57 against 49 in the previous year. The deaths of residents last year from these diseases were equal to 36 per 1,000 of the total deaths of residents registered and were at the rate of 0.4 deaths per 1,000 persons living. 127 The following table shows the deaths of residents registered from the seven principal zymotic diseases which occurred in the ten years, 1927 to 1936 :— Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Enteric Fever. Diarrhoea and Cholera. Total. 1927 0 2 1 11 4 0 28 46 1928 0 23 3 5 5 2 33 71 1929 0 2 0 5 41 2 19 69 1930 0 31 3 21 9 1 21 89 1931 0 0 2 6 7 0 23 38 1932 0 29 4 8 6 1 26 74 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 1936 0 15 3 5 7 2 25 57 Average last 10 yrs. 0 13 8 11 11 1 26 65 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was eight below the average number registered in the last ten years. Notifiable Diseases lother than Tuberculosis) during the year 1936 DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths. Diphtheria 130 129 5 Erysipelas 38 25 — Scarlet Fever 335 321 3 Enteric Fever 13 13 2 Puerperal Fever 9 9 1 Puerperal Pyrexia 21 21 — Cerebro-Spinal Meningitis 6 6 2 Encephalitis Lethargica — — 2 Ophthalmia Neonatorum 4 2 Pneumonia 83 36 110 Dysentery 14 13 — Poliomyelitis 2 1 — Malaria 2 1 — Food Poisoning 1 — — Totals 658 577 125 128 Smallpox.—No case of smallpox was reported. Cholera.—No case was reported as due to Cholera. Plague.—No case was reported as due to Plague. Diphtheria and Diphtheritic Membranous Croup.— One hundred and thirty cases were reported as due to Diphtheria or Diphtheritic Membranous Croup against three hundred and thirty-three cases in the previous year. One hundred and twenty-nine cases were treated at the Isolation Hospitals and one was treated at home. Five deaths were registered. The mortality rate on the cases reported was 3.8 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. 129 DIPHTHERIA IMMUNISATION. The Scheme for the prevention of Diphtheria in children between the ages of 1 and 12 years continued during the year. It will be seen that there was a distinct falling off in numbers of children dealt with. I have given careful consideration to this question and am of the opinion that this is due to the fact that the present scheme (provides for three inoculations by the doctors and the Schick test. It appears that children receive the first injection without much objection, but difficulty is experienced in persuading the child to attend for the second and third injections. They become nervous, cry, and owing to this difficulty immunisation has not been completed in many cases. In view of this falling off in the numbers I think that in the near future consideration must be given to the immunisation by the A.P.T. (one-shot) method, which is being successfullv used by many authorities. The following are the particulars of the work done under the above scheme during the year:— Number of children immunised by medical practitioners 557 Number of children who did not complete the three doses or Treatment completed in Cases coming into Borough:— 1 68 2 24 Number of children who were immunised without a pre-Schick 537 130 Schick Testing Clinic. Number of Clinics held 38 (7 of these were for inspection only) Pre-Schick tests. Positive 8 Negative 12 Post-Schick tests. Positive 8 Negative 740 No reading 26 Refusals of Post-Schick Test 108 Removals—address unknown—no Post-Schick Test 49 Refusals or non-attendances (immunising agent) 22 Removed—address unknown (incomplete doses) 20 Removed—information sent on to M.O.H. concerned 24 Additional doses recommended by the Immunisation Expert—1 dose, 3; 2 doses, 1 4 Fees paid to medical practitioners. £ s. d. 544 at 10s. 272 0 0 36 at 6s. 8d. 12 0 0 83 at 3s. 4d. 13 16 8 11 at 2s. 6d 1 7 6 £299 4 2 Scarlet Fever.—Three hundred and thirty-five cases were notified as due to Scarlet Fever, against three hundred 131 and forty-nine in the previous year. Three hundred and twenty-one cases were treated at the Isolation Hospitals, and fourteen at the homes of the patients. Three deaths were registered. The mortality rate was 0.9 per cent. Enteric Fever.—Thirteen cases were reported as due to Enteric Fever, against five cases in the previous year. The cases were treated in various hospitals. It was not possible to trace the source of infection. Erysipelas.—Thirty-eight cases were reported as due to Erysipelas, against fifty cases in the previous year. Thirteen cases were treated at the homes of the patients, and twenty-five in various hospitals. Typhus Fever.—No case was reported as due to Typhus Fever. The Chart hereunder shows the number of cases of Diphtheria notified week by week during the year. The Chart hereunder shows the number ot cages of Scarlet Fever notified seek by week during the year. 134 Relapsing Fever.—No case was reported as due to Relapsing Fever. Continued Fever.—No case was reported as due to Continued Fever. Puerperal Fever.—Nine cases were reported as due to Puerperal Fever, against two cases in the previous year. Six cases were treated at Isolation Hospitals of the London County Council, 2 at Queen Charlotte's Hospital and 1 at Hammersmith Hospital. One death was registered from Puerperal Sepsis and 2 from other accidents and diseases of pregnancy. Puerperal Pyrexia.—Twenty-one cases were reported as due to Puerperal Pyrexia against nineteen in the previous year. Once case was treated at a London County Council Isolation Hospital, three at Queen Charlotte's Hospital and seventeen at various other hospitals. Cerebro-Spinal Meningitis.—Six cases of Cerebrospinal Meningitis were reported against two cases in the previous year. Two cases were treated at Isolation Hospitals and four at various other hospitals. Two deaths were registered. Acute Polio-myelitis.—Two cases were reported as due to Polio-myelitis, against two cases in the previous year. One case was treated at a London County Council Isolation Hospital and 1 at home. Encephalitis Lethargica.—No case was reported as due to Encephalitis Lethargica, against two cases in the previous year. Ophthalmia Neonatorum.—Four cases were reported as due to Ophthalmia Neonatorum, against eleven cases in 135 the previous year. One case was treated at a London County Council Isolation Hospital, one at Hammersmith Hospital and two at the homes of the patients. In the cases treated at home arrangements were made for a nurse to attend the patients. Six 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. Hydrophobia.—No case was reported as due to Hydrophobia. Rabies Order, 1919.—No case of Rabies in dogs occurred in the Borough. Glanders.—No case was reported as due to Glanders. Measles and German Measles.—One thousand three hundred and seventy-two cases of Measles and German Measles were notified against forty-five in the previous year. Three hundred and seven cases were treated in the Isolation Hospitals of the London County Council. Fifteen deaths were registered. Use of Convalescent Serum in Prevention of or Attenuation of Measles. Twenty-three cases in all were treated with convalescent measles serum, twenty-two of which were given it as a preventive measure and one in order to produce attenuation of the attack. Eight were children attending the Latymer Road Day Nursery, and of the remaining fourteen, thirteen were 136 children attending the Princess Christian Day Nursery and one was a nurse at that same institution. Latymer Road Day Nursery.—A single case of measles arose in this day nursery on 20th May and was sent home at once. The eight children were immunised the same day; seven of them did not develop the disease; the eighth case was in contact with measles in his own home, and although he contracted the disease, he had, in the doctor's words, a " very mild attack." Four parents refused inoculation for their children, and it is significant to note every one of those children developed measles. Princess Christian Day Nursery.—Cases of measles had arisen in this Day Nursery on the 15th, 29th and 30th April and the 1st May. Convalescent serum was given to seven cases on the 1st May; the six children had doses proportionate to their ages, and the nurse one which was calculated to attenuate the attack. The nurse did not develop measles, three of the children were completely protected, two contracted measles the day after immunisation and one child developed an ''extremely mild" attack of the disease ten days later. A second batch of seven children was immunised on the 21st May on account of the widespread nature of measles in the neighbourhood. A single child was immunised on the 29th May. All these children escaped the disease. Two parents refused inoculation for their children. Both children developed measles. 137 Result of Immunisation of 23 Cases. Age. Temp. Reaction. Erythema or Ur icaria. Amount Given. Compl.ete Protection. Type of Attack. 6/12 None None 3 cc. Yes. - 6/12 99.8° None 3 cc. Yes. 7/12 Rise to 100° None 3 cc. Yes. 7/12 None None 3 cc. Yes. 9/12 None None 3 cc. Yes. — 10½/12 100° None 3 cc. Yes. 1 yr. None None 4 cc. Yes. 1 yr. None None 3 cc. Yes. 1 yr. None None 4 cc. Yes. 13/12 99.8° None 4 cc. Yes. — 14/12 None None 4 cc. Yes. — 14/12 None None 4 cc. Yes. 14/12. Rise to 99.4° None. 4 cc. Yes. — 16/12. 100.2° None. 4 cc. Yes. — 17/12. None. None. 4 cc. No. Dr. reported very mild attack. 18/12. 99.4° None. 4 cc. Yes. — 22/12: 100.° None. 4 cc. No. Dr. reported very mild attack for his age. 23/12. 100.2° None. 4 cc. Yes. — 2½yrs. 102° None. 5 cc. No. Moderate attack. 2/10/12. 99.4° None. 5 cc. No. Case so mild it was difficult to diagnose. 3 yrs. 99° Ery. on face. 5 cc. No. Attenuated attack. 4 yrs. 99.8° None. 6 cc. Yes. — 16½yrs. None. None. 2 cc. Yes. — 138 Whooping Cough.—Two hundred and thirty-four cases of Whooping Cough were reported, against three hundred and twelve in the previous year. Seven deaths were registered. Forty-three eases 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.—Two hundred and ninety-three cases of Chicken Pox were reported, against four hundred and thirty-five in the previous year. Thirty-seven cases were removed to hospital. The following Chart shows the number of Deaths from Measles per 100,000 inhabitants, 1916-1936. The following Chart shows the number of Deaths from Whooping-Cough per 100,000 inhabitants, 1916-1936. 140 In every case the premises were visited by your Lady Inspector and the parents advised as to the precautions necessary. Pneumonia.—Eighty-three cases of Pneumonia (twenty-eight Influenzal Pneumonia and fifty-five Primary Pneumonia) were notified during the year. Thirty-six cases were treated at various institutions. All cases were made the subject of inquiry by your lady Sanitary Inspector or Health Visitors, and in many cases it was found necessary to arrange for a nurse to visit, advise and assist in the nursing of the patients. This was done by arrangement with the Hammersmith District Nursing Association. One hundred and ten deaths were registered. Malaria.—Two cases were reported. Dysentery.—Fourteen cases of Dysentery were reported against fourteen cases in the previous year. Food Poisoning.—One case of Food Poisoning was reported under Section 7 of the London County Council (General Powers) Act, 1932. Influenza.—During the year fifteen deaths from Influenza occurred, as compared with eight in the previous year. Wrong Diagnosis.—Thirty-three cases of infectious disease were removed to the Hospitals of the London County Council and subsequently returned home in consequence of the patients being found not to be suffering from the disease stated on the certificates, or any other notifiable disease— Diphtheria 24 Scarlet Fever 9 Total 33 Psittacosis.—No case of psittacosis was reported in the Borough during the year. 141 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. Beds 139 Mattresses 680 Billows 1,761 Bolsters 356 Blankets 1,819 Sheets 1,216 Quilts 873 Articles of Clothing 2,910 Sundries 491 Carpets 7 Curtains 5 Total 10,257 Rooms (including 35 verminous rooms) 783 TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1927 to 1936. Year. Smallpox. Scarlet Fever. Diphtheria or Diphtheritic Croup. Typhus Fever. Enteric Fever. Simple Continued Fever. Relapsing Fever. Puerperal Fever. Puerperal Pyrexia. a Cholera. Erysipelas. Plague. Chickenpox. a Measles. b a Whooping Cough. a Cerebro-Spiual Fever. Anthrax. Glanders. Hydrophobia. Ophthalmia Neonatorum. Acute Polio-Myelitis. Encephalitis Lethargica. Pneumonia. c Malaria. c Dysentery. c Trench Fever, e Food Poisioning. f Total. 1927 0 312 368 0 11 0 0 7 22 0 41 0 269 60 83 0 1 0 0 16 0 4 145 2 3 0 0 1343 1928 0 337 380 0 8 0 0 7 18 0 52 0 114 631 45 8 0 0 0 21 3 3 130 5 1 0 0 1758 1929 0 409 249 0 4 0 0 9 15 0 74 0 87 237 113 3 0 0 0 13 0 3 232 0 1 0 0 1452 1930 21 498 384 0 6 0 0 10 26 0 63 0 432 1486 206 3 0 0 0 14 1 4 166 0 0 0 0 3320 1931 49 280 228 0 1 0 0 5 30 0 48 0 707 178 264 9 0 0 0 13 0 2 141 0 2 0 0 1957 1932 0 594 192 0 4 0 0 2 29 0 51 0 405 1588 330 8 0 0 0 19 1 1 178 0 1 0 2 3405 1933 0 895 241 0 8 0 0 9 33 0 97 0 333 299 319 6 0 0 0 10 4 1 179 0 3 0 8 2445 1934 0 609 549 0 1 0 0 2 22 0 79 0 422 1334 272 6 0 0 0 11 1 1 154 0 0 0 4 3467 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 1936 0 335 130 0 13 0 0 9 21 0 38 0 293 1372 234 6 0 0 0 4 2 0 83 2 14 0 1 2557 Average for 10 years 7 461 305 0 6 0 0 6 24 0 59 0 350 723 218 5 0 0 0 13 1 2 150 1 4 0 2 2338 a Not Notifiable. b Notifiable duiing the years 1916—1919. c Notifiable from 1st March, 1919. d Notifiable from 1st October, 1926. e Notifiable from 1st March, 1919, to 31/12/1927. f Notifiable from 12th July, 1982. 143 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 259 Impetigo 292 Verminous Cases 2,056 Adults— Scabies 137 Verminous Cases 12 Other Conditions — Children under School-age— Scabies 16 Verminous Cases 1 School Children—Non-Hammersmith— Scabies 31 Impetigo 2 Verminous 163 Adults—Non-Hammersmith— Scabies 39 Verminous 23 Common Lodging-houses— Scabies 3 Verminous 73 School Children—Non-Hammersmith (outside London)— Scabies 18 Children under School Age—(outside London)— Scabies 2 The County Council pay the sum of two shillings in respect of each child cleansed, except in cases of scabies 144 or impetigo in which case the payment is at the rate of 1s. for each bath given. The amount received from the London County Council during the year was £221 18s. Od. in respect of cleansings and £29 4s. 0d. in respect of cases of scabies 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 was made and paid by the responsible Authority. Owing to the large numbers of Hammersmith cases dealt with it was found to be impossible to carry on with the above arrangements and the scheme was accordingly discontinued in November. VACCINATION. The duties under the Vaccination Acts and the Vaccination Order were carried out by the Public Health Department. The Return for 1935 shows that 913 Infants were vaccinated, this being 68.0 per cent. of the Births and compared with 56.0 per cent, in 1934. No proceedings under the Vaccination Acts were instituted. VACCINATION RETURNS. RETURN FOR 1935. Registration Sub-Districts comprised in the Vaccination Officers' District Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st Dec., 1935 Number of these Births duly entered by 31st January, 1937, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1937, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1937. neither duly entered in the "Vaccination Register" (columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the "Report Book" (columns 8, 9 and 10 of this Return Number of Certificates of Successful Primary Vaccination of children under 14 years received during the calendar year 1930 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dutes of birth of the children to which they relate during the calendar year 1936 Col. 1 Successfully Vaccinated Col. II Col IV. Number in respect of whom Certificates of Conscientious Objection have been received Col. V I)ead, Unvaccinated Postpone ment by Medical Certificate Removal to Districts, the Vaccination Officer of which has been duly apprised Removal to Places unknown or which cannot be reached; and Cases not having been found Insusceptible of Vaccination Had SmallPox 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Hammersmith 511 252 - - 188 20 2 10 28 11 1,370 2. Hammersmith Hospital 434 205 2 — 120 28 1 31 41 6 569 3. South Hammersmith *444 220 2 - 128 24 2 20 34 13 4. "Invermead" 385 236 1 — 93 13 — 22 17 3 *1,774 913 5 — 529 85 5 83 120 33 1,370 569 * Including one nameless child found in street. Number of Copies of Certificates sent to other Vaccination Officers—144. Table showing Work of Vaccination Officer from 1st January to 31st December, 1936. No. of Vaccination Certificates received from— No. of Insusceptibility Certificates. Total No. of Certificates. No. of Declarations of Conscientious Objection. No. of Postponement Certificates. No. of Cases Removed Inwards. No. of Cases Removed Outwards. No. of "Q" Notices Sent. No. of "K" Notices Served. No. of Children Died Unvaccinated. No. of Cases Removed and not Traced. Nos. entered on ''H" Lists to Public Vaccinators. Dr. Durward. Dr. Dale. Dr. Townsend. Dr. Dockrill. Dr. Brash. Dr. Phillips. Dr. Barnes Other Doctors. Dr. Durward. Dr Dale. Dr. Townsend. Dr. Dockrill. Dr. Brash. Total North 3 95 48 62 1 — — 43 2 284 159 19 — 32 333 63 16 16 5 101 42 87 5 240 South 111 17 66 4 — — — 82 1 281 106 24 — 85 248 77 13 19 110 8 61 1 — 180 Hammersmith Hospital 67 100 86 77 5 — — 102 4 441 242 27 — 176 573 65 20 35 101 94 85 79 5 364 Queen Charlotte's Hospital 12 17 10 1 — - — 170 — 210 58 3 — 296 40 7 4 13 11 7 7 4 — 29 Removed Inwards 27 44 53 31 2 — 11 31 — 199 4 11 241 — 139 56 11 29 40 33 47 29 4 153 Above 14 years of age 6 12 11 2 - - - - - 31 - - - - - - - - - - - - - - Total 226 285 274 177 8 — 11 428 7 1446 569 84 241 589 1333 268 64 112 267 243 242 200 14 966 147 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.—One hundred and ninety-six cases of tuberculosis were reported during the year, one hundred and fifty-six of which were Pulmonary and forty being other forms of Tuberculosis, against two hundred and one cases in the previous year. PART I. Summary of Notifications during the period prom the 1st January, 1936, to the 31st December, 1936. Age Periods Formal Notifications Total Notifications. Number of Primary Notifications of new cases of Tuberculosis 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages) Pulmonary Males — 1 2 2 10 12 21 12 20 7 4 91 129 Pulmonary Females - - 1 1 11 15 14 13 6 3 1 65 82 Non -pulmonary Males — 5 7 2 3 3 2 1 - 1 1 25 28 Non-pulmonary Females — 4 1 2 - 1 4 2 1 - - 15 17 148 PART II. Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age Periods 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary Males — — — — 2 5 3 2 7 3 1 23 Pulmonary Females — — — — 1 5 9 3 — 1 — 19 Non-pulmonary Males — - 2 1 - 1 — 2 — 1 — 7 Non-pulmonary Females 1 1 — - 1 — 1 — — 1 — 5 Source of Information No. of cases Pulmonary Nonpulmonary Death Returns from local Registrars 3 3 transferable deaths from Registrar General 6 1 Posthumous notifications 4 2 "Transfers" from other areas (other than transferable deaths) 29 6 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, 1936, on the Registers of Notifications 412 304 716 159 188 347 1,063 Number of cases removed from the Register(s) during the year by reason, inter alia, of:— 1. Withdrawal of notification 1 1 2 1 1 2 4 2. Recovery from the disease 16 14 30 4 9 13 43 3. Death 70 33 103 10 8 18 121 149 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 sixteen deaths from Pulmonary Tuberculosis were registered, against one hundred and ten in the previous year, representing a death-rate of 0.9 per 1,000 compared with 0.9 in 1935. The notification of cases of Tuberculosis by medical practitioners is, unfortunately, not carried out m 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 fiction as the explanations have been considered satisfactory. I append figures for the years 1921-36, showing the interval between notification and death of tuberculous persons. 1921. 1922. 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1. Total number of deaths from Tuberculosis in the Borough 173 102 145 170 138 142 181 135 149 153 127 156 150 124 119 116 2. The number of cases notified at death 8 17 11 10 13 8 - 7 3 7 2 6 13 5 11 3 3. The number of cases notified within one month of death (excluding above) 29 20 21 23 18 30 25 17 32 18 16 21 17 21 11 20 4. The number of cases notified within three months of death (excluding above) 29 20 18 20 13 20 23 13 18 21 14 17 17 9 8 7 5. The number of cases notified within six months of death (excluding above) 9 16 13 16 18 12 18 9 8 9 14 15 16 11 11 7 150 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1936:— Age Periods. New Cases. Deaths. Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0 - - - - - - - 1 1 1 — 5 4 — — 2 2 5 4 2 9 3 — 1 3 1 15 22 26 6 1 13 3 3 0 25 33 27 3 6 21 18 2 2 45 27 9 1 1 29 8 1 — 65 and upwards 4 1 1 - 5 1 - - Totals 91 65 25 15 68 31 11 6 The ratio of non-notified tuberculous deaths to the total tuberculosis deaths is 1 to 16. 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 Cases on Dispensary Register. No. of Cases on Register of Notifications. Pulmonary. NonPulmonary. Total. 1917 335 82 417 230 — - 1918 330 44 374 230 — - 1919 313 52 365 170 — - 1990 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 45 265 138 — 1,280 1926 210 68 278 142 824 1,302 1997 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 1936 156 40 196 116 805 1,063 151 Average number of cases notified for the 10 years 1917-1926 (inclusive) = 319. Average number of cases notified for the 10 years 1927-1936 (inclusive) = 236. Average number of deaths for the 10 years 1917-1926 (inclusive) = 172. Average number of deaths for the 10 years 1927-1936 (inclusive) = 141. 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. Thursdays. 3 p.m. X-Ray Clinic. 152 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, 1936, the number of patients on the Dispensary Register was 805. During the year 59 definite eases of the disease were transferred from other areas into the Hammersmith district and 86 moved out of this district or were lost sight of. Thirty-two were written off the register as being cured cases who had previously been notified as suffering from tuberculosis. New Patients During the year 764 persons attended for examination for the first time, 369 males and 395 females. Of these, 253 were under the age of fifteen and 511 were adults. Of the total 175 were referred to the Dispensary by local practitioners for the purpose of consultation and 366 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. 153 Diagnosis Found to have Pulmonary Tuberculosis 147 Found to have other forms of Tuberculosis 30 Showing no evidence of Tuberculosis 587 Total Attendances and Examinations The total attendances of persons for the purpose of examination, observation or treatment, numbered 3,266 and physical examinations were carried out in 2,541 instances, i.e., in 78 per cent. of the total attendances. The names of 589 persons were written off the register as being non-tuberculous, and the total number on the Dispensary Register on 31st December, 1936, was 834. Sputum Examinations. Four hundred and sixty-two specimens of sputum and other pathological products were examined bacteriologically. Forty-nine showed the presence of Tubercle Bacilli, while 413 proved negative. Institutional Treatment. The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homes), under the London County Council's Scheme, numbered 279. 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. 154 Clinical Reports. To the London County Council, numbered 555 To the Ministry of Pensions 7 To General Practitioners and Hospitals 904 Home Visitation. The Tuberculosis Officer made 175 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 80 occasions. The Nurses visit the tuberculosis population on notification and thereafter as far as possible at intervals of six months or less, as may appear advisable. During the year 4,135 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. 155 Return showing the work of the Dispensary during the year 1986. Diagnosis Pulmonary Non-pulmonary Total Grand Total Adults Childr'n Adults Childr'n Adults Childr'n m. f. m. f. m. f. m. f. m. f. m. f. A—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 79 50 2 1 8 3 8 8 87 53 10 9 159 (b) Diagnosis not completed — — — — — — — — 1 — — — 1 (c) Non-tuberculous - - - - - - - - 86 91 35 26 238 B.—Contacts examined during the year:- (a) Definitely tuberculous 4 10 1 — — 1 2 — 4 11 3 — 18 (b) Diagnosis not completed — — — — — — — — — — — — - (c) Non-tuberculous - - - - - - - - 55 123 88 82 348 C.—Cases written off the Dispensary Register as:— (a) Recovered 11 9 — — 1 4 3 4 12 13 3 4 32 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 143 215 123 108 589 D.—Number of Cases on Dispensary Register on December 31st:— (a) Definitely tuberculous 311 251 14 14 57 75 57 54 368 326 71 68 833 (b) Diagnosis not completed — — — — — — — - 1 — — — 1 1. Number of cases on Dispensary Register on January 1st 805 2. Number of cases transferred from other ar as and cases returned after discharge under Head 3 in previous years 59 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of " 85 4. Cases written off during the year as Dead (all causes) 87 5. Number of attendances at the Dispensary (including contacts) 2,650 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 338 7. Number of consultations with medical practitioners (а) Personal 175 (б) Other 419 8. Number of visits by losis Officers to homes (including personal consultations) 255 9. Number of visits by Nurses or Health Visitors to homes for Dispensary purposes 4,135 10. Number of (а) Specimens of sputum, &c., examined 462 (б) X-ray examinations made, in connection with dispensary work 300 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above Nil 12. Number of " T.B. plus" cases on Dispensary Register on December 31st 371 PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1936 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the return relates Previous to 1926 1926 1927 1928 1929 1930 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 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 Arrested Adults M. 3 1 1 1 3 - 1 1 - 2 1 - 1 - 1 - - - - - 1 - 1 - 1 1 — — - — F. 2 — — - — — 2 2 — 1 — — 1 — 2 — — 2 — 2 — — 2 1 — 1 — 1 Children - — — — — 1 — — — — — — — — — — — — — — 1 — — — - 1 — —• - Disease not Arrested Adults M. 4 1 5 2 8 3 3 2 1 6 - 4 3 2 9 — 4 1 — 5 2 5 3 2 10 4 1 3 — 4 F. 2 1 3 - 4 5 1 — 1 — — — — — — — - — — 3 4 8 2 9 5 — — 4 4 Children - - - — - - - — - - 1 — — — — — — - — — 1 — - - — 3 1 1 — 2 Condition not ascertained during the year — - — - - - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 11 3 9 3 15 9 7 3 1 11 2 5 4 2 11 - 6 1 - 7 8 11 7 4 22 15 2 5 4 11 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 23 3 3 - 6 2 - - - - 4 - 2 - 2 4 4 - - 4 4 1 - - 1 4 - 1 - 1 F. 19 3 2 - 5 5 1 1 2 9 — — — 3 — - — 1 5 2 — — 2 4 — — — — Children 15 - - - - 5 - - - - 2 - - - - 1 - - - 1 - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 106 20 24 5 49 17 12 14 5 31 26 10 18 6 34 31 21 20 3 44 31 13 13 2 28 31 14 18 - 32 Dead Adults M. 3 1 5 6 12 5 5 19 13 37 1 5 15 31 51 2 5 16 15 36 12 8 14 10 32 9 11 22 12 45 F. 4 — 8 4 12 3 4 3 12 19 4 3 5 12 20 6 18 12 6 36 5 3 9 5 17 12 8 12 5 25 Children 2 — — — — — — — — — 2 — 1 — 1 2 — — — — — — — — — - - - - - Total written off Dispensary Register 172 27 42 15 84 37 22 37 30 89 48 18 41 49 108 49 48 49 24 121 58 27 36 17 80 60 33 53 17 103 Grand Totals 183 30 51 18 99 46 29 40 31 100 50 23 45 51 119 49 54 50 24 128 66 38 43 21 102 75 35 58 21 114 1931 1932 1933 1934 1935 1936 (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 2 - 2 2 1 - - - - - - - - - - - - - - - - - - - - - - - - F. — 2 1 — 3 — 1 4 — 5 — — 2 — 2 — — — — — — — — — — — — — — — Children 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Disease not Arrested Adults M. 8 7 5 4 16 6 7 7 1 15 10 - 18 3 21 8 10 21 5 36 18 7 29 4 40 21 9 25 5 39 F. 8 4 7 — 11 7 3 7 1 11 15 7 8 1 16 10 3 16 2 21 10 7 19 4 30 24 10 21 3 34 Children — 1 — — 1 4 1 1 - 2 1 — 1 — 1 4 — — — — 1 — — — — 3 — — — — Condition not ascertained during the year 19 14 15 4 33 18 12 19 2 33 26 7 29 4 40 22 13 37 7 57 29 14 48 8 70 48 19 46 8 73 Total on Dispensary Register at 31st December - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 4 - 1 - 1 - - - - - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 12 6 21 2 29 12 6 18 2 26 5 7 20 2 29 7 6 9 3 18 7 8 11 2 21 2 3 3 - 6 Dead Adults| M. 8 10 14 1 25 5 8 18 12 28 7 7 24 10 41 5 6 9 15 30 5 6 11 6 23 1 — 9 10 19 F. 5 4 11 3 18 7 8 9 1 18 4 5 16 7 28 7 3 15 7 25 1 2 5 4 11 1 — 1 1 2 Children 1 - — — — 1 — — — — 1 — - — — 2 — 1 — 1 — — — — — 1 — — — — Total written off Dispensary Register 30 20 47 6 73 25 22 45 15 82 17 19 60 19 98 21 15 34 25 74 13 16 27 12 55 5 3 13 11 27 Grand Totals 49 34 62 10 106 43 34 64 17 115 43 26 89 23 138 43 28 71 32 131 42 30 75 20 125 53 22 59 19 110 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1936 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 J oints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdomi0nal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 1 - - - 1 - - - - - - - - - - 1 - - 1 2 1 - — — 1 — - - — — F. 2 — — 1 3 — — 2 2 — — — — — — — - — 2 — - 1 3 1 - - - 1 Children 1 — — — 1 1 — 2 3 — — — - 1 — — - 1 2 - - 1 3 1 - - 2 3 Disease not Arrested Adults M. 1 - 3 - 4 - - - 2 2 — - - 1 1 2 1 1 — 4 1 - 2 — 3 3 - 1 1 5 F. — - 2 4 6 — 2 1 1 4 2 — — 2 — — 1 2 3 — 1 — 2 3 1 - — 3 4 Children — - — — — 1 — 1 — 2 — — — — • — 2 — 2 - - 1 1 2 6 - - 5 11 Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 5 - 5 5 15 2 2 2 7 13 2 - - 1 3 4 1 4 3 12 6 1 3 5 15 12 - 1 11 24 Transferred to Pulmonary (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 4 - 3 - 7 1 - - - 1 1 - - 1 2 - - - 1 1 1 - - — 1 — — — F. 2 1 1 6 10 1 3 2 6 1 1 — 2 — - — — — — — — 1 1 1 — 1 2 4 Children 9 1 1 16 27 — 1 7 8 2 1 - 2 5 3 - - 8 11 — - 1 3 4 - - - 4 4 Lost sight of, or otherwise removed from Dispensary Register 22 - 4 19 45 12 - - 7 19 8 1 3 6 18 3 - 2 7 12 2 - 7 7 16 12 2 - 5 19 Dead Adults M. 1 — — - 1 2 — — 2 1 — — — 1 1 — 1 — 2 1 — — — 1 1 — 2 — 3 F. — 1 — — 1 — — 1 1 — — — — — — — — — — 2 — — — 2 — 1 3 — 4 Children — — — — — — 1 1 — 2 — — — — — 2 — — - 2 - - - - - - - - - - Total written off Dispensary Register 38 3 9 41 91 16 5 1 17 39 13 3 3 9 28 9 — 3 16 28 6 - 8 11 25 14 3 6 11 34 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 43 3 14 46 106 18 7 3 24 52 15 3 3 10 31 13 1 7 19 40 12 1 11 16 40 26 3 7 22 58 1931 1932 1933 1934 1935 1936 (a) Remaining on Dispensary Register on 31s December. Disease Arrested Adults M. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 1 2 - - 3 - - - - - - - - - - - - - - - - - - - - - - - - - Children — 1 1 3 5 3 — — — — — — — — — — — — — — — — — — — — — — — — Disease not Arrested Adults M. 4 — — 2 6 — 1 2 3 — — 2 — 2 4 1 3 — 8 5 — — 2 7 4 — 3 1 8 F. 4 — 1 4 9 1 — — 2 3 4 — — 4 8 3 2 1 3 9 3 3 — 2 8 — 1 3 — 4 Children 5 — 1 2 8 6 1 — 9 16 1 3 1 5 10 4 1 — 10 15 2 3 — 4 9 6 2 1 8 17 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 14 3 3 11 31 10 2 - 13 25 5 3 3 9 20 11 4 4 13 32 10 6 - 8 24 10 3 7 9 29 Transferred to Pulmonary (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — Children 1 2 — 1 4 — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary 6 4 — 8 18 7 — — 5 12 3 1 1 3 8 1 — — 2 3 — — 1 — 1 — — — — — Dead Adults m. — — — — — 1 — — 1 1 — 1 1 3 — — — — — — — — — — — — — — — F. 1 2 — 3 Children — — — — — — — — — — — — — — — — — — 1 1 — — — — — 1 — 1 — 2 Total written off Dispensary Register 8 8 — 10 26 8 — — 5 13 4 1 2 4 11 1 — 1 3 5 1 1 2 1 — 1 _ 2 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 22 11 3 21 57 18 2 — 18 38 9 4 5 13 31 12 4 5 16 37 10 7 1 8 26 11 3 8 9 31 160 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 11 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 again organised by the members of the Tuberculosis Care Committee under the auspices of the National Association for the Prevention of Tuberculosis. ,£89 16s. 2½d. was collected with a net result of £60 13s. 2½d. 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, 1918. 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 seventy-eight 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. 161 Sixty-six cases were referred for assistance to the following agencies:— Invalid Children's Aid Association 9 Charity Organisation Society 1 Unemployment Assistance Board 1 School Care Committee 4 Public Assistance Committee 24 Mayor's Fund 12 United Services Fund 13 British Red Cross Society 2 In addition, clothing was supplied to six patients from the Dispensary sources. Nursing Comforts. The Hammersmith Borough Council has set aside an annual grant of £15, for the use of the Tuberculosis Care Committee, in supplying nursing comforts and appliances to necessitous cases, in pre- and post-sanatorium stages. These comforts and appliances are given out to patients on loan, and returned to the Dispensary after use, for disinfection and further distribution. The articles consist of rubber ring cushions, bed rests. aluminium and rubber hot-water bottles, air cushions and bed pans, &c. These articles are supplied on loan, to any tuberculous patient brought to our notice through the usual sources, and in this respect the co-operation of the Borough Medical Practitioners. Hospitals and other Associations is requested. Home nursing is provided by the District Nursing Association. 162 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 Patients to whom Loaned. Number still on Loan. Bed Rests 9 18 7 Rubber Rings 4 5 2 Air Rings 5 12 3 Rubber Hot-Water Bottles 13 13 12 Bed Pans 6 11 4 Ice Bags 4 1 — Air or Water Bed 2 1 — Inhalers 20 — — Air Cushion 1 — — Aluminium Hot-Water Bottles 6 3 4 Bronchitis Kettles 6 1 — Feeding Cups 6 2 — Bed Sheets 4 3 3 Water or Air Cushions 3 5 2 carap Bed 1 — 1 Iron Bedsteads with Mattress 4 8 2 Urinals 6 7 4 Invalid Chairs 1 1 1 Bed Cradles 3 3 1 Throat Spray 1 1 - Repairs to Surgical Appliances. During the year three 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. 163 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. 164 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 302. 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 12. The total number of refills performed by the Tuberculosis Officer in the dispensary for the year 1936 was 179. 165 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. Eighteen sanocrysin injections were made during the year. A Special Investigation (Brief Summary.) During the years 1935 and 1936 the Tuberculosis Officer carried out a special line of research, and investigation into the cases in the "T.B. Minus" group (this is a group in which Tubercle Bacilli have never been found in the sputum) on the Dispensary Register for the decade 19261935. It had been realised for some time that many of the cases in this group were not tuberculous, yet they had been notified, and in due course, would have been denotified as " recovered " from a disease which they never had. The erroneous diagnosis of tuberculosis has a serious psychological reaction upon the patient, important social and economic consequences arise, domestic relationship are strained, and definite industrial difficulties arise. To conclusively prove the absence of a tubercular lesion to such a patient has a natural reaction, individualism is changed, and the social circle of events is renewed. 166 Tuberculosis, therefore, should be conclusively proved before notification is made, and the evidence for such a notification should never be regarded as sufficient, if made on clinical grounds alone. An analysis of the evidence for the notifications in the T.B. Minus group revealed a lack of leal supporting evidence in most eases. Juvenile tuberculosis is not easy to diagnose without complete investigation, and, unless this is carried out, therefore, it is obvious, that this form of tuberculosis receives the greatest quota of errors in diagnosis and treatment. One cannot advocate too strongly for an increase in the use of X-rays in the diagnosis of chest diseases in general, and tuberculosis in particular. Very careful serial radiological examinations will definitely eliminate the pseudo-tuberculous conditions. Many non-tuberculous conditions are therefore seen, erroneously diagnosed as tuberculosis for want of a complete investigation, and thus find themselves classified in the " T.B. Minus group," and ultimately wend their way into sanatoria. Doubtful cases might sometimes be notified for the mere privilege of sending them away to sanatoria in the countrya preventorium would be a more ideal institution for this type of case. Local authorities should make provision for, or arrangements with, a first-class hospital laboratory for a more searching investigation into the fields of pathology, so that all possible pathological evidence can be obtained in doubtful cases of tuberculosis. The investigation consisted of two surveys into the 200 cases originally notified as suffering from Pulmonary Tuberculosis with negative sputum, occurring in the decade 1926-1935. The first survey was conducted on documental 167 evidence, whilst the second consisted of attendances for clinical, X-ray, and pathological examinations in 1936. Out of '200 cases originally notified as pulmonary tuberculosis with negative sputum, 44 or 22 per cent. had since been proved positive, the numbers which were possibly tubercular being 73 or 36.5 per cent., whilst 83 or 41.5 per cent. were not only non-tuberculous, but proved to be suffering from other and definite diseases. After deduction of the 44 positive cases, 156 cases were submitted to a full investigation and the " after results in 1936 were obtained. Out of 156 cases in the T.B. Minus group, for the decade 1926-1935, all were alive, except 15 " lost sight of " or "removed from the area," and only 8 were dead, 5 of which were proved by X-rav and post-mortem examinations to be due to cancer of the lung, one unproved, but suspected to be cancer of the lung, and 2 with pleurisy complicated by fluid, occurring in elderly patients. The number of deaths, therefore, in 10 years in the T.B. Minus group was extremely small, and none of them could be definitely attributed to tuberculosis. These figures, therefore, definitely bring forward the plea for higher standards and conditions for notification, and conclusive evidence before the acceptance of such notifications, since notifications are received from various sources, only a few being made at the Dispensary. To diminish the numbers in this group by the elimination of the non-tuberculous conditions, would result in more accurate statistics, and this could be accomplished by the increase of X-ray examinations, a policy and practice which has been adopted in Hammersmith for many years. The full clinical material, together with the statistical records and observations in relation to the above investigation have been written as an original article by the 168 culosis Officer, and will shortly be published in Tubercle, a monthly journal devoted to the publication of research work in Tuberculosis. PREVENTION OF BLINDNESS. Blind Persons Act, 1920. It was not found necessary to refer any case of blindness to the London County Council under the scheme for the education and training of the blind. SANITARY ADMINISTRATION. Staft.—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 Child 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 applications were received for certificates under the above Act. In sixteen cases the certificates were granted. This total includes six applications from owners, and four were issued where the work specified had been completed satisfactorily. 169 EXHUMATION AND RE-INTERMENT OF BODIES. St. Mary's Catholic Cemetery, Harrow Road. During the year licences were granted by the Secretary of State for the exhumation and removal of the bodies of three persons from the catacombs or graves in St. Mary's Cemetery. One body was removed to Central America, one to Roxwell, near Chelmsford, and one body was re-interred in St. Mary's Cemetery, Kensal Green. The following conditions were attached to the licences:— (1) That the removal be effected with due care and attention to decency early in the morning. (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 Road, are provided with aeration and filtration plants, whereby the water is continuously filtered, aerated and chlorinated. 170 The water is pumped from a point at the deepest part of the Baths, passed under pressure to gravel filters, then into a chamber or tank where it is aerated, and afterwards chlorinated before returning to the Baths. SWIMMING BATHS. During the year the purity of the water received constant attention. In all, 78 samples were taken and submitted to bacteriological examination. Generally the results were satisfactory, but on some occasions the bacterial content was found to be unduly high. The reports upon the water from the Open-Air Bath were particularly good. On two occasions only did the bacterial count exceed the maximum per cubic centimentre which has been adopted as a standard. On 5 occasions out of 29 the water from the First-Class Bath, Lime Grove, gave counts in excess of this standard, but on 14 occasions out of 29 the water from the SecondClass Bath did not conform to the requirements, although only on a few days was the count seriously in excess. The chlorine content of the water was also tested from time to time, and it was found generally that on those days when the bacterial count was high, the chlorine was low. The figures obtained for free chlorine varied from .2 parts per million to over 1 part per million. When the latter figure was shown the bacterial count was very low—3, 6 or 8 bacteria per c.c. The use of chlorine in this proportion, however, is unsafe and usually results in complaints from bathers of discomfort and smarting eyes. If is recommended that the chlorine should not exceed .(5 pts. per million nor fall below .4 pts. ZOTOFOAM BATHS. During the year the Council had under consideration the desirability of the provision of remedial baths (Zotofoam Baths). 171 It is claimed that these baths are suitable for the treatment of rheumatism and allied complaints. The Council decided to instal two baths in the Women's Department with three rest rooms, and one bath with one rest room in the Men's Department. A circular letter was addressed to all medical practitioners in the Borough, informing them of the provision which had been made and suggesting that they might desire to recommend patients suffering from rheumatism to take a course of treatment at the baths. These baths were opened on the 80th November, 1986, and I understand that they are proving to be very popular. PUBLIC WASH-HOUSES. The public wash-houses in Scotts Road form part of the building comprising the indoor Swimming Baths, Lime Grove. These wash-houses are very well patronised, and provide a means of clothes-washing for many families living in tenement houses without washing accommodation. They are open ordinary week-days from 8 a.m. to 8 p.m., except Saturdays, when they are available from 8 a.m. to 3 p.m. PROPAGANDA. During the year "Better Health," a monthly Health Journal, published under the auspices of the Society of Medical Officers of Health, was distributed. One thousand copies of this Journal being distributed monthly to the Schools and Infant Welfare Centres. The Journal is welcomed by the School Teachers ae a great help in the teaching of Hygiene. 172 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. Copies of the booklet were distributed to all mothers attending the Infant Welfare Centres and Ante-natal Clinics. PHARMACY AND POISONS ACT, 1933. The provisions of the Pharmacy and Poisons Act, 1938, relating to the sale of certain poisons came into operation on 1st May, 1936. In pursuance of this Act, it is the duty of the local authority by means of inspection and otherwise to secure compliance by listed sellers of poisons included in Part II of the Act, and other persons not being authorised sellers of poisons. Inspectors appointed under the Act have power at all reasonable times to enter any listed premises, and any premises upon which he has cause to suspect a breach of the law. They may also take samples for analysis. Preliminary inspections numbering 218 were made to ensure that shopkeepers other than chemists would not be selling Part II poisons without a certificate that their names are entered in the list required to be kept by the Council. In respect of the entry of his name on the list, a fee of 7s. 6d. must be paid to the local authority by every person requiring to sell the listed poisons. 173 During the year 85 names have been entered in the list, and certificates issued to all the applicants. The following are some of the requirements applying to the sale of all Part II poisons:— 1. Sales must be effected on the premises entered in the Council's List; 2. No sales can be made from vans, travelling shops, barrows or stalls; 3. Hawking carbolic disinfectants is now illegal; 4. Poisons must be sold in closed containers. The listed premises are kept under supervision by the Council's Sanitary Inspectors. SHOPS ACT, 1934. During the year 1,058 shops were inspected. The following notices were served for :— 1. Sanitary Accommodation 68 2. Ventilation 8 3. Temperature 86 4. Sanitary Accommodation and Ventilation 4 5. „ ,, „ Temperature 8 6. Ventilation and Temperature 3 7. Sanitary Accommodation, Ventilation and Temperature 1 8. Other 55 Total 223 In twenty 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. 174 Public Mortuary. Three hundred and sixty five bodies were admitted to the Mortuary in Fulham Palace Road during the year. Hammersmith— Admitted by order of Coroner 159 Admitted by order of Police 11 Admitted on application of undertakers for accommodation 23 193 Bodies admitted from other Boroughs:— Fulham 64 Chelsea 108 172 No. of P.-M. examinations conducted:- Hammersmith cases 131 Fulham cases 37 Chelsea cases 68 Total P.M.'s 236 No. of Inquests held:— Hammersmith cases 105 Fulham cases 47 Chelsea oases 85 Total Inquests held 237 The refrigeration plant has provided a means whereby bodies can be kept and insanitary and offensive conditions avoided. Metchim & Son, Ltd., Westminster and City. (20937) INDEX Page Introduction2 Staff of the Public Health Department 5 Statistics fob the Year, 1937 8 Natural and Social Conditions of the District. Births 9 Cancer 11 Deaths 10 Deaths of Aged Persons 11 Deaths of Residents (Outlying) 12 Deaths (Various Causes) 15 Marriages 9 Population 9 Statistics 12 Table—Whole of London—Comparison 16 General Provision of Health Services in the Borough. Ambulance Facilities 17 Hospitals (Public) 20 Hospitals (Voluntary) 21 Laboratory Facilities 17 Professional Nursing in the Home— General 18 Nursing 18 Rheumatism Advisory Clinic 19 School Clinics 18 Treatment Centre for Venereal Diseases 20 Tuberculosis Dispensary 19 Treatment and Nursing—Children under School Age 20 Minor Ailments. Maternity and Child Welfare. Accouchement Outfits and Maternity Bags 43 Ante-natal Clinics 40 Births—Notification 30 Centres—Infant Welfare 36 Chart—Infantile Mortality Rate 31 Circumcisions 35 Cod Liver Oil 40 Consultants 44 Convalescent Treatment (Invalid Children) 49 Convalescent Treatment (Nursing Mothers and Young Children) 50 Day Nurseries 49 Deaths of Infants 30 Deaths—Premature 33 Deaths in Institutions 34 Deaths—Illegitimate 34 Page Diarrhœa—Chart 35 Dinners40 Domiciliary Midwifery Service 42 Feeding of Infants—Statistics 29 Health Visitors—Work of 27 Home Helps 45 Hospital Treatment—Zymotic Enteritis 34 Infantile Mortality 24 Infectious Diseases of Mothers and Children under five years of age—Tabular Statement 47 Infective Enteritis and Pneumonia 33 Institutional Treatment for Unmarried Mothers 42 Massage and Remedial Exercises Clinic 37 Maternity Services—Facilities for Confinement 41 Maternal Mortality 45 Midwives 44 Milk (Mothers and Children) Orders, 1918-1919 39 Ophthalmia Neonatorum 48 Schedule of Attendances at Infant Welfare Centres 37 Sessions—Infant Welfare Centres 36 Stillbirths 30 Table—Births, Deaths, and Infant Death Rate 29 Child Life Protection 50 Sanitary Circumstances of the Borough. Closet Accommodation 52 Common Lodging Houses 63 Factories and Workshops—Inspection of 59 Fouling of Footpaths by Dogs 52 House to House 62 Houses Let in Lodgings 63 Inspections 53 Notices 54 Persons Living under Insanitary Conditions 59 Ray Flock Acts, 1911 and 1928 65 Rats and Mice (Destruction) Act, 1919 62 Sanitary Inspection of Area 52 Scavenging 52 Schools 64 Seamen's Lodging Houses 63 Smoke Abatement 62 Summonses 51 Tenement Houses 63 Vans 64 Housing. Eradication of Bed Bug 68 General Housing Conditions 67 Newly Erected Houses 68 Statistics 65 Slum Clearance 70 Bakehouses 80 Butter, Margarine 93 Page Inspection and Supervision of Food. Certification of Certain Food Products for Export 76 Cheese 92 Chemical and Bacteriological Examination of Food 83 Cocoa, Coffee and Tea 95 Condensed Milk 92 Cordials, Wines and Spirits 97 Condiments, &c. 96 Confectionery 94 Conserves 94 Cream 92 Drugs 98 Farinaceous Foods 95 Food and Drugs Adulteration Act, 1928 84 Food Premises (Public Health (London) Act, 1936) 75 Food Supplies 75 Fried Fish Shops 80 Fruit and Vegetables 93 Ice Cream Vendors 82 Inspection of Carcases of Animals slaughtered in Local Slaughterhouses 77 Markets 79 Meat and Fish Preparations 93 Miscellaneous Foods 98 Milk 87 Milk Supply 75 Milk (Special Designations) Order, 1936 75 Offensive Trades—Slaughterers of Poultry 78 Public Health (Meat) Regulations, 1924 76 Samples—Adulterated 84 Slaughterhouses 77 Street Trading 79 Unsound Food 83 Prevalence and Control over Infectious Diseases. Acute Polio-myelitis 108 Anthrax 109 Anti-toxin 103 Artificial Pneumothorax Treatment 135 Bacteriology 99 Cerebro-Spinal Meningitis 108 Chicken Pox 110 Cholera 102 Cleansing of Verminous Persons 115 Continued Fever 108 Diphtheria 102 Diphtheria—Chart 106 Diphtheria Immunisation 103 Disinfection 113 Dysentery 112 Encephalitis Lethargica 108 Enteric Fever 105 Page Erysipelas 105 Food Poisoning 112 Glanders 109 Hydrophobia 109 Infectious Diseases 99 Influenza 112 Malaria 112 Measles and German Measles 109 Measles—Chart 111 Measles—Serum 109 Notifiable Diseases 102 Nursing Comforts 132 Ophthalmia Neonatorum 108 Plague 102 Pneumonia 112 Public Health (Smallpox) Regulations, 1917 119 Public Health (Prevention of Tuberculosis) Regulations, 1925 123 Puerperal Fever 108 Puerperal Pyrexia 108 Psittacosis 112 Babies Order, 1919 109 Relapsing Fever 108 Report on Tuberculosis Work at Hammersmith Hospital 133 Sanocrysin Treatment 136 Soarlet Fever 105 Scarlet Fever—Chart 107 Smallpox 102 Tabular Statement—Zymotic Diseases 114 Tuberculosis 119 Tuberculosis Care Committee 131 Tuberculosis Dispensary 123 Typhus Fever 105 Vaccination 116 Vaccination Returns 117 Whooping Cough 110 Whooping Cough—Chart 111 Wrong Diagnosis 112 X-Ray Work 135 Zymotic Diseases 101 Prevention of Blindness 136 Sanitary Administration. Exhumation and Ee-interment of Bodies 137 Health Week Exhibition 140 Increases of Rent and Mortgage Interest Restrictions Acts, 1920-23 137 Pharmacy and Poisons Act 145 Propaganda 139 Public Baths 137 Public Mortuary 146 Public Wash-houses 139 Shops Act, 1934 146 Staff 136 Swimming Baths 1374