HAM 29 Metropolitan Borough of Hammersmith. ANNUAL REPORT of the Medical Officer of Health for the YEAR 1937. 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 1937. 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 12.6 is 0.1 greater than the previous year. There were four maternal deaths as compared with three in the previous year. The rate was equal to 2.03, whereas the rate for the whole country was 3.1. The infantile mortality rate has increased from 60 to 68 per 1,000 births. The rate for the County of London decreased from 66 to 60 per 1,000 births. I very much regret this increase in the infantile mortality rate, due to a very large increase in the number of deaths of premature babies. 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. Towards the end of the year the Maternity and Child Welfare Committee discussed the advisability of taking over the voluntary Infant Welfare Centres in the Borough. It was felt that, whilst being fully appreciative of the excellent work and whole-hearted services given by these associations, the time had come when the Council should assume 3 its responsibility under the Maternity and Child Welfare Act and be fully responsible for the provision and administration, so far as is practicable, of the Maternity and Child Welfare Services in the Borough. As a result, the Council, early in January of 1938, decided to take over the services conducted by the Hammersmith Infant Welfare Association. Diphtheria Immunisation. In my previous report I put forward the suggestion that the fall in the numbers of children immunised was due to the failure to attend for the second and third injections. In May this year you adopted my recommendation that the scheme should be amended to allow for the use of the Alum Precipitated Toxoid " one-shot " method. A copy of the amendment is as follows:— " The Council has now approved of the immunisation of children by what is known as the ' one-shot ' method (Alum Precipitate) with a view to securing a larger number of immunised children, the use of this method to be left to the discretion of the medical practitioner concerned. The Council has agreed to continue the payment of the fee of 10s. in respect of every child completely immunised (to be controlled by the Schick test) and 5s. for each case of incomplete or unsuccessful immunisation." In view of this alteration in the scheme, the number of children immunised during the year has, to say the least, been very disappointing. Milk. During the year a considerable amount of time has been spent in the supervision of the Milk Distributing Depots established in the Borough. 4 Experiments have been carried 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 below the average for the past 10 years. I very much regret to have to record the death of the late Dr. Naomi Dancy, who was appointed Assistant Medical Officer for Maternity and Child Welfare in April, 1936. Dr. Dancy had for many years, prior to her appointment with this Council, acted as medical officer to the Old Oak Infant Welfare Centre and was very highly esteemed by all the mothers living in that part of the Borough. Dr. Florence E. Millard Harvey was appointed in January, 1938, and is now responsible for the clinics in the northern part of the Borough. 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 1987. MEDICAL OFFICER OF HEALTH Administrative Officer for Tuberculosis, and Maternity and Child Welfare. Vaccination Officer. year OF Appointment J. B. Howell, M.R.C.S., L.R.C.P., D.P.H. 1914 Tuberculosis Officer and Deputy Medical Officer of Health. G.I. Davies, M.D., B.S., M.R.C.S., L.R.C.P., D.P.H 1930 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 Adelaide A. Renshaw, M.D., M.B., Oh.B. (Temporary Part Time) 1937 Consultant Gynaecologists. 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). H. A. Gillespie, M.B., B.Ch., B.A.O. A. R. Dale, M.R.C.S., L.R.C.P. J. W. Brash, M.R.C.S.. L.R.C.P. J. P. Henderson, M.B., B.Ch., B.A.O. M. M. Townsend, L.R.C.P., L.R.C.S. Public Analyst (Part time) F. W. Edwards, F.I.C., F.C.S. Pathologist. R. G. Waller, M.R.C.S., L.R.C.P. * Deceased 1937. 6 Ytar of Appointment Bacteriologist. F. H. Teale, M.D., F.R.C.P. Assistant Administrative Officer. *A. H. Wilmot 1902 Clerical Staff. J. C. Turner 1920 †Miss E. Cole 1923 A. H. Johns 1926 F. G. Holland 1929 T. J. Hares 1930 E. F. Yorke 1931 Miss V. Steadman 1935 Miss C. A. Grover 1937 Miss A. T. Malone 1937 E. W. Pike 1937 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. ||□"ø⁪⁪⁪⁪Miss E. M. Cross 1932 Health Visitors "||□†*Miss R. A. Henry 1916 ||□*Miss A. M. M. Willcox 1916 "||Miss D. G. Johnson 1922 ∆ø"||□ Miss C. M. Henniker 1929 "□||Miss H. M. G. Gurnett 1937 "□||Miss E. A. Llewellin 1937 "□||Miss O. Raper 1937 7 Year of Appointment 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 Medicinal Baths and Disinfecting Staff. A. H. S. Hutchinson (Superintendent) 1928 Mrs. Manners 1924 *C. Lapgley (Disinfector) 1900 G. W. A. Luxon (Disinfector) 1937 Mortuary Keeper. D. A. Mackay 1929 * Retired 1937. †Cert. Royal Sanitary Institute (Inspector). *Cert. Sanitary Inspectors Examination Board. □Cert. Central Midwives Board. §Cert. Royal Sanitary Institute (Meat and other foods). ||Trained Nurse. *Cert. Royal Sanitary Institute (Health Visitor). °Royal Sanitary Institute (Smoke Certificate). ||Apothecaries' Hall Certificate. øCert. Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. =Smoke Abatement Cert. L.C.C. School of Engineering. ∆Diploma in Nursing, London University. 8 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1937. Area 2,282.5 acres Population (1987) (estimated) 126,500 Population Census (1901) 112,239 „ „ (1911) 121,521 „ „ (1921) 180,295 „ „ (1931) 185,521 Natural increase, i.e., excess of births over deaths 320 Density of population 55.4 persons per acre Marriages registered 1,889 Number of inhabited houses 1931 17,402 Number of families or separate occupiers (1921) 33,263 Rateable value (1937) £1,256,649 Sum represented by a penny rate, 1937 £5,050 Vital Statistics. Births (legitimate) 1,778 ) Birth rate 15.1 ,, (illegitimate) 135 Rate per 1,000 (live and still births) 27 Stillbirths 58 Deaths (corrected) 1,598 Death rate 12.6 Deaths from puerperal causes Adjusted death rate 13.0 Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 0.5 Other puerperal causes 8 1.5 Total 4 2.0 9 Deaths of infants under one year of age per 1,000 births 68 Legitimate, 64. Illegitimate, 119. Deaths from cancer (all ages) 227 Deaths from measles (all ages) — Deaths from whooping cough (all ages) 9 Deaths from diarrhoea (under 2 years of age) 27 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., 126,500. The corrected number of births registered was 1,913, whilst the corrected number of deaths of residents was 1,593, thus showing a natural increase of population by excess of births over deaths of 320. The area of the Borough is 2,282.5 acres, there being a density of 55.4 persons to the acre. Marriages.—The number of marriages registered during the year was 1,389, the marriage-rate being 22. Births.—During the year 2,707 births were registered in the Borough. Adding 261 births which occurred, outside the Borough, transferred by the Registrar-General as belonging to Hammersmith, and deducting 1,055 births which occurred in the Borough, and transferred to other districts by the Registrar-General, the corrected number of births for the year was 1,913. On the estimated population, i.e., 126,500, 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, 15.1, is the same as that for the previous year. 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., 2,964. 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 2,707 as against 2,266 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 1.333 deaths were registered in the Borough, as compared with 1,399 in the previous year. Adding 639 deaths of residents of this Borough which occurred in general hospitals and other public institutions, and 28 deaths of residents transferred by the Registrar-General as having occurred in various parts of England, and deducting 392 deaths of non-residents and 10 transferable deaths which occurred in the Borough, the corrected number of deaths of residents was 1,593 (802 males, 791 females). On the estimated population, i.e., 126.500. 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 13.0. 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 12.3 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 793, against 789 in the previous year. These deaths were equal to 6.2 per 1,000 of the total persons living, and 498 per 1,000 of the total deaths of residents registered. Cancer.—There were 227 deaths from Cancer, and of this number, 205 occurred in persons over the age of 45 years. These deaths were equal to 1.78 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 1 All Ages. 1— 2— 5— 15— 25— 45— 65— 75— 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 40 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 1937 227 M 107 — — — — 11 41 37 18 F 120 — — - — 11 45 35 29 The average number of deaths for the ten years is 224. 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 1937 and previous years:— Vital Statistics of Whole District during 1937 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. ltate. 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 10.9 234 543 129 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 1937 126500 2707 1913 15.1 1333 10.5 402 662 130 68 1593 12.6 Deaths of Residents.—Belonging to the Borough, occurring in Public Institutions, &c., in districts outside, during the year :— MENTAL HOSPITALS. Tooting Bee Hospital 11 St. Bernard's, Hanwell 14 The Grove, Horton Lane 5 Horton Hospital, Epsom 5 1, West Park Road, Epsom 3 The Hospital, Coulsdon 1 1a, Manor Road, Ilford 2 St. Ebba's Hospital, Epsom 1 Leavesden Hospital, Watford 1 Hundred Acres, Banstead 1 Brookeide, Ilford 1 Mental Hospital, Chesterton 1 Springfield House, Tooting 1 Caterham Hospital 1 Brighton Mental Hospital, Haywards Heath 1 Gill House, Ashford, Kent 1 50 18 GENERAL HOSPITALS, NURSING HOMES, &c. St. George's, Westminster 5 Princess Louise, Kensington 10 Oueen Mary's, Chislehurst 3 St. John & St. Elizabeth 3 British Home for Incurables, Streatham 1 Home of Compassion, Thames Ditton 1 Acton Hospital 7 St. Joseph's, Brentford 2 London Hospital 3 Invalid's Home, Highbury 1 7, Knareeborough Place 1 Victoria Hospital for Children, Chelsea 4 Hounslow Hospital 1 Cray Valley Hospital, St. Paul's Cray, Kent 1 St. Joseph's Hospice for the Dying, Hackney 1 St. Mary's, Paddington 5 5, Collingham Gardens, Kensington 1 French Hospital, Holborn 1 Princess Beatrice, Kensington 1 Brompton Hospital 1 Royal East Sussex, Hastings 1 Clyde House, Reigate 1 Queen Mary's, Carshalton 2 Royal Hospital, Richmond 1 Middlesex Hospital 3 Bolingbroke Hospital 1 St. Thomas' Hospital 1 20, Glazbury Road, Fulham 1 •27, Welbeck Street, St. Marylebone 1 Hospital for Epilepsy and Paralysis Infants' Hospital, Westminister 3 Ashford Hospital, Ashford, Kent 1 Royal Waterloo Hospital 1 Carisbroke Home, Epsom 1 Colindale Hospital '2 Cottage Hospital, Newquay 1 National Hospital, Queen Square 1 King's College Hospital 1 Charing Cross Hospital 1 University College Hospital 1 4, Dorset Square 1 Municipal Hospital, Willesden 1 St. Barnabas Hostel, Lloyd Square, Finsbury 1 Royal Chest Hospital, Finsbury 1 Grosvenor Hospital for Women 1 Putney Hospital 1 St. Mary's Nursing Home, Brentford 1 Children's Hospital, Gt. Ormond Street 2 24, Newlands Park, Beckenham 1 King Edward Memorial, Ealing 1 Cancer Hospital 1 Royal Northern Hospital 1 Royal Sussex County Hospital, Brighton 1 32, Leigham Court Road 1 Sutton & Cheam Hospital 1 Malmesbury and District Hospital 1 Queen Charlotte's 1 General Hospital, Margate 1 St. Benedict's, Wandsworth 1 Norwood Hospital for Children 2 101 FEVER HOSPITALS. Western Hospital 22 Grove Hospital 2 Park Hospital 2 South Western Hospital 1 North Western Hospital 1 Eastern Hospital 1 29 14 PUBLIC INSTITUTIONS. St. Mary Abbot's, Kensington 87 St. Charles' Hospital, Kensington 115 New End, Hampstead 1 St. Stephen's Hospital 21 Fulham Hospital 73 Archway Hospital 8 St. Leonard's, Shoreditch 1 St. Paneras Hospital 14 St. George-m-the-East, Stepney 1 Whipps Cross, Ley ton 1 St. Luke's, Chelsea 22 St. John's Battersea 6 1, Northumberland Street 4 St. Peter's, Poplar 1 2a, Bow Road 1 Paddington Hospital 70 182, Westmoreland Road, Walworth 2 30, Twickenham Road, Isle worth 2 Lambeth Hospital 5 Twyford Lodge, Willesden 2 6, Ouseley Road, Balham 1 26, Wolverton Avenue, King ston 1 Dulwich Hospital 1 440 VARIOUS. 22, Colwyn Crescent, Hounslow 1 22, Cardigan Road, Richmond 1 On the way to St. Mary's Hospital, Paddington 1 In ambulance near St. Bartholomew's Hospital 2 R. Thames off Millbank 1 On the way to St. George's Hospital 1 31, Edrich Street, S.W.I 1 On foreshore of R. Thames at Barnes 1 43, Milton Road, Ealing 1 R. Thames off Blake's Wharf 1 167, Castle Road. Greenford 1 Putney Lower Common, near Cemetery 1 R. Thames at Barnes 3 40, St. John's Road, Orpington 1 35, Cross Deep Gardens, Twickenham 1 22, Micawber Avenue, Gt. Yarmouth 1 13, Grenville Place, Brighton 1 Telephone Exchange, Paddington 1 Arundel Lodge, Dappas Road, Croydon 1 41, Richmond Road, Kingston 1 On railway line, G.W.R. Goods Depot 1 27, Crystal Palace Park Road, Beckenham 1 129a, Fulham Palace Road 1 " Harwood," Cornaway Lane, Portchester, Hants 1 Victoria Hotel, Deansgate, Manchester 1 On cliff edge at Peacehaven 1 37, King Edward Avenue, Broadstairs 1 " Shenandoah," Wheatlands Avenue, South Hayling 1 17, Fairholme Road, Fulham 1 Upper Clatford, Andover 1 108, Clifford Road, Alperton 1 The Queen Adelaide, Kingston Road, Epsom 1 103, Old Tovil Road 1 36 15 Causes of, and Ages at, Death during the Year 1937. CAUSES OF DEATH. Sex. All Ages. 0— 1 — 2- 5— 15- 25— 35— 45- 55- 65— 75— All Causes M 802 85 7 7 11 25 39 47 98 151 194 138 F 791 45 5 6 17 20 28 37 65 107 186 275 1 Typhoid and Paratyphoid Fever M .. .. .. .. .. .. .. .. .. .. .. .. F 2 .. .. .. .. .. 1 1 .. .. .. .. 2 Measles M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 3 Scarlet Fever M .. .. .. .. .. .. .. .. .. .. .. .. F 1 .. 1 .. .. .. .. .. .. .. .. .. 4 Whooping Cough M 2 1 .. .. 1 .. .. .. .. .. .. .. F 7 6 .. .. 1 .. .. .. .. .. .. .. 5 Diphtheria M 5 1 .. .. 2 .. .. .. .. .. .. .. F 7 .. .. .. 5 .. .. .. .. .. .. .. 6 Influenza M 17 .. .. .. .. .. .. 2 2 7 2 4 F 32 1 .. .. .. .. .. 2 .. 2 10 10 7 Encephalitis Lethargica M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 8 Oerebo-spinal Fever M 1 1 .. .. .. .. .. .. .. .. .. .. F 1 .. .. .. .. 1 .. .. .. .. .. .. 9 Tuberculosis ol Respiratory System M 57 .. .. .. .. 7 14 8 14 8 5 1 F 38 .. .. .. 1 11 11 8 3 3 1 .. 10 Other Tubercu lous Diseases M 6 .. .. .. 1 .. 2 .. 1 .. 2 .. F 5 .. .. .. 1 1 1 .. .. .. .. .. 11 Syphilis M 8 1 .. .. .. .. .. 1 1 1 3 1 F 3 .. .. .. .. .. .. 1 .. 2 .. .. 12 General Paralysis of the insane tabes dorsalis M 9 .. .. .. .. .. .. 1 3 4 1 .. F 1 .. .. .. .. .. .. .. .. .. l .. 13 Cancer, malignant disease M 107 .. .. .. .. .. 6 5 13 28 37 18 F 120 .. .. .. .. .. 3 8 16 29 35 29 14 Diabetes M 3 .. .. .. .. .. .. 1 .. .. 1 1 F 11 .. .. .. .. .. 1 .. .. 3 3 4 15 Cerebral Hsemorrhage, &c. M 28 .. .. .. .. .. .. 1 4 5 13 5 F 46 .. .. .. .. .. .. .. 5 9 21 11 16 Heart Disease M 170 .. .. .. 1 2 3 6 19 28 61 50 F 201 .. .. .. .. .. 2 3 8 17 50 117 17 Aneurysm M 6 .. .. .. .. .. .. .. 1 3 2 .. F 6 .. .. .. .. .. .. .. 1 2 2 .. 18 Other circulatory diseases M 35 .. .. ..• .. .. .. .. 1 10 13 ] l F 4?) .. .. .. .. .. .. .. 2 9 16 21 19 Bronchitis M 37 4 .. .. .. 1 3 .. .. 6 9 11 F 12 .. .. .. .. .. .. .. 1 2 4 15 20 Pneumonia (all forms) M 82 13 4 2 2 1 1 3 13 22 13 8 F 44 7 1 1 1 2 .. .. .. 5 8 14 21 Other Respiratory Diseases M 10 .. .. .. .. 1 2 2 1 2 2 .. F 4 .. .. .. .. .. .. 1 1 2 .. .. 22 Peptic Ulcer M 21 .. .. .. .. .. 2 5 3 6 4 1 F 4 .. .. .. .. .. .. .. 3 .. 1 .. 23 Diarrhoea, &c. M 23 20 .. .. .. .. .. .. .. .. .. .. F 6 6 .. .. .. .. .. .. .. .. .. 2 24 Appendicitis M 3 .. .. .. 1 .. .. .. 1 .. .. .. F 2 .. 1 .. 1 .. .. .. 1 .. .. .. 25 Cirrhosis of Liver M 3 .. .. .. .. .. .. 1 1 1 .. .. F 2 .. .. .. .. .. .. .. l 1 .. .. 26 Other Diseases of Liver, &c. M 2 .. .. .. .. .. .. .. .. .. 2 F 5 .. .. .. .. .. .. 1 1 1 2 27 Other Digestive Diseases M 8 1 .. .. 1 .. 1 .. i 2 F 16 l .. 1 .. .. 1 1 2 5 2 2 28 Acute and Chronic Nephritis M 11 .. .. .. .. 2 1 .. 1 3 3 1 F 17 .. .. .. .. .. 2 .. 2 5 5 3 29 Puerperal Sepsis F 1 .. .. .. .. .. .. 1 .. .. .. .. 30 Other Puerperal Causes F 3 .. .. .. .. .. 2 1 .. .. .. .. 31 Congenital Debility, Premature Birth, Malformation, &c. M 38 37 .. 1 .. .. .. .. .. .. .. .. F 23 22 .. .. .. 1 .. .. .. .. .. .. 32 Senility M 8 •• .. .. .. .. .. .. .. .. 1 7 33 Suicide F 33 .. .. .. .. .. .. .. .. 8 25 M 7 .. .. .. .. 1 1 2 1 1 1 F 1 .. .. .. .. 1 .. .. .. 34 Other violence . M 37 1 .. 1 1 9 2 3 4 5 4 7 F 28 .. 1 1 3 .. 1 2 1 1 8 10 35 Other defined diseases M 58 5 2 1 l 1 1 6 10 9 17 5 F 50 2 .. .. 2 1 1 6 8 9 1 11 36 Causes ill-defined, or unknown M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Totals 1,593 130 12 13 28 45 67 84 163 258 380 413 16 This rate is calculated on the estimated population of each Ward. Ward. Estimated Population. No. of Deaths. Death Rate. No. 1 River 16,847 241 14.3 No. 2 Brook Green 24,460 319 13.0 No. 3 The Grove 21,814 261 12.0 No. 4 St. Stephens 8,774 109 12.5 No. 5 Starch Green 21,638 255 11.8 No. 6 Wormholt 22,648 289 12.8 No. 7 College Park and Latimer 11,519 119 10.3 LONDON AND METROPOLITAN BOROUGHS. Cities and Boroughs. Estimated Resident population (mid-1937). Live Births rate per 1,000 population. Death rate per 1,000 population. Infantile Mortality rate per 1,000 live births. Crude. Adjusted. County of London West District:— Paddington 138,300 13.65 13.05 12.91 66 Kensington 175,600 12.1 13.3 12.4 83 Hammersmith 126.500 15.1 12.6 13.0 68 Fulham 138.900 13.9 13.08 13.2 56 Chelsea 56,510 10.8 14.1 12.0 59 City of Westminster 124.300 8.2 11.5 11.8 59 North Districts— St. Marylebone 92,110 9.36 13.10 12.98 73 Hampstead 90.690 11.2 11.6 10.9 54 St. Pancras 181,900 13.0 12.7 13.0 62 Islington 295.400 15.25 12.9 13.02 66 Stoke Newington 50,250 14.9 12.5 12.0 38 Hackney 206,700 13.8 11.1 11.7 43 Central Districts- Holborn 34.600 8.09 11.85 12.68 79 Finsbury 58,700 13.8 14.6 15.9 71 City of London 8,980 6.1 11.2 12.4 36 East Districts— Shoreditch 82,240 14.86 12.47 13.72 54 Bethnal Green 94,560 13.3 12.5 14.1 54 Stepney 203.100 13.5 12.2 14.2 61 Poplar 136,800 15.5 12.6 14.0 61 South Districts— Southwark 147,400 14.7 13.6 14.1 64 Bermondsey 98,790 14.4 12.3 14.0 59 Lambeth 273,800 14.1 13.2 13.0 68 Battersea 143,500 14.94 12.89 12.76 70 Wandsworth 341,700 11.53 12.36 11.43 62 Camberwell 224,800 14.08 12.83 12.83 58 Deptford 96,580 15.1 11.8 12.3 45 Greenwich 95,990 13.88 12.03 12.27 50 Lewisham 226,000 13.9 10.8 10.9 46 Woolwich 149,400 14.2 11.1 11.7 40 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. W. 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 bDr. 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 fee. Ambulances 18 for accident cases are provided by the London County Council. Maternity Cases.—The London Ambulance Service provided by the London County Council is available for the conveyance of women to Maternity Homes. PROFESSIONAL NURSING IN THE HOME. General.—The Hammersmith District Nursing Association provides nurses in all cases for general nursing, upon application being made to the Nightingale Shore Home, 10, Mall Eoad. Patients are expected to make payments to the Nursing Association in accordance with their means, but no patient is refused the services of a nurse on account of inability to pay. Nursing.—The arrangements made by the Borough Council with the District Nursing Association to provide nurses in cases of measles, ophthalmia neonatorum, pneumonia, &c., continued throughout the year. When necessary two or three visits are paid daily. The Council make a grant to the Nursing Association of £250 per annum, for the nursing of all cases approved by the Medical Officer of Health. The amount being divisible as follows:— Maternity and Child Welfare Nursing £125 Public Health Regulations £125 SCHOOL CLINICS. The L.C.C. Hammersmith School Treatment Centre, 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 123). 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 Rheumatism 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 25 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 80 79 Children — — Maternitv 77 (Excl. 4 Labour Beds.) Tuberculosis 3 3 Chronic sick 72 29 Gynaecological — 53 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 1937 :—Admissions = 8,214 (including 1,642 births). 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 :—239. If used by persons resident outside the area, in what proportion :—75-80 per cent. Management:—Board of Management. No. of beds available for each sex for the following services:— M. F. General Medical 26 26 General Surgical 59 58 Children 19 Venereal Diseases 4 4 Ear, Nose and Throat 3 2 Skin Diseases 1 2 Others (Private Wing) (Mixed) 26 Others (Casualty) (Mixed) 5 Ophthalmic 2 2 Facilities available for:— 2 Major Operation Theatres. (1) Operative Surgery.— 1 Out-patient Theatre. 1 Casualty Theatre. (2) X-Ray.—Diagnostic and Therapeutic Departments. (3) Dental.—Clinics held twice weekly in Out-patients' Department (Extractions only). (4) Ophthalmic.—Three sessions a week in Out-patients' Department. (5) Massage.—Department open daily. 22 Arrangements for pathological work:—Pathological and Bio-chemical Laboratories. No. of patients during 1937 :—4,343 in-patients and 43,586 out-patients and casualties. Is the hospital provision for the area adequate?—There is always an average of about 190 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:— (а) Isolation Block:—98.7 per cent, outside. (б) Invermead :—88.8 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 1937 :—343 Maternity (35 Hammersmith patients), 373 Puerperal Sepsis. 28 Name :—St. John s Hospital for Skin Diseases. Situation:—262, Uxbridge Road, W.12. Purpose :-—For Skill Diseases. No. of available beds :—-10. If used by persons resident outside the area, in what proportion:—The Hospital does not serve any particular area. Management:—The Board of Management for St. John's Hospital for Diseases of the Skin. No. of beds available for each sex for the following services:— M. F. Skin Diseases 19 21 facilities available for:— (1) Operative Surgery.—Nil. (2) X-Ray.—X-Ray Out-patients' Department at 5, Lisle Stree*, 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 1937 :—313 in-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 1937 :—1,607. 24 MATERNITY AND CHILD WELFARE SERVICES. During the year the Maternity and Child Welfare Centres have been entrusted to the Assistant Medical Officers with the help of a part-time Medical Officer for those clinics which so overlapped as to prevent their being conducted by one of the Assistant Medical Officers. As the same Assistant Medical Officer sees the mothers at the Ante-natal Clinics and subsequently at the Infant Welfare Clinics, there is continuity of advice throughout, and, what is perhaps of more importance, that personal contact, which engenders the confidence of the mothers in the advice they receive, is maintained. There is a regrettable tendency upon the part of mothers not to breast feed their children and possible explanations, if not indeed excuses, are to be found in undernourishment generally and the necessity to go to work. To counteract this tendency, which in the main is not due to unwillingness on the part of the mother, milk, cod liver oil, iron and calcium are provided free in necessitous oases and at a low economic cost in other cases, but this does not take, the place of a good mixed diet. Consideration is now being given to the possibility of establishing a specific Breast Feeding Clinic in the hope that mothers will be encouraged and assisted to continue breast feeding and be educated in re-establishing failing lactation. From the vital, national and even economic point of view it would be more advantageous in general for mothers to breast-feed their infants rather than return too early to work which necessitates their children being placed upon artificial feeding. Infant Mortality. It is regretted that the mortality of infants under one year has increased from 60 to 68 per 1,000. It is all the more to be deplored since the rate for the whole of London has been reduced from 66 to 60. In some of the 25 Metropolitan Boroughs the rate is considerably lower, one in fact being as low as 86. Of the infantile deaths approximately 35 per cent, occurred in the first four weeks, the causes being due to prematurity, injury at birth and congenital malformations. The births of so many premature babies should be reduced with the co-operation of the mothers. With efficient ante-natal care throughout the expectant period a full-term, average-weight, vigorous baby should be born and, with proper care, survive. Even when babies are born prematurely there need not necessarily follow this high percentage of deaths. This has been clearly shown in the survival of some extremely small babies weighing as little as 2 lbs. and 3 lbs. in the last year or two. (A baby born in Hammersmith on the 22nd May, 1936, weighing 2 lbs. 11 ozs., weighed 7 lbs. 14 ozs. on the 11th September, 1936.) Extraordinary results have been achieved in the rearing of infants as is shown by the survival of triplets, quadruplets and even quintuplets when born of healthy parents, given unremitting care, and properly nursed in healthy surroundings. It is true that this has been accomplished with the assistance of funds supplied by an enterprising newspaper on the one hand and a government department on the other but it goes to show what is possible. There are so many examples of the survival of multiple births that it would seem a simple matter to rear a single child of healthy parents when an average knowledge of mothercraft is applied with intelligence. It would be more profitable and give better results if more time were given to the teaching of mothercraft to girls during the later years of school life and less to subjects which are of little value and never used after leaving school. To obviate prematurity it is essential that the expectant mother be afforded supervision, advice, and. if need be, extra nourishment at properly conducted and well-formed 26 ante-natal clinics. It is clear from the attendances at antenatal clinics that more women are taking advantage of these facilities as they become more widely known, and it is to be expected that when the full effects of the ante-natal clinics is felt, a reduction in the infant deaths due to prematurity will result. The deaths due to congenital malformations cannot, of course, be avoided; these will always occur and are beyond our control. These, however, only amount to approximately 10 per 1,000 and is the irreducible figure of the infant mortality rate to be aimed at. Other principal causes of infantile mortality are Bronchopneumonia and Gastro-enteritis. These deaths are generally due to the lack of proper mothering and could be avoided without much difficulty if the children were properly nursed. Enteritis is indubitably a preventable disease; cleanliness is of first importance and that can only be attained by such services as water, milk, housing, &c., being closely controlled and supervised. The importance of personal hygiene and general cleanliness is impressed upon all those who attend the clinics as it is through the medium of education that better results may be attained. Broncho-pneumonia.—This may be accounted for in one sentence:—Overcrowding and over-clothing. The former particularly in the ease of bedrooms. 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 2,772 Corrected Number of Births 1,966 The corrected figures represents 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 38 died under one week 130 Legitimate Infants 114, or 64 per 1,000 Births. Illegitimate Infants 16, or 119 per 1,000 Births. Infant Mortality Rate per 1,000 Births 68 27 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 seven 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 Dinners. (f) Provision of Consultants. (g) Provision of Maternity Outfits. (h) Provision of Home Helps. (i) Provision of Domiciliary Midwifery Service. (j) Provision of Convalescent Home Treatment. 2. Activities of independent Voluntary Agencies in receipt of grants- in-aid from the Borough Council: (a) Infant Welfare Centres (b) Day Nurseries. (c) Treatment and Nursing of Children under School Age. (d) Rheumatism Clinic. (e) Massage and Remedial Exercises. 3. Activities of independent Voluntary Agencies: (а) 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. 28 The visits paid are enumerated in detail below:— District. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 No. 7 Total. Number of Births notified 193 439 266 224 381 226 180 1909 Visits. First visits 167 399 275 212 353 220 140 1766 Re-visits (under 1 year) 1190 751 970 1183 1008 715 588 6405 Re-visits (1-5 years) 1034 594 1048 733 958 1026 472 5865 Out 489 1313 1464 413 1285 614 719 6297 Removals 126 337 337 117 196 135 125 137' Special visits 1 28 17 6 19 33 104 Ophthalmia-Neona torum 1st visits 5 1 6 1 1 2 16 Ophthalmia-Neonatorum Re-visits 1 - - - — — - 1 Puerperal Fever — — — - 1 — 1 2 Puerperal Pyrexia 1 1 7 2 1 — 1 13 Ante-natal — First visits 164 304 184 262 237 168 174 1493 Ante-natal — Revisits 143 81 67 130 78 101 20 620 Stillbirths 6 7 7 1 6 10 3 40 Infant Deaths 10 21 21 10 17 14 12 105 Measles — 1 1 — 3 — — 5 Pneumonia — 2 1 — 4 5 — 12 Encephalitis Lethargica 2 1 - - - - - 3 Chickenpox 1 2 2 - 1 6 - 12 Whooping Cough — 7 7 6 3 2 — 25 Polio-Myelitis — 1 — — 2 — - 3 Cerebro Spinal Meningitis 4 1 1 5 Epidemic Diarrœha — — 1 8 1 1 — 11 Home Helps 7 — 9 11 9 44 16 96 Child Life Protection 2 10 8 - 9 12 1 42 Diphtheria Immunisation 2 7 5 10 12 27 100 163 Total visits 3351 3868 4441 3104 4204 3101 2408 24477 Attendances at Infant Welfare Centres 54 101 63 67 106 140 77 608 Attendances at AnteNatal Clinics 21 39 39 16 23 25 63 226 Schick Test Clinics 3 1 3 2 4 — 1 14 Number of insanitary conditions reported 10 8 28 10 16 4 11 87 29 The feeding of the 1,766 infants visited was found to be as follows:— Breatst-feeding (first visit) 1,505 Artificial feeding 153 Mixed feeding 108 Every effort is made by the Health Visitors to encourage mothers to breast-feed their infants, and also to induce them to attend the Consultations at the Infant Welfare Centres, so that both mother and child may be kept under observation during the most critical months of the child's life. Unfortunately breast feeding is dropped by many in order that the mother may return to work. The following table gives the number of births and deaths of infants and the rate per 1,000 births since 1906, the year of the appointment of the first Health Visitor:— Year. Births. Deaths of Infants. Deaths of Infants per 1000 births. 1906 3112 430 138 1907 3029 362 117 1908 3204 383 120 1909 2995 360 120 1910 2906 329 99 1911 2929 434 146 1912 2880 259 90 1913 2951 314 103 1914 2935 276 94 1915 2708 277 102 1916 2605 222 85 1917 2278 251 110 1918 2014 210 104 1919 2296 228 99 1920 3312 219 66 1921 2779 245 83 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 1937 1913 130 68 30 Public Health (London) Act, 1936. Births notified 2,964 Corrected number of births 1,966 Notification Received from Midwives. Doctors. Lying in Hospitals and Nursing Homes. L.C.C. Institutions. Parents. M.O.H.'s. 568 65 562 1,754 2 13 Stillbirths.—Fifty-three stillbirths were allocated to this Borough. Seventy-five were registered in the Borough, of which number twenty-eight were outward transfers. Six 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 130, as compared with 116 in the previous year. The number of deaths of infants under one year of age was equal to 68 per 1.000 of the corrected births. The number of deaths of infants under one year of age, residents in London, was equal to 60 per 1,000 of the total registered births. The mortality rate of infants under one year of age was eight per thousand more in this Borough than in London. 31 The following table shows the deaths of infants under one year of age and the cause:— INFANT MORTALITY, 1937. Infantile Mortality during the year 1937. Nett Deaths from stated causes at various ages under one year of age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks. and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 1 year. Total Deaths under 1 Year ALL CAUSES. Certified 38 3 4 1 46 22 28 19 15 130 Uncertified - - - - - - - - - - Small-pox - - - - - - - - - - Chicken-pox - — - - - — - - - - Measles - — - - - - - - - - Scarlet Fever - — - - - — - - - - Whooping cough - - - - - 1 - 2 4 7 Diphtheria and Croup - - - - - - — 1 - 1 Influenza - - - - - 1 — - - 1 Erysipelas - - - - - — — - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not T.B.) _ - - - - 1 1 - 1 3 Laryngitis - - - - - - - - - Bronchitis — - — - - - 1 2 - 3 Pneumonia(all forms) — - 2 - 2 3 7 5 3 20 Infective Gastro Enteritis - - - - - 3 14 3 5 25 Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation, Overlying - - - - - 1 - - - 1 Injury at Birth 2 - - - 2 - - - - 2 Atelectasis 4 - - - 4 - - - - 4 Congenital Malformations 3 1 1 - 5 7 1 1 - 14 Premature Births 25 2 - 1 28 2 3 - - 33 Otitis Media - - - - - - 1 2 - 3 Violence — - - - — - - - - — Icterus Neonatorum 1 - - - 1 - - - - 1 Hœorrhage of the Newborn 2 - — - 2 - - - - 2 Other causes 1 - 1 - 2 3 — 3 2 10 Totals 38 3 4 1 46 22 28 19 15 130 Nett Births in the Year: Legitimate, 1778; Illegitimate, 135. nett Deaths in the Year of : Legitimate Infants, 114; Illegitimate Infants, 16. 32 The infant mortality rates of the London Boroughs varied from 88 in Kensington to 36 in the City of London. The following Chart shows the Infantile Mortality rate for the years 1903-1937. 33 A large proportion of the deaths, 46, equal to 35 per cent., died in the first month, and of these 38 occurred in the first week. Practically all of these may he ascribed to ante-natal or intra-natal causes. These facts point to the necessity of greater attention to and control of the expectant mother. The Number of Deaths from Prematurity increased from 13 to 33. Infective Enteritis and Pneumonia.— Pneumonia accounted for 20 deaths and infective enteritis for 25. These may be very properly ascribed to lack of knowledge on the part of the mother in the problems of infant feeding and management. 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 1937:— District. 1937. No. of Births. No. of Deaths of Children under 1 year of age. Infant Mortality Rate. England and Wales 610,850 34,917 58 London 55,011 3,265 60 The Borough 1,913 130 68 North Hammersmith 1,037 74 71 South Hammersmith 891 56 63 WARDS River 193 15 78 Brook Green 397 27 68 Grove 301 14 47 St. Stephen's 164 12 73 Starch Green 324 23 71 Wormholt 393 23 59 Latimer and College Park 156 16 104 34 Deaths in Institutions.—Of 130 infant deaths in the Borough only 17 took place at home, and the remaining 113 in institutions. Illegitimate Deaths.—The corrected number of deaths of illegitimate infants under one year of age was 16 or at the rate of 119 per 1,000 illegitimate births. 1935. 1936. 1937. Legitimate Deaths 66 per 1,000 60 per 1,000 64 per 1,000 Illegitimate Deaths 115 per 1,000 65 per 1,000 119 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 were continued. 35 The following Chart shows the number of deaths from Diarrhœa per 100,000 inhabitants, 1911-1937. Circumcisions.—Cases are referred by the Assistant Medical Officers to the Hammersmith Hospital. 36 Infant Welfare Work.—There are seven 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, one by a voluntary committee at Ponsard Road, College Park and one municipal centre at St. Thomas's Church Hall, Thornfield Road. This was opened in May, 1937, and is now a wellestablished and popular centre in a district which is densely populated with a high percentage of children. The numbers attending this clinic are rapidly increasing. The children are found in many instances to be undernourished and anaemic, but the provision of free milk and cod liver oil is making a difference to the health of these infants. Unfortunately the premises are quite unsuitable and it is hoped to vacate them for a more hygenic and well-equipped building in the near future. The Borough Council makes grants-in-aid to the voluntary associations. In addition a Municipal (Toddlers) Clinic is held weekly at the Old Oak Centre, and in all 15 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, Tuesdays, 10 a.m. Victoria Hall, Becklow Road, W.12. Mondays, 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. 37 St. Peter's Church Hall, Ponsard Road, N.W.10. Wednesdays, 10 a.m. Latymer Road Mission, Blechynden Street. W.ll. Tuesdays, 2 p.m. St. Thomas's Church Hall. Thornfield Road, W.12. Mondays, 2 p.m. Fridays, 10 a.m. Massage and Remedial Exercises Clinic. 46, 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 lyr. Antenatal. Postnatal. Under 1 yr. Over 1 yr. 48, Glenthorne Rd. 117 541 40 - - 2367 68 - - 48, Glenthorne Rd. 199 — — 414 74 — — 6397 2319 Victoria Mission Hall, Becklow Road 97 - - 278 31 - - 3691 698 Milson Road 103 — — 297 55 — — 4567 1220 Old Oak Centre, 100 258 30 — — 1137 69 — — Westway 151 — — 248 85 — — 3570 1793 Latymer Rd. Miss., 52 69 10 — — 367 12 — — Blechynden St. 52 — — 139 25 — — 1261 458 Presbyterian Hall, College Park 48 64 16 999 302 Thornfield Road 40 - - 178 34 - - 1274 135 Totals 959 868 80 1618 320 3871 149 21759 6925 Ante-natal Clinics 269 Infant Consultations 690 959 38 The average attendances for the various Centres are as follows:— Hammersmith Infant Welfare Centres 44 Latymer Mission 33 College Park Centre 27 Thornfield Road 35 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. In North Hammersmith the infants are fairly well nourished, but many are markedly anaemic. Pickets 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 Eoad 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 high infantile mortality rate in this ward of 104 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. During the year 77 cases received massage treatment, the total number of treatments being 1,007. There is a very long waiting list and it is probable that an additional 39 session will be necessary to deal with all the cases requiring attention. 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. 10,749 lbs. of dried milk and 21,863 quarts of raw milk were distributed during the year. The number of applications for free milk has averaged 60 per week during the year. The total expenditure during the year was approximately £1,165 6s. 7d. The amount of dried milk distributed during the year increased by 867 lbs., raw milk increased by 8,372 quarts. There was an increased cost of approximately £338 16s. 4d. due to the Council's decision to revise the scale by allowing deductions for fares, insurance and furniture on hire up to 7s. 6d. per week, and the supply of milk at half price. The distribution of this free milk continues to be an inestimable boon, and has, without doubt, contributed very largely to the improved condition of the children generally. Half-Price Milk.—During the year the Council extended the scheme for the supply of milk to mothers and children by authorising the sale of milk at half price to those coming within the scale approved by the Council. 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. 40 Cod Liver Oil.—The arrangement whereby mothers can obtain small quantities of cod liver oil for their children was continued throughout the year. This is provided free to those mothers who are receiving free milk under the Maternity and Child Welfare Scheme. Those above the scale are 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.—Dinners have been supplied to expectant and nursing mothers and in exceptional cases to children since May last through the Invalid Kitchens of London and the Second Feathers Club from premises situate in Melina Road and Norland Gardens respectively. These centres are provided by voluntary organisations where excellent well-balanced meals are served. Many voluntary workers assist at these centres and the value of their work is reflected in the great improvement in the health of those mothers and children who receive dinners under this scheme. During the year 147 cases were referred to these centres by the Borough Council to whom 4,886 dinners were served at an approximate cost of £144 10s. Ante-Natal Clinics. Owing to the increase in the number of ante-natal attendances it was found necessary to hold two additional sessions at the Glenthorne Road Centre. Seven ante-natal clinics are held at three Centres in the Borough, two in North Hammersmith and one in South Hammersmith. They are held at the following Centres:— 48, Glenthorne Road, W.6. Mondays, 6 p.m. Fridays, 10 a.m. Wednesdays, 10 a.m. Wednesdays, 2 p.m. Old Oak Centre, The Curve, Westway, W.12. Tuesdays, 6 p.m. Fridays, 2 p.m. Latymer Road Mission, Blechynden Street, W.ll. Thursday, 10 a.m. 41 The Borough Council's Assistant Medical Officers attend these clinics with the Municipal Midwife and Health Visitors. Any expectant mother being resident in the Borough may attend. Reports are furnished to hospitals, doctors and midwives in respect of their respective patients. The London County Council is the authority responsible for the domiciliary midwifery service under the Midwives Act. Frequent conferences have been held between representatives of that body and the Borough Medical Officers of Health. Midwives are now required to refer patients who have not booked a doctor to the Borough Ante-Natal Clinics for examination and report. It is hoped that this co-operation of the services will lead to a more efficient midwifery service and a reduction in maternal mortality. MATERNITY SERVICES. Facilities for Confinement. 1. Hospital Facilities. The excellent facilities existing at Hammersmith Hospital Post-Graduate Medical School for maternity cases are 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 1937 this had increased to 64 per cent., and there is not the least doubt that having experienced the comfort of the Hospital the numbers seeking admission will increase. During 1937 there were 986 Hammersmith cases confined in Hammersmith Hospital. All 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 modern treatment, equipment and consultative opinion of the medical, surgical, obstetric and special units is available, and readily given. 42 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 24 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. 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 7 mothers and their infants. Supported by voluntary subscriptions. Jewish Hostel for Girls, Charcroft House, Roseford Gardens, W.12.—Accommodation, 18 beds and 13 cots. This hostel is conducted by a voluntary society towards which the London County Council contributes. DOMICILIARY MIDWIFERY SERVICE. 1. Municipal Midwife. The provision of a Municipal Midwifery service by the Borough Council under arrangement with the Hammersmith District Nursing Association continued during the year. Mothers desiring the services of the Municipal Midwife have increased in number. 43 Only those eases 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. Thirty-one cases were attended by the Municipal Midwife in 1937. 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 1937 161 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 1937, 22. 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. (3) The Borough Council pay the fees of the Consultant, but where the financial position justifies it, the patient will be asked to pay a portion or the whole of the fee. One 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 emergency. 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 69 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. During the year 38 applications have been received for home helps. 32 home helps were supplied. Maternal Mortality.—There were four maternal deaths during the year as compared with three in the previous year and two the year before. The rate was equal to 2.09 per 1.000 live births whilst the rate for England and Wales was 3.23 per 1,000. The London rate being 2.22. The usual inquiries were made into the circumstances of each death and a report submitted to the Ministry of Health. One Mother only had attended the Borough ante-natal clinic. She attended during the early months of her pregnancy when her condition appeared to be quite normal. She subsequently booked a bed at one of the voluntary hospitals and came under the ante-natal care of the staff there. She was admitted to hospital at the commencement of labour, which was unusually prolonged (104 hours). A 12 lbs. child was delivered dead and the mother collapsed 46 and died about 3 hours after delivery. A grave error of judgment appears to have occurred in this case. Both mother and child might have been saved if induction had been performed at the proper time or a Cæsarian section at Term. The other three cases did not attend the Borough antenatal clinic and, so far as can be ascertained, one had no ante-natal care of any sort. One of these patients was only seen on two occasions by a midwife. One died from eclampsia after induction at Hammersmith Hospital after everything possible had been done for her. The third mother was admitted as an emergency to Fulham Hospital. She was not aware that she was pregnant; ruptured ectopic pregnancy was diagnosed and an operation performed, but unfortunately the patient died from hæmorrhage. The fourth mother had her baby at home. She died from puerperal peritonitis following rupture of the uterus. The ante-natal clinics numbered seven at the end of the year. By arrangement with the staff at the Hammersmith Hospital all cases that need consultation are referred to that institution, where the mother is admitted for observation if necessary, or other appropriate measures are taken to provide for her welfare. The number of patients booking beds at the hospital has become so great that it has been found impossible to supervise them all throughout the whole of their ante-natal period at the hospital clinics. By arrangement, most of these are now referred to the Borough clinics, where they are seen and carefully looked after until the 36th week and subsequently until they are admitted to the hospital for confinement. 47 The midwifery scheme now operating in London has also increased the number of mothers attending for antenatal care at the Borough clinics. Owing to the above arrangements the attendances at the Borough ante-natal clinics have increased enormously and it has been found necessary to increase the number of sessions. The co-operation between the Hammersmith Hospital and the Borough clinics is very close, as is also that between the latter and the County Council midwives. 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. 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 £ 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 1937 1 3 1,913 2.1* * The Maternal Death rate calculated on the total (live and still) births is 2.0. Infectious Diseases of Mothers and Children Under Five Years of Age. 48 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 9 9 - 9 Puerperal Pyrexia 37 21 37 1 36 Ophthalmia Neonatorum 14 4 14 6‡ 12 Epidemic Diarrhœa* 28 25 3 3 40 Measles & German Measles (under 5)† 42 86 42 5 28 Whooping Cough (under 5)† 145 12 145 - 59 Poliomyelitis (under 5) 2 2 2 - 2 * Summer Diarrhoea.—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. ‡ Subsequently removed. Ophthalmia Neonatorum.—The number of cases reported was fourteen against four in the previous year. The analysis of the final reports received is as follows:— Cases. Vision unimpaired. Vision Impaired. Total Blindness. Removed from trict. Still under Treatment. Deaths Notified. Treated. At Home. In Hospital. 1.1.37 - 1 Yes No No No No No 14.1.37 — 1 ,, ,, ,, ,, ,, ,, 16.3.37 — 1 ,, ,, ,, ,, ,, ,, 20.4.37 — 1 ,, ,, ,, ,, ,, ,, 4.6.37 — 1 ,, ,, ,, ,, ,, ,, 16.6.37 —. 1 ,, ,, ,, ,, ,, ,, 7.7.37 — 1 ,, ,, ,, ,, ,, ,, 20.7.37 — 1 ,, ,, ,, ,, ,, ,, 21.8.37 — 1 ,, ,, ,, ,, ,, ,, 1.9.37 — 1 ,, ,, ,, ,, ,, ,, 7.9.37 — 1 ,, ,, ,, ,, ,, ,, 27.9.37 — 1 ,, ,, ,, , ,, ,, 8.11.37 — 1 ,, ,, ,, Yes ,, ,, 24.11.37 1 - ,, ,, ,, No ,, ,, Totals 1 13 - — - 1 - - 49 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. This nursery continues to fill an apparently pressing need. On an average 60 children per day are accommodated and improvement in their health is marked; no doubt due in a large measure to the fact that the excellent dinner, the milk, cod liver oil, fresh air, appropriate clothing and discipline have a wonderful effect upon their health and general well being. Initial and weekly medical examinations of each child by one of the Assistant Medical Officers of Health of the Borough are carried out. The Princess Christian Day Nursery, Goldhawk Road, provides accommodation for 45 in winter and 50 in summer. 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, 31 children were sent to convalescent homes for periods varying from two weeks to six months, 50 compared with nineteen in 1936. 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. Twenty mothers, sixteen babies and nine toddlers were sent to the Zachary Merton Convalescent Home at Rustington, Sussex. The mothers greatly benefited by their rest and letters of thanks were received from grateful patients. CHILD LIFE PROTECTION. Public Health (London) Act, 1936. At the end of the year there were 68 foster children in the care of 84 foster-mothers. Eighteen 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 36 foster-mothers were removed from the register for various reasons and 37 new foster-mothers were registered. Twenty applications for registration were not approved. A summary of the work carried out during the year under review follows:— FOSTER-MOTHERS. No. of Foster-Mothers on Register December 31st, 1937 • • 84 ,, „ ,, Recommended for Registratior .. 37 No. of Foster-Mothers removed from Register .. 36 (1) Removed from Borough 6 (2) Adopted Children 1 (3) Unsuitable 3 (4) 9 years of age 5 (5) Temporarily approved 3 (6) No further Foster-Children required 15 (7) Illness of Foster Mothers 3 (8) Lack of accommodation — „ Applications for Registration received but not Recommended 20 51 FOSTER-CHILDREN. No. of Foster Children on Register December 31st, 1947 68 ,, ,, „ received by Foster-Mothers 90 „ „ „ moved from Foster-Mothers 116 (1) To Foster-Mothers 19 (2) To Parents or Guardians 55 (3) To Institutions 25 (4) Adopted 3 (5) Children removed from Borough with Foster- Mother 7 (6) Foster-Children who have reached the age of 9 years during the Year 7 VISITS. No. of visits to new Foster-Mothers 52 „ „ Registered Foster-Mothers 735 Verification Visits 18 Special Visits 22 Outs 288 Total Visits 1,115 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." 52 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 aie 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 hand 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 eleven summonses were taken, when a fine of 15s. was imposed in one case, 10s. in five cases and 5s. in five cases. Sanitary Inspection of the Area.—During the year 43,089 inspections were made by the Sanitary Inspectors. 58 Inspections.—The following table shows the number of visits made in each district under the various inspection head :— NUMBER OF INSPECTIONS MADE DURING 1937. Cause of Inspection. Districts. 1 2 3 4 5 6 7 8 Lady Sanitary Inspector Food and Drugs Inspector Housing Inspector Total. Infectious Disease 67 70 109 108 98 93 199 97 1,138 6 2 1,987 Complaints 487 537 524 571 434 697 551 454 486 1 9 4,751 House to House 18 82 9 5 62 .. 13 1 .. .. 718 908 220 93 123 246 402 275 54 203 183 1,799 House to House Consolidated Regulations .. .. 18 .. .. .. .. .. .. .. .. 18 Shops Act, 1934 37 80 221 48 116 163 14 88 .. .. .. 767 Food (other than Restaurants and Eating Houses) 68 88 264 117 123 372 128 343 .. 1,423 17 2,943 Restaurants and Eating Houses 30 91 46 84 37 22 24 75 .. 84 4 497 21 6 282 49 20 263 33 89 .. 568 24 1,355 Slaughterhouses .. .. 26 45 1 3 1 .. 3 1 80 Poultry Slaughterhouses .. .. .. .. .. .. .. .. .. .. .. .. Bakehouses 20 32 13 24 31 18 28 23 .. 62 2 253 Milk Vendors 24 38 54 73 61 34 26 114 .. 376 .. 800 Ice Cream Vendors 7 .. .. .. 9 .. .. 4 • • 226 .. 246 Factories (including Factory Laundries) 18 46 29 28 62 41 2 78 7 .. .. 311 Workshops including Workshop Laundries) 9 17 32 6 25 4 1 15 24 .. .. 133 Workplaces (other than Outworkers) 1 18 5 23 10 35 .. 15 .. .. .. 107 Out worers .. .. .. .. .. .. .. .. 91 .. .. 91 Public Urinals 38 74 144 217 128 77 86 99 5 .. 4 872 Public Urinals .. 19 4 28 2 .. 6 .. .. .. .. 59 Smoke Observations 649 802 877 1,410 479 569 611 221 .. .. 47 5,665 Dralnage 113 121 258 143 203 299 332 538 76 492 116 2,691 Re-visits 1,295 1,595 1,645 849 1,656 2,237 1,633 2,248 143 .. 2,130 15,431 Child Life Protection .. .. .. .. .. .. .. .. 1,118 .. .. 1,118 Common Lodging Houses .. .. 13 .. .. .. .. .. .. .. .. 13 Pharmacy and Poisons Act .. 27 13 20 8 15 6 13 .. .. .. 102 Diphtheria Immunisation .. .. .. .. .. .. .. .. .. .. .. .. Cancer .. .. .. .. .. .. .. .. 68 .. .. 68 Womens' Hostels .. .. .. .. .. .. .. .. 4 .. .. 4 Totals 3,122 3,836 4,709 4,094 3,967 5,217 |3,748 4,718 3,160 3,241 3,257 43,069 54 Notices.—The following table shows the number of Preliminary Notices served and complied with during the year:- Notices Served. Notices complied with. Infectious Diseases 142 117 Complaints 1,912 1,623 House to House 463 434 House to House Consolidated Regulations ― 1 Food (other than Restaurants) 28 26 Restaurants, &c. 17 13 Bakehouses 7 6 Milk Vendors 2 3 Factories 20 12 Workshops 9 4 Workplaces 6 6 Outworkers 2 2 Public Urinals 3 2 Smoke Observations 7 — Drainage 36 28 Miscellaneous 88 38 Re-visits 446 450 Common Lodging Houses 2 2 Housing Acts 72 35 Child Life Protection 3 3 Shops Act, 1934 81 128 Ice Cream Vendors — 4 Women's Hostels 1 — Markets 1 1 Total 3,348 2,938 During the year 1,429 Statutory Notices were served and 1,112 complied with. The following table shows the result of proceedings taken:— SUMMONSES—YEAR 1937. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 43, Godolphin Road Failing to comply with Statutory Notice 1 Withdrawn. 10. 6d. costs 55 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 190, 192 & 194, The Grove Improper 15 Fined £5 and £2 2s. costs struction of drain Failing to give notice Failing to deposit plans No ventilation, etc. Non-co mpliance with Byelaws 1 88, Addison Gardens Construction of waste pipe Fined 10s. ditto Failing to give notice 1 Fined 10s. 49, Adelaide Road Failing to comply with Statutory Notice 1 Withdrawn 10s. 6d. costs 27, Adelaide Road ditto 1 Withdrawn 10s. 6d. costs 211, Uxbridge Road Failing to carry out certain drainage work 1 Adjourned sine die. 10s. 6d. costs 213, Uxbridge Road ditto 1 Adjourned sine die 215, Uxbridge Road ditto 1 Adjourned sine die. 10s. 6d. costs 11, St. Paul's Mansions Construction of waste pipe 1 Fined 5s. ditto Failing to give notice 1 Fined 5s. 12, St. Paul's Mansions Construction of waste pipe 1 Fined 5s. ditto Failing to give notice 1 Fined 5s. 42, Lena Gardens Failing to comply with Statutory Notice 1 Withdrawn. 10s. 6d. costs 97, Greenside Road ditto 1 Withdrawn 10s 6d. costs 22, Cathnor Road ditto 1 Withdrawn 10s. 6d. costs 160, Percy Road Failing to comply with Statutory Notice 1 Withdrawn. 10s. 6d. costs Goldhawk Road Unlawful removal of offensive matter 2 1. Fined 10s. 2. Dismissed under P.O.A. Goldhawk Road ditto 1 Fined 10s. King Street ditto 1 Fined 15s. Goldhawk Road ditto 2 1. Fined 5s. 2. Fined 5s. 56 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 84, Masbro Road Failing to comply with Statutory Notice 1 Order made 14 days Uxbridge Road Unlawful removal of offensive matter 1 Fined 10s. Goldhawk Road ditto 1 Fined £1 King Street ditto 2 1. Fined 5s. 2. Fined 5s. 67, Tunis Road Failing to comply with Statutory Notice i Withdrawn. 10s. 6d. costs 87, Black Lion Lane ditto 1 Withdrawn 9, Westwick Gardens ditto 2 1. Withdrawn. 10s. 6d. costs 2. Withdrawn. 10s. 6d. costs 35, Iffley Road Failing to give notice 1 Dismissed ditto Wrongful connection to soil pipe 2 1. Withdrawn 2. Fined £2 ditto Construction of W.C. 1 Fined £5 49, Adelaide Road Failing to comply with Statutory Notice 1 Withdrawn. 10s. 6d. costs 84, Loftus Road ditto 1 Withdrawn. 10s. 6d. costs 46, Overstone Road Failing to give notice 1 Fined 5s. ditto Construction of waste pipe 1 Fined 5s. 33, Iffley Road Failing to comply with Statutory Notice 4 1. Fined 10s. 2. Order made 14 days 3. Order made 14 days 4. Fined 10s. 19. Adelaide Road Failing to comply with Statutory Notice 1 Withdrawn 4, Paradise Row ditto 4 Withdrawn 69, Frithvifle Gardens ditto 1 Withdrawn. 10s. 6d. costs 77, Silchester Road ditto 1 Withdrawn. 10s. 6d. costs 24, Porten Road ditto 1 Withdrawn. 10s. 6d. costs 21, Porten Road ditto I Withdrawn. 10s. 6d. 28a, Bolingbroke Road "ditto 1 Withdrawn. 10s. 6d. costs 187, The Grove ditto 1 Withdrawn. 10s. 6d. costs 57 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 78, Brook Green Construction of waste pipes 1 Dismissed under P.O.A. ditto Failing to give notice 1 Fined 2s. 6d. ditto Failing to deposit plans 1 Fined 2s. 6d. 47, Southerton Road Failing to give notice 1 Fined 10s. ditto Construction of waste pipe 1 Dismissed under P.O.A. 163, King Street Failing to deposit plans 1 ditto Failing to give notice 1 ditto Construction of waste pipes 3 1. 2. 3. HAMMERSMITH BOROUGH COUNCIL BYE-LAWS—DOGS. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mr. J. S., Fulham Contravention of Bye-law re nuisance by dogs in Bridge Avenue 1 Fined 5s. Mrs. E. T., Hammersmith ditto Batoum Gardens Fined 5s. Mr. W. L. K„ Hammersmith ditto Bloemfontein Road 1 Fined 10s. Mr. G. H , Hammersmith ditto Goldhawk Road 1 Fined 10s. Miss G. C., Fulham ditto Hammersmith Road 1 Fined 10s. Mr. D. A. O., Hammersmith ditto The Grove 1 Fined 5s. Mrs. M. H. H„ Hammersmith ditto Hammersmith Road 1 Fined 10s. Mr. R. C., Hammersmith ditto Goldhawk Road 1 Fined 5s. Mr. L. W., Hammersmith ditto Uxbridge Road 1 Fined 10s. Mrs. M. J., Hammersmith ditto Goldhawk Road 1 Fined 15s. Mr. H. H., Harlesden ditto Goldhawk Road 1 Fined 5s. 58 Summonses—continued. PUBLIC HEALTH (LONDON) ACT—UNSOUND FOOD. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. P.F. Ltd., Fulham Palace Road Exposing for sale unsound oysters for food of man 1 Dismissed ditto Exposing for sale unsound mussels for food of man 1 Dismissed J.Q. Ltd., King Street Depositing for purpose of sale 32 lb. of rice unfit for food of man 1 Fined £20 ditto Depositing for purpose of sale 24½ lb. of flour unfit for food of man 1 Fined £20 J. Q., Ltd.. King Street Depositing for purpose of sale 8 lb. of candied peel unfit for food of man 1 Fined £20 ditto Depositing for purpose of sale 3£ lb. of prunes unfit for food of man 1 Fined £20 MILK AND DAIRIES (AMENDMENT) ACT, 1922. MILK ACT, 1934. Name and Address. No. of Nature of Offence Summonses. Result of Proceedings Messrs. R. P., Hammersmith Unlawful use of designation "Pasteurised" without a milk licence authorising the use of that designation 1 Fined £1 1s. 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 seven 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 35 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 22 notices were complied with. During the previous year there were 65 notices served and 52 complied with. The following is a list of the Factories, Workshops and Workplaces upon the Register:- Restaurants, Hotels, &c. 195 Bakehouses (33 not in use as Bakeries) 68 Bootmakers 33 Motor and Cycle Makers 2 Dressmakers and Milliners 26 Laundries 44 Outworkers 112 Letterpress Printers and Bookbinders 16 Electrical and Mechanical Engineers 92 Smiths, Wheelwrights and Coach builders 23 Tailors 19 Builders, Carpenters and Joiners 22 Miscellaneous 229 Total 881 The whole of these premises have been periodically inspected during the year. The following tables have been prepared in accordance with the form prescribed by the Home Office on the Administration of the Factory and Workshops Act, 1901, in connection with Factories, Workshops, Workplaces and Homework. 60 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. Factories (including Factory Laundries) 311 20 — Workshops (including Workshop Laundries) 133 9 — Workplaces (other than outworkers' premises included in Part 3 of this report) 107 6 — Total 551 35 — 2.—DEFECTS FOUND IN FACTORIES, WORK SHOPS AND WORKPLACES. Particulars Number of Defects Number of Prosecutions Found Remedied Referrca to H.M. Inspector Nuisances under the Public Health Acts— Want of Cleanliness 15 14 — — Want of Ventilation — — — — Overcrowding — — — Want of Drainage of Floors — — — — Other Nuisances 11 9 — Sanitary insufficient. — — — — Accommo- unsuitable or defective 17 12 — — dation not separate for sexes — — — — Offences under the Factory and Workshops 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 43 35 — — 61 3.—HOME WORK. Nature of Work Outwork in Unwholesome Premises, Sec. 108 Outwork in Infected Premises, Sees. 109, 110 Instances Notices served Prosecutions Instances Ordeis made (Sec. 110) Proscutions (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 25 Laundries 8 Outworkers 112 Others 117 Total number of workshops on Register 288 5.—OTHER MATTERS. Class Number Matters notified to H M. Inspector of FactoriesFailure to affix Abstract of the Factory and Workshop Act 1901 (S. 133) Action taken in matters referred by H M. Inspector as remediable under the Public Health Acts, but r.ot under the Factory and Workshop Act, 1901 (S.5) Notified by H.M. Inspector 4 Reports of action taken sent to H.M. Inspector 4 Other 4 Underground bakehouses (S.101)— Certificates granted during year In use at the end of the year 20 62 House to House.—As a result of the house to house visitation 907 inspections were made, 463 notices served, and 484 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. Seven 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:— Glen Laundry, Landor Boad. Chibnall's Bakery, Chiswick Mall. Eyot Works, Eyot Gardens. Hammersmith Hospital (Incinerator). Waring & Gillow, Cambridge Road. rurewite Laundry, Gayford Road. Rats and Mice (Destruction) Act, 1919.--During the year the Rats and Mice (Destruction) Act, 1919, continued in operation, the District Inspectors being responsible for its administration in their respective districts. Section I places the responsibility of ridding the premises of the pest upon the occupier, but this is somewhat difficult when dealing with tenement houses containing in some cases three or more families. During the year many complaints were received with regard to rat infestation of premises. In each case an inspection was made and advice and instructions given. A supply of poison was given where necessary and in most cases satisfactory results have been obtained. National Rat Week was held in November, as in previous years. The Ministry of Agriculture and Fisheries again urged local authorities to take action, and arrangements were made for the baiting of the sewers, through the agency of the Borough Engineer and Surveyor's Department, 63 Fifty-six lbs. of rat poison was laid in sewer manholes throughout the Borough. The Borough Engineer and Surveyor reported that "it is considered that approximately 60 per cent, of the bait 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. Houses Let in Lodgings.—During the year no new houses were registered. Seamen's Lodging Houses.--There are no seamen's lodging houses in the Borough. Common Lodging Houses.—There is one common lodging house known as Jubilee Chambers situate in Bradmore Lane, Hammersmith. Application for the renewal of the licence was received from Mr. William George Parker, residence Jubilee Chambers, Hammersmith. The application was approved and a licence issued dated the 1st July, 1937. 64 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 Road, used for living and sleeping purposes by five adults and three children. The average cubic capacity for each person is 100 c. ft. Regular inspections have been made, but owing to the absence of special regulations and the fact that these vandwellers are of the lowest gypsy-type, any improvements in the sanitary conditions effected are of short duration. In Britannia Yard, Wharf Road, there is one caravan in which two adults sleep. No nuisance has been observed during inspections. In the National Car Park opposite the White City Stadium there are five caravans occupied by nine adults and two children. 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. 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.; 65 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 ACT, 1936. 1.—Inspection oj dwelling-houses during the year:— (1) (a) Total number of dwelling houses inspected for housing delects (under Public Health or Housing Acts) 8,520 (D) Number of inspections made for the purpose 26,158 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 18 (b) Number of inspections made for the purpose 18 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 10 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,726 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 66 3.—Action under Statutory Powers during the year:— (A) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 8 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (B) Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2,726 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 2,457 (b) By Local Authority in default of owners — (C) Proceedngs under Sections 11 and 13 of the Housing Act, 1936:— (1) Number of dwelling-houses in respect of which demolition orders were made 10 (2) Number of dwelling-houses demolished in pursuance of demolition orders 34 (D) Proceedings under Section 12 of the Housing Act, 1986:— (1) Number of separate tenements or underground rooms in respect of which closing orders were made 29 (2) Number of separate tenements or underground rooms in respect of which 67 closing orders were determined, the tenement or room having been rendered fit — 4.—Housing Act, 1936—Part IV. Overcrowding:— (a) (i) Number of dwellings over- crowded at the end of the year 1,687 (ii) Number of families dwelling therein 1,687 (iii) Number of persons dwelling therein 6,564 (b) Number of new cases of overcrowding reported during the year Nil (c) (i) Number of cases of ing relieved during the year 267 (ii) Number of persons concerned in such cases 868 (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 (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report Nil 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. 68 Fitness of Houses:— (a) No difficulties have been experienced under the Public Health Act or under the Housing Acts. (b) The water supply is through the Metropolitan Water Board. Very few houses have not an adequate internal water supply. (Notices are served where necessary under the London County Council (General Powers) Act, 1907, in the case of tenement houses.) Unhealthy Areas. A list of properties, recommended to be dealt with either as Clearance or Improvement Areas or by Closing Orders, has been submitted to the Borough Council. Bye-laws. No special difficulties have been experienced in the enforcement of the bye-laws relating to tenement houses, &c. Eradication of Bed Bugs. Number of Council houses found to be infested 5 Number of other houses found to be infested 166 Number of Council houses disinfested 0 Number of other houses disinfested 41 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. The furniture of tenants removing to Council houses is disinfested by hydrocyanic acid gas and the bedding disinfested in the Council's disinfeetor. This Council has an arrangement whereby the Kensington Borough Council carries out this work at a cost of £3 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. 69 One hundred and sixty-eight 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. Since the War, 4,436 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.C. Estate. H.B.C. Estate Private Enterprise. 1920 188 18 Nil 1921 169 166 Nil 1922 384 354 Nil 1923 Nil 5 22 1924 Nil 42 40 1925 Nil Nil 50 1926 Nil Nil 202 1927 284 Nil 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 168 1935 Nil Nil 189 1936 Nil Nil 301 1937 Nil Nil 168 Totals 1,638 793 2,005 The premises have provided accommodation for approximately 22,180 persons, but despite this fact overcrowding is still in evidence. 70 HOUSING ACT, 1930--SLUM CLEARANCE. Berghem Mews Area.—In May, 1986, 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 Council, entitled "The Hammersmith (Berghem Mews) Housing Confirmation Order, 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 was made in 1937 but was dismissed, and the Ministry of Health Order became operative. 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 71 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. In May, 1937, the Minister of Health issued an Order confirming the Clearance Order made by the Council, entitled "The Hammersmith (Rose and Crown Lane Area) Housing Confirmation Order, 1937." 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 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 .78 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 (6/11/36) the London County Council intimated 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, 1980. 72 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. In May, 1937. the Ministry of Health issued an Order confirming the Clearance Order made by the Council entitled" The Hammersmith (Wescombe Cottage) Housing Confirmation Order, 1937." 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 intimated 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 nine. In July, 1937. the Ministry of Health issued an Order confirming the Clearance Order made by the Council entitled "The Hammersmith (Edwin Cottages) Housing Confirmation Order, 1937." 78 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 intimated 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, 1980, 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 reeent count is 26. In July, 1937, the Ministry of Health issued an Order confirming the Clearance Order made by the Council entitled "The Hammersmith (Montague Street Ares) Housing Confirmation Order, 1937." The Evesham Street Area.—In September, 1937, I submitted an official representation with respect to the area known as the " Evesham Street Area.'' This area comprises ten brick-built, two-storey dwellings, seven being in Evesham Street and three in Latimer Road. Some of the buildings are old and worn out; the brickwork in part is bulged and defective; there is rising dampness in every house; the premises are badly ventilated and lighted and many other insanitary conditions exist. The premises provide accommodation for 47 persons. An Inquiry is being held in 1938. 74 The following table gives particulars of the Clearance Areas dealt with during the past three 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 1937 1. Becklow Place June, 1935 Compulsory Purchase Order 34 179 Order comfirmed with modifications. Premises not yet demolished. 2. Argyle Place October, 1935 Clearance Order 8 30 Order confirmed. 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 75 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 confirmed. 10. Wescombe Cottages November, 1936 Clearance Order 33 9 Order confirmed. Premises demolished. Order confirmed. 11. Montagu Street November, 1936 Clearance Order 7 26 12. Edwin Cottages November, 1936 Clearance Order 2 9 Order confirmed. 13. Berghem Mews May, 1936 Clearance Order 19 78 Order confirmed. Appeal by Owners dismissed. 14. Evesham Street September, 1937 Clearance Order 10 47 Enquiry to be held. 75 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 the 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. The total number of food premises on register is 100. Milk Supply.—During the year 370 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. Milk (Special Designations) Order, 1936. The following is a list of the licences issued during the year under the Milk (Special Designations) Order, 1936:— Description Number. (1) Dealers' Licences to use the designation "Tuberculin Tested " (a) Bottling Establishments 2 (b) Shops 11 (c) Supplementary Licences 4 (2) Licences to use the designation " Pasteurised " (a) Pasteurising Establishments 6 (b) Shops 17 (c) Supplementary Licences 6 (3) Dealers' Licences to use the designation " Accredited (a) Shops 1 76 Certification of Certain Food Products for Export to the Dominions. No application was received for the certification of food products for export to the Dominions. Meat.—With regard to meat inspection, this important commodity is kept under supervision by the Inspectors in charge of the districts. Most of the shops are now provided with glass fronts. Public Health (Meat) Regulations, 1924. The Public Health (Meat) Regulations, 1924, came into operation on the 1st day of April, 1925. The provision of these Regulations, regarding the giving of notice to the local authority of the times of slaughter, has enabled arrangements to be made for the inspection of all carcases of animals slaughtered in the local slaughterhouses. I append the number of animals slaughtered and examined in the slaughterhouses during the year:— Lambs 20 Sheep 28 Beasts 2 Pigs 68 Total 118 No application has been received for the stamping of carcases examined by the Sanitary Inspectors. 77 The following is a list of Unsound Food found during the Inspection of the Carcases of Animals Slaughtered in the Local Slaughterhouses. Description Disease. Approximate Weight. Inspecto Mason 4 sets of Pigs' lungs Congestion 8¼ lbs. 2 sets of Pigs' lungs Congestion 4 „ 1 Ox liver Distoma Hepaticum 15 „ 2 halves of Ox liver Distoma Hepaticum 16 „ Inspector Godden 1 Pig's liver Milk Spots 2 „ 1 Pig's messentery Tuberculosis 2 ,, Carcases Inspected and Condemned. Cattle, excluding Cows Cows Calves Sheep and Lambs Pigs Number killed (if known) 2 — 48 68 Number inspected 2 ~ — 48 68 All diseases except Tuberculosis— Whole carcases condemned - - - - Carcases of which some part or organ was condemned 2 - — - 7 Percentage of the number inspected affected with disease other than tuberculosis 100% - - - 9.7% Tuberculosis only— Whole carcases condemned - - - - - Carcases of which some part or organ was condemned — — - 1 Percentage of the number inspected affected with tuberculosis — - — - 0.8% Slaughterhouses.—There are three slaughterhouses in the Borough. Applications were received from three licensees for the renewal of their licences. 78 The following is a list of the licensed slaughterhouses in the Borough :— Premises. Name of Licensee. 40, Goldhawk Road Andrew George Hedges 65, King Street Richard Norman Hammett 341, King Street Stanley Brooks Midwinter Offensive Trades—Slaughterers of Poultry.—There is one authorised slaughterer of poultry in the Borough :— Premises. Name of Occupier. 109, Shepherd's Bush Road Solomon Shockett 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 1937 Number of notices 1937 Number of prosecutions 1937 On register in 1920. On register at end of 1936 Added in 1937 Removed in 1937 On register at end of 1937 Milk premises 128 173 13 8 178 Slaughterhouses. 7 4 - - 3 — — - Poultry Slaughterhouses. - 2 - - 1 - - - Ice Cream premises 162 186 25 42 169 - - - 79 Markets.—There are three markets in the Borough, situate in Bxadmore 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 103 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. 80 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 35 bakehouses in use in the Borough have been regularly inspected during the year. Seven 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. Maelen 67 Ditto G. Dunsby 98 Blythe Road Miss Schofield Ceylon Yard Olivers (London) Ltd. No. 2 DISTRICT. 82 Great Church Lane E. Galer Great Church Lane Fullers, Ltd 134 Shepherd's Bush Road Olivers (London) Ltd. 84 Ditto F. R. Ries 75 Blythe Road Olivers (London) Ltd. 31 Goldhawk Road Olivers (London) Ltd. 213 Hammersmith Road F. Hayes No. 3 DISTRICT. 33 Glenthorne Road Plumridge Bros. 51 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. 81 Address. Name. No. 4 DISTRICT. 93 Black Lion Lane G. Banham † 1 Eyot Gardens J. R. Chibnall, Ltd. † 258 King Street Miller & Son † 316 Ditto Acton Bakeries No. 8 DISTRICT. † 74 Askew Road J. Auer † 104 Ditto D. Miller No. 6 DISTRICT. †* 74 Goldhawk Road H. Crisp †* 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 128 Askew Road *13 Shepherd's Bush Green 167 Ditto *87 Masbro Road 242 Goldhawk Road *6 Beaconsfield Terrace 70 Glenthorne Road *47 Milson Road 16 Black Lion Lane † 65 Bridge Road 192 Dalling Road 2 Crisp Road 348 King Street * 94 Shepherd's Bush Road 10 Upper Mall 88 Queen Street 121 Askew Road * 77 Brackenbury Road 41 Gayford Road † 1 The Grove 126 Uxbridge Road * 17 Kilmarsh Road 132 Uxbridge Road *† 11 Lamington Street 2 Hunt Street *† 60 Richmond Road 104 Latimer Road 7 St. Peters Road Ceylon Road †*102 Dalling Road 106 Goldhawk Road †166 Goldhawk Road * Underground Factory 82 PUBLIC HEALTH (LONDON) ACT, 1986. 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, 1986 169 Restaurants 18 Factories 4 191 83 UNSOUND FOOD. During August, whilst the examination of a food store in connection with a grocers and provision shop was being carried out, a quantity of foodstuffs was found to be contaminated by excreta of mice. 32 lbs. of rice, 24½ lbs. of flour, 8 lbs. of candied peel and 3½ lbs. of prunes were seized as unwholesome and unfit for food of man and conveyed to a magistrate who ordered its destruction. Proceedings were taken at the Kensington Petty Sessions and penalties of £20 on each of four summonses (£80 in all) were imposed. The voluntary surrender of the following unsound food was accepted during the year :— Commodity Condition Result. 4 Turkeys Unsound and Unfit for food Surrendered 12 tins Pears ditto ditto 1 tin Peaches (15 oz.) ditto ditto 12 boats Tomatoes ditto ditto 17 boats Tomatoes ditto ditto 2 Fowls ditto ditto 2 boxes Fillets ditto ditto 3 Fow's ditto ditto 1 Liver Sausage ditto ditto 2 boxes Kippers ditto ditto 2 boxes Cod Fillets ditto ditto 27 lb. Beef ditto ditto CHEMICAL AND BACTERIOLOGICAL EXAMINATION OP 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. Nearly 50 per cent. of the articles analysed were milk samples. 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. 84 REPORT ON SAMPLES TAKEN UNDER THE FOOD AND DRUGS (ADULTERATION) ACT, 1928. Under the provisions of the Food and Drugs (Adulteration) Act, 1928, eight hundred samples were submitted to the Public Analyst during the year by the Council's Sampling Officers for analysis; fifty were found to be of inferior quality and fifty-five were adulterated. In Table I are given the numbers of samples analysed each quarter, together with the numbers of those classified as genuine, inferior and adulterated. Table I. Period. Genuine. Inferior. Adulterated. Total. 1st quarter 136 5 4 145 2nd 105 37 22 164 3rd „ 111 7 10 128 4th „ 343 1 19 363 Whole year 695 50 55 800 (Percentages) 86.9 6.2 6.9 — In Table 11 comparative percentages are given for the last ten years. Table II. Year. Genuine. Inferior. Adulterated. 1928 89.2 6.5 4.3 1929 93.5 5.4 1.1 1930 93.6 5.3 1.1 1931 95.6 3.1 1.3 1932 90.5 6.5 3.0 1933 92.6 5.1 2.3 1934 89.9 6.2 3.9 1935 90.5 4.9 4.6 1936 89.1 6.3 4.6 1937 86.9 6.2 6.9 85 The number and nature of the various articles analysed during the year are set out fully in Table III below:— Table III. Article. No. of samples analysed. Result of examination. Genuine. Inferior. Adulterated. Almonds, ground 3 3 Balsam, Friar's 4 4 — Biscuits, cheese 1 1 — Blackcurrant drink cubes 1 1 Borax 2 2 — Butter 40 40 Cheese 7 5 2 Chicken and Ham Roll 1 1 Chocolate Confectionery 9 3 — 6 Cinnamon, ground 1 1 — — Citrate of Magnesia 2 2 — — Cocoa 11 11 — Coffee 5 5 Coffee and Chicory Extract 5 5 — — Cordial, peppermint 2 2 — — Cream, 18 17 — 1 ,, banana 1 1 „ horseradish 1 1 Cream of Tartar 3 3 Dripping 1 1 — — Essence, Brandy 1 1 — — „ Rum 1 1 — " Ex-Lax " 1 1 Fish Cakes 1 1 „ Paste 6 6 „ Tinned 16 10 6 Flour 3 3 „ Self-raising 8 6 — 2 Fruit, bottled 2 2 „ dried 8 8 .. glace 2 2 — — Fruit, pectin 1 1 — — „ tinned 11 11 — Ginger beer cubes 1 1 — — Ginger, ground 1 1 — — Glycerin of Thymol 2 2 — — Honey 2 2 — — Jam 11 6 — 5 Jelly, mint 1 1 — — „ red currant 1 1 „ table 3 3 Lard 8 8 Lemonade Powder 2 2 Lemon Curd 2 2 Margarine 9 9 — Marmalade 3 3 Meat Paste 6 6 ,, Pie 11 11 — — 86 Article. No. of samples analysed. Result of examination Genuine Inferior Adulterated. Milk 370 302 50 18 „ Condensed 23 22 — 1 „ Malted 2 2 — — Mincemeat 4 4 — — Mint, bottled 1 1 — — Mustard, French 1 1 — — Oil, Camphorated 5 5 — — „ Eucalyptus 3 3 — — „ Olive 6 6 — — Ointment, Boric 1 1 — — „ Calomel 1 1 — — „ Iodine 1 — — 1 „ Sulphur 1 1 — — „ Wintergreen 2 1 — 1 Paraffin, liquid 4 4 — — Parrish's Chemical Food 3 3 — — Pastilles, Blackcurrant 1 1 — — „ Glucose 1 1 — — „ Glycerin and Blackcurrant 1 1 — — „ Halibut Liver Oil 1 1 — — „ Iodine and Blackcurrant 2 1 — 1 „ Lysantol 1 1 — — Pepper 3 3 — — " Pepsi-Cola " 1 1 — — Pudding mixture. Rice 1 1 — — „ „ Semolina 1 1 — — Rice 3 3 — — Salmon and Tomato Cutlets 1 1 — — Salt, Celery 2 1 — 1 „ Epsom 2 2 — — „ Glauber's 2 2 — — „ Iodised 1 1 — — Sauces 11 9 — 2 Sausages 16 15 — 1 Seidlitz Powder 4 4 — — Semolina 3 3 — — Soup 2 2 — — Sugar, Icing 2 2 — — „ Pudding 4 4 — — Syrup, greengage 1 1 — — Syrup of Figs 2 2 — — Tablets, Aspirin 6 5 — 1 „ Iodised Throat 1 1 — — „ Yeast 2 2 — — Tea 4 4 — — Tincture, Ammoniated Quinine .. 3 3 — — „ Iodine 3 2 — 1 Treacle, black 1 1 — — Vegetables, tinned 15 15 — — Vinegar 9 9 — — Whiskey 6 5 — 1 Wine 11 10 — 1 Totals 800 695 50 55 87 From the figures in these Tables it would appear that the percentage of adulterated samples (6.9) was unduly high when compared with the figure for the whole of the country, and the inference might be drawn that the traders of Hammersmith are less honest than those in other parts of the country. When, however, the sources from which the samples were taken and the reasons which lead to their being taken are considered. Hammersmith traders are, to a large extent, exonerated. The analyses are discussed in the sections which now follow, attention being directed to the new types of adulteration encountered, as well as to numerous instances of false or misleading labelling. Milk. Of the three hundred and seventy milks examined eighteen were adulterated and fifty were classed as inferior because they were poor in fat. The percentage of adulterated samples is therefore 4.9 and that of inferior samples is 13.5. Eleven of the adulterated samples contained added water, the amounts found ranging from 1.0 per cent. to 8.7 per cent., while the remaining seven were deficient in fat, the deficiencies being from 2.0 per cent. to 21.0 per cent. A large percentage of London's milk supply is now received in Hammersmith from farms in the country, '' processed " in the Borough and distributed to different parts. In addition to routine sampling by the Council's officers, a careful check is kept upon the milk upon arrival by the wholesale dairies, and when supplies from a particular farm are suspected the Sampling Officer is called in. Of the eighteen samples of milk reported '' adulterated '' during the year, eleven were taken from churns consigned by three farmers upon their arrival in the Borough, and one was taken upon delivery to a school in Hammersmith from a dairy in a neighbouring borough. The blame for these adulterations cannot be placed upon Hammersmith 88 dairymen. More and more milk is being dealt with in Hammersmith each year, and this, no doubt, to some extent accounts for the increase in the number of adulterated samples reported. The milk is adulterated before it arrives in the Borough. The fact that the percentage of adulteration in Hammersmith is greater than in most of the neighbouring boroughs is partly accounted for by the fact that none of the other boroughs have the number of large wholesale dairies that are in Hammersmith. It is, I think, safe to say that little milk is received in these boroughs direct from the farms, and the lower percentage of adulterated samples reported may perhaps in some measure be ascribed to the efficent control exercised over the milk in Hammersmith from which source most of their supplies are drawn. The Sale of Milk Regulations, 1901, state that milk containing less than 3 per cent. of milk fat or less than 8.5 percent. of non-fatty solids shall be presumed not to be genuine. The presumption of the milk's non-genuineness, however, can be rebutted by the vendor if he proves that the milk is of the same composition as when it came from the cow. The Milk and Dairies Act, 1915. provides that the Medical Officer of Health or Sampling Officer of a local authority within whose area milk from any dairy situate outside that area is being sold or exposed for sale may, by notice in writing, require samples to be taken at the farm at the time of milking or in the course of delivery. In each of the cases where milk received in the Borough direct from farmers was reported to be " adulterated " this procedure was adopted, and in each case the examination of the samples taken at the farms showed some of the samples to be below the standard of the Regulations. The presumption that the milk received in Hammersmith was adulterated was therefore " rebutted." It is, of course, well known that the milk from a single cow may depart considerably as regards the proportions of its various constituents from what is regarded as normal. 89 In practice, however, the milk from a single cow is seldom sold separately and the mixed milk from a herd conforms much more closely to the average than does the milk from individual cows. The composition of average cow's milk in this country is 3.75 per cent. fat, 8.9 per cent. solids not fat, and 87.35 per cent. water, as against the Government standard of 3 per cent., 8.5 per cent. and 88.5 per cent. The average figures for all samples taken in Hammersmith during the year (see Table IV), including samples reported to be adulterated, were 3.61 per cent. fat, 8.77 per cent. solids not fat. The amount of fat in cow's milk depends upon several factors. Chief of these is the length of intervals between milking and the breed of the cows. When the milking periods are not equally divided the milk obtained after the longer interval will contain less fat than the milk from the other milking. The more nearly equal the intervals of milking are the more closely will the morning and evening milk correspond in fat content. The breed of cattle in any herd will influence the quality of the milk from that herd. Channel Island cattle will usually give milk with a much higher fat percentage than, say, Shorthorns or Fresians, although the yield of milk from the latter will be higher. It would appear that, in recent years, many farmers have concentrated upon obtaining an increased yield from their cows and paid little regard to the quality of the milk. From paragraphs which have lately appealed in the Press it would seem that this policy is to be carried still further. Experiments with " gland extract " injections are being carried on which, it is claimed, will still further increase the milk yield. The interests of the consumer appear to be of secondary consideration. Milk of normal quality ought to be available to the public and the sale of milk below normal should be an offence. By careful milking and attention to the intervals between milking such a standard can be easily attained for milk from a mixed herd. In my opinion the 90 present standard should be made an absolute and not a presumptive standard. Figures published by the Ministry of Agriculture and Fisheries show that the examination of samples of milk from different breeds of cows gives the following average fat content:— Jersey 5.43 per cent. Guernsey 5.16 ,, Kerry 4.67 ,, Welsh 4.40 Ayrshire 4.09 ,, Shorthorns 3.91 ,, Various crosses 3.82 ,, British Friesians 3.63 ,, These figures are averages from large numbers of each breed. The herds, from which most of the milk received in Hammersmith is drawn, consist largely of Welsh, Shorthorns and various crosses and reference to the above figures shows that the average fat content from cows of these breeds is over 4 per cent. or 33⅓ per cent. more than the present legal minimum. Returning to consideration of samples taken in Hammersmith during the year, the remaining six adulterated milk samples were procured from four local dairymen. Of these, three contained 1.0 per cent., 1.0 per cent. and 1.3 per cent. extraneous water respectively. The amount of adulteration was small and the vendors (two in number) were warned. On further samples being taken, the milk was found to be genuine. In the other three cases (from two dairymen) the adulteration was more serious and proceedings were taken. Fines amounting to £10 with £1 1s. Od. costs were imposed. The following Table shows the average content of fat and non-fatty solids in samples taken in the Borough, calculated month by month upon the total number analysed (these figures include samples reported as adulterated):— 91 Table IV. Period. No. analysed. Fat (per cent.) Non-fatty Solids (per cent.) January 21 3.64 8.77 February 23 3.51 8.75 March 31 3.64 8.82 April 17 3.63 8.55 May 32 3.36 8.75 June 33 3.43 8.84 July 41 3.52 8.76 August 14 3.38 8.72 September 13 3.69 8.77 October 14 3.75 8.80 November 34 4.00 8.84 December 97 3.81 8.86 Whole year 370 3.61 8.77 In addition to the milks analysed under the Food and Drugs Act, fifty-nine were submitted to the phosphatase test in order to ascertain whether they had been properly pasteurised. Nineteen failed to pass the test and two reached the limiting value. All the nineteen samples upon which adverse reports were received were not submitted as "pasteurised " milk. This test is a new one and certain samples to which raw milk had been purposely added were prepared in order to check the efficiency of the test. Other samples which had only been " flashed " were also submitted in order to ascertain whether the test was capable of differentiating between milks which had been treated by the different processes. Of the samples reported to show ' some error in technique " or " improperly pasteurised," nine were sold as pasteurised, two were from plants outside the Borough and seven were from Hammersmith dairymen. Of the latter, four were from the plant of one dairyman who was prosecuted and convicted. Of the samples actually sold as " pasteurised," five were reported as grossly under heated. Four of these were from plants outside the Borough and one only from a Hammersmith dairy. The Council will doubtless be aware that this Borough was among the first of the authorities to adopt the phospha- 92 tase test and that the value of this test has been amply demonstrated. It may be remarked here that this year's experience of the test has further proved its merits. Condensed Milk. Twenty-three tins of this article were analysed; all but one complied with the requirements of the Condensed Milk Regulations, both in regard to composition and the equivalent pints " value. Five were sold as " full cream " and eighteen as " machine skimmed." The one sample previously referred to was sour and the tin was blown; it was reported adulterated because it was unfit for food. Examination of the rest of the vendor's stock revealed no other faulty tins. Cream. Nine tins of cream which bore on their labels no claims to richness, though all of them were described as thick, were passed as genuine. Like the bulk of tinned cream now marketed, they contained only 23 to 25 per cent, of fat. A tenth sample had a label with the words " A highly concentrated and rich cream," but it contained only 23.3 per cent. of fat. This was reported adulterated, the Public Analyst expressing the opinion that the label was grossly deceptive in spite of the fact that in another part a content of 23 per cent. of fat was declared. A highly concentrated and rich cream should contain not less than 50 per cent. of fat. Of eight creams sold loose or in cartons, all being genuine, four were sold as " coffee " or " fruit " cream and contained about 25 per cent. of fat; two were sold as rich cream and contained 50.9 and 48.4 per cent. of fat, and two which were sold without description contained 45.0 and 38.3 ner cent. of fat. Cheese, &c. Seven samples of cheese were analysed during the year, two being adulterated. One of these was sold as Cheddar cheese and in the opinion of the Analyst should have contained at least 45 per cent. of fat on the moisture-free 93 cheese, but only 37.8 per cent. was present. The other contained 29.6 per cent. of fat and was described as "Cheese de luxe." In a recent case elsewhere the use of this title was defended on the ground that it meant nothing whatever in the trade. The Court did not appear to agree with the contention of the prosecuting authority that any ordinary purchaser would take it to imply a superior kind of cheese. A specimen of cheese biscuits was genuine. Butter, Margarine, &c. Forty specimens of butter, nine of margarine, eight of lard and one of dripping were all genuine. No preservatives and no excess of water were detected in any of them. Meat and Fish Preparations. Of a total of fifty-nine samples falling under this heading seven were adulterated. One of the samples passed as genuine was sold as sandwich paste and was disarmingly described on the label as being of " chicken and ham flavour." A sample of sausages which was reported against contained 343 parts of sulphur dioxide per million. No notice of the presence of this was given on sale as required by the Preservative Regulations and a letter of warning was sent to the vendor. Six tins of sardines—all of the same brand—were taken from a large batch of tins voluntarily surrendered and specially examined for metallic contamination. Analyses revealed the presence of 24, 100, 28, 28, 32 and 28 parts of lead per million respectively. The whole of the rest of the stock—4,969—tins was destroyed. Fruit and Vegetables. The twenty -three samples of fruit of various descriptions set out in Table III and the fifteen specimens of tinned vegetables were all genuine. Four of the dried fruits contained sulphur dioxide, but within the limit laid down by the Preservative Regulations. All the tinned articles were 94 examined for metallic contamination, but none was discovered. Conserves. Five jams of a total of eleven were adulterated. Three sold as full fruit standard blackcurrant jam contained only 16, 23 and 21 per cent. respectively of blackcurrants in place of the 30 per cent. required, whilst two samples of apricot jam contained only 28 and 32 per cent. respectively of apricots, whereas the standards of the Food Manufacturers' Federation require in apricot jam of full fruit standard a minimum of 40 per cent. of the named fruit. The total of fines and costs recovered in cases of adulterated jam was £11 1s. 0d. Eighteen other samples of various descriptions were genuine. Confectionery. Two samples of chocolate sweets described as being filled with fresh flowing cream " were adulterated. They were found to be filled not with cream but with a quite ordinary type of soft sugar confection commonly used in chocolates. This is misdescription of the grossest type, and, upon the matter being taken up with the manufacturers, the advertising showpiece upon which the wording occurred was withdrawn. One sample each of glucose pastilles and blackcurrant pastilles were genuine. Seven specimens of various types of chocolate cakes were analysed, and no fewer than four were adulterated. Three contained no cocoa whatever, and one which was sold as "chocolate cream buns " had a coating which consisted merely of an artificial chocolate-coloured sugary material containing no cocoa and a filling which consisted of a substance resembling cream in outward appearance, but which was not cream in fact. In regard to the proportion of cocoa that should be present in chocolate confectionery, a standard suggested by the British Research Association for the Confectionery 95 Trade is four per cent. of fat-free cocoa. One of the genuine samples contained as much as 8.7 per cent. of fat-free dry cocoa. It is therefore clear that honest confectioners have to compete against those who adopt the mean practice of substituting for chocolate in these articles something which is cheaper. People who buy these cakes may be presumed reasonably to expect at least as much cocoa as will give a flavour of chocolate; many not unreasonably expect to get a particularly nourishing food; in either case they are prejudiced if they are sold an article containing no cocoa whatever. Fines and costs imposed in the two cases taken to Court totalled £10 7s. 0d. Cocoa, Coffee, Tea, &c. Eleven cocoas, five coffees, four teas, and five coffee and chicory extracts were all genuine. One of the coffees was labelled " Pure coffee without grounds—a dry extract— the coffee part of the coffee bean. On analysis this proved to be correctly described; it was quite a good article and contained no foreign extractives and no added sugar. Farinaceous Foods. A sample each of rice pudding mixture and semolina pudding mixture, and three each of rice and semolina were genuine. Three samples of flour and eight of self-raising flour were also analysed. Whilst all the latter were satisfactory in regard to their " raising " ingredients, two were reported adulterated because of the finding therein of not less than 20 per cent. of potato starch. The same adulterant was found in all the flours; two had 5 per cent. and the other had 20 per cent. A fine of £1 and 10s. 6d. costs were imposed in one case. All the samples which contained potato starch were prepared by the same manufacturer. One of the self-raising flours reported genuine consisted of an ordinary type of this article, artificially coloured yellow, and contained no egg. It was sold in a paper bag upon one side of which it was described as " Egg Substitute 96 Self-raising Flour," the words "Egg Substitute" being in much smaller type than the rest of the title. On the other side of the bag the flour was described as "Egg Self-raising Flour—no eggs or baking powder required." Condiments, Spices, &c. A variety of articles to be classified under this heading, totalling thirty-five, were analysed; three of them were adulterated. A celery salt was found to be contaminated with both iron and tin, and since the tinned-iron bottom and cap of the container were corroded the metallic contamination obviously came from this source. The amount of iron found was 0.25 per cent. and the amount of tin was onethird of a grain per pound. It is understood that no other faulty packages were discovered upon examination of the rest of the stock by the Sampling Officer. Two specimens of mint sauce were found to consist of mint, vinegar and sugar, and were artificially coloured green. The label in both instances claimed that the sauce was prepared with malt vinegar, but on analysis the claims could not be substantiated, so the samples were reported adulterated. In a prosecution which followed, the Court accepted the plea of the makers that distilled malt vinegar had been used, and dismissed the case, but without costs against the Council. In a sample of iodised salt a determination of the iodine present indicated six parts per million. In a report such as this wherein so many cases of false or misleading labelling have to be chronicled, it is refreshing to call attention to one which went far in pursuit of the truth. A bottle of vinegar was labelled " Non-brewed Artificial Vinegar, made from acetic acid diluted with water." The manufacturers, probably having in mind the result of a recent London appeal case, apparently desired to leave nothing to chance in their description of the article. Nevertheless, they are to be congratulated upon their frankness. 97 Wines, Spirits Cordials, &c. Eleven samples of wine were examined during the year and were found to be free from preservatives and any deleterious ingredients. Special tests for methyl alcohol all gave negative results. Where it was possible to make determinations of the amount of methyl alcohol, the results were satisfactory; eight samples contained amounts between 10 and 15 per cent. by volume. One sample, though sold as a wine, bore a label which described it as " Concentrated Essence of Green Ginger Wine." This was reported adulterated because it consisted merely of a slightly gingerflavoured solution of tartaric acid coloured with burnt sugar. Of a series of six whiskies, one was 38.16 degrees under proof, whereas the Food and Drugs Act provides that all spirits should be not more than 35 degrees under proof. The alcoholic strength recorded is such as to indicate that the sample contained 4.86 per cent. of added water. Though the summons against the vendor was dismissed under the Probation of Offenders Act, five guineas costs were awarded to the Council. One peppermint cordial contained sulphur dioxide and another contained benzoic acid, the preservative in both instances being present in amounts within the limits permitted by the Preservative Regulations. Since the peppermint oil contained in these cordials is itself a powerful preservative, it is difficult to imagine any need for the addition of other preservative substances. A specimen of brandy essence and one of rum essence had the composition of flavourings usually sold under these names and were therefore reported genuine, though they probably owed nothing to brandy in the one case or rum in the other. A sample of blackcurrant drink cubes and one of ginger beer cubes upon analysis proved to be merely compressed cubes of sherbet with blackcurrant and ginger flavourings. Three lemonade powders were passed as genuine, as also was a ginger-flavoured cordial sold under a proprietary name which might be taken to suggest that it contained 98 pepsin and kola, though no claims were made to the actual presence of these substances. Miscellaneous Food Samples. Three specimens of ground almonds were genuine, as also were one of black treacle, one of greengage syrup, two of icing sugar and four of pudding sugar. One of the icing sugars was coloured pink and had a flavour of raspberries. Drugs. Sixty-four drugs in an exceptionally varied assortment were examined during the year, and, of these, five did not comply with the requirements of the British Pharmacopoeia or of the British Pharmaceutical Codex, or were defective in other respects. A specimen of aspirin tablets was found to be deficient in aspirin to the extent of 37 per cent. and to contain 19.5 per cent. of mineral matter having the characters of talc. An iodine ointment contained only 0.24 per cent. of free iodine and no potassium iodine, whereas the British Pharmaceutical Codex requires the presence of 4 per cent. of each. It contained 4 per cent. of iodine combined with a fatty base and therefore had the composition of stainless iodine ointment of the Codex which was deficient in combined iodine to the extent of 20 per cent. of the amount that should have been present. Two other iodine preparations were also defective; a sample of iodine and blackcurrant pastilles contained no iodine, and a tincture of iodine was 8 per cent, deficient in iodine. A warning letter was sent to the vendor of the latter. A wintergreen ointment, the label upon which stated that it contained 2.5 per cent. of methyl salicylate, wae found to contain 25 per cent. of that ingredient. It thus did not comply with the maker's own prescription and his attention was called to the inaccuracy on the label. Of the genuine samples only two call for comment. A laxative tablet sold under a proprietary name was found 99 to consist of the purgative phenolphthalein in a chocolate basis. A phial of yeast tablets was proved by analysis to be free from the dangerous drug amidopyrine which has, in the past, been discovered in such preparations. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 747 cases reported as due to notifiable infectious diseases in the Borough, against 658 in the previous year. There were also reported 748 cases of infectious diseases that were not notifiable, against 1,899 in the previous year; 81 of these were Measles, 314 Whooping Cough and 353 Chickenpox. The number of cases of Tuberculosis notified was 174 against 196 in the previous year. BACTERIOLOGY. The following bacteriological examinations were made on behalf of the Council:— Material from oases of suspected Diphtheria— Positive results 57 Negative results 902 Sputa from cases of suspected Tuberculosis Tubercle bacillus found 65 Tubercle bacillus not found 476 Blood from cases of suspected Fever— Widal or Typhoid reaction obtained - Wi,dal or Typhoid reaction not obtained 1 Fæces 6 Grand Total 1,507 100 Cases of Infectious Disease notified during the year 1937. Notifiable Disease Number of Cases Notified wards Total Removed to hospital. At all Ages Age Periods 1 2 3 4 5 6 7 Under 1 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— Smallpox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera (C) Plague (P) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 179 5 14 10 15 18 77 18 3 16 2 1 .. 38 18 18 15 29 35 26 179 Erysipelas 51 2 2 1 .. .. 1 5 2 6 7 21 4 8 12 5 4 6 11 5 37 Scarlet Fever 332 4 17 16 27 33 130 56 21 20 4 4 1 30 48 39 19 69 119 8 322 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. 1 Relapsing Fever (R) Continued Fever (C) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 9 .. .. .. .. .. .. .. .. 6 3 .. .. 1 1 1 2 1 2 1 9 Puerperal Pyrexia 37 .. .. .. .. .. .. .. 1 31 5 .. .. 3 8 5 5 4 7 5 36 Cerebro-Spinal Meningitis 5 1 1 1 .. .. .. .. 2 .. .. .. .. .. .. 3 1 .. .. 1 5 Polio-myelitis 2 .. .. .. .. .. 1 .. .. 1 .. .. .. .. 1 .. .. 1 .. .. 2 Encephalitis Lethargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 14 14 .. .. .. .. .. .. .. .. .. .. .. 4 1 4 2 .. 1 2 13 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 89 7 5 3 3 1 8 4 3 13 12 23 7 7 14 9 4 17 35 3 33 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery 26 5 4 2 3 2 8 1 1 .. .. .. .. 3 3 3 1 7 6 3 23 Food Poisoning 2 .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. 2 .. .. TOTALS 747 38 43 32 48 54 225 86 33 93 33 50 12 95 106 87 53 134 218 51 660 101 Deaths from the Seven Principal Zymotic Diseases.— The total number of deaths of residents registered from the seven principal zymotic diseases was 52 against 57 in the previous year. The deaths of residents from these diseases were equal to 33 per 1,000 of the total deaths of residents registered and were at the rate of 0.4 deaths per 1,000 persons living. The following table shows the deaths of residents registered from the seven principal zymotic diseases which occurred in the ten years, 1928 to 1937:— Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Enteric Fever. Diarrhoea and C holera. Total. 1928 0 23 3 5 5 2 33 71 1929 0 2 0 5 41 2 19 69 1930 0 31 3 21 9 1 24 89 1931 0 0 2 6 7 0 23 38 1932 0 29 4 8 6 1 26 74 1933 0 3 4 14 5 1 27 54 1934 0 25 4 25 19 0 27 100 1935 0 0 3 12 7 1 28 49 1936 0 15 3 5 7 2 25 57 1937 0 0 1 12 9 2 29 53 Average last 10 yrs. 0 13 3 11 12 1 26 64 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was eleven below the average number registered in the last ten years. 102 Notifiable Diseases (other than Tuberculosis) during the Year 1937. DISEASE. Total cases notified Cases admitted to Hospital. Total deaths. Diphtheria 179 179 12 Erysipelas 51 37 — Scarlet Fever 332 322 1 Enteric Fever 1 1 2 Puerperal Fever 9 8 4 Puerperal Pyrexia 37 36 Cerebro-Spinal Meningitis 5 5 2 Encephalitis Lethargica — — — Ophthalmia Neonatorum 14 13 — Pneumonia 89 33 126 Dysentery 26 23 — Poliomyelitis 2 2 — Malaria — — —. Food Poisoning 2 — — Totals 747 659 147 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 seventy-nine cases were reported as due to Diphtheria or Diphtheritic Membranous Croup against one hundred and thirty cases in the previous year. All the cases were treated at the Isolation Hospitals. Twelve deaths were registered. The mortality rate on the cases reported was 6.7 per cent. The cases were fairly evenly distributed throughout the Borough. Diphtheria is a disease which calls for prompt action by both the parent and medical practitioner. Parents often delay calling in a doctor when children are ill. Any child who complains of a sore throat should be immediately seen by a doctor and removed to hospital when the clinical evidence is such as to give reasonable grounds for assuming the case to be positive. 103 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, the Hammersmith Hospital and the West London Hospital, for the use of Medical Practitioners attending patients residing in the Borough. No difficulty was experienced in removing cases to Hospital, tbe accommodation available being adequate for the number of cases. 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 further fall in the numbers of children dealt with. Diphtheria—Nazaxeth House.—An outbreak of Diphtheria occurred amongst the children of Nazareth House during the period 2nd to 28th September, when altogether 14 cases were notified and removed to hospital. In view of the large number of inmates of the institution I thought it advisable for some effective methods to be employed to prevent the disease spreading to the remainder of the children. Accordingly on the 25th September, accompanied by Drs. Davies, Dancy and Renshaw, I visited the home and we Schick-tested 171 children between the ages of 3 and 12 years. A further 12 children under 3 years were not tested. We again visited the House on the 29th September and on reading the results of the Schick test, 52 were found to be positive and 117 to be negative. On the same morning we injected the 52 positive children and the 12 under 3 years (who were not tested and were 104 assumed to be positive) with 2,000 units of Anti-toxin each to obtain immediate passive immunity. On the 7th October Dr. Davies and I actively immunised these 64 children with Alum Precipitated Toxoid (one shot). The efficacy of this last injection will be ascertained at a later date. After the administration of Anti-toxin on the 29th September no further case was reported. The following are the particulars of the work done under The immunisation scheme during the year:— Number of children who received immunising dose or doses 500 Number of children who did not complete the three doses:— 1 22 2 11 Schick Testing Clinic. Number of Clinics held 22* (8 of these were for inspection only) Pre-Schick tests. Positive 53 Negative 180 No reading 2 Post-Schick tests. Positive 1 Negative 269 No reading 7 Refusals of Post-Schick Test 18 Removals—address unknown—no Post-Schick Test 16 Removal—information sent on to M.O.H. concerned 11 * Does not include visits to Nazareth House, a Report of which precedes these figures. 105 Scarlet Fever.—Three hundred and thirty-two cases were notified as due to Scarlet Fever, against three hundred and thirty-five in the previous year. Three hundred and twenty-two cases were treated at the Isolation Hospitals, and ten at the homes of the patients. One death was registered. The mortality rate was 0.3 per cent. Enteric Fever.—One case was reported as due to Paratyphoid Fever, against thirteen cases in the previous year. The case was treated in hospital. Erysipelas.—Fifty-one cases were reported as due to Erysipelas, against thirty-eight cases in the previous year. Fourteen cases were treated at the homes of the patients, and thirty-seven in various hospitals. Typhus Fever.—No case was reported as due to Typhus Fever. Fees paid to medical practitioners. 220 at 10s. 110 0 0 12 at 6s. 8d. 4 0 0 1 at 5s. 0d. 5 0 25 at 8s. 4d. 4 3 4 12 at 2s. 6d. 1 10 0 £119 18 4 108 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 nine cases in the previous year. Four cases were treated at Isolation Hospitals of the London County Council, 1 at Queen Charlotte's Hospital, 2 at Hammersmith Hospital, and 1 at St. George's Hospital. One patient was not removed. One death was registered from Puerperal Sepsis and 3 from other accidents and diseases of pregnancy. Puerperal Pyrexia.—Thirty-seven cases were reported as due to Puerperal Pyrexia against twenty-one in the previous year. One case was treated at home, two at Queen Charlotte's Hospital, four at Isolation Hospitals of the London County Council, and thirty at various other hospitals. Cerebro-Spinal Meningitis.—Five cases of Cerebrospinal Meningitis were reported against six cases in the previous year. All cases were treated in hospitals and 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 University College Hospital and one at the Princess Louise Hospital. Encephalitis Lethargica.—No case was reported as due to Encephalitis Lethargica, against no case in the previous year. Ophthalmia Neonatorum.—Fourteen cases were reported as due to Opthalmia Neonatorum, against four cases in 109 the previous year. Five eases were treated at a London County Council Isolation Hospital, eight at Hammersmith Hospital and one at home. In the case treated at home arrangements were made for a nurse to attend. Thirteen 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.—Eighty-one cases of Measles and German Measles were notified against one thousand three hundred and seventy-two in the previous year. Thirty-eight cases were treated in the Isolation Hospitals of the London County Council. No deaths were registered. Use of Convalescent Serum in Prevention of or Attenuation of Measles. Princess Christian Day Nursery, 218, Goldhawk Road. —On the 7th September, 12 children of the above Day Nursery were injected with Convalescent Measles Serum obtained from the London Fever Hospital. The treatment was carried out by Dr. H. W. Hammond of No. 31, Girdlers Road, the Medical Officer of the Nursery. 110 Of the total who received the doses, 3 had complete immunity and the remaining 9 developed the disease. Of these, 8 had very slight uncomplicated attacks and 1 an average acute attack. Of the 9 children who contracted the disease, the period between the administration of the serum and attack is set out:— 1 in 4 days. 3 in 5 days. 5 in 6 days. The incubation period for measles is 9-12 days, and it is obvious that the children who contracted the disease had already been infected before the administration of the serum. Seven other children who had not been immunised contracted measles and had attacks of varying severity. Whooping Cough.—Three hundred and fourteen cases of Whooping Cough were reported, against two hundred and thirty-four in the previous year. Nine deaths were registered. Seventy cases were removed to hospital. The homes of the patients were visited by your Lady Inspector, and the parents advised as to the precautions that should be taken. Chicken Pox.—Three hundred and fifty-three cases of Chicken Pox were reported, against two hundred and ninety-three in the previous year. Forty-eight cases were removed to hospital. 112 Pneumonia.—Eighty-nine cases of Pneumonia (thirtytwo Influenzal Pneumonia and fifty-seven Primary Pneumonia) were notified during the year. Thirty-three cases were treated at various hospitals. 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 twenty-six deaths were registered. Malaria.—Two cases were reported. Dysentery.—Twenty-six cases of Dysentery were reported against fourteen cases in the previous year. Food Poisoning.—Two cases of Food Poisoning were reported. Influenza.—During the year forty-nine deaths from Influenza occurred, as compared with fifteen in the previous year. Wrong Diagnosis.—Twenty-seven cases of infectious disease were removed to the Hospitals of the London County Council and subsequently returned home in consequence of the patients being found not to be suffering from the disease stated on the certificates, or any other notifiable disease— Diphtheria 18 Scarlet Fever 9 Total 27 Psittacosis.—No case of psittacosis was reported in the Borough during the year. 118 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 118 Mattresses 553 Pillows 1,540 Bolsters 337 Blankets 1,844 Sheets 1,259 Quilts 1,045 Articles of Clothing 4,510 Sundries 465 Carpets 19 Curtains 13 Total 11,703 Rooms (including 62 verminous rooms) 789 TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1928 to 1937. Year. Smallpox. Scarlet Fever. Diphtheria or Diphtheritic Croup. Typhus Fever. Enteric Fever. Simple Continued Fever. Relapsing Fever. Puerperal Fever. Puerperal Pyrexia. d Cholera. Erysipelas. Plague. Chickenpox. a Measles b a Whooping Cough. a Cerebro-Spinal Fever. Anthrax. Glanders. Hydrophobia. Ophthalmia Neonatorum. Acute Polio-Myelitis. Encephalitis Lethargica. Pneumonia. c Malaria. c Dysentery. c Trench Fever. e Food Poisioning. f Total. 1928 0 337 380 0 8 0 0 7 18 0 52 0 114 631 45 3 0 0 0 21 3 3 130 5 1 0 0 1758 1929 0 409 249 0 4 0 0 9 15 0 74 0 87 237 113 3 0 0 0 13 0 3 232 0 1 0 0 1452 1930 21 498 384 0 6 0 0 10 26 0 63 0 432 1486 206 3 0 0 0 14 1 4 166 0 0 0 0 3320 1931 49 280 228 0 1 0 0 5 30 0 48 0 707 178 264 9 0 0 0 13 0 2 141 0 2 0 0 1957 1932 0 594 192 0 4 0 0 2 29 0 51 0 405 1588 330 8 0 0 0 19 1 1 178 0 1 0 2 3405 1933 0 895 241 0 8 0 0 9 33 0 97 0 333 299 319 6 0 0 0 10 4 1 179 0 3 0 8 2445 1934 0 609 549 0 1 0 0 2 22 0 79 0 422 1334 272 6 0 0 0 11 1 1 154 0 0 0 4 3467 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 1937 0 332 179 0 1 0 0 9 37 0 51 0 353 81 314 5 0 0 0 14 2 0 89 0 26 0 2 1495 Average for 10 years 7 464 287 0 5 0 0 6 25 0 60 0 358 725 241 5 0 0 0 13 2 2 144 1 6 0 3 2353 a Not Notifiable. b Notifiable during the years 1916—1919. e Notifiable from 1st March, 1919, to 31/12/1927. c Notifiable from 1st March, 1919. d Notifiable from 1st October, 1926. f Notifiable from 12th July, 1932. 115 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—Hammersmith. Scabies 325 Verminous 2,223 Impetigo 220 School Children—Non-Hammersmith— Scabies 3 Verminous 125 Impetigo 3 Children under Five Years—Hammersmith. Scabies 30 Verminous 4 Children under Five Years—Non-Hammersmith. Scabies 2 Adults—Hammersmith. Scabies 185 Verminous 17 Impetigo 2 Other Conditions 2 Adults—Non-Hammersmith— Verminous 12 Common Lodging-houses— Verminous 74 The County Council pay the sum of two shillings in respect of each child cleansed, except in cases of scabies 116 or impetigo in which case the payment is at the rate of Is. for each bath given. The amount received from the London County Council during the year was £234 16s. 0d. in respect of cleansings and £27 11s. 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 1936 shows that 1,159 Infants were vaccinated, this being 63.8 per cent. of the Births and compared with 68.0 per cent. in 1935. No proceedings under the Vaccination Acts were instituted. VACCINATION RETURNS. RETURN FOR 1936. 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., 1936 Number of these Births duly entered by 31st January, 1938, in Columns I, II, IV and V of the " Vaccination Register " (Birth List Sheets), viz.: Number of these Births which on 31st January, 1938, remained unentered In the " Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1938, 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 1937 Number of statutory Declarations of Conscientious Objection actually received by the Vaccination Officer irrespective of the dates of birth of the children to which they relate during the calendar year 1937 Col. 1 Successfully Vaccinated Col. II Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received Col. V Dead, Unvaccinated Postpone ment by Medical Certificate Removal to Districts, the Vaccination Officer of which has been duly apprised Removal to Places unknown or which cannot be reached; and Cases not having been found Insusceptible of Vaccination Had SmallPox 1 2 3 4 5 6 1 7 8 9 10 11 12 13 1. North Hammersmith 465 219 1 — 156 19 4 17 32 17 256 163 2. Hammersmith Hospital 985 530 — — 247 38 7 69 78 16 660 315 3. South Hammersmith 410 108 2 — 106 18 6 19 25 36 202 102 4. "Invermead" 407 209 — — 84 12 — 82 19 1 176 95 6. Removed into Borough — — — — — — — — — — 165 24 2,267 1,156 3 — 593 87 17 187 164 70 1,459 699 Table showing Work of Vaccination Officer from 1st January to 31st December, 1937. 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. District No. 1. District No. 2. District No. 3. District No. 4. District No. 5. Queen Charlotte Hospital. Marlesford Lodge. Other Doctors. District No. 1. District No. 2 District No. 3. District No. 4. District No. 5. Total North 2 100 48 54 3 — — 48 1 256 163 24 — 42 260 46 10 18 2 91 53 64 3 213 South 60 12 59 2 — — — 69 — 202 102 28 — 56 219 22 16 14 93 6 62 1 — 162 Hammersmith Hospital 77 103 130 54 2 — — 294 — 660 315 31 — 735 632 63 64 79 102 113 150 69 5 448 Queen Charlotte's Hospital 6 3 3 3 — — — 161 — 176 95 2 — 321 31 1 7 6 8 7 4 5 — 24 Removed Inwards 26 39 66 10 4 — — 20 — 165 24 28 254 — 111 27 — — 42 26 66 15 4 153 Total 171 257 306 123 9 — — 592 1 1459 699 113 254 1154 1253 159 97 137 247 243 335 140 12 1000 Total number of births registered during 1937 = 2,698. 119 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 seventy-four cases of Tuberculosis were reported during the year, one hundred and forty-one of which were Pulmonary and thirty-three being other forms of Tuberculosis, against one hundred and ninety-six cases in the previous year. PART I. Summary of Notifications during the period from the 1st January, 1937, to the 31st December, 1937. 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 — — — 3 5 6 18 17 14 10 5 78 98 Pulmonary Females 1 2 1 7 17 20 8 3 4 — 63 77 Non-pulmonary Males — 4 5 — — 3 2 1 — 1 — 16 18 Non-pulmonary Females 1 3 1 2 1 3 2 1 — 3 17 21 120 PART II. Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age Periods 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary Males — 1 — 1 3 2 13 5 5 3 1 34 Pulmonary Females - - - - - 3 12 1 1 1 I 19 Non-pulmonary Males.. - — 3 2 - - 1 1 - — - 7 Non-puimonary Females _ 1 — 1 1 1 — — — — 4 Source of Information No. of Cases Pulmonary Nonpulmonary Death Returns from local Registrars 5 transferable deaths from Registrar General 2 1 Posthumous notifications 6 2 "Transfers" from other areas (other than transferable deaths) 40 8 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, 1937, on the Registers of Notifications 411 303 714 166 189 354 1,068 Number of cases removed from the Register(s) during the year by reason, inter alia, of:— 1. Withdrawal of notification 2 1 3 — 1 1 4* 2. Recovery from the disease 13 11 24 2 7 9 33 3. Death 64 42 106 3 5 8 114 4. Otherwise 38 30 68 12 8 20 88 * Not to be included in Part I— Formal Notifications. 121 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. Ninety-five deaths from Pulmonary Tuberculosis were registered, against ninety-nine in the previous year, representing a death-rate of 0.8 per 1,000 compared with 0.8 in 1936. The notification of cases of Tuberculosis by medical practitioners is, unfortunately, not carried out in all cases as required by the Regulations, that is within 48 hours of the same coming to their knowledge. In all cases where failure to notify occurs, the attention of the medical practitioner is called to the fact and his observations requested. The majority of the non-notified cases are tuberculous meningitis, the diagnosis being made post mortem It has not been deemed necessary to take any further action as the explanations have been considered satisfactory. I append figures for the years 1928-37, showing the interval between notification and death of tuberculous persons. 1923. 1924. 1925. 1923. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1937. 1. Total number of deaths from Tuberculosis in the Borough 145 170 138 142 181 135 149 153 127 156 150 124 119 116 100 2. The number of cases notified at death 11 10 13 8 — 7 3 7 2 6 13 5 11 6 8 3. The number of cases notified within one month of death (excluding above) 21 23 18 30 25 17 32 18 16 21 17 21 11 20 16 4. The number of cases notified within three months of death (excluding above) 18 20 13 ! 20 23 13 18 21 14 17 17 9 8 7 11 5 The number of cases notified within six months of death (excluding above) 13 16 18 12 18 9 8 9 14 15 16 11 11 7 8 122 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1937:— ###]Periods New Cases. Deaths. Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0 — — — 1 — — — — 1 1 1 4 4 — — — 2 5 — 2 8 1 — 1 1 1 15 12 8 2 5 7 11 — 1 25 39 52 6 4 14 11 2 1 35 22 9 2 2 8 8 — — 45 19 4 — 1 14 3 1 — 55 13 5 1 — 8 3 — — 65 and on 6 1 — 3 6 1 2 — Total 112 82 23 21 57 38 6 5 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is 1 to 7. 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. 1918 330 44 374 230 — — 1919 313 52 365 170 — — 1920 284 75 359 157 — — 1921 260 51 311 173 — — 1922 246 49 295 162 — — 1923 211 63 274 145 — — 1924 200 56 256 170 — 1,426 1925 220 45 265 138 — 1,280 1926 210 68 278 142 824 1.302 1927 226 53 279 182 686 1,289 1928 205 56 261 135 744 1,308 1929 217 63 280 149 818 1,334 1930 196 54 250 153 803 1,293 1931 183 56 239 127 905 1,198 1932 183 45 228 156 763 1,128 1933 185 31 216 150 749 1,056 1934 184 31 215 124 715 1,070 1935 170 31 201 119 759 1,059 1936 156 40 196 116 805 1,063 1937 141 33 174 106 834 1,068 123 Average number of cases notified for the 10 years 1918-1927 (inclusive) = 306. Average number of cases notified for the 10 years 1928-1937 (inclusive) = 226. Average number of deaths for the 10 years 1918-1927 (inclusive) = 167. Average number of deaths for the 10 years 1928-1937 (inclusive) = 134. 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. Hammehsmith Hospital. Thursdays. 3 p.m. X-Ray Clinic. Wednesdays, 2 p.m. Dental Clinic. 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, 1937, the number of patients on the Dispensary Register was 834, 124 During the year 74 definite cases of the disease were transferred from other areas into the Hammersmith district and 116 moved out of this district or were lost sight of. Thirty-one were written off the register as being cured cases who had previously been notified as suffering from tuberculosis. New Patients. During the year 704 persons attended for examination for the first time, 326 males and 378 females. Of these, 215 were under the age of fifteen and 489 were adults. Of the total 171 were referred to the Dispensary by local practitioners for the purpose of consultation and 347 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 intiative. Diagnosis. Found to have Pulmonary Tuberculosis 126 Found to have other forms of Tuberculosis 24 Showing no evidence of Tuberculosis 554 Total Attendances and Examinations. The total attendances of persons for the purpose of examination, observation or treatment, numbered 2,503 and physical examinations were carried out in 1,685 instances, i.e., in 67 per cent. of the total attendances. The names of 555 persons were written off the register as being non-tuberculous, and the total number on the Dispensary Register on 31st December, 1937, was 824. Sputum Examinations. Four hundred and ninety-one specimens of sputum and other pathological products were examined bacteriologically. Sixty showed the presence of Tubercle Bacilli, while 431 proved negative. 125 Institutional Treatment. The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homes), under the London County Council's Scheme, numbered 248. Others have entered Convalescent Homes through the following agencies:—The local Children's Aid Association, the local Charity Organisation Society, the local branch of the United Services Fund, and the Public Assistance Committee. Clinical Reports. To the London County Council 462 To General Practitioners and Hospitals 742 Home Visitation. The Tuberculosis Officer made 171 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 56 occasions. The Nurses visit the tuberculosis population on notification and thereafter as far as possible at intervals of six months or less, as may appear advisable. During the year 3,887 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. Extra Nourishment. 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 (Continued on page 131) 126 Return showing the work of the Dispensary during the year 1937. Diagnosis Pulmonary Non-pulmonary Total Grand Total Adults Childr'n Adults Childr'n Adults Childr'n M. F. M. F. M. F. M. F. M. F M. F. A —New Casks examined during the year (excluding (a) Definitely tuberculous 63 44 2 2 5 7 5 6 68 51 7 8 134 *(b) Diagnosis not completed — — — — — — — — — — — — (c) Non-tuberculous - - - - - - - - 88 94 20 21 223 B.—Contacts examined during (a) Definitely tuberculous 3 11 1 — — — 1 — 3 11 2 — 16 *(b) Diagnosis not completed - - - - - - — - - - - - - (c) Non-tuberculous - - - - - - - - 61 113 77 80 331 C.—Cases written off the Dispensary Register as:— (a) Recovered 11 9 — 2 — 2 3 4 11 11 3 6 31 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 150 207 97 101 555 D.—Number of Cases on Dispensary Register on December 31st (a) Definitely tuberculous 298 260 19 10 58 76 53 50 356 336 72 60 824 (b) Diagnosis not completed — — — — — — — - — — — — — 1. Number of cases on Dispensary 8. Number of visits by Tubercu- Register on January 1st 834 losis Officers to homes (includ- 2. Number of cases transferred ing personal consultations)t.. 237 from other areas and cases returned after discharge under 9. Number of visits by Nurses or Head 3 in previous years 74 Health Visitors to homes for 3. Number of cases transferred to Dispensary purposes 3,837 other areas, cases not desiring further assistance under the 10. dumber of:- scheme, and cases " lost sight (a) Specimens of sputum, Ac., of" 116 examined 491 4. Cases written off during the year 86 X-ray examinations made, as Dead (all causes) in connection with dispensary 5. Number of attendances at the work 303 Dispensary (including con- tacts) 2,503 11 Number of " Recovered " cases 6. Number of Insured Persons restored to Dispensary Regis- under Domiciliary Treat- ter, and included in A (a) and ment on the 31st December 347 A (6) above Nil 7. Number of consultations with medical practitioners 12. Number of T.B. plus cases (o) Personalt 171 on Dispensary Register on (b) Other 474 December 31st 382 * i.e., remaining undiagnosed on 31st Dec. [see Memo. 37/T (Revised), p. 10, Sec. II, Note 4} † All personal consultations, whether held at the homes of patients or elsewhere, should be included in Item 7 (a); and all visits by Tuberculosis Officers to homes, whether or not accompanied by a personal consultation already included in Item 7 (a), should be entered in Item 8. PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1937 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 1927 1927 1928 1929 1930 1931 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 Adults Arrested children M. 3 1 2 3 1 1 - 1 - - _ _ - 1 - 1 - 1 1 - - 2 - 2 F. 2 2 — — 2 — 1 — 1 — I — 1 — — — - 1 1 — — 1 1 2 1 - 3 2 — — — — — — — — — — — — — - 1 — — — — 1 — — — — — — — — - Disease not Adults Arrested children M. 4 4 6 2 12 5 2 2 9 4 1 - 5 2 5 3 2 10 4 - 4 6 1 4 11 F. 8 2 4 — 6 — 1 — 1 — 1 1 2 2 3 2 7 4 1 — 3 4 4 4 4 — 8 — — — — — 1 — — — — — — ~ - - 1 — — - — 2 1 — — 1 — 1 — — 1 Condition not ascertained during the year — - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 19 9 12 2 23 2 6 4 2 12 - 6 1 _ 7 7 7 7 4 18 13 3 - 3 6 9 13 8 4 25 (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged Adults as Recovered Children M. 26 4 3 - 7 4 - 2 - 2 4 4 - - 4 4 2 - - 2 5 1 2 - 3 3 - - - - F. 24 4 3 7 9 - — — 3 1 -1 2 6 4 4 4 — 1 — 1 7 1 - 1 20 - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - Lost sight of, or otherwise removed from Dispensary Register 128 32 39 11 82 26 10 19 6 35 31 21 20 3 44 31 15 13 2 30 33 15 18 - 33 15 6 27 2 35 Dead Adults Children M. 8 6 24 20 50 1 5 15 31 51 2 5 17 15 37 12 8 14 10 32 9 11 24 12 47 8 11 15 1 27 F 7 4 11 16 31 4 3 5 12 20 6 18 12 0 36 5 3 9 5 17 12 8 12 6 26 5 4 13 3 20 2 — - — — 2 — 1 — 1 2 — — — — — — — — — — — 1 — 1 1 - — — - Total written off Dispensary Register 215 50 80 47 177 48 18 42 49 109 49 49 50 24 123 69 32 36 17 85 63 35 58 18 111 40 21 56 6 83 Grand Totals 234 59 92 49 200 50 24 46 51 121 49 55 51 24 130 60 39 43 21 103 76 88 58 21 117 49 34 64 10 108  1932 1933 1934 1935 1936 1937 (a) Remaining on Dis- pensary Register on 31st December. Disease Adults Arrested Chlldren M - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. 1 I 4 — ft — 1 4 — 5 1 - - - - - - - - - - - - - - - - - - - — — — — — — — - — — — — — — — — — — — — — — — — — — - Disease not Adults Arrested Children M. 3 0 4 10 10 1 14 2 17 7 8 19 2 29 14 5 24 3 32 15 6 20 5 37 15 5 26 3 34 F. 6 1 5 1 7 10 6 5 — 11 8 3 9 2 14 11 5 1 4 24 10 9 22 2 33 15 12 15 3 30 3 1 — — 1 1 — 1 — 1 4 — — — — 2 — — — — 3 — - - — 4 — — — — Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - Total on Dispensary Register at 31st December 13 9 13 1 23 27 8 25 2 35 20 11 28 4 43 27 10 39 7 56 34 15 48 7 70 34 17 41 6 64 (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged Adults as Recovered ChUdren M. 1 1 - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Resister 15 9 23 3 35 7 7 23 2 32 10 8 15 5 28 13 10 13 3 20 7 0 8 - 14 5 - 1 1 2 Dead Adults Children M. 6 a 18 12 38 7 8 20 11 45 5 7 11 10 31 5 i 18 7 32 2 — 13 11 24 — — 4 14 18 F. 7 9 1 18 4 5 16 8 29 7 3 18 7 28 3 3 9 ft 17 3 1 6 2 9 2 — 5 2 7 1 — 1 — 1 1 — — - - 2 — 1 — l — — — — — 1 — — — — 1 - — 1 1 Total written off Dispensary Register 30 20 52 16 94 19 20 63 21 106 24 18 45 28 91 21 20 40 15 75 13 7 27 13 47 8 — 10 18 28 Grand Totals 43 65 17 117 40 28 90 23 141 44 29 73 32 134 48 30 79 22 131 47 22 | 75 20 117 42 17 51 24 92 NON-PULMONARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of 1937 of all patients remaining on the Dispensary Register ; and (b) the reasons for the removal of all eases written off the Register. Condition at the time of the last record made during the year to which the ret,urn relates Previous to 1927 1927 1928 1929 1930 1931 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints ' Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dis pensary Register on 31st. December. Disease Adults Arrested children M. _ _ _ _ _ _ _ _ _ _ 1 _ _ 1 2 - - - - - - - - - - - - - - - F. 3 —- — 3 6 — — - — — - - - - 2 - 1 3 1 - - - 1 1 2 - - 3 1 - - 2 3 - - - - - - - - - - 2 - - 1 3 2 — 1 3 - 1 — 2 3 Disease not AdultsArrested children M. 1 _ 3 1 5 1 _ 1 2 2 1 1 _ 4 1 1 2 _ 1 1 4 6 _ _ 2 8 F. — 3 3 5 11 1 — — — 1 — - 1 1 2 — 1 2 3 1 — 3 4 4 — 1 3 8 — 1 1 2 — — — — — — — 1 — 1 — — -— — - 5 — — 4 9 4 — 1 1 6 Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 5 3 7 12 27 2 - - 1 3 3 1 3 2 9 4 1 1 1 10 11 - 1 9 21 15 3 2 8 28 Transferred to Pulmonary b) Not now on Dispensary Register and reasons for removal therefrom. Discharged Adults as Recovered Chi]dre| M. 5 3 - 8 1 - 1 2 - - 1 1 1 - - - 1 - - - - - F. 3 4 1 9 17 1 1 — — 2 — — — — — — — 1 1 1 — 1 2 4 — — _ 2 2 9 2 1 23 35 2 1 — 2 5 4 — - 8 12 — - 2 3 5 — — — 6 6 1 2 1 2 6 Lost sight of, or otherwise emoved from Dispensary Register 37 - 4 27 68 9 1 3 6 19 3 - 3 8 14 4 8 8 20 13 2 - 5 20 8 4 - 9 21 Dead Adults Children M. 3 — — — 3 1 — — — 1 1 — 1 - 2 1 — — — 1 1 — 2 — 3 — — — — - — 1 - 1 2 — — — — — — — — — — 2 — — — 2 — 1 3 — 4 1 o — — 3 - 1 1 - 2 - - - - - 2 - - - 2 - - - - - - - - - - - - - - - Total written off Dispensary Register 57 18 10 60 135 14 3 3 9 29 10 — 4 17 31 8 — 10 12 30 15 3 6 13 37 10 8 1 13 32 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary) 62 11 17 72 162 16 3 3 10 32 13 1 7 19 40 12 1 11 16 40 26 3 7 22 58 25 11 3 21 60  1932 1933 1934 1935 1936 1937 (a) Remaining on Dispensary Register on 31st December. Disease Adults Arrested childrer M. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - F. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 4 1 - 3 8 - - - - - - - - 1 1 - - - - - - - - - - - - - - - Disease Adults not Arrested Children {M. — 1 — 2 3 — — 2 — 2 3 1 3 - 7 5 — 1 6 5 3 1 9 3 - 1 1 5 { F. 1 — — 1 2 4 — — 3 7 2 1 2 2 7 2 3 3 8 - 1 3 - 4 3 1 - 2 6 4 — — 4 8 2 2 1 3 8 5 1 — 8 14 2 2 — 3 7 6 2 2 8 18 5 - — 4 9 Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - Total on Dispensary Register at 31st December 9 2 -- 10 21 6 2 3 6 17 10 3 5 11 29 9 5 - 7 21 11 3 8 9 31 11 1 7 20 Transferred to Pulmonary (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Adults Recovered Children ( M. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - {F. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 1 - - - 1 - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary 7 - — 8 15 3 2 1 6 12 3 1 — 4 8 1 1 1 2 5 — — - _ — — i — 1 2 Dead Adults Children { M 1 1 1 - 1 1 3 - - - - - - - - - - - - - - - - - - - - {F. - — — — - - - - - — — 1 — 1 - 1 — 1 - - - - - - - - - - - - - - 1 1 - - — - - 1 - 1 - 2 — — 2 — 2 Total written off Dispensary Register 9 — — 8 17 4 2 2 7 15 3 1 1 5 10 1 2 3 2 6 1 - 1 - 2 — 1 2 1 4 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 18 2 - 18 38 10 4 5 13 32 13 4 6 16 39 10 7 1 9 27 12 3 9 9 33 11 2 3 8 24 131 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 consideraton of the clinical and social features of the case. The number of patients who received this nourishment was fifty-six. 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, the Local Medical Practitioners, Invalid Kitchens, West London Hospital. Hammersmith Hospital, Local Employment Committee, War Pensions Committee and Messrs. J. Lyons & Co., Ltd. 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, £130 '2s. 7d. was collected with a net result of £92 2s. Id. 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. Forty-seven such patients were assisted. During the year two hundred and thirty-five 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. 132 One hundred and twenty-five cases were referred for assistance to the following agencies :— Invalid Children's Aid Association 16 Invalid Kitchens of London 8 Unemployment Assistance Board 6 School Care Committee 13 Public Assistance Committee 35 Mayor's Fund 25 United Services Fund 10 British Red Cross Society 1 London County Council 11 In addition, seventeen cases were recommended for preferential consideration for better housing accommodation. 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 arid 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. 133 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 10 17 3 Rubber Rings 3 I 1 Air Rings 9 10 4 Rubber Hot-Water Bottles 13 11 11 Bed Pans 6 9 6 Ice Bags 4 1 1 Air or Water Bed 2 1 1 Inhalers 21 3 3 Air Cushion 1 — Aluminium Hot-Water Bottles 6 4 4 Bronchitis Kettles 6 3 3 Feeding Cups 6 1 1 Bed Sheets 4 8 2 Water or Air Cushions 7 4 3 Iron Bedsteads with Mattress 5 4 4 Urinals 0 4 4 Invalid Chairs 1 1 1 Bed Cradles 3 1 1 Repairs to Surgical Appliances. During the year one repair was carried out to surgical appliances for necessitous patients. This repair was arranged by the Dispensary and financial assistance was given from the Nursing Comforts Fund at the recommendation of the Tuberculosis After-Care Committee. Report on Tuberculosis Work at the Hospital. All Tuberculosis cases are now treated at St. Charles Hospital in the Borough of Kensington. 134 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. 135 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 303. 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 who received this form of treatment was 22. The total number of refills performed by the Tuberculosis Officer in the dispensary for the year 1937 was 218. 136 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. Nine sanocrysin injections were made during the year. 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. Staff.—There are nine male Sanitary Inspectors and one lady Sanitary Inspector. Eight of the male Inspectors are employed as District Inspectors, being responsible for all matters excepting the taking of samples under the Sale of Food and Drugs Acts and the inspection of Ice Cream Vendors, for which the Special Inspector is responsible. The Special Inspector also inspects the Markets. The Lady Inspector carries out the duties in relation to Child Life Protection, inspects Factories, &c., where females are employed, and makes enquiries into cases of measles, whooping cough, chicken pox, &c. 137 Increase of Rent and Mortgage Interest Restrictions Act, 1920-1933.—During the year eighteen applications were received for certificates under the above Act. In seventeen cases the certificates were granted. This total includes four applications from owners, and all were issued where the work specified had been completed satisfactorily. EXHUMATION AND RE-INTERMENT OF BODIES. St. Mary's Catholic Cemetery, Harrow Road. During the year a licence was granted by the Secretary of State for the exhumation and removal of a body from the catacomb or grave in St. Mary's Cemetery. The body was removed to Italy. The work of removal and re-interment was carried out in accordance with the conditions and under the supervision of the Sanitary Inspector on my behalf. PUBLIC BATHS. The Public Swimming Baths in Lime Grove and the Open-air Swimming Bath in Bloemfontein Road, are provided with aeration and filtration plants, whereby the water is continuously filtered, aerated and chlorinated. The water is pumped from a point at the deepest part of the Baths, passed under pressure to gravel filters, then into a chamber or tank where it is aerated, and afterwards chlorinated before returning to the Baths. SWIMMING BATHS. During the year 72 samples were taken from water in the public swimming baths and submitted for bacteriological examination. Generally the results from the Open 138 Air Bath at Bloemfontein Road and the First-Class Bath at Lime Grove were satisfactory, on a few occasions only were adverse reports received in respect of these baths. The reports in regard to the Second-Class Bath at Lime Grove, however, were not so satisfactory. During the whole of the season that the Open-Air Bath was in use the water was particularly good. On no occasion did the plate count exceed the maximum per cubic centimetre which has been adopted as a standard. One report only disclosed the presence of B. Coli in '20 and 10 c.c., and it is interesting to note that the day upon which this sample was taken was the only occasion when the chlorine content of the water in this bath was found to have fallen below the recommended minimum. Five samples out of twenty-nine from the First-Class Bath were reported to have a bacterial count in excess of the standard, but on no occasion was B. Coli found to be present. Fourteen samples out of twenty-eight from the SecondClass Bath were reported to contain bacteria in excess of the standard, and on three occasons the presence of B. Coli was noted. It should be understood that a bacterial count in excess of the adopted standard does not necessarily indicate that the water is in a dangerous condition for bathing. Bather does it show that the treatment of the water had not been entirely satisfactory. The Ministry of Health has suggested that the chlorine dosage should be sufficient to maintain a strength of free chlorine in the water of the bath itself of not less than 0.2 parts of chlorine per million parts of water, or greater than 0.5 parts per million. In practice it is endeavoured to maintain the chlorine at about 0.4 to 0.5 parts per million. This concentration is sufficient to destroy all harmful bacteria and efficient filtration should give satisfactory results. Too large a dose of chlorine is likely to result in complaints from bathers of discomfort and smarting eyes. 139 The construction of the Open-Air Baths provides for continuous circulation of the water from 14 inlets spaced at intervals around the sides of the bath to one outlet in the centre of the bath. By this arrangement the concentration of chlorine is maintained fairly constant throughout the bath. At the Lime Grove Baths the water enters through an inlet at the shallow end and flows through the bath to an outlet at the deep end. Test made during the year showed that by this arrangement, samples taken as the water entered the bath contained twice the amount of chlorine as samples taken from the outlet. It was therefore necessary to slightly overchlorinate the water entering the bath in order to maintain the minimum amount in other parts of the bath. Experiments are now being carried out by the Borough Engineer and Surveyor to overcome this difficulty and small auxiliary inlets are being provided at other points in the bath which, it is hoped, will maintain a more equable distribution of the chlorine. PUBLIC WASH-HOUSES. The public wash-houses in Scotts Boad form part of the building comprising the indoor Swimming Baths, Lime Grove. These wash-houses are very well patronised, and provide a means of clothes-washing for many families living in tenement houses without washing accommodation. They are open ordinary week-days from 8 a.m. to 8 p.m., except Saturdays, when they are available from 8 a.m. to 3 p.m. PROPAGANDA. During the year " Better Health," a monthly Health Journal, published under the auspices of the Society of Medical Officers of Health, was distributed. One thousand copies of this Journal were distributed monthly to the Schools and Infant Welfare Centres. 140 The Journal is welcomed by the School Teachers as a great help in the teaching of Hygiene. Booklet—" Family Meals and Catering."—This booklet is issued by the British Medical Association and contains information as to the vitamins in various dishes and on the preparation and cooking of meals containing full nourishing values. Copies of the booklet were distributed to all mothers attending the Infant Welfare Centres and Ante-natal Clinics. " HEALTH WEEK EXHIBITION." In October a Health Exhibition was held at the Town Hall. The Exhibition was officially opened by Sir Arthur Salusbui v MacNalty. K.C.B., M.A., M.D., F.R.C.P., D.P.H., Chief Medical Officer, Ministry of Health and Board of Education, who was supported by His Worship the Mayor, Alderman John Rooke, J.P., Councillor A. Belsham, Deputy Mayor, and other members of the Borough Council. The Chair was taken by His Worship the Mayor. Sir Arthur Salusbury MacNalty said he was very glad of the opportunity of paying tribute to the good work being done in Hammersmith. He was fully aware of the initiative and the persistent zeal shown in the Borough towards the betterment of the health of its inhabitants. A progressive authority is not content merely to carry out the minimum duties required by Acts of Parliament. Any real progress in national health could not be made without public support and for this reason he had much pleasure in supporting the Health Exhibition in Hammersmith. Eighteen stalls were erected in the Large Hall, cooking demonstrations were held twice daily in the Committee Boom whilst the Council Chamber was used for lectures and films—two lectures being given each day, with the exception of Monday when one was given in the evening. 141 The exhibits consisted of demonstrations in clean foods, health and cleanliness, hygiene, dental work, eye services, baby clothes, smoke, vermin, diseased and unsound foods, electricity, &c., and provided a very attractive and interesting Exhibition. Seven hundred and five school children visited the Exhibition, in groups every morning except Monday, by special arrangement with the School Authorities, when short lectures and demonstrations were given at certain selected stalls dealing with subjects of interest to them. On Tuesday morning arrangements were made for 1,000 school children to visit the Pavilion Cinema, where films were shown on various subjects. The following is a list of the stallholders :— National Council for Maternity and Child Welfare. Dental Board of the United Kingdom. Messrs. Hovis Ltd. Messrs. Cow & Gate Ltd. National Association for the Prevention of Tuberculosis Messrs. Smith's Potato Crisps Ltd. Public Health Department. Wesleyan and General Assurance Society. Electricity Department. Health and Cleanliness Council. Cremation Society. British Red Cross Society. Messrs. John Knight Ltd. British Social Hygiene Council. National Smoke Abatement Society. Eugenics Society. C. Davis Keeler Ltd. National Eye Service and Hospital Saving Association. The lectures, all of which were given with the aid of lantern slides and films, were very well patronised. The following is a list of the lectures and demonstrations given during the week :— Monday, October 18th, 1937 12 noon. Official Opening of the Exhibition by Sir Arthur Salusbury MacNalty. K.C.B.. M.A.. M.D., F.R.C P., D.P.H., Chief Medical Officer, Ministry of Health and Board of Education. Chairman: His Worship the Mayor of Hammersmith, Alderman John Rooke, J P. 3 p.m. Cooking Demonstration. Pastries. 7 p.m. Cooking Demonstration. Breakfast and Supper Dishes. 142 7.30p.m. Public Meeting—Health and Cleanliness. Chairman : Councillor L. 0. Glenister (Chairman, Public Health Committee). Speaker : Dr. Julia Browne Kutschbach, M.B., Ch.B., D.P.H. (former Medical Officer of Health for Stepney). Subject: " Public Health and You." Films : " Silver Lining." " The Face of Britain." Tuesday, October 19th, 1937 3 p.m. Public Meeting. Of Especial interest to Mothers and Maternity and Child Welfare Workers. Chairman: Councillor Mrs. H. E. Russell (Chairman. Maternity and Child Welfare Committee). Speaker : Dr. Naomi Dancy, M.B., B.S., M.R.C.S., L.R.C.P., Assistant Medical Officer (Maternity and Child Welfare). Subject: " Infant Management." Films : " Bathing Baby." " Breast Feeding." 3 p.m. Cooking Demonstration. Ways with Left-Overs. 7 p.m. Deep Fat Frying. 7.30 p.m. Public Meeting—Tuberculosis. Chairman : Councillor S. A. V. Wood (Vice-Chairman, Public Health Committee.) Speaker: Dr. G. Ivor Davies, M.D., M.B., B.S., M.R.C.S., L.R.C.P., D.P.H., Tuberculosis Officer and Assistant Medical Officer of Health. Subject: " Tuberculosis." Films : " Papworth." " Contacts." " Makers of Men." Wednesday, October 20th, 1937 3 p.m. Public Meeting—Physical Education. Chairman : Councillor S. A. V. Wood (Vice-Chairman, Public Health Committee). Speaker : Captain J. G. Paterson, Industrial Welfare Society and National Advisory Council for Physical Training and Recreation. Subject: " Physical Education." Films : " Boys." " Rural School." " Citizens of the Future." 3 p.m. Cooking Demonstration. Complete Meal for Four People. 7 p.m. Cooking Demonstration. Puddings and Pies. 148 7.30 p.m. Public Meeting—Social Hygiene. (Adults only). Chairman : Councillor Mrs. E. Cox. Speaker : Dr. R. E. Hopton, L.B.C.P.Eng., L.R.C.S.Eng., L.R.F.P. & S.G., British Social Hygiene Council. Subject: " Sex and Other Problems of To-day." Films : " How to Tell." " Trial for Marriage." Thursday, October 21 at, 1937 3 p.m. Public Meeting. Of Especial Interest to Women. Chairman : Councillor Mrs. E. S. Hodgson (Vice-Chairman, Maternity and Child Welfare Committee). Speaker : Miss L. C. Dixon, National Council for Maternity and Child Welfare. Subject: " Balance your Meal." Films : " The Nutrition Film." " A Famous Cook at Work." 3 p.m. Cooking Demonstration. Dishes to Tempt the Children. 7 p.m. Cooking Demonstration. Meal on Grill Boiler. 7.30 p.m. Public Meeting—Diphtheria. Chairman : Alderman E. J. B. Spearing, J.P. Speaker : Dr. Guy Bousfield, B.Sc. Subject: " Diphtheria can be Prevented." Films : " The Empty Bed." " The Face of Britain." Friday, October 22nd, 1937 3 p.m. Public Meeting—Cremation. Chairman : Councillor A. Belsham (Deputy Mayor, ViceChairman, Mortlake Crematorium Board). Speaker : R. V. B. Perkins, Esq., The Crematorium Society. Subject: " Cemeteries or Playing Fields." Film : " The Great Purifier." 3 p.m. Cooking Demonstration. Complete Meal for Four People. 7 p.m. Cooking Demonstration. Full Meal in Oven. 7.30 p.m. Public Meeting—Nutrition. Chairman : Councillor Mrs. A. M. Hallett. Speaker : Professor B. H. Mottram, M.A., London. Subject: " Food and Fitness." Films : " The Nutrition Film." " Food for Thought." " Milk." 144 Saturday, October 23rd, 1937 3 p.m. Public Meeting—Care of the Teeth. Chairman : Councillor J. C. Clark. Speaker : F. V. Maguire, Esq., L.D.S., R.C.S. Subject: " Your Teeth—How they Come and Why they Go." Films : " Smile if you Dare." " The Trapeze Man Talks." 3 p.m. Cooking Demonstration. Unusual Ways with Fish and Eggs. 7 p.m. Cooking Demonstration. Tea Fancies. 7.30 p.m. Public Meeting—Hammersmith Health Services. Chairman : Councillor Mrs. G. E. Field. Speaker: Councillor L. O. Glenister, (Chairman, Publi® Health Committee). Subject: " Public Health Services." Films : " The Health of the Nation." " One Hundred Years." The cooking demonstrations were undertaken by the Hammersmith Borough Council Electricity Department. These demonstrations proved to be exceedingly popular. The accommodation was found to be insufficient to meet the demand of persons wishing to attend the demonstrations. Twenty thousand programmes were distributed through the School Organisation by the Central Council for Health Education and approximately another twenty thousand were distributed by the Public Health Department through the Superintendent of the Hammersmith Borough Council Estates, the Superintendents of the London County Council Estates, Welfare Centres, Tuberculosis Dispensary and house-to-house distribution. Posters were posted on sand bins, public hoardings, business premises, &c. Five thousand bookmarks were also distributed through the Public Libraries. It is estimated that 3,764 persons visited the Exhibition. I desire to express my thanks to Sir Arthur Salusbury MacNalty, the Mayor and lecturers and the various voluntary associations for their valuable assistance in arranging 145 certain of the lectures, demonstrations and exhibits, and to those ladies and gentlemen who undertook the duties of Chairman. Whilst the organisation of the Exhibition was carried out by the Central Council for Health Education, a great deal of work fell upon the Public Health staff, and I desire to place on record my appreciation of their enthusiasm and whole-hearted support throughout the Exhibition. I should also like to thank all those ladies and gentlemen who assisted in bringing this Exhibition to a successful conclusion. PHARMACY AND POISONS ACT, 1933. Inspections numbering 102 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. During the year 86 names have been entered on 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. 146 SHOPS ACT, 1934. During the year 767 shops were inspected. The following notices were served for :— 1. Sanitary Accommodation 27 2. Ventilation 5 3. Temperature 36 4. Sanitary Accommodation and Ventilation 5 5. ,, „ ,, Temperature 5 6. Ventilation and Temperature 3 7. Sanitary Accommodation, Ventilation and Temperature 2 Total 83 In sixty-five cases the Council granted a certificate of exemption where satisfactory arrangements had been made for the shop assistants to use conveniences in the same building or elsewhere in the immediate vicinity. Public Mortuary.—Four hundred and sixty-six bodies were admitted to the Mortuary in Fulham Palace Road during the year. H a m in er smith— Admitted by order of Coroner 189 Admitted by order of Police 5 Admitted on application of undertakers for accommodation 31 225 Bodies admitted from other Boroughs : — Fulham 100 Chelsea 141 241 No. of P.-M. examinations conducted - Hammersmith cases 172 Fulham cases 82 Chelsea cases 108 Total P.M.'s 362 147 No. of Inquests held :— Hammersmith oases 106 Fulham cases 80 Chelsea cases 98 Total Inqueets held 284 The refrigeration plant has provided a means whereby bodies can be kept and insanitary and offensive conditions avoided. Metchim & Son, Ltd., Westminster and City. (25419) . INDEX Page Introduction 2 Staff of the Public Health Department 4 Statistics for the Year, 1938 7 Natural and Social Conditions of the District. Births 8 Cancer 10 Deaths 9 Deaths of Aged Persons 10 Deaths of Besidents (Outlying) 11 Deaths (Various Causes) 14 Marriages 8 Population 8 Statistics 11 Treatment and Nursing-Children under School Age 15 General Provision of Health Services in the Borough. Ambulance Facilities 16 Hospitals (Public) 21 Hospitals (Voluntary) 22 Laboratory Facilities 16 Professional Nursing in the Heme— General 17 Nursing 17 Bheumatism Advisory Clinic 18 School Clinics 17 Treatment Centre for Venereal Diseases 2' Tuberculosis Dispensary 18 Treatment and Nursing—Children under School Age 21 Minor Ailments. Maternity and Child Welfare. Accouchement Outfits and Maternity Bags 41 Ante-natal Clinics 41 Births—Notification 22 Centres—Infant Welfare 38 Chart—Infantile Mortality Bate 34 Circumcisions 38 Cod Liver Oil 41 Consultants 41 Convalescent Treatment (Invalid Children) 48 Convalescent Treatment (Nursing Mothers and Young Children) 49 Day Nurseries 48 Deaths of Infants 32 Deaths—Premature. 35 Deaths in Institutions 36 Deaths—Illegitimate 86 Page Diarrhoea—Chart 37 Dinners 41 Domiciliary Midwifery Service 43 Feeding of Infants—Statistics 31 Health Visitors—Work of 29 Home Helps 45 Hospital Treatment—Zymotic Enteritis 36 Infantile Mortality 26 Infectious Diseases of Mothers and Children under five years of age—Tabular Statement 46 Infective Enteritis and Pneumonia 35 Institutional Treatment for Unmarried Mothers 43 Massage and Remedial Exercises Clinic 38 Maternity Services—Facilities for Confinement 42 Maternal Mortality 45 Midwives 44 Milk (Mothers and Children) Orders, 1918-1919 40 Ophthalmia Neonatorum 47 Schedule of Attendances at Infant Welfare Centres 39 Sessions—Infant Welfare Centres 38 Stillbirths 32 Sunlight 36 Table--Births, Deaths, and Infant Death Rate 31&35 Child Life Protection 49 Sanitary Circumstances ot the Borough. Closet Accommodation 51 Common Lodging Houses 64 Factories—Inspection of 60 Fouling of Footpaths by Dogs 51 House to House 68 Houses Let in Lodgings 64 Inspections 52 Notices 54 Persons Living under Insanitary Conditions 60 Rag Flock Acts, 1911 and 1928 67 Rats and Mice (Destruction) Act, 1919 63 Sanitary Inspection of Area 51 Scavenging 51 Schools 65 Seamen's Lodging Houses 64 Smoke Abatement 63 Summonses 54 Tenement Houses 64 Vans 65 Housing. Eradication of Bed Bug 70 General Housing Conditions 69 Newly Erected Houses 70 Slum Clearance 72 Statistics 67 Survey 66 Page Inspection and Supervision of Food. Bakehouses 83 Certification of Certain Food Products for Export 79 Chemical and Bacteriological Examination of Food 86 Food and Drugs Adulteration Act, 1928 86 Food Premises (Public Health (London) Act, 1936) 78 Food Supplies 78 Fried Fish Shops 83 Ice Cream Vendors 85 Inspection of Carcases of Animals slaughtered in Local Slaughterhouses 80 Markets 82 Milk 90 Milk Supply 78 Milk (Special Designations) Order, 1936 78 Offensive Trades—Slaughterers of Poultry 81 Public Health (Meat) Begulations, 1924 79 Samples—Adulterated 88 Slaughterhouses 80 Street Trading 82 Unsound Food 85 Prevalence and Control over Infectious Diseases. Acute Polio-myelitis 103 Anthrax 101 Anti-toxin 98 Artificial Pneumothorax Treatment 129 Bacteriology 94 Cerebro-Spinal Meningitis 103 Chicken Pox 101 Cholera 97 Cleansing of Verminous Persons 109 Continued Fever 103 Diphtheria 97 Diphtheria—Chart 101 Diphtheria Immunisation 98 Disinfection 107 Dysentery 106 Encephalitis Lethargica 103 Enteric Fever 100 Erysipelas 100 Food Poisoning 106 Glanders 101 Hydrophobia 101 Infectious Diseases 94 Influenza 106 Malaria 106 Measles and German Measles 101 Measles—Chart 105 Notifiable Diseases 97 Nursing Comforts 126 Ophthalmia Neonatorum 103 Page Plague 97 Pneumonia 106 Public Health (Smallpox) Regulations, 1917 113 Public Health (Prevention of Tuberculosis) Regulations, 1925 117 Puerperal Fever 103 Puerperal Pyrexia 103 Psittacosis 106 Rabies Order, 1919 104 Relapsing Fever 103 Report on Tuberculosis Work at Hammersmith Hospital 127 Sanocrysin Treatment 130 Scarlet Fever 100 Scarlet Fever—Chart 102 Smallpox 97 Tabular Statement—Zymotic Diseases 108 Tuberculosis 113 Tuberculosis Care Committee 120 Tuberculosis Dispensary 117 Typhus Fever 100 Vaccination 110 Vaccination Returns 111 Whooping Cough 104 Whooping Cough—Chart 105 Wrong Diagnosis 106 X-Ray Work 129 Zymotic Diseases 96 Prevention of Blindness 180 Air Raid Precautions 132 Sanitary Administration. Exhumation and Re-interment of Bodies 131 Increases of Rent and Mortgage Interest Restrictions Acts, 1920-23 131 Pharmacy and Poisons Act 133 Propaganda 132 Public Baths 131 Public Mortuary 134 Public Wash-houses 132 Shops Act, 1934 134 Staff 130 Swimming Baths 131