HAM 30 Metropolitan Borough of Hammersmith. ANNUAL REPORT of the Medical Officer of Health for the YEAR 1938. 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 1988. The report deals with the vital statistics, and with the work carried out under the direction of your Council during the year. The statistical tables included relate to the Public Health of the Borough. The death-rate of 11.3 is 1.3 less than the previous year. There were two maternal deaths as compared with four in the previous year. The rate was equal to 1.04, whereas the rate for the whole country was 2.97. The infantile mortality rate has decreased from 68 to 62 per 1,000 births. The rate for the County of London decreased from 60 to 57 per 1,000 births. In April the Infant Welfare Centres and Ante-Natal Clinics were taken over by the Council from the Hammersmith Infant Welfare Association (Report under Maternity and Child Welfare Services on page 25). The regulations relating to the compulsory notification of measles and whooping cough, with modifications, dated 9th September, 1938, came into operation on the 1st October. An agreement was reached between the Council and the Empire Rheumatism Council relating to the treatment of Hammersmith patients at the West London Hospital, details of which appear on page 18 of this Report. 8 The operation of the diphtheria immunisation scheme was again amended during the year, when the immunisation by one injection of A.P.T. was discontinued. (Details on page 98 of the Report). With regard to notifiable infectious diseases, the total number was below the average for the past 10 years. Air Raid Precautions, during the latter part of the year particularly, became a very important and considerable item in the work of the department generally, and early in 1939 a temporary staff was engaged to assist with the multifarious duties falling under this heading. Dr. G. Ivor Davies, the Deputy Medical Officer of Health and Tuberculosis Officer, resigned his appointment with this Council in November consequent upon his appointment as Medical Superintendent to the Kelling Sanatorium, Holt, Norfolk. Dr. F. M. Day commenced duties in his stead in January, 1939. 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. 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF THE YEAR 1938. 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. L. Davies, M.D., B.S., M.R.C.S., L.R.C.P., D.P.H 1930 (Resigned in November.) Assistant Medical Officers (M. and C.W.). Mary I. Adams, B.Sc., M.B., B.Ch., B.A.O., D.P.H. 1936 Florence E. M. Harvey, M.B., B.Ch. ... 1938 Adelaide A. Renshaw, M.D., M.B., Ch.B. (Temporary Part Time) 1937 Consultant Gynæcologists. Lady Florence Elizabeth Barrett, M.D., M.S. L. H. W. Williams, M.D., F.R.C.S. V. B. Greene Armytage, M.D., F.R.C.P., F.C.O.G. 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. M. M. Townsend, L.R.C.P., L.R.C.S. Elsie Warren, M.B., B.S., D.P.H. 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. 5 Year of Appointment. Assistant Administrative Officer. *A. H. Wilmot 1902 Clerical Staff. J. C. Turner 1920 †Miss E. Cole 1923 A. H. Johns 1925 F. G. Holland 1929 T. J. Hares 1930 E. F. Yorke 1931 Miss V. Steadman 1935 Miss C. A. Grover (Resigned September) 1937 Miss A. T. Malone 1937 E. W. Pike 1937 Miss V. Day (Resigned July) 1932 Miss E. B. Guest 1938 Miss I. Waller 1938 Mrs. M. Coles 1938 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 f§*W. J. Godden 1926 °t§*F. W. Mason 1926 §øG. W. Herrick 1929 §øW. Collins 1938 §øJ. C. Hopkins 1938 §H. W. Potter (Temporary) 1938 §øpC. W. Southerby (Temporary) 1938 Woman Sanitary Inspector and Infant Life Protection Visitor. ||øMiss E. M. Cross 1932 6 Year of Appointment Health Visitors. †Miss R. A. Henry 1916 |||* Miss A. M. M. Willcox 1916 "||Miss D. G. Johnson 1922 ø||QMiss C. M. Henniker 1929 "||Miss H. M. G. Gurnett 1937 ||Miss E. A. Llewellin 1937 "||Miss 0. Raper 1937 Tuberculosis Dispensary Staff. |||Mrs. Cameron (Nurse Visitor) 1924 ||Miss Murphy (Nurse Visitor) 1924 ||Miss N. Rees (Dispenser and Secretary) 1918 Miss Camish (Clerk) 1938 A. Pullin (Porter) 1918 Medicinal Baths and Disinfecting Staff. A. H. S. Hutchinson (Superintendent) 1928 Mrs. Manners 1924 G. W. A. Luxon (Disinfector) 1937 Mortuary Keeper. D. A. Mackay 1929 W. Gauntlett (Asst. Mortuary Keeper and, Motor Driver, etc.) 1938 †Cert. Royal Sanitary Institute (Inspector). *Cert. Sanitary Inspectors Examination Board. Cert. Central Midwives Board. §Ceri. Royal Sanitary Institute (Meat and other foods). || Trained Nurse. "Cert. Royal Sanitary Institute (Health Visitor). °Royal Sanitary Institute (Smoke Certificate). UApothecaries' Hall Certificate. ipCert. Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. = Smoke Abatement Cert. L.C.C. School of Engineering Diploma in Nursing, London University. 7 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1938. Area 2,282.5 acres Population (1938) (estimated) 125,100 Population Census (1901) 112,289 (1911) 121,521 (1921) 180,295 (1981) 185,521 Natural increase, i.e., excess of births over deaths 521 Density of population 54.8 persons per acre Marriages registered 1,411 Number of families or separate occupiers (1921) 88,268 Rateable value (1938) £1,271,922 Sum represented by a pennv rate, 1938 £5,050 Vital Statistics. Births (legitimate) ,, (illegitimate) .1,715 159 Birth rate Rate per 1,000 15.0 Stillbirths 59 1 (live and still births) 31 Deaths (corrected) 1,412 Death rate 11.3 Adjusted death rate 11.6 Deaths from puerperal causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis — — Other puerperal causes 2 1.03 Total 2 1.03 8 Deaths of infants under one year of age per 1,000 births 62 Legitimate, 62. Illegitimate, 62. Deaths from cancer (all ages) 234 Deaths from measles (all ages) 5 Deaths from whooping cough (all ages) 4 Deaths from diarrhoea (under 2 years of age) 26 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., 125,100. The corrected number of births registered was 1,933, whilst the corrected number of deaths of residents was 1,412, thus showing a natural increase of population by excess of births over deaths of 521. The area of the Borough is 2,282.5 acres, there being a density of 54.8 persons to the acre. Marriages.—The number of marriages registered during the year was 1,411, the marriage-rate being 22.5. Births.—During the year 2,840 births were registered in the Borough. The corrected number of births for the year supplied by the Registrar-General was 1,874. On the estimated population, i.e., 125,100, the corrected number of births registered was equal to an annual rate of 15.0 births per 1,000 persons living. The Birth-rate for the year, 15.0, is slightly lower than that for the previous year, when the rate was 15.1. 9 The Birth-rate in London on the estimated population, i.e., 4,141,100, was equal to an annual rate of 13.4 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., 3,132. 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 2,840 as against 2,707 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 1,340 deaths were registered in the Borough, as compared with 1,333 in the previous year. Adding 500 deaths of residents of this Borough which occurred in general hospitals and other public institutions, and 22 deaths of residents transferred by the Registrar-General as having occurred in various parts of England, and deducting 440 deaths of non-residents and 10 transferable deaths which occurred in the Borough, the corrected number of deaths of residents was 1,412 (734 males, 678 females). On the estimated population, i.e., 125,100, the corrected number of deaths of residents was equal to an annual rate of 11.3 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 11.6, a figure which is directly comparable with the contemporaneous crude death-rate for the 10 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 11.4 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 714, against 793 in the previous year. These deaths were equal to 5.7 per 1,000 of the total persons living, and 506 per 1.000 of the total deaths of residents registered. Cancer.—There were 234 deaths from Cancer, and of this number, 220 occurred in persons over the age of 45 years. These deaths were equal to 1.87 per 1,000 of the population. The following table shows the number of deaths from Cancer under the various age groups during the past 10 years :— Year. Total Deaths. Sex. All Ages. 1— 2— 5— 15— j25— 35— 45— 55- 65— 75— 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 4') 38 20 F 117 — — — 1 11 46 — 29 30 1934 235 M 112 — — — I 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 1938 234 M 123 — — — 2 6 21 45 28 21 F 111 — — — — 4 2 20 22 43 20 The average number of deaths for the ten years is 227. In all cases where death occurs from Cancer the Woman Sanitary Inspector visits and offers disinfection. 11 Statistics.—The following table gives the statistics of the Borough during 1938 and previous years:— Vital Statistics of Whole District during 1938 and Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. of Non-residents registered in the District. of Residents not registered in the District Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1923 133600 2571 2701 20-2 981 7.3 125 649 173 64 1473 11.0 1924 134200 2199 2399 17.9 1123 8-4 173 718 173 72 1668 12.4 1925 134500 2178 2351 17-5 1034 7-7 186 756 153 65 1604 11.9 1926 134400 2001 2188 16-3 1174 8-7 195 556 144 66 1535 11-4 1927 132800 1789 2076 15.6 1581 11.9 230 377 126 61 1728 13.0 1928 1363UO 1938 2258 16-6 1449 106 222 326 156 69 1553 114 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 13371-0 1795 1940 14.5 1465 10. 9 294 543 129 66 1714 12.8 1933 131400 1682 1827 13.9 1500 11.4 340 530 119 65 1690 12.9 1934 129170 1551 1783 13.8 1359 10.5 346 655 137 77 1668 12-9 1935 128100 1774 1877 14-7 1347 10.5 406 583 131 70 1524 11.9 1936 127700 2266 1922 15.1 1399 10.9 441 639 116 60 1597 12.5 1937 126500 2707 1913 15.1 1333 105 402 662 130 68 1593 12.6 1938 125100 2840 1874 15-0 1340 10 .7 450 522 117 62 1412 11.3 Deaths of Residents.—Belonging to the Borough, occurring in Public Institutions, &c., in districts outside, during the year 1938 : MENTAL HOSPITALS. Horton Hospital, Epsom 3 la, Manor Road, Ilford 1 St. Bernard's Hospital, Hanwell 12 Caterham Hospital 1 Tooting Bee Hospital 8 Camberwell House 1 Fnern Hospital, Fnem Barnet 1 Hundred Acres, Banstead 1 1, West Park Road, Epsom 3 Fountain Hospital 1 Mental Hospital Shenley 1 Leavesden Hospital, Watford 4 Cornwall Mental Hospital 1 The Grove, Horton Lane, Epsom 3 The Old Manor, Salisbury 1 42 MENTAL HOSPITALS. Horton Hospital, Epsom 3 la, Manor Road, Ilford 1 St. Bernard's Hospital, Hanwell 12 Caterham Hospital 1 Tooting Bee Hospital 8 Camberwell House 1 Friern Hospital, Friern Barnet 1 Hundred Acres, Banstead 1 1, West Park Road, Epsom 3 Mental Hospital, Shenley 1 Fountain Hospital 1 Cornwall Mental Hospital 1 Leavesden Hospital, Watford 4 The Grove, Horton Lane, Epsom 3 - — The Old Manor, Salisbury 1 42 12 GENERAL HOSPITALS, NURSING HOMES, &c. St. Joseph's Hospital, Brentford 1 St. Mary's Hospital, Sidcup 1 Leavesden Hospital, Watford 1 Samaritan Free Hospital 1 Home and Hospital for Jewish Incurables 1 Catholic Nursing Institute, 60, Lambeth Road 1 St. Mary's Hospital, Paddington 3 Colindale Hospital, Hendon 1 Princess Louise Hospital 14 Infants Hospital, Vincent Square 1 20, Glazbury Road 1 385, High Road, Brentford 1 Hampstead General Hospital 1 St. Barnabus Home, Torquay 1 St. Joseph's Hospice for the Dying Children's Hospital, Great Ormond 1 Royal Sussex County Hospital, Brighton 1 Street 1 87, Fordwych Road, Hampstead 1 Victoria Hospital for Children 1 St. Lukes Hospital 1 2, Grove Road, Richmond 1 Northern Hospital, Southgate 1 Guys Hospital 1 20, Pembridge Crescent 1 St. Thomas's Hospital 1 Consumption Hospital 2 Queen Mary's Hospital, Carshalton 4 Highwood Hospital, Brentwood 1 Homoeopathic Hospital, Great Ormond Street 1 Queen Mary's (Roehampton) Hospital 1 Mount Vernon, Ruislip 2 Royal Hospital for Incurables, Middlesex Hospital 4 Wandsworth 1 St. George's Hospital 2 University College Hospital Italian Hospital, Queen's Square 1 St. Benedicts Hospital 1 Old Court, Hanger Lane, Ealing 1 Princess Elizabeth of York Hospital 1 92, Redcliffe Gardens, Kensington 1 General Hospital, Willesden 1 Royal Infirmary, Kingston-uponHull 1 Queen Mary's Hospital, Chiselhurst 1 Home of Compassion, Thames Ditton 1 Mundesley Sanatorium, Gimingham 1 Holy Cross Sanatorium, Haslemere Maudsley Hospital, Denmark Hill jewish Home of Rest, Birchlands 1 7, Knaresborough Place 1 Avenue 1 Rous Memorial Hospital, All Saints, Newmarket 1 London Hospital 1 St. Columbas Hospital 1 Douglas House, Southbourne, Bournemouth 1 Westminster Hospital 2 St. Saviours Hospital, St. Pancras 1 Cliff Coombe, Broadstairs 43, Priory Road 1 Queen Charlotte's Hospital 2 84 FEVER HOSPITALS. Western Hospital 11 Grove Hospital 4 Eastern Hospital 1 South-Eastern Hospital 1 Southern Hospital 1 Park Hospital 1 Northern Hospital 1 Brook Hospital 1 25 South-Western Hospital 4 18 PUBLIC ASSISTANCE INSTITUTIONS. St. Mary Abbot's Hospital 56 182, Westmoreland Road, Walworth 1 St. Charles's Hospital 136 Twyford Lodge, Willesden 2 1, Northumberland Street, St. Marylebone 2 Paddington Hospital 18 Fulham Hospital 51 St. Giles Hospital 1 St. John's Hospital, Battersea 6 Lewisham Hospital 1 St. Luke's Hospital, Chelsea 32 Redhill House, Hendon 1 St. Mary's Hospital, Islington 2 North Middlesex County Hospital, Edmonton 1 St. Francis Hospital 1 St. Stephen's Hospital 15 76, Eridge Road, Croydon 1 St. Matthew's Hospital, Shoreditch 7 St. Pancras Hospital 3 St. Nicholas Hospital 1 St. Olave's Hospital 1 St. Leonards Hospital 1 30, Twickenham Road, Heston 3 Lambeth Hospital 1 344 VARIOUS. Ryarsh, Leigham Avenue 1 26, Grange Park, Ealing 1 55, Castle Bar Road, Ealing 1 20, Holm wood Gardens, Finchley 1 88, Hornsey Lane, Highgate 1 Springfield House, Beeehcroft Road 1 South Parade, Bedford Park On the way to and near St. Mary 1 " Rederoft," Sutton Road, Seaford 1 Abbot's Hospital 2 23, Fernlea Road, Harwich 1 Batehworth Hill, Rickmansworth 1 Sea Hotel, Sea Road, South Shields 1 16, Southcombe Street 1 Watling Street, Claybrooke Parva, Lutterworth 1 Maidstone Road, Chatham 1 " Homelea," Durham Road, Easington 1 On the way to Charing Cross Hospital 1 Sorrento, Lyme Regis 1 15, Three Crown Square, Southwark ] "The Boreen," Sharvclls Road, Milford-on-Sea 1 19, Medina Villas, Hove ] 14R, Sutton Buildings 1 — River Thames 4 27 14 Causes of, and Ages at, Death during the Year 1938. Caurks of death. Sex. All Ages. 0— 1 — 2 — 5- 15- 25— 35— 45— 55- 65— 75— All Causes M 734 63 12 7 8 15 n 36 84 160 174 154 F 678 54 5 7 7 16 s9 31 58 85 149 237 1 Typhoid and Para typhoid Fever M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .... .. .. .. .. 2 Measles M 4 1 1 2 .. .. .. .. .... .. .. .. F 1 .. .. 1 .. .. .. .. .. .. .. .. 3 Scarlet Fever M .. .. .. .. .. .. .. .... .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 4 Whooping Cough M 3 2 .. 1 .. .. .. .. .. .. .. .. F 1 1 .. 1 .. .. .. .. .. .. .. .. 5 Diphtheria M 3 .. .. .. 3 .. .. .. .. .. .. .. F 2 .. .. .. 2 .. .. .. .. .. .. .. 6 Influenza M 5 .. 1 .. .. .. .. .. .. .. .. 3 F 2 .. .. .. .. .. .. .. 1 .. .. 1 7 Encephalitis Lethargica M 2 .. .. .. .. .. .. .. 1 1 .. F 2 .. 1 .. .. .. .. 1 .. .. .. 8 Cerebo-spinal Fever M 2 1 .. .. 1 .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. 9 Puherculosis ol Respiratory System _ M 41 .. 1 .. .. 5 4 7 16 3 3 1 F 31 l .. .. .. 8 8 6 5 2 1 .. 10 Other Tubereu lous Diseases M 8 .. 1 .. 2 .. 1 1 1 2 1 .. F 7 .. .. 2 1 2 .. 1 .. .. 1 .. 11 Syphilis M 6 .. .. .. .. .. .. .. i 4 1 .. F 1 .. .. .. .. .. .. .. .. .. 1 .. 12 General Paralyse of the insane tabes dorsalis . M 6 .. .. .. .. .. .. .. 2 .. 4 .. F 2 .. .. .. .. .. .. 1 .. 1 .. 13 Cancer M 123 .. .. .. .. .. 2 6 .. 45 28 21 F 111 .. .. .. .. .. 4 2 20 22 43 20 14 Diabetes M 6 .. .. .. .. .. .. .. .. 2 1 3 F 9 .. .. .. .. 1 .. .. 1 3 2 2 15 Cerebral Hæmorr hage, &c. M 30 .. .. .. .. .. 2 .. .. 4 18 6 F 39 .. .. .. .. .. .. .. 4 7 12 16 16 Heart Disease M 164 .. .. .. 1 2 1 4 14 37 46 59 F 170 .. .. .. .. 1 2 4 6 14 45 98 17 Aneurysm M 8 .. .. .. .. .. 1 1 .. 2 2 2 F 5 .. .. .. .. .. .. 1 1 .. 3 .. 18 Other circulator) diseases M 39 .. .. .. .. .. .. .. 2 3 19 15 F 34 .. .. .. .. .. .. .. .. 4 9 21 19 Bronchitis M 27 1 .. .. .. .. .. 3 6 9 8 F 20 1 1 .. .. .. .. .. 2 .. 6 10 20 Pneumonia (all forms) M 53 9 4 1 1 2 1 4 5 15 6 5 F 41 11 2 3 .. .. 1 3 2 5 4 10 21 Other Respirator) Diseases M 8 .. .. .. .. 1 1 2 .. 1 2 1 F 9 .. .. .. .. .. .. .. .. 4 1 4 22 Peptic Ulcer M 8 .. .. .. .. .. .. 1 4 I 2 .. F .. .. .. .. .. .. .. .. .. .. .. .. 23 Diarrhæ, &c. M 13 10 1 .. .. .. .. .. .. .. 1 1 F 18 15 .. .. .. .. 1 .. 1 .. .. 1 24 Appendicitis M 3 .. .. .. .. 1 .. 1 .. .. 2 .. F 4 .. .. .. l .. .. .. .. 3 .. .. 25 Cirrhosis of Livei M 2 .. .. .. .. .. .. .. 1 .. 1 .. F 3 .. .. .. .. .. .. .. .. .. 2 1 26 Other Diseases ol Liver, M .. .. .. .. .. .. .. .. .. .. .. .. F 8 .. .. .. .. .. .. .. 2 2 3 1 27 Other Digestive Diseases M 21 1 1 2 .. 1 .. 1 2 9 2 2 F 10 l .. .. .. .. 2 .. 2 3 l l 28 Acute and Chronit Nephritis M 14 1 .. .. .. 1 1 .. 2 3 4 2 F 17 .. .. .. .. l .. 1 1 4 3 7 29 Puerperal Sepsis F .. .. .. .. .. .. .. .. .. .. .. .. 30 Other Puerperal Diseases.. F 2 .. .. .. .. .. 2 .. .. .. .. .. 31 Congenital Debility, Premature Birth, &C. M 28 27 1 .. .. .. .. .. .. .. .. .. F 22 22 .. .. .. .. .. .. .. .. .. .. 32 Senility M 12 .. .. .. .. .. .. .. .. .. 2 10 F 25 .. .. .. .. .. .. .. .. 1 .. 24 33 Suicide M 12 .. .. .. .. .. 1 3 1 5 2 .. F 3 .. .. .. .. .. 1 1 1 .. .. .. 34 Other violence . M 18 2 .. .. .. 2 5.. 2 2 2 4 1 F 81 1 1 1 1 ] 2 2 1 3 5 14 35 Other defined diseases M 65 7 l .. 1 .. 1 6 7 14 11 14 F 48 1 .. 1 2 2 6 9 7 7 7 6 36 Causes ill-defined or unknown M .. .. .. .. .. .. .. .. .. .. .. .. F .. .. .. .. .. .. .. .. .. .. .. .. Totals 1,412 117 17 14 ' 15 31 50 67 142 245 323 391 15 This rate is calculated on the estimated population of each Ward. Ward. Estimated Population. No. of Deaths. Death Rate. No. 1 River 16,206 188 11.6 No. 2 Brook Green 24,335 274 11.2 No. 3 The Grove 21,402 274 12.8 No. 4 St. Stephens 8,240 103 12.5 No. 5 Starch Green 21,424 216 10.0 No. 6 Wormholt 22,073 254 11.5 No. 7 College Park and Latimer 11,420 103 9.0 LONDON AND METROPOLITAN BOROUGHS. City or Borough. Estimated population. Birth rate. Death rate : crude adjusted. Infant Mortality rate. West Districts. Paddington 137,400 13.74 11.33 11.21 66.0 Kensington 174,100 12.8 11.7 10.9 78.0 Hammersmith 125,000 15.0 11.3 11.6 62.0 Fulham 137,700 14.2 11.6 11.7 51.0 Chelsea 56,050 10.2 13.5 11.5 80.0 City of Westminster 124,400 8.3 10.4 10.7 54.9 North Districts. St. Marylebone 90,680 8.84 11.12 11.0 60.0 Hampstead 90,480 11.7 11.4 10.7 57.0 St. Pancras 179,400 13.5 11.5 11.7 64.0 Islington 292,300 15.32 11.90 12.02 65.0 Stoke Newington 50,480 13.8 11.0 10.5 43.2 Hackney 205,200 13.4 10.7 11.2 56.46 Central Districts. Holborn 34,350 7.28 10.51 11.25 84.0 Finsbury 56,960 13.0 12.9 14.1 73.0 City of London 8,780 6.6 10.7 11.8 51.8 East Districts. Shoreditch 80,360 14.7 11.4 12.5 64.0 Bethnal Green 92,910 14.2 11.3 12.8 59.3 Stepney 200,500 13.06 11.05 12.92 60.7 Poplar 134,400 14.9 11.4 12.7 60.0 South Districts. Southwark 145,300 14.0 12.5 13.4 57.0 Bermondsey 97,420 14.8 11.0 12.54 45.0 Lambeth 272,800 14.09 11.9 11.7 51.0 Battersea 141,700 14.92 11.82 11.70 53.45 Wandsworth 340,100 11.92 11.17 10.38 46.0 Camberwell 222,400 13.97 12.27 12.27 61.0 Deptford 95,460 14.4 11.8 ? 54.0 Greenwich 95,770 13.64 10.89 11.1 42.0 Lewisham 229,000 13.9 10.49 10.5 47.0 Woolwich 150,900 13.6 10.4 11.0 50.0 16 GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. Laboratory Facilities. The chemical analysis of food is carried out by the PubLie Analyst (Mr. F. W. Edwards). 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. E. G. Waller, Pathologist of the West London Hospital, and the latter by Dr. Davies, Deputy Medical Officer of Health and Tuberculosis Officer. Throat swabs and sputum containers are supplied free on application to the Public Health Depaitment 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 17 for accident cases are provided by the London County Council. Maternity Cases.—The London Ambulance Service provided by the London County Council is available for the conveyance of women to Maternity Homes. PROFESSIONAL NURSING IN THE HOME. General.—The Hammersmith District Nursing Association provides nurses in all cases for general nursing, upon application being made to the Nightingale Shore Home, 10, Mall Road. Patients are expected to make payments to the Nursing Association in accordance with their means, but no patient is refused the services of a nurse on awount 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 £12,5 SCHOOL CLINICS. The L.C.C. Hammersmith School Treatment Centre, 108, Shepherd's Bush Boad, is provided by the Hammersmith District Nursing Association. The latter receive appropriate grants from the London County Council. 18 L.C.C. School Treatment Centre, Old Oak Welfare Centre, Westway. This centre is held in the Borough Council Clinic, who receive a rental for the use thereof. Children under school age are dealt with by arrangement with the Hammersmith Nursing Association. Dental Clinics.—Dental Clinics are held at the Old Oak Welfare Centre and 103, Shepherd's Bush Road, by the London County Council for the treatment of school children. TUBERCULOSIS DISPENSARY. Hammersmith Tuberculosis Dispensary, Ravenscourt Park. The above Dispensary is provided by the Borough Council (see page 117). Grants are received from the Ministry of Health and the London County Council. RHEUMATISM. Princess Louise Hospital.—In July, 1938, the Council approved the scheme whereby a capitation fee of 1s. 6d. be paid to the Princess Louise Hospital for each visit paid by a child of the Hammersmith area to the Rheumatism Advisory Clinic, and the scheme came immediately into operation. Up to the end of the year 68 visits were made at a cost to the Council of £4 14s. 6d. West London Hospital.—In accordance with the terms of the recommendation made by the Public Health Committee to the Council in June, 1938, an agreement was 19 entered into by the Council and the West London Hospital and the Empire Rheumatism Council whereby a sum of £150 was paid to the Empire Rheumatism Council by the Hammersmith Council under powers conferred upon them by Section 226 of the Public Health (London) Act, 1936. This grant is contributed to the West London Hospital for the part maintenance of the Rheumatism Advisory Clinic at the Hospital for the treatment of Hammersmith Residents. Sections of the agreement are as follows :— "1. Subject as hereinafter mentioned the Authority may at any time remove or cause to be removed to the said hospital any inhabitant of their district who shall be suffering from any form of chronic rheumatic disease and the Board shall cause every person so removed to be received into the said hospital and to be there provided with proper food and medicines accommodation and nursing and medical attendance for such period of time as may be necessary. 2. The Board shall not be bound to receive any patient who or whose attendant is not furnished with an admission order signed by the Clerk or the Medical Officer to the Authority nor (except in case of emergency to be certified upon such order by the Medical Officer to the Authority) any patient of whose intended arrival at the hospital notice has not been given on the preceding day. 3. In addition to the patients who shall be received into and remain at the hospital for treatment as aforesaid the Board shall also receive and supply medical attention as aforesaid to patients from the Authority's district who shall attend at the out-patient's Rheumatism Department of the hospital. 20 4. The Board shall arrange for the appointment to the Rheumatism Department of the h'ospital of a medical practitioner with expert knowledge of chronic rheumatism who shall be known as the Hammersmith Clinical Assistant and such medical practitioner shall give prior attention to patients from the Authority's district who shall be sent to the hospital for treatment. 5. The Board shall at any time on the request of the Authority furnish to the Medical Officer of Health to the Authority a report on any patient who shall be sent to the hospital for treatment as aforesaid and shall in the month of January in every year send to the Authority a statement showing the number of patients from the Authority's district received into the hospital and the number of out-patients receiving treatment during the year ending on the preceding thirty-first day of December and the number of days during which each patient remained under treatment." The Clinic is under the direction of Dr. W. Copeman, and up to the end of the year the following cases were dealt with:— In-patients Nil. Out-patients 15 patients made 68 attendances. TREATMENT CENTRE FOR VENEREAL DISEASES. West London Hospital, Hammersmith Boad. The above centre is provided under the scheme of the London County Council. This centre is open night and day. 21 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 30 Dental 11 HOSPITALS—PUBLIC. Name .—Hammersmith Hospital. Situation:—Du Cane Road, Shepherd's Bush, W.12. Purpose:—General. No. of available beds :—709. 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 164 184 General Surgical 80 132 Children 52 Maternity — 87 (Excl. 4 Labour Beds.) Tuberculosis 3 3 Chronic sick — — Gynaecological — — Puerperal Pyrexia — — Facilities available for:— (1) Operative Surgery.—Yes. (2) X-ray.—Yes. (3) Dental.—Yes. (4) Ophthalmic.—Yes. (5) Massage.—Yes. 22 Arrangements for pathological work :—Own laboratories, British Post-graduate Medical School and St. Mary Abbot's Hospital. No. of patients during 19_38 :—Admissions = 52,000 (in- and out-patients). 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 25 25 General Surgical 63 54 Children 19 Venereal Diseases 4 4 Ear, Nose and Throat 2 5 Skin Diseases 1 2 Others (Private Wing; (Mixed) 26 Others (Casualty) (Mixed) 5 Ophthalmic — — Gynaecological — 6 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. 28 Arrangements for pathological work:—Pathological anil Bio-chemical Laboratories. No. of patients during 1938 In-patients, 4546, and 43,575 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:— (a) *Treatment of and research into Puerperal Sepsis. (b) †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 :—97.7 per cent, outside. (б) Invermead :—91.2 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 1938:—308 Maternity, 390 Puerperal Sepsis. 24 Name:—St. John's Hospital for Skin Diseases. Situation:—262, Uxbridge Road, W.12. Purpose :—For Skin Diseases. No. of available beds :—40. If used by persons resident outside the area, in what proportion:—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:— M. F. Skin Diseases 19 21 Facilities available for.-— (1) Operative Surgery.—Nil. (2) X-Ray.—X-Ray Out-patients' Department at 5, Lisle Streef, Leicester Square, W.C.2. (3) Dental.—Hon. Dental Surgeon. (4) Ophthalmic.—Sent to various hospitals. (5) Massage.—None. Arrangements for pathological work.—At Out-Patients' Department, 5, Lisle Street, W.C.2. No. of patients during 1938 :—337 in-patients. Is the hospital provision far the area adequate1—Yes, excepting for children under 3 years of age and pay beds. 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 1938 :—1,637 25 MATERNITY AND CHILD WELFARE SERVICES. Whilst recording that in April, 1938, the Hammersmith Infant Welfare Association ceased to exist and the Infant Welfare Centres and Ante-Natal Clinics were transferred to the Hammersmith Borough Council, a warm tribute must be paid to the long, loyal and valuable service which that Association had contributed to this much-needed work. Those centres are now staffed by the Assistant Medical Officers, Health Visitors and Clerks employed by the Borough Council, and they in turn are assisted by voluntary helpers, some of whom formerly co-operated in the work previously done by the Hammersmith Infant Welfare Association, and some continuity of progress has thus been maintained throughout the transitional period. From the outset the confidence of the mothers in the medical advisers is first sought to be obtained and is maintained by the attendances at the Ante-Natal Clinics and at the Infant Welfare Centres, and as the same doctors attend the expectant mothers at the former and the children at the latter the value of their advice and recommendations becomes more appreciated, and are, therefore, more carefully followed. The problem of breast feeding is still a difficult one, and the number of mothers who are unable to feed their children for more than the first few weeks is regrettably great. There is, therefore, considerable need for the establishment of a Breast Feeding Clinic. All necessitous women when pregnant are allowed free milk, iron, calcium and cod liver oil. All benefit by these foods, but it would undoubtedly be preferable were they to take advantage of the free dinners provided. Many, however, find themselves unable to do so owing to the necessity of being at their own homes upon the return of their husbands from work and their children from school. 26 Infantile Deaths. It is satisfactory to be able to record that the infant mortality rate has decreased from 68 per 1,000 during last year to 62 per 1,000 in 1938, which may be compared with the rate of 57 per thousand for the whole of London. Approximately 38 per cent. of the infantile deaths occur in the first four weeks of life, and they are due in the main to birth injuries. Cruickshank, of Glasgow, and other observers who conducted many post-mortems on neo-natal deaths, are of the opinion that nearly 90 per cent. are due to obstetric difficulties. Other causes are prematurity, atelectasis, congenital malformation, &c. Although the cause of prematurity is still obscure, all is being done at the Ante-Natal Clinic to try to avoid this tragedy. Every ante-natal patient is seen at regular intervals, and if she fails to attend is visited by the Health Visitor. The Hammersmith Hospital has several antenatal beds, and will always admit any patient sent by the Medical Officer if there is any indication of an abnormal condition during the ante-natal period. As more antenatal care is afforded, abnormal pelves and other conditions are diagnosed and treated with the hope of diminishing those deaths from birth injuries, as abnormalities that are foreseen can be naturally coped with more successfully. No satisfactory explanation can as yet be advanced for congenital malformations, but it is, of course, obvious that the general health and condition of the parents must contribute in some measure to these incidents and therefore the diminution of deaths from these causes is to be sought in all probability in the improvement, mental and physical, of the parents' health. After the first four weeks of life and up to one year of age deaths due to prematurity still persist, and other deaths are caused chiefly by respiratory diseases and gastroenteritis. 27 Advice to parents as to over-clothing and over-crowding is always given, but its importance is frequently not understood, and the education of parents in the potential advantages of fresh air and cleanliness is unfortunately a slow process. At the same time, overcrowding and the lack of adequate larder accommodation will, it is hoped, be to some extent eliminated when the housing scheme has been brought into complete operation which, it is hoped, will have the effect of removing those factors which contribute so largely to pneumonia and enteritis. Infant Welfare Clinics are held at seven centres in the Borough. Of these, five are controlled by the Council and are situated in Glenthorne Road, Old Oak, Becklow Boad, Thornfield Road, and Milson Boad, and two by Voluntary Associations at Latimer Boad and College Park. The Borough Council is responsible for the medical staff at each of the centres and also for the staff of Health Visitors. The attendances at all the Clinics have increased, and all children within the borough are encouraged to attend their nearest centre until they atttain school age. All children are weighed and seen by the doctor at regular intervals, and such conditions as malnutrition, rickets and anæmia are treated in the appropriate manner. Extra food, including milk and dinners, cod liver oil and certain massage and remedial exercises are also available. When other physical defects are diagnosed, the patients are referred to their own doctor or afforded facilities for attendance at hospital. Toddlers' Clinics are held weekly at Glenthorne Boad and Old Oak, and the number of attendances has increased during the year. Parents are advised to have all children over the age of one year immunized against diphtheria and are advised to attend their own doctor for this treatment, but if they have no medical attendant the treatment 28 is provided by the Medical Officer at the Clinic. In either case no charge is made in respect of this treatment. The Health Visitors are giving this information to the parents when visiting the homes of such toddlers. Queen Charlotte's Hospital at Ravenscourt Park has started a milk bureau for the distribution of human milk. This should be a great advantage when dealing with premature and delicate children. The attendances at the Ante-Natal Clinics continue to increase, and the co-operation with Hammersmith Hospital and the London County Council midwives is excellent. All patients referred to the Ante-Natal Clinics by the London County Council midwives attend the Clinics at least once a month or more frequently if thought necessary, thus ensuring essential medical supervision. An arrangement has been made with the dental department at Hammersmith Hospital to provide dental treatment and dentures for ante-natal patients and nursing mothers, and this scheme has already proved efficacious. 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 2,840 Corrected Number of Births 1,874 The corrected figure represents a Birth-rate per 1,000 of the population of the Borough of 15.0 Corrected Number of Deaths of Infants under one year, of whom 43 died under one week 117 Legitimate Infants 107, or 62 per 1,000 Births. Illegitimate Infants 10, or 62 per 1,000 Births. Infant Mortality Rate per 1,000 Births 62 29 The work undertaken under this heading was continued on similar lines to previous years. 1. Activities directly initiated by the Borough Council: (а) 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 Convalescent Home Treatment. 2. Activities of Voluntary Agencies in receipt of grants- in-aid from the Borough Council: (a) Infant Welfare Centres. (b) Day Nurseriee. (c) Treatment and Nursing of Children under School Age. (d) Rheumatism Clinic. (e) Massage and Remedial Exercises. 3. Activities of independent Voluntary Agencies: (a) Rescue Homes. (b) Convalescent Treatment for Invalid Children (c) Homes for Unmarried Mothers and their Children. Health Visitors—Visits. The Health Visitors were engaged, as in former years, in visits of enquiry to Births, Infant Deaths. Ante-natal Visits, cases of Ophthalmia Neonatorum, Puerperal Fever, and other diseases of mothers and young children; they have also taken an active part in the work of the Voluntary Infant Welfare Centres. 30 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 248 372 293 274 337 202 214 1940 Visits. First visits 201 301 258 264 290 184 150 1648 Re-visits (under 1 year) 798 622 722 1325 868 587 727 5649 Re-visits (1-5 years) 1255 506 844 769 695 773 571 5413 Out 462 1063 1156 425 1006 460 776 5348 Removals 107 220 182 182 149 84 121 1045 Special visits 7 1 49 — 7 9 — 73 Ophthalmia-Neonatorum 1st visits 1 - - - 2 2 1 6 Ophthalmia-Neonatorum Re-visits - - 1 - - - - 1 Puerperal Fever — 1 2 — 3 — — 6 Puerperal Pyrexia 2 1 3 — 1 — 1 8 Ante-natal — First visits 213 234 199 300 200 187 227 1560 Ante-natal — Revisits 151 90 81 118 70 84 18 612 Stillbirths 7 5 4 8 11 3 3 41 Infant Deaths 11 19 13 16 10 8 16 93 Measles 38 23 34 25 22 35 28 205 Pneumonia — — 2 — — — 1 3 Encephalitis Lethargica 1 - - 1 - - - 2 Chicken-pox 8 5 7 3 10 6 — 39 Whooping Cough 1 — — — 1 5 1 8 Polio-Myelitis 2 1 2 — — — — 5 Cerebro Spinal Meningitis - 1 - - 1 2 - 4 Epidemic Diarrhœa — — 1 — — — — 1 Home Helps 27 5 — 18 10 62 6 128 Child Life Protection 4 1 - - 3 4 - 12 Diphtheria Immunisation 10 10 - 12 16 20 2 70 Scabies 2 1 - - - - - 3 Adoption of Children 4 — — — — 1 — 5 Dinners — — — 4 — — — 4 Convalescent Home — — — 7 1 4 10 22 Total visits 3312 3110 3560 3477 3376 2520 2659 22014 Attendances at Infant Welfare Centres 114 103 95 113 79 129 74 707 Attendances at AnteNatal Clinics 62 53 49 38 38 35 109 384 Schick Test Clinics 7 2 — 1 2 5 — 17 Number of insanitary conditions reported 2 3 17 8 21 4 7 62 31 The feeding of the 1,648 infants visited was found to be as follows:— Breast-feeding (first visit) 1,443 Artificial feeding 125 Mixed feeding 80 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 88 1922 2758 196 71 1923 2701 173 64 1924 2399 173 72 1925 2351 153 65 1926 2188 144 66 1927 2076 126 61 1928 2258 156 69 1929 2162 133 62 1930 2173 140 64 1931 2073 140 68 1932 1940 129 66 1933 1827 119 65 1934 1783 137 77 1935 1877 131 70 1936 1922 116 60 1937 1913 130 68 1938 1874 117 62 32 Public Health (London) Act, 1936. Births notified 3,132 Corrected number of births 1,874 Notification Received from Midwives. Doctors. Lying-in Hospitals and Nursing Homes. L.C.C. Institutions. Parents. M.O.H.'s. 577 54 510 1,981 — 10 Stillbirths.—Fifty-nine stillbirths were allocated to this Borough. Seventy-four were registered in the Borough, of which number nineteen were outward transfers. Four 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 117, as compared with 130 in the previous year. The number of deaths of infants under one year of age was equal to 62 per 1,000 of the corrected births. The number of deaths of infants under one year of age, residents in London, was equal to 57 per 1,000 of the total registered births. The mortality rate of infants under one year of age was five per thousand more in this Borough than in London. 88 The following table shows the deaths of infants under one year of age and the cause :— INFANT MORTAIITY, 1938. Infantile Mortality during the year 1938. 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 42 2 1 5 50 12 29 14 12 117 Uncertified - - - - - - - - - - Small-pox - - - - - - - - - - Chicken-pox - - - - - - - 1 - 1 Measles - - - - - - - - 1 1 Scarlet Fever - - - - - - - - - - Whooping Cough - - - - - - - 1 2 3 Diphtheria and croup - - - - - - - - - - Influenza - - - - - - - - - - Erysipelas - - - - - - - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - 2 - - 2 Meningitis (not T.B) - - - 1 1 - - 1 - 2 Laryngitis - - - - - - - - - - Bronchtis - - 1 - 1 - 1 3 - 5 Pneumonia (all forms) 1 1 - 1 3 3 12 3 4 25 Infective Gastro Enteritis - - - 1 1 5 6 4 5 21 Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation, Overlying - - - - - - - - - - Injury at Birth 3 - - - 3 - - - - 3 Atelectasis 7 — — — 7 — — — - 7 Congenital Malformations 4 1 — 2 7 — 1 — — 8 Premature Births 25 — — — 25 — 2 — — 27 Otitis Media - - - - - - 1 - - 1 Violence - - - - - - - - - - Icterus Neonatorum - - - - - - - - - - Hœmorrhage of the Newborn 2 — — — 2 — — — — 2 Other causes — — — — - 4 4 1 - 9 Totals 42 2 1 5 50 12 29 14 12 117 Nett Births in the Year: Legitimate, 1715; Illegitimate, 159. Nett Deaths in the Year of : Legitimate Infants, 107; Illegitimate Infants, 10. 34 The infant mortality rates of the London Boroughs varied from 84 in Holborn to 42 in Greenwich. Th» following Chart shows the Infantile Mortality rate for the years 1903-1938. 35 A large proportion of the deaths, 45, equal to 38 per cent., died in the first month, and of these 43 occurred in the first week. Practically all of these may be ascribed to ante-natal or intra-natal causes. These facts point to the necessity of greater attention to and control of the expectant mother, and to improved obstetric practice. The Number of Deaths from Prematurity decreased from 33 to 27. Infective Enteritis and Pneumonia.— Pneumonia accounted for 25 deaths and infective enteritis for 21. 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 1938:— District. 1938. No. of Births. No. of Deaths of Children under 1 year of age. Infant Mortality Rate. England and Wales 621,204 32,724 53 London 54,495 3,130 57 The Borough 1,874 117 62 North Hammersmith 1,021 55 54 South Hammersmith 853 62 72 WARDS River 159 10 63 Brook Green 405 36 90 Grove 289 16 55 St. Stephen's 180 6 33 Starch Green 343 18 53 Wormholt 355 17 50 Latimer and College Park 143 14 98 36 Deaths in Institutions.—Of 117 infant deaths in the Borough only 17 died at home, and the remaining 100 in institutions. Illegitimate Deaths.—The corrected number of deaths of illegitimate infants under one year of age was 10 or at the rate of 62 per 1,000 illegitimate births. 1936. 1937. 1938. Legitimate Deaths 60 per 1,000 64 per 1,000 62 per 1,000 Illegitimate Deaths 65 per 1,000 119 per 1,000 62 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. Artificial Sunlight.—Cases requiring artificial sunlight treatment are referred to the clinic at the Hammersmith Hospital by the Assistant Medical Officers at the Infant Welfare Centres. The Council paid for the attendances of 22 patients up to the end of the year. 37 The following Chart shows the number of deaths from Diarrhœa per 100,000 inhabitants, 1911-1938. 38 Circumcisions.—Cases are referred by the Assistant Medical Officers to the Hammersmith Hospital. Infant Welfare Work.—There are seven Infant Welfare Centres in the Borough. One is organised by the Latymer Road Mission, one by a voluntary committee at Ponsard Road, College Park and five are municipal centres. The Borough Council makes grants-in-aid to the voluntary associations. 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 Boad, W.12. Wednesdays, 2 p.m. Fridays, 2 p.m. Old Oak Centre, The Curve, Westway, W.12. Mondays and Thursdays, 2 p.m. Toddlers, Tuesdays 2 p.m. Milson Boad School, Milson Boad, W.14. Tuesdays 2 p.m. Thursdays, 2 p.m. St. Thomas's Church Hall, Thornfield Boad, W.12. Mondays, 2 p.m. Fridays. 10 a.m. St. Peter's Church Hall, Ponsard Boad, N.W.10. Wednesdays, 10 a.m. Latymer Boad Mission, Blechynden Street. W.ll. Tuesdays, 2 p.m. Massage and Remedial Exercises Clinic. 48, Glenthorne Road. W.6. Mondays, Thursdays and Fridays, 2 p.m. The work of the Centres has been of inestimable value. They form an important part of the Maternity and Child Welfare Scheme of the Borough Council. 39 Schedule of Attendances at Infant Welfare Centres. Address of Clinic. No. of Clinics New Cases. Total attendances Mothers. Children. Mothers. Children. Antenatal. Postnatal. Under 1 yr. Over 1 yr. Antenatal. Postnatal. Under 1 yr. Over 1 yr. 48, Glenthorne Rd. 230 738 32 - - 3566 36 - - 48, Glenthorne Rd. 199 — — 428 36 — — 5870 1359 Victoria Mission Hall. Becklow Road 103 - - 231 25 - - 3860 963 Milson Road 101 - — 259 78 — — 4165 1529 Old Oak Centre, 111 320 14 — — 1608 24 — — Westway 149 — - 205 42 — — 3522 936 Latvmer Rd. Miss., 50 105 2 — — 537 4 — — Blechynden St. 49 — — 128 35 — — 1653 854 Presbyterian Hall, College Park 49 - - 54 7 - 1340 155 Thornfield Road 98 - - 254 41 - - 3666 1029 Totals 1139 1163 48 1559 264 5711 64 24076 6825 Ante-natal Clinics 391 Infant Consultations 748 1,139 The average attendances for the various Centres are as follows:— Municipal Infant Welfare Centres 36 Latymer Mission 34 College Park Centre 27 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 103 cases received massage treatment, the total number of treatments being 1.071. There is a very long waiting list and it is probable that an additional 40 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. 13,689 lbs. of dried milk and 51,593¾ quarts of raw milk were distributed during the year. The number of applications for free milk has averaged 92 per week during the year. The total expenditure during the year was approximately £2,227 19s. 0d. The amount of dried milk distributed during the year increased by 2,940 lbs., raw milk increased by 29,730¾ quarts. There was an increased cost of approximately £1.062 12s. 5d. 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 continued 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. 41 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, 1937, 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 112 cases were referred to these centres by the Borough Council to whom 2,897 dinners were served at an approximate cost of £81 4s. 9d. Ante-Natal Clinics. Nine 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 Boad, W.6. Mondays, 6 p.m. Fridays, 10 a.m. Tuesdays, 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. Wednesdays, 2 p.m. Latymer Boad Mission, Blechynden Street, W.11. Thursdays, 10 a.m, 42 The Borough Council's Assistant Medical Officers attend these clinics with the Clinic Assistant and Health Visitors. Any expectant mother being resident in the Borough may attend. Beports 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 nnd a reduction in maternal and infant mortality. MATERNITY SERVICES. Facilities for Confinement. 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 1938 this had increased to 67 per cent., and there is not the least doubt that having experienced the comfort of the Hospital the numbers seeking admission will increase. During 1938 there were 1,061 Hammersmith cases confined in Hammersmith Hospital. All abnormal or complicated cases are at once trans-ferred 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. 43 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 30 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, Gharcroft 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. This service was transferred to the London County Council in January, 1938. 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 1938 161 Ante-natal and post-natal clinics are held in connection with these district cases. 44 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, Town Hall, 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 1938, 72. The Maternity Bags were handed over to the Hammersmith District Nursing Association when the Domiciliary Midwifery Scheme was terminated in December 1937. 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. No consultant was called in during the year. Midwives. The London County Council is the local Supervising Authority and I am informed by the Chief Medical Officer that 61 Midwives notified their intention to practice during the year in this area. 45 Service of Home Helps.—The service of Home Helps was continued during the year 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 91 applications were received for home helps. 78 home helps were supplied. Maternal Mortality.—During the year there were two maternal deaths compared with four in the previous year and three in the year before; one from acute peritonitis and septicaemia, following ectopic gestation in the very early months of pregnancy; and one from toxæmia, consequent upon pregnancy. A special inquiry was made by the Medical Officer of Health in each case in accordance with the Ministry of Health's requirements. The maternal death rate for the Borough of Hammersmith was 1.03 and compares with 2.6 for the whole of London. 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 46 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. 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. 1924 4 4 2,399 3.3 1925 6 7 2,351 5.5 1926 3 4 2,188 3.2 1927 3 4 2,076 3.4 1928 5 5 2,258 4.4 1929 5 2 2,162 3.3 1930 4 5 2,173 4.1 1931 2 5 2,073 3.4 1932 3 4 1,940 3.6 1933 6 2 1,827 4.4 1934 4 5 1,783 5.0 1935 1 1 1,877 1.1 1936 1 2 1,922 1.6 1937 1 3 1,913 2.1 1938 — 2 1,874 1.1* * The Maternal Death rate calculated on the total (live and still) births is 1.0. Infectious Diseases of Mothers and Children Under Five Years of Age. Statistics showing the incidence of all infectious diseases during the year are included in the general report, hut in 47 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 11 9 11 — 11 Puerperal Pyrexia 16 21 16 1 15 Ophthalmia Neonatorum 8 14 8 - 8 Epidemic Diarrhœa 19 28 - 1 - Measles & German Measles (under 5)† 712 42 712 96 200 Whooping Cough (under 5)† 106 145 106 38 Poliomyelitis (under 5) 3 2 3 - 3 * 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. f Notifiable diseases—in certain circumstance* since October 1st. Ophthalmia Neonatorum.—The number of cases reported was eight against fourteen in the previous year. The analysis of the final reports received is as follows :— Cases. Vision unimpaired. Vision Impaired. Total Blindness. Removed from District. Still under Treatment. Deaths. Notified. Treated. At Home. In Hospital. 13.5.38 - 1 Yes No No No No No 23.4 38 — 1 ,, ,, ,, ,, ,, ,, 15.5.38 — 1 ,, ,, ,, ,, ,, †Yes 22.8.38 — 1 ,, ,, ,, ,, ,, No 15.7.38 — 1 ,, ,, ,, ,, ,, ,, 19.8.38 — 1 ,, ,, ,, ,, ,, ,, 19.11.38 1 ,, ,, ,, ,, ,, ,, 10.8.38 — 1 ,, ,, ,, ,, ,, ,, Totals — 8 - - - - - 1 † Died—7 mths. Cert. Gastro-Enteritis. 48 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 cf the Borough are carried out. The Princess Christian Day Nursery, Goldhawk Road, provides accommodation for 45 in winter and 50 in summer. This is also visited and supervised by the Medical Officer of the Public Health Department. 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, 39 children were sent to convalescent homes for periods varying from two weeks to six months, 49 compared with thirty-one in 1937. On return the children are medically examined and a report sent upon 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. Nineteen mothers, seventeen babies and seven 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 66 foster-children in the care of 64 foster-mothers. The Lady Sanitary Inspector is responsible for visiting the homes of all foster-children. During the year 60 foster-mothers were removed from the register for various reasons and 40 new foster-mothers were registered. Five 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, 1938 64 ,, ,, „ Recommended for Registration 40 No. of Foster-Mothers removed from Register 60 (1) Removed from Borough 8 (2) Adopted Children 2 (3) Unsuitable 1 (4) 9 years of age 5 (5) Temporarily approved 1 (6) No further Foster-Children required 42 (7) Illness of Foster-Mothers (8) Lack of accommodation (9) Mother living at address 1 ,, Applications for Registration received but not Recommended 5 50 FOSTER-CHILDREN. No. of Foster-Children on Register December 31st, 1938 64 „ „ „ received by Foster-Mothers 80 „ ,, „ moved from Foster-Mothers 84 (1) To Foster-Mothers 13 (2) To Parents or Guardians 38 (3) To Institutions 12 (4) Adopted 2 (5) Children removed from Borough with FosterMother 14 (6) Foster-Children who have reached the age of 9 years during the Year 5 VISITS. No. of visits to new Foster-Mothers 40 „ ,, Registered Foster-Mothers 493 Verification Visits 4 Special Visits 3 Outa 196 Total Visits 736 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." 51 SANITARY CIRCUMSTANCES OF THE BOROUGH. Closet Accommodation.—There are as far as is known no privies in the Borough, all houses being provided with proper water-closets on the water carriage system. Scavenging.—The arrangements for the removal and disposal of house refuse include the use of both motor and horse-drawn vehicles. FOULING OF FOOTPATHS BY DOGS. In September, 1922, the Council obtained approval of the following Bye-law, for the good rule and government of the Borough in pursuance of Section 28 of the Municipal Corporation Act, 1882, and Section 16 of the Local Government Act, 1888. No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. Any person offending against the foregoing Bye-law shall be liable to a penalty not exceeding forty shillings. During the year under review seven summonses were taken, when fines of 10s. were imposed in five cases, one of 5s. and one of 2s. 6d. Sanitary Inspection of the Area.—During the year 44,604 inspections were made by the Sanitary Inspectors. 52 53 Inspections.-The following table show the number of visits made in each district under the various inspection heads:- NUMBER OF INSPECTIONS MADE DURING 1938. Cause of Inspection. Districts. 1 2 3 4 5 6 7 8 Lady Sanitary Inspector Food and Drugs Inspector Sanitary Inspector Bayes Sanitary Inspector Herrick Sanitary Inspector Mason Temporary H.V. Total Infectious Disease 75 107 28 59 69 85 139 107 1,985 6 ... 49 37 844 3,590 Complaints 540 385 233 447 336 716 552 373 381 1 5 269 211 ... 4,449 House to House 1 15 ... ... 2 ... 2 ... ... ... 234 559 312 ... 1,125 Housing Acts 279 349 85 598 471 384 179 348 18 ... 119 395 478 ... 3,703 House to House Consolidated Regulations ... ... ... 3 ... ... 1 ... ... ... ... ... ... ... 4 Shops Act, 1934 ... 30 2 42 13 7 13 28 ... ... ... 2 6 ... 143 Food (other than Restaurants and Eating Houses) 8 137 38 63 54 359 106 223 ... 1,233 ... 34 166 ... 2,421 Restaurants and Eating Houses 2 25 3 74 ... 7 10 34 ... 102 ... 20 11 ... 288 Markets ... 2 149 38 35 258 34 114 ... 429 12 34 160 ... 1,265 Slaughterhouses ... ... 2 41 ... 2 1 ... ... 1 ... ... 10 ... 57 Poultry Slaughterhouses ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 Bakehouses 2 6 ... 29 ... 13 32 19 ... 55 ... 9 9 ... 174 Milk Vendors 11 22 1 46 7 24 25 66 ... 304 6 24 20 ... 556 Ice Cream Vendors ... 1 ... ... ... ... ... ... ... 137 ... ... ... ... 138 Factories (Mechanical) 3 43 2 76 92 84 2 92 52 ... ... 16 10 ... 472 Factories (Nonmechanical) 11 10 8 37 5 20 13 1 129 ... ... 6 11 251 Outworkers 5 2 8 ... ... 16 18 2 94 ... ... ... ... ... 145 Public Urinals 5 93 4 213 56 61 107 38 11 ... ... 53 96 ... 737 Smoke Observations ... 10 ... 13 26 14 1 ... ... ... ... 1 2 ... 67 Drainage 281 603 212 846 675 545 538 470 ... ... ... 439 738 ... 5,347 Miscellaneous 152 277 272 187 412 197 150 327 35 491 205 119 110 ... 2,934 Re-visits 994 1,109 731 1,017 1,227 2,074 1,463 1,842 331 ... 1,890 1,808 1,327 ... 15,813 Child Life Protection ... ... ... ... ... ... ... ... 685 ... ... ... ... 51 736 Common Lodging Houses ... 2 8 ... ... ... ... ... ... ... ... ... 7 ... 17 Pharmacy and Poisons Act ... 19 ... 22 3 15 13 9 ... 2 ... 9 15 ... 107 Cancer ... ... ... ... ... ... ... ... 58 ... ... ... ... ... 58 Women's Hostels ... ... ... ... ... ... ... ... 5 ... ... ... ... ... 5 Totals 2,369 3,249 1,786 3,851 3,483 4,881 3,399 4,093 3,784 2,761 2,471 3,846 3,736 895 44,604 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 180 160 Complaints 2,109 2,080 House to House 412 117 House to House Consolidated Regulations - Food (other than Restaurants) 17 17 Restaurants, &c. 5 8 Bakehouses 5 5 Milk Vendors 7 6 Factories (Mechanical) 57 38 Factories (Non-Mechanical) 36 39 Outworkers 3 4 Public Urinals 4 1 Smoke Observations 17 — Drainage 35 34 Miscellaneous 91 62 Re-visits 496 491 Common Lodging Houses — 1 Housing Acts 444 203 Child Life Protection 1 1 Shops Act, 1934 16 35 Women's Hostels — 1 Poultry, Slaughterhouse 1 — Total 3,396 3,303 During the year 1,349 Statutory Notices were served and 1.156 complied with. The following table shows the result of proceedings taken:— SUMMONSES—YEAR 1988. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 117, Uxbridge Road Failing to comply with Statutory Notice 1 Withdrawn. Work done 55 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 52. Wormholt Road Failing to comply with Statutory Notice. 1 Order made 14 days 29, Lefroy Road ditto 1 Withdrawn. 10s. 6d. costs 138, The Grove ditto 1 Withdrawn. 10s. 6d. costs 111, Goldhawk Road ditto 2 1. Order made 14 days 2. Fined £5 33, Iffley Road ditto 2 1. Fined £5 2. Fined £5 14, Camden Gardens ditto 1 Withdrawn. 10s. 6d. costs 18, Rayleigh Road ditto 1 Withdrawn. Work done 152, Askew Road ditto 1 Adjourned sine die. 10s. 6d. costs 44, Gayford Road ditto 1 Withdrawn. Work done 46, Gayford Road ditto 1 Withdrawn. Work done 35, Richmond Gardens ditto 1 Withdrawn. 10s. 6d. costs 86, Frithyille Gardens ditto 1 Withdrawn. 10s. 6d. costs 63, Waldo Road ditto 1 Withdrawn. Work done 49, Porten Road ditto 1 Order made 14 days 74, Rayleigh Road ditto 1 Withdrawn. 10s. 6d. costs 53, Carthew Road ditto 1 Withdrawn. 10s. 6d. costs 33, Iffley Road ditto 4 1. Fined £5 2. Fined £5 3. Fined £1 4. Fined 10s. 3, Benbow Road ditto 2 1. Withdrawn. 10s. 6d. costs 2. Withdrawn. Work done 49, Benbow Road ditto 4 1. Withdrawn. 5s. 3d. costs 2. Withdrawn. 5s. 3d. costs. 3. Order made 7 days. 5s. 3d. costs 4. Withdrawn. 5s. 3d. costs 52, Wormholt Road ditto 2 1. Fined 10s. and 10s. costs 2. Order made 14 days 80, Masbro Road ditto 1 Withdrawn. Work done 56 Summonses—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 40, Granville Gardens Failure to comply with Statutory Notice. 1 Order made 28 days 149, Coningham Road ditto 2 1. Withdrawn. Work done 2. Withdrawn. Work done 88, Rayleigh Road ditto 1 Order made 28 days 45, Masbro Road ditto 1 Withdrawn. Work done 66, Rayleigh Road ditto 1 Withdrawn. Work done 139, Askew Road ditto 1 Order made 28 days 49, Porten Road ditto 1 Fined £5. £2 2s. costs 50, Hammersmith Grove ditto 5 1. Fined 10s. 2. Order made 28 days 3. Fined 10s. 4. Fined 10s. 5. Fined 10s. 58, Sinclair Road Unlawfully collecting house refuse 1 Fined 2s. 6d. 3, Letchford Gardens Claim for cost of drainage work 1 Order made for payment of £40 8s. 7d. 197, Hammersmith Grove Failing to comply with Statutory Notice 4 1. Withdrawn. 10s. 6d. costs 2. Withdrawn. 10s. 6d. costs 3. Withdrawn. 10s. 6d. costs 4. Withdrawn. 10s. 6d. costs 117/119, Hammersmith Grove Unnecessary bends in vent pipe 1 Fined £1 ditto Vent pipe of insufficient height 1 Fined £1 ditto Failing to deposit plans 1 Fined £1 ditto Improper construction of drain 1 Fined 5, Masbro Road Failing to comply with Statutory Notice 2 1. Order made 14 days 2. Withdrawn. Work done 8, 10 & 14, Galena Road Non-deposit of drainage plans 1 Plans deposited—withdrawn Goldhawk Road Removal of offensive matter without suitable covers 1 Fined 10s. ditto Removal of offensive matter during prohibited hours 1 Fined 10s. 57 SUMMONSES—continued. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. Stokesley Street Unlawfully distributing toys in exchange for jam jars 1 Dismissed 139, Askew Road Failing to comply with Statutory Notice 1 Fined 10s. 12, Luxemburg Gardens Failing to give notice 1 Fined 10s. ditto Gully inadequately ventilated 1 Fined 10s. 64, Frithville Gardens Nuisance from Cats 1 Withdrawn. Nuisance abated 18, Rayleigh Road Failing to comply with Statutory Notice 2 Withdrawn. Work done 20, Rayleigh Road Claim for cost of repairs 1 Withdrawn. Case settled for £50 18, Rayleigh Road Failing to comply with Statutory Notice 3 1. Adjourned 2. Withdrawn. Work done 3. Adjourned 50, Hammersmith Grove ditto 1 Withdrawn. Work done 387, Goldhawk Road ditto 1 Order made 21 days 395, Goldhawk Road ditto 1 Order made 21 days 9, Batoum Gardens ditto 1 Withdrawn. Work done 13, Batoum Gardens ditto 1 Withdrawn. Work done 73, Black Lion Lane ditto 2 1. Withdrawn. Work done 2. Withdrawn. Work done HOUSING ACT, 1936. Situation of Premises. Nature of Offence. No. of Summonses. Result of Proceedings. 30, Cathnor Road Non-compliance with Closing Order (Basement) 1 Fined £5 and £2 2s. costs 58 HAMMERSMITH BOROUGH COUNCIL BYE-LAWS—DOGS. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mr. H. S., Chiswick Contravention of Bye-law re nuisance by dogs in King Street 1 Fined 10s. Mr. R. J. A. S., Shepherds Bush ditto 1 Fined 10s. Stamford Brook Road Mr. J. M., Hammersmith ditto 1 Fined 10s. Hammersmith Rd. Mrs. K. M., Hammersmith ditto 1 Fined 10s. King Street Mrs. D. W., Acton ditto 1 Fined 5s. Askew Road Mr. H. H. C., Hammersmith ditto 1 Fined 2s. 6d. Goldhawk Road Miss E. B., Hammersmith ditto 1 Fined 10s. King Street CHILD LIFE PROTECTION. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mrs. M. M., Ladbroke Road, Notting Hill Failing to register infant with Local Authority 1 Dismissed under P.O.A. Mrs. E., Porten Road Unlawfully taking child for reward without giving notice 1 Fined 2s. 6d. ditto Unlawfully keeping child for reward after Magistrates' Order 1 Fined 2s. 6d. MILK AND DAIRIES ORDER, 1926. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. R.D.M. Supply, Ltd., Lancaster Road Kensington Causing milk bottles filled with milk to be delivered to Wormholt Park School, Bryony Road, when not in a state of thorough cleanliness 1 Dismissed under P.O.A. £2 2s. costs 59 MERCHANDISE MARKS ACT AND ORDERS. Name and Address. Nature of Offence. No. of Summonses. Result of Proceedings. Mrs. H. P., Bradmore Lane Exposing apples without show tickets — Bradmore Lane 1 Dismissed under P.O.A. ditto Exposing raw tomatoes without show tickets -Bradmore Lane 1 Dismissed under P.O.A. Mr. H. G., Elric Street Exposing apples without show tickets Bradmore Market 1 Dismissed under P.O.A. ditto Exposing raw tomatoes without show tickets — Bradmore Market 1 Dismissed under P.O.A. Mr. A. G. B., Porten Road Exposing apples without show tickets— Bradmore Market 1 Dismissed under P.O.A. ditto Exposing raw tomatoes without show tickets —B r a d m o r e Market 1 Dismissed under P.O.A. Mr. C. J. F., Hanover Cottages Exposing apples without show tickets— Bradmore Market 1 Dismissed under P.O.A. ditto Exposing raw tomatoes without show tickets —Bradmore Market 1 Dismissed under P.O.A. Mr. A. C., Margravine Road Exposing raw tomatoes without show tickets —Leamore Street 1 Fined 5s. PUBLIC HEALTH (LONDON) ACT—UNSOUND FOOD. Name and Address. Nature of Offence No. of Summonses. Result of Proceedings. Mr. F. H. J. P., Becker Street, Notting Hill Sale of pears unfit for the food of man—Norland Market 1 Dismissed under P.O.A. 5s. costs D. (1926), Ltd., Grays Inn Road, W.C. Sale of meat pies unfit for the food of man— 70, Goldhawk Road 1 Fined £25 Messrs. N., Ltd., Buckingham Palace Road, S.W. Sale of meat pies unfit for the food of man— 13, Queen Street 1 Fined £10 and £2 2s. costs 60 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 six persons who were unable to devote to themselves proper care and attention and living under insanitary conditions. They were removed to Institutions of the London County Council. Factories.—During the year 93 notices were served in reference to insanitary conditions and defects found to exist during the inspection of the factories in the Borough, and during the same period 77 notices were complied with. During the previous year there were 35 notices served and 22 complied with. The following is a list of the Factories upon the Register:— Restaurants, Hotels, &c 189 Bakehouses (33 not in use as Bakeries) 70 Bootmakers 16 Motor and Cycle Makers 2 Dressmakers and Milliners 27 Laundries 40 Outworkers 74 Letterpress Printers and Bookbinders 15 Electrical and Mechanical Engineers 87 Smiths, Wheelwrights and Coachbuilders 14 Tailors 13 Builders, Carpenters and Joiners 21 Miscellaneous 193 Total 761 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 and the Factories Act, 1937, dealing with Factories (Mechanical and Non-Mechanical). 61 1.—INSPECTION OF FACTORIES. Premises Number of Inspections. Written Notices. Occupiers Prosecuted. Factories (with Mechanical Power) 472 57 — Factories (without Mechanical Power) 251 36 — Other Premises - — — Total 723 93 — 2.—DEFECTS FOUND. Particulars Number of Defects Number of Proscutions Found Remedied Referred to H.M. Inspector Want of Cleanliness 30 26 — Unreasonable Temperatures — — — — Inadequate Ventilation 1 1 — — Overcrowding — — — — Ineffective Drainage of Floors — — — — Sanitary Conveniences insufficient 8 6 — — unsuitable or defective 30 28 — — not separate for sexes 3 1 — — Offences under the Factory and Workshops Act Illegal occupation of underground bakehouse - - - Other Offences (excluding offences relating to out-work which are included in Part 3 of this report) 6 3 - - Total 78 65 - — 62 3.—HOME WORK. Outwork in Unwholesome Premises. Outwork in Infected Premises. Nature of Work Instances Notices served Prosecutions Instances Orders made Prosecutions Wearing apparel— (1) making, etc. - — — - — — (2) cleaning and washing - — — - — — Furniture and upholstery - — — - — — Toymaking 1 1 — - — — Totals 1 1 — — — — 4.—OTHER MATTERS. Class Number Matters notified to H.M. Inspector of Factories- Failure to affix Abstract of the Factory Act 1937 (Sec. 2) 5 Action taken in matters referred by H. M. Inspector as remediable under the Public Health Acts, but rot under the Factory Act, 1937 Notified by H.M. Inspector 15 Reports of action taken sent to H.M. Inspector 15 Other 3 Underground bakehouses (S. 54)— Certificates granted during year — In use at the end of the year 20 68 House to House.—As a result of the house to house visitation 1,125 inspections were made, 412 notices served, and 117 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. Seventeen 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 Road. 17, Galena Road. Carpet Beating Co., rear of Glenthorne Road. Fullers, Ltd., Great Church Lane. Balmoral Laundry. Kensington Palace Laundry. Royal Chiswick Laundry. Alexandra Laundry. Purewite Laundry, Gayford Road. 136, Railway Approach, Uxbridge Road. Rats and Mice (Destruction) Act, 1919.-During the year the Rats and Mice (Destruction) Act, 1919, continued in operation, the District Inspectors being responsible for its administration in their respective districts. Section I places the responsibility of ridding the pre mises of the pest upon the occupier, but this is somewhat difficult when dealing with tenement houses containing in some cases three or more families. 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. 64 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 ill 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, 1938. 65 The maximum number of lodgers who may be received at any one time into this house is 209. 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 homes are inspected with a view to any insanitary conditions being remedied. 66 HOUSING SURVEY. In accordance with your instructions a survey of the Borough was carried out during the period commencing the 18th January and ending in July, 1987. A temporary staff of ten enumerators for house visiting and four clerks were engaged. The enumerators were under the supervision of two permanent Sanitary Inspectors, whose normal duties were undertaken by two temporary Sanitary Inspectors, and the clerical staff and keeping of records, etc., were under the supervision of a permanent member of my clerical staff. I append hereunder the figures at the end of the survey:— Number of houses surveyed 18,236 Number of dwellings in houses surveyed 35,927 Number of houses not surveyed 3,364 (Premises used solely for business purposes not included in figures.) Number of dwellings overcrowded:— Ward No. 1 165 Ward No. 4 138 Ward No. 2 394 Ward No. 5 201 Ward No. 8 197 Ward No. 6 348 Ward No. 7 118 Total South 756 Total North 805 Total for whole Borough 1,561 Number of overcrowded cases abated 100 Number of houses containing underground rooms:— Ward No. 1 652 Ward No. 4 622 Ward No. 2 1,775 Ward No. 5 905 Ward No. 8 1,240 Ward No. 6 353 Ward No. 7 317 Total South 3,667 Total North 2,197 Total for whole Borough 5,864 67 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 of dwelling-houses during the year:— (1) (a) Total number of dwelling house inspected for housing defects (under Public Health or Housing Acts) 12,020 (b) Number of inspections made for the purpose 28,038 (2) (a) Number of dwelling-houses (included under Sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 3 (b) Number of inspections made for the purpose 3 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 24 (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 4,435 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 68 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 474 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil (b) By Local Authority in default of owners Nil (B) Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 3,086 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 2,894 (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 1 (2) Number of dwelling-houses demolished in pursuance of demolition orders — (D) Proceedings under Section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which closing orders were made 15 69 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been dered fit 4.—Housing Act, 1936—Part IV. Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 1,420 (ii) Number of families dwelling therein 1,420 (iii) Number of persons dwelling therein 5,696 (b) Number of new cases of overcrowding reported during the year 34 (c) (i) Number of cases of overcrowding relieved during the year 287 (ii) Number of persons concerned in such cases 1,453 (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 31 (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report 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. 70 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 Hoard. Very few houses have not an adequate internal water supply. 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 3 Number of other houses found to be infested 185 Number of Council houses disinfested 3 Number of other houses disinfested 108 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 disinfector. This Council has a contract with a firm for the disinfestation with hydrocyanic acid gas. Newly-Erected Houses.—On the 27th April the new block of flats erected by the Council and known as Emlyn Gardens was officially opened by His Worshipful the Mayor of Hammersmith (Alderman W. H. Church, J.P.,. L.C.C.). 71 The land selected for this purpose was let as allotment gardens and the site consists of a total of 14 blocks comprising 269 flats containing the following:— 64 two-room flats; 144 three-room flats; 39 four-room flats; 22 five-room flats. Each block is five storeys in height with the exception of the blocks fronting Emlyn Road, which are restricted to four. Spacious and airy courtyards, with grass lawns and trees are provided, and also forecourts and grass spaces suitably planted. Four hundred and five 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, 4,841 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 239 1928 500 Nil 187 1929 1 60 297 72 Year. L.C.C. Estate. H.B.C. Estate. Private Enterprise 1930 Nil 56 90 1931 Nil 21 36 1932 Nil 39 1 1933 Nil 32 20 1934 112 Nil 163 1935 Nil Nil 189 1936 Nil Nil 301 1937 Nil Nil 168 1938 Nil 269 136 Totals 1,638 1,062 2,141 The premises have provided accommodation for approximately 24,205 persons, but despite this fact overcrowding is still in evidence. HOUSING ACT, 1936—SLUM CLEARANCE. Crisp Road Area.—In July, 1938, I submitted an official representation with respect to the area known as the Crisp Road Area. The area consists of two shops with living accommodation attached, and five brick-built two-storey houses, and is 0.173 of an acre, including roads. The buildings were old and worn out; the brickwork in part was defective; there was rising dampness in each house and dampness from defective roofs; the lighting and ventilation was in part bad; the brickwork generally decayed, and a large number of other insanitary conditions existed. The number of persons occupying the site on 4th April was 28. The Council declared the area to be a Clearance Area, and as freeholders, re-housed the tenants, and the premises are now boarded up. 73 Dalling Road (No. 1) Area.—In April, 1938, I made an official representation with regard to the area known as the Dalling Road (No. 1) Area, comprising the premises Nos. 52 to 60 even, inclusive. The premises consist of a row of small shops with living quarters at the rear and on two floors above. They are old, worn out. badly lighted and ventilated, badly arranged, rising dampness is generally present, and various other insanitary conditions exist. The number of persons occupying the site on the 4th April was 12. The Council declared it to be a Clearance Area, and an official enquiry is to be held in 1939. Dalling Road (No. 2) Area.—In September, 1938, I made an official representation with regard to the area known as the Dalling Road (No. 2) Area, comprising the premises Nos. 202 to 208 even, inclusive. The property involved comprises an area of 0.156 of an acre. The houses are two-storey dwellings and are old and worn out; the brickwork is defective; there is rising dampness in each house; lighting and ventilation is in part bad, and a large number of other insanitary conditions exist. The Council decided that the area should be declared a Clearance Area, and that it was necessary to acquire certain additional properties for the satisfactory development or user of the cleared area. The additional property (Nos. 1 and 3, Cardross Street) comprises two two-storey dwellings, covering 0.11 of an acre. The total area dealt with is 0.21 of an acre. The number of persons of the working classes in occupation of the buildings according to a recent count was 19. 6 of whom are in occupation of the houses on the additional lands. No enquiry was held. 74 King Street Area.—In November, 1938, I submitted an official representation with respect to the area known as the King Street Area, comprising Nos. 275 to 281 odd inclusive. The premises are old and worn out; the brickwork defective and bulged; the woodwork decayed; some of the roofs leaking; rising dampness and many other insanitary conditions exist. The number of persons occupying the site on the 2nd November was 30. A resolution was passed by the Council declaring this area to be a Clearance Area in September. Latimer Road (No. 1) Area.—In February, 1938, I made an official representation with regard to Nos. 133 and 135, Latimer Road, known as No. 1 Area, but this was withdrawn by the Public Health Committee, the owners having carried out extensive improvement works. The number of persons occupying this property on the 7th February was 12. Latimer Road (No. 2) Area.—In February, 1938, I made an official representation with regard to Nos. 163 and 165, Latimer Road, known as No. 2 Area. In both premises the roofs were leaking; there was rising dampness; the space beneath the floors was insufficiently ventilated and the forecourt paving undrained. In one instance there was a settlement in the main wall and many other insanitary conditions existed. The number of persons occupying the site on the 7th February was 8. The Council declared this to be a Clearance Area, and in February, 1939, the Ministry of Health issued an Order confirming the Order made by the Council entitled "Hammersmith (Latimer Road, No. 2) Housing Confirmation Order 1939." The premises are demolished. 75 Latimer Road (No. 3) Area.—In April, 1938, I made an official representation that the houses in the Latimer Road (No. 3) Area, known as 52 to 72 even, Latimer Road, and Nos. 69 to 79, St. Ann's Road, should be dealt with as a Clearance Area. The Council in July declared that the area should be a Clearance Area, and decided to purchase the land and the additional lands required for the purpose of securing a cleared area of convenient shape and dimensions for the satisfactory development or user of the cleared area, and accordingly made a compulsory purchase order. The number of persons occupying the site on the 4th April was 16. An enquiry is to be held in 1939. Shortlands (No. 2) Area.—In September, 1938, I made an official representation with respect to Nos. 35 and 37, Shortlands (known as No. 2 Area), which consists of two brick-built two-storey houses 0.038 acre in extent. The buildings were old and worn out; there is rising dampness in each house; the brickwork is defective; the lighting and ventilation generally bad and a large number of other insanitary conditions exist. The number of persons in occupation of the site was 4. The Council declared the area to be a Clearance Area. No enquiry was held. Shortlands (No. 3) Area.—In September, 1938, I submitted an official representation with respect to Nos. 38 and 40, Shortlands (known as No. 3 Area). The area consists of two brick-built two-storey houses, 0.018 acre in extent. The buildings are old and badly arranged; there is rising dampness and considerable dampness in the upper rooms; the lighting and ventilation is bad, and a large number of other insanitary conditions exist. 76 The number of persons occupying the site on the 14th September was 9. The Council declared the area to be a Clearance Area. An enquiry is to be held. Naylor's Cottages Area.—In September, 1938, I submitted an official representation with regard to Nos. 1, 2, 3 and 4, Naylor's Cottages, known as the Naylor's Cottages Area. The roofs in part were defective; some of the walls bulged; there was lack of proper lighting and ventilation; the woodwork was decayed and many other insanitary conditions existed. The number of persons occupying the site on the 14th September was 7. A resolution was passed by the Council declaring the area as a Clearance Area in September. 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 In April, 1938, the Ministry of Health issued an Order confirming the Clearance Order made by the Council entitled the "Hammersmith (Evesham Street) Housing Confirmation Order 1938." 77 The following table gives particulars of the Clearance Areas dealt with during the past four years :— Name of Area Date of Declaration Action taken by Council No. of Premises on Site No. of Persons Originally Living on Site ion at end of 1938 1. Becklow Place June, 1935 Compulsory Purchase Order 34 179 Premises demolished and building of Flats in progress. 2. Argyle Place October, 1935 Clearance Order 8 30 Cottages demolished & house empty. 3. Terrace Court March, 1936 Clearance Order 4 14 Premises demolished. 4. Bannisters Cottages June, 1936 Clearance Order 23 75 Three still standing and one occupied. 5. Coleman's Buildings March, 1936 Clearance Order 6 27 All empty but not yet demolished. 6. Hanover Cottages October, 1935 Clearance Order 30 164 Premises demolished. 7. Mulberry Place March, 1936 Clearance Order 2 11 Premises not yet demolished. 8. Britannia Court March, 1936 Clearance Order 11 42 Premises demolished. 9. Rose and Crown Lane November, 1936 Clearance Order 21 63 Six demolished and rest are empty, 10. Wescombe Cottages November, 1936 Clearance Order 33 9 Site cleared. 11. Montagu Street November, 1936 Clearance Order 7 26 Premises empty. 12. Edwin Cottages November, 1936 Clearance Order 2 9 Premises demolished. 13. Berghem Mews May, 1936 Clearance Order 19 78 Nos. 1-9 demolished. 14. Evesham Street September, 1937 Clearance Order 10 47 Order confirmed. 15. Crisp Road July, 1938 Clearance Order 7 28 Premises boarded up. Tenants rehoused. 16. Dalling Road (No. 1) April, 1938 Clearance Order 5 12 Enquiry to be held in 1939. 17. Dalling Road (No. 2) September, 1938 Clearance Order 4 13* * Two further houses acquired for satisfactory development of the area and a further 6 persons were concerned. 18. King Street November, 1938 Clearance Order 4 30 — 19. Latimer Road (No. 1) February, 1938 Withdrawn (Extensive works carried out by Owners) 20. Latimer Road (No. 2) February, 1938 Clearance Order 2 8 Order confirmed. Premises demolished. 21. Latimer Road (No. 3) April, 1938 Clearance Order 17 16 Enquiry to be held in 1939. 22. Shortlands (No. 2) September, 1938 Clearance Order 2 4 Not demolished, No enquiry to be held. 23. Shortlands (No. 3 September, 1938 Clearance Order 2 9 Enquiry to be held. 24. Naylor's Cottages September, 1938 Clearance Order 4 7 Premises not yet demolished. 78 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.—One shop was 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 101. Milk Supply.—During the year 260 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 TINI ft 1" (a) Bottling Establishments 2 (b) Shops 12 (c) Supplementary Licences 6 (21 Licences to use the designation "Pasteurised"— (a) Pasteurising Establishments 6 (b) Shops 23 (c) Supplementary Licences 9 79 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 33 Sheep 8 Beasts 6 Pigs 35 Total 82 No application has been received for the stamping of carcases examined by the Sanitary Inspectors. 80 The following is a list of Unsound Food found during the Inspection of the Carcases of Animals Slaughtered in the Local Slaughterhouse. Description Disease. Approximate Weight. 1 Bullock's lungs Tuberculosis 14 lbs. 1½ Bullock's livers Distoma Hepaticum 30 „ 2 Pigs' lungs Pneumonia 4 „ 1 Pig's liver Milk Spots 2 „ 1 Pig's messentery Tuberculosis 1 lb. 2 Sheeps' lungs Strongulus Rufescens 3 lbs. 1½ Ox livers Distoma Hepaticum 23 „ 1 Pig's liver Cirrhosis 3 „ 1 Pig's messentery Tuberculosis 2 „ 1 set of Beast's lungs Tuberculosis 14 „ 1 set of Pig's lungs Congestion 2½ „ Carcases Inspected and Condemned. Cattle, excluding Cows Cows Calves Sheep and Lambs Pigs Number killed (if known) 6 — — 41 35 Number inspected 6 — — 41 35 All diseases except Tuberculosis— Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 2 — — — 4 Percentage of the number inspected affected with disease other than tuberculosis 33½% — — 2.4% 11.4% Tuberculosis only— Whole carcases condemned — — — Carcases of which some part or organ was condemned 2 — - — 2 Percentage of the number inspected affected with tuberculosis 331/3% — — — 5.7% Slaughterhouses.—There are three slaughterhouses in the Borough. Applications were received from three licensees for the renewal of their licences. 81 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 OP PREMISES. Number of inspections 1938 Number of notices 1938 Number of prosecutions 1938 On register in 1920. On register at end of 1937 Added in 1938 Removed in 1938 On register at end of 1938 Milk premises 128 178 5 15 168 556 7 Slaughterhouses. 7 3 — — 3 57 — — Poultry Slaughterhouses. — 1 — — 1 2 1 - Ice Cream premises 162 169 19 4 184 138 — — 82 Markets.—There are three markets in the Borough, situate in Bradmore Lane, Approach Road and Norland Road. These markets have been the subject of much inspection during the year, both by the District Inspector concerned and the Inspector carrying out the requirements of the Food and Drugs Acts. Many of the stalls in the Railway Approach Market are constructed so as to form lock-ups when business for the day is finished and thereby provide a means of storage for all unsold food. In other instances, Bradmore and Norland Markets, wheelbarrows form the structure, and these are stored in premises which are inspected and approved. Street Trading.—The London County Council (General Powers) Act, 1927, made provision for the Licensing of Street Traders which came into operation on the 1st November, 1927. This Act provided that "it shall not be lawful for any person to sell or expose or offer for sale any article or thing from or upon any barrow cart stall or other receptacle occupying a stationary position at a place in the carriageway or footway of any street in any metropolitan borough without a licence from the borough council authorising him so to do." Provided that this section shall not apply to any person selling or exposing or offering for sale any article or thing from or upon any barrow cart stall or other receptacle which he ordinarily moves from place to place in pursuit of and while conducting his trade. During the year 102 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. 83 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 37 bakehouses in use in the Borough have been regularly inspected during the year. Five notices were served relating to various defects. The following is a list of bakehouses in the Borough :— Address. Name. No. 1 DISTRICT. † Cadby Hall, Hammersmith Road J. Lyons & Co. * 1 Masbro Road W. A. Maclen †* 67 Ditto G. Dunsby †* 98 Blythe Road Miss Schofield † 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 E. 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 Hammersmith Grove F. Becker 24 Bradmore Park Road T. Miller † 28 King Street (rear of) L. E. Jolly † Blacks Road Palmers Stores Ltd. * Underground. † Factory. 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 344 Ditto Miss E. Reader 387 Ditto Mrs. A. Meek No. 5 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 Glenthome 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 Caroline Street 121 Askew Road * 77 Brackenbury Road 41 Gayford Road † 1 Hammersmith 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 85 PUBLIC HEALTH (LONDON) ACT, 1936. Ice Cream Vendors.—Section 187 requires all premises used for sale, storage or manufacture of ice cream, to be registered with the Sanitary Authority, and imposes penalties for use of any premises without being so registered. Premises which are required to be registered under Factory Act and premises used as a hotel, restaurant or club are exempt. Proceedings must be taken under the above Act for breach of special regulations. ICE CREAM VENDORS. Registered under Public Health (London) Act, 1936 184 Restaurants 16 Factories 4 204 UNSOUND FOOD. During the year on two occasions seizures of meat pies were made and on one occasion a quantity of peas was seized and in each case they were taken before magistrates who ordered their destruction as being unwholesome and unfit for the food of man. The voluntary surrender of the following unsound food was accepted during the year:— 86 Commodity Condition Result. 19 Boxes of Pears (8 cwts.) Unsound and Unfit for food Surrendered 5 Barrels Apples (7 cwts.) ditto ditto 1 Box Roe (Cods) ditto ditto 6 Chickens ditto ditto 3-½ bushel baskets Cherries ditto ditto 1 jar English Pickles (16 lbs.) ditto ditto 50 bags Walnuts (6 cwt. 16 lbs.) ditto ditto 2 bags Chestnuts ditto ditto CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. The chemical examination of food is carried out by the Public Analyst at the Laboratories, Royal Dental Hospital, Leicester Square. Six hundred and two samples taken under the Sale of Food and Drugs Acts were examined during the year. Forty-three 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. REPORT ON SAMPLES TAKEN UNDER THE FOOD AND DRUGS (ADULTERATION) ACT, 1928. During the year 602 samples were submitted to the Public Analyst for analysis under the Food and Drugs (Adulteration) Act, Public Health (Condensed Milk) Regulations, Public Health (Dried Milk) Regulations and the Public Health (Preservatives, &c., in Food) Regulations. Of this number forty-one or 6.8 per cent. were reported "adulterated." The number and nature of the various articles analysed are set out in detail below:— 87 TABLE. Article. No. of samples analysed. Result of Analysis. Genuine. Inferior. Adulterated. Almonds (ground) 2 2 _ _ Ammoniated tincture of quinine 3 2 — 1 Aspirin tablets 4 4 — i— Bloater cream 1 1 — — Butter 28 28 — .— Camphorated oil 3 3 — — Cheese 5 4 — 1 Chicken and ham cutlets 1 1 —- — „ ,, „ roll 2 2 — — „ roll 1 1 — — Chocolate cakes 10 2 — 8 Citrate of magnesia 3 3 — — Cocoa 8 8 — — Coffee 6 6 — — „ and chicory 1 1 — — „ ,, „ extract 1 1 — — „ (liquid) 1 1 — — Cream 12 12 — — Dripping 2 2 — — Eucalyptus oil 2 2 — — Fish paste 4 4 — „ (tinned) 16 16 — — Flour 2 1 — 1 ,, (bun) 3 3 — — „ (self-raising) 4 4 — — Friar's balsam 3 3 — — „ ,, pastilles 1 1 — — Fruit (dried) 6 6 — — „ (tinned) 15 14 — 1 Ginger cordial 1 1 — — „ wine essence 2 2 — — Glauber's salt 2 2 — — Glycerin of thymol 2 2 — — Grape fruit crystals 1 1 — — Hani and tongue roll 1 1 — — Health salt 1 1 — — Horseradish cream 1 1 — — Iodine ointment 1 1 — — „ tincture 2 1 — 1 Jam 13 10 — 3 Jelly (table) 2 2 — — Lard 11 11 — — Lemonade powder 2 2 — — Margarine 6 6 — — Marmalade 3 3 — — Meat paste 12 12 — — Milk 260 203 36 21 „ (condensed) 24 22 — 2 ,, (dried) •_> 2 — — M.incemeat 4 4 — — Mint sauce 1 1 — — Nutmeg (ground) 1 1 — — Olive oil 9 9 — — Paraffin (liquid) 2 2 — — Parrish's chemical food 2 2 — — Pea soup 1 1 — — Pepper 2 2 — — Rice 2 2 — — Sausages 12 12 — — Seidlitz powder 2 2 — — Semolina 3 3 — — Suet 3 3 — — Sugar 6 6 — — Syrup of figs 4 4 — — Tea 5 5 — — Tomato juice 1 1 — — „ sauce 3 3 — — ,, soup 1 1 — — Vegetables (dried) 1 1 — — „ (tinned) 6 6 — — Vinegar 10 8 — 2 „ acid 1 1 — — Whisky 7 7 — — Wine 13 13 — — Yeast tablets 1 1 — — Totals 602 525 36 41 88 ftQ The following table shows the action taken on adulterated samples and other infringements of the Food and Drugs (Adulteration) Act. Sample No. Article. Analyst's Report. Proceedings. Other Action. Court. Date of Hearing. Result. 733 Flour Contained 25% potato starch Kensington Petty Sessions 15/3/38 Dismissed under P.O. Act. — 747 Chocolate cream buns Contained only 2.2% dry fat free cocoa matter — — — Informal sample. Proceedings in connection with sample from another branch. Dismissed under P.O.A. £5 5s. costs. 750 Chocolate buns Contained no dry fat free cocoa matter — — — Informal sample. See No. 753. 751 Apricot jam 17.5% deficient in apricots — — — Informal sample. Official sample genuine. 753 Chocolate roll Contained only 1.7% fat free cocoa matter — — — Informal sample. See No. 856. 757 Milk Contained 3% extraneous water — — — Letter of warning from Public Health Committee. 764 Apricot jam 12.5% deficient in apricots — — — Informal sample. 802 Milk 7.9% deficient in non-fatty solids — — — Samples taken upon arrival from farm. 803 do. 4.1% do. do. 804 do. 2.9% do. do. — — — No action. 805 do. 4.2% do. do. — — — See Samples 809 and 839 to 842. 806 do. 3.9% do. do. 807 do. 9.6% do. do. — — — "Appeal to Cow" samples. 809 Milk 1.6% deficient in non-fatty solids — — — "Appeal to Cow" sample taken at farm. See also 839 to 842. 813 "Triple" cream cheese. Contained only 42% fat — — — Informal sample. 835 Milk 4.0% deficient in non-fatty solids — — — Samples taken upon arrival from farm. 836 do. 4.6% do. do. 837 do. 3.2% do. do. — — — No action. 838 do. 2.3% do. do. — — — "Appeal to Cow" sample, also below standard. Sample No. Article. Analyst's Report. Proceedings. Other Action. Court. Date of Hearing. Result. 839 Milk 5.0% deficient in fat — — — "Appeal to Cow" samples in connection with 802 to 807. 840 do. 5.6% do. 841 do. 1.8% deficient in non-fatty solids 842 do. 3.2% do. do. 849 Tincture of iodine 8% deficient in iodine — — — Vendor warned. 856 Chocolate cake The cake portion contained not more than 1.6% dry fat-free cocoa and "chocolate" portion not more than 0.5%. Kensington Petty Sessions 31/5/38 Dismissed under P.O. Act. £5 5s. costs. — 857A Milk 3.1% deficient in non-fatty solids — — — "Appeal to Cow" samples taken in connection with sample 835 to 838. 858A do 1.4% do. do. — — — — 859A do. 3.3% deficient in non-fatty solids and 8% deficient in fat. — — — — 861A do. 2.3% deficient in non-fatty solids and 8.4% deficient in fat. — — — — 865 French vinegar 10% deficient in acetic acid — — — Informal sample. See No. 923. 869 Apricot jam (full fruit standard) Contained not more than 35% of apricots in place of 40% required. — — —- Informal sample. Official sample genuine. 907 Tinned tomatoes Consisted entirely of capsicum fruit — — — No action. 923 French vinegar 9.2% deficient in acetic acid Kensington Petty Sessions 21/6/38 Dismissed under P.O.A. £2 12s. 6d. costs. — 942 Milk 9% deficient in fat — — — Letter of warning from Public Health Committee. 20 Chocolate cream buns Contained not more than 1.5% dry fat-free cocoa in chocolate portion. — — — Informal sample. 180 Condensed milk 5.5% deficient in fat — — — No action. 192 Chocolate roll Only 0.7% of dry fat-free cocoa — — — Informal sample. See No. 248. 248 Chocolate roll Contained only 1.4% of dry fat-free cocoa Kensington Petty Sessions 17/1/39 Fine £5 5s. Costs £5 5s. — 196 Chocolate sandwich Contained only 1.1% of dry fat-free cocoa — — — Informal sample. 224 Ammoniated tincture of quinine 17% deficient in ammonia — — — Informal sample. 304 Condensed milk 3% deficient in fat — — — No action. 90 Milk. Of the two hundred and sixty milks analysed, twenty-one were adulterated, giving a percentage of adulteration of 8.1. Sixteen of the adulterated samples were deficient in nonfatty solids in amounts ranging from 1.4 to 9.6 per cent., three were deficient in fat—5.0, 5.6 and 9.0 per cent. respectively—and two were deficient in both constituents; in one of these there was a deficiency of 8.3 per cent. in non-fatty solids and 8.0 per cent, in fat, whilst in the other the corresponding deficiencies were 2.3 per cent. and 8.4 per cent. Nineteen of the twenty-one adulterated milk samples were taken from consignments of milk upon their arrival at wholesale depots in the Borough from farmers or were actually taken at farms in the country as ''Appeal to Cow" samples. Of 238 samples of milk taken from Hammersmith dairymen, only 2 were adulterated. A percentage of 84—an extremely low figure. In both of these cases it was thought that the adulteration was accidental and not wilful, and letters of warning were addressed to the vendors by the Public Health Committee. The large percentage of adulterated samples taken from farmers is due to the fact that in addition to routine sampling by the Council's officers, a careful check is kept upon all milk arriving at their depots by the large wholesale dairies, and when supplies from a particular source are suspected the Council's sampling officer is called in. The following table shows the average content of fat and non-fatty solids in the milk samples, calculated month by month. From these figures it will be seen that, on the whole, the milk sold in Hammersmith was of good quality and well above the minimum standard of the Sale of Milk Regulations, i.e., 3 per cent. milk fat and 8.5 per cent. solids not fat. 91 Period. No. Analysed Fat. % Non-fatty Solids. % January 2 4.25 8.70 February 23 3.56 8.80 March 36 3.38 8.52 April 20 3.56 8.66 May 36 3.38 8.83 June 11 3.33 8.80 July 29 3.53 8.83 August 22 3.67 8.78 September 30 3.52 8.80 October 11 3.62 8.93 November 15 3.71 8.82 December 24 3.72 8.85 Whole year 259 3.53 8.77 In addition to those examined under the Food and Drugs Act, fifty-four milk samples were submitted to the phosphatase test to determine whether the milk had been adequately pasteurised. The test is a comparatively new one, and included in the fifty-four were a series of samples submitted in connection with some experiments carried out to check the efficiency of the test. Hammersmith is a centre of the wholesale dairy trade, and some of the largest pasteurising plants in the country are situated within the Borough. Any new method of checking whether the pasteurising process has been properly carried out is of great value, and particular interest has therefore been taken in the phosphatase test. I have commented in some of my recent reports upon certain of the experiments which I have had carried out, and the following notes upon the further tests may be of interest. It is the custom of many retail dairymen in London, when a sample is taken under the Food and Drugs Act, to return the portion handed to them by the sampling officer to the wholesale dairy company for analysis. One of the largest companies in the Borough make it a practice to apply the phosphatase test to all of these samples in addition to carrying out a chemical analysis. 92 This rule is applied in all cases whether the milk has been sold under the designation "pasteurised" or not, as all milk, other than T.T. milk, is subjected to the process laid down for pasteurised milk under the Milk (Special Designations) Order before leaving the depot. Upon examination of a series of 216 samples it was found that three failed to pass the test. The adverse reports suggested that the milk had been heated and not properly pasteurised or else re-contaminated with raw milk. A careful check was made of the plant record charts for the dates upon which the processing had been carried out and details of routine tests were examined, but no explanation could be found. Other samples of milk sold on the same dates from the same plant were satisfactory. The facts were reported to me and I had detailed inquiries made. These showed that the first of the three unsatisfactory samples was taken in South London from a. churn of pasteurised milk supplied to a hospital. The sample had been taken by dipping a jug into the churn. Immediately prior to the taking of this sample the same jug had been used for mixing and dividing a bottle of Tuberculin Tested milk supplied to the same hospital. (The jug was said to have been cleansed between the taking of the two samples.) The second adverse report referred to a sample taken in another borough. This was from a bottle of pasteurised milk which had been mixed in a jug. Particulars of the sample taken before the one in question showed that it was from milk supplied by a firm who do not sell pasteurised milk and there are 99 chances out of 100 that it was raw milk. The same jug was used for both samples. It was stated that it is the practice in this particular borough to invert the jug after use to drain out any milk left after the division of the sample, but the jug is not wiped dry. It was claimed that the amount of milk remaining is so small that it would not be likely to affect the composition 93 of the next sample, and it was emphasised that the samples had been procured for chemical analysis and not for phosphatase test. Had the sample been taken for the latter purpose, particular care would have been taken to prevent contamination with other milk. I was unable to obtain any information with regard to the third unsatisfactory sample. In view of these findings I had a series of samples prepared. One-third pint of pasteurised milk (which had passed the test) was poured into a jug which had previously contained raw milk, but which had not been drained or cleansed, and a sample of this milk was submitted for phosphatase test. A second sample was also taken from one-third pint of pasteurised milk which had been poured into a jug in a similar manner, but in this case the jug had been inverted and drained for about five minutes. The report on these samples stated in each case that the milk was "raw or grossly underheated or contaminated with raw or improperly pasteurised milk." The Lovibond blue units value was 10+ as against a limit of 2.3 for properly pasteurised milk. The same tests were made with one pint of pasteurised milk poured into the same jug after it had been used to contain raw milk. The sample from the jug which had not been drained showed 3.7 units and from the jug after it had been inverted and drained for five minutes 3.1. The Analyst reported in both of these cases— "Some error in technique of pasteurisation or contaminated with a small quantity of raw or improperly pasteurised milk." It will thus be seen that even the very thin film of milk left on the inside of a jug after it has been drained for some time when mixed with one pint of pasteurised milk can be detected by this method. These tests, I think, confirm the delicate nature of the test and show its value. 94 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 638 cases reported as due to notifiable infectious diseases in the Borough, against 747 in the previous year. There were also reported 2,454 cases of infectious diseases that were not notifiable, against 748 in the previous year; 1,859 of these were *Measles, 166 *Whooping Cough and 429 Chickenpox. The number of cases of Tuberculosis notified was 192 against 174 in the previous year. BACTERIOLOGY. The following bacteriological examinations were made on behalf of the Council:— Material from cases of suspected Diphtheria— Positive results 58 Negative results 967 Sputa from cases of suspected Tuberculosis— Tubercle bacillus found 56 Tubercle bacillus not found 493 Blood from cases of suspected Fever— Widal or Typhoid reaction obtained — Widal or Typhoid reaction not obtained 1 Faeces 6 Grand Total 1,581 * Now notifiable under certain conditions. 95 Cases of Infectious Disease notified during the year 1938. Notifiable Disease Number of Cases Notified Wards Total Removed 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) 189 4 6 15 16 21 70 17 13 19 4 4 .. 18 36 32 6 46 30 21 188 Erysipelas 54 .. 1 1 .. 1 2 2 4 9 10 20 .. 4 9 6 3 11 17 4 34 Scarlet Fever 291 4 10 17 21 32 109 44 27 22 3 2 .. 41 51 3o 8 52 65 41 268 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 2 .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. .. 1 1 2 Relapsing Fever (R) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 11 .. .. .. .. .. .. .. .. 7 4 .. .. i 3 .. 1 5 1 .. 11 Puerperal Pyrexia 16 .. .. .. .. .. .. 1 13 2 .. .. 1 5 4 .. 2 2 2 15 Cerebro-Spinal Meningitis. 8 1 .. .. .. 2 1 1 .. 3 .. .. .. 1 1 2 .. 1 2 1 8 Polio-Myelitis 5 .. .. .. 1 2 2 .. .. .. .. .. .. 1 . 2 .. .. 2 .. 5 Encephalitis Lethargica 1 .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Ophthalmia Neonatorum 8 8 2 1 ] 1 1 8 Anthrax .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 115 4 12 4 4 5 18 2 8 14 18 20 6 i3 30 18 7 9 29 9 74 Malaria .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery 23 6 4 2 2 2 3 .. .. 1 1 1 1 1 4 .. .. 3 11 4 23 Food Poisoning 5 .. 1 .. .. .. .. .. .. 3 .. 1 .. .. 3 .. .. 1 1 .. 1 TOTALS 728 27 35 39 44 65 205 67 54 91 42 48 11 82 144 98 26 131 162 85 638 96 Deaths from the Seven Principal Zymotic Diseases.— The total number of deaths of residents registered from the seven principal zymotic diseases was 62 against 52 in the previous year. The deaths of residents from these diseases were equal to 44 per 1,000 of the total deaths of residents registered and were at the rate of 0.5 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, 1929 to 1938:— Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Enteric Fever. Diasrrhœa and Cholera. Total. 1929 0 2 0 5 41 2 19 69 1930 0 31 31 21 9 1 21 89 1931 0 0 2 6 7 0 23 38 1932 0 29 4 8 6 1 26 74 1933 0 3 4 14 5 1 27 54 1934 0 25 4 25 19 0 27 100 1935 0 0 3 12 7 1 28 49 1936 0 15 3 5 7 2 25 57 1937 0 0 1 12 9 2 29 53 1938 0 5 0 5 4 0 36 62 Average last 10 yrs. 0 11 2 11 11 1 26 65 It will be seen from the preceding table that the total number of deaths from these zymotic diseases last year was three below the average number registered in the last ten years. 97 Notifiable Diseases (other than Tuberculosis) during the Year 1938. DISEASE. Total cases notified Cases admitted to Hospital. Total deaths. Diphtheria 189 188 5 Erysipelas 54 34 — Scarlet Fever 291 268 — Enteric Fever 2 2 — Puerperal Fever 11 11 2 Puerperal Pyrexia 16 15 Cerebro-Spinal Meningitis 8 8 2 Encephalitis Lethargica 1 1 4 Ophthalmia Neonatorum 8 8 — Pneumonia 115 74 94 Dysentery 23 23 — Poliomyelitis 5 5 — Malaria — — — Food Poisoning 5 1 — Totals 728 638 107 Smallpox.—No case was reported. Cholera.—No case was reported. Plague.—No case was reported. Diphtheria and Diphtheritic Membranous Croup.— One hundred and eighty-nine cases were reported against one hundred and seventy-nine cases in the previous year. All the cases were treated at the Isolation Hospitals excepting one child, which died before removal could be effected. Five deaths were registered. The mortality rate on the cases reported was 2.6 per cent. The cases were fairly evenly distributed throughout the Borough. Diphtheria is a disease which calls for prompt action by both the parent and medical practitioner. 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. 98 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 Hoepital, the accommodation available being adequate for the number of cases. DIPHTHERIA IMMUNISATION. It was decided in July, 1938, that the method of Diphtheria Immunisation then in use, i.e., the A.P.T. (one shot) method was not satisfactory, by reason of the high percentage of children showing a positive reaction after Post Schick Testing, and accordingly the Council adopted my recommendation that this method should cease. The scheme now in use provides that all the immunising material is provided by the Council free of charge, and the treatment consists of two injections of A.P.T. (.1 and .5) or three doses of T.A.M., at fortnightly intervals, the Doctors to receive a fee of 2s. 6d. for each injection given. A satisfactory comparison cannot yet be given between the old 1 and the new 2 "shot" A.P.T. method as to the results of the Post Schick Testing. It is again to be regretted that the numbers of children immunised continue to fall. 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 439 99 Number of children who did not complete the three (T.A.M.) doses:— Had 1 dose only 1 Had 2 doses only 1 Schick Testing Clinic. Number of Clinics held 19 (excluding two at Nazareth House) Pre-Schick tests. Positive 41 Negative 87 No reading I Post-Schick tests. Positive 75 Negative 452 No reading 15 Refusals of Post-Schick Test 64 Removals—address unknown—no Post-Schick Test 44 Removal—information sent on to M.O.H. concerned 5 Fees paid to medical practitioners. 491 at 10s £245 10 0 9 at 7s. 6d 3 7 6 2 at 6s. 8d 1 3 4 161 at 5s. 0d. 40 5 0 2 at 3s. 4d 6 8 19 at 2s. 6d. 2 7 6 £292 10 0 100 Scarlet Fever.—Two hundred and ninety-one cases were notified, against three hundred and thirty-two in the previous year. Two hundred and sixty-eight cases were treated at the Isolation Hospitals, and twenty-three at the homes of the patients. No deaths were registered. Enteric Fever.—Two cases were reported as due to Typhoid Fever, against one case in the previous year. Both cases were treated in hospitals. Erysipelas.—Fifty-four cases were reported, against fifty-one cases in the previous year. Twenty cases were treated at the homes of the patients, and thirty-four in various hospitals. Typhus Fever.—No case was reported. Typhoid Fever.—During October an outbreak of Typhoid Fever occurred in some Western Boroughs of London (not Hammersmith). Of the total of 11 Typhoid and 1 Paratyphoid Fevers it appeared that several of the patients had eaten oysters at a restaurant in this Borough. On receipt of this information arrangements were made for the collection of samples of oysters from the restaurant in question, and they were submitted to the Pathologist at the West London Hospital. The report of the Pathologist stated that oysters from both batches were pooled, and after examination no evidence of the typhoid group of organism was found. 101 102 103 Relapsing Fever.—No case was reported. Continued Fever.—No case was reported. Puerperal Fever.—Eleven cases were reported, against nine cases in the previous year. Three cases were treated at Isolation Hospitals of the London County Council, two at Queen Charlotte's Hospital, five at Hammersmith Hospital, and one at St. Mary Abbot's Hospital. No deaths were registered from Puerperal Sepsis, but there were two from other accidents and diseases of pregnancy. Puerperal Pyrexia.—Sixteen cases were reported, against thirty-seven in the previous year. One case was treated at home* one at Queen Charlotte's Hospital, and fourteen at various other hospitals. Cerebro-Spinal Meningitis.—Eight cases were reported, against five cases in the previous year. All cases were treated in hospitals and two deaths were registered. Acute Polio-myelitis.—Five cases were reported, against two cases in the previous year. All cases were treated in various hospitals. Encephalitis Lethargica.—One case was reported, against no case in the previous year. The patient was treated in hospital. Ophthalmia Neonatorum.—Eight cases were reported, against fourteen cases in the previous year. All the cases were removed to hospitals. Ten 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. 104 Anthrax.—No case of Anthrax was notified. Hydrophobia.—No case was reported. Rabies Order, 1919.—No case of Rabies in dogs was reported in the Borough. Glanders.—No case was reported. Measles and German Measles.—One thousand eight hundred and fifty-nine cases of Measles and German Measles were notified against eighty-one in the previous year. Two hundred and ninety-eight cases were treated in the Isolation Hospitals of the London County Council. Five deaths were registered. Whooping Cough.—One hundred and sixty-six cases were reported, against three hundred and fourteen in the previous year. Four deaths were registered. Forty-three cases were removed to hospital. The homes of the patients were visited by your Lady Inspector, and the parents advised as to the precautions that should be taken. Chicken Pox.—Four hundred and twenty-nine cases were reported, against three hundred and fifty-three in the previous year. Twenty-nine cases were removed to hospital. 105 The following Chart shows the number of Deaths from Measles per 100,000 inhabitants, 1918-1938. The following Chart shows the number of Deaths from Whooping-Cough per 100,000 inhabitants, 1918-1938. 106 Pneumonia.—One hundred and fifteen cases (twenty-six Influenzal Pneumonia and eighty-nine Primary Pneumonia) were notified during the year. Seventy-four 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. Ninety-four deaths were registered. Malaria.—No case was reported. Dysentery.—Twenty-three cases were reported, against twenty-six in the previous year. Food Poisoning.—Five cases were reported. Influenza.—During the year seven deaths from Influenza occurred, as compared with forty-nine in the previous year. Wrong Diagnosis.—Sixteen 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 II Scarlet Fever 5 Total 16 Psittacosis.—No case of psittacosis was reported in the Borough. 107 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 312 Mattresses 788 Pillows 2,532 Bolsters 602 Blankets 2,647 Sheets 1,818 Quilts 1,442 Articles of Clothing 6,464 Sundries 831 Carpets 10 Curtains 110 Total 17,556 Rooms (including-108 verminous rooms) 753 801 TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1929 to 1938. 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. Chicken pox. a Measles. b Whoopine Cough. b Cerebro-Spinal Fever. Anthrax. Glanders. Hydrophobia. Ophthalmia Neonatorum. Acute Polio-Myelitis. Encephalitis Lfthargica. Pneumonia. e Malaria. c Dysentery. c Trench Fever. e Food Poisoning. / Total. 1929 0 109 249 0 4 0 0 9 15 0 74 0 87 237 113 3 0 0 0 13 0 3 232 0 i 0 0 1152 1930 21 498 384 0 6 0 0 10 2ti 0 63 0 432 1486 206 3 o 0 0 14 I 4 166 0 0 0 0 3320 1931 49 280 228 0 1 0 0 5 30 0 48 <1 707 178 264 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 1931 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 u 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 1938 0 291 189 0 2 0 0 11 16 0 54 0 429 1859 166 8 ! 0 0 0 7 5 1 115 0 23 0 5 3181 Average for 10 years 7 459 267 0 4 0 0 7 25 0 60 0 390 848 253 6 0 0 0 12 2 2 143 1 9 0 3 2496 a Not Notifiable. b Notifiable from 1st October, 1938. c Notifiable from 1st March, 1919. d Notifiable from 1st October, 1926. e Notifiable from 1st March, 1919, to 31/12/1927. / Notifiable from 12th July, 1982. 109 CLEANSING OF VERMINOUS PERSONS. The Medicinal Baths in Scotts Boad, 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 484 Verminous 2,190 Impetigo 283 School Children—Non-Hammersmith. Scabies 3 Verminous 138 Impetigo 3 Children under Five Years—Hammersmith. Scabies 51 Verminous 5 Impetigo I Children under Five Years—Non-Hammersmith. Nil Adults—Hammersmith. Scabies 219 Verminous 45 Other Conditions 2 Adults—Non-Hammersmith. Scabies 3 Common Lodging-houses. Verminous 89 Scabies 3 School Children—Non-Hammersmith—Outside London. Scabies 2 Verminous 2 The County Council pay the sum of two shillings in respect of each child cleansed, except in cases of scabies 110 or impetigo in which case the payment is at the rate of 1s. for each bath given. The amount received from the London County Council during the year was £232 16s. Od. in respect of cleansings and £38 13s. Od. 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. VACCINATION. The duties under the Vaccination Acts and the Vaccination Order were carried out by the Public Health Department. The Return for 1937 shows that 1,277 Infants were vaccinated, this being 62.8 per cent, of the Births and compared with 63.8 per cent, in 1936. No proceedings under the Vaccination Acts were instituted. Ill VACCINATION RETURNS. RETURN FOR 1937. 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., 1937 Number of these Births duly entered by 31st January, 1939, In Columns I, 11, IV and V of the " Vaccination Register " (Birth List Sheets), viz.: Number of these Births which on 31st January, 1939, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1939, 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 1938 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 1938 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 6 6 7 8 9 10 11 12 13 i. North Hammersmith 400 189 141 16 4 12 24 14 147 110 2. Hammersmith Hospital 1638 791 364 87 8 199 141 48 735 334 3. South Hammersmith 341 330 166 128 1 2 000 92 81 13 10 1 21 95 37 13 11 173 137 56 59 5. Removed into Borough - - - - - - - - - - 121 16 2,709 1,274 3 — 678 126 13 327 216 73 1,313 575 zu Table showing Work of Vaccination Officer from 1st January to 31st December, 1938. 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 55 30 31 2 — — 27 — 147 110 12 — 19 175 26 16 24 3 66 32 45 7 153 South 55 7 58 2 — — — 51 1 174 56 16 — 32 162 32 13 37 53 7 60 1 — 121 Hammersmith Hospital 91 68 101 35 12 — — 428 5 740 334 39 — 624 611 78 87 141 107 115 141 60 12 435 Queen Charlotte's Hospital 3 3 1 — — — — 130 I 138 59 1 — 223 20 5 10 13 6 7 3 — — 16 Removed Inwards 21 23 41 16 — — — 20 — 121 16 5 190 — 100 17 1 25 29 18 57 22 4 130 Total 172 166 231 84 14 — — 656 7 1320 575 73 190 888 1068 158 127 240 198 213 293 128 23 855 Total number of births registered during 1938 = 2,817. 118 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. Tuberculosa. Tuberculosis.—One hundred and ninety-two cases of Tuberculosis were reported during the year, one hundred and fifty-five of which were Pulmonary and thirty-seven being other forms of Tuberculosis, against one hundred and seventy-four cases in the previous year. PART I. Summary op Notifications during the period prom the 1st January, 1938, to the 31st December, 1938. Age Periods Formal Notifications Total Notifications Number of Primary Notifications of new cases of Tuberculosis 0- 1- 6- 10- 15- 20- 25- 36- 45- 55- 65- Total (all ages) Pulmonary Males 3 2 — 5 10 17 13 22 15 7 94 113 Pulmonary Females 1 1 1 2 11 11 17 6 6 3 2 61 71 Non-pulmonary Males — 2 1 3 2 1 1| 1 2 3 — 18 24 Non-pulmonary Females — 4 2 — 1 2 1 - 4 2 3 19 22 114 PART II. Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age Periods 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary Males 1 — 1 - _ 1 9 5 4 1 2 24 Pulmonary Females — 1 1 - 1 4 9 6 3 — 1 26 Non-pulmonary Males — — 1 1 2 — — 1 1 - - 6 Non-pulmonary Females — — 1 2 1 — 1 — — — — 5 No. of Cases Source of Information | Pulmonary Nonpulmonary from local Registrars 4 1 Death Returns transferable deaths from Registrar General 3 2 Posthumous notifications 7 1 “Transfers " from other areas (other than transferable deaths) 36 7 Other Sources, if any (specify) — PART III. Notification Register. Pulmonary Non-pulmonary Males Females Total Males Females Total Total Cases Numbr of cases of Tuberculosis remaining at the 31st December, 1938, on the Registers of Notifications 351 267 618 120 121 241 859 Number of cases removed from the Register(s) during the year by reason of:— 1. Withdrawal of notification - - - - - - - 2. Recovery from the disease 2 7 9 5 3 8 17 3. Death, all causes 43 41 84 12 4 16 100 4. Otherwise 190 121 311 38 46 84 395 115 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. Seventy-two deaths from Pulmonary Tuberculosis were registered, against ninety-five in the previous year, representing a death-rate of 0.6 per 1,000 compared with 0.8 in 1987. 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 1924-88, showing the interval between notification and death of tuberculous persons. 1924. 1925. 1923. 1927. 1928. 1029. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1937. 1938. 1. Total number of deaths from Tuberculosis in the Borough 170 138 142 181 135 149 153 127 156 150 124 119 116 106 87 2. The number of cases notified at death 10 13 8 - 7 3 7 2 6 13 6 11 6 8 8 3. The number of cases notified within one month of death (excluding above) 23 18 30 25 17 32 18 16 21 17 21 11 20 16 13 4. The number of cases notified within three months of death (excluding above) 20 13 20 23 13 18 21 14 17 17 9 8 7 11 6 5. The number of cases notified within six months of death (excluding above) 16 18 12 18 9 8 9 14 15 16 11 11 7 8 5 116 The Foliowing table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1938 :— Age Periods New Cases. Deaths. Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0- 1 1 - 1 1 1- 3 2 2 4 1 — 1 2 5- 3 4 6 5 — — 2 1 15- 16 27 5 4 5 8 — 2 25- 26 26 3 2 4 8 1 — 35- 18 12 2 — 7 6 1 1 45- 26 9 3 4 16 5 1 — 55- 16 3 3 2 3 2 2 — 65 and on 9 3 — 3 4 1 — 1 Total 118 87 24 24 41 31 8 7 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is 1 to 5. 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. 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 1938 155 37 192 87 824 859 117 Average number of cases notified for the 10 years 1919-1928 (inclusive) = 294. Average number of cases notified for the 10 years 1929-1938 (inclusive) = 219. Average number of deaths for the 10 years 1919-1928 (inclusive) = 157. Average number of deaths for the 10 years 1929-1938 (inclusive) = 129. 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. Fridays, 10.30 a.m. Men. Women and Children. Saturdays, 10 a.m. Schoolchildren. New Patients ma)' attend at any of the Sessions. Hammersmith Hospital. Wednesdays, 2 p.m. Dental Clinic. Thursdays, 3 p.m. X-Ilay 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, 1938, the number of patients on the Dispensary Register was 824. 118 During the year 49 definite cases of the disease were transferred from other areas into the Hammersmith district and 112 moved out of this district or were lost sight of. Thirteen were written off the register as being cured cases who had previously been notified as suffering from tuberculosis. New Patients. During the year 637 persons attended for examination for the first time, 307 males and 330 females. Of these, 167 were under the age of fifteen and 470 were adults. Of the total 191 were referred to the Dispensary by local practitioners for the purpose of consultation and 243 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 144 Found to have other forms of Tuberculosis 25 Showing no evidence of Tuberculosis 468 Total Attendances and Examinations. The total attendances of persons for the purpose of examination, observation or treatment, numbered 2,799 and physical examinations were carried out in 1,806 instances, i.e., in 65 per cent. of the total attendances. The names of 468 persons were written off the register as being non-tuberculous, and the total number on the Dispensary Register on 31st December, 1938, was 846. Sputum Examinations. Four hundred and ninety-nine specimens of sputum and other pathological products were examined bacteriologically. Fifty showed the presence of Tubercle Bacilli, while 449 proved negative. 119 Institutional Treatment. The admission of patients into Institutions (Sanatoria, Tuberculosis Colonies, Hospitals and Homes), under the London County Council's Scheme, numbered 865. 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 355 To General Practitioners and Hospitals 866 Home Visitation. The Tuberculosis Officer made 191 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 24 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 3,885 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 120 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 seventy-seven. 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 Bed 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. 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. £79 14s. 11d. was collected with a net result of £79 8s. 4d. 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 such patients were assisted. During the year one hundred and eighty-two 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. ('Continued on page 120) 121 Return showing the work of the Dispensary during the year 1938. Diagnosis Pulmonary Non-pulmonary Totai 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 contacts):— 82 46 1 3 11 6 4 3 93 5? 5 6 156 *(b) Diagnosis not completed - - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 86 109 25 18 238 B.—Contacts examined during the year (a) Definitely tuberculous 2 6 3 1 - - - 1 2 6 3 2 13 (b)Diagnosis not completed — — — — (c) Non-tuberculous - - - - - - - - 44 78 49 59 230 C.—Cases written off the Dis pensary Register as:— (a) Recovered 2 5 - - 1 4 i 2 6 4 1 13 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 130 187 74 77 468 D.—Number of Cases on Dispensary Register on December 31st (a) Definitely tuberculous 311 271 22 13 60 74 46 49 371 345 68 62 846 (b) Diagnosis not completed - - - - - — — — — — — — 1. Number of cases on Dispensary Register on January 1st 824 8. Number of visits by Tuberculosis Officers to homes (includ- 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 49 ing personal consultations)t 315 9. Number of visits by Nurses or 3. Number of cases transferred to other areas, cases not desiring further assistance under the tuberculosis scheme, and cases " lost sight of 112 Dispensary purposes 3,885 10. Number of:— (a) Specimens of sputum, &c., examined 499 4. Cases written off during the year as Dead (all causes) 71 (ft) X-ray examinations made, in connection with dispensary work 275 5. Number of attendances at the Dispensary (including con- 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 358 11. Number of " Recovered " cases restored to Dispensary Register, and included in A (a) and A (b) above Nil 7. Number of consultations with medical practitioners 12. Number of "T.B. plus" cases on Dispensary Register on (6) Other 519 (B) Number of Dispensaries for the treatment of Tuberculosis (excluding centres used only for special forms of treatment). Provided by the joint Board—Nil. Provided by Voluntary Bodies—Nil. * 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. 122 1933 1934 1935 1936 1937 1938 1 (a) Remaining on Dispensary Register on 31st December. Disease Adults { J?Arrested m-nri ' 1 * 3 ?. — 1 3 — 4 1 — | 1 — 1 2 - Disease not Adults j if* Arrested Childrenl 8 2 19 6 5 15 1 21 8 4 17 2 23 14 3 22 4 29 12 5 20 3 28 20 14 25 6 45 15 1 5 I — 8 1 4 4 3 Y 2 12 9 2 5 12 3 20 16 3 9 17 1 27 15 4 8 20 1 29 16 6 7 — 22 1 30 Condition not ascertained during the year Total on Dispensary Register at 31st December 24 8 24 — 32 15 8 26 3 37 23 9 29 5 43 33 12 39 5 56 31 13 40 4 57 42 21 47 ! 7 75 | (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged Adults j as Recovered Chndren' *• Lost sight of, or otherwise removed from Dispensary 8 7 27 4 38 16 9 17 6 32 17 11 19 4 34 11 9 12 3 24 8 1 9 1 11 2 1 7 8 Dead Adults 1 F.' Children 7 8 26 11 45 5 8 12 16 36 6 8 19 7 34 ?, 14 11 25 2 8 14 22 3 5 9 14 4 6 IS 8 32 7 3 19 7 29 4 4 14 6 24 3 1 10 ?, 13 2 6 5 11 1 V 3 1 — — 1 — — 2 — 1 1 — 1 1 — 1 1 2 — Total written off Dispensary Register 20 21 1 71 23 115 30 20 49 29 98 27 23 52 17 92 17 10 36 16 62 13 1 1 23 | 21 45 7 1 13 11 25 Grand Totals 44 29 95 , 23 147 45 28 75 32 135 50 32 | 81 22 135 50 22 75 21 118 44 i 14 63 ! 25 102 49 22 60 18 100 123 PULMONARY TUBERCULOSIS Supplementary Annual Return showing in summary form (a) the condition at the end of 1938 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 cord made during the year to which the return relates Previous to 1928 1928 1929 1930 1931 | 1932 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 00 g a ® . 8« Class T.B. plus | Class T.B. minus Class T.B. plu3 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. plun) Group 1 Group 2 Group 3 Total (Class T.B. plus) 31st- December. Disease Adults Arrested children{m. f. 3 1 3 4 1 _ 1 1 _ 1 2 2 — 1 3 - - 3 -- - 1 - -1 - - - - - 1 - - - - 4 l 1 1 — 2 — 1 — 4 2 - —- — - — — — — 1 — - — — 1 — — — — — — — — — — — Disease not Adults j ^' Arrested children 5 8 8 2 5 4 3 16 6 — 4 - — 4 2 1 5 2 2 1 2 2 9 5 4 5 - 1 1 - 1 1 3 4 4 4 2 4 8 6 2 6 5 1 3 5 1 8 7 1 — — — — — — — — — 1 — — — 2 1 — — 1 — 1 — 1 3 1 — 1 Condition not ascertained during the year — - - - - - - - - - - - - - - - - - - - - - - - - - - - - --- - Total on Dispensary Register at 31st December 20 14 12 3 29 — 5 - — 5 6 7 4 4 15 12 2 2 - 4 8 10 5 4 19 11 8 11 1 20 Register and reasons for Discharged Adults j jjf' as Recovered children ' 31 4 5 9 4 4 _ _ 4 4 2 2 6 2 3 3 _ _ _ 1 1 1 35 4 3 — 7 8 1 1 2 6 4 — 4 5 1 1 7 1 1 — 2 1 — 1 — 1 22 Lost sight of, or otherwise removed from Dispensary 154 43 62 17 122 31 22 21 3 46 31 15 15 2 32 33 15 18 3 36 16 8 27 2 37 16 10 25 3 38 Dead Adults { jr.' Children 9 11 41 52 104 2 5 17 15 37 12 8 15 10 33 9 11 24 12 47 8 11 16 1 28 5 8 18 12 38 11 7 ! 16 28 1 *>* 6 18 12 6 36 6 3 10 5 18 12 9 12 6 27 5 4 15 3 22 7 8 9 1 18 4 1 — 1 2 — — — — — — — — — — 1 — 1 1 — — — — 1 — 1 — 1 Total written off Dispensary Register 266 69 128 97 294 49 50 51 24 125 60 32 40 17 89 65 36 58 I21 115 41 24 59 6 89 32 27 54 16 97 Grand Totals 286 83 | 40 100 323 49 55 51 I 24 1 130 66 39 44 21 104 77 38 60 21 119 49 34 64 10 108 43 35 65 17 |117 124 NON-PLUMNARY TUBERCULOSIS. Supplementary Annual Return showing in summary form (a) the condition at the end of all patients remaining on the Dispensary Resister; and (b) the reasons for removal of all cases written off the Register. Condition at the time of the last record made during the year to which the return relates Previous to 1928 1 1928 1929 1930 1931 1932 Bones and Joints Abdominal Other Organs J^eripnerai 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 Dispensary Register on 31st December. Disease Adults {' Arrested chiidren ' - - - 1 1 1 - - 1 2 - - - - - - - - - - - - - - - - - - - 3 — — 3 6 — — — 2 — — 1 3 1 — — 1 1 2 — 9 3 4 ?, 6 1 — 2 ' (M Disease not Adults -i ' 2 ?, ?, 6 2 1 1 2 1 3 2 — 1 1 4 5 — — 2 7 — 1 — 2 3 1 3 4 5 13 1 1 2 — 1 2 3 — — — 3 3 2 — — 3 5 — — — 1 1 Arrested children - - 1 1 2 - - - - - - - - - - - - - 4 8 3 — i 4 3 ~~ 4 7 Condition not ascertained during the year — _ — — — _ — — — - - -— - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 7 3 7 14 31 3 1 2 2 8 6 1 1 4 12 9 - 1 9 19 12 2 1 7 22 7 1 — 9 17 Transferred to Pulmonary (b) Not now on DispensaryRegister and reasons for removal therefrom. Discharged Adults ] as Recovered children ' 6 3 1 10 1 1 1 _ - - - - - - - - - - - - - - - - - - 4 5 1 D 19 2 il 3 1 25 40 4 — — 8 12 2 Lost sight of, or otherwise removed from Dispensary Register 46 1 8 33 88 3 - 4 8 15 4 - 8 8 20 15 2 — 5 22 11 4 1 i10 26 9 - 8 17 Dead Adults { *f; Children 4 — — — 4 1 — 1 — 2 1 — — — 1 1 - 9 2 2 - - - - - - - - - - - — 1 1 2 2 — — — 2 — — — — — — — — — — — — — — ~~ — — — — Total written off Dispensary Register 71 11 14 69 165 10 5 17 32 8 — 10 12 30 17 3 6 13 39 14 9 2 14 39 n 1 — 9 21 Grand Totals of (a) ana (b) (excluding those transferred to Pulmonary) 78 14 21 83 196 13 1 7 L 19 40 14 1 1 16 42 26 3 7 22 58 26 11 3 21 61 18 2 18 38 125 1933 1934 1035 1936 1937 1938 (a) Remaining on Dispensary Register on 31st December. Disease Adults j 5jf' Arrested ChlWren - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — — — — — — — — — — — — — — - — — — — — _ — — — — — — Disease Adults { not Arrested Children 3 2 5 1 9 7 2 s — 6 1 7 1 1 1 3 b 1 1 2 9 2 2 1 4 9 6 1 6 13 2 2 2 6 6 2 2 7 17 3 _ 3 6 3 5 5 Condition not ascertained during the year - - - — - — — — — — — _ — _ _ Total on Dispensary Register at 31st December 5 2 2 6 15 11 3 5 8 27 7 5 - 5 17 9 2 8 8 27 7 1 i 6 15 7 1 4 7 19 Transferred to Pulmonary (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Adults { * Recovered chlldren' 1 — 1 1 — Lost sight of, or otherwise removed from Dispensary Register 3 2 2 7 14 3 1 — 6 10 2 1 1 4 8 2 1 1 4 3 1 2 6 1 1 2 Dead Adults { f.' Children 1 — 1 1 3 1 1 1 2 1 ■— 1 1 1 1 1 - — — — 1 — 1 — 2 — — 2 — 2 — — 2 — 2 Total written off Dispensary Register 5 2 3 8 18 3 1 1 9 14 3 2 1 4 10 3 1 1 i 6 4 1 2 2 9 1 4 1 6 Gband Totals of (a) and (6) (excluding those transferred to Pulmonary). 10 4 5 14 33 14 4 j 6 17 41 10 7 1 9 27 12 3 9 9 33 11 2 3 8 24 8 1 8 8 25 126 One hundred and fifty-four cases were referred for assistance to the following agencies:— Invalid Children's Aid Association 6 Invalid Kitchens of London 10 Unemployment Assistance Board 23 School Care Committee 4 Public Assistance Committee 60 Mayor's Fund 25 United Services Fund 8 London County Council 18 In addition, eighteen 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 and bed pans, &c. These articles are supplied on loan, to any tuberculous? patient brought to our notice through the usual sources, and in this respect the co-operation of the Borough Medical Practitioners, Hospitals and other Associations is requested. Home nursing is provided by the District Nursing Association. 127 The following Table shows the number of articles owned by the Borough Council as Nurniug Comforts, and also the number of patients who have been granted the use of these articles. Nursing Comports. Articles Quantity owned by the Borough Council. Number of Patients to whom Loaned. Number still on Loan. Bed Rests 9 7 5 Rubber Rings 3 2 0 Air Rings 9 4 3 Rubber Hot-Water Bottles 17 5 11 Bed Pans 6 4 2 Ice Bags 4 0 0 Air or Water Bed 2 1 0 Inhalers 19 3 4 Air Cushion 1 1 0 Aluminium Hot-Water Bottles 4 2 4 Bronchitis Kettles 6 0 0 Feeding Cups 6 2 0 Bed Sheets 4 3 0 Water or Air Cushions 7 2 2 Iron Bedsteads with Mattress 6 2 3 Urinals 6 1 2 Invalid Chairs 2 2 1 Bed Cradles 3 0 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. 128 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. 129 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 275. 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 alternoon 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 47. The total number of refills performed by the Tuberculosis Officer in the dispensary for the year 1938 was 311. 130 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 of 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. 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 ten permanent male Sanitary Inspectors, one permanent woman Sanitary Inspector, and two temporary male Inspectors. 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. Three Inspectors are concerned with the Housing Act, Underground Rooms, &c. The woman Inspector carries out the duties in relation to Child Life Protection, inspects Factories. &c., where women are employed, and makes enquiries into cases of measles, whooping cough, chicken pox, &c. 131 Increase of Rent and Mortgage Interest Restrictions Act, 1920-1933.—During the year twenty-eight applications were received for certificates under the above Act. In twenty-six cases the certificates were granted. This total includes seven 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 four licences were granted by the Secretary of State for the exhumation and removal of bodies from graves in St. Mary's Cemetery. Two were removed abroad, one to Osterley, Middlesex, and one to another grave in the Cemetery. The work of removal and re-interment was carried out in accordance with the conditions and under the supervision of the Sanitary Inspector on my behalf. PUBLIC BATHS. The Public Swimming Baths in Lime Grove and the Open-air Swimming Bath in Bloemfontein Boad. are provided with aeration and filtration plants, whereby the water is continuously filtered, aerated and chlorinated. The water is pumped from a point at the deepest part of the Baths, passed under pressure to gravel filters, then into a chamber or tank where it is aerated, and afterwards chlorinated before returning to the Baths. SWIMMING BATHS. During the year 63 samples were taken from water in the public swimming baths and submitted for bacteriological examination, and in the majority of cases the reports were satisfactory. 182 AIR RAID PRECAUTIONS. Organisation of Casualty Services. The organisation of the Casualty Services for this Borough under the above heading was commenced in real earnest in the second half of the year. Arrangements were made for the setting up of First Aid Posts throughout the Borough, equipping them with drugs, dressings, &c., and for the training of the volunteer first aid personnel. Schools in the area. were used for this latter purpose, and a number of medical practitioners and members of St. John Ambulance Brigade were engaged to lecture and teach the volunteers. The clerical work involved soon grew to alarming proportions, and it became obvious that additional assistance was necessary, but not until the early part of 1939 was a temporary Casualty Organising Officer engaged, together with two typists. Up to the end of the year 568 persons had enrolled to form part of the First Aid Parties and Personnel of First Aid Posts. PUBLIC WASH-HOUSES. The public wash-houses in Scotts Road form part of the building comprising the indoor Swimming Baths, Lime Grove. These wash-houses are very well patronised, and provide a means of clothes-washing for many families living in tenement houses without washing accommodation. They are open ordinary week-days from 8 a.m. to 8 p.m.. except Saturdays, when they are available from 8 a.m. to 3 p.m. PROPAGANDA. During the year "Better Health," a monthly Health Journal, published under the auspices of the Society of Medical Officers of Health, was distributed. One thousand copies of this Journal were distributed monthly to the Schools and Infant Welfare Centres. 133 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. PHARMACY AND POISONS ACT, 1933. Inspections numbering 107 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 88 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. 134 SHOPS ACT, 1934. During the year 143 shops were inspected. The following notices were served for:— 1. Sanitary Accommodation 1 2. Ventilation 3 3. Temperature 11 4. Sanitary Accommodation and Ventilation . — 5. „ „ „ Temperature — 6. Ventilation and Temperature 1 7. Sanitary Accommodation, Ventilation and Temperature — Total 16 Public Mortuary.—Five hundred and twenty-one bodies were admitted to the Mortuary in Fulham Palace Road during the year. Hammersmith— Admitted by order of Coroner 199 Admitted by order of Police 10 Admitted on application of undertakers for accommodation 29 238 Bodies admitted from other Boroughs:— Fulham 110 Chelsea 173 283 No. of P.-M. examinations conducted:— Hammersmith cases 182 Fulham cases 82 Chelsea cases 142 Total P.M.'s 406 No. of Inquests held:— Hammersmith cases 88 Fulham cases 68 Chelsea cases 99 Total Inquests held 255 The refrigeration plant has provided a means whereby bodies can be kept indefinitely for identification and other reasons, and insanitary and offensive conditions avoided. Metchim & Son, Ltd., Westminster, (29837)