ham 31 AC4347 Metropolitan Borough of Hammersmith. ANNUAL REPORT of the Medical officer of Health for the YEAR 1939. 2 Public Health Department, Town Hall, Hammersmith, W.6. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hammersmith. Ladies and Gentlemen,—In accordance with the recommendation of the Ministry of Health, the Annual Report upon the Health of the Borough for the year 1939, which I present herewith, is a very much abridged report and consists largely of a series of tables and statistics dealing with the vital services. It will be appreciated that, with the commencement of hostilities, the work of the Department was seriously disorganised, and practically all the public services had to be drastically curtailed. Early in the year most members of the Staff had been allocated to war-time duties, and immediately after the declaration of war these officers took their places in the Air Raids Precautions organisation. In consequence of the evacuation of many mothers and children to the country, a number of the infant welfare and ante-natal clinics were closed down. This allowed the Assistant Medical Officer to take over the supervision of First Aid Posts, and a number of the Health Visitors to act as Nurses in Charge. Some of the Sanitary Inspectors undertook the duties of Superintendents of Stretcher Party Depots, others acted as Liaison Officers at First Aid Posts, and the Food Inspector was transferred temporarily for service with the Food Control Committee. As a result of this depletion of staff the ordinary work of the Department was brought almost to a standstill. Inspections under the Housing Acts were suspended, and 3 it was only possible for essential work such as investigation into cases of infectious diseases, complaints, &c., to be undertaken. No intensive air attacks were made on London, and towards the end of the year mothers and children began to drift back. A number of the staff were recalled to their normal duties, and an attempt was made to reset in motion the ordinary machinery of the Department. All the clinics were re-opened and, in fact, the number of sessions have since been increased to more than the number held before the war. Work under the Housing Act in connection with the reconditioning of houses and the closing of underground rooms was recommenced, and two temporary Sanitary Inspectors were appointed to assist with this work in the place of permanent Inspectors who were still engaged on civil defence. In consequence of intensive bombing this work had to be again discontinued. These matters, however, more strictly concern 1940, and will be more fully dealt with in the report for that year. There is one matter in the report which calls for special comment—the infant mortality rate. This figure at 43 per thousand births is a record low figure and compares with 62 for the previous year. The infant mortality rate for the whole of London for 1939 was 48 and for the whole of England and Wales 50. Eeference to previous reports will show that since 1906, the year of the appointment of the first Health Visitor in the Borough, the infantile mortality rate has been reduced from 138 to 43. In 1911 the figure was as high as 146. There was no serious outbreak of any infectious diseases during the year under review in spite of the almost unprecedentedly severe winter. The anticipated epidemic of measles did not materialise, and on the whole the population stood up well to the changed conditions due to the war. Tuberculosis—(Discharge from Sanatoria).—The number of deaths from Tuberculosis are slightly higher during 1939 than in 1938. 4 There is little doubt that the death of some few of these was accelerated by the mistaken policy of evacuation of hospitals and sanatoria in the autumn of 1939. Patients who were bed cases and had not been getting up were sent out often to homes which were not prepared to receive them. Representations were made to the authorities in order to have this policy reversed, and before long many of the patients so discharged were back in hospital again. Some, however, refused to return for fear of another sudden order to leave, but by the end of the year conditions had much improved. It has been my usual practice in Annual Reports to record my appreciation of the work of the Staff of the Department. For their work and loyal co-operation during the trying period of 1939 I wish to tender to them my sincere thanks. Practically every member of the staff was called upon to work long hours and at week-ends, often on jobs which bore no resemblance to their normal duties, and without exception they gave their services ungrudgingly. I should also like to express to the Mayor and to the Members of the Public Health Committee and the Maternity and Child Welfare Committee my thanks for their co-operation and consideration. I am, Ladies and Gentlemen, Your obedient Servant, J. B. HOWELL, Medical Officer of Health. 5 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1939. Area 2,282.5 acres Population (1939) (estimated): For Birth Rate 122,800 For Death Rate 116,200 Population Census (1901) 112,239 „ „ (1911) 121,521 „ „ (1921) 130,295 „ „ (1931) 135,521 Natural increase, i.e., excess of births over deaths 438 Density of population 53.8 persons per acre Marriages registered 1,740 Rateable value (1939) £1,258,459 Sum represented by a penny rate, 1939 £5,000 Vital Statistics. Births (legitimate) 1,691 Birth rate 14.9 ,, (illegitimate) 138 Stillbirths 62 Rate per 1,000 (live and still births) 34 Deaths (corrected) 1,391 Death rate 12.0 Adjusted death rate 12.4 Deaths from puerperal causes:- Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 .5 Other puerperal causes 1 .5 Total 2 1.0 6 Deaths of infants under one year of age per 1,000 births 48 ,, from cancer (all ages) 227 ,, ,, measles ,, 0 ,, ,, whooping cough (all ages) 3 ,, ,, diarrhœa (under 2 years of age) 14 Cancer.—There were 227 deaths from Cancer, and of this number, 209 occurred in persons over the age of 45 years. These deaths were equal to 1.9 per 1,000 of the population. The following table shows the number of deaths from Cancer under the various age groups during the past 10 years :— Year. Total Deaths. Sex. All Ages. 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— 1930 213 M 106 - - - - 7 - 51 - 31 17 F 107 - 1 — — 9 — 48 — 24 25 1931 229 M 104 - - - — 11 - 53 — 29 11 F 125 - 1 — — 12 — 48 — 32 32 1932 206 M 92 - - - 1 6 - 48 — 26 11 F 114 - - 1 2 9 - 54 — 27 21 1933 231 M 114 - - — 2 8 — 40 — 38 20 F 117 - — — 1 11 — 46 — 29 30 1934 235 M 112 - - — 1 9 - 46 — 31 25 F 123 - — 1 - 9 — 40 — 51 22 1935 216 M 117 - - - - 8 - 57 — 38 14 F 99 — — — — 7 — 45 — 26 21 1936 249 M 111 - - 1 2 5 — 48 - 42 13 F 138 - — - 3 14 — 53 ' — 38 30 1937 227 M 107 — 11 — 41 — 37 18 F 120 - — — — 11 — 45 — 35 29 1938 234 M 123 - - - - 2 6 21 45 28 21 F 111 - — — — 4 2 20 22 43 20 1939 227 M 104 - - - 2 — 6 10 34 35 17 F 123 — - — - 1 9 19 29 37 28 The average number of deaths for the ten years is 227. 7 Statistics.—The following table gives the statistics of the Borough during 1939 and previous years:— Vital Statistics of Whole District during 1939 and Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the District. Transferable Deaths Nett Deaths belonging to the District. Uncorrected Number. Nett. Number. Rate. of Non-residents registered in the District. of Residents not registered in the District Under 1 Year of Age. At all Ages. Number. Rate. Number. Rate per 1,000 Nett Birth. Number. Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1924 134200 2199 2399 17.9 1123 8.4 173 718 173 72 1668 12.4 1925 134500 2178 2351 17.5 1034 7.7 186 756 153 65 1604 11.9 1926 134400 2001 2188 16.3 1174 8.7 195 556 144 66 1535 11.4 1927 132800 1789 2076 15.6 1581 11.9 230 377 126 61 1728 13.0 1928 136300 1938 2258 16.6 1449 10.6 222 326 156 69 1553 11.4 1929 136900 1869 2162 15.8 1757 12.8 222 340 133 62 1875 13.7 1930 136900 1962 2173 15.9 1387 10.1 219 436 140 64 1604 11.7 1931 135100 1954 2073 15.3 1567 11.6 288 373 140 68 1652 12.2 1932 133700 1795 1940 14.5 1465 10.9 294 543 129 66 1714 12.8 1933 131400 1682 1827 13.9 1500 11.4 340 530 119 65 1690 12.9 1934 129170 1551 1783 13.8 1359 10.5 346 655 137 77 1668 12.9 1935 128100 1774 1877 14.7 1347 10.5 406 583 131 70 1524 11.9 1936 127700 2266 1922 15.1 1399 10.9 441 639 116 60 1597 12.5 1937 126500 2707 1913 15.1 1333 10.5 402 662 130 68 1593 12.6 1938 125100 2840 1874 15.0 1340 10.7 450 522 117 62 1412 11.3 *1939 B122800 2214 1829 14.9 1311 11.2 362 442 77 43 1391 12.0 D116200 *B = Birth Rate Population Figure. D = Death „ ,, „ 8 Causes of, and Ages at, Death during the Year 1939. Causes of Death. Sex. All Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Causes M 732 57 4 4 4 16 29 50 81 161 170 156 F 659 20 1 3 5 19 23 25 51 110 165 237 1 Typhoid and Para- typhoid Fever M — — — — — — — — — — — F - - - - - - - - - - - - 2 Measles M - - - - - - - - - - - - F - - - - - - - - - - - - 3 Scarlet Fever M - - - - - - - - - - - - F - - - - - - - - - - - - 4 Whooping Cough M 2 2 - - - - - - - - - - F 1 1 - - - - - - - - - - 5 Diphtheria M 1 - - 1 - - - - - - - - F 3 — — — 1 — 2 — — — — — 6 Influenza M 5 — 1 — 1 1 — — — 1 1 — F 6 - - - - - - - 1 — 3 2 7 Encephalitis Lethargica M - - - - - - - - - - - - F - - - - - - - - - - - - 8 Cerebro-spinal Fever M 1 - - - - 1 - - - - - - F 1 — — — — - — — — 1 - - 9 Tuberculosis of Respiratory System M 65 — — — — 4 10 15 19 10 7 — F 33 _ - - 1 11 8 6 2 3 2 - 10 Other Tuberculous Diseases M 4 — — — 1 — 2 — — — 1 - F 5 — — 2 1 1 — — — — 1 - 11 Syphilis M 2 — — — — — — — 1 — 1 — F 1 - - - - - - - - 1 - - 12 General Paralysis of the insane tabes dorsalis . M 9 - - - - - - 1 5 - 2 1 F 2 - - - - - - - 1 1 - - 13 Cancer M 104 — — — — 2 — 6 10 34 35 17 F 123 - - - - - 1 9 19 29 37 28 14 Diabetes M 6 — 1 - - - - - - 2 1 2 F 8 - - - - - 1 1 — 2 1 3 15 Cerebral Hæmorr- hage, &c. M 23 - - - - - - 1 1 3 11 7 F 30 - - - - - - 2 3 10 8 7 16 Heart Disease M 137 — — — — 1 1 3 8 30 35 59 F 194 - - - - - 2 — 8 29 52 103 17 Aneurysm M 11 — - — - - 1 — — 7 1 2 F 5 — — — — — 1 1 — 1 - 2 18 Other circulatory diseases M 47 - - - - - - - 3 12 15 17 F 46 - - - - - - - 2 7 13 24 19 Bronchitis M 29 3 1 - - - - - 7 8 5 5 F 18 — — — — — — 1 — — 5 12 20 Pneumonia (all forms) M 55 9 — 1 — - 2 3 8 10 14 8 F 30 2 1 1 — 1 1 — 4 3 10 7 21 Other Respiratory Disease M 5 - - - - 1 - 1 - 2 - 1 F 4 1 - - - - 1 - - - 2 - 22 Peptic Ulcer M 21 - - - - - - 4 8 3 3 3 F 2 - - - - - - - - 1 - 1 23 Diarrhœa, &c. M 13 11 1 - - 1 - - - - - - F 4 2 — — — — — — 1 — 1 — 24 Appendicitis M 12 - - - - - 1 2 1 6 2 — F 2 - - - - - - - - 1 1 - 25 Cirrhosis of Liver M 6 — — — — — 1 — — 2 2 1 F 3 — — — — — — — 1 2 — — 26 Other Diseases of Liver M - - - - - - - - - - - - F 2 - - - - - - - 1 - - 1 27 Other Digestive Disease M 14 — — 1 — — 1 1 1 5 2 3 F 9 1 - - - 1 - - - 1 4 2 28 Acute and Chronic Nephritis M 12 - - - - 1 — 1 — 3 5 2 F 14 1 — — - 1 — — 2 3 6 1 29 Puerperal Sepsis F 1 - - - - 1 - - - - - - 30 Other Puerperal Diseases F 1 - - - - - - 1 - - - - 31 Congenital Debility, Premature Birth, &c. M 30 27 — 1 — — — 2 — — — — F 13 12 - - - - - - - - - - 32 Senility M 15 - - - - - - - - - 2 13 F 29 - - - - - - - - - 2 27 33 Suicide M 14 - - - - 1 1 — 3 6 2 1 F 6 - - - - - - 1 2 — 1 2 34 Other violence M 27 2 — — 1 — 3 6 3 4 2 6 F 21 — — — — 2 1 — — 1 5 12 35 Other defined diseases M 62 3 — — 1 3 6 4 3 13 21 8 F 42 — — — 2 1 4 3 4 14 11 3 36 Causes ill-deflned or unknown M - - - - - - - - - - - - F - - - - - - - - - - - - Totals 1,391 77 5 7 9 35 52 75 132 271 335 393 9 Death rate calculated on the estimated population of each Ward. Ward. Estimated Population. No. of Deaths. Death Rate. No. 1 River 14,935 191 12.8 No. 2 Brook Green 23,064 269 11.7 No. 3 The Grove 20,125 256 12.7 No. 4 St. Stephens 6,972 104 14.9 No. 5 Starch Green 20,153 211 10.5 No. 6 Wormholt 20,802 246 11.8 No. 7 College Park and Latimer 10,149 114 11.2 LONDON AND METROPOLITAN BOROUGHS. City and Boroughs. Estimated Population for Calculating Live Births Kate per 1,000 Population. Death Kate per 1,000 Population Crude Adjusted. Infant Mortality Rate per 1,000 Population. Birth Rate. Death Bate. West Districts. kensington 172,100 158,800 12.0 12.0 12.2 64.0 Paddington 135,300 - 13.39 12.74 12.64 60.0 Fulham 128,600 135,800 13.5 12.5 12.7 47.0 Hammersmith 122,800 116,200 14.9 12.0 12.4 43.0 City of westminster 123,000 113,300 8.0 10.7 11.0 33.4 Chelsea 55,400 50,890 9.7 14.6 12.4 33.0 North Districts. St. Marylebone 89,160 — 9.06 11.73 12.75 60.64 St. Pancras 177,900 167,300 12.29 12.97 13.23 54.0 Islington 288,100 272,300 14.47 12.79 12.91 50.0 Hackney 205,100 — 13.1 11.3 11.8 40.9 Hampstead 90,170 84,930 10.9 11.6 10.9 38.0 Stoke Newington 49,360 46,930 13.7 10.2 9.8 28.2 Central, Districts. Holborn 33,400 30,660 6.85 12.33 12.16 61.05 Finsbury 55,110 — 12.2 13.6 14.9 33.5 City of London 8,720 — 5.0 — 10.9 Nil East Districts. Stepney 197,200 183,600 12.9 12.05 14.09 53.7 Bethnal Green 90,130 85,020 12.8 11.5 13.0 51.0 Poplar 131,200 124,100 15.7 12.4 13.7 31.0 Shoreditch 77,280 72,910 14.40 12.92 14.21 31.0 South Districts. Battersea 139,200 131,600 14.39 12.82 12.69 61.66 Lambeth 270,800 254,800 13.17 — 13.37 57.0 Greenwich 94,790 89,710 14.26 10.96 11.18 53.0 Deptford 94,080 89,500 15.01 12.5 12.9 49.0 Woolwich 150,800 143,400 14.1 11.1 11.7 49.0 South wark 141,120 132,100 14.0 13.9 14.9 47.0 Wandsworth 339,000 321,000 11.99 11.75 10.92 47.0 Lewisham 229,000 — 13.6 10.69 10.79 42.0 Bermondsey 95,500 90,210 — 11.2 12.7 37.0 Camberwell 219,500 208,500 13.85 12.43 12.43 36.0 10 MATERNITY AND CHILD WELFARE. The following table gives the number of births and deaths of infants and the rate per 1,000 births:— 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 1939 1829 77 43 11 The following table shows the deaths of infants under one year of age and the cause:— INFANT MORTALITY, 1939. Infantile Mortality during the year 1939. Nett deaths from stated causes at various ages under one year of age. CAUSES 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. Small-pox - - - - - - - - - - Chicken-pox - - - - - - - - - - Measles - - - - - - - - - - Scarlet Fever - - - - - - - - - - Whooping Cough — — — — — — 3 — — 3 Diphtheria and Croup - - - - - - - - - - Influenza — — — — — — — — — — Erysipelas — - — — — — - - - - Tuberculous Meningitis - - - - - - - - - - Abdominal Tuberculosis - - - - - - - - - - Other Tuberculous Diseases - - - - - - - - - - Meningitis (not T.B.) — — — — — 1 1 — — 2 Laryngitis - - - - - - - - - - Bronchitis - - - - - 1 1 — — 2 Pneumonia (all forms) — 1 — 1 2 2 7 1 — 12 Infective Gastro Enteritis - - - - - - 7 2 — 9 Syphilis - - - - - - - - - - Rickets - - - - - - - - - - Suffocation, Overlying - - - - - - - - - - Injury at Birth 1 — — — 1 — — — — 1 Atelectasis 2 - - - 2 - - - - 2 Congenital Malformations 3 — — — 3 5 1 1 1 11 Premature Births 16 3 2 2 23 — — — — 23 Otitis Media - - - - - - 1 1 — 2 Violence — — — — — — 1 — — 1 Icterus Neonatorum - - - - - - - - - - Hæmorrhage of the Newborn - - - - - - - - - - Other causes 1 1 — — 2 2 2 2 1 9 Totals 23 5 2 3 33 11 24 7 2 77 Nett Births in the Year: Legitimate, 1,691; Illegitimate, 138. Nett Deaths in the Year of: Legitimate Infants, 70; Illegitimate Infants, 7. 12 The following Chart shows the Infantile Mortality rate for the years 1903-1939. 13 The following Chart shows the number of deaths from Diarrhoea per 100,000 inhabitants, 1911-1939. 14 Visits paid by Health Visitors are enumerated in detail below:— District. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 No. 7 Total. Visits. First visits 167 259 213 215 277 154 99 1384 Subsequent Visits. Under 1 year 600 501 639 594 512 714 416 3976 1-5 Years 845 419 509 449 552 596 700 4070 Outs 387 754 639 316 746 231 711 3784 Removals 93 178 125 158 127 35 49 765 Other Visits. Infant Deaths 9 16 15 9 10 4 5 68 Stillbirths 3 9 5 7 11 4 4 43 Ophthalmia Neonatorum 1 - 3 6 3 - 3 16 Puerperal Fever — — 1 1 1 — — 3 Puerperal Pyrexia 1 1 4 9 2 2 — 19 Epidemic Diarrhœa — — 4 — — 1 — 5 Encephalitis Lethargica 1 - - - - - - 1 Polio-Myelitis — — — — — 1 — 1 Measles — 1 2 — — 2 — 5 Diphtheria — — 4 — — — — 4 Cerebro-Spinal Fever — 1 — — — 1 — 2 Pneumonia — — 1 1 — 1 3 6 Chickenpox 1 1 — — — — — 2 Whooping Cough 2 5 6 7 3 1 8 32 Scabies — 2 5 — — — — 7 Child Life Protection — 3 17 2 4 — 1 27 Diphtheria Immunisation 2 2 - - - 9 2 15 Home Helps 29 4 6 13 14 11 11 88 Evacuation Scheme — 3 — — — — — 3 Convalescent 1 — 6 1 — 4 9 21 Free Milk 1 — — — — — — 1 Free Dinners — — 6 2 — 4 — 12 Adoption of Children — — 5 — — — — 5 Factories, &c. — — 18 — — — — 18 Special — — 8 7 7 — — 22 Ante-Natal. First Visits 115 157 157 139 169 135 101 973 Subsequent Visits... 88 80 67 85 50 53 43 466 Total Visits 2346 2396 2465 2021 2488 1963 2165 15844 Attendances at Infant Welfare Centres 69 105 77 85 98 84 76 594 Attendances at Antenatal Clinics 40 47 36 58 39 55 41 316 Schick Test Clinics 2 — 1 3 1 3 — 10 Number of insanitary conditions reported 8 3 9 4 7 4 1 36 15 Schedule of Attendances at Infant Welfare Centres, and Ante-Natal Clinics. 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 I yr. Over lyr. 48, Glenthorne Rd. 176 620 14 - - 2649 19 - - 48, Glenthorne Rd. 158 - - 339 63 — — 4523 1981 Victoria Mission Hall, Becklow Road 93 - - 245 42 - - 3833 1364 Milson Road 79 - - 240 59 - - 2781 1617 Old Oak Centre, 114 292 16 - - 1468 31 - - West way 121 - - 260 90 - - 3195 1958 Latvmer Rd. Miss., 33 59 - - - 389 1 - - Blechynden St. 32 - - 98 10 - - 1202 741 Presbyterian Hall, College Park 32 - - 35 3 - - 691 168 Thornfield Road 66 - - 153 41 - - 2878 1015 Totals 904 971 30 1370 308 4506 51 19103 8844 Ante-natal Clinics 323 Infant Consultations 581 904 The average attendances for the various Centres are as follows:— Municipal Infant Welfare Centres 49 Latymer Mission 60 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 115 cases received massage treatment, the total number of treatments being 1,244. There is a very long waiting list and it is probable that an additional 16 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. 13,631½ lbs. of dried milk and 49,901 quarts of raw milk were distributed during the year. The number of applications for free milk has averaged 94 per week during the year. The total expenditure during the year was approximately £2,177 17s. 2d. The amount of dried milk distributed during the year decreased by 57½ lbs., raw milk decreased by 1,692¼ quarts. There was a decreased cost of approximately £50 1s. 10d. 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. 17 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 Eoad and Norland Gardens respectively. During the year 26 cases were referred to these centres by the Borough Council to whom 2,363 dinners were served at an approximate cost of £42 18s. 5d. MATERNAL DEATHS. 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. 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 1939 1 1 1,829 1.0 18 Infectious Diseases of Mothers and Children under Five Years of Age. Disease. No. of Cases Notified. Previous Year. No. of Cases Visited. No. of Cases Nursed. No. of Cases Removed to Hospital. Puerperal Fever 6 11 6 - 6 Puerperal Pyrexia 32 16 32 — 27 Ophthalmia Neonatorum 12 8 12 6 10 Epidemic Diarrhœa* 16 19 16 - 16 Measles and German Measles (under 5) 15 712 15 7 Whooping Cough (under 5) 445 106 445 2 74 Poliomyelitis (under 5) 3 3 3 — 3 * Summer Diarrhœa.—As this is not a notifiable disease the figures available are those of deaths which were registered as having been due to this cause. Ophthalmia Neonatorum.—The number of cases reported was twelve against eight 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. 28.1.39 - 1 - - - - - 1† 28.1.39 — 1 Yes — — — — - 21.2.39 - 1 „ — — — - - 19.3.39 — 1 „ — — — — — 3.4.39 — 1 „ — — — — — 5.4.39 — 1 „ — — — — — 15.4.39 — 1 „ — — — — — 26.4.39 1 „ — — — — — 23.6.39 — 1 „ — — — — — 30.6.39 — 1 „ — — — — — 10.7.39 1 — „ — — — — — 4.9.39 1 — „ — — — — — Totals 2 10 11 — — — — 1 †Died 3.2.39. Ophthalmia secondary cause of death. 19 CHILD LIFE PROTECTION. Public Health (London) Act, 1936. At the end of the year there were 28 foster-children being cared for in the Borough, and 37 names on the list of foster-mothers. The Lady Sanitary Inspector is responsible for visiting the homes of all foster-children. During the year 49 foster-mothers were removed from the register for various reasons and 31 new foster-mothers were registered. Nine 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, 1939 37 „ „ „ Recommended for Registration 22 No. of Foster-Mothers removed from Register 49 (1) Removed from Borough 6 (2) Adopted Children 1 (3) Unsuitable 2 (4) 9 years of age 3 (5) Temporarily approved — (6) No further Foster-Children required 30 (7) Illness of Foster-Mothers 1 (8) Lack of accommodation 1 (9) Mother living at address — (10) Evacuation 5 ,, Applications for Registration received but not Recommended 9 FOSTER-CHILDREN. No. of Foster-Children on Register December 31st, 1939 28 ,, ,, „ received by Foster-Mothers 34 „ „ ,, moved from Foster-Mothers 70 (1) To Foster-Mothers 10 (2) To Parents or Guardians 23 (3) To Institutions 7 (4) Adopted 1 (5) Children removed from Borough with FosterMother 3 (6) Foster-Children who have reached the age of 9 years during the Year 4 (7) Evacuated 22 VISITS. No. of visits to new Foster-Mothers 31 „ „ Registered Foster-Mothers 254 Verification Visits 7 Special Visits 4 Outs 91 Total Visits 387 20 21 Sanitary Circumstances of the Borough. Inspections.—The following table shows the number of visits made in each district under the various inspection heads:— NUMBER OF INSPECTIONS MADE DURING 1939. Cause of Inspection. Inspectors. C. Southerby W. Collins W. Godden H. Potter J. Hopkins F. Barry S. Daly A. Hayes E. Nether F. Mason P. Bayes G. Herrick P. Pottier Miss E. Cross Totals Infectious Disease 53 54 40 46 24 62 8 100 29 1 — — — 1,323 1,740 Complaints 635 246 326 557 152 565 127 594 235 4 9 11 — 258 3,719 House to House 2 1 — 65 142 114 — — 324 Housing Acts 452 322 224 268 205 307 53 305 244 109 38 60 — 2 2,589 Shops Act, 1934 — 27 95 4 20 1 — 1 24 - - - - 172 Food (other than Restaurants and Eating Houses) 59 104 296 74 42 159 1 46 81 407 - - 155 1,424 Restaurants and Eating Houses 15 18 46 22 9 2 — 1 7 — — 1 8 — 129 Markets 6 3 26 295 26 166 6 44 66 142 6 9 76 — 871 Slaughterhouses — — 27 4 — 3 — 2 — — — — — — 36 Bakehouses 2 7 15 1 5 6 9 28 3 76 Milk Vendors 7 5 56 4 — 8 — 11 32 8 — — 33 — 164 Ice Cream Vendors - - - - - - - - - - - - 1 — 2 Factories (Mechanical) 28 44 10 24 41 1 28 2 - - - 29 207 Factories (Nonmechanical) - 10 15 4 5 - - 3 - - - - - 49 86 Outworkers - — 3 — — — — — — — — — — 59 62 Public Urinals 15 59 134 30 26 43 — 71 14 — — 10 — 6 408 Smoke Observations 7 6 36 6 17 13 4 4 1 94 Drainage 453 315 367 535 241 472 29 548 294 34 _ 3,288 Miscellaneous 137 339 228 129 650 187 13 596 821 37 50 33 77 8 3,305 Re-visits 1,605 688 912 1,487 877 1,746 284 1,243 1,415 1,425 2,141 1,142 — 177 15,142 Child Life Protection - - - - - - - - - - - - - 387 387 Common Lodging Houses — — 2 13 - - - - - - - - - - 15 Pharmacy and Poisons Act 10 11 14 14 5 11 — 15 9 89 Cancer — — — — 3 — — — — — — — — 43 46 Women's Hostels - - - - - - - - - - - - 4 4 Totals 3,456 2,242 2,906 3,503 2,326 3,792 527 3,592 3,309 2,228 2,386 1,414 353 2,345 34,379 22 Notices.—The following table shows the number of Preliminary Notices served and complied with during the year:- Notices Served. Notices complied with. Infectious Diseases 51 50 Complaints 1,840 1,621 House to House 123 167 Housing Act 73 12 Food (other than Restaurants) 7 3 Restaurants, &c 9 4 Bakehouses 2 2 Milk Vendors - — Factories (Mechanical) 24 29 Factories (Non-Mechanical) 15 7 Outworkers - — Public Urinals 1 1 Smoke Observations 11 — Drainage 27 13 Miscellaneous 26 24 Re-visits 471 401 Common Lodging Houses 1 — Child Life Protection 1 3 Shops Act, 1934 31 29 Women's Hostels — — Poultry, Slaughterhouse — — Total 2,713 2,366 During the year 911 Statutory Notices were served and 898 complied with. SUMMONSES—YEAR 1939. The following table shows the number of proceedings instituted during the year:— Public Health (London) Act, 1936 64 Food and Drugs (Adulteration) Act, 1928 10 Hammersmith Borough Council Bye-laws—Dogs 2 London County Council (General Powers) Act, 1937 1 London County Council (General Powers) Act, 1908—Bye-laws 1 Housing Act, 1936 1 London County Council Drainage Bye-laws 2 Food and Drugs Act, 1938 1 23 1.—INSPECTION OF FACTORIES. Premises Number of Inspections. Written Notices. Occupiers Prosecuted. Factories (with Mechanical Power) 207 24 — Factories (without Mechanical Power) 86 15 — Other Premises - — — Total 293 39 — 2.—DEFECTS FOUND IN FACTORIES, Etc. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Want of Cleanliness 10 10 - - Unreasonable Temperatures 2 4 — — Inadequate Ventilation 1 — — — Overcrowding — — — — Ineffective Drainage of Floors — 1 - — Sanitary Conveniences insufficient 1 1 - — unsuitable or defective 15 8 — — not separate for sexes — - - - 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) 3 2 - - Total 32 26 — — 24 3.—HOME WORK. Nature of Work Outwork in Unwholesome Premises. Outwork in Infected Premises. Instances Notices served Prosecutions Instances Orders made Prosecutions Wearing apparel— (1) making, etc. - - - - - - (2) cleaning and washing - - - - - - Furniture and upholstery - - - - - Toymaking — — — —- — — Totals — — — — — — 4.—OTHER MATTERS RELATING TO FACTORIES. Class Number Matters notified to H.M. Inspector of Factories— Failure to affix Abstract of the Factory Act 1937 (Sec. 2) 7 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory Act, 1937 Notified by H.M. Inspector 2 Reports of action taken sent to H.M. Inspoctor 2 Other — Dnderground bakehouses (S. 54)— Certificates granted during year — In use at the end of the year 18 25 OVERCROWDING (a) (i) Number of dwellings overcrowded at the end of the year 1,303 (ii) Number of families dwelling therein 1,303 (iii) Number of persons dwelling therein 4,968 (b) Number of new cases of overcrowding reported during the year 27 (c) (i) Number of cases of overcrowding relieved during the year 144 (ii) Number of persons concerned in such cases 860 (d) Particulars of any cases in which dwelling- houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil NEWLY ERECTED HOUSES AND FLATSWATER SUPPLY. Number of certificates granted during the year 481 INCREASE OF RENT AND MORTGAGE RESTRICTIONS ACT, 1920/33. During the year 46 applications were received for certificates under the above Act, and in 41 cases certificates were granted. EXHUMATION AND RE-INTERMENT OF BODIES. During the year two Licences were granted by the Secretary of State for the exhumation and removal of bodies from graves in St. Mary's Catholic Cemetery, Harrow Road. 26 PUBLIC MORTUARY. Six hundred and thirty-six bodies were admitted to the Mortuary in Fulham Palace Eoad during the year:— Hammersmith:— Admitted by order of Coroner 259 Admitted by order of Police 3 Admitted on application of undertakers for accommodation 31 293 Bodies admitted from other Boroughs :— Fulham 127 Chelsea 216 343 No. of P.-M. examinations conducted:— Hammersmith cases 231 Fulham cases 105 Chelsea cases 190 Total P.Ms. - 526 No. of Inquests held:— Hammersmith cases 89 Fulham cases 52 Chelsea cases 72 Total Inquests held - 213 27 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 830 cases reported as due to notifiable infectious diseases in the Borough, against 638 in the previous year. There were also reported 576 cases of infectious diseases that were not notifiable, against 2,454 in the previous year; 17 of these were *Measles, 371 *Whooping Cough and 188 Chickenpox. The number of cases of Tuberculosis notified was 198 against 192 in the previous year. *Totals (incl. notifiable cases—Measles 33 and Whooping Cough 736) noted in Department. BACTERIOLOGY. The following bacteriological examinations were made on behalf of the Council:- Material from cases of suspected Diphtheria- Positive results 23 Negative results 634 Sputa from cases of suspected Tuberculosis— Tubercle bacillus found 43 Tubercle bacillus not found 291 Urine for Tuberculosis—Negative 2 Blood from cases of suspected Fever- Widal or Typhoid reaction obtained 1 Widal or Typhoid reaction not obtained 2 Faeces 1 Other 1 Grand Total 998 28 Cases of Infectious Disease notified during the year 1939. Notifiable Disease Number of Cases Notified. Age Periods. Wards. Total Removed to Hospital. At all Ages. Under 1 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— 1 2 3 4 5 6 7 Smallpox - - - - - - - - - - - - - - - - - - - - - Cholera (C) Plague (P) — — — — — — — — — — — — — - - - - - - Diphtheria (including Membranous Croup) 104 3 2 6 10 8 37 19 6 11 1 1 - 13 20 7 18 19 19 8 104 Erysipelas 33 - — 1 — - - - 1 1 3 18 9 4 9 5 1 2 5 7 11 Scarlet Fever 125 1 7 7 12 18 42 17 8 10 1 2 - 16 20 19 4 26 31 9 119 Typhus Fever — - - - - - - - - - - - - - - - - - - - - Enteric Fever 1 — — — — — — — — — — 1 — — 1 1 Relapsing Fever (R) Continued Fever (C) - - - - - - - - - - - - - - - - - - - - - Puerperal Fever 6 — — — — — — — — 4 2 — - - - 2 3 1 6 Puerperal Pyrexia 32 — — — — — — — 1 27 4 — - 2 9 3 7 5 4 2 27 Cerebro-Spinal Meningitis 4 1 — 1 — — 1 — — 1 — — — 1 1 1 — 1 - 4 Polio-myelitis 4 1 — 2 1 - - 1 - 3 - 4 Encephalitis Lethargica - - - - - - - - - - - - - - - Ophthalmia Neonatorum 12 12 - - - - - - - - - - - 2 2 1 1 2 2 2 10 Anthrax — — — — — — — — — — — — — -_ - - - - -_ - -_ Pneumonia 96 - 2 2 1 2 7 1 5 23 9 37 7 18 13 17 6 10 24 8 63 Malaria - - - - - - - - - - - - - - - - - - - - - Dysentery 29 3 5 8 2 1 7 — _- 2 1 - - 5 5 3 1 6 6 3 29 Food Poisoning 3 - - - - - __ - - 1 1 1 - - 1 - - 1 1 - - *Measles 16 2 6 1 - 3 1 2 - - 1 - - 7 1 1 4 3 - 6 *Whooping Cough 365 47 47 46 51 61 106 3 1 1 1 1 — 30 56 53 25 74 99 28 40 Totals 830 70 69 71 79 90 203 41 24 82 23 62 16 91 144 112 65 152 198 68 424 * Notified under New Regulations—for total brought to notice of the Department, see page 27. 29 Deaths from the Seven Principal Zymotic Diseases.— The total number of deaths of residents registered from the seven principal symotic diseases was 24 against 62 in the previous year. The deaths of residents from these diseases were equal to 17 per 1,000 of the total deaths of residents registered and were at the rate of 0.2 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, 1930 to 1939:- Year. Small pox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Entaric Fever. Diarrhœa and Cholera. Total. 1930 0 31 3 21 9 1 24 89 1931 0 0 2 6 7 0 23 38 1932 0 29 4 8 6 1 26 74 1933 0 3 4 14 5 1 27 54 1934 0 25 4 25 19 0 27 100 1935 0 0 3 12 7 1 28 49 1936 0 15 3 5 7 2 25 57 1937 0 0 1 12 9 2 29 53 1938 0 5 0 5 4 0 36 62 1939 0 0 0 4 3 0 17 24 Average last 10 yrs. 0 11 2 11 7 1 26 60 Notifiable Diseases (other than Tuberculosis) during the Year 1939. DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths. Diphtheria 104 104 4 Erysipelas 33 22 - Scarlet Fever 125 119 — Enteric Fever 1 1 — Puerperal Fever 6 6 2 Puerperal Pyrexia 32 27 Cerebro-Spinal Meningitis 4 4 2 Encephalitis Lethargica — — — Ophthalmia Neonatorum 12 10 — Pneumonia 96 63 85 Dysentery 29 29 — Poliomyelitis 4 4 — Malaria — — — Food Poisoning 3 — — *Measles 16 6 — *Whooping Cough 365 40 3 Totals 830 435 86 *Notified under Regulations-this is not total brought to notice of Department. 80 DIPHTHERIA IMMUNISATION. The scheme whereby 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, for which the Doctors receive a fee of 2s. 6d. for each injection, continued throughout the year. 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 275 Number of children who did not complete the doses 14 Schick Testing Clinic. Number of Clinics held 6 Pre-Schick tests. Positive 2 Negative - No reading - Post-Schick tests. Positive 10 Negative 123 No reading 2 Refusals of Post-Schick Test 5 Failed to attend (repeated requests) 7 Removals-address unknown-no Post-Schick Test 16 Removal—information sent on to M.O.H. concerned Number who had additional dose or doses 15 Fees paid to medical practitioners. 38 at 11s. 6d. £21 17 0 26 at 10s. 0d. 13 0 0 87 at 7s. 6d. 32 12 6 4 at 7s. 8d. 1 10 8 120 at 5s. 0d 30 0 0 2 at 3s. 10d. 7 8 20 at 2s. 6d 2 10 0 £101 17 10 31 The Chart hereunder shows the number of cases of Diphtheria notified week by week during the year. 32 The Chart hereunder shows the number of cases of Scarlet Fever notified week by week during the year. TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1930 to 1939. Year. Smallpox. Scarlet Fever. Diphtheria or Diphtheritic Croup. Typhus Fever. Enteric Fever. Simple Continued Fever. Relapsing Fever. Puerperal Fever. Puerperal Pyrexia. d Cholera. Erysipelas. Plague. Chickenpox. a Measles. b Whooping Cough. b Cerebro-Spinal Fever. Anthrax. Glanders. Hydrophobia. Ophthalmia Neonatorum. Acute Polio-Myelitis. Encephalitis Lethargica. Pneumonia. c Malaria. c Dysentery. c Trench Fever. e Food Poisoning.f Total. 1930 21 498 384 0 6 0 0 10 26 0 63 0 432 I486 206 3 0 0 0 14 1 4 166 0 0 0 0 3320 1931 49 280 228 0 1 0 0 5 30 0 48 0 707 178 264 9 0 0 0 13 0 2 141 0 2 0 0 1957 1932 0 594 192 0 4 0 0 2 29 0 51 0 405 1588 330 8 0 0 0 19 1 1 1 78 0 1 0 2 3405 1933 0 895 241 0 8 0 0 9 33 0 97 0 333 299 319 6 0 0 0 10 4 1 179 0 3 0 8 2445 1934 0 609 519 0 1 0 0 2 22 0 79 0 422 1334 272 6 0 0 0 11 1 1 154 0 0 0 4 3467 1935 0 349 333 0 5 0 0 2 19 0 50 0 435 45 312 2 0 0 0 11 2 2 88 0 14 0 9 1678 1936 0 335 130 0 13 0 0 9 21 0 38 0 293 1372 234 6 0 0 0 4 2 0 83 2 14 0 1 2557 1937 0 332 179 0 1 0 0 9 37 0 51 0 353 81 314 5 0 0 0 14 2 0 89 0 26 0 2 1495 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 1939 0 125 104 0 1 0 0 6 32 0 33 0 188 33 736 4 0 0 0 12 4 0 96 0 29 0 3 1406 A verage for 10 years 7 430 242 0 4 0 0 7 27 0 56 0 400 828 315 6 0 0 0 12 2 1 129 0 11 0 3 2480 33 a Not Notifiable. b Notifiable from 1st October, 1938. e Notifiable from 1st March, 1919, to 31/12/1927. e Notifiable from 1st March, 1919. f Notifiable from 12th July, 1932. d Notifiable from 1st October. 1926. 34 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 265 Mattresses 752 Pillows 1,931 Bolsters 369 Blankets 2,390 Sheets 1,418 Quilts 1,053 Articles of Clothing 4,748 Sundries 936 Carpets 8 Curtains 124 Total 13,994 Rooms (Infectious Disease, &c.) 466 Verminous Rooms 40 A.R.P. Visits for Disinfection 47 553 35 CLEANSING OF VERMINOUS PERSONS. The Medicinal Baths in Scotts Road, Shepherd's Bush, provide for the treatment of cases of Scabies, Impetigo and the cleansing of verminous persons, &c. I append figures showing the numbers dealt with during the year. School Children-Hammersmith. Scabies 449 Verminous 1,305 Impetigo 132 School Children—Non-Hammersmith. Scabies 1 Verminous 145 Impetigo - Children under Five Years-Hammersmith. Scabies 78 Verminous 7 Impetigo 3 Children under Five Years-Non-Hammersmith. Nil Adults—Hammersmith. Scabies 217 Verminous 41 Other Conditions 3 Adults—Non-Hammersmith. Scabies 17 Verminous 1 Common Lodging-houses. Scabies - Verminous 88 VACCINATION. The duties under the Vaccination Acts and the Vaccination Order were carried out by the Public Health Department. The Return for 1938 shows that 1,581 Infants were vaccinated, this being 66.2 per cent. of the Births and compared with 62.8 per cent. in 1937. No proceedings under the Vaccination Acts were instituted. 36 VACCINATION RETURNS. RETURN FOR 1938. Registration Sub-Districts comprised in the Vaccination Officers' District 1 Number of Births returned in the " Birth List Sheets" as registered from 1st January to 31st Dec., 1938 2 Number of these Births duly entered by 31st January, 1940, in Columns I, 11, IV and V of the " Vaccination Register " (Birth List Sheets), viz.: Number of these Births which on 31st January, 1940, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1940, 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 11 Number of Certificates of Successful Primary Vaccination of children under 14 years received during the calendar year 1939 12 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 1939 13 Col. 1 Col. II Col. IV. Number in respect of whom Certificates of Conscientious Objection, have been received 6 Col. V Postpone ment by Medical Certificate 8 Removal to Districts, the Vaccination Officer of which has been duly apprised 9 Removal to Places unknown or which cannot be reached; and Cases not having been found 10 Successfully Vaccinated 3 Insusceptible of Vaccination 4 Had SmallPox 5 Dead, Unvaccinated 7 1. North Hammersmith 368 168 - - 129 14 - 6 37 14 2. Hammersmith Hospital 1,840 931 3 - 416 94 - 121 230 45 3. South Hammersmith 298 167 3 — 73 11 — 7 34 3 1,422 591 4. Queen Charlotte's Hospital 309 168 - - 74 6 - 39 20 2 5. Removed into Borough 269 147 1 — 37 2 2 3 62 25 3,084 1,581 7 — 729 127 2 176 383 89* 1,422 591 * Includes 17 cases registered out of time or re-registered. 37 Table showing Work of Vaccination Officer from 1st January to 31st December, 1939. 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'sHospital. Marlesford Lodge. Other Doctors. District No. 1. District No. 2 District No. 3. District No. 4. District No. 5. Total North 1 58 15 55 1 — — 34 - 164 91 11 — 14 238 55 — — 1 69 16 66 3 155 South 73 7 18 21 — — — 22 2 143 59 22 — 26 179 28 — — 50 23 34 29 1 137 Hammersmith Hospital 56 142 62 136 3 — — 520 2 921 403 51 — 796 779 121 — — 78 222 147 185 6 638 *Queen Charlotte's Hospital 2 3 — 1 — — — 69 1 76 29 65 4 1 3 1 - - 4 Removed Inwards 10 25 25 15 — — — 17 2 94 9 11 76 — 113 21 — — 15 35 24 30 2 106 Total 142 235 120 228 4 — — 662 7 1398 591 95 76 901 1313 226 — — 144 352 222 310 12 1040 Total number of births registered during 1939=2214. *Closed temporarily April, 1939. 38 TUBERCULOSIS. Tuberculosis.—One hundred and ninety-eight cases of Tuberculosis were reported during the year, one hundred and sixty-five of which were Pulmonary and thirty-three being other forms of Tuberculosis, against one hundred and ninety-two cases in the previous year. part 1. summary of notifications during the period from the 1st january, 1939, to the 31st december, 1939. Age Periods Number of Primary Notifications of new cases of Tuberculosis 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages) Pulmonary Males — 2 2 — 6 16 24 18 20 16 8 112 Pulmonary Females — — — 3 5 10 14 11 3 4 3 53 Non-Pulmonary Males — 1 2 3 3 2 2 1 1 — 2 17 Non-Pulmonary Females — 3 1 2 1 2 2 2 2 - 1 16 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 2 1 — 2 7 5 3 2 2 25 Pulmonary Females — — 2 2 3 3 11 5 1 — — 27 Non-Pulmonary Males — 1 1 — 2 1 — 1 — - — 6 Non-Pulmonary Females — 1 — 1 1 1 5 — — — — 9 39 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1939:- ###]Periods New Cases. Deaths. Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0- - - - - - - - - 1- 3 — 2 4 — — 2 5- 5 7 6 4 — 1 1 1 15- 24 21 8 5 4 11 — 1 25- 31 25 2 7 10 8 2 35- 23 16 2 2 15 6 — — 45- 23 4 1 2 19 2 — — 55- 18 4 — — 10 3 — 65 and on 10 3 2 1 7 2 1 1 Total 137 80 23 25 65 33 4 5 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is 1 to 13. 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 1939 165 33 198 107 887 889 40 Ninety-eight deaths from Pulmonary Tuberculosis were registered, against seventy-two in the previous year, representing a death-rate of 0.8 per 1,000 compared with 0.6 in 1938. I append figures for the years 1925-39, showing the interval between notification and death of tuberculous persons. 1925. 1926. 1927. 1928 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1937. 1938. 1939. 1. Total number of deaths from Tuberculosis in the Borough 138 142 181 135 149 153 127 156 150 124 119 116 106 87 107 2. The number of cases notified at death 13 8 - 7 3 7 2 6 13 5 11 6 8 8 5 3. The number of cases notified within one month of death (excluding above) 18 30 25 17 32 18 16 21 17 24 11 20 16 13 12 4. The number of cases notified within three months of death (excluding above) 13 20 23 13 18 21 14 17 17 9 8 7 11 6 3 5. The number of cases notified within six months of death (excluding above) 18 12 18 9 8 9 14 15 16 11 11 7 8 5 5 Average number of cases notified for the 10 years 1920-1929 (inclusive)=286. Average number of cases notified for the 10 year 1930-1939 (inclusive)=211. Average number of deaths for the 10 years 1920-1929 (inclusive)=155. Average number of deaths for the 10 years 1930-1939 (inclusive)=125. 41 FOOD SUPPLIES. Unsound Food. No seizure of unsound food was made during the year. The following is a list of unsound food voluntarily surrendered and destroyed during the year:- Commodity. Condition. 3 barrels Apples Unsound and unfit for food 1 box Grapes (10 lbs.) do. 38 lbs. Apples do. 1½ cwt. Winkles do. 1 box Pears (49 lbs.) do. 1 box Lemon Soles (4¾ stone) do. 14½ lbs. sliced Breakfast Sausage do. 1 box Skate Cuttings (1½ stone) do. 35 Rabbits do. 1 tin boiled Ham (12 lbs.) do. 2 legs of Pork (19½ lbs.) do. Beef Trimmings (2 cwts. 11 lbs.) do. Beef Messenteries (2 cwts. 24 lbs.) do. Beef Offal (Plucks, Tails, Kidneys) (2 cwts. 19 lbs.) do. Pork Trimmings (2 cwts. 1 qtr. 26 lbs.) do. 44 Pigs' Plucks (1 cwt. 2 qtrs. 19 lbs.) do. Lambs Carcase (12 lbs.) do. FOOD AND DRUGS (ADULTERATION) ACT, 1928. 958 samples of various foods and drugs were submitted to the Public Analyst during the year by the Council's Sampling Officers for analysis; 100 were found to be inferior and 26 were adulterated. Legal proceedings were taken in respect of 9 of the adulterated samples, and penalties and costs amounting to £12 1s. 6d. were imposed. PHOSPHATASE TEST. 22 samples of milk sold under the special designation " Pasteurised " were submitted to the phosphatase test during the year. The results of these examinations showed that in 19 cases the pasteurising es' been properly carried out and that 3 samples incorrectly pasteurised or had become admixed milk. Metchim & Son, Ltd, Westminster, S.W. I.