HAM 33 3 Public Health Department, Town Hall, Hammersmith, W.6. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hammersmith. Ladies and Gentlemen, I present herewith my annual report for the year 1941. As in the past two years this report is represented in abridged form, and consists for the most part of a series of tables and statistics dealing with the vital services. Vital Statistics.—Although the actual number of births registered during the year was 195 less than in 1940, the birth rate is slightly higher (16.5 per 1,000) and is the highest recorded for 15 years. Comparative figures for London and for England and Wales are 8.9 and 14.2 respectively. The death rate for the year was 15.6 per 1,000 as compared with 17.9 in 1940. This reduction is accounted for by the fact that there were considerably fewer deaths due to enemy action during 1941 than in 1940. The death rate for London as a whole in 1941 was 16.3 and for England and Wales 12.9. Both the birth rate and the death rate have been calculated upon the estimated population supplied by the Registrar General (84,800). This figure is 38,000 less than the estimated population of the Borough before the war, and this fact should be borne in mind when making comparison with pre-war figures. Much depends upon the accuracy of the estimated population. The infantile mortality rate for the year was 41, the lowest figure yet recorded for Hammersmith, and 4 pares with 68 for London as a whole and 59 for England and Wales. The rate has been calculated upon a figure supplied by the Registrar General—1,253. Calculated upon the number of births actually registered in Hammersmith (1,405) the rate would be 37. Every credit must be given to the Maternity and Child Welfare services of the Borough for this excellent result. The number of cases of tuberculosis notified during the year was 199 as compared with 167 during the previous year and 198 in 1939. The average number of cases notified during the previous ten years was 202. The number of deaths from tuberculosis during the year was 103 compared with 118 in 1940, 107 in 1939 and an average of 121 in the previous ten years. As this will be the last report which I shall submit as Medical Officer of Health of the Borough, it may be of interest to record some of the progress which has been made in the health services during the 28 years (except for two years' service in the Army during the last war) which I have held the office. When I took office in September, 1914, I was the only medical officer in the service of the Council. At the present time the medical staff comprises, in addition to myself, one Deputy Medical Officer of Health and Tuberculosis Officer, three Assistant Medical Officers (women) engaged chiefly on maternity and child welfare work, and one Assistant Medical Officer for civil defence. Only one Health Visitor was employed bv the Council at the time of my appointment ; now there are ten Health Visitors and two trained nurses acting as Clinic Assistants. The clerical staff of the department which then consisted of one chief clerk and two assistants has now increased to eighteen. In 1914 and for some years after I took office the Infant Welfare Centres and Ante-Natal Clinics in the Borough were conducted by voluntary societies working from three centres, the Borough Council contributing to their upkeep. At the present time all the maternity and child welfare services are administered by the Council and clinics are 5 held at six centres. Each week nine sessions are held for expectant mothers and 12 infant welfare and three toddlers' clinics are held. In 1914 the infantile mortality rate was 94 per 1,000 live births; by 1941 this had been reduced to 41. In 1914, '276 of the 2,985 children born to Hammersmith mothers died during their first year (the highest number recorded was in 1911 when 434 of the 2,929 children born died before attaining the age of one year). In 1941 only 52 infants died in their first year. Of these 27 died in the first month (neonatal deaths), chiefly due to birth injuries and prematurity. These figures are calculated upon statistics supplied by the Registrar General. If the infantile mortality rate for 1941 is calculated upon the actual number of births in the Borough (1,405) the figure is 37. It is of interest to note that if the rate of 37 per thousand had existed in 1911 it would have represented the death of 108 children only, whereas the number that actually died was 434. Conversely, if the death rate of 1911 had existed in 1941 the number of deaths under one year would have been approximately 204 instead of 52. Since the Hammersmith Hospital assumed responsibility for the obstetrics service there has been the closest cooperation between the British Post-Graduate Medical School and the Borough, with great advantage to the Maternity and Child Welfare services generally. The number of babies born in the Hospital during 1941 was 699. In September, 1919, the first municipal Maternity Home under the Maternity and Child Welfare Act, 1918, was established in Hammersmith at Parkside, Ravenscourt Park, and provided accommodation for 21 mothers and babies. From that time until the maternity work was transferred to Hammersmith Hospital in 1926, the number of children born in the Home was 2,594. In estimating the number of beds required at Parkside it was found that 6 per cent, of the Hammersmith babies were born in institutions. In 1941 this figure equalled 73 per cent., born chiefly in Hammersmith Hospital. 6 I followed up the history of the children born in Parkside during these years, and was able to show that the children born in the Home had a 3-1 chance of surviving their first year over those who were not born there. In my opinion this was due to the care given them during their residence in the Home (14 days) and the education of the parent in mothercraft. Credit for these results must be given to Miss Edington, the Matron of the Home, who afterwards became the Superintendent of the Hammersmith District Nursing Association. It was largely due to her initiative and zeal that we owe much of the good which followed. Very shortly after my appointment I submitted a scheme ;o the Council for the establishment of a dispensary in the Borough for the treatment of tuberculosis. This was adopted, and the Dispensary was opened on 1st September, 1918, in Eavenscourt Park. During the first full year that the Dispensary was open 724 new patients were examined by the Tuberculosis Officer, and a total of 3,896 attendances for the purposes of examination, observation and treatment were recorded. In addition 351 visits were made by the Tuberculosis Officer to the homes of patients. During 1914 212 deaths from tuberculosis were registered in the Borough. By 1938 this number had gradually been reduced to 87. In 1941 the number of persons attending the Dispensary for examination for the first time was 524 and the total attendances 2,733. Deaths from tuberculosis registered during the year had fallen to 103. In the main body of the Report reference has been made to the destruction of the old Tuberculosis Dispensary in Ravenscourt Park and its removal to the British Postgraduate Medical School. Since its establishment there the work has been carried on under much better conditions, and in my opinion the Dispensary is now in the place where it always should have been, where the Tuberculosis Officer has the advantage of all the ancilliary services, 7 medical and surgical, afforded by the staff of the Postgraduate School. No better arrangement could be made. During my term of office considerable improvement has been effected in housing conditions in the Borough. Representations have been made in regard to a number of insanitary areas and proposals submitted in regard to several clearance schemes. Much of the insanitary property has now been demolished, but completion of some of the schemes has been held up by the war. The Council has completed a number of re-housing schemes, and it was one of the first boroughs to deal seriously with the housing shortage after the last war. At that time they developed a large area in the north of the Borough as a housing estate, and replaced the slums bordering the river by blocks of flats known as Riverside Gardens. Subsequently large blocks of working-class flats were built at Emlyn Gardens and Becklow Gardens. The first and last of these blocks of flats were built upon sites which had been dealt with as clearance areas. Space will not allow me to say more in this brief ReportNevertheless it will be seen that Public Health condition,, in the Borough have materially improved in the last 28 years. Much has been accomplished, but much more remains to be done. In conclusion I wish to thank all those members of the staff who have given devoted service to the Public Health Department. Without their co-operation and keen interest the present sound position of the Public Health service could not have been attained. I am, Ladies and Gentlemen, Your obedient servant, J. B. HOWELL, Medical Officer of Health. 8 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1941. Area 2,282.5 acres Population (1941) (estimated) 84,880 Population Census (1901) 112,289 „ „ (1911) 121,521 „ „ (1921) 130,295 „ „ (1931) 135,521 Natural increase, i.e., excess of births over deaths 77 Density of population 37.1 persons per acre Marriages registered 1,161 Rateable value (April, 1941) £1,240,608 Sum represented by a penny rate (April, 1941) £4,503 Vital Statistics. Births (legitimate) 1,288 Birth rate 16.5 ,, (illegitimate) 117 Stillbirths 41 Rate per 1,000 (live and still births) 29 Deaths (corrected) 1,328 Death rate 15.6 Deaths from puerperal causes :- Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 .77 Other puerperal causes 1 .77 Total 2 1.54 9 Deaths of infants under one year of age per 1,000 births 41 „ from cancer (all ages) 181 „ „ measles „ — „ „ whooping cough (all ages) 5 „ „ diarrhœa (under 2 years of age) 7 Cancer.—There were 181 deaths from Cancer, and of this number, 169 occurred in persons over the age of 45 years. These deaths were equal to 2.1 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- 1932 206 M 92 — — — 1 6 — 48 — 26 11 F 114 — — 1 2 9 — 54 — 27 21 1933 231 M 114 — — — 2 8 — 46 — 38 20 F 117 — — — 1 11 — 46 — 29 30 1934 235 M 112 — — — 1 9 — 46 — 31 25 F 123 — — 1 — 9 — 40 — 51 22 1935 216 M 117 — — — — 8 — 57 — 38 14 F 99 — — — — 7 — 45 — 26 21 1936 249 M 111 — — 1 2 5 — 48 — 42 13 F 138 — — — 3 14 — 53 — 38 30 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 1940 220 M 111 1 — 7 51 52 F 109 — — 7 46 56 1941 181 M 96 — 1 2 45 48 F 85 — — 9 33 43 The average number of deaths for the ten years is 223. 10 Statistics.—The following table gives the statistics of the Borough during 1941 and previous years :— Vital Statistics of Whole District during 1941 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 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 184400 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 D116200 2214 1829 14•9 1311 11•2 362 442 77 43 1391 12•0 1940 98320 1733 1600 16.3 1725 17.5 370 401 76 51 1756 17•9 1941 84880 2480 1405 16.5 1315 15.4 351 364 52 41 1328 15.6 * B = Birth Rate Population Figure. D = Death „ „ „ 11 Causes of, and Ages at, Death during the Year 1941. of Death. Sex. 0— 1— 5 — 15— 45— 65— Total all Ages. 1. Typhoid and Paratyphoid Fevers M — — — — 1 — 1 F — — — — — — — 2. Cerebro-spinal Fever M — 2 — 1 — — 3 F — 1 — — — — 1 3. Scarlet Fever M — — — — — — — F — — — — — — — 4. Whooping Cough M 2 1 — — — — 3 F 1 1 — — — — 2 5. Diphtheria M — — 1 1 — — 2 F — 1 2 — — — 3 6. Tuberculosis of Respiratory System M — — — 27 24 7 58 F — 1 — 21 7 2 31 7. Other forms of Tuberculosis M — 1 1 2 2 2 8 F 1 1 1 3 — — 6 8. Syphilitic Diseases M — — — 1 5 7 13 F — — — — 1 2 3 9. Influenza M 2 — — — — 5 7 F — — — 1 5 2 8 10. Measles M — — — — — — — F — — — — — — — 11. Ac. Polio-myelitis and Polioencephalitis M — — — — — — — F — — — — — — — 12. Ac. Inf. Encephalitis M — — — — — 1 1 F — — — — — 1 1 13. Cancer of Buc. Cav. and Oesoph. (M), Uterus (F) M — — — — 4 11 15 F — — — 3 5 7 15 14. Cancer of Stomach and Duodenum M — — — 1 12 9 22 F — — — — 1 7 8 15. Cancer of Breast M — — — — — — — F — — — 2 7 2 11 16. Cancer of all other sites M — — 1 1 29 28 59 F — — — 4 20 27 51 17. Diabetes M — — — 1 1 1 3 F — — — 2 1 5 8 18. Intra-cranial Vascular Lesions M — — — — 14 26 40 F — — — — 10 46 56 19. Heart Disease M — — 2 9 38 89 138 F — — — 10 19 105 134 20. Other Diseases of Circ. System M — — — 2 7 23 32 F — — — 1 2 24 27 21. Bronchitis M 2 — — 4 27 31 64 F 1 — — 1 8 30 40 22. Pneumonia M 2 — — 3 30 21 56 F 4 2 — 1 2 33 42 23. Other Respiratory Diseases M — — — 2 3 3 8 F — — 1 — 3 2 6 24. Ulcer of Stomach or Duodenum M — — — 2 6 2 10 F — — — — 1 2 3 25. Diarrhœa under 2 years M 4 — — — — — 4 F 2 1 — — — — 3 26. Appendicitis M — — 1 — — — 1 F — — — 1 1 2 4 27. Other Digestive Diseases M 1 — — 1 8 12 22 F 1 — 1 3 1 5 11 28. Nephritis M — — — 7 4 6 17 F — 1 — 2 8 7 18 29. Puerperal and Post-abortive Sepsis M — — — — — — — F — — — 1 — — 1 30. Other Maternal causes M — — — — — — — F — — — 1 — — 1 31. Premature Birth M 7 — — — — — 7 F 3 3 32. Con. Mal. Birth Injuries Infant Dis. M 8 — — 1 — 1 10 F 7 — — — — — 7 33. Suicide M — — — 1 3 — 4 F — — — — 3 — 3 34. Road Traffic Accidents M — — 1 2 7 4 14 F — — — 1 4 3 8 35. Other violent causes M — — — 14 18 5 37 F 1 — 1 9 7 10 28 36. All other causes M 2 3 1 5 9 43 63 F 1 3 — 5 12 42 63 Totals all causes M 30 7 8 88 252 337 722 F 22 12 6 72 128 366 606 52 19 14 160 380 703 1,328 12 Death rate calculated on the estimated population of each Ward. Ward. Estimated Population. No. of Deaths. Death Rate. No. 1 River 10,689 175 16.4 No. 2 Brook Green 16,886 251 14.9 No. 3 The Grove 14,651 233 15.9 No. 4 St. Stephens 5,152 72 14.0 No. 5 Starch Green 14,670 211 14.4 No. 6 Wormholt 14.937 285 19.1 No. 7 College Park and Latimer 7,895 101 12.8 METROPOLITAN BOROUGHS. City and Boroughs. Live Births Rate per 1,000 Population. Death Rate per 1,000 Population. Infant Mortality Rate per 1,000 Live Births. West Districts. Kensington 12.75 17.1 62.0 Paddington 15.67 18.26 60.0 Fulham 15.37 15.55 50.0 Hammersmith 16.5 15.6 41.0 City of Westminster 10.1 21.4 74.8 Chelsea 11.6 22.7 38.0 North Districts. St. Marylebone 9.34 19.49 41.77 St. Pancras 13.81 19.80 51.0 Islington 16.27 19.12 59.0 Hackney 13.7 15.6 50.2 Hampstead 10.9 15.9 59.0 Stoke Newington 14.0 15.22 62.5 Central Districts. Holborn 11.13 25.17 47.12 Finsbury 14.8 24.7 70.4 City of London 6.4 18.0 Nil East Districts. Stepney 15.5 25.1 79.5 Bethnal Green 17.0 20.5 62.0 Poplar 18.4 22.2 48.0 Shoreditch 17.44 24.17 63.0 South Districts. Battersea 15.74 18.33 63.35 Lambeth 14.56 20.83 78.0 Greenwich 16.17 16.7 31.0 Deptford 16.5 19.1 61.0 Woolwich 14.7 15.7 50.0 Southwark 15.9 27.5 80.0 Wandsworth 12.79 15.73 41.0 Lewisham Not available Bermondsey 17.1 23.7 61.0 Camberwell 15.6 19.9 58.7 13 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 1940 1600 76 51 1941 1405 52 41* * Rate calculated on a birth figure supplied by the Registrar-General of 1,253. Calculated on the figure of 1,405 the rate is 37. 14 The following table shows the deaths of infants under one year of age and the cause:— INFANT MORTALITY, 1941. Infantile Mortality during the year 1941. 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 — — — — — 1 1 — 1 3 Diphtheria and Croup — — — — — — — — — — Influenza — — — — — — — — — — Erysipelas — — — — — — — — — — Tuberculous Meningitis — — — — — — — — 1 1 Abdominal Tuberculosis — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — Meningitis (not T.B.) — — — — — — — — — 1 Laryngitis — — — — — — — — — — Bronchitis — — — — — 3 — — — 3 Pneumonia (all forms) 1 1 — 3 5 1 3 2 — 11 Infective Gastro Enteritis — — — — — — 1 1 — 2 Syphilis — — — — — — — — — — Rickets — — — — — — — — — — Suffocation Overlying — — — — — — — — — — Injury at Birth 5 — — — — — — — — 5 Atelectasis — — — — — — — — — — Congenital Malformations 1 1 — — 2 — 1 — 1 4 Premature Births 10 — — — 10 — 1 — — 11 Otitis Media — — — — — — 1 — — 1 Violence — — — — — — — — — — Icterus Neonatorum 2 — — — 2 — — — — 2 Hæmorrhage of the Newborn — 1 — — 1 — — — — 1 War Operations — — — — — — — — — — Other causes 1 — 1 — 2 2 2 — 1 7 Totals 20 3 1 3 27 8 10 3 4 52 Nett Births in the Year: Legitimate, 1,288; Illegitimate. 117. _ Nett Deaths in the Year of: Legitimate Infants, 45; Illegitimate Infants, 7. 15 The following Chart shows the Infantile Mortality rate for the years 1905-1941. 16 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 No. 8 No. 9 Total Visits. First visits 109 126 50 185 114 163 90 110 152 1,099 Subsequent Visits. Under 1 year 431 646 312 526 569 473 753 429 206 4,345 1-5 Years 934 713 468 430 680 937 641 758 773 6,334 Outs 429 235 408 887 698 572 412 675 477 4,793 Removals 115 212 180 190 242 378 156 145 160 1,778 Other Visits. Infant Deaths 2 3 2 9 4 6 7 2 5 40 Stillbirths 2 4 — 7 6 3 3 3 5 33 Ophthalmia Neonatorum — 8 2 3 1 1 1 1 3 20 Puerperal Fever — — — 3 1 2 — 1 1 8 Puerperal Pyrexia — 2 1 — 2 6 — — 2 13 Epidemic Diarrhœa 20 1 4 5 2 4 — 1 3 40 Encephalitis gica — — — — — — — — — — Polio-Myelitis — — — 1 — — — — — 1 Measles — 6 — 9 25 25 — 30 13 108 Diphtheria — — — — — — — — — — Cerebro-Spinal Fever — — — — — — — — 1 1 Pneumonia — 2 — 2 3 1 — 1 — 9 Chickenpox — — — — — — — 4 — 4 Whooping Cough — 8 1 14 — 10 — 2 — 35 Scabies 3 — — 15 14 — — — — 32 Child Life Protection — — — 2 — 2 — — — 4 Diphtheria Immunisation 25 — — 51 6 — 5 — 25 112 Home Helps 2 5 6 7 — 14 — 4 5 43 Evacuation Scheme 2 — — 41 — — — — — 43 Convalescent — — 7 — — — — — — 7 Free Milk — — — 13 — — — — — 13 Special 6 56 28 10 1 54 — 50 12 217 Rest Centres 1 — — — — — — — — 1 Tuberculosis 229 257 136 202 195 230 123 178 191 1,741 Ante-natal. First Visits 93 122 61 138 76 120 64 88 127 889 Subsequent Visits 163 94 114 152 56 145 1 79 78 882 Total Visits 2,566 2,500 1,780 2,902 2,695 3,146 2,256 2,561 2,239 22,645 Attendances at Infant Welfare Centres 82 127 46 103 108 89 45 83 105 788 Attendances at Antenatal Clinics 58 37 20 56 68 71 38 66 70 484 Attendances at Tuberculosis Clinics 3 — — 4 — — — 2 2 11 Attendances at Diphtheria Immunisation Clinics — 44 36 — 4 42 5 9 12 152 Number of insanitary conditions reported 3 8 11 — 2 2 — — — 26 17 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 1 yr. Over 1 yr. 48, Glenthorne Rd. 143 294 4 — — 1,271 4 — — 130 — — 240 28 — — 3.199 1,597 Becklow Gardens 69 172 1 — — 912 4 — — 255 — — 334 133 — — 5,322 3.208 Milson Road 29 84 2 — — 412 8 — — 135 — — 188 62 — — 2,307 1,200 Old Oak, Westway 106 278 12 — — 1,350 17 — — 150 — — 233 121 — — 3,703 2,040 Latymer Road 53 72 1 — — 421 2 — — 52 — — 91 51 — — 874 581 College Park 7 — — 3 2 — — 43 56 Totals 1,129 900 20 1,095 397 4,366 35 15,448 8,754 Ante-natal Clinics 400 Infant Consultations 729 1,129 The average attendances at Infant Welfare Centres = 33. 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 94 cases received massage treatment, the total number of treatments being 842. Milk for Expectant Mothers and Children.—In June, 1940, the National Milk Scheme was introduced. Under this scheme all expectant and nursing mothers and children under five years of age can obtain one pint of milk per day, either free or at the reduced price of 2d. per pint according to the family income. 18 The income scale laid down by the Ministry of Food which entitles a person to a free issue is lower than that which had been adopted by the Hammersmith Borough Council for their own scheme for the distribution of milk to expectant and nursing mothers and young children. The Council decided, therefore, that they would pay the 2d. a pint in all cases where the income did not exceed 10s. Od. more than that prescribed by the Ministry. The introduction of the national scheme has considerably decreased the Council's expenditure in connection with the distribution of milk. During the year 8,428 quarts of liquid milk and 3,008 packets of dried milk were issued free to expectant and nursing mothers and children under five by the Council. Although the National Milk Scheme is under the direction of the Ministry of Food the inauguration of the Scheme in Hammersmith was undertaken by the staff of the Maternity and Child Welfare Section of the Public Health Department and the administrative work has been carried out by that staff throughout the year. National dried milk is distributed through the Welfare Centres which are so situated throughout the Borough that no mother has a great distance to go for the food. Cod Liver Oil, &c.—In December, 1941, the Ministry of Food extended their scheme to include the distribution of cod liver oil to all children under five and orange juice to children under two. These commodities are also distributed at the Welfare Centres by the Public Health Department Staff. The scheme whereby the Council supplied cod liver oil has, of course, been superseded by the Ministry of Food's Vitamins Scheme. Dinners.—Dinners have been supplied to expectant and nursing mothers, and in exceptional cases to children since May, 1987. Owing to the closing of the Invalid Kitchens of London in Melina Road and the Second Feathers Club in Norland Gardens, the dinners are now provided at the 19 Communal Dining Centres in the Borough. During the year under review, the Centres situated in Iffley Road and Wormholt Road have been used for this purpose. During the year 3 adults and 1 child were referred to these centres by the Borough Council, and 302 dinners were served at an approximate cost of £11 6s. 4d. MATERNAL DEATHS. The number of Maternal Deaths during the past seventeen 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 1940 — — 1,600 — 1941 1 1 1,405 1.5* * Rate calculated on a (live and still) birth figure supplied by the Registrar-General of 1,289. 20 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 12 14 12 — 12 Puerperal Pyrexia 13 31 13 — 13 Ophthalmia Neonatorum 8 5 8 — 8 Epidemic Diarrhœa* 7 8 — — — Measles and German Measles (under 5) 193 65 193 4 66 Whooping Cough (under 5) 146 15 146 6 72 Poliomyelitis (under 5) 1 — 1 — 1 * Summer Diarrhcea.—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 eight against five 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. 15.5.41 — 1 Yes — — — — — 15.5.41 — 1 „ — — — — — 16.5.41 — 1 „ — — — — — 3.7.41 — 1 „ — — — — — 11.7.41 — 1 „ — — — — — 25.8.41 — 1 „ — — — — — 15.9.41 — 1 „ — — — — — 5.11.41 — 1 „ — — — — — Totals — 8 8 — — — — — 21 Day Nurseries.—Before the outbreak of war there were two day nurseries in the Borough run by Voluntary Associations to which the Council contributed. Just before the outbreak of hostilities both of these nurseries were evacuated to the country. As the war progressed and more and more women took up war work, the need for accommodation in the Borough where mothers could leave their young children became apparent, and the Council decided to open day nurseries. This decision was taken before the Government inaugurated their scheme for war-time nurseries. On 27th January, 1941, the first nursery was opened in Blechynden Street, Latimer Road. (The Ministry of Health have since taken over financial responsibility for the nursery, and it is now one of four day nurseries which have been provided under the Government's plan.) The Nursery has accommodation for 36 children (28 toddlers and 8 babies), and the staff comprises a Matron, Staff Nurse, 6 Probationers, a Teacher, Cook and Cleaner. The Nursery has been well patronised, and has met the needs of the mothers in the neighbourhood. 22 CHILD LIFE PROTECTION. Public Health (London) Act, 1936. At the end of the year there were 80 foster-children being cared for in the Borough, and 22 names on the list of foster-mothers. The Lady Sanitary Inspector is responsible for visiting the homes of all foster-children. During the year 17 foster-mothers were removed from the register for various reasons and 24 new foster-mothers were registered. Three 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, 1941 22 „ „ Recommended for Registration 24 „ „ removed from Register 17 (1) Removed from Borough — (2) Adopted Children — (3) Unsuitable o (4) 9 years of age 3 (5) Temporarily approved 1 (6) No further Foster-Children required 10 (7) Illness of Foster-Mothers — (8) Lack of accommodation — (9) Mother living at address 1 (10) Evacuated with Child — (11) Child evacuated — „ Applications for Registration received but not Recommended 3 FOSTER-CHILDREN. No. of Foster-Children on Register December 31st, 1941 30 „ „ received by Foster-Mothers 40 „ „ moved from Foster-Mothers 27 (1) To Foster-Mothers 2 (2) To Parents or Guardians 19 (3) To Institutions — (4) Adopted 2 (5) Children removed from Borough with FosterMother 1 (6) Foster-Children who have reached the age of 9 years during the Year 3 (7) Evacuated — VISITS. No. of visits to new Foster-Mothers 27 „ „ Registered Foster-Mothers 208 Verification Visits — Special Visits 8 Outs 81 Total Visits 324 28 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 1941. Cause of Inspection. Inspectors. W. A. Collins P. T. Bayes H. W. Potter W. Rigby J. R. Baily J. C. Hopkins A. Hayes E. J. Nether W. J. Godden Miss E. M. Cross Total Infectious Disease 70 26 39 5 34 55 102 80 — 2,157 2,568 Complaints 635 102 460 23 191 254 460 423 99 368 3,015 House to House — 5 — — — — — — — — 5 Housing Acts 8 — 25 — — — 12 — — — 45 Shops Act. 1934 41 11 46 — 2 21 12 2 — — 135 Food (other than Restaurants and Eating Houses) 109 54 34 35 59 437 107 189 1,364 — 2,388 Restaurants and Eating Houses 42 48 6 4 — 102 2 44 32 — 280 Markets 21 3 259 3 23 135 11 147 236 — 838 Slaughterhouses — — — — — 2 — — 1 — 3 Bakehouses 30 11 11 11 2 22 8 8 30 — 133 Milk Vendors 22 18 15 9 24 74 53 37 95 — 347 Ice Cream Vendors — — — — — — — — 25 — 25 Factories (Mechanical) 33 19 14 43 3 25 15 20 — 12 184 Factories (Non-mechanical) 24 5 8 32 — 8 — — — 38 115 Outworkers 3 6 6 — 2 — 9 3 — 73 102 Public Urinals 88 37 20 — 52 34 79 37 — 3 350 Drainage 233 42 246 5 11 225 134 264 — — 1,160 Miscellaneous 406 150 81 55 92 252 280 546 115 26 2,003 Re-visits 1,461 428 1,675 86 1,246 835 1,155 1,728 — 57 8,671 Child Life Protection — — — — — — — — 19 324 324 Common Lodging Houses — — 8 — — — — — — 27 Pharmacy and Poisons Acts 16 2 25 — 1 4 10 22 — — 80 Cancer — — — — — — — — 15 15 Rest Centres — — — — — — — — — 18 18 Air Raid Shelters 116 29 124 — 88 200 183 61 — — 801 Fire Watchers Order 3 — — — — — — — — — 3 War Damage—House to House 45 46 — 26 — 45 — 179 — — 341 War Damage — — 62 130 60 — — — — — 252 Women's Hostels — — — — — — — — — 1 1 Total 3,406 1,042 3,164 467 1,890 2,730 2,632 3,790 2,016 3,092 24,229 24 Notices.—The following table shows the number of Preliminary Notices served and complied with during the year:— Notices Served. Notices complied with. Infectious Diseases 21 8 Complaints 1,061 933 House to House — 10 Housing Act 4 9 Food (other than Restaurants) 13 3 Restaurants, &c. 14 4 Bakehouses 3 - Milk Vendors 5 2 Factories (Mechanical) 10 — Factories (Non-Mechanical) 3 3 Public Urinals 5 2 Rest Centres 1 1 Drainage 16 4 Miscellaneous 96 12 Re-visits 254 127 Child Life Protection 1 1 Shops Act, 1934 8 5 Air Raid Shelters 1 1 War Damage 7 1 House to House War Damage 18 7 Total 1,541 1,133 During the year 486 Statutory Notices were served and 288 complied with. SUMMONSES—YEAR 1941. The following table shows the number of proceedings instituted during the year:— Public Health (London) Act, 1936 37 Food and Drugs Act, 1938 8 H.B.C. Byelaws—Dogs 1 25 1.—INSPECTION OF FACTORIES. Premises Number of Inspections. Written Notices. Occupiers Prosecuted. Factories (with Mechanical Power) 184 10 — Factories (without Mechanical Power) 115 3 — Other Premises — — — Total 299 13 — 2.—DEFECTS FOUND IN FACTORIES, Etc. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Want of Cleanliness 9 2 — — Unreasonable Temperatures 2 1 — — Inadequate Ventilation 1 1 — — Overcrowding — — — — Ineffective Drainage of Floors — — — — Sanitary Conveniences insufficient 1 — — — unsuitable or defective 13 2 — — not separate for sexes 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) 4 1 — — Total 31 7 — — 26 3.—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) — 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 — Reports of action taken sent to H.M. Inspector — Other — Underground bakehouses (Sec. 54)— — Certificates granted during year — In use at the end of the year 18 RATS AND MICE (DESTRUCTION) ACT, 1919. The above Act continued in operation during the year, the District Inspectors being responsible for its administration in their respective districts. Following the receipt of a Circular from the Ministry of Food, in which it was stated that the Government was anxious that further efforts "be taken in the destruction of rats and setting out the Ministry's proposals in regard to the action to be taken under the Rats and Mice Order No. '2069, dated 3rd December, 1940, the Council appointed, for the duration of the war, a temporary Rodent Officer, who commenced duties on the 19th May. His duties, in addition to working in conjunction with the Sanitary Inspectors, are :— 1. To give advice in all matters relating to the destruction of rats. 2. To inspect factories, wharves, warehouses, and shops in the Borough where food is stored, in order to ensure that they are free from infestation. 3. To take what measures he considers necessary to destroy rats and prevent their return. 4. To see that instructions issued to occupiers or owners of infested premises are complied with. 27 I append a summary of the work carried out during the year No. of complaints 120 No. of houses inspected 490 No. of food premises inspected 417 No. of stores inspected 163 No. of factories inspected 59 No. of premises found to be rat infested 195 Amount of rat poison laid 30 lbs. approx. Total No. of visits 1,324 NEWLY ERECTED HOUSES AND FLATSWATER SUPPLY. Number of certificates granted during the year 9 INCREASE OF RENT AND MORTGAGE RESTRICTIONS ACT, 1920/38. During the year 12 applications were received for certificates under the above Act, and in 11 cases certificates were granted. EXHUMATION AND RE-INTERMENT OF BODIES. During the year one Licence was granted by the Secretary of State for the exhumation and removal of bodies from graves in St. Mary's Catholic Cemetery, Harrow Road. 28 PUBLIC MORTUARY, AND CIVILIAN WAR DEATHS MORTUARY. Six hundred and nine bodies were admitted to the Public Mortuary and Civilian War Deaths Mortuary during the year:— Hammersmith Public Mortuary:— Admitted by order of Coroner 264 Admitted by order of Police 6 Admitted on application of undertakers for accommodation 67 Admitted by order of Medical Officers of Institutions 1 War operations 6 - 344 Civilian War Deaths Mortuary:— War operations 18 - 18 Bodies admitted from other Boroughs:— Fulham 116 Chelsea 127 Paddington 4 - 247 No. of P.-M. examinations conducted:— Hammersmith cases 238 Fulham cases 107 Chelsea cases 106 Paddington cases 2 Total P.-M.s - 453 No. of Inquests held:— Hammersmith cases 87 Kensington cases 46 Fulham cases 46 Paddington cases 86 Chelsea cases 59 St. Marylebone cases 29 Total Inquests held - 353 29 PREVALENCE OF, AND CONTROL OVER, INFECTIOUS DISEASES. Infectious Diseases.—There were, omitting tuberculosis, 876 cases reported as due to notifiable infectious diseases in the Borough, against 461 in the previous year. There were also reported 237 cases of infectious diseases that were not notified, against 64 in the previous year; 155 of these were *Measles, 57 *Whooping Cough and 25 Chickenpox. The number of cases of Tuberculosis notified was 199 against 167 in the previous year. *Totals (incl. notifiable cases—Measles 546 and Whooping Cough 254) noted in Department. BACTERIOLOGY. The following bacteriological examinations were made on behalf of the Council:— Material from cases of suspected Diphtheria— Positive results 21 Negative results 362 Sputa from cases of suspected Tuberculosis— Tubercle bacillus found 55 Tubercle bacillus not found 260 Blood from cases of suspected Fever— Widal or Typhoid reaction not obtained 3 Faeces 2 Other 17 Grand Total 720 30 Cases of Infectious Disease notified during the year 1941. Notifiable Disease Number of Cases Notified. Wards. Total Removed to Hospital. At all Ages. Age Periods. 1 2 3 4 5 6 7 Under 1 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— Small pox — — — — — — — — — — — — — — — — — — — — — Cholera, Plague — — — — — — — — — — — — — — — — — — — — — Diphtheria (including Membranous Croup) 69 3 2 6 6 5 15 9 13 10 _ 6 12 10 3 15 15 8 69 Erysipelas 20 — — — 1 6 1 7 5 4 2 6 2 4 2 12 Scarlet Fever 70 1 4 3 6 7 25 8 9 5 2 — — 9 7 7 4 8 25 10 70 Typhus Fever — — — — — — — — — — — — — — — — — — — Enteric Fever 4 — — — — — 1 — 1 2 — — — — 1 1 — 1 1 — 4 Relapsing Fever, Continued Fever — — — — — — — — — — — — — — — — — — — — — Puerperal Fever 12 — — — 6 5 1 — — 4 2 1 4 1 12 Puerperal Pyrexia 13 — — — — — — — 1 11 1 — — 1 1 2 6 3 — 13 Cerebrospinal Meningitis 33 2 2 1 2 1 2 1 6 7 4 4 1 2 8 5 8 8 2 33 Polio-myelitis 2 1 — — — — — — — — — — — — — — — — 1 — 2 Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 8 8 — — — — — — — — — — — 1 3 2 1 — 1 — 8 Anthrax — — — — — — __ — — — — — — — — — — — — — Pneumonia 45 3 1 2 1 1 — — 2 13 2 10 4 4 10 6 3 8 8 6 17 Malaria — — — — — — — — — — — — — — — — — — — — — Dysentery 7 — 2 2 — — 1 — — 1 1 — 1 1 — — 1 1 3 7 Food Poisonin 5 — — — — — — — — — — — — — — — — — — — Measles 391 20 32 46 48 47 166 12 6 14 — — 29 32 75 21 84 133 17 104 Whooping Cough 197 45 28 35 22 21 42 1 — 2 1 — — 19 25 37 5 36 49 20 85 Totals 876 83 71 95 86 82 253 31 39 79 17 29 11 76 106 157 39 170 253 75 441 31 Deaths from the Seven Principal Zymotic Diseases.— The total number of deaths of residents registered from the seven principal zymotic diseases was 51 against 48 in the previous year. The deaths of residents from these diseases were equal to 38 per 1,000 of the total deaths of residents registered and were at the rate of 0.6 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, 1932 to 1941:— Year. Smallpox. Measles. Scarlet Fever. Diphtheria and Membranous Croup. Whooping Cough. Enteric Fever. Diarrhoea and Cholera. Total. 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 1940 0 1 0 3 0 0 44 48 1941 0 0 0 5 5 1 40 51 Average last 10 yrs. 0 8 2 9 7 1 30 57 Notifiable Diseases (other than Tuberculosis) during the Year 1941. DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths. Diphtheria 69 69 5 Erysipelas 20 12 — Scarlet Fever 70 70 — Enteric Fever 4 4 1 Puerperal Fever 12 12 2 Puerperal Pyrexia 13 13 Cerebro-Spinal Meningitis 33 33 4 Encephalitis Lethargica — — 2 Ophthalmia Neonatorum 8 8 — Pneumonia 45 17 98 Dysentery 7 7 — Poliomyelitis 2 2 — Malaria — — — Food Poisoning 5 5 — *Measles 391 104 — *Whooping Cough 197 85 5 Totals 876 441 117 *This is not total brought to notice of Department. 32 DIPHTHERIA IMMUNISATION. The big drive to immunise all children in the Borough, which was commenced in November, 1940, was continued throughout 1941, and it is gratifying to report that there has been a very large increase in the number of children immunised, especially at the Council's Welfare Centres. Fourteen L.C.C. Elementary Schools in the Borough have now been approached with a view to obtaining the parents' consents to the immunisation of their children. The following are the particulars of the work carried out under the immunisation scheme during the year:— Number of children immunised at the Council's Welfare Centres 1,741 Number of children immunised privately or in hospitals, &c. 210 Number of children who attended for first inoculation at the Council's Welfare Centres 245 Number of children who received first inoculation privately 12 Number of attendances at Welfare Centres 4,412 Number of Pre-Schick Tests—positive result 15 Number of Pre-Schick Tests—negative result 16 Number of Post-Schick Tests—positive result 40 Number of Post-Schick Tests—negative result 614 Fees paid to Medical Practitioners £51 2s. 6d. 88 The Chart hereunder shows the number of cases of Diphtheria notified week by week during the year. 34 The Chart hereunder shows the number of cases of Scarlet Fever notified week by week during the year. 35 TABULAR STATEMENT—ZYMOTIC DISEASES. The following table shows the number of cases that were reported as due to the undermentioned diseases during the years 1932 to 1941. Year. Smallpox. Scarlet Fever. Diphtheria or Diphtheritic Croup. Typhus Fever. Enteric Fever. Simple Continued Fever. Relapsing Fever. Puerperal Fever. Puerperal Pyrexia. d Cholera. Erysipelns. 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. 1932 49 594 192 0 4 0 0 2 29 0 51 0 405 1588 330 8 0 0 0 19 1 1 178 0 1 0 2 3405 1933 0 895 241 0 8 0 0 9 33 0 97 0 333 299 319 6 0 0 0 10 4 1 179 0 3 0 8 2445 1934 0 609 549 0 1 0 0 2 22 0 79 0 422 1334 272 6 0 0 0 11 1 1 154 0 0 0 4 3467 1935 0 349 333 0 5 0 0 2 19 0 50 0 435 45 312 2 0 0 0 11 2 2 88 0 14 0 9 1678 1936 0 335 130 0 13 0 0 9 21 0 38 0 293 1372 234 6 0 0 0 4 2 0 83 0 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 2 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 1940 0 71 43 0 9 0 0 14 31 0 26 0 46 172 18 33 0 0 0 5 1 0 48 1 2 0 5 525 1941 o 71 68 0 4 0 0 12 13 0 20 0 25 546 254 33 0 0 0 8 2 0 45 0 7 0 5 1113 A verage for 10 years 5 367 202 0 5 0 0 7 25 0 50 0 293 733 295 12 0 0 0 10 2 1 107 0 12 0 4 2127 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. f Notifiable from 12th July, 1932. 36 RHEUMATISM. During the year the Council continued their grant to the West London Hospital in connection with the treatment of rheumatism. The Department of Chronic Rheumatic Diseases was opened in 1938. At the outbreak of war in 1939 it was considered to be impossible to continue the work of the Clinic owing to the mobilisation for war service of members of the medical staff. In April, 1940, however, arrangements were made to resume work with one session weekly. After a time the demand on the services of the Clinic was such that two sessions per week were found necessary. The experience of the Clinic—the distress which was caused by its temporary closing, and the constant increase in the number of its patients since it was re-opened—show that, under the stress of war conditions, there is even greater need than in peace for the provision of effective means for treatment for rheumatic sufferers. During the year 53 new Hammersmith patients were seen at the Clinic, and a total of 292 attendances were recorded. The following figures show the number of Hammersmith cases dealt with at the Clinic since its inception. New patients. Attendances. 1938 35 189 1939 70 396 1940-41 31 205 1941-42 53 292 189 1,082 37 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 153 Mattresses 450 Pillows 1,254 Bolsters 137 Blankets 2,587 Sheets 1,257 Quilts 703 Articles of Clothing 2,180 Sundries 307 Carpets 5 Curtains 5 Total 9,038 Rooms (Infectious Disease, &c.) 744 Verminous Rooms 44 A.R.P. Shelters, Posts, &c 2 790 38 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 1,437 Verminous 1,079 Impetigo 168 School Children—Non-Hammersmith. Nil. Children under Five Years—Hammersmith. Scabies 311 Verminous 42 Impetigo 7 Children under Five Years—Non-Hammersmith. Scabies 2 Adults—Hammersmith. Scabies 1,210 Verminous 130 Impetigo 8 Other Conditions 2 Adults—Non-Hammersmith. Scabies 2 Common Lodging-houses. Scabies 21 Verminous 132 Gibraltar Refugees. Scabies 286 Verminous 70 Impetigo 6 Evacuees. Scabies 13 Verminous 38 VACCINATION. The duties under the Vaccination Acts and the Vaccination Order were carried out bv the Public Health Department. The Return for 1940 shows that 801 Infants were vaccinated, this being 67.6 per cent, of the Births and compared with 61.3 per cent, in 1939. No proceedings under the Vaccination Acts were instituted. 39 VACCINATION RETURNS. RETURN FOR 1940. Registration Sub-Districts comprised in the Vaccination Officers' District N umber of Births returned in the "Birth List Sheets" as registered from 1st January to 31st Dec., 1940 Number of these Births duly entered by 31st January, 1942, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1942, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Numbe of these Births remaining on 31st January, 1942, neither duly entered in the "Vaccination Register" (columus 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 1941 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 1941 Col. 1 Col. II Col. IV. Col. V 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 Number in respect of whom Certificates of Conscientious Objection have been Successfully Vaccinated Insusceptible of Vaccination Had SmallPox Dead, Unvaccinated 1 2 3 4 5 6 7 8 9 10 11 12 #] 1. North Hammersmith 313 112 — — 92 10 — 3 91 5 1,059 381 2. Hammersmith Hospital 1,013 424 1 — 194 33 — 4 349 8 3. South Hammersmith 218 91 — — 44 8 — — 73 2 4. Queen Charlotte's Hospital 201 75 2 — 19 8 — 82 13 2 5. Removed into Borough 195 99 — — 12 — — — 79 5 1,940 801 3 — 361 59 — 89 605 22 1,059 381 40 Table showing Work of Vaccination Officer from 1st January to 31st December, 1941. 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. Other Doctors. District No. 1. District No. 2 District No. 3. District No. 4. District No. 5. Total North 30 10 37 2 18 — 97 51 16 — 9 131 82 6 11 54 21 62 6 143 South 32 24 — — 8 — 64 31 2 — 7 102 45 6 12 62 45 2 — 109 Hammersmith Hospital 120 38 06 3 201 3 431 174 18 — 308 332 153 42 52 184 93 106 8 391 Queen Charlotte's Hospital 20 7 4 — 361 2 394 125 3 — 822 92 10 35 5 33 20 7 1 61 Removed Inwards 35 8 25 1 9 2 80 — 4 111 — 42 46 1 21 54 33 27 2 116 Total 237 87 132 6 597 7 1066 381 43 111 1146 699 336 90 101 387 212 204 17 820 Total number of births registered during 1941 — 2,480. 41 TUBERCULOSIS. Tuberculosis.—One hundred and ninety-nine cases of Tuberculosis were reported during the year, one hundred and sixty of which were Pulmonary and thirty-nine being other forms of Tuberculosis, against one hundred and sixty-seven cases in the previous year. PART 1. Summary of Notifications during the period from the 1st January, 1941, to the 31st December, 1941. Age Periods Formal Notifications Number of Primary Notifications of new cases of Tuberculosis 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total (all ages Pulmonary Males — — 2 1 14 15 22 21 8 10 3 96 Pulmonary Females — 1 — 1 12 13 19 7 6 3 2 64 Non-Pulmonary Males — 1 3 1 3 3 3 2 — 1 2 19 Non-Pulmonary Females 1 4 2 — 2 5 4 1 1 — — 20 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 7 5 3 3 2 24 Pulmonary Females — 1 — — — 1 4 3 — 5 1 15 Non-Pulmonary Males 1 1 — — — — 1 1 — — — 4 Non-Pulmonary Females — 1 — — — 2 — 1 — — — 4 42 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1941:— Age Periods New Cases. Deaths. Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0- 1 1 1 1 1- — 2 2 5 — 1 1 1 5- 3 1 4 2 — — 1 1 15- 32 26 6 9 27 21 2 3 25- 29 23 4 4 35- 26 10 3 2 45- 11 6 — 1 24 7 2 — 55- 13 8 1 — 65 and on 5 3 2 — 7 2 2 — Total 120 79 23 24 58 31 8 6 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is 1 to 4. The following table indicates the number of cases and deaths from Tuberculosis:— Year. No. of Cases notified. No. of Deaths. No. of Cases on Dispensary Register. No. of Cases on Register of Notifications. Pulmonary. NonPulmonary. Total. 1922 205 44 249 162 — — 1923 197 56 253 145 — — 1924 200 56 256 170 — 1,426 1925 221 45 266 138 — 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 1940 143 24 167 118 791 813 1941 160 39 199 103 812 828 43 Eighty-nine deaths from Pulmonary Tuberculosis were registered, against one hundred and five in the previous year, representing a death-rate of 1.0 per 1,000 compared with 1.1 in 1940. I append figures for the years 1925-41, 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. 1940. 1941. 1. Total number of deaths from Tuberculosis in the Borough 138 142 181 135 149 153 127 156 150 124 119 116 106 87 107 118 103 2. The number of cases notified at death 13 8 — 7 3 7 2 6 13 5 11 6 8 8 5 9 10 3. The number of cases notified within one month of death (excluding above) 18 30 25 17 32 18 16 21 17 21 11 20 16 13 12 11 13 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 10 10 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 11 6 Average number of cases notified for the 10 years 1922-1931 (inclusive) = 261. Average number of cases notified for the 10 years 1932-1941 (inclusive) = 199. Average number of deaths for the 10 years 1922-1931 (inclusive) = 150. Average number of deaths for the 10 years 1932-1941 (inclusive) = 119. 44 BOROUGH COUNCIL CLINIC, HAMMERSMITH HOSPITAL. I submit a short report on the work carried out at the Borough Council Clinic at Hammersmith Hospital during the year under review. The Tuberculosis Dispensary in Eavenscourt Park was destroyed by enemy action in January. With the cooperation of the Medical Superintendent of Hammersmith Hospital, arrangements were made with the London County Council for the work of the Dispensary to be carried on at the Hospital for the duration of the war. Patients have been seen by appointment at the sessions held on the following days :— Mondays (morning). Tuesdays (evening). Fridays (morning). Saturdays (morning) school children. Clinics have been held for special treatment on the following days:— Tuesdays (afternoon). Tuesdays (evening). Wednesdays (afternoon). Thursdays (afternoon). The accommodation at the hospital has made it possible for patients to be X-rayed at the time of their attendance at the Clinic, and thus the patient has made one visit for examination and X-ray instead of two as was the custom under the previous system. During the year 46 definite cases were transferred from other areas into the Borough and 142 moved out or were 45 lost sight of. Eight were written off the register as being cured. New Patients.—During the year 524 persons attended for examination for the first time, 302 males and 222 females. Of these 79 were under the age of fifteen and 445 were adults. Of the total 220 were referred to the Clinic by local practitioners for the purpose of consultation and 298 were "contacts" of persons suffering from tuberculosis. Of the "contacts" examined seven were definitely cases of tuberculosis whilst 291 were nontuberculous. Total Attendances and Examinations.—The total attendances of persons for the purpose of examination, observation or treatment, numbered 2;733 and physical examinations were carried out in 2,348 instances, i.e., in 86 per cent, of the total attendances. Home Visitation.—The Tuberculosis Officer made 15 visits to homes of patients for the purpose of examination, and investigation of the home conditions. Following the retirement of the two Nurse Visitors on the 31st December. 1940. arrangements were made for the home visitation, etc., to be undertaken by the Health Visitors. The Health Visitors visit cases of tuberculosis on notification and thereafter as far as possible at intervals of six months or less, as may appear advisable. During the year 2,092 such visits were made. 46 FOOD SUPPLIES. Unsound Food. Two seizures of unsound food were made during the year:— 95 lbs. Sausages. 36 Tins Pork and Beans. Summonses were issued in both cases and penalties and costs amounting to £24 7s. Od. were imposed. The following is a list of unsound food voluntarily surrendered during the year:— Apples, 6 cases. Apple Pulp, 4 cwts. Bacon, 6¼ lbs. Beef, 5 tons 14 cwts. 4 lbs. Brawn, Pressed Beef, etc., 4 cwt. 23 lbs. Bread, Cakes, Pastries, 6 cwt. 2 qtrs. Blackcurrant Pulp, 1 ton 1 cwt. 3 qtrs. 8 lbs. Crabs, 198. Currants, Sultanas, Raisins, Apple Rings, 4 tons 11 cwt. 6 qtrs. 15 lbs. Cheese, 2 qtrs. 24 lbs. Eggs, 5,242. Egg Yolk (liquid), 3 qtrs. Egg White (frozen), 2 cwt. 1 qtr. 5 lbs. Eggs, whole (frozen), 4 tons, 5 cwt. 2 qtrs. 17 lbs. Egg Substitute Powder, 6 cwt. 16 lbs. Fish and Fish Paste, 5 cwt. 2 qtrs. 17 lbs. Fish Entree (cooked), 1,040 portions. Figs, 16 lbs. Flour, 1 qtr. 24 lbs. Fruit Pies, 6. Lentils, 1 qtr. 14 lbs. Milk, Tinned, 261 tins. Meat, Fish. Fruit, Vegetables, Tinned, 5,786 tins. Marmalade and Jam, 12 lbs. Pilchards and Herrings, 5 boxes. Pork, Pork Bones and Offal, 4 cwt. 2 qtrs. 19½ lbs. Rabbits, 1,002. Sausages, Beef, 74 lbs. Turkey, 1. Veal, 2 cwt. 1 qtr. 14 lbs. A large proportion of the foodstuffs were salvaged for use as animal and chicken food or recovery of fats for trade purposes other than for human consumption. 47 FOOD AND DRUGS ACT, 1928. 801 samples of various foods and drugs were submitted to the Public Analyst during the year by the Council's Sampling Officers for analysis; 17 were found to be inferior and 29 were adulterated. Legal proceedings were taken in respect of 7 of the adulterated samples, and penalties and costs amounting to £51 7s. 0d. were imposed. PHOSPHATASE TEST. 30 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 process had been properly carried out and that 11 samples had been incorrectly pasteurised or had become admixed with raw milk. The dealer from whom the unsatisfactory samples were obtained has had his Pasteuriser's Licence revoked by the Council. Metchim & Son, Ltd, Westminster, S.W. I.