HAH 36 3 Town Hall, Hammersmith, W.6. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hammersmith. Mr. Mayor, Ladies and Gentlemen,—During 1944 Hammersmith had reason to receive special attention from the enemy. The consequence was that a considerable amount of the time of the Public Health staff was occupied in work directly due to enemy bombing. This meant extra hours to many, but more important than time was the friendly spirit in which they tackled the work. The reward was the satisfaction of work well done. Another sequel to the bombing was the variation in the population due to evacuation, which called for considerable extra work, especially from the staff directly concerned with the Maternity and Child Welfare section. The Tuberculosis Clinic lost the services of the Acting Medical Officer, who was doing excellent work. The difficulty of finding a suitable successor led to many changes in the medical staff, which was not in the best interest of the patients. The permanent staff worked harder, and, on the whole, few complaints were received before a satisfactory arrangement was made. Although reduced in numbers the Sanitary Inspectors continued their routine work which the war conditions have considerably curtailed. The impossibility of continuity has made much of the Sanitary Inspectors' work almost heartbreaking to anyone keen on results. As this may be the last report I have the honour to submit, I should like to thank all with whom I have been associated for the pleasure it has given me to work with them. I am, Your Worship, Ladies and Gentlemen, Your obedient Servant, W. H. BRODIE, Medical Officer of Health. 4 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1944. Area 2,282.5 acres Population (1943) (estimated) 92,050 (1944) „ 89,190 Population Census (1901) 112,239 „ „ (1911) 121,521 „ „ (1921) 130,295 „ „ (1931) 135,521 Natural increase, i.e., excess of births over deaths 370 Density of population (persons per acre) 39.08 Marriages registered 933 Rateable value (April, 1944) £1,221,638 Sum represented by a penny rate (April, 1944) £4,700 Vital Statistics. Births (legitimate) 1,583 Birth rate 20.0 ,, (illegitimate) 205 Rate per 1,000 Stillbirths 63 . (live and still births) 34 Deaths (corrected) 1,418 Death rate 15.9 Deaths of infants under one year of age per 1,000 births 53 ,, from cancer (all ages) 200 ,, ,, whooping cough (all ages) 5 ,, ,, diarrhoea (under 2 years of age) 17 5 Statistics.—The following table gives the statistics of the Borough during 1944 and previous years :— Vital Statistics of Whole District during 1944 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 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 114 1929 136900 1869 2162 15.8 1757 12.8 222 340 133 62 1875 13.7 1930 136900 1962 2173 15.9 1387 10.1 219 436 140 64 1604 11.7 1931 135100 1954 2073 15.3 1567 11.6 288 373 140 68 1652 12.2 1932 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 1931 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 10.9 411 639 116 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 1911 81880 2480 1405 16.5 1315 15.4 351 364 52 41 1328 15.6 1942 89370 2735 1589 17.8 1270 14.2 356 338 94 59 1252 14.0 1943 92050 3941 1768 19.2 1278 13.9 365 387 102 58 1300 14.1 1944 89190 4178 1788 20.0 1447 16.2 418 389 95 53 1418 15.9 * B = Birth-rate Population Figures. D= „ „ „ 6 Causes of, and Ages at, Death during the Year 1944. Cause 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 — 1 — — 1 — 2 F — 1 — — — — 1 3. Scarlet Fever M — — — — — — — F — — — — — — — 4. Whooping Cough M 2 — 1 — — — 3 F 1 1 — — — — 2 5. Diphtheria M — 1 — — — — 1 F — 2 — .— — — 2 6. Tuberculosis of Respiratory System M — — — 22 25 8 55 F — — — 25 4 — 29 7. Other forms of Tuberculosis M — 1 — 1 2 — 4 F — 3 1 1 — — 5 8. Syphilitic Diseases M — — — — 9 3 12 F — — — — 1 5 6 9. Influenza M — — — — 2 4 6 F — — — — 1 1 2 10. Measles M — — — — — — — F — — — — — — — 11. Ac. Polio-myelitis and Polioencephalitis M — — — — — — — F — — — — — — — 12. Ac. Inf. Encephalitis M — — — — — — — F — — — — — — — 13. Cancer of Buc. Cav. and Oesoph. (M), Uterus (F) M — — — — 2 7 9 F —- — — 3 5 2 10 14. Cancer of Stomach and Duodenum M — — — 1 6 3 10 F — — — — 2 10 12 15. Cancer of Breast M — — — — 1 — 1 F — — — 2 12 6 20 16. Cancer of all other sites M — — — 1 44 43 88 F — 1 — 6 20 23 50 17. Diabetes M — — — — 1 1 2 F — — — 1 — 8 9 18. Intra-cranial Vascular Lesions M — — — 2 14 20 36 F — — — — 15 49 64 19. Heart Disease M — — 1 3 39 93 136 F — — 1 4 18 117 140 20. Other Diseases of Circ. System M — — — — 15 28 43 F — — — 2 4 32 38 21. Bronchitis M 1 — — 2 11 40 54 F 4 — — — 8 26 38 22. Pneumonia M 13 — 1 2 16 23 55 F 10 1 — 1 7 14 33 23. Other Respiratory Diseases M — — — — 6 1 7 F — — — 1 2 1 4 24. Ulcer of Stomach or Duodenum M — — — 2 9 1 12 F — — — 1 1 1 3 25. Diarrhoea under 2 years M 13 — — — — — 13 F 4 — — — — — 4 26. Appendicitis M — — — — — 2 2 F — — 1 1 — — 2 27. Other Digestive Diseases M — — — 1 3 7 11 F — — — 1 3 5 9 28. Nephritis M — — — 1 2 7 10 F — — — 5 2 4 11 29. Puerperal and Post-abortive Sepsis M — — — — — — F — — — 1 — — 1 30. Other Maternal causes M — — — — — — — F — — — 1 — — 1 31. Premature Birth M 6 — — — — — 6 F 7 — — — — — 7 32. Con. Mai. Birth Injuries Infant Dis. M 14 — 1 — — — 15 F 7 — — — — 1 8 33. Suicide M — — — 1 2 1 4 F — — — 2 2 1 5 34. Road Traffic Accidents M — — 1 2 1 5 9 F — — — — — 3 3 35. Other violent causes M 2 4 8 28 28 24 94 F 2 1 11 40 33 18 105 36. All other causes M 4 1 — 6 16 27 54 F 5 2 1 10 4 17 39 Totals of all causes M 55 8 13 75 256 348 755 F 40 12 15 108 144 344 663 95 20 28 183 400 692 1,418 7 MATERNITY AND CHILD WELFARE. The following table gives the number of births and deaths of infants and the rate per 1,000 births since 1906:— Year. Births. Deaths of Infants. Deaths of Infants per 1000 births. Average 1906-1913 3000 359 117 1914-1923 2639 230 88 1924-1933 2145 141 66 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† 1942 1589 94 59 1943 1768 102 58 1944 1788 95 53 * Rate calculated on a birth figure supplied by the Registrar-General of 1,781. † Rate calculated on a birth figure supplied by the Registrar-General of 1,501. ‡ Rate calculated on a birth figure supplied by the Registrar-General of 1,253. 8 INFANT MORTALITY, 1944. Infantile Mortality during the year 1944. Nett deaths at various ages under one year of age. Under 1 week 25 1-2 weeks 7 2-3 weeks 5 3-4 weeks 2 4 weeks and under 3 months 15 3 months and under 6 months 23 6 months and under 9 months 8 9 months and under 1 year 10 Total deaths under 1 year 95 Nett Births in the Year : Legitimate, 1,583 ; Illegitimate, 205. Nett Deaths in the Yeah : Legitimate Infants 71 ; Illegitimate Infants, 24. Visits paid by Health Visitors are enumerated below:— No. of visits 23,688 No. of ineffective visits 4,954 Total No. of effective visits 18,734 Attendances at Infant Welfare Centres 1,210 Attendances at Ante-Natal Clinics 848 Attendances at Tuberculosis Clinics 243 9 The following Chart shows the Infantile Mortality rale tor the years 1906-1944. 10 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. 104 414 35 — — 1,791 35 — — 156 — — 291 33 — — 3,411 1,681 Becklow Gardens 206 483 32 — — 3,131 39 — — 256 — — 524 93 — — 6,921 2,876 Milson Road 96 195 5 — — 1,727 5 — — 154 — — 248 35 — — 3,284 1,626 Old Oak, Westway 104 328 33 — — 2,321 33 — — 152 — — 288 20 — — 3,994 1,510 Latymer Road 51 107 12 — — 749 18 — — 51 78 2 — — 1,050 421 College Park 52 — — 14 — — — 537 344 Totals 1,382 1,527 117 1,443 183 9,719 130 19,197 8,458 Ante-natal Clinics, Number of Sessions held. 561 Infant Consultations, ,, ,, ,, ,, 821 1,382 The average attendance at Infant Welfare Centres = 34. During the year 144 cases received massage treatment, the total number of treatments being 1,691. Milk for Expectant Mothers and Children.—During the year the scheme by which the Council provide free one pint of milk a day for all expectant mothers and children under five where the family income does not exceed 10s. Od. more than the scale of the Ministry of Food entitling them to free milk was continued. 14,921 quarts of liquid milk and 4,947 packets of dried milk were supplied under the scheme during the year. 11 Dinners.—Free dinners are supplied by the Council to expectant mothers and children under five recommended by the Assistant Medical Officers through the Londoners' Meals Service at Communal Dining Centres in the Borough. MATERNAL DEATHS. The following table gives the number of Maternal Deaths since 1924 :— Year. Number of Deaths. Number of live Births. Maternal Death Rate. Puerperal Sepsis. Other Accidents of Pregnancy. Average 1924-1933 4 4 2,145 3.5 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* 1942 —† 3 1,589 1.9 1943 2 1 1,768 1.6 1944 1 1 1,788 1.08 * Rate calculated on a (live and still) birth figure supplied by the Registrar-General of 1,289. t 1 death from puerperal sepsis not counted as " Maternal death." 12 War-time Day Nurseries.—The following particulars show the daily average attendance for each month at the six nurseries now in operation:— 1944. Brook Green. Accomdn. 83. Dalling Rd. Accomdn. 70. Australia Rd. Accomdn. 70. Uxbridge Rd. Accomdn. 65. Westway. Accomdn. 50. Latimer Rd. Accomdn. 36. Mon. to Fri. Mon. to Fri. Mon. to Fri. Mon. to Fri. Mon. to Fri. Mon. to Fri. Jan. 56 40 31 53 41 30 Feb. 51 46 38 49 44 33 Mar. 54 49 46 47 37 34 April 52 54 51 53 37 29 May 54 58 56 56 41 24 June 65 58 60 46 46 31 July 45 33 39 35 29 21 Aug. 50 37 35 32 30 25 Sept. 61 49 35 39 32 30 Oct. 66 56 52 49 37 31 Nov. 62 42 58 54 44 35 Dec. 63 52 59 49 39 34 The nurseries are open until 12 noon Saturday, and the attendances then are much below the average. 13 CHILD LIFE PROTECTION. Public Health (London) Act, 1936. At the end of the year there were 24 foster-children being cared for in the Borough, and 23 names on the list of foster-mothers. The Health Visitors are responsible for visiting the homes of all foster-children in their various districts. During the year 15 foster-mothers were removed from the register for various reasons and 8 new foster-mothers were registered. A summary of the work carried out during the year under review follows :— FOSTER-MOTHERS. No. of Foster-Mothers on Register December 31st, 1944 23 „ Recommended for Registration 8 ,, removed from Register 15 (1) Removed from Borough 3 (2) Adopted Children — (3) Unsuitable. 1 (4) 9 years of age — (5) Temporarily approved — (6) No further Foster-Children required 8 (7) Illness of Foster-Mothers. 2 (8) Lack of accommodation. — (9) Mother living at address — (10) Evacuated with Child — (11) Child evacuated 1 ,, Applications for Registration received but not Recommended — FOSTER-CHILDREN. No. of Foster-Children on Register December 31st, 1944 24 „ „ received by Foster-Mothers 23 „ „ moved from Foster-Mothers 39 (1) To Foster-Mothers 7 (2) To Parents or Guardians 14 (3) To Institutions 1 (4) Adopted 3 (5) Children removed from Borough with Foster- Mother 2 (6) Foster-Children who have reached the age of 9 years during the Year 1 (7) Evacuated to Residential Nursery — (8) No payment now received 1 VISITS. No. of visits to Registered Foster-Mothers 257 14 SANITARY CIRCUMSTANCES OF THE BOROUGH. The following table shows the number of visits made by the Sanitary Inspectors, and the number of Preliminary Notices served and complied with during the year :— Cause of Inspection No. of Inspections No. of Notices served. No. of Notices complied with. Bakehouses 58 2 I Cancer 5 — — Complaints 4,298 1,209 1,076 Drainage 1,797 18 24 Evacuation 116 — — Factories (Mechanical) 258 15 14 Factories (Non-mechanical) 20 2 1 Food (other than Restaurants and Eating Houses) 2,568 4 9 Housing Act 101 1 1 Infectious Diseases 1,761 20 17 Licences (Building) 769 1 — Markets 1,068 — — Milk Vendors 504 4 4 Outworkers 199 — — Pharmacy and Medicines Act 64 1 — Public Urinals 179 1 — Rats (Sewer) 110 — — Rats and Mice 2,231 108 37 Restaurants and Eating Houses 254 12 7 Requisitioning of Houses 58 — — Scabies 140 — 1 Shelters (A.R.P.) 359 4 — Shops Act 33 2 1 Slaughterhouses 1 — — Smoke Observations 77 8 — War Damage 259 63 22 Re-visits 7,292 154 322 Miscellaneous 2,163 40 27 Total 26,642 1,669 1,564 During the year 590 Statutory Notices were served and 475 complied with. INCREASE OF RENT AND MORTGAGE RESTRICTIONS ACT, 1920/38. During the year 7 applications were received for certificates under the above Act, and in 5 cases certificates were granted. This total includes two applications from owners, both of which were issued as the work specified had been completed satisfactorily. 15 SUMMONSES—YEAR 1944. The following table shows the number of proceedings instituted during the year Public Health (London) Act, 1936 37 Food and Drugs Act, 1938 13 1.—INSPECTION OF FACTORIES Premises Number of Inspections. Written Notices. Occupiers Prosecuted. Factories (with Mechanical Power) 258 15 — Factories (without Mechanical Power) 20 2 — Total 278 17 — 2.—DEFECTS FOUND IN FACTORIES, ETC. • Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Want of Cleanliness 5 — — — Unreasonable Temperatures 1 — — — Inadequate Ventilation — — — — Overcrowding — — — — Ineffective Drainage of Floors — — — — Sanitary [ insufficient 5 2 — — Conveniences unsuitable or defective 9 12 — — not separate for sexes 3 4 — — Offences—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) 2 — — — Total 25 18 — — 16 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) — rNotified by H.M. Inspector — Action taken under Public Health Acts in matters referred by H.M. Inspector Reports of action taken sent to H.M. Inspector — Other 2 Underground bakehouses (Sec. 54)— Certificates granted during year — In use at the end of the year 16 RATS AND MICE DESTRUCTION ACT. The work of remedying infestations by rats and mice in accordance with directions received from the Minister of Food continued throughout the year. In order to accelerate the work the staff of operatives was increased in November from one to three. The operatives work under the supervision of the Sanitary Inspectors. The following is a summary of the baiting work carried out on private property bv these men :— No. of premises baited following prepayment of estimated cost ... ... ... ... ... ... ... ... 114 No. of premises baited on default of occupier, where the cost has since been paid 11 No. of premises baited on default of occupier, where the account is still outstanding 19 No. of premises baited where the cost is considered irrecoverable ... ... ... ... ... ... ... 9 Total No. of private premises baited by the Council's operatives ... ... ... ... ... ... ... ... 153 The baiting of each premises takes from 8 to 20 days. Eighty-six Statutory Notices have befen served during the year. The baiting of the Council's sewers was .carried out in January and December. Property occupied by the Council has also been dealt with throughout the year. 17 CERTIFICATES OF ESSENTIALITY AND BUILDING LICENCES. The procedure for dealing with applications for certificates of essentiality has continued throughout the year with the exception of a period following upon the commencement of the flying-bomb attack when, on instructions from the Minister of Health, the issue of such certificates was temporarily suspended. On the 3rd October, Defence Regulation 56A—S.R. & 0. 1944, No. 1112, came into operation. This Order reduced the limit of expenditure from £100 to £10, above which building work must not be carried out without consent. Applications for works costing more than £100 continued to follow the existing procedure, but below this amount applications are dealt with by the local authority. The Sanitary Inspectors in their respective districts investigate and report upon the applications and follow up where licences are issued to see that the terms of the licence are complied with. Much unessential work has been prevented as a result of these investigations. LANDLORD AND TENANT (WAR DAMAGE) (AMENDMENT) ACT, 1941. Applications for certificates of fitness for housing purposes are dealt with by the Senior Sanitary Inspector. Fourteen applications were received and nine certificates have been issued during the year. The small number of applications received is evidence of the large amount of agreement which has been arrived at between tenants and landlords without recourse to the courts. EXHUMATION AND RE-INTERMENT OF BODIES. During the year three 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. 18 FOOD SUPPLIES. Unsound Food. Two seizures of unsound food were made during the year:— Two fowls, weighing 4¾ lbs. A quantity of unsound food was voluntarily surrendered during the year of which a large proportion was salvaged for use as animal and chicken food or recovery of fats for trade purposes other than for human consumption. Included in this amount was eight quarters of cow beef weighing a total of 768 lbs., which, upon inspection, was found to be tubercular. FOOD AND DRUGS ACT, 1938. 800 samples of various food and drugs were submitted to the Public Analyst during the year by the Council's Sampling Officer for analysis; 13 were found to be inferior and 7 were adulterated.. Legal proceedings were taken in respect of 4 of the adulterated samples, and penalties and costs amounting to £11 5s. 6d. were imposed. PHOSPHATASE TEST. In addition to those examined under the Food and Drugs Act, 1938, twelve samples of milk sold under the special designations "Pasteurised" and "Tuberculin Tested Pasteurised," and seven samples of milk taken direct from milk pasteurising plants in the borough at the time of pasteurisation, were submitted to the phosphatase test during the year. The results of these examinations showed that the pasteurising process had been properly carried out in each case. BACTERIOLOGICAL EXAMINATION OF FOOD. Twenty samples of milk were submitted for bacteriological examination during the year. 19 PUBLIC MORTUARY, AND CIVILIAN WAR DEATHS MORTUARY. Eight hundred and seventy-four bodies were admitted to the Public Mortuary and Civilian War Deaths Mortuary during the year:— Hammersmith Public Mortuary:— Admitted by order of Coroner 263 Admitted by order of Police 10 Admitted on application of undertakers for accommodation 54 War operations 147 474 Civilian War Deaths Mortuary, Bloemfontein Road:— War operations 41 41 Bodies admitted from other Boroughs:— Fulham 100 Chelsea 256 Kensington 3 359 874 No. of P.-M. examinations conducted:— Hammersmith cases 268 Fulham cases 97 Chelsea cases 248 Kensington 3 Total P.-M.s 616 No. of Inquests held:— Hammersmith cases 107 Kensington cases 109 Fulham cases 65 Chelsea cases 92 Total Inquests held - 373 There were no admissions to the C.D. Emergency Mortuary, Ravenscourt Square, W.6, 20 INFECTIOUS DISEASES (EXCLUDING TUBERCULOSIS). Infectious Diseases.— There were, omitting tuberculosis, 1,810 cases reported as due to notifiable infectious diseases in the Borough, against 2,238 in the previous year. There were also reported 349 cases of infectious diseases that were not notified, against 876 in the previous year; 44 of these were *Measles, 55 *Whooping Cough, 52 *Scabies and 198 Chickenpox. *Totals (notified eases and cases reported from other sources)—Measles 120, Scabies 1,215 and Whooping Cough 232. BACTERIOLOGY. The following bacteriological examinations were made on behalf of the Council:— Diphtheria Swabs— Positive results 9 Negative results 504 Enteric Group— Faeces 5 Other 2 21 Cases of Infectious Disease notified during the year 1944. Notifiable Disease. Number of Cases Notified. At all Ages. Age Periods. Under 1 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— Smallpox - - - - - - - - - - - - - Cholera, Plague - - - - - - - - - - - - - Diphtheria(including Membranous Croup) 38 2 1 3 1 5 6 4 6 8 1 1 - Erysipelas 35 - - - - - 1 1 - 7 4 18 4 Scarlet Fever 153 2 11 8 7 12 56 29 10 12 3 3 - Typhus Fever - - - - - - - - - - - - - Enteric Fever 1 - - - - - - - - - - - - Relapsing Fever, Continued Fever - - - - - - - - - - - - - Puerperal Fever 41 - - - - - - - 2 33 6 - - Puerperal Pyrexia 26 - - - - - - - 1 23 2 - - Cerebro-Spinal Meningitis 10 2 2 - 1 1 - - 1 1 - 2 - Polio-myelitis - - - - - - - - - - - - - Encephalitis Lethargica - - - - - - - - - - - - - Ophthalmia Neonatorum 6 6 - - - - - - - - - - - Anthrax - - - - - - - - - - - - - Pneumonia 26 3 - 2 - 1 1 1 1 1 2 7 7 Malaria 1 - - - - - - - - 1 - - - Dysentery 49 4 6 5 6 3 10 1 4 5 2 2 1 Food Poisoning 8 - - - - - - - 1 - 3 3 1 Measles 76 3 15 10 6 8 16 6 4 6 2 - - Whooping Cough 177 30 38 22 31 11 40 2 - 1 - 2 - Scabies 1,163 33 35 31 35 37 150 114 131 336 122 105 34 Totals 1,810 85 108 81 87 78 280 158 161 435 147 143 47 22 Deaths from the Seven Principal Zymotic Diseases.— The total number of deaths of residents registered from the seven principal zymotic diseases was 26 against 48 in the previous year. The deaths of residents from these diseases were equal to 18 per 1,000 of the total deaths of residents registered and were at the rate of 0.29 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, 1935 to 1944 :— Year. 8mallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea. Total. 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 1942 0 0 0 1 8 0 40 49 1943 0 2 0 0 9 0 37 48 1944 0 0 0 3 5 1 17 26 Average last 10 yrs. 0 2 1 5 6 1 31 46 Notifiable Diseases (other than Tuberculosis) during the Year 1944. DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths. Diphtheria 38 38 3 Erysipelas 35 21 — Scarlet Fever 153 130 — Enteric Fever 1 1 1 Puerperal Fever 41 40 1 Puerperal Pyrexia 26 26 Cerebro-Spinal Meningitis 10 8 3 Encephalitis Lethargica — — — Ophthalmia Neonatorum 6 2 — Pneumonia (Acute Primary and Influenzal) 26 2 †88 Dysentery 49 42 — Poliomyelitis — — — Malaria 1 I — Food Poisoning 8 — — *Measles 76 34 — *Whooping Cough 177 81 5 *Scabies 1,163 — — Totals 1,810 426 101 *This is not total brought to notice of Department †Deaths from all forms of Pneumonia. 23 DIPHTHERIA IMMUNISATION. The immunisation of children at the Borough Welfare Centres and at the schools by L.C.C. doctors continued during 1944. At the 31st December it was estimated that 60.4 per cent, of the children under five in the Borough and 67.5 per cent, of those between 5-15 years had been immunised. 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 673 Number of children immunised at schools by L.C.C. 274 Number of children immunised by local medical practitioners 22 Number of Schick Tests—positive result 1 Number of Schick Tests—negative result 196 Fees paid to Medical Practitioners £5 11s. 0d. 24 TUBERCULOSIS. Tuberculosis.— Two hundred and fourteen eases of Tuberculosis were reported during the year, one hundred and ninety-two of which were Pulmonary and twenty-two being other forms of Tuberculosis, against two hundred and one cases in the previous year. PART 1. Summary of Notifications during the period from the 1st January, 1944, to the 31st December, 1944. 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 — 3 5 1 11 15 23 18 18 ?7 9 120 Pulmonary Females — 3 1 1 11 17 27 6 2 3 1 72 Non-Pulmonary Males — — — 1 2 1 — 2 1 — — 7 Non-Pulmonary Femaleas — 2 1 — 2 3 3 — 2 1 1 15 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 — 4 10 17 7 3 6 4 52 Pulmonary Females — 3 — 1 — 11 14 5 1 — 1 36 Non-Pulmonary Males — 1 1 — 1 1 1 — — 1 — 6 Non-Pulmonary Females — 2 1 - 3 — 4 1 1 — 1 13 25 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1944:— Age Periods New Cases. Deaths. Respiratory NonRespiratory Respiratory NonRespiratory M. F. M. F. M. F. M. F. 0- - - - - - - - - 1- 3 6 1 4 - - 1 3 5- 7 3 2 2 - - - 1 15- 40 39 5 8 22 25 1 1 25- 40 41 1 7 35- 25 11 2 1 45- 21 3 1 3 25 4 2 - 55- 23 3 1 1 65 and on 13 2 - 2 8 - - - Total 172 108 13 28 55 29 4 5 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. 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 1942 169 31 200 104 935 963 1943 177 24 201 72 1,044 1,097 1944 192 22 214 93 1,098 1,184 26 Eighty-four deaths from Pulmonary Tuberculosis were registered, against sixty in the previous year, representing a death-rate of 0.94 per 1,000 compared with 0.65 in 1943 and 1.0 in 1942. Figures for the years 1927-44, showing the interval between notification and death of tuberculous persons are as under:— 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1937. 1938 1939. 1940. 1941. 1942. 1943. 1944. 1. Total number of deaths from Tuberculosis in the Borough 181 135 149 153 127 156 150 124 119 116 106 87 107 118 103 104 72 93 2. The number of cases notified at death - 7 3 7 2 6 13 5 11 6 8 8 5 9 10 22 14 26 3. The number of cases notified with in one month of death (excluding above) 25 17 32 18 16 21 17 21 11 20 16 13 12 11 13 16 10 6 4. The number of cases notified within three months of death (excluding above) 23 13 18 21 14 17 17 9 8 7 11 6 3 10 10 8 5 9 5. The number of cases notified within six months of death (excluding above) 18 9 8 9 14 15 16 11 11 7 8 5 5 11 6 3 3 6 Average number of cases notified for the 10 years 1925-1934 (inclusive) = 251. Average number of cases notified for the 10 years 1935-1944 (inclusive) = 194. Average number of deaths for the 10 years 1925-1934 (inclusive) = 146. Average number of deaths for the 10 years 1935-1944 (inclusive) = 102. BACTERIOLOGY. The following bacteriological examinations were made on behalf of the Council Sputa from cases of suspected Tuberculosis— Tubercle bacillus found 94 Tubercle bacillus not found 403 Pleural Fluid- Positive results 1 Negative results 2 Urine— Negative results 2 27 TUBERCULOSIS DISPENSARY.— The work of the Tuberculosis Dispensary was continued at the Hammersmith Hospital under the arrangement made with the London County Council and the British Post-Graduate Medical School. Five sessions, at which patients are seen by appointment, are held each week. New Patients.—During the year 875 persons attended for examination for the first time, 384 males and 491 females. Of these 188 were under the age of fifteen and 687 were adults. Of the total 450 were referred to the clinic by local practitioners for the purpose of consultation and 33 by the National Service Medical Boards. Two hundred and thirty-seven were "contacts" of persons suffering from tuberculosis. Of the "contacts" examined 19 were definitely cases of tuberculosis, whilst 218 were non-tuberculous. Total Attendances and Examinations.—The total attendances of persons for the purpose of examination, observation or treatment, numbered 3,983, and physical examinations were carried out in 3,905 instances, i.e., in 98 per cent, of the total attendances. Home Visitation.—The Tuberculosis Officer made 2 visits to homes of patients for the purpose of examination and investigation of the home conditions. 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 2,810 such visits were made. During the year 81 definite cases were transferred from other areas into the Borough and 127 moved out or were lost sight of. Sixteen were written off the register as being cured. 28 Mass Radiography.— The campaign for the early detection of symptomless tuberculosis was continued during the year by miniature mass-radiography groups operating in other districts. Thirty-one cases were referred to the Clinic from these units. Of these, 14 were cases of active tuberculosis whilst 3 were referred to hospital for observation. Tuberculosis Allowances.—The Government scheme for the payment of allowances to persons suffering from pulmonary tuberculosis who have to give up remunerative employment to undergo treatment continued during year 1944. The total number of cases considered was 757—86 of which were new ones. Of these, 61 received maintenance grants only, 15 maintenance grants plus discretionary allowances, 7 special allowances and 3 were considered to be ineligible. 671 cases were reviewed owing to changed circumstances. The total money paid to patients during the year amounted to £6,114 19s. Od. 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. In July, 1943, a circular (2831) was issued by the Ministry of Health dealing with infestations by head lice and certain lines of action were suggested. Generally, these lines have been followed. Special attention has been given to this question by the Doctors and Health Visitors in the Welfare Centres and by the Matrons in the day nurseries and examinations of the children's heads have been carried out during routine inspections to discover any infestations. Mothers have been advised as to the best methods of eradication and of preventing recurrence of the trouble. Families known to be in need of special attention have been frequently visited by the Health Visitors, and infested school children, together with their contacts of pre-school age, have been followed up in the home. 29 Facilities for cleansing at the Council's Medicinal Baths have been made available in all cases and the opportunity given to purchase at cost price special combs. Figures showing the number of cases dealt with at the Baths during the year are as under:— School Children—Hammersmith. Scabies 2,072 Verminous 1,557 Impetigo 13 School Children—Non-Hammersmith. Nil. Children under Five Years—Hammersmith. Scabies 573 Verminous 119 Impetigo 14 Children under Five Years—Non-Hammersmith. Nil. Adults—Hammersmith. Scabies 2,122 Verminous 223 Impetigo 11 Other Conditions 2 Adults—Non-Hammersmith. Nil. Common Lodging-houses. Scabies 23 Verminous 208 VACCINATION. The duties under the Vaccination Acts and the Vaccination Order were carried out by the Public Health Department. The Return for 1943 shows that 2,087 Infants were vaccinated, this being 71.28 per cent. of the Births compared with 75.18 per cent. in 1942. No proceedings under the Vaccination Acts were instituted. 30 VACCINATED RETURNS. RETURN FOR 1943. Registration Sub-Districts comprised in the Vaccination Officers' District Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st Dec., 1943 Number of these Births duly entered by 31st January, 1945, in Columns I, II, IV and V of the " Vaccination Register " (Birth List Sheets), viz.: Number of these Births which on 31st January, 1945, remained unentered in the " Vaccination Register " on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1945, neither duly entered in the "Vaccination Register" (columns 3, 4, 5, 6 and 7 of this Return) nor temporarily accounted for in the "Report Book" (columns 8, 9 and 10 of this Return Number of Certificates of Successful Primary Vaccination of children under 14 years received during the calendar year 1944 Number of Statutory Declarations of Conscientious Objection actually received by the Vaccination Officer inrespective of the dates of birth of the children to which they relate during the calendar year 1944 Col. 1 Successfully Vaccinated Col. II Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received Col. V Dead, Unvaccinated Postpone ment by Medical Certificate Removal to Districts, the Vaccination Officer of which has been duly apprised Removal to Places unknown or which cannot be reached; and Cases not having been found Insusceptible of Vaccination Had SmallPox 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Hammersmith 306 132 — — 86 11 - 9 6 62 184 59 2. Hammersmith Hospital 1,476 834 5 — 228 77 — 132 68 132 957 247 3. South Hammersmith 202 97 1 — 36 9 — 3 9 47 111 40 4. Queen Charlotte's Hospital 1,781 1,024 5 — 216 41 — 384 73 38 1,073 209 3,765 2,087 11 — 566 138 — 528 156 279 2,325 555 31 Table showing Work of Vaccination Officer from 1st January to 31st December, 1944. 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. Noa. 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 90 16 42 36 184 59 1 -- 23 208 27 9 5 64 28 66 1 159 South 54 33 — — 24 — 111 40 4 — 1 150 26 5 3 65 50 3 — 118 Hammersmith Hospital 184 96 99 1 575 2 957 247 10 — 945 624 58 47 50 221 139 121 7 488 Queen Charlotte's Hospital 65 13 13 — 981 1 1073 209 2 — 1549 193 17 47 30 110 34 11 - 155 Removed Inwards 255 46 30 — 50 — 381 8 5 251 — 121 27 5 25 67 37 38 1 143 Total 648 204 184 1 1666 3 2706 563 22 251 2518 1296 155 113 113 527 288 239 9 1063 Total number of births registered during 1944 — 4,178. Metchim & Son, Ltd, Westminster, S.W. I.