HAM 37 3 Town Hall, Hammersmith, W.6. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hammersmith. Mr. Mayor, Ladies and Gentlemen,—I submit to you the annual report on the health of the Borough for the year 1945. This report is still controlled by instructions from the Ministry of Health and is in a very abridged form. As is known to you, Dr. W. H. Brodie, the Medical Officer of Health, returned to his permanent work at Penang in the autumn and discontinued his duties in Hammersmith on the last day of September. It is not for me to enumerate his fine achievements whilst in the Borough, as these are probably better known to yourselves. Before Dr. Brodie left England, however, he had, so far as possible, geared the health services to a peace-time regime. During the year the health of the Borough was remarkably good. The infant mortality rate was the lowest on record, except for the war-time years of 1939 and 1941, when the rate was calculated on a special birth figure supplied by the Registrar General. It is pleasing to be able to record also that only one maternal death took place. For the first time for over four years part of the year now reviewed deals with peace-time conditions. The total number of deaths in the Borough was 110 less than in the previous year: this decrease is due to the war ending in May. The figures for air-raid deaths during 1944 were 188, as against only 29 in 1945. There was an increase in the number of infectious disease notifications of over 1,000 cases. This is explained by an epidemic of measles. There was also an increase in the number of cases of dysentery notified. In the majority of these cases 4 the causative organism was not isolated, but it is felt that an influenza virus may be responsible for some. It is of interest to refer to the annual notifications of all forms of tuberculosis now that the war is over. Tuberculosis, particularly in its pulmonary form, is a fairly accurate barometer of the level of the people's standard of living. The figures for the last twenty-one years are therefore quoted :— Year. No. of Cases Notified. 1925 266 1926 278 1927 279 1928 261 1929 280 1930 250 1931 239 1932 228 1933 216 1934 215 1935 201 1936 196 1937 174 1938 192 1939 198 1940 167 1941 199 1942 200 1943 201 1944 214 1945 230 This trend can clearly be observed by referring to these figures. It will be noticed that the war-time rise in the number of annual notifications was maintained during 1945. The number of notified cases resident in the Borough is now greater than in any year since 1930. It is very pleasing to note, however, that the number of cases attending the Borough Council Clinic is greater than ever before, and is now 91 per cent, of the total resident in Hammersmith. In 1927 the attendance was approximately 50 per cent. 5 Epidemiologists have recently estimated that where a 75 per cent, figure for the immunisation of children against diphtheria has been reached, the community is in a relatively safe position so far as this disease is concerned. It is estimated in this Borough that the figure is now between 60-70 per cent. A new drive has been started by the Public Health Department and it is hoped by the end of 1946 that the percentage will be well in excess of 75 per cent. We are passing through the transition stage between war and peace. The standard of living of the people is not at present satisfactory. Great advances in their health are unlikely to be seen until there is an improvement in the situation with regard to housing, food, shortage of hospital beds for infectious disease, maternity cases, etc. It is pleasing to record that members of the staff, previously serving with H.M. Forces, are returning to their peace-time employment in the Department. Dr. Brodie's thanks and my own are clearly due to the staff of the Department for their loyal support throughout the year. I am, Your Worship, Ladies and Gentlemen, Your obedient Servant, F. M. DAY, Medical Officer of Health. 6 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1945. Area 2,282.5 acres Population (1944) (estimated) 89,190 ,, (1945) „ 96,100 Population Census (1901) 112,239 (1911) 121,521 (1921) 130,295 (1931) 135,521 Natural increase, i.e., excess of births over deaths 434 Density of population (persons per acre) 42.11 Marriages registered 1,174 Rateable value (April, 1945) £1,202,372 Sum represented by a penny rate (April, 1945) £4,762 Vital Statistics. Births (legitimate) 1,582 Birth rate 18.1 ,, (illegitimate) 210 Rate per 1,000 Stillbirths 40 (live and still births) 22 Deaths (corrected) 1,308 Death rate 13.6 Deaths of infants under one year of age per 1,000 births 45 ,, from cancer (all ages) 207 ,, ,, whooping cough (all ages) 3 ,, ,, diarrhoea (under 2 years of age) 15 7 Statistics.—The following table gives the statistics of the Borough during 1945 and previous years :— Vital Statistics of Whole District during 1945 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. 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. 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 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 60 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 10.5 406 533 131 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 1942 89370 2735 15S9 17.8 1270 14.2 356 338 94 59 1252 11.0 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 1945 96100 4884 1742 18.1 1464 15 423 267 78 45 1308 13.6 * B = Birth-rate Population Figure. D = Death-rate „ „ 8 Causes of, and Ages at, Death during the Year, 1945. Cause of Death. Sex. 0— 1— 5- 15— 45— 65— Total all Ages. 1. Typhoid and Paratyphoid Fevers M — — — — — — — F — — — — 1 — 1 2. Cerebro-spinal Fever M — — — — 1 — 1 F — 1 — — — — 1 3. Scarlet Fever M — — — — — — — 4. Whooping Cough r M — — — — — — — F 2 1 — — — — 3 5. Diphtheria M F — — — — — — — 6. Tuberculosis of Respiratory System M 1 1 — 15 26 12 55 F — 1 — 19 5 2 27 7. Other forms of Tuberculosis M — 2 — 4 — — 6 F — — 1 2 2 — 5 8. Syphilitic Diseases M — — — 1 3 2 6 F — — — 1 4 2 7 9. Influenza M — 1 — 1 2 2 6 F — — — — 2 1 3 10. Measles M — 1 — — — — 1 11. Ac. Polio-myelitis and r M — 1 — — 1 encephalitis F — — — 1 — — 1 12. Ac. Inf. Encephalitis M — — — — — — F — — — — — 1 1 13. Cancer of Buc. Cav. and Oesoph. (M), Uterus (F) M — — —- — 3 5 8 F — — — 1 7 4 12 14. Cancer of Stomach and Duodenum M — — — 1 9 7 17 F — — — — 3 13 16 15. Cancer of Breast M — — — — — — — F — — — 1 12 7 20 16. Cancer of all other sites M — — — 2 36 47 85 F — — — 3 11 35 49 17. Diabetes M — — — 1 — 2 3 F — — — 1 — — 41 9 18. Intra-cranial vascular Lesions M — — — 1 12 36 F — — — 3 17 39 59 19. Heart Disease M — — — 5 34 117 156 F — — — 5 17 117 139 20. Other Diseases of Circ. System M — — — 1 8 13 22 F — — — — 3 23 26 21. Bronchitis M — 1 — 2 18 31 52 F 2 — — 3 12 25 42 22. Pneumonia M 9 1 — 2 15 25 52 F 7 1 1 2 5 24 40 23. Other Respiratory Diseases M — 1 — 1 5 5 12 F — — — — 2 2 4 24. Ulcer of Stomach or Duodenum M — — — 2 5 8 15 F — — — — 2 2 4 25. Diarrhooa under 2 years M 8 2 — — — — 10 F 4 1 — — 5 26. Appendicitis M — — — — — — — F — — — 2 1 3 27. Other Digestive Diseases M — — — 2 4 7 13 F — — — — 5 6 11 28. Nephritis M — — — 2 3 9 14 F — — — — 5 5 10 29. Puerperal and Post-abortive Sepsis M — — — — — — F — — — — — — 30. Other Maternal causes M — — — — — — — 31. Premature Birth r M 5 — — 1 — — 1 5 F 1 — — — — — 1 32. Con. Mai. Birth Injuries Infant Dis M 18 — — — — — 18 F 15 1 — 1 1 1 19 33. Suicide M — — — 1 4 1 6 F — — — 3 1 — 4 34. Road Traffic Accidents M — — 1 5 1 1 8 F — 1 1 1 — 2 5 36 Other violent causes M 5 3 6 11 8 6 39 F 1 6 3 10 3 12 35 All other cauies M — — — 4 8 30 42 F — — — 5 9 37 51 Totals of all causes M 46 13 7 65 205 366 702 F 32 13 6 63 131 361 606 78 26 13 128 336 727 1,308 9 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 1945 1742 78 45 * 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. 10 INFANT MORTALITY, 1945. Infantile Mortality during the year 1945. Nett deaths at various ages under one year of age. Under 1 week 32 1-2 weeks 3 2-3 weeks 2 3-4 weeks 6 4 weeks and under 3 months 10 3 months and under 6 months 15 6 months and under 9 months 6 9 months and under 1 year 4 Total deaths under 1 year 78 Nett Births is the Year : Legitimate, 1,532 ; Illegitimate, 210. Nett Deaths in the Year : Legitimate Infants 62 ; Illegitimate Infanta, 16. Visits paid by Health Visitors are enumerated below :— No. of visits 26,606 No. of ineffective visits 3,990 Total No. of effective visits 22,616 Attendances at Infant Welfare Centres 1,058 Attendances at Ante-Natal Clinics 1,025 Attendances at Tuberculosis Clinics 302 11 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. Antenata 1. Postnatal. Under 1 yr. Over 1 yr. 48, Glenthorne Rd. 150 388 133 — — 4,586 2,568 95 443 13 — — 2,659 31 — — Becklow Gardens 251 — — 599 137 — — 9,212 4,027 244 672 24 3,898 26 — — Milson Road 150 307 65 — — 4,706 2,627 98 334 1 2,173 10 — — Old Oak, Westway 152 238 25 — 4,643 2,095 101 288 33 1,719 38 Latimer Road 50 99 7 1,445 699 50 140 14 890 17 — — College Park 52 36 11 — — 807 488 Totals 1,393 1,877 85 1,667 378 11,339 122 25,399 12,504 Ante-natal Clinics, Number of Sessions held 588 Infant Consultations, ,, ,, ,, ,, 805 1,393 The average attendance at Infant Welfare Centres = 47. During the year 232 cases received massage treatment, the total number of treatments being 1,855. 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. 13,755 quarts of liquid milk and 3,908 packets of dried milk were supplied under the scheme during the year. 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. 12 MATERNAL DEATHS. The following table gives the number of Maternal Deaths since 1924 :— Number of Deaths. Number of live Births. Maternal Death Bate. Year. 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 —t 3 1,589 1.9 1943 2 1 1,768 1.6 1944 1 1 1,788 1.08 1945 — 1 1,742 0.56 * Rate calculated on a (live and still) birth figure supplied by the Registrar-General of 1,289. † 1 death from puerperal sepsis not counted as "Maternal death." War-time Day Nurseries.—The following particulars show the daily average attendance for each month at the six nurseries now in operation :— 1945. Brook Green. Dalling Rd. Australia Rd. Uxbridge Rd. Westway. Latimer Rd. Accomdn. 83. Accomdn. 70. Accomdn. 70. Accomdn. 65. Accomdn. 50. Accomdn. 36. Mon. to Fri. Mon. to Fri. Mon. to Fri. Mon. to Fri. Mon. to Fri. Mon. to Fri. Jan. 62 46 51 55 32 27 Feb. 58 56 58 54 21 25 Mar. 51 57 31 37 26 20 April 66 62 60 52 36 30 May 69 62 66 57 38 32 June 69 64 70 56 48 34 July 69 63 69 58 48 31 Aug. 72 63 62 49 41 29 Sept. 73 60 68 57 40 22 Oct. 74 62 66 59 40 27 Nov. 68 65 56 55 39 26 Dec. 65 61 57 51 39 26 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 32 foster-children being cared for in the Borough, and 28 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 8 foster-mothers were removed from the register for various reasons and 13 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, 1945 28 „ ,, Recommended for Registration 13 „ „ removed from Register 8 (1) Removed from Borough 1 (2) Adopted Children — (3) Unsuitable 3 (4) 9 years of age — (5) Temporarily approved — (6) No further Foster-Children required 2 (7) Illness of Foster-Mothers 2 (8) Lack of accommodation — (9) Mother living at address — (10) Evacuated with Child — (11) Child evacuated — Applications for Registration received but not Recommended — FOSTER-CHILDREN. No. of Foster-Children on Register December 31st, 1945 32 „ „ received by Foster-Mothers 29 „ „ moved from Foster-Mothers 21 (1) To Foster-Mothers 5 (2) To Parents or Guardians 13 (3) To Institutions — (4) Adopted 1 (5) Children removed from Borough with Foster-Mother 1 (6) Foster-Children who have reached the age of 9 years during the Year — (7) Evacuated to Residential Nursery 1 (8) No payment now received — VISITS. No. of visits to Registered Foster-Mothers 282 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 3 Cancer 5 — — Complaints 4,242 2,125 1,421 Drainage 1,362 22 21 Factories (Mechanical) 154 12 10 Factories (Non-mechanical) 29 1 1 Food (other than Restaurants and Eating Houses) 1,475 25 15 Housing Act 386 30 21 Ice Cream Vendors 237 3 3 Infectious Diseases 1,938 36 19 Licences (Building) 3,076 7 5 Markets 839 1 1 Milk Vendors 318 12 9 Outworkers 205 2 — Pharmacy and Medicines Act 71 — — Public Urinals 60 2 1 Rats and Mice 1,394 129 89 Requisitioning of Houses 140 — — Restuarants and Eating Houses 108 4 5 Scabies 983 9 4 Shelters (A.R.P.) 11 — — Shops Act 19 2 3 Slaughterhouses 3 — — Smoke Observations 7 3 — War Damage 186 63 44 Miscellaneous 1,577 59 35 Re-visits 5,745 282 201 No Answer 2,809 — — No. of Ineffective Visits 27,437 2,809 2,831 1,911 Total 24,628 2,831 1,911 During the year 664 Statutory Notices were served and 442 complied with. INCREASE OF RENT AND MORTGAGE RESTRICTIONS ACT, 1920/1939. During the year 14 applications were received for certificates under the above Act, and in 8 cases certificates were granted. 15 This total includes three applications from owners, two of which were issued as the work specified had been completed satisfactorily. SUMMONSES—YEAR 1945. The following table shows the number of proceedings instituted during the year:— Public Health (London) Act, 1936 19 Eats and Mice (Destruction) Act, 1919 1 Food and Drugs Act, 1938 8 Housing Act, 1936, and L.C.C. Byelaws 4 1.—INSPECTION OF FACTORIES. Premises Number of Written Notices. Inspections. Occupiers Prosecuted. Factories (with Mechanical Power) 154 12 — Factories (without Mechanical Power) 29 1 — Total 183 13 — 2.—DEFECTS FOUND IN FACTORIES, ETC. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Want of Cleanliness 3 6 — — Unreasonable Temperatures — — — — Inadequate Ventilation — — — — Overcrowding — — — — Ineffective Drainage of Floors — — — — Sanitary Conveniences insufficient — — — — unsuitable or defective not separate for sexes 5 3 — — — — — — Offences—Factories Act— Illegal occupation of underground bakehouse — — — — Other Offences (excluding offences relating to out-work which are included in Part 3 of this report) 1 1 — — Total 9 10 — — 16 ?—OTHER MATTERS RELATING TO FACTORIES. Class. Number. Matters notified to H.M. Inspector of Factories— Failure to affix Abstract of the Factories Act 1937 (Sec. 2) — Action taken under Public Health Acts in matters referred by H.M.Inspector 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 16 RATS AND MICE DESTRUCTION ACT. The operation of the "Block Control" scheme, which commenced in 1944, was completed during the year. This scheme entailed making enquiries at practically all premises in the Borough and resulted in the discovery of many unreported infestations and the destruction of a large number of rats. In March, the Council decided to discontinue charging occupiers of private dwellings for baiting work carried out, and this policy has greatly facilitated the work. Occupiers of business premises are mostly quite willing to pay the cost of baiting and little difficulty in recovering these charges has been experienced. It was not found necessary to retain three men exclusively on rodent work after 25th June, and one man was accordingly transferred to other duties. The operatives work under the supervision of the Sanitary Inspectors. The following is a summary of the baiting work, &c carried out:— 1. Block Control Scheme. No. of premises baited where cost of work has been paid 203 No. of premises baited where cost of work is outstanding 12 No. of premises baited free of charge 83 2. Individual Infestation. No. of premises baited where cost of work has been paid 62 No. of premises baited where cost of work is outstanding 1 No. of premises baited free of charge 191 Total number of premises baited 552 17 The number of baits laid at each premises varies according to the size of the premises and the degree of infestation. The baiting of each premises entails an average of fourteen visits by the rodent operative. No. of Statutory Notices served under the Act 74 No. of premises for which application was made to the Minister of Food under the Infestation Order, 1943, to treat the " Owners " as " Occupiers " for the purpose of the Act 5 No. of cases in which proceedings were taken to recover the cost of work carried out upon default of the Occupier 1 CERTIFICATES OF ESSENTIALITY AND BUILDING LICENCES. During the year the Control of Building Operations (No. 5) Order, 1945, dated 30th June, 1945, made by the Minister of Works under Regulation 56A and the Defence (General) Regulations, 1939, came into force. The Order contained provisions applicable during the month of July, 1945, and provisions applicable as from 1st August, 1945. Under the Order work could be carried out on any single property without licence to the extent of two pounds per month, in addition to which, a further sum of ten pounds could likewise be expended during the period 1st August, 1945, to 31st January, 1946. The monthly sum of two pounds was not cumulative. Work to private dwellings by unpaid labour could be carried out without licence and the cost of any materials used by such unpaid labour was disregarded. Apart from these exemptions, no building work could be carried out without licence. The Sanitary Inspectors have continued to investigate and report upon all applications received. The number of applications received during the year was 2,265. LANDLORD AND TENANT (WAR DAMAGE) (AMENDMENT) ACT, 1941. Applications for certificates of fitness for housing purposes are dealt with by the Senior Sanitary Inspector. Sixteen certificates were 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. 18 EXHUMATION AND RE-INTERMENT OF BODIES. During the year four Licences were granted by the Secretary of State for the exhumation and removal of bodies from graves in St. Mary's Catholic Cemetery, Harrow Road, but in one case the removal was not effected. FOOD SUPPLIES. Unsound Food. 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. 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; 70 were found to be inferior and 13 were adulterated. Legal proceedings were taken in respect of 5 adulterated samples, and penalties and costs amounting to £25 2s. 0d. were imposed. MILK (SPECIAL DESIGNATIONS) REGULATIONS, 1936-1945, AND REGULATION 55G OF THE DEFENCE (GENERAL) REGULATIONS, 1939. In addition to those taken under the Food and Drugs Act, 1938, 142 samples of milk sold as " Pasteurised," " Tuberculin Tested Pasteurised," " Tuberculin Tested," " Sterilised " and " Heat Treated " were taken under the above Regulations and submitted for bacteriological examination, the phosphatase test and the methylene blue test. 27 of these samples were taken direct from milk processing plants using the high temperature short-time method of pasteurisation and which are installed and licensed in the Borough. 19 PUBLIC MORTUARY, AND CIVILIAN WAR DEATHS MORTUARY. Seven hundred and two bodies were admitted to the Public Mortuary during the year :— Hammersmith Public Mortuary :— Admitted by order of Coroner 291 Admitted by order of Police 18 Admitted on application of undertakers for accommodation 41 War operations 29 379 Bodies admitted from other Boroughs :— Fulham 88 Chelsea 228 Kensington 12 323 702 No. of P.-M. examinations conducted:— Hammersmith cases 288 Fulham ,, 79 Chelsea ,, 221 Kensington ,, 12 Total P.-M.s 600 No. of Inquests held:— Hammersmith cases 104 Kensington ,, 90 Fulham ,, 55 Chelsea ,, 61 Total Inquests held 310 There were no admissions to the C.D. Emergency Mortuary, Ravenscourt Square, W.6, or the Civilian War Deaths Mortuary, Blomfontein Road, W.12. 20 INFECTIOUS DISEASES (EXCLUDING TUBERCULOSIS). Infectious Diseases.—There were, omitting tuberculosis, 2,922 cases reported as due to notifiable infectious diseases in the Borough, against 1,810 in the previous year. There were also reported 572 cases of infectious diseases that were not notified, against 349 in the previous year; 380 of these were *Measles, 25 *Whooping Cough, 56 *Scabies and 111 Chickenpox. ♦Totals (notified cases and cases reported from other sources)—Measles 1,442, Scabies 1,301 and Whooping Cough 108. BACTERIOLOGY. During the year the following 832 bacteriological examinations were made on behalf of the Council:— Specimen. Positive. Negative. Total . Swab for or suspected cases of Diphtheria 5 731 736 Blood for suspected cases of Typhoid or Paratyphoid Fever 1 1 Miscellaneous 24 71 95 29 803 832 The miscellaneous specimens consisted of 35 swabs for haemolytic streptococci and 60 faeces. Cases of Infectious Disease notified during the year 1945. Notifiable Disease. Ntjmbek 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) 46 2 6 1 1 4 12 7 4 6 2 1 Erysipelas 20 1 — — — — — — 1 2 3 6 7 Scarlet Fever 182 4 10 15 13 40 59 26 7 7 1 Typhus Fever — — — — — — — — — — Enteric Fever 3 — — — — — — — 2 1 Relapsing Fever, Continued Fever — — — — — — — — — — — Puerperal Fever 26 — — — — — — — 2 21 3 — — Puerperal Pyrexia 23 — — — — — — — — 19 4 — Cerebro-Spinal Meningitis 9 1 2 2 — — 1 — 1 1 — 1 — Polio-myelitis 4 — — — — 2 1 — 1 — — Encephalitis Lethargica — — — — — — — — — — — — Ophthalmia Neonatorum 14 14 — — — — — — — — — Anthrax — — — — — — — — — — — Pneumonia 49 5 5 — 3 1 3 — — 3 7 8 14 Malaria 5 — — — — — — — 5 — — — Dysentery 143 14 25 13 10 10 31 8 3 15 5 4 5 Food Poisoning 8 — — — — — — — — 4 2 2 Measles 1,062 63 138 172 130 131 384 22 5 17 — Whooping Cough 83 15 16 17 14 6 13 1 1 — Scabies 1,245 26 32 42 35 42 163 127 142 384 126 96 30 Totals 2,922 145 234 262 206 234 668 192 166 487 151 119 58 22 Deaths from the Seven Principal Zymotic Diseases.— The total number of deaths of residents registered from the seven principal zymotic diseases was 20 against 26 in the previous year. The deaths of residents from these diseases were equal to 15 per 1,000 of the total deaths of residents registered and were at the rate of 0.20 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, 1986 to 1945:— Year. Smallpox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Enteric Fever. Diarrhoea. Total. 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 1945 0 1 0 0 3 1 15 20 Average last 10 yrs. 0 3 1 4 5 1 30 44 23 Notifiable Diseases (other than Tuberculosis) during the Year 1945. DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths. Diptheria 46 45 Erysipelas 20 10 — Scarlet Fever 182 98 1 Enteric Fever 3 3 1 Puerperal Fever 26 26 — Puerperal Pyrexia 23 23 Cerebro-Spinal Meningitis 9 9 2 Encephalitis Lethargica — — — Opthalmia Neonatorum 14 8 — Pneumonia (Acute Primary and Influenzal) 49 †92 Dysentery 143 120 — Poliomyelitis 4 4 2 Malaria 5 3 — Food Poisoning 8 2 — *Measles 1,062 131 1 *Whooping Cough 83 29 3 *Scabies 1,245 — — Totals 2,922 511 102 *This is not total brought to notice of Department. †Deaths from all forms of Pneumonia. DIPHTHERIA IMMUNISATION. The immunisation of children at the Borough Welfare Centres and by L.C.C. doctors at the Schools continued during 1945. 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 1,3'20 Number of children immunised at schools by L.C.C. 231 Number of children immunised by local medical practitioners 31 Number of Schick Tests—positive result 1 Number of Schick Tests—negative result 61 Fees paid to Medical Practitioners £8 17s. 0d. 24 TUBERCULOSIS. Tuberculosis.—Two hundred and thirty cases of Tuberculosis were reported during the year, two hundred and seven of which were Pulmonary and twenty three being other forms of Tuberculosis, against two hundred and fourteen cases in the previous year. PART I. Summary of Notifications during the period from the 1st January, 1945, to the 31st December, 1945. 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 1 2 — 5 9 14 18 19 15 15 9 107 Pulmonary Females — 6 1 3 12 30 25 9 5 6 3 100 Non-Pulmonary Males — 2 1 2 2 1 1 — 2 — — 11 Non-Pulmonary Females — 2 1 1 2 2 1 1 1 — 1 12 PART II. Supplemental Return. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Age Periods. 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total Pulmonary Males — 1 1 1 I 5 6 4 3 3 3 28 Pulmonary Females — — — 3 4 5 10 6 — — 31 Non-Pulmonary Males — — — 2 1 1 2 — — — — 6 Non-Pulmonary Females — — 4 1 2 — — — — — 7 25 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1945:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory M. F. M. F. M. F. M. F. 0- ] — 1 — 1- 3 6 2 2 1 1 2 — 5- 7 7 5 6 — — — 1 15- 29 51 5 7 15 19 4 2 25- 24 35 3 1 35- 23 15 — 1 26 5 — 2 45- 18 8 2 1 55- 18 6 — 65 and on 12 3 — 1 12 2 — — Total 135 131 17 19 55 27 6 5 26 Eighty-two deaths from Pulmonary Tuberculosis were registered, against eighty-four in the previous year, representing a death-rate of 0.85 per 1,000 compared with 0.94 in 1944 and 0.65 in 1943. Figures for the years 1927-45 showing the interval between notification and death of tuberculous persons are as under:— 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1630. 1937. 1938. 1939. 1940. 1941. 1942. L943. 1944. 1945. 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 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 13 3. The number of cases notified within one month of death (excluding above) 25 17 32 18 16 21 17 21 11 20 16 13 12 11 13 16 10 6 13 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 6 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 10 Average number of cases notified for the 10 years 1926-1935 (inclusive) = 245. Average number of cases notified for the 10 years 1936-1945 (inclusive) = 197. Average number of deaths for the 10 years 1926-1935 (inclusive) = 144. Average number of deaths for the 10 years 1936-1945 (inclusive) = 100. BACTERIOLOGY. The following bacteriological examinations were made on behalf of the Council:— Sputa from cases of suspected Tuberculosis— Tubercle bacillus found 83 Tubercle bacillus not found 625 Fleural Fluid— Positive results 5 Negative results 11 Urine— Negative results 4 Blood Counts 18 27 TUBERCULOSIS DISPENSARY.—The work of the Tuberculosis Dispensary was continued at the Hammer¬smith 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 894 persons attended for examination for the first time, 395 males and 499 females. Of these 186 were under the age of fifteen and 708 were adults Of the total 498 were referred to the clinic by local practitioners for the purpose of consultation, 23 by the National Service Medical Boards and 38 by mass Radiography Groups. Two hundred and thirty-one were "contacts" of persons suffering from tuberculosis. Of the "contacts" examined 11 were definitely cases of tuber¬culosis, whilst 220 were non-tuberculous. Of the 38 cases referred to the Clinic by mass Radiography Groups, 23 had active disease. Total Attendances and Examinations.—The total attendances of persons for the purpose of examination, observation or treatment, numbered 4,638, and physical examinations were carried out in 2,785 instances, i.e., in 60 per cent. of the total attendances. Home Visitation.—The Tuberculosis Officer made 8 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 2,579 such visits were made, of which 239 were ineffective. During the year 64 definite cases were transferred from other areas into the Borough and 58 moved out or were lost sight of. Twelve 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 units and one such unit was provided by the London County Council at St. Luke's Hospital, Chelsea. A number of the large industrial undertakings in the Borough were again invited to allow their employees to undergo examination by the unit, transport to and from Chelsea being provided by the Borough Council. The managements of the firms proved very co-operative and in all 4,396 men and women submitted themselves to examination. This compares with 2,444 examinations in 1943. The following particulars give the results of the examinations:— Total examined. Referred for large films. Did not reattend. No abnormality. Calcd. and other lesions N.F.A. Referred to General Practitioners. i Further Investigation Pending. Probably Tuberculous. Probably Not Tuberculous. Cardio. Vase. 4,396 118 4 21 35 44 4 8 2 These are satisfactory figures for one year in the present stage of our mass-radiography campaign, but it must be pointed out that this Borough is not visited yearly by L.C.C. mass-radiography teams on account of shortage of staff and mobile units. Until recently the R.A.M.C. were in possession of various such units, and it is to be hoped that the County Council's organisation will be able to give this Borough considerably more attention than it has received up to the present time. 29 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 1945. The total number of cases considered was 775—86 of which were new ones. Of the new cases, 55 received maintenanc. grants only, 18 maintenance grants plus discretionary allowances and 13 special allowances. 689 cases were reviewed owing to changed circumstances. The total money paid to patients during the year amounted to £6,180 3s. 7d. 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. 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. 30 Figures showing the number of cases dealt with at the Baths during the year are as under:— School Children—Hammersmith. Scabies 2,141 Verminous 1,555 Impetigo 54 School Children—Non-Hammersmith. Nil. Children under Five Years—Hammersmith. Scabies 561 Verminous 74 Impetigo 11 Other Conditions 8 Children under Five Years—Non-Hammersmith. Nil. Adults—Hammersmith. Scabies 2,090 Verminous 166 Impetigo 6 Adults—Non-Hammersmith. Verminous 7 Lodging-houses. Scabies 19 Verminous 214 VACCINATION. The duties under the Vaccination Acts and the Vaccination Order were carried out by the Public Health Department. The Return for 1944 shows that 1,984 Infants were vaccinated, this being 67.51 per cent. of the Births compared with 71.28 per cent. in 1943. No proceedings under the Vaccination Acts were insti¬tuted. VACCINATION RETURNS. RETURN FOR 1944. Registration N umber of Births returned in the '' Birth List Sheets " as registered from 1st January to 31st Dec., 1944 Number of these Births duly entered by 31st January, 1946, in Columns I, II, IV and V of the '' Vaccination Register " (Birth List Sheets), viz.: Number of these Births which on 31st January, 1946, remained unentered in the '' Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1946, 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 1945 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 1945 Sub-Districts comprised in the Col. I Col. II Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received 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 Vaccination Officers, District Successfully Vaccinated Insusceptible of Vaccination Had SmallPox Dead, Unvaccinated 1 2 3 4 5 6 7 8 9 10 11 12 13 1. North Hammersmith 287 121 — — 65 10 — 3 15 73 112 49 2. Hammersmith Hospital 1,681 831 2 — 250 67 — 207 136 188 890 276 3. South Hammersmith 196 70 — — 32 7 — 1 7 79 82 37 4. Queen Charlotte's Hospital 1,784 962 1 — 214 58 — 449 45 55 1,188 233 3,948 1,984 3 — 561 142 — 660 203 395 2,272 595 31 Table showing Work of Vaccination Officer from 1st January to 31st December, 1945. No. of Vaccinal ion 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 — 23 17 27 6 39 — 112 49 6 - 10 199 23 8 3 — 62 31 46 10 149 South 5 24 35 - - 18 — 82 37 1 — 2 164 16 3 3 29 38 66 2 — 135 Hammersmith Hospital 22 82 80 68 10 626 2 890 276 10 — 989 636 66 52 27 45 194 150 127 13 529 Queen Charlotte's Hospital 14 62 25 18 — 1067 2 1188 233 4 — 2070 228 22 51 33 24 122 37 30 — 213 Removed Inwards 5 58 38 26 3 20 — 150 14 5 274 — 76 32 1 4 6 51 52 37 2 148 Total 46 249 195 139 19 1770 4 2422 609 26 274 3071 1303 159 115 70 104 467 336 242 25 1174 32 Total number of births registered during 1945 — 4,884. Metchim & Son, ltd., westminster, s.w.i.