C.I ack AC4347 HAM 32 Metropolitan Borough of Hammersmith. ANNUAL REPORT of the Medical Officer of Health for the YEAR 1946. 2 METROPOLITAN BOROUGH OF HAMMERSMITH. Health Committee. At 31st December, 1946. Councillor Maycock (Chairman). ,, Bennie, J.P., L.C.C. (Vice-Chairman). Alderman Hallett (Mrs.). Councillor Baker. Councillor Gosling. „ Kirby. „ Martin. „ Pinnell (Miss). „ Russell. ,, Thatcher. ,, Turner (Mrs.). ,, Woods (Miss). Ex officio : The Mayor (Alderman Buckingham, J.P.). Maternity and Child Welfare Committee. At 31st December, 1946. Alderman Hallett (Mrs.) (Chairman). Councillor Woods (Miss) (Vice-Chairman). Councillor Bennie, J.P., L.C.C. Councillor Field (Mrs.). „ Pearce. „ Pinnell (Miss). ,, Sinclair. „ Slatter. „ Turner (Mrs.). Ex officio: The Mayor (Alderman Buckingham, J.P.). Co-opted: Mrs. F. M. Buckland, Mrs. M. Rosefield and Mrs. F. A. Underwood. 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 1946. The report is still controlled by economy measures and it is not possible to embark on an elaborate account of your health services. It would have been appropriate as we pass from the end of the old epoch to the dawning of the new health age to reflect fully on the past. It is impossible to do this because of the restrictions mentioned above. Exactly a hundred years ago the first medical man was designated a Medical Officer of Health. In those days, hygiene of water supplies and of sewage disposal were the prime responsibility of the M.O.H. Now these are relegated to the engineer and the laboratory technician. Geriatrics and social medicine are in the forefront of any health plan for the future. Our immediate, needs—a legacy from the world clash of 19391945—are so acute that they are known to all. In spite of their urgent necessity we still remain very free from alarming increase in disease; only the future can tell how much cardio vascular wear and tear has been brought about by the turmoil of living in war-affected areas during the war-time and post-war years. It is of great interest to notice how the diminution of smoke abatement for eight years has affected the death rate from chronic bronchitis and its complications in towns subject to atmospheric pollution. In Hammersmith, 7.3 per cent. of all deaths of borough residents in 1946 are associated with this environmental hazard. Smoke abatement has not been pressed since secret war-time instructions encouraged smoke production as an air-raid screen. The present rebuilding of London would seem a unique 4 opportunity to introduce District Heating, both as a measure to improve our standard of living and also as the first major attempt to reduce atmospheric pollution in the world's greatest city. In Hammersmith, perhaps the most interesting features of the year were the much greater attendances at the Council's Infant Welfare Centres, Ante-natal Clinics and Tuberculosis Dispensary. This resulted from a greater use of the Clinics, in addition to increases caused by the larger birth rate and larger incidence of tuberculosis during the war years. The following figures illustrate to a startling degree what has taken place since 1938:— Year 1938. Year 1945. Year 1946. Total attendances at Tuberculosis Dispensary 2,799 4,638 5,840 Total attendances at Ante-natal Clinics 5,775 11,461 16,012 Total attendances at Welfare Centres 30,901 37,901 42,072 The position with regard to mass radiography (the early diagnosis of tuberculosis of the lungs) is not satisfactory. The facilities provided by the Loudon County Council for this method of examination are not such as to adequately cover the need for it. The L.C.C. Mass Radiography mobile unit has not visited Hammersmith since it commenced X-raying Londoners in 1943. Hammersmith last had the service available from Chelsea in 1945. The unit will not again come near the Borough until about January, 1948. The hope that a greater proportion of children under five years of age in the Borough would receive immunisation during 1946 has not been fulfilled. The aim of the Health Department was to increase the percentage immunised from a figure beneath 70 per cent. to one well above it, but although the total number of immunisations 5 in this age group has increased substantially, the percentage of the total is no higher than 61 per cent. The reason for this is largely attributable to a number of non-immunised children transferred into the Borough and also to the greater number of children under five available for immunisation resulting from the increased birth rate. Continued endeavours will be made to improve on the present position. The numerical increase in children immunised, upon the previous year, was 282. Interest has been caused by the delivery service, maintained by the Council, of meals to invalids. So far as is known this service is quite unique and has resulted from co-operation between the Council and the Invalid Kitchens of London. The Council's part in the service is to collect the meals in suitable containers from the kitchen and to deliver them to the bedside of the invalid. The Council also assisted a new venture in the treatment of Rheumatism during the year. In this instance, cooperation with the Empire Rheumatism Council resulted in opening a clinic in Council premises in the north of the Borough. A mobile unit containing staff and the required apparatus visits the premises on the morning of the clinic, unloads staff and equipment and re-collection takes place when work is finished. This provides treatment facilities, near their homes, for persons who would otherwise have to travel to the E.R. Council's clinic at the West London Hospital in South Hammersmith. I should like finally to refer to the part that the staff of the Department have played in the successful running of the Council's Health Services during 1946. The cooperation, pleasant manner and efficient service provided by every one of them is an example to all of a staff of which the Council may be very proud. 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, 1946. Area 2,282.5 acres Population (1945) (estimated) 96,100 „ (1946) „ 111,860 Census (1901) 112,239 „ „ (1911) 121,521 (1921) 130,295 „ (1931) 135,521 Natural increase, i.e., excess of births over deaths 974 Density of population (persons per acre) 49.01 Marriages registered 1,234 Rateable value (April, 1946) £1,213,200 Sum represented by a penny rate (April, 1946) £4,810 Vital Statistics. Total. M. F. Live Births Legitimate 2,124 1,117 1,007 Birth Rate per 1,000 estimated resident population = 20.6 Illegitimate 186 86 100 Stillbirths 65 37 28 Rate per 1,000 total (live and still) births = 27 Deaths 1,336 686 650 Death Rate per 1,000 estimated average population = 11.9 Deaths from puerperal causes— Deaths. Rate per 1,000 total (live and still) births Puerperal sepsis 2 0.84 Other puerperal causes 5 2.10 Total 7 2.94 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 45 Legitimate Infants per 1,000 legitimate live births 41.90 Illegitimate Infants per 1,000 illegitimate live births 75.26 Deaths from Cancer (all ages) 226 „ „ Measles (all ages) Nil „ „ Whooping Cough (all ages) 2 „ „ Diarrhæa (under 2 years of age) 17 7 Statistics.-The following table gives the statistics of the Borough during 1946 and previous years:- vital Statistics of Whole District during 1946 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 1925 134500 2178 2351 17.5 1034 7.7 186 756 153 65 1604 11.9 1926 134400 2001 2188 16.3 1174 8.7 195 556 144 66 1535 11.4 1927 132800 1789 2076 15.6 1581 11.9 230 377 126 61 1728 13.0 1928 136300 1938 2258 16.6 1449 10.6 222 326 156 69 1553 11.4 1929 136900 1869 2162 15.8 1757 12.8 222 340 133 62 1875 13.7 1930 136900 1962 2173 15.9 1387 10.1 219 436 140 64 1604 11.7 1931 135100 1954 2073 15.3 1567 11.6 288 373 140 68 1652 12.2 1932 133700 1795 1940 14.5 1465 10.9 294 543 129 66 1714 12.8 1933 131400 1682 1827 13.9 1500 11.4 340 530 119 65 1690 12.9 1934 129170 1551 1783 13.8 1359 10.5 346 655 137 77 1668 12.9 1935 128100 1774 1877 14.7 1317 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 149 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 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 1945 96100 48 1742 18.1 1464 15.2 423 267 78 45 1308 13.6 1946 111860 5663 2310 20.6 1522 13.6 463 277 103 45 1336 11. 9 * B = Birth-rate Population Figure. D = Death-rate „ „ 8 Causes of, and Ages at, Death during the Year, 1946. Cause of Death. Sex. 0— 1— 5— 15— 45— 65— Total all Ages. 1. Typhoid and Paratyphoid Fevers M - - - - - - - F - - - - - - - 2. Cerebro-spinal Fever M — — — — 1 — 1 F 2 - - - - - 2 3. Scarlet Fever M - - - - - - - F - - - - - - - 4. Whooping Cough M 2 - - - - - 2 F - - - - - - - 5. Diphtheria M - - - - - - - F 1 — — - — — 1 6. Tuberculosis of Respiratory System M — — — 15 23 7 45 F — — — 23 4 5 32 7. Other forms of Tuberculosis M 1 — - 2 1 1 5 F 1 — — 2 — — 3 8. Syphilitic Diseases M — — — 2 7 4 13 F — — — — 1 4 5 9. Influenza M 1 — — 1 — 2 4 F 1 — — 1 1 2 5 10. Measles M — — — — — — — F - - - - - - - 11. Ac. Polio-myelitis and Polioencephalitis M — — — — — — — F — — — — — — — 12. Ac. Inf. Encephalitis M — — — — — — — F — — — 1 — 1 13. Cancer of Buc. Cav. and Oesoph. (M), Uterus (F) M — — 5 4 9 F — — — 2 8 4 14 14. Cancer of Stomach and Duodenum M — — — 1 7 9 17 F — — — 3 7 6 16 15. Cancer of Breast M — — — — 1 — 1 F — — — — 7 7 14 16. Canccr of all other sites M — — 1 7 46 41 95 F — 1 — 3 19 37 60 17. Diabetes M — — — — - — — F — — — — 2 6 8 18. Intra-cranial vascular Lesions M — — — 1 7 40 48 F — — — — 17 53 70 19. Heart Disease M — — — 7 46 88 141 F — — — 5 15 126 146 20. Other Diseases of Circ. System M — — — — 8 27 35 F — — — — 8 26 34 21. Bronchitis M — — — 4 21 29 54 F 1 — — 5 10 38 54 22. Pneumonia M 4 2 — 1 12 20 39 F 5 — — 3 5 21 34 23. Other Respiratory Diseases M — 1 — 2 1 5 9 F — — — 1 2 4 7 24 Ulcer of Stomach or Duodenum M — — — 2 4 9 15 F — — — — 5 3 8 25. Diarrhæa under 2 years M 9 — — — - - 9 F 8 - - - - - 8 26. Appendicitis M 1 — — — — 2 3 F — — 1 2 3 27. Other Digestive Diseases M 1 — — 2 3 7 13 F 1 — — 2 3 13 19 28 Nephritis M — - 1 2 2 6 11 F — — — 3 4 10 17 29. Puerperal and Post-abortive Sepsis M — — — — - - - F — — — 2 2 30. Other Maternal causes M — — — — _ F — — 5 - 5 31. Premature Birth M 15 — 15 F 8 - - - - - 8 32. Con. Mal. Birth Injuries Infant Dis. M 23 1 1 25 F 9 — — 2 2 - 13 33. Suicide M — — — - 3 2 5 F - - - - 1 1 2 34. Road Traffic Accidents M — — — 3 1 4 8 F - - - - 3 - 3 35. Other violent causes M 4 — 1 5 2 7 19 F 2 — — 1 1 13 17 36. All other causes M 2 1 — 6 9 27 45 F 1 — 1 5 8 24 39 Totals of all causes M 63 4 4 63 210 342 686 F 40 1 2 69 133 405 650 103 5 6 332 343 747 1,336 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 4l‡ 1942 1589 94 59 1943 1768 102 58 1944 1788 95 53 1945 1742 78 45 1946 2310 103 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, 1946. Infantile Mortality during the year 1946. Nett deaths at various ages under one year of age. Under 1 week 42 1-2 weeks 11 2-3 weeks 4 3-4 weeks 3 4 weeks and under 3 months 13 3 months and under 6 months 13 6 months and under 9 months 12 9 months and under 1 year 5 Total deaths under 1 year 103 Nett Births in the Year: Legitimate, 2,124; Illegitimate, 186. Nett Deaths in the Year: Legitimate Infants 89; Illegitimate Iufants, 14. Visits paid by Health Visitors are enumerated below:— No. of visits 27,714 No. of ineffective visits 3,887 Total No. of effective visits 23,827 Attendances at Infant Welfare Centres 1,027 Attendances at Ante-Natal Clinics 1,144 Attendances at Tuberculosis Clinics 167 Attendances at Diphtheria Immunisation Clinics 105 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. Antenatal. Postnatal. Under 1 yr. Over 1 yr. 48, Glenthorne Rd. 154 — — 455 118 — — 6,211 2,688 155 532 9 — — 3,710 40 — — Becklow Gardens 264 — — 776 109 — — 10,243 3,794 267 956 8 — — 5,732 61 — — Milson Road 157 — — 331 12— — — 4,772 2,766 98 468 — — — 2,740 19 — — Old Oak, Westway 151 — — 311 41 — — 5,093 2,070 102 415 31 — — 2,277 63 — — Latimer Road 52 — — 108 13 — — 2,578 646 52 215 10 — — 1,310 18 — — College Park 51 — — 31 2 — — 823 388 6 1 — — — 42 — — — Totals 1,509 2,587 58 2,012 295 15,811 201 29,720 12,352 Ante-natal Clinics, Number of Sessions held. 680 Infant Consultations, ,, ,, ,, ,, 829 1.509 The average attendance at Infant Welfare Centres = 52. During the year 173 cases received massage treatment, the total number of treatments being 1,249. 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. 1,493 quarts of liquid milk and 583 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. During the year two adults were referred to the Centres and 95 dinners were supplied. 12 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 1945 - 1 1,742 0.56 1946 2 5 2,310 2.94 * 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:— 1946. Brook Green. Accomdn. 83. Dalling Rd. Accomdn. 70. Australia Rd. Accomdn. 70. Uxbridge Rd. Accomdn. 65. West way. 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. 64 53 52 48 39 25 Feb. 66 60 55 54 43 30 Mar. 70 63 61 50 45 28 April 72 65 61 57 45 24 May 77 65 64 64 47 18 June 71 60 63 62 45 11 July 64 57 73 58 30 Aug. 69 56 66 58 closed 28 Sept. 71 60 68 60 21 Oct. 67 71 69 56 32 Nov. 60 63 63 53 26 Dec. 48 60 55 55 30 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 40 foster-children being cared for in the Borough, and 37 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 7 foster-mothers were removed from the register for various reasons and 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, 1946 37 „ ,, Recommended for Registration 22 „ ,, removed from Register 7 (1) Removed from Borough — (2) Adopted Children 2 (3) Unsuitable 1 (4) 9 years of age 2 (5) Temporarily approved — (6) No further Foster-Children required 2 (7) Illness of Foster-Mothers — (8) Lack of accommodation — (9) Mother living at address — „ Applications for Registration received but not Pecommepded — FOSTER-CHILDREN. No. of Foster-Children on Register December 31st. 1946 40 received by Foster-Mothers 39 „ „ moved from Foster-Mothers 23 (1) To Foster-Mothers. 1 (2) To Parents or Guardians 14 (3) To Institutions 4 (4) Adopted 2 (5) Children removed from Borough with Foster-Mother — (6) Foster-Children who have reached the age of 9 years during the Year 2 (7) Evacuated to Residential Nursery 1 (8) No payment now received — VISITS. No of visits to Registered Foster-Mothers 295 14 HOME AND DOMESTIC HELPS SCHEME Since 1936, a scheme has been in operation in the Borough for providing domestic assistance in the home during the time a mother is unable to carry out her household duties on account of her confinement. The " Home Help " usually attends for 30 hours per week for two weeks but these periods are extended in exceptional circumstances. The " Home Helps " are paid by the Council and the families to whom the assistance is provided make a contribution towards the cost according to their financial means. In 1945, on the suggestion of the Minstry of Health, the service was extended to provide domestic help for sick or infirm persons (whether through old age or otherwise) resident in the Borough, who themselves are unable to obtain such help. A panel of women willing and able to undertake this work, either on a part-time or full-time basis, has been prepared. The amount of assistance rendered varies from one or two hours per week to several hours per day, according to the needs of the household. The success of the scheme depends largely upon the numbers of Home and Domestic Helps available and also upon their suitability for the work. During the year 1946, " Home Helps " were provided for 67 confinement cases and " Domestic Helps " attended 152 cases of old persons or households in which the mother was unable to carry out her domestic duties owing to illness. At the end of the year there were 30 women in the Council's employment and further efforts are being made to substantially increase this number. SANITARY CIRCUMSTANCES OF THE BOROUGH. The following table shows the number of visits made by the Sanitary Inspectors, and the number of Preliminary 15 Notices served and complied with during the year:— Cause of Inspection. No. of Inspections. No. of Notices served. No. of Notices complied with. Bakehouses 40 4 3 Cancer 3 - - Complaints 5,173 3,033 2,094 Drainage 1,348 33 26 Factories (Mechanical) 239 21 15 Factories (Non-mechanical) 42 7 7 Food (other than Restaurants and Eating Houses) 1,407 12 10 Housing Act 35 2 1 Ice Cream Vendors 355 - - Infectious Diseases 848 21 10 Licences (Building) 5,064 2 3 Markets 976 - - Milk Vendors 431 3 3 Outworkers 202 1 1 Pharmacy and Medicines Act 87 - - Public Urinals 43 - - Rats and Mice 1,204 132 89 Re-Housing 931 11 2 Restaurants and Fating Houses 141 9 6 Scabies 727 7 3 Shops Act 13 1 1 Slaughterhouses 3 - - Smoke Observations 35 3 - War Damage 36 5 34 Miscellaneous 1,344 44 15 Re-visits 6,972 512 393 No Answer 2,980 - - No. of Ineffective Visits 30,679 3,863 2,716 2,980 - - Total 27,699 3,863 2,716 During the year 1,282 Statutory Notices were served and 952 complied with. INCREASE OF RENT AND MORTGAGE RESTRICTIONS ACT, 1920 1939. During the year 16 applications were received for certificates under the above Act, and in 15 cases certificates were granted. 16 This total includes two applications from owners, both of which were issued as the work specified had been completed satisfactorily. summonses—year 1946. The following table shows the number of proceedings instituted during the year:— Public Health (London) Act, 1936 42 L.C.C. Drainage Byelaws 6 L.C.C. Tenement House Byelaws 2 Milk and Dairies (Consolidation) Act, 1915, and Milk and Dairies Order, 19261 Rats and Mice (Destruction) Act, 19191 Food and Drugs Act, 1938 2 Housing Act, 1936, and L.C.C. Byelaws 4 1.—inspection of factories Premises Number of Inspections. Written Notices. Occupiers Prosecuted. Factories (with Mechanical Power) 239 21 — Factories (without Mechanical Power) 42 7 — Total 281 28 — 2.—DEFECTS FOUND IN FACTORIES, ETC. Particulars Number of Defects Number of Prosecutions Found Remedied Referred to H.M. Inspector Want of Cleanliness 9 7 Unreasonable Temperatures — — — — Inadequate Ventilation 1 1 — — Overcrowding — — — — Ineffective Drainage of Floors 1 — — — Sanitary Conveniences insufficient 1 1 — unsuitable or defective 8 6 — — not separate for sexes 1 — — — 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 22 16 — — 17 3.—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) 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 1 Underground bakehouses (Sec. 54)— Certificates granted during year — In use at the end of the year 16 RODENT CONTROL. Rats and Mice (Destruction) Act, 1919. Infestation Order, 1943. For the first six months of the year two rodent operatives were employed for baiting premises where infestations were reported or discovered. In June, the Council accepted the invitation of the Ministry of Food to take part in a Special Scheme and submitted proposals, which were subsequently approved, for a systematic survey and baiting treatment of the whole of the Borough within the financial year. The Ministry's scheme provided for the baiting of private houses without charge to the occupier, unless the infestation was due to the occupier's neglect. This accords with the policy adopted by the Council in 1945. Under the Special Scheme, however, the Ministry accepted responsibility for 60 per cent. of the cost of "free" baiting. The cost of baiting commercial premises is charged to the occupiers. As a result of the increased work it was found necessary to increase the number of rodent operatives from two to four. These men work under the supervision of one of the district sanitary inspectors, and they carry out preliminary inquiries in addition to bait laying. Drain testing and detailed inspections are the responsibility of the district sanitary inspectors. 18 The following is a summary of the premises baited:— Individual Infestations (excluding premises dealt with under the Special Scheme). Number of private houses baited free of charge 320 Number of business premises baited 117 Special Scheme. Number of private houses baited 110 (60 per cent. of cost to be borne by the Ministry.) Number of business premises baited 75 Total number of premises baited 028 Number of Statutory Notices served 59 The number of baits laid at each premises varies according to the size of the premises and the extent of the infestation. The baiting is carried out in accordance with the procedure recommended by the Director of Infestation of the Ministry of Food. Sewers. The baiting of the Council's sewers is undertaken bi-annuallv by the Borough Engineer and Surveyor's Department as a routine measure of control. Additional baiting of sewers is carried out at the request of the Public Health Department where it is considered desirable. The preparation of the baits is undertaken by the Public Health Department. CERTIFICATES OF ESSENTIALITY AND BUILDING LICENCES. The arrangements existing for dealing with applications for building licences have continued in operation throughout the year. The Sanitary Inspectors have continued to investigate and report upon all applications received. The number of applications received during the year was 4,866. During the year a system of issuing Certificates of Essential Repair to assist builders to obtain materials, other than controlled materials, was instituted. Such certificates are issued by the Senior Sanitary Inspector. The number issued to the end of the year was 2,080. 13 Circular 171/46, dated 6th September, 1946, restricted the issue of building licences to the following categories of work : (a) The repair of a sanitary breakdown in a building to safeguard the health of occupants. (b) The repair of a building to avoid the imminent collapse of a defective part of the structure. This may include painting for protective purposes where there would otherwise be a danger of disintegration and minimum repairs to maintain weather-tightness. (c) The essential repair of gas, electrical and water services, drains and sewers, where the whole or part of the installation is either out of use or in a dangerous condition. (d) The replacement of defective stoves, fires, boilers, water heaters, other essential equipment, in order to make the premises fit for occupation. (e) Urgent works required by a Statutory Notice. From the 28th October a quota system has been in operation which has limited the total value of licences and certificates of essential repair issued by the Council— exclusive of expenditure on works providing additional units of family accommodation—to a weekly average of £4,720. This represents a reduction of from 30 to 40 per cent. of the value for which licences were issued before that date. LANDLORD AND TENANT (WAR DAMAGE) (AMENDMENT) ACT, 1941. Applications for certificates of fitness for housing purposes are dealt with by the Senior Sanitary Inspector. No application was received during the year. EXHUMATION AND RE-INTERMENT OF BODIES. During the year thirty-five 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. 20 UNSOUND FOOD. During the year, on two occasions, quantities of grapes and bananas were seized under Section 10 of the Food and Drugs Act, 1938. In each case they were taken before a Magistrate, who ordered their destruction as being unfit for human consumption. A quantity of unsound food was also voluntarily surrendered, 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 : 120 were found to be inferior and 10 were adulterated. MILK (SPECIAL DESIGNATIONS) REGULATIONS, 1936-1946, AND REGULATION 55G OF THE DEFENCE (GENERAL) REGULATIONS, 1939. In addition to those taken under the Food and Drugs Act. 1938, 147 sample's 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. 26 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. TUBERCULIN TESTED MILK. It is of interest to report that tests for tubercle bacilli on 36 samples of "Tuberculin Tested" milk were made by the animal inoculation method. Reports received in respect of each sample were negative, 21 PUBLIC MORTUARY. Six hundred and ninety-four bodies were admitted to the Public Mortuary during the year :— Bodies admitted from the Borough :— By order of Coroner 261 By order of Police 23 On application of undertakers for accommodation 49 333 Bodies admitted from other Boroughs:— Fulham 75 Chelsea 264 Kensington 22 361 694 No. of P.- M. examinations conducted:— Hammersmith cases 250 Fulham ,, 70 Chelsea ,, 260 Kensington ,, 22 Total P.-M.s 602 No. of Inquests held:— Hammersmith cases 75 Fulham ,, 65 Chelsea ,, 81 Kensington ,, 101 Total Inquests held 322 22 INFECTIOUS DISEASES (EXCLUDING TUBERCULOSIS). Infectious Diseases.—There were, omitting tuberculosis, 2,552 cases reported as due to notifiable infectious diseases in the Borough, against 2,922 in the previous year. There were also reported 499 cases of infectious diseases that were not notified, against 572 in the previous year; 174 of these were *Measles, 85 *Whooping Cough, 73 *Scabies and 167 Chickenpox. *Totals (notified cases and cases reported from other sources)—Measles 778, Scabies 1,282 and Whooping Cough 358. BACTERIOLOGY. During the year the following 991 bacteriological examinations were made on behalf of the Council:— Specimen. Positive. Negative. Total. Swab for or suspected cases of Diphtheria 10 737 747 Blood for suspected cases of Typhoid or Paratyphoid Fever 1 1 Haemolytic Streptococci 75 37 112 Faeces — 60 60 Vincents Organisms 19 45 64 Stomach Contents — 2 2 Breast Discharge — 1 1 Whooping Cough — 4 4 104 887 991 23 Cases of Infectious Disease notified during the year 1946. Notifiable Disease. Number or Cases Notified. At all Ages. Age Periods. Under 1 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— Smallpox - - - - - - - - - - - - - Cholera, Plague, Typhus, Anthrax — - — - - - — — - — — - — Diphtheria 63 2 4 5 2 3 19 8 6 6 5 3 - Erysipelas 26 - — — — — — — — 3 4 15 4 Scarlet Fever 174 — 10 11 19 10 61 39 13 4 5 2 — Enteric Fever — — — — - — — — — — — — — Relapsing Fever — — — — — — — — — — — — — Puerperal Fever 14 — — — — — — - 12 2 — — — Puerperal Pyrexia 27 - - - - - - - 25 2 — — — Cerebro-Spinal Meningitis 8 2 — — 1 1 1 1 — 2 — — — Polio-myelitis 4 — 2 — — — 1 1 — — — — — Encephalitis Lethargica - - - - - - - - - - - — - Ophthalmia Neonatorum 6 - — — — — — — — — — — — Pneumonia 75 6 2 5 3 2 9 3 — 7 12 14 12 Malaria 6 — — — — — — — — 5 1 — — Dysentery 22 1 4 3 — — 1 1 — 5 4 1 2 Food Poisoning 41 — — — — — 2 — —- 14 l2 11 2 Measles 604 32 62 94 78 72 232 21 5 8 — — — Whooping Cough 273 44 47 51 35 33 59 2 — 1 1 — — Scabies 1,209 24 33 43 41 28 136 100 102 464 124 87 27 Totals 2,552 117 164 212 179 149 521 176 163 523 168 133 47 24 Notifiable Diseases (other than Tuberculosis) during the Year 1946. DISEASE. Total cases notified. Cases admitted to Hospital. Total deaths. Diptheria 63 63 1 Erysipelas 26 11 — Scarlet Fever 174 84 — Enteric Fever — — — Puerperal Fever 14 14 2 Puerperal Pyrexia 27 21 Cerebro-Spinal Meningitis 8 8 3 Encephalitis Lethargica — — 1 Opthalmia Neonatorum 6 2 — Pneumonia (Acute Primary and Influenzal) 75 173 Dysentery 22 18 — Poliomyelitis 4 4 — Malaria 6 3 — Food Poisoning 41 1 - *Measles 604 81 - *Whooping Cough 273 68 2 *Scabies 1,209 1 — Totals 2,552 379 82 *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 1946. 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 1,532 Number of children immunised at schools by L.C.C. 299 Number of children immunised by local medical practitioners 79 Number of Schick Tests—positive result Number of Schick Tests—negative result 17 Fees paid to Medical Practitioners £21 18s. 0d. 25 TUBERCULOSIS. Tuberculosis.—Two hundred and eleven cases of Tuberculosis were reported during the year, one hundred and eighty-eight of which were Pulmonary and twenty-three being other forms of Tuberculosis, against two hundred and thirty cases in the previous year. PART I. Summary of Notifications during the period from the 1st January, 1946, to the 31st December, 1946. 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 6 5 6 12 14 20 20 7 10 6 107 Pulmonary Females 1 6 4 1 16 10 22 13 4 3 1 81 Non-Pulmonary Males — — 3 5 1 1 3 1 — 1 — 15 Non-Pulmonary Females — — 1 2 2 — 2 1 — — — 8 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 — — 4 10 7 2 3 3 31 Pulmonary Females — 2 2 — 3 12 17 3 1 2 1 43 Non-Pulmonary Males 1 2 - - - - 1 - - - - 4 Non-Pulmonary Females 1 1 2 1 - - - - - - - 5 26 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1946 :— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0- 1 1 1 1 — - 1 1 1- 7 8 2 1 — - — — 5- 12 7 8 6 — — — — 15- 30 41 2 2 1 - - - 25- 30 39 4 2 15 23 2 2 35- 27 16 1 1 1 - - - 45- 9 5 — — 23 4 1 - 55- 13 5 1 — 65 and on 9 2 — — 7 5 1 — Total 138 1 24 19 13 45 32 5 3 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is 1 to 6. 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. NonPulmonarv. Total. 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 1945 207 23 230 93 1,176 1,282 1946 188 23 211 85 1,278 1,487 27 Seventy-seven deaths from Pulmonary Tuberculosis were registered, against eighty-two in the previous year, representing a death-rate of 0.67 per 1,000 compared with 0.85 in 1945 and 0.94 in 1944. Figures for the years 1927-10 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. 1945. 1946. 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 85 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 14 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 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 6 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 5 Average number of cases notified tor the 10 years 1927-1936 (inclusive) = 236. Average number of cases notified for the 10 years 1937-1946 (inclusive) = 199. Average number of deaths for the 10 years 1927-1936 (inclusive) =141. Average number of deaths for the 10 years 1937-1946 (inclusive) = 97. BACTERIOLOGY. The following bacteriological examinations were made on behalf of the Council:— Sputa from cases of suspected Tuberculosis— Tubercle bacillus found 89 Tubercle bacillus not found 489 Pleural Fluid— Positive results 1 Negative results 12 Urine— Negative results 2 Blood Counts 14 28 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 982 persons attended for examination for the first time, 443 males and 539 females. Of these 215 were under the age of fifteen and 767 were adults. Of the total 523 were referred to the clinic by local practitioners for the purpose of consultation, 23 by the National Service Medical Boards and 9 by mass Badiographv Groups. Two hundred and ninety-six were "contacts" of persons suffering from tuberculosis. Of the "contacts'' examined 40 were definitely cases of tuberculosis, whilst 256 were non-tuberculous. Of the 9 cases referred to the Clinic by mass Badiography Groups, 3 had active disease. Total Attendances and Examinations.—The total attendances of persons for the purpose of examination, observation or treatment, numbered 5.840, and physical examinations were carried out in 3,173 instances, i.e., in 54 per cent. of the total attendances. Home Visitation.—The Tuberculosis Officer made 28 visits to homes of patients for the purpose of examination and investigation of the home conditions, and 27 visits to St. Charles" Hospital. 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 2,584 such visits were made, of which 321 were ineffective. During the year 75 definite cases were transferred from other areas into the Borough and 70 moved out or were lost sight of. Nineteen were written off the register as being cured. 29 Mass Radiography.—The campaign for the early detection of symtomless tuberculosis was continued during the year by miniature mass-radiography groups operating in other districts. Nine cases were referred to the Clinic from these units. Of these, three were cases of active tuberculosis. 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 1946. The total number of cases considered was 757—70 of which were new ones. Of the new cases, 50 received maintenance giants only, 15 maintenance grants plus discretionary allowances and 5 special allowances. 687 cases were reviewed owing to changed circumstances. The total money paid to patients during the year amounted to £6,802 2s. 9d. 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 30 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. Figures showing the number of cases dealt with at the Baths during the year are as under:— School Children—Hammersmith. Scabies 1,468 Verminous 1,476 Impetigo 34 School Children—Non-Hammersmith. Nil. Children under Five Years—Hammersmith. Scabies 518 Verminous 68 Impetigo 8 Other Conditions 1 Children under Five Years—Non-Hammersmith. Nil. Adults—Hammersmith. Scabies 2,247 Verminous 181 Impetigo 8 Adults—Non-Hammersmith. Nil Lodging-houses. Scabies 13 Verminous 234 VACCINATION. The duties under the Vaccination Acts and the Vaccination Order were carried out by the Public Health Department. The Return for 1945 shows that 2,636 Infants were vaccinated, this being 74.83 per cent, of the Births compared with 67.51 per cent, in 1944. No proceedings under the Vaccination Acts were instituted. VACCINATION RETURNS. RETURN FOR 1945. 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., 1945 Number of these Births duly entered by 31st January, 1947, in Columns I, II, IV and V of the " Vaccination Register " (Birth List Sheets), viz.: Number of these Births which on 31st January, 1947, remained unentered in the " Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1947, 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 1940 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 1940 Col. I Successfully Vaccinated Col. II Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received Col. V Dead, Unvaccinated Postpone ment by Medical Certificate Removal to Districts, the Vaccination Officer of which has been duly apprised Removal to Places unknown or which cannot be reached; and Cases not having been found Insusceptible of Vaccination Had SmallPox 1 2 3 4 & 6 7 8 9 10 11 12 13 1. North Hammersmith. 274 107 — — 64 9 - 6 29 59 158 65 2. Hammersmith Hospital 1,800 1,002 4 — 272 73 — 185 134 130 1,298 280 3. South Hammersmith 214 117 — — 52 4 — — 14 27 163 47 4. Queen Charlotte's Hospital 2,330 1,410 7 — 241 61 — 497 69 45 1,633 282 4,618 2,636 11 — 629 147 — 688 246 261 3,252 674 31 32 Table showing Work of Vaccination Officer from 1st January to 31st December, 1946. 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 3 38 26 61 9 21 — 158 65 11 — 4 255 21 4 3 5 96 25 83 5 214 South 60 11 72 1 — 19 — 163 47 — — 3 210 15 1 3 84 9 66 4 — 163 Hammersmith Hospital 111 122 147 116 . 9 788 5 1298 280 20 — 1193 841 68 89 76 123 186 148 158 5 620 Queen Charlotte's Hospital 43 38 36 12 — 1489 15 1633 282 4 — 2488 209 24 81 60 49 64 35 23 1 172 Hammersmith 1 — 1 — — — — 2 3 — — 1 8 — 3 — — 2 1 — — 3 Removed Inwards 49 47 75 47 4 14 — 236 13 2 219 — 78 13 — 25 23 23 50 34 4 134 Total 267 256 357 237 22 2331 20 3490 690 37 219 3689 1601 141 178 167 284 380 325 302 15 1306 Metchim & Son, Ltd., Westminster, S.W.i. Total number of births registered during 1946 — 5,633. 1 R7/67