Metropolitan Borough of Hammersmith Abridged Annual Report of the Medical Officer of Health for the Year 1947 by F. M. DAY, M.R.C.S., L.R.C.P.,D.T.M., D.P.H. 65872 METROPOLITAN BOROUGH OF HAMMERSMITH. Health Committee. At 31st December, 1947. Councillor Bennie, J.P., L.C.C. (Chairman). „ Thatcher (Vice-Chairman). Alderman Hallett (Mrs.). Councillor Baker. Councillor Gosling. „ Kirby. „ Martin. „ Pinnell (Miss). „ Russell. ,, Morris. „ Turner (Mrs.). „ Woods (Miss). Ex officio : The Mayor (Alderman Buckingham, J.P.). Maternity and Child Welfare Committee. At 31st December, 1947. 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. 1 Town Hall, Hammersmith, W.6. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hammersmith. Mr. Mayor, Ladies and Gentlemen,—It is with mixed feelings that I introduce my Annual Report for 1947. This Report is, of course, the last before the new Act alters the Health Services of the Metropolitan Boroughs. The Maternity and Child Welfare services, so long the pride of the Hammersmith Committee, pass out of its jurisdiction in July, similarly the Tuberculosis service developed by the Health Committee into its present shape no longer will remain a credit to the Hammersmith Borough Council. It seems, perhaps, unfortunate, that the efficient and progressive Authorities must pay by loss for the shortcomings of their less conscientious brethren, but on the profit side of the balance sheet it is clear that the new Health Scheme will inherit services which are already in first-class working order, and therefore will have an excellent opportunity to make an immediate success of this great social experiment. The last complete year of the "old Health world" has brought much which is a continuation of evidence of the success of the present Health Services. The maternal mortality rate and the infant mortality rate in the Borough both reached very low levels, the latter a record. We are particularly fortunate in Hammersmith in having in the north and south of the Borough two large hospitals, each with a large number of births taking place every year. In addition to the service for the care of premature children which the Borough Council provide through medical and health visitor staffs, both Hammersmith Hospital and Queen Charlotte's Hospital have particularly 2 efficient follow-up arrangements for the care of premature children born at the two hospitals. There are, therefore, three separate large organisations available for providing the much-needed specialist care, without which the premature child is unlikely to survive. The fall in our infant mortality rate is no doubt much to the credit of each three of these arrangements. A particular source of swollen infant mortality figures is the illegitimate infant mortality rate. This normally is in excess of the infant mortality rate for the legitimate child. Five Day Nurseries with a total of 294 places for children under five years of age is a fairly high proportion for a Borough of just over 100,000 population. It is gratifying to find that a quarter of these places are occupied by illegitimate children. By assisting the illegitimate child in this way, I am certain that the Council is giving enormous assistance towards the substantial reduction of the Illegitimate Infant Mortality Bate. The Council's five Day Nurseries functioned efficiently and smoothly, and no epidemic of Infectious Disease upset their serene and happy organisation. The birth rate is the highest for 27 years, and the death rate is even lower than last year, when it was 11.9 per 1,000. The percentage of children immunised is still below the optimum which is desired. Cases of diphtheria are, though, again less, and no Hammersmith child has died of this condition since 1944. During the year 1,929 children were immunised as against 1,910 in 1946, and the proportion protected is now 63 per cent. A postal campaign, to parents of children who had eluded us, has resulted in the protection of a number of children against diphtheria. Tuberculosis, after the war-time and post-war increases, so tar has stopped increasing, and new cases in 1947 were again lower. 3 The Council's Meals Service to Invalids continues and the Westway Rheumatism Clinic provides bi-weekly sessions for the benefit of residents in the north of the Borough. The epidemic of poliomyelitis affected this part of London, but not to such a serious extent as other less fortunate districts. There were 23 cases from local doctors, and one of these only was fatal. Two deaths, in addition, were found at post mortem examination to have died from poliomyelitis. Perhaps the most interesting feature of our part of the epidemic was the fact that in only three instances were cases notified in the same street, and no example occurred where two cases arose in the same house or even in adjoining properties. Such absence of relationship between cases makes the time and method of infection of extraordinary interest. My Report to you, Mr. Mayor, Aldermen and Councillors, is prefaced by only these few brief remarks, as it is felt that a short preamble followed by paragraphs of explanatory introduction to each series of statistics make, perhaps, a more readable account than by other forms of presentation of large numbers of columns of figures. Finally, ladies and gentlemen, I wish to again draw your attention to the work of the staff during the year. This enabled the Department to function efficiently and well, and generous praise is due to every member. I am, Your Worship, Ladies and Gentlemen, Your obedient Servant, F. M. DAY, Medical Officer of Health. 4 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1947. The population of the Borough continues to increase, and the excess of births over deaths is largely the reason for this. The record low infant mortality rate also plays its part, pushing up our population. Area 2,282.5 acres Population (1946) (estimated) 111,860 (1947) „ 117,280 Census (1901) 112,239 „ (1911) 121,521 „ (1921) 130,295 „ (1931) 135,521 Natural increase, i.e., excess of births over deaths 1,190 Density of population (persons per acre) 51.39 Marriages registered 1,345 Rateable value (April, 1947) £1,227,225 Sum represented by a penny rate (April, 1947) £4,950 Vital Statistics. A drop in maternal deaths from 7 in 1946 to 1 during the year under review, is the most satisfactory item listed below. The deaths from cancer are above the previous year, and this again raises the question as to whether cancer is becoming increasingly frequent or whether the increase in the number of deaths from this condition is explained by improved diagnosis. Probably both factors are true. Total. M. F. Legitimate 2,375 1,156 1,219 Birth Rate per 1,000 Live Births estimated resident Illegitimate 184 93 911 population = 21.8 Stillbirths 58 36 22 Rate per 1,000 total (live and still) births = 22-1 Deaths 1,369 711 658 Death Rate per 1,000 estimated average population = 11.6 Deaths from puerperal causes— Rate per 1,000 total Deaths. (live and still) births Puerperal sepsis 1 0.38 Other puerperal causes — Total 1 0.38 Death Rate of Infants under one year of age :— All Infants per 1,000 live births 38 Legitimate Infants per 1,000 legitimate live births 36.63 Illegitimate Infants per 1,000 illegitimate live births 54.34 Deaths from Cancer (all ages) 253 „ „ Measles (all ages) 2 „ „ Whooping Cough (all ages) 2 „ „ Diarrhœa (under 2 years of age) 16 5 Statistics.—The following table gives the statistics of the Borough during 1947 and previous years:— Vital Statistics of Whole District during 1947 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 1347 10·5 406 583 131 70 1524 11·9 1936 127700 2266 1922 15·1 1399 10·9 441 639 116 60 1597 12·5 1937 126500 2707 1913 15·1 1333 10·5 402 662 130 68 1593 12·6 1938 125100 2840 1874 15·0 1340 10·7 450 522 117 62 1412 11·3 * 1939 B122800 D116200 2214 1829 14·9 1311 11·2 362 442 77 43 1391 12·0 1940 98320 1733 1600 16·3 1725 17·5 370 401 76 51 1756 17·9 1941 84880 2480 1405 16·5 1315 15·4 351 364 52 41 1328 15·6 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 4884 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 1947 117280 5821 2559 21·8 1570 13·3 472 271 97 38 13 69 11·6 * B = Birth-rate Population Figure. D = Death-rate „ „ 6 Causes of, and Ages at, Death during the Year, 1947. It will be noted with satisfaction that no child, in fact no person, lost their life as the result of diphtheria. The Council's campaign to increase diphtheria immunisation obviously must have played a part here. Typhoid fever also did not claim a death, but this is undoubtedly due to London's excellent water supply and to modern sanitation and hygiene. Cause of Death. Sex. 0— 1— 5- 15— 45— 65— Total all Ages. 1. Typhoid and Paratyp Fevers M - - - - - - - F - - - - - - - 2. Cerebro-spinal Fever M - - - - - - - F - - - - - - - 3. Scarlet Fever M - - - - - - - F - - - - - - - 4. Whooping Cough M — 1 — — — — 1 F 1 — — — — — 1 5. Diphtheria M - - - - - - - F - - - - - - - 6. Tuberculosis of Respiratory System M — — — 24 19 6 49 F — — 1 20 2 4 27 7. Other forms of Tuberculosis M — 1 3 1 5 — 10 F — — 2 2 — — 4 8. Syphilitic Diseases M — — — — 3 — 3 F — — — — 1 2 3 9. Influenza M 1 — — — — 1 2 F — — — 1 — 5 6 10. Measles M — 1 — — — — 1 F 1 - - - - - 1 11. Ac. Poliomyelitis and Polioencephalitis M — — — 1 — — 1 F — — 1 1 — — 2 12. Ac. Inf. Encephalitis M — — — — 1 — 1 F - - - - - - - 13. Cancer of Buc. Cav. and Oesoph. (M), Uterus (F) M — — — 1 1 8 10 F — — — 1 4 4 9 14. Cancer of Stomach and Duodenum M — — — 2 7 13 22 F — — — 1 5 11 17 15. Cancer of Breast M — — — — — — — F — — — 1 11 9 21 16. Cancer of all other sites M — — — 7 46 55 108 F — — — 3 15 48 66 17. Diabetes M — — — — 1 2 3 F — — — — 2 3 5 18. Intra-cranial vascular Lesions M — — — — 11 42 53 F — — — 1 13 54 68 19. Heart Disease M — — — 3 42 103 148 F — — — 6 22 144 172 20. Other Diseases of Circ. System M — — — 1 5 20 26 F — — — — 8 19 27 21. Bronchitis M 1 — — 1 18 29 49 F — — — 3 6 41 50 22. Pneumonia M 8 1 — — 9 33 51 F 5 — — 3 10 26 44 23. Other Respiratory Diseases M — — — 2 4 5 11 F — — — — 3 5 8 24. Ulcer of Stomach or Duodenum M — — — — 7 12 19 F — — — - 2 1 3 25. Diarrhœa under 2 years M 9 - - - - - 9 F 6 1 — — — — 7 26. Appendicitis M — — 1 — 1 — 2 F — 1 — 1 — — 2 27. Other Digestive Diseases M — — 1 1 6 7 15 F — — — — 4 11 15 28. Nephritis M — — — 2 3 4 9 F — — — 5 3 7 15 29. Puerperal and Post-abortive Sepsis M - - - - - - - F — — — 1 — — 1 30. Other Maternal causes M — — — — — — — F - - - - - - - 31. Premature Birth M 20 — — - - - 20 F 14 - - - - - 14 32. Con. Mal. Birth Injuries Infant Dis. M 20 - — 2 - - 22 F 5 - - 1 2 - 8 33. Suicide M - — — 3 2 - 5 F — — — 2 1 2 5 34. Road Traffic Accidents M — — 1 3 1 2 7 F — — — - 1 2 3 35. Other violent causes M 3 — 1 6 4 5 19 F — — — 1 4 8 13 36. All other causes M 3 — — 3 10 19 35 F — — 2 4 12 23 41 Totals of all causes M 65 4 7 63 206 366 711 F 32 2 6 58 131 429 658 97 6 13 121 337 795 1369 7 MATERNITY AND CHILD WELFARE. The number of births again increased, and the infant mortality rate was the lowest ever recorded in the Borough. 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 1946 2310 103 45 1947 2559 97 38 * 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, 1947. Infantile Mortality during the year 1947. Nett deaths at various ages under one year of age. Under 1 week 45 1—2 weeks 6 2-3 weeks 2 3-4 weeks 2 4 weeks and under 3 months 18 3 months and under 6 months 14 6 months and under 9 months 8 9 months and under 1 year 2 Total deaths under 1 year 97 Nett Births in the Year: Legitimate, 2,375; Illegitimate, 184. Nett Deaths in the Year: Legitimate Infants 87; Illegitimate Infants, 10. Visits paid by Health Visitors are enumerated below:— No. of visits 33,197 No. of ineffective visits 5,549 Total No. of effective visits 27,648 Attendances at Infant Welfare Centres 895 Attendances at Ante-Natal Clinics 967 Attendances at Diphtheria Immunisation Clinics 31 It will be seen that the Health Visitors' attendances at Infant Welfare Centres were reduced, whilst their visits to the homes increased by several thousands. This is in line with the Council's policy that during the shortage of Health Visitors, their activities should be concentrated in the homes rather than at the clinics, where State Registered Nurses, acting as clinic assistants, have temporarily replaced them. 9 Schedule of Attendances at Infant Welfare Centres and Ante-Natal Clinics. It will be noted that comparable with the increased birth rate, attendances of children under one year of age have increased from 29,720 to 34,476. There was also an increase in the amount of massage given to post-natal mothers and to children. 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. 199 - - 523 97 - - 8,390 2,747 203 506 8 — — 2,701 65 — — Becklow Gardens 253 — — 754 90 — — 10,566 3,180 258 655 69 — — 4,060 70 — — Milson Road 157 — — 441 25 — — 6,070 2,455 97 410 6 — — 2,234 24 — — Old Oak, Westway 156 — — 421 35 — — 6,531 2,194 107 401 11 — — 2,331 65 — — Latimer Road 52 - — 109 12 — — 1,818 664 53 122 5 — — 879 15 — — College Park 49 — — 37 12 — — 1,101 416 50 42 1 — — 267 4 — — Totals 1,634 2,136 90 2,285 271 12,472 243 34,476 11,656 Ante-Natal Clinics, Number of Sessions held 866 Infant Consultations, ,, ,, ,, ,, 768 1,634 The average attendance at Infant Welfare Centres = 60. During the year 222 cases received massage treatment, the total number of treatments being 1,414. 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 10 under five where the family income does not exceed 10s. 0d. more than the scale of the Ministry of Food entitling them to free milk was continued. 1ll quarts of liquid milk and 215 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 and one child were referred to the Centres and 45 dinners were supplied. MATERNAL DEATHS. As mentioned previously, only one occurred in the Borough during 1947. The following table gives the number of Maternal Deaths since 1924:— Number of Deaths. Number of live Births. Maternal Death Rate. 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 —† 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 1947 1 — 2,559 0.38 * 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." 11 DAY NURSERIES. No unusual happening occurred to interfere with the smooth running of the Council's Day Nurseries during the year. It was learnt, however, that a new development was taking place in this sphere. Day Nurseries of various types were being set up by private individuals, usually in unsuitable premises for profit motives. In the absence of any legal powers, little if anything could be done to either improve the existing conditions, or where, for instance, gross overcrowding existed, to appeal to the Courts. These nurseries were visited by the Council's medical staffs, and advice was given and help offered where possible. The following particulars show the daily average attendance for each month at the Council's five Day Nurseries now in operation:— 1947. Brook Green. Accomdn. 83. Dalling Rd. Accomdn. 70. Australia Rd. Accomdn. 45. Uxbridge Rd. Accomdn. 60. Latimer Rd. Accomdn. 36. Mon. to Fri. Mon. to Fri. Mon. to Fri. Mon. to Fri. Mon. to Fri. Jan. 67 56 31 50 19 Feb. 73 36 29 33 27 Mar. 72 60 42 50 28 April 75 59 43 50 31 May 66 65 49 56 31 June 62 64 46 57 27 July 59 63 42 50 29 Aug. 48 56 42 50 26 Sept. 53 59 46 60 29 Oct. 57 61 47 55 29 Nov. 58 62 46 54 30 Dec. 65 60 44 56 33 The nurseries are open until 12 noon Saturday, and the attendances on that day are much below the average. 12 CHILD LIFE PROTECTION. Public Health (London) Act, 1936. At the end of the year there were 37 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. Nineteen foster-mothers were removed from the list for various reasons and ten new foster-mothers were permitted to replace them. A summary of the work carried out during the year under review follows:— FOSTER-MOTHERS. No. of Foster-Mothers on Borough Council's List, Dec. 31st, 1947 28 „ „ recommended for insertion on List 10 „ „ removed from List 19 (1) Removed from Borough - (2) Adopted Children 3 (3) Unsuitable — (4) 9 years of age 2 (5) Temporarily approved — (6) No further Foster-Children required 14 (7) Illness of Foster-Mothers - (8) Lack of accommodation - (9) Mother living at address — „ Applications for Registration received but not Recommended — FOSTER-CHILDREN. No. of Foster-Children on List December 31st, 1947 37 „ „ received by Foster-Mothers 20 „ „ moved from Foster-Mothers 23 (1) To Foster-Mothers 1 (2) To Parents or Guardians 13 (3) To Institutions 3 (4) Adopted 4 (5) Children removed from Borough with Foster-Mother - (6) Foster-Children who have reached the age of 9 years during the Year 2 VISITS. No. of visits to Listed Foster-Mothers 319 13 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. This 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 1947, "Home Helps" were provided for 58 confinement cases and "Domestic Helps" attended 311 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 50 women in the Council's employment and further efforts are being made to substantially increase this number. SANITARY CIRCUMSTANCES OF THE BOROUGH. The work of the Sanitary Inspectors was again comprehensive and very extensive. The table below emphasises the wide and varying duties which each Inspector performs in his own District. The Inspectorate consists of the Senior Sanitary Inspector, the Food and Drugs Inspector, a Woman Sanitary Inspector employed on Special Duties, and eight District Inspectors plus one vacancy for a District Inspector. 14 Cause of Inspection. No. of Inspections. No. of Notices served. No. of Notices complied with. Bakehouses 55 4 2 Cancer 3 - – Complaints 5,202 2,917 1,877 Drainage 1,615 30 25 Factories (Mechanical) 185 10 12 Factories (Non-mechanical). 81 9 5 Food (other than Restaurants and Eating Houses) 1,415 11 10 Housing Act 39 11 2 Ice Cream Vendors 425 – – Infectious Diseases 724 16 12 Licences (Building) 4,095 2 2 Markets 682 – – Milk Vendors 303 – – Outworkers 547 11 9 Pharmacy and Medicines Act 91 – – Public Urinals 87 1 1 Rats and Mice 1,183 139 105 Re-Housing 767 38 6 Restaurants and Eating Houses 163 7 6 Scabies 458 3 1 Shops Act 62 2 1 Slaughterhouses 7 – – Smoke Observations 43 3 – Miscellaneous 1,158 27 20 Re-visits 6,062 614 541 No Answer 2,981 – – 28,433 3,855 2,637 No. of Ineffective Visits 2,981 – – Total 25,452 3,855 2,637 During the year 1.297 Statutory Notices were served and 884 complied with. INCREASE OF RENT AND MORTGAGE RESTRICTIONS ACT, 1920 1939. During the year 44 applications were received for certificates under the above Act, and in 35 cases certificates were granted. This total includes eleven applications from owners, nine of which were issued as the work specified had been completed satisfactorily. 15 SUMMONSES—YEAR 1947 The following table shows the number of proceedings instituted during the year:— Public Health (London) Act, 1936 61 L.C.C. Tenement House Byelaws 1 Rats and Mice (Destruction) Act, 1919 1 Food and Drugs Act, 1938 17 Housing Act, 1936, and L.C.C. Byelaws 1 FACTORIES ACT, 1937. 1.—INSPECTIONS Premises. Number on Register. Number of Inspections Written Notices. Occupiers Prosecuted. (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 185 81 9 – (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 358 185 10 – (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) – – – – Total 543 266 19 – 2.—CASES IN WHICH DEFECTS WERE FOUND. Particulars. Number of Cases in which Defects were Found. Number of Cases in which Prosecutions were Instituted. Found. Remedied. Referred To H.M. Inspector. By H.M. Inspector. Want of Cleanliness (S.1) 5 4 – – – Overcrowding (S.2) – – – –. – Unreasonable perature (S.3) – – – – – Inadequate Ventilation (S.4) – – – – – Ineffective Drainage of Floors (S.6) – – – – – Sanitary Conveniences (S.7)— – – – – – (a) Insufficient 3 3 – – – (b) Unsuitable or Defective 6 5 – – – (c) Not separate for Sexes 1 2 – – – Other offences against the Act (not including offences relating to Outwork) – – – – – Total 15 14 – – – 16 OUTWORK. Nature of Work. Section 110. Section 111. No. of Outworkers in August List required by Sect. 110 (1) (c) No. of Cases of Default in Sending Lists to the Council. No. of Prosecutions for Failure to Supply Lists. No. of Instances of Work in Unwholesome Premises. Notices Served. Prosecutions. Wearing Apparel— Making, &c. 77 – – – – – Cleaning and Washing – – – – – – Household Linen 3 – – – – – Lace, Lace Curtains and Nets – - – – – – Curtains and Furniture Hangings – – – – – – Furniture and Upholstery – – – – – – Electro-plate 4 – – – – – File Making – – – – – – Brass and Brass Articles – – – – – – Fur Pulling 1 – – – –– – Iron and Steel Cables and Chains – – – – – – Iron and Steel Anchors and Grapnels – – – – – – Cart Gear – – – – – – Locks, Latches and Keys – – – – – – Umbrellas, &c. 2 – – – – – Artificial Flowers 2 – – – – – Nets, other than Wire Nets – – – – – – Tents – – – – – – Sacks – – – – – – Racquet and Tennis Balls – – – – – – Paper Bags – – – – – – The making of Boxes or other Receptacles or parts thereof made wholly or partially of Paper 60 – – – – – Brush Making 1 – – – – – Pea Picking – . – – – – – Feather Sorting 2 – – – – – Carding, &c., of Buttons, &c. 29 – – – – – Stuffed Toys 6 – – – – – Basket Making – – – – – – Chocolates and Sweetmeats – – – – – – Cracker Bon-bon, Christmas Crackers, Christmas Stockings, &c. 71 – – 3 2 – Textile Weaving – – – – – – Lampshades 1 – – – – – Total 259 – – 3 2 – 17 RODENT CONTROL. Rats and Mice (Destruction) Act, 1919. Infestatation Order, 1943. Rats.—The special scheme, commenced during 1946, under which systematic enquiries over the whole Borough, followed by baiting or other appropriate measures where rat infestations were discovered, was completed by 30th June, 1947. The infestations discovered as a result of working the scheme were all "sewer" (brown) rat type, and the Borough is practically free from "ship" (black) rat. The surface infestations, apart from Shepherds Bush Market, were not widespread. It was not possible to trace the source of all infestations, but undoubtedly many rose from the sewers and drains. The keeping of poultry in back yards and gardens was also found to result in rat infestations in areas formerly free from rats. In the case of Shepherds Bush Market area, the co-operation of the Hammersmith and City Railway Joint Committee was obtained and extensive baiting carried out. The baiting of the market and adjoining areas was carried out by the Council's operatives, whilst the railway rodent staff laid baits on the railway. The cost of the work carried out by the Council was reimbursed by the Railway Joint Committee. Mice.—The mice infestations in private houses can usually be dealt with by tenants without the Council's assistance. Traps are loaned free of charge. Where the Sanitary Inspector considers that assistance is required, the services of the rodent operatives are utilised for laying baits. &c. Baiting and trapping was carried out in several commercial premises by the Council at the cost of the occupiers. General—A few firms in the Borough employ servicing contractors to carry out regular control measures. 18 All baiting carried out by the Council's operatives is in accordance with the procedure recommended by the Ministry of Agriculture and Fisheries. The number of baits laid varies according to the size of the premises and the extent of infestation. The baiting of private houses was carried out without charge to the occupier. At the completion of the special scheme it was found unnecessary to retain the services of three operatives, and the number of operatives was reduced to two. Sewers.—The baiting of the Council's sewers is undertaken bi-annually 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. Prosecutions.—Legal proceedings were instituted in one instance during the year for failure to take reasonable steps to keep premises free from rats. A fine of 40s. was imposed. Individual Infestations (excluding premises dealt with under the special scheme). Number of private houses baited free of charge 207 Number of business premises baited 38 Special Scheme. Number of private houses baited 262 (60 per cent. of the cost to be borne by the Ministry.) Number of business premises baited 91 Total number of premises baited 598 Statutory Action under the Rats and Mice (Destruction) Act, 1919. Number of Statutory Notices served 17 Number of prosecutions 1 19 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 5,494. Certificates of Essentiality were dispensed with after the 31st January, the licensing of all work to private dwellings after that date becoming a matter for the local authority irrespective of the estimated cost of the work. On the 1st September, the system of issuing Certificates of Essential Repair to assist builders to obtain materials was superseded by the issue of W.B.A. Material Priority Certificates, which are issued by the Borough Engineer and Surveyor on the recommendation of the Sanitary Inspector. LANDLORD AND TENANT (WAR DAMAGE) (AMENDMENT) ACT, 1941. Applications for certificates of fitness for housing purposes are dealt with by the Senior Sanitary Inspector. One application was received during the year, which was granted. EXHUMATION AND RE-INTERMENT OF BODIES. During the year twenty-two Licences were granted by the Secretary of State for the exhumation and removal of bodies from graves in St. Mary's Catholic Cemetery, Harrow Boad. Each of these was attended by the Sanitary Inspector for this area, and in each case it was possible to certify that the removal was carried out in a proper manner. 20 FOOD AND DRUGS ACT, 1938. Unsound Food. During the year a quantity of bread and cake was seized under Section 10 of the Food and Drugs Act, 1938. This was taken before a magistrate, who ordered its destruction as being unfit for human consumption. Summonses were issued, and penalties and costs amounting to £14 17s. 0d. were imposed. 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. Sampling. Eight hundred samples of various foods and drugs were submitted to the Public Analyst during the year by the Council's Sampling Officer for analysis. One hundred and two were found to be inferior and 11 were adulterated. Ice Cream. Section 14 of the Food and Drugs Act, 1938, requires all premises used for the sale, storage or manufacture for the purpose of sale of ice cream, to be registered by the Local Authority and imposes penalties for use of any promises without being so registered. In two cases legal proceedings were taken under this section in respect of the sale of ice cream from unregistered premises, and fines totalling £20 with £1 1s. 0d. costs were imposed. Samples of ice cream were taken for bacteriological examination, and the Methylene Blue Test. The samples from one manufacturer in the Borough were reported to be unsatisfactory. A careful check was made of the ice cream-making plant and ice cream in all stages of manufacture, which resulted in the ice cream being brought to a satisfactory standard. 21 Itinerant Vendors. Section 16 of the Food and Drugs Act, 1938, provides that Itinerant Vendors of Ice Cream shall have their names and addresses conspicuously displayed on vehicles, &c. A Local Authority may by resolution extend this section to all kinds of food, and the Council have availed themselves of this power. In 17 cases legal proceedings were taken under this section, and fines totalling £12 12s. 6d. were imposed; three cases were dismissed. 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, 190 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. Thirty-five 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. CORONERS' COURT AND PUBLIC MORTUARY. An increase in the number of bodies dealt with at the Public Mortuary occurred during the year. An agreement was made with the Borough of Chelsea that in future all that Borough's mortuary duties should be taken over by Hammersmith. It will be seen that Fulham and Kensington cases are also admitted to the Council's Mortuary. Mr. Goodman was appointed deputy to Mr. Mackay, the Mortuary Keeper, on the 14th April, 1947. Seven hundred and twenty-two bodies were admitted to the Public Mortuary during the year:— 22 Bodies admitted from the Borough:— By order of Coroner 287 By order of Police 15 On application of undertakers for accommodation 61 363 Bodies admitted from other Boroughs:— Fulham 88 Chelsea 266 Kensington 5 359 722 No. of P.-M. examinations conducted:— Hammersmith cases 280 Fulham ,, 82 Chelsea ,, 260 Kensington 5 Total P.-M.s 627 No. of Inquests held:— Hammersmith cases 81 Fulham ,, 48 Chelsea ,, 65 Kensington ,, 124 Total Inquests held 318 23 INFECTIOUS DISEASES (EXCLUDING TUBERCULOSIS). The number of notifications was reduced by 506 during the year, and there was also a reduction in the nonnotifiable infectious diseases of 84 cases. It should be pointed out that German Measles, Chicken Pox and Mumps are not notifiable by Statute. There were, omitting tuberculosis, 2,046 cases reported as due to notifiable infectious diseases in the Borough, against 2,552 in the previous year. There were also reported 415 cases of infectious diseases that were not notified, against 499 in the previous year; 181 of these were *Measles, 104 *Whooping Cough, 21 *Scabies and 109 Chickenpox. *Totals (notified cases and cases reported from other sources)—Measles 1,099, Scabies 530 and Whooping Cough 409. BACTERIOLOGY. During the year the following 926 bacteriological examinations were made on behalf of the Council:— Specimen. Positive. Negative. Total. Swabs for suspected cases of Diphtheria – 672 672 Haemolytic Streptococci 133 40 173 Faeces – 26 26 Vincents Organisms 7 41 48 Occult Blood 1 2 3 Lung Swabs (Post-mortem) 3 – 3 Intestinal Swabs (Post-mortem) 1 – 1 145 781 926 24 Cases of Infectious Disease notified during the year 1947. Notifiable Disease. Number of Cases Notified. At all Ages. Age Periods. Under 1 1— 2— 3— 4— 5— 10— 15— *0- 35— 45— 65— Smallpox – – – – – – – – – – – – – Cholera, Plague, Typhus, Anthrax – – – – – – – – – – – – – Diphtheria 32 1 5 1 5 4 6 1 2 5 2 – – Erysipelas 23 – – – – – – – – 4 2 9 8 Scarlet Fever 132 2 5 5 10 10 67 17 8 4 1 3 – Enteric Fever 1 – – – – – 1 – – – – – – Relapsing Fever – – – – – – – – – – – – – Puerperal Fever 18 – – – – – – – – 14 4 – – Puerperal Pyrexia 8 – – – – – – – 2 6 – – – Cerebro-Spinal Meningitis 3 – 1 – – – 1 – – 1 – – – Poliomyelitis 32 1 3 3 3 1 9 3 2 5 – 2 – Polioencephalitis 3 – – – – – 1 1 – 1 – – – Encephalitis Lethargica – – – – – – – – – – – – – Ophthalmia Neonatorum 8 8 – – – – – – – – – – – Pneumonia 31 – 2 – – 2 4 1 – 4 4 7 7 Malaria 1 – – – – – – – – – –– 1 – Dysentery 19 2 2 4 2 2 2 – – 4 1 – – Food Poisoning 3 – –. – – – – – – 2 – 1 – Measles 918 50 108 127 122 138 303 28 13 25 3 1 – Whooping Cough 305 48 44 55 41 42 68 4 1 1 1 – – Scabies 509 11 7 13 11 10 66 55 39 161 66 55 15 Totals 2,046 123 177 208 194 209 528 110 67 237 84 79 30 25 Notifiable Diseases (other than Tuberculosis) during the Year 1947. DISEASE. Total cases notified Cases admitted to Hospital. Cases where diagnosis was not confirmed Total deaths. Diphtheria 32 31 15 Erysipelas 23 10 2 – Scarlet Fever 132 49 10 – Enteric Fever 1 1 1 – Puerperal Fever 18 17 – – Puerperal Pyrexia 8 8 – Cerebro-Spinal Meningitis 3 3 1 – Encephalitis Lethargica – – – 1 Opthalmia Neonatorum 8 6 – – Pneumonia (Acute Primary and Influenzal) 31 1 – † 95 Dysentery 19 14 9 – Poliomyelitis 32 32 10 3 Polioencephalitis 3 3 2 Malaria 1 1 – – Food Poisoning 3 1 – – *Measles 918 85 6 2 *Whooping Cough 305 48 4 2 *Scabies 509 2 – – Totals 2,046 312 60 104 * 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 1947. 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 1,550 Number of children immunised at schools by L.C.C. 284 Number of children immunised by local medical practitioners 95 Number of Schick Tests—positive result – Number of Schick Tests—negative result 11 Fees paid to Medical Practitioners £14 5s. 0d. 26 TUBERCULOSIS. This condition, at any rate in Hammersmith, seems now to have reached the peak of the war-time and post-war increase in new cases, and to have begun to return to its expected "peace-time" level. It is characteristic that the number of new cases is high in times of war, post-war adjustments and at all times when there is a low standard of living, and is reduced in times of prosperity, and where there is a high standard of living. PART I. Summary of Notifications during the period from the 1st January, 1947, to the 31st December, 1947. 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 5 2 1 19 14 29 12 14 15 4 116 Pulmonary Females – 5 1 3 12 11 26 5 6 1 3 73 Non-Pulmonary Males – 6 1 1 1 – 1 – – – – 10 Non-Pulmonary Females – 2 4 – – 1 1 3 – – – 11 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 2 1 8 21 7 3 5 2 54 Pulmonary Females – – – 1 1 7 13 8 – 1 1 32 Non-Pulmonary Males – – 3 2 – – – 1 2 – 1 9 Non-Pulmonary Females – 1 2 – – – – – 1 – – 4 27 The following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1947:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0- 1 – – – – – – – 1- 6 5 6 3 – – 1 – 5- 9 5 7 6 – 1 3 2 15- 42 31 1 1 24 20 1 2 25- 50 39 1 1 35- 19 13 1 3 45- 17 6 2 1 19 2 5 – 55- 20 2 – – 65 and on 6 4 1 – 6 4 – – Total 170 105 19 15 49 27 10 4 The ratio of non-notified tuberculosis deaths to the total tuberculosis deaths is 1 to 4.5. 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. 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 1947 189 21 210 90 1,278 1,517 28 Seventy-six deaths from Pulmonary Tuberculosis were registered, against seventy-seven in the previous year, representing a death-rate of 0.64 per 1,000 compared with 0.67 in 1946 and 0.85 in 1945. Figures for the years 1927-47 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 35 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 for the 10 years 1928-1937 (inclusive) = 226. Average number of cases notified for the 10 years 1938-1947 (inclusive) = 202. Average number of deaths for the 10 years 1928-1937 (inclusive) = 133. Average number of deaths for the 10 years 1938-1947 (inclusive) = 95. BACTERIOLOGY. The following bacteriological examinations were made on behalf of the Council:— Sputa from cases of suspected Tuberculosis— Tubercle bacillus found. 183 Tubercle bacillus not found 680 Pleural Fluid— Positive results 2 Negative results 31 Urine— Negative results 3 Blood Counts 55 Gastric Contents 4 29 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. Ten sessions, at which patients are seen by appointment, are held each week. New Patients.—During the year 1,211 persons attended for examination for the first time, 539 males and 672 females. Of these 216 were under the age of fifteen and 995 were adults. Of the total 664 were referred to the Clinic by local practitioners for the purpose of consultation, 16 by the National Service Medical Boards and 3 by Mass Badiography Groups. Four hundred and two were "contacts" of persons suffering from tuberculosis. Of the "contacts" examined 21 were definitely cases of tuberculosis, whilst 381 were non-tuberculous. Of the 3 cases referred to the Clinic by Mass Badiography Groups, 1 had active disease. Total Attendances and Examinations.—The total attendances of persons for the purpose of examination, observation or treatment, numbered 7,323, and physical examinations were carried out in 4,025 instances, i.e., in 55 per cent. of the total attendances. Home Visitation.—The Tuberculosis Officer made 169 visits to homes of patients for the purpose of examination and investigation of the home conditions, and 46 visits to St. Charles' Hospital. The Tuberculosis 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 2,634 such visits were made, of which 401 were ineffective. During the year 77 definite cases were transferred from other areas into the Borough and 41 moved out or were lost sight of. Fifty-six were written off the register as being cured. 30 Mass Radiography.—No facilities were provided by the London County Council, the Statutory Authority, during the year. 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 1947. The total number of cases considered was 762—81 of which were new ones. Of the new cases, 48 received maintenance grants only, 23 maintenance grants plus discretionary allowances and 10 special allowances. 681 cases were reviewed owing to changed circumstances. The total money paid to patients during the year amounted to £7,194 3s. 8d. CLEANSING OF VERMINOUS PERSONS. The Council opened on the 18th October, 1947, large and attractive new premises on their Scotts Road site, in order to make improved provision for those persons requiring disinfestation. Scabies (the "itch"), louse infestation ("lousiness"), and the bed bug are the main objectives in this service. The new premises, particularly because of their "newness" and attractive interior, are used largely for dealing with the child visitors to Scotts Eoad. Special attention has been given to head lice 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. 31 Facilities for cleansing at the Council's Medicinal Baths have been made available in all cases and the opportunity given to purchase special combs at cost price. Figures showing the number of cases dealt with at the Baths during the year are as under:— School Children—Hammersmith. Scabies 999 Verminous 1,538 Impetigo 26 School Children—Non-Hammersmith. Nil. Children under Five Years—Hammersmith. Scabies 228 Verminous 49 Impetigo 1 Children under Five Years—Non-Hammersmith. Nil. Adults—Hammersmith. Scabies 957 Verminous 164 Impetigo 1 Adults-Non-Hammersmith. Nil Lodging-houses. Scabies 30 Verminous 166 VACCINATION. 1947 is the last year during which vaccination is compulsory, or may be avoided on grounds of conscience. It will, therefore, be of great interest to compare the numbers of children who were vaccinated in the year under review with the numbers of successful vaccinations completed during the first few years of the National Health Service Act. It is, of course, hoped that the Act will increase these numbers largely and that the percentage of successful vaccinations will be much nearer 100. Voluntary methods of persuasion should be designed on the lines of the Anti-Diphtheria Campaign, and much publicity will be necessary to convince parents that vaccination is just as important and successful as diphtheria immunisation. 32 VACCINATION RETURNS. RETURN FOR 1946. Registration Sub-Districts comprised in the Vaccination Officers' District N umber of Births returned in the " Birth List Sheets" as registered from 1st January to 31st Dec., 1940 Number of these Births duly entered by 31st January, 1948, in Columns I, II, IV and V of the "Vaccination Register" (Birth List Sheets), viz.: Number of these Births which on 31st January, 1948, remained unentered in the "Vaccination Register" on account (as shown by Report Book) of Number of these Births remaining on 31st January, 1948, 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 1947 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 1947 Col. I Successfully Vaccinated Col. II Col. IV. Number in respect of whom Certificates of Conscientious Objection have been received Col. V Dead, Unvaccinated Post2 ponement 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. Hammersmith 701 369 – – 140 17 – 5 49 121 670 187 2. Hammersmith Hospital 2,218 1,091 3 – 277 112 – 450 148 137 1,066 284 3. Queen Charlotte's Hospital 2,722 1,573 14 – 256 88 – 653 98 40 1,587 255 5,641 3,033 17 – 673 217 – 1,108 295 298 3,323 726 33 Table showing Work of Vaccination Officer from 1st January to 31st December, 1947. 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 Nos. 1 and 2. District No. 3. District No. 4. District No. 5. Other Doctors. District Nos. 1 and 2. District No. 3. District No. 4. District No. 5. Total Hammersmith 172 108 86 11 72 – 449 180 16 – 1 723 29 24 25 309 167 114 13 603 Hammersmith Hospital 261 161 132 18 494 1 1067 284 27 – 1044 1008 42 55 44 436 205 193 24 858 Queen Charlotte's Hospital 89 37 15 1 1445 5 1592 255 6 – 2487 225 8 42 36 142 25 26 1 194 Removed Inwards 95 49 32 5 40 – 221 7 4 259 – 131 13 2 34 79 59 44 4 186 Total 617 355 265 35 2051 6 3329 726 53 259 3532 2087 92 123 139 966 456 377 42 1841 Total number of births registered during 1947—5,821.