AC4347 LIBRARY HAM 40 Metropolitan Borough of Hammersmith Abridged Annual Report of the Medical Officer of Health for the Year 1948 by F. M. DAY, M.R.C.S., L.R.C.P., D.T.M., D.P.H. , METROPOLITAN BOROUGH OF HAMMERSMITH. Health Committee. At 31st December, 1948. Councillor Thatcher (Chairman). „ Pinnell (Miss) (Vice-Chairman). Alderman Hallett (Mrs.). Councillor Bennie, J.P., L.C.O. Councillor Gosling. „ Kirby. „ Martin. „ Freeman. „ Russell. „ Morris. „ Turner (Mrs.). „ Woods (Miss). Ex officio : The Mayor (Alderman Buckingham, J.P.). 1 Town Hall, Hammersmith, W.6. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hammersmith. Mr. Mayor, Ladies and Gentlemen,—My annual report for 1948 deals with a year which, in many ways, is quite unique. 1948 saw the introduction of the National Health Services, and it is possible now to comment, at least superficially. on the changes which have come about. Whilst the new Service in many ways had no repercussion on many of the Health Department's activities, its onset inevitably brought about changes that could not have been forecast. Perhaps the most important of these was to bring closer together the staff of the Fulham Health Department and our own. By agreement between the two Councils, the medical staff of each became interchangeable, and therefore familiar with both services. The benefits of this arrangement have, I think, been obvious to each Council. On the 5th July the change-over envisaged in the Act took place. The necessary transfer of staff from the Boroughs to the County proceeded, and the Medical Officers of Health of the London Boroughs continued their supervisory control of the transferred services. Their responsibility covered, in particular. day-to-day administration. It is pleasing to record that the liaison between the new Divisional staff of the County Council and ourselves is of the most cordial and sincere description. A relationship of this kind makes the introduction of great administrative changes so much easier and more efficient. It is gratifying also to note that in the last year of the Hammersmith Maternity and Child Welfare Committee, the 2 infant mortality rate fell to a record new low level, and also that only one mother was lost during the year —the same as last year's record low figure for maternal deaths. The Borough has indeed been fortunate in its health, and there is no doubt that the cumulative effect of its social services during a period of many years, has been responsible for the high standard of health which was enjoyed during 1948. My report to you, Mr. Mayor, Ladies and Gentlemen, is still in an abridged form, on instructions from the Ministry of Health, and I have included, the same as last year, a short paragraph of explanatory introduction to each series of statistics and tables. In conclusion, I should like to express my appreciation of the kindness and consideration shown to by me the Chairman and members of the Health Committee, and the Maternity and Child Welfare Committee, and to record my thanks to the members of the staff for their loyal co-operation, without which, the services of the Department could not have been so highly and efficiently maintained. 1 feel that it should be emphasised that the staff during this year of change have been subjected to unusual stresses and strains, often of a personal nature, and resulting from the professional horizon confronting them. No sign of this has interfered with the efficiency of any one of them, and evidence of this is the almost unnoticed change-over of the transferred services. I am, Your Worship, Ladies and Gentlemen. Your obedient Servant, F. M. DAY. Medical Officer of Health. 3 STATISTICS AND SOCIAL CONDITIONS OF THE AREA. General Statistics, 1948. There has been a slight fall in the population of the Borough, but the natural increase resulting from an excess of births over deaths has been maintained. The fall in the population, therefore, is likely to be due to an outward movement of people to other parts of the country. Area 2,282.5 acres Population (1947) (estimated) 117,280 „ (1948) 115,800 „ Census (1901) 112,239 „ (1911) 121,521 „ (1921) 130,295 „ (1931) 135,521 Natural increase, i.e., excess of births over deaths 847 Density of population (persons per acre) 50.74 Marriages registered 1,366 Rateable value (April, 1948) £1,229,454 Sum represented by a penny rate (April, 1948) £4,800 Vital Statistics. As in the previous year, one maternal death only was recorded in the Borough. The infant mortality rate is the lowest that has been recorded in Hammersmith, and it may seem appropriate that this happy position occurred during the last year that the Borough Council was responsible for the Maternity and Child Welfare Services. There is no change in the number of deaths from Cancer and this condition remains one of our most serious problems. There were no deaths from Typhoid, Dysentery or Food Poisoning. Live Births Legitimate Total. M. F. Birth Rate per 1.000 estimated resident population= 18.5 1,967 1,036 931 Illegitimate 182 105 77 Stillbirths 39 21 18 Rate per 1,000 total (live and still) births=17.8 Deaths 1,302 667 635 Death Rate per 1,000 estimated average population=11.2 Deaths from puerperal causes- Rate per 1,000 total (live and still) births. Puerperal sepsis Deaths. 1 0.45 Other puerperal causes — — Total 1 0.45 Death Rate of Infants under one year of age:- All Infants per 1,000 live births 35 Legitimate Infants per 1.000 legitimate live births 32.53 Illegitimate Infants per 1,000 illegitimate live births 60.43 Deaths from Cancer (all ages) 254 „ „ Measles (all ages) — „ „ Whooping Cough (all ages) 2 „ „ Diarrhœa (under 2 years of age) 4 4 Statistics. The following table gives the statistics of the Borough during 1948 and previous years:— Vital Statistics of Whole District during 1948 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 l 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 * 19391 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 56 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 1369 11·6 1948 115800 5510 2149 18·5 1608 13·8 547 241 75 35 1302 11·2 * B = Birth-rate Population Figure. D = Death-rate ,, „ 5 Causes of, and Ages at, Death during the Year 1948. It can still be stated, with satisfaction, that no death resulted from Diphtheria during the year under review. The last death from Diphtheria in Hammersmith took place in 1946. [####]Cause of Death. Sex. 0- 1- 5- 15- 45- 65- Total all Ages.[/####] 1. Typhoid and Paratyphoid Fevers m 0 0 0 0 0 0 0 F 0 0 0 0 0 0 o 2. Cerebro-spinal Fever m 3 0 0 0 0 0 3 F 2 0 0 0 0 0 2 3. Scarlet Fever m 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 4. Whooping Cough m 0 1 0 0 0 0 1 F 1 0 0 0 0 0 1 5. Diphtheria m 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 6. Tuberculosis of Respiratory System m 0 0 0 19 22 4 45 F 1 0 0 15 5 1 22 7. Other forms of Tuberculosis m 1 2 1 0 2 0 6 F 0 0 0 I 2 0 3 8. Syphilitic Diseases m 0 0 0 0 3 5 8 F 0 0 0 0 0 3 3 9. Influenza m 0 0 0 0 0 0 0 F 1 0 0 0 1 1 3 10. Measles m 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 11. Ac. Poliomyelitis and Polioencephalitis m 0 0 0 0 1 0 1 F 0 0 0 0 0 0 0 12. Ac. Inf. Encephalitis m 0 0 0 0 0 0 0 F 0 0 0 0 1 0 1 13. Cancer of Buc. Cav. and Oesoph. (M), Uterus (F) m 0 0 0 0 3 9 12 F 0 0 0 1 7 3 11 14. Cancer of Stomach and Duodenum m 0 0 0 2 8 12 22 F - - - 1 9 10 20 15. Cancer of Breast M 0 0 0 0 0 1 1 F 0 0 0 4 8 12 24 16. Cancer of all other sites m 0 0 0 2 42 45 89 f 0 1 0 6 28 40 75 17. Diabetes m 0 0 0 0 0 3 3 F 0 0 0 0 2 2 4 18. Intra-cranial vascular Lesions m 0 0 0 1 17 35 53 F 0 0 0 2 13 66 81 19. Heart Disease m 0 0 0 3 47 103 153 F 0 0 0 2 27 121 150 20. Other Diseases of Circ. System M 0 0 0 1 7 29 37 F 0 0 0 0 5 30 35 21. Bronchitis m 1 0 0 3 12 40 56 F 0 0 1 1 5 28 35 22. Pneumonia m 3 1 0 1 6 17 28 F 1 1 0 3 1 29 35 23. Other Respiratory Diseases m 0 0 0 2 3 3 8 F 0 0 0 0 4 2 6 24. Ulcer of Stomach or Duodenum m 0 0 0 1 7 3 11 F 0 0 0 0 0 0 0 25. Diarrhoea under 2 years m 1 0 0 0 0 0 1 F 3 0 0 0 0 0 3 26. Appendicitis m 0 0 0 0 0 1 1 F 0 0 0 0 0 0 0 27. Other Digestive Diseases m 0 1 0 0 5 6 12 F 0 1 0 0 4 9 14 28. Nephritis m 0 0 0 3 5 6 14 F 0 0 1 1 3 8 13 29. Puerperal and Post-abortive Sepsis m 0 0 0 0 0 0 0 F 0 0 0 1 0 0 1 30. Other Maternal causes m 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 31. Premature Birth m 11 0 0 0 0 0 11 F 6 0 0 0 0 0 6 32. Con. Mal. Birth Injuries Infant Dis. m 17 1 0 0 0 0 18 F 11 1 0 1 0 0 13 33. Suicide m 0 0 0 1 7 0 8 F 0 0 0 2 1 0 3 34. Road Traffic Accidents m 0 0 0 1 0 4 5 F 0 1 0 0 1 2 4 35. Other violent causes m 3 3 0 5 3 8 22 F 4 1 1 0 2 16 24 36. All other causes m 2 0 2 5 8 21 38 F 3 1 2 10 6 21 43 Totals of all causes. m 42 9 3 50 208 355 667 F 33 7 5 51 135 404 635 75 16 8 101 343 759 1302 6 INFANT MORTALITY, 1948. There was a reduction in the number of births but 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 1948 2149 75 35 * 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. 7 Nett deaths of infants at various ages under one year of age. Under 1 week 37 1-2 weeks 5 2-3 weeks 2 3-4 weeks 1 4 weeks and under 3 months 11 3 months and under 6 months 8 6 months and under 9 months 11 9 months and under 1 year - Total deaths under 1 year 75 Net. Births in the Year: Legitimate, 1,967; Illegitimate, 182. Net. Deaths in the Year : Legitimate Infants, 64 ; Illegitimate Infants, 11. MATERNAL MORTALITY. As mentioned previously, only one death occurred in the Borough during 1948. The following table gives the number of Maternal Deaths and the rate per 1,000 (live and still) births 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 1948 1 — 2,149 0.45 * 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." 8 SANITARY CIRCUMSTANCES OF THE BOROUGH. The duties of the Sanitary Inspectors continued at a very high level. Fortunately little time was lost on account of sickness and the Inspectors were able to deal with all the outstanding work which faced them. Much praise is due to them for the able and efficient way in which they overcame the swollen list of visits and other duties during the year. Cause of Inspection. No. of Inspections. No. of Notices served. No. of Notices complied with. Bakehouses 64 4 - Cancer 2 - - Complaints 4,979 2,761 3,417 Drainage 1,648 18 13 Factories (Mechanical) 344 41 33 Factories (Non-mechanical) 175 24 17 Food (other than Restaurants and Eating Houses) 1,417 4 5 House to House 3 1 Housing Act 100 - - Ice Cream Vendors 719 2 1 Infectious Diseases 363 18 22 Licences (Building) 3,199 - - Markets 631 - - Milk Vendors 381 - - Outworkers 613 4 7 Pharmacy and Medicines Act 112 - - Public Urinals 15 1 - Rats and Mice 1,274 130 140 Re-Housing 2,085 86 53 Restaurants and Eating Houses 194 6 3 Scabies 245 - - Shops Act 19 7 2 Slaughterhouses 3 - - Smoke Observations 16 3 3 Miscellaneous 807 33 47 Re-visits 10,353 831 601 No Answer 3,563 - - 33,324 3,974 4,364 No. of Ineffective Visits 3,563 - - Total 29,761 3,974 4,364 During the year 1,889 Statutory Notices were served and 1,204 complied with. 9 INCREASE OF RENT AND MORTGAGE RESTRICTIONS ACT, 1920 1939. During the year 32 applications were received for certificates under the above Act, and in 16 cases certificates were granted. This total includes ten applications from owners, nine of which were issued as the work specified had been completed satisfactorily. SUMMONSES—YEAR 1948 The following table shows the number of proceedings instituted during the year:— Public Health (London) Act, 1936 158 Rats and Mice (Destruction) Act, 1919 1 Food and Drugs Act, 1938 5 Housing Act, 1936 10 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 209 175 24 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 422 344 41 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 631 519 65 — 10 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) 10 5 - - - Overcrowding (S.2) 1 1 — — — Unreasonable Temperature (S.3) 1 1 - - - Inadequate Ventilation (S.4) 1 1 - - - Ineffective Drainage of Floors (S.6) - - - - - Sanitary Conveniences (S.7)— (a) Insufficient 3 2 - - - (b) Unsuitable or Defective 25 21 - - - (c) Not separate for Sexes 1 - - - - Other offences against the Act (not including offences relating to Outwork) - - 10 - - Total 42 31 10 — — 11 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. 81 — — 1 1 — Cleaning and Washing - - - - - - Household Linen — — —• — — — Lace, Lace Curtains and Nets - - - - - - Curtains and Furniture Hangings 1 - - - - - Furniture and Upholstery 4 - - - - - Electro-plate 5 — — — — — 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 12 - - 1 1 - Brush Making 1 — - — — — Pea Picking - — - — — — Feather Sorting 2 — - — — — Carding, &c., of Buttons, &c 17 - - - - - Stuffed Toys 23 — - 1 1 — Basket Making — — - — — — Chocolates and Sweetmeats - - - - - - Cracker Bon-bon, Christmas Crackers, Christmas Stockings, &c. 39 - - 2 2 - Textile Weaving — — - — — — Lampshades 1 — — — — — Total 191 - - 5 5 - 12 RODENT CONTROL. Rats and Mice (Destruction) Act, 1919. Infestation Order, 1943. Rats.—The degree of rat infestation in the Borough has shown a decrease, doubtless due to the special campaigns carried out during the previous years and the routine baiting of sewers and other fertile breeding grounds. The infestations reported or discovered during the year were all found to be " common " or " sewer " rats. Fortunately the Borough appears free of "ship" ("black"') rats, but infestation from outside sources is always a possibility. In view of the high breeding rate of both species, continual measures are necessary to prevent a rise in the rat population and to guard against re-infestation of premises. All complaints of rats are investigated by a Sanitary Inspector, and efforts are made to trace the source of infestation. Baiting is still the most effective way of destroying rats in occupied buildings, and is carried out by the Council's operatives free of charge to private householders. Baiting is also carried out in business premises, and the cost of the work charged to the occupier. Mice.—The most serious mice infestations arise in certain types of business premises, particularly those where food supplies are available. Complete extermination in these cases is very difficult; re-infestation is always likely, and arrangements have been made in one or two instances for the Council's operatives to make periodical visits to keep a check on the position, and lay baits as required. The expenses thus incurred are recovered from the occupier. Where complaints of mice infestation are received from occupiers of dwelling houses, assistance is given by loaning traps or laying baits. As in the case of rat infestation, no charge is made for this service. If the infestation is due to the occupier's neglect, a notice is served by the Sanitary Inspector. General.—The Council's rodent staff comprises two operatives. They work under the supervision of one of the Sanitary Inspectors. All baiting is carried out in accordance 13 with the technique prescribed by the Ministry of Agriculture and Fisheries. On an average, each infestation entails 14 visits by the operative. A few firms in the Borough employ servicing contractors to carry out routine control measures. Occasionally, some of these firms also seek the Council's assistance. Sewers.—The baiting of the Council's sewers is undertaken by the Borough Engineer and Surveyor's Department. The rodent operatives assist by preparing and mixing the baits. Statutory Action under the Rats and Mice (Destruction) Act, 1919. Number of Statutory Notices served 14 Number of Prosecutions Nil Number of Private Houses baited 313 Number of Business Premises baited 48 HOUSING. Statistics—Year 1948. l. Total number of houses in the borough, including flats, tenements, &c., separately assessed 24,000 (approx.) Public Health Act 2. Number of houses inspected on account of complaints or illness 4,979 3. Number of statutory notices served 1,889 4. Number of houses repaired or nuisances remedied 3,417 Housing Act, 1936 5. Number of houses inspected-house to house (Housing Consolidated Regs. 1925) Nil 6. (a) Number of houses included by representations by the Borough Medical Officer under Sec. 25 of H.A., 1936 Nil (b) Number of houses demolished following representation by Borough Medical Officer under Sec. 25 of H.A., 1936 Nil 7. Number of houses repaired under Sections 9 and 10 of H.A., 1936:- (a) by owners 1 (6) by L.A. in default of owners 2 8. Number of houses demolished:- (a) in pursuance of orders under Sec. 11 of the Housing Act, 1936 Nil (6) voluntarily Nil 9. Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) Nil 14 10. Number of Closing Orders determined (i.e., houses made fit) 2 11. Overcrowding (Housing Act, 1936) Number of families found to be living in overcrowded conditions 521 Number of overcrowded families who have obtained alternative accommodation 237 12. Number of houses erected by the Borough Council for working classes during the year 62 (Flats) 13. Underground Rooms Number occupied but unfit 3 Number closed or modified occupation approved Nil 14. Houses let In Lodgings Number in Borough 9,600 (approx.) ♦Number of inspections Nil Number of prosecutions Nil fNumber of complaints remedied under the By–laws (not included under any other heading) Nil * Included under item No. 2. † Included under item No. 4. 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 2,939. 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 fourteen 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. With one exception 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. 15 NATIONAL ASSISTANCE ACT, 1948. Removal to suitable premises of persons in need of care and attention. The above Act came into operation on the 5th July, 1948. Section 47 provides that the Local Authority shall be responsible for the removal to suitable premises of persons who are suffering from a grave chronic disease or being aged, infirm or physically incapacitated, who are living in insanitary conditions and who are unable to devote to themselves and are not receiving from other persons, proper care and attention. It has been found necessary on one occasion only to apply to the Court for an Order under this section. The case was that of an old lady who was infirm, living in insanitary conditions and was unable to devote to herself, and was not receiving from other persons, proper care and attention. Enquiry and consideration showed that, in her interest and for preventing injury to the health of others, she should be removed from the premises in which she was residing. An Order was obtained from the West London Magistrates Court for her removal to and detention in Fulham Hospital for a period of three months. Burial or cremation of the dead It is provided that the Local Authority shall arrange burial or cremation in the case of any person who has died or been found dead in the Borough, in any case where it appears to the authority that no suitable funeral arrangements have been or are b.eing made. The Council may recover from the estate of the deceased person or from any person who for the purposes of this Act was liable to maintain the deceased person immediately before his death, expenses incurred for the burial or cremation. Up to the end of the year forty–four burials and one cremation have been carried out in Hammersmith at a total cost of £269 2s. 6d. Of this amount, £26 18s. has been recovered. In one case re imbursement is being made by instalments 16 FOOD AND DRUGS ACT, 1938. Meat and other Foods. Shops, stalls, vehicles and premises where food intended for human consumption is prepared, stored, etc., were subjected to routine inspection throughout the year. A quantity of dried apricots was seized under Section 10 of the Food and Drugs Act, 1938, and quantities of unsound food, including meat, were voluntarily surrendered. In accordance with the Livestock (Restriction on Slaughtering Order), 1940, the three licensed slaughter–houses in the Borough are not in use. A comprehensive survey of underground bakehouses has been made in connection with the Certificates of Suitability as required by Section 54 of the Factory Act, 1937. At the time of the passing of the Act, there were 17 underground bakehouses in the Borough to which the provisions of the Section applied. One bakehouse has been demolished and five are not now in use. Schedules, showing the respects in which the remaining 11 underground bakehouses fall short of the standard adopted by the Council, have been served. Sampling. The chemical analysis of food is now carried out by the Public Analyst at the City of Westminster Depot, Monck Street, S.W.I. Eight hundred samples of various foods and drugs were submitted by the Council's Inspector for chemical analysis. One hundred and thirty–three were found to be inferior and three, or a percentage of 0.37, were reported adulterated. Ice–Cream. Premises where ice–cream is manufactured, stored and sold have been frequently inspected by the Council's Food and Drugs Inspector for the purpose of enforcing the requirements of the Ice–Cream (Heat Treatment, etc.) Regulations, 1947. In a number of cases, entirely new ice–cream making plants have been installed. 17 Sixty–nine samples of ice–cream were taken for examination by the methylene blue test. Twenty–two samples were reported to be within grade 1, 16 samples within grade 2, 21 samples within grade 3, and 10 samples within grade 4. This test is mentioned by the Ministry of Health as one which appears to provide the best available means for ascertaining the bacterial cleanliness of ice–cream. It is suggested that, if out of the four grades recommended, ice–cream consistently fails to reach grades 1 and 2, it would be reasonable to regard this as indicating defects of manufacture, or of handling, which call for further investigation. Milk Two hundred and seventy–six samples of milk were submitted to the Public Analyst for chemical analysis. Two, or a percentage of 0.72, were reported adulterated. There are five milk pasteurising plants licensed by this Authority operating in the Borough. These plants are of modern design and employ the latest process of pasteurisation known as the High Temperature Short Time Method. One of these milk plants is considered to be the largest in this country. In addition to those taken for chemical analysis, 164 samples of milk were taken under the Milk (Special Designations) Regulations, 1936/1946, and Regulation 55G of the Defence (General) Regulations, 1939, and submitted for phosphatase, methylene blue and bacteriological tests. It is of interest to note that all samples of milk submitted for the phosphatase test—a test which reveals whether milk has been effectively pasteurised or heat–treated—were reported by the Public Analyst to be satisfactory. FOOD POISONING. Total number of outbreaks. Number of cases. Number of deaths. Organisms or other agents responsible with number of outbreaks of each. Foods involved with number of outbreaks of each. 2 First outbreak—13 2 Bacillus Typhi Murium (Aertrycke). Not known. Second outbreak— 48. Nil Not isolated. Dinner cooked at School Meals Kitchen. 18 Two examples of food poisoning occurred during the year. One was apparently entirely of a domestic nature, whilst the other took place at a public elementary school. In the first, two children died as a result of attacks of Gastro–enteritis and in each case Bacillus Typhi Murium (Aertrycke) was isolated in pure culture from the stools. Later it was found in the family of 13 persons ten carried this organism in the stools for varying periods of time. In one of these there was a history of intermittent attacks of abdominal pain and diarrhoea for about a year. Treatment of three of the most persistent carriers was successful and was of the nature of a " blunderbus " attack with Sulphaguanidine, Sulphadiazine, Sulphasuccidine and Penicillin. In the cases of the other seven carriers of the Bacillus it was found that the carrier state " died " out in periods varying between one and three months without treatment. An epidemic of mild diarrhoea and vomiting was reported in February from an elementary school– in the Borough. Forty–eight members of the children and staff complained of diarrhoea and vomiting with abdominal pains. All had partaken of a school luncheon consisting of roast beef, yorkshire pudding and vegetables, followed by prunes and custard. This meal was delivered at the school immediately before it was consumed. Enquiries at the kitchen where the meal was prepared revealed a sorry state of affairs. Bomb damage, lack of equipment and inadequate supervision of food, during the cooling period after initial cooking, was painfully obvious. Although no organism was isolated from any of the affected persons or from food, I formed the opinion that the luncheon was responsible. CORONERS' COURT AND PUBLIC MORTUARY. There was a slight reduction in the number of bodies admitted to the Public Mortuary during the year. There are no unusual facts to report and the work of the staff continued smoothly and efficiently, as in the previous year. Six hundred and forty–three bodies were admitted to the Public Mortuary during the year 19 BACTERIOLOGY. During the year the following 954 bacteriological tions were made on behalf of the Council:- Specimen. Positive. Negative. Total. Swabs for suspected cases of Diphtheria 1 689 690 Haemolytic Streptococci 148 40 188 Faeces — 52 52 Vincents Organisms — 16 16 Occult Blood — 1 1 Widal — 4 4 Sputum — 3 3 149 805 954 Bodies admitted from the Borough:— By order of Coroner 280 By order of Police 12 On application of undertakers for accom– modation 47 —— 339 Bodies admitted from other Boroughs :— Fulham 3 Chelsea —— 304 643 No. of P.–M. examinations conducted : — Hammersmith cases 271 Fulham „ 46 Chelsea „ 213 Total P.–M.s —— 530 No. of Inquests held :— Hammersmith cases 80 Fulham „ 54 Chelsea „ 62 Kensington „ 100 Total Inquests held —— 296 INFECTIOUS DISEASES (EXCLUDING TUBERCULOSIS). There were, omitting tuberculosis, 1,933 cases of infectious diseases notified in the Borough during the year, against 2,046 in the previous year. 20 Cases of Infectious Disease notified during the year 1948. Notifiable Disease. Number of Cases Notified. At all Ages. Age Periods. Under 1 1— 2- 3— 4— 5- 10— 15— 20— 35— 45— 65— Smallpox — — — — — — — — — — — — — Cholera. Plague. Typhus, Anthrax — — — — — — — — — — — — — Diphtheria 29 — 5 2 — — 2 3 3 7 3 4 — Erysipelas 25 — 1 — — — 1 — — 4 3 12 4 Scarlet Fever 141 2 6 8 17 13 59 17 9 4 5 1 — Enteric Fever 5 — 1 1 — — — — — 3 — — — Relapsing Fever — — — — — — — — — — — — — Puerperal Pyrexia 19 — — — — — — — — 17 2 — — Cerebro–Spinal Meningitis 8 3 1 — — — 1 2 — — — 1 — Poliomyelitis 1 — 1 — — — — — — — — — — Polioencephalitis — — — — — — — — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — Ophthalmia Neonatorum 10 10 — — — — — — — — — — — Pneumonia 70 8 8 9 6 2 5 — 4 3 4 12 9 Malaria 1 — — — — — — — — 1 — — — Dysentery 30 1 — 4 3 1 6 1 2 4 2 6 — Food Poisoning — — — — — — — — — — — — — Measles 905 46 154 119 135 117 303 10 5 14 2 — — Whooping Cough 429 41 84 75 51 51 122 2 — 1 1 1 — Scabies 260 6 6 15 7 8 27 25 13 86 31 27 9 Totals 1,933 117 267 233 219 192 526 60 36 144 53 64 22 21 Notifiable Diseases (other than Tuberculosis) during the Year 1948. DISEASE. Total cases notified. Cases admitted to Hospital. Cases where diagnosis was not confirmed Total deaths. Diphtheria 29 29 24 — Erysipelas 25 14 1 — Scarlet Fever 141 63 5 — Enteric Fever 5 5 4 — Puerperal Pyrexia 19 13 1 1 Cerebro–Spinal Meningitis 8 8 1 5 Encephalitis Lethargica — — — 1 Ophthalmia Neonatorum 10 — — — Pneumonia (Acute Primary and Influenzal) 70 5 †63 Dysentery 30 17 8 — Poliomyelitis 1 1 — 1 Polioencephalitis — — — Malaria 1 — — — Food Poisoning — — — — *Measles 905 70 6 — * Whooping Cough 429 53 6 2 *Scabies 260 — — — Totals 1,933 278 56 73 * This is not total brought to notice of Department, † Deaths from all forms of Pneumonia. TUBERCULOSIS. The number of notifications of tuberculosis registered a considerable fall during the year. This is a very hopeful sign and it is reasonable to suppose that the expected post–war drop in the incidence of the disease has now begun. 22 Part I. Summary of Notifications during the period from the 1st January, 1948, to the 31st December, 1948. Age Periods. Formal Notifications. Number of Primary Notifications of new cases of Tuberculosis. 0– 1– 2– 5– 10– 15– 20– 25– 35– 45– 55– 65– 75– Total (all ages) Respiratory, Males – 1 6 3 3 3 8 21 7 14 11 6 – 83 Respiratory, Females 2 4 2 8 3 18 19 17 6 3 2 – – 84 Non–Respiratory, Males 1 1 3 5 – – 1 3 – – 1 – – 15 Non–Respiratory, Females – – 1 1 2 1 – – – – – – – 5 Part II. New cases of Tuberculosis coming to the knowledge of the Medical Officer of Health during the above-mentioned period, otherwise than by formal notification. Source of Information Number of cases in age Groups. 0- 1- 2- 5- 10- 15- 20- 25- 35- 45- 55- 65- 75- Total Death Returns from Local Registrars Respiratory M - - - - - - - - - - 2 - - 2(A) F - - - - - - - - 1 - - - - 1 (B) Non-Respiratory M - 1 1 - - - - - - - - - - 2 (C) F - - - - - - - - - - 1 - - 1(D) Death Returns from RegistrarGeneral (Transferable deaths) Respiratory M - - - - - - - - - - - - - — (A) F - - - - - - - - - - - - - — (B) Non-Respiratory M 1 - - - - - - - - - - - - 1 (C) F - - - - - - - - - - - - - — (D) Posthumous Notifications Respiratory M - - - - - - - - - - - - - — (A) F - - - - - - - - - - - - - — (B) Non-Respiratory M - - - - - - - - - - - - - — (c) F - - - - - - - - - - - - - — (D) "Transfers" from Other Areas (excluding transferable deaths) Respiratory M - - 1 - - 6 2 11 10 3 - - - 33 (A) F - - - 2 - 1 12 14 3 2 - i - 35 (B) Non-Respiratory M - - - - - - - - - - - - - 1 (c) F - - - - - - - - - - - - - — (D) Other Sources Respiratory M - - - - - - - - - - - - - — (A) F - - - - - - - - - - - - - — (B) Non-Respiratory M - - - - - - - - - - - - - — (c) F - - - - - - - - - - - - - — (D) TOTALS A) 35 (B) 36 (C) 4 D) 1 23 The' following table has been prepared, giving particulars of new cases of tuberculosis and of deaths from tuberculosis during 1948 :— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0- 2 2 1 1 1- 8 6 6 1 — — 2 — 5- 6 13 5 3 — — 1 — 15- 19 50 1 1 19 25- 32 31 4 — 15 — 1 35- 17 10 — — 45- 17 5 — — 22 5 2 2 55- 13 2 1 1 65 and on 6 1 — — 4 1 — — Total 118 120 19 6 45 22 6 3 The ratio of non–notified tuberculosis deaths to the total tuberculosis deaths is 1 to 11. The following table indicates the number of cases and deaths from Tuberculosis:— Year. No. of Cases notified. No. of Deaths. No. of Cases on Register of Notifications. Pulmonary. NonPulmonary. Total. 1929 217 63 280 149 1,334 1930 196 54 250 153 1,293 1931 183 56 239 127 1,198 1932 183 45 228 156 1,128 1933 185 31 216 150 1,056 1934 184 31 215 124 1,070 1935 170 31 201 119 1,059 1936 156 40 196 116 1,063 1937 141 33 174 106 1,068 1938 155 37 192 87 859 1939 165 33 198 107 889 1940 143 24 167 118 813 1941 160 39 199 103 828 1942 169 31 200 104 963 1943 177 24 201 72 1,097 1944 192 22 214 93 1,184 1945 207 23 230 93 1,282 1946 188 23 211 85 1,487 1947 189 21 210 90 1,517 1948 167 20 187 76 1,599 24 Sixty–seven deaths from Pulmonary Tuberculosis were registered, against seventy–six in the previous year, representing a death rate of 0.57 per 1,000 compared with 0.64 in 1947 and 0.67 in 1946. Figures for the years 1929–48 showing the interval between notification and death of tuberculous persons are as under:— 1929. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1937. 1938. 1939. 1940. 1941. 1942. 1943. 1944. 1945. 1946. l. Total number of deaths from Tuberculosis in the Borough 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 3 7 9 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) 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) 18 21 14 17 17 9 8 7 11 6 3 10 10 8 5 9 6 5. The number of cases notified within six months of death (excluding above) 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 1929–1938 (inclusive)=219. Average number of cases notified for the 10 years 1939–1948 (inclusive)=202. Average number of deaths for the 10 years 1929–1938 (inclusive) = 128. Average number of deaths for the 10 years 1939–1948 (inclusive)=94. 25 MASS RADIOGRAPHY. The Campaign for the early detection of symptomless tuberculosis was continued during the year by Miniature Mass Radiography Units provided by the London County Council, and one such Unit was established at the Town Hall for three weeks, 7th June to 12th June and 21st June to 3rd July, for the purpose of conducting the X-ray examinations. Arrangements were also made for the Unit to operate at the premises of the E.N.V. Engineering Company Limited, Hythe Road, Willesden, N.W.10, for a week commencing 14th June, and the directors of the firm very kindly offered the facilities to employees of other firms in the immediate vicinity. The scheme enables large groups of persons to have their chests X-rayed. The object is, of course, to detect anything abnormal and, in particular, to discover cases of early tuberculosis. In the vast majority of cases nothing abnormal is found. Tuberculosis of the lungs begins without any warning, and often before the patient is aware of it, the disease is in an advanced stage. The only method of detecting it before it produces symptoms is by X-ray examination. When discovered in the early stages the treatment of tuberculosis is simple. A number of large industrial undertakings in the Borough were again invited to allow their employees to undergo examination by the Unit, and the managements of the firms proved very co-operative. Certain sessions were reserved for the examination of private residents. The scheme was advertised to the public in the local Press, and the Campaign was started by His Worship The Mayor, who very kindly agreed to be photographed with X-ray apparatus and permitted the Press to publish photographs with suitable captions. It is gratifying to be able to report that the Campaign was an outstanding success, and I append particulars giving the results of the examinations. 26 Total examined Referred for large films Did not reattend No abnormality Caled. and other lesions N.F.A. Referred to General Practitioners Refused further Investigations Probably Tuberculous Probably not Tuberculous Cardio Vase. Males 3,039 150 13 51 49 28 4 5 — Females 1,568 90 2 43 27 13 1 3 1 4,607 240 15 94 76 41 5 8 1 These figures include scholars from the Upper Latymer School, King Street. Following the termination of the examinations at the Town Hall, the Unit visited St. Clement Danes School, Ducane Road. The total, quoted above, was, however, well exceeded, as the Campaign was completed in the autumn with the visit of the Unit to one large firm in the Borough, where, I understand, approximately 3,000 employees were examined. It must be realised, of course, that a particular section of the population was sought out in this Campaign, and therefore the numbers examined do not compare in any way with, say, the total population of the Borough. Workers in particular were the object of the survey, and I have no hesitation in saying that the London County Council's effort was a great success. CLEANSING OF VERMINOUS PERSONS. It is interesting to observe that there has been a reduction in the number of cases treated at the Council's Medicinal Baths during the year 1948. The number of cases arising locally has become less and, in addition, the number of applications from other local authorities for treatment at the Hammersmith Centre has diminished. This is a normal occurrence in peace time and is to be expected, providing there are no major social upheavals, but it may well be that the additional facilities provided by 27 the Council last year for the treatment of the various infestations has had the effect of further reducing the incidence of human insect parasites in Hammersmith. 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. 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 420 Verminous 1,436 Impetigo 17 School Children—Non–Hammersmith. Nil. Children under Five Years—Hammersmith. Scabies 153 Verminous 47 Impetigo 4 Children under Five Years—Non–Hammersmith. Nil. Adults—Hammersmith. Scabies 525 Verminous 123 Adults—Non–Hammersmith. Nil. 28 Lodging–houses. Scabies 6 Verminous 121 DISINFECTION. The following table shows the amount of disinfection carried out by your Council during the year; all bedding and articles of clothing etc., being removed to the Council's Disinfecting Station:- Beds 40 Mattresses 388 Pillows 241 Bolsters 42 Blankets 248 Sheets 96 Quilts 63 Curtains 2 Articles of Clothing 275 Sundries 29 1,424 Rooms (including 410 verminous rooms) 485