AC 4347 Public health Dept. HEM 41 Metropolitan Borough of Hammersmith ABRIDGED ANNUAL REPORT of the Medical Officer of Health WITH STATISTICAL SUPPLEMENT for the Year 1949 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, 1949. Alderman Buckingham, L.C.C. (Chairman). „ Hallett (Mrs.) (Vice-Chairman). Councillor Belsham. Councillor Hayes. ,, Chambon (Mrs.) „ Martin. „ Finn (Mrs.) M.B.E. „ Moore (Mrs.) „ Freeman. „ Pinnell (Miss). „ Giles. „ Woods (Miss). Ex officio: The Mayor (Councillor Hewitt, J.P.) Town Hall, Hammersmith, W.6. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hammersmith. Mr. Mayor, Ladies and Gentlemen,—I have much pleasure in introducing my annual report for 1949. It is presented in two parts—the first in the form of a commentary and the second, statistical tables. This is quite a new feature and one which, I feel, will make the report more readable. 1949 was, of course, the first complete year of the new National Health Service, and is therefore the first complete year of the new regime. Our link with the Health Department of the Borough of Fulham became even closer, and Dr. Mary Irene Adams, our Deputy Medical Officer of Health, was appointed, in addition, Deputy Medical Officer of Health to the Metropolitan Borough of Fulham. It is with much regret that I have to record the sad death of Dr. Harry Smith, the Divisional Medical Officer for this part of London. Nobody could have been more helpful, and his premature demise was a severe loss to the County Council's Health Services. These, however, maintain very happy working liaison with the Borough Council's Health Department, and we all welcome the appointment of Dr. Violet Russell as Divisional Medical Officer in December. Perhaps the most undesirable feature of the year was the severe national epidemic of acute poliomyelitis. A review of the occurrence of cases in the Borough has been made and reveals that more than half of the total number came from that part of Hammersmith where the best housing conditions exist. Furthermore, the next highest total originates from the second best housing area, total percentage from both being 85 per cent. On the other hand, the worst housed area, whose population is about a quarter of the total, only produced one eighth of the 39 cases that we had. It is therefore true to say that more cases have come from the better housed area, and least from the worst. Though, perhaps, conclusions should be conservative, this distribution is in line with the theory that the infection is almost universal, in infancy, but unnoticed. In conjested, badly housed, areas the infection presumably has easy access to all young children, and it is only those who avoid it that are likely to suffer severely later on in life, should they be infected. The ability of recovery of muscle power in the child, of course, becomes less as age advances. a 2 An experiment with terminal disinfection for Scarlet Fever, Measles, Whooping Cough, Dysentery, Food Poisoning, Diphtheria, Puerperal Pyrexia and Erysipelas has been in process for about five years. The experiment is based on the theory that, at the present time, disinfection for any of these conditions is scientifically unnecessary. I refer to spraying of rooms only, and to steam disinfection of clothing. An exception is made in all cases where, for psychological reasons, it might be indicated. The analysis of the incidence of cases of these infectious diseases throughout the London area shows that no greater number have occured in Hammersmith than anywhere else. In fact, if anything, incidence is less than in many other Boroughs. Request for disinfection from relatives are met with an explanation that it is regarded as unnecessary, and this explanation is invariably accepted with relief. In cases, however, where there is some other reason for disinfection it is done. The total number of such cases does not exceed 20 per annum. It is fully realised, however, that should the incidence or clinical severity in any of these conditions alter for the worse, it would be necessary to reconsider the advisability of an experiment of this nature, and the Council's disinfecting services have been so planned that such a reversal of policy could be carried out without any delay in that event. The Council decided during 1949 to appoint an additional Food and Drugs Inspector, and also to appoint three additional District Sanitary Inspectors, and two Inspectors for a survey of housing conditions here. The decision made by the Council during 1948 to sponsor the Hammersmith Clean Food Traders' Guild was followed by its development during 1949 and onwards. In June the first invitations for membership were sent out, and by the end of the year 54 traders had been approved for membership. So far as I am aware, this Guild was the first of its kind in this country to issue to its members an emblem which, in the case of employee members, was worn on the lapel of the jacket or coat. Trader members had display emblems awarded them, which they are encouraged to exhibit in prominent positions in their establishments. The enthusiasm of the trades concerned was such, that without it, little or no progress could have been made. A feature of the Guild's work was the considerable amount of work of improvement carried out in shops, etc. 1949 was, of course, the first whole year in which the responsibility for maternal and child health was removed from the Borough Council. 3 The reduction in maternal and infant mortality so marked up to the end of 1948, continued during 1949. The incidence of Diphtheria remained very low, and no one has died from it in Hammersmith since 1946. The policy of the Housing Committee of the Council has resulted in much new accommodation being made available to nearly 600 Hammersmith families. The provision of such first class accommodation for so many persons can only result in an improvement in health and happiness amongst the Council's new tenants. The County Council also are making marked progress in providing new accommodation, particularly in the White City area of the Borough. The ravages of aerial bombardment and neglect during the war years are still, however, the cause of much bad and unsatisfactory housing conditions. The health of the Borough continues to be of a high standard, and 1949 has turned out to be another of those post war years during which healthy conditions continue to be at a high level. Finally, Mr. Mayor, Ladies and Gentlemen, I wish to thank yourselves, and particularly the members of the Health Committee and its Chairman and Vice-Chairman, for the help and sympathetic consideration that has been given to the problems of the Health Department. The staff, also, are again responsible for the high grade of the work done during the year, and to them, particularly, I wish to extend my very sincere thanks. I am, Your Worship, Ladies and Gentlemen, Your obedient Servant, F. M. DAY, Medical Officer of Health. 4 GENERAL PROVISION OF HEALTH SERVICES. General Statistics. The population of the Borough is now higher than in any of the post war years. The tendency to overcrowd dormitory areas within the County of London appears to be almost unchecked. No epidemic resulting in high mortality occurred during the year. Apart from Poliomyelitis, infectious disease has been of a mild nature and deaths resulting from it have also been at a minimum. Vital Statistics. The infant mortality rate is a new low record, and is now 28 infants for every thousand births. The trend towards greater saving of infant life thus continues to limits hitherto thought almost unobtainable. As no lower death rate (11.0) has ever been recorded, the position becomes comparable to that in many other parts of the country where less children are dying, and more people are living longer. The biggest "killers" are still diseases affecting the heart and important blood vessels, and cancer. It is gratifying, however, to report that during the last ten years the cancer death rate has not increased, but has remained stationary (see table in Statistical Supplement). This, perhaps, is one of few bright spots in the gloomy picture of our failure to master this disease. Infant Mortality. The number of infant deaths was 55 as against 75 in 1948. The tendency, therefore, towards an even lower infant mortality rate appears to be continued. It may be felt of interest to refer, in the Statistical Supplement, to the figures dealing with infant mortality since the beginning of the present century. No better picture could be had of the improvement which has taken place. Maternal Mortality. Only two maternal deaths occurred during the year. Sanitary Inspection. The year was notable for the decision to appoint six new Inspectors. The first three of those to be appointed were scheduled for work as District Inspectors. This would produce 11 districts as against the 8 districts which had been adequate since 1914. It was decided to appoint two further Inspectors in order to carry out a house-to-house survey of the Borough. These two appointments will be of a temporary nature. 5 It was also decided to appoint a further permanent full time Food and Drugs Inspector. The work, therefore, which the Food and Drugs Act, 1938, places upon the Borough Council will be shared in 1950 between 11 District Inspectors and 2 Food and Drugs Inspectors. The increase in the establishment of the Inspectors' department will enable the Senior Inspector and his team to carry out all the statutory duties placed upon them. The war, and its aftermath, and particularly the housing situation, has resulted in a certain amount of "marking time" in the less urgent of the Inspectors' duties in the past. I am hopeful that in future each Inspector will have a full and varied day's work, and a job which he is not incapable of carrying out in the time at his disposal. INCREASE OF RENT AND MORTGAGE RESTRICTIONS ACT, 1920 1939 During the year 11 applications were received for certificates under the above Act, and in 10 cases certificates were granted. This total includes two applications from owners, both of which were issued as the work specified had been completed satisfactorily. RODENT CONTROL. Rats and Mice (Destruction) Act, 1919. Infestation Order, 1943. Rats.—The number of complaints and infestations showed a slight increase over last year, nevertheless, taking the Borough as a whole, the infestation is not severe. All complaints receive thorough investigation, and efforts are made to deal with the origin of each infestation. No instances of "ship" ("black") rats were discovered, all cases being of the "common" or "sewer" rat species. A number of these are found to arise from the sewers, via defective drains, and the repair of the drainage system usually terminates such infestations. A few business firms employ servicing contractors to carry out routine control measures. Others use the services provided by the Council and are charged according to the labour and materials expended. In only nine instances was it found necessary to serve formal notices. By arrangement with the London Transport Executive, baiting of Shepherds Bush Market was undertaken in January and June. Baiting of the Council's sewers is executed by the Borough Engineer and Surveyor's Department. During the 6 year experiments with new materials were tried out by the Infestation Control Division of the Ministry of Agriculture and Fisheries. These experiments are not yet completed but the results, so far, are encouraging. Eighty-eight complaints of mice were received during the year, compared with fifty-two last year. Usually the householder is able to deal with mice infestations. The Sanitary Inspectors are, however, always prepared to give advice on the subject and traps are loaned by the Department on request. In difficult cases the Council's Operatives give practical assistance. Summary:— Total number of complaints received 432 No. of inspections made by Sanitary Inspectors 1339 No. of Private Houses baited 320 No. of Business Premises baited 66 No of Statutory Notices served 9 No. of Prosecutions Nil HOUSING. 1041 complaints of unsatisfactory housing were made to the department during the year. 358 families were found upon investigation to be living in overcrowded conditions, and particulars of this overcrowding were passed to the Housing Department for transmission to the London County Council. 61 cases were recommended for re-housing on grounds of health, tuberculosis, inadequate hygienic facilities for the proper care of babies and young children, and many other serious conditions. The remainder of the cases were found to be living in circumstances which were not considered sufficiently necessitous to recommend for re-housing. A new feature of interest, however, should be included in this report. A recommendation for re-housing of a special character was made to the Borough Council's Housing Department in all cases where the applicant represented a recently married family who were expecting a baby, or where there were young children already living in impossible conditions. Applications from persons such as these are most important, as, though in good health, they are likely to suffer from health deficiencies, because of their housing conditions. The Housing Department, in spite of their many difficult responsibilities, agreed to accept these recommendations, and do the best they could in each case. During the year 34 such recommendations were made to the Housing Estates Manager of the Borough Council. 7 One can only record with pleasure that, during the year, blocks of new flats have been opened on the Estates in Aspen Gardens, Flora Gardens, Kelmscott Gardens, Becklow Gardens, Westville/Percy Roads, Coningham Road, and Frithville Gardens, and approximately 380 families have been re-housed. It is unlikely, owing to the difficulty in metropolitan London of obtaining sites for further new buildings, that similar progress can be maintained for very long. 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 1,173. 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 sixteen 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. 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. NATIONAL ASSISTANCE ACT, 1948. Removal to suitable premises of persons in need of care and attention. Section 47 of the above Act provides that a 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 five occasions to apply to the Court for Orders under this section during the year. Enquiry and consideration into all the cases showed that, in their interest and for preventing injury to the health of others, they should be removed from the premises in which they were residing. 8 In one case, an Order was obtained from the West London Magistrates' Court for the patient's removal to and detention in an Institution for a period of three months, which was extended for a further period of three months. In the other four cases, Orders were obtained from the West London Magistrates' Court for their removal to and detention in various Hospitals for a period of three months. Two of the cases died whilst in hospital. The condition of the other two cases so improved—no further nursing was considered necessary—that a variation of the Court Orders was obtained for their removal to and detention in an Institution for a period of three months, which was further extended for periods of three months. Fifty-five other cases, all elderly persons, alleged to be living without proper care and attention, were reported, but in no case was it found necessary to take legal action to enforce removal to hospital. In sixteen cases, however, it was possible to arrange voluntary admission to hospital. 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 being 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 twenty-two burials have been carried out in Hammersmith at a total cost of £199 18s. Of this amount, £73 2s. 7d. has been recovered. FOOD AND DRUGS ACT, 1938. Meat and other Foods. Two seizures of unsound food were made under Section 10 of the Act. The commodities were bread and a meat pie, and in each case they were taken before magistrates who ordered the destruction of the foodstuffs as being unfit for human consumption. Quantites of unsound food were also voluntarily surrendered during the year (see list in Statistical Supplement). Shops, stalls, vehicles and premises where food intended for human consumption is prepared, stored, etc., were subjected to routine inspection throughout the year. 9 Sampling. During the year 637 samples were submitted to the Public Analyst for analysis by the Council's Food and Drugs Inspector. Of this number, 9 or 1.4 per cent. were reported adulterated. Markets. There are three markets in the Borough, situate in Bradmore Lane, Railway Approach and Norland Road. These markets have been inspected throughout the year by the District Inspector concerned and the Food and Drugs Inspector. Structural alterations and improvements have been made in connection with Section 13 of the Food and Drugs Act, 1938. One butcher's business and one refreshment business has been entirely reconstructed. Washing facilities for staff have been provided in 18 food premises. Slaughterhouses. In accordance with the Livestock (Restriction on Slaughtering Order) 1940, the three slaughterhouses in the Borough are not in use, but the licences have been renewed by the occupiers. Underground Bakehouses. Section 54 of the Factory Act, 1937, provides that a basement bakehouse shall not be used as a bakehouse unless it was so used at the date of the passing of the Act, and a Certificate of Suitability in respect thereof had been issued prior to that date. The Act placed upon the Council the duty of examining every basement bakehouse during the year following the coming into operation of the Act, and in every fifth succeeding year. If, as the result of any such examination, the Council are not satisfied that the bakehouse is suitable for use as regards construction, height, light, ventilation and any hygienic respect, they may give notice that the Certificate shall cease to have effect after a specified period, and from that date the bakehouse may not be used as such. 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 since been demolished, and the use of five as bakehouses discontinued. The remaining eleven were inspected by the Food and Drugs Inspector and schedules showing the respects in which they fell short of the standard adopted by the Council were served. As a result of this, the use of five more as bakehouses has been discontinued, two are in use temporarily pending the building of new bakehouses at ground floor level, and in four cases only have the Certificates of Suitability been renewed following completion of the work to the satisfaction of the Council. 10 Ice Cream. Section 14, Food and Drugs Act, 1938, requires all premises used for the sale, or the manufacture for the purpose of sale, or the storage of ice-cream intended for sale, to be registered by the local authority and imposes a penalty for the use of any premises without being so registered. Premises used primarily as a club, hotel, inn or restaurant, etc., are exempt. Three applications for registration under this Section were refused by the Council as the premises failed to comply with the requirements of the Act. There are 207 registered ice-cream premises in the Borough, and 459 visits were made at these premises by the Food and Drugs Inspector. During the year 84 samples of ice-cream were taken in course of manufacture and during sale for bacteriological examination and chemical analysis. The results of the methylene blue test (which indicated the bacterial cleanliness of ice-cream) is as follows:— 23 Samples were within Grade 1 standard. 23 Samples were within Grade 2 standard. 14 Samples were within Grade 3 standard. 24 Samples were within Grade 4 standard. A large percentage of samples falling within Grade 4 was due to concentrated sampling of one particular manufacturer, whose product in addition to being reported in the lowest grade of the methylene blue test, contained bacillus coli of faecal origin. In order to ascertain the cause of this, samples were taken at frequent intervals at the factory, and at all stages of manufacture. All the staff were interviewed and questioned on their work and habits. Following structural alterations to the premises, the installation of modern manufacturing equipment and the re-organisation of methods of sterilization of plant and utensils, the samples reverted to Grade 1. Although there is no legal chemical standard for ice-cream, the Ministry of Food has asked local authorities to inform them of any samples reported to contain a minimum fat content of 2½ per cent. in order to ensure that additional supplies of sugar and fats made available to certain ice-cream manufacturers are being used. All samples showed a fat content above this figure, ranging from 3.3 per cent. to 11.8 per cent., together with a non-fatty solid content between 18.2 per cent. and 34.7 per cent. Milk. 58 samples of milk were submitted to the Public Analyst for chemical analysis, all of which were reported genuine. 11 In addition to those taken for chemical analysis samples of Special Designated milk were submitted for the phosphatase, methylene blue and turbidity tests. During the year the Milk and Dairies Regulations, 1949 and the Milk (Special Designations) Regulations, 1949, came into force and became operative on the 1st October. A brief comparison of the old and new regulations showing the more important alterations made in the law may be of interest. The Milk and Dairies Regulations, 1949, which revoke the Regulations of 1926/1943 also re-enact those Regulations with amendments. The description "Distributor" is new, and is defined as a person trading as a dairyman elsewhere than at or from premises in relation to which he is registered as a dairy farmer. A dairy farmer means a dairyman who produces milk from cows, and under Part 3 (Para. 8) no person shall carry on the trade of distributor or use any such premises as a dairy, not being a dairy farm, unless he, or as the case may be, those premises are registered. Except in the case of a purveyor of milk, both the premises and the person must be registered with the Local Authority, and unless a person is a dairy farmer, he must now be registered as a distributor. In the general provisions relating to buildings and water supplies, certain premises must not be used which are so situated as to lead to the risk of contamination of the milk. It has been said that this provision is vague, but it may be found useful in cases where adjoining premises are unsuitable by reason of the trade or business carried on. Useful new provisions are made in respect of the construction of the floor and walls of all buildings or part of buildings, except where milk is solely or mainly dealt with by way of retail sale. Under the 1926/1943 Regulations producers only were required to bring the temperature of milk down to 55°F; now the dairy farmer and distributor must cool milk, with certain exceptions, to 50°F, providing in the case of the latter, the milk has not been previously cooled. Some new points in connection with the protection of milk against contamination are given in Part 3 (Para. 21) which prohibits the handling, processing or storing of milk in any room or part of a building which communicates directly by the door, window, or otherwise with a boiler house, fuel store, or a room in which an internal combustion engine is operated. Except in premises where milk is kept in sealed containers, the occupier must provide facilities for persons to wash and c 12 cleanse themselves, including an adequate supply of soap, clean towels and clean water, both hot and cold. This paragraph is disappointing; it does not even go as far as the much criticised washing provision of Section 13, Food and Drugs Act, 1938. The Milk (Special Designations) Act, 1949, revokes Regulation 55G of the Defence (General) Regulations, 1939, and in place of the Milk (Special Designations) Regulations, 1936/1948, we now have two sets of legislation dealing with designated milk, one for designated raw milk, and the other for designated heat treated milk. The Milk (Special Designations) (Raw Milk) Regulations, 1949, relate only to cows' milk which has not been treated by heat, and authorises the use of the designations "Accredited" and "Tuberculin Tested". Producers' licences are issued by the Ministry of Agriculture, and Dealers' licences by the Local Authorities. The Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949, provides for two designations, "Pasteurised" and "Sterilised". The Food and Drugs Authority is responsible for the licencing in relation to milk pasteurised or sterilised on the premises of the applicant, and the Local Authority for the licencing of other dealers. Under both Regulations, the charging of fees is abolished. It should be borne in mind that the granting of dealers' licences is subject to the applicant satisfying the licencing authority that his arrangements for the handling, storage, treatment and distribution of milk, as the case may be, are such as to comply with all the relevant provisions of the Milk and Dairies Regulations, 1949, and the Milk (Special Designations) Regulations under which the application is made. The Regulations provide that licences shall authorise the sale of milk only at or from the premises mentioned on the licence, so removing the provision contained in Article 4 (2) of the 1936/1948 Regulations by which a licence for a pasteurising establishment applied also to milk pasteurised there and sold by the licencee from any other place in the same area. A person holding a dealer's licence for the sale of a designated milk by wholesale, may sell such milk, by wholesale, outside the licencing area without holding a supplementary licence. Also, a person holding a Pasteuriser's or Steriliser's licence need not hold a dealer's licence for such milk he sells wholesale. From 1st October, 1949, Sterilised milk became a special designation, and may only be sold by the holder of a licence. The prescribed test (the methylene blue reduction test of 4½ hours between May and October, and 5½ hours between November and April) for "Accredited" and "Tuberculin 13 Tested" milk remains the same; the requirement that these milks shall contain no coliform bacillus in 1/100 of a millilitre, is discontinued. The tests for Pasteurised milk, a methylene blue test of 30 minutes' duration, and the phosphatase test are unaltered. The turbidity test is prescribed for Sterilised milk; the presence of any signs of turbidity indicating that the milk has not been effectively heated to sterilisation temperatures. 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. 1 4 (all in one family). Nil. Not isolated. Suspected food involved was a joint of meat purchased on 9th July, but not finally consumed until 12th July after which date the symptoms occurred. In addition to the above, seven cases were notified from various addresses in the Borough. There were no deaths. In three of the cases Bacillus Aertrycke was isolated as the responsible organism, and in one case Salmonella. Organisms were not isolated in the remaining three cases. Foods involved included rock salmon, meat pies and duck eggs, but it was not possible to isolate any organism from any of these foods. HAMMERSMITH CLEAN FOOD TRADERS' GUILD. The Hammersmith Clean Food Traders' Guild was formed during the year to promote improvement in the conditions under which foodstuffs are prepared and sold in the Borough and to encourage the adoption of more hygienic methods of manufacture, handling and distribution of foodstuffs. The formation of the Guild followed the presentation of reports to the Health Committee of the Council, in which it was shown that whilst in many cases conditions were satisfactory, in a number of instances the hygienic standards left much to be desired. It was pointed out that the condition of many premises had deteriorated during the war. During that period labour and materials for carrying out necessary repairs and improvements were scarce, inspection and supervision of food shops and factories could not be undertaken to the extent that was the practice in pre-war days, the man-power available to 14 the food traders was insufficient and often unsatisfactory. These and several other factors had contributed to the lowering of the hygienic standards which there is every right to expect wherever foodstuffs are handled. The report pointed out further that whilst the position in regard to some of these matters was still not entirely satisfactory, circumstances had improved to an extent sufficient to warrant a considerable improvement over war-time conditions. The Health Committee considered how best to seek this improvement. They could, of course, have concentrated upon the inspection of premises and the service of notices in regard to all matters falling short of present day legal requirements, followed, in cases of non-compliance, by prosecutions in the Courts. They felt, however, that a better course would be to invite the co-operation of the traders themselves and for the two parties to work out jointly an agreed plan of campaign. They, therefore, invited to a meeting representatives of the various Food Trades Associations, the Chamber of Trade and Commerce, the Trades Council, the larger firms manufacturing and retailing foodstuffs in the Borough and representatives of the Employees' Unions. The meeting was well attended and after a very full discussion it was unanimously agreed to form the Hammersmith Clean Food Traders' Guild. A Committee was set up to draft a Constitution and to undertake the management of the Guild. One of the first tasks of the Committee was the preparation of "Codes of Practice" for each of the different sections of the food trade, e.g., bakers, butchers, dairies, etc. The codes as drafted, were accepted as reasonable and agreed to by the representatives of the Borough Council, the Trades Organisations and the Employees' Trades Unions. Every food retailer and distributor in the Borough was supplied with a copy of the Code applicable to his particular trade and he was invited to apply for membership of the Guild. To qualify for membership of the Guild, a trader must give an undertaking that he will comply with the requirements of the appropriate Code of Practice and his premises must be the subject of a satisfactory report by the Borough Medical Officer of Health. Each trader accepted as a member of the Guild is supplied with an Emblem, which is of attractive and distinctive design, which he can display in his window, or on his premises. The first response to the invitations was good, and a number of applications were received. In all cases where the premises complied with the Guild's requirements the trader was enrolled as a member. In quite a number of cases, however, 15 the reports upon the premises showed some departure from the Code. In each of these cases, the applicant was informed of the respects in which his premises fell short of the required standard. The majority of such applicants were anxious to co-operate, and many have since made such alterations or amendments as were necessary to enable them to be accepted into membership. As soon as a trader is enrolled in the Guild, a letter is sent to each of his employees informing them of the objects of the Guild, and inviting them to become "Employee Members." To do so they, also, must give an undertaking to comply with the Guild's Code of Practice. Each Employee Member is entitled to wear a badge which is in metal gilt and blue enamel, and bears a reproduction of the Borough Coat of Arms. A deposit of 1s. is required for each badge, but this is returnable should the member leave his employment and return the badge. The Scheme is still in the experimental stage. Up to the time of writing this report, applications for membership in respect of 114 shops have been received. Of this number 67 have been enrolled, three have been refused membership as the premises or type of business was considered unsuitable, and two are in abeyance. In the remaining 42 cases, the traders have been asked to carry out certain work to bring their premises into line with the appropriate code of practice before membership is granted. 150 Employee Members have been enrolled in the Guild. For the future, much will depend upon its becoming widely known to the general public. It is hoped that, before long, housewives and others will look for the Emblem when shopping, and will patronize those shops where it is displayed with the knowledge that foodstuffs sold from the premises have been prepared and handled in accordance with the Code of Practice agreed upon by the Guild. Schemes, similar in many respects to that operating in Hammersmith, have been started in other areas including some of the Metropolitan Boroughs. Having this in mind, the Advisory Committee of the Guild suggested to the Council that the Metropolitan Boroughs' Standing Joint Committee should be approached with a request that that body consider the various schemes in operation, and make representations to their constituent Councils with a view to concerted action over the whole of the Metropolitan area. The Advisory Committee felt that a unified scheme covering the whole of London would be likely to achieve greater success than a number of smaller campaigns in scattered areas, moreover, wider publicity could be obtained by combined effort, and at a lower cost. 16 The representations of the Council were sympathetically received by the Standing Joint Committee, and they are at present collecting information upon which a model outline scheme could be based. CORONERS' COURT AND PUBLIC MORTUARY. The amount of work at the Coroners' Court and Mortuary did not vary much from the previous year. The Mortuary and Court were again used by the Boroughs of Chelsea, Kensington and Fulham. TUBERCULOSIS. The fall in notifications which I had pleasure in reporting last year was not maintained, and new cases rose to a very similar number to those notified in 1947. Deaths, however, dropped to a number well below that for any year on record, and whilst this is a reassuring feature, the incidence of new cases, in my opinion, more than overshadows it. However, the willingness of the Housing Authorities to re-house tuberculous persons is such that this complaint receives greater priority than any other, and so it is reasonable to suppose that control will be maintained over the spread of all the various types of this condition. MEDICINAL BATHS. There has been a further fall in the incidence of Scabies and the various verminous conditions requiring treatment at the Council's Medicinal Baths. The County Council continue to use this centre for treatment of school children, and special attention has been given also to head infestations at the Welfare Centres and at the Day Nurseries. Domiciliary advice on methods of prevention, treatment and eradication is a further necessary requirement and has been maintained. Families particularly troubled with re-occurrences have received care and attention also from the Health Visitors and from the Sanitary Inspectors. One mobile team is available for dealing with homes that require spraying and other treatment, and because of the reduction in cases dealt with at the Baths itself, it has been possible to send out this team to a greater extent than since before the war. STATISTICAL SUPPLEMENT TO ANNUAL REPORT FOR YEAR 1949 2 GENERAL STATISTICS—1949 Area 2,282.5 acres Population (1948) (estimated) 115,800 „ (1949) 118,440 „ Census (1901) 112,239 „ (1911) 121,521 „ (1921) 130,295 „ (1931) 135,521 Natural increase, i.e., excess of births over deaths 662 Density of population (persons per acre) 51.90 Marriages registered 1,246 Rateable value (April, 1949) £1,189,683 Sum represented by a penny rate (April, 1949) £4,880 EXTRACT FROM VITAL STATISTICS—1949. Total. M. F. Birth Rate per 1,000 estimated resident population= 16.6 Live Births Legitimate 1,823 902 921 Illegitimate 148 88 60 Stillbirths 41 20 21 Rate per 1,000 total (live and still) births=20.3 Deaths 1,309 653 656 Death Rate per 1,000 estimated average population=11.0 Deaths from puerperal causes— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis — — Other puerperal causes 2 0.99 Total 2 0.99 Death Rate of Infants under one year of age:— All Infants per 1,000 live births 28 Legitimate Infants per 1,000 legitimate live births 27.97 Illegitimate Infants per 1,000 illegitimate live births 27.02 Deaths from Cancer (all ages) 238 „ „ Measles (all ages) — „ „ Whooping Cough (all ages) 1 „ „ Diarrhoea (under 2 years of age) 2 3 INCIDENCE OF CANCER DURING THE PAST 10 YEARS. Year. Population. Deaths. Rate per 1,000 1940 98,320 220 2.2 1941 84,880 181 2.1 1942 89,370 204 2.2 1943 92,050 206 2.2 1944 89,190 200 2.2 1945 96,100 207 2.1 1946 111,860 226 2.0 1947 117,280 253 2.1 1948 115,800 254 2.1 1949 118,440 238 2.0 4 VITAL STATISTICS OF WHOLE DISTRICT—1949 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. Number. Rate. 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 per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 1925 134500 2351 17.5 1034 7.7 186 756 153 65 1604 11.9 1926 134400 2188 16.3 1174 8.7 195 556 144 66 1535 11.4 1927 132800 2076 15.6 1581 11.9 230 377 126 61 1728 13.0 1928 136300 2258 16.6 1449 10.6 222 326 156 69 1553 11.4 1929 136900 2162 15.8 1757 12.8 222 340 133 62 1875 13.7 1930 136900 2173 15.9 1387 10.1 219 436 140 64 1604 11.7 1931 135100 2073 15.3 1567 11.6 288 373 140 68 1652 12.2 1932 133700 1940 14.5 1465 10.9 294 543 129 66 1714 12.8 1933 131400 1827 13.9 1500 11.4 340 530 119 65 1690 12.9 1934 129170 1783 13.8 1359 10.5 346 655 137 77 1668 12.9 1935 128100 1877 14.7 1347 10.5 406 583 131 70 1524 11.9 1936 127700 1922 151 1399 10.9 441 639 116 60 1597 12.5 1937 126500 1913 151 1333 10.5 402 662 130 68 1593 12.6 1938 125100 1874 15.0 1340 10.7 450 522 117 62 1412 11.3 *1939 B122800 1829 14.9 1311 11.2 362 442 77 43 1391 12.0 D116200 1940 98320 1600 16.3 1725 17.5 370 401 76 51 1756 17.9 1941 84880 1405 16.5 1315 15.4 351 364 52 41 1328 15.6 1942 89370 1589 17.8 1270 14.2 356 338 94 59 1252 14.0 1943 92050 1768 19.2 1278 13.9 365 387 102 58 1300 14.1 1944 89190 1788 20.0 1447 16.2 418 389 95 53 1418 15.9 1945 96100 1742 18.1 1464 15.2 423 267 78 45 1308 13.6 1946 111860 2310 20.6 1522 13.6 463 277 103 45 1336 11.9 1947 117280 2559 21.8 1570 13.3 472 271 97 38 1369 11.6 1948 115800 2149 18.5 1608 13.8 547 241 75 35 1302 11.2 1949 118440 1971 16.6 1532 12.9 545 322 55 28 1309 11.0 * B=Birth-rate Population Figure. D = Death-rate Population Figure, 5 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1949. cause of death. Sex. 0— 1— 5— 15— 45— 56— Total all Ages. 1. Typhoid and Paratyphoid Fevers m 0 0 0 0 0 0 0 F 0 0 0 0 0 o o 2. Cerebro-spinal Fever m 0 0 0 0 0 0 0 3. Scarlet Fever F 0 1 0 0 0 0 1 m 0 0 0 0 0 0 0 4. Whooping Cough F 0 0 0 0 0 o o m 0 0 0 0 0 0 0 5. Diphtheria F 1 0 0 0 0 0 1 m 0 0 0 0 0 0 0 6. Tuberculosis of Respiratory System F 0 0 0 0 0 0 0 m 0 0 0 9 16 4 29 F 0 0 0 11 4 1 16 7. Other forms of Tuberculosis m 0 1 0 2 0 0 3 8. Syphilitic Diseases F 0 2 0 1 0 0 3 m 0 0 0 1 3 1 5 9. Influenza F 0 0 0 0 1 1 2 m 0 0 0 2 1 3 6 10. Measles F 0 1 0 0 2 4 7 M 0 0 0 0 0 0 0 11. Ac. Poliomyelitis and Polioencephalitis F 0 0 0 0 0 0 0 m 0 1 1 0 0 0 2 F 0 0 0 0 0 0 0 12. Ac. Infantile Encephalitis m 0 0 0 0 0 0 0 13. Cancer of Buc. Cav. and Oesoph. (M), Uterus (F) F 0 0 0 0 0 0 0 m 0 0 0 1 1 0 11 F 0 0 0 1 3 6 10 14. Cancer of Stomach and Duodenum m 0 0 0 1 8 0 18 F 0 0 0 0 7 11 18 15. Cancer of Breast m 0 0 0 0 0 0 0 16. Cancer of all other sites F 0 0 0 3 12 10 25 m 0 0 1 10 47 45 103 17. Diabetes F 0 0 1 2 18 32 53 m 0 0 0 0 0 2 2 18. Intra-cranial vascular Lesions F 0 0 0 0 1 2 3 m 0 0 0 0 14 38 52 19. Heart Disease F 0 0 0 2 13 80 95 m 0 0 0 7 39 115 161 20. Other Diseases of Cire. System F 0 1 0 4 27 171 203 M 0 0 0 0 6 26 32 21. Bronchitis F 0 0 0 1 6 24 31 m 0 0 0 2 17 37 56 22. Pneumonia F 0 0 0 1 8 32 41 m 7 1 0 0 10 26 44 23. Other Respiratory Diseases F 1 1 0 3 5 21 31 m 2 0 0 0 6 5 13 24. Ulcer of Stomach or Duodenum F 0 0 0 1 4 4 9 m 0 0 0 2 4 5 11 F 0 0 0 0 0 4 4. 25. Diarrhoea under 2 years m 1 1 0 0 0 0 2 26. Appendicitis F 0 0 0 0 0 0 0 m 0 0 0 1 2 1 4 27. Other Digestive Diseases F 0 0 0 0 0 0 0 m 0 0 0 0 2 6 8 28. Nephritis F 0 0 0 1 4 6 11 m 0 0 0 1 5 3 9 29. Puerperal and Post-abortive Sepsis F 0 1 0 2 2 3 8 m 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 30. Other Maternal Causes m 0 0 0 0 0 0 0 31. Premature Birth F 0 0 0 1 1 0 2 m 14 0 0 0 0 0 14 32. Con. Mal. Birth Injuries Infant Dis F 8 0 0 0 0 0 8 m 9 0 0 1 0 0 10 F 8 0 0 0 4 0 12 33. Suicide M 0 0 0 4 3 0 7 34. Road Traffic Accidents F 0 0 0 2 1 2 5 M 0 1 2 3 2 1 9 35. Other Violent Causes F 0 0 0 0 0 2 2 M 1 0 1 6 1 3 12 36. All Other Causes F 0 1 0 2 1 8 12 m 2 0 0 4 9 15 30 F 1 0 0 7 16 19 43 m 36 5 5 57 196 354 653 F 19 8 1 45 140 443 656 Total of all Causes 55 13 6 102 336 797 1309 6 INFANT MORTALITY- 1949 and Previous Years. Year. Births. Deaths of Infants. Deaths of Infants per 1,000 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 4 ‡ 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 1949 1971 55 28 * 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 36 1-2 weeks 2 2-3 weeks 1 3-4 weeks 1 4 weeks and under 3 months 5 3 months and under 6 months 6 6 months and under 9 months 3 9 months and under 1 year 1 Total deaths under 1 year 55 Net. Births in the Year: Legitimate, 1,823 ; Illegitimate, 148. Net. Deaths in the Year: Legitimate Infants, 51; Illegitimate Infants, 4. MATERNAL MORTALITY—1949 and Previous Years Year. Number of Deaths. Number of live Births. Maternal Death Rate. Puerperal Sepsis. Other Accidents of Pregnancy. Average 1924-1933 4 4 2,145 3.5 1934 4 5 1,783 5.0 1935 1 1 1,877 1.1 1936 1 2 1,922 1.6 1937 1 3 1,913 2.1 1938 — 2 1,874 1.1 1939 1 1 1,829 1.0 1940 — — 1,600 — 1941 1 1 1,405 1.5* 1942 - † 3 1,589 1.9 1943 2 1 1,768 1.6 1944 1 1 1,788 1.08 1945 — 1 1,742 0.56 1946 2 5 2,310 2.94 1947 1 — 2,559 0.38 1948 1 — 2,149 0.45 1949 — 2 1,971 0.99 * Rate calculated on a (live and still) birth figure supplied by the Registrar-General of 1,289. † I death from puerperal sepsis not counted as "Maternal death." 8 ENVIRONMENTAL HEALTH SERVICES. (A) SANITARY INSPECTION. Cause of Inspection. No. of Inspections. No. of Notices served. No. of Notices complied with. Bakehouses 156 3 1 Cancer 4 — — Complaints 4.391 2,552 2,536 Drainage 1,712 26 14 Factories (Mechanical) 313 29 17 Factories (Non-mechanical) 130 3 13 Food (other than Restaurants and Eating Houses) 1,450 7 2 House to House 636 — — Housing Act 492 4 2 Ice Cream Vendors 375 3 — Infectious Diseases 486 11 7 Licences (Building) 1,144 3 4 Markets 282 — — Milk Vendors 280 — — Outworkers 674 6 6 Pharmacy and Medicines Act 115 — — Public Urinals 25 1 2 Rats and Mice 1,339 143 116 Re-Housing 1,276 112 67 Restaurants and Eating Houses 159 12 5 Scabies 7 — — Shops Act 176 26 12 Slaughterhouses 4 — - Smoke Observations 86 6 6 Miscellaneous 1,176 41 25 Re-visits 11,076 985 893 No Answer 4,432 — — No. of Ineffective Visits 32,396 3,973 3,728 4,432 — — Total 27,964 3,973 3,728 During the year, 1,689 Statutory Notices were served and 1,373 complied with. (B) SUMMONSES—Proceedings instituted during the year Public Health (London) Act, 1936 124 Rats and Mice (Destruction) Act, 1919 1 Food and Drugs Act, 1938 5 Housing Act, 1936 5 9 (C) 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 215 130 3 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 447 313 29 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 662 443 32 — 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) 2 4 - - - Overcrowding (S.2) — — — — — Unreasonable Temperature (S.3) - - - - - Inadequate Ventilation (S.4) - - - - - Ineffective Drainage of Floors (S.6) - - - - - Sanitary Conveniences (S.7)— (a) Insufficient 2 2 — — — (b) Unsuitable or Defective. 1 1 - - - (c) Not separate for Sexes 3 3 - - - Other offences against the Act (not including offences relating to Outwork) - - 23 - - Total 8 10 23 — — 10 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. 141 — — 2 2 — Cleaning and Washing — Household Linen 2 - — — — — Lace, Lace Curtains and Nets - - - - - - Curtains and Furniture Hangings 3 - - - - - Furniture and Upholstery 1 — Electro-plate 1 - — — — — File Making — - — — — — Brass and Brass Articles — - — — — — Fur Pulling — - — — — — Iron and Steel Cables and Chains - - - - - - Iron and Steel Anchors and Grapnels - - - - - - Cart Gear — - - — — — Locks, Latches and Keys — - — — — — Umbrellas, &c. 5 - — — — — Artificial Flowers 6 - — — — — Nets, other than Wire Nets - - - - - - Tents — - — — — — Sacks — - — — — — Racquet and Tennis Balls - - - - - - Paper Bags 7 - — — — — The making of Boxes or other Receptacles or parts thereof made wholly or partially of Paper 14 - - - - - Brush Making 1 - — — — — Pea Picking — - — — — — Feather Sorting 2 - — 2 2 — Carding, &c., of Buttons, &c. 30 - - 1 1 Stuffed Toys 60 - — — — — Basket Making — - — — — — Chocolates and Sweetmeats - - - - - - Cracker Bon-bon, Christmas Crackers, Christmas Stockings, &c. 96 - - 1 1 - Textile Weaving 1 - — — — — Lampshades — - — — — — Total 370 — — 6 6 — 11 (D) HOUSING. 1. Total number of houses in the borough, cluding flats, tenements, &c., separately assessed 24,000 (approx.) Public Health Act 2. Number of houses inspected on account of complaints or illness 4,391 3. Number of statutory notices served 1,689 4. Number of houses repaired or nuisances remedied 2,536 Housing Act, 1936 5. Number of houses inspected—house to house (Housing Consolidated Regs. 1925) Nil 6. (a) Number of houses included by tions 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 18 (b) by L.A. in default of owners 1 8. Number of houses demolished:— (a) in pursuance of orders under Sec. 11 of the Housing Act, 1936 Nil (b) voluntarily 11 9. Number of houses (wholly or in part) the subject of Closing Orders (excluding underground rooms) 2 10. Number of Closing Orders determined (i.e., houses made fit) Nil 11. Overcrowding (Housing Act, 1936) Number of families found to be living in overcrowded conditions 358 Number of overcrowded families who have obtained alternative accommodation 132 12. Number of houses erected by the Borough Council for working classes during the year 380 (Flats) 13. Underground Rooms Number occupied but unfit Unknown Number closed or modified occupation approved 6 14. Houses let in Lodgings Number in Borough 9,600 (approx.) *Number of inspections Nil Number of prosecutions Nil † Number of complaints remedied under the By-laws (not included under any other heading) Nil * Included under item No. 2. † Included under item No. 4. 12 (E) UNSOUND FOOD CONDEMNED—1949. Baby Food 29 tins Bacon 24 lbs. Baked Beans 157 tins Beetroot 10 tins Bovril 1 jar Cakes 68 lbs. Carrots 18 tins Cereals, Various 198 lbs. Cheese 98 lbs. Chickens 850 lbs. Chocolates 18 lbs. Chocolate Rolls 25 lbs. Cocoa 37 tins Coffee 7 bottles Dried Fruit 88 lbs. Eggs 756 Eggs (Dried) 63 lbs. Fish 1,607 lbs. Fish 992 tins Fish Cakes 2 Flour 57 lbs. Fruit 1.410 tins Fruit Pulp 1,857 lbs. Gravy Powder 16 tins Jam and Marmalade 119 lbs. Meat 2,595 lbs. Milk 3,433 tins (Skimmed Milk) 15 cwt. (Skimmed Milk Powder) 5 cwt. Nut Butter 34 lbs. Olives 8 jars Pastry Mixture 25 lbs. Peas 310 tins Pickles, Sauces 55 bottles Rabbit 376 lbs. Salad Cream 73 bottles Sausages 123 lbs. Sausage Rolls 560 Soup 88 tins Spaghetti 37 tins Spinach 12 tins Sponge Puddings 50 lbs. Syrup 2 tins Tea ½ lb. Tomatoes 638 lbs. Tomato Juice 9 tins Tomato Puree 430 lbs. Tongue (Tinned) 48 lbs. Trifle 18 lbs. Vinegar 3 bottles 13 PUBLIC MORTUARY—Bodies admitted, &c. Bodies admitted from the Borough:— By order of Coroner 256 By order of Police 4 On application of undertakers for accommodation 27 287 Bodies admitted from other Boroughs:— Fulham 86 Chelsea 217 Kensington 4 307 Total bodies admitted 594 No. of P.-M. examinations conducted:— Hammersmith cases 233 Fulham „ 79 Chelsea ,, 200 Kensington ,, 4 Total P.-M.s 516 No. of Inquests held:— Hammersmith cases 66 Fulham „ 50 Chelsea „ 44 Kensington „ 112 Total Inquests held - 272 14 INFECTIOUS DISEASES (A) Cases notified during the year 1949. 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 42 1 1 1 3 2 10 — 5 9 9 1 — Erysipelas 19 — — — — — 1 2 1 3 4 2 6 Scarlet Fever 180 2 7 15 20 16 93 22 3 1 — 1 — Enteric Fever 1 — — — — — — — — 1 — — — Relapsing Fever — — — — — — — — — — — — — Puerperal Pyrexia 16 — — — — — — — 2 10 4 — — Cerebro-Spinal Meningitis 8 2 — 1 — — 4 — — — — 1 — Poliomyelitis 62 2 12 7 5 3 14 7 3 8 1 — — Polioencephalitis 2 — — — — — 2 — — — — — — Encephalitis Lethargica — — — — — — — — — — — — — Ophthalmia Neonatorum 3 3 — — — — — — — — — — — Pneumonia 50 1 3 7 3 2 5 — — 9 1 12 7 Malaria 1 — — — — — — — 1 — — — — Dysentery 16 3 3 1 — 1 1 1 — — 3 2 1 Food Poisoning 11 1 — 1 — — — 1 1 1 1 5 — Measles 867 32 138 137 119 129 290 4 8 6 2 2 — Whooping Cough 244 21 50 34 36 37 61 1 — 2 1 1 — Scabies 138 — 4 3 7 6 11 12 8 53 16 12 6 Totals 1,660 68 218 207 193 196 492 50 32 103 42 39 20 15 (B) NOTIFIABLE DISEASES (OTHER THAN TUBERCULOSIS) DURING THE YEAR 1949. DISEASE. Total cases notified. Cases admitted to Hospital. Cases where diagnosis was not confirmed Total deaths. Diphtheria 42 40 36 — Erysipelas 19 9 — — Scarlet Fever 180 108 15 — Enteric Fever 1 1 — — Puerperal Pyrexia 16 16 — — Cerebro-Spinal Meningitis 8 8 6 1 Encephalitis Lethargica — — — — Ophthalmia Neonatorum 3 — — — Pneumonia (Acute Primary and Influenzal) 50 4 — †75 Dysentery 16 11 7 — Poliomyelitis 62 61 23 }2 Polioencephalitis 2 2 — Malaria 1 — — — Food Poisoning 11 4 — - *Measles 867 50 1 — *Whooping Cough 244 34 — 1 *Scabies 138 — — — Totals 1,660 348 88 79 * This is not total brought to notice of Department, † Deaths from all forms of Pneumonia. (C) BACTERIOLOGICAL EXAMINATIONS. Specimen. Positive. Negative. Total. Swabs for suspected cases of Diphtheria 13 647 660 Haemolytic Streptococci 143 40 183 Faeces 5 15 20 Vincents Organisms 3 10 13 Occult Blood 2 - 2 Urine — 1 1 166 713 879 16 TUBERCULOSIS (a) part i. summary of notifications during the period from the 1st january, 1949,to the 31st december, 1949. 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 - 3 5 1 - 11 15 22 16 22 11 8 1 115 Respiratory, Females - 1 5 4 7 12 13 19 10 5 1 1 - 78 Non-Respiratory, Males - - 4 1 1 - - 1 1 - - - - 8 Non-Respiratory, Females - 1 1 - 1 — - 3 - - — — — 6 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 - - - - - - - 1 - - 1 2 1 5 (A) F - - - - - - - 2 - - - - - 2 (B) Non-Respiratory M - - - - - - - - - - - - - -(C) F — 1 - - - - - - - - - - - 1 (D) Death Returns from Registrar-General (Transferable deaths) Respiratory M - - - - - - 1 1 2 — 1 - - 5 (A) F - - - - - - - - 1 1 - - 1 3 (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 - 1 - 7 9 7 3 2 - - 30 (A) F - - - - - 2 4 14 7 1 - - - 28 (B) Non-Respiratory M - - - - 1 1 - - - - - - - 2 (C) F - - - - - - - - - - - - - -(D) Other Sources Respiratory M - - - - - - - - - - - - - -(A) F - - - - - - - - - - - - - -(B) Non-Respiratory M - - - - - - - - - - - - - -(C) F - - - - - - - - - - - - - -(D) Totals (A) 40 (B) 33 (C) 3 (D) 1 17 (B) SUMMARY OF NEW CASES IN AGE GROUPS AND DEATHS—1949. Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0- — — — — — — - - 1- 9 6 5 3 — — 1 2 5- 2 11 3 1 - - - - 15- 34 31 1 — }9 11 2 1 25- 33 35 1 3 35- 25 18 1 — 45- 25 7 - - }16 4 — — 55- 15 1 — - 65 and on 12 2 — — 4 1 — — Total 155 111 11 7 29 16 3 3 (C) CASES NOTIFIED AND DEATHS—1949 and Previous Years. Year. No. of Cases notified. No. of Deaths. No. of Cases on Register of Notifications. Pulmonary. NonPulmonary. Total. 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 1949 193 14 207 51 1,674 Average number of cases notified for the 10 years 1930-1939 (inclusive)=211. Average number of cases notified for the 10 years 1940-1949 (inclusive)=203. Average number of deaths for the 10 years 1930-1939 (inclusive)=124. Average number of deaths for the 10 years 1940-1949 (inclusive)=88. 18 (D) INTERVAL BETWEEN NOTIFICATION AND DEATH—1949 and Previous Years. 1930. 1931. 1932. 1933. 1934. 1935. 1936. 1937. 1938. 1939. 1940. 1941. 1942. 1943. 1944. 1945. 1946. 1947. 1948. 1949. 1. Total number of deaths from Tuberculosis in the Borough 153 127 156 150 124 119 116 106 87 107 118 103 104 72 93 93 85 90 76 51 2. The number of cases notified at death 7 2 6 13 5 11 6 8 8 5 9 10 22 14 26 13 14 20 7 17 3. The number of cases notified within one month of death (excluding above) 18 16 21 17 21 11 20 16 13 12 11 13 16 10 6 13 6 9 5 2 4. The number of cases notified within three months of death (excluding above) 21 14 17 17 9 8 7 11 6 3 10 10 8 5 9 6 9 4 2 5. The number of cases notified within six months of death (excluding above) 9 14 15 16 11 11 7 8 5 5 11 6 3 3 6 10 5 6 4 3 MEDICINAL BATHS— Cleansing of Verminous Persons. School Children—Hammersmith. Scabies 218 Verminous 1,212 Impetigo 4 Other conditions 2 School Children—Non-Hammersmith. Nil. Children under Five Years—Hammersmith. Scabies 67 Verminous 71 Children under Five Years—Non-Hammersmith. Scabies 1 Adults—Hammersmith. Scabies 240 Verminous 137 Other conditions 1 Adults—Non-Hammersmith. Scabies 7 Verminous 1 Lodging-houses. Scabies 7 Verminous 97 19 DISINFECTION. Beds 53 Mattresses 442 Pillows 359 Bolsters 43 Blankets 221 Sheets 111 Quilts 92 Curtains 2 Articles of Clothing 498 Carpets 1 Sundries 57 1.879 Rooms (including 643 verminous rooms) 737