AC 4347 HAM 4-5 Metropolitan Borough of Hammersmith ANNUAL REPORT of the Medical Officer of Health with STATISTICAL SUPPLEMENT for the year 1953 by F. M. DAY, M.R.C.S., L.R.C.P., D.T.M., D.P.H. pc ask. 13/7/54 METROPOLITAN BOROUGH OF HAMMERSMITH Health Committee At 31st December, 1953 Councillor E. O'K. Finn (Mrs.), M.B.E. (Chairman) „ L. Freeman (Vice-Chairman) Alderman R. J. Buckingham „ W. H. Church, J.P. „ C. E. Turner (Mrs.) Councillor A. Belsham „ J. A. Brady „ L. C. Clover „ J. J. Cohen „ L. C. Newton „ B. Wildman (Miss) „ E. C. Woods (Miss) Ex Officio: The Worshipful the Mayor (Councillor H. G. Reynolds, J.P.). OTHER COMMITTEES OF THE COUNCIL CONCERNED WITH VARIOUS ASPECTS OF THE HEALTH SERVICES Baths Committee. Management and supervision of the Council's Public Baths and Washhouses. Establishment Committee. Dealing with medical examination of Staff, etc. Housing and Town Planning Committee. Powers and duties of the Council under the Housing Acts (other than those delegated to the Health Committee). Works Committee. Construction, maintenance and improvement of sewers and public sanitary conveniences. Collection, removal and disposal of house and trade refuse. Cleansing of public highways. Management and control of the Council's cemeteries. Maintenance and control of parks, gardens and open spaces provided by the Council. CONTENTS Page Introduction 1-2 Staff 3 SECTION A—Social Conditions and Statistics:- Births 6 Census of Great Britain, 1951 6 Deaths 6 Expectation of Life 7 Infant Mortality 6 Marriages 5 Maternal Mortality 6 Population 5 Social Conditions 4 SECTION B—Prevalence of and Control over Infectious Diseases:- Contacts and Carriers—Sickness Benefit 9 Food Poisoning 11 Health Laundry 12 Medicinal Baths 11 Notifications 9 Public Health (Infectious Diseases) Regulations, 1953 10 Tuberculosis 10 SECTION C—Housing:- Building Licences 16 Overcrowding (Section 61) 16 Permanent Estates 15 Re-housing 14 Slum Clearance 16 SECTION D—Inspection and Supervision of Food:- Clean Food Campaign-Hammersmith Clean Food Traders' Guild 24 Designated Milk-Licences 23 Ice Cream 22 Markets 21 Meat and other Foods 17 Merchandise Marks Act, 1926 22 Milk Supplies 22 Olympia Exhibition Halls 21 Public Health (Condensed Milk) Regulations, 1923/1948 23 Sampling 19 Wormwood Scrubs Fair 21 SECTION E—Sanitary Administration:- Coroner's Court and Public Mortuary 26 Exhumation and Re-interment of Bodies 26 Heating Appliances (Fire Guards) Act, 1952 27 L.C.C. (General Powers) Act, 1952—Rag and Bone Dealers 28 Pet Animals Act, 1951 27 Pharmacy and Poisons Act, 1933 27 Public Baths and Wash-houses 28 Rag Flock and Other Filling Materials Act, 1951 26 Rent Restrictions Act 26 Staff-Inspectorial 26 SECTION F—Sanitary Circumstances:- Page Atmospheric Pollution 33 Drainage 29 Dustbins 29 Factories 30 Public Cleansing and Salvage 29 Rodent Control 30 Sanitary Inspection 30 Water Supply 29 SECTION G—General Provision of Health Services:- Ambulance Facilities 34 Burial or Cremation of the Dead 38 Conferences 40 Diseased or Infirm Persons 37 Financial Contributions to Voluntary Organisations 40 Health Information Bureau 40 Hospitals 34 International Certificates of Vaccination and Inoculation 37 Laboratory Facilities 34 Old People's Welfare 38 Personal Health Services 35 Clinics and Welfare Centres 35 Day Nurseries 37 Domestic Help Service 37 Staff Medical Examinations 39 STATISTICAL SUPPLEMENT—TABLES Bacteriological Examinations 62 Causes of Death in Age Groups 49 Deaths from Carcinoma of Lungs in Age Groups from year 1941 45 Disinfection 65 Extract from Vital Statistics 43 Factory Defects 56 Factory Inspections 56 General Statistics 43 Housing 58 Incidence of Cancer during the past 10 years 44 Incidence of Pulmonary Tuberculosis and Neoplasms of the Lung 46 Infant Deaths under 1 year in age groups 52 Infant Mortality 51 Infant Mortality Rates - England and Wales and various other Countries from year 1948 54 Infectious Diseases-Notifications in age groups 61 Maternal Mortality 54 Medicinal Baths-Cleansing of Verminous Persons 65 Mortuary and Coroner's Court 60 Natural Increase or Decrease of the Population during the past 20 years 44 Outworkers 57 Sanitary Inspection, Notices served and complied with 55 Summonses-Proceedings instituted 55 Tuberculosis-Notifications and Deaths for the past 20 years 63 Tuberculosis-Notifications in Sex and Age Groups 63 Unsound Food Condemned 59 Vital Statistics of whole District from year 1925 47 CHARTS Birth and Death Rates for the past 20 years 48 Number of Infant Deaths under 1 year of age during the past 20 years 53 Number of new cases of Tuberculosis notified during the past 20 years 64 Proportion of Deaths from Principal Causes 50 1 Town Hall, Hammersmith, W.6. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hammersmith. Mr. Mayor, Ladies and Gentlemen, I have very much pleasure in submitting to you my Annual Report on the health and sanitary conditions of the Borough for the year 1953. Once again I regret that it was not possible to publish this earlier as the Registrar General's figures required to calculate the various rates were not available sooner. I am again able to report that the general health of the community has remained good, and that there was no serious outbreak of any infectious disease. The population, as estimated by the Registrar General, shows a decrease of 1,200 and is now 117,600, compared with the 1952 estimate of 118,800. There was a decrease of 27 in the number of births notified during the year as compared with last year, and although the number was in excess of the deaths by 543, the birth rate of 14.9 remains the same as the previous year. The number of deaths dropped by 150, resulting in a rate of 10.3 per thousand of the population, which constitutes a new record low figure for the Borough. Three maternal deaths occurred. Thirty-five children died before they reached the age of one year, giving an infant mortality rate of 20 deaths per thousand registered live births. Of these 35 children who died, 25 succumbed before they reached the age of one month. It must be borne in mind though, when one is considering this figure, the number of stillbirths that occurred. These amounted to 44, an increase of 10 over last year, and these losses show that there must be no let-up in our efforts to cater for the expectant mother and in our provision for maternity services. I am particularly happy to report that there were no deaths among illegitimate infants. This is the first occasion that Hammersmith has had no such loss, the mortality rate hitherto having been nearly always higher than that for legitimate children. It is also very pleasing to report that the number of deaths from cancer (all causes) shows a decrease of 72 as compared with last year's, and these now occupy third place in the killing diseases,-last year cancer occupied second place. Cancer of the lung likewise shows a decrease for the year, the number of deaths being 52 as compared with 64 for 1952. There has been an increase in the incidence of tuberculosis, but the number of deaths from this disease is the lowest ever recorded. 2 The liaison existing between the medical and lay staff of the London County Council Divisional Offices and ourselves has continued on a very happy and friendly basis, as has our relationship with the Chest Clinic and its staff. The Minister of Health, in his directions on Annual Reports of Medical Officers of Health for 1953, asks for reference to any progress made towards closer integration with the general medical services provided by general practitioners and hospitals. During the year the Council planned and prepared to launch on 1st January, 1954, a Health Enquiry Bureau. It was intended that this Bureau would publish annually a Guide to all the local health services, including a comprehensive reference to local hospitals and doctors. Thus the Bureau would become, as it were, a focal point where all the services converged and where the public could obtain information about any of them. No additional staff was appointed to run the project and 5,000 copies of the Guide were printed at a cost of £150. Time will show whether the idea was a good one, but at the time of writing, all indications are more than favourable. The B.B.C. broadcast the opening of the Bureau on January 1st, 1954, and the National and local Press reported favourably on the event. In my next Annual Report I hope to be able to give full details of our first year's experience of the experiment. I regret that it has not been possible to maintain the sanitary inspector services at their full establishment. The dearth of adequate numbers of inspectors to make up the required complement in much of London has reduced us here to scratch along in a manner satisfactory to no one. As yet no dividends have accrued from the labours of the Working Party that dealt with training and recruitment of Sanitary Inspectors, but one feels that little improvement in our local position can be expected until the Working Party's findings bring forth larger numbers of well-trained young men available for employment. Once more I wish to thank the members of the Council and, in particular, the Public Health Committee, for the help, encouragement and courtesy I have at all times received, and to express my appreciation and thanks to all the members of the public health staff for their ever ready co-operation, hard work and helpful assistance. I am, Your Worship, Ladies and Gentlemen, Your obedient Servant, F. M. DAY, Medical Officer of Health. 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT at 31st December, 1953 Medical Officer of Health: F. M. Day, M.R.C.S., L.R.C.P., D.T.M., D.P.H. Deputy Medical Officer of Health (Part-Time): M. Golding, L.R.C.P.I. & L.M., L.R.C.S.I.& L.M., D.P.H. Administrative Officer: †º P. W. Pottier Clerical: J. C. Turner (1st Assistant) W. Robinson T. J. Hares Mrs. F. Lawford Mrs. D. Kelley E. Baines (Temporary) Mrs. L. G. Stimpson Miss J. Mynott (Temporary) Miss I. E. Waller R. W. Hart (Temporary) (M.O.H.'s Secretary) Senior Sanitary Inspector: ¶†º W. Rigby Sanitary Inspectors: ¶†°P. T. Bayes (Deputy Senior) §E. W. Pike º†§ J. C. Hopkins °S. Kelly $†° E. J. Nether § B. E. Martin †§ G. G. Gardiner †§ A. H. Chappell ||‡"§ Miss E. M. Cross § J. L. Harvey †§B. Berry Food and Drugs Inspectors: †§ J. Collier $†º W. J. Godden Mortuary Keeper: D. A. Mackay Medicinal Baths Superintendent: ||F. G. Baldwin Public Analyst: D. F. H. Button, A.R.C.S., F.R.I.C. ° Cert. Sanitary Inspectors' Examination Board. † Cert. Royal Sanitary Institute (Meat and other foods). ¶ Smoke Abatement Cert., L.C.C. School of Engineering. § Cert. Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. $ Cert. Royal Sanitary Institute (Inspector). " Cert. Royal Sanitary Institute (Health Visitor). ° Cert. Royal Sanitary Institute (General Science and Sanitation). ‡ State Certified Midwife. || State Registered Nurse. 4 SECTION A SOCIAL CONDITIONS OF THE BOROUGH AND STATISTICS Hammersmith is the most westerly Borough in the County of London. It has an area of 2,282.5 acres and is bounded on the north by the Borough of Willesden, on the south by the River Thames, on the east by the Boroughs of Kensington and Fulham and on the west by the Boroughs of Acton and Chiswick. The sub-soil in the northern half of the Borough (north of Uxbridge Road) mainly consists of clay, whilst in the south it consists of a layer of some 20ft. of gravel above blue clay. Years ago there was a layer of several feet thick of brown clay, particularly in the east of the Borough, much of which was excavated for brick-making purposes before building development took place. Under the control of the Council are 23 acres of public gardens and open spaces. The London County Council similarly controls 255 acres of public open spaces. In addition to the five pre-war housing estates many post-war dwellings consisting of 1, 2, 3 and 4 bedroomed flats have been erected by the Borough Council on various sites in the Borough. Under the control of the London County Council are also six housing estates. The total length of roads is approximately 67 miles. There are many industries, most of which are situated in our northern extremity. Further progress was made in Hammersmith during the year under review. The Riverside Development Scheme undertaken by the Council is nearing its completion and properties on the eastern side of Furnivall Gardens have been acquired. The Hammersmith Vicarage in Lower Mall, which has stood empty and derelict for years, has been purchased. This fine old 18th Century house, formerly the Vicarage of the Parish Church of St. Paul's, has been tastefully redecorated and altered, recapturing much of its early Georgian beauty. The acquisition of this property, which has been named Westcott Lodge, will enable local associations and organisations to hold their meetings there in surroundings that are unique, and will be invaluable as a centre for community purposes. A report is now being prepared with regard to the future development of the grounds and buildings adjoining Westcott Lodge, and when these have been completed, the final stage in this great improvement scheme will offer to the public one of the finest planned waterfronts. 5 Vital Statistics. (a) Population In this report the rates are calculated on the estimated population adopted by the Registrar General, i.e., 117,600. This compares with 118,800 for the year 1952. No epidemic resulting in high mortality occurred during the year and the excess of births over deaths has been maintained. The following statement has been prepared as a matter of interest showing the number of houses and population from the first regular census taken in 1801 to that taken in 1951, with a view to comparing the number of occupants per house. It will be seen that from 1801 to 1931 there was only a slight variation in the number of persons in occupation, i.e., between 5.70 and 7.56 persons per house, whereas in 1951 the census showed a considerable improvement in the housing position, i.e., 4.58 persons in occupation per house. It is, of course, true that the proportion of purpose built flats to houses occupied by one or more families has increased particularly since the war. The number of occupants in post-war flats owned by the Borough Council is approximately 2,855. Year Inhabited Houses Uninhabited Houses Population No. of occupants per house Males Females Total 1801 871 49 2497 3103 5600 6.43 1811 978 32 3262 4131 7393 7.56 1821 1406 68 4032 4777 8809 6.26 1831 1712 173 4645 5577 10222 5.97 1841 2214 95 6262 7191 13453 6.08 1851 3115 199 7819 9941 17760 5.70 1861 4164 258 10770 13749 24519 5.89 1871 6719 874 19304 23387 42691 6.35 1881 10543 1492 32743 39173 71916 6.82 1891 14049 1026 44195 53044 97239 6.92 1901 15202 638 52719 59514 112233 7.38 1911 16121 759 58084 63437 121521 7.54 1921 º19869 402 62479 67816 130295 6.55 1931 º22307 421 64989 70534 135523 6.07 1951 º26045 184 57224 62143 119367 4.58 ° Structurally separate dwellings. (b) Marriages. The number of marriages registered during the year was 1,226, this being a decrease of 36 as compared with the previous year. 6 (c) Births. The corrected number of births for the year, supplied by the Registrar-General, was 1,750. On the estimated population, i.e., 117,600, this represents an annual rate of 14.9 births per thousand persons living, the same as the previous year. (d) Deaths. During the year 1,409 deaths were registered. Adding 296 deaths of residents of this Borough transferred by the RegistrarGeneral as having occurred in various parts of England, and deducting 477 deaths of non-residents and 21 transferable deaths which occurred, the corrected number of deaths of residents was 1,207 (672 males, 535 females). On the estimated population, i.e., 117,600, the corrected number of deaths of residents was equal to an annual rate of 10.3 deaths per 1,000 persons living, as compared with the previous year's rate of 11.4. In the Statistical Supplement will be found a chart showing the proportion of deaths from the principal causes, from which will be seen that diseases affecting the heart and important blood vessels come first and cancer occupies third place-lung conditions having taken second place. (e) Infant Mortality. The number of deaths of infants under one year of age during the year was 35, giving an annual mortality rate per 1,000 live births of 20. (f) Maternal Mortality. Three maternal deaths occurred during the year as against two for the previous year, resulting in a death rate of 1.67 per 1,000 live and still-births. Census of Great Britain, 1951. Following the 1951 census, the County Report for London by the Registrar-General has now been published. The report contains many statistical tables and much useful information, and the following is of considerable interest. In the last 20 years there has been a marked decrease in large families living in the County of London. During this period the decrease in households of 8 or 9 is as much as 75%, whilst households of 6 or 7 have decreased by 58% and those with 5 by 36%. 7 On the other hand the number of persons living alone has increased by 42% and the number of persons where two live together has increased by 17%. Twenty years ago 532 of the homes in London consisted of dwellings with six or more rooms. To-day the percentage has fallen to 35. 4% of the population of Hammersmith to-day are living more than two persons per room. Twenty years ago the percentage was 10. Expectation of Life. During recent years an extraordinary change has taken place in the health and well being of the average man and his family and many diseases which once were rampant are now either under control or well on their way towards control. We now enjoy a much higher standard of living-more abundant and better food, housing, clothing, educational and recreational facilities. One way to illustrate this progress is by examining the increase in our expectation of life. Assessment of the expectation of life of any group of people must of necessity be only guesswork, but to the best of my ability I have prepared a table which gives an idea of the normal chances of a man in Hammersmith, in Japan, in America and elsewhere and even among some of the various tribes of Eskimos. Here it is:— EXPECTATION OF LIFE AT BIRTH BY SEX Country and Period Males Females England and Wales 1901-1910 48.5 52.4 1937 60.2 64.4 1951 65.8 70.8 Australia 1901-1910 55.2 58.8 1932-1934 63.5 67.1 1946-1948 66.1 70.6 Austria 1901-1905 39.1 41.1 1930-1933 54.5 58.5 1949-1951 61.9 67.0 Canada 1926-1930 57.7 59.7 1947 65.2 69.1 8 Country and Period Males Females Denmark 1901-1905 52.9 56.2 1941-1945 65.6 67.7 1946-1950 67.8 70.1 France 1898-1903 45.7 49.1 1947 62.8 67.7 Germany (Federal Republic) 1949-1952 64.6 68.5 Greenland (North) (Eskimos) 1950 25.0 27.0 Greenland (N.W.) Thule (Eskimos) 1952 28.0 22.0 HAMMERSMITH 1952 (estimated) 61.8 66.2 Holland 1900-1909 51.0 53.4 1931-1940 65.7 67.2 1947-1949 69.4 71.5 Israel (Jewish) 1949 65.2 67.9 Japan 1899-1903 44.0 44.9 1935-1936 46.9 49.6 1948 55.6 59.4 Norway 1901-1911 54.8 57.7 1921-1931 61.0 63.8 1945-1948 67.8 71.7 Poland 1931-1932 48.2 51.4 1948 55.6 62.5 Scotland 1910-1912 50.1 53.2 1930-1932 56.0 59.5 1949 64.0 67.6 Thailand 1947-1948 48.7 51.9 Union of South Africa 1945-1947 (Europeans) 63.8 68.3 1945-1947 (Asiatics) 50.7 49.8 1945-1947 (Mixed)º 41.7 44.0 United States 1900-1902 (White) 48.2 51.1 1901-1910 „ 49.3 52.5 1919-1921 „ 56.3 58.5 1920-1929 „ 57.9 60.6 1929-1931 „ 59.1 62.7 1930-1939 „ 60.6 64.6 1939-1941 „ 62.8 67.3 1948 „ 65.5 71.0 1950 66.6 72.4 1900-1902 (Negroes) 32.5 35.0 1948 „ 58.1 62.5 1950 „ 59.2 63.2 º Mixed and other coloured, not including indigenous population. 9 SECTION B PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES Infectious Disease. 1,878 cases of infectious disease were notified in the Borough during the year. Included in this total are cases of tuberculosis notified under the Public Health (Tuberculosis) Regulations, 1952, which were made by the Minister of Health under powers conferred upon him by the Public Health Act, 1936, and which came into force on 1st May, 1952. 124 cases were removed to isolation hospitals. Of this number, however, 66 were on discharge from hospital notified as not having suffered from the disease suspected. Thus the corrected number of cases of infectious disease for the year was 1,812. Even with the inclusion of the tuberculosis cases, this total shows a reduction of 443 as compared with the previous year, which is mainly accounted for by the fact that there was no measles epidemic. Eight cases of diphtheria were notified but not one case was confirmed, and it is with much gratification that I am able to record no death from this disease in the Borough during the past nine years. During recent years great strides have been made in protecting children against diphtheria, and this service, free of charge, is carried out by the London County Council at clinics, which are held regularly at local Infant Welfare Centres and also by many general practitioners. Figures recently made available with regard to diphtheria prevention show that, since the inception of the present Health Act, there has been a substantial increase in total numbers of children rendered safe. This is particularly pleasing as I believe that the position elsewhere is not so favourable. To assist correct diagnosis the Council has made arrangements for the examination of specimens from patients sent in by doctors in doubtful or suspicious cases of diphtheria, typhoid fever, tuberculosis, etc. This service is carried out at the West London Hospital and is referred to later in the report. Contacts and Carriers of Infectious Disease—Sickness Benefit. Ministry of Health circular 115/48 empowers the Medical Officer of Health, where justified, to issue certificates to persons who have been in contact with or who are carriers of an infectious disease, thus enabling them to claim sickness benefit under the National Insurance Acts during the period of exclusion from their work. 10 Certificates were issued by the Medical Officer of Health during the year to two persons–one engaged in a confectioner's shop who had been in contact with a case of poliomyelitis, and the other engaged in a hospital dining room who had been in contact with a case of sonne dysentery. Tuberculosis. It is with regret that I have to report an increase in the incidence of this disease. The number of new cases notified during the year was 215 as against 194 for the previous year. There was an increase of 18 in the number of pulmonary cases and an increase of 3 in the number of non-pulmonary cases. This total is the same as that for 1934, and only once since then has it been exceeded, when in 1945 the total was 230. In the statistical supplement will be found a chart showing the number of new cases of tuberculosis notified during the past 20 years. Tuberculosis remains a very serious menace to public health and affects largely those age groups which are of the greatest value to the productive ability of the nation and has a serious influence on the industrial life of the people. Although high priority is given by the housing authorities in re-housing tuberculous persons, the housing position results in inevitable difficulty in obtaining satisfactory homes at the right rent for the tuberculous and their families. The number of deaths from tuberculosis was 33 as compared with 43 for the previous year. The Public Health (Infectious Diseases) Regulations, 1953. These Regulations, made by the Minister of Health, came into operation on 1st April, 1953. They are in substitution for Regulations made in 1927, and correspond with the old Regulations in requiring notification of malaria, dysentery, acute primary pneumonia and acute influenzal pneumonia, and in prescribing action, in conformity with the present working of the health services, in relation to the diseases named in the fourth schedule. They amplify, however, the precautionary measures provided for in the revoked regulations against food poisoning:— (a) by relating these (instead of to enteric fever and dysentery, as formerly) to typhoid fever, paratyphoid fever or other salmonella infections (which includes the diseases previously known as enteric fever), dysentery and staphylococcal infection likely to cause food poisoning; 11 (b) by applying these measures in general to persons shown to be carriers of these diseases as well as to persons suffering from them; (c) by preventing such persons (in either class) not only from continuing employment involving the handling of food, as formerly, but also from entering such employment; and (d) by enabling a local authority to authorise the medical officer of health to issue notices in emergency, in order to check the spread of these diseases. Food Poisoning. Thirty-one cases occurred as compared with thirty-nine for the previous year. This total includes two outbreaks (three in one family and 10 employees of a large food factory). There were no deaths. In four cases Salmonella Typhi Murium were identified as the responsible organisms. Responsible organisms were not identified in the remaining cases. Foods alleged to have been involved included cold roast beef, roast pork, sausage sandwich, liver sausage, cream cakes, fish and chips and stuffed ox hearts and sauce. With regard to the two outbreaks, one was entirely of a domestic nature, whilst the other occurred amongst the employees of a food factory who had taken a meal in the firm's canteen, which included stuffed ox heart with sauce. The symptomatology was in all cases mild, but an interesting feature was that there was little or no vomiting. Few, if any, of the cases affected had to stay away from their work. Investigations carried out were all negative except that co-agulase positive staphylococci were recovered from cuts on two of the chef's fingers. A number of cases were examined bacteriologically but no pathogen was discovered in any case. The opinion was formed that this was an example of a staphylococcal heat resistant toxin outbreak. Medicinal Baths. The Medicinal Baths in Scotts Road, Shepherds Bush, provide for the cleansing of verminous persons, etc., and for the treatment of scabies, impetigo, psoriasis, and other forms of dermatitis. The figures showing the numbers dealt with during the year will be found on reference to the table in the Statistical Supplement. 12 It is very pleasing to report that there has been a decrease in the incidence of scabies and verminous conditions. The scabies total of 197 cases is the lowest for 23 years, whilst the verminous total of 1,194 cases is the lowest ever recorded since the Station was opened in 1923. The County Council continue to use this centre for the treatment of school children, and special attention has been given to head infestations at the Welfare Centres and at the Day Nurseries. Infested school children, together with their contacts of pre-school age, have been followed up in the home, and facilities (for all ages) have been made available at the Medicinal Baths. Advice is always given as to the best methods of eradication and of preventing recurrence. The treatment and cleansing of persons from the Boroughs of Ealing, Richmond and Southall is also undertaken at the Disinfecting Station and Medicinal Baths. Assistance was further afforded to five other local authorities during the year. On 46 occasions the West London Hospital used the services at the Medicinal Baths. Arrangements also exist between this Council and the Borough Councils of Ealing and Barnes for the disinfection of bedding. Early in the year 316 mattresses were sterilised before being used for the relief of the East Coast Flood victims. The mobile team which is available for dealing with homes that require treatment, was again actively engaged and during the year 340 premises were sprayed for vermin (830 rooms) and 47 premises for infectious disease (61 rooms). Following notification of vermin infestation or infectious disease, bedding and articles of clothing, etc., were collected from 197 premises and removed to the Disinfecting Station for sterilisation, and particulars are summarised in a table in the Statistical Supplement. Health Laundry. A year has now elapsed since the introduction of the health laundry scheme. The scheme has been much appreciated by district nurses and home helps, as well as by the patients themselves, in whose condition a general improvement can usually be seen as a result of the service. In view of the precarious health of many of the patients, this can be considered as most satisfactory. The personal nature of the Council's assistance to these necessitous people reminds them that their needs are not forgotten and for this they are more than grateful. 13 During the year 71 certificates have been signed authorising the laundering of bed linen, etc., and 16 persons have benefited. It must be emphasised that this is essentially a service which covers only those cases falling within the terms of Section 122 of the Public Health (London) Act, 1936. Cleansings carried out during the year included:— Blankets 33 Sheets 183 Quilts 11 Clothing 72 Sundries 180 479 14 SECTION C HOUSING Rehousing. During the year applications for rehousing by the Borough Council were made to the Housing Department, 218, Goldhawk Road, Shepherds Bush, W.12. The Housing Estates Manager relies on the Health Department for inspections to be made with a view to ascertaining whether a family is living in overcrowded conditions. Enquiries regarding these conditions are made by the Sanitary Inspectors, and where found to exist, the appropriate report is forwarded for submission to the L.C.C. In many cases the Housing Estates Manager forwards certificates supporting the family's application on medical grounds, and careful consideration is given that recommendations are made only for the most urgent cases, having regard to the nature of the illness, the condition of the premises and the amenities available. Applications for rehousing by the London County Council are made to that authority direct, and requests are received from them through the Housing Estates Manager, for similar enquiries to be made. In cases where there is medical evidence the Medical Officer of Health to the London County Council is responsible for allocating priorities on health grounds. Reports are also asked for and supplied in regard to existing overcrowding and sanitary condition of premises. Enquiries of this nature totalled 395 and of them 178 families were found, upon investigation, to be living in overcrowded conditions. Thirty cases were recommended for rehousing on grounds of health. In addition to the above, a recommendation for rehousing was made to the Borough Council's Housing Department in cases where the applicant represented a recently married family who were expecting a baby, or where there were young children already living in unhygienic surroundings which are inadequate to maintain the high level of health which is so vital to the family unit in its early stages. In spite of the many claims made upon them, the Housing Department do the best they can in each case. During the year 17 such recommendations were made to the Housing Estates Manager. These figures show that in less than 25% of applications for rehousing on medical grounds, I supported the application. It also shows that in 75% or thereabouts of persons presenting medical certificates, I find myself unable to support the applicant. 15 I append a table showing the number of cases recommended for rehousing under the three headings mentioned above and those actually rehoused from 1949:— Year HEALTH GROUNDS OVERCROWDING GROUNDS SPECIAL CASES Recommended Rehoused Recommended Rehoused Recommended Rehoused 1949 61 25 358 132 34 4 1950 35 10 439 203 8 9 1951 37 10 243 88 9 4 1952 27 10 187 79 7 7 1953 30 6 178 65 17 5 Those rehoused are not necessarily those recommended for the same year. Permanent Estates. During the year both the Borough Council and the London County Council have been actively engaged in providing accommodation for those in the greatest need, and further schemes are in progress. Ninety-five flats on the White City Estate were completed by the London County Council and the under-mentioned were completed by the Borough Council:— Nos. 1-18, Marryat Court, Cromwell Grove 18 Nos. 1-8, Essex Court, Hammersmith Grove 8 No. 91 (A-H), Coningham House, Coningham Road 8 Nos. 34, 36, 38, St. Peter's Road, 3 Nos. 30, 32, 34, 36, 38, 40, 40a, 40b, Richmond Way 8 Nos. 99, 101, 103, 105, Iffley Road 4 Nos. 19-19d and 21-21d, Benbow Road 10 Nos. 57, 57a, 57b, 57c, 57d, Percy Road 5 Nos. 1-48, Thackeray Court, Blythe Road 48 Nos. 36-51, Kelmscott Gardens, Askew Road 16 Nos. 52-67, Kelmscott Gardens, Askew Road 16 Nos. 31-42, Charcroft Court, Minford Gardens 12 Nos. 1-8, Morland Court, Coningham Road 8 Nos. 79, 79a, 81, 81a, 83, 83a, Lime Grove 6 TOTAL 170 16 The Council acts as landlords for 3,781 principal tenants. The properties managed include houses, flats, pre-fabs and requisitioned accommodation. At the end of the year there were 5,411 applicants for accommodation on the Borough Council's list awaiting rehousing. No points scheme is used to assess these applicants. Their need according to bedroom deficiency, ill-health, insanitary conditions, overcrowding and separation of families is measured and used as a guide in allocating houses. The following table illustrates the progress that is being made:— 1. Number of families rehoused by the Borough Council in new flats since the war 793 2. Number of families rehoused by the Borough Council in rebuilt houses since the war 30 3. Number of families rehoused by the Borough Council in prefabricated dwellings since the war 80 4. Number of Borough Council licensees living in requisitioned properties at the end of the year 1628 Overcrowding (Section 61). Four licences were granted under Section 61 of the Housing Act, 1936, authorising a number of persons in excess of the permitted number as specified in the licence to sleep in a house. Slum Clearance. The properties Nos. 1-10, Latimer Mews, in respect of which a compulsory purchase order was confirmed by the Minister in May, 1952, have now been vacated and demolition of the premises is completed. Building Licences. The arrangements existing for dealing with applicants for building licences have continued in operation throughout the year. The Sanitary Inspectors have continued to investigate and report upon all applications. Applications received 41 Licences issued 31 Pending 10 The amount of work which could be carried out to residential property during the year without licence was limited to £500. 17 SECTION D INSPECTION AND SUPERVISION OF FOOD Food and Drugs Act, 1938. Meat and Other Foods. The supervision of the food supplies of the community is one of the most important duties which devolves upon the Health Committee. The maintenance of frequent inspection of all kinds of premises where food is sold, stored and manufactured for human consumption is the key to a successful service. Conditions vary according to the nature of the trade carried on, the type of person or employee engaged, working conditions and structural arrangements, all of which have a direct bearing on the final product consumed by the public. The careless handling of food or storage under unsuitable conditions are a major danger. Food in good condition, unless suitable and proper precautions are taken, easily becomes contaminated by bacteria, dirt, dust or vermin. The Food and Drugs Act, 1938/52 is the principal Act under which premises and the handling of food in general are controlled. During the 15 years since the passing of this Act, its shortcomings have become increasingly obvious. It has been found that its scope is too limited to provide for the higher standard of hygiene required for the public and enlightened sections of the food industry. In view of this, two distinct Working Parties were appointed by the Minister of Food. The first of these, the Catering Trade Working Party was appointed in 1948 to make recommendations to the Ministers of Food and Health as to the precautions considered practicable and desirable with a view to securing the observance of sanitary and cleanly conditions in the catering trade. The second, the Manufactured Meat Products Working Party, was appointed in 1949 to review present trade practice and legal requirements for ensuring that conditions in the meat manufacturing trades are clean and sanitary, and that the products, and the materials from which they are prepared, are wholesome in all respects and to consider if new legislation was desirable. Following the reports of these Working Parties it was decided that a new statute should be introduced. This is now nearing fulfilment in the Food and Drugs (Amendment) Bill which is at present before Parliament. In the meantime, the introduction in November, 1952, of the London County Council Byelaws for the Protection of Food has provided some help in this direction. These byelaws were 18 made under Section 15 of the Food and Drugs Act, 1938, for securing the observance of sanitary and cleanly condition and practices in connection with the handling, wrapping and delivery of food sold or intended for sale for human consumption, and in connection with the sale or exposure for sale in the open air of food intended for human consumption. Whilst these byelaws have given additional powers of control, their provisions are in the main of a general character. Among these, however, some new and necessary features have been introduced, for instance, the hygienic control of premises is now extended to embrace food stalls generally; also the power to require suitable and sufficient means of lighting in all food premises and stalls, and the prohibition of unsuitable wrapping materials. The Authority here has been particularly active in the enforcement of this latter provision. The byelaws provided that food other than uncooked vegetables should not be wrapped in such a manner as to come in direct contact with newsprint. A detailed investigation showed that a number of traders were using newsprint only for wrapping some foods. Fish is most commonly ill-wrapped. Warning letters were sent which in some cases produced satisfactory results. It was found, however, in some instances that only a token covering in the form of a small piece of plain paper of insufficient size was being used, allowing the food to come into direct contact with an outer covering of newsprint. Further warnings have been given in these cases, but I am not altogether hopeful that part of the trade is taking the matter as seriously as statute and the public require. Another useful requirement is that a notice shall be affixed near every sanitary convenience in food premises requesting employees to wash their hands. In order to assist traders to comply with this provision, a number of suitable notices have been designed and produced and have been made available at cost price. Throughout the years, routine inspections of premises, shops, stalls and vehicles where food is prepared, stored and sold has been carried out. During 1953, 5,652 visits were made and at 90 of these, unsatisfactory conditions constituting contraventions under Section 13 of the Food and Drugs Act, 1938, and byelaws made thereunder were present. In each of these cases the unsatisfactory conditions were remedied following the issue of warning letters. During the year no seizures were made of unsound food under Section 10 of the Food and Drugs Act, 1938. 19 The Council's Food and Drugs Inspectors accepted the voluntary surrender of foodstuffs which upon examination was found to be unfit for human consumption. A list of the commodities condemned and the amount involved is shown in the Statistical Supplement. Sampling. Throughout the year 1,300 samples of food and drugs were submitted to the Public Analyst for chemical analysis. Of this number 16 or 1.230 per cent, samples were reported to be nongenuine; this represents a small increase on last year. The following are details of the 16 samples which were reported non-genuine:— Sample Cake Porridge Oats Self Raising Flour Solution of Acetic Acid Concentrated solution of Acetic Acid Table Jelly Table Jelly Glauber Salts B.P. Whipping Compound "Esko" Whipping Compound Sal Volatile Sal Volatile Pork sausages Pork sausages Beef Sausages Mincemeat Result of Analysis Had a strong flavour of mineral paraffin Smoky odour and taste ditto Incorrectly labelled Incorrectly labelled 7.9 per cent. deficient in sugar 4 per cent. deficient in sugar Effloresced 11 per cent. deficient in fat stated 14 per cent. deficient in fat stated 60 per cent. deficient in ammonia 80 per cent. deficient in ammonia and 45% deficient in ammonium carbonate Contained 580 parts per million sulphur dioxide Contained 480 parts per million sulphur dioxide Contained 500 parts per million sulphur dioxide Slightly deficient in soluble solids Remarks Matter taken up with Manufacturer Samples taken following a fire. Remainder of stocks used for animal feeding Warning letter Warning letter Informal sample Warning letter Remainder of stock withdrawn Informal sample Warning letter Formal sample satisfactory No further supplies of this sample available. Other follow-up samples satisfactory Legal proceedings taken on formal sample Legal proceedings taken— unconditional discharge. Follow-up sample satisfactory Formal sample satisfactory A total of 49 samples of synthetic and butter cream used in bakers' confectionery was taken for bacteriological examination. The results obtained throughout the year are as follows:— 20 Total number of samples of synthetic and butter cream 49 Bacillus coli (non faecal) present in 14 Bacillus coli (faecal) present in 3 Salmonella typhi-murium present in 1 A sample of "Mille Feuille" cream slices containing synthetic cream was taken for bacteriological examination from a retail shop in the Borough. The bacteriologist reported by telephone that he had found salmonella typhi-murium organisms present in the sample. An inspection of the shop showed that the general hygienic condition of the premises and staff was good. As the cream slices were manufactured at the Company's bakery in an adjoining Borough, I immediately informed the Medical Officer of Health of that area by telephone of the report. The same day a further sample of synthetic cream taken from a chocolate eclair was obtained from the retail shop and was found to be free from salmonella organisms. In the meantime, as a result of investigations carried out by the Medical Officer of Health of the adjoining Borough at the Company's bakehouse, four carriers of salmonella typhi-murium were found and were put off work. A bacteriological examination of the synthetic cream in pastry slices at the bakery showed no organisms of salmonella dysentery groups or coagulase+staphylococci, but coliform bacilli (faecal) were present in more than one brand. Subsequent samples taken from the branch shop have shown no further contamination. The following articles of food were also submitted for bacteriological examination for routine and other purposes:— Article of Food Organisms Found Other Organisms Faecal Coli Non-faecal Coli 3 samples of Rabbit Meat - 3 2 „ Roast Beef - - No pathogens 1 „ Jam — — do. 3 „ Shellfish 2 — 1 no pathogens 1 „ Veal and Ham Pie — — do. 2 „ Tonic Waters — - do. 19 „ Flour 1 8 1 „ Meringue Powder — — 1 no pathogens 6 „ Desiccated Coconut 1 2 1 Staph. Aureus 1 „ Milk Powder — — Staph. Aureus 1 „ Yorkshire Pudding — — do. 21 So far as I can trace, we have never carried out sampling of uncooked ready to eat pork products for infectivity. I believe that smoked continental sausages carried the biggest hazard and since 19th August we have examined 31 of various types. Schmeerwurtz, garlic, cervelati and salami have all been thoroughly examined and in every case I am glad to say, have been found wholesome. It is of particular interest that three months after this survey began, Liverpool experienced a considerable outbreak of trichinosis—the first in this country for some years. It is perhaps even more interesting (to me) to learn that the majority of those infected in Liverpool were housewives who make a practice of eating raw sausage meat. I do not know if this habit exists in London, but now propose to sample raw sausage meat for trichinae. During the year samples of fruit were taken for the purpose of identification. In one case the vendor had invented the name of "Strawberry Pippin" for a red eating apple. These were identified as Cox's Pearmain by the Royal Horticultural Society, but since there was no prejudice to the purchaser, no legal action was taken. Cox's Pearmain is a sound appetising dessert apple and had the vendor known its name, I am confident that he would not have bothered to give it a substitute name, however attractive to prospective purchasers this might be. Markets. The Food and Drugs Inspectors made 390 visits to the three markets at Bradmore Lane, Railway Approach and Norland Road. A large amount of food is sold in these markets and there is a call for careful and vigilant supervision. Wormwood Scrubs Fair. Inspectors visited this fair, which is held during the three spring and summer Bank Holiday periods. Stalls selling foodstuffs and drinks were inspected and samples were taken for bacteriological examination and chemical analysis. Olympia Exhibition Halls. Some of the best known exhibition premises in this Country are situated in the Borough and are visited by very large numbers of the public, for which a considerable amount of catering is required. At some exhibitions, which deal with the various food trades, the food inspectors are in constant attendance to ensure compliance with legal and hygienic requirements. Exhibitors are particularly advised by the Inspectors on practical hygiene, e.g., cleansing and sterilising of utensils, washing facilities, etc., and samples are taken for bacteriological examination. 22 A high standard of hygiene is maintained in spite of the restricted conditions unavoidable at so many exhibitions. Merchandise Marks Act, 1926. Regular inspections were carried out under this Act. In some cases warnings were given by the Food and Drugs Inspectors in connection with the labelling requirements for fruit, particularly tomatoes. In no case, however, was it necessary to take legal proceedings. Ice Cream. Fifteen premises were registered for the sale of ice cream during the year and at the end of 1953 the total number of registrations in compliance with Section 14 of the Act was 299. The Food and Drugs Inspectors made 699 visits to premises where ice cream is sold, stored or manufactured. During the year, 105 samples of ice cream were taken for bacteriological examination. The results of the methylene blue test were as follows : — 62 samples were within Grade 1 standard 22 „ „ „ „ 2 „ 15 „ „ „ „ 3 „ 4 „ „ „ „ 4 „ 2 „ „ „ „ ungraded Samples graded in 1 and 2 are considered satisfactory, but samples graded in 3 and 4 are doubtful. This shows an improvement on the results for 1952. In addition, 80 samples of ice cream were taken for chemical analysis, all of which complied with the standard laid down by the Food Standards (Ice Cream) Orders, 1951/52. Milk Supplies. 93 persons were registered as Distributors of Milk at the close of the year. The number of small retailers bottling milk on their premises has been further reduced and the remaining few will, of course, cease bottling on the 1st October, 1954, as required by the Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949. This is also the appointed date from which it shall be compulsory to use overlapping caps on containers of pasteurised milk. All milk pasteurised in the Borough at the two large milk depots is processed by the high temperature short time method. There are altogether nine of these Plants including one of Swedish design which has only recently been introduced into 23 this Country. This is in addition to the processing of sterilised milk, the bottling of cream and the production of specially fermented milks and chocolate milk. Designated Milk. During the year 163 samples of Special Designated milk were taken from milk distributors, milk processing depots, hospitals and schools and submitted for the phosphatase, methylene blue and turbidity tests, the results of which are set out below: — Class of Milk No. Tested Phosphatase Test Meth. Blue Test Turbidity Test Passed Failed Passed Failed Passed Failed Pasteurised 99 99 — 99 — — — T.T. Pasteurised 31 31 — 31 - - — Tuberculin Tested 13 — — 9 4 — — Sterilized 20 - - — — 20 - Total 163 130 — 139 4 20 — The four samples of tuberculin tested milk which failed to pass the methylene blue test were reported to the Ministry of Agriculture and Fisheries, and further samples from the same sources proved to be satisfactory. A further 94 samples of milk were submitted to the Public Analyst for chemical analysis, all of which were reported genuine. Under the Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949, and the Milk (Special Designation) (Raw Milk) Regulations, 1949, the following licences were issued during the year: — Dealer's (Pasteuriser's) Licence 2 Dealer's (Steriliser's) Licence 1 Dealer's (Bottling) Licence 1 Dealer's Licences Tuberculin Tested 63 Pasteurised 69 Sterilised 82 Dealer's Supplementary Licences Tuberculin Tested 15 Pasteurised 17 Sterilised 19 Public Health (Condensed Milk) Regulations, 1923/1948. These Regulations provide standards for milk fat and milk solids of condensed milk and control the labelling of tins and 24 other receptacles. During the year 34 samples were submitted for examination to the Public Analyst and were reported genuine. Hammersmith Clean Food Traders' Guild. The Clean Food Traders' Guild, which was formed to encourage more hygienic practices in the preparation, handling and sale of foodstuffs, continued its work during the year. Control of the Guild is in the hands of a Committee comprising representatives of the Health Committee, nominees of the Food Trades Associations and the Chamber of Trade and Commerce and representatives of the Employees' Trade Unions, the majority being Trade Members. At the end of the year the number of Food Traders enrolled in the Guild was 112. This figure shows a slight reduction compared with the previous year, a few of the traders having allowed their membership to lapse by the non-payment of subscriptions. On the other hand several new members were registered. Reports by the inspectors of the Health Department showed that the standard imposed by the Guild's Codes of Practice was generally well maintained by the members and improvement in the condition of a number of premises was obtained. The Educational work of the Guild was continued by the distribution of leaflets, talks to school children and women's organisations and by direct contact with food trade employees. During the year the Guild, in conjunction with the Health Committee, published a handbook on "Food Hygiene." 1,000 copies were distributed, mostly to members of the general public. At the end of the year (1953) the number of premises from which foodstuffs were being sold by retail, so far as was known to the Department, was 617. Classified under different types of business they were as under:— Bakers 33 Butchers 66 Cooked meats, eel-pie shops, etc. 17° Departmental and Chain stores 7 Fishmongers and Fried-fish shops 41 Fruiterers and Greengrocers 82 Grocers, Provision merchants and allied traders 232† Sweetstuff shops 139 617 ° including 2 registered for the sale of milk. † including 86 registered for the sale of milk. 25 There were approximately 231 premises in the Borough where food could be consumed on the premises. Sub-divided, they were as under:— Cafes, Restaurants, Snack-bars, etc. (not including public-houses where food was sold and coffee stalls) 139 Industrial and Staff canteens 53 Places of entertainment, Social and Sports Clubs, etc. 36 Old People's Luncheon Clubs 3 231 The number of licensed premises in the Borough was 134, comprising 102 Public-houses and 33 Wine and Spirit merchants and Beer retailers. (This figure does not include restaurants, grocers' shops, etc., licensed for the sale of intoxicating liquors). There were 38 licensed street traders who sold foodstuffs and 16 coffee-stalls occupying sites in streets in the Borough. Large factories where foodstuffs of one sort or another were manufactured numbered 16 and there were three wholesale dairies with milk processing plant. The number of milk distributors registered in the Borough is 93, ice cream premises 299 and premises for the preparation or manufacture of sausages or potted, pressed or preserved food intended for sale 110. 861 inspections were carried out at milk distributors' premises during the year and 699 inspections of ice cream premises were made. A quantity of various foodstuffs have been condemned as unfit for human consumption after examination by the Council's Inspectors. This unsound food has been disposed of in one of three ways: — 1. Butchers' meat, after treatment with naphthalene green dye has been collected by a waste food processing company in agreement with the Wholesale Meat Supply Association. 2. Other foodstuffs suitable for use as pigs' food has been collected by the Council's pig food recovery service. 3. The remaining articles, small quantities of canned goods, etc., have been collected by the cleansing department and disposed of as household refuse. 26 SECTION E SANITARY ADMINISTRATION Staff. The establishment of Sanitary Inspectors consists of one Senior Sanitary Inspector, a Deputy Senior Sanitary Inspector and 10 other district Inspectors, two Food and Drugs Inspectors and one woman Inspector. One district Inspector also acts as Inspector in charge of rodent control operations. There were no resignations during the year. Three of the four positions of district Inspector which were vacant at the beginning of the year were filled, but not without difficulty and loss or time. For the year as a whole, the shortage averaged 3½ Inspectors over the entire period. Exhumation and Re-interment of Bodies. During the year six 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 local district Inspector and in each case it was possible to certify that the removal was carried out in a proper manner. Increase of Rent and Mortgage Restrictions Act, 1920/1939. Five applications were received during the year for certificates under the above Act, but in only one case was it possible to grant a certificate, the other applications being in respect of premises which were not controlled under the principal Act. Coroner's Court and Public Mortuary. The number of bodies admitted to the Public Mortuary shows an increase of 25 as compared with last year. There was also an increase of 24 over last year in the number of post mortem examinations conducted. The Mortuary and Court were also used by the Boroughs of Fulham, Chelsea and Kensington. The Mortuary is equipped with a large refrigeration plant and this ensures a completely satisfactory standard of hygiene. Full particulars relating to the work carried out will be found in the Statistical Supplement. Rag Flock and Other Filling Materials Act, 1951, The above Act, which came into operation on the 1st November, 1951, makes it compulsory for manufacturers, 27 retailers and other users of rag flock and other prescribed filling materials to be registered or licensed by the local authority. Registered premises are those where certain filling materials are used in upholstery, including the stuffing or lining of bedding, toys, baby carriages, etc. Licensed premises are those where rag flock is (a) manufactured, or (b) stored for distribution to registered premises. During the year only one certificate of registration of premises was granted, making a total of 10 since the Act came into force. Pharmacy and Poisons Act, 1933, and Pharmacy and Medicines Act, 1941. The names and addresses of 117 retailers were entered on the Council's list of persons entitled to sell poisons under Part 2 of the Pharmacy and Poisons Act, 1933, and Pharmacy and Medicines Act, 1941. No action was necessary in respect of any offence under the Act. All have been inspected as to their suitability, method of storage and labelling, as required under the Act, and have been found satisfactory. Pet Animals Act, 1951. Under the above Act, which came into operation on the 1st April, 1952, local authorities are responsible for issuing licences to persons for keeping pet shops and for the inspection of premises so licensed to check whether the requirements are complied with. The Act includes requirements as to the suitability of the accommodation, the adequate supply of suitable food and drink for animals, that mammals are not to be sold at too early an age and for reasonable precautions against fire and spread of infectious diseases amongst animals. Certain conditions approved by the Council are applied to all licences issued. Ten applications for renewal of licences were received and granted during the year. Heating Appliances (Fire Guards) Act, 1952. This Act, which received the Royal Assent on the 1st August, 1952, came into operation on the 1st October, 1953. 28 The Act prohibits the sale or letting of unguarded domestic electric fires, gas fires or oil heaters, empowers authorised officers of local authorities to inspect and list appliances kept on any premises for sale or letting, and imposes penalties for contraventions. No reports of any contravention were received since the Act came into force. London County Council (General Powers) Act, 1952. No reports of any contravention of Section 26 of the above Act, which deals with restrictions on sales, etc., by dealers in rags, old clothes and similar articles were received during the year. Public Baths and Wash-houses. The public baths and wash-houses in Lime Grove, Shepherds Bush provide facilities for bathing (slipper baths), swimming and for laundry work. The water in the swimming baths is, of course, filtered and chlorinated to secure a high degree of purity. In the public wash-houses, modern facilities are provided for washing, drying, ironing and mangling at a small cost. The Open Air Bath at Bloemfontein Road, Shepherds Bush, provides during the summer months, facilities for swimming and sun-bathing. The water in this bath also undergoes the required purification treatment. During the year 47 samples of water were taken from the baths and submitted to the Public Analyst for examination. In addition, 29 samples were taken for bacteriological examination. All these samples were satisfactory. 29 SECTION F SANITARY CIRCUMSTANCES OF THE BOROUGH Water Supply. The Metropolitan Water Board is responsible for the water supply of the Borough and no complaints with regard to the condition of the water were received during the year. 267 certificates were granted under Section 95 (2) of the Public Health (London) Act, 1936, with regard to newly erected houses and flats having a proper and sufficient water supply. Public Cleansing. The Borough Engineer and Surveyor, who is responsible for supervising the collection, removal and disposal of refuse, has kindly furnished the following information with regard to this service. Tons Amount of house refuse and House Refuse 33,837 kitchen waste collected during the year 1953 Kitchen Waste 2,353 36,190 Method ot disposal By road to tip at Denham Frequency of collection (a) House refuse—weekly. (b) Trade refuse—as required. Drainage. The bye-laws made by the London County Council under the Metropolis Management Acts with regard to drainage, and also those under the Public Health (London) Act relating to water closets, etc., are enforced by the Council. During the year 99 drainage plans (7 combined drainage) were submitted and approved, ancl a total of 2,000 inspections were made in connection with supervision of drainage works. Dustbins. 74 notices were served under section 105 of the Public Health (London) Act, 1936 requiring the provision of proper and sufficient ashpit (dustbin) accommodation. No appeals were lodged against any of the notices served. 30 Sanitary Inspection. The sanitary conditions of the Borough were subject to routine inspection and investigations were made into all complaints received. Particulars of visits made by the Sanitary Inspectors during the year, the numbers of preliminary and statutory notices served and complied with, and proceedings instituted, will be found on reference to the table in the Statistical Supplement. Owing to the difficulty in filling vacancies in the inspectorial staff, it was not always possible to take action to investigate complaints and secure the abatement of nuisances as expeditiously as desired. Factories. During the year 17 notices were served relating to insanitary conditions found to exist during the inspection of factories in the Borough. In the Statistical Supplement will be found a table which has been prepared in accordance with the form prescribed by the Minister of Labour and National Service on the administration of the Factories Act, 1937, dealing with factories (mechanical and non-mechanical) and outwork. Rodent Control. Prevention of Damage by Pests Act, 1949. In 1951 we instituted the practice of every visit to any premises being used as an inspection for rodents, and considerable success followed in discovering hidden infestations. The Ministry of Agriculture and Fisheries have now written to all local Authorities to follow the same procedure. Complaints and infestations discovered by Sanitary Inspectors have both increased during the year, and in many cases it has been more difficult than usual to locate the source. We have also undertaken four "Block" controls which demand a great deal of preliminary investigation. "Block" control is decided upon when a number of infestations occur in a well-defined area. The whole area, or " Block," is then treated. Six major infestations were encountered and were successfully dealt with, but it should be borne in mind that very often a minor, less clearly defined infestation, is much harder to combat than that of a major one whose boundaries are easier to demarcate. Sewer manholes were baited, as is usual, twice during the year, and the takes of poison were substantially the same as in previous years. 31 Sewer baiting is done at the same time as neighbouring boroughs, and the large number of dead rats collected at the sewer outfalls show that treatments are successful. The complaints of rodents rose from 410 to 467 (314 rats, 153 mice) but 40 rat complaints were "false alarms." Infestations discovered by inspection, other than by complaint, rose from 125 to 134 (84 rats and 50 mice). From the above it will be seen that this has been a very busy year for Rodent Control and staff have been working at full pressure. I do not regard the increased figures in a bad light, but rather it tends to show that the more that can be found from the enormous relatively untouched pool that exists, the less likely it is that the total population can ever increase, but will be perhaps slowly but remorselessly whittled down to nonentity. I am including two photos which show how an adult male rat had stored his food in a manhole taking the drainage of 14 houses. Drain manhole showing rat's nest and food store. 32 The tenant leaving home. The food, consisting of bacon rind, potatoes, cabbage leaves, bread, etc., had been fished out of the drain channel and placed on the "benching " by the rat. The rat's nest, which consisted of paper, can be seen in the top right corner. This was discovered in consequence of a complaint that a rat had been seen diving into a lavatory six houses away. When the manhole was opened, the rat was seen on top of the food. Subsequently the manhole cover was lifted and the rat was seen to run up a branch drain. The branch was then flushed with water and the photographs taken as the rat tried to make his getaway. The drain was eventually cleared of the food and the rat killed by poison. 33 If this is an example of how much food can find its way into a comparatively short length of drain, it is no wonder that so many rats can and do live in sewers. One Notice was served under the Prevention of Damage by Pests Act. 52 Notices to repair drains, etc., causing rat infestations were served under the Public Health (London) Act. Approximately £110 has been received for treatment by baiting and trapping at 73 business premises. The following is a summary of work done for the year, but in future this will differ from that supplied to the Ministry of Agriculture and Fisheries as they now require figures to correspond with the financial year. Summary Premises inspected: Dwellings 470, Business 1,312 1,782 Complaints of rats and mice 467 Premises infested by rats : — Dwellings 299, Business 59 358 Premises infested by mice: — Dwellings 173, Business 30 203 New infestations treated: Rats 317, Mice 203 520 Notices served relating to Rodent Control 53 Inspections and re-inspections by Sanitary Inspectors re Rodent Control 3,192 Atmospheric Pollution. In December, 1952, the Metropolitan Boroughs' Standing Joint Committee invited the constituent Councils to co-operate with the London and Home Counties Smoke Abatement Society by setting up stations in their areas for measuring and recording the extent of atmospheric pollution. The Council at once agreed and stations have been set up in (a) Westville Road, and (b) Australia Road. These are in addition to that which had been established in Ravenscourt Park and is maintained by the London County Council. The apparatus, which was purchased towards the end of the year, consists of a deposit gauge and a lead peroxide instrument. The deposit gauge collects the grit, ash and finer particles of matter and the lead peroxide instrument measures the quantity of sulphurous gases (gases which irritate the lungs and penetrate the masonry of buildings) on a specially prepared cylinder. Monthly readings are to be taken and the information made available to the Department of Scientific and Industrial Research. During the year 200 observations of non-domestic chimneys in the Borough were made by the Sanitary Inspectors as a result of which six Notices were served to abate smoke nuisances. 34 SECTION G GENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH Laboratory Facilities. Following the appointment of Mr. D. F. H. Button, A.R.C.S., F.R.I.C. (Public Analyst to the Southwark Borough Council) on the 1st October, 1952, to the position of Public Analyst to this Council, the chemical analysis of food is now carried out at the Southwark Borough Council's Laboratory situated at The Health Centre, Walworth Road, S.E. Bacteriological examination of food and drugs is carried out by the Public Health Laboratory Service, County Hall, and the Borough Council have arranged for the convenience of local doctors and their patients that various bacteriological investigations are made at the West London Hospital. Our work at this laboratory includes the examination of throat swabs and intestinal specimens, etc., and the service is of much benefit in view of its immediate accessibility. Throat swabs and faeces outfits are supplied free on application to the Public Health Department to all medical practitioners practising in the Borough. Ambulance Facilities. The London County Council is responsible, under the National Health Service Act, 1946, for the provision of ambulance facilities within the administrative County of London. Hospitals. The following hospitals are situated in Hammersmith: — Hammersmith Hospital, Du Cane Road, W.12. Queen Charlotte's Maternity Hospital, Goldhawk Road, W.6. Royal Masonic Hospital, Ravenscourt Park, W.6. West London Hospital, Hammersmith Road, W.6. Hammersmith Hospital and West London Hospital are designated as teaching hospitals, and together with St. Mark's Hospital, Chelsea, are under the control of a joint board or governors. The Royal Masonic Hospital is a private hospital and Queen Charlotte's is a maternity hospital with its own board of governors. It is one of the largest of its kind in the country. 35 The Hammersmith Chest Clinic, established at Hammersmith Hospital, continued to function during the year, and sessions are held regularly at the following times: — Monday mornings 9 a.m.—Adult routine „ afternoons 1.30 p.m.—Male X-Ray only. „ „ 2 p.m.—B.C.G. vaccination. „ „ 2.30 p.m.—Female X-Ray only „ evenings 5 p.m.—Workers' refills and Contact X-Rays. Tuesday mornings 9 a.m.—Adult routine. „ afternoons 1.30 p.m.—Female refills. Wednesday mornings 10 a.m.—Ambulance X-Rays. Thursday mornings 9 a.m.—Adult routine. „ afternoons 1.30 p.m.—Male refills. „ „ 2 p.m.—Preliminary skin testing for B.C.G. Friday mornings 9 a.m.—Children's clinic. „ afternoons 1.30 p.m.—Adult routine. All new patients should bring a letter of introduction from their family doctor. Personal Health Services. The County Council remained responsible for the personal health services under the charge of Dr. V. I. Russell, and her deputy, Dr. R. H. Simpson. The day to day administration of these services is provided by the Medical Officers of Health for the Boroughs of Chelsea, Fulham, Hammersmith and Kensington. The liaison between the staffs of the county council and the borough council continue on a very happy and cordial footing. The following is a list of the various clinics: — Ante-natal Clinics. 1/3, Milson Road Monday 1.30 p.m. Tuesday 9.30 a.m. Friday 9.30 a.m. 48, Glenthorne Road Monday 6 p.m. Tuesday 1.30 p.m. Friday 1.30 p.m. Becklow Gardens Monday 1.30 p.m. Tuesday 9.30 a.m. Thursday 1.30 p.m., 6 p.m. The Curve, Westway Monday 9.30 a.m. Wednesday 9.30 a.m., 1.30 p.m. The Library, College Park . Tuesday 1.30 p.m. 36 Infant Welfare Centres. 1/3, Milson Road Tuesday 1.30 p.m. Wednesday 9.30 a.m. Thursday 9.30 a.m., 1.30 p.m. 48, Glenthorne Road Monday 1.30 p.m. Wednesday 1.30 p.m. Thursday 1.30 p.m. Friday 9.30 a.m. Becklow Gardens Tuesday 1.30 p.m. Wednesday 9.30 a.m., 1.30 p.m. Friday 9.30 a.m., 1.30 p.m. The Curve, Westway Monday 1.30 p.m. Thursday 9.30 a.m., 1.30 p.m. Friday 1.30 p.m. The Library, College Park . Friday 9.30 a.m. Physiotherapy (Massage and Light). 48, Glenthorne Road Monday 1.30 p.m. Tuesday 1.30 p.m. Wednesday 1.30 p.m. Thursday 1.30 p.m. Friday 1.30 p.m. Diphtheria Immunisation. 1/3, Milson Road Friday 1.30 p.m. 48, Glenthorne Road Wednesday 9.30 a.m. Becklow Gardens Thursday 9.30 a.m. The Curve, Westway Tuesday 9.30 a.m. The Library, College Park . Friday 9.30 a.m. Vaccination. J/3, Milson Road Friday 1.30 p.m. 48, Glenthorne Road Wednesday 9.30 a.m. Becklow Gardens Thursday 9.30 a.m. The Curve, Westway Tuesday 9.30 a.m. Chiropody. 48, Glenthorne Road Monday 2 p.m. Tuesday 2 p.m. Wednesday 2 p.m. Thursday 2 p.m. Friday 10 a.m. 37 During the year dried milk and other nutrients have been issued from the Maternity and Child Welfare Centres. In addition, the Ministry of Food has been responsible for National Dried Milk, Concentrated Orange Juice and Cod Liver Oil in accordance with their recognised scale of charges. The County Council also maintain the following four Day Nurseries, which are available for children up to five years of age: — Brook Green Day Nursery Dalling Road Day Nursery Latimer Road Day Nursery Uxbridge Road Day Nursery Each is open on Mondays to Fridays from 7.30 a.m. to 6 p.m., and the charge for children received into them is based on the parents' income and is reduced if the circumstances warrant it. Domestic Help Service. This service, also administered by the County Council, employs 8 full-time and 68 part-time helpers and maintained its good and valuable work during the year. Its local headquarters are in the Public Health Department in the Town Hall. Number of cases in which help was provided: — Maternity 30 Tuberculosis 85 Other 837 1,522 effective visits were made to various homes by the organiser. International Certificates of Vaccination and Inoculation. Arrangements continued during the year for the authentication by the Medical Officer of Health of certificates of vaccination and inoculation in the international form. These certificates are required by passengers proceeding abroad from this country and the purpose of the authentication is to provide proof to health authorities abroad that the signature of the person issuing the certificate is that of a registered medical practitioner. National Assistance Act, 1948. National Assistance Amendment Act, 1951. Removal to Suitable Premises of Persons in Need of Care and Attention. Under the provisions of the National Assistance Acts, a Medical Officer of Health is empowered to apply to the Courts for an Order for the compulsory removal to a hospital or other 38 suitable place, of persons who are suffering from grave chronic disease or, being aged, infirm or physically incapacitated, are living in insanitary conditions and unable to devote to themselves, and are not receiving from others, proper care and attention. During the year it was only necessary to take action under the above on one occasion. In this particular case a lady of 60 years, suffering from advanced cancer of the face, was found living alone, without attention or help. She had had no medical care and was obviously at the point of death. A Magistrate's Order was obtained and she was taken to hospital and made comfortable and warm. Her death followed in a few days. If this was an uncommon and unusual type of tragedy one would feel happier about our old people. Far too many, it is to be deplored, spend the ends of their lives alone and without a friend and have to be rescued at death's door by one or other of the country's health services. In addition to the above, many other cases, mostly elderly and infirm persons, were brought to our notice, but in none, however, was there justification for certifying that application for an order for removal be made. In the majority of cases it was possible, however, to render assistance by securing the provision of nursing by the District Nursing Association, Home Help, visits by the Welfare Organiser of the Hammersmith Old People's Welfare Association, Invalid Meals and by arranging admissions to hospitals where necessary. Close co-operation with all the bodies working for the welfare of the elderly in the Borough is maintained but there is no doubt that the problem of the ageing population is slowly increasing and is a matter of great concern. 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. During the year 23 burials were carried out by the Council at a total cost of £267 18s. Od. Of this amount, £159 11s. Od. has been recovered. In no case was a wish expressed for cremation. Hammersmith Old People's Welfare Association. The Hammersmith Old People's Welfare Association which discovers and meets the needs of necessitous old persons continued to make even further progress during the year. 39 At the end of the year approximately 1,600 cases were on the records of the Association, an increase of 650 on last year's figure, and new cases continue to be brought to the notice of the Association daily. For the financial year 1953/4, a grant of £4,510 was made by the Council to the Association, and at the time of writing provision has been made for £.4,483 for the year 1954/5. The Association's sphere of activity embraces party holidays at the seaside, three luncheon clubs, domiciliary meals to the needy, a chiropody service, free legal advice, friendly visiting service and social visitation on a very large scale. Very much good work is being done and the expansion which has taken place during the year will undoubtedly continue. Medical Examination of Council's Staff. During the year I have continued to carry out the duties of medical advisor to the Council. Every new entrant to the service is required to undergo a medical examination, including a chest X-ray, in order to ascertain whether he or she is fit to be admitted to the Council's Superannuation and/or Sick Pay Schemes. In addition to this, medical examinations are conducted in all cases where the prescribed "sick leave with pay" has been exceeded. The Council in many such instances makes up sick pay for further periods to bring their employee back to good health. The total number of first examinations carried out during 1953 was 304, and of this number 76 were found to be unfit for the following reasons: — Hypertension 9 Vertigo and Migraine 1 Bilateral Otorrhoea 2 Loss of left lower limb 1 Otitis Media 9 Petit Mal 1 Duodenal Ulcer 3 History of depression 1 Gastric Ulcer 2 Persistent disc symptoms 1 Glycosuria 4 Neurosis 1 Chest condition 9 Gingivitis and caries 3 Dermatitis 3 Defective vision 1 Varicose Veins 4 Recurrent symptoms left arm 1 L.I. Hernia 2 R.I. Hernia 4 T.B. Hip (left) 1 Double Hernia 2 Sciatica 1 Anxiety state 3 Asthma 1 History of Tubercle 1 Arthritis (right knee) 1 Presence of Hydrocele 1 Heart 1 Nervous Debility 1 Lumbago 1 40 At the beginning of last year the Council decided to put into operation a scheme for streamlining sick leave arrangements. The scheme adopted has worked satisfactorily and efficiently and during the year 49 examinations were conducted by the Department's medical staff. Financial Contributions to Voluntary Organisations. Payments to the funds of voluntary bodies were, on the recommendation of the Health Committee, made by the Council during 1953, as indicated below: — Organisation Amount Statutory Authority £ s. d. Central Council for Health Education 10 10 0 Public Health (London) Act, 1936, Section 298. National Smoke Abatement Society 12 12 0 Public Health (London) Act, 1936, Section 298. Local Government Act, 1948, Section 136. Conferences. The Council were officially represented at the undermentioned Conferences dealing with matters within the purview of the Public Health Department: — Conference Delegates Royal Sanitary Institute, Hastings — 28th April/lst May, 1953. Councillor A. R. Mingaye Dr. F. M. Day, Medical Officer of Health. Sanitary Inspectors' Association, Morecambe—8th/llth September, 1953. Mr. W. Rigby, Senior Sanitary Inspector. National Smoke Abatement Society, Glasgow — 30th September/2nd October, 1953. Councillor L. Freeman Dr. F. M. Day, Medical Officer of Health. Health Information Bureau. Early in 1953 a project to set up a Health Information Bureau was considered and approved by the Health Committee. It was known that there was a need for a local Centre where information regarding the various health services provided by the State, the Borough and County Councils and voluntary Associations could be collated and made available to the general public. Some of these services were already known to the man in the street, but there were many of whose existence he was less sure. The 41 Committee were of the opinion that a Bureau where advice on health problems and information as to how the right expert help could be obtained would be of considerable public value. The Bureau was opened on the 1st January, 1954. A number of reporters from national, daily and local newspapers were present. The British Broadcasting Corporation sent representatives who made a recording which was broadcast throughout the Country the same evening in Radio Newsreel in the Light Programme. Simultaneously with the opening of the Bureau, a Health Services Guide was issued. This Guide sets out information regarding all the Health Services ranging from comprehensive lists of doctors, dentists, opticians and chemists practising in the Borough to particulars of facilities provided at the public baths and wash-houses. Details of a large number of voluntary associations and their activities are included. The Guide was widely circulated and copies are available to anyone interested upon application to the Bureau. The Bureau is conveniently sited in the Offices of the Public Health Department, and its personnel springs from the staff of the Department. No additional accommodation or staff have been required. A number of appreciative and complimentary letters have been received regarding the booklet from doctors, associations and members of the public, and from abroad. The Bureau has, since it was opened, dealt with a number of enquiries varying widely in their features and this in itself is confirmation, originally believed, that a need existed broad in its wants and when satisfied, of real benefit to the actual health of the public. STATISTICAL SUPPLEMENT TO ANNUAL REPORT FOR YEAR 1953 43 GENERAL STATISTICS— 1953 Area 2,282.5 acres Population (1953) (estimated) 117,600 „ (1952) (estimated) 118,800 „ Census (1951) 119,367 Natural increase, i.e., excess of births over deaths 543 Marriages registered 1,226 Rateable value (April, 1953) £1,271,109 Sum represented by a penny rate (April, 1953) £5,447 EXTRACT FROM VITAL STATISTICS—1953 Live Births Total M. F. Birth Rate per 1,000 estimated resident population = 14.9 Legitimate 1,610 833 777 Illegitimate 140 76 64 Stillbirths 44 23 21 Rate per 1,000 total (live and still) births = 24.5 Deaths 1,207 672 5.35 Death Rate per 1,000 estimated average population = 10.3 Deaths from maternal causes— Deaths Rate per 1,000 total (live and still) births Pregnancy, childbirth, abortion 3 1.67 Total 3 1.67 Death Rate of Infants under one year of age: — All Infants per 1,000 live births 20 Legitimate Infants per 1,000 legitimate live births . 21.73 Illegitimate Infants per 1,000 illegitimate live births Nil Deaths from Cancer (all ages) 222 „ „ Measles (all ages) — „ „ Whooping Cough (all ages) 1 44 NATURAL INCREASE OR DECREASE OF THE POPULATION DURING THE PAST 20 YEARS Year Population Excess of Births over Deaths Excess of Deaths over Births 1934 129,170 115 - 1935 128,100 353 — 1936 127,700 325 — 1937 126,500 320 — 1938 125,100 521 — 1939 b122,800 438 — d1 16,200 1940 98,320 — 156 1941 84,880 77 — 1942 89,370 337 — 1943 92,050 468 — 1944 89,190 370 — 1945 96,100 434 — 1946 111,860 974 — 1947 117,280 1,190 — 1948 115,800 847 — 1949 118,440 662 — 1950 119,200 691 - 1951 118,300 377 - 1952 118,800 420 — 1953 117,600 543 — b = Birth Rate Population Figure. d = Death Rate Population Figure INCIDENCE OF CANCER DURING THE PAST 10 YEARS Year Population Deaths Rate per 1,000 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 1950 119,200 258 2.1 1951 118,300 254 2.1 1952 118,800 290 2.4 1953 117,600 222 1.9 45 DEATHS FROM CARCINOMA OF LUNGS Year 0—25 -45 —65 —75 +75 Total 1941 M - - 10 1 - 11 F — — 2 3 — 5 Total — — 12 4 — 16 1946 M - 6 30 5 1 42 F — — 2 2 — 4 Total — 6 32 7 1 46 1947 M - 3 25 7 2 37 F — — 1 1 1 3 Total - 3 26 8 3 40 1948 M - 1 19 8 4 32 F - 1 8 3 1 13 Total - 2 27 11 5 45 1949 M - 7 25 13 4 49 F — — 3 1 1 5 Total — 7 28 14 5 54 1950 M - 4 28 10 3 45 F — 1 3 2 2 8 Total — 5 31 12 5 53 1951 M - 1 33 11 3 48 F - 1 3 3 1 8 Total - 2 36 14 4 56 1952 M - 3 31 14 5 53 F - — 5 4 2 11 Total - 3 36 18 7 64 1953 M - 2 18 25 2 47 F - — 1 3 1 5 Total — 2 19 28 3 52 46 INCIDENCE OF PULMONARY TUBERCULOSIS AND NEOPLASMS OF THE LUNG Age Groups Pulmonarv Tuberculosis Neoplasms of the Lung or Bronchus 1952 1953 1952 1953 MALES 0— — — — — 1— — — — 5— — — — — 15— — — — — 25— 4 6 3 2 45— 14 16 31 18 65— 11 6 14 25 75— 2 — 5 2 Total Males 31 28 53 47 FEMALES 0- — — — 1— — — — — 5— — — — — 15— 1 — — 25— 3 1 — — 45— 4 1 5 1 65— — 1 4 3 75- — — 2 1 Total Females 8 3 11 5 47 VITAL STATISTICS OF WHOLE DISTRICT 1953 and Previous Years Year Population estimated to middle of each year Births Total Deaths Registered in the District Transferable Deaths Net 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 Net Births Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 1925 134,500 2,351 17.5 1,034 7.7 186 756 153 65 1,604 11.9 1926 134,400 2,188 16.3 1,174 8.7 195 556 144 66 1,535 11.4 1927 132,800 2,076 15.6 1,581 11.9 230 377 126 61 1,728 13.0 1928 136,300 2,258 16.6 1,449 10.6 222 326 156 69 1,553 11.4 1929 136,900 2,162 15.8 1,757 12.8 222 340 133 62 1,875 13.7 1930 136,900 2,173 15.9 1,387 10.1 219 436 140 64 1,604 11.7 1931 135,100 2,073 15.3 1,567 11.6 288 373 140 68 1,652 12.2 1932 133,700 1,940 14.5 1,465 10.9 294 543 129 66 1,714 12.8 1933 131,400 1,827 13.9 1,500 11.4 340 530 119 65 1,690 12.9 1934 129,170 1,783 13.8 1,359 10.5 346 655 137 77 1,668 12.9 1935 128,100 1,877 14.7 1,347 10.5 406 583 131 70 1,524 11.9 1936 127,700 1,922 15.1 1,399 10.9 441 639 116 60 1,597 12.5 1937 126,500 1,913 15.1 1,333 10.5 402 662 130 68 1,593 12.6 1938 125,100 1,874 15.0 1,340 10.7 450 522 117 62 1,412 11.3 1939} B122,800 D 116,200 1,829 14.9 1,311 11.2 362 442 77 43 1,391 12.0 1940 98,320 1,600 16.3 1,725 17.5 370 401 76 51 1,756 17.9 1941 84,880 1,405 16.5 1,315 15.4 351 364 52 41 1,328 15.6 1942 89,370 1,589 17.8 1,270 14.2 356 338 94 59 1,252 14.0 1943 92,050 1,768 19.2 1,278 13.9 365 387 102 58 1,300 14.1 1944 89,190 1,788 20.0 1,447 16.2 418 389 95 53 1,418 15.9 1945 96,100 1,742 18.1 1,464 15.2 423 267 78 45 1,308 13.6 1946 111,860 2,310 20.6 1,522 13.6 463 277 103 45 1,336 11.9 1947 117,280 2,559 21.8 1,570 13.3 472 271 97 38 1,369 11.6 1948 115,800 2,149 18.5 1,608 13.8 547 241 75 35 1,302 11.2 1949 118,440 1,971 16.6 1,532 12.9 545 322 55 28 1,309 11.0 1950 119,200 1,988 16.6 1,433 12.0 482 346 34 17 1,297 10.8 1951 118,300 1,874 15.8 1,605 14.4 509 401 41 22 1,497 12.6 1952 118.800 1,777 14.9 1.509 12.7 535 383 37 21 1.357 11.4 1953 117,600 1,750 14.9 1.409 12.0 408 296 35 20 1.207 10.3 • B = Birth-rate Population Figure. D= Death-rate Population Figure. 48 CHART SHOWING BIRTH AND DEATH RATES PER 1000 POPULATION FOR THE PAST 20 YEARS . 49 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1953 Cause of Death Sex 0— 1_ 5— 15— 25- 45- 65— 75- Total all Ages 1. Tuberculosis, respiratory... M - - - 6 16 6 _ 28 F — — — — - 1 1 —" 3 2. Tuberculosis, other M — — — — — 1 — 1 F - - - - - 1 — 1 3. Syphilitic disease M — — — — 2 — 1 3 F — — — — — 1 — - 2 4. Diphtheria M - — - — — —- — — F - - - - - - - - - 5. Whooping cough M 1 - - - — 1 F - - - - - - - - - 6. Meningo-coæal infections M - - - - - - - - - F - - - - - - - - - 7. Acute poliomyelitis M - - - - - - - - - F - - - - 2 - - - 2 8. Measles M - - - - - - - - F - - - - - - - - - 9. Other infective and parasitic diseases M - - - - - - - - - F - 1 - - - — 1 10. Malignant neoplasm, stomach M — — — — 1 10 12 4 27 F — — — — — 8 9 4 16 11. Malignant neoplasm, lung bronchus M — — — — 2 18 25 2 47 F - — — — — 1 3 1 5 12. Malignant neoplasm, breast ... M - - - - — — — F - - 1 7 3 3 14 13. Malignant neoplasm, uterus M — — — — — — — — — F — — — — — 6 3 2 11 14. Other malignant and lymphatic neoplasms M — — — — 3 21 18 23 65 F _ — — — 1 8 12 16 37 15. Leukaemia, aleukaemia ... M - — — 1 — 1 F - - 1 — — — 1 16. Diabetes M — — — — - — 2 1 3 F - - - - - 1 3 - 4 17. Vascular lesions of nervous system M - - - - - 14 22 15 51 F — — — - 4 14 21 42 81 18. Coronary disease, angina M — — — — 3 40 39 17 99 F — — — — 2 10 28 29 09 19. Hypertension with heart disease M __ — 4 7 7 18 F - — — — — 2 12 10 24 20. Other heart disease M — — — — 3 8 11 24 46 F - 2 9 20 53 84 21. Other circulatory disease M - - 1 3 9 6 5 24 F - - - - - 2 6 11 19 22. Influenza M - - - - 4 2 3 9 F - - - - - - 1 7 8 23. Pneumonia M 2 1 — 1 — 9 15 16 44 F — - — — 1 6 6 18 32 24. Bronchitis M — - — — — 30 26 21 77 F 2 — — 1 4 18 19 44 25. Other diseases of respiratory system M - - — — 1 6 3 4 14 F 1 - - — — — — 1 26. Ulcer of stomach and duodenum M - - __ 1 6 4 3 14 F — — — — 1 1 2 4 27. Gastritis, enteritis and diarrhoea M 2 — - - - - - 1 3 F — — — — — — 1 — 1 28. Nephritis and nephrosis M - —. 1 — 3 1 1 1 7 F - - - - - 1 2 — 3 29. Hyperplasia of prostate M - - — — — 1 3 7 11 F - - - - - - - - - 30. Pregnancy, childbirth, abortion M — — - - - - - - — F - - — 1 2 — — — 3 31. Congenital malformations M 4 1 - 1 — — 1 —- 7 F 2 - 1 .— — 3 32. Other defined and illdefined diseases M 10 1 — — 3 5 7 10 36 F 12 — — 1 13 5 11 42 33. Motor vehicle accidents ... M - — — 1 1 2 2 2 8 F - 1 - 1 - - 1 - 4 34. All other accidents M - - 3 - 4 4 3 — 17 F — 1 — — — 5 4 10 35. Suicide M - _- - 1 3 6 1 — 11 F - - - - 1 2 2 — 5 36. Homicide and operations of war ... M — — — — — — — — - F — — — 1 — — - - - M 18 5 4 7 37 217 217 167 672 F 17 3 1 3 20 95 163 233 535 Total of all causes 35 8 5 10 57 312 380 400 1207 50 PROPORTION OF DEATHS FROM PRINCIPAL CAUSES 1953 51 INFANT MORTALITY- 1953 and Previous Years Year Births Death of Infant Death of Infant per 1,0000 births Average 1906-1913 3,000 359 117 ,, 1914-1923 2,639 230 88 ,, 1924-1933 2,145 141 66 1934 1,783 137 77 1935 1,877 131 70 1936 1,922 116 60 1937 1,913 130 68 1938 1,874 117 62 1939 1,829 77 43* 1940 1,600 76 51 † 1941 1,405 52 41 ‡ 1942 1,589 94 59 1943 1,768 102 58 1944 1,788 95 53 1945 1,742 78 45 1946 2,310 103 45 1947 2,559 97 38 1948 2,149 75 35 1949 1,971 55 28 1950 1,988 34 17 1951 1,874 41 22 1952 1,777 37 21 1953 1,750 35 20 * 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. 52 Net deaths of infants at various ages under one year of age Under 1 week 25 1-2 weeks — 2-3 weeks — 3-4 weeks — 4 weeks and under 3 months 1 3 months and under 6 months 6 6 months and under 9 months 1 9 months and under 1 year 2 Total deaths under 1 year 35 Net Births in the Year: Legitimate, 1,610; Illegitimate, 140. Net Deaths in the Year: Legitimate Infants, 35; Illegitimate Infants,— 53 CHART SHOWING THE NUMBER OF DEATHS OF INFANTS UNDER 1 YEAR OF AGE DURING THE PAST 20 YEARS . 54 INFANT MORTALITY RATES — ENGLAND AND WALES AND VARIOUS OTHER COUNTRIES Deaths under 1 year per 1,000 live births Country 1948 1949 1950 1951 1952 England and Wales 34 32 30 30 28 Scotland 45 41 39 37 35 Northern Ireland 46 45 40 41 39 Australia 28 25 24 25 24 Canada 44 43 41 38 38 Chile 160 169 153 149 134 Denmark 35 34 31 29 29 France 51 61 52 51 46 Irish Republic 49 53 45 45 41 Italy 70 74 64 67 64 Netherlands 29 27 25 25 23 New Zealand 22 24 23 23 22 Sweden 23 23 20 21 20 United States 32 31 29 29 29 of America MATERNAL MORTALITY—1953 and Previous Years Year Number of Deaths Pregnancy, childbirth, abortion Number of live Births Maternal Death Rate Average 1924-1933 8 2,145 3.5 1934 9 1,783 5.0 1935 2 1,877 1.1 1936 3 1,922 1.6 1937 4 1,913 2.1 1938 2 1,874 1.1 1939 2 1,829 1.0 1940 _ 1,600 1941 2 1,405 1.5* 1942 3 † 1,589 1.9 1943 3 1,768 1.6 1944 2 1,788 1.08 1945 1 1,742 0.56 1946 7 2,310 2.94 1947 1 2,559 0.38 1943 1 2,149 0.45 1949 2 1,971 0.99 1950 1 1,988 0.49 1951 1 1,874 0.52 1952 2 1,777 l.10 1953 3 1,750 1.67 * 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". 55 ENVIRONMENTAL HEALTH SERVICES (A) SANITARY INSPECTION Cause of Inspection No. of Inspections NO. of Notices served No. of Notices complied with Bakehouses 105 - - Cancer 1 — — Complaints 4,094 1,382 1,012 Drainage 2,000 8 11 Factories (Mechanical) 483 15 11 Factories (Non-Mechanical) 165 2 3 Fireguard Regulations 3 — — Food (other than Restaurants and Eating Houses) 3,106 6 — Housing Act 518 4 1 Housing Applications 1,030 49 23 House to House 16 7 3 Ice Cream Vendors 699 — — Infectious Diseases 282 2 — Licences (Building) 32 — — Markets 390 — — Milk Vendors 861 1 Outworkers 1,514 9 4 Pet Animals Act 35 Pharmacy and Medicines Act 107 - - Public Urinals 51 - Rag Flock Act 3 - Rats and Mice 3,193 52 35 Restaurants and Eating Houses 490 15 11 Shops Acts 87 3 2 Slaughterhouses 1 - Smoke Observations 200 6 1 Miscellaneous 1,601 33 33 Re-visits 9,212 456 754 No Answer 1,643 — 31,925 2.050 1,904 No. of Ineffective Visits 1,643 - - Total 30,282 2,050 1,904 During the year, 844 Statutory Notices were served and 622 complied with. (B) SUMMONSES—Proceedings instituted during the year Public Health (London) Act, 1936 136 Food and Drugs Act, 1938 6 H.B.C. Byelaws 1 L.C.C. Byelaws 17 56 (C) FACTORIES ACT, 1937 1.—INSPECTIONS Premises Number on Register Number of Inspections Writen Notices Occupiers Prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 184 165 2 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 511 483 15 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) Total 695 648 17 — 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) 6 4 - - - Overcrowding (S.2) — — — Unreasonable Temperature (S.3) Inadequate Ventilation (S.4) 1 1 - - - Ineffective Drainage of Floors (S.6) - - - Sanitary Conveniences (S.7)— (a) Insufficient — — — (b) Unsuitable or Defective 7 6 - - - (c) Not separate for Sexes - - - - - Other offences against the Act (not including offences relating to Out-work) 3 3 2 - - Total 17 14 2 — — 57 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 Chocolate and Sweetmeats 133 — — 27 — - Wearing Apparel— Making, &c. 220 5 — — — — Lampshades 6 2 — — — - Curtains and Furniture Hangings 7 — — — — Furniture and Upholstery 2 — — — — —- Artificial Flowers 4 — — — — — Paper Bags 49 — — — — — Feather Sorting 6 — — — — — Carding, &c, of Buttons, &c. 42 _ Stuffed Toys 70 2 — 1 — — Umbrellas 1 — — — — — -! Cracker Bon-bon, Christmas Crackers, Christmas Stockings, &c. 177 - - - - - The making of Boxes and other receptacles or parts thereof made wholly or partially of paper 3 - - - - - Total 720 9 - 28 — — 58 (D) HOUSING 1. Total number of houses in the Borough, including flats, tenements, etc., separately assessed 25,900 (approx.) Public Health (London) Act, 1936 2. No. of houses inspected on account of complaints or illness ... 4,094 3. Number of statutory notices served 844 4. Number of prosecutions 136 5. Number of houses repaired or nuisances remedied 1,042 Housing Act, 1936 6. Number of houses inspected — house-to-house (Housing Consolidated Regs. 1925) Nil 7. (a) Number of houses included in representations by the Borough Medical Officer under Sec. 25 of H.A., 1936 Nil (b) Number of houses demolished following representations by Borough Medical Officer under Sec. 25 of H A. 1936 4 8. Number of houses repaired under Sections 9 and 10 of H.A., 1936: — (a) By owners Nil (b) By L.A. in default of owners Nil 9. Number of houses demolished: — (a) In pursuance of orders under Sec. 11 of the Housing Act, 1936 Nil (b) Voluntarily Nil 10. Number of rooms on which Closing Orders were made (excluding underground rooms) Nil 11. Number of Closing Orders determined (excluding underground rooms) Nil Overcrowding (Housing Act, 1936) 12. Number of families living in overcrowded conditions 178 Number of overcrowded families who have obtained alternative accommodation 65 13. Number of dwellings erected by the Borough * Council during year 170 (Flats) Underground Rooms 14. Number occupied but unfit Unknown Number closed or modified occupation approved . 20 Number of Closing Orders 20 Number of Closing Orders determined 14 Houses Let in Lodgings 15. Number in Borough 9,600 (approx.) *Number of inspections Number of prosecutions Nil † Number of complaints remedied under the Bye-laws (not included under any other heading) - ° Included under item No. 2. † Included under item No. 5 59 (E) UNSOUND FOOD CONDEMNED—1953 Bacon 31 lbs. Beans, dried 3 lbs. Beans, baked 58 tins Beverages 1 tin Biscuits 53 lbs. Butter 41 lbs. Cakes 30 lbs. Cereal 157 lbs. Cheese 60 lbs. Chickens 30 Cream 5 lbs. Cream 15 tins Custard Powders 3 Eggs 9 cases Eggs 16 tins Fat 62 lbs. Fish 116 tins Fish 126 lbs. Flour 6 lbs. Fruit, dried 276 lbs. Fruit, tinned 1,108 tins Fruit, pulp 223 tins Jam 112 jars Jelly 2 pkts. Meat, butcher's 386 lbs. Meat 397 tins Milk, powdered 105 lbs. Milk, tinned 225 tins Milk, bottled 14 bottles Mincemeat .. 67 jars Nuts 100 lbs. Peas, dried 179 lbs. Peas 235 tins Pease pudding 8 tins Pickles 11 jars Pudding Mixture ... 8 pkts. Salad Dressing 12 jars Sandwich Spread ... 6 jars * Sauce 1 bottle Sauerkraut ... 70 lbs. Sausages 13 tins Sausages 1,615 lbs. Soup 41 tins Soup, Mix. & Flav. 100 lbs. Spaghetti 3 tins Sugar 336 lbs. Sweets 40 lbs. Tea ... 22 lbs. Tomatoes 140 tins Tomato Juice 2 tins Tomato Puree 2 tins Tongue 14 tins Vegetables ... 45 tins 60 PUBLIC MORTUARY—Bodies Admitted, &c. Bodies admitted from the Borough: — By order of Coroner 269 By order of Police 3 On application of undertakers 18 290 Bodies admitted from other Boroughs: — Fulham (Fifty-five by order of Coroner and sixteen by order of Police) 71 Chelsea (Two hundred and forty-three by order of Coroner, four by order of Police and five by application of undertakers) 252 Kensington (Fourteen by order of Coroner and two by order of Police) 16 339 Total bodies admitted 629 No. of P.M. examinations conducted: — Hammersmith cases 268 Fulham cases 71 Chelsea cases 247 Kensington cases 16 Total P.M.'s 602 No. of Inquests held: — Hammersmith cases 65 Fulham cases 53 Chelsea cases 55 Kensington cases 93 Total Inquests held 266 61 (A) INFECTIOUS DISEASES Diseases Notifications Total Cases Notified Cases Removed to Hospital Deaths Corrected Figures 0—1 year 1—2 years 2—5 years 5—15 years 15—25 years 25—45 years 45—65 years 65 + years Scarlet Fever 4 31 78 2 2 — 117 28 106 Whooping Cough 56 54 190 155 — 3 — — 458 42 1 447 Acute Poliomyelitis (Par.) — 1 4 7 3 5 1 — 21 21 1 6 „ (Non Par.) — — — 1 1 — — •— 2 2 1 2 Measles 30 73 245 172 10 6 2 — 538 33 — 537 Diphtheria — — 2 1 2 3 — — 8 8 — — Pneumonia 6 3 20 11 4 17 18 22 101 17 76 101 Dysentery 6 17 23 5 7 4 2 64 20 — 56 Acute Encephalitis (Inf.) — — 2 — — - 2 2 — 1 Enteric or Typhoid Fever 1 1 — — 2 2 1 Paratyphoid Fever 1 2 3 3 3 Erysipelas 1 1 1 17 3 23 8 21 Meningococcal Infection 2 3 2 1 8 8 2 Food Poisoning 1 1 2 5 7 13 4 - 33 6 31 Puerperal Pyrexia - - 86 139 - 225 2 *225 Ophthalmia Neonatorum 15 - - - - - 15 15 Malaria - - - 1 1 - - 2 2 2 Scabies 1 - 2 6 9 12 6 5 41 - 41 Tuberculosis (Pulmonary) - 1 7 19 38 69 50 14 198 49 31 198 „ (Non-Pulmonary) — 1 - 5 7 2 2 - 17 11 2 17 Totals 115 138 522 491 179 280 107 46 1,878 124 1 12 1,812 ° Of this total only 57 cases related to persons residing in the Borough. 62 (B) BACTERIOLOGICAL EXAMINATIONS Specimen Positive Negative Total Swabs for suspected cases of Diphtheria - 100 100 Haemolytic Streptccocci 7 38 45 Faeces 43 69 112 Vincents Organisms — 16 16 50 223 273 63 TUBERCULOSIS Summary of Notifications during the period from the 1st January, 1953, to the 31st December, I9F3 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 2 8 4 6 11 19 18 17 20 9 - 115 Respiratory, Females - - 5 - 4 - 17 24 8 10 3 3 2 83 Non-Respiratory, Males - - - - 2 2 1 1 1 1 - - - 11 Non-Respiratory, Females - - — 1 — 4 — — — 1 — — 6 CASES NOTIFIED AND DEATHS—1953 and Previous Years Year No. of Cases notified No. of Deaths No. of Cases on Register of Notifications Pulmonary NonPulmonary Total 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 1950 166 21 187 39 1,779 1951 193 15 208 44 1,852 1952 180 14 194 43 1,494 1953 193 17 215 33 1,595 Average number of cases notified for the 10 years 1934-1943 (inclusive)—194. Average number of cases notified for the 10 years 1944-1953 (inclusive)—206. Average number of deaths for the 10 years 1934-1943 (inclusive)—106. Average number of deaths for the 10 years 1944-1953 (inclusive)—65. 64 CHART SHOWING THE NUMBER OF- NEW CASES OF TUBERCULOSIS NOTIFIED DURING THE PAST 20 YEARS . 65 MEDICINAL BATHS Cleansing of Verminous Persons School Children—Hammersmith Scabies 59 Verminous 803 Impetigo 6 School Children—Non-Hammersmith Scabies 3 Verminous 2 Children under Five Years—Hammersmith Scabies 24 Verminous 38 Other Conditions 2 Children under Five Years—Non-Hammersmith Scabies 1 Verminous 2 Adults—Hammersmith Scabies 111 Verminous 137 Other Conditions 15 Adults—Non-Hammersmith Scabies 17 Verminous 16 Other Conditions 1 Lodging-Houses Scabies 3 Verminous 216 DISINFECTION Hammersmith Cases Non Hammersmith Cases Mattresses 436 427 Pillows 273 68 Bolsters 8 9 Blankets 275 267 Sheets 137 12 Quilts 31 19 Clothing 267 + 264 Sundries 168 43 Total 2,704 + 17 Custom's Certificates issued in respect of 235 articles. Rooms (including 830 verminous Rooms) 891