PRO. Region 5 AC 4347 HAM 46 Metropolitan Borough of Hammersmith ANNUAL REPORT of the Medical Officer of Health with STATISTICAL SUPPLEMENT for the year 1954 by F. M. DAY, M.R.C.S., L.R.C.P., D.T.M., D.P.H. METROPOLITAN BOROUGH OF HAMMERSMITH Health Committee At 31st December, 1954 Councillor E. O'K. Finn (Mrs.), M.B.E. (Chairman) „ E. R. Gosling (Vice-Chairman) Alderman R. J. Buckingham Councillor A. Belsham „ L. C. Clover „ J. Farndale „ E. W. Flynn „ L. C. Newton „ B. Wildman (Miss) E. C. Woods (Miss) „ E. A. Worne 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 5 Deaths 5 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 7 Food Poisoning 12 Health Laundry 13 Mass Badiography 8 Medicinal Baths 12 Notifications 7 Poliomyelitis 12 Tuberculosis 7 SECTION C—Housing:- Building Licences 19 Overcrowding (Section 61) 19 Permanent Estates 17 Be-housing 16 SECTION D—Inspection and Supervision of Food:- Clean Food Campaign—Hammersmith Clean Food Traders' Guild 27 Designated Milk—Licences 26 Food and Drugs Act, 1938—Meat and Other Foods 20 Ice Cream 25 Markets 25 Merchandise Marks Act, 1926 25 Milk Supplies 26 Olympia Exhibition Halls 25 Public Health (Condensed Milk) Begulations, 1923/48 27 Sampling 22 Wormwood Scrubs Fair 25 SECTION E—Sapitary Administration:- Coroner's Court and Public Mortuary 32 Exhumation and Be-interment of Bodies 30 Heating Appliances (Fire Guards) Act, 1952 33 Housing Bepairs and Bents Act, 1954 30 L.C.C. (General Powers) Act, 1952—Bag and Bone Dealers 33 Pet Animals Act, 1951 32 Pharmacy and Poisons Act, 1933 32 Public Baths and Wash-houses 33 Bag Flock and Other Filling Materials Act, 1951 32 Staff—Inspectorial 30 SECTION F—Sanitary Circumstances:- Page Atmospheric Pollution 36 Drainage 34 Dustbins 34 Factories 35 Public Cleansing 34 Rodent Control 35 Sanitary Inspection 35 Water Supply 34 SECTION C—Ceneral Provision of Health Services:- Ambulance Facilities 37 Burial or Cremation of the Dead 42 Conferences 45 Diseased or Infirm Persons 41 Financial Contributions to Voluntary Organisations 44 Hammersmith Chest Clinic 37 Health Information Bureau 45 Hospitals 37 International Certificates of Vaccination and Inoculation 41 Laboratory Facilities 37 Old People's Welfare 42 Personal Health Services 38 Clinics and Welfare Centres 39 Day Nurseries 40 Domestic Help Service 40 Staff Medical Examinations 43 STATISTICAL SUPPLEMENT—TABLES Bacteriological Examinations 66 Causes of Death in Age Groups 53 Deaths from Carcinoma of Lungs in Age Groups from year 1941 49 Disinfection 69 Extract from Vital Statistics 47 Factory Defects 60 Factory Inspections 60 General Statistics 47 Housing 62 Incidence of Cancer during the past 10 years 48 Incidence of Pulmonary Tuberculosis and Neoplasms of the Lungs 50 Infant Deaths under 1 year in age groups 56 Infant Mortality 55 Infant Mortality Rates—England and Wales and various other Countries from year 1949 58 Infectious Diseases—Notifications in age groups 65 Maternal Mortality 58 Medicinal Baths—Cleansing of Verminous Persons 69 Mortuary and Coroner's Court 64 Natural Increase or Decrease of the Population during the past 20 years 48 Outworkers 61 Sanitary Inspection, Notices served and complied with 59 Summonses—Proceedings instituted 59 Tulerculosis—Notifications and Deaths for the past 20 years 67 Tuberculosis—Notifications in Sex and Age Groups 67 Unsound Food Condemned 63 Vital Statistics of whole District from year 1925 51 CHARTS Birth and Death Rates for the past 20 years 52 Number of Infant Deaths under 1 year of age during the past 20 years 57 Number of new cases of Tuberculosis notified during the past 20 years 68 Proportion of Deaths from Principal Causes 54 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 presenting to you my Annual Report on the health and sanitary circumstances of the Borough for the year 1954. Once again I regret that it was not possible to publish it earlier, as the Registrar General's figures which are necessary in order to calculate the vital statistics were not available sooner. The year behind us is chiefly notable for a decrease in illhealth and a further increase in the standard of living of our citizens. The death rate was the lowest ever recorded in the Borough —9.1 deaths per thousand living persons. Hammersmith is quoted by the Registrar General also for having a particularly low suicide rate, comparable in fact with those places in England which have least suicides of all. Only three were better than Hammersmith and these were Wakefield, Cardiff and Bermondsey. We can congratulate ourselves also on the lowest number of deaths from tuberculosis ever recorded—21 for the whole year —and, furthermore, that now there has been no death from diphtheria for ten years. Standards of living depend substantially on standards of housing. Both the County Council and the Borough Council continue to provide new flats, mostly in the south of Hammersmith. It is to such places that the Medical Officer of Health and Sanitary Inspector rarely have to go. That speaks for itself. It means that, on average, tenants of healthy homes have less ill-health than those who live in doubtful accommodation. The position of the elderly, however, continues to be an unfavourable aspect of present-day times. Hospital accommodation for them is virtually non-existent, and it would seem that more and more confine themselves to one miserable room and become, as it were, hermits and outcasts. As they mix less and less with others, so do they retire more into themselves and so their health declines. Much as the Council are doing for the elderly in this Borough, much more remains to be done, and the Council have no powers to proceed further. A local Doctor quotes that a patient of his—a case of high blood pressure—who was living alone and was falling "all over the place with giddiness" was admitted to Hospital in November, urgent application for admission having been made the previous May. He continues "The plain fact is for the chronic sick the Hospitals are closed to us." 2 I regret to report that during the year Dr. Mark Golding, who was acting as my deputy, passed away. A brilliant and delightful man, we were more than fortunate to have his help to assist me in my work. Dr. Andrew Shinnie was appointed to succeed him and his appointment has now been approved by the Ministry of Health. In conclusion, I wish to record my appreciation and thanks to the Chairman and Members of the Health Committee for the support and help they have given me during 1954, and to express my thanks also to the Staff of the Health Department for their efficient work and loyal co-operation throughout the year. 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, 1954 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): A. J. Shinnie, O.B.E., M.D., D.P.H. Administrative Officer: †☼.P. W. Pottier Clerical: J. C. Turner (l.st Assistant) W. Robinson T. J. Hares Mrs. F. Lawford Mrs. D. Kelley E. Baines (Temporary) Mrs. L. G. Stimpson Miss J. Mynott Miss I. E. Waller R. W. Hart (.M.O.H.'s Secretary) Senior Sanitary Inspector: ¶†°W. Rigby Sanitary Inspectors: ¶ †☼P. T. Bayes (Deputy Senior) †§J. Garratt ° † § J. C. Hopkins §E. W. Pike † §G. G. Gardiner † § A. H. Chappell ║‡"§Miss E. M. Cross † §R- C. Stuttle † §B. Berry Food and Drugs Inspectors: † § J. Collier $ †°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, covering an area of 2,282.5 acres. It is bounded on the north by the Borough of Willesden, on the south by the River Thames, on the east by the Royal Borough of Kensington and the Metropolitan Borough of Fulham, and on the west by the Boroughs of Acton, and Brentford and Chiswick. The sub-soil in the northern half of the Borough, i.e., 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 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. There are 23 acres of public gardens and open spaces which are controlled by the Council, and 255 acres by the London County Council, 4½ acres of the Grand Junction Canal and 128 acres covered by the River. The Borough, once a quiet rural area in the County of Middlesex and relatively untouched by the spread of London, became part of the County of London in 1885, and is now both a highly developed industrial and residential area, in which little of the old world remains apart from such places as the Latymer Foundation School founded in 1624, Kent House and others in the Lower and Upper Malls dating back to the 17th century, Kelmscott House, the home of William Morris and Hammersmith Terrace which is composed of 17th and 18th century houses. Apart from its residential and industrial population, the Borough attracts a large number of visitors by reason of various centres which are to be found within its boundaries. St. Paul's Boys' and Girls' Schools, West London, Royal Masonic and Queen Charlotte's Maternity Hospitals, the Hammersmith Hospital and British Postgraduate Medical School, White City Stadium, Olympia, the Television Studios at Lime Grove and the Television Centre in Wood Lane, and of course Wormwood Scrubs, all attract their quota of people from outside our boundaries. The Boat Race also brings many people to our attractive riverside for a few hours every spring, whatever the weather may be. The total length of the roads in the Borough is approximately 67 miles, and traffic on the main roads is very heavy, particularly over Hammersmith Bridge leading to the south, and to the main road to Oxford, the West, and London Airport. There are approximately 300 industrial undertakings, the majority of which are situated in the North, although some of the largest single employers of labour are to be found in the South. 5 Vital Statistics. (a) Population. In this report the rates are calculated on the estimated population adopted by the Registrar General, namely 116,500, which compared with 117,600 for 1953, shows a reduction in population of 1,100. No epidemic causing any mortality occurred during the year and the excess of births over deaths has been maintained. (b) Marriages. The number of marriages solemnised during the year was 1,270, this being an increase of 44, as compared with the previous year. Particulars are set out hereunder: — The Register Office 530 Buildings registered for marriages (Roman Catholic Churches and Chapels) at which a Registrar attends 324 Churches of the Church of England 364 Authorised Persons (Chapels at which a Registrar does not attend) 26 Jewish Synagogues 26 1,270 (c) Births. The corrected number of births for the year as supplied by the Registrar General was 1,776. On the estimated population of 116,500 this represents an annual rate of 15.2 births per thousand persons living, which is a slightly higher rate than for the previous year. (d) Deaths. During the year 1,382 deaths were registered. Add to this figure 295 deaths of residents of the Borough who died in various parts of England and transferred by the Registrar General, and deduct 580 deaths of non-residents and 26 transferable deaths which occurred, the corrected figures show a total of 1,071 deaths of residents (564 males, 507 females) which shows a reduction of 136 as compared to 1953. On the estimated population of 116,500 the corrected number of deaths per 1,000 persons living was 9.1 as compared to 10.3 last year. This is the lowest death rate ever recorded in the Borough. 6 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, with cancer second and lung conditions now occupying fourth place. The Registrar General in his statistical survey of England and Wales for 1950 published during the year states that the death rate in Greater London is lower even than that of the countryside. Age for age, for both sexes, mortality in the North and Wales is higher than in the East or the South of England. Many reasons for this the Report suggests were greater crowding of the population in terms of persons per room and possibly the diminished sunlight and greater atmospheric pollution of the industrial North. There were probably also socio-economic causes. It also appears from the Report that suicide was commonest in Hampstead with a rate of 287 per million, followed by Holborn with 270, Burnley with 259 and Westminster with 257. There were also high rates in the seaside boroughs of Eastbourne, Bournemouth, Blackpool and Brighton. At the other end of the scale were Wakefield 33, Cardiff 45, Bermondsey and Hammersmith 50, Plymouth 53, and Wigan 59. A comparison with 1841-1850 shows that the younger children have benefited from the decline in mortality. The death rate of school age girls was only 6% of that 100 years ago, whilst men aged 65-84 have still 812 of those 100 years back. (e) Infant Mortality. The number of deaths of infants under one year of age during the year was 38, giving an annual mortality rate per 1,000 live births of 21. (f) Maternal Mortality. There were three maternal deaths during the year, the same as in 1953, resulting in a death rate of 1.66 per 1,000 live and still-births. 7 SECTION B PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES Infectious Disease. Only 1,155 cases of infectious diseases were notified in the Borough during the year. 167 cases were removed to Hospital and of this number 39 were notified on discharge as not having suffered from the disease originally notified. As a result, the corrected number of cases of notifiable infectious disease for the year was 1,116. These figures show the considerable decrease on the previous year of 696 cases. This decrease is almost entirely due to the fact that once again there was no epidemic of measles and the number of cases of whooping cough notified was 276 less. Six cases of suspected diphtheria were notified but once again I am pleased to report that not one of them was confirmed. It affords me much satisfaction to be able to report that for the tenth year in succession I do not have to record any deaths from this disease. Contacts and Carriers of Infectious Disease—Sickness Benefit. Five Certificates were issued during the year in the following circumstances: — (a) Woman employee (Post Office Sorter) who was a contact of a suspected case of Typhoid. (b) Woman cleaner in a children's ward at a hospital who was a contact of Chicken Pox. (c) Cook at a Bakery who was a contact of a case of Sonne Dysentery. (d) Bus Conductress who was a contact of a case of Para- Typhoid and was found to be suffering from this infection. She was in fact infected by the first case. (e) Domestic in a Ward of Maternity Hospital who was a contact of a case of Scarlet Fever. Tuberculosis. It is with much pleasure that I am able to report a considerable decrease in the incidence of this disease. The number of new cases notified during the year was only 180 as against 215 in the previous year. These figures show a decrease of 31 in pulmonary cases and 4 in non-pulmonary cases. 8 The total figures correspond more than favourably with those over the last 20 years, there being only two years in that period, namely 1937 and 1940, when the number of cases notified was lower. In the Statistical Supplement will be found a chart showing the number of new cases of tuberculosis notified during the past 20 years. Although the figures for this year show such an improvement, it must be borne in mind that tuberculosis still remains a serious menace to public health and is affecting seriously the age groups which are of the utmost value to the productive ability of the nation. Although high priority is given by the housing authorities in re-housing tuberculous persons, the housing shortage still 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 21 as compared with 33 for the previous year. This is the lowest figure of deaths from tuberculosis ever recorded in the Borough. Mass Radiography. The campaign was once again conducted by the North West Metropolitan Regional Hospital Board during April, May and June. Prior to the visit of the Unit, an informative meeting of representatives of various organisations, presided over by His Worship the Mayor, was held on 3rd March, and those present agreed to support the survey by taking part in a propaganda drive through the distribution of leaflets and posters, as well as through their personal influence. In order to make it as easy as possible for Hammersmith residents to be X-rayed, three sites were chosen where the general public could attend—Tlie Town Hall, Wormholt Community Centre and Shepherds Bush Common. A large number of firms in the Borough were invited to allow their employees to attend for examination at the Unit and the managements proved very co-operative. The scheme was also advertised to the public in the local and national evening Press, and by means of posters and handbills, and many took advantage of the opportunity afforded as shown below: — Males Females Total Number examined 5577 3167 8744 Recalled for large films 10 77 185 9 These 8,744 persons were X-rayed during 23 working days at an average of 400 miniatures per day. Of this total 33 people were referred to Chest Clinics and Hospitals for further investigations. Of the total number of persons examined, 3,167 were members of the general public. Results of the attendances and examinations at the various sites are shown hereunder:— 26th April—12th May. Town Hall. The attendance was on the whole good; 4,309 persons were X-rayed, including 1,913 volunteers from the general public. Males Females Total Number examined 1907 2402 4309 Recalled for large films 47 43 90 Disposal of large film cases: (a) No further action 64 (b) To return to Unit for further X-ray 1 (c) Further investigation required (this does not necessarily indicate tuberculosis) 21 (d) Known cases had or having treatment — (.e) Failed to return for large films 4 14th May. George Wimpey & Co. Ltd., Hammersmith Grove. This factory survey was well attended and the support of the management was noteworthy. Males Females Total Number examined 358 133 491 Recalled for large films 8 — 8 Disposal of large film cases: — (a) No further action 6 (b) To return to Unit for further X-ray — (c) Further investigation required (this does not necessarily indicate tuberculosis) 2 (d) Known cases had or having treatment — (e) Failed to return for large films — 10 17th May. H.M. Prison, Wormwood Scrubs. There was a much smaller attendance than expected. Males Females Total Number examined 351 — 351 Recalled for large films 8 — 8 Disposal of large film cases: — (a) No further action 6 (b) To return to Unit for further X-ray — (c) Further investigation required (this does not necessarily indicate tuberculosis) 2 (d) Known cases had or having treatment — (e) Failed to return for large films — 20th May. George Cohen, Son & Co. Ltd., Wood Lane. This factory survey was well attended and the support of the management was noteworthy. Males Females Total Number examined 377 209 586 Recalled for large films 10 2 12 Disposal of large film cases: — (a) No further action 10 (b) To return to Unit for further X-ray — (c) Further investigation required (this does not necessarily indicate tuberculosis) 2 (d) Known cases had or having treatment — (e) Failed to return for large films — 24th—25th May. Wormholt Community Centre. This visit was arranged at the special request of the Wormholt and White City Community Association, who felt that the residents of the White City Estate would readily volunteer for an X-ray if the unit was brought to them. The Community Association undertook detailed publicity on the Estate. The result, however, was disappointing—only 175 people attending during the two days, including an evening session. Males Females Total Number examined 59 116 175 Recalled for large films 4 3 7 11 Disposal of large film cases: — (a) No further action 5 (b) To return to Unit for further X-ray — (c) Further investigation required (this does not necessarily indicate tuberculosis) 2 (d) Known cases had or having treatment — (e) Failed to return for large films — 26th—31st May. Shepherds Bush Common. For the first time a Mass Radiography Unit was installed on a borough green. This was possible through the cooperation of the Parks Department of the London County Council and through the invaluable help given by Messrs. George Wimpey & Co. Ltd. in lending a mobile office for the staff. The survey was an unqualified success. During four working days 2,173 people were X-rayed, among them 1,254 from the general public. Males Females Total Number examined 1099 1074 2173 Recalled for large films 27 24 51 Disposal of large film cases:— (a) No further action 40 (.b) To return to Unit for further X-ray — (c) Further investigation required (this does not necessarily indicate tuberculosis) 8 (d) Known cases had or having treatment — (e) Failed to return for large films 3 1st—2nd June. B.B.C. Television Centre, Wood Lane. Attendance figures were satisfactory. Males Females Total Number examined 388 271 659 Recalled for large films 4 5 9 Disposal of large film cases:— (a) No further action 8 (b) To return to Unit for further X-ray — (c) Further investigation required (this does not necessarily indicate tuberculosis) 1 (d) Known cases had or having treatment — (e) Failed to return for large films - 12 A final survey of the visit of the Unit for the Borough shows that of the 8,744 persons examined, only 13 were found to require treatment for pulmonary tuberculosis, i.e., 1.5 per 1,000 of those examined, although it is possible that some of the observation cases might, in the course of investigation, prove to require treatment. Bearing in mind that mobile surveys in London boroughs are difficult to assess, it is fair to say that this survey was undoubtedly a numerical success and well worth the effort involved. In February of this year, Division I of the London County Council held a Health Week Exhibition at the Town Hall and in conjunction with this, a Mobile Unit of the South Western Metropolitan Begional Hospital Board was in attendance. The Exhibition was open for a week and during that period many persons were examined. Food Poisoning. Nineteen cases of food poisoning occurred as compared with 31 in the previous year. I am pleased to report that there have been no serious outbreaks. In seven cases, Salmonella Typhi-murium were identified as the responsible organisms, but in the remaining cases no specific organisms were isolated. Foods alleged to have been responsible for the patients' condition included boiled bacon, sausages, eggs, minced meat, chips, cold meat, rabbit stew and meat pie. Poliomyelitis. Only one person suffered from this disease during the year. This was a girl of 9 years who remained in hospital for six weeks, after which she was discharged with paralysis of the left arm. Medicinal Baths. The Medicinal Baths in Scotts Road, Shepherds Bush, provide for the treatment of scabies, impetigo, psoriasis, and certain verminous conditions. The figures showing the numbers dealt with during the year will be found on reference to the table in the Statistical Supplement. It is pleasing to report a continued decrease in verminous conditions, the total of 1,017 being the lowest ever recorded. There has, however, been an increase in the number of treatments for scabies for the first time since the War. 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. 13 Infected 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 home treatment 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 four other local authorities during the year. On 59 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. The mobile team which is available for dealing with homes that require treatment, was again actively engaged and during the year 233 premises were sprayed for bed bugs and fleas (595 rooms) and 39 premises for infectious disease (57 rooms). This shows the considerable decrease of 37% in which disinfestation or disinfection was required. Following notification of vermin infestation or infectious disease, bedding and articles of clothing, etc., were collected from 111 premises and removed to the Disinfecting Station for sterilisation, and particulars are summarised in a table in the Statistical Supplement. Certificates of disinfection are issued when required to enable clothing, etc., to pass through foreign customs. In this connection 52 certificates were issued after sterilisation of 805 articles. Health Laundry. Two years have now elapsed since the introduction of the health laundry scheme. The rapidly increasing demand for the service from all those sections of the community with whom the aged people in particular are a vital problem, proves its valuable aid in the alleviation of distress and suffering of those ill, with a consequently sooner restoration to their former state of health. It also provides help to the people on whom the sick depend for bodily needs, with a better opportunity to give those services to the full advantage of the patients and with less inconvenience to themselves. This help is of inestimable gain. Requests are received from doctors, nurses, welfare associations, relatives and friends, and all are carefully considered and sympathetically approached from both medical and social aspects. In view of the precarious health of many of the patients and the fact that a general improvement in condition is usually seen, results 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. 14 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. During the year 10 new cases were added to the list of patients benefiting by the scheme and 111 certificates were signed authorising the laundering of bed linen, etc. Only one patient of 92 years of age died during 1954 while receiving help, five were admitted to hospital in a much better condition for further treatment than would otherwise have been possible. In five other cases the service was still in operation at the end of the year, one patient having been bedfast for over four years, and still no sign of broken or unhealthy skin. Despite incontinence, no patient developed bedsores after the start of the service, although the average age of all cases was 77.7 years. The following are details of the service to individuals:— Sex and Age Collections up to 31.12.54 Primary Cause of Ill-health Sequel M 79 22 Apoplexy Admitted to Hospital F 92 9 Senility Died F 82 55 Arthritis Service still in operation F 74 15 Cardiac Failure ditto F 80 1 Found collapsed Admitted to Hospital F 83 5 Prolapsed Haemorrhoids Condition improved F 69 13 Spondylitis Service still in operation F 78 7 Cerebral Haemorrhage Admitted to Hospital F 81 5 Arthritis ditto F 68 4 Apoplexy Service still in operation M 66 4 Apoplexy ditto M 80 1 Cardiac Failure Admitted to Hospital 15 Cleansings carried out during the year included: — Sheets 514 Blankets 19 Pillow Slips 163 Towels 141 Nightdresses 131 Pyjamas 9 Sundries 197 Total 1,201 16 SECTION C HOUSING. Rehousing. During the year the Housing Department was transferred from 218, Goldhawk Road to the Town Hall. The Housing Estates Manager relies on the Health Department for inspections to be made regarding overcrowding and for advice when applications are supported by medical evidence. If overcrowding is found to exist by the District Sanitary Inspector, an appropriate report is forwarded for submission to the London County Council. 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 conditions of premises. Enquiries of this nature totalled 370 and of these 145 families were found to be living in overcrowded conditions. Thirty-four 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 14 such recommendations were made to the Housing Estates Manager. I append a table showing the number of cases recommended for rehousing under the three headings mentioned above and those actually rehoused from 1949:— 17 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 1954 34 2 145 86 14 4 18 19 Blythe Road is one of the oldest roads in the Borough, being known prior to 1889 as Blythe Lane, and is narrow and winding throughout most of its length. The opportunity was then taken to re-align the road in this vicinity. The Council acts as landlords for 3,872 principal tenants. The properties managed include houses, flats, pre-fabs and requisitioned accommodation. At the end of the year there were 5,672 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 874 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 (Still living in pre-fabricated dwellings at end of year, 48). 80 4. Number of Borough Council licensees living in requisitioned properties at the end of the year 1566 Overcrowding (Section 61). Three 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. Building Licences. By the direction of the Minister of Housing and Local Government on 10th November, 1954, the necessity for obtaining licences to carry out work was dispensed with. Up to that date the original arrangements for dealing with applicants was still in operation and the Sanitary Inspectors continued to investigate and report upon all applications. Applications received 8 Licences issued 8 20 SECTION D INSPECTION AND SUPERVISION OF FOOD Food and Drugs Act, 1938. Meat and Other Foods. It is of manifest importance to the welfare of the community that the purity of its food supply should remain inviolate. The adulteration of foodstuffs is by no means a new practice, for one may turn to the writings of one of the ancient Roman philosophers, and there read of a case where adulterated wine was served at a royal banquet. English history of the Middle Ages reveals many examples of attempts, crude, it is true, that were made to defeat the machinations of fraudulent vendors. Advances in analytical science resulted in the introduction of legislature aimed at preventing these fraudulous practices. It would be a serious reflection on the administration of the Food and Drugs Acts and the efficiency of the Health Department if the gross adulterations which were once rife were common to-day. By 1860 the need was apparently seen for a comprehensive Act, since Adulteration of Food and Drink Act was passed in that year. The year 1875 was an important milestone in food and drugs administration with the passing of the Sale of Food and Drugs Act, 1875. The next major statute in this field was introduced in 1928, the Food and Drugs Adulteration Act of that year. Then, of course, food and drugs legislation came up for consolidation as part of the general revision of public health law which took place just before the last war, resulting in the Food and Drugs Act, 1938. This Act was born at an unfortunate period since the war prevented its immediate application, and in the years that followed the war it became obvious that rapid and accelerated changes in public opinion and behaviour had created a demand for more extensive legislation. The year 1954 has seen a major step forward in the field of food hygiene by the passing through Parliament of the Food and Drugs Amendment Act, 1954. This is an amending and enabling Act and will operate mainly by regulations made thereunder. The Act will become operative in the near future, when the regulations have been made by the Ministers, and while not yet in force, it introduces considerable changes approaching more nearly the modern outlook on food hygiene. 21 Nevertheless at this early stage I feel that this Act might have been stronger in certain respects. A new feature is the introduction of codes of practice but these may be beneficial only in certain instances where perhaps the trader realises the advantages to himself of adopting the code guidance. Many requirements contained in the codes, some of us think might have been embodied in the Regulations with the weight of the law behind them. Modern manufacture and preparation of foods have produced difficult and more complex forms of adulteration as compared with the more crude and fraudulent adulterations of the past. One example is the presence of harmful chemicals on fruit as a result of spraying. Besides the more usual nicotine and arsenical residues which have given cause for concern, newer substances are now in use. It was found in 1954 that thiourea was being used as a fungicide on oranges in Spain as a rot and mould suppressant. Thiourea can penetrate the skin of citrus fruits and find its way into the juice. Experiments have shown that this chemical is lethal to some animals in very low concentrations. Its use is accordingly open to strong objections on grounds of possible toxicity. Samples of Spanish oranges taken in this Borough were found, upon analysis, to contain thiourea. This was reported to the Ministry of Food and at the same time warning letters were sent to all fruiterers in the Borough. Further samples taken were free from possible danger. The presence of minerals in harmful quantities in foodstuffs is a matter which is receiving special attention by the Metallic Contamination Sub-Committee of the Food Standards Committee, who have made reports respecting the limits of certain metals including zinc, lead, arsenic, tin and copper. Some of these metals are essential and beneficial to health in small quantities, but in excess are poisonous. Another recent development in the preparation of food is the use of anti-oxidants, that is substances which retard or prevent the development of oxidative rancidity. Samples are taken to ascertain the presence of any of these substances. Conditions under which food is handled, stored, prepared and manufactured, and the supervision and control of the same, are as important as any other factor coming within the orbit of the Health Authority. During the year 4,939 visits were made to premises, shops, stalls and vehicles where food is prepared, stored and sold, and at 17 of these, unsatisfactory conditions constituting contraventions under Section 13 of the Food and Drugs Act, 1938, and Byelaws made thereunder were found. In all cases the unsatisfactory conditions were remedied following the issue of warning letters. 22 The Food and Drugs Inspectors reported four cases where food was being wrapped in contravention of Section 6 (a) of the London County Council Byelaws for the Protection of Food, in that newsprint was used in such a manner that it came in direct contact with the food. Letters of warning were sent in each case. During the year two seizures of unsound chocolates were made under Section 10 of the Food and Drugs Act, 1938. The chocolates, which contained the larval form of the insect Ephestia Elutella, were found in two retail shops in the Borough owned by one company. It was found that the chocolates were manufactured by two different manufacturers and were stored for various periods at the retail shops' warehouse situate in another part of London. Inspections made at the shops and the warehouse revealed no obvious infestation. The infestation was reported to the Ministry of Agriculture and Fisheries, who instructed a representative of the Infestation Control Division to visit the premises concerned and investigate. It was found that from the dates of arrival of both types of chocolates at the Company's warehouse, infestation could have taken place there, or at the shops. Since the warehouse and the two shops in question were all found to be in a clean and tidy condition, this case is an example of the care which must be taken to protect food from insect infestation, and of the potential ability of the moth to turn up in places apparently free from it. Many boxes of chocolates are flimsily constructed and have an inadequate cellophane cover which can easily be penetrated, not only by larvae, but by moths for egg laying. As a precautionary measure at the two premises concerned, it was recommended that a regular spraying routine should be carried out during the emergence period of the moth the following year, that is, from August until September. The Food and Drugs Inspectors accepted the voluntary surrender of foodstuffs which upon examination were found to be unfit for human consumption. A list showing the amount involved is shown in the statistical supplement. Sampling. Throughout the year 1,298 samples of food and drugs were submitted to the Public Analyst for chemical analysis. Of this number 27 or 2% samples were reported to be non-genuine; this represents a slight increase on last year. 23 The following are details of the defective samples: — Sample Result of Analysis Remarks Oranges Contained 30 parts per million Thiourea Warning letter. Reported to Ministry of Food. Oranges Ditto 5.2 parts per million ditto Oranges 4.6 parts per million ditto Oranges 9 parts per million ditto Fishcake 57% deficient in fish Informal sample Fishcake 20% deficient in fish No action Tomato Soup Contained 5.4 grains tin per pound Informal sample Tomato Soup Contained 4 grains of tin per pound Stock destroyed Citrate of Magnesia Incorrectly labelled — contained no magnesium sulphate Warning letter Meringue Mix Misleading label No action Meringues (5) Consisted of imitation meringues; contained no egg albumin Reported to Ministry of Food and Metropolitan Standing joint Committee Minced Turkey Deficient in meat, misleading label Informal sample Minced Turkey Misleading label Legal proceedings taken. Case dismissed. Butter Contained 0.9% excess water Informal sample. Formal sample genuine Whisky 40.5 degrees under proof Legal proceedings, 40/- fine, £10 10s. Od. costs Gingerbread Mixture Incorrect label Informal sample Gingerbread Mixture Incorrect label — contained no raising ingredients Satisfactory explanation received from manufacturer Sal Volatile 50% deficient in ammonia and 78% deficient in ammonium carbonate Informal sample. Formal sample genuine Canned Meat Soup Contained 3.8 grains tin per pound Stock destroyed Jelly Crystals 8% deficient in sugar Further sample genuine Jelly Crystals 6% ditto ditto Self Raising Flour 37% deficient in available carbon dioxide Informal sample. Further sample genuine A total of 53 samples of synthetic and butter cream used in bakers' confectionery was taken for bacteriological examination. The results obtained throughout the year are as follows:— Total number of samples of synthetic and butter cream 53 Bacillus coli (non faecal) present in 10 Bacillus coli (faecal) present in 8 24 The following articles of food were also submitted for bacteriological examination for routine and other purposes:— Article of Food Organisms Found Other Organisms Faecal Non-faecal Coli Coli 1 sample of Chocolate Milk — — 6,600 per ml. 76 „ Tinned Cream — — See below 7 „ Tinned Fish - — 2 samples had anerobic sporebearers 10 „ Shellfish 4 6 — 6 „ Milk Powder — — No pathogens 2 „ Luncheon Meat — — ditto Following a report that typhoid organisms had been found in tinned cream manufactured in Ireland, a search was made throughout the Borough by the Food and Drugs Inspectors and 72 tins of the particular brand concerned were found. These included a case from the original batch which had given rise to complaints at Birmingham. All these tins were submitted to the Public Health Laboratories, County Hall, for examination, in connection with an inquiry carried out by the Ministry of Health, who reported as follows:— " Of 955 cans of the same make examined in various laboratories, 17 per cent, contained living bacteria of numerous sporing and non-sporing species. The contamination rate of the implicated batch examined at Birmingham was 66 per cent. Expert examination of the can suggested that it had been ineffectually sealed at the canners' end, and that contamination arose from leakage of the cooling water applied after heat sterilisation. The water was from a shallow well subject to pollution. No case of typhoid fever was reported." The microscopical examination of continental and raw pork sausages for the presence of Trichinae was continued; 23 samples were submitted to the bacteriologist for examination. These were subjected to a pre-digestive test evolved by the bacteriologist and myself. All samples were found to be wholesome. We shall continue to chase the elusive little pale nematode, as the recent epidemic in the north proves that Trichinosis is still a potential danger to public health in this country. 25 Markets. In addition to the three markets in the Borough at Bradmore Lane, Norland Road and Railway Approach, a privately owned market has been opened adjoining the Market in Railway Approach, and on the site of the old Silver Cinema, Uxbridge Road. At the new Uxbridge Road Market, water closet accommodation and washing facilities have been installed for the use of the stallholders. Some shops have been built on the site and where food is sold washing facilities have been provided. During the year 378 visits were made by the Food and Drugs Inspectors to these markets. In the case of one stallholder, legal proceedings were taken under the Public Health (Meat) Regulations, 1924/1935, and a fine of 40/- was imposed, with 40/- costs. 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. During exhibitions, visits were made to the numerous food stands and catering establishments. It was found necessary to draw the attention of a number of exhibitors to unsatisfactory washing facilities in connection with food samples served to the public. In each instance the co-operation of the exhibitors was obtained and hygiene was improved. Merchandise Marks Act, 1926. Regular inspections were carried out under this Act. In some cases warnings were given by the Food and Drugs Inspector in connection with the labelling requirements for meat, fruit and tomatoes. In no case, however, was it necessary to take legal proceedings. Ice Cream. At the end of the year 301 premises were registered for the sale of ice cream. The Food and Drugs Inspectors made 433 visits to premises where ice cream is sold, stored or manufactured. 26 During the year 89 samples of ice cream were taken for bacteriological examination. The results of the methylene blue test were as follows:— 64 samples were within Grade 1 standard 16 „ „ „ „ 2 „ 5 „ „ „ „ 3 ,, 4 „ „ „ „ 4 „ Samples graded in 1 and 2 are considered satisfactory but samples graded in 3 and 4 are doubtful. These results again show an improvement on the previous year. It should be pointed out that the four samples in grade 4 were manufactured outside this Borough. In addition 35 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. 98 persons were registered as Distributors of Milk at the close of the year. Under the Milk (Special Designations) (Pasteurised and Sterilised Milk) Regulations, 1949, the Minister of Food appointed the 1st October, 1954, to be the date after which all pasteurised milk should be placed in the containers in which it is sold on the premises where it is pasteurised. The effect of this is that only at licensed pasteurisers' premises can pasteurised milk be bottled. Since sterilised milk must be bottled during processing, and raw tuberculin tested milk is bottled on the farm, the small retail milk bottler has now disappeared from London. Designated Milk. During the year 126 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 68 68 - 68 — — — T.T. Pasteurised 29 29 — 29 — — — Tuberculin Tested 11 — — 10 1 — — Sterilized 18 — - — — 18 — Total 126 97 — 107 1 18 - The sample of tuberculin tested milk which failed to pass the methylene blue test was reported to the Ministry of Agriculture and Fisheries, this having been bottled on the farm. Further samples from the same source proved to be satisfactory. 27 In addition, seven samples of pasteurised cream were taken for bacteriological examination and reported to be satisfactory. 68 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 Designations) (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 68 Pasteurised 75 Sterilised 88 Dealer's Supplementary Licences Tuberculin Tested 15 Pasteurised 16 Sterilised 18 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 other receptacles. During the year 33 samples were submitted for examination to the Public Analyst and were reported genuine. Hammersmith Clean Food Traders' Guild. The Hammersmith Clean Food Traders' Guild which was formed in 1948 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. Conditions of membership provide that reports shall be submitted to the Committee at least once a year in regard to each trader's premises. These reports indicated that the standard of hygiene required by the Guild was, generally, being well maintained. In only a few instances was it necessary to call attention to a departure from the Codes of Practice approved by the Guild and in all cases the deviation was soon remedied. At the end of the year the membership of the Guild was 95. This figure shows a reduction compared with the previous year, 28 some of the traders having allowed their membership to lapse by the non-payment of subscriptions. On the other hand several new members were registered. A number of talks on "Clean Food," illustrated by film strips, were given during the year to various organisations. As a means of obtaining publicity to the work of the Guild and to call attention to the Council's campaign for cleaner food, arrangements were made for an exhibit to be entered in the Hammersmith "Carnival Procession," organised by the Community Recreation Committee, on June 12th. Unfortunately, the function had to be cancelled at the last moment owing to very bad weather conditions. At the end of the year the number of premises from which foodstuffs were being sold by retail, so far as was known to the Department, was 642. Classified under different types of business they were as inder:— Bakers 33 Butchers 73 Cooked meats, eel-pie shops, etc. 17° Departmental and Chain stores 7 Fishmongers and Fried-fish shops 39 Fruiterers and Greengrocers 91 Grocers, Provision merchants and allied traders 234† Sweetstuff shops 148 642 ° including 2 registered for the sale of milk. † including 86 registered for the sale of milk. There were approximately 234 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) 142 Industrial and Staff Canteens 53 Places of entertainment, Social and Sports Clubs, etc. 36 Old People's Luncheon Clubs 3 234 29 The number of licensed premises in the Borough was 135, 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). Large factories where foodstuffs of one sort or another were manufactured numbered 16, and there was three wholesale dairies with milk processing plants. The number of milk distributors registered in the Borough is 98, ice cream premises 301 and premises for the preparation or manufacture of sausages or potted, pressed or preserved food intended for sale 113. 752 inspections were carried out at milk distributors' premises during the year and 433 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. 30 SECTION E SANITARY ADMINISTRATION Staff. The establishment of Sanitary Inspectors consists of the 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 four resignations during the year, but only two of these were replaced, with great difficulty and loss of time. Exhumation and Re-interment of Bodies. During the year five licences were granted by the Secretary of State for the exhumation and removal of six 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 Acts, 1920/1939. The Housing Repairs and Rents Act, 1954. The Housing Repairs and Rents Act, 1954, came into operation on the 30th August, 1954. The Act is described as "An Act to make further provision for the clearance and redevelopment of areas of unfit housing accommodation, and for securing or promoting the reconditioning and maintenance of houses and otherwise to amend the enactments relating to housing, the exercise of certain powers relating to land, and rent control." Part I contains further Provisions as to Clearance and Redevelopment, Reconditioning of Unfit Houses, and other Amendments of Housing Acts. The local authority is required to submit proposals for the exercise of its functions as to clearance areas, etc., to the Minister within one year from the commencement of the Act subject to the Minister's power to extend the time in exceptional circumstances. 31 Powers are given to local authorities for the following purposes:— (a) To retain for temporary accommodation certain houses in clearance areas. (b) To purchase houses for temporary accommodation in lieu of making demolition orders. (c) To postpone demolition under clearance order in the case of houses let to local authority. (d) To permit reconstruction of condemned houses. (e) To licence for temporary occupation houses subject to existing demolition or clearance orders. Provision is made for Exchequer contributions towards expenses of local authorities in buying houses for temporary occupation. A new standard of fitness of houses for human habitation is set out. Provisions are made regarding houses let-in-lodgings for securing fitness for occupation by number of families accommodated and for the prevention of overcrowding. Part II deals with Repairs Increase in Respect of Controlled Dwelling-houses and Other Amendments of the Rent Acts, etc. Before the increase of rent permitted by the Act is operative in the case of a Controlled Dwelling House, certain conditions must be fulfilled. In addition to the landlord producing to the tenant satisfactory evidence that work of the required specified value has been carried out, the dwelling-house must be in good repair and be reasonably suitable for occupation having regard to certain specified matters. The expression "good repair" is defined in the Act for this purpose. A tenant served with a notice of increase, if not satisfied that the house is in good repair and reasonably suitable for occupation can apply to the local authority for a certificate of disrepair. The landlord can apply for the revocation of the certificate and the local authority must revoke the certificate if satisfied that the landlord has executed such work as requires to be executed. Up to the end of the year, applications were received as follows:— Applications for Certificates Number received 88 Number granted 77 Applications for Revocation of Certificates Number received 8 Number granted 6 32 Coroner's Court and Public Mortuary. The number of bodies admitted to the Public Mortuary during the year was 629, the same as last year. There were 592 post mortem examinations conducted, which is 10 less than last year. The Mortuary and Court were also used by the Boroughs of Fulham, Chelsea, Kensington, Paddington and Westminster. 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, 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. No fresh certificates were issued during the year. The total number of premises registered since the Act came into force still remains at 10. Pharmacy and Poisons Act, 1933, and Pharmacy and Medicines Act, 1941. The names and addresses of 114 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. 33 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. Nine applications for renewal of licences were received and granted during the year. At the time of writing, it is obvious that the post-war shortage of pets is ending. The common or garden tortoise (testudo graeca) and the European Pond Tortoise are back in the shops again. Neither breeds in England as does the Budgerigar, which has replaced the Canary in public esteem. Heating Appliances (Fire Guards) Act, 1952. This 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. There was one contravention of Section 26 of this Act, which deals with restrictions on sales, etc., by dealers in rags, old clothes and similar articles. The offender was prosecuted, found guilty and fined 10/-. 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 bath is 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 Boad, 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 a new chlorination and testing plant was installed at a cost of approximately £ 1.000. 34 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. 156 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 kitchen waste collected during the year 1954 House and Trade Refuse 29,628 Kitchen Waste 131 29,759 Method of Disposal By road to tip at Harefield 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 114 drainage plans (12 combined drainage) were submitted and approved, and a total of 1,876 inspections were made in connection with supervision of drainage works. Dustbins. 76 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. 35 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 number 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 quickly as we would have liked. Factories. During the year 16 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. Once again I have to report a very busy year, both as regards the number of complaints investigated, and stubborn infestations being traced to their source and then cleared. The number of stubborn cases requiring extra investigations appears to be on the increase. The complaints for rats and mice increased steeply from 467 to 617, but in about 70 cases these proved to be duplication or false alarms. Infestations discovered, other than by complaint, fell from 134 to 101 (60 rat and 41 mice). The nett result is that the number of premises actually infested fell from 561 to 535. Mice account for 40% of all infestations, a similar figure to that of 1953, and as part of the programme to combat this purely domestic pest, we are endeavouring to educate the public to be more careful in food management at home. Four "Block" control areas were inspected and treated. The sewer manholes were baited twice during the year and showed a slight decrease in "takes." 87 Notices under the Public Health Act and 4 under the Prevention of Damage by Pests Act were served for drain and other defects relating to Bodent Control. Fifteen other drains were repaired without notice. 36 Approximately £ 134 was received for treatment at Business premises. The photographs in last year's Report were evidently of great interest as they brought many enquiries and the Ministry of Agriculture and Fisheries had slides made for lecturing purposes. The following is a summary of the work for the year, with the comparable figures for 1953 in parenthesis:— Premises inspected:— Dwellings 725 (470); Business 1,251 (1,312) 1,976 (1,782) Complaints of rats 404 (314), mice 213 (153) 617 (467) "Discovered" other than by complaint:— Dwellings 68 (102) Business 33 (32) 101 (134) Premises infested by rats:— Dwellings 284 (299), Business 47 (59) 331 (358) Premises infested by mice:— Dwellings 180 (173), Business 24 (30) 204 (203) Premises treated for infestation 535 (550) Notices served relating to Rodent Control 91 (53) Inspections and re-inspection by Sanitary Inspectors re rodent control 3,333 (3,192) Atmospheric Pollution. In February two new stations were set up for measuring and recording the extent of atmospheric pollution. The station in Australia Road is a lead peroxide instrument measuring the quantity of sulphur gases and is situated on the roof of a school in a large and fairly new housing estate. The other, in Westville Road, is a deposit guage collecting grit, ash and fine particles of matter. This instrument is also on the roof of a school in the centre of a well populated area of older type properties. These two stations are in addition to a lead peroxide instrument which is maintained by the London County Council in Ravenscourt Park. During the year the Council agreed to set up two more stations, this time for carrying out examinations daily on the volumetric system, and these will be situated at the Council's Depot in Hythe Road in the extreme north of the Borough in an area which consists almost wholly of factories. The other at Westcott Lodge, on the river front near the Town Hall. During the year 189 observations of non-domestic chimneys in the Borough were made by the Sanitary Inspectors, as a result of which two Notices were served to abate smoke nuisances. 37 SECTION G CENERAL PROVISION OF HEALTH SERVICES IN THE BOROUGH. Laboratory Facilities. Our Public Analyst works at the Southwark Borough Council's Laboratory situated at The Health Centre, Walworth Road, S.E. Bacteriological examination of food 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 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 of 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, perhaps, the best known of its kind in the country. Hammersmith Chest Clinic. The Hammersmith Chest Clinic continued to function during the year. 38 The Clinic, with its associated independent radiography department and 27 tuberculosis beds, is housed in Hammersmith Hospital and is run as an integral unit. A consultant diagnostic service for chest diseases is provided for local practitioners, who may send patients for full consultation, provided a letter of introduction is produced, or for X-ray examination only; this is arranged by a special form of reference. This latter service provides a rapid means of obtaining a chest X-ray without the formality of being examined by a consultant or other hospital physician. In addition to the diagnostic services provided, out-patient Clinics are held for new and follow-up cases, for refills, ambulance cases, contacts, and for anti-tuberculosis vaccinations. Attendances at all clinics (with the exception of the X-ray only service, which is held on Monday afternoon) are strictly by appointment only. During the treatment, rehabilitation and re-settlement of tuberculous patients, many social and financial problems arise. To provide adequate help and advice in these circumstances a fully equipped social welfare department forms an integral part of the Chest Clinic service. This department is in the hands of a certificated Almoner, who is in contact with many statutory and voluntary agencies through which advice and assistance can be provided. In view of the relative shortage of sanatorium beds, a comprehensive domiciliary management scheme for tuberculous patients is in operation in Hammersmith. Patients are treated with modern methods in their own homes and visited there by the staff of the Chest Clinic. Visits to the Clinic are arranged as necessary by ambulance and patients are also admitted to the Chest Clinic beds for chemotherapy and for major and minor thoracic surgery. Sanatorium treatment, when this is necessary, is undertaken in sanatoria under the auspices of the North-West Metropolitan Regional Hospital Board. 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. 39 The following is a list of the various clinics:— Ante-natal Clinics. 1/3, Milson Road Monday 1.30 p.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. 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. 40 Vaccination. 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. Chiropody. 48, Glenthorne Road Monday 2 p.m. Tuesday 2 p.m. Wednesday 2 p.m. Thursday 2 p.m. Friday 10 a.m. Speech Therapy. 48, Glenthorne Road Monday 1.30 p.m. Tuesday 1.30 p.m. Wednesday 1.30 p.m. Thursday 1.30 p.m. 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 12 full-time and 75 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 35 Tuberculosis 51 Other 887 1.574 effective visits were made to various homes by the organiser. 41 international Certificates of Vaccination and Inoculation. Arrangements continued during the year for the authentication by the Medical Officer of Health of the signatures of Doctors on certificates of vaccination and inoculation required by travellers from this country going abroad. This authentication is required to prove that the Doctor named on the certificate as having carried out the vaccination or inoculation is a duly registered medical practitioner. During the year 424 certificates were authenticated. 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 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 36 cases were referred to the Department as being in need of care and attention but in only four instances was it necessary to take action under the above Acts. These cases were in respect of:— 1. Mrs. A., age 83, found to be living in a dirty condition, confined to bed, the only person able to do anything for her was an old lady living in the same house who was also 83. Mrs. A. was a difficult type of woman and refused all help. She was removed to Hospital and later transferred to a Mental Hospital. 2. Miss B., age 76, who was found on the floor by the Home Help Organiser. Miss B was later visited and was then found sitting in a chair with her clothes saturated with urine, and appeared to be unable to use her legs and to be suffering from malnutrition. A Court Order was obtained and she was removed to hospital. 3. Mrs. C., age 81, unable to get about, had rheumatism in her legs and was also in a very dirty condition, as was the room in which she lived. She refused to go to Hospital for treatment. An Order for removal was obtained under an Emergency Order and after two months she was removed to a Private Nursing Home. 42 4. Miss D., age 70, found to be living in filthy surroundings for which she was entirely responsible. She spent most of the day cooking horse flesh for the local cats and birds. Many complaints were received regarding the conditions, particularly the smell, from neighbours and others. All offers of help were refused and an Order was obtained and Miss D was removed to Hospital and two months later was transferred to a Mental Hospital suffering from Senile Dementia. With regard to the other cases it was possible to ease the position either by reference to the family doctor or by arranging admission to Hospital, assistance by Home Helps, District Nurses, Old People's Welfare Association and also through the use of the Health Laundry. Burial or Cremation of the Dead. It is provided by Section 50 of the National Assistance Act, 1948, that a local authority shall arrange for burial or cremation in the case of any person who has died or been found dead in the Borough where it appears to the Authority that no suitable arrangements have been or are being made for a funeral. During the year seven burials, including one stillborn child, were carried out, and one cremation, at a cost of £84 15s. 6d., of which amount £37 8s. 5d. was recovered. The cremation was in respect of the remains of a man who had been killed by enemy action (air raid) in 1940, and which were found in July, 1954, after the removal of pre-fabricated dwellings and during excavation of the site prior to the erection of a new block of flats. The deceased left a widow who was unable to meet the cost of a private 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. The activities of the Association include:— Clubs arranged by the British Bed Cross Society, Women's Voluntary Services, Old Age Pensioners' Association, Missions and Churches. Each open one or two afternoons a week. Much of the entertainment at these Clubs is provided by the Council and grants are made for expenses, such as hire of halls, etc. A friendly visiting service has been arranged for lonely old people through volunteers who provide such things as magazines, jig-saw puzzles, playing cards, handicraft materials, send birthday cards and generally "adopt" old people who are really lonely and isolated. 43 An Old People's Club which enables the old people to save for a holiday and other personal needs. Party holiday trips with reduced transport and accommodation charges for a week or fortnight's duration. Help is also arranged on Saturdays with fetching water and fuel, shopping and similar services. These are carried out by the cadets of the St. John Ambulance Brigade. Sick room equipment may also be hired through the British Bed Cross Society. Arrangements have been made at five centres where old people or others interested in their welfare can be interviewed and advised. Leaflets are prepared and published informing the old people and others of the services available and by whom provided, and the Organiser of the Association is available to give talks to any interested organisations in the Borough. There are three luncheon clubs in Church or Mission Halls providing mid-day means at l0d. each, and two mobile meals services delivering meals at the same price. The Missions and Churches lend the premises, provide the helpers and organise day-to-day running of the clubs. Free baths open Monday to Friday at the public baths, and a chiropody service at two foot clinics in the Borough, one of which is free to those on National Assistance or charging 2/6 per treatment for others. The other is operated by the British Bed Cross Society in conjunction with the Association, and is open once a week at a charge of 1/6 per treatment, the Association paying the chiropodist on a sessional basis. Special facilities haVe also been arranged for evening classes for men and women in boot repairing, woodwork, leatherwork and home tailoring. A fortnightly legal advice service has been inaugurated in conjunction with the Family Welfare Association, free to pensioners with certain income limits. Arrangements have been made for reduced prices at Cinemas other than on Bank Holidays. Also various outings and gatherings are arranged by the Council's Community Recreation Officer. 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 find whether he or she is fit to be admitted to the Council's Superannuation and/or Sick Pay Schemes. 44 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 the year was 210, and of this number 52 were found to be unfit for the following reasons:— R.I. Hernia 3 Varicose Veins 1 Otorrhoea 2 Thyrotoxicosis 1 Otitis Media 6 Pulmonary T.B. 1 Anxiety State 2 Vertigo 1 Deafness 2 Dyspepsia 1 Gastric Ulcer 1 Psychiatric reasons 1 Nerves 2 Fracture of L. Jaw Neuralgia 1 Hypertension 9 Chest Condition 5 Albuminuria 1 Diabetes 3 Hard Glands L.I. region 1 Heart 3 Mitral stenosis 1 L.I. Scrotal Hernia 1 Arthritis 1 Pyorrhoea 1 Totally unfit 1 At the beginning of 1953 the Council decided to put into operation a scheme for streamlining sick leave arrangements. The scheme has worked satisfactorily and smoothly and during the year 16 examinations in this connection 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 1954, as indicated below:— Organisation Amount Statutory Authority £ s. d. Central Council for Health Education 10 0 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. 45 Conferences. The Council were officially represented at the undermentioned Conferences dealing with matters within the purview of the Public Health Department:— Conference Delegates Sanitary Inspectors' Association, Southport—7th-10th September, 1954 Mr. W. Bigby, Senior Sanitary Inspector. Royal Sanitary Institute, Scarborough—27th-30th April, 1954. Councillor Mrs. E.O'K. Finn, M.B.E. National Smoke Abatement Society, Scarborough— 22nd-24th September, 1954. Councillor E. R. Gosling, Dr. F. M. Day, Medical Officer of Health. Health information Bureau. The Health Information Bureau was opened on 1st January, 1954, and has functioned successfully throughout the year. The opportunity was taken to fuse into the Bureau the various lines of enquiry on numerous health matters which normally come to the Department, and during the year 4,866 enquiries varying widely in their features were dealt with. These enquiries, apart from routine matters, included mass X-ray, Old People's Welfare, National Insurance, Dentists, Migraine Clinic, Repair of Deaf Aid and many others. Simultaneously with the opening of the Bureau a booklet entitled "Hammersmith Health Services" was printed, and approximately 3,000 were distributed to various persons and associations locally. Interested enquiries came from as far afield as New Zealand and Canada. The British Council made a feature of the Guide at the 31st All India Medical Conference held at Lucknow. Applications were also received from Authorities in various parts of this country. Authority has been received from the Health Committee for a revised edition of the Guide to be issued for 1955. STATISTICAL SUPPLEMENT TO ANNUAL REPORT FOR YEAR 1954. 49 GENERAL STATISTICS—1954 Area 2,282.5 acres Population (1954) (estimated) 116,500 „ (1953) (estimated) 117,600 „ Census (1951) 119,367 Natural increase, i.e., excess of births over deaths 705 Marriages registered 1,270 Rateable Value (April, 1954) £ 1,277,925 Sum represented by a penny rate (April, 1954) £.5,136 EXTRACT FROM VITAL STATISTICS—1954 Live Births Legitimate Total M. F. 1,638 849 789 Birth Rate per 1,000 estimated resident population = 15.2. Illegitimate 138 71 67 Stillbirths 28 17 11 Rate per 1,000 total (live and still) births = 15.5 Deaths 1,071 564 507 Death Rate per 1,000 estimated average population = 9.1 Deaths from maternal causes— Deaths Rate per 1,000 total (live and still) births Pregnancy, childbirth, abortion 3 1.66 Total 3 1.66 Death Rate of Infants under one vear of age:— All infants per 1,000 live births 21 Legitimate infants per 1,000 legitimate live births 21.97 Illegitimate infants per 1,000 illegitimate live births 14.49 Deaths from Cancer (all ages) 232 „ „ Measles (all ages) — „ „ Whooping Cough (all ages) — 50 NATURAL INCREASE OR DECREASE OF THE POPULATION DURING THE PAST 20 YEARS Year Population Excess of Births over Deaths Excess of Deaths over Births 1935 128,100 353 — 1936 127,700 325 — 1937 126,500 320 — 1938 125,100 521 — 1939 b122,800 438 — d116,200 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 — 1954 116,500 705 — 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 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 1954 116,500 232 2.0 51 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 1954 M - - 31 11 11 53 F - — 4 3 2 9 Total - — 35 14 13 62 52 INCIDENCE OF PULMONARY TUBERCULOSIS AND NEOPLASMS OF THE LUNGS Age Groups Pulmonary Tuberculosis Neoplasms of the Lung or Bronchus 1953 1954 1953 1954 MALES 0— - ~~ — — 1— — — — — 5— — — — — 15— — 1 — — 25— 6 2 2 — 45— 16 4 18 31 65— 6 5 25 11 75— — 1 2 11 Total Males 28 13 47 53 FEMALES 0- — — - - 1— — — - - 5— — — — — 15- - - - — 25— 1 2 - — 45— 1 2 1 4 65— 1 1 3 3 75- — — 1 2 Total Females 3 5 5 9 53 VITAL STATISTICS OF WHOLE DISTRICT 1954 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 D116,200 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 1,8 74 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 I 357 11.4 1953 117,600 1,750 14.9 1,409 12.0 498 296 35 20 1.207 10.3 1954 116,500 1,776 15.2 1.382 11.8 606 295 38 21 1,071 9.1 * B= Birth-rate Population Figure. D= Death-rate Population Figure. CHART SHOWING BIRTH AND DEATH RATES PER. 1,000 POPULATION FOR. THE PAST 20 YEARS . 54 BIRTH RATE- 55 CAUSES OF, AND AGES AT, DEATH DURING THE YEAR 1954 Cause of Death Sex 0— 1— 5— 15— 25— .... 45— 65— 75— Total all Ages 1. Tuberculosis, respiratory M - - - 1 2 4 5 1 13 F — — — — 2 2 1 — 5 2. Tuberculosis, other M — — — 1 — — — — 1 F - - - - — - 1 1 2 3. Syphilitic disease M - — — — — - 3 — 3 F - - - - - 1 - — 1 4. Diphtheria M - - - - - - - - - F - - - - - - - - - 5. Whooping cough M - - - - - - - - - F - - - - - - - - - 6. Meningo-coccal infections M — 1 — — 1 — — — 2 F - - - - - - - - - 7. Acute poliomyelitis M - - - - - - — — — F - - - - - - - - - 8. Measles M - - - - - - - - - F - - - - - - - - - 9. Other infective and parasitic diseases M — - - - - - - - - F — - - - - 1 1 1 3 10. Malignant neoplasm, stomach M - - - 2 8 9 - 19 F — — — — 1 2 1 5 9 11. Malignant neoplasm, lung bronchus M - - - - - 31 11 11 53 F — — — — — 4 3 2 9 12. Malignant neoplasm, breast M - - - - - - - - - F — — — — 2 14 2 12 30 13. Malignant neoplasm, uterus M - - - - - - - - - F — — - — 2 8 3 1 14 14. Other malignant and lymphatic neoplasms M — — 1 1 5 21 14 12 54 F — — — 1 1 12 16 14 44 15. Leukaemia, aleukaemia M 1 — — — 2 — — 3 F - - - - - - - 1 1 16. Diabetes M — — — — —' 1 1 — 2 F - - - - -1 - 2 1 4 17. Vascular lesions of nervous system M — — — 1 — 8 16 18 43 F — — — — — 9 23 3i 63 18. Coronary disease, angina M - — — — 3 46 28 20 97 F - - - - - 9 21 17 47 19. Hypertension with heart disease M — — — — — 3 5 3 11 F — — — — — 3 8 8 19 20. Other heart disease M - — - 1 1 10 15 24 51 F — — — — 1 7 11 48 67 21. Other circulatory disease M — — — — — 8 7 5 20 F —- — — — — 1 7 16 24 22. Influenza M - — — — 1 — 1 F - - - - - - - 1 1 23. Pneumonia M 1 — — — 2 3 2 5 13 F 1 — — — 3 6 15 25 24. Bronchitis M — — — — 1 12 19 19 51 F 1 1 — — 1 6 8 9 26 25. Other diseases of respiratory system M — — — — 1 1 3 1 6 F — — — — - 1 1 — 2 26. Ulcer of stomach and duodenum M - - - - - 7 4 2 13 F — - - - - 3 1 2 6 27. Gastritis, enteritis and diarrhoea M - - - - - - - 2 2 F - - — - - 2 1 1 4 28. Nephritis and nephrosis M — — — — — 4 — 2 6 F - - - - - 1 2 1 4 29. Hyperplasia of prostate M — - - - - 1 5 6 12 F - - - - - - - - - 30. Pregnancy, childbirth, abortion M - - - - - - - - - F - — - - 3 — — — 3 31. Congenital malformations M 5 - - 1 1 - - - 7 F 1 - - - - - - - 1 32. Other defined and ill- defined illnesses M 16 — 1 - 5 9 11 8 50 F 12 - - - 5 13 10 17 57 33. Motor vehicle accidents M 1 1 1 3 1 2 9 F - - - 1 - 2 1 - 4 34. All other accidents M - — 2 1 3 i 1 1 9 F - - - - 2 4 4 12 22 35. Suicide M — — — 4 7 1 1 13 F - - - - 3 3 1 1 8 36. Homicide and operations of war M - - - - - - - - - F - 1 1 — — — — — 2 M 23 2 5 8 36 186 163 141 564 F 15 2 1 2 24 111 135 217 507 Total of all causes 38 4 6 10 60 297 298 358 1071 56 PROPORTION OF DEATHS FROM PRINCIPAL CAUSES 1954. TOTAL DEATHS, 1071. 57 INFANT MORTALITY—1954 and Previous Years Year Births Deaths of Infants Deaths of Infants per 1,000 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 1954 1,776 38 21 * 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. 58 Net deaths of infants at various ages under one year of age Under 1 week 24 1-2 weeks 3 2-3 weeks 1 3-4 weeks — 4 weeks and under 3 months 5 3 months and under 6 months 4 6 months and under 9 months 1 9 months and under 1 year — Total deaths under 1 year 38 Net Births in the Year: Legitimate 1,638; Illegitimate, 138. Net Deaths in the Year: Legitimate Infants, 36; Illegitimate Infants, 2. 59 CHART SHOWING THE. NUMBER. OF DEATHS OF INFANTS UNDER 1 YEAR. OF AGE DURING THE PAST 20 YEARS. 60 INFANT MORTALITY RATES — ENGLAND AND WALES AND VARIOUS OTHER COUNTRIES Deaths under 1 year per 1,000 live births Country 1949 1950 1951 1952 1953 England and Wales 32 30 30 28 27 Scotland 41 39 37 35 38 Northern Ireland 45 40 41 39 37 Australia 25 24 25 24 23 Canada 43 41 38 38 35 Chile 169 153 149 134 114 Denmark 34 31 29 29 27 France 61 52 51 46 42 Irish Republic 53 45 45 41 39 Italy 74 64 67 64 59 Netherlands 27 25 25 23 22 New Zealand 24 23 23 22 20 Sweden 23 20 21 20 19 United States of America 31 29 29 29 28 MATERNAL MORTALITY 1954 and Previous Years Year Number of Deaths Number of live Births Maternal Death Rate Pregnancy, childbirth, abortion 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 1948 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 1.10 1953 3 1,750 1.67 1954 3 1.776 1.66 *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". 61 ENVIRONMENTAL HEALTH SERVICES (A) SANITARY INSPECTION Cause of Inspection No. of Inspections No. of Notices served No. of Notices complied with Atmospheric Pollution 10 - - Bakehouses 89 - - Complaints 3,972 1,399 855 Drainage 1,876 14 7 Factories (Mechanical) 407 13 9 Factories (Non-Mechanical) 149 3 3 Food (other than Restaurants and Eating Houses) 2,737 1 - Housing Act 191 2 3 Housing Applications 914 86 51 House to House - - 6 Housing Repairs and Rents Act 95 4 1 Ice Cream Vendors 433 1 — Infectious Diseases 266 4 1 Licences (Building) 3 — — Markets 378 - - Milk Vendors 752 - - Outworkers 1,441 3 4 Pet Animals Act 15 - — Pharmacy and Medicines Act 121 - - Public Urinals 10 — - Rag Flock Act 1 — - Rats and Mice 3,156 87 62 Restaurants and Eating Houses 550 15 18 Shops Act 169 8 6 Slaughterhouses 3 - — Smoke Observations 189 2 2 Miscellaneous 1,500 81 36 Re-visits 8,309 512 948 No Answer 1,681 — — 29,417 2,235 2,012 No. of Ineffective Visits 1,681 — — Total 27,736 2,235 2,012 During the year 816 Statutory Notices were served and 519 complied with. (B) SUMMONSES—Proceedings instituted during the year Public Health (London) Act, 1936 121 Food and Drugs Act, 1938 6 H.B.C. Byelaws 3 L.C.C. Byelaws 2 62 (C) FACTORIES ACT, 1937 1.—INSPECTIONS Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 228 149 3 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 578 407 13 - (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) - - - - Total 806 556 16 — 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.l) 3 3 - - - Overcrowding (S.2) — — — — — Unreasonable Temperature (S.3) - - - - - Inadequate Ventilation (S.4) 2 2 - - - Ineffective Drainage of Floors (S.6) - - - - - SanitaryConveniences (s.7)- (a) Insufficient 1 1 - — — (b) Unsuitable or Defective 9 4 - - - (c) Not separate for Sexes 1 1 - - - Other offences against the Act (not including offences relating to Out-work) 3 2 1 - - Total 19 13 1 — — 63 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 83 — - - - — Wearing Apparel— Making, &c. 246 — — — — — Brass and Brass Articles 1 - - — — — Lampshades 4 — — — — — Curtains and Furniture Hangings 7 — — — — — Furniture and Upholstery 2 — — — — — Electro-Plate 1 — - — — — Artificial Flowers 2 — — 1 1 — Paper Bags 61 - — 1 1 — Feather Sorting 5 - — — — — Carding, &c., of Buttons, &c. 58 - - - - - Stuffed Toys 92 — — 2 2 — Umbrellas 1 - — — — — Cracker Bon-bon, mas Crackers, Christmas Stockings, &c. 175 - - - - - The making of Boxes and other receptacles or parts thereof made wholly or partially of paper 5 - - - - - Total 743 - — 4 4 — 64 (D) HOUSING Total number of houses in the Borough, including flats, tenements, etc., separately assessed 26,238 (approx.) Housing Consolidated Regulations, 1925, as amended Information required by the above Regulations set out below:— (1) The number of houses which on inspection were considered to be unfit tor human habitation 25 (2) The number of houses the defects in which were remedied in consequence of informal action by the Local Authority or their Officers Nil (3) The number of representations made to the Local Authority with a view to— (a) the serving of notices requiring the execution of works, or 6 (b) the making of demolition or closing orders 21 (4) The number of notices served requiring the execution of works 6 (5) The number of houses which were rendered fit after service of formal notices 1 (6) The number of demolition or closing orders made 19 (7) The number of houses in respect of which an undertaking was accepted under sub-section (2) of section 19 of the Housing Act, 1930 Nil (8) The number of houses demolished Nil 65 (E) UNSOUND FOOD CONDEMNED—1954 Bacon 60½ lbs. Beans, baked 121 tins Biscuits l0½ lbs. Cake Mixture 12 jars Cereal 10 pkts Cheese 63 lbs. Chickens 3 tins Choc. Tea Cakes 12 tins Cocoa 8 tins Cream 60 tins Custard Powder 1 Eggs (Whole Frozen) 171 tins Fats 1lb. Fish 1,955 tins Fish 248½ lbs. Flour 17 lbs. Fruit, dried 3 lbs. Fruit, juice 3 bottles Fruit 1,128 tins Ham 44 tins Jam 338 tins Meat 537½ lbs. Meat 477 tins Milk (Cond. or Evap.) 201 tins Mincemeat 25 jars Nuts 4 oz. Peas 213 tins Pease Pudding 2 tins Pickles 26 jars Sandwich Spread 8 jars Sauce 10 bottles Sauerkraut 44 tins Sausages 26 tins Sausages 44½ lbs. Soup 163 tins Spaghetti 22 tins Spice 4 pkts. Sweets 51 lbs. Tomatoes 108 tins Tomatoes 6 tins Tomato Puree 28 tins Vegetables 35 tins Xmas Puddings 2 66 PUBLIC MORTUARY—Bodies Admitted, &c. Bodies admitted from the Borough:— By order of Coroner 251 By order of Police 9 On application of undertakers 6 266 Bodies admitted from other Boroughs:— Fulham (Fifty-four by order of Coroner, thirteen by order of Police and six by application of undertakers) 73 Chelsea (Two hundred and seventy-one by order of Coroner and two by order of Police) 273 Kensington (Sixteen by order of Coroner) 16 Westminster (One by order of Coroner) 1 363 Total bodies admitted 629 No. of P.M. examinations conducted:— Hammersmith cases 251 Fulham cases 54 Chelsea cases 271 Kensington cases 16 Total P.M.'s 592 No of Inquests held:— Hammersmith cases 90 Fulham cases 38 Chelsea cases 53 Kensington cases 87 Paddington cases 19 Westminster cases 7 Total Inquests held 294 67 (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 - 2 18 48 2 2 - - 72 12 - 69 Whooping Cough 24 14 60 68 2 1 - — 175 29 - 171 Acute Poliomyelitis (Par.) — — 2 4 — — - — 6 6 - 1 „ „ (Non-Par.) — — - — — — - — — — - — Measles 12 13 47 77 1 - - - 150 3 - 150 Diphtheria - - - — 4 1 1 — 6 6 - — Pneumonia 4 2 5 9 1 24 17 11 73 12 38 73 Dysentery 6 4 12 46 4 14 4 1 91 27 - 84 Acute Encephalitis (Inf.) — - — — — — — — — — — — Enteric or Typhoid Fever - — — 3 — 2 — - 5 5 — — Paratyphoid Fever — — — 1 — 1 — - 2 2 — 2 Erysipelas - — — — — 1 4 2 7 2 — 7 Meningococcal Infection 1 1 — 1 1 1 1 - 6 6 2 2 Food Poisoning — 4 4 6 2 5 3 - 24 7 — 19 Puerperal Pyrexia — — — — 112 179 — — 291 — — 291° Ophthalmia Neonatorum 3 — — — — — — 3 — — 3 Malaria - - — - 2 — — — 2 2 — 2 Scabies - 1 1 11 21 18 9 1 62 — — 62 Tuberculosis (Pulmonary) 2 1 1 6 32 76 35 14 167 37 18 167 „ (Non-Pulmonary) 1 — 1 3 1 6 1 — 13 11 3 13 Totals 53 42 157 283 185 331 75 29 1,155 167 61 1,116 Of this total only 54 cases related to persons residing in the Borough. 68 (B) BACTERIOLOGICAL EXAMINATIONS Specimen Positive Negative Total Swabs for suspected cases of Diphtheria - 65 65 Haemolytic Streptococci 14 26 40 Faeces 74 194 268 Vincents Organisms 2 3 5 Urine — 2 2 90 290 380 69 TUBERCULOSIS Summary of Notifications during the period from the 1st January, 1954, to the 31st December, 1954 Age Periods Formal Notifications Number of Primary Notifications of new cases of tuberculosis Total (all ages) 0— 1— 2— 5— 10— 15— 20— 25— 35—45— 55— 65— 75— Respiratory, Males - - 1 1 2 4 8 25 16 3 14 9 2 95 Respiratory, Females 2 1 — — 3 8 12 20 15 5 3 3 - 72 Non-Respiratory, Males - - — — 1 — — 1 - - — - — 2 Non-Respiratory, Females 1 — 1 1 1 1 - 3 2 1 — — - ii CASES NOTIFIED AND DEATHS—1954 and Previous Years Year No. of Cases notified No. of Deaths No. of Cases on Register of Notifications Pulmonary NonPulmonary Total 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 198 17 215 33 1,595 1954 167 13 180 21 1,495 Average number of cases notified for the 10 years 1935-1944 (inclusive)—194. Average number of cases notified for the 10 years 1945-1954 (inclusive)—203. Average number of deaths for the 10 years 1935-1944 (inclusive)—102. Average number of deaths for the 10 years 1945-1954 (inclusive)—57. 70 CHART SHOWING THE NUMBER- OF NEW CASES OF TUBERCULOSIS NOTIFIED DURING THE PAST 20 YEARS . PULMONARV TUBERCULOSIS NON -PULMONARY TUBERCULOSIS 71 MEDICINAL BATHS Cleansing of Verminous Persons School Children—Hammersmith Scabies 39 Verminous 648 School Children—Non-Hammersmith Scabies 7 Children under Five Years—Hammersmith Scabies 39 Verminous 48 Children under Five Years—Non-Hammersmith Scabies 4 Other Conditions 2 Adults—Hammersmith Scabies 153 Verminous 154 Other Conditions 1 Adults—Non-Hammersmith Scabies 18 Verminous 11 Lodging-Houses Scabies 4 Verminous 166 DISINFECTION Hammersmith Cases Non-Hammersmith Cases Mattresses 438 113 Pillows 371 108 Bolsters 15 8 Blankets 340 75 Sheets 101 27 Quilts 45 12 Clothing + 971 24 Sundries + 178 71 Total 2,897 + 52 Custom's Certificates issued in respect of 805 articles (768 Clothing, 37 Sundries) Rooms (including 595 verminous Rooms), 652