AC 4347 HAM 53 Metropolitan Borough of Hammersmith Report on the Health of the Borough 1961 F. M. DAY, M.R.C.S., L.R.C.P., D.T.M., D.P.H., MEDICAL OFFICER OF HEALTH. METROPOLITAN BOROUGH OF HAMMERSMITH HEALTH COMMITTEE at 31st December, 1961. Councillor E. O'K. Finn (Mrs.), M.B.E. (Chairman) Councillor E. D. Freeman (Mrs.) (Vice-Chairman) Alderman H. G. Reynolds Councillor D. M. Heaks (Mrs.) Councillor F. W. Ing Councillor L. S. Jones, A.E.Ae.S. Councillor D. R. P. Murray, M.A., Ph.D. Councillor R. W. Oak Councillor C. Parsons Councillor D. A. Reynolds Councillor S. E. Simpson Councillor D. W. Thorpe, T.D., M.I.E.E. Ex-Officio: The Worshipful the Mayor (Councillor Miss E. C. Woods, 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 Staff of the Health Department 2 Social Conditions 3 PART I STATISTICS AND TABLES Area and Population 4 Vital Statistics 5-8 Deaths: 8 Causes in age groups 9 Cancer 10-11 Infant Mortality 11-12-13 Maternal Mortality 13 Marriages 14 PART II EPIDEMIOLOGY Notification of infectious diseases 15 Vaccination and immunisation 16 Incidence of infectious disease: — Dysentery 17 Food Poisoning 17 Poliomyelitis 17 Smallpox 18 Tuberculosis 18-21 Typhoid 21 International Certificates of Vaccination and Inoculation 21 PART III ENVIRONMENTAL HYGIENE Staff—Inspectorial 22 Sanitary Circumstances Housing 22-24 Rent Act, 1957 and Housing Repairs and Rents Act, 1954 24 Sanitary Inspections 24-25 Summonses 25 Sewerage 25 Water Supply 26-27 Public Cleansing 27 Page Drainage 27 Dustbins 27 Factories, Workshops & Outworkers 27-28 Rodent Control 28-29 Licences and Registrations Hairdressers 29 Pharmacy and Poisons 30 Rag Flock 30 Pet Animals 30 Rag and Bone Dealers 30 Caravans 30 Atmospheric Pollution Smoke Control Areas 30 Measurement of Atmospheric Pollution 31 Inter-Borough Smoke Liaison Committee 31 Area Maps 32-35 Inspection and Supervision of Food General 36 Food: Premises 37 Unsound 37 Sampling 38 Bacteriological Examinations of Food 39 Ice-Cream and Preserved Food 40 Milk Supplies 40 Designated Milk Licences: P.H. (Condensed Milk) Regs. 1923/48 41 Skimmed Milk with Non-Milk Fat Regs. 1960 42 Markets 42 Medicinal Baths Treatment Centre 42 Section 43 of L.C.C. (G.P.) Act, 1953 43 Sterilisation 43 Health Laundry 44-45 Disinfestation 46 Disinfection 46 Page Coroner's Court and Mortuary 46-47 Exhumation 47 PART IV GENERAL HEALTH & WELFARE SERVICES Ambulance facilities 48 Conferences 48 Financial Contributions to Voluntary Organisations 48 Health Information Bureau 48 Hospitals 48 Hamersmith Chest Clinic 49 Laboratory facilities 49 Page National Assistance Act 50 Old People's Welfare 50 Personal Health Services 50 Ante-Natal Clinics 51 Infant Welfare Centres 51 Immunisation 51 Chiropody 51 Speech Therapy 51 Creche 51 Day Nurseries 52 Home Help Service 52 Public Baths and Wash-houses 52 Staff Medical Examinations 53 ALPHABETICAL INDEX 54-55 1 Telephone: TOWN HALL. Riverside 3020. HAMMERSMITH, W.6. To The Mayor, Aldermen and Councillors of the Metropolitan Borough of Hammersmith. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Annual Report for 1961. There was an increase in the notifications of Infectious Disease, but this was almost entirely due to large numbers of measles cases occurring in the first quarter, which was the peak of the two year cycle. Many attempts have been made to explain the regularity of the epidemic occurring every other year, but the answer probably lies in the relationship between the immune and the susceptible in the early years of schooling. The Council paid compensation in accordance with Section 26 of the London County Council (General Powers) Act, 1959, to two carriers of food poisoning organisms, who were advised to discontinue their employment as food handlers. Happily pulmonary tuberculosis is still on the decline, but it is wrong to consider it is no longer an important issue. Many serious cases still occur. In the year under review the Department was again handicapped by the shortage of Public Health Inspectors, and much of the routine work of inspection of food premises, house-to-house inspection and so on, was again deferred. I must pay a tribute to the Inspectors who through the shortage of staff have had so many additional responsibilities thrust on them. I wish to thank the members of the Council, and in particular, the Chairman and members of the Health Committee and the Establishment Committee, for the support and encouragement which I have at all times received. I would also express my sincere thanks to the staff of the Health Department for their loyal support and conscientious attention to duty throughout the year. I am, Your Worship, Ladies and Gentlemen, Your obedient servant, F. M. DAY, Medical Officer of Health. 2 STAFF OF THE PUBLIC HEALTH DEPARTMENT at 31st December, 1961 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. Assistant Administrative Officer S. G. Bennett Clerical J. C. Turner (1st Assistant) Mrs. F. Lawford A. E. Blake F. E. Martin (Resigned 29.12.61) Mrs. J. P. Brodie (Resigned 22.10.61) W. M. Robinson Mrs. M. Gray Mrs. L. G. Stimpson T. J. Hares Miss C. Tappenden Mrs. D. Kelley Miss L. Veal Miss I. E. Waller (M.O.H.'s Secretary) Chief Public Health Inspector P. T. Bayes Deputy Chief Public Health Inspector E. W. Pike Public Health Inspectors W. R. Bland J. C. Hopkins J. Collier S. E. Thelner G. G. Gardiner W. H. Tyrrell (Assistant) Food and Drugs Inspector W. J. Godden Public Health Inspector i/c Clean Air J. Beagle Enquiry Officers P. E. C. Pendock (Temporary) E. R. James (Temporary) Technical Officer E. Bonnar (Unestablished) Public Health Welfare Officer Miss E. M. Cross Old People's Welfare Mrs. E. Coats Miss M. A. Tyreman (Nursing Visitor) Mrs. C. Willison (Part-time) Mortuary Keeper W. Gauntlett Medicinal Baths Superintendent F. G. Baldwin Public Analyst D. F. H. Button, A.R.C.S., F.R.I.C. 3 SOCIAL CONDITIONS OF THE BOROUGH Hammersmith, the most westerly of the Metropolitan Boroughs, although semi-industrial in character has the River Thames for its southern boundary and is within easy reach of the many riverside beauty spots. The waterfront between Chiswick Mall and Hammersmith Bridge offers even to-day an interesting change from the usual daily surroundings with its many period places that contrast strongly with the twentieth century dwellings. It is however a far cry from the old coaching road to the Great West Road as we know it to-day—a Clearway with the Fly-over constructed by the most up-to-date methods. All those activities that are part of modern urban life can be found in Hammersmith, from the processing of raw materials in factories to the retailing of the finished article in the fine shops of the Borough. There is a variation of approximately 120 ft. in the elevation of the Borough from the southern boundary at the River Thames to the northern boundary. The highest point is at the junction of Scrubs Lane and Harrow Road (133 feet above Mean Sea Level at Newlyn. Cornwall), and the lowest at points in the Lower and Upper Malls (13 ft. above Mean Sea Level). The Borough has an estimated population for 1961 of 108,010, and an area of 2,282.5 acres of which 286 acres are given over to parks and open spaces. There are approximately 70 miles of roads, most of which carry the very heavy traffic that is such a feature of life to-day. Apart from the residents, many people come to Hammersmith for relaxation; athletics are to be found at the White City Stadium; and exhibitions of all kinds are held at Olympia. Excellent transport service facilitates these events. The new B.B.C. Television Centre in Wood Lane provides entertainment for millions. 4 PART I STATISTICS AND TABLES The following statistical information relating to the Borough has been completed from the Local and National Statistics issued by the Registrar-General in connection with Population, Birth-rate, Death-rate, Maternal and Infantile Mortality. The comparability factor used in the calculation of the adjusted birth and death rate figures is provided by the Registrar General. The relative age groups of residents in each local authority area differ considerably in number. The number of elderly residents in a southern seaside resort is obviously far greater than in one of our new towns. Equally obviously, the same disparity will apply between the numbers of deaths in two such towns. Conversely, the births in the new town will be considerably greater. Comparison, therefore, between the birth and death rates of two such towns would be impracticable. The comparability factor, in effect, reduces the age groups of each town in the country to the same proportions, and thus enables direct comparisons to be made between areas of different nature. From the factors supplied it might be inferred that in Hammersmith the proportion of elderly to younger people is slightly below the national level. Area (acres) 2,282.5 Population: — Census, 1951 119,367 Census, 1961 (provisional) 110,147 Registrar-General's estimate, mid-1961 108,010 1960 108,290 Rating: — Number of inhabited Houses 28,236 Rateable Value £2,306,495 Product of a penny rate £9,400 5 Mortality: — Number of Deaths 1,246 Death Rate per 1,000 population: Corrected 11.5 Adjusted (Comparability Factor 1.03) 11.8 Deaths from Cancer (all ages) 277 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) 1 Live Births: — Number 2,263 Rate per 1,000 population: — Corrected 20.95 Adjusted (Comparability Factor 0.95) 19.9 Illegitimate Live Births per cent. of total live births 13.4 Stillbirths: — Number 40 Rate per 1,000 total live and still births 17.37 Total Live and Still Births 2,303 Infant Deaths (deaths under 1 year) 38 Infant Mortality Rates: — Total infant deaths per 1,000 total live births 16.8 Legitimate infant deaths per 1,000 legitimate live births 16.3 Illegitimate infant deaths per 1.000 illegitimate live births 19.8 Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 11.9 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 total live births) 9.7 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 26.9 Maternal Mortality (including abortion): — Number of deaths — Rate per 1,000 total live and stillbirths — A summary of the vital statistics of the district for 1961 and previous years is given in the following table. 6 VITAL STATISTICS OF WHOLE DISTRIC 1961 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 B 122,800 1,829 14.9 1,311 11.2 362 442 77 43 1,391 12.0 D116,200 1940 98,320 1,600 16.3 1,725 17.5 370 401 76 51 1,756 17.9 1941 84,880 1,405 16.5 1,315 15.4 351 364 52 41 1,328 15.6 1942 89,370 1,589 17.8 1,270 14.2 356 338 94 59 1,252 14.0 1943 92,050 1,768 19.2 1,278 13.9 365 387 102 58 1,300 14.1 1944 89,190 1,788 20.0 1,447 16.2 418 389 95 53 1,418 15.9 1945 96,100 1,742 18.1 1,464 15.2 423 267 78 45 1,308 13.6 1946 111,860 2,310 20.6 1,522 13.6 463 277 103 45 1,336 11.9 1947 117,280 2,559 21.8 1,570 13.3 472 271 97 38 1,369 11.6 1948 115,800 2,149 18.5 1,608 13.8 547 241 75 35 1,302 11.2 1949 118,440 1,971 16.6 1,532 12.9 545 322 55 28 1,309 11.0 1950 119,200 1,988 16.6 1,433 12.0 482 346 34 17 1,297 10.8 1951 118,300 1,874 15.8 1,605 14.4 509 401 41 22 1,497 12.6 1952 118,800 1,777 14.9 1,509 12.7 535 383 37 21 1,357 11.4 1953 117,600 1,750 14.9 1,409 12.0 498 296 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 1955 114,700 1,707 14.8 1,495 13.0 643 393 51 30 1,245 10.8 1956 113,300 1,810 15.9 1,414 12.4 582 449 39 21 1,281 11.3 1957 111,700 1,886 16.8 1,412 12.6 603 420 48 25 1,229 11.0 1958 110,200 2,027 18.3 1,416 12.8 655 480 49 24 1,241 11.2 1959 108,900 2,004 18.4 1,442 13.2 709 504 55 27 1,237 11.3 1960 108,290 2,212 20.4 1,429 13.1 688 464 50 23 1,205 11.1 1961 108,010 2,263 20.9 1,492 13.8 755 509 38 17 1,246 11.5 * B = Birth-rate Population Figure. D = Death rate Population Figure. The chart giving birth and death rates per 1,000 population for the past 20 years shows an interesting point in the death rate for the past 7 years, the figure being constant around the 11 line; in marked contrast to previous years. CHART SHOWING BIRTH AND DEATH RATES PER 1,000 POPULATIOW FOR THE PAST PO YEARS _ BIRTH RATE - DEATH RATE 8 (a) Population The Registrar General's estimated population for Hammersmith for 1961 is 108,010, which shows a reduction of 280 compared with 1960. The provisional figure for the 1961 Census, however, gives a population of 110,147, an increase of 2,137 over this latest estimate. It has long been my contention that the estimated population suggested by the Registrar General was not realistic, and the population of the borough was not being reduced at such a rate. The latest census figure would appear to uphold this view. For purposes of comparison birth and death rates have been calculated on both sets of figures. NATURAL INCREASE OR DECREASE OF THE POPULATION DURING THE PAST 20 YEARS Year Population Excess of Births over Deaths Year Population Excess of Births over Deaths 1942 89,370 337 1952 118,800 420 1943 92,050 468 1953 117,600 543 1944 89,190 370 1954 116,500 705 1945 96,100 434 1955 114,700 462 1946 111,860 974 1956 113,300 529 1947 117,280 1,190 1957 111,700 657 1948 115,800 847 1958 110,200 786 1949 118,440 662 1959 108,900 767 1950 119,200 691 1960 108,290 1,007 1951 118,300 377 1961 108,010 1,017 (b) Births The corrected number of births for the year was 2,263 as against 2,212 in 1960. On the estimated population of 108,010 this represents an annual rate of 20.95 births per thousand persons living. On the census population the figure is 20.5. In 1960 the birth rate per thousand of the population was 20.4. There was an increase in illegitimate births from 261 in 1960 to 303 in 1961. During the same period the number of legitimate births increased by 9 only, a somewhat disturbing position. (c) Deaths The number of deaths registered during the year was 1,492. From this figure must be deducted 755 in respect of non-resident and transferable deaths, and added to it 509 deaths of residents of the Borough who died in various parts of England. This gives the corrected figure of deaths as 1,246 (650 males and 596 females). Using the estimated figure of 108,010, the number of deaths per thousand of the population is 11.5 compared with 11.1 in 1960. Calculated on the census population the figure becomes 11.3. Once more the principal causes of death during 1961 were diseases of the heart and cancer. In the following table will be found a detailed analysis of deaths from all causes with separate comparison tables for carcinoma of the lungs and cancer. 9 CAUSES OF, AND AGE AT, DEATH DURING THE YEAR 1961 AS SUPPLIED BY THE REGISTRAR GENERAL Cause of Death Sex 0— 1— 5— 15— 25— 45— 65— 75— Total all Ages 1. Tuberculosis, respiratory M - - - - - 1 3 - 4 F - - - - - - - - - 2. Tuberculosis, other M - - - - - 1 - - 1 F - - - - - - - - - 3. Syphilitic disease M - - - - - - - - - F - - - - - - - - - 4. Diphtheria M - - - - - - - - - F - - - - - - - - - 5. Whooping Cough M - - - - - - - - - F - - - - - - - - - 6. Meningococcal infections M - -- - - -- - - - - F - - - - - - - - - 7. Acute poliomyelitis M - - - - - - - - - F - - - - - - - - - 8. Measles M - - - - - - - - - F - - - - - - - - - 9. Other infective and parasitic diseases M - - - - - 1 1 - 2 F — — — — — 1 — — 1 10. Malignant neoplasm, stomach M — — — — — 6 3 6 15 F — — — — — 5 5 9 19 11. Malignant neoplasm, lung bronchus M — — — — 4 38 21 11 74 F — — — — 1 7 3 2 13 12. Malignant neoplasm, breast M — — — — — — — — — F — — — — 1 3 8 4 16 13. Malignant neoplasm, uterus M — — — — — — — — — F — — — — — 2 3 3 8 14. Other malignant and lymphatic neoplasms M — — — 2 2 16 20 17 57 F — — — 2 1 24 22 20 69 15. Leukaemia, aleukaemia M — — — — — 2 — 1 3 F — — — — 1 1 — 1 3 16. Diabetes M —— — — — — — — 1 1 F — — — — 1 — 4 3 8 17. Vascular lesions of nervous system M 1 — — — — 15 13 19 48 F — — — — — 9 23 50 82 18. Coronary disease, angina M — — — — 7 56 39 33 135 F — — — — 1 19 34 51 105 19. Hypertension with heart disease M — — — — — 1 2 5 8 F — — — — — 2 1 9 12 20. Other heart disease M — — — 1 4 12 18 20 55 F — — — — 2 12 11 48 73 21. Other circulatory disease M — — — — — 10 6 14 30 F — — — — 1 - 9 22 32 22. Influenza M — — — — — 1 — — 1 F - - - - - 1 1 3 5 23. Pneumonia M 3 1 — — 1 5 6 12 28 F — — — — 1 3 4 23 31 24. Bronchitis M - - - - - 11 23 21 55 F - - - - - 4 9 17 30 25. Other diseases of respiratory system M 1 1 - - 1 3 3 2 11 F - 1 — — — 1 2 4 26. Ulcer of stomach and duodenum M - - - - - 3 1 1 5 F - - - - - — 3 2 5 27. Gastritis, enteritis and diarrhoea M 1 — — — — — 2 4 7 F - - - - - - 2 1 3 28. Nephritis and nephrosis M - - - - - 1 1 1 3 F - - - - - - 1 - 1 29. Hyperplasia of prostate M - - - - - 1 3 1 5 F - - - - - - - - - 30. Pregnancy, childbirth, abortion M - - - - - - - - - F - - - - - - - - - 31. Congenital malformations M 6 — 1 1 1 1 — — 10 F 6 — — — — 2 — — 8 32. Other defined and ill-defined illnesses M 15 — 1 — 2 13 6 10 47 F 4 1 - — 2 9 10 22 48 33. Motor vehicle accidents M — — 2 4 3 6 2 1 18 F — — — — 1 1 1 2 5 34. All other accidents M 1 — — 4 2 2 1 3 13 F — 2 — — 1 1 1 4 9 35. Suicide M — — — 1 4 6 1 2 14 F - - - - - 3 2 1 6 36. Homicide and operations of war M - - - - - - - - - F - - - - - - - - - Total of all causes M 28 2 4 13 31 212 175 185 650 F 10 4 — 2 14 109 158 299 596 38 6 4 15 45 321 333 484 1246 10 DEATHS FROM CARCINOMA OF LUNGS Year 0—25 —45 —65 —75 +75 Total 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 1955 M 1 4 31 19 3 58 F — 1 3 — 2 6 Total 1 5 34 19 5 64 1956 M - 5 27 24 8 64 F — — 3 3 3 9 Total — 5 30 27 11 73 1957 M - 3 36 25 3 67 F — — 2 6 4 12 Total — 3 38 31 7 79 1958 M - 1 29 23 6 59 F — - 1 3 1 5 Total — 1 30 26 7 64 1959 M - 2 27 20 7 56 F — — 2 3 2 7 Total — 2 29 23 9 63 1960 M - 2 39 18 10 69 F — 2 7 2 4 15 Total — 4 46 20 14 84 1961 M - 4 38 21 11 74 F — 1 7 3 2 13 Total — 5 45 24 13 87 11 DEATHS FROM CANCER DURING THE PAST TEN YEARS Year Population Deaths Rate per 1,000 Year Population Deaths Rate per 1,000 1952 118,800 290 2.4 1957 111,700 284 2.5 1953 117,600 222 1.9 1958 110,200 249 2.2 1954 116,500 232 2.0 1959 108,900 252 2.3 1955 114,700 269 2.3 1960 108,290 291 2.6 1956 113,300 229 2.0 1961 108,010 277 2.6 (d) Infant Mortality The number of deaths of infants under one year of age during the year was 38, giving a mortality rate per 1,000 live births of 17. A glance at the next table shows that this low figure has been achieved only once previously, in the year 1950. INFANT MORTALITY—1961 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 „ 1934-1943 1,756 103 59 „ 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 „ 1955 1,707 51 30 „ 1956 1,810 39 21 „ 1957 1,886 48 25 „ 1958 2,027 49 24 „ 1959 2,004 55 27 „ 1960 2,212 50 23 „1961 2,263 38 17 Net deaths of infants at various ages under one year of age Under 1 week 22 1—2 weeks 1 2—3 weeks 2 3—4 weeks 2 4 weeks and under 3 months 3 3 months and under 6 months 4 6 months and under 9 months 1 9 months and under 1 year 3 Total deaths under 1 year 38 Net Births in the Year: Legitimate 1.960. Illegitimate 303. Net Deaths in the Year: Legitimate Infants 32. Illegitimate Infants 6. 12 CHART SHOWING THE NUMBER OF DEATHS OF INFANTS UNDER 1 YEAR OF AGE DURING THE PAST SO YEARS. 13 (e) Maternal Mortality There were no maternal deaths during the year, as the table shows, a satisfactory position which has obtained only in two previous years. INFANT MORTALITY RATES—ENGLAND AND WALES AND VARIOUS OTHER COUNTRIES Deaths under 1 year per 1,090 live births Country 1955 1956 1957 1958 1959 1960 England and Wales 25 24 23 23 22 22 Scotland 30 29 29 28 28 27 Northern Ireland 32 29 29 28 28 27 Australia 22 22 21 20 22 20 Canada 31 32 31 30 28 27 Chile 121 113 117 127 120 127 Denmark 25 25 23 22 22 22 France 39 36 34 32 30 27 Irish Republic 37 36 33 35 32 30 Italy 49 48 50 48 45 44 Netherlands 20 19 17 17 17 17 New Zealand 22 19 20 19 20 20 Sweden 17 17 17 16 16 16 United States of America 27 26 26 26 26 26 MATERNAL MORTALITY—1961 and Previous Years Year Number of Deaths Pregnancy, childbirth, abortion Number of live Births Maternal Death Rate Average 1924-1933 8 2,145 3.5 1934 9 1,783 5.0 1935 2 1,877 1.1 1936 3 1,922 1.6 1937 4 1,913 2.1 1938 2 1,874 1.1 1939 2 1,829 1.0 1940 — 1,600 — 1941 2 1,405 l.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 1955 2 1,707 1.14 1956 — 1,810 — 1957 2 1,886 1.04 1958 2 2,027 0.96 1959 1 2,004 0.48 1960 1 2,212 0.44 1961 — 2,263 — † 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". 14 (f) Marriages The number of marriages was 1,333, an increase of 25 compared with the previous year. Particulars are set out hereunder : The Register Office 528 Buildings registered for marriages (Roman Catholic Churches and Chapels at which a Registrar attends) 441 Churches of the Church of England 317 Authorised Persons (Chapels at which a Registrar does not attend) 39 Jewish Synagogues 8 1,333 15 PART II EPIDEMIOLOGY Notification of Infectious Diseases 1,687 cases of infectious diseases were notified during the year. 128 cases were removed to hospital and of this number 12 were notified on discharge as not having suffered from the condition originally notified. As a result, the corrected number of cases of notifiable infectious diseases for the year was 1,675. These figures show an increase on the previous year of 656 cases. This is largely due to the fact that there were many more cases of Measles. Scarlet Fever, Pneumonia and Dysentry showed a decrease, and there was also a considerable decrease in the number of cases of Whooping Cough. Full details are given under age groups in the following table: — 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 vears 65+ years Age not known Scarlet Fever — 2 9 13 2 — — — — 26 8 — 24 Whooping Cough 3 5 10 3 — — — — — 21 — — 21 Acute Poliomyelitis (Par.) — — — — — 1 — — — 1 1 — — ,, ,, (Non-Par.) — — — 1 — — — — — 1 1 — 1 Measles 52 184 507 416 12 15 1 — — 1,187 42 — 1,187 Diphtheria — — 1 2 1 — — — — 4 4 — — Pneumonia 5 2 6 6 — 8 9 8 — 44 14 59 44 Dysentery 6 10 26 39 9 18 5 4 — 117 17 — 114 A. Encephalitis (Inf.) — — — — — — — — — — — — — Enteric or Typhoid Fever — — — — — — — — — — — — — Paratyphoid Fever — — — — 2 — — — — 2 2 — Erysipelas — — — — 1 1 2 1 — 5 1 — 5 Meningococcal Infection — — — — — — 1 — — 11 — 1 Food Poisoning 2 1 3 13 6 10 4 2 — 41 9 — 40 Puerperal Pyrexia — — — — — 52 63 — — 115 — — *115 Ophthalmia Neonatorum — — — — — — — — — — — — — Smallpox — — — — — — — — — — — — — Malaria — — — — — — 1 — — 1 1 — 1 Scabies — — 2 6 5 3 3 — — 19 — — 19 Tuberculosis (Pulmonary) — 2 — 2 16 30 28 9 — 87 24 4 87 (Non-Pulmonary) — — 1 1 3 6 4 — — 15 3 1 15 Totals 68 206 565 502 57 144 121 24 — 1 687 128 64 1,675 * Of this total only 43 cases related to patients residing in the Borough. 16 It is interesting, once again, to note the regular habits of the Measles cycle, which is clearly seen in the following chart showing figures relating to notifications received during the past ten years. I am pleased to be able to report that no cases of Diphtheria were brought to the attention of the Department during the year. Contacts and Carriers of Infectious Disease—Sickness Benefit One certificate was issued during the year to a hospital nurse who had been in contact with a case of German Measles. Immunisation and Vaccination This work is organised from the No. 1 Divisional Health Office of the London County Council, which serves the boroughs of Chelsea, Fulham, Hammersmith and Kensington. Prevention of Diphtheria and Whooping Cough The majority of children are immunised against these diseases, the proportion of those in the 1-4 years age group being approximately 75 per cent. Prevention of Smallpox It is estimated that only 1 child in every 2 is vaccinated against this disease. It is possible that the publicity given to the recent outbreak of smallpox in this country will produce a considerable improvement in the figures for 1962. Prevention of Poliomyelitis In the No. 1 Division 41,935 vaccinations against this disease were carried out by the London County Council during 1961. A scheme has been formulated to deal with any possible outbreak of Poliomyelitis in this area, and full details are given under the appropriate heading later in this report. Prevention of Tuberculosis B.C.G. vaccination is offered to all children in their 13th year, with the object of providing artificial immunity during the adolescent period when young people are most susceptible to this disease. 17 In the No. 1 Division a total of 3.527 received these innoculations during the year. Incidence of Infectious Diseases Dysentery 114 cases of dysentery occurred during 1961, which is 14 more than last year. There were no deaths, nor were there any outbreaks. Food Poisoning This year there were 40 cases of Food Poisoning. The following agents were identified: — Salmonella Typhimurium 17 Salmonella Agama 1 Salmonella St. Paul 1 19 In 21 other cases no specific organism was isolated. A report was received from a catering manager of a large establishment in the Borough that a number of people, including himself, had suffered from food poisoning. The possible sources of infection had been narrowed down to Hollandaise sauce, which was served with fresh cooked scotch salmon. Arrangements were made for the kitchens to be inspected and for swabs to be taken from the chef who prepared the sauce. Results of these swabs showed that the chef had Staphylococcus aureus (food poisoning variety) in large quantities on both hands. It was also discovered that this chef prepared food at a restaurant in the City of London, and the Medical Officer of Health was informed of the position. The patient was advised to consult his own doctor on the matter, and at the same time was requested not to handle any more food until the danger from contamination had been eliminated. The patient made application for and received payment of compensation in accordance with Section 26 of the London County Council (General Powers) Act. 1959, which provides where, in a case of this nature, the Medical Officer of Health requests in writing a person to discontinue his employment, the Borough Council may, if they think fit. compensate such person for any loss occasioned by compliance with such a request. Another case of Food Poisoning was reported in which Salmonella Agama was found to be the responsible agent. It was discovered that the patient was employed as a food handler in a canteen in the Borough, and a notice was served stipulating that she must refrain from handling food until the risk of spreading the infection was removed. As in the previous case the patient made application for, and received, compensation under the Act referred to above. Poliomyelitis During the year a severe outbreak of Poliomyelitis occurred in Hull, and as a result arrangements were made by the London County Council as to the steps to be taken in the event of an outbreak in the London area. It was anticipated that a district holding 100,000 people would be covered by the Ministry's instructions to proceed with the issue of oral vaccine. The Divisional Health Office of the London County Council would arrange suitable propaganda to ensure that every household in the affected area knew exactly what to do and where to go to obtain protection. In Hammersmith thirteen centres were earmarked to be opened for inoculations, teams of volunteers were available to man the centres, and arrangements were made for supplies of vaccine to be delivered. It was envisaged that each team would consist of six persons whose duty it would be to issue the vaccine and record the personal details of each person treated. Mobile 18 teams would deal with homebound people, whilst hospitals and prisons would man their own centres. Happily the necessity did not arise for these arrangements to be put into force, but the scheme remains organised in every detail, and can be put into operation forthwith should the necessity arise. I am pleased to report that there was only one confirmed case of poliomyelitis in the Borough during 1961. It was found to be of the non-paralytic type. Smallpox There were no cases of Smallpox in the Borough during the year under review. Tuberculosis Ten years ago the principles of modern treatment for tuberculosis were in their infancy and were applied to a minority of cases only. These methods of treatment are now well tried and established, forming a major part of the work of the Hammersmith Chest Clinic. Every patient with active tuberculosis now receives the benefit of treatment which very rarely fails to control a disease which previously carried an appalling mortality rate. The number of patients on the Register of Tuberculous persons has not materially decreased in the period 1957/61, and this is largely because so many lives are now saved. The problem of tuberculosis among immigrants to this country has received wide publicity in recent years. During a six month period in 1953/54 the London County Council conducted a survey into this problem and found that in the whole of the County Council area only 26 persons coming into the country during the preceding six months were notified as suffering from tuberculosis, out of a total of 2,256 notifications. It was considered likely that 16 of these people were infected before arrival. The contribution of Hammersmith to this figure was one patient. Although it has been suggested in many quarters that the problem of tuberculosis is fast becoming unimportant, this is a very short sighted and unwarranted view. It still provides a large proportion of the work in the Chest Clinic and many tragic cases are still seen. The condition is aggravated by poor and overcrowded housing conditions, and it must also be realised that many children are not receiving B.C.G. vaccination as recommended, and therefore remain at serious risk from the ever-present pool of tuberculous infection which will not be finally eradicated unless Tuberculous individuals, on their own initiative, present themselves for a complete course of treatment. This risk is clearly indicated by the following table which shows that nearly half of notifications received last year were in the age group 15 to 34. whilst the last column in the next table shows how the number of cases on the Register remains fairly constant. Summary of Notifications during the period from the 1st Jaunary, 1961, to the 31st December, 1961 Age Periods Formal Notifications Number of Primary Notifications of new cases of tuberculosis 0— 1 — 2— 5— 10— 15— 20— 25— 35— 45— 55— 65— 75 + Total (all ages) Respiratory, Males — 1 — 1 — 3 5 13 4 7 16 6 2 58 Respiratory, Females — 1 — 1 — 4 4 12 1 4 1 — 1 29 Non-Respiratory, Males — — — 1 — 1 1 1 3 2 — — — 9 Non-Respiratory, Females — — 1 — — — 1 — 2 2 — — — 6 CASES NOTIFIED AND DEATHS—1961 and Previous Years Year No. of Cases notified No. of Deaths No. of Cases on Register of Notifications Pulmonary NonPulmonary Total 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 1955 135 15 150 16 1,510 1956 156 9 165 17 1,536 1957 126 16 142 9 1,517 1958 123 5 128 15 1,537 1959 135 8 143 8 1,581 1960 98 13 111 7 1,528 1961 87 15 102 5 1,456 19 Average number of cases notified for the 10 years 1942/1951 (inclusive)—205. Average number of cases notified for the 10 years 1952/1961 (inclusive)—153. Average number of deaths for the 10 years 1942/1951 (inclusive)—74.7. Average number of deaths for the 10 years 1952/1961 (inclusive)—21. 20 CHART SHOWING THE NUMBER OF NEW CASES OF TUBERCULOSIS NOTIFIED DURING THE PAST 20 YEARS. 21 The remarkable improvement achieved in the last ten years in the treatment of this disease is shown in the decrease of notifications from 208 in 1951 to 102 in 1961. The notification figures for England and Wales in the same period show a similar reduction; from 49.440 in 1951 to 23,605 in 1960. The number of deaths from the disease has fallen dramatically from 44 in 1951 to 5 in 1961, and this compares very favourably with the corresponding figures for England and Wales, where there were 13,706 deaths in 1951, falling to 3,435 in 1960. Typhoid Carrier On the 2nd November, 1961, a letter was received from the Principal Medical Officer, Ministry of Health, Kingston, Jamaica, West Indies, stating that a lady was arriving in this country to take up permanent residence in Hammersmith, and that she was recorded as a typhoid carrier. It appears that her intention to come to this country became known to the Ministry of Health at Kingston after she had left Jamaica. Investigation on her arrival in Hammersmith confirmed that she was a typhoid carrier. Therefore, regular tests were instituted for all members of the household where this lady had come to live. At the same time a Notice was served in accordance with the Infectious Diseases Regulations. 1953 requiring that she refrain from engaging in any occupation connected with the preparation and handling of food or drink for human consumption, and also that all necessary precautions be taken to prevent the spread of infection. In co-operation with the family practitioner the carrier and household contacts were kept under close observation until, eventually, she was referred to hospital where a successful operation was performed to end the carrier state. International Certificates of Vaccination and Inoculation Arrangements continued for the authentication by the Medical Officer of Health of the signature of doctors on certificates of vaccination and inoculation by travellers from this country going abroad as required by the International Sanitary Regulations. During the year 612 certificates were authenticated. 22 PART III ENVIRONMENTAL HYGIENE Staff—Inspectorial Thei establishment of ^Public Health Inspectors consists of a Chief Public Health Inspector, Deputy Chief Public Health Inspector, eight District Inspectors, one Food and Drugs Inspector, one Public Health Inspector in charge of Clean Air, and one Woman Inspector, who is also the Public Health Welfare Officer. An additional Inspector commenced duties in December but despite continued advertisements two vacancies remained unfilled. In May, 1960 the Council appointed two Assistants to help the Inspectors and they were given training facilities as both of them intended to become Public Health Inspectors. One of them, however, was called up for National Service in October of that year. The shortage of qualified Inspectors has resulted in a serious decline in the number of routine visits on housing and to food premises, factories, shops, etc., and it is not possible to ensure that the various Acts and Regulations are being observed. Sanitary Circumstances Housing The Housing Manager continues to co-operate with the Health Department on applicants with overcrowding or medical problems. Requests are received asking for inspections to be made with a view to ascertaining whether a family is living in overcrowded conditions. Enquiries are then made by the Public Health Inspector, and, if a family is found to be living in such conditions, overcrowding is duly certified. In instances where the request is accompanied by medical certificates supporting the family's application on medical grounds, very careful consideration is given that the recommendations are made only for the most urgent cases, having regard to the nature of the illness, the condition of the premises and the amenities available. Applications for rehousing by the London County Council are made to that authority direct, and requests for various enquiries to be made are received from that Council through the Housing Manager. 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. Rehousing on such grounds has however become very substantially reduced, as new building is almost wholly confined to rehousing people from slum clearance areas. 5 cases were recommended for rehousing on grounds of health, 71 on grounds of overcrowding and 2 for exchange accommodation. I append a table showing the number of cases recommended for rehousing under the headings mentioned above, and those actually rehoused from 1949. 23 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 1955 28 3 129 55 6 5 1956 16 4 97 4 5 1957 18 5 90 13 — — 1958 20 13 69 16 — 1 1959 10 6 57 25 — 1 1960 10 2 80 9 — — 1961 5 1 71 5 — — Totals 331 97 2,143 780 100 40 To make the above figures realistic it should be pointed out that the figures for those rehoused are extremely unlikely to be from recommendations of the same year. Permanent Estates During the year both the Borough Council and the London County Council were engaged in providing accommodation for those in the greatest need, and whilst no new dwellings were actually erected by the London County Council the undermentioned flats were completed by the Borough Council: — Cardross House 11 1/9 Lakeside Road (Conversions) 10 Total 21 The Council acts as landlord for 3.441 principal tenants. The properties managed include houses, flats, pre-fabs, acquired and converted accommodation. The following table illustrates the progress that is being made: — 1. Number of families rehoused by the Borough Council in new flats and houses since the war 1,422 2. Number of families rehoused by the Borough Council in rebuilt houses since the war 30 3. Number of families rehoused in pre-fabricated dwellings since the war 80 (Still living in pre-fabricated dwellings at the end of the year=38) 4. Number of families on the Waiting List at the end of the year 1,564 Slum Clearance Since 1956 a total of 118 houses have been demolished or closed, and during the five year period 1961/1965 it is proposed to deal with a further 524 properties. It is anticipated that 330 of these houses will be dealt with by London County Council and the remaining 194 by the Hammersmith Borough Council. 24 Demolition of the 85 houses in the Mardale/Southbrook Street Slum Clearance Area commenced during the year and it is hoped that this site will be cleared by the end of 1962. The Housing Department have made considerable progress in re-housing residents from this area and by the end of the year approximately 90 families had been found alternative accommodation leaving a further 60 to be dealt with. The Council propose to erect on this site accommodation for 92 families in two blocks of 10 storey flats and one of 4 storeys, comprising 88 flats with 2 bedrooms and 4 flats with 1 bedroom. The site of the Latimer Road (South) Clearance Area is practically cleared. Of the 120 families in occupation approximately 100 have now been re-housed. It is hoped to proved accommodation for more than 300 families in multi-storey flats but re-development of this site has not been easy and final details have not yet been settled. The area north of the Metropolitan Railway Bridge is to be dealt with by the London County Council. The Hammersmith (Poynter/Stebbing Street) Nos. 1 and 2, Compulsory Purchase Orders were submitted to the Ministry and confirmation is awaited. These cover 6 small sections dealing with a further 61 properties in the Latimer Road Area. The greatest obstacle to the Slum Clearance programme is the difficulty experienced in finding acceptable accommodation for the families to be displaced. A scheme was devised with the London County Council whereby 60 properties would be loaned to the Council for tenants living in the slum clearance areas, but very few have accepted accommodation offered. Several Council tenants have been moved to out-County estates and the properties thus vacated have been re-let to families from the Clearance Areas. Housing Act, 1957. Closing Orders During the year 3 Closing Orders were made in respect of 4 properties and Closing Orders on 4 properties were determined. Rent Act, 1957 During the year applications under the above Act were received as follows: — For Certificates of Disrepair Number received 12 Number granted 2 For Revocation of Certificates Number received 2 Number granted 1 Undertakings given by Landlord Number accepted 10 Sanitary inspections The sanitary conditions of the Borough were subject to routine inspection and investigations were made into all complaints received. Particulars of the visits made by the Public Health Inspectors together with the number of preliminary and statutory notices and the number of proceedings instituted are set out overleaf. 25 Sanitary Inspection Cause of Inspection No. of Inspections No. of Notices served No. of Notices complied with Atmospheric Pollution and Clean Air 497 4 2 Bakehouses 98 Complaints 2,324 705 310 Drainage 2,145 7 11 Factories (Mechanical) 54 8 2 Factories (Non-Mechanical) 22 Food (other than Restaurants and Eating Houses) 1,576 7 4 Hairdressers and Barbers 36 1 1 Housing Act 185 2 1 Housing Applications 101 3 — House to House 1 Housing Repairs and Rents Act 36 7 Ice Cream Vendors 199 Infectious Diseases 327 1 Litter Act 4 — Markets 560 Milk Vendors 185 I 1 Noise Abatement Act 24 Old People's Welfare 600 Outworkers Pet Shops Act 9 — — Pharmacy and Poisons Act 80 Public Urinals 1 Rag Flock Act — Rats and Mice 1,456 26 15 Restaurants and Eating Houses 436 6 3 Shops Act 32 1 1 Miscellaneous 700 28 19 Re-visits 7,898 169 640 Visits paid and no access gained (472) — — Total 9,586 975 1,011 During the year 421 Statutory Notices were served and 323 were complied with. Summonses—Proceedings instituted during the year Public Health (London) Act. 1936 62 Food and Drugs Act. 1955 28 L.C.C. Byelaws 17 H.B.C. Byelaws 1 Housing Act, 1957 — Noise Abatement Act. 1960 2 Sewerage The main sewers and the sewage disposal system in London are the responsibility of the London County Council. Rainwater and soil sewage are carried in the same sewers, but the arrangements for Hammersmith are not yet adequate inasmuch as some basements in the Borough are liable to flooding from time to time when heavy storms cause the sewers to become surcharged. The area mostly affected is in the vicinity of the northern end of Askew Road. 26 It is anticipated that when the long awaited improvement scheme is put into effect there will be no further trouble of this nature, except to those basements which are either below or less than one foot above the crown of the sewers. If possible, works of a minor nature will be enforced to protect such basements from flooding, but in those which cannot be so treated the drains may be sealed-off and the use of the premises for residential purposes discontinued. Water Supply The water supplied to the Borough by the Metropolitan Water Board during 1961 has been satisfactory both in quantity and quality. It is derived from the River Thames, stored in the Walton and Staines reservoirs and filtered and chlorinated at Hampton, Ashford Common and Barn Elms Works. The average results of chemical and bacteriological analyses of water supplied are set out below: — Chemical Examinations : (Milligrammes per litre unless otherwise stated.) Hampton Ashford Common Barn Elms No. of samples 52 52 52 Ammonia Nitrogen 0.045 0.055 0.034 Albuminoid Nitrogen 0.080 0.084 0.082 Oxidised Nitrogen-Nitrate 4.1 3.9 3.9 Chlorides as CI. 26 26 26 Oxygen abs. from Permanganate 4 hrs. at 27°C. 1.06 1.14 1.14 Turbidity (Units) 0.2 0.2 0.4 Hardness (Total) 268 278 276 Hardness (non-carbonate) 52 52 52 pH Value 7.9 8.0 8.0 Phosphate as PO4 0.95 0.95 0.90 Silicate as SiO2 9 9 9 Sulphate as SO4 50 50 50 Fluoride as F 0.20 0.20 0.20 Magnesium as Mg 6 6 6 Surface Active Material as Manoxol 0.11 0.11 0.11 Bacteriological Examinations: No. of samples Hampton Ashford Common Barn Elms 1.066 765 510 Agar plate count per ml.: 20-24 hours at 37 °C. 11.7 24.1 19.7 Coliform count: Per cent samples negative in 100 ml. 99.91 99.87 100.0 E. coli/count: Per cent samples negative in 100 ml. 100.0 100.0 100.0 No new important extensions of trunk mains, nor changes in the general scheme of supply have been made during the past year, but 757 yards of mains have been laid. All new as well as repaired mains are disinfected with chlorine before being brought into or restored to service. One certificate was granted under Section 95(2) of the Public Health (London) Act, 1936, with regard to newly erected flats having a proper and sufficient supply of water. 27 All of the houses in the Borough, numbering some 28,000, are supplied with water direct from the mains. Public Cleansing The Borough Engineer and Surveyor, who is responsible for the collection, removal and disposal of refuse, has kindly furnished the following information with regard to this service. Amount of house refuse collected during the year 29,763 tons Amount of trade refuse collected during the year 3,914 tons 33,677 tons Method of disposal By road to tip at Hartfield 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 Act. 1855, with regard to drainage, and also those under the Public Health (London) Act, 1891, relating to water closets, etc., are enforced by the Council. During the year 89 plans (12 of which related to combined drainage) were submitted to the Health Department and a total of 2,145 inspections were made ir connection with supervision of drainage works. Dustbins Once again there were no appeals lodged in respect of Notices served under Section 107 of the Public Health (London) Act. 1936, requiring the provision of proper ashpit (dustbin) accommodation. Factories It was found necessary to serve eight notices relating to contraventions of the Act during the year. The following is a table in the form prescribed by the Minister of Labour or the administration of the Factories Act, 1937, dealing with factories, both mechanical and non-mechanical, and outwork. Factories Act, 1937 1. Inspections Premises Number on Register Inspections Number of Written Notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 104 22 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 330 54 8 _ (iii) Other Premises in which Section 7 is enforced by the Local Authority, (excluding outworkers' premises) - - - - Total 434 76 8 — 28 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.) 4 1 — — — Overcrowding (S.2.) — — — — — Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4.) Ineffective drainage of floors - - - - - (S.6) Sanitary Conveniences (S.7) - — — ~~ (a) Insufficien 4 1 — — — (b) Unsuitable or defective — — — — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — Total 8 2 — — — Outwork Section 110 Section 111 Nature of Work No. of Outworkers in August List required by Sect. 110 (1) (c) No. of Cases of Default in Sending Lists to the Council No. of Prosecutions for Failure to Supply Lists No. of Instances of Work in unwholesome Premises Notices Served Prosecutions Wearing apparel— Making, etc. 145 - - - - - Lampshades 3 - - - - - Curtains and furniture hangings 2 - - - - - Jewellery 7 - - - - - Paper bags 27 - - - - - Carding, etc. of Buttons.etc. 43 - - - - - Stuffed Toys 19 - - - - - Cracker Bob-bon, Christmas crackers, Christmas stockings, etc. 27 - - - - - Total 273 — — — — — Rodent Control Sewer treatment is the responsibility of the Borough Engineer and the two usual six monthly treatments were given during 1961. Due possibly to the disturbance and exposure of drains during the construction of the "Flyover" and demolition of buildings in various parts of the Borough there 29 was a considerable increase in the number of complaints of rat infestations. Driven from their usual haunts the rats presumably sought shelter on the surface with the result that 114 more dwellings were treated, an increase of 45 per cent, over the previous year. A similar increase was recorded in the case of business premises. Every effort was made by the staff to overcome this disturbing influx, a total of 99 defective drains being traced and repaired in connection with various infestations. That their efforts were successful is borne out by the very satisfactory figures recorded for the final quarter of the year, they were, in fact, less than those of the previous year. Great credit must be given to this section of the department for the hard work and extreme patience shown in dealing with this problem. There is little doubt that a considerable reservoir of infestation still remains within or adjacent to the Borough. Any relaxation in our sewer maintenance treatments or property surveys and treatment programme could lead to very serious surface infestations. 27 fewer premises were found to be infested with mice compared with last year. However there are still far too many infestations in private dwellings. The exercise of a little more care by householders in protecting foodstuffs, a higher standard of cleanliness, to ensure that food scraps are not left lying about, and some effort on their own initiative when the first signs of mice are discovered, would soon result in a considerable reduction of our work in this connection. The amount received for baiting, etc. at business premises was £113 as against £171 last year. The following is a summary for the year with comparable figures for in brackets. Premises inspected: Dwellings 585 (580) Business 1,386 (1,166) Total 1,971 (1,746) Complaints: Rats 516 (379) Mice 155 (214) Total 671 (593) "Discovered" other than by complaints: Dwellings 24 (23) Business 4 (2) Total 28 (25) Premises infested by rats: Dwellings 368 (254) Business 60 (41) Total 428 (295) Premises infested by mice: Dwellings 152 (188) Business 40 (31) Total 192 (219) Premises treated by Council staff ...... 612 (518) Major infestations ...... 102 (23) Notices served relating to Rodent Control ...... 69 (66) Re-inspections by Public Health Inspectors on Infested premises ..... 1,456 (1,588) LICENCES AND REGISTRATIONS London County Council (General Powers) Act, 1954 Hairdressers and Barbers During the year 18 new applications were received and registered, making a total of 127 hairdressers and barbers registered in the Borough. All the premises were kept under observation during the year. 30 Pharmacy and Poisons Act, 1933 Pharmacy and Medicines Act, 1941 The names and addresses of 91 retailers were entered on the Council's list of persons entitled to sell poisons under Part II of the above Acts. Many of these persons are food retailers and in some instances the poisons sold are only household disinfectants, but a careful watch is kept on commodities sold under proprietary names containing other poisons mentioned on the list. No action was necessary in respect of any offences under the Acts. Rag Flock and Other Filling Materials Act, 1951 The above Act remained in force during the year and the number of premises on the register at the end of the year was two. Pet Animals Act, 1951 This ACt remained in force and ten applications for licences were received and granted during the year. London County Council (General Powers) Act, 1952 During the year there were no contraventions of Section 26 of this Act, which deals with the restrictions on sales, etc., by dealers in rags, old clothes and similar articles. London County Council (General Powers) Act, 1959 Caravans Section 22 of the above Act forbids the use of land within the Borough as sites for movable dwellings unless licenced by the Council. The Council may also attach to any licence granted under this Section such conditions as they think fit with respect to the number and class of caravans kept on the site, the space between such dwellings, fire protection, prevention of nuisance from noise, and for securing adequate water supplies and sanitary conditions. Three applications in respect of sites for 9 caravans were dealt with during the year. Food and Drugs Act and Designated Milk Licences Full particulars of all licences issued and registrations affected under the provisions of the above Acts and Orders are given in the section dealing with the Inspection and Supervision of Food. Clean Air Act, 1956 Smoke Control Areas The Hammersmith (No. 1) Smoke Control Order, 1959, came into operation on 1st November, 1959, and covers the area shown on Map No. 1. 31 The Hammersmith (No. 2) Smoke Control Order, 1960, came into operation on 1st July, 1961. It consists of 170 acres and is shown on Map No. 2. Publicity measures included a small exhibition at the Town Hall to which the North Thames Gas Board, the London Electricity Board, and the Solid Smokeless Fuels Federation contributed Stands. At the same time the Solid Smokeless Fuels Federation's Mobile exhibition van toured the Area. The Order was confirmed on 26th May, 1960, but up to the 16th April, 1961, only 427 applications for approval had been received out of an estimated total of 2,080. A further survey of outstanding cases was carried out, and when the Council applied a closure to applications in November, 1961, it was found that the number of applications had reached a total of 813. The re-survey showed that a large number of occupiers were electing to comply with the Order either by using portable oil convector heaters, portable electric appliances, or using a premium fuel without having the existing firegrate adapted. In December, 1960, the Council made an Order in respect of the No. 3 Area, which has been confirmed and comes into operation on 1st November, 1962. The coverage of this Area is shown in Map No. 3. Owing to the re-survey of Area No. 2 referred to above, it was not possible to complete the survey of Area No. 4 during the year, but it is hoped that the Council will make an Order early next year in connection with this Area, which is shown fin Map'No. 4. Atmospheric Pollution The stations set up in the Borough for measuring and recording the extent of atmospheric pollution continued to function during the year. Inter-Borough Smoke Control Liaison Committee This Committee continued to meet during the year and many interesting discussions took place on matters which affected all members, and at one meeting the National Coal Board showed films relating to Smoke Control Areas in general, and also on Mechanical Stoking. All the Councils concerned made good progress in the establishment of Smoke Control Areas during the year. 32 THE HAMMERSMITH (No. 1) SMOKE CONTROL AREA, 1959 33 THE HAMMERSMITH (No. 2) SMOKE CONTROL AREA, I960 34 THE HAMMERSMITH (No. 3) SMOKE CONTROL AREA (PROPOSED) 35 THE HAMMERSMITH (No. 4) SMOKE CONTROL AREA (PROPOSED) 36 INSPECTION AND SUPERVISION OF FOOD Food and Drugs Act, 1955 Food Hygiene Regulations, 1955 and 1960 Modern conditions produce difficult and more complex forms of adulteration as compared with the more crude and fraudulent adulterations of the past. It is with apprehension that I view the use of potentially toxic substances on foodstuffs whilst the detection and identification of their presence remains difficult to achieve. Over a period of about three years, some 80 circulars have been received from the Ministry of Agriculture, Fisheries and Food, giving particulars of different chemical compounds and the recommendations for their safe use. These chemicals, which are applied in the form of sprays to fruit, vegetables and crops, and are used as insecticides, fungicides, etc., may be safe if used strictly in accordance with the instructions provided, but it is disturbing to consider the possible ill effects the consumer may suffer should these instructions be not properly observed over a period of time. The danger in the use of these materials is related to the human factor and apparent impossibility of ensuring that they would be applied properly and in the correct strengths. A number of these chemicals are harmful to animals, bees, birds, fish and water supplies, and in many instances there is insufficient information available for their safe use on fruit and edible crops. Some of these substances should not be used at all on edible produce as they are acknowledged by the Ministry of Agriculture to be definitely poisonous, whilst others permitted for such purpose must be used only at certain periods before harvesting. In the past, a non-volatile insecticidal spray applied to fruit, tomatoes, etc., could be relied upon to leave a visible residue when it dried. If the spray happened to be too strong or applied too near harvesting time the residue would be sufficiently noticeable to give warning of its presence. Many of the newer insecticides, however, might leave little or no visible deposit. It is a fact that small, but possibly toxic, proportions of many of the new pesticides would escape detection in a general analysis made by the Public Analyst, and although the manufacturers of some of the new pesticides have published methods of analysis, these are usually difficult, lengthy and unsuitable for routine control in a general food laboratory. Moreover it is impracticable for the Public Analyst to examine for example, a sample of fruit for the presence of all the possible harmful adulterants as there are literally dozens of different chemical substances involved. During the year 3,054 visits were made at food premises, stalls and markets and at 80 of these, conditions constituting contraventions under the Food Hygiene Regulations, 1955-1960, were found. Legal proceedings were taken in two cases, resulting in fines totalling £27 with £5 5s. costs being imposed. No exemption certificates were granted by the Council in connection with the Regulations during the year. 37 Premises A list showing the number and type of premises in the borough where food is sold, stored and prepared, is given below: — Bakehouses (level) 13 Bakehouses (basement) 2 Bakers Retail Shops 29 Beer Bottlers 1 Biscuit Manufacturers 2 Butchers 65 Cafes and Restaurants 260 Canteens and Clubs 115 Chemists 33 Confectioners (Sweet Shops) 138 Fishmongers (wet and fried) 24 Fruit and Greengrocers 74 Fruit Drinks (bottling) 1 Grocers and Provisions 195 Honey (packing) 1 Ice-Cream Manufacturers 3 Jellied Eels and Pies (manufacture and sale) 5 Milk Processing Depots 2 Milk Distributors 124 Off Licences 38 Public Houses 95 Sweet and Chocolate Manufacturers 5 Wine (bottling) 1 Legal proceedings were taken under Section 8, Food and Drugs Act, 1955, against a butcher for selling a chicken with a diseased liver condition. The liver tissue showed numerous encapsulated deposits of cancer. The defendant pleaded "not guilty" to the offence. The Court found the case proved and granted the defendant an absolute discharge. The Council were awarded 5 guineas costs. A large quantity of foods, which although unsound, did not call for action under Section 9, was voluntarily surrendered. A list of the commodities and the amounts involved is shown below: — Unsound Food Condemned 1961 Bacon 29 lbs. Meat 241 tins Bacon cooked 221 lbs 221 1bs Milk 9 tins Baked Beans tins 11 tins 11 tins Nescafe 1 tin Butter 49 tins Nuts, peeled 7 cwt. Chicken 2 tins Paste 2 jars Coconut Mallows 155 lbs. Peas 3 tins Cream 1 tin Pickles 6 jars Creamed Rice 1 tin Sauce 1gallon Fish, wet 450 lbs. Sauasage 1tin Fish 38 tins Soap 7 tins. Fruit 784 tins Spaghetti 17 cwt. Ham 205 lbs. Tomatoes 43 tins Ham 66 tins Tomato Juice 16 tins Jam 6 jars Vegetables 76 tins Marshmallow Creams 1,752 lbs. Vegetables, dried 13 lbs. Meat 1,671 lbs. Yams (Nigerian) 5 tons 7 cwt. 38 Unsound Food Condemned 1961—continued FROZEN FOODS Bacon 18 pkts. Mousse 150 pkts. Chickens 59 Pastry 39 pkts. Eclairs, chocolate 6 pkts. Peas 26 lbs. Fish 196 pkts. Pudding Mixture 22 pkts. Fruit 6 pkts. Hamburgers 46 pkts. Sausage Rolls 14 pkts. Meat 59 pkts. Vegetables 209 pkts. Sampling Throughout the year 750 samples of food and drugs taken by the Food anc Drugs Inspector were submitted to the Public Analyst for chemical analysis. Adverse reports received in respect of 5 samples are shown in the following summary:— Sample Infringement Remarks Hydrogen Peroxide 20 vols. 10 volume strength Informal sample. Formal sample satisfactory. Wine Yeast Tablets Incorrectly labelled. Ingredients not stated. Informal sample. Wine Yeast Tablets Incorrectly labelled. Ingredients not stated. Legal proceedings taken resulting in an absolute discharge on payment of £5 5s. Od. costs. Whisky Contained 18.5 per cent excess water. Legal proceedings taken resulting in a penalty of £2 with £5 5s. 0d. costs. Shredded Beef Suet 5 per cent deficient in fat Informal sample. The following summary shows the action taken after a full investigation was made in each case of 19 complaints received from members of the public in connection with food. Nature of Complaint Action taken Maggots in Cereal Warning letter Foreign substance in loaf Warning letter Maggoty Semolina Penalty £2:2 gns. costs Mouldy Pork Pie Penalty £1:2 gns. costs Glass in ham roll Penalty 10s.:2 gns. costs Insect in Chicken Soup Warning letter Soapy taste in Chocolate Sponge Warning letter 39 Nature of Complaint Action taken Piece of cloth in loaf Penalty £10:3 gns. costs Mouldy Orange Drink Penalty £5:3 gns. costs Mouldy Jam Sandwich Penalty £3:3 gns. costs Pieces of paper in loaf Penalty £10:3 gns. costs Mouldy Cream Cheese Warning letter Mouldy Meat Pie Penalty £3:2 gns. costs Mouldy Apple Puff Warning letter Mouldy Pork Pie Penalty £3:5 gns. costs Metal cap in bottle of milk Warning letter Rancid Butter Penalty £5: 2 gns. costs Dirty bottle of milk Warning letter Dirty bottle of milk Warning letter Bacteriological Examination of Food The following samples were submitted for bacteriological examination. These examinations were made by the Public Health Laboratory Service, and in some instances by the Royal Institute of Public Health and Hygiene, Queens Square, London:— Ice-cream 62 Ice Lollies 3 Milk 99 Imitation Cream 8 Coconut Biscuits 1 Live Mussels 2 Canned Frozen Egg 6 Examinations of the samples of live mussels showed them to contain faecal coli 6 per gram of body tissue and 10 per gram of body tissue respectively. Ice-Cream Ice-cream is manufactured at three premises in the Borough, two of which are wholesale. Most of the ice-cream sold in the Borough is pre-packed. A systematic inspection of premises used for the sale, storage and manufacture of ice-cream has been made, particular attention being given by the Food and Drugs Inspector where manufacture takes place. During the year 62 samples of ice-cream were taken and submitted to the Public Health Laboratory Service for bacteriological examination and the methylene blue test. This test is recommended by the Ministry of Health as a guide for ascertaining the bacteriological cleanliness of ice-cream, the time taken to decolourise methylene blue being recorded, and the samples graded as follows:— Provisional Grade Time taken to decolourise Methylene Blue 1 4½ hours or more 2 2½hours to 4 hours 3 ½ to 2 hours 4 Less than ½ hour 40 The 62 samples were placed in the following grades:— 43 samples were within Grade 1 Standard 5 samples were within Grade 2 Standard 4 samples were within Grade 3 Standard 10 samples were within Grade 4 Standard Nine of the ten samples placed in Grade 4 Standard were manufactured outside the Borough. In addition, 17 samples of ice-cream were taken for chemical analysis by the Public Analyst, all of which complied with the standard laid down by the Food Standards (Ice-Cream) Regulations, 1959, i.e., not less than 5 per cent, fat and not less than 1\ per cent, milk solids other than fat. The fat content of the samples taken ranged from 6.5 per cent, to 12 per cent. Ice-Cream and Preserved Food Premises The following summary, which includes new registrations effected during the year, shows details of the number and type of premises registered under Section 16 of the Food and Drugs Act, 1955. Ice-Cream Manufacturers 3 Ice-Cream sales only 18 Confectioners (Sweet Shops) selling ice-cream 138 Restaurants (selling ice-cream for consumption off the premises) 41 Grocers selling ice-cream 105 Bakers and Confectioners selling ice-cream 5 Fruiterers and Greengrocers selling ice-cream 16 Butchers preserving meat and/or manufacturing sausages 50 Grocers and Provision Dealers preserving meat 19 Grocers and Provision Dealers preserving fish 1 Fishmongers curing fish 2 Food Factories manufacturing sausages and preserved food 3 Total 401 Milk Supplies There are two large milk bottling depots situated in the borough each with its own private railway siding enabling them to receive milk by rail and road from all parts of the country. Rail tanks, each holding 3.000 gallons of milk, are received daily, and a large quantity of milk is also delivered to these depots by road tankers each holding the same amount. The total quantity of milk handled by these two depots is some 180,000 gallons daily. A proportion of this mik is pasteurised and distributed in churns, 12,000 gallons are sterilised in bottles, and the remainder is bottled after pasteurisation. This involves the washing and filling of about 8,000,000 bottles a week. The milk from one of these depots is delivered in the north-west London area to 29 distributing depots, which in turn supply the Company's shops and milk roundsmen. Milk from the other bottling depot is distributed to the smaller dairymen who have no facilities themselves for pasteurising and bottling milk, and 41 to hospitals, hotels and restaurants, etc. in the greater London area and beyond, reaching as far as Camberley and Gerrards Cross. There are nine milk pasteurising plants in which milk is processed by the high temperature short time method. By this method, milk is retained at a temperature of not less than 161°F. for at least 15 seconds and immediately cooled to a temperature of not more than 50°F. At regular intervals, the Food and Drugs Inspector checks the efficiency and working temperatures of these plants and takes samples to ensure that they comply with the requirements of the Milk (Special Designation) Regulations, 1960. All samples taken from these milk plants during the year were reported to be satisfactory. 185 inspections of premises used in connection with the processing and distribution of milk were made. Generally, the premises were found to be satisfactory. 127 persons were registered as distributors of milk and two premises were registered at Dairies at the close of the year. The following licences were issued by the Council under the Milk (Special Designation) Regulations, 1960:— Dealers' (Pre-Packed) Licences Pasteurised 102 Sterilised 70 Tuberculin Tested 92 Dealers' Licences Tuberculin Tested 2 Pasteurisers 2 Sterilisers 1 Ninety-eight samples of Special Designated milk were taken under the Regulations from milk processing plants, and milk distributors. These samples were submitted for the phosphatase, methylene blue and turbidity tests, the results of which are set out below. Class of Milk No. Tested Phosphatese Test Methylene Blue -Test Turbidity Test Passed Failed Passed Failed Passed Failed Pasteurised 55 55 55 — — — T.T. Pasteurised 10 10 — 10 — — — Tuberculin Tested (Raw) 12 — — 12 — — — Sterilised 21 - - - - 21 - 98 65 — 77 — 21 — 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 15 samples were submitted for examination by the Public Analyst and were reported genuine. 42 Skimmed Milk with Non-Milk Fat Regulations, 1960 These Regulations which came into operation on 19th September, 1961, require: — (1) Labels and advertisements for "specified foods" to bear the words "Skimmed Milk with non fat", or certain alterations. (A "Specified Food" is defined as skimmed milk with non-milk fat, condensed skimmed milk with non-milk fat, dried skimmed milk with non-milk fat.) (2) Labels for "specified foods" to bear the words "Unfit for Babies" or "Not to be used for Babies". Where the kind and amount of fat used is specified, the words "Not to be used for babies except under medical advice" may be substituted. (3) Any label for a "specified food" which carries a claim in relation to coronary disease to bear a statement of the kind of fat and the amount used. (4) Prohibits the labelling or advertising of "specified foods", etc., in a manner suggestive of milk or anything connected with dairy interest. Markets The Street Traders using the market sites in Bradmore Lane and Norland Road operate from approved pitches licenced by the Borough Council under section 21 of the London County Council (General Powers) Act, 1947. The markets in Cinema Extension, Uxbridge Road, and in Railway Approach are privately owned. Frequent inspections of the food stalls in these markets were made, particular attention being paid to the storage accommodation used by the traders. During the year, 601 visits were made to these markets by the Food and Drugs Inspector. MEDICINAL BATHS AND HEALTH LAUNDRY Medicinal Baths The usual treatment is provided for scabies, impetigo, verminous conditions, and for psoriasis. The year started with work well in hand for the modernisation of the treatment centre in Scotts Road, Shepherds Bush. Finally completed in May it is pleasing to the eye. has comfortable working conditions for the staff, and the privacy provided for the patients is appreciated by all. The elderly particularly welcome the comfort of the infra red heaters strategically sited in the bathing cubicles to provide heat exactly where it is needed. During the year the facilities at the Cleansing Station were used by the Boroughs of Barnes, Brentford and Chiswick, Ealing, Heston and Isleworth, Kensington, Southall and Wandsworth both for steam sterilisation and personal cleansings. Treatment Centre There were 93 individuals attending at the centre for scabies, involving 162 treatments. This is the first year in which no cleansing of school children has taken place under the supervision of L.C.C. staff. All school children who were treated were accompanied by their mothers or older members of the family, who were in need of treatment. A resume of several of the more interesting cases treated in 1961 is given below. A male child aged 10 months was referred by its doctor for pediculosis capitis cleansing. Five treatments were needed to clear the lice encrusted to his eyelashes. The baby was treated with ung. hyd. p. flav. B.P.C. The mother was also treated. A man aged 36 and his 20 year old wife asked for treatment for pubic lice. Both also had verminous heads and all necessary treatment was provided, including 43 stoving of their bedding and clothing. The lady's clothing consisted of a pair of stiletto heel shoes and a full length frock only. They were living in furnished rooms which they said were bug infested. Except for the mattress the bedding was their own property and "to keep it clean" it was rolled up and strapped to the motorcycle on which they went to work each day. The wife using the bedding as a pillion seat. The Health Inspector visited the premises, and reported that there was no foundation for the statement of bug infestation. An old man of no fixed abode was taken to the West London Hospital after collapsing in the street. His underclothing was a moving mass of lice. These were soon liberally shared by those in attendance. A well-dressed man passing through the Borough expressed pleasure and thanks for the cleansing he received. In his haste to leave he misplaced the bath towel, bath cloth, nail brush and soap. Of the verminous conditions treated only two had impetigo of the head. The cleansing of aged persons under the London County Council (General Powers) Act, 1953, Sec. 43, at regular intervals and specified times is a new venture by this department. It is a service which needs careful planning. Firstly, there must be transport available, which means that laundry collection and disinfestation times must be considered. Secondly, it is necessary for staff to be spared from other duties, and lastly, very important from the point of view of those concerned, it must not coincide with the visit to their homes of the meals service van, and in some cases the Home Help and the district nurse. It has been possible to accommodate up to 10 persons in one week. The service was inaugurated in the autumn and was made possible by the improvements in the Medicinal Baths, and the employment of an additional member on the laundry staff, who is available for limited periods to assist in cleansing work. The baths are greatly appreciated by the arthritic elderly, who gain confidence from assistance they receive and express pleasure in a "floating warmth." If suitable times could be arranged it is estimated that twenty persons per week could be dealt with under the present circumstances. In all cases the person requesting help is certified, by his or her doctor, as fit to travel to the baths before the service is provided. Relations or friends could play a big part in helping the elderly, both the active, or slow moving, if they gave them a ride to the baths in their car. It would often allow the bathing to be done at a time to suit their convenience, as conveyance to and from the baths takes up more time than the actual bathing, and transport is our main difficulty. In one case a person was brought to the baths in a car by a nurse of the British Red Cross Society. This is a service about which enquiries are made mainly in early Summer, but is not regarded by the elderly with any enthusiasm during the winter months. The peak period therefore clashes with the difficult time of annual leave-taking by the staff. Although this section of the Act allows bathing at the place where the person resides, this is not practicable with the present staff. From 1953-1960 an average of two cases a year were dealt with as emergencies, but during this year the total rose to 187. Steam Sterilisation During the year a total of 1,157 articles of bedding and clothing from the West London Hospital, and 300 mattresses from Olympia were sterilised. In addition 22 requests for the disinfecting of 488 articles of clothing, to be posted abroad, were received and clearance certificates issued. For the last quarter of the year the sterilizer was in constant use as, in addition to its normal work, it acted as a drier for the laundry during the alterations. 44 Health Laundry During the year the Council agreed that the disused extension building should be converted into a laundry in order to cope with the ever increasing demand for the Health Laundry service. The work was carried out in such a way that the minimum of inconvenience was caused to those receiving help. In little more than 6 months after approval by the Council all machinery was ready for use. The Health Laundry will now be able to operate almost as an independent unit of the cleansing station. Stores and supplies can be provided from those of the infestation section, but the staff are still required to work in both buildings. In 1960 the yearly total of collections for soiled bedding and clothing numbered 1.529. This total was passed in August of this year, and the number of articles handled was 70 per cent, up on the 1960 figures. New requests, or requests for discontinued services to be started number 105. Many persons have been served for a number of years. One for 8 years. Origin of requests for service District nurses or other nursing sisters 40 Home Helps 23 Welfare departments or health visitors 18 The person concerned or his/her relations/friends 14 Doctors or hospital almoners 7 Voluntary societies 3 Total 105 45 Every year the story is one of expansion. The figures below speak for themselves. 1953 1954 1955 1956 1957 1958 1959 1960 1961 New requests, or request to restart a closed case 21 16 44 37 38 42 46 61 105 Requests within the Act 14 10 34 32 32 34 37 56 97 Number of persons served during the year, not all being new cases in 1961 16 12 40 39 39 45 45 71 125 Number of cases reported or follow up visits to home 33 26 65 60 64 132 151 256 348 Certificates issued for collections during year 71 111 350 352 511 1.018 1,137 1,529 2,638 Number of articles washed and ironed each year 479 1,201 3,903 4,137 5,580 10,437 11,504 14,977 25,459 Average weekly collections 2 3 9 9 14 22 27 32 63 Maximum collections in any one week of the year 6 10 15 14 19 25 38 52 100 It was thought that in 1960 the number of articles to be washed and ironed in 1961 might reach 20,000. As will be seen it exceeded 25.000. So far 363 collections are recorded for a lady of 34 with disseminated sclerosis. This complaint forced her to leave University and she is now in the terminal stages of the disease. Only her mother understands her efforts to speak, she is almost blind and deaf, and has very little muscular control. Her mother does not wish her to leave home. A man of 85, born paralysed from the waist down, managed to get from the floor to a chair and then to sit on a table on which he worked as a cobbler until he retired. His agility in his old age was amazing. He died during the year. A lady with congenital paralysis cared for her mother until her death at 103. She was then admitted to hospital with anaemia at the age of 72. Almost blind, an alcoholic aged 78, of violent nature had ill-treated his wife since their early marriage. He refused to co-operate with the laundry collector, and crammed a cupboard under the stairs with fouled clothing and bedding. At the time of the first visit his wife was just out of hospital after treatment for coronary thrombosis. The youngest on the list is that of a boy of 9 years. He was a normal baby until the age of 11 months, at which age he fell ill with tuberculous meningitis. Oblivious of his environment, a blind deaf mute with no co-ordinated muscular movement. Although needing constant care his mother wishes him to stay at home. To end this collection, reference must be made to a request from the district nurse for an assisted bath and laundry service for a man with a cervical syringeomyelia and psoriasis. Despite his affliction he is a most endearing man. He welcomed the suggestion of a bath, but refused the laundry idea as he would miss the company of the lady who came to do his washing. 46 Disinfestation The work of disinfestation of premises during the year under review was considerably less than previous years. 36 treatments for cockroaches, 54 for fleas and 354 for bugs were made. The following note was left on a table for the disinfcstors when they called at one house in the Borough to treat for bugs. " This is all that is left—I've killed them all by now, but I can't get at the fellows under the floorboards. They have been eating us for months. There appear to be at least three different species. The majority are very flat and thin, a few much bigger and darker in colour, and a third which stinks so much you can smell them coming for you in the dark. I've taken a dozen or so of them to the hospital where I work and had them mounted in the form of microscope slides—they tell me they are capable of migrating in quantity from house to house as well as transmitting several diseases—Thank God for the Flit ! ! !" Disinfection Unless a specific request is received premises are not treated following cases of the more common infectious diseases. Of the 43 cases so treated 14 were after the death of an occupant of the premises. In all a total of 55 private dwellings were disinfected, with only 4 requests for formaldehyde disinfection from the West London Hospital. CORONER'S COURT AND PUBLIC MORTUARY The number of bodies admitted to the Public Mortuary during the year was 1,234, an increase of 30 compared with 1960. There were 1,213 post-mortem examinations. This also is an increase of 19 compared with last year. The Mortuary and Court continue to be used by the Boroughs of Fulham. Kensington and Chelsea. Details are set out below: — Bodies admitted from the Borough:— By order of Coroner 349 By order of Police — On application of Undertakers 3 352 Bodies admitted from other Boroughs — Fulham (218 by order of Coroner and 6 on application of undertakers) 224 Chelsea (251 by order of Coroner and 3 on application by undertakers) 254 Kensington (395 by order of Coroner and 9 on application by undertakers) 404 882 Total bodies admitted 1,234 47 No. of Post-Mortem examinations conducted:— Hammersmith cases 349 Fulham cases 218 Chelsea cases 251 Kensington cases 395 Total Post-mortems 1,213 No. of Inquests held: — Hammersmith cases 96 Fulham cases 33 Chelsea cases 56 Kensington cases 81 Total Inquests held 266 EXHUMATION AND RE-INTERNMENT OF BODIES During the year two licences were granted by the Secretary of State for tke exhumation and removal of two bodies from graves in St. Mary's Catholic Cemetery. Harrow Road. Each case was attended by the local District Inspector, and it was possible to certify that removal had been carried out in a proper manner. 48 PART IV GENERAL HEALTH AND WELFARE SERVICES Ambulance Facilities The London County Council is responsible under the National Health Service Act, 1946 for the provision of ambulance facilities throughout the County. Conferences The Council was officially represented at the undermentioned Conferences:-— Conference The Royal Society of Health (Health Congress) Blackpool. 24th-28th April, 1961. The Association of Public Health Inspectors. The National Society for Clean Air. Delegates Councillor Mrs. E. O'K. Finn. M.B.E. Mr. S. G. Bennett, Assistant Administrative Officer. Mr. P. T. Bayes, Chief Public Health Inspector. Councillor Mrs. E. D. Freeman. Mr. P. T. Bayes, Chief Public Health Inspector. Financial Contributions to Voluntary Organisations Subscriptions to the funds of voluntary bodies were, on the recommendation of the Health Committee, made by the Council during the year as follows:— Organisation Amount Statutory Authority National Society for Clean Public Health (London) Act. 1936 Air £23 0 0 Section 298. Local Government Act, 1948 Section 136. Central Council for Health Public Health (London) Act, 1936 Education £14 9 9 Section 298. Health Information Bureau As in previous years the Health Information Bureau continued to deal with the varied enquiries coming daily into the Department. The Public make use of this Bureau and are provided with on-the-spot help and information. Once again 2,500 copies of the 1961 edition of the Health Services Guide were printed and distributed in the usual way. This booklet is becoming better known with every edition and each year more people ask to be put on the mailing list. The Guide not only has a wide distribution but is also widely referred to, and greatly appreciated by the recipients. Hospitals The following hospitals are situated in Hammersmith:— Hammersmith Hospital, Ducane 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. 49 Hammersmith Hospital is the headquarters of the Post-graduate Medical School of London, and also includes the Medical Research Council's Linear Accelerator and Cyclotron building in connection with Cancer Research and treatment. The Royal Masonic Hospital is one of the few remaining private hospitals. Queen Charlotte's is a maternity hospital with its own Board of Governors, and is the largest independent maternity hospital in the British Isles. It has an average annual birth rate of between 2.400 and 3,000 babies of all nationalities. Hammersmith Chest Clinic All aspects of the tuberculosis problem are dealt with at this Clinic which is housed at Hammersmith Hospital. The Clinic is closely linked with the PostGraduate Medical School of London and takes part in the teaching of post-graduate students. Management of the Clinic is under the direct supervision of a Consultant Chest Physician, who is also a lecturer in chest diseases on the staff of the PostGraduate Medical School. The Clinic, its associated independent radiography department and hospital beds are housed in the same building and are run as an integral unit. A consultant diagnostic service for all chest diseases is provided for local practitioners who may send patients for a full consultation if a letter of introduction is produced, or for an X-ray examination only, which 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-patients clinics are held for new and follow-up cases, for ambulance cases, for contacts and for anti-tuberculosis vaccinations. A special Clinic is also held for patients suffering from Chronic Bronchitis. Attendances at all Clinics, apart from the X-ray only service, are strictly by appointment only. During the treatment, rehabilitation and re-settlement of tuberculosis and other 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 Certified Almoner, who is in contact with many statutory and voluntary agencies through which advice and assistance can be provided. A comprehensive management scheme for tuberculosis patients is in operation in the Borough. Suitable 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. Such admission can only be arranged through the Chest Clinic, as is also the case with tuberculosis patients to be admitted to Hammersmith Hospital. Laboratory Facilities The Public Analyst for the Borough works at the Southwark Borough Council's laboratory situated in the Health Centre, Walworth Road, S.E. Bacteriological examination of food is carried out by the Public Health Laboratory Service, County Hall. S.E.l. and this Laboratory, together with the Laboratory at West London Hospital is also available to doctors for bacteriological examinations. throat swabs, intestinal specimens, etc. The necessary swabs and outfits for both Laboratories can be obtained from the Public Health Department. 50 National Assistance Act, 1948 National Assistance (Amendment) Act, 1951 Removal to Hospital of Persons in Need of Care and Attention Under the provisions of the above Act, application may be made to a Court of Summary Jurisdiction for an Order for the compulsory removal to hospital of persons in need of proper care and attention. It was not found necessary to take action under these Acts in respect of any person in the borough during the year. In all cases it was found possible to find a solution in other ways, either by co-operation with the family doctor or by making use of available services. National Assistance Act, 1948, Section 50 Burial or Cremation of the Dead. During the year eleven burials were carried out by the Council. Hammersmith Old People's Welfare Association During the course of the year under reveiw the Old People's Welfare Association continued to expand its services, forging even closer links with the Health Department. In the provision of meals a further heated van was purchased during the year and it has been agreed to open another Luncheon club in the College Park area. This service is now delivering some 300 meals a day: 150 for the luncheon clubs and 150 mobile meals. One very useful service to the elderly which became established during the year was the re-decoration of old people's rooms by members of the United Nations Association. The Old People's Welfare Association provides the means in the way of material and the U.N. members, who are quite skilled in the work, undertake the re-decoration, quite voluntarily, at week-ends. The decision of the London County Council to make no charge for chiropody treatment to persons receiving old age or retirement pensions is another contribution to a healthier old age. There was a considerable influx of new patients when the word " got around " that chiropody was free! The Executive Committee of the Association expressed its concern in the autumn over the dangers to elderly people from oil heaters. A leaflet was prepared by the Association, drawing attention to the dangers, and circulated to old people throughout the Borough. Personal Health Services The County Council remained responsible for the personal health services with Dr. B. E. A. Sharpe and Dr. E. M. Cran as Divisional Medical Officer and Deputy, respectively. Much of the day to day administration of the service was provided by the Medical Officers of Health for the Boroughs of Chelsea, Fulham. Hammersmith and Kensington, which four Boroughs comprise Division 1. The liaison between the staffs of the County Council and the Borough Council continues on a very happy and cordial footing. 51 The following is a list of Clinics:— Ante-Natal Clinics 1/3 Milson Road Monday 1.45 p.m. Friday 9.30 a.m. 48 Glenthorne Road Monday 6.00 p.m. Tuesday 1.45 p.m. Friday 1.45 p.m. Becklow Gardens Tuesday 9.30 a.m. Wednesday 6.00 p.m. Thursday 1.45 p.m. The Curve, Westway Wednesday 1.45 p.m. Friday 9.30 a.m. Infant Welfare Centres 1/3 Milson Road T uesday 1.45 p.m. Wednesday 9.30 a.m. (toddlers by appointment) Thursday 9.30 a.m. 48 Glenthorne Road Monday 1.45 p.m. Tuesday 9.30 a.m. (toddlers by appointment) Thursday 1.45 p.m. Becklow Gardens Tuesday 1.45 p.m. Wednesday 9.30 a.m. (toddlers by appointment) Wednesday 1.45 p.m. Friday 9.30 a.m.. 1.45 p.m. The Curve, Westway Monday 1.45 p.m. Thursday 9.30 a.m., 1.45 p.m. Friday 1.45 p.m. (toddlers by appointment) Queen Charlotte's Maternity Hospital Tuesday 1.30 p.m. Immunisation (Diptheria, Poliomyelitis, Smallpox, Tetanus and Whooping Cough) 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 to Friday at 2 p.m. Thursday and Friday at 10 a.m. 207 Westway Monday, Wednesday and Thursday. 1.30 p.m. Speech Therapy 48 Glenthorne Road 103 Shepherds Bush Road Monday and Thursday 1.30 p.m. Tuesday p.m., Wednesday all day. Friday a.m., Saturday a.m. Creche 48 Glenthorne Road Tuesday and Friday 9.30 a.m. to 12 noon. 52 The Creche is a public nursery in which children are taken care of whilst their parents are otherwise engaged. There is suffiicent accommodation for 10 children if required. Application for admission is made to the Superintendent of the Welfare Centre or the Health Visitor in charge. In all instances priority is given to children whose mothers have to attend a clinic, hospital, doctor or dentist for treatment or otherwise. No charge is made when the mother is attending a clinic or class on the premises, or if the mother or father is in receipt of National Assistance Benefit. Otherwise a charge of Is. 9d. per session is made, but this may be abated in certain circumstances. The Creche opened in 1955, and since that date it has proved a great success and has been welcomed by many people. During the year, Welfare foods and other nutrients including National Dried Milk, concentrated Orange Juice and Cod Liver Oil have continued to be provided at Welfare Centres. Day Nurseries The County Council also maintains the following four Day Nurseries in the Borough, which are available for children up to five years of age. Brook Green Day Nursery 7.00 a.m. to 6.00 p.m. Dalling Road Day Nursery 8.00 a.m. to 6.00 p.m. Latimer Road Day Nursery 8.00 a.m. to 6.00 p.m. Uxbridge Road Day Nursery 7.30 a.m. to 6.00 p.m. The charge for children received into these Nurseries is based on parents' income and is reduced if the circumstances warrant it. Home Help Service This service, also administered by the County Council, employs 13 full-time and 129 part-time helpers and maintained its good and valuable work during the year. Its headquarters are at 48 Glenthorne Road, W.6. The number of cases in which help was provided is as follows:-— Maternity 34 Tuberculosis 9 Other 1,373 Public Baths and Wash-houses Lime Grove: The Public baths and wash-houses in Lime Grove, Shepherds Bush, provide facilities for bathing, swimming and laundry work. For bathing there are private hot baths or shower cubicles; and towels, soap, bath cubes and shampoos are supplied at a small cost. There are concession rates for children, and for old age pensioners free baths on certain days. In the public wash-houses, fully automatic machinery is provided for washing and spin drying. There are alsc hand irons. There are two swimming baths at Lime Grove. The smaller is open all the yeai round and the larger one is open during summer months only. During the winter season it is converted into a public hall which may be hired for meetings, concerts, wrestling, dances, etc. In addition, certain periods are set aside for Badminton and Indoor Bowls. 53 Bloemfontein Road: There is an open air pool at Bloemfontein Road, Shepherds Bush which, during summer months, provides for swimming and sun bathing. The Metropolitan Water Board supply water for all the Baths and all pools are subjected to chlorination, alkali treatment and filtration with continuous circulation of the water. Samples of the water were taken for chemical analysis and all were reported to be satisfactory. In addition frequent checks are made during each day by the staff at the baths. Staff Medical Examinations During the year 1 have continued to carry out the duties of Staff Medical Adviser to the Council. The total number of medical examinations carried out in connection with admission to the Council's Superannuation and/or Sick Pay Scheme during the year was 247 and of this number 53 were found to be unfit for the following reasons:— Hernia 5 Migraine 1 Bronchitis 4 Ear condition 2 Heart Condition 2 Chest condition 3 Hypertension 13 Arthrodesis of Ankle 1 Psychiatric history 3 T.B. history 1 Diabetes 1 Chronic Otitis Media 5 Dermatitis 1 Arthritis 1 Renal condition 1 Gastric History 2 Lobectomy 1 Mental history 1 Partial Gastrectomy 1 Epilepsy 1 Petit Mal 1 Congenital Eventration 1 Albuminuria 1 At the beginning of 1953 the Council decided to put into operation a scheme for streamlining sick leave arrangements. The scheme still works smoothly and satisfactorily and during the year 46 examinations were carried out in this connection. 54 INDEX Page Ambulance facilities 48 Ante-Natal Clinics 51 Atmospheric Pollution 31 Barbers 29 Births 5-8 Burials 50 Cancer, Deaths 10-11 Caravans 30 Causes of Death in Age Groups 9 Chest Clinic 49 Chiropody Clinics 51 Clean Air 30 Closing Orders 24 Condemnation of Food 37 Condensed Milk Regulations 41 Conferences 48 Contacts and Carriers of Infectious Diseases 16 Coroner's Court 46 Creche 51 Day Nurseries 52 Deaths 8 Deaths—Principal Causes in Age Groups 9 Deaths—Rates 5-13 Deaths—From Carcinoma of Lungs in Age Groups 10 Diphtheria Immunisation 16 Disinfection 46 Disinfestation 46 Drainage 27 Dustbins 27 Dysentery 17 Environmental Hygiene — Administration 22 Exhumation and Re-interment of Bodies 47 Factories 27 Factories—Defects 28 Factories—Inspections 27 Financial Contributions to Voluntary Organisations 48 Food—Bacteriological Examination 39 Food and Drugs Act, 1955 36 Page Food Hygiene Regulations, 1955 and 1960 36 Food—Inspection and Supervision 36 Food Poisoning 17 Hairdressers and Barbers 29 Health Services 48 Health Information Bureau 48 Health Laundry 44 Home Help Service 52 Hospitals 48 Housing 22 Ice Cream 39 Ice Cream and Preserved Food Premises 40 Immunisation 16 Infant Mortality 5, 6, 9, 11, 12, 13 Infectious Diseases: Contacts and Carriers 16 Dysentery 17 Food Poisoning 17 Measles 16 Notifications 15 Poliomyelitis 17 Smallpox 18 Tuberculosis 16-21 Typhoid 21 International Certificates of Vaccination and Inoculation 21 Inter-Borough Smoke Control Liaison Committee 31 Introduction 1 Laboratory facilities 49 Markets 42 Marriages 14 Maternal Mortality 5-13 Measles 16 Medical Examination of Staff 53 Medicinal Baths 42 Milk Licences 41 Milk Supplies 40 Mortuary 46 National Assistance Acts 1948/51 50 Notifications of Infectious Diseases 15 55 Page Old People's Welfare 50 Outworkers 28 Personal Health Services 50 Permanent Estates 23 Pet Animals Act, 195130 Pharmacy and Poisons Act, 1933 30 Pharmacy and Medicines Act, 1941 30 Poliomyelitis 17 Poliomyelitis Immunisation 16 Population 4, 6, 8 Public Baths 52 Public Cleansing 27 Rag and Bone Dealers 30 Rag Flock and Other Filling Materials Act, 1951 30 Rehousing 23 Removal of Aged Persons 50 Rent Act, 1957 24 Rodent Control 28 Sampling 38 Sanitary Circumstances 22 Sanitary Inspection 24 Sanitary Inspection—Notices served and complied with 25 Page Sewerage 25 Skimmed Milk with Non-Milk Fat Regulations, 1960 42 Slum Clearance 23 Smallpox 18 Smallpox Immunisation 16 Smoke Control Areas 30 Smoke Control Area Maps 32-35 Social Conditions 3 Speech Therapy 51 Staff, at 31st December, 1961 2 Staff—Inspectorial 22 Statistics 4-13 Summonses 25 Tetanus Immunisation 51 Tuberculosis 16, 18, 19, 20, 21 Typhoid Carrier 21 Unsound Food Condemned 37 Vital Statistics 5-8 Washhouses 52 Water Supply 26 Welfare Centres 51 Whooping Cough Immunisation 16