Ac 4347 2.10 ' 6 HAM 54 Metropolitan Borough of Hammersmith Report on the Health of the Borough 1962 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, 1962. Councillor E. O'K. Finn (Mrs.). M.B.E. (Chairman) Councillor E. D. Freeman (Mrs.) (Vice-Chairman) Councillor L. W. Heading Councillor D. M. Heaks (Mrs.) Councillor J. M. Henry (Miss) Councillor F. W. Ing Councillor L. S. Jones, A.E.Ae.S. Councillor R. W. Oak Councillor C. Parsons Councillor G. D. Powers (Miss) Councillor S. E. Simpson Councillor S. E. Ward 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 3 Social Conditions 5 PART I STATISTICS AND TABLES Area and Population 6 Vital Statistics 6-8 Deaths: 9 Causes in age groups 11 Cancer 12-13 Infant Mortality 13-15 Maternal Mortality 15 Marriages 16 PART II EPIDEMIOLOGY Notification of infectious diseases 17 Vaccination and immunisation 18 Incidence of infectious disease:— Dysentery 19 Food Poisoning 19 Poliomyelitis 19 Smallpox 19 Weil's Disease 20 Tuberculosis 20-23 International Certificates of Vaccination and Inoculation 23 PART III ENVIRONMENTAL HYGIENE Staff—Inspectoral 24 Sanitary Circumstances Housing 24-26 Rent Act, 1957, and Housing Repairs and Rents Act, 1954 26 Sanitary Inspections 26-27 Summonses 27 Sewerage 27-28 Water Supply 28 Public Cleansing 29 Page Drainage 29 Dustbins 29 Factories, Workshops & Outworkers 29-30 Rodent Control 30-31 Licences and Registrations Hairdressers 31 Pharmacy and Poisons 31 Rag Flock 32 Pet Animals 32 Rag and Bone Dealers 32 Caravans 32 Atmospheric Pollution Smoke Control Areas 32 Measurement of Atmospheric Pollution 33 Inter-Borough Smoke Liaison Committee 33 Area Maps 34-38 Exhibition 39 Inspection and Supervision of Food General 40 Food: Premises 41 Unsound 41-42 Sampling 42 Bacteriological Examinations of Food 43 Ice-Cream and Preserved Food 43-44 Milk Supplies 44 Designated Milk Licences 45 Condensed Milk Regs. 1959 45 Markets 45 Medicinal Baths Treatment Centre 46 Section 43 of L.C.C. (G.P.) Act, 1953 46 Sterilisation 47 Disinfestation 47 Disinfection 48 Health Laundry 48 Page Coroner's Court and Mortuary 49 Exhumation 49 PART IV GENERAL HEALTH & WELFARE SERVICES Ambulance facilities 50 Conferences 50 Financial Contributions to Voluntary Organisations 50 Health Education 50 Health Information Bureau 51 Hospitals 52 Hammersmith Chest Clinic 52 Laboratory facilities 52 Page National Assistance Act 53 Old People's Welfare 53 Personal Health Services 53 Ante-Natal Clinics 54 Infant Welfare Centres 54 Immunisation 54 Chiropody 54 Speech Therapy 54 Creche 54 Day Nurseries 55 Home Help Service 55 Public Baths and Wash-houses 55 Staff Medical Examinations 56 ALPHABETICAL INDEX 57-58 1 Telephone: TOWN HALL. Riverside 3020. HAMMERSMITH. W.6. To His Worship 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 1962. In my reports in previous years I have made mention of the difficulties being experienced in undertaking many of the statutory duties laid on the Health Department, due to the shortage of Public Health Inspectors. It therefore gives me some pleasure to report that thanks to the Council's review of the salaries of Public Health Inspectors and to its introducing the scheme for the training of Student Inspectors, there has been an improvement in the staff position towards the end of the year and we are ensuring future recruitment of Inspectors through the Student Scheme. Should the position continue to improve it is hoped to make up the lee-way occasioned by the many years of shortage of staff. The picture in regard to infectious diseases is fairly satisfactory. There is a considerable decrease in notifications which has been occasioned in the main by the very few measles cases. There was also a considerable reduction in the number of food poisoning infections throughout the year as compared with 1961, but it would not be wise to draw rash conclusions as the cool, wet summer of 1962, would have inhibited the spread of infection. Also it is unfortunately true that many cases of food poisoning are not reported to the department. There is a significant increase in the number of illegitimate births in the Borough, with the proportion this year being 15.5% of the total live births of children whose parents reside in the Borough. In 1955 the proportion was 7.8% These figures may reflect society's present attitude to morality, but one must bear in mind that some part of this increase is due to the fact that the vastness of London, the facilities available and the anonymity which one can obtain are all factors which attract the unmarried pregnant woman to the capital city. Once again there are many more deaths (572) from heart and other circulatory diseases than from any other cause. It is perhaps encouraging that the public conscience is now awakened to the need for more research and investigation into the causes. Deaths from lung cancer still give cause for concern and the Council's campaign which is described in the body of the report should have some impact on the adolescent smoker. The Health Department in its health education measures has found the Press extremely co-operative and helpful and always willing to give publicity on matters affecting the public health. 2 The year unaer review was notable for the number of changes in personnel. There were no fewer than 5 retirements, 4 resignations, one transfer to another department and one death. Dr. Shinnie, my part-time Deputy, retired during the year. He had been of great service to the department where his long experience as a Medical Officer of Health proved invaluable. He was most liked and was missed by everyone. The news of his death at the time of writing this report (May 1963) was a blow to us all. The sudden death of Mr. Gardiner in December at the age of 54 was a sad loss. He had been with us since 1947 and was a popular and efficient officer. Mr. Turner and Mr. Godden had each served the Council for more than 30 years, and both Mrs. Stimpson and Mr. Robinson were long-serving officers; their combined knowledge and experience will be missed by the Department. I should like once again to thank all members of the Council, and in particular the Chairman and members of the Health Committee and the Chairman and members of the Establishment Committee, for their guidance and counsel during the year under review. The staff of the Health Department, in a year where there were a number of changes gave me loyal support and I should like to stress their conscientious attention to duty. I am. Your Worship, Ladies and Gentlemen, Your obedient servant, F. M. DAY, Medical Officer of Health 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT at 31st December, 1962 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. (Retired) Assistant Administrative Officer S. G. Bennett Clerical G. W. Nickolls (1st Assistant) Miss J. Jewell J. C. Turner (Retired) Mrs. D. Kelley A. E. Blake Mrs. F. Lawford Miss P. Brown (Transferred) W. M. Robinson (Retired) Miss J. Colpus Mrs. L. G. Stimpson (Retired) Mrs. M. Gray Miss C. Tappenden (Resigned) Mrs. J. Hall Miss L. Veal T. J. Hares J. A. Wyatt Miss L E. Waller (M.O.H.'s Secretary) Chief Public Health Inspector P. T. Bayes Deputy Chief Public Health Inspector J. G. Tompkins E. W. Pike (Resigned) Public Health Inspectors W. R. Bland P. M. King G. G. Gardiner (Deceased) P. J. Smith J. C. Hopkins W. H. Tyrrell S. E. Thelner (Resigned) Student Public Health Inspectors R. K. W. Bolton, R. J. Darrington Food and Drugs Inspector W. J. Godden (Retired) J. Collier 4 Public Health Inspector i/c Clean Air J. Beagle Technical Officer E. Bonnar (Resigned) J. Curley Enquiry Officers P. E. C. Pendock (Temporary) E. R. James (Temporary) 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) Mrs. L. G. Stimpson (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. 5 SOCIAL CONDITIONS OF THE BOROUGH The Borough of Hammersmith with the River Thames as its southern boundary is the most westerly of the Metropolitan Boroughs. There is a variation of approximately 120 ft. in elevation from the River to the northern boundary, the highest points being at the junction of Scrubs Lane and Harrow Road (133 ft. above sea level), with the lower points in Lower and Upper Malls (13 ft. above sea level). Industry within the Borough is very varied so that, apart from heavy industry, most trades are represented. This development has undoubtedly been assisted by the excellent transport facilities available for goods by water, road and rail. Of equal importance to the industrialists and also to residents are the very comprehensive passenger transport services within the area; a time-table for eighteen hours a day being provided, both by buses and London Transport trains to most parts of London and surrounding districts. Unemployment is not a serious problem in Hammersmith, but as the following figures show, it is evident that work is not quite so easy to find as in previous years: Men Women Total No. of persons registered as unemployed on 10.12.62 2,786 677 3,463 No. of unfilled vacancies on 5.12.62 238 335 573 The corresponding total figures for 1961 were 2,901 and 508. These details, obtained by courtesy of the Manager of the Employment Exchange, Hythe House, also cover part of the Borough of Kensington. Hammersmith provides all the usual facilities for relaxation and recreation, a total of 286 acres being given over to parks and open spaces. Swimming baths are in Lime Grove, the small pool being open all the year round whilst the large pool is open for the summer season only, being converted to a public hall from October to April. An open air swimming pool, size 150 ft. x 75 ft., at Bloemfontein Road provides facilities for swimming and sunbathing. Most people are aware that probably the best known dance hall in the country, the Palais de Danse, is at Hammersmith. Other notable features are Hammersmith Bridge, connected with the Oxford and Cambridge boat race, the famous White City Stadium for football, athletics and greyhound racing; Olympia, which stages such well-known exhibitions; and the headquarters of B.B.C. television at the T.V. Centre in Wood Lane. 6 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 and sex of residents in each local authority area differ considerably. The factor, in effect, adjusts these groups of the populations to the same proportions. and thus enables direct comparisons to be made between areas of different nature. Area (acres) 2.282.5 Population:— Census, 1951 119.367 Census, 1961 110,333 Registrar-General's estimate, mid-1961 108,010 Registrar-General's estimate, mid-1962 108.120 Rating:— Number of inhabited Houses 28,040 Rateable Value £2,350,300 Product of a penny rate £9,700 Mortality:— Number of Deaths 1,287 Death Rate per 1.000 population: Corrected 11.9 Adjusted (Comparability Factor 1.02) 12.1 Deaths from Cancer (all ages) 284 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) - 7 Live Births:— Number 2,366 Rate per 1,000 population:— Corrected 21.9 Adjusted (Comparability Factor 0.95) 20.8 Illegitimate Live Births per cent. of total live births 15.5 Stillbirths:— Number 34 Rate per 1.000 total live and stillbirths 14.1 Total Live and Still Births 2,400 Infant Deaths (deaths under 1 year) 51 Infant Mortality Rates:— Total infant deaths per 1,000 total live births 21.6 Legitimate infant deaths per 1,000 legitimate live births 21.5 Illegitimate infant deaths per 1,000 illegitimate live births 21.7 Neo-natal Mortality Rate (deaths under 4 weeks per 1.000 total live births) 17.7 Early Neo-natal Mortality Rate (deaths under 1 week per 1.000 total live births) 17.3 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 31.25 Maternal Mortality (including abortion):— Number of deaths 3 Rate per 1,000 total live and stillbirths 1.25 A summary of the vital statistics of the district for 1962 and previous years is given in the following table. 8 VITAL STATISTICS OF WHOLE DISTRICT 1962 and Previous Years Year Population estimated to middle of each year Live Births Total Deaths Registered in the District Transferable Deaths Net Deaths belonging to the District Number Rate per 1,000 Pop. 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 Live Births Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 1925 134,500 2,351 17.5 1,034 7.7 186 756 153 65 1,604 11.9 1926 134,400 2,188 16.3 1,174 8.7 195 556 144 66 1,535 11.4 1927 132,800 2,076 15.6 1,581 11.9 230 377 126 61 1,728 13.0 1928 136,300 2,258 16.6 1,449 10.6 222 326 156 69 1,553 11.4 1929 136,900 2,162 15.8 1,757 12.8 222 340 133 62 1,875 13.7 1930 136,900 2,173 15.9 1,387 10.1 219 436 140 64 1,604 11.7 1931 135,100 2,073 15.3 1,567 11.6 288 373 140 68 1,652 12.2 1932 133,700 1,940 14.5 1,465 10.9 294 543 129 66 1,714 12.8 1933 131,400 1,827 13.9 1,500 11.4 340 530 119 65 1,690 12.9 1934 129,170 1,783 13.8 1,359 10.5 346 655 137 77 1,668 12.9 1935 128,100 1,877 14.7 1,347 10.5 406 583 131 70 1,524 11.9 1936 127,700 1,922 15.1 1,399 10.9 441 639 116 60 1,597 12.5 1937 126,500 1,913 15.1 1,333 10.5 402 662 130 68 1,593 12.6 1938 125,100 1,874 15.0 1,340 10.7 450 522 117 62 1,412 11.3 *1939 B122,800 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 1962 108,120 2,366 21.9 1,445 13.3 669 511 51 22 1,287 11.9 * B=Birth-rate Population Figure. D=Death rate Population Figure. The following 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 8 years, the figure being constant around the 11 line; in marked contrast to previous years. 9 10 (a)Population For the first time since 1952 the Registrar-General's estimated population shows a slight increase, the figure for 1962 being 108,120 which is 110 more than the previous year's estimate but more than 2,000 less than the census figure. 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 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 1952 118,800 420 1962 108,120 1,079 (b)Births The corrected number of births was 2,366 compared with 2,263 in 1961, giving an annual rate of 21.9 per thousand of the population. The actual increase in numbers of 103 was composed of 38 legitimate and 65 illegitimate births. The increase in illegitimate births has continued unabated since 1955 when the number was 133, comprising 7.8% of the total live births. This year the number has increased to 368 and the percentage to 15.5. 5.842 births were registered in Hammersmith during 1962, comprising 3,028 males and 2.814 females. Queen Charlotte's Hospital had 3,270 births and Hammersmith Hospital 2,270; only 302 other births were registered. Most of these births were in respect of non-residents, and these were transferred to their home towns. (c)Deaths Deaths registered during the year numbered 1,445. From this figure must be deducted 669 in respect of non-residents transferred to their home towns. To counter-balance this must be added a total of 511 residents of the Borough who died in other parts of England. This gives the corrected figure of deaths as 1,287. comprising 686 males and 601 females. It should be mentioned that of the outward transferable deaths, 612 occurred in three of the large hospitals within the Borough. Once again our death rate is increased by 13 deaths in hospital of patients from such far-away places as Antigua. South Africa, Sierra Leone, Mombasa, Ghana, Jamaica, Athens. Bombay and also France. Jersey and Norway. The Registrar-General rules that where there is no place of residence in the British Isles the authority for the area where death occurs accepts the death. 11 CAUSES OF, AND AGE AT, DEATH DURING THE YEAR 1962 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 5 — — 6 F — — — — 1 — 1 — 2 2. Tuberculosis, other M - - - - - - - - - F — 1 — — — — — — 1 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 — — — — — 2 — — 2 F — — — — — — — — — 10. Malignant neoplasm, stomach M — — — — — 7 8 3 18 F — — — — 1 5 6 6 18 11. Malignant neoplasm, lung bronchus M — — — — — 35 28 9 72 F — — — — — 5 3 2 10 12. Malignant neoplasm, breast M — — — — — — — — — F — — — — 5 12 7 — 24 13. Malignant neoplasm, uterus F — — — — 1 5 1 1 8 14. Other malignant and lymphatic neoplasms M 1 2 3 22 22 20 70 F — 1 — — 2 15 19 20 57 15. Leukaemia, aleukaemia M — 1 — 2 — 1 1 — 5 F — — — — — — — 2 2 16. Diabetes M — — — — — 1 3 — 4 F — — — — —— — 1 4 5 17. Vascular lesions of nervous system M — — — — — 8 17 20 45 F — — — — 3 7 26 45 81 18. Coronary disease, angina M — — — — 5 63 56 26 150 F — — — — — 14 29 51 94 19. Hypertension with heart disease M — — — — — 2 2 1 5 F — — — — — 3 3 8 14 20. Other heart disease M 2 — — 3 2 13 10 26 56 F — — — — 1 11 10 48 70 21. Other circulatory disease M — — — 1 — 5 5 10 21 F — — — — 2 3 13 18 36 22. Influenza M — — — — — — — — — F — — — — —— — — 7 7 23. Pneumonia M 3 1 — — 1 2 8 17 32 F 5 — — — — 2 8 27 42 24. Bronchitis M — — — — — 15 28 35 78 F — 1 — — — — 3 18 22 25. Other diseases of respiratory system M — — — — — 4 5 — 9 F — — — — — 2 — 1 3 26. Ulcer of stomach and duodenum M — — — — — 2 3 1 6 F — — — — — — 2 2 4 27. Gastritis, enteritis and diarrhoea M — — — — — 2 1 — 3 F — — — — 2 — 1 5 8 28. Nephritis and nephrosis M — — — — — — — — — F — — — 2 1 — — 1 4 29. Hyperplasia of prostate M — — — — — — 2 3 5 30. Pregnancy, childbirth, abortion F — — — — 3 — — — 3 31. Congenital malformations M 1 — 1 — — — 1 — 3 F 5 — — — — — — — 5 32. Other defined and ill-defined illnesses M 22 — 1 1 3 8 10 17 62 F 13 1 — — 6 4 11 24 59 33. Motor vehicle accidents M — — 1 1 3 4 1 I 11 F — 1 — — — 1 1 — 3 34. All other accidents M — — — 2 3 1 5 11 F — — — — 1 — 4 9 14 35. Suicide M — — — — 3 5 3 1 12 F — — — — 2 2 1 — 5 36. Homicide and operations of war M — — — — — — — —— — F — — — — — — — — — M 28 3 5 8 23 209 215 195 686 F 23 5 — 2 31 91 150 299 601 Total of all causes 51 8 5 10 54 300 365 494 1,287 12 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 1962 M — — 35 28 9 72 F — — 5 3 2 10 Total — — 40 31 11 82 13 DEATHS FROM CANCER DURING THE PAST TEN YEARS Year Population Deaths Rate per 1,000 Year Population Deaths Rate per 1,000 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 1957 111,700 284 2.5 1962 108,120 284 2.6 (d)Infant Mortality The number of deaths of infants under one year of age during the year was 51, giving a mortality rate per 1,000 live births of 22. INFANT MORTALITY—1962 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 1962 2,366 51 22 Net deaths of infants at various ages under one vear of age Under 1 week 41 1—2 weeks — 2—3 weeks — 3—4 weeks 1 4 weeks and under 3 months 5 3 months and under 6 months 3 6 months and under 9 months 1 9 months and under 1 year — Total deaths under 1 year 51 Net Births in the Year: Legitimate 1,998, Illegitimate 368. Net Deaths in the Year: Legitimate Infants 43, Illegitimate Infants 8. 14 15 INFANT MORTALITY RATES—ENGLAND AND WALES AND VARIOUS OTHER COUNTRIES Deaths under 1 year per 1,000 live births Country 1955 1956 1957 1958 1959 1960 1961 England and Wales 25 24 23 23 22 22 22 Scotland 30 29 29 28 28 27 26 Northern Ireland 32 29 29 28 28 27 27 Australia 22 22 21 20 22 20 19 Canada 31 32 31 30 28 27 27 Chile 121 113 117 127 120 127 116 Denmark 25 25 23 22 22 22 22 France 39 36 34 32 30 27 26 Irish Republic 37 36 33 35 32 30 30 Italy 49 48 50 48 45 44 40 Netherlands 20 19 17 17 17 17 16 New Zealand 22 19 20 19 20 20 19 Sweden 17 17 17 16 16 16 16 United States of America 27 26 26 26 26 26 25 (e)Maternal Mortality There were 3 maternal deaths during the year. MATERNAL MORTALITY—1962 and Previous Years Year Number of Deaths Number of live Births Maternal Death Rate Pregnancy, childbirth, abortion Average 1924-1933 8 2,145 3.5 1934 9 1,783 5.0 1935 2 1,877 1.1 1936 3 1,922 1.6 1937 4 1,913 2.1 1938 2 1,874 1.1 1939 2 1,829 1.0 1940 - 1,600 — 1941 2 1,405 1.5† 1942 3* 1,589 1.9 1943 3 1,768 1.6 1944 2 1,788 1.08 1945 1 1,742 0.56 1946 7 2,310 2.94 1947 1 2,559 0.38 1948 1 2,149 0.45 1949 2 1,971 0.99 1950 1 1,988 0.49 1951 1 1,874 0.52 1952 2 1,777 1.10 1953 3 1,750 1.67 1954 3 1,776 1.66 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 — 1962 3 2,366 1.27 † 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". 16 (f)Marriages The number of marriages was 1,445, an increase of 112 compared with the previous year. Particulars are set out hereunder: The Register Office 549 Buildings registered for marriages (Roman Catholic Churches and Chapels at which a Registrar attends) 520 Churches of the Church of England 321 Authorised Persons (Chapels at which a Registrar does not attend) 45 Jewish Synagogues 10 1,445 17 PART II EPIDEMIOLOGY Notification of Infectious Diseases 583 cases of infectious diseases were notified during the year. 78 cases were removed to hospital and of this number 3 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 580. These figures show a decrease on the previous year of 1,095 cases. This is largely due to the fact that there were many fewer cases of Measles. Whooping Cough, Pneumonia and Dysentery showed a decrease. There was, however, a slight rise in the number of cases of Puerperal Pyrexia and Scabies. 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 years 65 + years Scarlet Fever — 2 9 12 1 1 — — 25 2 — 25 Whooping Cough 4 3 3 4 — — — — 14 2 — 14 Acute Poliomyelitis (Par.) — — 1 — — — — — 11 — 1 Measles ..." ~7 28 Tl 76 8 2 — — 192 5 — 192 „ „ (Non-Par.) - - - - - - - - - - - - Diphtheria — — — — 1 1 — — 2 2 — — Pneumonia 4 2 2 1 1 1 4 10 25 4 — 25 Dysentery 6 2 10 12 5 5 3 144 5 — 44 A. Encephalitis (Inf.) — — — — — — — — — — — — Enteric or Typhoid Fever — — — — — 1 — — 1 1 — — Paratyphoid Fever — — — — — — — — — — — — Erysipelas — — — — — 13 1 5 2 — 5 Meningococcal Infection — 2 — 1 — — — — 3 3 — 3 Food Poisoning 1 2 2 3 — 5 5 4 22 5 — 22 Puerperal Pyrexia — — — — 68 67 1 — 136 — — *136 Ophthalmia Neonatorum — — — — — — — — — — — — Smallpox — — — — — — — — — — — — Malaria — — — — — 1 — — — 1 Scabies 1 — 4 9 8 6 4 2 34 — — 34 Tuberculosis (Pulmonary) — — 2 1 12 23 23 7 68 39 — 68 (Non-Pulmonary) — — 1 — 2 6 1 — 10 6 — 10 Totals 23 41 105 119 106 120 44 25583 78 — 580 * Of this total only 52 cases related to patients residing in the Borough. 18 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 confirmed cases of Diphtheria were notified during the year. Contacts and Carriers of Infectious Disease—Sickness Benefit One certificate was issued during the year to a hospital student nurse who had been in contact with an anthrax culture at the hospital. 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, Whooping Cough and Tetanus 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. A total of 11,224 children within the Division were protected against tetanus, 14,082 against diphtheria and 8,734 against whooping cough during the year. Prevention of Smallpox Considerable support has been forthcoming for the suggestion that routine infant vaccination should cease and that outbreak control measures should take its place. The Standing Medical Advisory Committee has considered the problem and decided that there is no evidence to justify this suggestion and have advised the Minister of Health that routine vaccination should continue in early childhood. Research to discover an alternative effective and safe vaccine to obviate the complications of vaccination has not reached the stage at which present vaccine can be superseded. However, in the light of present information it is suggested that smallpox vaccination should be offered to children during their first two years of life, but preferably during the second year. In the No. 1 Division this year 21,573 primary vaccinations and 40,206 revaccinations were performed. 19 Prevention of Poliomyelitis In the No. 1 Division 21,984 vaccinations against this disease were carried out by the London County Council during 1962. A scheme has been formulated by the London County Council to deal with any possible outbreak of Poliomyelitis in the Hammersmith Area. 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. A total of 1,441 Hammersmith children received this vaccination this year. Incidence of Infectious Diseases Dysentery 44 cases of dysentery occurred during 1962. which is 70 less than last year. There were no deaths, nor were there any outbreaks. Food Poisoning This year there were 22 cases of Food Poisoning. The following agents were identified:— Salmonella Typhimurium 2 Salmonella Heidelburg 1 Salmonella Newport 2 5 In 17 other cases no specific organism was isolated. Poliomyelitis There was only one confirmed case of poliomyelitis in the Borough during 1962. It was found to be of the paralytic type. Smallpox In December 1961 and in the early part of the year, many cases of smallpox were notified in various parts of the country and as a result large numbers of people required vaccination. The department was directly concerned in one incident where a passenger from Karachi was conveyed by coach from London Airport to the Air Terminal. He was subsequently found to be suffering from smallpox and as the coach was garaged and maintained at a London Transport garage within the Borough, every effort was made to protect all possible contacts. The coach itself was disinfected by the London County Council, who were also dealing with the ambulance which took the patient to hospital. The maintenance men who had worked on the coach were vaccinated and advised by the health department; fortunately there were no further cases. Several firms in the borough who did business in parts of the country where cases had been notified also made requests for their staffs to be vaccinated. In all 444 vaccinations were carried out either at the Town Hall or at the places of business. These vaccinations were carried out by myself with the assistance of the Council's two Assistant Medical Officers. In South Wales the disease persisted and was not finally cleared until the end of April. Altogether there were 24 deaths. 20 Leptospiroses (Weil's Disease) On 17th November, 1962, I received notification that a man had been admitted to a hospital in the Borough and had been diagnosed as suffering from Weil's disease. He had been transferred from a hospital in an adjoining Borough and the date of onset was stated to be 31st October, 1962. His occupation was a Master Builder. This disease may be contracted by such people as farmers and sewermen. The sources of infection include cattle, dogs and swine; rats and other rodents are frequently infected and water birds are reported as being carriers. The disease is transmitted by contact with water contaminated with the urine of infected animals. The infection results from penetration of abraded skin or mucous membrane, or possibly through ingestion. In natural conditions direct transmission from man to man is negligible. Enquiries were made and it was found that the patient had been carrying out drainage works at three different premises, none of which were in Hammersmith. The Medical Officers concerned were notified. The patient died on 25th November and death was due to Weil's Disease. T uberculosis 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 r.ot materially decreased in the period 1957/62, and this is largely because so many lives are now saved. 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. The risk is clearly indicated by the following table which shows that nearly half of notifications received last year were in the age group 20 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 1st January, 1962, to the 31st December, 1962. 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 6 11 3 11 10 2 — 45 Respiratory, Females — — 1 — 1 — 5 7 3 1 — 4 — 22 Non-Respiratory, Males — — — — — — 2 2 — 1 1 — — 6 Non-Respiratory, Females — — 1 — — — — 4 — — — — — 5 21 CASES NOTIFIED AND DEATHS—1962 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 1962 67 11 78 9 1,429 Average number of cases notified for the 10 years 1943/1952 (inclusive)—205. Average number of cases notified for the 10 years 1953/1962 (inclusive)—141.4. Average number of deaths for the 10 years 1943/1952 (inclusive)—68.6. Average number of deaths for the 10 years 1953/ 1962 (inclusive)—14. CHART SHOWING THE NUMBER OF MEW CASES OF TUBERCULOSIS NOTIFIED DURING THE PAST 2.0 YEARS. zz 23 The remarkable improvement achieved in the last 11 years in the treatment of this disease is shown in the decrease of notifications from 208 in 1951 to 78 in 1962. The notification figures for England and Wales in the same period show a similar reduction: from 49,440 in 1951 to 20,658 in 1962. The number of deaths from the disease has fallen from 44 in 1951 to 9 in 1962. The corresponding figures for England and Wales being 13,706 deaths in 1951, falling to 3,329 in 196 K the last year for which figures are available. General It is of interest to note that 60 years ago in 1902, there were 92 cases of smallpox notified in the Borough, of which 14 died. Measles was not then notifiable, but 293 cases were reported. 349 cases of scarlet fever, 171 cases of diphtheria and 110 cases of erysipilas were also notified during that year. Tuberculosis was only voluntarily notifiable from 7th April, 1902, and 127 cases were notified during the remainder of that year. 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. 24 PART III ENVIRONMENTAL HYGIENE Staff—Inspectoral The 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. Two Inspectors were appointed during the year, and one Student Inspector qualified and was appointed as a District Inspector. Despite continued advertisements, however, one vacancy remained unfilled at the close of the year. As a long term measure the Council decided to inaugurate a training scheme for Public Health Inspectors. An establishment of three Students was agreed and the two Assistant Inspectors appointed in May 1960, were included in the scheme together with an additional Student. There is no doubt in my mind that it is only by the sanitary authorities arranging in conjunction with the Public Health Inspectors Education Board to train their own Inspectors that we shall have a sound reservoir of able officers in the future upon which draw to complete establishments. Sanitary Circumstances Housing Requests continue to be received from the Housing Manager for inspections to be made in suspected overcrowded cases. 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. Re-housing on these grounds in Hammersmith, is shown in the following table: 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 1962 — — 26 9 1 — Totals 331 97 2,169 789 101 40 *2 cases were referred to the Housing Manager. 25 To make these figures realistic it should be pointed out that the figures for those rehoused are -extremely unlikely to be from recommendations of the same year. The re-housing of families displaced by slum clearance now receives priority over all other categories. This means that the hard core of those living in overcrowded dwellings or with medical conditions requiring better housing, is gradually increasing and their condition becoming more acute. A solution to this problem is not easy to envisage, particularly in Hammersmith, where building sites are at a premium. Residents who might with advantage move to one of the new towns are loathe to leave their own particular locality within the Borough and very few indeed will even consider living outside London. One of Hammersmith's problems has been the occupation of the older, larger type residence by several families in place of the single family for which it was designed. This frequently gives rise to unsatisfactory housing conditions as the change in user often takes place without any structural alteration and without the provision of adequate amenities in the way of water supply, baths, w.c. accommodation, with the consequent loss of privacy and the sharing of the sanitary arrangements. Squalid conditions arise as a result. Overcrowding results either from the growth of the family in limited space or, because of the shortage of housing accommodation in London and the high rental charges, families are forced to accept inadequate housing. With the coming into force of the 1961 Housing Act with its powers to require the provision of additional amenities; to apply Regulations for a decent standard of management, and to fix as a limit the maximum number of persons who should occupy a house having regard to the amenities available, it was thought that we could deal with this type of property more effectively. In the event, however, there have been many difficulties arising from involved procedure and also the lack of space for additional amenities, which often result in reducing the number of habitable rooms available. It does mean that we have to proceed cautiously to try to overcome these conditions, and unless the number of people coming into London remains stationary or is reduced, the position is likely to deteriorate still further. Overcrowding in the Borough remains a very serious problem, but although there is ample legislative power to exercise, the enforcement of the legal provisions would only result either in placing an additional burden on the Welfare and Children's Departments of the County Council or in compelling families to leave this borough and embarrass other authorities by adding to their housing lists. Demolition of the 85 houses in the Mardale/Southbrook Slum Clearance Scheme continued during the year. The erection of the 88 two-bedroom and 4 one-bedroom flats planned for the area will commence mid-1963. The site of the Latimer Road (South) Clearance Area has been cleared and Town Planning consent for the first stage was received from the London County Council on 3rd October, 1962. Provision has been made for the erection on this site of two blocks of multistorey flats each consisting of 88 two-bedroom, 44 one-bedroom and 44 bed-sitting room flats; a block of 14 two-bedroom maisonettes, 4 one-bedroom and 4 bedsitting room flats, and another of 26 three-bedroom and 6 two-bedroom maisonettes, 16 one-bedroom flats and 8 lock-up garages. In all a total of 430 units of accommodation. Town Planning consent was received on 26th July, 1962, from the London County Council for the erection of 20 three-bedroom and 20 two-bedroom maisonettes on the Hammersmith Grove/Goldhawk Road site, together with 14 twobedroom and 42 one-bedroom flats. 42 garages will also be provided. 26 Work by the London County Council on the Galena Road and Masbro Road Clearance Areas is also proceeding and confirmation of the Hammersmith (Poynter/ Stebbing Street) Compulsory Purchase Order has now been received. Whilst only 11 units of accommodation were erected by the Borough Council during 1962, work was proceeding on the following schemes:— Mylne Close, Upper Mall, 9 three-bedroom houses, 7 three-bedroom maisonettes and 2 four-bedroom maisonettes. Frithville Court, 6 three-bedroom flats and 2 two-bedroom flats. 19/26 Marryat Court, 8 one-bedroom aged persons flats. In addition a further 29 dwellings were completed by other persons during the year. The Council acts as landlord for 3,371 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 1,433 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 year1,546 Slum Clearance Programme During the initial five year stage, 118 houses were demolished or closed, whilst for the second stage 1961/65, a further 524 properties were scheduled for demolition. It is anticipated that 330 of these houses will be dealt with by the London County Council and the remaining 194 by Hammersmith Borough Council. Satisfactory progress was made during 1962, a total of 90 dwellings being demolished. Housing Act, 1957. Closing Orders During the year 4 Closing Orders were made and Closing Orders on 15 properties were determined. Rent Act, 1957 Applications under the above Act have been received as follows:— For Certificates of Disrepair 1957 1958 1959 1960 1961 1962 Number received 164 167 48 12 12 3 Number granted 56 78 22 4 2 — For Revocation of Certificates Number received 13 36 33 7 2 5 Number granted 11 35 33 5 1 4 Undertakings given by Landlord Number accepted 61 117 25 8 10 3 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. 27 Sanitary Inspection Cause of Inspection No. of Inspections No. of Notices served No. of Notices complied with Atmospheric Pollution and Clean Air 895 5 1 Bakehouses 96 1 Complaints 2,210 627 182 Drainage 2,344 12 22 Factories (Mechanical) 145 8 9 Factories (Non-Mechanical) 15 Food (other than Restaurants and Eating Houses) 1,774 33 11 Hairdressers and Barbers 55 2 Housing Act 245 3 2 Housing Applications 108 3 Houses in Multiple Occupation 132 6 3 Housing Repairs and Rents Act 27 2 1 Ice Cream Vendors 434 1 Infectious Diseases 127 Markets 435 Milk Vendors 241 1 1 Noise Abatement Act 18 Outworkers 6 Pet Animals Act 13 2 Pharmacy and Poisons Act 79 Public Urinals 11 1 Rag Flock Act 2 Rats and Mice 1,628 51 16 Restaurants and Eating Houses 348 20 5 Shops Act 229 12 10 Miscellaneous 687 36 14 Re-visits 7,189 185 742 Visits paid and no access gained (366) — — Total 19,493 1,009 1,021 During the year 313 Statutory Notices were served and 397 were complied with. Summonses—Proceedings instituted during the year Public Health (London) Act, 1936 54 Food and Drugs Act, 1955 29 L.C.C. Byelaws 1 H.B.C. Byelaws 1 Housing Act, 1957 5 Noise Abatement Act, I960 1 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. 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 not drained efficiently by gravitation into a sewer at all times and under all conditions of flow in the sewer. 28 The London County Council (General Powers) Act, 1962, authorises this Council to serve a notice requiring the owner or occupier of such premises to close the basement where the situation could not be remedied at reasonable expense, or otherwise to carry out works to secure the proper and efficient drainage of such property. The responsibility for appropriate action under this Act has been given to the Works Committee of the Council. Water Supply The water supplied to the Borough by the Metropolitan Water Board during 1962 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 and Ashford Common. The average result of chemical and bacteriological analyses of water supplied are set out below:— Chemical Examinations: (Milligrammes per litre unless otherwise stated.) Hampton Ashford Common No of samples 52 52 Ammonia Nitrogen 0.040 0.046 Albuminoid Nitrogen 0.078 0.081 Oxidised Nitrogen-Nitrate 4.0 4.0 Chlorides as Chlorine 31 31 Oxygen abs. from Permanganate 4 hrs. at 27°C 1.12 1.14 Turbidity (Units) 0.3 0.2 Colour 12 12 Hardness (Total) 264 276 Hardness (non-carbonate) 58 58 pH Value 7.8 7.9 Phosphate as PO4 1.2 1.3 Silicate as SiO2 9 10 Sulphate as SO4 61 61 Fluoride as F 0.25 0.25 Magnesium as Mg 6 6 Surface Active Material as Manoxol 0.12 0.12 Electrical Conductivity 550 560 Bacteriological Examinations : Hampton Ashford Common No. of samples 1,121 767 Agar plate count per ml. : 20-24 hours at 37°C 11.9 20.1 Coliform count: Per cent samples negative in 100 ml. 99.91 100.0 E. coli-count: Per cent samples negative in 100 ml. 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 595 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. 29 Three certificates were granted under Section 95(2) of the Public Health (London) Act, 1936, with regard to new flats having a proper and sufficient supply of water. 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 29,724 tons Amount of trade refuse collected during the year 2,987 tons 32,711 tons Method of disposal By road to Contractors tip 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 103 plans were submitted to the Health Department and a total of 2,344 inspections were made in 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 three notices relating to contraventions of the Act during the year. The following is a table in the form prescribed by the Minister of Labour on 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 119 15 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 335 145 3 - (iii) Other Premises in which Section 7 is enforced by the Local Authority. (excluding outworkers' premises) - - - — Total 454 160 3 — 30 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 5 Overcrowding (S.2.) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4.) 1 1 — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient — — — — — (b) Unsuitable or defective 3 3 (c) Not separate for sexes Other offences against the Act (not including offences relating to Outwork) — Total 8 9 — — — Outwork Nature of Work Section 110 Section 111 No. of Outworkers in August List required by Sect. 110 (1) (c) No. of Cases of Default in Sending Lists to the Council No. of Prosecutions for Failure to Supply Lists No. of Instances of Work in unwholesome Premises Notices Served Prosecutions Wearing apparel— Making, etc. 69 _ _ _ _ _ Cleaning and Washing 4 _ _ _ _ _ Lampshades 2 _ _ _ _ _ Curtains and furniture hangings 2 _ _ _ _ _ Paper bags 13 _ _ _ Carding, etc. of Buttons,etc. 46 _ Stuffed Toys 2 Cosaques, Christmas stockings, etc 3 _ _ _ _ _ Furniture and Upholstery 2 _ — _ — — Total 143 — — — — — Rodent Control There has been a slight decrease in all sections of Rodent Control with the exception of mice infestations in business premises, where 45 such cases were investigated as compared with 40 in the previous year. Most of this work is in dealing with complaints of rats in dwelling houses. In many inspections the source of infestation can be traced to drainage defects, 92 31 being discovered this year compared with 88 in 1961. As each defective drain can be the source of several surface infestations, the importance of regular and systematic treatment of the sewers cannot be over-emphasised. The Borough Engineer is responsible for sewer treatments and in the autumn of the year under review, discussions were held between the Borough Engineer, myself and officers from the Ministry of Agriculture, as a result of which it was agreed to use sodium fluoracetamide in the poison bait used in the sewers in future. It is anticipated that a considerable reduction in sewer infestation will result, as reports of this new treatment method are most promising. 50 fewer dwellings were found to be infested with mice, compared with last year. This is a most encouraging result as much time is spent on these treatments, time which could be more profitably utilised in other aspects of rodent control where negligence by the complainant is not a contributory factor to the infestation. It is, we hope, evidence that the public are beginning to take active steps in the way of proper storage of food and general cleanliness to discourage these rodents. Income from treatments at business premises amounted to £134 for the current year, an increase of £21 over 1961. The following is a summary for the year with comparable figures for 1961 in brackets. Dwellings Business Total Premises inspected 520 (585) 1120 (1386) 1640 (1971) Discovered other than by complainants 9 (24) 6 (4) 15 (28) Premises infested by rats 327 (368) 38 (60) 365 (428) Premises infested by mice 102 (152) 45 (40) 147 (192) Complaints of rat infestation 475 (516) Complaints of mice infestation 116 (155) Premises treated by Council staff 512 (612) Major infestations 49 (102) Notices served relating to Rodent Control 51 (69) Re-inspections by Public Health Inspectors on Infested premises 1,037 (1,456) LICENCES AND REGISTRATIONS London County Council (General Powers) Act, 1954 Hairdressers and Barbers During the year 5 new applications were received and registered, making a total of 132 hairdressers and barbers registered in the Borough. Due to the shortage of Inspectors it was not possible to keep all these premises under observation during the year. Pharmacy and Poisons Act, 1933 Pharmacy and Medicines Act, 1941 The names and addresses of 86 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. 32 Rag Flock and Other Filling Materials Act, 1951 The above Act remained in force during the year, the number of premises on the register being 3 only. Pet Animals Act, 1951 Ten applications for licences were received and granted during the year. All the premises were kept under observation. 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. One application in respect of a site for 3 caravans was dealt with during the year. This makes a total of 4 sites housing 12 caravans within the Borough. 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 During the past year progress has been well maintained, and in March, 1962, the Committee's revised proposals for completing the Smoke Control programme by 1970 were approved. In April, 1962. the Council made an Order in respect of the No. 4 Area, which was confirmed in September and will come into operation on the 1st July, 1963. This makes a total area of 641 acres subject to Smoke Contiol Orders, which is 27% of the Borough. A Survey of the proposed No. 5 Smoke Control Order has been completed and it is hoped to make a Smoke Control Order early in 1963. This will cover 173 acres. 33 S.C.O. No. Acreage Date Made Date Confirmed Operative Date No. of Premises No. of Dwellings No. of adaptations Tons of S.S.F. Req uired 1 169 28.1.59 29.4.59 1.11.59 2,359 2,025 1,157 1.750 2 170 24.2.60 26.5.60 1.7.61 3,787 3,600 2,080 2,080 2 (V)* 24.5.61 4.8.61 1.3.62 3 128 22.12.60 14.11.61 1.11.62 3,759 3,450 1.285 2,800 4 165 18.4.62 7.9.62 1.7.63 2.852 3,675 2,985 3,926 5 P 173 1.11.63 985 1,831 1,005 1,430 (V)*—Variation Order exempting buildings included in the London County Council Slum Clearance Programme, 1961-5. P Proposed Order. Atmospheric Pollution The stations set up in the Borough at the Town Hall and Hythe Road for measuring and recording the extent of the atmospheric pollution continued to function during the year. In November automatic apparatus, which runs continuously for eight days without attention, was installed at the Hythe Road station. At the time of installation it was the only apparatus of its kind in regular use in the Metropolitan area and is a great improvement on the standard apparatus in general use throughout the country. During the London Smog, which occurred in the first week of December, the stations proved very useful in recording the extent of the pollution in the atmosphere from smoke and sulphur dioxide. The recordings for that period are set out in the following tables:— London " Smog"—Smoke and Sulphur Dioxide Concentration. The readings for the concentration of smoke and sulphur dioxide recorded at the Town Hall and Hythe Road sites during the period 27th November—14th December. 1962. Pollutant Site of recording instrument Average Daily Concentration in Micrograms/cu.m. Tues.—Fri. 27th to 30th Nov. Tues.- Fri. 4th to 7th Dec. "SMOG WEEK" Tues.—Fri. 11th to 14th Dec. Smoke Town Hall 205 961 153 Hythe Road 215 1,443 171 Sulphur Town Hall 410 2,532 243 Dioxide Hythe Road 259 2,302 342 It can clearly be seen how the concentration of smoke and sulphur dioxide in the atmosphere increases rapidly during a heavy smog. Inter-Borough Smoke Control Liaison Committee This Committee continued to meet during the year and many interesting discussions took place to the mutual benefit of all the participating local authorities. Good progress was reported in the establishment of Smoke Control Areas during the year. 34 THE HAMMERSMITH (No. 1) SMOKE CONTROL AREA, 1959 35 THE HAMMERSMITH (No. 2) SMOKE CONTROL AREA, 1960 36 THE HAMMERSMITH (No. 3) SMOKE CONTROL AREA 37 THE HAMMERSMITH (No. 4) SMOKE CONTROL AREA 38 THE HAMMERSMITH (No. 5) SMOKE CONTROL AREA (PROPOSED) 39 Permanent exhibition of Clean Air appliances at the I'own Hall. 40 INSPECTION AND SUPERVISION OF FOOD Preservatives in Food Regulations, 1962 These regulations focus attention on the subtle changes which are rapidly talcing place in the field of food technology and the effect of these on food control. It is extremely doubtful if these regulations will last as long, with so few amendments, as their predecessors, the Preservatives in Food Regulations, 1925. Before 1925 comparatively crude forms of preservatives were used haphazardly without any regard to their cumulative toxicity and without any real control. The regulations of 1925 were sufficiently comprehensive to fulfil their task for almost 40 years. As might be expected, the 1962 regulations cover a larger field as regards both the type of preservatives and the foods in which preservatives are permitted. Amongst the new preservatives are sorbic acid, diphenyl, propionic acid, and the antibiotic tetraculines, which are limited in certain specified foods. The list of foods which may contain preservatives, now extended to include such popular items as bread, potatoes (both peeled and dehydrated), flour (for the making of biscuits), marzipan and raw fish, leads one to hope that developments in this light will be watched with great care. The increased list of exemptions from the definition of "preservatives" also indicates the need for a watchful eye on future progress. Antioxidants. colouring matters, emulsifiers and stabilisers which are permitted by the regulations governing their use are, of course, exempted but so are tocopherols, nicotinic acid, carbon dioxide, nitrogen or hydrogen (for packing food in hermetically sealed containers) and Nitrous oxide (when used for the making of whipped cream.) All these are indicative of modern trends in food production. Another is the tolerance of up to 5 p.p.m. of formaldehyde "derived from wet strength wrappings containing any resin based on formaldehyde or any plastic food container or utensil manufactured from any resin of which formaldehyde is a condensing component." Colouring Matter in Food Regulations, 1957 A sample of canned red cherries was stated by the Public Analyst to contain the colouring matter fluorescein, which is not permitted colouring matter in accordance with the Colouring Matter in Food Regulations, 1957. Legal proceedings were authorised but discussions between the Public Analyst and the Director of a Research Association brought to light the fact that research recently carried out in certain laboratories had shown that fluorescein might be formed in un-lacquered cans of fruit by the action of fruit acids and the tin of the can on the permitted dye erythrosine. It seems that erythrosine, which was present in this sample, is the only permitted red dye suitable for colouring cherries and the reaction does not occur in lacquered cans. After due consideration of all the circumstances and especially as the fluorescein had not been "added" as a colouring matter, the proceedings were withdrawn and a report of the case was made to the Ministry of Agriculture, Fisheries and Food. I feel that this case is indicative of the type of problem which we shall meet more frequently in the future as the whole range of food additives broadens with the changing methods of food production. During the year 3,328 visits were made at food premises, stalls and markets and at 56 of these, conditions contravening Food Hygiene Regulations were found. Legal proceedings were taken in 5 cases resulting in fines totalling £97 with 31 guineas costs being imposed. No exemption certificates were granted by the Council in connection with the regulations during the year. 41 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 150 Canteens and Clubs 117 Chemists 34 Confectioners (Sweet Shops) 139 Fishmongers (wet and fried) 24 Fruit and Greengrocers 78 Fruit Drinks (bottling) 1 Grocers and Provisions 194 Honey (packing) 1 Ice-Cream Manufacturers 3 Jellied Eels and Pies (manufacture and sale) 4 Milk Processing Depots 2 Milk Distributors 128 Off Licences 44 Public Houses 87 Sweet and Chocolate Manufacturers 5 Wine (bottling) 1 Food & Drugs Act, 1955 Legal proceedings were taken under Section 8, Food and Drugs Act, 1955, against the proprietor of a self-service store for having in his possession two cold cooked chickens which were mouldy. A fine of £5 was imposed with two guineas costs. A large quantity of food which, although unsound did not call for action under Section 9, was voluntarily surrendered. A list of the commodities and the amount involved is shown below:— Unsound Food Condemned 1962 Bacon 208 lbs. Nuts (shelled) 11 cwt. Baked Beans 7 tins Peas 40 tins Chicken 1 tin Pickles 27 jars Cheese 11 cwts 20 lbs. Poultry 149 lbs. Chocolate Bars 300 lbs. Preserves 9 jars Creamed Rice 26 tins Ravioli 141 tins Fish (wet) 1,106 lbs. Sausage 2 tins Fish 29 tins Soup 17 tins Fruit (fresh) 36 lbs. Spaghetti 8 cwt 10 lbs. Fruit (dried) 6 lbs. Fruit 854 tins Spaghetti 14 tins Ham 59 tins Syrup 1 tin Macaroni 4 tins Tomatoes 136 tins Meat 915 lbs Tomato Juice 12 tins Meat 251 vegetables 92 tins Milk 82 tins Yams (Nigerian) 2 cwt 20 lbs. 42 Unsound Food Condemned 1962—continued FROZEN FOODS Arctic Roll 1 pkt. Mousse 97 pkts. Chicken 13 pkts. Pastry 6 pkts. Cream Cakes 6 pkts. Pudding Mixture 1 pkt. Fish 102 pkts. Potatoes 16 pkts. Fishcakes 137 pkts. Sausage Rolls 33 pkts. Hamburgers 43 pkts. Sweet Corn 3 pkts. Meat 8 pkts. Vegetables 373 pkts. Sampling Throughout the year 750 samples of food and drugs taken by the Food and Drugs Inspector were submitted to the Public Analyst for chemical analysis. Adverse reports received in respect of 3 samples are shown in the following summary :— Sample Infringement Remarks Canned Red Cherries Contained non-permitted colour. Informal sample. Canned Red Cherries Contained non-permitted colour. Reported to Ministry of Agriculture, Fisheries & Food. Butter Contained 17.7 per cent water. Informal sample. (Formal samples taken.) During the year 30 complaints were received from members of the public in connection with food. The following summary shows the action taken after full investigations into each case. Nature of Complaint Action taken Glass in cheese Penalty £2 : 7 gns. costs Stone in bottle of milk Warning letter Dirty bottle of milk Penalty £12: 3 gns costs Glass in carton of peas Warning letter Poor quality walnuts Stock surrendered Foreign substance in bread Warning letter Hair in corned beef Informal action Alleged glass in milk bottle Informal action Stone in fruit cake Informal action Malformation in egg Informal action Hair in pot of marmalade Informal action Insects in chocolate eclairs Penalty £5 : 3 gns. costs Mouldy steak and kidney pie Warning letter Insects in sterilised milk Penalty £3 : 3 gns. costs Mouldy meat pie Penalty £3 : 3 gns. costs Mouldy bread Penalty £10 : 5 gns. costs Mouldy Pork pie Penalty £5 : 3 gns. costs 43 Nature of Complaint Action taken Mouldy bread Penalty £5 : 3 gns. costs Mould on raspberries Informal Action Mould on custard tart Warning letter Weevils in macaroni Warning letter Dirty bottle of milk Warning letter Foreign body in corned beef Reported to Ministry of Agr., Fish and Food. Mould in apple turnover Informal Action Stale eggs Taken up with vendor Metal cap in bottle of milk Informal Action Black substance in bread Informal Action Dark substance in fish cake Informal Action Foreign body in carton of milk Penalty £10 : 3 gns. costs Match stick in fruit slice Penalty £5 : 3 gns. costs 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, Queen Square, London:— Ice Cream 29 Milk 69 Imitation Cream 7 Canned Frozen Egg 6 Ice lollies 2 Ice-Cream Ice cream is manufactured at three premises in the Borough, two of which are wholesale distributors. Most of the ice cream sold in the Borough is prepacked, but there is a steady increase in the amount of "soft" ice cream now being sold, which calls for particular attention at the place of sale, where the ice cream is frozen. The Ice Cream (Heat Treatment, etc.) Regulations, 1959, require that where a can of sterilised ice cream mix is opened the mixture shall "be reduced forthwith to a temperature of not more than 45°F and shall be kept at such a temperature until the freezing process has begun". It is the usual practice to place the mix straight into the freezer from which it is served on demand, but it is important that the above instruction should be observed and that great care should be taken in cleaning the freezer. During the year 28 samples of ice cream were taken for bacteriological examination and the methvlene blue test bv the Public Health Laboratorv Service. The Methylene Blue 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 2½ hours to 4 hours 3 ½ to 2 hours 4 Less than ½ hour 44 The 28 samples were placed in the following grades :— 18 were within Grade 1 3 were within Grade 2 4 were within Grade 3 3 were within Grade 4 Two of the three samples placed in grade four were manufactured outside the Borough. Further samples of the one manufactured in the Borough were satisfactory. The two samples of ice cream lollies were of satisfactory bacteriological standard. In addition 16 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 7½ per cent. milk solids other than fat. The fat content of the samples taken ranged from 7.8% to 12.3% and averaged 10.1%. 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 21 Confectioners (Sweet Shops) selling ice-cream 107 Restaurants (selling ice-cream for consumption off the premises) 15 Grocers selling ice-cream 80 Bakers and Confectioners selling ice-cream 5 Fruiterers and Greengrocers selling ice-cream 14 Off-Licensed Premises serving ice-cream 5 Butchers preserving meat and/or manufacturing sausages 48 Grocers and Provision Dealers preserving meat 16 Grocers and Provision Dealers preserving fish 1 Fishmongers curing fish 2 Food Factories manufacturing sausages and preserved food 3 Total 320 Milk Supplies There are two large milk processing 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. Raw milk is brought to these depots daily in rail tanks of 3.000 gallons capacity and also in road tankers each holding the same amount. The amount of milk handled by these depots is some 180.000 gallons daily. There are nine "high temperature—short time" milk pasteurising plants in which the milk is heated to, and retained at, a temperature of 161°F for 15 seconds, and then is cooled to below 45 50°F in accordance with the requirements of the Milk (Special Designation) Regulations, 1960. There are also a number of ovens for the production of sterilised milk. Some of the milk is distributed in churns after pasteurisation, about 12,000 gallons is sterilised in bottles and the remainder is bottled after pasteurising. 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 were reported to be satisfactory. 183 inspections were made of premises used in connection with the processing of milk. Generally the premises were found to be satisfactory. 128 persons were registered as distributors of milk and two premises were registered as dairies at the close of the year. The following licences were issued by the Council under the Milk (Special Designation) Regulations, 1960. The figures in brackets relate to licences issued the previous year:— Dealers' (Pre-Packed) Licences Pasteurised 15 (102) Sterilised 11 (70) Tuberculin Tested 11 (92) These licences will be renewable in 1965. 72 samples of designated milk were taken under the Regulations from milk processing plants and from 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 Phosphatase Tests Methylene Blue Tests Turbidity Tests Passed Failed Passed Failed Passed Failed Pasteurised 36 36 - 36 - - - T.T. Pasteurised 16 16 - 15 1 - - Tuberculin Tested (Raw) 7 - - 6 1 - - Sterilised 13 — — - - 13 — 72 52 — 57 2 13 — Condensed Milk Regulations, 1959 These Regulations provide standards for milk fat and milk solids of condensed milk, and control the labelling of containers. During the year 14 samples were submitted to the Public Analyst for examination and were reported genuine. 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 street traders. 46 MEDICINAL BATHS & TREATMENT CENTRE It is pleasing to report that the recently modernised Cleansing Station has completed its first full year with satisfying results. A total of 919 persons, involving 1,432 treatments were dealt with. To have treated such numbers using the old premises would have been difficult if not impossible and the Council are to be congratulated on their foresight in supplying these splendid modern facilities. Our latest venture to assist the bathing of the elderly and infirm is making steady progress. It has been possible to arrange up to four baths in one day, but the morning sessions are not easy to arrange and a number of fruitless journeys arc made to the homes. 17 persons shared the 256 baths arranged. At the moment this service is confined to cases receiving medical attention, mainly skin conditions, arthritis, paralysis and senility. It is very easy to envisage how this service would expand if additional transport and labour were available to bathe all elderly people lacking facilities in their own homes. The following three cases highlight the problems encountered in this service :— 1. In February a certificate was received requesting bathing for a man aged 75. He was in a filthy condition, as was his ground floor one room flat. The premises were cleansed, the rubbish removed, the little bedding there was laundered and arrangements made for his weekly bathing. On the 1st March he collapsed in the bath, was taken to Hammersmith Hospital and his condition diagnosed as malnutrition. After discharge from hospital, meals were arranged for him at one of the luncheon clubs. He was rarely at home on his bath day, or if at home was not feeling well enough for a bath. His meals at the club were discontinued as he would not pay for them. In May the cycle recommenced following receipt of a certificate from his doctor asking for bathing to be arranged. 2. One old lady at her first visit brought her husband, who is 20 years younger, as she felt safer if he bathed her. 3. In July an elderly male was encouraged to have a weekly bath. He was extremely deaf and had not had a bath for 20 years. Good clothing was obtained for him and his old torn and filthy clothes burnt. After a few baths he decided that he would be fit enough to last to the next summer. The year under review has seen a considerable increase in the number of persons, resident outside the area, treated for scabies and lice. This increase was due to the treatment of all Kensington Borough Council cases and certain L.C.C. and Acton cases normally treated at the Kensington Centre, which was closed in May 1962 for re-construction. Apart from this influx, which it is anticipated will terminate in mid-1963, facilities were utilised by several neighbouring authorities outside the London area. In all, 498 treatments were given to Hammersmith patients and 633 to outsiders. Of some concern is the increase in the number of males requiring treatment for pubic lice, approximately 80% being in the 18 to 25 age group. 10 males and 5 females were treated in 1955, but whilst the number of females reporting has tended to decrease (only 1 being treated this year), the number of males has gradually increased so that 43 were dealt with in 1962. An increasing number of these cases are being referred by the special V.D. Clinics. The younger patients have no doubt as to the cause of their infection but the older man is either purposely vague or blames a public lavatory. In either case the reservoir of infection remains untreated. The number treated for head lice decreased from 145 in 1961 to 101 this year. Most cases of live vermin are in the heads of teenage girls, school children being mainly in the nit stage when treated. 47 Of some interest and compliment to the efficiency of our treatment is the following case :— A mother and her three children, formerly resident on the White City Estate came from their "new town" home outside London by car for treatment "as this was the only place the mother knew where nits could be removed". A total of 137 males were treated for body lice; 27 residents, 66 from a lodging house and 44 vagrants. The latter section cause considerable disruption at the Baths. Residents attending for treatment resent being associated with this class of person and in several cases have not returned for second treatment. Three baths are available and waiting time does not normally exceed 30 minutes but let one of these tramps use a bath and it means a full morning or afternoon. The following is commonplace: having entered the bathroom it is at least half an hour before their clothing can be collected for sterilisation. Hundreds of cigarette ends are removed from pockets, the tobacco shredded into a tin with the pieces of discarded paper scattered like confetti over the floor. Next it is usual for them to take advantage of the abundant hot water to give their kitchen utensils a good wash and then they condescend to have their bath and treatment. There are variations of this routine but the combined operations of kit inspection, to washing and dressing rarely take less than two hours. Once they depart, up to 30 minutes can be spent in cleansing, deodorising and disinfesting the room. Before modernisation of the Baths it was possible to segregate these vagrants; now this is impossible and their proximity is objectionable to any normal user and very forthright opinions are expressed, particularly by mothers with children. Whilst appreciating it is to the general good for such persons to be cleansed as and when facilities are encountered in their wanderings, should the problem continue to increase it will be advisable to provide a separate bathroom with all facilities but no "trimmings" to ensure a speedier turn-over and to avoid contact with normal users. Steam Sterilisation This was a very busy year for this section. A total of 310 mattresses from Olympia was stoved after the Dairy Show in October. Work was undertaken for Kensington and the L.C.C. during reconstruction of the Kensington section, and nearly 3,000 articles were dealt with for Barnes Borough Council. This work received from Barnes included more than 2,000 articles from a laundry, which were thought to have been infected by clothing of a smallpox case Disinfestation Treatments of verminous premises continue to decrease, a total of 297 bug infestations being dealt with compared with 354 last year. In addition 17 treatments for cockroaches, 29 for fleas, and 36 for various minor infestations were made. 48 Disinfection Premises are not normally sprayed following cases of the more common infectious diseases unless a definite request is received. During the year seven requests for formaldehyde disinfection were received from the West London Hospital, 8 from premises following a death and 8 from premises following illness. In most of the latter requests the illness was not of an infectious nature and spraying was carried out as a palliative treatment only. HEALTH LAUNDRY With the opening of the new laundry on the 8th January routine collections and deliveries were soon operating once again. So smoothly did the work flow through the machines that it was difficult to realise at the end of the year that output was up by 50% of the 1961 figure. The new press has materially assisted here by reducing the time spent on tedious jobs of drying, ironing and packing. It has been estimated that the present machines could cope with double the work, provided the labour force was increased, so that continued expansion for a few years presents no problem, thanks to the foresight of the Council in providing these modern mechanical aids. It is difficult to foresee the trend this service will take. The chronic cases that persist year after year are the problem, and the ratio of such, over acute cases, has steadily risen since the inception of the scheme in 1953, the present figure being 2.3 to 1. Approximately one third of the chronic sick remain on the list to be carried over to the ensuing year. As a result the reduction in collections that formerly coincided with the staff's annual leave period no longer applies to anything like the same extent. Origin of requests for service District nurses or other nursing sisters 74 Home Helps 14 Welfare departments or health visitors 25 The person concerned or his/her relations/friends 16 Doctors or hospital almoners 6 Voluntary societies 4 Total 139 Every year the story is one of expansion. The figures below speak for themselves. 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 New requests, or request to restart a closed case 21 16 44 37 38 42 46 61 105 96 Requests within the Act 14 10 34 32 32 34 37 56 97 91 Number of persons served during the year, not all being new cases 16 12 40 39 39 45 45 71 125 139 Number of cases reported or follow up visits to home 33 26 65 60 64 132 151 256 348 239 Certificates issued for collections during year 71 111 350 352 511 1,018 1,137 1,529 2,638 3.494 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 38.069 Maximum collections in any one week of the year 6 10 15 14 19 25 38 52 100 107 49 CORONER'S COURT AND PUBLIC MORTUARY The Coroner's Court and Mortuary in Fulham Palace Road provide comprehensive facilities, including a modern post mortem-room with four post-mortem tables and a battery of 18 refrigerators. The Mortuary is also used, by arrangement, by the neighbouring boroughs of Fulham, Kensington and Chelsea. Special facilities have also been provided for those of the Jewish faith. The number of bodies admitted to the Mortuary during the year was 1,263, an increase of 29 over 1961. There were 1,252 post-mortem examinations, an increase of 39 over the previous year. In all 269 Inquests were held at the Coroner's Court compared with 266 the previous year. Details are set out below :— Bodies admitted from the Borough: — By order of Coroner 361 On application of Undertakers 2 363 Bodies admitted from other Boroughs: — Fulham (226 by order of Coroner and 4 on application of undertakers) 230 Chelsea (252 by order of Coroner and 1 on application by undertaker) 253 Kensington (413 by order of Coroner and 4 on application by undertakers) 417 900 Total bodies admitted 1,263 Of this total 6 were admitted by order of the Police. No. of Post-mortem examinations conducted :— Hammersmith cases 361 Fulham cases 226 Chelsea cases 252 Kensington cases 413 Total Post-mortems 1,252 No. of Inauests held:— Hammersmith cases 61 Fulham cases 126 Chelsea cases 44 Kensington cases 38 Total Inquests held 269 EXHUMATION AND RE-INTERNMENT OF BODIES No licences were granted by the Secretary of State for the exhumation and removal of bodies from graves in the Borough during the year. 50 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 Delegates National Old People's Welfare Council, Mr. S. G. Bennett, Administrative Eastbourne, 29th-31st March. Officer. Royal Society of Health (Health Con- Councillor Mrs. E. O'K. Finn, M.B.E., gress), Scarborough, 9th-13th April. Dr. F. M. Day. Association of Public Health Inspec- Mr. P. T. Bayes, Chief Public Health tors, Southport, 11th-14th September. Inspector. National Society for Clean Air, Councillor E. W. Flynn, Mr. P. T. Harrogate, 9th-12th October. Bayes, Chief Public Health Inspector. Royal Institute of Public Health and Mr. S. G. Bennett, Administrative Hygiene, Eastbourne, 10th - 12th Officer. October. 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 £21 0 0 Section 298. Local Government Act, 1948 Section 136. Central Council for Health Public Health (London) Act, 1936 Education £14 17 0 Section 298. R.o.S.P.A. (Home Safety Section) £2 2 0 do HEALTH EDUCATION Campaign re Smoking and Lung Cancer The Council decided, on the recommendation of the Health Committee, to undertake a Cancer Campaign in Hammersmith. The campaign was timed to commence with the issue of the Royal College of Physicians Report on Cancer in March, 1962. Literature and posters were supplied to many firms in the Borough as well as Youth Clubs and similar organisations. An article also appeared in a programme at one of the games of a local professional football club in the Borough, at which over 10,000 people attended, and posters were also sent for display. 51 Posters were exhibited throughout the Borough, at the Chest Clinic and at the Public Libraries where bookmarkers and leaflets were also distributed. A slogan was also printed on all letters sent out by the Council. Considerable interest was shown by the local Press, who not only reported the arrangements for the Campaign but also published leading Articles on the subject. Films were shown to the Women's Voluntary Services Mothers' Club, Student Nurses at the West London Hospital and members of the Council. An ode on the subject, which was prepared by a member of the staff of the Public Health Department, was also widely distributed and published in the local Press, the Council's News Sheet and the Staff Magazine. The London County Council helped very considerably in the Campaign by arranging for the supply of Posters and Leaflets and the loan of films. The Corporation of London, in conjunction with St. Bartholomew's Hospital, set up a Cancer Diagnostic Clinic for women over 35 years of age, which was made available for any woman, as well as those working in the City. Details were sent to all firms in the Borough, and 18 of the larger firms employing women agreed to co-operate. The Central Council for Health Education proposed to provide Mobile Units to augment any campaigns arranged by Local Authorities, and it was agreed to take advantage of one of these Units in conjunction with the County Council. We communicated with the County Medical Officer of Health, and have been informed that the London County Council are setting up their own Mobile Unit to visit schools, etc., and to link it with publicity drives locally. It is hoped that the Unit will be available in the near future. Campaign re Oil Heaters For a period commencing on 16th October, 1962, a campaign was held in the Borough with regard to the safety of Oil Heaters, and as this coincided with the commencement of Home Safety Year, it was decided to include general home safety principles in the campaign. Arrangements were made with the Oil Heaters Manufacturers Association through their public relations organisation for the supply of descriptive panels and oil heaters, at an exhibition which was held in the Town Hall. The London County Council supplied posters and leaflets and also exhibits for display. Posters and leaflets were distributed to the public by way of Old People's Clubs, and the Council's Libraries who also distributed bookmarkers. Posters were also displayed throughout the Borough. With the assistance of the Jamaica Migrants' Service, leaflets and posters were distributed to many of the coloured population in the Borough through local branches of the West Indian Association and the Overseas Social Centre. 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 good use of this Bureau and are provided with on-the-spot help and information. 2,500 copies of the 1962 edition of the Health Services Guide were printed and distributed. This booklet is becoming better known with every edition and each year more people ask to be put on the mailing list. The Guide has almost a world wide distribution and is greatly appreciated by the recipients. The British Council alone distributed copies to interested people in U.S.S.R., Buenos Aires, Chicago, Vienna, Madrid Mexico, Thailand. Japan, Germany and Sweden. 52 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. 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. It also has a large Maternity Section where more than 2,000 children were born this year. 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 More than 3,000 babies of all nationalities were born there during 1962. Hammersmith Chest Clinic All aspects of the tuberculosis problem and other chest diseases are dealt with at this Clinic which is housed at Hammersmith Hospital. The Clinic is closely linked with the Post-graduate 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 Post-graduate Medical School. The Clinic, its associated independent radiography department and 27 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 in conjunction with the Department of Medicine for patients suffering from Chronic Bronchitis. During the treatment, rehabiliation and re-settlement of tuberculous 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 tuberculous 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 if 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 tuberculous patients to be admitted to Hammersmith Hospital. Laboratory Facilities The Public Analyst for the Borough operates from the Southwark Borough Council's laboratory situated in the Health Centre, Walworth Road, S.E.17. 53 Bacteriological examination of food is carried out by the Public Health Laboratory Service, County Hall, S.E.I and the Royal Institute of Public Health, and these laboratories, together with the laboratory at West London Hospital are also available to doctors for bacteriological examinations, throat swabs, intestinal specimens, etc. The necessary swabs and outfits for the laboratories can be obtained from the Public Health Department. 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 Acts, 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 as in all cases it was found possible to find a solution in other ways, eithet by co-operation with the family doctor or by making use of ancillary services. National Assistance Act, 1948, Section 50 Burial or Cremation of the Dead. During the year 21 burials were carried out by the Council. OLD PEOPLE'S WELFARE In the year under review the Hammersmith Old People's Welfare Association continued to promote the general welfare of the old people of the Borough. Under the provisions of the National Assistance Act, 1948, the Borough Council is permitted to make contributions to the funds of any voluntary organisation whose activities consist in or include the provision of recreation or meals for old people. Aided by substantial grants from the Council, the Association has steadily expanded its services for old people along the lines of the provision of meals both for the active and the homebound, holidays and outings, social visiting and chiropody. The Association also co-ordinates the work of the various voluntary organisations in the field of social visiting, holidays and the provision of meals at the Luncheon Clubs. During the year the National Assistance Act, 1948 (Amendment) Act, 1962, came into force. This Act empowers a local authority to provide meals and recreation for old people directly if it so desires, and the Hammersmith Council will be assuming responsibility for these welfare services as from 1st April, 1963. The voluntary organisations will still have an important part to play in the provision of these services, working together with the Council and other statutory bodies, and we can confidently look forward to an even greater contribution to the social health of the older members of the community. 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. 54 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. 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 Wednesday 9.30 a.m., 1.45 p.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 (Diphtheria, 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. Wednesday, Thursday and Friday at 10 a.m. 207 Westway Monday to Friday, 1.30 p.m. Speech Therapy 48 Glenthorne Road Monday and Thursday 1.30 p.m. 103 Shepherds Bush Road Tuesday p.m., Wednesday all day. Friday a.m., Saturday a.m. Creche 48 Glenthorne Road Tuesday, Wednesday and Friday 9.30 a.m. to 12 noon. 55 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 1s. 9d. per session is made, but this may be abated in certain circumstances. 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. Situation Capacity Time Brook Green 83 7.30 a.m. to 6.00 p.m. Dalling Road 55 8.00 a.m. to 6.00 p.m. Latimer Road 36 8.00 a.m. to 6.00 p.m. Uxbridge Road 60 7.30 a.m. to 6.00 p.m. The charge for children received into these Nurseries is based on their parents income. Home Help Service Administered by the County Council, this service employs 13 full-time and 130 part-time helpers. It continued its good and valuable work during the year from its headquarters at 48 Glenthorne Road, W.6. The 1,006 cases in which help was provided are classified as follows:— Maternity 8 Tuberculosis 9 Problem families 4 Mothers with school children 4 Chronic sick over 65 872 Chronic sick under 65 54 Acute sick 55 Specially trained home helps are used to assist and educate problem families in housecraft. Public Baths and Wash-houses The Metropolitan Water Board supply is utilised for both baths and pool. The water is subjected to chlorination, alkali treatment and filtration with continuous circulation. Samples of water were taken for analysis and all were reported satisfactory. In addition frequent checks are made by the staff at the baths, particularly during heavy bathing loads. 56 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 also hand irons. There are two swimming baths at Lime Grove. The smaller is open all the year 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. Bloemfontein Road: There is an open air pool at Bloemfontein Road, Shepherds Bush which, during the summer months, provides for swimming and sun bathing. Staff Medical Examinations During the year I 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 276 and of this number 57 were found to be unfit for the following reasons: — Arteriosclerosis 1 History of depression 1 Bronchitis 4 Migraine 1 Heart Condition 3 Ear condition 6 Hypertension 19 Eye condition 1 Psychiatric history 4 Chest condition 1 Diabetes 1 T.B. history 1 Dermatitis 1 History of duodenal ulcer 2 Cystostomy 1 Gastric history 4 Peptic Ulcer 1 Hernia 3 Albuminuria 1 Disc lesion 1 At the beginning of 1953 the Council decided to put into operation a scheme for controlling sick leave arrangements. The scheme still works smoothly and satisfactorily and during the year 39 examinations were carried out in this connection. 57 INDEX Page Ambulance facilities 50 Ante-Natal Clinics 54 Atmospheric Pollution 33 Barbers 31 Births 7-10 Burials 53 Cancer, Deaths 12-13 Caravans 32 Causes of Death in Age Groups 11 Chest Clinic 52 Chiropody Clinics 54 Clean Air 32-39 Closing Orders 26 Condemnation of Food 41-42 Condensed Milk Regulations 45 Conferences 50 Contacts and Carriers of Infectious Diseases 18 Coroner's Court 49 Creche 54 Day Nurseries 55 Deaths 10 Deaths—Principal Causes in Age Groups 11 Deaths—Rates 6-15 Deaths—From Carcinoma of Lungs in Age Groups 12 Diphtheria Immunisation 18 Disinfection 48 Disinfestation 47 Drainage 29 Dustbins 29 Dysentery 19 Environmental Hygiene — Administration 24 Epidemiology 17 Exhumation and Re-interment of Bodies 49 Factories 29 Factories—Defects 30 Factories—Inspections 29 Financial Contributions to Voluntary Organisations 50 Food—Bacteriological Examination 43 Page Food and Drugs Act, 1955 41 Food Hygiene Regulations, 1955 and 1960 40 Food—Inspection and Supervision 40 Food Poisoning 19 Food Premises 41 Food Preservatives 40 Hairdressers and Barbers 31 Health Services 50 Health Education 50 Health Information Bureau 51 Health Laundry 48 Home Help Service 55 Hospitals 52 Housing 24-26 Ice-Cream 43 Ice Cream and Preserved Food Premises 44 Immunisation 18 Infant Mortality 7-15 Infectious Diseases: Contacts and Carriers 18 Dysentery 19 Food Poisoning 19 Measles 18 Notifications 17 Poliomyelitis 19 Smallpox 19 Tuberculosis 20-23 Weil's Disease 20 International Certificates of Vaccination and Inoculation 23 Inter-Borough Smoke Control Liaison Committee 33 Introduction 1-2 Laboratory facilities 52 Licences 31-32-45 Markets 45 Marriages 16 Maternal Mortality 7-15 Measles 18 Medical Examination of Staff 55 Medicinal Baths 46 Milk Licences 45 Milk Supplies 44 58 Page Mortuary 49 National Assistance Act, 1948/51 53 Notifications of Infectious Diseases 17 Old People's Welfare 53 Outworkers 30 Personal Health Services 53 Permanent Estates 26 Pet Animals Act, 1951 32 Pharmacy and Poisons Act, 193 31 Pharmacy and Medicines Act, 1941 31 Poliomyelitis 19 Poliomyelitis Immunisation 19 Population 6, 8, 10 Public Baths 55 Public Cleansing 29 Rag and Bone Dealers 32 Rag Flock and Other Filling Materials Act, 1951 32 Rehousing 24 Removal of Aged Persons 53 Rent Act, 1957 26 Rodent Control 30-31 Sampling 42 Sanitary Circumstances 24 Sanitary Inspection 26 Page Sanitary Inspection—Notices served and complied with 27 Sewerage 27 Slum Clearance 26 Smallpox 19 Smallpox Immunisation 18 Smoke Control Areas 32 Smoke Control Area Maps 34-38 Social Conditions 5 Speech Therapy 54 Staff, at 31st December, 1962 3-4 Staff-Inspectoral 24 Statistics 6-16 Steam Sterilisation 47 Summonses 27 Tetanus Immunisation 18 Treatment Centre 46 Tuberculosis 19-23 Unsound Food Condemned 41 Vaccination 18 Vital Statistics 6-8 Washhouses 55 Water Supply 28 Weil's Disease 20 Welfare Centres 54 Whooping Cough Immunisation 18