Ac 4347 AS II HAM 55 Metropolitan Borough of Hammersmith Report on the Health of the Borough 1963 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, 1963. Councillor E. O'K. Finn (Mrs.), M.B.E. (Chairman) Councillor E. D. Freeman (Mrs.) (Vice-Chairman) Councillor C. E. Arnold Councillor E. W. Flynn Councillor D. M. Heaks (Mrs.) Councillor J. M. Henry (Miss) Councillor F. W. Ing Councillor L. S. Jones, A.R.Ae.S. Councillor G. D. Powers (Miss) Councillor G. E. C. Simpson Councillor S. E. Ward Councillor E. C. Woods (Miss) Ex-Officio: The Worshipful the Mayor (Councillor S. M. Atkins, J.P.) OTHER COMMITTEES OF THE COUNCIL CONCERNED WITH VARIOUS ASPECTS OF THE HEALTH SERVICES. Baths Committee Management and supervision of the Council's Public Baths and Washhouses. Establishment Committee Dealing with medical examination of staff, etc. Housing and Town Planning Committee Powers and duties of the Council under the Housing Acts (other than those delegated to the Health Committee). Works Committee Construction, maintenance and improvement of sewers and public sanitary conveniences. Collection, removal and disposal of house and trade refuse. Cleansing of public highways. Management and control of the Council's Cemeteries. Maintenance and control of parks, gardens and open spaces provided by the Council. CONTENTS Page Introduction 1 Staff of the Health Department 2 Physical and Social Conditions 3 PART I STATISTICS AND TABLES Area and Population 4 Vital Statistics 4-9 Census, 1961 8 Deaths : 9 Causes in age groups 10 Cancer 11-12 Infant Mortality 12-14 Maternal Mortality 14 Stillbirths 14-15 Marriages 15 PART II EPIDEMIOLOGY Notification of infectious diseases 16 Immunisation and vaccination 17 Incidence of infectious disease: — Dysentery 18 Food Poisoning 18 Poliomyelitis 18 Smallpox 18 Weil's Disease 19 Tuberculosis 19-21 Typhoid 22 Paratyphoid B. 22-23 International Certificates of Vaccination and Inoculation 24 PART III ENVIRONMENTAL HYGIENE Staff—Inspectoral 25 Sanitary Circumstances Housing 25-28 Rent Act, 1957, and Housing Repairs and Rents Act, 1954 28 Sanitary Inspections 28-29 Summonses 29 Sewerage 29-30 Water Supply 30 Public Cleansing 31 Page Drainage 31 Factories, Workshops & Outworkers 31-32 Rodent Control 32-33 Licences and Registrations Hairdressers 33 Pharmacy and Poisons 33 Rag Flock 33 Pet Animals 33 Caravans 33 Atmospheric Pollution Smoke Control Areas 34 Measurement of Atmospheric Pollution 34-35 Inter-Borough Smoke Control Liaison Committee 35 Area Map (inside back cover) Inspection and Supervision of Food General 35-36 Food: Premises 36-37 Unsound 37-38 Sampling 38 Complaints 39 Bacteriological Examinations of Food 39 Ice-Cream and Preserved Food 40-41 Milk Supplies 41 Designated Milk Licences 41-42 Condensed Milk Regs. 1959 42 Markets 42 Medicinal Baths General 42 Section 43 of L.C.C. (G.P.) Act, 1953 42-43 Treatment Centre 43 Sterilisation 43 Disinfestation 43 Disinfection 43 Health Laundry 43-44 Page Coroner's Court and Mortuary 44-45 Exhumation 45 PART IV GENERAL HEALTH & WELFARE SERVICES Ambulance facilities 46 Conferences 46 Financial Contributions to Voluntary Organisations 46 Health Education 46 Health Information Bureau 47 Hospitals 47 Hammersmith Chest Clinic 47 Laboratory facilities 48 Page National Assistance Act 48 Old People's Welfare 48 Personal Health Services 48 Ante-Natal Clinics 49 Infant Welfare Centres 49 Immunisation 49 Chiropody 49 Speech Therapy 49 Creche 49 Day Nurseries 49 Home Help Service 49 Public Baths and Wash-houses 50 Staff Medical Examinations 50-51 ALPHABETICAL INDEX 52-53 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 1963. For the first time since 1950, the Health Department has had a full establishment of Public Health Inspectors, and this has resulted in a closer control being exercised over environmental health matters, particularly as regards food premises, by the Inspectorate. With regard to Infectious Diseases, there was an increase over the previous year of 816 cases, due almost entirely to the peak of the two year Measles cycle occurring in 1963, with 1,004 notifications as against 192 in 1962. It is interesting to note that there was a fall in the number of notifications of food poisoning from 22 in 1962 to 13 in 1963. It should again be pointed out however, that many cases of food poisoning are not reported to the Health Department. The Department became very much involved in the outbreak of Typhoid Fever which had its source in Zermatt, as one of the first persons to contract the disease was a Sister in a local hospital who had just returned from a holiday in Zermatt. It was due to the prompt action by everybody concerned that Medical Officers of Health for the areas in which the Sister's fellow travellers resided, were quickly alerted, and action was taken which undoubtedly helped to confine the outbreak. During the year under review I was for the major part on sick leave and unable to carry out my duties. I am very grateful to Dr. Settle, the Medical Officer of Health of Fulham, who so readily stepped into the breach and advised the Department on its medical problems. The burden of responsibility for the work of the Health Department has fallen on the Administrative Officer and I should like to record my appreciation of the capable manner in which he has shouldered the task. The Chief Public Health Inspector has also had to undertake added responsibility and to him and to all members of the staff of the Health Department I should like to record my grateful thanks. In conclusion I would like to thank the Chairmen and Members of the Committees for their support and guidance to the Health Department during the year. I am, Your Worship, Ladies and Gentlemen, Your obedient servant, F. M. DAY, Medical Officer of Health. 2 STAFF OF THE PUBLIC HEALTH DEPARTMENT at 31st December. 1963 Medical Officer of Health F. M. Day, M.R.C.S., L.R.C.P., D.T.M., D.P.H. Administrative Officer S. G. Bennett Clerical G. W. Nickolls (1st Assistant) Mrs. D. Kelley A. E. Blake Mrs. F. Lawford Miss J. Colpus V. J. Quayle Mrs. M. Gray W. M. Robinson Mrs. J. Hall Miss L. Veal T. J. Hares J. A. Wyatt Miss I. E. Waller (M.O.H.'s Secretary) Chief Public Health Inspector P. T. Bayes Deputy Chief Public Health Inspector J. G. Tompkins Public Health Inspectors W. R. Bland P. M. King D. H. Boucher P. J. Smith J. C. Hopkins W. H. Tyrrell G. W. Huddleston S. E. Thelner Student Public Health Inspectors R. K. W. Bolton, R. J. Darrington, Miss A. E. Barket Food and Drugs Inspector J. Collier Public Health Inspector ilc Clean Air J. Beagle Technical Officer E. Curley Enquiry Officers P. E. C. Pendock (Temporary) E. R. James Mortuary Keeper W. Gauntlett Medicinal Baths Superintendent F. G. Baldwin Public Analyst D F H. Button, A.R.C.S., F.R.I.C 3 PHYSICAL AND SOCIAL CONDITIONS OF THE BOROUGH Hammersmith, the most westerly of the Metropolitan Boroughs, covers an area of 2,282½ acres with 69 miles of roads. It is bounded on the South by the Thames, on the North by Willesden, East by Fulham and Kensington, and West by Brentford and Chiswick. The subsoil in the northern section of the Borough is mainly clay whilst in the south there is a layer of some 20 ft. of gravel over blue clay. There is a variation of aproximately 120 ft. in elevation from the river to the northern boundary, the lowest point in Upper and Lower Malls being 13 ft. above sea level. There are more than 400 factories within the Borough of varied nature, so that, apart from heavy industry, most trades are represented. This development has undoubtedly been assisted by the excellent transport facilities available by water, road and rail. Of equal importance to the industrialists and also to residents are the 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 as the following figures show : Men Women Total No. of persons registered as unemployed on 9.12.63 2,063 582 2,645 No. of unfilled vacancies on 4.12.63 422 529 951 The corresponding total figures for 1962 were 3,463 and 573. 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. For the onlooker Hammersmith provides a wide and varied choice indeed. Most week-ends the river along the Mall is a spectacle with racing eights, skiffs and sailing boats from the various rowing and sailing clubs, practising and racing; the highlights undoubtedly being the Oxford & Cambridge boat race and Head of the River each Spring. The White City Stadium stages international athletics and greyhound racing; Olympia attracts thousands to its well known exhibitions and shows, whilst the B.B.C. Television Centre in Wood Lane and the Lime Grove Studios, providing entertainment for millions, are household names. 4 PART 1 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, live births, stillbirths and deaths. The "area comparability" factors for use with crude birth and death rates contain adjustments for boundary changes and make allowances for the way in which the sex and age distribution of the local population differs from that for England and Wales as a whole. In addition, the death rate "area comparability" factors have been adjusted specifically to take account of the presence of any residential institutions in each area. When local crude birth and death rates are multiplied by the appropriate "area comparability" factor, they are comparable with the crude rate for England and Wales or with the corresponding adjusted rate for any other area. Area (acres) 2,282.5 Population: — Census, 1951 119,367 Census, 1961 110,333 Registrar-General's estimate mid-1962 108,120 Registrar-General's estimate mid-1963 107,660 Rating: — Number of inhabited houses 25,249 Rateable Value £7,688,681 Product of a penny rate £31,900 Mortality: — Number of deaths 1,305 Death Rate per 1,000 population : Crude 12.1 Adjusted (Comparability Factor 112) 13.5 England and Wales 12.2 Deaths from Cancer (all ages) 294 Deaths from Measles (all ages) — Deaths from Whooping Cough (all ages) — Deaths from Diarrhoea (under 2 years of age) - 5 Live Births: — Legitimate 2,078 Illegitimate 383 Total 2,461 Rate per 1,000 population: — Crude 22.9 Adjusted (Comparability Factor 0.86) 19.7 England and Wales 18.2 Illegitimate Live Births per cent, of total live births 15.6 Stillbirths:— Legitimate 42 Illegitimate 11 Total 53 Rate per 1,000 total live and stillbirths 21.1 Rate per 1,000 total live and stillbirths England and Wales 17.3 Total Live and Stillbirths 2,514 Infant Deaths (deaths under 1 year) Legitimate 37 Illegitimate 13 Total 50 (deaths under 4 weeks) 35 (deaths under 1 week) 30 Infant Mortality Rates:— Total infant deaths per 1,000 total live births 20.3 Total infant deaths per 1,000 live births England and Wales 21.0 Legitimate infant deaths per 1,000 legitimate live births 17.8 Illegitimate infant deaths per 1,000 illegitimate live births 33.9 Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 14.2 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 total live births) 12.2 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 33.1 Maternal Mortality (including abortion):— Number of deaths — Rate per 1,000 total live and stillbirths - A summary of the vital statistics of the district for 1963 and previous years is given in the following table 6 VITAL STATISTICS OF WHOLE DISTRICT 1963 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. Num ber Rate per 1,000 Pop. 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 per 1,000 Pop. 1 2 3 4 5 6 7 8 9 10 11 12 1925 134,500 2,351 17.5 1,034 7.7 186 756 153 65 1,604 11.9 1926 134,400 2,188 16.3 1,174 8.7 195 556 144 66 1,535 11.4 1927 132,800 2,076 15.6 1,581 11.9 230 377 126 61 1,728 13.0 1928 136,300 2,258 16.6 1,449 10.6 222 326 156 69 1,553 11.4 1929 136,900 2,162 15.8 1,757 12.8 222 340 133 62 1,875 13.7 1930 136,900 2,173 15.9 1,387 10.1 219 436 140 64 1,604 11.7 1931 135,100 2,073 15.3 1,567 11.6 288 373 140 68 1,652 12.2 1932 133,700 1,940 14.5 1,465 10.9 294 543 129 66 1,714 12.8 1933 131,400 1,827 13.9 1,500 11.4 340 530 119 65 1,690 12.9 1934 129,170 1,783 13.8 1,359 10.5 346 655 137 77 1,668 12.9 1935 128,100 1,877 14.7 1,347 10.5 406 583 131 70 1,524 11.9 1936 127,700 1,922 15.1 1,399 10.9 441 639 116 60 1,597 12.5 1937 126,500 1,913 15.1 1,333 10.5 402 662 130 68 1,593 12.6 1938 125,100 1,874 15.0 1,340 10.7 450 522 117 62 1,412 11.3 *1939 B122,800 D116,200 1,829 14.9 1,311 11.2 362 442 77 43 1,391 12.0 1940 98,320 1,600 16.3 1,725 17.5 370 401 76 51 1,756 17.9 1941 84,880 1,405 16.5 1,315 15.4 351 364 52 41 1,328 15.6 1942 89,370 1,589 17.8 1,270 14.2 356 338 94 59 1,252 14.0 1943 92,050 1,768 19.2 1,278 13.9 365 387 102 58 1,300 14.1 1944 89,190 1,788 20.0 1,447 16.2 418 389 95 53 1,418 15.9 1945 96,100 1,742 18.1 1,464 15.2 423 267 78 45 1,308 13.6 1946 111,860 2,310 20.6 1,522 13.6 463 277 103 45 1,336 11.9 1947 117,280 2,559 21.8 1,570 13.3 472 271 97 38 1,369 11.6 1948 115,800 2,149 18.5 1,608 13.8 547 241 75 35 1,302 11.2 1949 118,440 1,971 16.6 1,532 12.9 545 322 55 28 1,309 11.0 1950 119,200 1,988 16.6 1,433 12.0 482 346 34 17 1,297 10.8 1951 118,300 1,874 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 1963 107,660 2,461 22.9 1,478 13.7 685 512 50 20 1,305 12.1 * 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 no great variation for the past 9 years in the death rate but the birth rate shows a pronounced rise. 7 CHART SHOWING BIRTH AND DEATH RATES PER 1,000 POPULATION FOR THE PAST £0 YEARS BIRTH RATE DEATH RATE 8 CENSUS 1961 The following extracts from the 1961 Census Report, issued from the General Register Office, relating to the birthplace and nationalities of the population of our Borough, are of some interest in relation to the housing problem in Hammersmith:— Birthplace Males Females Total 54,338 55,995 British Isles 47,842 50,515 England 38,898 42,340 Wales 1,232 1,345 Scotland 1,234 1,027 Northern Ireland 594 488 United Kingdom (part not stated) 197 233 Irish Republic 5,204 4,768 Ireland (part not stated) 451 264 Isle of Man 4 12 Channel Islands 28 38 Total born outside the British Isles Residents 6,017 5,018 Visitors 117 150 Commonwealth Countries Residents 1,393 1,000 Visitors 43 50 Colonies, Protectorates, etc. Residents 2,234 1,664 Visitors 19 11 Foreign Countries and at Sea Residents 2,390 2,354 Visitors 55 89 Birthplace not stated Residents 358 306 Visitors 4 6 Nationality and Citizenship of Residents born outside the British Isles 6,017 5,018 U.K. & Colonies by birth or descent 2,417 1,943 U.K. & Colonies by registration or marriage 126 544 U.K. & Colonies by naturalisation 455 320 U.K. & Colonies mode of acquisition not stated 135 102 Other Commonwealth (and Irish) 812 474 Aliens (including Stateless) 1,633 1,292 Not stated 439 343 9 (a) Population: Once again the Registrar-General's estimated population figure shows a decrease, the figure for 1963 of 107,660 being 460 less than the previous year. 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 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 1953 117,600 543 1963 107,660 1,156 (b) Births: The corrected number of births was 1,294 males, 1,167 females giving a total of 2,461 compared with 2,366 in 1962. This gives an annual rate of 22.9 per thousand of the population. The actual increase in numbers of 95 was composed of 80 legitimate and 15 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 383 and the percentage is 15.6%. 5,961 births were registered in Hammersmith during 1963. Queen Charlotte's Hospital had 3,368 births and Hammersmith Hospital 2,341; only 252 other births were registered. Most of the births in the hospitals were in respect of non-residents and these were transferred to their home towns. (c) Deaths: Deaths registered during the year numbered 1,478. From this figure must be deducted 685 in respect of non-residents transferred to their home towns. To counter-balance this must be added a total of 512 residents of the Borough who died in other parts of England. This gives the corrected figure of deaths as 1,305, comprising 665 males and 640 females. It should be mentioned that of the outward transferable deaths, 626 occurred in three of the large hospitals within the Borough. Once again our death rate is increased by 11 deaths, in hospital, of patients from such far-away places as Cyprus, Portugal, Ceylon, U.S.A., Malta, Iraq, Cairo and Calcutta. 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. 10 CAUSES OF, AND AGE AT, DEATH DURING THE YEAR 1963 AS SUPPLIED BY THE REGISTRAR-GENERAL Cause of Death Sex Total All Ages Under 4 weeks 4 weeks and under 1 year AGE IN YEARS 1- 5- 15- 25- 35- 45- 55- 65- 75 & over 1. Tuberculosis, respiratory M 3 - - - - - - 2 1 - F 3 - - - - - 1 - 1 1 2. Tuberculosis, other M 1 — — — — — — — - 1 — - F 1 - - - - - - - - - 1 — 3. Syphilitic disease M - - - - - - - - - - - - F 2 - - - - - - - - - 2 — 9. Other infective and Parasitic Diseases M 3 - - - - - - - 2 - 1 - F - - - - - - - - - - - - 10. Malignant Neoplasm, Stomach M 21 — — — — — — 1 3 9 6 2 F 18 - — — — — 1 1 3 4 9 11. Malignant neoplasm, lung, Bronchus M 67 — — — — — — 2 11 28 19 7 F 22 — — — 1 — — — 5 7 4 5 12. Malignant Neoplasm, breast M - - - - - - - - - - - F 23 - - - - - - - 4 6 6 7 13. Malignant neoplasm, uterus F 11 — — — — — — 2 2 4 3 - 14. Other malignant and lymphatic Neoplasms M 66 - - - - 1 1 1 12 15 20 16 F 53 — — — — — — 2 6 10 15 20 15. Leukaemia, aleukaemia M 5 — — — 1 1 1 — 1 — — 1 F 3 - - - - - - - - - 2 1 16. Diabetes M 3 — — — — — — — 1 — 1 1 F 4 - - - - - - - - 2 - 2 17. Vascular lesions of nervous system M 45 - — — — — — 2 4 5 14 20 F 89 - — — — — — — 1 6 22 60 18. Coronary disease, angina M 143 - - — — — — 5 23 38 45 32 F 85 - - — — — — — — 8 34 43 19. Hypertension with heart disease M 5 - — — — — — — 1 1 2 1 F 12 - - - - - - - - - 4 8 20. Other heart disease M 38 - - — — 1 — 1 5 8 7 16 F 74 - 1 — — — 2 1 4 5 13 48 21. Other circulatory disease M 24 — — — — — — 1 — 2 7 14 F 43 - — — — — — — 3 11 29 22. Influenza M 1 - - - - - - 1 - - - - F 2 - - — — — — - — 1 — 1 23. Pneumonia M 41 - 3 1 - - - - - 4 9 24 F 57 1 5 - - - - - - 3 8 40 24. Bronchitis M 71 - 2 - - - - - 3 19 25 22 F 35 - — — — — — 2 2 9 22 25. Other diseases of respiratory system M 9 — — 1 — — — — 2 3 1 2 F 1 - - - - - - - - - 1 — 26. Ulcer of stomach and duodenum M 3 — — — — — — 1 — — 1 1 F 4 - - - - - 1 1 2 27. Gastritis, enteritis and diarrhoea M 3 - — - — — - 2 1 - F 6 - - - 1 - 1 - - 1 3 — 28. Nephritis and nephrosis M 4 - - - - 1 - - - - 2 1 F 2 — - — — — 1 — 1 — — — 29. Hyperplasia of prostate M 5 — — — — — — — — 1 1 3 31. Congenital malformations M 12 6 1 1 2 - 1 1 - - F 9 5 2 - - - - - - - 1 1 32. Other defined and ill-defined diseases M 47 14 - — — — 3 3 3 10 5 9 F 55 9 1 1 1 1 — — 1 5 9 27 33. Motor vehicle accidents M 11 — — — 1 3 3 — 3 — — 1 F 5 - - - - - - - 1 1 2 - 34. All other accidents M 14 - 2 1 1 2 1 1 1 2 3 F 12 - — — — 1 — 2 — 2 1 6 35. Suicide M 20 - - — 1 4 4 5 3 3 - F 9 — — — — 1 2 2 2 2 — — Total all causes M 665 20 6 5 5 9 14 23 81 153 173 176 F 640 15 9 1 3 3 6 11 31 72 157 332 1305 35 15 6 8 12 20 34 112 225 330 508 11 DEATHS FROM CARCINOMA OF LUNGS Year 0—25 —45 —65 —75 +75 Total 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 1963 M - 2 39 19 7 67 F 1 - 12 4 5 22 Total 1 2 51 23 12 89 12 DEATHS FROM CANCER DURING THE PAST TEN YEARS Year Population Deaths Rate per 1,000 Year Population Deaths Rate per 1,000 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 1958 110,200 249 2.2 1963 107,660 294 2.7 (d) Infant Mortality The number of deaths of infants under one year of age during the year was 50, giving a mortality rate per 1,000 live births of 20. INFANT MORTALITY—1963 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 „ 1944-1953 1,991 65 32 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 1963 2,461 50 20 13 CHART SHOWING THE NUMBER OF DEATHS OF INFANTS UNDER 1 YEAR OF AGE DURING THE PAST 20 YEARS 14 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 1962 England and Wales 25 24 23 23 22 22 22 22 Scotland 30 29 29 28 28 27 26 27 Northern Ireland 32 29 29 28 28 27 27 27 Australia 22 22 21 20 22 20 19 20 Canada 31 32 31 30 28 27 27 28 Chile 121 113 117 127 120 127 116 121 Denmark 25 25 23 22 22 22 22 20 France 39 36 34 32 30 27 26 26 Irish Republic 37 36 33 35 32 30 30 29 Italy 49 48 50 48 45 44 40 41 Netherlands 20 19 17 17 17 17 16 15 New Zealand 22 19 20 19 20 20 19 20 Sweden 17 17 17 16 16 16 16 15 United States of America 27 26 26 26 26 26 25 26 (e) Maternal Mortality There were no maternal deaths during the year. MATERNAL MORTALITY—1963 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 „ 1934-1943 3 1,756 1.7 „ 1944-1953 2 1,991 10.2 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 1963 — 2,461 - (f) Stillbirths In August, 1963, the Registrar-General made available for the first time details of inward and outward transferable stillbirths. The opportunity was taken to obtain from our local Registrars details of the cause of death in all cases of stillbirths registered with them during the year but unfortunately in one case details were not available from 1st January, 1963, to 28th April, 1963, as a completed register had been handed over to the Registrar-General. The following table therefore shows the cause of death in respect of the 37 stillbirths which occurred in Hammersmith Hospital, the 35 known cases which occurred in Queen Charlotte's Hospital and the three cases within the Borough outside the two hospitals. In addition particulars of 9 inward transfers are included, giving a total of 84. 15 CAUSES OF STILLBIRTH Code No. Cause Males Females Y.30 Chronic disease in mother 1 Y.31 Acute disease in mother 2 Y.32 Diseases and conditions of pregnancy and childbirth (1) Ectopic gestation (2) Haemorrhage 10 6 (3) and (4) Toxaemia 2 5 (5) Infection Y.34 Difficulties in Labour 1 Y.35 Other causes in mother 1 Y.36 Placental and cord conditions 11 5 Y.37 Birth injury Y.38 Congenital malformation of foetus 6 8 Y.39 Diseases of foetus and ill-defined causes: (0-3) Diseases of foetus 4 7 (4-6) Other ill-defined or unspecified cause 9 6 TOTAL 46 38 The actual number of stillbirths credited to the Borough after deduction of outward transfers was 53. (g) Marriages The number of marriages was 1,448 an increase of 3 compared with the previous year. Particulars are set out hereunder: The Register Office 604 Buildings registered for marriages (Roman Catholic Churches and Chapels at which a Registrar attends) 513 Churches of the Church of England 279 Authorised Persons (Chapels at which a Registrar does not attend) 37 Jewish Synagogues 15 1,448 PART II EPIDEMIOLOGY Notification of Infectious Diseases 1,399 cases of infectious diseases were notified during the year including 96 cases removed to hospital. These figures show an increase on the previous year of 816 cases. This is largely due to the fact that there were many more cases of Measles. Whooping Cough and Pneumonia showed an increase. There was, however, a slight fall in the number of cases of Puerperal Pyrexia, Scarlet Fever and Food Poisoning. Full details are given under age groups in the following table:— Diseases Notifications Total cases notified Cases removed to Hospital Deaths Corrected Figures1 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 - 1 5 10 2 1 - - 19 3 - 19 Whooping Cough 12 14 27 23 — — — — 76 4 - 76 Acute Poliomyelitis (Par.) — — — — 1 — — — 1 — - — ,, ,, (Non-Par.) - - - - - - - - - - - - Measles 46 129 428 388 7 5 1 — 1004 21 - 1004 Diphtheria — — — — — — — — — — - - Pneumonia 2 2 5 5 1 2 12 8 37 17 - 37 Dysentery 3 6 13 15 6 4 1 — 48 5 - 48 Encephalitis (P.I.) — — — 1 — — — — 1 1 - 1 Enteric or Typhoid Fever — — — — — 1 — — 1 1 - 1 Paratyphoid Fever — — — — — — — — — - - - Erysipelas — — — — — — 5 — 5 - - 5 Meningococcal Infection — — — — 1 — — — 1 1 - 1 Food Poisoning 1 1 1 — 2 4 3 1 13 1 - 13 Puerperal Pyrexia — — — — 29 55 — — 84 1 - §84 Ophthalmia Neonatorum 5 - - - - - - - 5 - - ‡5 Smallpox — — — — — - - - - - - - Malaria - - - - - - - - - - - - Scabies 1 2 3 6 13 4 2 - 31 2 - 31 Tuberculosis (Pulmonary) — — 1 4 14 23 11 6 59 28 - 59 „ (Non-Pulmonary) — 1 1 1 2 7 2 — 14 11 — 14 Totals 70 156 484 453 78 106 37 15 1399 96 — 1398 § Of this total only 26 related to patients residing in the Borough. ‡ ,, ,, ,, 2 „ „ „ „ „ „ „ 17 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 No certificates were issued during the year in this connection. 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 80 per cent. A total of 12,060 children within the Borough were protected during the year against tetanus, 14,702 against diphtheria and 8,727 against whooping cough. Prevention of Smallpox Smallpox vaccination continues to be offered to children during the first two years of their life and in the No. 1 Division this year 1,287 children received primary vaccination and 501 re-vaccinations were performed. Speed of travel in the modern world enhances the likelihood of an infected traveller gaining entry to this country and spreading the disease. Such an event- uality can be dealt with by the use of outbreak control measures only if the majority of the population have previously been vaccinated. Re-vaccination diminishes the risk of complications and provides more speedy protection than primary vaccination, particularly in adults. When a safe and effective vaccine which causes no complications is finally perfected, its 100 per cent. use in infancy will ensure that even in the supersonic age we shall have a good chance of maintaining our comparative immunity to this dread disease. 18 Prevention of Poliomyelitis In London 77 per cent. of the child population from the age of 6 months to 14 years received either three injections or doses of polio vaccine. Only three notifications were received for the whole of London, of which two were not con firmed. The one case of paralytic poliomyelitis was in respect of an unvaccinated man age 34 years. The number of cases of poliomyelitis in England and Wales, which was lower last year than for nearly half a century, continued at a low level, surely a vindication of the faith and perseverance of those concerned in the protection of the more youthful members of our country over the past decade. These reports have always stressed the danger of any relaxation of effort in the prevention of tuberculosis, and precisely the same arguments apply to poliomyelitis. Every effort should continue to be made to increase the percentage of persons protected against this disease, with particular emphasis on children and adolescents. Use of the newer oral type vaccine should facilitate this endeavour. In the No. 1 Division 11,614 vaccinations against this disease were carried out by the London County Council during 1963. 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 957 Hammersmith children received this vaccination this year. Incidence of Infectious Diseases Dysentery 48 cases of dysentery occurred during 1963, which is 4 more than last year. There were no deaths, nor were there any outbreaks. In one case I was notified that the patient, aged 3½ years attended a Day Nursery in the Borough and the mother worked in a cafe. Specimens were submitted for the remainder of the family and all proved positive for Sonne Dysentery. All the children were removed to the Western Isolation Hospital. A notice under the Public Health (Infectious Disease) Regulations, 1953, was served on the Mother precluding her from carrying on her duties in the cafe until the risk of infection was removed. This notice also informed her of the Council's powers under the London County Council (General Powers) Act, 1959, to compensate her for loss of earnings as a result of complying with the notice. The mother was away from work from 25th July to 20th August, 1963, and a sum of £15 7s. 4d. was paid to her by way of reimbursement for loss of earnings. Food Poisoning This year there were only 13 cases of Food Poisoning. The following agent was identified:— Salmonella Typhimurium 2 In the other 11 cases no specific organism was isolated. Smallpox There were no confirmed cases of smallpox in the Borough during the year or indeed in England. Conceivably the more stringent regulations arising from the recommendation by the Public Health Committee of the Council of Europe have had some effect in making less likely the importation of smallpox by air passengers. These regulations which came into operation on 1st August 1963, recommended that a valid International Certificate of Vaccination against smallpox should normally be required by national health administrations from travellers arriving from local infected areas and from "endemic areas", the latter to be defined as consisting of Africa, Asia and the Americas (excluding Canada and the United 19 States of America), also that this general definition of "endemic areas" should replace the various definitions, differing from country to country, which had previously been employed. The Airport Medical Officer (or the customs officer or immigration officer on his behalf) should, as a matter of routine, ask to see the International Certificates of all travellers (whether in transit or not) arriving directly by air from:— (a) any place in Asia, Africa or the Americas (excluding Canada and the U.S.A.). or (b) any smallpox-infected local area wherever it may be. He should also continue the existing arrangements for issuing warning notices ("yellow cards") to all such travellers. Travellers defined in (a) and (b) above who do not possess valid International Certificates or who do not show sufficient evidence of protection by a previous attack of smallpox should be offered vaccination and, unless they are in transit, placed under surveillance in accordance with Regulation 31 of the 1952 Regulations. If travellers defined in (b) above refuse vaccination, then unless they are in transit, they should be isolated for fourteen days from the date of their departure from the infected area, or for the length of their stay in this country, whichever is the less. During the year 8 possible contacts have been placed under surveillance. All cases remained free from infection during the ensuing critical fourteen days. Leptospirosis (Weil's Disease) In October, 1963, I was informed that a man was in hospital suffering from Weil's disease. He was employed as a sewerman and was assisting in rebuilding an old sewer in another Borough. The Medical Officers of Health for the Borough in which he was working and where the employer's offices were situated were notified. In November, 1963, I received a message from a hospital in the Borough that they had admitted a man from Hampshire suspected to be suffering from Weil's disease. He was stated to be employed in kennels. The Medical Officer of Health for Hampshire was notified. The patient was later transferred to another hospital. Details of a case of this disease involving the death of the patient were given in last year's Annual Report, and in view of the fact that there had been three cases of this disease within twelve months it was arranged that letters should be sent to all builders in the Borough warning them of the seriousness of the disease and of the precautions which should be taken. It was also agreed that the cards issued to the Council's sewermen should be amended and further information given to them. Several Builders in the Borough requested further information and permission was asked for our letter to be used by other Medical Officers of Health. Tuberculosis Twelve 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. However, the number of cases on the register remains fairly constant indicating that a reservoir of infection still remains. Various theories are advanced in support of different views. One school of thought considers that adolescence is the danger period as many children still do not receive B.C.G. vaccination. It is also considered in some quarters that the main reservoir of infection is in the elderly 20 male, living in hostel accommodation, or alone in one or two rooms, who persistently refuses medical attention. Immigrants are also blamed and certainly the analysis of British born and other ethnic groups carried out in the Static Centre of the N.W. Metropolitan Regional Hospital Board Mass Radiography service at Islington during 1962, tends to confirm this opinion, as the non-British born contingent formed only 25% of those examined but yielded approximately 42% of active tuberculosis. The highest incidence rate was amongst Irishmen at the rate of 18 per 1,000 examined. Summary of Notifications during the period from 1st January, 1963, to the 31st December, 1963 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 - - - - - 6 5 8 7 1 5 3 1 36 Respiratory, Females — — 1 1 3 — 3 4 4 3 2 1 1 23 Non-Respiratory, Males — — 1 1 — — — 4 — — — — — 6 Non-Respiratory, Females — 1 — — — — 2 2 1 2 — — — 8 CASES NOTIFIED AND DEATHS—PAST TWENTY YEARS Year No. of Cases notified No. of Deaths No. of Cases on Register of Notifications Pulmonary NonPulmonary Total 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 1963 59 14 73 10 1,379 Average number of cases notified for the 10 years 1944/1953 (inclusive)—206.3. Average number of cases notified for the 10 years 1954/1963 (inclusive)—127.2. Average number of deaths for the 10 years 1944/1953 (inclusive)—64.7. Average number of deaths for the 10 years 1954/1963 (inclusive)—11.7. 21 CHART SHOWING THE NUMBER OF NEW CASES OF TUBERCULOSIS NOTIFIED DURING THE PAST 20 YEARS. PULMONARY TUBERCULOSIS: _____________________ NOW-PULMONARY TUBERCULOSIS: 22 Typhoid—Food Handler On 22nd November, 1962, I was informed by the Medical Officer of Health for Wembley that he had been notified by the Medical Officer of Health for Plymouth that a resident in that town, who was a student and had been living in Wembley, was suffering from typhoid. The student was an apprentice in an engineering firm in this Borough and there had been no absences for intestinal troubles during the previous two months. Upon further enquiries being made it was found that the man with whom the student was lodging was a manager in a food store in this Borough. By arrangement with his employers this man was relieved of his duties and agreed to consult his doctor. Specimens submitted by him and his wife were positive. Treatment was given and further specimens taken. The manager who had produced a negative specimen and who promised to limit his personal handling of food and obey strict instructions over his personal hygiene, was allowed to return to work on 7th December, 1962. Further specimens were taken and on 6th April, 1963, a specimen showed that the manager was excreting Salmonella Typhi. He was immediately taken off his duties and a certificate under the Public Health (Infectious Diseases) Regulations, 1953, was served upon him which incorporated a notice under the London County Council (General Powers) Act, 1959, informing him of the powers of the Council to compensate him for any financial loss suffered as a result of complying with the Notice. On 29th May, 1963, I was informed that three negative specimens had been obtained and the manager was allowed to return to work. No claim for compensation was received as the employers treated him as being on sick leave. I am grateful to the Medical Officer of Health for Wembley for his help and co-operation in this long drawn out case. Typhoid—Zermatt On 11th March, 1963, I was informed that a Nursing Sister in a hospital in the Borough had been isolated as she was suffering from Typhoid Fever. She was removed to an Isolation Hospital later in the day. It appeared that the patient had been on holiday with a party at Zermatt, Switzerland. The agents who arranged the trip were immediately contacted and particulars obtained of all other members of the party who were staying in the same hotel as the patient. A list of contacts was prepared and the Medical Officers of Health of the areas in which their home addresses were situate were notified. The Ministry of Health was notified and close contact was kept with them throughout the spread of infection. There were many cases of Typhoid during the outbreak, both in this country and abroad and considerable publicity was given to the matter both by Press and Radio. All doctors in the Borough, together with food factories were notified of the position as requested by the Ministry. I am pleased to say that although the Sister's illness was severe she was only kept in Isolation Hospital for a month. Paratyphoid B—Case "A" On 1st May, 1963, I received information from the Medical Officer of Health of Brentford and Chiswick that a resident in that Borough employed by a large organisation in Hammersmith, was suffering from Paratyphoid B. The date of onset was given as 19th April, 1963, and he was removed to an Isolation Hospital on 29th April, 1963. There were no other cases of illness in the family but he did eat at the works canteen. Later in the day a message was received from the Borough of Wembley that a resident in the Borough was also suffering from Paratyphoid B. Date of onset was given as 22nd April, 1963, and the patient worked for the same organisation and took meals in the canteen. 23 The canteen and kitchens were inspected and it was arranged for urine and faecal specimens to be taken from all the members of the kitchen and canteen staffs, 140 in all. These all proved negative. On 3rd May, 1963, I was informed that a resident in the Borough of Finchley, also employed by the same organisation, was in hospital with Paratyphoid B. On 8th May, 1963, I was notified by the Public Health Laboratory that the three cases in hospital were all Phage type 3B. The Ministry of Health were notified of the cases, and, having regard to their memo of 2nd May, 1963, regarding Paratyphoid B type Taunton, special enquiries were made regarding the possible use of Chinese bulked egg. The Canteen Manager stated that none of this substance was used, only whole eggs, either English or Polish, were used and albumen which had been imported from Holland. Samples of this albumen and various "mixes" used in the kitchen were submitted for examination—all with negative results. The three cases duly returned to work and no further cases were reported. The source of infection is still not known. Case "B" On 15th May, 1963, I received a message that a girl living in Kensington and working in a food factory in this Borough had been admitted to the Western Isolation Hospital suffering from Paratyphoid "B". The onset was given as 27th April, 1963. She complained of malaise and was admitted to a General Hospital on 2nd May, 1963. Two urine specimens showed coliform organisms and a third showed positive Paratyphoid B. She was then transferred to the Isolation Hospital. She was stated to have worked at the particular food factory until 26th April, and then transferred to another food factory on 29th April, 1963, but only worked there on that day and the following day. It was found that at the first food factory her hands were protected when dealing with the food products and in the second factory very little handling of the finished article took place. There were no other suspects among the staff of the first factory and no abnormal sick absences in either factory. The Public Health Laboratory were of opinion that no further action was called for and the Ministry of Health on being informed of the facts concurred with this view. I arranged with the Medical Officers of both factories to be kept in touch with any further developments. There have been none. In this case I was informed that the infection had been typed as Phage type 1. Case "C" On 9th May, 1963, I received a communication from the Medical Officer of Health for Hendon informing me that a resident in his Borough was suffering from Paratyphoid B Taunton. It had not been possible to trace the source of infection but the Ministry of Health had suggested that Chinese bulked egg products might be responsible, and the patient had informed the Medical Officer of Health that she ate some doughnuts at an exhibition held in this Borough. Enquiries were made and it was found that the doughnuts in question were made at the exhibition and sold direct to the public but no Chinese egg was used in the "mix" from which they were made. 24 International Certificates of Vaccination and Inoculation. Arrangement 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. Fifty Years Ago In 1913 there were 718 cases of tuberculosis notified and 818 other cases of notifiable diseases; included in this latter number were 141 cases of diphtheria, 533 cases of scarlet fever and 98 cases of erysipelas. There were also 1,242 cases of non-notifiable diseases of which 700 were measles and 371 whooping cough. There were 49 deaths from measles, 12 from diphtheria, 41 from whooping cough and 183 from tuberculosis—a total of 285. If one looks at these figures and compares them with the figures for 1963 (no deaths from measles, diphtheria or whooping cough and 10 only from tuberculosis) it can be seen what great strides have been made in preventive medicine during the last fifty years. 25 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 three Student Inspectors. Three Inspectors and one Student Inspector were appointed during the year bringing the establishment up to full strength, the first time for several years. This happy position continued for the last three months of the year and it is anticipated that considerable progress in those aspects of Public Health Inspectors' work, which have so long been neglected, will be made during the coming year. The Council's scheme for training Public Health Inspectors in conjunction with the Public Health Inspectors' Education Board, is beginning to bear fruit. The first Pupil Inspector qualified and was absorbed into the establishment in December, 1962, and two more pupils sit the examination in 1964. It is anticipated that in future an average of one pupil per year will qualify, sufficient we hope to cover normal wastage. Sanitary Circumstances Housing Requests continue to be received from the Housing Manager for inspections to be made in suspected overcrowded cases. Where the request is accompanied by medical certificates supporting the family's application, very careful consideration is given so that recommendations are made only for the most urgent cases. 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 — 1963 10 — 41 13 1 1 Totals 341 97 2,210 802 102 41 *2 cases were referred to the Housing Manager. 26 To make these figures realistic it should be pointed out that those rehoused are extremely unlikely to be from recommendations of the same year. The rehousing of families displaced by slum clearance continues to receive 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 not decreasing, as it should. A solution to this problem is not easy to envisage, particularly in Hammersmith, where building sites are at a premium. One of Hammersmith's problems is 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 often takes place without the provision of adequate amenities in the way of water supply, baths, w.c. accommodation. Squalid conditions arise as a result of the subsequent loss of privacy and the sharing of sanitary arrangements. Overcrowding results either from the growth of the family in limited space or from families being forced to accept inadequate housing because of the shortage of housing accommodation in London and the high rental charges. During the year the provisions of Part II of the Housing Act, 1961, have continued to receive the attention of the Health Department. This legislation was designed to deal with unsatisfactory conditions in houses let in lodgings or occupied by members of more than one family. It gives the Council powers to act in the following ways:— (i) Section 12—To make a Management Order in the case of any house in multiple occupation where it appears to the Council that the premises are in an unsatisfactory state as a result of a failure to maintain proper standards of management. The effect of the Management Order is to apply to the premises Regulations made by the Minister of Housing and Local Government which requires those parts of the premises used in common to be kept in good order and repair. (ii) Section 15—To require the provision of additional amenities under the following headings where their absence renders the house not reasonably suitable for the multiple occupation:— Natural and Artificial Lighting. Ventilation. Water Supply. Personal Washing Facilities. Drainage and Sanitary Conveniences. Facilities for the storage and preparation and cooking of food and for the disposal of waste water. Installations for space heating or for the use of space heating appliances. The Council have adopted general standards to be applied for the provision of such amenities. (iii) Section 16—To require with the approval of the London County Council the provision of satisfactory means of escape from fire. The Council has adopted the Code of Practice for means of escape in case of fire at houses in multiple occupation, formulated by the London County Council. 27 (iv) Section 19—To make a "Direction" to fix as a limit the highest number of individuals who should live in a house having regard to the existing amenities available. Cases are dealt with as they are found by the District Public Health Inspectors during the course of their duties. In addition, during 1963 house to house inspections have been carried out in two separate districts in the Borough. In common with other London Boroughs, difficulties have been experienced in the administration of this legislation: in Hammersmith the following problems were encountered:— (i) Lack of space for the housing of additional amenities. (ii) Tendency for landlords to give notice to tenants and thereby aggravate the housing situation. (iii) Operation of the Direction Procedure under Section 19 is severely restricted. A measure is before Parliament at the time of writing, and it is hoped that this will assist further in improving conditions in houses in multiple occupation. The following is a summary of the work undertaken this year:— No. of Premises inspected 129 (464 lettings) No. of premises where informal action taken 36 No. of premises where no further action taken under the Housing Act 93 (Public Health Act notices were served for a number of defects discovered) Analysis of informal action taken: Notices Served Re: Section 12 (Management) 20 15 (Standards) 35 16 (Fire escape) 4 No. of premises where formal action taken 18 Analysis of formal action taken: No. of Management Orders made (S.12) 13 No. of Directions made (S.19) 1 Notices Served: Re: Section 15 (Standards) 6 16 (Fire escape) 5 Total No. of Inspections made 577 Overcrowding in the Borough remains a very serious problem for although there is ample legislative power, its enforcement 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. The provision of additional housing accommodation continues:— Preparatory work is proceeding on the following sites:— Hammersmith Grove/Goldhawk Road (96 units) Latimer Road area (South) (430 units) Building operations commenced during the year on the following schemes:— Mardale Street/Southbrook Street (92 units) Netherwood Road (24 units) 28 The following dwellings were completed during the year:— Marryat Court 8 Mylne Close 18 Raybourne Court 12 (purchased by Council) Other persons 6 The Council acts as landlord for 3,394 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 1,471 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 (Still living in pre-fabricated dwellings at the end of the year=33) 80 4. Number of families on the Waiting List at the end of the year 1,594 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 1963, a total of 68 dwellings being demolished. Housing Act, 1957. Closing Orders During the year no Closing Orders were made but Closing Orders on 55 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 1963 Number received 164 167 48 12 12 3 2 Number granted 56 78 22 4 2 — 2 For Revocation of Certificates Number received 13 36 33 7 2 5 4 Number granted 11 35 33 5 1 4 3 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 3,714 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. In addition a total of 9,236 revisits were made. 29 Sanitary Inspection Cause of Inspection No. of Inspections No. of Notices served No. of Notices complied with Atmospheric Pollution and Clean Air 2,705 4 - Bakehouses 76 2 1 Club Licensing 26 — — Drainage 3,546 35 64 Factories (Mechanical) 374 13 7 Factories (Non-Mechanical) 33 4 3 Fireguard Regulations 21 — — Food (other than Restaurants and Eating Houses) 2,038 67 17 Hairdressers and Barbers 58 2 2 Housing Act 440 7 3 Housing Applications 108 7 1 Houses in Multiple Occupation 577 33 4 Housing Repairs and Rents Act 23 — — House to House 52 13 — Ice Cream Vendors 317 — — Infectious Diseases 50 1 — Markets 315 — — Milk Vendors 541 — - Noise Abatement Act 38 — — Offices 5 — — Outworkers 109 — — Pet Animals Act 9 — — Pharmacy and Poisons Act 89 — — Public Health Act 3,487 1261 1,264 Public Urinals 2 — — Rats and Mice 2,768 59 20 Restaurants and Eating Houses 235 18 6 Shops Act 203 10 7 Miscellaneous 885 63 1 Total 19,130 1,599 1,400 During the year 647 Statutory Notices were served and 678 were complied with. Summonses—Proceedings instituted during the year Public Health (London) Act, 1936 107 Food & Drugs Act, 1955, and regulations made thereunder 46 L.C.C. Byelaws 37 H.B.C. Byelaws 4 Housing Act 12 Noise Abatement Act, 1960 2 Consumer Protection Act, 1961 (Heating Appliances, Fireguard Regulations) 2 Sewerage The main sewers and the sewage disposal system in London are the responsibility of the London County Council. Rainwater and soil sewage are carried in the same sewers, but the arrangements for Hammersmith are not yet adequate inasmuch as some basements in the Borough are liable to flooding from time to time when heavy storms cause the sewers to be surcharged. However, work is now being undertaken by the L.C.C. to obviate the trouble caused by storm water, 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. The London County Council (General Powers) Act, 1962, authorises this cil 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. 30 The responsibility for appropriate action under this Act has been given to the Works Committee of the Council. Fluoridation of Water Supplies On 30th January, 1963, the Council agreed to ask the Metropolitan Borough's Standing Joint Committee to support the London County Council in its approach to the Metropolitan Water Board for the addition of fluoride to water supplies. As a result of reports in the local Press many letters and papers were received from residents and others, some asking for more particulars, others objecting. Many pamphlets were received both for and against fluoridation and in April, 1963, the Ministry of Health published a booklet setting out the salient facts regarding the matter. The Health Committee of the Council gave consideration to arranging a debate on the matter and a meeting was arranged for 15th October, 1963. Invitations were sent to all doctors and dentists in the Borough and the local and National Press. The meeting under the chairmanship of His Worship the Mayor (Councillor S. M. Atkins, J.P.) was addressed by Dr. A. J. Dalzell-Ward, Medical Director of the Central Council for Health Education; Mr. W. Stewart Ross, the Chairman of the Dental Health Committee of the British Dental Association; and Dr. H. M. Sinclair of Magdalene College, Oxford. Many questions were asked by the audience and answered by the speakers. Water Supply The water supplied to the Borough by the Metropolitan Water Board during 1963 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 Ammoniacal Nitrogen 0.165 0.22 Albuminoid Nitrogen 0.076 0.083 Nitrate Nitrogen 3.9 3.9 Chlorides as Chlorine 32 32 Oxygen abs. from Permanganate 4 hrs. at 27°C 1.22 1.26 Turbidity (Units) 0.3 0.2 Colour 11 11 Hardness (Total) 276 284 Hardness (non-carbonate) 68 66 pH Value 7.8 7.9 Phosphate as P04 1.3 1.3 Silicate as Si02 12 12 Sulphate as SO4 60 60 Magnesium as Mg 5 5 Natural Fluoride as F 0.25 0.25 Surface Active Material as Manoxol O.T 0.08 0.08 Sodium as Na 25 25 Potassium as K. 5.2 5.2 Electrical Conductivity 560 560 31 Bacteriological Examinations: Hampton A shford Common No. of samples 1,091 768 Agar plate count per ml.: 20-24 hours at 37°C 10-6 13-6 Coliform count : Per cent samples negative in 100 ml. 100-0 99-87 E. coli-count : Per cent samples negative in 100 ml. 100-0 99-87 No new important extensions of trunk mains, nor changes in the general scheme of supply have been made during the past year, but 592 yards of new service mains have been laid. All new as well as repaired mains are disinfected with chlorine before being brought into or restored to service. All of the houses in the Borough, numbering some 25,000. 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 31,038 tons Amount of trade refuse collected during the year 2,900 tons 33,938 tons Method of disposal By road to Contractor's tip Frequency of collection (a) House refuse—weekly. (b) Trade refuse—as required. Drainage The Byelaws made by the London County Council under the Public Health (London) Acts, with regard to drainage, and also those relating to water closets etc., are enforced by the Council. During the year 139 plans were submitted to the Health Department and a total of 3,546 inspections were made in connection with supervision of drainage works. Factories 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, 1961 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 83 33 4 - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 325 374 13 - (iii) Other Premises in which tion 7 is enforced by the Local Authority, (excluding outworkers' premises) - - - - Total 408 407 17 - 32 2. Cases in which defects were found Particulars Number of Cases in which Defects were Found Number of Cases in which Prosecutions were Instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.l.) 10 3 — 1 — Overcrowding (S.2.) — — — — — Unreasonable temperature (S.3) - - - - - Inadequate ventilation (S.4.) 3 3 - — — Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) (a) Insufficient - - - — — (b) Unsuitable or defective 4 4 - — — (c) Not separate for sexes — — - — — Other offences against the Act (not including offences relating to Outwork) - - - — — Total 17 10 — 1 — 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 91 - - - - - Jewellery 11 - - - - - Plastic Bags 2 - - - — - Carding, etc. of Buttons,etc. 48 - - - - - Stuffed Toys 2 - - - — - Cosaques, Christmas stockings, etc 5 - - - - - Chocolates & Sweetmeats 16 - - - — - Total 175 — — — — — Rodent Control Once again there has been a slight decrease in the number of dwellings infested with rats, but 120 dwellings were found to be infested with mice compared with 102 last year. A defective drain can be the source of several surface infestations of rats and 70 such drains were discovered after testing, last year. This compares with 92 in 1962. The sewer treatment by sodium fluoracetamide has proved to be most successful, 1,183 sewer manholes were baited and after the fourth treatment 791 were apparently clear of rats. The effects of this improvement should show a 33 welcome decrease in surface infestations in the coming year. The income from treatment at business premises amounted to £190 for the current year, an increase of £56 over 1962. The following is a summary of the work for the year:— TYPE OF PROPERTY Local Authority Dwelling Houses Business etc. Totals Number of properties 42 25,249 4,275 29,566 Number of Complaints 4 535 82 621 Number of properties inspected 10 1,195 202 1,407 Found to be infested by rats, major - 15 5 20 ,, „ ,, ,, ,, ,, minor 3 261 44 308 Found to be infested by mice, major 1 22 5 28 „ „ „ ,, „ ,, minor — 98 40 138 No. of properties treated 4 396 94 494 LICENCES AND REGISTRATIONS London County Council (General Powers) Act, 1954 Hairdressers and Barbers During the year 6 new applications were received and registered, making a total of 133 hairdressers and barbers registered in the Borough. 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. 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, 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. Two sites in respect of which licences are issued to private individuals house 6 caravans. A further site housing 3 caravans is owned by the L.C.C. to whom an additional licence was issued this year authorising them to erect six movable dwellings on a further site. 34 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 (Section II) Smoke Control Areas During the past year continuous progress has been made, and in January, 1963, the Council made an Order in respect of No. 5 (Ravenscourt) area, which was confirmed in August and will come into operation on the 1st July, 1964. In July the Council made a variation order to No. 3 (Addison) Smoke Control Order to exempt those private dwellings in the area of the development scheme to be carried out by a Private Company. This makes a total area of 805 acres subject to Smoke Control Orders, which is 35% of the Borough. A survey of the proposed No. 6 (St. Stephens) Smoke Control area has been completed and it is hoped that the Smoke Control Order will be made early in 1964. This will cover 121 acres. s.c.o. No. Acreage Date Made Date confirmed Operative date No. of premises No. of dwellings Estimated No. adaptations Tons of S.S.F. 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 3.(v)† 25.7.63 7.10.63 1. 5.64 4. 165 18.4.62 7. 9.62 1. 7.63 2,852 3,657 2,985 3,926 5. 173 30.1.63 7. 8.63 1. 7.64 985 1,831 1,005 1,430 6.P 121 2,167 3,127 1,861 1,714 (V)*—Variation Order exempting buildings included in the London County Council Slum Clearance Programme, 1961-5. (V)†—Variation order exempting buildings included in the development area of a private company. P—Proposed Order. Clean Air Act, 1956, Section 3 (2) Applications for prior approval for the installation of furnaces. Applications received 7 Approval given 3 Awaiting approval 4 Clean Air Act, 1956, Section 3 (3) Notification of intention to instal furnaces. No. of notifications received 8 (oil fired 5, gas fired 3) Atmospheric Pollution The two stations set up in the Borough at the Town Hall and Hythe Road for measuring and recording the extent of atmospheric pollution continued to function during the year. Fortunately the latter months of 1963 were comparatively 35 more temperate than those of the previous year and there were no serious periods of extensive smog. It is hoped to set up a third Station to complete the coverage of the Borough and a survey will be made in 1964 to find a suitable site in the centre of the Borough. The emission of smoke in those areas covered by Smoke Control Orders appears to be diminishing, but the wider use of fuel oil in industry, commerce and domestic central heating is likely to increase the emission of sulphur dioxide. This is not peculiar to Hammersmith but appears to be the trend in the London area. Changes in the availability of solid smokeless fuels In December the Ministry of Housing and Local Government published a circular No. 69/63 which dealt with rapid technological changes in the gas industry affecting the future production of open fire gas coke, and the changes in the availability of smokeless fuels. The current position will need to be reviewed as in all probability future Smoke Control Orders will be affected with regard to revised grant arrangement and subsequent increase in expenditure. The choice of approved appliances will have to be widened to include openable stoves, underfloor draught fires and electric thermal storage space heaters, which hitherto have not been extensively used in Hammersmith. Inter-Borough Smoke Control Liaison Committee The Committee met three times 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. INSPECTION AND SUPERVISION OF FOOD Canned Meat For some time past the Health Committee have been increasingly perturbed at the number of complaints received from the general public concerning imported canned foodstuffs and the fact that any action taken must stop at the importer, so frustrating all efforts to bring the matter to the manufacturers concerned. The Committee felt that the Public should be made aware of its concern in these cases and of the action it has taken, therefore authority was given for a statement to be released to the local Press in the following terms:— "The Health Committee of the Hammersmith Council would like to draw the attention of the public to the limited action which the Borough Council can take with regard to complaints about food imported from abroad. "During the past 12 months the Hammersmith Council have received four complaints regarding tins of corned beef, two as to the presence of foreign bodies and two as to the condition of the meat itself. These complaints are, of course, extremely small in relation to the many thousands of tins of corned beef sold in the Borough of Hammersmith, but it is the duty of the Council as the local food and drugs authority to consider all complaints and to take appropriate steps with a view to preventing further similar complaints. "Corned beef is prepared and canned abroad so that it is not possible for the Borough Council to approach the manufacturer as is the case with food prepared in this country. Accordingly, particulars of the complaints were forwarded by the Council to the Ministry of Agriculture, Fisheries & Food, and the Council have been informed by the Ministry that when complaints of this nature are notified to them they make suitable representations to the government of the country in which the corned beef was packed. It is hoped that by so doing the attention of the respective firms will in turn be drawn to the need for increased care in the preparation of products for export to this country." 36 The Milk (Special Designation) Regulations, 1963 Only a small part of these regulations came into force in 1963 in that after September 1st, any pasteurised milk may be sold as "Tuberculin Tested, Pasteurised". This brief measure marks the achievement of a goal to which many years of effort have been applied and the Press Notice preceding the Regulations bears a statement that must have given great satisfaction to all engaged in working for Public Health. All the milk in England and Wales now comes, and will continue to come, from "attested herds." Thirty years ago such a situation seemed almost impossible to attain. This is the culmination of a programme begun in the early thirties. At that time it was estimated that at least 20% of all cattle in Great Britain were affected with tuberculosis. A start was made on a voluntary basis whereby an owner could apply for an official "Tuberculin Test" on his herd after it had been shown by his own veterinary surgeon to be free from reactors in two consecutive tests during a period of twelve months. It was then known as an "attested herd". Progress at first was slow and particularly so in those parts of the country where the need was greatest and infection heaviest. In 1943 a White Paper "Measures to improve the quality of the nation's milk supply" was issued. This forecast far reaching changes in milk and dairies administration. The Government's policy outlined in the White Paper included the following : (1) Achievement of sound breeding policy. (2) Veterinary inspection of all dairy herds at least once a year. (3) Restriction on the sale of milk by retail in specified areas unless it is either "heat" treated, "tuberculin tested" or "accredited" milk. It was decided to eliminate infection in selected areas, gradually covering the country, and at the same time certain areas were chosen as "specified", in which only milk from "attested" or "accredited" herds could be sold raw and all other milk must be subject to heat treatment, either pasteurised or sterilised. After 1954 the designation "accredited" ceased to be used. By the end of 1960 the whole country was an attested area and in 1962 only 0.11% of cattle reacted to the tuberculin test, most of them being only slightly infected. The benefit to the health of the nation from this successful campaign against bovine tuberculosis is inestimable when we realise that something like 250 million gallons of milk a year go into the national larder, and that in the slaughter houses tuberculosis as a cause of condemnation is becoming comparatively rare. This is only one chapter in the Public Health story and it is not yet finished, for work must go on to maintain what has so far been achieved, but one is led to feel that it has been achieved only just in time, especially in view of the present trend towards intensive production of meat animals—a development that would have been fraught with danger 30 years ago. Premises During the year 3,522 inspections were made at food premises, stalls and markets and at 87 of these conditions contravening Food Hygiene (General Regulations) were found. Legal proceedings were taken in 4 cases resulting in fines totalling £160 with 17 gns., costs being imposed. No exemption certificates were granted by the Council in connection with the Regulations during the year. 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) 1 37 Bakers Retail Shops 29 Beer Bottlers 1 Biscuit Manufacturers 2 Butchers 64 Cafes and Restaurants 141 Canteens and Clubs 93 Chemists 31 Confectioners (Sweet shops) 158 Fishmongers (wet and fried) 22 Fruit and Greengrocers 73 Fruit Drinks (bottling) 1 Grocers and Provisions 204 Honey (packing) 1 Ice-Cream Manufacturers 3 Jellied Eels and Pies (manufacture and sale) 3 Milk Processing Depots 2 Milk Distributors 134 Off Licences 43 Public Houses 95 Sweet and Chocolate Manufacturers 5 Wine (bottling) 1 Wholesale food stores 11 Food & Drugs Act, 1955 Legal proceedings were taken under Section 8 of the Food & Drugs Act, 1955, in two cases. One against the proprietor of a cafe in respect of mouldy sausages found in a refrigerator on his premises. The second case concerned a package of rock fish exposed for sale in a self-service store which was found on inspection to be unfit for human consumption. A fine of £5 was imposed with £2 2s. Od., cost. 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 1963 Bacon 64 lbs. Milk 72 tins Baked Beans 25 tins Nescafe 24 tins Blanc Mange 12 pkts. Oatmeal 17 pkts. Biscuits 135 pkts. Peas 162 tins Cereals 1,202 pkts. Peas (dried) 8 lbs. Chicken 5 tins Pickles 4 jars Coffee 29 tins Preserves 12 jars Cream 7 tins Puff Pastry 12 lbs. Creamed Rice 24 tins Ravioli 17 tins Eggs 432 Rice 58 lbs. Fish (wet) 328 lbs. Salad Cream 62 btles. Fish 55 tins Salami 3 lbs. Flour 24 pkts. Salt 36 pkts. Fruit (fresh) 14 lbs. Sauce 30 btles. Fruit (dried) 56 lbs Sausage 122 lbs. Fruit 635 tins Soft Drinks 612 btles. Ham 58 tins Soup 44 tins Jellies (table) 12 pkts Spaghetti 11 tins Lard 24 pkts Tomatoes 136 tins Meat (fresh) 980 lbs Vegetables 203 tins Meat 282 tins 38 Unsound Food Condemned 1963—continued FROZEN FOODS Meat 312 pkts Cheeseburgers 58 pkts. Meat Pies 89 Chickens 59 Mousse 42 pkts. Chicken Pie 111 Pastry266 Pkts Chips 154 pkts. Peas 355 pkts. Chocolate Whip 12 pkts. Pet Pax 31 pkts. Cream Cakes 74 Sausage 32 pkts. Fish 816 pkts. Sausage Rolls 6 pkts. Fishcakes 419 pkts. Vegetables 1,488 pkts. Fruit Pies 59 Vol-au-Vents 5 Hamburgers 71 pkts. Sampling Throughout the year 750 samples of food and drugs taken by the Food and [)rugs Inspector were submitted to the Public Analyst for chemical analysis. Adverse reports received in respect of 14 samples are shown in the following summary :— SAMPLE INFRINGEMENT REMARKS Butter Contained 16.1 % water Further samples satisfactory no action Pork Sausage Contained 51 % Meat Informal sample. Formal samples satisfactory Minced Steak Contained sulphur dioxide 70 p.p.m. Informal sample. Formal sample taken Minced Steak Contained sulphur dioxide 60 p.p.m. Penalty £25 : 3 gns. costs Pork Sausage Sulphur dioxide undeclared 170 p.p.m. Informal sample. Formal sample taken Pork Sausage Meat Sulphur dioxide undeclared 270 p.p.m. Penalty £5 : 5 gns. costs Minced Steak Contained sulphur dioxide 125 p.p.m. Penalty £20 : 3 gns. costs Chicken Pickle Incorrectly labelled Informal sample. Formal sample taken Chicken Pickle Incorrectly labelled Warning letter to retailer Liquid Sweetener Incorrectly labelled Letter to importers who agreed to alter label Strawberry Syrup Incorrectly labelled Informal sample. Formal sample taken Strawberry Syrup Incorrectly labelled Warning letter to retailer Pork Sausage Meat Contained undeclared preservative Informal sample. Unable to obtain formal sample Avocado Pear Stamped on skin with yellow pig ment containing lead Letter to Ministry of Health and Importers. Use of this pigment discontinued 39 In addition to normal routine samples, a number of samples of fresh vegetables and fruit were submitted for examination to detect residual pesticides. All were satisfactory. A number of prescribed drugs on restricted sale were also sampled and all were reported genuine. During the year 31 complaints were received from members of the general Public in connection with food. The following summary shows the action taken after full investigation into each case : Nature of Complaint Action taken Foreign matter in bottle of milk Warning letter Foreign matter in custard tart Warning letter Nail in cooked fish Warning letter Foreign matter in butter Warning letter Unfit corned beef Warning letter Dirty milk bottle Warning letter Unfit corned beef Warning letter Mouldy sausage rolls Warning letter, witness refused to give evidence. Mouldy wrapped sliced bread Warning letter Mould spot in meat pie Warning letter Maggots in bacon Warning letter Caterpillar in tin of peas Legal proceedings. Penalty £2: 2 gns. costs. Flies in tea Informal action Maggots in chicken Legal proceedings. Penalty £ 10: 2 gns. costs Mouldy wrapped bread Vendor absconded, no action possible Metal in doughnut Legal proceedings. Penalty £10: 2 gns. costs Pin in bottle of milk No action Foreign matter in loaf of bread Legal proceedings. Penalty £10: 2 gns. costs Mouldy sliced bread Legal proceedings. Penalty £10: 2 gns. costs Small stone in biscuits Warning letter Mouldy pork pie Legal proceedings. Penalty £10: 2 gns. costs Mould on sliced luncheon meat Legal proceedings. Penalty £5 : 3 gns. costs Foreign matter in flour Proceedings after inspection of premises Foreign object in corned beef Warning letter Mould on tongue sandwich Warning letter Unfit corned beef Warning letter Mould spot on butter Legal proceedings. Penalty £3 : 2 gns. costs Bottle cap in bottle of milk Warning letter Paper in loaf of bread Warning letter Foreign matter in loaf of bread Warning letter Unfit tinned cream Warning letter 40 Bacteriological Examination of Food The following samples were submitted for bacteriological examination by the Public Health Laboratory service : — Ice Cream 81 Milk 91 Ice-Cream Ice cream was manufactured at three premises in the Borough, two of which were wholesale distributors, but at the moment of going to Press one of these has closed down. Most of the ice cream sold in the Borough is pre-packed but the trend to "soft" ice cream is steadily increasing, though it was retarded no doubt by poor weather last summer. Particular attention was paid to sampling from soft ice machines and from mobile vehicles during the year, and as might be expected a number of unsatisfactory results were obtained, but samples improved after advice on management, although some vendors stopped using soft ice machines before the end of the season owing to the bad weather. During the year 81 samples ot ice cream were taken tor bacteriological examinition and the Methylene Blue test by the Public Health Laboratory 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 ½to 2 hours 4 Less than ½ hour The 81 samples were placed in the following grades : — 43 were within Grade 1 14 were within Grade 2 8 were within Grade 3 15 were within Grade 4 Eight of the 15 samples in Grade 4 were manufactured outside the Borough. Four of those manufactured in this Borough were from soft ice machines, and all were followed by satisfactory samples after investigation. One sample gave a satisfactory "plate count" but the methylene blue test was not readable due to chocolate covering. In addition eight samples of ice cream were taken for chemical analysis by the Public Analyst, all of which complied with the standards laid down by the Food Standards (Ice Cream) Regulations. 1959, i.e. not less than 5% fat and not less than 1½% milk solids other than fat. 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. 41 Ice-Cream Manufacturers 2 Ice-Cream sales only 15 Confectioners (Sweet Shops) selling ice-cream 119 Restaurants (selling ice-cream for consumption off the premises) 10 Grocers selling ice-cream 65 Bakers and Confectioners selling ice-cream 4 Fruiterers and Greengrocers selling ice-cream 12 Off-Licensed Premises serving ice-cream 4 Butchers preserving meat and/or manufacturing sausages 49 Grocers and Provision Dealers preserving meat 20 Grocers and Provision Dealers preserving fish 1 Fishmongers curing fish 4 Food Factories manufacturing sausages and preserved food 3 Total 308 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 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 pasteurisation. At one of these depots extensive cartoning of milk is now carried out and a variety of types of cartons are filled for supply by retail sale, especially in milk vending machines of which there are now 18 in the Borough. 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. 488 inspections were made in connection with the processing of milk. Generally the premises were found to be satisfactory. 134 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 in force the previous year: — Dealers' (Pre-Packed) Licences Pasteurised 21 (117) Sterilised 16 (81) Tuberculin Tested 7 (103) These licences will be renewable in 1965. 42 91 samples of designated milk, were taken under the Regulations from milk processing plants and from distributors and automatic vending machines. 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 27 27 27 T.T. Pasteurised 54 53 — 51 2 — — Tuberculin Tested (Raw) 2 — — 1 1 — — Sterilised 8 — — — — 8 — 91 80 — 79 3 8 — One sample of T.T. Pasteurised Milk was void. 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 Tor 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. MEDICINAL BATHS & TREATMENT CENTRE General Due to the bitterly cold weather of January and February, work in this section was rendered very difficult and arduous. Assistance continued to be rendered to Acton, Kensington and the L.C.C. and Middlesex County Council, as the reconstruction of the Kensington Cleansing Station was still in progress. In addition, early in January, frozen water pipes made the Kensington Health Laundry non-effective and their staff were granted limited facilities at our laundry to maintain this valuable service. In February the Kensington .Station became completely inoperative and disinfecting and disinfestation services were carried out by the Hammersmith Station. With the advent of milder weather numerous requests were made for bedding to be dried, as premises were flooded from burst water tanks in roof spaces. Unfortunately due to the influx of work from our own residents, assistance in this connection to neighbouring authorities could not be given. Additional staff were engaged to cope with the extra work, but conditions did not return to normal until the end of March. Assistance has continued to be rendered to the Old People's Welfare section of the Town Clerk's department, 2,536 towels and 74 overalls being laundered for the Luncheon Clubs. The Dormobile was used to convey patients for chiropody treatment, for club meetings and collection and delivery of baggage for holiday participants. Our latest venture to assist the bathing of elderly and infirm continues to make steady progress. It has been possible to arrange up to four baths in one day, but the morning sessions are not easy to organise, 73 fruitless journeys being made to the homes. 20 persons shared the 407 baths arranged. 43 At the moment this service is confined to cases receiving medical attention, mainly for 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. Cleansing and Treatment of Persons The number of persons requiring treatment for scabies and verminous skin conditions is almost the same as last year. A total of 126 people receiving treatment for scabies, whilst 80 were given 83 treatments for head lice, 41 received 64 treatments for pubic lice, and 129 were given 134 treatments for body lice. Due to the disturbing influence of our vagrant visitors, an attempt was made in the Autumn months to restrict their attendance to one afternoon per week. Autumn is the time for their "refresher before camping down for the Winter." 37 received treatment for varying verminous conditions and 7 others who attended at other times did not keep the special appointments made. In addition 345 treatments were given to 272 individuals from neighbouring authorities. Steam Sterilisation This was a quiet year. 429 requests involving 3,614 articles were dealt with compared with 6,741 the previous year. 919 articles from West London Hospital and 352 mattresses from the Dairy Show at Olympia together with 761 articles for 6 neighbouring authorities, were the major items in this year's work. Disinfestation Requests for spraying of premises infested with vermin continue to decrease, only 90 complaints being received in respect of bugs, 11 of cockroaches, 6 of flies and 5 of fleas. As a precautionary measure 28 premises were sprayed prior to removal of household effects to Council properties. Disinfection Premises are not normally sprayed following cases of the more common infectious diseases unless a definite request is received. During the year 14 requests for formaldehyde disinfection were received following death and illness. In most cases the illness was not of an infectious nature and spraying was carried out as a palliative treatment only. HEALTH LAUNDRY The new laundry continued to work smoothly during the year, providing help throughout the prolonged and severe winter, when it was most needed. This service cannot be provided by private enterprise as most of the linen, from incontinent patients, is badly soiled and must receive special treatment. In many cases the provision of clean linen once or twice a week provides that vital extra assistance which makes all the difference to a family nursing a sick member at home. Origin of requests tor service District nurses or other nursing sisters 75 Home Helps 10 Welfare departments or health visitors 54 The person concerned or his/her relations/friends 30 Doctors or hospital almoners 10 Voluntary societies 2 Total 181 44 Every year the story is one of expansion. The figures below speak for themselves. 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 New requests, or request to restart a closed case 16 44 37 38 42 46 61 105 96 133 Requests within the Act 10 34 32 32 34 37 56 97 91 127 Number of persons served during the year, not all being new cases 12 40 39 39 45 45 71 125 139 177 Number of cases reported or follow up visits to home 26 65 60 64 132 151 256 348 239 292 Certificates issued for collections during year 111 350 352 511 1,018 1,137 1,529 2,638 3,494 t 1,650 Number of articles washed and ironed each year 1,201 3,903 4,137 5.580 10,437 11,504 14,977 25,459 : 58.069 5: 5,515 Maximum collections in any one week of the year 10 15 14 19 25 38 52 100 107 139 CORONER'S COURT AND PUBLIC MORTUARY Every convenience is provided for the Coroner, Pathologist and members of the Public. The accommodation comprises Court, Jury room and suite of offices for the Coroner and his officers, a modern post-mortem room with four special tables, refrigerated accommodation for eighteen bodies, and office accommodation for the Pathologist and Mortuary Superintendent. A large waiting room comfortably furnished and a viewing room are also available for the Public. These facilities are utilised by the neighbouring Boroughs of Fulham, Kensington and Chelsea. The number of bodies admitted to the Mortuary during the year was 1,354 an increase of 91 over 1962. There were 1,331 post-mortem examinations, an increase of 79 over the previous year. In all 276 inquests were held at the Coroner's Court compared with 269 the previous year. Details are set out below : Bodies admitted from the Borough: — By order of Coroner 366 On application of Undertakers 3 369 Bodies admitted from other Boroughs: — Fulham (274 by order of Coroner and 9 on application of Undertakers) 283 Chelsea (233 by order of Coroner and 2 2 on application of Undertakers) 235 Kensington (458 by order of Coroner and 9 on application of Undertakers) 467 985 Total bodies admitted 1,354 Of this total 4 were admitted by order of the Police. 45 No. of Post-mortem examinations conducted Hammersmith cases 366 Fulham cases 274 Chelsea cases 233 Kensington cases 458 Total Post-mortems 1,331 No. of Inquests held: — Hammersmith cases 76 Fulham cases 41 Chelsea cases 34 Kensington cases 125 Total Inquests held 276 EXHUMATION AND RE-INTERNMENT OF BODIES Two licences were granted by the Secretary of State for the exhumation and removal of bodies from graves in the Borough during the year. 46 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 Central Council for Health Education, Mr. S. G. Bennett, Administrative London, 24th June. Officer. National Home Safety, Westminster, Councillor Oak. 10/11th October. Mental Health Conference, London, Mr. S. G. Bennett, Administrative 23/24th May. Officer. Clean Air, Scarborough 8/11th October. Councillor E. W. Flynn, Mr. J. Beagle, Clean Air Officer. Association Public Health Inspectors, Mr. P. T. Bayes, Chief Public Health Eastbourne, 24/27 September. Inspector. Royal Institute Public Health & Mr. S. G. Bennett, Administrative Hygiene, Harrogate, 23/27 September. Officer. Royal Society of Health, Eastbourne, Councillor Mrs. E. D. Freeman. 29th April/3rd May. Mr. S. G. Bennett, Administrative Officer. 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: — London and Home Counties Clean Air Advisory Council £2 2s. Od. Noise Abatement Society £10 10s. Od. National Society for Clean Air £26 5s. Od. Central Council for Health Education £14 17s. Od. HEALTH EDUCATION Lectures have been given to various groups on different aspects of the work of the Health Department. Posters have been exhibited throughout the Borough. Topical literature has continued to be distributed to food shops and good use has been made of the Hammersmith News Sheet & Diary, which has a very wide distribution throughout the Borough. Concise articles covering all facets of the Department's work have been published during the past twelve months. 47 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 1963 edition of the Health Service Guide were printed and distributed. This booklet provides a comprehensive guide to all aspects of personal and environmental health, welfare, national health insurance, etc., affecting Hammersmith residents. The British Council alone distributed copies to interested people in Bolivia, Norway, U.S.A., Argentina, Mexico and Brazilia. 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 1963. 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-patient clinics are held foi 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, rehabilitation and re-settlement lof 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 axe 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 48 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.I7. 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. The Public Health Laboratory Service is also available to doctors for bacteriological examinations, throat swabs, intestinal specimens, etc. The necessary swabs and outfits for the laboratory 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 necessary to take action under these Acts in respect of any person in the borough during the year as in all cases it was possible to find a solution in other ways, either 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 18 burials were carried out by the Council. OLD PEOPLE'S WELFARE With the passing of the National Assistance Act, 1948 (Amendment) Act 1962, the Borough Council became able for the first time to supply meals direct to old people, instead of using a voluntary organisation for the purpose, and to make their own arrangements for providing entertainments for old people. The Council decided to avail themselves of these powers and to bring these new arrangements into operation on the 1st April, 1963. The Welfare Committee was appointed to deal with these activities and also entertainments for the blind, physically handicapped and the hard of hearing. The Committee was also charged with the duty of deciding whether contributions should be made by the Council to those voluntary organisations providing services of a welfare nature for old people which the Council is not empowered by statute to provide. Although these services are dealt with in the Welfare Section (Town Clerk's Department), the Health Department continues to play its part in matters of the welfare of old people and closely co-operates with the Welfare Section. PERSONAL HEALTH SERVICES The London 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. 49 The liaison between the staffs of the County Council and the Borough Council continues on a very happy and cordial footing Ante-Natal Clinics, Infant Welfare Centres and Immunisation Sessions etc., are held at the four main clinics situate at:— 1-3, Milson Road 48, Glenthorne Road Becklow Gardens The Curve, Westway In addition there is an Infant Welfare Centre at Queen Charlotte's Hospital each Tuesday afternoon and Chiropody Clinics are held daily at 48, Glenthorne Road and 207, Westway. There are speech therapy clinics at 48, Glenthorne Road and 103, Shepherds Bush Road. The Creche at 48, Glenthorne Road is a public nursery in which children are taken care of whilst their parents are otherwise engaged. There is sufficient 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 £s given to children whose mothers' have to attend the 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. 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 Brook Green 83 Dalling Road 55 Latimer Road 36 Uxbridge Road 60 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 26 full-time and 136 part-time helpers. It continued its good and valuable work during the year from its headquarters at 48 Glenthorne Road, W.6. The 903 cases in which help was provided are classified as follows :— Maternity 17 Tuberculosis 8 Problem families 3 Mothers with school children 7 Chronic sick over 65 751 Chronic sick under 65 77 Acute sick 40 Specially trained home helps are used to assist and educate problem families n housecraft. 50 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 con tinuous circulation. Samples of water were taken for analysis and all were repoited satisfactory. In addition frequent checks are made by the staff at the baths, particularly during heavy bathing loads. Lime Grove: The Public baths and wash-houses in Lime Grove, Shepherds Bush, provide facilities for bathing, swimming and laundry work. For bathing there are private hot baths or shower cubicles; and towels, soap, bath cubes and shampoos are supplied at a small cost. There are concession rates for children, and for old age pensioners free baths on certain days. In the public wash-houses, fully automatic machinery is provided for washing and spin drying. There are alsc hand irons. There are two swimming baths at Lime Grove, the smaller being open all the year round. The larger one is available during summer months only, as during the winter season it is converted into a public hall which may be hired for meetings, concerts, wrestling, dances, etc., and 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 by the Assistant Medical Officers in connection with admission to the Council's Superannuation and/or Sick Pay Scheme during the year was 296 and of this number 79 were found to be unfit for the following reasons :— Chronic Otitis Media 6 Pulmonary Tuberculosis 5 Hypertension 13 Hernia 6 Bronchitis 7 Chest Condition 7 Gastric History 3 Anaemia 2 Varicose Veins 2 Arthritis 2 Cardiac condition 7 Ear condition 3 Arteriosclerosis 1 Neurological symptoms 1 Old Hemiplegia 1 Myxoedema 1 Diabetes 1 Removed R. Patella I Mental History 2 Psychiatric condition 1 Prostate trouble 1 Nervous Debility 2 Old T.B. Ankle 1 Blackouts 1 Abdominal operation 1 Mitral stenosis 1 51 In the past ten years medical examinations have included the taking of x-ray films by private agency. In May of this year agreement was reached with Hammersmith Chest Clinic whereby the Council utilised the special general practitioners' service for a trial period of six months. The service included the full x-ray examination of staff and was so successful that it has been continued on a permanent basis. There are, however, occasional instances where it is more convenient to use the services of a private firm. No charge is made by the Chest Clinic for these examinations, and the Council has recognised this valuable service by making a contribution of £100 to the Hammersmith Hospital Chest Clinic Instrument Fund. The scheme for controlling sick leave works smoothly and satisfactorily. During the year 128 examinations were carried out in this connection. 52 INDEX rage Ambulance facilities 46 Ante-Natal Clinics 49 Atmospheric Pollution 34 Barbers 33 Births 5-15 Burials 48 Cancer, Deaths11-12 Canned Meat 35 Caravans 33 Causes of Death in Age Groups 10 Census 1961 8 Chest Clinic 47 Chiropody Clinics 49 Clean Air 34-35 Closing Orders 28 Condemnation of Food 37-38 Condensed Milk Regulations 42 Conferences 46 Contacts and Carriers of Infectious Diseases 17 Coroner's Court 44 Creche 49 Day Nurseries 49 Deaths—Principal Causes in Age Groups 10 Deaths—Rates 4-15 Deaths—From Carcinoma of Lungs in Age Groups 11 Diphtheria Immunisation 17 Disinfection 43 Disinfestation 43 Drainage 31 Dysentery 18 Environmental Hygiene—Administration 25 Epidemiology 16 Exhumation and Re-internment of Bodies 45 Factories 1-32 Factories—Defects 31-32 Factories—Inspections 31-32 Financial Contributions to Voluntary Organisations 46 Fluoridation 30 Food—Bacteriological Examination 40 Food—Complaints 39 Food and Drugs Act, 1955 37 Food Hygiene Regulations, 1955 and I960 36 Page Food—Inspection and Supervision 35 Food Poisoning 18 Food Premises 36 Hairdressers and Barbers 33 Health Services 48 Health Education 46 Health Information Bureau 47 Health Laundry 43 Home Help Service 49 Hospitals 47 Housing 25-28 Houses in Multiple Occupation 26-27 Ice-Cream 40 Ice Cream and Preserved Food Premises 40-41 Immunisation 17-18 Infant Mortality 5-15 Infectious Diseases : Contacts and Carriers 17 Dysentery 18 Food Poisoning 18 Measles 17 Notifications 16 Paratyphoid 22 Poliomyelitis 18 Smallpox 17-19 Tuberculosis 18-21 Typhoid 22-23 Weil's Disease 19 International Certificates of Vaccination and Inoculation 24 Inter-Borough Smoke Control Liaison Committee 31 Introduction Laboratory facilities 4 Licences 33-34-41 Leptospirosis 19 Markets 42 Marriages 15 Maternal Mortality 5-15 Measles 17 Medical Examination of Staff 50 Medicinal Baths 42 Milk Licences 41 Milk Supplies 41 Milk Regulations 3 53 Page Mortuary 44-45 National Assistance Act, 1948/51 48 Notifications of Infectious Diseases 16 Old People's Welfare 48 Outworkers 32 Overcrowding 27 Paratyphoid B 22-23 Personal Health Services 48 Pet Animals Act, 1951 33 Pharmacy and Poisons Act, 1933 33 Pharmacy and Medicines Act, 1941 33 Physical Conditions 3 Poliomyelitis Immunisation 18 Population 4, 6, 9 Public Baths 50 Public Cleansing 31 Rating 4 Rag Flock and Other Filling Materials Act. 1951 33 Rehousing 25 Removal of Aged Persons 48 Rent Act. 1957 28 Rodent Control 32-33 Sampling 38 Sanitary Circumstances 25 Sanitary Inspection 28 Page Sanitary Inspection—Notices served and complied with 29 Sewerage 29 Slum Clearance 28 Smallpox 18 Smallpox Vaccination 17 Smoke Control Areas 34 Smoke Control Area Map (inside back cover) Social Conditions 3 Speech Therapy 49 Staff, at 31st December, 1963 2 Staff-Inspectoral 25 Statistics 4-15 Steam Sterilisation 43 Summonses 29 Stillbirths 14-15 Tetanus Immunisation 17 Treatment Centre 42 Tuberculosis 19-21 Typhoid 22 Unsound Food Condemned 37 Vaccination 17 Vital Statistics 4-6 Washhouses 50 Water Supply 30-31 Weil's Disease 19 Welfare Centres 49 Whooping Cough Immunisation 17 Printed by Bromley Office Supplies, 39 & 41 East Street, Bromley, Kent.