AC 4347 HAM 56 Metropolitan Borough ol Hammersmith Report on the Health of the Borough 1964 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, 1964. Councillor E. D. Freeman (Mrs.) (Chairman) Councillor J. M. Henry (Miss) (Vice-Chairman) Councillor C. E. Arnold Councilor S. M. Atkins Councillor E. W. Flynn Councillor D. M. Heaks (Mrs.), 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 Mrs. Elizabeth Finn, M.B.E., J.P.) OTHER COMMITTEES OF THE COUNCIL CONCERNED WITH VARIOUS ASPECTS OF THE HEALTH SERVICES. Baths Committee Management and supervision of the Council's Public Baths and Washhouses. Establishment Committee Dealing with medical examination of staff, etc. Housing and Town Planning Committee Powers and duties of the Council under the Housing Acts (other than those delegated to the Health Committee). Works Committee Construction, maintenance and improvement of sewers and public sanitary conveniences. Collection, removal and disposal of house and trade refuse. Cleansing of public highways. Management and control of the Council's Cemeteries. Maintenance and control of parks, gardens and open spaces provided by the Council. CONTENTS Page Introduction 1-2 Staff of the Health Department 3 Physical and Social Conditions 4 PART 1 STATISTICS AND TABLES Area and Population 5 Vital Statistics 5-9 Deaths: 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 19 Smallpox 19 Tuberculosis 19-21 Paratyphoid 22 Poliomyelitis 22 Typhoid 22 International Certificates of Vaccination and Inoculation 22 Mass X-ray 22 PART III ENVIRONMENTAL HYGIENE Staff—Inspectoral 23 Sanitary Circumstances Housing 23-26 Rent Act, 1957, and Housing Repairs Repairs and Rents Act, 1954 26 Sanitary Inspections 26-27 Summonses 27 Sewerage 27-28 Water Supply 28 Public Cleansing 29 Drainage 29 Page Factories, Workshops & Outworkers 29-30 Rodent Control 30-31 Pigeons 31 Licences and Registrations, etc. Hairdressers 31 Pharmacy and Poisons 31 Rag Flock 32 Pet Animals 32 Caravans 32 Children's Nightdress Regs 32 Atmospheric Pollution Smoke Control Areas 32 Measurement of Atmospheric Pollution 33-34 Fuels 34 Inter-Borough Smoke Control Liaison Committee 34 Area Map (inside back covcrj Inspection and Supervision of Food Premises 34-35 Unsound 35 Sampling 36 Complaints 37-38 Bacteriological Examinations of Food 38 Ice-Cream and Preserved Food 38-39 Pasteurised Egg 39 Milk Supplies 39 Designated Milk Licences 40 Condensed Milk Regs. 1959 41 Markets 41 Medicinal Baths General 41 Section 43 of L.C.C. (G.P.) Act, 1953 41 Treatment Centre 41 Sterilisation 41 Disinfestation 42 Disinfection 42 Health Laundry 42 Coroner's Court and Mortuary 43 Page PART IV GENERAL HEALTH & WELFARE SERVICES Ambulance facilities 44 Conferences 44 Financial Contributions to Voluntary Organisations 44 Health Education 45 Food Hygiene Regs 45 Shop Display 45 Health Information Bureau 45 Hospitals 45 Hammersmith Chest Clinic 46 Laboratory facilities 46 Page National Assistance Act 47 Personal Health Services 47 Ante-Natal Clinics 47 Infant Welfare Centres 47 Immunisation 47 Chiropody 47 Speech Therapy 47 Creche 47 Day Nurseries 47 Home Help Service 48 Public Baths and Wash-houses 48 Staff Medical Examinations 48-49 ALPHABETICAL INDEX 50-51 1 Telephone: OLD TOWN HALL, FULham 1212. FULHAM, S.W.6. To the Mayor, Aldermen and Councillors, of the Metropolitan Borough of Hammersmith. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report for 1964. Vital Statistics The Registrar-General's estimate of the population at mid-1964 was at 107,530, only very slightly less than his estimate for the previous year. For the first time since 1955 the birth rate also showed a slight decrease although the adjusted rate of 19.2 per 1,000 live births was still higher than the corresponding rate for the country as a whole. The percentage of the total births in Hammersmith which were illigitimate continued to increase to 17.1 per cent in 1964. The total number of deaths fell during 1964 and the adjusted death rate of 12.0 per 1,000 of the population was in line with the figure for England and Wales which was 12.2 per 1,000 population. Ninety-one of the total deaths were due to cancer of the lung and forty-eight of these deaths occurred in persons of under sixty-five years of age. By contrast there were only five deaths from all forms of tuberculosis during the year, four of which occurred in persons over sixty-five years of age. Only one death was attributable to infectious disease. Sixty-three of the total deaths involved the deaths of infants under one year of age, and the resultant infant mortality rate of 26 per 1,000 live births was rather higher than the corresponding rates experienced during the previous four years, and higher than the rate for England and Wales which during 1964 was 21 per 1,000 live births. Fluctuation of the infant mortality rate must be expected when a relatively small number of deaths are involved. Forty-four of these deaths occurred during the first four weeks, forty-one during the first week. It is gratifying that for the second year running, during which period there was a total of 4,859 births, no deaths were attributed to childbirth. Infectious Disease Once more there were no confirmed cases of diphtheria reported in Hammersmith during the year. This has been the position for the last five years and is an index of the efficacy of immunisation against the condition. It in no way detracts from the necessity to ensure that all children continue to receive their full complement of prophylactic treatment. Poliomyelitis paralytic was reported in a man in the twenty-five/forty-five age group. Fortunately the residual paralysis was not extensive and a good recovery was made. This particular patient had not been immunised against the disease. Some dysentery had to be dealt with during the year and the energetic measures taken to deal with the situation in a school is set out in the body of the report. In recent years this condition has proved to be highly infectious and only the highest standards of hygiene both environmental and personal, are effective in its control. 2 Environmental Health The wide variety of problems dealt with by the Public Health Inspectors during the year, ranging from matters involving housing, clean air, food hygiene, control of nuisance from pigeons are fully described in this report and are only mentioned here to draw attention to the continuing importance of all these aspects of the work in relation to the health of the residents of the Borough. The facilities provided by the Metropolitan Borough Council in regard to health laundry, home bathing, and related services also made a much appreciated contribution to the welfare of the elderly in the community. Conclusion Although it has fallen to me to present the Annual Report for 1964 the responsibility for the work of the department throughout the year fell on Dr. F. M. Day, the Medical Officer of Health. Unfortunately, Dr. Day was on sick leave and I am sure that he would wish me to acknowledge his indebtedness to Dr. H. L. Settle, the Medical Officer of Health of Fulham, who so readily stepped into the breach and advised the Department on its medical problems. I know also that Dr. Day would wish me to pay particular tribute to the Administrative Officer for his excellent work and loyalty during this difficult period as well as to the Chief Public Health Inspector for the added work and responsibility which he so willingly undertook. The good wishes of Dr. Day and all of us in the Public Health Department are extended to Mr. Bayes, for a long and happy retirement. The entire staff of the Health Dept., including his personal secretary, once more receive Dr. Day's grateful thanks for their work during 1964 and his best wishes for their future careers. On my own behalf I should like also to express my sincere thanks to all of those officers for the great help which they so freely gave to me when I took up my duties in Hammersmith. May I in conclusion pay tribute to Dr. Day himself and express to him my admiration for the excellent work which he did in Hammersmith first of all as Deputy and later as Medical Officer of Health. Dr. Day served the Hammersmith Metropolitan Borough Council in both capacities for 27 years and it is particularly sad that his premature retirement, because of ill health, should have coincided with the dissolution of the Metropolitan Borough Council, with the result that his wise advice and experienced services were lost to the new form of health administration in London. During his service in Hammersmith Dr. Day's work was well known beyond the boundaries of the Borough. He was a member of many professional bodies and committees by whom his opinions were very much respected. He takes into his retirement the good wishes not only of all the staff of the Public Health Department in Hammersmith but all of his colleagues in Public Health particularly in London. On behalf of Dr. Day and myself I would like to thank the Chairmen and members of the Committees for their support and guidance to the Health Dept., during this the last year of administration of the Metropolitan Borough Council. I am, Your Worship, Ladies and Gentlemen, Your obedient Servant, A. D. C. S. CAMERON, Deputy Medical Officer of Health. 3 STAFF OF THE PUBLIC HEALTH DEPARTMENT at 31st December, 1964. 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. Whiddett W. M. Robinson Mrs. D. E. Wilson E. Thomson 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 Miss A. E. Barker J. C. Hopkins W. R. Bland G. W. Huddleston D. H. Boucher P. J. Smith R. A. Cummins S. E. Thelner R. J. Darrington Student Public Health Inspectors R. K. W. Bolton, V. J. Quayle, Miss M. Flint Food and Drugs Inspector J. Collier Public Health Inspector ifc 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. 4 PHYSICAL AND SOCIAL CONDITIONS OF THE BOROUGH Hammersmith, the most westerly of the Metropolitan Boroughs, covers an area of 2,282^ 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 20ft. of gravel over blue clay. There is a variation of approximately 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. Unemployment is not a serious problem in Hammersmith as the following figures for the year 1964 indicate:— No. of persons registered as unemployed 1,761 No. of unfilled vacancies 934 The corresponding total figures for 1963 were 2,645 and 951. 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 and 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. 5 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-1963 107,660 Registrar-General's estimate mid-1964 107,530 Rating:— Number of inhabited houses 25,249 Rateable Value £7,983,555 Product of a penny rate £31,250 Mortality:— Number of deaths 1,152 Death Rate per 1,000 population: Crude 10.7 Adjusted (Comparability Factor 1.12) 12.0 England and Wales 12.2 Deaths from heart and circulatory diseases 480 Deaths from Cancer 296 Deaths from Measles — Deaths from Whooping Cough — Deaths from Diarrhoea (under 2 years of age) — 6 Live Births:— Legitimate 1,987 Illegitimate 411 Total 2,398 Rate per 1,000 population:— Crude 22.3 Adjusted (Comparability Factor 0.86) 19.2 England and Wales 18.2 Illegitimate Live Births per cent, of total live births 17.1 Stillbirths:— Legitimate 25 llleeitimate 9 Total 34 Rate per 1,000 total live and stillbirths 14.0 Rate per 1,000 total live and stillbirths England and Wales 17.3 Toal Live and Stillbirths 2,432 Infant Deaths (deaths under 1 year) Legitimate 55 Illegitimate 8 Total 63 (deaths under 4 weeks) 44 (deaths under 1 week) 41 Infant Mortality Rates:— Total infant deaths per 1,000 total live births 26.3 Total infant deaths per 1,000 live births England and Wales 21.0 Legitimate infant deaths per 1,000 legitimate live births 27.7 Illegitimate infant deaths per 1,000 illegitimate live berths 19.5 Neo-natal Mortality Rate (deaths under 4 weeks per 1,000 total live births) 18.3 Early Neo-natal Mortality Rate (deaths under 1 week per 1,000 total live births) 17.1 Perinatal Mortality Rate (stillbirths and deaths under 1 week combined per 1,000 total live and stillbirths) 30.8 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 1964 and previous years is given in the following table 7 VITAL STATISTICS OF WHOLE DISTRICT 1964 and Previous Years Year Population estimated to middle of each year Live Births Total Deaths Registered in the District Transferable Deaths Net Deaths belonging to the District Number Rate per 1,000 Pop. Number Rate 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 19.5 556 144 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 1964 107,530 2,398 22.3 1,328 12.3 660 484 63 26 1,152 10.7 * 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 a slight decrease in both births and deaths this year. This is the first decrease in the birth rate since 1955. CHART SHOWING BIRTH AND DEATH RATES PER 1,000 POPULATION FOR THE PAST 20 YEARS 8 9 (a) Population: Once again the Registrar-General's estimated population figure shows a decrease, the figure for 1964 of 107,530 being 130 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 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 1954 116,500 705 1964 107,530 1,246 (b) Births: The corrected number of births was 1,224 males, 1,174 females, giving a total of 2,398 compared with 2,461 in 1963. This gives an annual rate of 22.3 per thousand of the population. Although there was a decrease of 63 in the number of births there was an increase of 28 in 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 411 and the percentage is 17.1%. 5,899 births were registered in Hammersmith during 1964. Queen Charlotte's Hospital had 3,332 births and Hammersmith Hospital 2,325; only 242 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 1,328. From this figure must be deducted 660 in respect of non-residents transferred to their home towns. To counterbalance this must be added a total of 484 residents of the Borough who died in other parts of England. This gives the corrected figure of deaths as 1.152, comprising 613 males and 539 females. It should be mentioned that of the outward transferable deaths, 584 occurred in three of the large hospitals within the Borough. Once again our death rate is increased by 13 deaths, in hospital, of patients from such far-away places as Greece, Australia, Pakistan, Sierra-Leone, Kuwait. 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 1964 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 4 - - - - - - 1 - - 3 — F - - - - - - - - - - - - 2. Tuberculosis, other M - - - - - - - - - - - - F 1 - - - - - - - - - - 1 3. Syphilitic disease M - - - - - - - - - - - - F 1 - - - -1- - - - - - - - 9. Other Infective and Parasitic Diseases M 1 - - - - - - - - 1 — F 1 - - - - - - - - 1 - - 10. Malignant Neoplasm, Stomach M 20 - - - - - - 2 3 6 5 4 F 18 - - - - - - - 3 1 4 10 11. Malignant Neoplasm, Lung Bronchus M 76 - - - - - - - 11 28 24 13 F 15 — — — — 1 — 1 3 4 4 2 12. Malignant Neoplasm, breast .. M — — — — — — — — — — — — F 19 - - - - - - 2 2 6 5 4 13. Malignant Neoplasm, uterus .. F 12 — — — — — — 1 2 3 3 3 14. Other Malignant and lymphatic M 69 1 3 2 6 21 23 13 Neoplasms F 55 — — — 1 2 1 5 7 7 13 19 15. Leukaemia, Aleukaemia M 3 - - 1 - - - - - 2 - - F 3 - - 1 - - - 1 - - 1 - 16. Diabetes M 3 - - - - - - - 1 - 2 F 4 - - - - - - - - 2 2 — 17. Vascular lesions of nervous System M 35 - - - - - - 2 4 8 9 12 F 68 — — — — 1 — 2 5 6 14 40 18. Coronary Disease, Angina M 145 — — — — — 1 5 18 52 41 28 F 95 - - - - - - - 2 5 29 59 19. Hypertension with Heart disease M 7 - - - - - - - 1 2 — 4 F 4 - - - - - - - - - 3 1 20. Other Heart disease M 23 — — — — 1 — 2 2 3 4 11 F 51 — — — 1 1 4 5 40 21. Other Circulatory disease M 21 — — — — 1 — 2 2 4 6 6 F 31 - - - - - - - - 3 9 19 23. Pneumonia M 37 1 7 - - - - - - 6 4 19 F 37 — 1 2 - - - - 1 6 27 24. Bronchitis M 50 1 — — — 1 1 4 5 19 19 F 18 - - - - - - - - 2 5 11 25. Other Diseases of Respiratory System M 10 - - - 1 - - 1 2 2 3 1 F 4 - - - - - - - - 2 1 1 26. Ulcer of stomach and duodenum M 8 - - - - - 1 - - 3 1 3 F 5 - - - - - 1 - - 1 3 — 27. Gastritis, Enteritis and diarrhoea M - - - - - - - - - - - - F 1 - - - - - - - - - 1 — 28. Nephritis and Nephrosis M 2 - - - - 1 - - - 1 - - F 2 1 1 29. Hyperplasia of prostate M 6 - - - - - - - - - 1 5 31. Congenital Malformations M 13 5 5 1 1 1 F 8 3 2 1 2 - - - - - - - 32. Other defined and ill-defined diseases M 44 22 1 1 — 1 1 2 1 3 5 7 F 56 13 I 2 — — — 1 1 4 12 22 33. Motor vehicle accidents M 12 — — — — 7 — — 2 — 2 1 F 10 - - - - 2 - - - 1 5 2 34. All other accidents M 14 1 2 3 3 1 4 F 9 - 1 - - 1 - 1 5 - 1 35. Suicide M 10 - — 2 1 2 2 2 1 - F 10 — — — — 2 — 1 2 2 2 1 36. Homicide and operations of War M - - - - - - - - - - - - F 1 - - - - 1 - - - - - - M 613 28 15 3 2 14 10 25 61 152 151 152 F 539 16 4 7 4 9 4 14 30 60 127 264 Total all causes 1152 44 19 10 6 23 14 39 91 212 278 416 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 1964 M - 11 28 24 13 76 F 1 4 4 4 2 15 Total 1 15 32 28 15 91 12 DEATHS FROM CANCER DURING THE PAST TEN YEARS Year Population Deaths Rate per 1,000 Year Population Deaths Rate per 1,000 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 1959 108,900 252 2.3 1964 107,530 296 2.8 (d) Infant Mortality The number of deaths of infants under one year of age during the year was 63, giving a mortality rate per 1,000 live births of 26. INFANT MORTALITY—1964 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 ,, 1964 2,398 63 26 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 1963 England and Wales 25 24 23 23 22 22 22 22 21 Scotland 30 29 29 28 28 27 26 27 26 Northern Ireland 32 29 29 28 28 27 27 27 27 Australia 22 22 21 20 22 20 19 20 20 Canada 31 32 31 30 28 27 27 28 26 Chile 121 113 117 127 120 127 116 121 111 Denmark 25 25 23 22 22 22 22 20 19 France 39 36 34 32 30 27 26 26 26 Irish Republic 37 36 33 35 32 30 30 29 27 Italy 49 48 50 48 45 44 40 41 40 Netherlands 20 19 17 17 17 17 16 15 14 New Zealand 22 19 20 19 20 20 19 20 20 Sweden 17 17 17 16 16 16 16 15 15 United States of America 27 26 26 26 26 26 25 26 24 (e) Maternal Mortality There were no maternal deaths during the year. MATERNAL MORTALITY—1964 and Previous Years Year Number of Deaths Pregnancy, childbirth, abortion Number of live Births Maternal Death Rate Average 1924-1933 8 2,145 3.5 ,, 1934-1943 3 1,756 1.7 ,, 1944-1953 2 1.991 1.02 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 — 1964 — 2,398 — (f) Stillbirths In August, 1963, the Registrar-General made available for the first time details of inward and outward transferable stillbirths. The opportunity was therefore taken to obtain from our local Registrars details of the cause of death in all cases of stillbirths registered with them during the year. The following table shows the cause of death in respect of the 28 stillbirths which occurred in Hammersmith Hospital, the 46 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 86. 15 CAUSES OF STILLBIRTH Code No. Cause Males Females Y.30 Chronic disease in mother 4 5 Y.31 Acute disease in mother 1 Y.32 Diseases and conditions of pregnancy and childbirth (1) Ectopic gestation (2) Haemorrhage (3) and (4) Toxaemia (5) Infection 3 2 3 4 Y.34 Difficulties in Labour 1 Y.35 Other causes in mother Y.36 Placental and cord conditions 10 12 Y.37 Birth injury 3 Y.38 Congenital malformation of foetus 1 2 Y.39 Diseases of foetus and ill-defined causes: (0-3) Diseases of foetus (4-6) Other ill-defined or unspecified cause 7 10 10 8 TOTAL 42 44 The actual number of stillbirths credited to the Borough after deduction of outward transfers was 34. (g) Marriages The number of marriages was 1,386 a decrease of 62 compared with the previous year. Particulars are set out hereunder: The Register Office 535 Buildings registered for marriages (Roman Catholic Churches and Chapels at which a Registrar attends) 494 Churches of the Church of England 302 Authorised Persons (Chapels at which a Registrar does not attend) 49 Jewish Synagogues 6 1,386 16 PART II EPIDEMIOLOGY Notification of Infectious Diseases Six hundred and thirty-five cases of infectious diseases were notified during the year including 82 cases removed to hospital. These figures show a decrease on the previous year of 764 cases. This is largely due to the fact that there were few cases of Measles. Dysentery showed an increase due mainly to an epidemic at one of the schools. There was, however, a slight fall in the number of cases of Puerperal Pyrexia, Whooping Cough, Pneumonia 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 Figures 0—1 year 1—2 years 2—5 years 5—15 years 15—25 years 25—45 years 45—65 years 65 + years Scarlet Fever 11 8 1 20 20 Whooping Cough 7 12 19 18 — — — — 56 2 — 56 Acute Poliomyelitis (Par.) — — — — — 1 — — 1 1 — 1 „ „ (Non-Par.) — — — — — — — — — — — — Measles 15 38 85 67 4 — — — 209 5 — 209 Diphtheria — — — — — — — — — — — — Pneumonia 2 — 3 — — 3 6 4 18 11 — 18 Dysentery 3 10 37 62 6 4 2 — 124 14 — 124 Encephalitis (P.I.) — — — — — 1 1 — 2 2 — 2 Enteric or Typhoid Fever — — — — — 1 — — 1 1 — 1 Paratyphoid Fever - - - - - - - - - - - - Erysipelas 2 2 4 1 — 4 Meningococcal Meningitis 1 1 - - - - - - 2 2 — 2 Food Poisoning 1 1 1 1 2 5 — — 11 1 — 11 Puerperal Pyrexia — — — — 38 43 1 — 82 — — 82* Ophthalmia Neonatorum 6 — — — — — — — 6 — — 6† Smallpox - - - - - - - - - - - - Malaria — — — 1 — — — — 1 1 — 1 Scabies — — — 5 5 4 1 1 16 — - 16 Tuberculosis (Pulmonary) 1 — 2 1 16 24 25 6 75 38 — 75 „ (Non-Pulmonary) — — — — 4 3 — — 7 3 — 7 Totals 36 62 158 163 76 89 38 13 635 82 — 635 * Of this total only 21 cases were in respect of residents 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 quarterly 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. 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 8,996 children within the Borough were protected during the year against tetanus, 9,370 against Diphtheria and 7,564 against whooping cough. Prevention of Smallpox Smallpox vaccination continues to be offered to children during the first two years of their life. This year 1,325 children received primary vaccination and 538 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 eventuality 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 18 we shall have a good chance of maintaining our comparative immunity to this disease. 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 two notifications were received for the whole of London. The number of cases of poliomyelitis in England and Wales 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 Hammersmith 5,371 vaccinations against this disease were carried out by the London County Council during 1964. Prevention of Tuberculosis B.C.G. vaccination is offered to all children in their 13th year, with the object of providing artificial immunity during the adolescent period when young people are most susceptible to this disease. A total of 1.065 Hammersmith children received this vaccination this year. Incidence of Infectious Diseases Dysentery 124 cases of dysentery occurred during 1964 which is 76 more than last year, 99 of these cases occurred in the age group 2 to 15 years. This increase of cases over the previous year was partly due to an outbreak of sonne dysentery in two schools in the north of the Borough. Early in June it was reported that several children were absent suffering from diarrhoea. As a precautionary measure it was arranged that specimens would be taken from all absentees and no child would be permitted to return to school until two clear specimens were obtained. The first batch submitted showed that some of the children were suffering from sonne dysentery. Absenteeism continued to increase and all patients found to be suffering from the disease were referred to their family doctor for treatment and further examination. At one period of the outbreak 74 children were absent from one school with 28 positive cases, 37 were absent from the other school with 10 positive cases. The positive cases included family contacts. Food is prepared on the school premises and the kitchen was examined by the District Public Health Inspector and found to be in a thoroughly clean and hygienic condition. Specimens were taken from all kitchen staff but all were clear. In consultation with the Deputy Divisional Medical Officer it was arranged that in the school with the greater number of absentees a specimen would be taken from every child in attendance. The outbreak was controlled and the few remaining cases cleared during the summer recess. 19 Food Poisoning This year there were only 11 cases of Food Poisoning. The following agent was identified:— Salmonella Muenchen 1 In the other 10 cases no specific organism was isolated. Smallpox There were no confirmed cases of smallpox in the Borough during the year or indeed in England. The regulations made as the result of recommendation by the Public Health Committee of the Council of Europe may 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 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.). (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 11 possible contacts were placed under surveillance including 1 case in category (b). All cases remained free from infection during the ensuing critical fourteen days. 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 reservoirs of infection still remain. Various theories are advanced in support of different views. It is considered in some quarters that the main danger is in the elderly 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 20 graphy service at Islington during 1963, tends to confirm this opinion, as the non-British born contingent formed about 25% of those examined but yielded approximately 46% of active tuberculosis. The highest incidence rate was amongst Indians and Pakistanis. Whatever the main reservoir ot infection there is little doubt that adolescence is the danger period for contracting the disease. Despite this there are still many children who do not receive B.C.G. vaccination. Summary of Notifications during the period from 1st January, 1964, to the 31st December, 1964 Age Periods Formal Notifications Number of Primary Notifications of new cases of tuberculosis 0— 1— 2— 5— 10— 15- 20— 25— 35— 45— 55— 65— 75+ Total (all ages) Respiratory, Males — — 1 — — 2 3 11 8 7 10 5 — 47 Respiratory, Females 1 — 2 — 1 5 5 3 1 9 — 2 — 29 Non-Respiratory, Males — — - — — 2 2 — — — — — 4 Non-Respiratory, Females - - - - - 2 1 1 — — — — 4 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 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 1964 76 8 84 5 1,373 Average number of cases notified for the 10 years 1945/1954 (inclusive)—202.9 Average number of cases notified for the 10 years 1955/1964 (inclusive)—117.6 Average number of deaths for the 10 years 1945/1954 (inclusive)—57.5. Average number of deaths for the 10 years 1955/1964 (inclusive)—10.1. 21 CHART SHOWING THE NUMBER OF NEW CASES OF TUBERCULOSIS NOTIFIED DURING THE PAST 20 YEARS. 22 Poliomyelitis The one case of acute poliomyelitis (paralytic) reported was a Nigerian priest who had been visiting hospitals in Nigeria. He arrived in England on the 15th May and was admitted to hospital on the following day. In the opinion of the doctor at the hospital he was suffering from poliomyelitis when he arrived and there is no doubt whatsoever that the disease was contracted in Nigeria. He had not been immunised against poliomyelitis. Paratyphoid Fever A case of paratyphoid was reported by the Medical Officer of Health of a neighbouring borough. The patient was a scholar at a large girls school in the area. An immediate check was made by the District Public Health Inspector who found that the girl had only been at school recently on odd days as she was taking examinations. Out of a total of 475 scholars only 25 were absent. None of the girls had been away on school holidays. The school had its own private swimming bath, the water of which was filtered and chlorinated. As, however, many of the absentees were stated to be suffering from gastro enteritis a check was made on the school kitchen hygiene and specimens were taken of all absentees and kitchen staff. A talk on personal hygiene was given by the Acting Medical Officer of Health. Fortunately with one exception all specimens taken both of staff and scholars proved negative and there was no outbreak. The exception was a scholar found to be secreting salmonella muenchen. Typhoid An immigrant who had suffered from this disease twelve years ago sought employment with a large catering firm in the area. He was dissuaded from this course and found employment as an engineering worker in no way connected with food handling. An immigrant employed in a large catering firm in the area was found to be a typhoid carrier. He was admitted to hospital and eventually discharged as fit. In view of the danger of his reverting to the carrier state he was prohibited from engaging in food handling and suitable employment was found for him in light industry. International Certificates of Vaccination and Inoculation Arrangements continued for the authentication by the Medical Officer of Health of the signature of doctors on certificates of vaccination and inoculation for travellers from this country going abroad as required by the International Sanitary Regulations. Visit of Mass X-Ray Unit to Hammersmith By arrangement with the West Metropolitan Regional Radiography service a mass x-ray unit was made available at six different sites within the Borough during March. The visit was very successful. 23 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, two Public Health Inspectors engaged on duties under the Offices, Shops & Railway Premises Act, 1963, and three Student Inspectors. 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 were successful in 1964. 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. Rehousing 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 1964 8 — 29 — 4 13 Totals 349 97 2,239 802 106 54 * 2 Cases were referred to the Housing Manager. 24 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 houses in multiple occupation have continued to receive the attention of the Health Department. The Housing Act, 1964, has augmented the provisions of the Housing Act, 1961, in respect of houses in multiple occupation. The Act enables local authorities to prosecute in cases where notices served under Section 14, 15 or 16 of the 1961 Act have not been complied with. Under the 1961 Act it was necessary for the local authority to carry out work in default where notices had not been complied with. The new Act gives local authorities the option of carrying out work in default or of prosecuting. Another important amendment of the 1961 Act enables local authorities to combine the improvement of amenities in houses in multiple occupation with the making of a Direction Order limiting the number of persons who may occupy such a house. These powers were used in one case during the year when it was apparent that the new provisions are more satisfactory than the provisions which they replaced. During the year cases have continued to be dealt with by District Public Health Inspectors as they are found during the course of their duties. House-tohouse inspections have also been carried out in three separate districts in the Borough. The following is a summary of the work undertaken: — Houses in multiple occupation 1962 1963 1964 Number of new premises inspected 20 (143 lettings) 129 (464 lettings) 46 (277 lettings) Of these, informal action was taken in respect of 18 premises 36 premises 46 premises Number of premises where no further action taken 2 ,, 93 ,, Nil Number of premises where formal action commenced 2 ,, 18 ,, 19 „ Total number of inspections made 132 577 929 25 Analysis of informal action taken 1962 1963 1964 Served Number complied irrespective of year complied Percentage compl'd of those served Served Number complied irrespective of year complied Percentage compl'd of those served Served Number complied irrespective of year complied Percentage compl'd of those served Re. S.12 (Management) 11 6 54.5% 20 11 55% 18 13 72.2% Re. S.15 (Standards) 18 10 55.5% 35 19 54.3% 30 8 26.6% Re. S.16 (Fire) — — — 4 3 75% 28 4 14.2% Re. S.19 (Overcrowding) 6 4 66.6% 9 5 55.5% 5 1 20% Analysis of formal action taken 1962 1963 1964 Formal action commenced Complied irrespective of year complied Formal action commenced Complied irrespective of year complied Formal action commenced Complied irrespective of year complied Management Orders Nil — 13 Orders made 7 revoked 4 — Section 15 (Standards) 2 2 6 6 8 Nil Section 16 (Fire) Nil Nil 5 5 27 Nil Section 19 (Overcrowding) — — 1 — — — Number of cases in which the Council authorised legal proceedings: — 1962—Nil. 1963—3 cases (all successful). 1964—1 case (not yet heard). 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 Council acts as landlord for 3,416 principal tenants. The properties managed include houses, flats, pre-fabs, acquired and converted accommodation. 26 The following table illustrates the progress that is being made in meeting housing needs: — 1. Number of families rehoused by the Borough Council in new flats and houses since the war 2,250 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 1,550 Slum Clearance Programme During the initial five year stage, 118 houses were demolished or closec whilst for the second stage 1961/5, a further 524 properties were scheduled fo demolition. It is anticipated that 330 of these houses will be dealt with by th London County Council and the remaining 194 by Hammersmith Boroug Council. Satisfactory progress was made during 1964, a total of 49 dwellings bein demolished. Housing Act, 1957. Closing Orders During the year 5 Closing Orders were made and Closing Orders on 1 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 1964 Number received 164 167 48 12 12 3 2 3 Number granted 56 78 22 4 2 — 2 — For Revocation of Certificates Number received 13 36 33 7 2 5 4 2 Number granted 11 35 33 5 1 4 3 2 Undertakings given by Landlord Number accepted 61 117 25 8 10 3 — 2 Sanitary Inspections The sanitary conditions of the Borough were subject to routine inspection and investigations were made into all 2,747 complaints received. Particulars of the visits made by the Public Health Inspectors together with the number of preliminary and statutory notices and the number of proceedings instituted are set out overleaf. 27 Sanitary Inspection Cause of Inspection No. of Inspections No. of Re-visits No. of Notices Served No. of Notices Complied with HOUSING Housing Act 1957 637 4 4 House to House 84 6 6 Housing Defects 7811 2201 965 1227 H.M.O. 898 31 81 26 Overcrowding 30 — — - Re-Housing applications 67 5 5 Rent Act 25 1 1 Moveable Dwellings 12 — - - Drainage 4647 154 50 109 Refuse accommodation 1206 334 222 112 FOOD PREMISES Bakers 60 3 2 1 Bakehouses 133 4 3 1 Butchers 409 17 12 5 Chemist 65 1 1 Confectioners 216 10 5 5 F. Fish 98 2 2 Wet Fish 59 1 1 Grocers 919 52 26 26 Greengrocers 209 19 10 9 Ice-cream 374 2 1 1 Milk Vendor 342 4 3 1 Provisions 163 2 1 1 Caterers 1484 104 50 54 Markets 314 — Licensed Premises 312 38 19 19 Sampling 460 — — — LICENCES Hairdressers and Barbers 95 2 1 1 Club Licensing 25 2 2 — Pharmacy and Poisons 110 — — — Pet Animals 9 — — — Animal Boarding 1 — — — Rag and Flock — — — — Factory (M) 606 38 28 10 Factory (Non M) 27 3 2 1 Outworkers 107 2 — 2 Offices 39 1 1 Shops 227 17 12 5 Noise 153 1 1 — Public Urinals 11 — — — Fireguard Regulations 5 — — — Nightdress Regulations 30 — — — Infectious Disease 198 1 1 — Rats and Mice 1507 32 22 10 Pigeons 73 — — — Clean Air 2678 5 4 1 Miscellaneous 758 1 — 1 No Access 1371 — — — TOTALS 29.064 3100 1544 1628 During the year 671 Statutory Notices were served and 682 were complied with. Summonses—Proceedings instituted during the year Public Health (London) Act, 1936 74 Food & Drugs Act. 1955, and regulations made thereunder 58 L.C.C. Byelaws 22 H.B.C. Byelaws 2 Housing Act 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, 28 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 Council to serve a notice requiring the owner or occupier of such premises to close the basement where the situation could not be remedied at reasonable expense, or otherwise to carry out works to secure the proper and efficient drainage of such property. The responsibility for appropriate action under this Act has been given to the Works Committee of the Council. Water Supply The water supplied to the Borough by the Metropolitan Water Board during 1964 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.) All Thames Derived No. of samples 371 Ammoniacal Nitrogen 0033 Albuminoid Nitrogen 0079 Nitrate Nitrogen 4.8 Chlorides as Chlorine 33 Oxygen abs. from Permanganate 4 hrs. at 27° 1.08 Turbidity (Units) 0.2 Colour 11 Hardness (Total) 270 Hardness (non-carbonate) 64 pH Value 7.6 Phosphate as PO4 1.4 Silicate as SiO2 8 Sulphate as SO4 60 Magnesium at Mg 5 Natural Fluoride as F 0.25 Surface Active Material as Manoxol O.T. 0.09 Electrical Conductivity 550 Bacterioligical Examinations : All Thames Derived No. of samples 3,811 Agar plate count per ml.: 20-24 hours at 37°C 14.1 Coliform count: Per cent, samples negative in 100 ml. 99.95 E. coli-count: Per cent, samples negative in 100 ml. 1000 No new important extensions of trunk mains, or changes in the general scheme of supply have been made during the past year, but 245 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. 29 Public Cleansing The Borough Engineer and Surveyor, who is responsible for the collection, removal and disposal of refuse, has kindly furnished the following information with regard to this service. Amount of house refuse collected during the year. 29,313 tons Amount of trade refuse collected during the year 3,293 tons 32,606 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 165 plans were submitted to the Health Department and a total of 4,647 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 59 27 2 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 506 606 28 - (iii) Other Premises in which Section 7 is enforced by the Local Authority, (excluding outworkers' premises). - - - - Total 565 633 30 — 30 2. Cases in which defects were found Particulars Number of Cases in which Defects were Found Number of Cases in which Prosecutions were Instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of Cleanliness (S.l.) — — — — — Overcrowding (S.2.) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4.) — — — — Ineffective drainage of floors (S.6.) - - - - - Sanitary Conveniences (S.7.) (a) Insufficient - — — — — (b) Unsuitable or defective 30 11 1 — — (c) Not separate for sexes — — — — — Other offences against the Act (not including offences relating to Outwork) — — — — — Total 30 11 1 — — Outwork Nature of Work Section 110 Section 111 No. of Outworkers in August List required by Sect. 110(l)(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 113 - - - - - Jewellery 10 - - - - - Plastic Bags 2 - - - - - Carding, etc. of Buttons, etc. 54 - — - - - Stuffed Toys 2 - - - - - Cosaques, Christmas stockings, etc 16 - - - - - Chocolates & Sweetmeats 15 - - - - - Household Linen 1 - - - - Total 213 — — — — — Rodent Control There was an increase in the number of dwellings infested with rats of 34 compared with the previous year, but only 88 dwellings were found to be infested with mice as against 120 last year. A defective drain can be the source of several surface infestations of rats and 51 such drains were discovered after testing, last year. This compares with 70 in 1963. The sewer treatment by sodium fluoracetamide has continued. The income 3! from treatment at business premises amounted to £186 for the current year, a decrease of £4 over 1963. The following is a summary of the work for the year:— TYPE OF PROPERTY Local Authority Dwelling Houses Business etc. Totals Number of properties 43 25,200 4,230 29,473 Number of Complaints 14 392 69 475 Number of properties inspected 21 862 192 1,075 Found to be infested by rats, major — 15 2 17 minor 8 294 42 344 Found to be infested by mice, major 2 — 1 3 minor 4 88 19 111 No. of properties treated 14 400 64 478 Nuisance from Pigeons For some time past complaints have been received of the nuisance caused by pigeons. Efforts made to trap and destroy these pests met with little success. The Council accordingly wrote to the Ministry of Agriculture, Fisheries and Food expressing their concern at the damage to health which could be occasioned by disease carried by pigeons, and requesting the Ministry to arrange for more extensive research to be carried out into this aspect of public health. A reply was received from the Ministry of Health which stated "the risk to public health of the ordinary town pigeons would not appear to us to be of such magnitude as to justify the kind of public campaign on health grounds which your Council suggests, and we would not consider that there is a case for stimulating further research into this matter". In view of the fact that complaints continued to be received, particularly of the nuisance caused to passers-by under the railway bridges in the vicinity of Ravenscourt Park, it was decided to employ the services of a specialist firm to clear four sites in this vicinity. The treatment was to prebait various points in the area using a narcotic poison. As a result 147 pigeons were caught on Sunday morning, the 31st May. The firm then cleansed the girders on the bridges and placed scarecrow strip on the inside of the girders to prevent the pigeons roosting. The treatment would appear to be successful as no further complaints have as yet been received. LICENCES AND REGISTRATIONS London County Council (General Powers) Act, 1954 Hairdressers and Barbers During the year 13 new applications were received and registered, making a total of 119 hairdressers and barbers registered in the Borough. Pharmacy and Poisons Act, 1933 Pharmacy and Medicines Act, 1941 The names and addresses of 74 retailers were entered on the Council's list of persons entitled to sell poisons under Part II of the above Acts. Many of these persons are food retailers and in some instances the poisons sold are only household disinfectants, but a careful watch is kept on commodities sold under proprietary names containing other poisons mentioned on the list. No action was necessary in respect of any offences under the Acts. 32 Rag Flock and Other Filling Materials Act, 1951 The above Act remained in force during the year, the number of premises on the register being 3 only. Pet Animals Act, 1951 Eight 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 licensed 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. Three sites are owned by the L.C.C., housing 3 caravans and 8 movable dwellings. 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. The Children's Nightdresses Regulations, 1964 These regulations made by the Secretary of State under the provisions conferred by Section 1 of the Consumer Protection Act, 1961, came into force on 1st October, 1964. From the date the regulations came into operation no person may sell or have in his possession for sale a children's nightdress not complying with the regulations (subject to certain exceptions). These regulations also require the cautionary labelling against washing with soaps of nightdresses made from fabrics which have been chemically treated to make them flame resistant. Publicity in the Borough's News Sheet was given to these new regulations and the Public Health Inspectors instructed to check on children's nightdresses offered for sale in all shops. The initial survey of 52 shops revealed that 6 shops were offering unsuitable nightdresses for sale and 7 shops selling unsuitable material for making up. It was decided to purchase and test any nightdress offered for sale which did not appear to comply with the regulations. CLEAN AIR ACT, 1956 (Section II) Smoke Control Areas During the past year steady progress has been made and in March 1964 the Council made an order in respect of the No. 6 Smoke Control Area (St. Stephens) which was confirmed in May and came into operation on the 1st December, 1964. In Oc.cber a variation order to the No. 6 Area was made to exempt some private dwellings which had been acquired by the Council for future housing development. In December the Council made an order in respect of the No. 7 Smoke Control Area (Starch Green) which if confirmed will come into operation on the 1st November, 1965. 33 This makes a total area of 1,109 acres subject to smoke control orders which is 50% of the Borough. A survey of the proposed No. 8 Area (Old Oak, Wormholt and White City) has been completed and it is hoped that the Smoke Control Order will be made early in 1965. This will cover 568 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. I. 169 28.1.59 29.4.59 1.11.59 2359 2025 1157 1750 2. 170 24.2.60 26.5.60 1.7.61 3787 3600 2080 2080 2. (v)* 24.5.61 4.8.61 1.3.62 3. 128 22.12.60 14.11.61 1.11.62 3759 3450 1285 2800 3. (v)† 25.7.63 7.10.63 1.5.64 4. 165 18.4.62 7.9.62 1.7.63 2852 3657 2985 3926 5. 173 30.1.63 7.8.63 1.7.64 985 1831 1005 1430 6. 121 25.3.64 28.5.64 1.12.64 2167 3127 1861 1714 6. (v)° 21.10.64 7. 183 30.12.64 2925 5716 3800 1300 8. p 568 Survey completed 5393 5580 6500 4500 (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. (v)o Variation order exempting buildings included in a development area of the Hammersmith Council. p Proposed Order. Clean Air Act, 1956 Section 3 (2) Applications for prior approval for the installation of furnaces. Applications received 8 Approval given 7 Awaiting approval 1 Clean Air Act, 1956 Section 3 (3) Notification of intention to instal furnaces. No. of notifications received (oil fired 9, gas fired 10, coal fired 1) 20 Atmospheric Pollution The two existing stations at the Town Hall and Hythe Road for measuring and recording the extent of atmospheric pollution continued to function during the year. A third station at Hilary Road was set up in May which completed the entire coverage of the Borough from north to south. There were no serious smogs during the year. The trend was for the pollution by smoke to diminish by as much as 50 per cent. as more use was made of smokeless fuels for domestic heating, especially gas, which has largely replaced coal. 34 The ground level concentration of sulphur dioxide remained much the same as in the previous year in spite of the increased use of oil for industrial, commercial and domestic heating but not withstanding this in September the Council passed a resolution which was forwarded to the Ministry of Power expressing concern at the increase of sulphur dioxide in the atmosphere arising from the greater use of oil fuels. Availability of Solid Smokeless Fuels Following the publication of the Ministry of Housing and Local Government Circular No. 69/63 regarding the changes of availability of solid smokeless fuels, there was some concern lest this would curtail the Council's programme. However, fortunately a shortage did not materialize and the Smoke Control Orders were brought into operation without any undue delay. Changes in Methods of Heating in Smoke Control Areas 1964 also saw a marked change in the method of domestic heating. The gas room heater supplanting the open fire as the main source of heating, and the introduction of a larger grant to encourage the installation of free-standing openable stoves, and under-floor-draught open fires and electric thermal storage heaters. In December, 1964. the Government Circular 60/64 excluded the cost of the installation of direct acting electric space heaters (electric fires) from expenditure attracting grant under the Clean Air Act, to curtail the demand for electricity in peak periods and thus avoid load shedding. Inter-Borough Smoke Control Liaison Committee The Committee met three times and a mutual exchange of information took place. In September a joint meeting was held with the West Middlesex Clean Air Co-ordinating Committee to discuss the formation of a new committee owing to the forthcoming changes affecting constituent members under the Local Government Act, 1963. Hammersmith agreed to refer the matter to the new council at the earliest opportunity with a recommendation for future participation. INSPECTION AND SUPERVISION OF FOOD Premises During the year 5,092 inspections were made at food premises, stalls and markets and at 135 of these conditions contravening the Food Hygiene (General) Regulations were found. Legal proceedings were taken in 6 cases resulting in fines totalling £230 with 30 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) 11 Bakehouses (basement) 1 Bakers' Retail Shops 24 Beer Bottlers 1 Biscuit Manufacturers 2 Butchers 65 Cafes and Restaurants 144 Canteens and Clubs 99 Chemists 31 35 Confectioners (Sweet shops) 171 Fishmongers (wet and fried) 20 Fruit and Greengrocers 81 Fruit Drinks (bottlers) 1 Grocers and Provisions 212 Honey (packing) 1 Ice Cream Manufacturers 3 Jellied Eels and Pies (manufacture and sales) 2 Milk Processing Depots 2 Milk Distributors 130 Off Licences 46 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 2 cases. 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: — Condemned Food 1964 Baked Beans 14 tins. Biscuits 26 pkts. Bovril 35 btles. Butter 119 lbs. Cereals 31 pkts. Cheese 32 lbs. Chocolate 275 lbs. Choc. Liqueurs 44 boxes. Coffee 14 btles. Cooking fat 1120 lbs. Cream 14 tins. Creamed Rice 11 tins. Custard Pdr 12 tins. Fish (wet) 632 lbs. Fish 167 tins. Fruit (dried) 140 lbs. Fruit (fresh) 883 lbs. Fruit 778 tins. Ham 28 tins. Jellies 12 pkts. Macaroni 18 pkts. Margarine 200 lbs. Meat (fresh) 772 lbs. Meat 352 tins. Milk (powdered) 336 lbs. Milk 107 tins. Mincemeat 1008 lbs. Nougat 112 lbs. Nuts (shelled) 388 lbs. Peas 179 tins. Peas (dried) 1618 lbs. Peas Pudding 13 tins. Pepper 14 lbs. Pickles 149 jars. Preserves 947 lbs. Puff Pastry 224 lbs. Pumpkins 7 cwt. Ravioli 12 tins. Rice 6 lbs. Soft Drinks 737 btles. Soup 58 tins. Spaghetti 25 tins. Sugar 1120 lbs. Syrup 56 lbs. Tomatoes 153 tins. Tomato Juice 19 tins. Vegetables 170 tins. Yams 11 tons l½wt. 36 Unsound Food Condemned 1964—continued FROZEN FOOD Beefburgers 30 pkts. Cheeseburgers 14 pkts. Chickens 38 Chicken pies 14 Chips 59 pkts. Fish 193 pkts. Fishcakes 197 pkts. Hamburgers 77 pkts. Meat 11 pkts. Meat pies 98 pkts. Mousse 19 pkts. Pastry 81 pkts. Peas 342 pkts. Sausage 18 pkts. Sausage Rolls 21 pkts. Vegetables 367 pkts. Sampling Throughout the year 750 samples of food and drugs were submitted to the Public Analyst for chemical analysis. Adverse reports received in respect of 12 samples are shown in the following summary. SAMPLE INFRINGEMENT REMARKS Steakette Contained Sulphur Dioxide 580 p.p.m. Informal sample. Formal sample taken. Steakette Contained Sulphur Dioxide 430 p.p.m. Penalty £10 : 5 gns. costs Beef Patties Deficient in meat Informal sample. Formal sample taken. Beef Patties Deficient in meat The sample was divided in accordance with present legal requirements. The Public Analyst considered that this may not give a representative sample in view of the remarks made by the Food Standards Committee on Meat Pies. No action. Beef Sausage Contained 270 p.p.m. Sulphur Dioxide (undeclared) Warning letter to Retailer. Cereal Beverage Not labelled in accordance with the Labelling of Food Order Informal sample. Formal sample satisfactory. Soft Cheese Deficient in fat Informal sample. Cottage Cheese Deficient in fat Formal sample. Referred to Metropolitan Borough Standing Joint Committee. Cottage Cheese Deficient in fat Informal sample. Referred to Metropolitan Borough Standing Joint Committee. Butter Contained 16.2% water Informal sample. Formal sample satisfactory. Slarch Reduced Biscuits Incorrectly labelled Informal sample. Label altered to comply. Starch Reduced Rolls Incorrectly labelled Informal sample. Label altered to comply. 37 In addition to normal routine samples a number of samples of fresh vegetables and fruit were submitted for examination to detect residual pesticides, no evidence of any such residue was found. A number of drugs on restricted sale by prescription only were sampled and all were reported genuine. During the year 39 complaints were received from members of the general public in connection with food purchased in the Borough. The following summary shows the action taken after full investigation in each case Nature of Complaint Can of processed peas—offensive smell Pork Pie caused sickness Cigarette end in Eccles cake Mouldy butter Foreign matter in bottle of milk Cloth in loaf of bread Mould on cheese sandwich Foreign matter in milk bottle Dirty milk bottle Mouldy sausage Insect in marmalade Mouldy sausage roll Sour sausage meat Unfit chicken Mouldy steak and kidney pie Tin of luncheon meat containing sellotape Foreign matter in meat pie Tin of cream—bitter taste Mouldy apple pie Black stains in tin of luncheon meat Corned beef—unpleasant smell Metal in slice of bread Unsound bacon Hairpin in bottle of milk Piece of cigar in ground almonds Action taken Warning letter to manufacturers. No action. Legal proceedings. Penalty £5: 2 gns. costs. Legal proceedings. Penalty £3: 2 gns. costs. Legal proceedings. Penalty £15: 2 gns. costs. Legal proceedings. Penalty £10: 2 gns. costs. Warning letter. No action (insufficient evidence). Legal proceedings. Penalty £5: 2 gns. costs. Legal proceedings. Penalty £20: 7 gns. costs. Letter to manufacturer. Legal proceedings. Penalty £10: 2 gns. costs. Legal proceedings. Penalty £5: 2 gns. costs. No action. Legal proceedings. Penalty £5: 10 gns. costs. Report to Ministry of A.F.F. Legal proceedings. Penalty £10: 10 gns. costs. Letter to manufacturers. Legal proceedings. Penalty £10: 5 gns. costs. Letter to manufacturer. No action. Letter to baker. Legal proceedings. Penalty £20: 7 gns. costs. Legal proceedings. Penalty £5: 2 gns. costs. No action. 38 Nature of Complaint Mouldy shredded suet Pencil pieces in wrapped ham joint Mouldy steak and kidney pie Maggots in bacon Discoloured corned beef Flies in bottle of milk Unsound tinned luncheon meat Foreign body in bottle of milk Dirty milk bottle Sterilised milk with extraneous water Foreign body in sausages Unsound bacon Damaged tin of corned beef Black spots in sausage Action taken Legal proceedings. Penalty £5: 3 gns. costs. Legal proceedings. Penalty £5: 3 gns. costs. Legal proceedings. Penalty £20: 2 gns. costs. Legal proceedings. Penalty £5: 3 gns. costs. Notified Minister. Legal proceedings. Penalty £5: 2 gns. costs. Legal proceedings. Penalty £15: 2 gns. costs. Warning letter. No action (insufficient evidence). Warning letter. Legal proceedings. Penalty £5: 2 gns. costs. Legal proceedings. Penalty £5: 2 gns. costs. No action (insufficient evidence). Warning letter to manufacturers. Bacteriological Examination of Food The following samples were submitted for bacteriological examination by the Public Health Laboratory Service: — Ice Cream 38 Milk 66 Pasteurised Egg 14 Cream 5 Ice Cream Ice cream is manufactured at two premises in the borough, one of which is a large wholesale manufacturing and distributing company. The trend towards the sale of soft ice cream, noticed a year or two ago, has now eased off and in fact a number of small traders have reverted to wrapped ice cream having found that the soft ice cream trade did not suit their particular circumstances. During the year 38 samples of ice cream were taken for bacteriological examination 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: — 39 Provisional Grade 1 2 3 4 Time taken to decolourise Methylene Blue 4½ hours or more 2½ hours or more ½ to 2 hours Less than ½ hour The 38 samples were placed in the following grades: — 25 were within Grade 1 8 were within Grade 2 3 were within Grade 3 2 were within Grade 4 The two samples in grade 4 were manufactured outside the Borough. 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. Premises Registered under Section 16, Food & Drugs Act 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 52 Bakers and Confectioners selling ice-cream 4 Fruiterers and Greengrocers selling ice-cream 11 Off-Licensed Premises serving ice-cream 4 Butchers preserving meat and /or manufacturing sausages 45 Grocers and Provision Dealers preserving meat 21 Grocers and Provision Dealers preserving fish 1 Fishmongers curing fish 4 Food Factories manufacturing sausages and preserved food 3 Total 291 Pasteurised Egg The Liquid Egg (Pasteurisation) Regulations 1963 came into force on 1st January, 1964; they require that all liquid egg used for food must be pasteurised by being retained at a temperature not lower than 148°F. for at least 2\ minutes, and immediately thereafter cooled to a temperature below 38°F. In March a large bakery company in the Borough commenced pasteurisation of liquid egg which had been imported into this country. Frequent inspections were made to ascertain that the required temperatures were being maintained. The plant ceased to operate in June. The fourteen samples of liquid egg taken during the period of operation were all found to be satisfactory. 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 the country. 40 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. Milk is collected from the farms and bulked at creamery centres in the dairying areas and after preliminary tests it is despatched to the processing and distributing depots. A large quantity of milk is also received at these depots in churns direct from the farms. The two depots handle altogether about 180,000 gallons of milk per day. There are nine "high temperature—short time" pasteurising plants in which the milk is heated to, and retained at, a temperature of 161 °F. for 15 seconds, and is then cooled to below 50°F. in accordance with the requirements of the Milk (Special Designation) Regulations 1960-1963. 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 or filled into cartons after pasteurisation. At one of these depots extensive cartoning of milk is now carried out and a variety of types of carton are filled for supply by retail sale, especially in milk vending machines. At regular intervals the Food and Drugs Inspector checks the efficiency and working temperatures of the processing plants and takes samples to ensure that they comply with the requirements of the Milk (Special Designation) Regulations, 1960-1963. All samples taken from these milk plants were reported to be satisfactory. 346 inspections were made in connection with the processing of milk. Generally the premises were found to be satisfactory. 146 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 1960-1963. The figures in brackets relate to licences in force the previous year:— Dealers (Pre-Packed) Licences Pasteurised 20 (138) Sterilised 9 (97) Tuberculin Tested 6 (110) Untreated 4 (Nil) All these licences will be renewable in 1965. 66 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 Test Methylene Blue Test Turbidity Test Passed Failed Passed Failed Passed Failed Pasteurised 18 18 18 _ T.T. Pasteurised 33 33 — 33 - Tuberculin Tested (Raw) 8 — — 7 1 Sterilised 7 - — — — 7 - No samples of milk were submitted for Brucella Abortas check. 41 Two samples of untreated milk were submitted for antibiotics test—no penicillin was detected. Condensed Milk Regulations, 1959 These Regulations provide standards for milk fat and milk solids of condensed milk, and control the labelling of containers. During the year 14 samples were submitted to the Public Analyst for examination and were reported genuine. Markets The Street Traders using the market sites in Bradmore Lane and Norland Road operate from approved pitches licensed 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 A steady flow of work in all sections has been maintained during the year. The winter was relatively mild, the only influx of work being due to flooding caused by heavy rainfall. When this happens every assistance is given to the unfortunate householder. Mattresses are sterilized and dried, bedding is laundered, premises are disinfected. If necessary bedding can be loaned and temporary accommodation provided. Assistance has continued to be rendered to the Old People's Welfare section of the Town Clerk's department, 2397 towels and 104 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. In addition a total of 4378 articles were laundered for use within the department. Bathing of the elderly and infirm is confined to cases receiving medical attention mainly for skin conditions, arthritis, paralysis, and senility. Patients are collected and taken to the medicinal baths where they are bathed under the personal supervision of the superintendent who is a state registered nurse. A total of 22 persons shared the 381 baths arranged. It is very easy to envisage how this service would expand if additional transport and labour were available to bathe all elderly and infirm people lacking facilities in their own homes. Cleansing and Treatment of Persons The number of persons requiring treatment for scabies increased by 41 this year whereas other conditions showed a slight decrease. A total of 161 people received treatment for scabies, whilst 69 were given treatments for head lice, 41 received 66 treatments for pubic lice, and 113 were given 122 treatments for body lice. In addition 214 treatments were given to 144 individuals from neighbouring authorities. Steam Sterilisation 347 requests involving 2,977 articles were dealt with compared with 3,614 the previous year. 910 articles from West London Hospital and 325 mattresses from the Dairy Show at Olympia together with 123 articles for 6 neighbouring authorities, were the major items in this year's work. 42 Disinfestation Due possibly to the warmer summer, requests for spraying of premises infested with vermin showed an increase, 111 complaints being received in respect of bugs, 7 of cockroaches, 3 of flies and 18 of fleas. As a precautionary measure 12 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 13 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. As a precautionary measure 21 dwellings were treated following flooding from surcharged sewers. HEALTH LAUNDRY 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 for Service District nurses or other nursing sisters 56 Home Helps 17 Welfare departments or health visitors 39 The person concerned or his/her relations/friends 23 Doctors or hospital almoners 12 Voluntary societies 5 Other sources 2, Total 154 The output from the laundry continues to expand as the number of articles washed and ironed each year indicates. 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 New requests or request to restart a closed case 16 44 37 38 42 46 61 105 96 133 99 Requests within the Act 10 34 32 32 34 37 56 97 91 127 91 Number of persons served during the year, not all being new cases. 12 40 39 39 45 45 71 125 139 177 154 N umber of cases reported or follow up visits to home 26 65 60 64 132 151 256 348 239 292 269 Certificates issued for collections during year 111 350 352 511 1,018 1,137 1,529 2,638 3,494 4,650 5,476 Number of articles washed and ironed each year 1,201 3,903 4,137 5,580 10,437 11.504 14,977 25,459 38,069 55,515 60,520 Maximum collec tions in any one week of the year 10 15 14 19 25 38 52 100 107 139 154 43 CORONER'S COURT AND PUBLIC MORTUARY The accommodation provided comprises Court, Jury room and suite of offices for the Coroner and his officers, a modern post-mortem room with four 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 1,149, a decrease of 205 over 1962. There were 1,134 post-mortem examinations, a decrease of 97 over the previous year. In all 228 inquests were held at the Coroner's Court compared with 276 the previous year. Details are set out below. Bodies admitted from the Borough:— By order of Coroner 321 On application of Undertakers 6 327 Bodies admitted from other Boroughs:— Fulham (214 by order of Coroner and 5 on application of Undertakers) 219 820 Chelsea (231 by order of Coroner) 231 Kensington (366 by order of Coroner and 4 on application of Undertakers) 370 Wandsworth (Total of bodies admitted) 1 2 Acton (Total of bodies admitted) 1 Total bodies admitted 1,149 No. of Post-mortem examinations conducted:— Hammersmith cases 321 Fulham cases 214 Chelsea cases 231 Kensington cases 366 Wandsworth cases 1 Acton cases 1 Total Post-mortems 1,134 No. of Inquests held:— Hammersmith cases 60 Fulham cases 35 Chelsea cases 42 Kensington cases 90 Wandsworth cases 1 Total Inquests held 228 44 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:— 1. Central Council for Health Education London, 30th January. 2. Area No. 10 Home Safety mittee, 4th April. 3. Royal Society of Health, Torquay, 27th April/1st May. 4. Noise Abatement Society, Brighton, 4th/7th August. 5. Association Public Health Inspectors Portsmouth, 15th/18th September. 6. Association of Public Health istrators, Leeds, 16th/19th Sept. 7. Royal Institute Public Health & Hygiene, Folkestone, 7th/9th October. 8. Mental Health Conference, London, 8th/9th October. 9. Clean Air, Harrogate, 20th/23rd October. 10. National Home Safety, London, 27th/'28th October. Councillor Miss Henry, Mr. S. G. Bennett, Administrative Officer. Councillor Mrs. E. D. Freeman. Councillor Mrs. E. D. Freeman, Mr. S. G. Bennett, Administrative Officer. Councillor Mrs. E. D. Freeman, Mr. J. G. Tompkins, D.C.P.H.I. Mr. P. T. Bayes, Chief Public Health Inspector. Mr. S. G. Bennett, Administrative Officer. Councillor Mrs. E. D. Freeman, Mr. S. G. Bennett, Administrative Officer. Mr. S. G. Bennett, Administrative Officer. Councillor E. W. Flynn, Mr. J. Beagle, Clean Air Officer. Councillor Miss Wood. 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:— Hammersmith Deanery Association for Moral Welfare Work £50 0s. Od. 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 £16 7s. Od. Family Welfare Association £750 0s. Od. Atmospheric Pollution. Standing Conference of co-operating Bodies £2 2s. Od. 45 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. Food Hygiene Regulations Difficulty has been experienced by the Public Health Inspectors in making known their requirements under these regulations to foreign restaurant and cafe proprietors. Although enquiries were made from various sources it was not found possible to purchase suitable literature in foreign languages for distribution. The Council therefore decided to initiate translations in Bengali, Urdu, Greek, Turkish, Italian and Chinese of a simple list of instructions which would be of valuable assistance to food handlers. All London Boroughs were circularised and informed of our intentions with the result that over 2,000 copies of these translations were supplied to 23 councils and also to the Central Council of Health Education. Copies of the notice "now wash your hands" were also made available in all six languages. Shop Display In July last, Messrs. Marks & Spencer Ltd. offered the free use of shop premises at No. 37 King Street, until Christmas 1964, for the purpose of displaying health education publicity material. The General Purposes Committee accepted the offer at its July meeting and works of adaptation were carried out to make it suitable for display material. The Chairman of the Health Committee was consulted and arrangements were made for the display of Food Hygiene and Cleanliness material during August and September, to be followed by displays on "General Public Health", "Clean Air", and just before Christmas a special display on "Home Safety". Much interest was shown by the public in the various displays and a number of enquiries were made at the Health Department. 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. 3,000 copies of the 1964 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. Requests for copies from outside bodies continued to be received. 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. 46 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 1964. 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 for new and follow-up cases, for ambulance cases, for contacts and for antituberculosis 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 of tuberculous and other patients, many social and financial problems arise. To provide adequate help and advice in these circumstances a fully equipped social welfare department forms an integral part of the Chest Clinic service. This department is in the hands of a Certified Almoner, who is in contact with many statutory and voluntary agencies through which advice and assistance can be provided. A comprehensive management scheme for tuberculous patients is in operation in the Borough. Suitable patients are treated with modern methods in their own homes and visited there by the staff of the Chest Clinic. Visits to the Clinic are arranged if necessary by ambulance and patients are also admitted to the Chest Clinic beds for chemotherapy and for major and minor thoracic surgery. Sanatorium treatment, when this is necessary, is undertaken in Sanatoria under the auspices of the North West Metropolitan Regional Hospital Board. Such admission can only be arranged through the Chest Clinic, as is also the case with tuberculous patients to be admitted to Hammersmith Hospital. Laboratory Facilities The Public Analyst for the Borough operates from the Southwark Borough Council's laboratory situated in the Health Centre, Walworth Road, S.E. 17. 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. 47 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, usually by co-operation with the family doctor and providing ancillary services. National Assistance Act, 1948, Section 50 Burial or Cremation of the Dead During the year 15 burials were carried out by the Council. 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. 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 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 is 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 48 The charge for children received into these Nurseries is based on theii parents' income. Home Help Service Administered by the County Council, this service employs 26 full-time ant 136 part-time helpers. It continued its good and valuable work during the yeai from its headquarters at 48, Glenthorne Road, W.6. The 1,094 cases in which help was provided are classified as follows:— Maternity 12 Tuberculosis 7 Problem families 3 Chronic sick over 65 950 Chronic sick under 65 86 Emergency 36 Specially trained home helps are used to assist and educate problem families in housecraft. Public Baths and Wash-houses The Metropolitan Water Board supply is utilised for both baths and pool. The water is subjected to chlorination, alkali treatment and filtration with continuous circulation. Samples of water were taken for analysis and all were reported satisfactory. In addition frequent checks are made by the staff at the baths, particularly during heavy bathing loads. Lime Grove: The Public baths and wash-house in Lime Grove, Shepherds Bush, provide facilities for bathing, swimming and laundry work. For bathing there are private hot baths or shower cubicles; and towels, soap, bath cubes and shampoos are supplied at a small cost. There are concession rates for children, and for old age pensioners free baths on certain days. In the public wash-houses, fully automatic machinery is provided for washing and spin drying. There are also hand irons. There are two swimming baths at Lime Grove, the smaller 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 1 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 49 and/or Sick Pay Scheme during the year was 330 and of this number 90 were found to be unfit for the following reasons:— Chronic Otitis Media 11 Renal History 1 Hypertension 14 Peptic Ulcer 2 Diabetes 1 Parkinson Disease 1 Precardial Pain 1 Operation for carotied stenosis 1 Pitts fracture pain 1 Chest condition 5 Low back strain 2 Heart condition 3 Dermatitis 1 Psychiatric condition 2 Sciatica 1 Urethral stricture 1 Chronic dyspepsia 1 Defective vision 1 Hernia 8 Pituitary gland trouble 1 Old thrombophlebitis 1 Pulm. T.B.2 Arteriosclerosis 1 Old T.B. history 1 Epilepsy 2 Varicose V's & ulceration 1 Heart lesion 1 Obesity 1 Old bayonet wounds 1 Bronchitis 4 Respiratory Infection 1 Gastric condition 3 Laparotomy 1 Chronic asthma 1 Colectomy 1 Papilloma of bladder 1 Emphysema 1 Arthritis 1 Hydrocele 1 History of mental illness 1 Duodenal ulcer history 2 Disc lesion history 1 Nervous debility 1 Evidence of recent satisfactory chest X-ray examination is required from all applicants. When this is not available this service is undertaken by the Hammersmith Chest Clinic under the special general practitioners service. This arrangement, a recent innovation, has worked extremely satisfactorily over the year. No charge is made by the Chest Clinic for these examinations, but the Council has recognised this valuable service by making a contribution of £400 to the Hammersmith Hospital Chest Clinic Instrument Fund. The scheme for controlling sick leave works smoothly and satisfactorily. During the year 69 examinations were carried out in this connection. INDEX Page Ambulance facilities 44 Ante-Natal Clinics 47 Atmospheric Pollution 32 Barbers 31 Births 5-15 Burials 47 Cancer, Deaths 11-12 Caravans 32 Causes of Death in Age Groups 10 Chest Clinic 46 Chiropody Clinics 47 Clean Air 32-34 Closing Orders 26 Condemnation of Food 35-36 Condensed Milk Regulations 41 Conferences 44 Contracts and Carriers of Infectious Diseases 18 Coroner's Court 43 Creche 47 Day Nurseries 47 Deaths—Principal Causes in Age Groups 10 Deaths—From Carcinoma of Lungs in Age Groups 11 Diphtheria Immunisation 17 Disinfection 42 Disinfestation 42 Drainage 29 Dysentery 18 Environmental Hygiene Administration 23 Epidemiology 16 Exhibition 45 Eggs—Pasteurised 39 Factories 29-30 Factories—Defects 29-30 Factories—Inspections 29-30 Finance Contributions to Voluntary Organisations 44 Food—Bacteriological Examination 38 Food—Complaints 37-38 Food and Drugs Act, 1955 35 Food Hygiene Regulations, 1955 and 1960 34-45 Food—Inspection and Supervision 34 Food Poisoning 19 Food Premises 34-35 Fuels 34 Page Hairdressers and Barbers 31 Health Services 44 Health Education 45 Health Information Bureau 45 Health Laundry 42 Home Help Service 48 Hospitals 45 Housing 23-26 Houses in Multiple Occupation 24-25 Ice-Cream 38-39 Ice Cream and Preserved Food Premises 39 Immunisation 17 Infant Mortality 5-15 Infectious Diseases: Contacts and Carriers 18 Dysentery 18 Food Poisoning 19 Measles 17 Notifications 16 Paratyphoid 22 Poliomyelitis 22 Smallpox 19 Tuberculosis 19-21 Typhoid 22 International Certificates of Vaccination and Inoculation 22 Inter-Borough Smoke Control Liaison Committee 34 Introduction 1 Laboratory Facilities 46 Licences 31-32-44 Markets 41 Marriages 15 Mass X-Ray 22 Maternal Mortality 14 Measles 17 Medical Examination of Staff 48-49 Medicinal Baths 41-42 Milk Licences 40 Milk Supplies 39 Mortality 43 National Assistance Act, 1948/51 47 Nightdress Regulations 32 Notifications of Infectious Diseases 16 Outworkers 30 Overcrowding 25 Page Paratyphoid 22 Personal Health Services 47 Pet Animals Act, 1951 32 Pharmacy and Poisons Act, 1933 31 Pharmacy and Medicines Act, 1941 31 Physical Conditions 4 Pigeons 31 Poliomyelitis Immunisation 17 Population 5-7-9 Public Baths 48 Public Cleansing 29 Rating 5 Rag Flock and Other Filling Materials Act, 1951 32 Rehousing 23 Removal of Aged Persons 47 Rent Act, 1957 26 Rodent Control 30-31 Sampling 36 Sanitary Circumstances 23 Sanitary Inspection 26-27 Sanitary Inspection—Notices served and complied with 27 Sewerage 27-28 Slum Clearance 26 Page Smallpox 19 Smallpox Vaccination 17 Smoke Control Areas 32 Smoke Control Area Map Social Conditions 4 Speech Therapy 47 Staff, at 31st December, 1963 3 Staff-Inspectoral 23 Statistics 5-15 Steam Sterilisation 41 Summonses 27 Stillbirths 14-15 Tetanus Immunisation 17 Treatment Centre 41 Tuberculosis 19-21 Typhoid 22 Unsound Food Condemned 35 Vaccination 17 Vital Statistics 5-9 Washhouses 48 Water Supply28 Welfare Centres 47 Whooping Cough Immunisation 17