HAM P3 1 8 9 6. REPORT ON THE SANITARY CONDITION OF THE Parish of St. John, Hampstead, For the Year 1895. BY EDMUND GWYNN, M.D., Medical Officer of Health. E. Mitchener, Printer and Stationer, 26, Eversholt Street, n.w. 1896. REPORT ON THE SANITARY CONDITION OF THE Parish of St. John, Hampstead, For the Year 1895. BY EDMUND GWYNN, M.D., Medical Officer of Health. REPORT OF THE MEDICAL OFFICER OF HEALTH. Vestry Hall, Hampstead, N.W., 4th July, 1896. To the Vestry of the Parish of St. John, Hampstead. Gentlemen, I have the honour to lay before you my Annual Report upon the vital statistics of the Parish of Hampstead for the registration year, 1895. The ordinary sanitary statistics will, as before, be compiled for the parochial year, which terminated on the 25th March, 1896. The first quinquennial census of the whole of London was taken on the 29th of March, 1896, when our numbers were found to bo 75,449. This is equivalent to an annual increase of 1400 persons for the last five years. For the purposes of this report it is necessary, by the directions of the Local Government Board, to estimate ou population to the middle of 1895, which may therefore be taken to be, at that period, 74,399. During 1895 193 now houses came into occupation, of which 138 were situated in the Kilburn and SVest End Wards, against 55 in the Town and Belsize Wards. 4 Marriages.—The number of marriages celebrated was 510, showing an increase of 55 on the previous year. The largest number of marriages took place in the September quarter. Births.—The births registered during 1895 were 1,453, or 42 less than in the previous year. The birth-rate was equal to 19.8, or rather above that for the preceding year, which was 19.6. The birth-rate for London was 30.5, this being, with the single exception of the year 1894, when the rate was 30.1, the lowest London birth rate recorded. The natural increment of our population by excess of births over deaths was 452. Deaths.—During the 52 weeks of the year the deaths registered were 1265. Of this total 403 were deaths, within the district, of non-parishioners who died in various hospitals and institutions. The number of parishioners who died in Hampstead during 1895 was 862, and to these we must add the deaths of 69 parishioners who died in institutions outside our parish, making a grand total of 931. The annual death-rate will be equal to a ratio of 13.4, being higher than that for the preceding year, which was 10.6. The death-rate for London was 19.8 per 1000 for the year. Mortality at different Ages.—The deaths of children under one year were 196, or equal to 19.5 per cent. on total deaths, and to 14 per cent. on total births. Between the ages of 1 year and under 5, the deaths were 74. At 65 years and upwards there were 251 deaths, and of these 131 died between 65 and 75 ; 88 between 75 and 85, and 32 between 85 and 95. Only four persons attained to 90 and upwards, the oldest on the list being an annuitant aged 94. 5 Deaths in Public Institutions. North-Western Fever Hospital 285 Hampstead Hospital 8 St. Peter's Home 17 North London Hospital for Consumption 28 Friedenheim 76 Workhouse 62 476 Special Causes of Death.—The deaths of parishioners from the seven principal zymotic diseases, after correction for those of our parishioners who died in hospitals outside our district, are equal to a ratio of 1.0 per 1000 living inhabitants, and less than that for the preceding year, which was equivalent to 1.4. The ratio for London was 2.74, and for the Northern districts 2 26. The following table will show, at a glance, the diminution or excess of deaths in 1895 from the seven principal zymotic diseases:— Causes of Death. 1895. 1894. Diminution in 1895 Excess in 1895. Small-Pox — 3 3 — Scarlet Fever 8 10 2 — Diphtheria 14 20 6 — Measles 9 31 22 — Whooping Cough 7 26 19 — Enteric & Typhoid Fever 9 5 — 4 Diarrhcea 29 8 — 21 Total 76 103 52 25 6 Thus, whilst under the headings of enteric fever and diarrhœa there has been some excess, there has been a considerable diminution under the heads of small-pox, scarlet fever, diphtheria, measles, and whooping cough. Small-Pox.—No death from this cause occurred, and it is satisfactory to report that only two cases of small pox were registered in the year. One of these cases was that of a male aged 28, who became infected in Bermondsey, and the other an inmate of the North London Consumption Hospital, who had recently been admitted from a lodging house in the East of London, from which a porter suffering from small-pox had been removed. Both these cases were stated to have been vaccinated in infancy. The following measures were taken at the Consumption Hospital: after the removal of the patient, the Isolation Ward in which he had been placed, and the Common Ward which he had previously occupied with other patients, wore closed, carefully disinfected and cleansed. The patient's bedding was destroyed by fire. The nurses, officers and others who had come in contact with the patient were vaccinated on the following day. Revaccination was advised and offered to all the inmates, and accepted by 26 people, and no subsequent case occurred in the hospital. The serious outbreak of small-pox in the course of the summer, many of the cases having, in the first instance, been removed from Salvation shelters and lodging houses, pointed to the fact that these shelters were the means of spreading disease. Representations to the Local Government Hoard, urging that body to bring in a Bill to promote legislation to place all shelters under the provisions of the Common Lodging 7 House Acts, having been made by the Whitechapel Board of Works, it was resolved by your Vestry to support these representations. Scarlet Fever. — 308 cases of this disease were registered against 230 for the previous year, and of these 149 were removed to hospital. The fatal cases were eight, shewing a diminution of two deaths over the preceding year, the rate of mortality being 2.6 per cent. from which it may be inferred that the cases were mostly of a mild type. Diphtheria was the cause of 14 deaths, showing a diminution of six deaths over the preceding year. The total number of cases notified was 112, against 96 for 1894 and 158 for 1893. The total deaths in London from diphtheria and croup taken together numbered 2460. Although fewer by 376 than the number thus returned in 1894, these deaths were still 299 in excess of the average. A question of much public interest has been raised, chiefly by the reports of Mr. iShirley Murphy, the Medical Officer of Health to the London County Council, as to how far the influence exerted by schools in promoting the diffusion of diphtheria, measles, and other infectious diseases. In these reports it is shown, with regard to both scarlet fever and diphtheria, that cases of these diseases decline with the commencement of the School Board holidays and increase again with the re-opening of the Schools. The progressive greater liability of girls as compared with boys, in relation to age, points to personal contact as another important source of infection. In connection with the subject 8 of diphtheria may be mentioned the report on the use of antitoxin in the Asylums Board's hospitals recently issued. It appears that three-fifths of the total cases admitted were treated with antitoxin, and those mostly of the severer type. The mortality on the total number of cases of all classes treated in 1894 was 29.6; in 1895, 22.6, showing a reduction of 7.2 per cent. under the antitoxin treatment. It was found that there was a reduction of mortality in every age group, that is, it diminished progressively as the age advanced. The day of disease at which the treatment commences is an important point; thus, whilst there was shown a reduction of 10.8 per cent. on cases treated on the first day, it had fallen to 3.7 per cent. on cases treated on the 5th day and later. The Superintendents of the various hospitals declare, that in their opinion, " we possess in antitoxin serum a remedy of distinctly greater value in the treatment of diphtheria than any other with which we are acquainted." Measles occasioned nine deaths in the year, and was below our annual average, which is 16. In the previous year there had been 31 deaths from this cause, and after a period of abeyance of many months, towards the end of 1895 this disease again assumed formidable proportions, and attacked large numbers of young children in the Netherwood Street Board School with fatal results. 1 he aggregation of large numbers of infants under one roof certainly seems to add to the danger from a disease too often regarded with indifference by parents, and suffered to run its course unheeded as one of the inevitable diseases of child life. I have long made the observation that this disease is only fatal to the children of the working and labouring classes, a fact which points to a want either of care or means in the treatment of this disease. 9 Whooping Cough.—The deaths from this disease show a a considerable diminution over those for the previous year, being 7 against 26. Diarrhcea caused 29 deaths and was rather above our average. This disease was in excess in London, and the number of deaths from this cause was higher than in any year since 1887. Erysipelas occasioned four deaths. The total number of cases resistered was 53 against 52 for the previous year. Influenza.—This disease again assumed an epidemic form in February and March, and became as fatal as the epidemics of 1891 and 1893. Altogether 50 deaths were attributed to this cause, including primary and secondary cases. The outbreak commenced early in the year, but it was not until the middle of March that the epidemic assumed formidable proportions and carried off victims from all parts of the parish, the Adelaide and Belsize Wards being particularly affected. Local Diseases.—Diseases of the respiratory organs caused 124 deaths, of which 64 were caused by bronchitis, 59 by pneumonia, and 1 by pleurisy. Diseases of the nervous system caused 108 deaths, including 51 from apoplexy, 12 from inflammation of the brain, 20 from convulsions, 10 from diseases of the spinal cord, 5 from epilepsy, and 1 from insanity. Diseases of the heart proved fatal to 76, and those of the digestive system to 59 persons, which latter class includes 8 from peritonitis, and 11 from enteritis; whilst diseases of the liver carried off 25, for the most part diseases due to habits of intemperance. Diseases of the urinary 10 system, including Bright's disease and affections of the bladder, caused 37 deaths. There were 9 deaths from the perils of child birth, including 2 from puerperal fever. Constitutional Diseases—To these causes were attributed 158 deaths, including 59 from cancer, an increase of 9 on the preceding year, 62 from consumption, 11 from tubercular meningitis, 3 from rheumatism and gout, and 6 from diabetes. Developmental Diseases include premature birth, which was answerable for the deaths of 28 infants, and congenital malformations for 8, whilst at the other end of life 40 deaths were attributed to senile decay and old age. In accordance with the requirements of the Local Govern ment Board, under the Public Health Act, Tables No. I. and II. have been prepared. The first of these sets forth the population, births and number of new cases of infectious disease which have come to my knowledge during the year 1895; and also the number of cases removed from their homes for treatment in isolation hospitals. No. II. shows the deaths which have been registered in the Parish, including also the deaths of parishioners in hospitals and other institutions outside the sanitary district classified according to diseases, ages and localities. The total number of certificates received during 1895 was 548, and the amount paid to medical practitioners for furnishing the certificates was £63 14s. 6d. This sum is recouped to the Vestry by the Asylums Board out of the Metropolitan Common Poor Fund. The total number of cases removed to the Fever Hospitals for treatment was 204. 11 Upon receiving notification of a ease of infectious disease the premises where the case occurs is visited within a few hours, particulars taken of the number and circumstances of the family, the state of accommodation of the patient, the number of lodgers (if any) in the house, the school, milk supply and laundress of the family, and of the movements and history of the patient for some days previous to the attack. Every endeavour is made to remove suitable cases to hospital; the parents of children in the affected house are warned not to send them to school, and the head teachers of schools are notified of the illness. In the case of small-pox revaccination of the family and lodgers is looked after. In the case of diphtheria and typhoid fever an inspector subsequently makes an examination of the drainage and water supply, and reports any defects discovered. Lastly, on receipt from the medical attendant of notice that the patient has recovered, or upon his removal to hospital, the clothing, &c., and the premises are thoroughly disinfected, and the latter ordered to be cleansed, whitewashed and re-papered. The school authorities are again notified that the children at the affected house may return to school. When it has been ascertained that the infection has occurred beyond the boundaries of the Parish, a communication to that effect is sent to the Medical Officer of Health of the district concerned. Work of the Sanitary Department.—Table III. contains the summary of the work of the Sanitary Inspectors during the year ending March, 1896. Throughout the Parish 3061 houses and premises were inspected, and 4947 re-inspections were made after the serving of notices. Orders were made for the cleansing, 12 washing and repairs of 454 houses, 448 house drains required repairs or reconstruction, &c., 142 new closets were ordered to be provided, and 400 to he repaired and cleansed. The paving of 126 house yards required to be repaired or new provided; 77 new dustbins were ordered and 85 to be repaired, 177 cisterns required to be cleansed, repaired and covered, and 11 new to be provided ; 29 orders were made to provide suitable receptacles for manure, and 125 for removal of dung and other accumulations Overcrowding was attended to in 7 instances. The total number of complaints received during the year was 258, or somewhat less than for the preceding year. The number of applications to examine the drainage of private houses was 202. The total number of orders made for sanitary amendments of houses and premises was 1683. It was necessary to take legal proceedings in 22 instances. Houses unfit for Habitation.—The premises, 25, New End and Nos. 2, 3, 4 and 6, Grove Place, were in January, 1896, declared to be unfit for habitation. Proceedings were taken under the Housing of the Working Classes Act, 1890, and these houses were ordered to be discontinued to be used for human habitation. (See Table IV.) Cowsheds and Slaughter-houses.—Cowsheds in London will soon become things of the past; only one now remains in Hampstead. The number of slaughter-houses remains the same as that for last year, viz., 7. All these premises were visited by the Public Health Committee, and mostly found to be in good order. 13 Bake-houses. — These now number 40, and are regularly inspected, with the result that the sanitary conditions have been fairly maintained. Section 27 of the Factory and Workshops Act, 1895, provides that a place underground shall not he used as a bake-house, unless it was so used at the commencement of the Act. Disinfection.—The total number of articles disinfected reached 9110, but was less than for the preceding year. Further particulars of these will be found in Table III. 465 houses were disinfected after infectious diseases. Unsound Food.—Certain articles of unsound food were seized during the year, including vegetables, fruit, meat, fish and poultry. Inspectors were directed to visit the street markets on Saturday nights occasionally, to prevent the sale of stale or unwholesome food. Inquests.—The number of inquests held was 52, 31 of which were upon deaths caused by violence. Among the deaths caused by violence were 3 deaths from falls from ladders and stairs, 2 from fracture of the skull, one of which was caused by a fall from a tram ; an infant perished from impaction of teat in the throat from a feeding bottle, and 3 from being suffocated whilst in bed with mother, and three from neglect at birth. Among the 11 cases of suicide 4 were found to have poisoned themselves with carbolic acid, and one with prussic acid. One may remark that carbolic acid, from the facility with which it can be obtained, appears to have replaced the oxalic acid of a former generation, as a common means of 14 suicide. Three died from self-inflicted wounds with razors and carving knife, and 3 from drowning in the Hampstead ponds. Mortuary.—70 bodies were received during the year, the number of post-mortem examinations upon these being 14; 16 bodies were brought in by the police, either the result of accident or bring found dead, 3 by order of the medical officer, 2 by order of medical men, and 4 by the request of friends. The Coroner orders the removal of bodies in many cases for the purposes of inquest. Factory and Workshops Act, 1895.—This Act came into force on January 1st, 1896. By this Act all workshops are to be registered, and Section 6 provides a penalty for allowing wearing apparel to be made, cleansed or repaired in places where there is infectious disease, particularly small-pox and scarlet fever. Lists of outworkers are to be kept, and such lists are to be open to inspection by any officer of the Vestry. Any workshop which does not provide 250 cubic feet of air in proportion to the number of persons employed, and 400 cubic feet of air during overtime, shall be deemed to be overcrowded. The Sanitary Authority is to deal with nuisances arising from overcrowding, and to enforce cleanliness, lime washing, ventilation and freedom from effluvia. Laundries are workshops under the meaning of the Act. Water Supply.—In his report on the chemical, physical, and bacteriological examination of water supplied by the Metropolitan Water Companies during 1895, Professor Frankland states that the Thames water distributed during the year 1895 was of better average quality than that sent 15 out during the four previous years. Of the water chieflyderived from the River Lea, that supplied by the New River Company contained, in every case, as usual, less organic matter than that present in the water of the East London Company, which was in this respect, on the average, equal to the best of the Thames waters. The water of the New River was found to be clear and transparent on 10 occasions out of 12, and that of the West Middlesex on all 12 occasions. The average proportion of organic matter, in a given quantity of water, was stated to be, West Middlesex 3.1, New River 1.6. The hardness of water, due to the presence of bi-carbonite of lime in solution, was found to be more in the New River than in that of the Thames, due to the fact that a large portion of the former Company's water is pumped up from deep wells in the chalk. I am, Gentlemen, Your obedient Servant, EDMUND GWYNN, M.D., Medical Officer of Health. Table No. I. Table of POPULATION, BIRTHS, and of NEW CASES OF INFECTIOUS SICKNESS coming to the knowledge of the Medical Officer of Health during the year 1895, in the Metropolitan Sanitary District of Hampstead ; classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Population at all Ages. Registered Births. Aged under 5 or over 5. New Cases of Sickness in each Locality coming to the knowledge of the Medical Officer of Health. Number of such Cases Removed from their Homes in the Several Localities for Treatment in Isolation Hospital. Census, 1896. Estimated to middle of 1895. 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. Typhus. Enteric or Typhoid. Continued. Relapsing. Puerperal. (a) (b) (C) (d) (e) Hampstead Workhouse, New End ... ... ... Under 5 5 upwds. ... 2 ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... 7 2 ... ... 3 ... ... ... ... 1 ... 5 1 ... ... ... ... ... ... ... ... "Trewint," Haverstock Hil ... ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... ... Field Lane School, Hillfield Road ... ... ... Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... Hampstead ... ... ... Under 5 5 upwds. ... 71 24 2 ... ... ... ... ... ... 9 ... 33 9 1 ... ... ... ... ... ... 1 2 225 85 1 ... 59 3 ... 4 ... 41 2 106 20 ... ... 17 2 ... ... ... 2 Totals 75449 74399 1453 Under 5 5 upwds. 0 73 24 2 0 0 0 0 0 0 10 0 35 9 1 0 0 0 0 0 0 1 2 235 88 1 0 62 3 0 4 0 43 2 114 21 0 0 17 2 0 0 0 2 Table No. II. Table of DEATHS during the Year 1895, in the Metropolitan Sanitary District of Hampstead, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics; Public Institutions being shown as separate localities. Mortality from all causes, at subjoined ages. (i) Mortality from subjoined causes, distinguishing Deaths of Children under Five Years of Age. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 At all ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards Smallpox. Scarlatina. Diphtheria. Membranous Croup. Fevers. Cholera. Erysipelas. Measles. Whooping Cough Diarrhoea & Dysentery. Rheumatic Fever. Ague. Phthisis. Bronchitis, Pneumonia, & Pleurisy. Heart Disease. Injuries. All other Diseases. ??? Typhus Enteric or Typhoid Continued. Relapsing. Puerperal. (a) (b) (c) (d) (e) (f) (g) (h) Hampstead (less Institutions below) 789 186 63 31 31 265 213 Under 5 ... 2 4 ... ... ... ... ... ... 1 2 7 6 27 ... ... 2 35 1 11 151 ??? 5upwds. ... ... 6 ... ... 7 1 ... 3 1 2 1 1 4 1 56 73 65 15 304 ??? Workhouse 62 6 3 ... 4 23 26 Under 5 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 8 9 5upwds. ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... 10 0 11 1 24 53 N. W. Hospital 285 11 173 69 16 16 ... Under 5 ... 53 124 ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 1 ... ... 4 184 5upwds. ... 22 51 ... ... 15 ... ... ... ... ... ... ... ... 1 ... 1 4 ... 2 5 101 Home Hospital 8 ... 1 1 ... 6 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 5 7 St. Peter's Home 17 ... ... 1 4 9 3 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 ... 4 ... 4 17 N. L. Consumption 28 ... ... 1 2 25 ... Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 1 ... ... ... 28 Friedenheim 76 ... ... 6 14 52 4 Under 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5upwds. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 51 ... 1 1 23 76 (Registered in the District ) totals 1265 203 240 109 71 396 146 Under 5 5 upwds. ... 55 128 ... ... ... ... ... ... 1 3 9 6 27 ... ... 2 37 1 11 163 443 ... 22 57 ... ... 23 1 ... 3 ... 1 2 1 1 5 1 154 85 81 20 365 822 The subjoined numbers have also to he taken into account in judging of the above records of mortality. Deaths occurring outside the District among persons belonging thereto 69 5 1 3 8 39 13 Under 5 5 upwds. 1 1 1 3 6 1 1 1 5 4 7 2 42 63 Deaths occurring within the District among persons not belonging thereto 403 12 167 75 36 105 8 Under 5 5upwds. 49 121 2 2 5 179 20 51 15 1 86 6 5 8 32 224 18 Table No. III. PARISH OF ST. JOHN, HAMPSTEAD. Inspector's Report of the Sanitary Work, &c,, completed in the year ending 25th March, 1896. Number of complaints received during the year 258 Number of Houses, Premises, &c., inspected 3061 Number of Re-inspections after order or notice 4947 Number of Applications to examine private house drains, &c 202 Results of Inspection. Orders issued for sanitary amendments of houses and premises 1683 House and premises, &c., cleansed, repaired, and white-washed 454 Yard paving repaired, renewed, &c 105 ,, ,, new provided 21 Houses disinfected after infectious diseases 465 House Drains : - Repaired, trapped, &c 230 Ventilated 114 Disconnected from the sewer 117 Reconstructed 193 New provided 24 Cesspools abolished 1 Water Closets:— Repaired, cleansed, &c 400 Ventilated 23 New provided 142 Dust-bins:— New provided 77 Repaired, covered, &c 85 Water Supply:— Cisterns cleansed, repaired, and covered 171 New Cisterns provided 11 Miscellaneous:— Overcrowding abated 7 Removal of accumulations of dung, stagnant water, animal and other refuse 125 Removal of animals improperly kept 2 Manure receptacles reconstructed or new provided 29 Regularly Inspected. Houses registered under Public Health (London) Act. 1891 843 Bakehouses 40 Licensed Cowhouse 1 Licensed Slaughter-houses 7 Legal proceedings 22 19 Table No. III. (continued). Articles Disinfected in Apparatus. Beds 320 Palliasses 524 Mattresses 258 Bolsters 426 Pillows 1119 Blankets 1571 Sheets 678 Counterpanes 558 Articles of Clothing 1827 Carpets 93 Miscellaneous Articles 1736 9110 20 Table No. IV. PARISH OF ST. JOHN, HAMPSTEAD. Housing of the Working Classes Act, 1890. Premises. Date of Notice requiring premises to be made fit for human habitation. Subsequent action of Vestry. Results. 1896 No. 25, New End Jan. 27 Nil. Discontinued to be used for human habitation. ,, 2, Grove Place „ 30 „ „ „ „ 4, „ „ „ 30 „ „ „ „ 6, „ „ „ 30 „ „ „ „ 3, „ „ „ 30 Summary proceedings taken and closing order obtained. „ „