1900. REPORT ON THE SANITARY CONDITION OF THE Parish of St. john, Hampstead, FOR THE YEAR 1899. BY EDMUND GYWNN, M.D., Medical Officer of Health. LONDON: Printed by E. MITCHENER, 26, Eversholt Street, Camden Town, N.W. REPORT OF THE MEDICAL OFFICER OF HEALTH. Vestry Hall, Hampstead, N.W. June, 1900. To the Vestry of the Parish of St. John, Hampstead. Gentlemen, For the purpose of this report it is necessary, by the direction of the Local Government Board, to estimate our population to the middle of 1899. The first quinquennial census for the whole of London was taken on March 29, 1896, the next is to be held on March 31, 1901. The rapid growth of the houses in new neighbourhoods, and especially of the flat system, must necessarily make all calculations regarding population somewhat uncertain, but after making allowance for newly inhabited dwellings and for the natural increase of population by access of births over deaths, I estimate our numbers at the middle of 1899 to be over 82,593. During the year 1899 the new houses that came into habitation numbered 180, and the new flats 142. Marriages.—The total number of marriages celebrated in Hampstead during 1899 was 572, a decrease of 41 on the preceding year. Births.—The births registered were 1,576, an increase of 60 on the previous year. The birth rate was equal to 19.7 per 1,000 population and somewhat above that for the previous year, which was equal to 181. The rate for the Metropolis was 29.4, the lowest yet recorded birth rate for London. Deaths.—The deaths registered in the year 1899 numbered 1,262, 4 of this total 398 were deaths within the district of non-parishioners who died in the various hospitals and institutions. The number of parishioners who died in Hampstead was 864, and to these we must add the deaths of 62 parishioners who died in institutions outside our parish, making a complete total of 926. The annual death rate will be equal to a ratio of 11.2, being slightly lower than that for the preceding year, which was equivalent to 11.4. The death rate for London corresponds to a rate of 19.8 per 1,000 of population, the average death rate in the previous ten years having been 19.6. Mortality at different Ages.—The deaths of children under one year of age were 206, or equal to 22 per cent, on total deaths of parishioners and to 13 per cent, on total births. At 65 and upwards there were 268 deaths, and of these, 109 reached ages between 70 years and 80, the proportion being 44 males to 65 females; between 80 and 90 years there were 28 deaths, viz., 13 males and 35 females, and 7 attained 90 years and upwards; the two greatest ages recorded being those of widows, aged 94 and 99 respectively. Deaths in Public Institutions. Males. Females. Total. 132 276 North-Western Fever Hospital 144 9 14 Hampstead Hospital 5 13 North London Hospital for Consumption 9 22 St. Peter's Home .. 20 20 80 35 45 Friedenheim 34 75 41 Workhouse 487 247 240 5 Special causes of Death. —The deaths of parishioners from the seven principal zymotic diseases, after correction for those of our parishioners who died in hospital outside our district, are equal to a ratio of 1.19. The ratio for London was 2.48. The following table shows the diminution or excess of deaths in 1899 from the seven principal zymotic diseases. Causes of death. 1899. 1898. Diminution in 1899. Excess in 1899. Small Pox .. .. .. .. 6 3 .. Scarlet Fever 3 Diphtheria 13 19 6 .. Measles 26 22 4 .. 11 7 Enteric and Continued Fever 4 .. Whooping Cough 27 16 11 .. 24 15 Diarrhœa and English Cholera 39 .. Total 95 110 18 33 Small Pox.—It is satisfactory to be able to report that no case of Small Pox was registered in the year, this making the fourth year since the disease visited our parish. From the returns of the Registrar-General it appears that there were only three deaths from Small Pox in London in 1899, against 55, 9, 16 and 1 in the four preceding years. Vaccination. —The number of conscientious objectors' certificates as to vaccination in 1599, for the parish of Hampstead, is stated by the Vaccination Officer to be 36, or rather more than two per cent, on 6 total births. It would seem that contrary to expectation the new law as to vaccination had throughout the country produced a decided effect in increasing the proportion borne by vaccinated children to births. The use of glycerinated calf lymph in which the public have confidence, the abolition of public vaccination stations and domiciliary vaccination, together go to make the operation much more acceptable to the people. The Local Government Board issue some thousands of tubes daily, of glycerinated lymph, which is prepared for them by a considerable staff, in premises rented from the Jenner Institute, with care and accuracy calculated to place the lymph beyond suspicion. Healthy calves are selected and vaccinated. The lymph is prepared with glycerine and the emulsion tested by culture, to see that it contains no harmful organisms. The calf yielding the lymph is subsequently slaughtered, and the lymph is not passed for use until a certificate has been given that the animal from which it was taken was healthy in all respects.* Scarlet Fever. —Two hundred and eighty-five cases of this disease were registered, against 238 for the previous year; 206 of these were removed to isolation hospitals,'including eight cases occurring among the Nursing Staff in the North-Western Hospital. Our deaths from this cause were six, or three above the number recorded for 1898; the mortality was 2.1 per cent, on registered cases. Diphtheria. —The total number of cases of this disease notified during the year was, including four cases which occurred among the staff of the North-Western Hospital, 106 against 131 for 1898. The fatal cases from this cause were 15, equivalent to a mortality of 13.2 per cent, on registered cases. The cases removed from their homes to isolation hospitals numbered 62. Diphtheria was the assigned cause of 1,964 deaths in London in the course of the year 1899. To quote from the Registrar-General, "The London death rate from Diphtheria in 1899 was below the average of the rates in the ten years, 1889-1898, which had been 0.49 * Report of Local Government Board. 7 per 1,000 living population. The total mortality from Diphtheria is very seriously disturbed by the existence of hospitals in certain of the areas: in Hampstead, for example, 153 deaths from Diphtheria were registered in 1899; most of these occurred in the Metropolitan Asylums Board Hospital, to which the patients had been admitted from other districts, and after distribution of institution deaths, only 15 remained as belonging to Hampstead sanitary area." The death rate for Hampstead from Diphtheria per 1,000 living was 0.27, for Marylebone 0.51, for St. Pancras 0.50, and Islington 0.67. The treatment of Diphtheria by antitoxin serum continues, according to the reports of the Medical Superintendents of the various fever hospitals, to be giving satisfactory results. Measles. —Measles was the cause of 22 deaths, against 26 for 1898. The disease became prevalent in March, April and May, finally disappearing towards the end of June. The greatest fatality was in the Town Ward, where several of the elementary and infant departments of public schools were largely affected. Two children died from this disease in the Workhouse. Enteric Fever. —The total number of cases of this disease registered was 41, against 49 for 1898. These 41, however, include 9 cases of nurses and members of the female staff in the North-Western Hospital, who contracted the disease in the discharge of their duties, so that the number of cases referred to Hampstead parishioners may be reduced to 32. The fatal cases were four, against 10 for 1898. Enteric Fever was the registered cause of 801 deaths in the Metropolis. These deaths were equal to a rate of 0.18 per 1,000 living population, as compared with 0.14, the average rate in the ten years 1889-1898. The Registrar-General states that the lowest rates from this disease were 0.4 in St. Saviour, and 0 - 5 in Hampstead; the highest rates were 0.30 in Bethnal Green, 0.35 in Clerkenwell, and 0.43 in the City of London. Diarrhœa was returned as the cause of 39 deaths, all of which occurred in the third quarter of the year, when the temperature was 8 above the average. Thirty-two of these deaths were of Infants under one year. The deaths from diarrhoea were considerably in excess in the Metropolis of the average rate in the preceding 10 years. Whooping Cough was the assigned cause of 11 deaths, against 27 for 1898. The whooping cough death rate in London was 0.38 per 1,000; the mean rate in the 10 years, 1889-98, having been 0.54 per 1,000. Erysipelas. —Fifty-one cases of this disease were registered during the year; there was no death from this cause. Puerperal Fever. —Two deaths were registered from this cause, and five cases in all were recorded. Infection by the agency of the Midwife was thought to be traced in certain instances. A Bill for the Registration and Control of Midwives is now before Parliament, but owing to the pressure of other matters appears at present to have little chance of passing. Notification of Infectious Disease. —The total number of certificates received was 491, for notifying which the sum of £59 14s. was paid to Medical Practitioners. This amount is recouped to the Vestry by the Asylums Board, out of the Metropolitan Common Poor Fund. The total number of cases removed to fever hospitals for treatment was 291. Upon receiving notification of a case 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 the school are notified of the illness. 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 and whitewashed. 9 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. Influenza. —Influenza was the registered cause of 32 deaths, the disease being prevalent in the months of February, March, and April, when complications of Pneumonia and Bronchitis were most common and fatal, besides thoso of other organs, such as the heart, liver, and the nervous system. The victims were of all ages, from six months to 79 years of age, but most commonly over 50 years, the cases being spread over all parts of the parish. In London the number of deaths from Influenza reached 1,817, which is the highest recorded since 1895. Local Diseases. —Diseases of the respiratory organs caused 135 deaths, of which 79 were attributed to Bronchitis and 54 to Pneumonia. Diseases of the Nervous System caused 80 deaths, a decline of 20 on the preceding year. This class includes Apoplexy, Paralysis, and Convulsions of infants. Deaths from Diseases of the Heart were numerous, and rose to 100, against 87 for the preceding year. The class Digestive includes enteritis, peritonitis, diseases of the liver and stomach, &c, and was responsible for 75 deaths; eight deaths were directly attributed to alcoholism and delirium tremens, but there is no doubt that many more deaths registered under the head of diseases of the liver owe their origin to this cause. The class Urinary includes nephritis, B right's disease, and diabetes, and caused 40 deaths. Developmental Diseases. —Under the head of developmental diseases are classed the premature births of infants and malformations, which caused 42 deaths, and old age, to which latter 40 deaths were referred, but many deaths of old people were registered from other causes, such as bronchitis and cancer. 10 Constitutional Diseases. —The 58 deaths from cancer show a fall of 11 on those for the preceding year. Rheumatism and gout caused 6 deaths; consumption 81, an increase of 27 over the preceding year, but the other forms of tubercular diseases show a decrease of 15. The phthisis death rate for the year 1899 is stated by the Registrar-General to be for the Metropolis I*BB per 1000, as compared with a rate of l - 77 in each of the two years immediately preceding. After distribution, the death rates in the Metropolitan sanitary areas range from 0"81 in Hampstead to I*ls in Paddington, 3 - 08 in Ilolborn, 353 in St. Lukes and St. George the Martyr, Southwark. Tuberculosis in Milk. —A great deal of attention has been called to the alleged infection of milk and cream with tubercle bacilli. A bacteriological examination made of 100 samples of milk, for the Hackney Vestry, by the Jenner Institute of Preventive Medicine, showed that 22 per cent, of the samples were infected with tubercle bacilli. The matter was also dealt with by the Public Health Committee of the London County Council. The opinion was expressed by your Vestry that steps should be taken to induce the Government to introduce a Bill into Parliament to give effect to the recommendations of the Royal Commission on Tuberculosis, as far as it applies to milk. Among the conclusions arrived at by the Royal Commission appointed to enquire into the administrative procedure for controlling danger to man through the use of meat and milk of tuberculous animals were as follows : —" Any person who takes tuberculous matter into tho body incurs risk of acquiring tuberculous disease." And again, "No doubt the largest part of the tuberculosis which man obtains through his food is by means of milk containing tuberculous matter." Tuberculous diseases of children, known as consumption of tho bowels, &c, are also believed to be largely due to the introduction of the bacillus into their systems by the medium of milk from infected cows taken as food. This especially is the case with children under one year of age, and due to the increasing practice of substituting cows milk for that from the breast of the human female. Fortunately the danger can, to a great extent, be met by sterilization of the milk at a temperature of not less than 160 Fahrenheit for 30 or 40 minutes, or by boiling the milk for a few minutes. 11 Inquests. —The number of inquests held was 79 ; the deaths in 47 cases were caused by violence; 5 infants perished by infanticide, or by neglect at birth ; 4 were suffocated whilst in bod with their mothers during the winter months. Burns and scalds caused the death of 4 children. Fractures of skull, &c, and contusions by falls caused 8 deaths ; 2 persons were run over by trains; 2 perished by drowning The death of a man under the influence of alcohol was caused by the band of his shirt inducing asphyxia. Suicide cases numbered 10; death in these latter was caused by wounds in throat (2), by bullet wound in head, by drowning, by hanging, and by poisoning by nitric and carbolic acids. Mortuary. —The total number of bodies received during the year was 77, an increase of 2 on the previous year. Fifty of these were admitted on the coroner's order, 20 were brought in by the police, and 7at the request of friends and relatives. The number of post mortem examinations made was 42. Work of the Public Health Department. —Table No. 4 contains full details of the work carried out by the District Inspectors. Three thousand one hundred and five inspections of houses and premises were made during the year, and 5710 re-inspections were made after order or notice had been served ; 462 orders were for tho cleansing, whitewashing, and repair of houses; 278 for the repair and 321 for the reconstruction of house drains. The number of closets requiring attention, such as repair to water supply and cleansing, ventilation, &c, was 370, and 347 required to be reconstructed ; 102 dustbins required renewal or repair ; 131 yard pavings required repairing, and in 42 instances to bo renewed. It was necessary to make 264 orders for cleansing, repairing, or covering of cisterns ; 13 new cisterns were ordered to be provided. The worst instances of neglected cisterns were found in private houses of good class; in one instance the cistern had not been cleansed for three years, and contained a deposit of three inches of mud. The bye-laws under the provisions of the Public Health (London) Act, 1891, for securing the cleanliness and freedom from pollution of cisterns and other receptacles for storing of water used, or likely to be used by man 12 for drinking or domestic purposes, provide that the occupier of the premises shall empty and cleanse the cistern or receptacle once at least in every six months, and at such times as may be necessary to keep the same in a cleanly state and free from pollution. The offender against this bye-law is liable to a penalty of Five Pounds. Householders frequently excuse their neglect by stating that it is the duty of the landlord to cleanse the cistern, or say that the cistern only supplies the closets, and quite overlook the fact that a draw-off tap from the cistern is liable to be used by housemaids and others for filling bedroom jugs and waterbottles. The artizan or tenant of the labourer classes pays more attention to his water supply than his more wealthy neighbour, it being a frequent habit of the former to cleanse out his cistern as a Sunday morning recreation. Covers of cisterns should be well fitting to exclude light and dust. Whilst constant supply has become almost general in the parish, there still remain houses which depend upon cistern storage for their drinking water, and all houses should be provided with cisterns for storage of water for ordinary domestic purposes, for cleansing, and for the flushing of drains and waterclosets. To have the full benefit of constant supply, the drinking and cooking water should be drawn from the rising main or service pipe by a screw-down draw-off tap, and a tap should be provided for turning off the water from the main in frosty weather. Removal of Manure. —No less than 389 orders were necessary for the removal of manure. Private owners of stables appear to have more and more difficulty in securing the prompt removal of stable manure, especially in hay and harvest time. The Sanitary Authority has power under Section 36 of the Public Health (London) Act, 1891, to collect and remove refuse of this sort within their district, but has no power to charge for such removal. In consequence of the numerous complaints of nuisances arising from stable manure, especially in certain mews, the divisional inspectors were instructed to visit these premises at least three times a week. The use of peat moss litter in the various stables of omnibus and tramway companies, where many horses are stabled, has also been the cause of much nuisance to the surrounding 13 inhabitants upon removal. This material becomes saturated with the urine of the horses, which, decomposing, creates a terribly offensive odour when the manure is placed in heaps and is disturbed in the process of removal. The best means of dealing with the nuisance has been to cause the owners of the stables to place a vehicle in each of their yards for the reception of the refuse on removal from the stables, so that it might be taken away without further disturbance. The number of applications to examine the drainage of private houses was 175, an increase of 24 on the previous year. Owing to the uncertain and unsatisfactory results of the smoke tests, the water test is ordered by your Vestry to be applied, but in houses where no manhole interceptor on the main drain has been originally provided this cannot be done without opening the ground. This the private applicant frequently refuses to do, and the matter falls through. This does not apply, of course, to premises where illness or a nuisance is proved to exist, when an order to open up would in ordinary course be made. The total number of complaints received during the year was 232, an increase of 33 over the previous year, caused no doubt by the hot dry summer. The total number of orders made for sanitary amendments was 1,130. Legal proceedings were taken in 20 instances, all of which were successful. It may be added that owners generally do what is necessary, upon receipt of the preliminary, or intimation, notice. Statutory Notices are issued by the Public Health Committee, who are empowered by the Vestry to act as the Sanitary Authority in connection with the carrying out of the Public Health Acts. Slaughterhouses. —The annual inspection of these premises by the Public Health Committee took place on October 3rd, when they were mostly found to be in good order, so that it was not necessary to make any objection to the renewal of the several licenses. Cowhouses have now, for some years, finally disappeared from the Parish. 14 Bakehouses. —The 39 bakehouses were regularly inspected with reference to their cleanliness, ventilation, water supply, drainage, &c, and orders made when necessary, for works required, chiefly whitewashing and cleansing. By the Factory and Workshop Act, no underground place which was not so used before January Ist, 1896, shall be used as a bakehouse. Workshops. —Table No. 5 contains a list of workshops, from which it will be seen that the chief trades carried on are those of dressmakers, tailors, laundries, and milliners. We have very few factories, that is, places where steam is used as a mechanical power. Regular inspection has been made with respect to ventilation, cleanliness, closet accommodation, &c. Overcrowding was abated in two instances, and orders made for cleansing and whitewashing 31 workshops. Overcrowding. —Ten cases of illegal overcrowding were reported during the year. Complaints are frequently heard of the difficulties the artizan or laborer, with several children, has in obtaining house room. Our Bye-laws require a provision of 300 cubic feet of free air space for each person of an age exceeding ten years, and 150 feet for each child under ten years, to occupy a room for sleeping purposes; but where such room is used also as a living room, then 400 feet is required for each adult, and 200 for each person under ten years of age. Active building operations, and the presence of tramway company stables, &c, have tended to attract labour to Hampstead, and consequently to raise the rents of available houses. The question of cubical area is one which cannot be overlooked. The labourer with a family of five or six children is called upon to pay a third of his wages for house accommodation if he is to avoid overcrowding. The cubical area of the rooms, therefore, becomes to him of more importance than their convenience or sanitary condition. As a rule, cubical air space can be obtained at a cheaper rate in cheaply built houses in the Kilburn Ward, or in old and decayed houses in the Town Ward, than in model buildings, or flats, built to suit the convenience of the poor. These latter, indeed, seem to be taken possesion of by the superior artizan classes, who can be trusted to look after themselves, and being punctual in payment of rent, and giving no trouble by drunkenness or disorderly 15 conduct, become permanent tenants. The poorer class sink into the basement rooms of tenement houses, where accommodation is cheaper, and their peculiar habits less likely to come under observation. The action of public bodies in building model accommodation for housing the working classes is to be commended as models or standards of what such accommodation should be ; but that they do more than touch the fringe of the question is apparent, or that they directly benefit the class for which they were obviously intended must bo denied, for they do little more than replace, in many instances, the buildings pulled down to make room for them, and nothing to accommodate the increase of population caused by immigration, or of excess of births over deaths. Until public bodies can produce a good-sized room at 2s. per week for the use of the very poor there is little chance that they will be successful in competing with the ordinary builder. Unhealthy Dwellings. —Two houses were certified under " The Housing of the Working Classes Act, 1890," and "Public Health (London) Act, 1891," as unfit for habitation ; one of these, situated in the Bolton Road, was condemned on account of the owner neglecting to comply with the order of the Court requiring him to repair the drainage, and put the premises into sanitary repair. The other house, situated in the Vale of Health, was found to be damp, and the rooms to be deficient in light and ventilation. Closing orders were obtained in both instances. Disinfection. —The number of houses disinfected after infectious disease was 412. The total number of articles disinfected reached 7,951, showing some decrease on the number of the previous j r ear. Owing to the extension of the works connected with the Electrical Department at the stone yard, an interruption of some weeks occurred in the use of the Lyons Washington steam apparatus, during which period the work of disinfection of infected articles was, by permission of the Vestry of St. Marylebone, carried out at their disinfecting station. Our own apparatus was removed to a convenient site, put into thorough repair, and supplied with a new boiler, and has since been working in a satisfactory manner. Unsound or Unwholesome Food. —The Inspectors have continued to 16 visit the streets late on Saturday night, in order to prevent the sale of stale and unwholesome food. Samples of milk for analysis have been taken at stations, public institutions, and hospitals in the parish. Some cases of illness after partaking of ices at a confectioner's shop, in the evening, occurred in July, during very hot weather. The symptoms were those of sickness, and severe gastro enteritis, attended with diarrhoa. The ice in question having been all sold out, we had no opportunity of examining it. Samples of the three kinds of ices found on the premises, were taken, and submitted to our Analyst, and were pronounced by him to be free from any metals thai could be injurious to health, and after examination'microscopically " for deleterious bacteria or microbes" were pronounced by him to be " good and wholesome food." It is probable that, owing to the great heat of the weather at the time, some decomposition had taken place in part of the cream or other articles with which part of the ices were prepared. All the patients recovered. Preservatives and Coloring matters in Food. —The President of the Local Government Board has appointed a Committee to enquire into the use of preservatives and coloring matters in the preservation and coloring of food in certain quantities, and to report whether the use of such materials, or any of them, is injurious to health, and if so, in what proportion does their use become injurious, &c. The Committee having requested the co-operation of your Vestry in securing samples from the district, the senior divisional inspector was instructed to obtain about eighty samples for the use of the Committee. These comprised mostly such foods as are likely to be treated with boric and salicylic acids, and other preservatives, such as milk, cream, butter, lard, margarine, cheese, bacon, sausages, jams, various tinned foods such as tinned pastes, bottled soups, calves feet jelly in pots, pork pies, brawn and lime juice, &c. The subject is one of considerable importance, especially in regard to the food of invalids and children, and the report of the Committee, which will be issued in the form of a "Blue Book," will be looked forward to with much interest. The Sale of Food and Drugs Act, 1899, came into force on January Ist, 1900. It amends and enlarges previous Acts relating to 17 food and druga, Power is given to the Board of Agriculture to make regulations for determining the standards to be taken in the analysis of milk, cream, butter, and cheese, and articles of food may be sampled by the Local Government Board, and by the Board of Agriculture. When condensed, separated or skimmed milk or cream, is sold in tins, the tin containing the article must be conspicuously marked indicating the nature of the contents. Margarine cheese, which means any substance which is prepared in imitation of cheese, and which contains fat not derived from milk, comes in for special notice, and no one is allowed to sell or expose for sale any Margarine the fat of which contains more than ten per cent. of butter fat. Every person, who by himself or his servant, in any highway or place of public resort, sells milk or cream from any vehicle, can, &c, must have his name and address conspicuously inscribed on the vehicle or receptacle. All mixtures are to be clearly labelled, and the labels must not be obscured by other matter printed thereon. At the request, or with the consent of, the purchaser, or consignee, samples of all articles may be taken in course of delivery. Proceedings for prosecutions must be taken within twenty-eight days, with a minimum limit of fourteen days for summons to be returnable. The expression " Food " now includes any article used for food or drink by man, except drugs and water and any article which ordinarily enters into, or is used in, the composition or preparation of food, condiments, and flavoring matters. Sanitary Legislation, 1899. —Among the Acts passed in 1899, the sanitary provisions of which affect the Metropolis, may be mentioned:— The London Government Act, 1899. By this Act, 2nd Schedule, part 1, section 6 (4), the following duties and powers will be transferred from the London County Council to the Borough Councils : the registration of dairymen, and the duty of enforcing the Bye-laws and Regulations with respect to dairies and milk, and with respect to slaughter houses, knackers yards, and offensive businesses; and the power to adopt part 111. of the Housing of the Working Classes Act. The Small Dwellings Acquisition Act, 1899, empowers Local 18 Authorities to advance money for enabling persons to acquire the ownership of small houses in which they reside. The Seats for Shop Assistants Act, 1899, provides for seats being furnished in the proportion of at least one for every three female assistants in each room of retail shops, and is to be enforced by the London County Council. Sewer Emanations. —In spite of the hot dry weather, complaints of bad smells from gullies and gratings were less during the year than for some time past. The general policy of the Public Health Committee, who have carefully investigated the complaints which came before them, has been to find a remedy by the maintenance of more frequent ventilation openings, both at the sewer level and by means of pipes carried up the sides of houses. Flushing of sewers was also frequently resorted to, together with the free use of disinfectants. The duties of Sanitary Inspectors entail a great deal of work which is often of an unpleasant, or, it may be, dangerous nature. I am glad to report that they have been carried out in a cheerful and considerate manner, and to my satisfaction, whilst a word of recognition is also due to the Clerical Staff in connection with the department. To the Chairman and Members of the Public Health Committee I have once more to tender my thanks and acknowledgement for the assistance and support afforded me in superintending the work of the department. I am, Gentlemen, Your obedient Servant, EDMUND GWYNN, 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 1899, in the Hampstead Sanitary District; classified according to Diseases, Ages, and Localities. Population at all Ages. Registered Births. (d) New Cases of Sickness in each Locality coming to the knowledge of the Medical Officer of Health. Number of such Cases Removed prom their Homes in the Several Localities for Treatment in Isolation Hospital. Aged under 5 or over 5. (e) Names of Localities adopted for the purpose of these Statistics, Public Institutions being shown as separate localities. (a) Census, 1896. (b) Estimated to middle of 1899. (c) 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. Fevers. Scarlatina. Membranous Croup. Smallpox. Erysipelas. Diphtheria. Typhus. Continued. Relapsing. Puerperal. Erysipelas. Enteric or Typhoid. Enteric or Typhoid. Continued. Relapsing. Puerperal. Typhus. Cholera. Cholera. North Western Hospital, Haverstock Hill Under 5 ...{ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. ... 8 ... 8 4 ... ... 7 ... ... ... 1 ... 4 ... 7 ... 1 ... ... ... ... ... Under 5 ... ... Soldiers' Daughters' Home, Rosslyn Hill ... ... ... ...{ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 7 ... ... 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Under 5 ...{ ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... Hampstead Workhouse ... ... ... 5 upwds. ... 1 1 ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Under 5 1 1576{ ... 67 36 ... ... ... ... 5 ... 54 24 ... ... ... ... ... ... ... Hampstead 75449 82593 ... ... ... 2 5 upwds. 33 ... ... 13 ... 203 64 ... 5 ... 44 ... 137 32 ... ... ... ... ... ... ... Under 5 5 54 75449 82593 1576{ 67 37 1 ... ... ... ... 25 ... ... ... ... ... ... ... ... ... ... ... ... Totals 5 upwds. 46 152 ... 218 69 2 ... 41 ... ... 5 ... 37 20 3 ... ... ... ... ... ... ... Table No. II. Table of DEATHS during the Year 1899, in the Hampstead District, classified according to Diseases, Ages, and Localities. Names of Localities adopted for the purpose of these Statistics, Public Institutions being shown as separate. localities. (a) Mortality from all causes, at subjoined Ages. Aged under 5 or over 5. (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 Fevers. At all ages. (b) Under 1 year. (c) 1 and under 5. (d) 5 and under 15. (e) 15 and under 25. (f) 25 and under 65. (g) Smallpox. Membranous Croup. Cholera. Erysipelas. Measles Whooping Cough. Diarrhœa & Dysentery. Rheumatic Fever. Influenza. Phthisis. Bronchitis, Pneumonia, & Pleurisy. Heart Disease 65 and upwards (h) Scarlatina. Diphtheria. All other Diseases. Injuries. Typhus. Continued. Relapsing. Enteric or Typhoid Puerperal. Total. Sub-district 775 188 23 223{ Under 5 5 upwds. 1 1 4 19 10 33 5 1 40 8 119 243 55 269 ... 2 ... ... ... ... ... ... ... ... 17 1 2 7 2 1 ... 4 2 1 1 3 51 76 90 25 248 532 Workhouse 8 ... ... ... ... ... ... 75 2 29 { Under 5 5 upwds. 2 2 6 10 2 2 32 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 10 5 9 9 30 65 9 ... ... ... ... ... ... ... ... ... ... ... N. W. Hospital 276 ... ... ... 1 20 ...{ under 5 5 upwds. 42 95 1 ... ... 2 ... ... ... 2 2 4 149 140 84 23 ... ... ... ... ... ... ... ... 24 52 39 ... 1 2 3 2 4 127 ... ... ... ... ... ... ... ... ... ... ... ... ... Friedenheim 14 1 1 1 6 56 3{ Under 5 5 upwds. ... ... ... ... ... ... ... ... ... ... ... ... . ... ... ... ... 80 ... ... ... 1 54 79 ... ... ... 1 3 20 St. Peter's Home 20 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 Under 5 5 upwds. ... 1 1 1 8 3{ ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 8 4 6 19 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... N. L. Consumption Hospital }22 ... Under 5 5 upwds. ... ... ... ... 5 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 16 3 1 2 22 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Hampstead Hospital 1 2{ Under 5 5 upwds. ... ... 1 1 2 14 1 1 1 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 3 6 12 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 260{ Totals 1262 206 200 114 23 5 69 413 Under 5 5 upwds. 43 97 1 1 4 11 33 2 45 ... 10 131 406 ... ... ... ... ... ... ... 1 2 1 1 1 1 5 29 142 109 37 316 856 ... 24 55 44 ... ... .. 88 ... The subjoined numbers have also to be taken into account in judging of the above records of mortality. Deaths occurring outside the district among persons belonging thereto }62 3 30 Under 5 7 4 5 13{ 1 5 ... 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... 11 ... ... 5 upwds. 31 ... 4 4 5 7 51 ... ... ... ... ... ... ... ... ... ... ... ... ... .. } 398 ... Deaths occurring within the district among persons not belonging thereto Under 5 10 137 44 114 5{ 1 2 6 88 43 91 2 1 1 3 147 ... ... ... ... ... ... ... ... ... ... ... ... 5 upwds. 21 2 6 37 251 ... 50 ... 40 1 ... ... ... 80 6 8 ... ... ... ... ... ... 21 Table No. III. CAUSES OF DEATH IN HAMPSTEAD. Measles 22 Whooping Cough 11 Enteric Fever 4 Diarrhœa 39 Diphtheria 13 Scarlet Fever 6 Puerperal Fever 2 Erysipelas 0 Influenza 32 Phthisis 81 Tabes Mesenterica 3 Brain Tubercle 8 Other Tubercular diseases 6 Cancer and Malignant disease 58 Gout and Rheumatism 6 Dietetic 7 Nervous Diseases 64 Convulsions 16 Circulatory 110 Respiratory 135 Digestive 75 Generative 9 Urinary 40 Locomotary 1 Integumentary 1 Premature Birth 34 Congenital Defects and Malformations 8 Old Age 40 Violence 33 All others, &c., and those dying outside Parish 62 926 22 Table No. IV. PARISH OF ST. JOHN, HAMPSTEAD. Inspector's Report of the Sanitary Work, &c., completed in the year ending 31st December, 1899. Number of complaints received during the year 232 Number of Houses, Premises, &c., inspected 3105 Number of Re-inspections after order or notice 5710 Number of Applications to examine private house drains, &c. 175 Results of Inspections. Orders issued for sanitary amendments of houses and premises 1130 Houses and premises, &c., cleansed, repaired, and whitewashed 462 Yard pavings repaired, &c. 131 „ „ new provided 42 Houses disinfected after infectious diseases 412 House Drains:— Repaired, trapped, &c. 278 Ventilated 179 Disconnected from the sewer 119 Reconstructed 321 Water Closets:— Repaired, cleansed, &c. 293 Ventilated 77 Reconstructed 347 Dust-bins:— New provided 102 Repaired, covered, &c. 35 23 Table No. IV. (continued.) Water supply:— Cisterns cleansed, repaired and covered 264 New cisterns provided 13 Miscellaneous:— Overcrowding abated 10 Removal of accumulations of dung, stagnant water, animal and other refuse 389 Removal of animals improperly kept 13 Manure receptacles reconstructed or new provided 24 Underground rooms discontinued to be used as dwellings 6 Regularly Inspected. Houses registered under Public Health (London) Act, 1891 840 Bakehouses 39 Licensed Slaughter-houses 7 Legal proceedings 20 Articles Disinfected in Apparatus. Beds 222 Palliasses 95 Mattresses 448 Bolsters 361 Pillows 948 Blankets 1010 Sheets 605 Counterpanes 506 Articles of Clothing 2022 Carpets 152 Miscellaneous Articles 1582 7951 24 Table No. V. List of WORKSHOPS, &c., under the Factory and Workshop Acts, 1878—1895, inspected during the Year ending 31st December, 1899. Laundries 44 Dressmakers 138 Tailors 24 Milliners 20 Upholsterers 9 Mineral Water Manufacturers 1 Manufacturing Stationers 1 Pianoforte Manufacturers 3 „ Key Makers 2 Engineers 2 Art Metal Workers 1 Photographic Paper Manufacturers 1 Window Blind Makers 4 Brass Finishers 1 Surgical Instrument Makers 1 Corset Makers 4 Work executed during the Year ending 31st December, 1899. Workshops cleansed, limewashed, &c. 31 Washhouses repaved and drained 1 Water-closets cleansed, repaired, &c. 8 Overcrowding abated 2