HAMP 12. THE Metropolitan Borough of Hampstead. REPORT FOR THE YEAR 1905 OF THE Acting Medical Officer of Health. FRANK E. SCRASE, F.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Lond.) 3 INDEX. page Accidents, Deaths from 38 Adulteration 79-82 Alcoholism 37 Analyses, Results of 79-82, 109 Analytical Work, Summary of 109 Aneurism 38 Apoplexy 38 Application for Redrainage 99-101 Appendicitis 38 Area of Borough 17 Bacteriological Examination 43-45 Bakehouses 77, 134 Birth Rate 20 „ (Illegitimate) 25 Births, Number of (Legitimate and Illegitimate) 24 ,, ,, in Wards 21-22 Bronchitis 38 Bye-Laws, Drainage 99-101 Cancer and other Malignant Disease 37 Carcinoma 37 Cerebral Hœmorrhage 38 Cerebro-Spinal Fever 38 Chicken-pox 57 Circulatory System, Diseases of 37 Cirrhosis of Liver 37 Common Lodging Houses 87 Complaints received 131 Conscientious Objector Certificates—Vaccination 51 Continued Fever 56 Cowhouses 87 Customs and Inland Revenue Acts 87-88 Dairies and Milkshops 83-84 4 PAGE Death Rate 26 ,, Infantile 34 Deatlh returns 29 Deaths, at various ages 29 „ Causes of 36-38 ,, Chart shewing Weekly Number of 26 ,, Infantile Death Rate 34 ,, Infantile Deaths 29-30 „ Number of 25-26 ,, Senile Mortality 36 Debility from Birth 31, 38 Diarrhœa 31 Diarrhœa, Epidemic 58 Diphtheria 55 Disinfection 130 Drains, Examination of 99-100 Embolism 38 Enteric Fever 52-55 Enteritis 31 Epidemic Diarrhœa 58 Epilepsy 38 Epithelioma 37 Erysipelas 56 Factories 69, 71, 120 Factory and Workshop Act 69-76 Flat Dwellings 95-97 Food and Drugs Acts 79-82 Food Inspection 82-83 Foodshops, Inspection of 85-86 General Tuberculosis 36-37 Hairdressers' Business 92-93 Heart Diseases 36 Hemiplegia 38 Homework 74-76 Houses Let in Lodgings 92 5 PAGE Housing .Committee 11 Housing of the Working Classes Act, 1890 77-78 Ice Cream Shops 85 Illegitimate Births 24 Illegitimate Birth Rate 25 Inanition 38 Infantile Death Rate 34 „ „ „ Preventable 32 Infantile Deaths, Causes of. 30 ,, „ Preventable, and Non-Preventable 32-33 Infantile Deaths 29-35, 119 Infants, advice as to rearing of 23-24 Infectious Disease, Cases occurring 43-117 „ „ ,, ,, in each Month 49-50 „ „ „ „ „ Ward 49-50,117 ,, ,, Deaths from 43 ,, ,, Charts 26 Influenza 58 Insanitary and Uninhabitable Premises 78 Inspections and Re-Inspections of Premises 132-133 Kidney, Diseases of 38 Kilburn Yale Area 77 Laundries 69, 72, 73, 120 Legal Proceedings 104-105 Local Government Board Tables 113-119 Lower Cross Road Housing Scheme 78 Marasmus 31, 38 Marriage Rates, 1895-1905 19 Marriages, Number of 19 Measles 57 Membranous Croup 55 Milk Shops 83-84 Mistaken Diagnosis of Infectious Disease 43-45 Mortuary, Public 102-103 Murder 38 Natural Increase of Population 24 6 PAGE Non-Preventable Infantile Deaths 33 Nuisances, Inspection of 89 „ Smoke 98 Offensive Trades 87 Outlying Deaths, Returns of 29 Outworkers 74-76, 120 Overcrowding 133 Peat Moss Litter 89 Persons per Acre 19 Phthisis, Pulmonalis 36, 61-63 ,, ,, Voluntary Notification of 63-65 Physical Deterioration and Alcohol 94 Pleurisy 38 Pneumonia 38 Population, Density of 19 „ Estimated to Middle of 1905 19 In Wards 19 „ Natural Increase of 24 Preventable Infantile Death Rate 32 Preventable Infantile Deaths 33 Public Health Committee 11 Puerperal Fever 56 Redrainage Application 99-101 Registered Houses 92 Respiratory System, Diseases of 38 Restaurant Kitchens 87, 135 Rheumatism 38 Sale of Food and Drugs Acts 79-83 Sarcoma 37 Scarlet Fever 51 Schools 89-92 Scirrhus Cancer 37 Senile Decay 38 Senile Mortality 36 Sewers, Condition and Ventilation of 101, 139-151 Shelter, Temporary 46 7 PAGE Slaughter-houses 86 Small-pox 51 Smoke Nuisances 98 Staff of Public Health Department 12, 101 Suicides 38 Summary of Vital Statistics for 1905 17 Syphilis 30,118 Temporary Offices 102 Thrombosis 38 Tubercular Diseases 31, 36 Tubercular Meningitis 36 Tubercular Peritonitis 36 Tuberculosis, General 36-07 Tuberculosis of the Kidney and Bladder 36 Uninhabitable and Insanitary Premises 78 Vaccination 51, 134 Vital Statistics of Hampstead, 1801-1901 129 Water Supply, Certificates as to 99 Whooping Cough 57 Workshops and Workplaces 69-76, 120-121 Zymotic Diseases 43 ,, „ Deaths from 43 ,, ,, Notifiable, Attack Rate 43 „ ,, Notified in each Month 49-50, 58 „ „ „ „ Ward 49-50,58 „ „ Death Rate 43 „ „ (7 principal) Death Rate 43 TABLES. Table shewing estimated populations of the various Wards . 19 „ marriages registered in 1905 19 „ marriage-rates 1895-1904 20 „ estimated birth-rates of the various Wards 21 ,, births registered in the various Wards 22 ,, illigitimate birth-rates of the various Wards 25 „ death-rates of the various Wards 27 8 PAGE Table shewing death rate for Hampstead, as compared with the County of London, the City of London, and the other Metropolitan Boroughs 28 Table shewing causes of death of children under the age of one year 30 Tables shewing causes of death of children under the age of one year, classified as " Preventable," and " Non-Preventable " 33 Table shewing infantile death rates of the various Wards 34 Table shewing infantile death rate for Hampstead, as compared with the County of London, the City of London and the other Metropolitan Boroughs 35 Table shewing "Resident" Cancer deaths per 1000 of the population, and percentage of "Resident" Cancer deaths on total deaths of Residents, 1901-1905 37 Table giving a comparison of annual death rates from the 7 principal Zymotic diseases in Hampstead, England and Wales, 76 Great Towns, 141 Smaller Towns, and England and Wales less the 217 Towns 46 Table shewing the attack rate, and death rate from Smallpox, Diphtheria and Membranous Croup, Scarlet Fever and Enteric Fever, from 1901-1905 47 Table shewing cases of infectious disease sent from Hampstead to Hospitals and returned as wrongly diagnosed 45 Tables shewing notifications of infectious disease in each Month and Ward 48-50 Table shewing details of Enteric Fever 53-54 Table shewing the notifications of Measles in each Month and Ward 58 Tables re Factories, Workshops and Workplaces 71-74 ,, Samples purchased for Analysis 79-80 ,, Food seized or surrendered 83 „ Premises certified under the Customs and Inland Revenue Acts 88 Table shewing Mortuary Returns 103 9 APPENDIX I. page TABLES. Table I.—Population. Births and Deaths for the whole Borough, from 1895 to 1905, including Deaths of Non residents in the Borough, also Deaths in Public Institutions in the Borough, Deaths of Residents registered beyond the Borongh. Institutions inside and outside the Borough receiving sick and infirm persons from the Borough 113-115 Table II. - Population, Births registered, Deaths at all ages, and Deaths under one year for each Ward 116 Table III.—Cases of Infectious Disease notified, at all ages, at various ages, and distributed according to Wards 117 Table IV.—Deaths at all ages, at various ages, from all Causes, and distributed according to Wards 118 Table V. Infantile Deaths, at various ages, from all Causes 119 Table VI.—Particulars of Factories, Workshops, Laundries, Workplaces and Homework 120-121 Table VII.—Particulars of Milk shops, Cow sheds, Slaughterhouses, Offensive trade premises, Ice cream premises, Houses let in Lodgings, Overcrowding, Underground rooms, &c , Certificates under Customs and Inland Revenue Acts, Prosecutions, &c., in 1905 122-123 Table VIII.—Estimated Population, Birth, Death, Infantile, and 7 principal Zymotic Diseases Death Rates, and Notifiable Zymotic Diseases attack rate, 1902-1905 124 Table VIII1-VIII7.—Ditto, in the various Wards 124-127 Table IX.—Natural Increase of Population, and Notifiable Zymotic Disease Rate in Hampstead : Birth Rate, 7 principal Zymotic Diseases Death Rate, and General Death Rate in England and Wales and Hampstead, from 1875 to 1905 128 Table X—Statistics of Hampstead, 1801-1901 129 10 PAGE Table XI.—Disinfection carried out during 1905 130 Table XII.—Number and Subjects of Complaints received during 1905 131 Table XIII.—Number of Inspections, &c., made, notices served, letters sent, and sanitary works, &c., carried out during 1905 132-133 Table XIV.—Bakehouses arranged in Wards 134 Table XV.—Restaurant Kitchens arranged in Wards 135 Table XVI.—Vaccination Statistics, 1900-5 136 APPENDIX II. Report of the Special Committee on Sewer Ventilation 139-151 11 PUBLIC HEALTH COMMITTEE, NOVEMBER, 1904-5 Ex-Officio. His Worship The Mayor (Mr. Alderman D. McMillan) Chairman. Mr. Councillor L. Farmer. Mr. Alderman T. G. Randall. Mr. Councillor E. C . M.D. „ J. G. Cracknell. ,, C. T. Green. ,, C. Hall. ,, C. Hendrick. „ C. L. Jupp. ,, J. P. R. Lyell. „ T. H. Nunn. „ W. R. Rider. ,, J. Stopher. ,, E. C. Taylor, M.D. HOUSING COMMITTEE, NOVEMBER, 1904=5. Ex-Officio. His Worship The Mayor (Mr. Alderman D. McMillan). Chairman. Mr. Councillor W. R. Rider. Mr. Alderman T. G. Randall. Mr. Councillor G. Buckle. ,, H. Candler. „ J. Chown „ H. Davis. „ J. T. Dyter. ,, W. G. S. Gard. ,, C. Hendrick. ,, E E. Lake. ,, H. D. Pearsall. ,, C. H. Smith. ,, W. J. Spriggs. ,, J. Stopher. 12 STAFF OF THE PUBLIC HEALTH DEPARTMENT, 1905. Senior Sanitary Inspector. W. G. Kershaw. Divisional Sanitary Inspectors. R. Geary, No. 1 District (Wards 1 and 2). J. Grimsley, No. 2 District (Wards 3 & 7). P. A. Heath, No. 3 District (Wards 4 & 5). W. H. Edmonds, No. 4 District (Ward 6). Special Sanitary Inspectors. F. H. Hudson. Mrs. T. Fisher, M.A. Assistants to Inspectors. G. Rowe. W. Darken. A. J. Brown. Public Mortuaty Keeper. W. Larken. Disinfectors. T. H. Rider. G. Allaway. R. Bell. Clerks. W. Sell, First Clerk. F. S. Hill, Second Clerk. J. E. Stone, Third Clerk. Clerk-Draughtsman. E. J. Cooper Public Analyst. A. W. Stokes, F.C.S., F.I.C. Medical Officer of Health. Herbert Littlejohn, M.B., C.M., F.R.C.S. (Edin.), D.P.H. Deceased 4th September, 1905. Acting Medical Officer of Health. Frank E. Scrase, F.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Lond.). 13 The Metropplitan Borough of Hampstead. REPORT of the ACTING MEDICAL OFFICER OF HEALTH For the Year 1905. Public Health Department, 7, Belsize Park Gardens, Hampstead, N.W., 20th February, 1906. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Gentlemen, In accordance with your instructions given on 28th November last, I have the honour to submit to you the Medical Officer of Health's Annual Report for the Year 1905. It is drawn up in accordance with the instructions of the Local Government Board, and contains a record of the work of the Department as carried out under the Public Health Committee, during the year passed. In the compilation of this Report, I have adhered to the headings and general outline of previous reports, and as my term of office only commenced on September 11th, the following Report must necessarily be restricted to a more or less bare statement of facts and figures. In this respect, however, it deals with the whole of the year 1905. Pursuant to instructions sent me by the Local Government Board, I have utilized the notes and records left by the late Medical Officer of Health, and it is from such notes that I have compiled the Table of Flat Dwellers in Hampstead and their effect upon the Vital Statistics of the Borough. 14 In like manner, the idea of dividing the Infant Deaths into so called "Preventable" and "Non-Preventable" causes, is a classification which I believe was contemplated by the late Dr. Littlejohn, and I have endeavoured to fulfil his intentions in these two respects; as far as I comprehend them. This Report contains several facts of great interest, and chronicles at least 4 records, for as will be seen by the appropriate Tables, the General Death Rate, 7 Principal Zymotic Diseases Death Rate and Notifiable Zymotic Diseases Attack Rate, of Hampstead, are all the lowest ever recorded. On the other band, the birth rate has again fallen, following the consistent decline which began about 15 years ago, and last year reached a point lower than any previous year. I desire to take the opportunity of expressing my thanks to the Council, and especially to the Chairman and Members of the Public Health Committee, for the support and sympathetic consideration they have always afforded me during my term of office as Acting Medical Officer of Health. I am also deeply indebted to the Members of the Staff of the Department who have carried out their work in a most satisfactory and efficient manner, and at all times accorded me their most loyal and unselfish co-operation. I am, Gentlemen, Your obedient Servant, FRANK E. SCRASE, Acting Medical Officer of Health. VITAL STATISTICS. 17 Summary of Vital Statistics for 1905. Population Estimated to middle of 1995 88,142 Density ,, „ 38·9 persons per acre Births 1421 Birth Rate 16·1 Marriages 602: Marriage Rate 6·8. Deaths 823. Recorded Death Rate 9·3 Infantile Mortality 93·6 per 1000 births Zymotic Death Rate 0·47 Population at Census, 1901 81,942: Inhabited Houses „ 11,294. Area of Borough (excluding area covered by water) 2,253 acres. 19 POPULATION. Estimated Population. For the purpose of calculating the death and other rates, the population employed is that estimated to the middle of 1905, which amounted to 88,142. The following is a rough estimate of the population of the various Wards of the Borough :— Ward 1 (Town) 13,330 „ 2 (Belsize) 13,840 „ 3 (Adelaide) 10,800 „ 4 (Central) 9,762 „ 5 (West End) 13,580 „ 6 (Kilburn) 15,790 „ 7 (Priory) 11,040 The Borough 88,142 In Table X., page 129, the population of Hampstead is shewn at each census, from 1801 to 1901, together with the increase per cent. during the inter-censal periods. Density of Population. The area of the Borough is 2265 acres, and the estimated number of persons to the acre is 38.9. The proportion of persons to the acre at the Census, 1901, was 36∙17. It is interesting to note how the density of the population is increasing. At the Census of 1881 the number of persons per acre was 23; in 1891, 30; and in 1901, 36. MARRIAGES. According to the Returns of the Registrar-General, 602 marriages were registered in the Borough during 1905; they were distributed in the four quarters of the year as follows:— 1st quarter 97 2nd „ 170 3rd „ 198 4th „ 137 Total 602 This figure, which is equivalent to a rate of 6∙8 per 1000 of the population, is a decrease on that for the year 1904, when 625 marriages were registered, or 7∙2 per 1000 of the population. 20 The following Table gives the marriage rate for the years 18951904, and the average rate for the decade:— Year. Marriage rate per 1000 of the population. 1895 6∙6 1896 6∙9 1897 6∙6 1898 7∙6 1899 7∙0 1900 6∙7 1901 6∙6 1902 7∙5 1903 7∙0 1904 7∙2 Average for the decade 6∙9 1905 6∙8 BIRTHS. During the year, 1421 births were registered, a decrease of 24 as compared with 1445 registered in the previous year. Of the total, 723 were of male, and 698 of female children. The birth-rate was 16∙1 per 1000 of the population, as compared with the rate of 16∙7 per 1000 in 1904, and 18∙5, the average for the years 1895-1904. The following Table shews a comparison of the birth rates in 1905 for England and Wales, 76 Great Towns, 141 Smaller Towns, England and Wales less the 217 Towns, and Hampstead : — Birth rate per 1000 of the population. England and Wales 27∙2 76 Great Towns 28∙2 141 Smaller Towns 26∙9 England and Wales less the 217 Towns 26∙3 Hampstead 16∙1 21 Reference to Table IX., page 128, shews the birth rates for Hampstead as compared with those for England and Wales since 1875, And it will be noted that the rate for the year under review is the lowest recorded since that date. The following Table shews the Ward and Sex distribution of these 1421 births, and gives the estimated birth rate for each Ward:— Ward. Births. Estimated Birth rate. Males. Females. Total. No. 1 (Town) 103 91 194 14∙5 No. 2 (Belsize) 103 106 209 15∙1 No. 3 (Adelaide) 47 49 96 8∙9 No. 4 (Central) 56 57 113 11∙6 No. 5 (West End) 122 128 250 18∙4 No. 6 (Kilburn) 225 201 426 26∙9 No. 7 (Priory) 67 66 133 12∙0 The Borough 723 698 1421 16∙1 The number of births occurring during each quarter of the year in each Ward of the Borough, together with their sex distribution, are shewn in the following Table:— BIRTHS REGISTERED—1905. Quarter of Year. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). The Borough. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. First 28 23 51 28 26 54 11 10 21 12 14 26 32 26 58 59 58 117 19 17 36 189 174 363 Second 27 19 46 19 30 49 14 14 28 12 16 28 39 35 74 60 51 111 19 22 41 190 187 377 Third 33 36 69 17 27 44 12 15 27 23 15 38 25 35 60 53 50 103 14 16 30 177 194 371 Fourth 15 13 28 39 23 62 10 10 20 9 12 21 26 32 58 53 42 95 15 11 26 167 143 310 1905 103 91 194 103 106 209 47 49 96 56 57 113 122 128 250 225 201 426 67 66 133 723 698 1421 22 23 Upon the notification of a birth, the Lady Sanitary Inspector has visited all those cases where it was thought her advice would be of value, and investigated the immediate surroundings of the infant, and advised upon the best mode of feeding, where such advice seemed desirable. The Returns of the Registrar have hitherto been practically the sole source from which information of the occurrence of a birth could be obtained, and as the period within which registration must take place is six weeks, it will be readily understood that much valuable time elapses before any effective steps can be taken. During the year 1905, 41 per cent. of the total infantile deaths occurred in children under the age of one month. The Council have recently expressed their approval of proposals to shorten the period in which a birth must be notified from 42 to 21 days as in Scotland, and I quite agree with the suggestion, as the whole value of our efforts depends on obtaining the earliest possible information of the births. In a number of cases we do not get the information early enough to exercise any supervision, the infant succumbing before its birth is notified, birth and death being sometimes registered together, and in some instances notification of the child's death has been received before that of its birth. The London County Council have recently initiated an arrangement by which they obtain early information of the births where a Midwife only is in attendance, and these are promptly forwarded to the Medical Officer of Health for the district. Speaking at the recent meeting of the Society of Medical Officers of Health, Sir Shirley Murphy, Medical Officer of Health of the London County Council, said " that owing to the bonus of one shilling given to Midwives, almost immediate knowledge of nearly a third of the children born in the Metropolis was now obtainable." This arrangement came into effect in the early part of November, and since then up to the end of the year, the number thus notified to Hampstead was 15. The arrangement appears to me an exceedingly useful one, as it concerns, with rare exceptions, the poorest class, where supervision of the environment of the newly-born by the Public Health Department, is most likely to be beneficial. 24 The visitation of births by the Lady Sanitary Inspector was commenced at the end of May, since when 227 have been visited. Of these :— 28 infants were members of families living in 1 room. 105 „ „ „ 2 rooms. 59 „ „ „ 3 rooms. 35 „ „ „ more than 3 rooms. The majority of the mothers appeared to care for their babies to the very best of their ability; such errors as were observed being due in nearly every case to ignorance and not to wilful neglect. It is noticeable that in homes where the other children are neglected and dirty, the baby is often the cleanest member of the family. The younger women in most cases welcomed the advice given by the Inspector. Most of the infants, when visited, appeared to be healthy, but 33 were found to be unwell or weakly. Of the 227 infants visited, 189 were found to be nursed by the mother, 26 were hand-fed, 12 were partly hand-fed and partly nursed. In a number of cases the mother was found to be quite insufficiently nourished through poverty, the mother's want of food affecting of course her power to properly nurse her infant. In some cases on a later visit, the infant was found to be hand fed. This extreme poverty was found in 31 cases. Some slight headway seems to have been made in the fight against the use of the obnoxious long-tubed bottle; in 10 cases, however, it was found to be in use. In every case, except where a very recent inspection had been made the sanitary condition of the premises was inspected; insanitary conditions were discovered and remedied in 54 instances; and overcrowding in 6. The Natural Increase of the population for the year, being the excess of births over deaths, was 598 as compared with 553 in 1904. Illegitimate Births.—Out of the total of 1421 births registered, 35 were those of illegitimate children. 25 The following table shews the Ward and Sex distribution of these illegitimate births, having regard to the home addresses of the mothers. Males. Females. Total. Ward 1 (Town) 2 2 4 „ 2 (Belsize) 1 2 3 „ 3 (Adelaide) 1 1 2 „ 4 (Central) — 1 1 „ 5 (West End) 2 2 4 „ 6 (Kilburn) 6 9 15 „ 7 (Priory) 3 3 6 The Borough 15 20 35 Illegitimate birth rate. The following are the illegitimate birth rates for the various Wards and the Borough, after the distribution referred to :— WARD. Illegitimate Birth Rate, per 1000 births. No. 1 (Town) 20∙6 No. 2 (Belsize) 14∙4 No. 3 (Adelaide) 20∙8 No. 4 (Central) 8∙8 No. 5 (West End) 16∙0 No. 6 (Kilburn) 35∙2 No. 7 (Priory) 45∙1 The Borough 24∙6 The illegitimate birth rate for the year 1904 in the Borough was 29∙06 per 1000 births. DEATHS. The total deaths registered in Hampstead during the year amounted to 1089. Of these, however, no less than 350 were of persons not belonging to the Borough, while 84 residents of Hampstead died in outlying districts. 26 The total number of deaths, therefore, amongst persons belonging to Hampstead amounted to 823. Table IV., page 118, affords all available information as to the causes of deaths of persons belonging to the Borough. The accompanying Chart shews the number of deaths of persons resident in, or belonging to, the Borough, occurring during each week of 1905. Death Rate. The crude death rate was 12'3 per 1000 of the population, but after subtracting from the total registered deaths the deaths of nonresident persons dying in Hampstead, and adding the deaths of Hampstead residents who died outside the district, the recorded death rate was 9·3 per 1000 of the population, as compared with the rate of 10·3 per 1000 of the population in 1904. The average rate for the 10 years 1895—1904, was 11·1. It is of interest to note that this is the lowest rate ever recorded for Hampstead; the previous lowest being that of 9·8 in 1903. The following table shews a comparison of the death rates in 1905, for England and Wales, 76 Great Towns, 141 Smaller Towns, England and Wales less 217 Towns, and Hampstead:— Death rate per 1000 of the Population. England and Wales 15·2 76 Great Towns 15·7 141 Smaller Towns 14·4 England and Wales, less the 217 Towns 14·9 Hampstead 9·3 Chart shewing the number of Deaths of persons resident in or belonging to the Borough, occurring during each week of 1905. 3 deaths also occurred after the 52ND complete week, viz. on 31st December. 27 The following are the estimated death rates for each of the wards:— WARD. Estimated Death Rate. No. 1 (Town) 9·5 No. 2 (Belsize) 9·4 No. 3 (Adelaide) 8·5 No. 4 (Central) 6·1 No. 5 (West End) 9·6 No. 6 (Kilburn) 10·8 No. 7 (Priory) 9·3 In Table IX., page 128, the death rates of Hampstead may be compared with those of England and Wales since 1875. The following table, which is issued by the Registrar-General, shews the death rate for Hampstead as compared with the County of London, the City of London, and the other Metropolitan Boroughs. It will be noted that the death rate for Hampstead is lower than that for any other district within the County. [The census of the population residing in Flats and Artizans Dwellings, with their Birth and Death Bates compared with the whole Borough, will be found on pages 95-98.] 28 Table shewing the Death Rates from All Causes in the County of London, the City of London, and the Metropolitan Boroughs during the 52 Weeks of 1905, as calculated by the Registrar-General. Death rate from all causes. County of London 15·1 Hampstead 9·3 Lewisham 11·7 Wandsworth 12·6 Woolwich 12·8 Stoke Newington 12·9 Paddington 13·3 Greenwich 13·4 City of Westminster 13·5 Camberwell 13·7 Hammersmith 13·9 Hackncy 14·0 Kensington 14·0 Deptford 14·3 Battersea 14·5 Islington 14·5 Chelsea 14·8 Lambeth 14·9 Fulham 15·1 St. Marylebone 15·5 St. Pancras 15·8 City of London 17·4 Holborn 17·5 Poplar 17·6 Stepney 17·7 Southwark 18·5 Bethnal Green 18·6 Bermondsey 18·7 Finsbury 19·0 Shoreditch 19·7 29 Outlying Deaths. The practice (to which reference was made in the Annual Report for 1904, page 74) of forwarding information concerning deaths of "residents" of other places, to the Medical Officer of Health for the district to which they belong, immediately upon receipt of the Registrar's weekly Return, has been continued during the year. Information concerning 57 such deaths has been transmitted to the following districts (excluding the Metropolitan Boroughs:— Acton. Lee on-Solent. Charlton. Leytonstone. Chiswick. Lower Walmer. Croydon. Manchester. Ealing. Merton. East Dulwich. Morton-in-Marsh. Edmonton. Penge. Epping. Pinner. Forest Gate. Purley. Gateshead. Richmond. Great Malvern. Rickmansworth. Goodmayes. Wallington. Groombridge. Watford. Han well. West Ealing. Hendon. Willesden. Harrow. Wood Green. Hornsey. Worthing. Kingston. Deaths at Various Ages. The following table shews the number of Deaths at the various age periods, the causes of such deaths being shewn in Table IV., page 118. Age Periods. Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. At all Ages. Deaths 133 56 16 38 303 277 823 Under one year the mortality was 133, a decrease of 28 as compared with the previous year. 30 In the following table, these infantile deaths are distributed in Wards, under their respective causes. CAUSE OF DEATH. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Totals. Common Infectious Diseases: Small-pox .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. 1 1 Scarlet Fever .. .. .. .. .. .. .. .. Diphtheria: Croup .. .. .. .. .. .. .. .. Whooping Cough 1 .. .. .. 2 3 .. 6 Diarrhœal Diseases: Diarrhœa, all forms 1 .. .. .. 1 3 2 7 Enteritis (not tuberculous) .. .. .. .. 2 .. 1 3 Gastritis, Gastro-intestinal Catarrh 2 .. .. .. 1 2 1 6 Wasting Diseases: Premature Birth 4 2 l .. 3 12 2 24 Congenital Defects 3 3 .. 2 6 4 1 19 Injury at Birth 1 .. 1 1 2 1 2 8 Want of Breast Milk .. .. .. .. .. .. .. .. Atrophy, Debility, Marasmus .. 1 .. .. 1 10 1 13 Tuberculous Diseases: Tuberculous Meningitis 1 .. .. .. .. 1 .. 2 Tuberculous Peritonitis: Tabes Mesenterica 1 .. .. .. .. .. .. 1 Other Tuberculous Diseases .. 1 .. .. 1 .. 1 3 Erysipelas .. .. .. .. .. .. .. .. Syphilis .. .. .. .. 1 1 .. 2 Pickets .. 1 .. .. .. .. .. 1 Meningitis (not tuberculous) 2 .. 1 2 2 .. .. 7 Convulsions 1 2 .. .. .. 1 .. 4 Bronchitis .. .. .. .. .. 3 1 4 Laryngitis .. .. .. .. .. .. .. .. Pneumonia 4 2 .. .. 1 4 .. 11 Suffocation, overlaying 1 .. 1 .. .. 2 1 5 Other Causes 2 1 .. .. .. 3 .. 6 All Causes 24 13 4 5 23 50 14 133 31 Of the total infantile deaths 60 were investigated with the following results:— 4 were found to have occurred in 1 roomed tenements. 33 ,, ,, 2 ,, 16 ,, yy 3 ,, 7 in tenements with more than three rooms. In 23 instances the children had been nursed by the mother; in 22, hand-fed; in 13, partly nursed and partly hand-fed; while two infants, owing to prematurity of birth, &c., had been unable to take food. Diarrhoea.—Of the 7 deaths from Diarrhoea, 6 were investigated, and it was found that all had been entirely hand-fed. Enteritis. — The 3 deaths from Enteritis were investigated, and it was found that 1 was nursed and 2 hand-fed. Tubercular Diseases. - Of the 6 deaths of infants from tubercular disease, 2 were investigated; both were breast-fed, in one case there was a history of consumption in the family. Marasmus, Debility, &c.—Of the 13 infantile deaths from Marasmus, Debility, &c., 9 were investigated; 4 infants had been hand-fed, 4 had been partly hand-fed and partly nursed, and only 1 had been entirely nursed, a twin infant whose mother was quite insufficiently nourished through extreme poverty. An inspection was made of the sanitary condition of the dwellings, and in 23 instances defects were discovered and dealt with. One case of overcrowding was found and remedied. The lack of any suitable place for the storage of milk and other food is still a striking feature in the majority of tenements visited. The question of infantile mortality is one which has come into considerable prominence during recent years, and consequently receives more attention from all direetions than was previously the case. Probably the decline in the birth-rate has been a factor in bringing about this result, but quite apart from that, it has long been apparent to all students that although the death rate of children under one year of age varied from time to time, influenced by such causes as the variations in climatic conditions, the rise and fall of subsoil water, or the prevalence of zymotic diseases, yet even in the most favourable seasons it has always been higher than should have been the case, had proper care and 32 attention been exercised in the feeding, rearing, treating, and sleeping of infants. It is inevitable that a considerable number of deaths must always occur among children at this early period of life, and a large proportion of these deaths can scarcely be said to be due to any illness contracted bv the infant itself who is born with the condition which leads to its early death—immaturity and deficient or defective vitality dependant upon some ante-natal influences, of which excessive alcoholism in one or both parents is one important factor. Therefore, in considering the efforts of those concerned with public health administralion in the direction of effecting a decrease in the infantile death rate, it becomes necessary to analyze the causes of death under the headings of "Preventable" and "Non-preventable." Such analysis is interesting from many points of view, and discloses the fact that 98 out of 133 such deaths which occurred in Hampstead during the year could not have been prevented by any steps that a Sanitary Authority might reasonably be expected to take. The "Preventable" infantile death rate is therefore 25 per 1000 births, or 26 per cent. of the total infantile deaths. The term "Preventable," as applied to a cause of death, has been interpreted by me to include: — (a) deaths from diseases, the contraction of which it is possible to avoid by proper care and due application of modern scientific knowledge; (b) deaths from diseases in which it is possible that the efforts of Public Health Authorities can be of avail in avoiding a fatal termination; (c) deaths which occur through causes which arc preventable but only by those in immediate contact with the infant. During the last seven months special efforts have been made in the Borough for the preservation of infant life. It would be fallacious to claim that these efforts have been entirely responsible for the satisfactory decline in the figures for the year under review, but the fact remains that the infantile death rate has fallen from 111 per 1,000 births in 1904 to 93 in 1905, and I have every hope that when the statistics for a number of years are available, they will show that the infantile death rate from " Preventable " causes has been considerably diminished. Some idea of the efforts made by the Department in this direction of infantile mortality can be gathered by reference to the routine followed upon the notification of each birth, as set out in pages 23 and 24. 33 Table shewing Infantile Deaths classified as from "Preventable" and "Non-Preventable" causes of Death:— PREVENTABLE. NON-PREVENTABLE. CAUSE OF DEATH. Totals. CAUSE OF DEATH. Totals. Common Infectious Diseases: Common Infectious Small-pox - Diseases: Chicken-pox - Scarlet Fever — Measles 1 Diphtheria: Croup — Whooping Cough 6 Diarrhœal Diseases: Wasting Diseases: Diarrhœa, all forms 7 Premature Birth 24 Enteritis (not Tuberculous) 3 Congenital Defects 19 Gastritis, Gastro- intestinal Catarrh 6 Injury at Birth 8 Atrophy, Debility, Marasmus 13 Wasting Diseases: Want of Breast-milk Erysipelas — Tuberculous Diseases: Syphilis 2 Meningitis (not Tuberculous) 7 Tuberculous Meningitis 2 Tuberculous Peritonitis: Tabes Mesenterica 1 Convulsions 4 Bronchitis 4 Other Tuberculous Diseases 3 Laryngitis — Rickets 1 Pneumonia 11 Suffocation, overlaying 5 Other Causes 6 Total 35 Total 98 34 I am well aware that these definitions and tables of "Preventable" and "Non-Preventable" Infantile Deaths may not be concurred in by other observers of the subject; however, I have endeavoured to demonstrate under this heading that there is a large field in which your Public Health Department hopes to effect further reduction in Infantile Mortality; but there appears to me a still greater field where any efforts of theirs can have little or no result. Infantile Death Rate. The infantile death rate for 1905 was 93·6 per 1,000 births, a figure lower than that for the year 1904, when the rate was 111·4. The following table shews a comparison of the infantile death rates in 1905), for England and Wales, 76 Great Towns, 141 Smaller Towns, England and Wales less the 217 Towns, and Hampstead. Infantile Death Rate per 1000 births. England and Wales 128 76 Great Towns 140 141 Smaller Towns 132 England and Wales less the 217 Towns 113 Hampstead 93·6 The following are the estimated infantile death rates for each of the Wards:— WARD. Estimated Infantile Death Rate per 1000 Deaths. No. 1 (Town) 123·7 No. 2 (Belsize) 62·2 No. 3 (Adelaide) 41·7 No. 4 (Central) 44·2 No. 5 (West End) 92·0 No. 6 (Kilburn) 117·4 No. 7 (Priory) 105·3 The following table, which is issued by the Registrar-General, shews the infantile death rate for Hampstead as compared with the County of London, the City of London, and the other Metropolitan Boroughs. It will be noted that only three other districts within the County have a lower infantile death rate than Hampstead:— 35 Table shewing the. Infantile Death Rates of the County of London, the City of London, and the Metropolitan Boroughs during the 52 "Weeks of 1905, as calculated by the Registrar General. Deaths under 1 year to 1000 Births Registered. County of London 129 St. Marylebone 88 Holborn 92 Lewisham 92 Hampstead 94 Woolwich 102 City of Westminster 114 Lambeth 115 Chelsea 117 Wandsworth 119 Greenwich 119 Stoke Newington 122 Deptford 122 Paddington 123 Camberwell 124 Islington 125 Finsbury 127 Hackney 129 Battersea 131 St. Pancras 135 Hammersmith 135 Stepney 141 Kensington 144 Fulham 145 Bermondsey 148 Southwark 148 City of London 149 Bethnal Green 151 Poplar 153 Shoreditch 167 36 Senile Mortality. The deaths of persons of 65 years of age and upwards numbered 277, as compared with 275 in 1904. The ages of persons who died over 85 years of age were as follows:— 4 at 86 9 „ 87 3 „ 88 4 „ 89 2 „ 90 2 „ 91 3 „ 92 1 „ 95 2 „ 96 30 The causes of death of these 30 persons were as follows:— Gangrene 1 Intestinal obstruction 1 Gout 1 Diseases of Kidney 2 Diseases of Respiratory Organs 6 Heart Diseases and Syncope 17 Accidents 2 30 Causes of Death. Pulmonary Phthisis Accounted for 73 deaths, as compared with 73 deaths during 1904, and representing 8·9 per cent. of the total deaths, of which number 13 occurred in persons under the age of 25 years, and 57 between 25 and 65 years of age. The Ward distribution of these deaths will be found on page 61. Other Tubercular Diseases. In addition to the deaths classified under the previous heading 10 were due to Tubercular Meningitis, 2 to Tubercular Peritonitis, 1 to Tuberculosis of the Kidney and Bladder, and 9 to other forms of Tuberculosis. 37 The total mortality, therefore, from Tuberculosis in 1905 was 95, or 11·6 per cent. of the total deaths from all causes, as compared with 102 or 11·4 per cent. in 1904. Alcoholism and Cirrhosis of the Liver. In all, 11 deaths were recorded from Alcoholism and Cirrhosis of the Liver, the latter a condition most frequently associated with alcoholic intemperance. Cancer and other Malignant Disease. 73 deaths, or 8·9 per cent. of the total deaths, were certified as being due to Cancer and other malignant disease, as compared with 85 or 9·5 per cent. in 1904. Of the total deaths under this heading, 3 were certified as due to Epithelioma, 4 to Sarcoma, 2 to Scirrhus Cancer, and 64 to other malignant growths, merely described in the death certificates as Carcinoma, Cancer, or Malignant disease. Of the total deaths from this disease, 50 were of females and 23 of males, and all occurred in persons over the age of 25, of which 34 were of persons of 65 years of age or upwards. Career deaths. Year. Per 1000 of the estimated population. Per cent. of total deaths from all causes. Males and Females. Males. Females. 1901 0·93 8·8 3·3 5·5 1902 1·09 10·0 4·1 5·9 1903 1·23 12·5 3·1 9·4 1904 0·98 9·5 3·1 6·4 1905 0·83 8·9 2·8 6·1 In considering the percentages of Cancer deaths of males and females, if should be borne in mind that at the Census of 1901, 38·7 per cent. of the population were males, and 61·3 per cent. of the population were females. Diseases of the Circulatory System. These accounted for 133 deaths, or 16·2 per cent. of the total deaths, as compared with 79 or 8·8 per cent. in 1904. 38 Diseases of the Respiratory System. The total mortality from this class of disease was 145, or 17·6 per cent. of the total deaths, of which 3·3 or 22·7 per cent. occurred in children under the age of 5 years, and 57 or 39·3 per cent. in persons of 65 years of age or upwards. Of the total deaths, 76 were due to Pneumonia, 50 to Bronchitis, 1 to Pleurisy, and 18 to other diseases of the respiratory organs. Accidents. Of the 32 deaths classified under this heading 9 were due to falls, 2 to lightning stroke, 2 to burns, 6 to street accidents, 11 to suffocation, 1 to drowning, and 1 to railway accident. Suicides. Of the 9 deaths from this cause, 3 were due to drowning, 2 to shooting, 1 to hanging, 1 to jumping from a bridge, and 2 to cut throat- Murder. 1 death from Murder was registered, a case of an infant, and due to want of attention at birth. All other Causes. Under the heading of "All other Causes," in Table IV., page 118, are included the following:— Inanition, Debility from birth, and Marasmus 19 Epilepsy 2 Aneurism 1 Cerebral haemorrhage, Thrombosis, Embolism, Hemiplegia, Apoplexy 48 Senile Decay 49 Diseases of Kidney (Acute and Chronic) 40 Rheumatism (Acute) 1 Appendicitis 8 Cerebro-Spinal Fever. The somewhat extensive prevalence of this disease in Central Europe, America, and its appearance in this country, brought the subject into prominence. 39 The Local Government Board issued a circular to the various Sanitary Authorities, asking them to be on the alert to detect any cases that might occur in their districts. This communication came to hand during the summer vacation. The matter being one of considerable importance, the medical practitioners of the Borough were at once circularized, calling their attention to the subject, and a copy of the Local Government Board's "Memorandum" was enclosed. No case of this disease has occurred during 1905. ZYMOTIC DISEASES. 43 ZYMOTIC DISEASES. Of the notifiable Zymotic diseases, 295 cases, equivalent to an attack rate of 3·3 par 1000 of the population, and comprising— Scarlet Fever 170 Enteric Fever 17 Diphtheria and Membranous Croup 63 Puerperal Fever 2 Erysipelas 42 Continued Fever 1 were notified during the year, with a mortality of 14, while Chickenpox, Whooping Cough, Measles, and Epidemic Diarrhoea, to which notification does not apply, contributed 28 deaths. It affords me considerable pleasure to bo able to report that further records have been established in the Vital Statistics of Hampstead in regard to the zymotic diseases. The total mortality from all the Zymotic diseases was 42, representing a Zymotic death rate of 0·47 per 1000 of the population, as compared with 56 or 0·65 per 1000 of the population in 1904. The attack rate from notifiable zymotic diseases has fallen to the extraordinarily low figure of 3·3 per 1000 of the population, and the mortality from the 7 principal zymotic diseases to 38, equivalent to a rate of 0·43 per 1000 of the population. I have no hesitation in stating that after making due allowance for the improvement in the sanitary condition of the Borough, these eminently satisfactory results are to a very large extent due to the prompt and thorough manner in which the Staff of the Public Health Department has investigated each case as it occurred, and taken the necessary steps to prevent the spread of the disease. Mistaken Diagnosis and Bacteriological Examination. Each Annual Report of the Metropolitan Asylums Board contains statistics of the number of cases sent to their Hospitals wrongly diagnosed, and on several occasions last year these statistics led to statements being made which would appear to contain reflections on the medical men upon whose certificate the case was sent to the Fever Hospital. 44 It must be patent to all that a certain number of mistakes in the diagnosis of Infectious Disease must be unavoidable, and any reflection cast upon the Medical Profession for such mistakes is to be deprecated, as calculated to impede the Sanitary Authorities in effecting that prompt and complete isolation which it is their aim to attain. That individuals sent to Hospitals with their diseases wrongly diagnosed may come to harm in consequence is possible, but very improbable, and no such effect has hitherto been apparent, but a doubtful case kept in the crowded homes of the poor for days or even weeks until the diagnosis is absolutely certain, is capable of doing incalculable mischief by infecting other persons. The certifying practitioner is often placed at considerable disadvantage in making his diagnosis; he has to act upon his judgement, and it is most desirable in the interest of the whole community that he should act with all promptitude and despatch. Some idea of the difficulty of making universal correctness may be gleaned from a statement made by the Medical Superintendent of the South Eastern Hospital at the time that Hospital was about to be reconstructed. He states as follows: "During the year 1903, 1,286 patients were admitted with a certificate of Scarlet Fever or Diphtheria. Of 735 cases certified as Scarlet Fever, 538 cases were diagnosed (only one incorrectly) Scarlet Fever in the receiving room; whilst the diagnosis in the receiving room was 'doubtful' in 197 instances. Of these 197 cases, 158 were 'ultimately' diagnosed Scarlet Fever, and 39 were 'ultimately' diagnosed other diseases. Of 551 cases certified Diphtheria, 317 were diagnosed (only two incorrectly) Diphtheria in the receiving room, whilst the diagnosis in the receiving room was 'doubtful' in 234 cases. Of these 234 cases, 154 were 'ultimately' diagnosed Diphtheria and 80 were 'ultimately' diagnosed other diseases." It will thus be seen that certifying practitioners were wrong in their diagnosis in but 54 per cent. of the cases of Scarlet Fever and 14·9 per cent. of the cases of Diphtheria. As will be seen from the subjoined table, the number of cases sent back in Hampstead is small, but I am of opinion that it might be further Chart shewing the monthly notifications of all Notifiable Infectious Diseases (excepting Chickenpox) during 1905, and previous year. Dotted lines denote Monthly Notifications of all Notifiable Infectious Diseases (excepting Chickenpox) in 1904. 45 considerably reduced with the consequent saving of the expenditure involved, if you were to make arrangements similar to those which have been in operation for several years in a number of Metropolitan Boroughs, by which medical practitioners can have the assistance of a bacteriological examination and report. TABLE of Cases of Infectious Disease sent from Hampstead to the Metropolitan Asylums Board Hospitals and returned as wrongly diagnosed:— Year. Disease. No. of Removals. Returned as not suffering from the disease certified. 1902 Scarlet Fever 169 4 1903 111 5 1904 120 8 1905 134 10 1902 Diphtheria 55 4 1903 56 5 1904 31 4 1905 39 1 1902 Enteric Fever 27 4 1903 9 4 1904 11 1 1905 10 1 1902 Small Pox 17 1 1903 1 - 1904 1 1 1905 - - In addition to the above, during the year 1905, two certificates of cases of Scarlet Fever nursed at home were withdrawn by the medical attendants. 46 Temporary Shelter. It is convenient here to note that the houses—6 and 8, Pond Street —which were rented in the early part of 1902 at the suggestion of the Local Government Board, to provide accommodation for families dishoused while their rooms were being disinfected, had been so little used (one family only having been housed there) that in March it was decided to give up No. 6, No. 8 being rented for another 12 months, but in the meantime I reported that the premises were unsuitable for the purpose, and it was decided not to continue the occupation of the house, and that the Town Clerk should take the necessary steps to terminate the tenancy. The following table gives a comparison of the annual death rates from the 7 principal Zymotic diseases in Hampstead, England and Wales, 76 Great Towns, 141 Smaller Towns, and England and Wales less the 217 Towns, during 1905:— 7 Principal Zymotic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhœa. England and Wales 1·52 0·00 0·32 0·11 0·16 0·25 0·09 0·59 76 Great Towns 1·88 o·oo 0·39 0·13 0·16 0·29 0·08 0·83 141 Smaller Towns 1·50 0·00 0·31 0·11 0·15 0·23 0·13 0·57 England and Wales less the 217 Towns 1·09 o·oo 0·24 0·09 0·15 0·20 0·09 0·32 Hampstead 0·43 — 0·09 0·07 0·03 0·11 0·02 0·02 The following table shews the attack and death rates from Smallpox, Diphtheria and Membranous Croup, Erysipelas, Scarlet Fever and Enteric Fever, for the years 1901 to lb05 :— 47 TABLE shewing the attack rate and death rate for the Borough from Smallpox, Diphtheria and Membranous Croup, Scarlet Fever, and Enteric Fever, during the years 1901-1905. Year. Smallpox. Diphtheria and Membranous Croup. Erysipelas. Scarlet Fever. Enteric Fever. Attack rate per 1000 of the population. Death rate per 1000 of the population. Attack rate per 1000 of the population. Death rate per 1000 of the population. Attack rate per 1000 of the population. Death rate per 1000 of the population. Attack rate per 1000 of the population. Death rate per 1000 of the population. Attack rate per 1000 of the population. Death rate per 1000 of the population. 1901 0.09 0.02 1.72 0.21 0.58 0.03 2.60 0.04 0.54 0.08 1902 0.20 0.02 1.01 0.11 0.66 — 2.99 0.08 0.52 0.11 1903 0.01 — 0.92 0.12 0.47 0.01 1.93 0.03 0.28 0.02 1904 — — 0.63 0.06 0.62 0.04 1.83 0.02 0.30 0.06 1905 — — 0.71 0.03 0.48 0.03 1.93 0.07 0.19 0.02 48 Cases of Infectious Disease occurring in each Ward during 1905. Diseaes. No. 1 (Town) No. 2 (Belsize) No. 3 (Adelaide) No. 4 (Central) No. 5 (West End) No. 6 (Kilburn) No. 7 (Priory) Totals. Diphtheria and Membranous Croup 18 3 7 5 10 7 13 63 Erysipelas 14 6 3 2 5 6 6 42 Scarlet Fever 34 29 16 15 12 41 23 170 Typhoid and Enteric Fever 5 3 1 2 2 2 2 17 Puerperal Fever 1 1 — — — — — 2 Continued Fever — — — — — 1 — 1 Totals 72 42 27 24 29 57 44 295 49 Cases of Infectious Disease occurring in each Month during 1905. Ward. Disease. January. February. March. April. May. June. July. August. September. October. November. December. Totals. No. 1 (Town) Diphtheria and Membranous Croup 1 ... 3 2 ... 1 7 ... 1 2 ... 1 18 Erysipelas 1 2 5 ... 1 ... 2 ... 1 ... 1 1 14 Scarlet Fever 2 9 11 2 2 ... 2 1 ... 2 2 1 34 Typhoid and Enteric Fever ... ... 1 ... ... ... 2 ... 1 ... 1 ... 5 Puerperal Fever ... ... 1 ... ... ... ... ... ... ... ... ... 1 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 4 11 21 4 3 1 13 1 3 4 4 3 72 No. 2 (Belsizc) Diphtheria and Membranous Croup ... ... ... ... 1 ... ... 1 ... ... 1 ... 3 Erysipelas ... 1 ... ... 2 ... ... .. . ... 1 1 1 6 Scarlet Fever 1 ... 4 3 4 4 ... ... 3 2 4 1 29 Typhoid and Enteric Fever 1 ... ... ... 1 ... ... ... ... ... ... 1 3 Puerperal Fever 1 ... ... ... ... ... ... ... ... ... ... ... 1 Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 3 1 4 3 8 4 3 1 3 3 6 3 42 No. 3 (Adelaide) Diphtheria and Membranous Croup ... ... 1 1 1 ... ... ... 1 ... ... 3 7 Erysipelas ... ... 1 ... ... ... ... ... 1 ... 1 ... 3 Scarlet Fever ... ... 2 2 3 2 1 1 1 2 2 ... 16 Typhoid and Enteric Fever ... ... ... ... ... ... ... 1 ... ... ... ... 1 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Totals ... ... 4 3 4 2 1 2 3 2 3 3 27 No. 4 (Central) Diphtheria and Membranous Croup ... ... 1 ... 1 ... ... ... ... 1 1 1 5 Erysipelas ... ... ... 1 ... ... ... ... ... ... ... 1 2 Scarlet Fever 1 1 1 3 ... 4 ... ... ... 3 2 ... 15 Typhoid and Enteric Fever ... 1 ... ... ... ... ... ... 1 ... ... ... 2 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 1 2 2 4 1 4 ... ... 1 4 3 2 24 50 Cases of Infectious Disease occurring in each Month during 1905 (cont.). Ward. Disease. January. February. March. April. May. June. July. August. September. October. November. December. Totals. No. 5 (West End) Diphtheria and Membranous Croup 1 ... 3 1 1 1 ... 1 ... 1 ... 1 10 Erysipelas 1 1 ... ... ... ... ... 3 ... ... ... ... 5 Scarlet Fever ... 1 ... 1 1 1 2 1 ... 3 1 1 12 Typhoid and Enteric Fever ... ... ... ... 1 ... ... 1 ... ... ... ... 2 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 2 2 3 2 3 2 2 6 ... 4 1 2 29 No. 6 (Kilburn) Diphtheria and Membranous Croup ... 1 1 ... 1 ... 1 ... ... 1 1 1 7 Erysipelas ... ... ... 1 ... ... 1 ... ... 1 2 1 6 Scarlet Fever 1 ... 2 6 7 3 8 ... ... 4 ... 10 41 Typhoidand Enteric Fever ... ... ... 1 1 ... ... ... ... ... ... ... 2 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... 1 ... ... ... ... ... ... ... ... 1 Totals 1 1 3 9 9 3 10 ... ... 6 3 12 57 No. 7 (Prior}') Diphtheria and Membranous Croup ... 2 3 1 1 1 2 2 ... 1 ... ... 13 Erysipelas 1 1 ... ... 2 ... 2 ... ... ... ... ... 6 Scarlet Fever 3 3 5 4 3 1 3 ... 1 ... ... ... 23 Typhoidand Enteric Fever ... ... ... ... ... ... 1 ... ... 1 ... ... 2 Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Continued Fever ... ... ... ... ... ... ... ... ... ... ... ... ... Totals 4 6 8 5 6 2 8 2 1 2 ... ... 44 The Borough Diphtheria and Membranous Croup 2 3 12 5 6 3 10 4 2 6 3 7 63 Erysipelas 3 5 6 2 5 ... 5 3 2 2 5 4 42 Scarlet Fever 8 14 25 21 20 15 19 3 5 16 11 13 170 Typhoid and Enteric Fever 1 1 1 1 3 ... 3 2 2 1 1 1 17 Puerperal Fever 1 ... 1 ... ... ... ... ... ... ... ... ... 2 Continued Fever ... ... ... 1 ... ... ... ... ... ... ... ... 1 Totals 15 23 45 30 34 18 37 12 11 25 20 25 295 Chart shewing the Monthly Notifications of Scarlet Fever during 1905 and previous year. Dotted lines denote Monthly Notifications of Scarlet Fever in 1904. 51 Smallpox. No case of this disease has been notified during the year. Vaccination. By the courtesy of the Vaccination Officer, who has kindly supplied me with the necessary data, I am enabled to give some information as to the important question of vaccination in Hampstead. The figures for the year 1905 are not yet complete, as the time limit for the vaccination of children born in the last few months of 1905 has not yet expired. From the Table (No. XVI., p. 136) it will be seen the extent to which the inhabitants of the Borough are availing themselves of the security which vaccination affords. The number of instances in which the inhabitants of Hampstead have taken advantage of the " Conscientious Objector" clause continues about the same as in preceding years, being between 2 and 2.5 per cent. of the registered births. The Public Vaccinator, Dr. A. II. Cook, informs me that the clause works well in his district, and that he encounters very little opposition, the great majority of the poorer inhabitants being glad to avail themselves of the facilities for vaccination afforded them. From reference to the Table (No. XVI., p. 136) it will be seen that 206 exemption certificates have been issued since the beginning of 1900, which is equal to 2.3 per cent. of the registered births. When the Act of 1898 was passed, it was as a five years' experiment, but in spite of the fact that in the meantime a Smallpox Epidemic of considerable severity has visited the country, the question has never been reviewed, but the provisions of that Act have been kept in operation from year to year through the instrumentality of the Annual Expiring Laws Continuance Act. Scarlet Feyer. 170 cases were notified, as compared with 159 in 1904, and the attack rate per 1000 of the population was 1.93. Six deaths were recorded, equal to 3.8 per cent. of the cases notified, or 0.07 per 1000 of the population. 52 Of the cases notified, 134 or 78 per cent. were removed to hospital. The houses in which cases occurred were inspected and the drains examined. Defective drains were found in 43 instances, defective soil pipes in 32 instances, defective water supplies in 24 instances, and general defects in 52 instances. Cases of Scarlet Fever notified in each Month. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 8 14 25 21 20 15 19 3 5 16 11 13 170 Cases of Scarlet Fever notified in each Ward. Ward 1 (Town). Ward 2 (Belsize). Ward 3 (Adelaide) Ward 4 (Central). Ward 5 (West End). Ward 6 (Kilburn). Ward 7 (Priory). Total. 34 29 16 15 12 41 • 23 170 It should he noted that of the cases notified from the Belsize Ward 2 occurred in the North-Western Fever Hospital. These occurred in members of the Staff of the Hospital. Enteric Fever. 17 cases of this disease were notified, as compared with 26 in 1904. The attack rate per 1000 of the population was 0.19. It will he seen from the following table that the disease was rather more prevalent in May and July than any other months. Of the total cases 2 proved fatal, giving a case mortality of 11.8 per cent., or 0.02 per 1000 of the population. The sanitary condition of houses in which the cases occurred was investigated and the drains tested. Defective drains were found in 5 instances, defective soil pipes in 5 instances, defective water supplies in 3 instances, and general defects in 3 instances. Of the eases notified, 10, or 58 per cent., were removed to hospital. Chart shewing the Monthly Notifications of Enteric Fever during 1905 and previous year. Dotted lines denote Monthly Notifications of Enteric Fever in 1904. 53 In every case of Enteric Fever occurring in the Borough, I have made special investigations with the object of detecting the cause and origin of the disease. Thus, the habits, food, occupation, and movements of the patient prior to the onset of his illness have been ascertained, and I append a table of the results of these enquiries. It will there be seen that nearly half of the cases of Enteric Fever occurring in 1905 were direct importations from outside districts, and in at least five instances, the disease was contracted outside England altogether at points as widely apart as Toronto and Moscow. Enteric Fever has an incubation period of usually 12 to 14 days, and I am assuming this to have been so in the Enteric Fever cases of 1905, of which the following arc the chief points of interest. Case No. Initials and Age. Locality. History of Case. 1 A. S., 31 Southampton Road Notified 23rd January. The patient was a sewer labourer and had been following his employment up to the onset of his illness. 2 N. Q., 17 A Frognal Parade, Finchley Road Notified 21st February. No history of the place or origin of infection could be ascertained. 3 W. M. 13 Church Lane Notified 25th March. Beyond the fact that the patient had been recently eating winkles, no history of the infection could be traced. Case terminated fatally on 7th April. 4 A. S., 22 Netherwood Street Notified 15th April. The patient returned ill from Clacton-on-Sea. Case terminated fatally on 15th April. 5 E. S. 20 Belsize Lane Notified 5th May. The patient was a lady's maid, and had returned from Venice eight days previously. 6 C. R., 5 Fortune Green Road Notified llth May. No history of infection could be ascertained, but the drains of the house were found to be exceedingly defective. 7 A. R., 14½ Hemstal Road Notified 25th May. No history of the place or origin of infection could be ascertained. 8 E. S. 27 Frognal Lane. Notified 15th July. The patient was a lady's maid, and had recently returned from Switzerland feeling unwell. 54  Case No. Initials and Age. Locality. History of Case. 9 W. H., 48 Fairfax Mews Notified 29th July. No history of infection could be ascertained, but the drains of the house were found to be exceedingly defective, and the premises generally in an insanitary state. 10 H. B., 19 Frognal Notified 29th July. The patient had been working for a railway contractor in Islington, and had been known to have drunk considerable quantities of mineral waters, which were alleged to be the cause of his illness. 11 B. W., 24 Finchley road Notified 22nd August. The patient had been very ill for some weeks prior to the development of the disease, and had been sucking ice obtained from a local butcher. The drains of the house were found to be defective. 12 L.P., 19 Winchester Road Notified 29th August. The patient was a domestic servant. No history of infection could be ascertained, but the drains of the house were found to be defective. 13 F. H., 30 Lithos Road Notified 21st September. The patient had been spending a holiday in Moscow, and only returned to this country three days prior to the onset of the illness. 14 E. H., 29 Carlingford road Notified 23rd September. The patient arrived in London six days previously from Toronto, and was then suffering from what ultimately proved to be Enteric Fever. 15 B.J., 40 Goldhurst Terrace Notified 3rd October. The patient had returned six days previously from Germany. The disease was probably contracted at Frankfort. 16 M. L., 40 Carlingford Road Notified 21st November. The patient had been travelling in England for the past month, and arrived in Hampstead two days previous to the onset of the illness. 17 A. H., 24 South End Green Notified 11th December. Patient was a van dweller travelling with an itinerant auctioneer, and had suffered for a week before coming to Hampstead from what ultimately proved to be Enteric Fever. Chart shewing the Monthly Notifications of Diphtheria and Membranous Croup during 1905 and previous year. Dotted lines denote Monthly Notifications of Diphtheria and Membranous Croup in 1904. 55 Cases of Enteric Fever notified in each Month. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec Total. 1 1 1 1 1 — 3 2 2 l 1 1 17 Cases of Enteric Fever notified in each Ward. Ward 1 (Town). Ward 2 (Belsize). Ward 3 (Adelaide). Ward 4 (Central). Ward 5 (West End). Ward 6 (Kilburn). Ward 7 (Priory). Total. 5 3 1 2 2 2 2 17 Diphtheria and Membranous Croup. 63 cases were notified as compared with 55 in 1904, and the attack rate per 1000 of the population was 0.71. The mortality was 3, or 4.7 per cent., of the cases notified, or 0.03 per 1000 of the population. As a result of the inspection of the houses in which the cases occurred, defective drains were found in 12 instances, defective soil pipes in 7 instances, defective water supplies in 14 instances, and general defects in 10 instances. Of the cases notified, 39, or 61 per cent., were removed to hospital. Cases of Diphtheria and Membranous Croup notified in each Month. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 2 3 12 5 6 3 10 4 2 6 3 7 63 Cases of Diphtheria and Membranous Croup notified in each Ward. Ward 1 (Town). Ward 2 (Belsize). Ward 3 (Adelaide). Ward 4 (Central). Ward 5 (West End). Ward 6 (Kilburn) Ward 7 (Priory). Total. 18 3 7 5 10 7 13 63 56 Puerperal Fever. 2 cases were notified, neither of which proved fatal, as compared with 6 cases and 4 deaths in 1904. The houses in which the cases occurred were inspected, and defective drains were found in 2 instances, defective soil pipes in 1 instance, defective water supply in 1 instance, and general defects in 1 instance. The Ward distribution of these cases is as follows:— 1 in Ward 1, and 1 in Ward 2. Erysipelas. 42 cases were notified, and 3 deaths occurred, as compared with 54 cases and 4 deaths in 1904. The case mortality was 7.1 per cent. The attack rate per 1000 of the population was 0.48 and the death rate 0.03. Of the cases notified, 6, or 14 per cent., were removed to hospital. As a result of the inspection of the houses in which the cases occurred, defective drains were found in 12 instances, defective soil pipes in 6 instances, defective water supplies in 6 instances, and general defects in 12 instances. Cases of Erysipelas notified in each Month. Jan. Feb. Mar. April. May. June. July. Aug. Sept. Oct. Nov. Dec. Total. 3 5 6 2 5 — 5 3 2 2 5 4 42 Cases of Erysipelas notified in each Ward. Ward 1 (Town). Ward 2 (Belsize). Ward 3 (Adelaide). Ward 4 (Central). Ward 5 (West End). Ward 6 (Kilburn). Ward 7 (Priory). Total. 14 6 3 2 5 6 6 42 Continued Fever. One case was notified during 1905, in April, from the Kilburn Ward. On inspection, the water supply was found to he defective. 57 Chicken Pox. This disease accounted for one death during the year. Whooping Cough. This disease accounted for 17 deaths during the year, as compared with 8 in 1904. The mortality was 0.11 per 1000 of the population. Measles. Eight deaths were recorded from this disease, as compared with 15 in 1904. The mortality was 0.09 per 1000 of the population. Measles is now included amongst the dangerous infectious diseases in so far as Sections 60-65, 68-70, and 72-74 of the Public Health (London) Act, 1891, apply. These Sections extend to Measles, the provisions relating to isolation and disinfection, hut do not render it Compulsorily notifiable. During the year 1905, 376 eases have been brought to the knowledge of the Department, as compared with 741 in 1904. The sources of information were as follows:— Cases notified by medical practitioners 8 ,, parents or guardians 63 „ school teachers 295 „ employers and others 5 Death Returns 5 376 In 74 cases it was found, on enquiry, that no doctor was in attendance. These 376 cases occurred in 246 houses:— In 159 houses there was 1 case in each house. ,, 55 „ „ were 2 cases ,, ,, 24 „ ,, ,, 3 ,, ,, ,, 5 ,, ,, ,, 4 ,, ,, „ 3 „ „ „ 5 ,, ,, Owing to an outbreak of Measles, the Infants' Department of the Broomsleigh Street Provided School was closed, from 25th May to 5th June, by the Education Department of the London County Council. Thorough disinfection was carried out by your Officers. 58 The following Table shews the Ward and Month distribution of the cases of Measles: Month. Total No. of Cases Ward 1 (Town) Ward 2 (Belsize) Ward 3) (Adelaide) Ward 4 (Central) Ward 5 (West End) Ward 6 (Kilburn) Ward 7 (Priory) January l — — — — — — 1 February 41 — 2 — — 37 2 — March 26 — 1 — 2 20 1 2 April 5 — 1 l — 3 — — May 67 — — — 2 44 21 — June 81 l 4 l — 22 53 — July 64 — 10 — — 6 41 7 August 5 — 1 — — — 4 — September 1 — — — — — 1 — October 14 — — 14 — — — — November 10 l 7 — — — — 2 December 61 7 53 — — — 1 Totals 376 9 79 16 4 132 123 13 Epidemic Diarrhœa. The number of deaths registered from this cause was 2, as compared with 13 in 1904. The death rate per 1000 of the population from this disease was 0'02. Both of these deaths occurred in the Kilburn Ward in the persons of children under 1 year of age. Influenza. 18 deaths resulted from this disease, as compared with 11 in 1904. Of the total deaths, 1 occurred to a person between 15 and 25 years of age, 5 to persons between 25 and 65 years of age, and 12 to persons of 65 years of age or upwards. PULMONARY PHTHISIS AND ITS VOLUNTARY NOTIFICATION. 61 Deaths from Pulmonary Phthisis. The deaths from this disease amounted to 73 as compared with 73 in 1904. In the following table the deaths are distributed in Wards, and it will be noted that the mortality was greatest in the Kilburn Ward. Phthisis deaths arranged in Wards:— 1905. Ward. Area (Acres) Estimated Population middle of 1905. Phthisis Deaths. Phthisis Death Rate per 1000 of the Population. No. 1 (Town) 686 13330 9 0.67 „ 2 (Belsize) 271 13840 10 0.72 „ 3 (Adelaide) 325 10800 4 0.37 „ 4 (Central) 312 9762 6 0.61 „ 5 (West End) 247 13580 11 0.81 „ 6 (Kilburn) 195 15790 26 1.65 „ 7 (Priory) 229 11040 7 0.63 The Borough 2265 88142 73 0.83 From these figures it will be at once seen that the deaths from Phthisis vary in direct ratio to the density of population, that is, the number of persons per acre. Of the 73 deaths, 3 occurred outside the district, leaving the number of deaths of "residents" which took place in the Borough at 65, 25 of which were of notified and 40 of non-notified cases. Deaths of Notified Cases. Of the 25 notified cases which terminated fatally during the year, 17 were notified during 1905, 7 in 1904, and 1 in 1903. 17 of the deaths occurred in the Workhouse Infirmary, 2 at Friedenheim, and 6 of the patients died at home. Of these 6 cases disinfection was carried out by your disinfectors after 5 of the deaths. In the remaining case it was done by the occupier of the house. In 16 of the 17 cases which died in the Workhouse Infirmary, and in both of those which occurred 62 at Friedenham, the disinfection of the patients' home was carried out at the time of the removal of the patients to those institutions. Besides these 25 deaths, 3 notified cases died in institutions outside the Borough. Deaths of Non-notified Cases. 40 deaths took place of cases which had not been notified, viz.:— 33 in private houses, and 7 in institutions. Upon becoming aware, by means of the Registrar's Returns, of a death from Pulmonary Phthisis occurring in a private house, and not previously notified to the Medical Officer of Health, an Inspector has called in suitable cases and offered disinfection; such offer was accepted in 16 instances. The 65 Hampstead "residents" who died in the Borough during the year consisted of 38 males and 27 females, and their occupations were as follows:— Males. Females. No occupation 4 No occupation given in death returns 19 Army pensioners 2 Art master 1 Daily servant 1 Baker 1 Dressmaker 1 Barrister 1 Milliner 1 Carpenter 1 Needlewomen 2 Clerks 3 Newsagent 1 Coachmen 3 Upholstresses 2 Coal porter 1 27 Concert manager 1 Domestic servant 1 Electric light trimmer 1 Embosser on paper 1 Furniture remover 1 House painters 3 Labourers 2 Page 1 Photographer's traveller 1 Plumber's mate 1 Police constable 1 Porter 1 Potman 1 Printer's compositor 1 Shipowner 1 Stockbroker 1 Tailor's salesman 1 Tutor 1 38 63 Table shewing age, at death, from consumption in Hampstead for the three years 1903, 1904, and 1905. Year. Age Period. All Ages. 0—5 5—15 15—25 25—65 65— 1903 — 1 14 46 5 66 1904 1 1 15 53 3 73 1905 1 — 12 57 3 73 Totals 2 2 41 156 11 212 Voluntary Notification. 29 notifications of cases of phthisis were received during 1905, being 14 less than in 1904. Of these cases 1 was twice notified during the year and one had been notified in a previous year; the number of new cases notified during 1905 was therefore 27, 16 being males and 11 females. Of the cases notified 16 have died during the year, and 7 within one month after notification. In 24 instances the circumstances of the case were investigated with the following results:— In 12 cases a definite history of phthisis having occurred amongst other members of the family was obtained. In 7 cases there was no family history of phthisis or other tubercular disease, but in 2 instances it appeared that other members of the family had suffered from chest affections. In 5 cases, no particulars of family history were obtainable. Disinfection of rooms and bedding was carried out in 22 of the cases notified during the year 1905, and in 3 instances it has been repeated during the year. In those cases where it appeared to be desirable suitable advice and instructions were given to the patient and the persons in charge of the case. 64 The following is a list of the occupations of the 24 cases where investigations were made:— Male. Females. Baker 1 Cook 1 Bus Conductor 1 Daily Servant 1 Caretaker 1 Dressmaker 1 Carmen 2 Housewives 5 Carpenter 1 Upholsteresses 2 Clerk 1 10 Coachman 1 Electric Light Trimmer 1 Furniture remover 1 House painter 1 Porter 1 Potman 1 Stockbroker 1 14 65 I must confess to a feeling of disappointment upon reviewing last year's result of Voluntary Notification. Only a small number out of a total of possibly hundreds of cases which must have come under the notice of the medical profession and others in the Borough were notified. Thus, while the number of notified cases was only 29, the deaths alone from the disease were 73. Of the 29 notifications received, 14, or 48 per cent., were received from the Workhouse; doubtless a large proportion of the patients admitted to the Infirmary were seen by some one prior to admission, who for some reason failed to notify us of the case. In only one instance, however, had the case been previously notified. I am well aware, from actual experience, of the difficulties of obtaining the sufferers' consent to notification even among the poorer class ; the extent of such difficulties is reflected in the fact that the Authorities at the Mount Vernon Hospital for Consumption when approached on this subject, demurred to the Council's proposals that they should notify the cases which came under their care, and up to the present we have failed to secure the co-operation of this important Institution. SANITARY ADMINISTRATION AND GENERAL MATTERS. 69 FACTORY AND WORKSHOP ACT, 1901. Section 132 of the Factory and Workshop Act requires a specific report on the administration of that Act so far as it is the duty of the Borough Council to enforce it, and the following information has been .compiled in pursuance of that requirement. Table showing classification of trade premises on Register, with additions and removals during 1905:— Class of Work. On register at end of 1904. Added in 1905. Removed in 1905. On register at end of 1905. Factories— Factory Laundries 6 1 1 6 Factory Bakehouses 2 — — 2 Other Factories 43 6 2 47 Workshops— Workshop Laundries 6 — — 6 Workshop Bakehouses 36 1 2 35 Other Workshops 631 94 79 646 Workplaces— Places where food is prepared for sale 331 82 5 408 Laundries 38 5 1 42 Other Workplaces 330 35 1 364 Inspection of Workshops (other than Bakehouses). Number of Inspections.—Workshop Laundries 11 Other Workshops 980 Workrooms measured 66 Cleanliness.—29 workrooms were found on inspection in such a condition as to require cleansing. Five of these are standing over at the end of 1905. In 19 cases the occupier at once took steps to remedy the condition of the room, hut in 5 instances it was found necessary to serve notices before the nuisance was abated. 70 Ventilation.—As in previous years, difficulty has been experienced in persuading workers and employers alike of the importance to health of proper ventilation of the workrooms while work is in progress. Windows and other ventilators are frequently found to he closed. The means of ventilation has been improved in 2 workrooms. Overcrowding.—11 workrooms were found to be overcrowded. In 4 instances the overcrowding was immediately abated on the request of the Inspector. In 6 cases it was abated on the service of an Intimation notice, while in one case in which it was found to exist on two occasions, a Statutory notice was served, since when no recurrence of the overcrowding has been discovered. 71 Factories in Wards. Trade or Business. Ward 1 (Town). |Ward 2 (Belsize) Ward 3 (Adelaide Ward 4 (Central) Ward 5 (West End) Ward 6 (Kilburn) Ward 7 (Priory) Art metal worker .. .. .. .. .. .. 1 Bookbinder .. 1 .. .. .. .. .. Bootmaker .. .. .. .. 1 .. .. Brewer 1 .. .. .. .. .. .. Builders .. .. .. .. .. .. .. Butchers 1 .. 1 .. .. 2 .. Carpet beaters .. 1 .. .. .. 1 .. Coach builder .. 1 .. .. .. .. .. Coffee roasters .. .. 1 .. 1 1 .. Dairymen 1 .. 1 .. .. .. .. Engineers .. .. .. 1 1 .. .. Joiners and plasterers .. 1 .. .. .. 1 .. Manufacturing stationer .. 1 .. .. .. .. .. Monumental mason .. .. .. .. 1 .. .. Optician .. 1 .. .. .. .. .. Photographic paper manufacturer .. 1 .. .. .. .. .. Pianoforte maker .. 1 .. .. .. .. .. Pianoforte string makers .. 2 .. .. .. .. .. Picture frame maker .. .. .. .. .. .. 1 Printers 3 1 .. 2 1 1 2 Provision merchants .. .. .. 1 1 .. .. Stained glass maker .. .. .. .. .. .. 1 Steel grinder . . .. .. .. .. 1 .. Upholsterers .. .. .. .. .. .. 1 Totals 7 11 3 4 6 7 9 (Excluding Bakehouses.) 72 Workshops and Laundries in Wards. Trade or Business. Ward 1 (Town). Ward 2 (Belsize), Ward 3. (Adelaide) Ward 4 (Central). Ward 5 (West End). Ward 6 (Kilburn). Ward 7 (Priory). Art metal workers .. 1 .. 1 .. .. .. Blind makers .. 1 .. 2 .. .. 1 Boot makers 13 14 7 3 14 22 13 Builders and carpenters 3 5 2 4 6 8 7 Cabinet makers and polishers 3 1 .. 1 .. 2 .. Carriage builders 3 1 .. 1 l 1 5 Cycle makers and repairers 2 1 2 1 2 2 1 Dressmakers & ladies' tailors 35 16 11 20 30 79 32 Dyers and cleaners .. 1 .. .. .. 1 1 Embroiderers 1 1 1 .. .. 2 .. Engineers .. 1 .. 2 .. .. .. Harness makers 2 .. 3 1 1 1 1 Ironmongers 5 .. 2 3 5 3 .. Lace makers and cleaners .. .. .. 2 .. 2 .. Laundries (Hand) 17 6 .. .. 4 14 7 Laundries (Steam) 1 3 .. 1 .. .. 1 Mantlemakers .. .. .. .. .. 2 .. Milliners 10 1 4 5 4 7 7 Miscellaneous 5 6 .. 4 4 10 8 Monumental Masons .. .. .. 1 2 .. 1 Motor manufacturers .. .. .. 1 .. 1 1 Needlewomen 2 .. 1 .. .. 2 1 Organ builders .. .. .. .. 1 .. .. Outfitters .. .. .. 4 .. 2 3 Pianoforte key makers .. 2 .. .. .. .. .. Pianoforte makers .. 3 1 • • .. .. .. Picture frame makers 4 1 2 2 2 .. 3 Smiths 2 2 .. 1 1 3 1 Stained glass workers 1 .. .. .. .. .. .. Tailors.. 3 4 5 3 8 18 5 Trunk makers .. .. .. 1 1 .. .. Umbrella makers and repairers .. .. .. .. 1 1 1 Upholsterers 2 .. 2 2 6 .. 4 Watchmakers and jewellers 2 1 2 5 3 3 3 Wigmakers .. .. 1 2 2 .. .. Totals 116 72 46 73 98 187 108 (Excluding Bakehouses.) 73 Nature and Number of Businesses, Character of Workshop and Number and Sex of Persons employed. Trade or Business. No. of Premises. Domestic Workshops and Workplaces. Workshops. Number of Workrooms. Number of Employees. Males. Females Art metal workers 2 1 1 1 2 .. Blind makers 4 1 3 6 8 7 Bootmakers 86 38 48 56 99 .. Builders and carpenters 35 7 28 37 61 .. Cabinet makers and polishers 7 2 5 6 9 .. Carriage builders 12 .. 12 22 46 .. Cycle makers and repairers .. 11 .. 11 16 28 .. Dressmakers & ladies' tailors 223 96 127 163 3 676 Dyers and cleaners 3 1 2 4 3 6 Embroiderers 5 2 3 3 .. 10 Engineers 4 .. 4 4 8 .. Harness makers 9 2 7 8 20 .. Ironmongers 18 1 17 18 24 .. Lacemakers and cleaners 4 2 2 2 .. 5 Laundries (Hand) 48 42 6 19 3 49 Laundries (Steam) 6 .. 6 19 20 262 Mantlemakers 2 1 1 4 .. 20 Milliners 38 6 32 35 .. 99 Miscellaneous 37 10 27 38 68 14 Monumental masons 4 .. 4 6 24 .. Motor manufacturers 3 .. 3 5 11 .. Needlewomen 6 6 .. .. .. .. Organ builders 1 .. 1 1 4 .. Outfitters 9 .. 9 33 6 238 Pianoforte key makers 2 1 1 1 2 .. Pianoforte makers 4 .. 4 6 29 .. Picture frame makers 14 2 12 15 22 .. Smiths 10 .. 10 10 31 .. Stained glass workers 2 .. 2 3 5 .. Tailors 46 18 28 31 53 22 Trunk makers 2 .. 2 3 3 .. Umbrella makers & repairers 3 3 .. .. .. .. Upholsterers 16 5 11 16 23 1 Watchmakers & jewellers 19 4 15 15 30 .. Wigmakers 5 1 4 5 7 4 Totals 700 252 448 611 652 1413 (Excluding Bakehouses.) 74 Lists of Outworkers (Section 107). Class of Homework. 1905. Number of Lists Received. Number of Addresses of Outworkers. Due Feb. 1st. Due Aug. 1st. Forwarded to other Authorities. Received from other Authorities. No. of Lists. No. of Outworkers. No. of Lists. No. of Outworkers. Due Feb. 1st. Due Aug. 1st. Due Feb. 1st. Due Aug. 1st. Wearing Apparel— Bootmaking 15 26 19 29 23 19 . . . . Dress and Blouse making 4 7 4 7 7 5 7 8 Needlework and Underclothing 8 24 8 20 22 18 l . . Tailoring 8 33 9 34 29 32 4 5 Dyeing and Cleaning 2 7 2 7 7 7 . . . . Pleating and Pinking 5 9 5 8 7 6 . . . . Cabinetmaking and Upholstery 4 10 5 11 3 4 . . . . Miscellaneous 4 48 3 51 41 43 5 1 Totals 50 164 55 167 139 134 17 14 There are 71 Outworkers' premises in Hampstead:—2 are Factories, 22 are Workshops, 47 are Domestic Workshops or Workplaces, 75 Some difficulty has been experienced in obtaining the Lists of Out workers which must be forwarded to the Medical Officer of Health on the first of February and August of each year. Tradesmen who omit to send them when due are reminded of their obligation by letter, and I am pleased to say that they have ultimately all been obtained without resort to legal proceedings. On the 15th August, 1905, the Home Secretary issued a new Order extending the kind of work to which this requirement applies, which is now as follows:— Section 107 (relating to lists of out-workers), and Section 108 (relating to employment in unwholesome premises). The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel and any work incidental thereto; The making, ornamenting, mending, and finishing of lace and of lace curtains and nets; Cabinet and furniture making and upholstery work; The making of electro-plate; The making of files; Fur-pulling; The making of iron and steel cables and chains; The making of iron and steel anchors and grapnels; The making of cart gear, including swivels, rings, loops, gear buckles, mullin bits, hooks, and attachments of all kinds; The making of locks, latches, and keys; *The making of covers for, and the covering, finishing, altering or repairing of, umbrellas, sunshades, parasols, and articles of a similar character, and any work incidental thereto; *The making of paper bags and of paper boxes; *Brushmaking; and *The making of stuffed toys. *These are the additional trades included in the new Order. 76 Section 110 (relating to the prohibition of home work in places where there is infectious disease). The making, cleaning, washing, altering, ornamenting, finishing, and repairing of wearing apparel and any work incidental thereto (as in the said section specified); The making, ornamenting, mending, and finishing of lace and of lace curtains and nets; Upholstery work; Fur pulling; *The making of covers for, and the covering, finishing, altering or repairing of, umbrellas, sunshades, parasols, and articles of a similar character, and any work incidental thereto; *The making of paper bags and of paper boxes; *Brushmaking; and *The making of stuffed toys. The object of this enactment is to ensure that the making of those articles most likely to convey infection shall be carried on in wholesome premises and under sanitary conditions, and that immediate information of any outbreak of infectious disease may be given to the tradesmen giving out work to be done at the home of the worker. In addition to this, it has been found to be the means of discovering a considerable number of small workshops and workplaces, which would otherwise have escaped inspection. * These are the additional trader included in the new Order. 77 Bakehouses. At the end of 1905 there were 37 Bakehouses on the Register,. 22 being under, and 15 over ground. This is a decrease in the total number of 1, as compard with the previous year, and is due to the fact that the overground bakehouse at 43, High Street, and the underground bakehouse at 132, High Road, Kilburn, have been voluntarily closed, and a new overground bakehouse having been opened at 57, Heath Street. A list of the Bakehouses on the Register at the end of the year will be found in Table XIV., page 134. These premises have been kept under constant supervision during the year. HOUSING OF THE WORKING CLASSES ACT, 1890. Part I, Kilburn Vale Area. The Annual Report for 1904, stated "that the representation of this Area was still under the consideration of the Housing Committee." The matter occupied their careful attention, and on 16th March it was decided, " That the London County Council be approached with a view of ascertaining whether, in the event of this Council dealing with the area in question, they would be willing to contribute towards the cost of a scheme under Part II. of the Housing of the Working Classes Act, 1890." The London County Council, on the 20th April, replied "that having regard to the general disposition of the houses in the area as compared with the condition of other districts within the County, the Housing of the Working Classes Committee of the County Council regret that they do not see their way to recommend that Council to make a contribution in respect of a scheme for the improvement of the area in question under the Housing of the Working Classes Acts." In consequence of this reply, it was decided not to ask the Secretary of State to prosecute an enquiry in respect of the area in question, but to refer the houses in the area to the Public Health Committee to deal with. 78 Part III, Lower Cross Road Scheme. The materialisation of the scheme for the erection of Working Class Dwellings, adopted by the Council on the 28th April, 1904, and which was referred to at length in the annual report for that year, was advanced another step on the 23rd May, when His "Worship the Mayor (Mr. Alderman McMillan) laid the foundation stone of the new dwellings. The erection of the buildings has since been pushed rapidly forward, and they will soon be ready for occupation. The amended Bye-laws relating to Houses let in Lodgings having come into operation on the 22nd June, arrangements were at once made for carrying into effect the counterpart of this scheme, namely, the vigilant enforcement of the sanitary regulations in regard to the tenement houses in the surrounding district. INSANITARY AND UNINHABITABLE DWELLINGS. From time to time, as circumstances have permitted, progress has been made in dealing with the premises of this class. In many cases this has involved extensive structural alterations. Notices have been served under the Metropolis Management and Public Health Acts, and complied with, or works voluntarily carried out at the following dwellings :— Albert Mews, 4. Alexandra Mews, 1, 3, 8. Belsize Park Mews, 10. Eresby Mews, 6. Fairfax Mews, 27, 29, 46. Fairhazel Gardens, 10a. King's College Mews East, 7, 20. Loudoun Mews, 6, 8, 10, 12, 14. Victoria Yard, 1, 2. Wavel Mews, 7. West End Lane, Potter's Cottages, 7—13. White Bear Lane, 3, 4. 79 SALE OF FOOD AND DRUGS ACTS- During the year 414 samples were taken for analysis, as compared with 406 in 1904. It is with great satisfaction that I have to report that only 8 of these, or 1.9 per cent., were found to be adulterated, which as will he seen in the table on page 81 bears very favourable comparison with London as a whole where the per centage is 8.0. Only 4 of the 8 adulterated samples were purchased from Hampstead tradesmen, the other 4 having been bought from barrows belonging to traders residing in other parts, and 3 of these latter were samples of milk purchased on Hampstead Heath on August Bank Holiday, which cannot be said to affect the food supply of the Borough ; therefore, deducting these, it will be found that the adulteration of the food of the Borough only amounts to 1.2 per cent. of the samples purchased, which will be found to be the lowest of any in the Metropolis. I believe that the purity of the food supply contributes in some measure to the extremely low death rate of the Borough. The Samples were as follows:— Article. Number taken Ammoniated Tincture of Quinine l Arrowroot 3 Bread and Butter 2 Buttered Toast l Butter 103 Cheese 31 Citrate of Magnesia 1 Citrate of Quinine and Iron 2 Cocoa 10 Cod Liver Oil 1 Coffee 33 Ice Cream 4 Jam 1 Lard 20 Lime Juice Cordial 2 Margarine 4 Marmalade 1 Milk 171 80 Article. Number taken Mustard 2 Olive Oil 1 Pepper 3 Preserved Peas 2 Rum 1 Sarsaparilla Wine 1 Sugar 2 Sweets (coloured) 5 Tapioca 2 Tea 2 Whiskey 2 414 The following statement shows the articles which were found on analysis to be adulterated; and the percentage of samples adulterated to those analysed:— Nature of Article. Number Adulterated. Percentage adulteraled to total taken. Butter 1 0.97 Milk 7 4.09 In addition to these adulterated samples, 4 samples of milk have been reported as being of low quality. The following table gives a comparison of the work accomplished from 1902-1905, from which it will be seen that although the number of samples taken has considerably increased, the percentage of adulteration shows a steady decline:— Year. Samples analysed. Number adulterated. Percentage adulterated. Fines and coats. £ s. d. 1902 315 15 4.7 42 7 6 1903 366 14 3.8 37 3 0 1904 406 8 1.9 35 8 6 1905 414 8 1.9 33 15 0 81 The following table shows a comparison of the wards in the Borough in respect of the samples purchased from Hampstead tradesmen. Ward. Samples analysed Number adulterated. Percentage adulterated. No. 1 (Town) 59 — — No. 2 (Belsize) 81 — — No. 3 (Adelaide) 26 — — No. 4 (Central) 23 1 4.35 No. 5 (West End) 76 2 2.63 No. 6 (Kilburn) 81 1 1.23 No. 7 (Priory) 41 — — Totals 387 4 1.03 Prosecutions wore ordered which resulted as follows:— Adulterated Sample. Nature of Adulteration. Fines and Costs. No. 45, Milk 20 per cent, added water. £ s. d. £ s. d. 0 10 0 0 12 6 No. 125 „ 11 per cent, less than the proper proportion of butter fat. 2 0 0 0 17 0 * No. 169 „ 20 per cent. do. Dismissed without costs owing to vendor proving warranty. *No. 246,, 95 per cent, do., also 10 per cent, added water. 23 0 0 or 2 months' imprisonment 0 0 or 1 month for not having name and address on can. 2 * No. 247 „ 34 per cent, added water. 0 5 0 0 16 6 Defendant went to prison for 14 days in lieu of paying fine. * No. 249 „ 89 per cent, less than the proper proportion of butter fat. 0 5 0 0 16 6 No. 378, Butter 89 per cent, of foreign fat. Cautioned. No. 396, Milk 15 per cent, less than the proper proportion of butter fat. 2 0 0 0 12 6 £ 30 0 0 £3 15 0 * Indicates samples purchased from non-resident traders. 82 The following table shows a percentage of adulterated samples in Hampstead compared with London generally:— Milk. Total Samples. Hampstead 4 per cent. 1.9 per cent. London 12 „ 8 ,, The purchases were, with a few exceptions, made by Agents. Three of the adulterated samples of milk, Nos. 246, 247, 249 were taken on Hampstead Heath on Bank Holiday. No. 246, containing 95 per cent. less than the proper proportion of butter fat, and 10 per cent. added water, was purchased from a man who was selling milk from a hand can. his name and address was not on his can, and he gave a false one. Some months afterwards he was found to be living at Lambeth, and the two summonses were served personally. He did not appear at the Police Court, his wife attending in his stead. His record was a bad one, and previous convictions at Greenwich and Lambeth Police Courts were proved, and the Bench marked their ssnse of the case by imposing penalties of £23 or two months' imprisonment on one summons, and £2 or one month on the other, the imprisonment to run consecutively. A warrant for his arrest was issued, but so far he has evaded all attempts to execute it.* No. 378, butter. This sample was served from a tub marked "Margarine," although "butter" was asked for. It was wrapped in plain paper contrary to the Statute, but as the price charged was only 6d. per lb., and the shop where it was purchased being a small one, it was thought that the justice of the case would be met if the vendor was cautioned. FOOD INSPECTION. The Food prepared or exposed for sale in the Borough has been frequently and carefully inspected as regards its wholesomeness and freedom from disease. * After a very great amount of trouble, the man was arrested on 17th February, 1906. 83 Special attention has been given to the barrows of itinerant vendors who sell food on the Heath on Bank Holidays. As will be seen from the subjoined table, the amount of food found to be unwholesome was exceedingly small, and shews that in addition to being exceptionally free from adulteration, the food supply of Hampstead bears very favourable comparison with that of London as a whole as regards its wholesomeness. The following table shews the Unsound or Unwholesome food dealt with by your Inspectors during the year. Date. Premises. Food seized or surrendered. March 20th Mill Lane 2 pigs' hearts, 3 sausages. April 4th West End Lane 1 pair lungs (sheep's). May 16th High Road, Kilburn 3 bottles preserved currants, 2 pots preserved fish paste. June 15th Cavendish Parade 6½ lbs. tin of preserved apples. July 17th Fleet Road 6 lbs. beef, 1 shoulder of mutton. July 25th High Road, Kilburn 5 boxes kippers. July 31st Mill Lane 1 bushel peas, 1 bushel broad beans, 12 lettuces, 20 cabbages, and 12 oranges. September 9 th. Kingsgate Road 1½ sacks potatoes. October 19th High Road, Kilburn 23 boxes of figs. DAIRIES AND MILK SHOPS. At the end of the year 1904, there were 90 persons on the register as purveyors of milk, occupying 114 shops, as follows:— Dairies 50 Bakers and Confectioners 29 Restaurants and Coffee Shops 11 General Shops 24 and during 1905, the following additions were made to the register:— Persons registered as milk sellers, owing to change of Proprietorship 5 New premises opened as milk shops 4 84 The names of 5 persons who had discontinued selling milk were removed, so that at the end of the year the register comprised 89 persons, occupying 113 shops, as follows:— Dairies 51 Bakers and Confectioners 28 Restaurants and Coffee Shops 11 General Shops 23 These orders only require the registration of persons, any of whom may occupy more than one shop in the Borough. This accounts for the difference between the number of persons registered and the shops occupied. 350 inspections were made of premises where milk is sold. Table of sanitary works carried out at shops within the Borough where milk is sold:— Premises or parts of premises cleansed and washed 18 Lumber and refuse removed from premises 6 Dilapidated premises repaired (walls and ceilings) 6 Roofs repaired 5 Drains amended or reconstructed and ventilated 3 Soil pipes reconstructed 2 Gully traps cleansed 4 "Water closets cleansed 11 Water closets unstopped 4 Water closet accommodation provided 2 Flushing cisterns to water closets repaired or renewed 8 New sinks provided 2 Water cisterns cleansed 2 Water cisterns covered 3 Movable metal dustbins provided 5 Yard and washhouse paving repaired or renewed 9 Yards cleansed 2 Nuisance from chickens and ducks abated 1 86 ICE CREAM SHOPS. 140 inspections have been made during the year of the 73 shops in the Borough where ice cream is made or sold. In addition to these, the harrows which stand in the streets or on Hampstead Heath on bank holidays were inspected, and found to be generally satisfactory. One barrow in Kilburn had no name and address on it. The attendant was cautioned, and when next inspected it was found that the omission had been made good. Table of sanitary work carried out:— Premises or parts of premises cleansed and limewashed 3 Water accommodation provided 1 Roofs repaired 1 Area cleansed 1 Water closets cleansed 1 Gully traps cleansed 2 INSPECTION OF PREMISES WHERE FOOD IS PREPARED OR STORED (other than Bakehouses, Milk Shops, Eating Houses, and Slaughter Houses). The premises inspected during the year, together with the nature of the business carried on, were as follows:— Butchers and Pork Butchers 238 Confectioners 104 Grocers 80 Provision and Cheesemongers 44 Greengrocers and Fruiterers 44 Fishmongers 18 Fried Fish 6 General Shops 74 608 86 As the result of these inspections the following remedial sanitary works have been carried out:— Premises or parts of premises cleaned and repaired 11 Drains amended or reconstructed and ventilated 8 Drains unstopped 3 Soil pipes repaired or reconstructed 3 Water closets cleansed 14 Water closet accommodation provided 3 Water closets amended or reconstructed 5 Improperly placed water closets abolished 2 ,, ,, „ altered and ventilated 3 Flushing cisterns to water closets repaired or renewed 7 Urinal removed from inside scullery 1 Waste pipes to sinks repaired, renewed, or trapped 6 Premises supplied with proper water supply 4 Roof repaired 1 Yard pavings repaired or renewed 10 Yards and areas cleansed 10 Dustbins provided 9 SLAUGHTER HOUSES. There are five slaughter houses in the Borough, and these have been regularly inspected during the year. On the 11th October the annual inspection by the Public Health Committee was made, in view of the approach of the licensing session, as a result of which it was decided that no opposition should be offered to any of the licenses. Table of inspections and work carried out:— Inspections made 146 Lime washing carried out 20 Defective wall repaired 1 Leaky water supply pipe repaired 1 Yard cleansed 1 Water closet cleansed 1 The following is a list of the existing slaughter houses in the Borough:— 40, England's Lane; 17, High Street; 69, High Street; 242 Belsize Road, 6, Fairfax Mews. 87 RESTAURANT KITCHENS. Inspection of these premises has been made, from time to time during the year and their sanitary conditions supervised. Reference to Table XV., page 135 gives a list of the 50 restaurant kitchens on the Eegister at the end of 1905. COW-HOUSES. There has been no licensed cow-house in the Borough since 1898. COMMON LODGING HOUSES. There has been no Common Lodging House in Hampstead since 1903. Hampstead is now the only Metropolitan Borough which has no common lodging house within its boundaries. OFFENSIVE TRADES. There are none of the trades classified under this heading carried on in the Borough. CUSTOMS AND INLAND REVENUE ACTS. During the year, applications were received for Certificates under this Act in respect to 215 dwellings, being 47 in excess of tbe number applied for in 1904. Each application involves a detailed survey of the dwelling, as well as an inspection of the drains and sanitary fittings. In most cases a considerable amount of work has had to be carried out before the premises were in such a condition as to entitle the owner to a Certificate. It will be readily understood that this has resulted in a great increase in the work of the staff of the department, and illustrates how year by year additional duties and responsibilities are imposed upon Local Sanitary Authorities and their Officers. During the year under review Certificates having been issued in rcspect of 218 "dwellings," as compared with 102 "dwellings" in 1904. The following is a list of the "dwellings" certified, together with the date of year in which the application was made, and the date of certification:— 88 Table of Premises certified during 1905. Showing the number of dwellings therein, and date of application and certification. Premises. No. of Dwellings. When Certificate applied for. Date when Certified, 1905. 1904. 1905. 47, Iverson Road 4 yes — Jan. 21st. 53, „ 3 yes — „ 21st. 50-102, (even Nos.) Lyncroft Mansions, Lyncroft Gardens 27 yes — „ 27th. 51, Iverson Road 4 yes — „ 31st. 38, Netherwood Street 4 yes — „ 31st. Blocks 5, 7, 8, 12, Antrim Mansions, Antrim Street (6 dwellings per block) 24 yes — Feb. 14th. 7, The Studios, Sheriff Road (ground floor suite) 1 — yes „ 16th. 88, Palmerston Road 3 yes — „ 21st. 87, ,, 3 yes — „ 24th. 50, Mazenod Avenue 3 yes — „ 24th. 26, Willow Road 2 — yes Mar. 13 th. 16, Kelson Street 3 yes — April 12th. 4, Murray Terrace, Flask Walk 3 yes — „ 12th. 1-8, Albany Flats 8 yes — „ 12th. 49, Iverson Road 4 yes — „ 18th. 1-28, Priory Court Mansions, Mazenod Avenue 28 yes — „ 18th. 1-6, Workmen's Tenements, Lymington Road 6 — yes May 12th. Blocks 1-4, Antrim Mansions, Antrim Street (7 dwellings per block) 28 yes — July 13th. Blocks 6, 9, 10, 11, 13, Antrim Mansions, Antrim Street, (6 dwellings per block) 30 yes — „ 13th. 2-48 (even Nos.), Lyncroft Mansions, Lyncroft Gardens 24 — yes „ 20th. Priory Mansions, England's Lane 4 __ yes Dec. 18th. Antrim House, England's Lane 2 — yes „ 18th. 89 INSPECTION OP NUISANCES. During the year 11,960 inspections have been made by the District and other Inspectors, and in 11,491 instances premises were re-inspected, as compared with 11,927 inspections and 12,266 re-inspections in 1904. PEAT MOSS LITTER. The increasing use of peat moss litter, especially by jobmasters owning a large number of horses, gives rise to a nuisance which was not contemplated when the Orders governing the removal of manure were made, and, even when these Orders are strictly obeyed, this manure cannot be removed without setting up a very serious effluvium nuisance which is felt within a considerable radius of the stables. A simple remedy for this has been found by the adoption of an arrangement by which an empty van is allowed to stand outside the stables, into which the manure is deposited as it is taken from the stable, and in which it can be removed without further disturbance. Frequent complaints having been received of a nuisance of this kind, caused by a jobmaster in Fairfax Mews, the Medical Officer of Health visited the premises while the manure was in course of removal, and had no hesitation in certifying it under Section 21 of the Public Health (London) Act, 1891, as a premises used for a trade or business causing effluvium. When the matter came before the Public Health Committee they authorized proceedings to be taken, but before the day of hearing the defendant gave an undertaking that there should be no further cause of complaint, and undertook to pay the sum of £1 Is. as costs. Since this date the remedy suggested above has been closely observed and no further complaints have been received. SANITARY CONDITION OF SCHOOLS. NON-PROVIDED SCHOOLS. "The London County Council on the 28th June, 1904, sanctioned expenditure for making a survey of non-provided schools, which under the Education Acts, 1902 and 1903, are maintainable by them." 90 The survey was duly carried out and the result reported to the Council on 7th April, 1905, by the Education Committee, when it was decided to serve a list of works on the Managers of the schools which were then deemed to be unsuitable. The requirements as to drains and sanitary fittings are those which closely concern you as being the Sanitary Authority, under whose supervision the necessary alterations and amendments will have to be effected. In the case of St. Mary's School, Holly Place, it was resolved "that the premises were altogether unsuitable," but in regard to the other seven, the works were required to be carried out, and completed in six instances by the 31st July, and in the other by 31st December, 1906, as a condition precedent to the taking over of the schools by the London County Council. So far as they involve drainage and sanitary fittings the requirements were as follows:— All Soul's School, Fairhazel Gardens. Mixed Department. To provide sufficient lavatory basins for the girls. Infants' Department. To provide sufficient lavatory basins. All Departments. To reconstruct the water closets. Christ Church School, Hampstead Square. All Departments. To provide sufficient lavatory accommodation. To overhaul the water closet fittings. To remove the boys' water closets and to rebuild them away from the building to scale. To put the drains in a sound condition. Emmanuel School, Mill Lane. Both Departments. To provide proper lavatory accommodation. To provide more urinal accommodation. To put the drains in a sound condition. 91 Hampstead School, Holly Bush Yale. Girls' Department. To Provide sufficient lavatory accommodation. Infants' Department. To provide sufficient lavatory accommodation. All Departments. To pull down and to reconstruct the offices. To provide additional water closets according to scale. To provide sparge pipes and automatic flushing cisterns to the urinals. To put the drains in a sound condition. St. Mary's School, West End Lane. Boys' Department. To provide proper lavatory accommodation. All Departments. To put the drains in a. sound condition. St. Paul's School, Winchester Road. All Departments. To remove the dustbin. To provide a sanitary dustbin. To put the drains in a sound condition. Trinity School, Finchley Road. Both Departments. To provide one extra water closet for the giris. To provide two extra water closets for the infants. To provide sufficient ventilation to the water closets. To put the drains in a sound condition. The work has been carried out at the following:— St. Paul's School, Winchester Road. St. Mary's School, West End Lane. All Soul's School, Fairhazel Gardens. 92 PROVIDED SCHOOLS. The drainage system, the W.C.'s, and fittings at Rosslyn Hill School were re-constructed in the early part of this year. HOUSES LET IN LODGINGS. The defect in the penalty clause of the Bye-laws made in 1895, under Section 94 of the Public Health (London) Act, 1891, which had rendered them inoperative since 1904, has been remedied during the year. On the 11th May the Council made a Bye-law, providing that proceedings should not be taken against the landlord of a lodging house for an offence against Bye-laws 3, 4, 9, 11, 13, 15 and 17, until after service upon him of a notice in writing, requiring him within such reasonable time as is specified in the notice to comply with the Bye-law. This received the approval of the Local Government Board on the 22nd June, 1905. It was then thought that the difficulties in the way of administering these bye-laws had come to an end, but the Council were advised that the decision which had declared the Bye-laws of 1895 to be invalid, also invalidated the registration of all the houses already on the Register, consequently it became necessary to proceed with the work of re-registration. As this involves an inspection of each house, and a detailed report as to the occupation of each room, it will be readily understood that some considerable time must elapse before the new Register is completed. At the end of the year 199 houses had been registered. HAIRDRESSERS BUSINESS. The Guild of Hairdressers have actively taken up the question of the promotion of cleanliness and aseptics in the conduct of Hairdressers' establishments, and after consultation with the Medical Officer of Health of the City of London, drew up a code of regulations, the observance of which, it is hoped, will effectually safeguard customers against those risks which are undoubtedly present where the business of a Hairdresser is not carried on with the strictest of cleanliness. Borough of hampstead. This is to Certify that We, the Mayor. Hldermen & Councillors of the Metropolitan Borough of Hampstead, in the County of London have ascertained that the premises of at in the above Borough, are suitable for the business of a Hairdresser and that the said has undertaken to carry on the business of a Hairdresser at the said premises in accordance with the Regulations hereinafter mentioned. Dated this day of 190 Mayor. Tomn Clerk. The following are the Regulations referred to:- 1. All shaters, fittings, and tables in which implements are placed to be of glass, marble, slate or other similar material. 2. Clean towels is to be used for each customer, and a fresh piece of paper or clean linen to be placed on the back of chair or head cost. 3. No general powder puffs to be used, and powder pulverizens or cotton wool substituted. No spenges to be used. 4. All hairclippers, razers, scissors, combs or other tools after use, to be placed in a desinfecting solution. 5 Razer to be wiped on paper. 6.Perfectly clean hairbrushes must be used. 7. Shaving brushes after use to be placed in a disinfecting solution. 8. Liquid or powdered soap or shaving cream to be used. 9.But hair falling on the flour to be immediately. 10. No general clean crystals or blocks to be used as a stiptie, but a liquid or powder applied. 11. The most serufinlins cleanlyness to be observed in all that pertains to the bussiness. Regular customers and subscribers should be strongly recommended to provide their own toilet articles, razers, brushes &c. which beexclusivly reserved for the owner's *The following disinfectonts to be used, viz:- by them solution in the prepertion of one leasprerful of by them in one quarl of water, or Izal solution, in the prepretion of one leasprerful of Izal in a fient of ualer. This Certificate will remain in force only during the pleasure of the Council. 93 On 5th January the Guild approached the Council asking for its co-operation, and submitting a code of requirements which they had drawn up detailing the structural and sanitary arrangements of such premises of which the following is a copy:— "That all saloons are adequately ventilated and in a cleanly condition. This specially applies to those in basements. "That the drains have been inspected and tested, and found to be in good condition, trapped and ventilated. (All lavatory basins must be separately under-trapped.) "That the products of combustion and fumes from all gas-heated apparatus are conducted to the outer air by means of shafts or chimneys. "That the premises are in all other respects suitable for the purpose." On the 16th March, the Council approved these requirements, and instructed the Medical Officer of Health to inspect the premises of any Hairdresser making application, and report to the Public Health Committee when the necessary works had been carried out. They at the same time stipulated that the Hairdresser should undertake to carry on his business in accordance with a set of regulations drawn up by the Guild of Hairdressers relating to the mode of conduct of the business (vide Certificate). One Hairdresser made application, and the following schedule of works were reported by the Medical Officer of Health to be necessary:— "To reconstruct and properly ventilate the drains. "Remove gully traps from inside the premises. "Properly cover the water cistern in basement. "Provide a waste pipe to sink in basement. "Cause all waste pipes to discharge in the open air. "Provide proper hood and flue to the gas stove." The works were carried out by the applicant, and the Public Health Committee viewed the premises on 11th October. I subsequently submitted the following Certificate as the one the Council should grant, which was adopted and issued in that form to the Hairdresser previously mentioned. This is the first certificate of this nature issued in the Borough, or any other Metropolitan Borough. 94 PHYSICAL DETERIORATION AND ALCOHOL. The Report of the Royal Commission on Physical Deterioration having drawn attention to the serious manner in which indulgence in alcohol is affecting the stamina of the race, the question as to whether the example of some other of the Metropolitan Boroughs in issuing warning placards on the subject should be followed was referred to the Public Health Committee. After lengthy consideration it was decided to recommend the Council to issue the following notice:— BOROUGH OF HAMPSTEAD. Physical Deterioration and Alcohol. The report of the Committee, presented to Parliament by command of His Majesty, emphasises the following facts:— The abuse of alcoholic stimulants is a most potent and deadly agent of physical deterioration. If the mother as well as the father is given to drink the future of the race is imperilled. Abstinence from alcohol is conducive to full physical strength and activity. Alcoholic persons are specially liable to consumption and all inflammatory diseases. Alcohol is really a narcotic, and often its first effect is to weaken a man's self-control while his passions are excited; hence the number of crimes which occur under its influence, as well as the spreading of vice and disease. Lunacy figures show a large and increasing number of men and women admitted to asylums through drink. Alcoholism perverts the moral nature, affects the judgment, and weakens the memory; it creates an enormous loss to the community through destroying the productiveness of the worker. This placard is issued by order of the Borough Council. GEORGE BARHAM, Mayor. Arthur P. Johnson, Town Clerk. G. F. McCleary, m.d., Town Hall, Hampstead). Medical Officer of Health, November, 1905, 95 This was approved by the Council on 23rd November and ordered to be posted at the Council's Offices, on the Borough Depot boards, and at the underground conveniences; the L.C.C. was also asked to allow copies to be posted on the notice boards outside their schools. FLAT DWELLINGS. The most noticeable feature cf Metropolitan development during the last docade has been the extraordinary increase in the number of dwellings built on the flat principle. So great has this been in some districts (of which Hampstead is one), that now a very considerable portion of the population resides in houses of that description. When a change of this kind has taken place in the mode of living of a community, the question as to what effect such alteration has had on the lifo and health of that section who are living under the altered conditions naturally arises. So far as I am aware, the only statistics available are based upon estimated data ; tables compiled upon actual figures will therefore be of very considerable interest. The difficult task of taking the census of flat dwellers was undertaken by the Staff of the Public Health Department, and carried through in such a manner as to entitle them to considerable credit. The dwellers in Flats are divided into two distinct classes. Firstly, those of the well-to-do class living in dwellings to which the name of " Flat" is popularly applied; and secondly, those of tho working class population inhabiting dwellings to which the name of Model or Artizans' Dwellings is more appropriate. Under the latter category will come the Council's new Dwellings in Lower Cross Road, and the statistics of the existing Artizans' Dwellings shewn below will therefore be of utility in future in comparing the Council's Dwellings with others of a like nature. "Flats," not including Working Class or Artizans' Dwellings. Ward No. 1. Total Flat Population, 332. Ciardnor Mansions, Church Row. Hampstead Mansions, Heath Street. Ellerdale Mansions, Fitzjohn's Avenue. Express Mansions, Heath Street. Frognal Mansions, Frognal. The Pryors, East Heath Road. Heath Mansions, The Grove. Express Buildings, Heath Street. Northcote House, Heath Street. Albermarle Mansions, Heath Drive. „ Mansions, Heath Street. 96 Ward No. 2. Total Flat Population, 336. 1, Grove House, Belsize Grove. Oman Mansions, Oman Road. Belsize Grove Mansions, Belsize Grove. Rosslyn Court, Ornan Road. Manor Mansions, Belsize Park Gardens. Warwick Mansions, Pond Street. Hampstead Hill Mansions, Downsliire Wedderburn House, Wedderburn Road. Hill. Belsize Parade Flats, Haverstock Hill. Wentworth Mansions, John Street. Ward No. 3. Total Flat Population, 268. Antrim House, Antrim Street. Antrim Mansions, Antrim Street. Ward No. 4. Total Flat Population, 1214. Broadhurst Mansions, 97, Broadhurst Langland Mansions, 228, Finchley Gardens. Road. 1, Maisemore Mansions, 35, Canfield Sutherland House, 2, Greencroft Gardens. Gardens. 2, Maisemore Mansions, 35, Canfield Rutland House, 30, Greencroft Gardens. Gardens. Greencroft Mansions, 62, Greencroft Redesdale Mansions, 65. Canfield Gardens. Gardens. Leinster Mansions, Langland Gardens. 1, Stirling Mansions, Canfield Gardens. Norfolk Mansions, Lithos Road. Ellesmere Mansions, Canfield Gardens. Rosemont Mansions, Lithos Road. Pembroke Mansions, Canfield Gardens. Jesmond Dene, Lithos Road. Rowenhurst, Canfield Gardens. Gainsboro' House, Lithos Road. Wroxham Mansions, 36, 38, Canfield Claremont House, Lithos Road. Gardens. Fitzjolin's Mansions, 10, Netherhall 2, Stirling Mansions, Compayne Gardens. Gardens. Glensliaw Mansions, Priory Road. Compayne Mansions, Compayne Buntingford House, Rosemont Road. Gardens. Tower Mansions, West End Lane. Ranworth Mansions, Compayne Canterbury Mansions, West End Lane. Gardens. Lymington Mansions, West End Lane. Waveney House, 66, Fairhazel Gardens. Fawley Mansions, West End Lane. Cantley Mansions, 68, Fairhazel 125 to 139, Broadhurst Gardens. Gardens. Harvard Court, Honeybourne Road. Arkwright Mansions, Finchley Road. Yale Court, Honeybourne Road. Cumberland Mansions, West End Lane. Ward No. 5. Total Flat Population, 1510. Marlborough Mansions, Cannon Hill. Burgess Park Mansions, Fortune Green Avenue Mansions, Finchley Road. Road. Burgess Parade Mansions, Finchley Lyncroft Mansions, Fortune Green Road, Road. Holly Mansions, Fortune Green Road. 97 Laurel Mansions, Fortune Green Road. Dene Mansions, Dennington Park Beech Mansions, „ Road. Oak Mansions, „ Holmdale Mansions, Holmdale Road. Willow Mansions, Welbeck Mansions, Inglewood Road. South Mansions, Gondar Gardens. Lyncroft House, Lyncroft Gardens. Chase Mansions. „ Polperro House, Lyncroft Gardens. St. Elmo Mansions. „ Cavendish Mansions, Mill Lane. 1 & 2, Gondar House, „ Victoria Mansions, Sumatra Road. Spring Mansions, „ Sandwell Mansions, West End Lane. Tudor Mansions, „ Alexandra Mansions, „ Downe Mansions, „ Buckingham Mansions, „ Clyda Mansions, „ West End Mansions, „ Kenmar Mansions, „ Inglewood Mansions, „ Snowdon Mansions, „ Inglewood House, „ Lawn Mansions, „ Dennington Park Mansions, „ Pine Mansions, „ The Mansions, Hillfield Road. Eden Mansions, „ Oliver Mansions, „ Ward No. 6. Total Flat Population, 500. Bcacon House, Hemstal Road. Carlton Mansions, West End Lane. St. James' Mansions, Hilltop Road. St. .Tames' Mansions, West End Lane. Smyrna Mansions, Smyrna Road. Priory Court Mansions, Mazenod Douglas Mansions, West End Lane. Avenue. King's Gardens, West End Lane. Ward No. 7. Total Flat Population, 83. Fairhazel Mansions, 14, Fairliazel Rosslyn Mansions, 21, Goldhurst Gardens. Terrace. Goldhurst Mansions, 13, Goldhurst Terrace. Total Populations. Births. Deaths. Infantile Deaths. Registered in 1905. Rate per 1000 of the Population. Occurring in 1905. Rate per 1000 of the Population, Occurring in 1905. Rate per 1000 Births.. "Flats," not including 4243 59 13.9 23 5.4 3 50.8 Working Class or Artizans' Dwellings The Borough 88142 1421 16 1 823 9.3 133 93.6 98 Working Class and Artizans' Dwellings. Ward No. 1, Population, 958. Albany Flats, Flask Walk. Greenhill Flats, Perrin's Court. Wells Buildings, Oriel Court. Prince Arthur Buildings, Church Lane. Grove Place Flats, Grove Place. Willow Buildings, Willow Road. Christ Church Place Flats, Christ New Buildings, Flask Walk. Church Road. Campden Buildings, Holly Bush Vale. The Flats, Back Lane. Streatley Buildings. Streatley Place. Manor Buildings, Silver Street. 4. Murray Terrace. Total Populations. Births. Deaths. Infantile Deaths. Registered in 1905. Rate per 1000 of the Population Occurring in 1905. Rate per 1000 of the Population. Occurring in 1905. Rate per 1000 Births. Working Class and Artizans 958 20 20.9 9 9.4 3 150.0 Dwellings The Borough 88142 1421 16.1 823 9.3 133 93.6 SMOKE NUISANCE. Complaints of nuisances caused by smoke to tlie number of 13 have come to hand during 1905. Seven referred to chimneys of private houses, and consequently did not eome within the operation of the Public Health (London) Act, 1891. The others were as follows:— Bakehouse chimney 2 Laundry chimney 1 Contractor's engine 2 Motor water cart 1 Observations were kept in each case, and five of the complaints were found to be well founded, four of which were abated on the service of notice. In the remaining instance the nuisance was found to arise from three engines used by a contractor carrying out the widening of the Midland Railway at Mill Lane, and as he had been previously cautioned, proceedings were ordered to be taken against him, and resulted in a penalty of £2 and costs being imposed in each case. 99 CERTIFICATES AS TO WATER SUPPLY. During the year 105 Certificates have been issued under Section 48 of the Public Health (London) Act, 1891, as compared with 320 in 1904. EXAMINATION OF DRAINS. The power given to Local Authorities by Section 82 of the Metropolis Management Act, 1855, to cause ground to be opened for the purpose of making an examination of a drain, is an exceedingly important provision. During the year it has been found necessary to exercise this power on seven occasions, and in each case it was found that the drains were in a very defective state. It is sometimes contended that, in exercising the authority to open ground, resort is being had to an old Act which is obsolete, but when it is remembered that the Orders and Bye-laws governing the construction or reconstruction of all drains are made in pursuance of its provisions, it will be seen that this contention cannot be maintained. When the Public Health (London) Act, 1891, was passed, it repealed the greater part of Section 82, except so far as it related to a drain or sewer. Without this power it would be a comparatively easy matter to defeat the requirements of a Sanitary Authority regarding defective drains; the smoke test is not sufficiently reliable to demonstrate many serious defects which may exist, and if there is no inspection chamber the water test cannot be applied. In relation to this last test, I would point out that there are cases where the application of such a severe test may not be advisable, and where the actual condition of the drain can only be safely ascertained by direct inspection of the pipes. The most notable instance was in a case where, as a result of the examination, a notice was served on the owners to "reconstruct the drains." This was resisted on the ground that the requirement was in excess of the Statute, and that the drains were capable of being repaired. 100 The Magistrate dismissed the summons, and the owners did not press for costs, on the understanding that the case should not be taken further, and that all necessary works should be carried out. It is satisfactory to note that the drains were ultimately reconstructed, by which it appears to me to be a fair deduction that the original requirements of the Council were justified. In the other cases it was not found necessary to resort to legal proccedings, as the owners in each instance proceeded to have the necessary works carried out after the actual state of the drains had been demonstrated by opening up the ground. DRAINAGE BYE-LAWS. These Bye-laws, which require that plans and written particulars of all drainage construction and alteration shall be deposited in duplicate with the Sanitary Authority, came into operation on the 20th August, 1903. Since that date, to the end of 1905, no less than 163 plans for the drainage of new buildings, and 1,211 for alterations, amendments, or additions to drains of existing houses, have been approved by the Council. During the year, 671 notices of alteration or addition to, or the reconstruction of, drains or sanitary fittings in existing houses have been received, 573 of them being for such work as necessitated the deposit of drawings and written particulars. Of the latter, 365 were cases of urgency, in which the work could not be delayed, but had to be proceeded with at once, notice being given on the prescribed " Urgency " form, and the required plans and particulars being sent in at a later date. It is satisfactory to record that with a very few exceptions there has been little difficulty in obtaining the required particulars, but in four cases it became necessary to resort to legal proceedings to enforce comjdiance with these Eye-laws. The case of Agar v. Nokes, decided in the High Court on the 9th August, is of considerable interest, from the light it throws on the vexed question as to whether amendments to a drain constitute "a repair" or "reconstruction." In this case it was held that the 101 owners of the house who relaid a drain some 12 feet long, upon a new concrete foundation, but in its own line and at its own level, leaving one old pipe undisturbed and using one old and five new pipes, and two gullies, one old and one new—had executed works which amounted to a "reconstruction," which made it imperative that the Drainage B}re-laws should be complied with. CONDITION OP SEWERS. Sewer Ventilation.—During 1905, 90 complaints of nuisances caused by sewer ventilators were received in the Public Health Department. In considering a memorial from inhabitants in Hillfield Road district complaining of the nuisance caused by the emanations from the sewer ventilators in that locality, the Council decided to revive the Special Committee which had previously reported on the subject to further investigate the matter. The constitution of the Special Committee is given on page 140. On their recommendation the Council decided on 20th July, to spend a sum not exceeding £50 for the purposes of making a bacteriological and chemical examination of the air of sewers under their control. Drs. Andrewes and Hurtley wore entrusted with this investigation and reported in September : subsequently the Special Committee received reports from the Borough Engineer and myself and presented their report, a copy of which will be found in Appendix II. From this report it will be seen that the matter has been the subject of exhaustive enquiry on their part. STAFF OF THE PUBLIC HEALTH DEPARTMENT. The only alteration that has taken place in the Staff is that necessitated by the death of the Medical Officer of Health, Dr. II. Littlejohn, which regrettable event took place on September 4th. To fill the vacancy thus created, the Public Health Committee did me the honour of appointing me Acting Medical Officer of Health pending the appointment of a permanent official, and on the 21st December the Council formally appointed G. F. McCleary, B.A., M.D., D.P.H., Medical Officer of Health to the Metropolitan Borough of Battersea as Medical Officer of Health to this Borough. 102 TEMPORARY OFFICES. In November, it was thought desirable to re-arrange the Offices occupied by the Public Health Staff. The matter was carefully considered by the Public Health Committee, and the alterations suggested by them were carried into effect with very beneficial results to the work of the Department. PUBLIC MORTUARY. During the year the bodies of 97 persons were brought to the Mortuary as against 82 last year—57 by order of the Coroner, 26 by the Police, and 14 at the request of friends of the deceased persons. In 83 instances, or 85 per cent, of the bodies admitted, inquests were held, and in 45 instances, or 46 per cent., post-mortem examinations were made. The following table indicates the causes of death of the persons whose bodies were received into the Mortuary:— Cause of Death. Number of Bodies received. Deaths from natural causes 44 Accidental deaths 24 Suicide 14 Neglect at birth 3 „ „ (Wilful Murder) 1 Misadventure 10 Found drowned 1 Total 96 One of the bodies received at the Mortuary was that of a still born child. In 3 instances were the bodies of persons who had died from infectious disease brought to the Mortuary. 103 MORTUARY RECORD FOR THE YEAR, 1905. Bodies Admitted. No. of Post-Mortems. No. of Inquests. No. of Funerals from Mortuary. Month. Males. Females. Totals. Males. Females. Totals. January 8 5 13 5 3 8 13 10 February 1 2 3 1 1 2 2 2 March 4 5 9 3 2 5 7 6 April 1 3 4 — 1 1 2 2 May 3 1 4 1 — 1 3 2 June 2 — 2 — — - — 2 July 7 3 10 2 1 3 9 10 August 9 3 12 4 2 6 10 10 September 6 2 8 — 1 1 6 5 October 7 3 10 4 1 5 10 7 November 9 1 10 6 — 6 10 9 December 8 4 12 4 3 7 11 11 Totals 65 32 97 30 15 45 83 76 104 LEGAL PROCEEDINGS. During the year legal proceedings have had to be resorted to in several cases, the details of which I append. Statement of Summary Proceedings taken during the year 1905. Ward No. Date when proceedings ordered. Date of Hearing. Court. Offence. Result of Hearing. 1 1904 6th Dec. 1905 18th Jan. Hampstead Petty Sessional Court. Contravention of bye-laws. Fined ,£10 and £1 18s. 6d. costs. 1 1905 19th Jan. 1st Feb. Do. Selling (1) adulterated butter; (2) margarine without a proper wrapper. Fined £5 and £1 1s. 0d. costs. 5 1904 20th Dec. 8th Feb. Do. Not obtaining water certificates (2 premises.) Dismissed. 3 8th Nov. 10th Mar. Marylebone Police Court. Non - compliance with notice. Dismissed with £5 5s. costs. 7 8th Nov. 7 th April Do. Non-compliance with notice. Withdrawn, tenant having left'premises; costs, 3s., paid. 4 1905 7th March Do. Do. Selling adulterated milk. Fined 10s. and 12s. 6d. costs. 6 21st Feb. 28th April Do. Non - compliance with notice. Withdrawn, work done; costs, 3s., paid. 7 Do. Do. Do. Nuisances (6 premises). Withdrawn, undertaking given as to future, and £1 1s. 0d. costs paid. 2 2nd May 17th May Hampstead Petty Sessional Court. (1) Nuisance. (2) Non-compliance with notice. (1) Abatement order made. (2) Fined 5s. and 12s. 6d. costs. 5 2nd May 7th June Do. Selling adulterated milk. Fined £2 and 17s. costs. 5 30th May 28th; June Do. Smoke nuisance in connection with use of (1) steam crane, (2) shunting engine, (3) Stationary engine. Fined £2 and costs in each case. 6 Do. Do. Do. Non-deposit of plans, &c. Dismissed without costs. 7 6th July 14th July Marylebone Police Court Selling adulterated milk Dismissed on proof of warranty. 5 2nd Feb. Do. Do. Non-compliance with order Work done, summons withdrawn, 23s. costs allowed. 5 11th July 2nd Aug. Hampstead Petty Sessional Court Non-deposit of plans, &c. Fined 20s., and 9s. 6d. costs. 105 Ward No. Date when proceedings ordered. Date of Hearing. Court. Offence. Result of Hearing. 4 6th July 11th Aug. Marylebone Police Court (1) Non-compliance with Order, (2) & (3) Non-compliance with notices in respect of ashpits (1) Dismissed, no costs allowed; (2) & (3) Withdrawn, work done. 1 18th August 27th Sept. Hampstead Petty Sessional Court Selling adulterated milk Fined 5s,, and 16s. 6d. costs. 1 Do. Do. Do. Do. Fined 5s. and 16s. 6d. costs. 1 Do. Do. Do. (1) Selling adulterated milk, (2) Can improperly inscribed Summonses not served, wrong address given.* 7 12th Oct. 10th Nov. Marylebone Police Court Nuisance Abatement order made, and 6s. costs allowed. 6 20th July Do. Do. Nuisance Abatement order made, and 6s. costs allowed. 6 Do. Do. Do. Nuisance Abatement order made, and 6s. costs allowed. 6 Do Do. Do. (1) & (2) Nuisances Abatement order made, and 6s. costs allowed on each summons. 6 Do. Do. Do. Nuisance Abatement order made, and 6s. costs allowed 5 3rd August 24th Nov. Do. Nuisance Abatement order made, and 6s. costs allowed. 3 9th Nov. Do. Do. (1) (2) & (3) contravention of Byelaws of L.C.C. under Public Health (London) Act, 1891, (4) contravention of drainage Byelaws under Metropolis Management Act, 1855 Withdrawn on undertaking given to comply with Bye-laws.'and £1 9s. Od. costs paid. 7 12 Oct. 8th Dec. Marylebone Police Court Failure to deposit plans,&c.,of drainage work Summons withdrawn on deposit of plans and payment of 10s. 6d. costs. * Summonses served on 14th December, 1905, and case heard on 3rd January, 1906. See page 82. REPORT on the ANALYTICAL WORK OF THE YEAR 1905, by ALFRED W. STOKES, F.C.S., F.I.C., Public Analyst. 109 Laboratory, Town Hall, Paddington Green, W., 24th January, 1906. A short summary of the analytical work of the year 1905 may be of interest. A total of 414 samples were analysed, comprising milk 171 samples, butter 100, cheese 31, groceries 72, lard 20, drugs 6, ices 4, spirits 3, and margarine 1. Of these only 8 samples, consisting of 7 milks and 1 butter were adulterated. Hampstead, therefore, shows a total adulteration of only 1 9/10 per cent, compared with the average for all London of 8 per cent. This is far below any other Borough in London, and shows a state of purity of the food supply unattainable elsewhere. The most adulterated article in this Borough is Milk, even that, however, shows only 4 per cent, of adulterated samples as compared with the 13 per cent, of the rest of London. Every effort has been made to secure samples representative of the food supply of the whole Borough. They have been taken from all parts of the Borough, on Sundays as well as week days, and on the open heath on Bank Holidays, by the Inspector as well as by his deputies. I have applied the same standards of purity to these that I use for other districts where, alas, the result shows a far larger amount of adulteration. The fines imposed have been comparatively light, totalling only £4 15s., with £2 18s. costs for the whole year. The real reward, however, of the labours of the Public Health Committee is the attainment of a food supply for this Borough unrivalled in all London. ALF. W. STOKES, F.C.S., F.I.C., Public Analyst, APPENDIX 1. 113 TABLE I. Vital Statistics of whole Borough during 1905 and Previous Years. Year. Population estimated to Middle of each year. Births. Total Deaths Registered in the Borough. Total Deaths in Public Institutions in the Borough. Deaths of Noil residents registered in Public Institutions in the Borough. Deaths of Residents registered in Public Institutions beyond the Borough. Nett Deaths at all Ages belonging to the Borough. Number Rate.* Number Rate* Under 1 year of Age. At all Ages. N umber Rate per 1000 Births registered. Number Rate* 1 2 3 4 5 6 7 8 9 10 11 12 13 1895 74399 1453 19.8 203 139.7 1265 17.0 476 403 69 931 13.4 1896 76216 1462 19.1 187 127.9 1308 17.1 548 472 80 916 12.0 1897 78549 1479 20.0 193 130.4 1219 15.5 472 397 89 911 11.6 1898 80623 1516 18.1 198 130.6 1296 16.0 552 460 81 917 11.4 †1899 80926 1576 19.5 206 130.7 1262 15.5 487 398 62 926 11.4 1900 81230 1621 20.0 170 104.8 1200 14.7 458 372 94 922 11.3 1901 82280 1506 18.3 155 102.0 1196 14.5 532 424 101 873 10.6 1902 83743 1516 18.1 155 102.2 1199 14.3 482 390 95 904 10.7 1903 85197 1453 17.0 155 106.7 1019 12.3 424 312 100 837 9.8 1904 86663 1445 16.7 200 138.0 1135 13.1 455 338 95 892 10.3 Averages for years 1895-1904 80982 1502 18.5 182 121.2 1212 15.0 488 396 86 902 11.1 1905 88142 1421 16.1 169 118.9 1089 12.3 464 350 84 823 9.3 The figures for this year have been corrected. * Rates in Columns 4, 8 and 13 calculated per 1000 of estimated population. Note.—The deaths included in Column 7 of this Table are the whole of those registered during the year as having actually occurred within the Borough. The deaths included in Column 12 are the number in Column 7, corrected by the subtraction of the number in Column 10, and the addition of the number in Column 11. By the term "Non-residents" is meant persons brought into the Borough on account of sickness or infirmity, and dying in public institutions there; and by the term "Residents" is meant persons who have been taken out of the Borough on account of sickness or infirmity, and have died in public institutions elsewhere. The "Public Institutions" taken into account for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. A list of the Institutions in respect of the deaths in which corrections have been made is given on the next page. Area of Borough in acres (exclusive of area covered by water), 2253. Total population at all ages, 81,942. Number of inhabited houses, 11,294. Average number of persons per house, 7.2. At Census of 1901. 114 TABLE I. (continued). I. Institutions within the Borough receiving sick and infirm persons from outside the Borough. II. Institutions outside the Borough receiving sick and infirm persons from the Borough. III. Other Institutions, the deaths in which have been distributed among the several localities in the Borough. Consumption Hospital, Mount Vernon Belgrave Children's Hospital Friedenheim, Upper Avenue Road Bethlehem Royal Hospital Chelsea Hospital for Women North Western Fever Hospital, Lawn Road Chest Hospital, Bethnal Green St. Peter's Home, Mortimer Road Childrens' Hospital, Paddington Green Claybury Asylum Colney Hatch Asylum Infants' Hospital, 7, Denning Road Cottage Hospital, Harlesden Darenth Asylun Hampstead General Hospital, Hampstead Green French Hospital, Shaftesbury Avenue German Hospital, Dalston Hampstead Workhouse, New End Great Ormond Street Hospital Grosvenor Hospital Hospital for Incurable Children, College Villas Road Guy's Hospital Hanwell Asylum Home Hospitals Association, 16, Fitzroy Square, W. Hospital for Women, Soho Square Ilford Asylum King's College Hospital Leavesden Asylum London Hospital London Temperance Hospital Middlesex Hospital Homoeopathic Hospital, Gt. Ormond Street Home for Consumptive Females, Marylebone 115 TABLE I. (continued). I. Institutions within the Borough receiving sick and infirm persons from outside the Borough. II. Institutions outside the Borough receiving sick and infirm persons from the Borough. III. Other Institutions the deaths in which have been distributed among the several localities in the Borough. North Eastern Hospital, Hackney Road North West London Hospital Norwood Asylum Royal Free Hospital Royal Hospital for Incurables, Wandsworth St. Bartholomew's Hospital St. George's Hospital St. Joseph's Hospital, Hackney St. Mark's Hospital, City Road St. Mary's Hospital St. Pancras Infirmary St. Thomas' Hospital Tooting Bec Asylum University College Hospital West London Hospital 10, Greville Place The Workhouse is within the Borough and situate at New End in No. 1 (Town) Ward. 116 TABLE II. Vital Statistics of Separate Localities in 1905 and Previous Years. Names of Localities. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 1895 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1896 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1897 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1898 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1899 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1900 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1901 11944 ... 142 26 12968 ... 139 29 10438 ... 98 9 9137 ... 60 9 12222 ... 112 27 14838 ... 200 44 10733 ... 113 11 1902 12240 192 163 20 13280 239 135 18 10500 103 95 3 9233 110 71 11 12550 275 107 20 15100 435 219 45 10840 162 110 16 1903 12550 194 127 14 13520 211 121 13 10600 95 101 9 9357 99 60 8 12850 243 111 21 15370 417 184 39 10950 194 116 21 1904 12970 195 125 20 13660 217 141 23 10790 100 99 13 9503 90 62 11 13200 283 120 22 15550 408 206 54 10990 152 121 13 Averages of Years 1895 to 1904 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1905 13330 194 127 24 13840 209 131 13 10800 96 92 4 9762 113 60 5 13580 250 131 23 15790 426 171 50 11040 133 103 14 Notes.—Deaths of residents occurring in public institutions beyond the Borough are included in sub-column c of this Table, and those of non-residents registered in public institutions in the Borough excluded. (See note on Table I. as to meaning of terms " resident " and " non-resident.") Deaths of residents occurring in public institutions, whether within or without the Borough, are allotted to the respective localities according to the addresses of the deceased. In 1901 there were 9 deaths of persons over 1 year of age ; in 1902, 4 deaths of persons over 1 year of age; in 1903, 16 deaths of persons over 1 year of age, and 1 infantile death ; and in 1904, 13 deaths of persons over 1 year of age, and 5 infantile deaths, which were not able to be classified in wards owing to a definite address not having been registered. In 1905 there were 8 deaths of persons over 1 year of age, which were not able to be classified in wards owing to a definite address not having been registered. 117 TABLE III. Cases of Infectious Disease Notified during the Year 1905. Notifiable Disease. Cases Notified in whole Borough. Total Cases Notified in cach Locality. Number of Cases Removed to Hospital from each Locality. At all Ages. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65 65 and upwards. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 63 .. 12 27 14 10 .. 18 3 7 5 10 7 13 16 3 3 3 4 6 4 Membranous Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 42 .. 1 4 2 30 5 14 6 3 2 5 6 6 1 1 1 .. 1 1 1 Scarlet fever 170 1 37 100 22 10 .. 34 29 16 15 12 41 23 31 20 12 5 10 40 16 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 17 .. .. 4 8 5 .. 5 3 1 2 2 2 2 4 3 1 1 1 .. .. Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever 1 .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. Puerperal fever 2 .. .. .. 1 1 .. 1 1 .. .. .. .. .. .. 1 .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 295 1 50 135 47 57 5 72 42 27 24 29 57 44 52 28 17 9 16 47 21 118 TABLE IV. Causes of, and Ages at Death during the Year 1905. Causes of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the Borough. Deaths at all ages of "Residents" belonging to Localities whether occurring in or beyond the Borough. Total Deaths whether of "Residents" or "Non-residents" in Public Institutions in the Borough. All ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 8 1 6 1 .. .. .. 1 2 .. .. 4 .. 1 .. Scarlet Fever 6 .. 2 2 1 1 .. 1 2 .. 1 .. .. .. 80 Whooping Cough 17 6 10 .. 1 .. .. 2 1 1 .. 6 6 1 1 Diphtheria & Membranous Croup 3 .. 2 1 .. .. .. 1 .. .. .. 1 .. 1 33 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 2 .. 1 .. 1 .. .. 1 .. .. .. .. 1 .. 10 Other continued .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic Influenza 18 .. .. .. 1 5 12 .. 4 5 2 1 1 5 1 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 2 2 .. .. .. .. .. .. .. .. .. .. 2 .. 1 Enteritis 15 14 1 .. .. .. .. 3 .. 1 .. 4 3 4 7 Puerperal Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 3 .. .. 1 .. 2 .. .. .. 1 .. 1 1 .. 1 Other Septic Diseases 2 .. .. .. .. 2 .. .. 2 .. .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 73 .. 1 .. 12 57 3 9 10 4 6 11 26 7 124 Other Tubercular Diseases 22 6 5 2 3 5 1 5 2 4 2 3 2 3 15 Cancer, Malignant Disease 73 .. .. .. .. 39 34 11 13 9 14 9 9 8 34 Bronchitis 50 4 7 1 .. 14 24 9 6 4 1 15 8 6 13 Pneumonia 76 11 10 1 2 28 24 12 17 6 1 8 24 7 19 Pleurisy 1 .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. Other Diseases of Respiratory Organs 18 1 .. .. .. 8 9 3 2 1 4 .. 4 4 2 Alcoholism,Cirrhosis of Liver 11 .. .. .. .. 9 2 2 2 2 1 2 1 1 3 Venereal Diseases 5 2 .. .. .. 3 .. .. 2 .. .. 2 1 .. 1 Premature Birth 31 31 .. .. .. .. .. 5 4 1 1 4 14 2 5 Diseases & Accidents of parturition 5 3 .. .. .. 2 .. 1 .. 1 .. 1 1 1 .. Heart Diseases 84 2 .. .. 2 36 44 16 10 17 8 9 11 13 21 Accidents 32 8 5 2 3 10 4 6 4 4 .. 2 8 7 15 Suicides 9 .. .. .. .. 6 3 .. 2 .. 2 1 1 1 16 Murder 1 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. All other causes 56 41 6 5 12 75 117 38 46 31 17 47 46 29 68 All causes 823 133 56 16 38 303 277 127 131 92 60 131 171 103 464 Note.—It will be noted that the total number of deaths in the Ward distribution is 8 less than the total number of deaths at the age periods. This is accounted for by the fact that in these cases a definite address was not registered (See Note at foot of Table II.) 119 TABLE V. Infantile Mortality in the Borough. Deaths from Stated Causes in Weeks and Months under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-2 Months. 2-3 Months. 3-4 Months. 4-5 Months. 5-6 Months. 6-7 Months. 7-8 Months. 8-9 Months. 9-10 Months. 10-11 Months. 11-12 Months. Total Deaths under 1 Year. All Causes. Certified 37 6 7 4 54 12 9 9 9 7 7 4 6 7 1 8 133 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Common Infectious Diseases. Small pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria Crop .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. 2 .. .. 2 .. .. 1 .. 1 6 Diarrhœal Diseases. Diarrhœa, all forms .. .. .. .. .. .. .. 2 .. 3 .. .. 1 1 .. .. 7 Enteritis {not Tuberculous) .. .. .. .. .. .. 1 1 .. .. .. 1 .. .. .. .. 3 Gastritis Gastrointestinal Catarrh .. .. 1 .. 1 .. 3 .. 1 1 .. .. .. .. .. .. 6 Wasting Diseases. Premature Birth 13 3 1 2 19 4 .. .. 1 .. .. .. .. .. .. .. 24 Congenital Defects 11 1 .. .. 12 1 .. 1 3 .. .. 1 .. .. .. 1 19 Injury at Birth 6 1 .. .. 7 .. .. 1 .. .. .. .. .. .. .. .. 8 Want of Breast Milk .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Atrophy, Debility Marasmus 2 .. 2 2 6 2 2 2 1 .. .. .. .. .. .. .. 13 Tuberculous Diseases. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 2 Tuberculous Peritontis: Tabes Mesenterica .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Other lous Diseases ) .. .. .. .. .. .. .. .. 1 1 .. .. 1 .. .. .. 3 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Syphilis .. .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. 2 Rickets .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 Meningitis (not Tuberculous) 1 .. .. .. 1 .. 2 .. 1 .. 1 .. 1 .. .. 1 7 Convulsions .. .. 2 .. 2 1 .. .. .. .. .. .. .. .. 1 4 Bronchitis .. .. 1 .. 1 2 .. .. .. .. .. .. .. 1 .. .. 4 Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia .. .. .. .. .. 1 .. .. .. 1 3 .. 1 3 .. 2 11 Suffocation, overlaying 2 .. .. .. 2 .. 1 .. .. 1 .. 1 .. .. .. .. 5 Other Causes 2 1 .. .. 3 1 .. .. .. .. 1 .. .. .. .. 1 6 37 6 7 4 54 12 9 9 9 7 7 4 6 7 1 8 133 Births in the year, legitimate, 1,386; illegitimate, 35. Population estimated to middle of 1905, 88,142. Deaths from all Causes at all Ages, 823. 120 TABLE VI. Factories, Workshops, Laundries, Workplaces and Homework. 1.—Inspection. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (Including Factory Laundries) 122 8 - Workshops (Including Workshop Laundries) 1229 68 1 Workplaces 1366 75 4 Homeworkers' Premises 22 1 — Total 2739 152 5 2.—Defects Found. Particulars, Number of defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:— Want of cleanliness 82 82 .. .. Want of ventilation 18 18 .. .. Overcrowding 11 11 .. .. Want of drainage of floors 3 3 .. .. Other nuisances 274 274 .. 3 Sanitary accommodation insufficient 18 18 .. .. unsuitable or defective 76 76 .. 1 not separate for sexes 4 4 .. 1 Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) .. .. .. .. Breach of special sanitary requirements for bakehouses (SS. 97 to 100) .. .. .. .. Failure as regards lists of outworkers (S. 107) .. .. .. .. Giving out work to be done in premises which are unwholesome (S.108) .. .. .. .. infected (S. 110) .. .. .. .. Allowing wearing apparel to be made in premises infected by Scarlet Fever or Smallpox (S. 109) .. .. .. .. Other offences .. .. .. .. Total 486 486 .. 5 121 TABLE VI.—continued. 3.—Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (S. 133) 52 Action taken in matters referred by H.M. Inspectors, as remediable under the Public Health Acts, but not under the Factory Act (S. 5) Notified by H.M. Inspector 1 Reports (of action taken) sent to H.M. Inspectors .. Other .. Underground Bakehouses (S. 101):— Certificates granted during the year .. In use at the end of the year 22 Homework:— Number of Lists. Outworkers. List of Outworkers (S. 107): — Lists received 105 331 Addresses of outworkers forwarded to other Authorities 273 received from other Authorities 31 Homework in unwholesome or infected premises:— Wearing Apparel. Other. Notices prohibiting homework in unwholesome premises (S. 108) .. .. Cases of infectious disease notified in homeworkers' premises 3 .. Orders prohibiting homework in infected premises (S. 110) .. .. Workshops on the Register (S. 131) at the end of the year:— Workshop Laundries 6 Workshop Bakehouses 35 Other Workshops 646 Total Number of Workshops on Register 687 122 Table VII. PREMISES. NUMBER OF PLACES. Number of inspections, 1905. Number of notices, 1905. Number of prosecutions, 1905. On register at end of 1904. Added in 1905. Removed in 1905. On register at end 1905. Milk premises 114 4 5 113 322 9 l Cowsheds — — — — — — — Slaughter-houses 5 — — 5 146 — — Other offensive trade premises - - - - - - - Ice cream premises 69 7 3 73 140 — — *Registered houses let in lodgings - 199 — 199 — — — *See page 92. Total number of Intimation Notices served for all purposes 711 Overcrowding— Number of dwelling rooms overcrowded 11 Number remedied 11 Number of notices issued 11 Number of prosecutions — Underground rooms— Number closed during year 5 Illegal occupation dealt with during year — Insanitary houses — Number closed under the Public Health (London) Act, 1891 1 „ ,, Housing of the Working Classes Act — Shelters provided under Sec. 60 (4) of the Public Health (London) Act, 1891— Number of persons accommodated during the year — Customs and Inland Revenue Acts— Number of houses for which applications were received during year 181 Number of dwellings comprised therein 215 „ Certificates granted (houses) 39 „ „ refused - „ „ deferred 142 123 Table VII—continued. Number of prosecutions under Bye-laws under Public Health (London) Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, &c. - (b) For prevention of nuisance arising from offensive matter running out of any manufactory, &c. - (c) For the prevention of keeping of animals in such a manner as to be injurious to health - (d) As to paving of yards, &c., of dwelling houses — (e) In connection with the removal of offensive matter, &c. — (f) As to cesspools and privies, removal and disposal of refuse, &c. — (g) For securing the cleanliness of tanks, cisterns, &c. — (h) With respect to water closets, earth closets, &c. 5 (i) With respect to sufficiency of water supply to water closets — Number of prosecutions under Bye-laws under Metropolis Management Acts- (a) With respect to drainage, &c. 4 (b) With respect to deposit of plans as to drainage, &c. 5 London County Council (General Powers) Act, 1904- Number of Notices served re premises. Sec. 20 9 „ sanitary conveniences removed or altered. Sec. 22 — „ fixed ashpits removed. Sec. 23 1 Mortuaries— Total number of bodies removed 97 Total number of infectious bodies removed 3 124 TABLE VIII. Vital Statistics of the Borough. Number of occupied houses 11,294 At Census 1901. Population 81,942 Average number of persons per house 7.25 Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Zymotic Diseases. 7 Principal Zymotic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 Births. Cases Notified (excluding Chicken-pox). Attack rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 83743 1516 18.1 904 10.7 133 87.7 460 5.4 58 0.69 1903 85197 1453 17.0 837 9.8 126 86.7 311 3.8 42 0.49 1904 86663 1445 16.7 892 10.3 161 111.4 301 3.5 48 0.55 1905 88142 1421 16.1 823 9.3 133 93.6 295 3.3 38 0.43 TABLE VIII. (1). Vital Statistics of No. 1 (Town) Ward. Number of occupied houses 1,616 At Census 1901. Population 11,895 Average number of persons per house 7.36 Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Zymotic Diseases. 7 Principal Zymotic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 Births. Cases Notified (excluding Chicken-pox). Attack rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 12240 192 15.7 163 13.3 20 104.1 64 5.3 8 0.65 1903 12550 194 15.4 127 10.1 14 72.1 38 3.1 10 0.79 1904 12970 195 15.0 125 9.6 20 102.5 65 5.1 2 0.16 1905 13330 194 14.5 127 9.5 24 123.7 72 5.4 6 0.45 125 TABLE VIII. (2). Vital Statistics of No. 2 (Belsize) Ward. Number of occupied houses 1,581 At Census 1901. Population 12,915 Average number of persons per house 8.16 Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Zymotic Diseases. 7 Principal Zymotic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 Births. Cases Notified (excluding Chicken-pox). Attack rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 13280 239 17.9 135 10.2 18 75.3 94 7.1 12 0.90 1903 13520 211 15.6 121 8.9 13 61.6 60 4.5 3 0.22 1904 13660 217 15.9 141 10.3 23 105.9 47 3.5 8 0.59 1905 13840 209 15.1 131 9.4 13 62.2 42 3.0 5 0.36 TABLE VIII. (3). Vital Statistics of No. 3 (Adelaide) Ward. Number of occupied houses 1,657 At Census 1901. Population 10,395 Average number of persons per house 6.27 Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Zymotic Diseases. 7 Principal Zymotic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 Births. Cases Notified (excluding Chicken-pox). Attack rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 10500 103 9.8 95 9.0 3 29.1 40 3.8 2 0.19 1903 10600 95 8.9 101 9.4 9 94.7 22 2.1 1 0.09 1904 10700 100 9.3 99 9.2 13 130.0 36 3.4 2 0.19 1905 10800 96 8.9 92 8.5 4 41.7 27 2.5 1 0.09 126 TABLE VIII. (4). Vital Statistics of No. 4 (Central) Ward. Number of occupied houses 1,299 At Census 1901. Population 9,099 Average number of persons per house 7.00 Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Zymotic Diseases. 7 Principal Zymotic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 Births. Cases Notified (excluding Chicken-pox). Attack rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 9233 110 11.9 71 7.7 11 100.0 40 4.4 ... ... 1903 9357 99 10.6 60 6.4 8 80.8 34 3.7 4 0.43 1904 9503 90 9.5 62 6.5 11 122.2 17 1.8 2 0.21 1905 9762 113 11.6 60 6.1 5 44.2 24 2.5 1 0.10 TABLE VIII. (5). Vital Statistics of No. 5 (West End) Ward. Number of occupied houses 1,778 At Census 1901. Population 12,172 Average number of persons per house 6.84 Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Zymotic Diseases. 7 Principal Zymotic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 Births. Cases Notified (excluding Chicken-pox). Attack rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 12550 275 21.9 107 8.5 20 72.1 102 8.2 10 0.79 1903 12850 243 18.9 111 8.6 21 86.4 55 4.3 2 0.15 1904 13200 283 21.4 120 9.1 22 77.7 70 5.4 8 0.61 1905 13580 250 18.4 131 9.6 23 92.0 29 2.1 11 0.81 127 TABLE VIII. (6). Vital Statistics of No. 6 (Kilburn) Ward. Number of occupied houses 1,686 At Census 1901. Population 14,777 Average number of persons per house 8.76 Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Zymotic Diseases. 7 Principal Zymotic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 Births. Cases Notified (excluding Chicken-pox). Attack rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 15100 435 28.8 219 14.5 45 103.4 76 5.1 23 1.52 1903 15370 417 27.1 184 11.9 39 93.5 59 3.9 15 0.97 1904 15550 408 26.2 206 13.2 54 132.3 43 2.8 25 1.61 1905 15790 426 26.9 171 10.8 50 117.4 57 3.6 9 0.57 TABLE VIII. (7). Vital Statistics of No. 7 (Priory) Ward. Number of occupied houses 1,677 At Census 1901. Population 10,689 Average Number of persons per house 6.38 Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Zymotic Diseases. 7 Principal Zymotic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 Births. Cases Notified (excluding Chicken-pox). Attack rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 10840 162 14.9 110 10.5 16 98.7 44 4.1 3 0.28 1903 10950 194 17.7 116 10.5 21 108.2 43 4.0 7 0.64 1904 10990 152 13.8 121 11.0 13 85.5 23 2.1 ... ... 1905 11040 133 12.0 103 9.3 14 105.3 44 3.9 5 0.45 128 TABLE IX. Year. Birth rate per 1000. Natural increase [Hampstead] . Seven Principal Zymotic Diseases death rate per 1000. Notifiable Zymotic disease rate per 1000, Hampstead. General death rate per 1000. Hampstead. England and Wales. Hampstead. England and Wales, Hampstead. England and Wales. 1875 22.6 35.4 394 — 3.4 — 12.5 22.7 1876 24.4 36.3 367 — 3.1 — 15.2 20.9 1877 24.0 35.0 413 — 2.7 — 13.7 20.3 1878 24.5 35.6 409 — 3.4 — 14.8 21.6 1879 22.8 34.7 365 — 1.9 — 13.2 20.7 1880 24.1 34.2 521 1.2 3.3 — 12.6 20.5 1881 23.8 33.9 502 2.0 2.3 — 12.7 18.9 1882 23.6 33.8 546 2.2 2.7 — 13.0 19.6 1883 23.8 33.5 685 1.8 2.3 — 11.2 19.5 1884 22.0 33.6 554 1.9 2.8 — 12.5 19.5 1885 21.2 32.9 593 1.4 2.2 — 11.5 19.0 1886 21.0 32.8 554 1.2 2.4 — 12.2 19.3 1887 21.9 31.9 628 1.1 2.4 — 11.0 18.8 1888 20.5 31.2 616 1.0 1.8 — 10.6 17.8 1889 21.0 31.1 728 0.95 2.2 — 10.7 17.9 1890 21.9 30.2 613 1.5 2.1 — 13.1 19.1 1891 21.5 31.4 670 1.0 1.9 4.5 12.2 22.5 1892 20.4 30.5 591 1.7 1.8 8.0 12.4 19.0 1893 20.5 30.8 547 1.3 2.47 11.1 12.9 19.2 1894 19.6 29.6 674 1.4 1.76 6.2 10.8 16.6 1895 19.8 30.2 452 1.0 2.14 7.3 13.4 18.7 1896 19.1 29.7 546 1.8 2.18 7.8 12.0 17.1 1897 20.2 29.7 568 1.1 2.15 5.1 11.6 17.4 1898 18.1 29.4 599 1.4 2.22 5.7 11.4 17.6 1899 19.7 29.3 650 1.1 2.21 6.0 11.4 18.3 1900 20.0 28.7 699 1.0 2.0 5.8 11.3 18.3 1901 18.3 28.5 633 0.77 2.05 5.6 10.6 16.9 1902 18.1 28.6 612 0.69 1.64 *5.4 10.7 16.3 1903 17.0 28.4 616 0.49 1.46 *3.8 9.8 15.4 1904 16.7 27.9 553 0.55 1.94 *3.5 10.3 16.2 1905 16.1 27.2 598 0.43 1.52 3.3 9.3 15.2 * Excluding Chicken-pox. 129 TABLE X. Vital Statistics of Hampstead 1801—1901. Census Year. Population at Census. Increase of population per cent. during the decade ending. Average death rate per 1000 of the population during the decade ending. 1801 4,343 * 1811 5,483 26 * 1821 7,263 32 * 1831 8,588 18 * 1841 10,093 17 * 1851 11,986 18 17 1861 19,104 59 * 1871 32,271 68 14 1881 45,436 40 13 1891 68,425 50 11 1901 81,942 19 11 * The rates for these years are not available. 130 TABLE XI. Disinfection. Number of premises disinfected 608 Number of Articles disinfected— Beds 315 Mattresses 522 Palliasses 20 Bolsters 428 Pillows 1332 Blankets 1542 Sheets 797 Counterpanes 631 Articles of Clothing 2314 Carpets 111 Miscellaneous 4177 Total 12189 The Number of Premises disinfected during 1904 was 680, and the Number of Articles 14274. 131 TABLE XII. 881 Complaints were received during the year 1905, and related to the following matters:— Accumulations, offensive 12 „ of refuse 8 Animals, keeping of 12 „ dead 11 Carpet beating 5 Dampness in premises 23 Dirty premises 13 Drains, bad condition of 34 „ defective 15 „ stopped 28 Dust, non-removal 64 Dust receptacles, foul or defective 9 „ absence of 5 „ improperly placed 2 Insanitary premises 40 Illness attributable to defective drains 15 Manure not removed 12 Overcrowded premises 9 Rats, nuisance from 7 Roadways, condition of 1 Road gullies stopped 2 Roofs defective 11 Rubbish, offensive 3 „ burning 28 Smells 22 „ on premises 28 „ from road gullies 16 „ „ sewer ventilators 90 „ „ stables 1 „ „ drains, &c. 31 „ „ water closets 12 „ „ manure 8 „ „ dust bins 12 „ „ „ carts 1 Smoke nuisances 13 Urinals, condition of 6 Uninhabitable premises 1 Unsound food 1 Vacant land, state of 8 Verminous clothing, &c. 8 Water closets, absence of 2 „ insanitary condition of 21 „ stopped 5 „ without water 6 „ „ proper flush 4 „ position of 1 Water, absence of 2 „ cut off 212 „ leakage of 9 Water cisterns, dirty, &c 2 Miscellaneous 85 Total 976 During 1904, 852 complaints were received, referring to 1080 matters. 132 TABLE XIII. Number of Inspections, &c., Made; Notices Served; Letters, &c., Issued; and Sanitary Works Carried Out. 903. 1904. 1905. Number of Inspections 8002 11927 11960 „ Re-inspections 13865 12266 11491 „ Intimation Notices issued 1037 908 711 „ Statutory Notices issued 366 479 211 „ Letters issued 2408 5211 4673 Number of Notifications sent to "Head Teachers" of Schools respecting notified cases of infectious disease 417 Number of Notifications respecting cases of Measles 248 1905. Houses or parts of houses cleansed 327 Dampness in houses or parts of houses abated 88 Dilapidated „ „ „ repaired 61 Inlets or surface drains trapped 10 Improperly constructed water closets altered 22 Defective water closets repaired or renewed 106 Water closets unstopped 22 Improperly placed water closets removed 28 External ventilation provided to water closets 49 Water closet accommodation provided 33 Soil pipes repaired, renewed, or ventilated 446 Improperly placed gully traps removed 13 Gully traps cleaned 51 Yards drained 30 Waste pipes of sinks disconnected from drains, trapped, or renewed 404 „ „ lavatories „ „ „ „ 166 „ „ baths „ „ „ „ 112 Water cisterns repaired or renewed 10 Accumulations or deposits of refuse, manure, &c , removed 697 Foul or defective dustbins or ashpits abolished 79 Foul drains cleansed 110 Defective drains amended or reconstructed 928 Drains unstopped 88 Rainwater pipes disconnected from drains 126 „ „ „ „ soil pipes 12 „ „ repaired or renewed 86 133 TABLE XIII.—continued. 1905. Water supplies used for domestic purposes disconnected from the cistern for flushing the water closet 16 Houses provided with proper water supply 134 Roofs repaired 115 Gutterings repaired or renewed 32 Areas cleansed 3 „ drained 4 Washhouse pavings repaired or renewed 15 Scullery „ „ „ 11 Animals ceased to be kept in such a manner as to be a nuisance 5 Cases of overcrowding abated 11 Underground rooms ceased to be occupied as dwellings 5 Tents, vans, sheds, or similar structures in such a state as to be injurious or dangerous to the health of the inmates, ceased to be used for human habitation - Spaces below floors in the basement or ground floors ventilated 3 Chimneys carried to a sufficient height 2 Ventilating pipes of drains carried to a sufficient height above windows 8 Fresh air inlets repaired or renewed 17 Separate and sufficient water closet accommodation provided for persons of each sex 1 Water closets cleansed 69 „ „ provided with a sufficient water supply 48 Flushing cisterns to water closets repaired or renewed 217 Water closets provided with means of constant ventilation 9 Sufficient water closet accommodation provided 3 Yard pavings repaired or renewed 202 Area „ „ „ 80 Defective or improper manure receptacles abolished 4 Manure receptacles provided 10 Dust „ „ 195 Covers to dust receptacles provided 171 Water cisterns cleansed 153 „ „ fitted with close fitting covers 115 Improperly placed water cisterns removed 6 Stable pavings repaired or renewed 24 134 TABLE XIV. Bakehouses. Bakehouses in Wards. Those marked * are underground bakehouses. Those marked † are factory bakehouses. No. 1 (Town) Ward— No. 5 (West End) Ward con.— 57, Heath Street. *43, Mill Lane. 3, High Street. 44, do. 67, do. 4, Munro Terrace, Fortune Green. 19, New End. (4) 1, The Parade, Cricklewood. No. 2 (Belsize) Ward— †26, do. 6, Fleet Road. 251, West End Lane. *65, do. *279, do. (9) 2, Heath Hurst Road. (3) No. 3 (Adelaide) Ward— No. 6 (Kilburn) Ward- *44, England's Lane. *63, Hemstal Road. *90, Haverstock Hill. *94, High Road, Kilburn. *2, King's College Road. (3) *354, do. *4, Kelson Street. No. 4 (Central) Ward— 67, Kingsgate Road. *10, Belsize Park Terrace. *99, Palmerston Road. (6) *225, Finchley Road. *289, do. No. 7 (Priory) Ward— †307, do. *202, Belsize Road. *98, West End Lane. (5) *228, do. No. 5 (West End) Ward— *98, Boundary Road. 2, Burgess Parade, Finchley Road. *55, Fairfax Road. *93. do. Field Lane School, Hillfield Road. *7, Fairhazel Gardens. *137, Finchley Road. (7) Bakehouses—Underground 22 „ Above ground 15 Total 37 135 TABLE XV. Restaurant Kitchens in Wards. No. 1 (Town) Ward— No. 5 (West End) Ward— Jack Straw's Castle, Hampstead Heath. 92, Fortune Green Road. 3, The Parade, Cricklewood. West End Coffee House, West End Lane. 37, Heath Street. 63 & 65, do. 70, do. 8, Cavendish Parade, West End Lane. (4) 109, do. Bull and Bush, North End. 60, Rosslyn Hill. (7) No. 6 (Kilburn) Ward— No. 2 (Belsize) Ward— 2, Elm Terrace, Constantine Road. 188, High Road, Kilburn. 272, do. do. 2, Fleet Road. 308, do. do. 25, do. 368, do. do. 98, do. Towers' Coffee Rooms, Loveridge Road. 106, do. 210, Haverstock Hill. 96, Palmerston Road. (6) 11, South End Road. 17, do. (8) No. 7 (Priory) Ward— No. 3 (Adelaide) Ward— 21, Alexandra Road. 1, Adelaide Road. 203, Belsize Road. 143, do. 264, do. 97, Haverstock Hill. 274, do. 11, King's College Road. 114, Boundary Road. Winchester Hotel, Winchester Road. (5) 65, Fairfax Road. 115, Finchley Road. No. 4 (Central) Ward— 3, Goldhurst Terrace. 14, Belsize Park Terrace. 34, High Road, Kilburn. 17, do. 38, do. do. 159, Broadhurst Gardens. 43, Loudoun Road. 1, Canfield Place. Steer's Restaurant, Upper Avenue Road. 104, Finchley Road. 100, West End Lane. Swiss Cottage Tavern, Upper Avenue Road. (13) 1, Central Parade, do. (7) Total 50 136 TABLE XVI. Vaccination Statistics. Year. Births. Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. Number in respect of whom Certificates of "Conscientious Objection" has been received. Died Unvaccinated. Vaccination Postponed. Remaining. Percentage of Births Registered. Successfully Vaccinated. Exempted by" Conscientious Objection" Certificates. Not finally accounted for (including cases postponed). Unvaccinated. 1 2 3 4 5 6 7 8 9 10 11 12 13 1900 1623 1323 13 - 37 108 11 131 (Col. 3) 81.5 (Col. 6) 2.3 (Cols. 8 & 9) 8.7 (Cols. 6, 8 & 9) 11.0 1901 1508 1232 15 — 39 111 7 104 81.7 2.6 7.4 10.0 1902 1517 1255 18 — 27 104 11 102 82.7 1.8 7.4 9.2 1903 1452 1190 19 — 30 106 11 96 81.9 2.0 7.4 9.4 1904 1446 1197 16 — 35 100 8 90 82.8 2.4 6.8 9.2 1905 1421 954 18 — 38 85 26 300* — — — — Note.—The number of births given as occurring in each year differs slightly from those stated elsewhere in this Report, but for all practical purposes the difference is negligible. * In this figure are included 242 births in the last four months of the year, in respect of which no action as to vaccination has yet been taken. The rates for Columns 10-13 have therefore not been calculated. APPENDIX II. 139 REPORT OF THE SPECIAL COMMITTEE re SEWER VENTILATION, Adopted at Council Meeting, 15th February, 1906. 30th January, 1906. Your Committee beg to report as follows : — On 22nd June, 1905, a report was submitted to the Council by the Works Committee: Stating— (a) That they have considered the memorial, dated 20th May, from residents in Hillfield Road, alleging that the sewer gratings in that road were a danger to health, a public nuisance, and a contravention of section 19 of the Public Health Act, 1875, and demanding that steps be at once taken to abate such alleged nuisance by forthwith sealing the road openings, and by adopting a proper and sanitary method of sewer ventilation, in lieu of the existing arrangements. (b) That they have also considered a letter, dated 10th June, from the London County Council, forwarding copy of a similar memorial addressed to them on the subject. (c) That on the 26th November, 1903, the Committee mended the Council to substitute for the existing sewer ventilating gratings in that vicinity, gratings of a larger size, but the recommendation was deferred by the Council on 17th March, 1904. (d) That since that date several up-cast shafts have been erected in the neighbourhood in order to assist in the ventilation of the sewers. (e) That they are of opinion that the best means of dealing with the question would be to carry out the abovementioned works; and therefore 140 Recommending— (/) That the Borough Engineer be instructed to substitute for existing sewer ventilating gratings in Hillfield Road, Agamemnon Road, and adjacent roads, sixty-two gratings of a larger size, and having a minimum ventilating area of 60 square inches, at an estimated cost of £125. (Included in the estimates for the current year.) After discussion the Council resolved— "That such statements and recommendation be referred to a Special Committee consisting of 3 members to be nominated by the Works Committee, and 3 members to be nominated by the Public Health Committee, for consideration and report." On 6th July the Works Committee reported— "That they have nominated Messrs. Councillors Spriggs, Payne, and Rider, to serve on the Special Committee appointed by the Council at their last meeting re Sewer Ventilation." And on the same date the Public Health Committee reported— "That they have nominated the Chairman of the Committee (Mr. Councillor Farmer) together with Messrs. Councillors Andrews and Hendrick to serve on the Special Committee appointed by the Council, 22nd June, re Sewer Ventilation." These nominations were duly approved by the Council. Subsequently in reply to an enquiry in Council as to the scope of the reference to the Special Committee, the Mayor ruled that a consideration of the ventilation of the sewers of the Borough generally was clearly involved, and your Committee have accordingly felt it their duty to extend their investigations in accordance with this decision, and to deal with the problem as affecting Hampstead sewers in general, and not those of one area alone. The complaints received of sewer smells have engaged the careful consideration of the Committee. 141 A register of all such complaints is kept by the Borough Engineer. This register shews the date of complaint, locality, and any other details, with the Sewer Inspector's report as to the nearest ventilator and the condition of the sewer, and any action which has been taken. The following is a summary of the number of complaints received during each month in one complete year:— 1904. October 12 November 10 December 9 1905. January 0 February 5 March 4 April 3 May 12 June 19 July 14 August 6 September 31 125 It would thus appear that by far the largest number of complaints occur during September, the next largest in June, and the fewest during the months from January to April. It appeared to be desirable to enquire whether any relation could be traced between the incidence of infectious disease, and the complaints of nuisance from the sewers. The Hillfield Road area was selected for this purpose, not because the Committee considered it the worst, but because it was here possible to mark out and deal with a definite area of convenient size. The late Medical Officer of Health was requested to prepare a report on this subject, and subjoined is that received from the Acting Medical Officer of Health. 142 " 27th November, 1905. To the Chairman and Members of the Special Committee on Sewer Ventilation. Gentlemen, In accordance with your instructions to the late Medical Officer of Health, I beg to submit the following report upon the incidence of infectious disease in the "Hillfield Road Area," which I have defined as the district bounded by a line starting at West End Green, passing down the centre of Mill Lane, up Gondar Gardens, along the Cemetery wall, and down the centre of Fortune Green Road, and which consists of 41½ acres. The report deals with the years 1902, 1903, and 1904. During this period, 61 cases of infectious disease were notified (excluding Chicken-pox) being 29, 16, and 16, respectively, and comprised: — 1 case of Small-pox. 39 cases of Scarlet Fever. 12 „ Diphtheria. 3 „ Enteric Fever. 6 ,, Erysipelas. Chicken-pox, which was notifiable from 20th December, 1901, to 7th January, 1903, and from 8th April, 1904, to 7th November, 1904, has been purposely omitted from the tables as its inclusion would have been misleading. The distribution of the cases was fairly general throughout the area. The population of a district is the usual basis upon which comparative tables are prepared, but no Census being available for this area, I have been compelled to fall back on other data. For the purposes of comparison I have therefore tabulated the number of cases of notifiable infectious diseases which have occurred in the various wards of the Borough, together with the average population, and aggregate number of births, 143 Ward. Number of cases. Average population. Aggregate Number of Births. No. of cases per 100 births. During the years 1902, 1903, and 1904. No. 5, "West End Ward 227 12,850 801 28 „ 2, Belsize ,, 201 13,520 667 30 „ 6, Kilburn „ 178 15,370 1,260 14 „ 1, Town „ 167 12,550 581 29 „ 7, Priory „ 110 10,950 508 21 „ 3, Adelaide „ 98 10,600 298 33 „ 4, Central „ 91 9,357 299 30 The case rate has been further analysed so far as it affects No. 5, West End Ward, by comparing the number of eases per acre, in the whole Ward, and the "Hillfield Road Area," respectively:— District. Area in Acres. Cases per Acre. No. 5, West End Ward 247 0.9 "Hillfield Road Area" 41½ 1.5 In considering a matter of this nature the point should be borne in mind that the presence of infectious disease among any community depends largely upon the age of the population, and especially upon the presence of a large infant population, this latter class being by far the most susceptible. I append another table which may be of interest in the investigation which you are pursuing, shewing the relative position of the cases of infectious disease to surface sewer ventilators; the distance in each case being measured along the centre of the roadway:— 14 cases with ventilator opposite house. 11 „ within 10 yards of house. 14 „ „ 20 „ 7 „ „ 30 ,, 15 „ over 30 yards away from house. I am, Gentlemen, Your obedient Servant, (Signed) FRANK E. SCRASE, A,cting Medical Officer of Health." 144 In addition, at the suggestion of Drs. Andrewes and Hurtley (the experts employed by the Committee on the authority given by the Council on 20th July, 1905), a map was prepared by the Borough Engineer shewing the distribution of notifiable infectious diseases, and the complaints received for 12 months. Several important conditions which do not appear in the report or map have to be borne in mind in considering this point. Thus there is no return as to the number of cases in which the house drains were tested and found to be defective, while several infectious diseases are included in the return, such, for instance, as scarlet fever, which have never been attributed to sewer air. In the Hillfield Road area 64 per cent. of the notified cases were scarlet fever. Attention is directed to the opinion of Dr. Andrewes as set out at the bottom of page 19 of his report, which has been separately furnished to the members of the Council. After careful consideration of all the facts, your Committee have arrived at the conclusion that the returns and map supply no evidence that any relation exists between infectious diseases and complaints of nuisances. Four letters making specific complaints were referred to the Committee, and have been considered by them. It is obviously a matter of no small difficulty to establish a connection between any particular case of illness and an alleged smell arising from a sewer ventilator. To maintain any such relation of cause and effect it would be requisite to first eliminate any such source of disease as foul or imperfect house drains, contaminated water, milk, or other food taken at home or elsewhere, and any contact with another person capable of communicating infection. In addition, to arrive at a convincing proof, it would be necessary to obtain evidence of the presence in the body of the patient of a specific germ which could also be demonstrated in the emanation from the sewer. It is thus apparent that the investigation of individual cases of alleged illness is not likely to lead to any useful result. In view, however, of the seriousness of the allegations contained in the letter of Mr. E. W. Evill, of 33, Hillfield Road, your Committee 145 caused enquiries to be made, with the result that, as already reported to the Council, no such disease as typhoid fever was found to have occurred, and that no connection with the sewer ventilator and the illness could be discovered. It may be well to point out at this place that while, as indicated by Drs. Andrewes and Hurtley (p. 26 of their report), the sense of smell in man is most acute, it is at the same time capable of undoubted errors. Thus, both in Hampstead and in many other localities assertions have been repeatedly made that a smell has persisted when the closure of a ventilator at the sewer level and out of sight has made such continuance impossible. In connection with the effect of sewer air on health, it is useful to instance the health of the men employed in the sewers. Upon enquirv your Committee find that these employes certainly lose no more days from sickness than do the other workmen of the Council, and they have been unable to find that any septic or zymotic disease has occurred among them. It may be objected that this freedom from illness is due to an immunity acquired by long continued work in the sewers, but if this were so it would follow that when first commencing this class of work, men would be liable to sickness. This, however, does not appear to be the case. We would on this point also refer to the observations made by Drs. Andrewes and Hurtley (p. 22 of their report) as to the absence of any ill-effects consequent on their remaining for some hours in the most foul of the Hampstead sewers. As the investigations of the Committee had thus far arrived at only negative results, it appeared to us that it was desirable to attack the problem in a different way, and to endeavour to ascertain whether the sewer air contained any gases or organisms which would be likely to cause disease, and also whether a scientific investigation of sewer air would suggest any remedy for the alleged nuisance. The Committee accordingly obtained the sanction of the Council on 20th July, 1905, to their proposal to employ experts to make analyses of sewer air and on the bacteria suspended therein. The Committee's choice of Dr. Andrewes to conduct these investigations, in conjunction with Dr. Hurtley, was made after independent 146 enquiry by the Chairman and by the late Dr. Littlejohn, as to the Scientist best qualified for such work. The month of September was selected by the Committee as the most appropriate time for the investigation, as it was during this month that the largest number of complaints have been received. The report of Drs. Andrewes and Hurtley was received in November, and is in the opinion of your Committee a very valuable contribution both to a right understanding of the question as regards this Borough, and to scientific knowledge generally. Dealing first with the bacteriological portion of the report, it will be observed that Dr. Andrewes in the Parliament Hill experiment (p. 9 of his report) found that the sewer air bacteria were much less numerous than those of fresh air—in this case as 1 to 3. This observation is in entire accord with the views of other scientists such as Haldan and Carnelley, who represented at Dundee, Westminster, and Bristol, and J. P. Laws who worked for the London County Council. It must accordingly be regarded as established that the number of germs in sewer air is very small, and always smaller than in outside air. Having thus dealt with the number of germs, Dr. Andrewes proceeds to consider their nature. There he finds ground in believing that sewer air may be the bearer of microbes derived from sewage (p. 18 of his report) but he considers the evidence is slender and incomplete. With regard to the sewer air as it escapes from the ventilators into the atmosphere—and this is after all the most important practical issue— Dr. Andrewes considers the chance of disease being thus conveyed is almost negligible. The results of Dr. Hurtley's analyses show a very satisfactory diminution in carbonic acid gas as compared with Dr. Tidy's analyses at the time of Mr. Mansergh's report. It will be noticed that Dr. Hurtley attributes this to the increase in the number of ventilating grids. 147 Dr. Hartley's final conclusion is that " there is 110 chemical gas or vapour of a dangerous kind present in appreciable amount" (p. 25 of his report). After a careful review of all the evidence, the number and locality of complaints, and the investigations of Drs. Andrewes and Hurtley, taken in conjunction with the fact that no definite case of illness has ever been traced and recorded as due to sewer ventilating grids in the middle of the road, your Committee has arrived at the conclusion that no connection between the ventilators and disease has been proved, and that it is extremely unlikely that such connection has existed or will in the future exist. On the other hand there can be no doubt that sewer smells are diffused from the grids, and that, though not a nuisance dangerous to health, they are still a nuisance. Your Committee have therefore given much careful consideration as to the means which may usefully be adopted to secure a prevention of the nuisance. Drs. Andrewes and Hurtley remark (p. 26 of their report) that "the problem of sewer ventilation lies in the freest possible admixture of the sewer air with the fresh air outside the sewer," and in this opinion the Committee entirely concur. It has hence been adopted as the principle which must underlie all practical measures in dealing with the problem. The report of the bacteriologist and chemist was referred to the Borough Engineer, and the Committee have had the advantage of receiving a report on the recommendations, and also other reports and statements. It will be noted that, in the opinion of the Borough Engineer and all other observers, the gradient of the sewers is satisfactory, and the flow of the sewage steady and at a good speed. Of the 58 miles of Borough Council sewers, 34½ miles are brick of varving size, and it is from ventilators in these brick sewers, or in pipe sewers immediately in connection with them, that the smells arise. It is improbable that brick sewers of this nature would be constructed at the present time, and there can be no doubt that it is to their existence in 148 Hampstead, as in all other districts in London, that the present problem is due. County Council Sewers. The views of the Borough Engineer (page 8 of his report) as to the condition of the London County Council sewers have obviously an important bearing on the question at issue. It is the opinion of your Committee that the matter should be brought to the notice of the London County Council, and later in this report they submit a recommendation to this effect. Faushing Tanks. With the satisfactory velocity of sewage, sewers may be regarded as self-cleansing, and hence the need for flushing tanks occurs chiefly at the summits of the sewers. In Hampstead the tanks are 40 in direct connection with the water mains, and 45 others supplied by hose from the mains, and in one case from the White Stone Pond. In the opinion of the Committee this number is sufficient, and they therefore do not recommend any increase. Ventilating Shafts. Both in London and the provinces efforts have been made to effect ventilation by means of shafts. It is clear that to maintain an adequate circulation of fresh air it would be necessary, if the grids are to be closed, to provide at least twice as many shafts as there are grids at present in existence. With few exceptions the shafts would have to be carried up the front of houses, and hence the air channel must necessarily be bent at a right angle. Such shafts frequently do not serve the purpose in the slightest degree; the shaft will not, in most cases, ventilate itself; often the air is only oscillating in the shaft. Added to the more than questionable efficiency of such shafts there is the considerable expense involved, together with the great difficulty of obtaining permission from owners to affix them to houses. It may be useful to instance here the proposal, approved by the Council, to erect a shaft at Upper Terrace. When the work was put in hand the surrounding householders protested so strongly that the Works Committee decided not to proceed with the erection. Furthermore, as pointed out by the Town Clerk, such permission may be at any time withdrawn, and necessitate the removal of the 140 shaft. Litigation may be caused by any defect in the shaft, and one case is on record where heavy damages were obtained from a Sanitary Authority, while quite recently a similar case was tried in the High Court. In narrow thoroughfares, where the houses have 110 forecourts, shafts may possibly be of service, but in the opinion of the Committee their use in Hampstead must continue to be the exception and not the rule. Ventilating Grids. It thus appears to the Committee that grids at the surface of the roadway must be continued as the usual and most important means of ventilation, and they have considered at length and in detail the methods which may be adopted to render the emanations inoffensive. Charcoal. Various devices consisting of trays or baskets containing charcoal have been tried in order to absorb offensive gases. The effect of such contrivances is to block the air passage, and as this method has been tried in Hampstead with unsatisfactory results, your Committee are unable to recommend its adoption. Fans. Proposals have been made to utilise fans driven by electricity to cause a down draught in shafts in conjunction with an up-cast ventilating shaft placed in the vicinity. Such methods are undoubtedly in use in mines, but it would appear that in sewers with their numerous openings any effect would be very local, and that the apparatus would hence need to be employed at a great number of points if it were to be of any service. Reeves' Apparatus. Drs. Andrewes and Hurtley make favourable mention of Reeves' Apparatus, and it is also commended by the Borough Engineer. The suggestions made by the latter as to the employment of this invention appear to the Committee as likely to attain the objects desired, viz.:- to induce a down draught at certain points where it is desirable to do so, and further to allow of the introduction of disinfectants when required, in a useful and economical manner. Webb's Lamp. In association with Reeves' Apparatus the Borough Engineer proposes the use of Webb's Lamp as described in his report. 150 It appears to the Committee that this lamp should not only serve as an efficient exhaust, hut that it should destroy the offensive elements in the sewer air by the process of combustion, while the adjoining grids would be rendered effective inlets of fresh air. The necessity of lighting the lamp in the day time appears to the Committee a detail which must necessarily depend on the practical experience of the working and the presence or absence of complaints. Your Committee are, therefore, of opinion that the scheme proposed by the Borough Engineer is well worth a trial, but they are not prepared to recommend that it be adopted as a whole until its working has been tested on a smaller scale. It would seem desirable to select an area of moderate size within which to test the action of Reeves' Apparatus and Webb's Lamps, and it appears to the Committee that a convenient locality for the purpose would be the Hillfield Road, Maygrove Road, District. To make any satisfactory test is would be necessary to erect Webb's Lamps at the spots coloured red and numbered 1, 2, and 3 on the map, and Reeves' Apparatus at the spots coloured blue and numbered 2, 3, 4, 5, and 6. The cost would be as follows: — 3 Webb's Lamps £75 5 Reeves' Apparatus £60 £135 Cleansing of Sewer Walls. It now remains to consider the observations of Drs. Andrewes and Hurtley as to the cleansing of the sewer walls. It must be clearly stated that these investigators were for the purpose of their examinations taken to the most offensive sewers. It would clearly be an error to conclude that the walls of all the sewers are as dirty as those which came under their observation. Your Committee are informed by the Borough Engineer that elsewhere the walls are free from dirt and slime, and could not be the source of disagreeable emanations. It has, however, been stated by other observers that a slime on a sewer wall is an undoubted cause of offensiveness, and the Committee, therefore, consider that where complaints arise in connection with a grid, and the walls of the sewer in its vicinity are found to be dirty, they should be carefully cleansed. 151 Your Committee, therefore, recommend- 1. —That Webb's Lamps be erected at the spots marked in red on the map 1, 2, and 3, and Reeves' Apparatus be provided at the points marked in blue 2, 3, 4, 5, and 6 at a total estimated cost of £135. (Provision for this amount has been made in the estimates of expenditure for the ensuing financial year.) 2. —That the ventilating grids already existing in the Borough be retained, and where necessary be enlarged or the number increased. 3.—That the condition of the Fortune Green Sewer be referred to the Works Committee. 4.—That sewers, the walls of which are found dirty in the neighbourhood of a ventilating grid, be periodically cleansed. 5.—That the attention of the London County Council be directed to the necessity for better ventilation of their sewers in the Borough. 6.—That the writers of letters referred to this Committee be informed that in the opinion of the Council there is no evidence in Hampstead or elsewhere of danger to health due to sewer air arising from ventilators, and that the Council is taking steps to prevent the unpleasant effluvium. (Signed) E. COLLING WOOD ANDREWS, Chairman,