HAMP 13 THE Metropolitan Borough of hampstead REPORT FOR THE YEAR 1906 OF THE Medical Officer of Health. Q. F. McCLEARY B.A. M.D., D.P.H. 3 INDEX. pagb. Accidents, Deaths from 26 Adulteration 90-94 Alcoholism 26 Analyses, Results of 90-94, 101 Analytical Work, Summary of 101 Application for Redrainage 82, 83 Area of Borough 15 Bacteriological Examinations 93 Bakehouses 109, 110 Birth-Rate 16, 17 Births, Illegitimate 19 ,, Number of .. 16,17,18 inWards.. 16,17,18 Cancer 25 Circulatory System, Diseases of 26 Complaints received 97, 98 Continued Fever 64 Customs and Inland Revenue Acts.. 81 Dairies and Milkshops 94, 95 Death-Rate 19, 20 ,, Infantile 30 Death returns 22, 23 Deaths, at various ages 23 ,, Causes of 25 „ in Public Institutions 24 ,, Infantile Death-Rate 30,31 „ Infantile Deaths 29 ,, Number of 19 ,, Outlying 22 ,, Senile Mortality 25 Diarrhoea 68 Diphtheria 60, 61 Disinfection 74 Drainage Work 82-85 Enteric Fever 62,63 Epidemic Diseases, Seven Principal, Deaths from 65 ,, „ Death Rate 65 Erysipelas 63, 64 Factories 113,114 Factory and Workshop Act 105-117 Food Inspection 94 Foodshops, Inspection of 96 Health Visiting 39-48 Homework 112, 113, 116 4 page. Houses let in Lodgings 79 Housing Commitee 7 Housing of the Working Classes Act, 1890 88-90 Ice Cream Shops 95, 96 Infantile Mortality 29-49 Infants, advice as to rearing of 41-47 Infectious Diseases, etc. 53-74 ,, „ Notifiable, Cases occurring 53 ,, ,, „ ,, „ in each Month 55 ,, ,, ,, „ ,, „ Ward 56 ,, ,, „ Deaths from 58 ,, ,, Attack Rate 53 ,, ,, ,, Death Rate 53 ,, ,, Principal Epidemic, Death Rate 65 ,, „ „ Deaths from 65 Insanitary and Uninhabitable Premises 79,80 Inspections and Re-Inspections of Premises 77 Laundries 114, 117 Legal Proceedings 121-128 Local Government Board Tables 131-137 Lower Cross Road Housing Scheme 88-90 Marriage Rates, 1896-1906 16 Marriages, Number of 15 Measles 66, 67 Membranous Croup 60, 61 Milk Shops 94, 95 Mortuary, Public 86,87 Natural Increase of Population 19 Nuisances, Inspection of Outlying Deaths, Returns of 22, 23 Outworkers 112,113,116 Persons per Acre I5 Phthisis, Pulmonalis 68 „ „ Voluntary Notification of 70-73 Population, Density of 15 ,, Estimated to Middle of 1906 15 ,, InWards 15 ,, Natural Increase of 19 Preservatives in Food 92-94 Principal Epidemic Diseases 64-68 Public Health Committee 7 Puerperal Fever 63 Rearing of Infants 41-47 Redrainage Applications 82-85 Registered Houses 79 Respiratory System, Diseases of 26 5 page. Restaurant Kitchens Ill Sale of Food and Drugs Acts 90-94,101 Scarlet Fever 58-60 Schools 85 Senile Mortality 25 Sewers, Condition and Ventilation of 85 Slaughter-houses 97 Small-pox 57 Staff of Public Health Department 8,88 Suicides 26 Summary of Vital Statistics for 1906 13 Tinned Meat 93, 94 Tuberculosis 69 Underground Rooms 81,82 Uninhabitable and Insanitary Premises 79,80 Vaccination 57 Water Supply, Certificates as to 86 Whooping Cough 67 Workshops 106-110 Workplaces 110, 111 6 APPENDIX. TA BLE S. page. Tables I, II, III, IV and V. required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health :— Table I.—Population. Births and Deaths for the whole Borough, from 1896 to 1903, including Deaths of Non-Residents in the Borough, also Deaths in Public Institutions in the Borough, Deaths of Residents registered beyond the Borough. Institutions inside and outside the Borough receiving sick and infirm persons from the Borough 131-133 Table II.—Population, Births registered. Deaths at all ages, and Deaths under one year for each Ward 134 Table III —Cases of Infectious Disease notified, at various ages, and distributed according to Wards 135 Table IV.—Deaths at all ages, from all Causes, and distributed according to Wards 36 Extended Table IV.—Schedule A facing page 136 Table V.—Infantile Deaths, from all Causes 137 Table VI.—Suggested by the Medical Officer of Health, London County Council, giving particulars of Milk premises, Slaughter houses, Ice cream premises, Houses let in Lodgings, Overcrowding, Underground rooms, Insanitary houses, Applications and Certificates under Customs and Inland Revenue Acts. Prosecutions, Proceedings under London County Council (General Powers) Act, 1904, and Mortuary, 1906 138, 139 Table VII.—Population, Birth-Rate, Death-Rate, Infantile Mortality, Notifiable Infectious Diseases Attack and Death-Rates, and seven Principal Epidemic Diseases Death-Rates in the Borough, 1902-1906 140 Tables VII. 1-7.—Ditto, in each Ward 140-143 Table VIII.—Natural Increase of Population, and Notifiable Infectious Diseases Attack-Rate in Hampstead; and Birth-Rate, seven Principal Epidemic Diseases Death-Rate, and General Death-Rate in England and Wales and Hampstead, 1875-1906 144 7 PUBLIC HEALTH COMMITTEE, NOVEMBER, 1905-6. Ex-Officio. His Worship The Mayor. (Sir George Barham). Chairman. Mr. Councillor L. Farmer. Mr. Councillor E. C. Andrews, M.D. C. Hall. „ C. Hendrick. ,, C. Humphrey. „ C. L. Jupp. „ J. P. R. Lyell. „ T. H. Nunn. W. R. Rider. „ J. Stopher. „ J. C. Swinburne-Hanham. „ E. C. Taylor, M.D. HOUSING COMMITTEE, NOVEMBER 1905-6. Ex-Officio. His Worship The Mayor (Sir George Barham) Chairmen. Mr. Councillor J. Stopher (until May). Mr. Councillor J. Chown (Appointed Chairman upon Mr. Stopher's resignation) Mr. Alderman T. G. Randall (until July). Mr. Councillor A. W. Blessley (from Dec.) „ G. Buckle. „ H. Candler. „ C. Hendrick (until July). „ W. J. Hounslow. „ C. Humphrey. „ C. L. Jupp. „ E. E. Lake (until May). „ W. R. Rider. „ C. H. Smith W. J. Spriggs. 8 STAFF OF THE PUBLIC HEALTH DEPARTMENT, 1906. 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 and 7). A. Peverett, No. 3 District (Wards 4 and 5). W. H. Edmonds, No. 4 District (Ward 6). Special Sanitary Inspectors. F. H. Hudson. Mrs. T. Fisher, M.A. t Assistants to Inspectors. G. Rowe. W. Larken. A. J. Brown. Public Mortuary Keeper. W. Larken. Disinfectors. T. H. Rider. G. Allaway. R. Bell. Clerks. W. Sell, First Clerk. F. S. Hill, Second Clerk. P. T. Roberts, Third Clerk. Clerk-Draughtsman. E. J. Cooper. Public Analyst. A. W. Stokes, F.C.S., F.I.C. Medical Officer of Health. G. F. McCleary, B.A., M.D., D.P.H. 9 The Metropolitan Borough of Hampstead. REPORT of the MEDICAL OFFICER OF HEALTH, For the Year 1906. Public Health Department, 7, Belsize Park Gardens, Hampstead, N.W., 30th April, 1907. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Gentlemen, I have the honour to place before you my Annual Report for the year 1906. In the main I have adopted the headings and general form of previous reports, but in view of the interest excited by the questions of infantile mortality at the present time, I have devoted a special section of the Report to that subject. I would take this opportunity of thanking the Staff of the Public Health Department for their excellent work throughout the year. My thanks are also due to the Chairmen and the Members of the Public Health Committee for their cordial support, which I have greatly valued. I have the honour to be, Gentlemen, Your obedient Servant, G. F. McCLEARY, Medical Officer of Health. Vital Statistics. 13 Summary of Vital Statistics for 1906. Population estimated to middle of 1906 89,633 Density 39-8 persons per acre Births 1,437 Birth-Rate 16.0 Marriages 578 Marriage-Rate 12.9 Deaths of " Residents" 850 Death-Rate 9.5 Infantile Mortality 77.2 per 1000 births Notifiable Infectious Diseases Attack-Rate 6.2 Notifiable Infectious Diseases Death Rate 0.25 Death Rate from the Seven Principal Epidemic Diseases 0.55 Population at Census, 1901 81,942 Inhabited Houses 11,294 Area of Borough 2,265 acres „ „ (excluding area covered by water) 2,253 acres 15 POPULATION. The population of Hampstead at the middle of 1906 was estimated by the Registrar-General to be 89,633. The Registrar-General's estimate has been adopted in this report, and it forms the basis upon which the various rates have been calculated. The following is an approximate estimate of the population of the various Wards of the Borough :— Ward 1 (Town) 13,590 „ 2 (Belsize) 14,190 „ 3 (Adelaide) 10,840 „ 4 (Central) 10,123 „ 5 (West End) 13,790 „ 6 (Kilburn) 16,030 „ 7 (Priory) 11,070 The Borough 89,633 The area of the Borough (excluding the area, twelve acres in extent, covered by water), is 2253 acres, and the estimated number of persons to the acre is 39.8. The proportion of persons to the are at the Census, 1901, was 36.17. At the Census ot 1881 the number of persons per acre was 23; and in 1891 it was 30. MARRIAGES. According to the Returns of the Registrar-General, 578 marriages were registered in the Borough during 1906; they were distributed in the four quarters of the year as follows : — 1st quarter 81 2nd „ 147 3rd „ 208 4th „ 142 Total 578 The total number of persons married in Hampstead during 1906 was 1156, which is equivalent to a rate of 12.9 per 1000 of the population, and is a decrease on that for the year 1905, when the marriages of 1204 persons were registered, equivalent to a rate of 13.6 per 1000 of the population. 16 The following Table gives the marriage rate for the years 1896— 1905, and the average rate for the decade:— Year. No. of persons married per 1000 of the population. 1896 13.8 1897 13.2 1898 15.2 1899 14.0 1900 13.4 1901 13.2 1902 15.0 1903 14.0 1904 14.4 1905 13.6 Average for the decade l4.0 1906 12.9 BIRTHS. During the year, 1,437 births were registered, an increase of 16 as compared with the number, 1,421, registered in the previous year. Of the total births, 721 were of male, and 716 of female children. The birth-rate was 16.0 per 1000 of the population, as compared with the rate of 16.1 per 1000 in 1905, and 18.2, the average for the years 1896—1905. The following Table shows the birth-rates in 1906 for England and Wales, the 76 Great Towns, the 142 Smaller Towns, England and Wales less these 218 Towns, London and Hampstead:— Birth rate per 1000 of the population. England and Wales 27.0 76 Great Towns 27.9 142 Smaller Towns 26.5 England and Wales less the 218 Towns 26.3 London 26.6 Hampstead 16.0 17 The Table on page 144, shows 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 shows the Ward and sex-distribution of these 1437 births, and the birth-rate for each Ward :— Ward. Births. Birth rate. Males. Females. Total. No. 1 (Town) 94 111 205 15.1 No. 2 (Belsize) 102 85 187 13.2 No. 3 (Adelaide) 52 45 97 8.9 No. 4 (Central) 43 52 95 9.4 No. 5 (West End) 128 131 259 18.8 No 6 (Kilburn) 225 219 444 27.7 No. 7 (Priory) 77 73 150 13.5 The Borough 721 716 1437 16.0 The following Table gives the number of births occurring during each quarter of the year in each Ward of the Borough, together with their sex-distribution :— 18 BIRTHS REGISTERED, 1906. 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 Boroufh Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Total. Males. Females. Totals. Males. Females. Total. Males. Females. Total. First 23 28 51 28 16 44 14 11 25 11 11 22 28 25 53 55 41 96 19 23 42 178 155 333 Second 18 27 45 21 27 48 13 8 21 10 16 26 37 32 69 57 59 116 20 18 38 176 187 363 Third 28 36 64 23 30 53 12 14 26 9 15 24 32 42 74 64 52 116 18 14 32 186 203 389 Fourth 25 20 45 30 12 42 13 12 25 13 10 23 31 32 63 49 67 116 20 18 38 181 171 352 1906 94 111 205 102 85 187 52 45 97 43 52 95 128 131 259 225 219 444 77 73 150 721 716 1437 19 Illegitimate Births.—Out of the total of 1437 births registered, 34, or 24 per 1000, were those of illegitimate children. The following table shows the Ward and sex-distribution of these illegitimate birth, the births being allocated according to the home addresses of the mothers. Males. Females. Total. Ward 1 (Town) 5 6 11 „ 2 (Belsize) 2 1 3 „ 3 (Adelaide) — 1 1 „ 4 (Central) — 3 3 „ 5 (West End) 2 3 5 „ 6 (Kilburn) 6 2 8 „ 7 (Priory) 3 — 3 The Borough - 18 16 34 The Natural Increase of the population, i.e., the excess of births over deaths, was 587 in 1906, as compared with 598 in 1905. DEATHS. The total deaths occurring in Hampstead during the year amounted to 1104. Of these, however, no less than 364 were of persons not belonging to the Borough, while 110 residents of Hampstead died in outlying districts. The total number of deaths, therefore, amongst persons belonging to Hampstead amounted to 850. Death-Rate. The crude death-rate, that is, the rate calculated upon the total number of deaths (whether of resident or non-resident persons) occurring in the Borough during the year, was 12.3 per 1,000 of the population; but after subtracting from the total deaths registered the deaths of non-resident persons dying in Hampstead, and adding the deaths of Hampstead residents who died outside the district, the recorded death-rate is found to be 9.5 per 1,000 of the population, as compared with the rate of 9.3 per 1,000 of the 20 population in 1905. The average recorded death-rate for the 10 years 1896-1905 was 10.8. This is the second lowest death-rate ever recorded in Hampstead, the lowest being that of 9.3 in 1905. The following table shows the death-rates in 1906, for England and Wales, the 76 Great Towns, the 142 Smaller Towns, England and Wales less these 218 Towns, London, and Hampstead:— The following table shows the death-rates in 1906, for England and Wales, the 76 Great Towns, the 142 Smaller Towns, England and Wales less these 218 Towns, London, and Hampstead:- Death-rate per 1,000 of the population. England and Wales 15.4 76 Great Towns 15.9 142 Smaller Towns 14.5 England and Wales, less the 218 Towns. 15.1 London 15.1 Hampstead 9.5 The following are the death-rates for each of the wards: — WARD. Death-Rate. No. 1 (Town) 9.6 No. 2 (Belsize) 8.9 No. 3 (Adelaide) 8.5 No. 4 (Central) 8.2 No. 5 (West End) 8.3 No. 6 (Kilburn) 12.3 No 7 (Priory) 8.4 In the table on page 144 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, shows the death-rate of Hampstead as compared with the rates of the County of London, the City of London, and the other Metropolitan Boroughs. It will be noted that the death-rate of Hampstead is lower than that of any other district within the County. 21 Table showing the Death-Rates from All Causes in the County ok London, the City of London, and the Metropolitan Boroughs during the 52 Weeks of 1906, as calculated by the Registrar-General. Death rate from all causes. Hampstead 9.4 Stoke Newington 11.5 Lewisham 12.0 Paddington 12.5 Wandsworth 12.8 City of Westminster 12.9 Woolwich 13.1 Hackney 13.3 Battersea 13.4 Greenwich 13.5 Fulham 13.7 Kensington 13.8 Cambcrwell 14.6 Islington 14.7 Hammersmith 14.8 St. Marylebone 14.9 Lambeth 15.0 Chelsea 15.7 St. Pancras 15.9 Deptford 16.1 City of London 17.3 Poplar 17.6 Stepney 17.7 Holborn 18.0 Southwark 18.1 Bethnal Green 18.9 Shoreditch 19.6 Bermondsey 19.7 Finsbury 20.7 County of London 15.1 22 Outlying Deaths. The deaths of patients formerly resident in districts outside London, who have died in Hampstead Institutions, are reported to the Medical Officer of Health of the district to which they belong, immediately upon receipt of the Registrar's weekly return. In the case of deaths belonging to other Metropolitan districts this procedure is not necessary, for the information is circulated by the Registrar-General. Information concerning 78 such deaths has been transmitted to the following extra-metropolitan districts. Acton. Ashford, Middlesex. Andover. Bath. Balham. Barnet. Brighton. Bromley. Bushey. Birmingham. Burnham. Chiswick. Coulsdon. Cambridge. Canning Town. Dartford. East Ham. Enfield. Flitwick. Forest Hill. Farnborough. Folkestone. Glasgow. Guisbury. Hartpury. High Wycombe. Hythe. Hothfield. Hornsey. Hendon. Hitchin. Leeds. Leamington. Leicester. Leytoustone. Margate. Netheravon. Norwich. Ottery St. Mary. Portsea. Pinner. Redbourn. Ripon. Rickmansworth. Ruanhigh Lanes. Shillingstone. Stratford. Tunbridge Wells. West Ham. West Green. Walthamstow. Willesden. Woodford. Wood Green. 23 Information as to the deaths of Hampstead residents was received from the Medical Officers of Health of the following districts, in which the deaths had occurred :— Clacton. Walton-on-the-Naze. Edinburgh. Willesden. St. Albans. The number of deaths of Hampstead residents that occurred in public institutions was 240, or 28.2 per cent, of the total deaths, and the number of deaths occurring in workhouses or workhouse infirmaries was 90, or 10.6 per cent, of the total deaths. A list of the institutions in which the deaths occurred is given on page 24. Deaths at Various Ages. The following table shows the number of deaths at the various age periods, the causes of such deaths being shewn in table IV. and V., pages 136 and 137. Age Periods. Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards At all Ages. Deaths 111 60 23 34 300 322 850 24 Deaths of Hampstead Residents in Public Institutions Institution. Total. Group Total. Infirmaries and Workhouses :— Hampstead Infirmary - 84 Paddington Workhouse 2 St. Marylebone Workhouse 1 90 St. Pancras Workhouse 2 Willesden Workhouse 1 Metropolitan Asylums Board's Hospitals :— North Western Fever Hospital 11 11 General Hospitals :— Brompton Hospital 1 Brook Hospital 1 Cancer Hospital, Chelsea 1 Children's Hospital, Paddington 9 Friedenheim, Upper Avenue Road 4 German Hospital, Dalston 2 Guy's Hospital 1 Hampstead General Hospital 21 Homoeopathic Hospital, Gt. Ormond Street 2 Hospital of St. John and St. Elizabeth, Marylebone 3 Hospital for Women, Soho Square 1 Infants' Hospital, Denning Road 1 King's College Hospital 2 London Temperance Hospital 1 Mount Vernon Hospital 1 Middlesex Hospital 6 98 National Hospital, Queen Square, W.C. 2 New Hospital for Women 1 North-West London Hospital 3 Royal Free Hospital 1 St. Alban's Hospital 1 St. Bartholomew's Hospital 3 St. George's Hospital 2 St. Luke's House, Kensington 3 St. Mary's Hospital 13 St. Monica's Home, Brondesbury 1 St. Peter's Home, Mortimer Road 3 St. Thomas's Hospital 1 Salvation Army Maternity Home, Hackney 1 University College Hospital 4 Westminster Hospital 2 County and other Lunatic Asylums 16 Elsewhere 25 240 The names of the Institutions that are situated in Hampstead are printed in heavy type. 25 Senile Mortality. The deaths of persons of 65 years of age and upwards numbered 322, as compared with 277 in 1905. Of these, 41 attained the age of 85 years and upward. Causes of Death. The causes of death are given in Table IV. of the Local Government Board's series of tables, see page 136, and are set out in more detail in the extended table on the opposite page. The mortality from the various communicable diseases is given in the section of the Report devoted to those diseases. The following causes of death require special mention. Cancer. The following table gives the number of deaths from cancer, and the death-rate.per 1000 population in each of the six years 1901-06. Year. No. of Deaths from Cancer. Death-rate per 1000 population. 1901 77 0.93 1902 91 1.09 1903 105 1.23 1904 85 0.98 1905 73 0.83 1906 93 1.04 The next table gives the anatomical distribution of the disease in each sex. It will be noted that a large proportion of the patients, 65 out of a total of 93 cases, were females. In 44 cases the patients were over 65 years of age. Situation. Males. Females. Totals. Tongue 2 — 2 Oesophagus 2 1 3 Stomach 3 4 7 Liver 5 8 13 Intestines 1 8 9 Pancreas 1 1 2 Rectum 5 5 10 Other abdominal organs, &c. 2 5 7 Lungs and Thorax 3 1 4 Breast — 15 15 Uterus — 7 7 Other situations 4 10 14 Totals 28 65 93 26 Alcoholism. In 4 cases death was certified to be due to Alcoholism, and 10 persons died from Cirrhosis of the Liver, a disease usually attributed to the consumption of alcohol. The total number of deaths recorded as due to alcohol was, therefore, 14, but this is certainly an under statement of the total mortality that may be directly attributed to this drug. Deaths due to alcoholism, especially those occurring in the higher social ranks, are often certified to be due to some less invidious condition. If death certificates, instead of being handed to the patient's relatives, were sent by the certifying practitioner direct to the Registrar, there is little doubt that the recorded mortality from alcoholism and certain other diseases would soon show a marked increase. Diseases of the Circulatory System. These accounted for 134 deaths, as compared with 133 in 1905. Diseases of the Respiratory System. The total mortality from these diseases was 118. 23 deaths occurred in children under five years of age, and 57 in persons from 65 years upwards. Of the total deaths 57 were due to Pneumonia, 47 to Bronchitis, 1 to Pleurisy, and 13 to other diseases of the respiratory organs. Accident. 19 deaths were classified under this heading, as compared with 32 in 1905. 11 were due to falls, 3 to burns or scalds, 3 to suffocation and 2 to other accidents. Suicide. Seven persons committed suicide as against 9 in 1905. In one case the cause of death was poisoning, one death was due to drowning, one to shooting and one to hanging. Infantile Mortality. 29 INFANTILE MORTALITY. The number of deaths under one year was 139, but of these deaths 28 occurred in children not belonging to the Borough. The number of deaths of Hampstead infants was therefore 111, a decrease of 22 as compared with the previous year. 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). Non-distributable. Totals. Diarrhœa, Dysentery 3 1 ... 1 2 4 ... ... 11 Epidemic Enteritis 1 ... ... ... ... 1 ... ... 2 Syphilis ... ... 1 ... ... 1 ... ... 2 Erysipelas ... ... ... ... ... 1 ... ... 1 Tuberculosis of Brain ... 1 ... ... ... 2 ... ... 3 Abdominal Tuberculosis ... ... ... ... ... 1 ... ... 1 General Tuberculosis ... ... ... ... ... 1 ... ... 1 Premature Birth 6 1 2 ... 3 9 3 ... 24 Injury at Birth ... 1 ... ... ... ... ... 3 4 Debility at Birth ... ... 1 ... ... 1 ... ... 2 Atelectasis 1 ... ... ... 1 ... ... ... 2 Congenital Defects 1 1 ... ... ... 1 2 ... 5 Atrophy, Debility, Marasmus 3 1 2 1 3 2 2 ... 14 Dentition ... ... 1 ... ... ... ... ... 1 Rickets ... 1 ... ... ... ... ... ... 1 Convulsions 2 ... ... 1 ... 2 ... 1 6 Meningitis ... ... ... ... 2 2 ... ... 4 Laryngitis ... ... 1 ... ... ... ... ... 1 Acute Bronchitis ... ... ... ... 1 ... ... ... 1 Lobar Pneumonia 1 ... ... ... ... ... ... ... 1 Lobular Pneumonia l ... 1 ... ... 3 ... ... 5 Pneumonia ... ... ... ... 1 3 1 ... 5 Diseases of Stomach ... ... ... ... ... 2 ... ... 2 Enteritis 1 ... 1 ... 1 2 ... ... 5 Other Diseases of Intestine ... ... ... ... ... ... 1 ... 1 Other Diseases of Digestive System 1 ... ... ... ... 1 ... ... 2 Suffocation, Overlaid in Bed ... 1 ... ... ... 1 ... ... 2 Falls not specified ... ... ... ... ... 1 ... ... 1 111 defined and unspecified causes ... ... ... ... ... ... ... 1 1 Totals 21 8 10 3 14 41 9 5 111 30 The "Infantile Mortality," i.e., the number of deaths under one year per 1000 births registered was 77.2. This is considerably below the corresponding figure in 1905, which was 94, and is in fact the lowest infantile mortality ever recorded in Hampstead The following table shows the infantile mortality of Hampstead in each year since 1880:— 1880 - 140 1894 - 113 1881 - 136 1895 - 135 1882 - 99 1896 - 123 1883 - 98 1897 - 127 1884 - 143 1898 - 125 1885 - 110 1899 - 129 1886 - 131 1900 - 100 1887 - 107 1901 - 102 1888 - 110 1902 - 88 1889 - 122 1903 - 87 1890 - 122 1904 - 111 1891 - 104 1905 - 94 1892 - 122 1906 - 77 1893 - 102 The following table shows a comparison of the infantile mortality rates in 1906 for England and Wales, the 76 Great Towns, the 142 Smaller Towns, England and Wales less these 218 Towns, London, and Hampstead:— Deaths of Infants under 1 year per 1,000 births. England and Wales 133 76 Great Towns 145 142 Smaller Towns 138 England and Wales less the 218 Towns 116 London 131 Hampstead 77.2 31 The following are the infantile mortality rates for each of the Wards:— WARD. Deaths of Infants under 1 year per 1,000 births. No, 1 (Town) 102.4 No. 2 (Belsize) 42.8 No. 3 (Adelaide) 103.1 No. 4 (Central) 31.6 No. 5 (West End) 54.1 No. 6 (Kilburn) 92.0 No. 7 (Priory) 60.0 The following table, which is issued by the Registrar-General, shows the infantile mortality in each of the Metropolitan Boroughs and in the County of London. It will be noted that the mortality is very much lower in Hampstead than in any other Borough. 32 Table showing the Infantile Mortality Rates of the County of London, the City of London, and the Metropolitan Boroughs during the 52 Weeks of 1906, as calculated by the Registrar General. Deaths under 1 year to 1000 Births Registered. Hampstead 77 City of London 101 Stoke Newington 102 Paddington 105 Woolwich 109 City of Westminster 110 Lewisham 113 St. Marylebone 117 Hackney 119 Greenwich 119 Holborn 120 Wandsworth 121 St. Pancras 123 Islington 124 Battersea 126 Camberwell 130 Lambeth 131 Kensington 132 Chelsea 133 Fulham 134 Stepney 134 Hammersmith 138 Deptford 143 Southwark 144 Poplar 152 Bermondsey 153 Bethnal Green 155 Finsbury 160 Shoreditch 163 County of London 131 33 If we compare the Hampstead infantile mortality rate in 1906 with the rate in the 76 Great Towns of England and Wales, we again find our Borough honourably distinguished. In only six of these towns was the rate below 100, and only in one town—Winchester— did the figures fall below those of Hampstead. The following table shows the infantile mortality in each of these six towns in 1906. Town. Deaths under 1 year per 1000 Births, 1906 Winchester 74 Richmond 82 Tunbridge Wells 83 Eastbourne 88 Reigate 91 Oxford 97 The following table shows the rate of infantile mortality in Hampstead as compared with that in the whole of London in each quinquennium since 1880, and in the years 1905 and 1906. Years. Deaths under 1 year per 1,000 births. Hampstead. London. 1880-84 123 152 1885-89 112 150 1890-94 116 156 1895-99 128 164 1900-04 99 145 1905 94 129 1906 77 131 It is evident, then, that in the matter of infantile mortality Hampstead compares favourably with other urban districts in London and elsewhere; but in considering the mortality statistics of a large community, it is most important that the figures for the whole district should be supplemented with those for the various sub-divisions of the district, especially when, as in the case of Hampstead, the whole district is made up of parts that vary widely in the social condition of their inhabitants. Since 1902 it has been possible to calculate a separate infantile mortality figure for each of the seven Wards of the Borough, and from the following c 34 table, which shows the average mortality for the five years 1902-1906 inclusive, it is evident that the mortality varies greatly in the different Wards. Ward. Deaths of Infants per 1000 births, 1902-1906. No. 1 (Town) 101 No. 2 (Belsize) 71 No. 3 (Adelaide) 79 No. 4 (Central) 75 No. 5 (West End) 76 No. 6 (Kilburn) 108 No. 7 (Priory) 92 The Borough 91 In considering these figures, it must be borne in mind that the weather in some of these years was favourable to a low infantile mortality, and that a series of hot dry summers would, in the absence of additional remedial action, have given rise to a much heavier loss of life. The preceding table shows that the mortality in the Kilburn, Town and Priory Wards is distinctly higher than in the four other Wards, and that the rate in the Kilburn Ward is the highest of all. If, instead of taking the whole mortality of infants from all causes, we take that from the most directly preventable of the causes of death, namely, diarrhoea, the Wards are placed in much the same order, except that the position of the West End Ward is worse than in the former table. Ward. Deaths from Diarrhœa and Enteritis per 1000 births, 1902-1906. No. 1 (Town) 12.2 No. 2 (Belsize) 2.8 No. 3 (Adelaide) 4.1 No. 4 (Central) 5.9 No. 5 (West End) 9.2 No. 6 (Kilburn) 11.7 No. 7 (Priory) 7.6 35 When a further analysis is made, and the Wards split up into smaller areas, it is found that certain parts of Hampstead have a very high infantile mortality. I have not been able to make a systematic analysis of the whole Borough, but I have extracted the figures for two areas. One of these is the area comprising Netherwood Street, Palmerston Road, Kelson Street, Linstead Street, and Lowfield Road. This area at the Census of 1901 had a population of 3,049 and there is good reason to conclude that this number has undergone little, if any change since. In the five years 1902-1906, the number of births was 588, and the birth-rate per 1000 population was 38.6. The number of deaths at all ages was 285, equivalent to a death-rate of 18.7 per 1000 population. In the same period the number of deaths of children under one year was 82, and the infantile mortality, or proportion of the deaths under one year per 1000 births registered was 139.5. The corresponding figures in the Kilburn Ward, of which this area forms part, and in the whole Borough were 112.7 and 91.3 respectively. The other area is that known as the Kilburn Vale area which comprises the following:— Abbey Lane Munden Cottages Edward Terrace Providence Place Kilburn Vale West End Lane (7 houses in) King's Cottages William Terrace The population of this area was enumerated in a special census taken by the late Medical Officer of Health in 1903, and was found to be 360. From the special report of the late Medical Officer of Health for which this census was taken, it appears that during the five years 1898-1902, the number of births in this area was 46, and the number of infant deaths 10, giving a mortality of 217 per 1000 births. I have ascertained the corresponding figures for the four years 1903-1906. In this period the number of births was 44 and the number of infant deaths 10. This is equivalent to a mortality of 227 per 1000 births. The average annual infantile mortality in the Kilburn Vale area during the nine years 1898-1906 was 222, the total number of births being 90 and the deaths of infants 20. The figures for the Kilburn Vale area are, of course, small, but they are fairly uniform from year to year, and relating as they do to a period of nine years they may be taken as indicating that the conditions c 2 36 giving rise to the terrible waste of infant life which is so generally deplored at the present time are found in a virulent form in at least one area in the healthiest Borough in London. The mortality in the Netherwood Street area is also high, and it is probable that a detailed examination of certain other areas would reveal somewhat similar results. In spite of our comparatively favourable mortality figure last year it is evident that there is still much to be done in Hampstead to protect infant life. Nothing could be more mistaken than to take the vital statistics of a whole district as indications of the vital conditions in any given part of the district; and the fact that the infantile mortality of Hampstead as a whole is comparatively low furnishes an additional reason for increased preventive action in those less favoured portions of the Borough where it is exceptionally high. In considering the preventive measures that appear to be most urgently called for at the present time it will be useful briefly to consider some of the chief conditions giving rise to infantile mortality. These are exceedingly numerous, and it would be impossible to deal with them adequately in one Report. Broadly speaking, they may be arranged under two headings as follows:— (A) Defective hygiene of the environment. (B) Defective hygiene of the person. (A) U nder the former heading are included the conditions that are spoken of collectively as "insanitation." Formerly, the importance of these conditions was over estimated, but at the present time it is in danger of being under estimated. There is now a tendency to regard personal hygiene as the only matter of any consequence in the problem of infantile mortality. Undoubtedly the personal care the infant receives is the chief factor in the problem, but it would be a profound mistake to allow our enthusiasm for the new and attractive work of the promotion of personal hygiene to blind us to the importance of the sanitation of surroundings. In what follows I have given some consideration to certain unwholesome conditions of environment which seem to be of special importance in this connection. The term "insanitation" comprises many conditions, by far the most important of which is dirt. This may be considered under several heads. 37 1. Dirt in the Atmosphere.—The impurities cast into the atmosphere from factory and domestic chimneys shut out a considerable part of the sunlight, and such atmospheric pollution must, therefore, be injurious to young growing organisms. Dr. Shaw, the Director of the Meteorological Office, has estimated that London's 600,000 houses cast into the atmosphere through their chimneys about 300 tons of soot daily. As a result of this gross pollution of the air that Londoners must breathe for want of something better, "London loses one-sixth of its sunshine in summer, and presumably also about the same fraction of its daylight, on account of its smoke, while in winter its loss amounts to one-half." Sir Thiselton Dyer found that after a week of fog in London in 1891 there was on the greenhouses at Kew Gardens a deposit of tarry matter which was equivalent in amount to six tons to the square mile. To the heavy pall of smoke that overhangs our large towns must be attributed some portion of the heavy infantile mortality of those towns. Hampstead compares favourably with most of the London districts in this respect, which, no doubt, in some part accounts for its comparatively low infantile mortality. 2. Dirt in the Streets.—Street cleansing in Hampstead is very efficiently done, but it may be said that as long as street carriageways are paved with macadam, and as long as their gross pollution with unlimited amounts of animal excreta is looked upon as a matter of course, satisfactory street cleansing will be impossible to secure. The paving of street carriage-ways with an impervious substance such as asphalte or tarred macadam, and the exclusion of the horse from London, are sanitary reforms which are much needed at the present time. By employing motor carts for municipal purposes, the Council is encouraging the latter process; and an effective step in the prevention of infantile mortality would be taken if streets such as Kelson Street and Lowfield Road, where the mortality is unusually high, were paved with asphalte or tarred macadam. 3. Dirt round the House.—Unpaved backyards in the poorer districts are nearly always untidy and dirty. Such yards are associated with the prevalence of summer diarrhoea, partly, no doubt, by encouraging the growth of the house-fly, which plays an important part in the causation of summer diarrhœa by ccnveying 38 pollution and infection to milk and other foods. The paving of backyards and forecourts is well known as an important remedial measure, and there is much need for work of this kind in Hampstead. Unfortunately, however, the Council is not at present in a strong position to enforce the paving of backyards and forecourts. The bye-law relating to this subject made by the late Vestry in 1893 under Section 16 of the Public Health (London) Act, 1891, would be useful if it could be enforced, but after some decisions in the High Court a few years ago, it would be unwise to rely upon it. This bye-law is in the following terms:— "The owner of every dwelling house in connection with which there is any yard or open space shall, where it is necessary for the prevention or remedy of insanitary conditions, that all or part of such yard or open space shall be paved, forthwith cause the same to be properly paved with a hard, durable, and impervious pavement, evenly and closely laid upon a sufficient bed of good concrete, and so sloped to a properly constructed channel as effectually to carry off all rain or waste water therefrom, and he shall cause such pavement to be kept in proper repair." The bye-law has been amended by the Council this year (1907) and the proposed new bye-law has been submitted to the Local Government Board for approval. When this approval has been received it will be possible to carry out valuable work in enforcing yard paving in certain parts of the Kilburn Ward, and in other areas where such work is badly needed. 4. Dirt in the House.—It has been found that summer diarrhoea, which must be looked upon as a filth disease, is specially prevalent in dirty houses. It is obvious that it is difficult to prevent the contamination of food in such houses. In most cases a house is dirty because the tenant is dirty, but another factor is the lack of adequate water supply. In many of the tenement houses in Hampstead, the occupiers of the upper tenements are obliged to go down several flights of stairs, sometimes even to the basement to obtain water. After a decision in the Woolwich Police Court some eighteen months ago it was thought that the Sanitary Authority had power to insist on an adequate water supply in tenement houses, but 39 some more recent decisions in the Marylebone Police Court have demonstrated that fresh legislation will be necessary before the matter can be dealt with effectively. The London County Council's General Powers Bill now before Parliament contains provisions which, if passed, will materially strengthen the powers of sanitary authorities to enforce the provision of adequate water supply in tenement houses. Another serious defect in most tenement houses is the fact that no proper provision is made for food storage; but here again without further legislation the Sanitary Authority can take no effective action. The regular, frequent and systematic supervision, and consequent cleansing, of tenement houses under the bye-laws relating to houses let in lodgings is, in my opinion, an important factor in the prevention of infantile mortality. There are in Hampstead some 1000 houses which require such supervision. With the present staff, however, it is impossible to carry out an adequate system of inspection. (B) But although unwholesome surroundings play an important part in the causation of infantile mortality, a much more important factor is defective "mothering." Whether any given infant will survive to attain his first birthday depends above all things on the care and attention that is bestowed upon him. In the poorer districts, infants often do not receive proper care, not, however, because the mother is careless, but because she does not possess the necessary knowledge of infant life or the necessary facilities for infant management. It might be thought that it is not the business of a Sanitary Authority to teach mothers how to look after their children, but, as a matter of fact, all over the country ihe public health work of the municipality has very definitely been extended so as to include not only the hygiene of the environment, but also the hygiene of the person, and the education of mothers in the feeding and general care of infants has become part of the ordinary routine work of the municipal health department. Educational work of this kind is carried out by the distribution of advisory literature and by the domiciliary visitation of lady inspectors and health visitors. Both these methods have been employed in Hampstead for some time. 40 Every week the Registrar supplies me with a list of particulars of the births registered during the previous week, and Mrs. Fisher visits as many of the homes as possible and leaves with the mother a card containing instructions on the feeding and general care of infants, supplementing the printed directions with simple practical advice. Subsequent visits are paid as occasion permits. The English system of birth registration, however, does not tend to facilitate the work of health visiting. Births may legally be registered as long as six weeks after the birth has occurred, and the consequence is that many babies are already dead by the time the birth is registered. The London County Council, as the Supervising Authority under the Midwives Act, has endeavoured to meet this difficulty so far as London is concerned by arranging for the early notification of births attended by midwives. Under this arrangement the midwife notifies the birth within a week of its occurrence to the County Medical Officer of Health, who sends to each Medical Officer of Health in the County a weekly list of the names and addresses of the babies notified in this way. During 1906 the number of births notified in Hampstead under this arrangement was 104. In 1905 Huddersfield obtained statutory powers to compel the notification of births within 48 hours, and in several districts a system of voluntary notification has been adopted. A system of this kind would be of considerable value in Hampstead, especially in the Kilburn Ward. The number of newly-born infants visited by Mrs. Fisher during the year was 386, including 97 notified by midwives through the County Medical Officer of Health. 57 infants were visited before they were a fortnight old, 11 were visited during the second fortnight, 79 during the second month, and 55 after the second month. In addition to these primary visits a large number of subsequent visits were paid where occasion required. Of the 206 infants visited during the first two months, 155 were found to be breast-fed, 25 partly breast-fed, and 26 wholly hand-fed. Of the total 386 infants visited:— 43 infants were members of families living in 1 room. 180 „ „ 2 rooms. 111 „ „ 3 ,, 38 „ „ more than 3 rooms. 41 In 14 cases the number of rooms occupied by the family was not ascertained. At the first visit paid to a house where a birth has occurred a card of printed directions on infant management is given to the mother. The Council has issued two kinds of advisory cards. The first applies to breast-fed babies, and it is this card that is generally distributed. This card is in the following terms:— BOROUGH OF HAMPSTEAD. public health department. Advice on the Rearing op Infants. Mother's milk is by far the best food for babies. Anything else, even the best cow's milk, is but a poor substitute for mother's milk. It is the duty of every healthy mother to suckle her baby. Suckling is good for the mother's health as well as for the child's. Sometimes mother's milk seems not to suit a newly born-baby. In these cases there is often something wrong with the mother's food; perhaps she has been taking pickles, vinegar, or too many green vegetables. The baby should not be weaned, but the mother's diet should be regulated. If mother's milk does not suit the baby, it is very unlikely that any other food will be better. It is most important that the baby should be fed regularly and not too often. Do not give the breast every time the baby cries. During the first two mouths feed the baby every two hours in the day, and every four hours at night. When between two and three months old, the baby should be fed every two-and-a-half hours in the day, and allowed to sleep from 11 at night till 6 in the morning. When three months old, the baby should be fed every three hours in the day, and allowed to sleep from 11 at night till 5 in the morning. If you feed regularly in this way the milk will do more good, and the baby will sleep better. A nursing mother should lead a quiet life, get plenty of sleep, and avoid excitement and worry. Never take stout, beer, or spirits, when suckling; drink plenty of milk instead. Milk puddings, gruel, and cocoa will also help. After each time you feed baby, wash the nipples with warm water and dry them carefully. If you take care of the nipples they will not crack or become sore. 42 The baby should be fed at the breast for at least nine months. A baby under nine months should never be weaned unless weaning is ordered by a docter. If a mother has not enough milk of her own for the baby, she should give some cow's milk as well. The two milks will not disagree. Solid food, such as bread, biscuits, or tops and bottoms, should not be given. Remember that all foods except mother's milk have a tendency to upset the baby's stomach, and should never be given to a baby under nine months old unless advised by a doctor. Wean your baby gradually. Never wean during July, August or September if you can possibly help it. In those months many babies die from summer diarrhoea. A hand-fed baby is fifty times more likely to die from summer diarrhoea than a breast-fed baby. In hot weather the baby may cry because he is thirsty. If it is not time for feeding, give a teaspoonful or two of water which has been boiled and cooled. Never let the baby suck a dummy teat. It may upset the baby's digestion, and cause diarrhoea, besides being harmful in other ways. Never give your baby medicine unless it is ordered by a doctor. clothing. The baby must always be kept warm. The underclothing should be of woollen, or flannel, and it must not be tight. Only one binder is needed. It must be of flannel, not linen, and it must never be tight. In winter, stockings should reach up to the knees; no part of the leg should be bare. The arms should be protected by long sleeves. feesh air. The windows of the bedrooms and living room should always be kept open at the top. The rooms should be thoroughly aired twice a day. The baby should be taken out of doors in the daytime as much as possible when the weather is fine. Babies should not be taken out at night. Never sleep with a baby in your bed. Each child should sleep in a separate cot. Many babies die every year because they have been overlaid in bed by their parents. washing. The baby should be washed all over every day with soap and warm water. G. F. McCLEARY, M.D., Medical Officer of Health. Public Health Department, 7, Belsize Park Gardens, N.W. 43 The card for the hand-fed babies is only distributed in those cases where the baby is already weaned, or is about to be weaned under medical advice. It is desirable that some such precaution should be observed, for it is possible that the indiscriminate distribution of literature that assists mothers to bring up their babies by hand might have a tendency to discourage breast-feeding. The hand-feeding card is as follows:— BOROUGH OF HAMPSTEAD. public health department. Advice on the Rearing of Infants. (These directions are intended for babies who cannot be fed at the breast.) If possible the baby should be fed at the breast for at least nine months. Mother's milk is by far the best food for babies. Anything else, even the best cow's milk, is but a poor substitute for mother's milk. But if you cannot feed your baby at the breast, feed the baby on cow's milk. Never give solid food, such as bread, biscuits, tops and bottoms, or anything but milk until the baby is twelve months old, unless your doctor orders it. The milk should be given in a bottle with a short teat, or in a spoon. On no account whatever should you use the bottle with the long tube. Cow's milk must be prepared with great care, or it will not agree with the baby. Prepare the milk in the following way:— When you receive the milk from the milkman, put it in a very clean jug, and keep it closely covered so as to keep out dust and flies. Place the jug in cold water and store it in the coolest place you have. In summer boil all the milk when you receive it from the milkman, and then cool it before putting it in the jug. Make up each meal in the following way:— For a Baby under Two Weeks old. Milk, 1 table-spoonful; water, 2 table-spoonfuls. Mix and then warm. Give this to the baby every two hours in the day and every four hours at night. For a Baby from a Fortnight to Two Months old. Milk, l½ table-spoonfuls, gradually increasing to 3; water, 8 table-spoonfuls. Mix and warm. Feed as before. 44 For a Baby between Two and Four Months old. Milk, 3 table-spoonfuls, gradually increasing to 4; water, 3 table-spoonfuls, gradually increasing to 4. Mix and warm. Give this every three hours during the day and once at night. For a Baby between Four and Six Months old. Milk, 5 table-spoonfuls, gradually increasing to 8; water, 5 table-spoonfuls, gradually decreasing to 4. Mix and warm. Give this every three hours during the day and once at night. For a Baby between Six and Nine Months old. Milk, 9 table-spoonfuls, gradually increasing to 11; water, 3 table-spoonfuls. Mix and warm. Give this every three hours in the day and once at night. A tea-spoonful of cream, and a tea-spoonful of sugar (a small tea-spoonful of sugar when baby is under two months old) should be put into each meal before warming. All water which you intend to mix with the milk must be boiled first. Each meal should take about fifteen minutes. When the baby is nine months old the milk may be given without anything being added, and the number of table-spoonfuls in each meal may be increased from 14 to 16. The food must be freshly prepared for each meal, and if any of the meal is left it must not be given again to the baby. But it need not be wasted; give it to the older children. Carefully wash the bottle and teat with hot water after each meal. Turn the teat inside out and hold it under the tap, and then keep it in clean water. Keep the bottle, teat, and all the things for holding the milk, cream, and sugar, perfectly clean. In hot weather the baby may sometimes cry because he is thirsty. If it is not time for feeding, give a tea-spoonful or two of water which has been boiled and cooled. Never let the baby suck a dummy teat. It may upset the baby's digestion, and cause diarrhoea, besides being harmful in other ways Unless ordered by a doctor, never give your baby skimmed or separated milk, condensed milk, patent foods, or medicine of any kind. N.B.—These directions are not intended to apply to those babies who are ordered a special diet by a doctor. clothing. The baby must always be kept warm. The underclothing should be of woollen, or flannel, and it must not be tight. Only one binder is needed. It must be of flannel, not linen, and it must never be tight. 45 In winter, stockings should reach up to the knees ; no part of the leg should be bare. The arms should be protected by long sleeves. FRESH AIR. The windows of the bedrooms and living room should always be kept open at the top. The rooms should be thoroughly aired twice a day. The baby should be taken out of doors in the day-time as much as possible when the weather is fine. Babies should not be taken out at night. Never sleep with a baby in your bed. Each child should sleep in a separate cot. Many babies die every year because they have been overlaid in bed by their parents. WASHING. The baby should be washed all over every day with soap and warm water. G. F. McCLEARY, M.D., Medical Officer of Health. Public Health Department, 7, Belsize Park Gardens, N.W. Copies of these cards were sent to all the doctors in Hampstead, many of whom have since been supplied, at their own request, with additional copies for distribution among their own patients. The cards have also been distributed through other agencies. During the year the Hampstead Health Society organised a body of voluntary Health Visitors to co-operate with the Council in the prevention of infantile mortality in the Town and Belsize Wards. It was thought advisable that the visitors before beginning work should attend a course of lectures on infant management, etc. These lectures were given in November and December, and were well attended. The syllabus of this course of lectures is given below. LECTURE I. "Health Visiting." "Breast-Feeding" By The Medical Officer of Health. Aims of the Health Visitor—Methods of work. Scope of the instruction to be given by the Visitors. The nutrition of the infant—Growth. The essentials of infant feeding. Advantages of breast-feeding. Comparison of breast-feeding with other methods of infant feeding. The proper regulation of breast-feeding. 46 LECTURE II. "Artificial Feeding." By Dr. Mina Dobbie. Defects of artificial foods, including milk. Cow's Milk: preparation, dilution, quantities, boiling, pasteurisation, sterilisation. Storage of milk—Bottles—Teats. Condensed milk—Difference between emergency feeding and permanent feeding—Albumen water, raw beef juice, Whey—Barley water—Some patent foods. LECTURE III. " The Clothing and General Management of Infants." By Dr. Lilias Fraser Nash. The skin and its functions—Cleanliness. Objects of clothing—Source of heat. Values of different materials. Dangers of flannelette, how obviated. Special clothing: binder, napkins, undergarments, foot and head clothing, bed clothes. Mail or push cart. Nursing: the room (open fireplace, window), food storage; temperature, vomiting, diarrhoea, rigors. LECTURE IV. " The Health of the Mother." By Dr. E. Claude Taylor. Before the birth of the child: food, activity and rest; surroundings (physical and mental); woman's labour, factories, etc.— What we may learn from the Jews. After the birth: dangers of getting up too early, heavy work, etc. Suckling: advantages to mother as well as to infant; care of the breasts, cleanliness. Food: how best to keep up the supply of milk; danger of reliance on stout or other alcoholic beverages. Rest and recreation. Questions as to other children in the family. Supreme importance to the national life of the Home. 47 LECTURE V. "The Relation between Visitors and Doctors." "Common Diseases of Infancy." By Dr. W. A. Mallam. General signs of ill-health. Diseases of the Digestive System— Thrush, Vomiting, Flatulence, Colic, Constipation, Diarrhœa. Diseases of the Respiratory System— Bronchitis, Pneumonia. Diseases of the Nervous System— Convulsions, Spasm of the Larynx. Common Rashes. Dentition, Rickets, Scurvy, Atrophy, Tuberculosis, Conjunctivitis. Infectious Diseases— Scarlet Fever, Measles, German Measles, Diphtheria, Chicken Pox, Vaccinia, Whooping Cough. LECTURE VI. "Relief Agencies." By Me. T. Hancock Nunn. The general qualifications of a Visitor— Care of the Poor. Knowledge of conditions. Knowledge of agencies. Training. Co-operation. The need of a working ideal. The principles of Personal Charity. The principles of Co-operation. Preventive Co-operation. Remedial Co-operation. The Visitors began work early in the present year. Their work is done under the supervision of the Medical Officer of Health, to whom they report periodically, and no doubt when it is more developed it will be productive of much good. But voluntary health visitors, valuable as their work is, cannot take the place of trained and experienced health officers. Hampstead is fortunate in having in Mrs. Fisher a health visitor of exceptional ability and attainments. 48 She has worked with a devotion of which it is difficult to speak too highly, and to her efforts must be attributed much of the gratifying fall in our infantile mortality figures in 1906. Mrs. Fisher, however, can give but a comparatively small part of her time to this work, she has many other duties to carry out, and there is much need of an additional lady inspector to develop the work of health visiting that has lately been begun with so much promise in Hampstead. One more point remains to be considered. In the prevention of infantile mortality difficulties are met with that health visiting, valuable as it is, can do little to remove. In all large centres of population there are many young infants for whom breast-feeding is impossible. This is a fact that must be faced as well as deplored. It is this residuum of hand-fed babies that gives rise to most of the more pressing problems of infantile mortality. All methods of hand-feeding young infants are deplorable, but some are better than others, and one of the most important functions of the health visitor is to instruct mothers in the less harmful methods. But it is one thing to know how to feed a baby artificially, and quite another thing to be able to do it. The proper modification and preparation of cow's milk for the consumption of young infants can only be done by observing certain conditions that are often difficult enough to fulfil even in the small family of the well-to-do household. In the large family of the over-worked housewife in the overcrowded homes of the poor, the difficulties of hand-feeding are great, and any measures that tend to remove those difficulties deserve careful consideration. It is well to emphasise this point, for in some recent popular discussions on this subject much has been said about the ignorance and short-comings of the working-class mother, and very little about the difficulties against which she has to contend. In the movement for the prevention of infantile mortality that is now developing in this country, increasing attention is being given to the methods employed in France, where the welfare of infant life is studied with an interest and enthusiasm that contrast favourably with the comparative apathy that still prevails in this country. One of the most popular of the French institutions for the prevention of infantile mortality is the Goutte de Lait, which, under the name of "Infants' Milk Depot," was introduced into England in 1899 by. the St. Helens Corporation. The work of these 49 institutions has been much misunderstood. The Infants' Milk Depot is not a milk shop. It supplies not ordinary milk, but milk specially prepared under medical supervision for the consumption of infants. The milk is supplied in separate bottles, each bottle containing sufficient for one meal and no more. By this method not only is the labour of the mother reduced to a minimum, and with it the opportunities for making mistakes, but the danger of the home contamination of food, which Dr. Newsholme has shown to be the chief factor in the causation of summer diarrhœa, is also greatly reduced. But the work of the Infants' Milk Depot is far from being restricted to the distribution of specially-prepared milk. The milk is only supplied to those mothers who can give good reasons for their discontinuing to nurse the baby; and by advising applicants for the milk it is possible, as I can testify from my own experience, to persuade many mothers to continue nursing who would otherwise have prematurely weaned their babies. A careful record is kept of each child, for whose varying needs the milk is modified as occasion requires. The homes of the babies fed upon the milk are visited by health visitors, who explain the proper use of the milk, and the mothers are encouraged to bring the babies periodically to the depot to be weighed. The Milk Depot represents something far more than a mere unregulated outburst of "municipal trading." It is really, as Professor Marshall has pointed out in the current number of the Economic Journal, a valuable educational influence. It does things that a milk company does not do. And in considering the question of "unfair competition" it must be borne in mind that many of the children who are brought to the Depot have not been, and but for the Depot, would not be, fed upon cow's milk at all. Everyone who has worked amongst the poor knows that large numbers of hand-fed babies are fed not upon cow's milk but upon worthless patent foods and cheap brands of condensed milk. My own experience has convinced me that the Infants' Milk Depot is of great value from a public health point of view, and I have no doubt that the establishment of a Milk Depot in the Kilburn Ward would greatly tend to prevent the waste of infant life that now goes on in that part of our Borough. D Infectious Diseases, &c. D 2 53 NOTIFIABLE INFECTIOUS DISEASES. The total cases of infectious diseases notified numbered 557. This is equivalent to an attack-rate of 6.2 per 1,000 of the population. The following shows the number of cases of each disease notified:— Scarlet Fever 385 Enteric Fever 20 Diphtheria and Membranous Croup 97 Puerperal Fever 2 Erysipelas 52 Continued Fever 1 The number of fatal cases was 22, equal to 3.9 per cent, of the cases notified. The deaths were distributed as follows:— DISEASE. WARDS. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central.) No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). TOTALS. Scarlet Fever 2 1 1 1 5 Enteric Fever 1 1 1 3 Diphtheria and Membranous Croup 2 3 3 1 1 10 Puerperal Fever 1 1 Erysipelas 1 2 3 Totals 6 4 5 5 2 22 The death rate from the notifiable infectious diseases was, therefore, 0.25 per 1,000 of the population. The following table shows the attack and death rates from Smallpox, Diphtheria and Membranous Croup, Erysipelas, Scarlet Fever and Enteric Fever, for the period 1891-1906:— TABLE shewing the attack rate and death-rate for the Borough from Smallpox, Diphtheria and Membranous Croup, Scarlet Fever, and Enteric Fever, during the year 1891-1906. 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. 1891 0.03 — 1.27 0.19 0.64 0.04 2.32 0.01 0.49 0.01 1892 0.01 — 1.92 0.38 0.73 0.04 4.51 0.07 0.69 0.03 1893 0.17 003 2.18 0.52 1.03 0.03 7.05 0.28 0.51 0.11 1894 0.23 0.04 1.31 0.27 0.91 0.03 3.15 0.14 0.67 0.07 1895 0.03 — 1.51 0.19 0.71 0.05 4.14 0.11 0.83 0.12 1896 — — 2.48 0.38 0.67 0.01 3.82 0.09 0.72 0.09 1897 — — 1.27 0.22 0.47 0.08 2.86 0.06 0.42 0.06 1898 — — 1.62 0.24 0.51 0.05 2.95 0.04 0.61 0.12 1899 — — 1.31 0.19 0.63 — 3.52 0.07 0.51 0.05 1900 — — 1.88 0.37 0.60 0.01 2.72 0.05 0.60 0.11 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 54 Cases of Infectious Disease occurring in each Monte during 1906. January. February. March. April. May. June. July. August. September. October. November. December. Totals. Diphtheria and Membranous Croup 8 1 8 4 6 2 8 7 10 15 15 13 97 Erysipelas 4 ... 3 3 10 3 5 3 5 7 6 3 52 Scarlet Fever 17 14 14 34 40 25 72 27 30 38 35 39 385 Typhoid and Enteric Fever ... ... ... 2 2 3 ... 2 ... 2 2 3 20 Puerperal Fever ... ... ... ... 1 ... ... ... ... 1 ... ... 2 Continued Fever ... ... ... ... ... ... ... ... ... 1 ... ... 1 Totals 29 15 25 43 59 33 85 39 49 64 58 58 557 55 Cases of Infectious Disease occurring in each Ward during 1906. Diseases. No. 1 (Town) No. 2 (Belsize) No. 3 (Adelaide) No. 4 (Central) No. 5 (West End) No. 0 (Kilburn) No. 7 (Priory) Totals. Diphtheria and Membranous Croup 11 15 6 3 34 16 12 97 Erysipelas 16 7 2 5 3 17 2 52 Scarlet Fever 78 30 16 24 130 92 15 385 Typhoid and Enteric Fever .. 8 5 1 1 3 2 20 Puerperal Fever 2 ... ... ... ... ... ... 2 Continued Fever ... ... ... 1 ... ... ... 1 Totals 107 60 29 34 168 128 31 557 56 57 Smallpox No case of this disease was notified during the year. Vaccination. The table below gives some idea of the working of the Vaccination Act in Hainpstead since 1900. I am indebted to the Vaccination Officer for the statistics in this table. Vaccination Statistics. Percentage of Births Registered. Unvaccinated. 13 (Cols. 6, 8, & 9) 11.0 10.0 9.2 9.5 9.2 9.2 Not finally accounted for (including cases postponed). 12 (Cols. 8 & 9) 8.7 7.4 7.4 7.4 6.8 6.4 ... Exempted by "Conscientious Objection" Certificates. 11 (Col. 6) 2.3 2.6 1.8 2.1 2.4 2.8 ... Successfully Vaccinated. 10 (Col. 3) 81.5 81.7 82.7 82.0 82.8 83.1 •• Remaining. 9 131 104 102 96 90 77 347* Vaccination Postponed. 8 11 7 11 11 8 14 31 Died Unvaccinated. 7 108 111 104 106 100 91 81 Number in respect of whom Certificates of "Conscientious Objection" has been received. 6 37 39 27 30 35 40 30 Had Smallpox. 5 ... ... ... ... ... ... ... Insusceptible of Vaccination. 4 13 15 18 19 16 18 9 Successfully Vaccinated. 3 1323 1232 1255 1190 1197 1181 940 Births. 2 1623 1508 1517 1452 1446 1421 1438 Year. 1 1900 1901 1902 1903 1904 1905 1906 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 299 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. 58 Scarlet Fever. The number of cases of Scarlet Fever notified in each of the last six years is set out below. Year. No. of Cases Notified. 1901 214 1902 251 1903 165 1904 159 1905 170 1906 385 In 1906 Scarlet Fever was unusually prevalent not only in Hampstead but generally throughout London. The disease, however, was exceptionally mild; although the number of cases notified in 1906 was more than double the number in 1905, the fatal cases were less. The deaths from Scarlet Fever in 1906 were 5 only, as compared with 6 in the previous year. The number of cases and the number of deaths per 1000 of the population were 4.30 and 0.06 respectively, and the case mortality, or percentage of deaths to cases, was 1.3. The corresponding figures in 1905 were 1.93, 0.07, and 3.8 respectively. It is evident, therefore, that in 1906 the disease was more prevalent but less fatal than in 1905. Of the cases notified, 334, or 87 per cent., were removed to hospital. The corresponding percentage in 1905 was 78. The sanitary condition of every house in which a case of Scarlet Fever occurred was thoroughly investigated, and the following defects were discovered:— Drains defective 75 Soil pipes defective 48 Water supplies defective 57 Other defects 108 The following table shows the number of cases occurring each month in the various Wards:— 59 Month. 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. January 3 3 1 1 2 6 1 17 February 2 4 2 — 1 5 — 14 March — 1 2 1 3 6 1 14 April 7 8 1 1 7 7 3 34 May 10 6 — 3 8 13 — 40 June 9 — 1 — 6 8 1 25 July 21 2 — 2 40 7 — 72 August 9 1 — 2 10 4 1 27 September 8 — — 4 6 10 2 30 October 4 4 1 4 10 12 3 38 November 3 1 3 4 15 7 2 35 December 2 — 5 2 22 7 1 39 Totals 78 30 16 24 130 92 15 385 The disease was most prevalent in West Hampstead, and the chief incidence was upon the children attending Broomsleigh Street School. During the latter half of the year it was found necessary to close and disinfect several class-rooms in this school, and the whole of the school was thoroughly disinfected during the summer holidays and again in the Christmas holidays. The disease was undoubtedly spread by unrecognised or "missed" cases. In a considerable number of instances the patient was so mildly attacked that the parents, not knowing the nature of the illness, did not think there was sufficient reason to seek medical advice, and, after a few days' absence, sent the child to school as if nothing out of the common had happened. One child was found in class to be in the early desquamating stage of Scarlet Fever and was promptly sent 60 home, where I found a brother to be suffering from the disease, and two days later two other members of the family were attacked. The teachers kindly supplied me from time to time with lists of children absent from school suffering from "sore throat," or from some other suspicious illness. I visited the homes of such children, and where no doctor was in attendance I examined the patient. In this way and by making other enquiries I was able to discover no less than nine cases of Scarlet Fever. In none of these cases had a doctor been called in, nor had any attempt been made to isolate the patient. In some of the cases the patient had been attending school while in an infectious condition. These cases illustrate the difficulties met with in dealing with infectious diseases, and they help to explain the comparative ineffectiveness of our present methods for the control of such diseases by isolation and disinfection. For the success of these methods it is necessary that the sanitary authority should be made aware of the existence of practically all the cases of the disease it is endeavouring to control as such cases arise. For this purpose compulsory notification was instituted, but it has now been abundantly proved that compulsory notification of identified cases, though useful, is not an adequate safeguard. In addition we require some method of discovering those patients who at present do not come under medical observation. In the outbreak of Scarlet Fever at West Hampstead I received very valuable assistance from the teachers of the school chiefly affected, and there is no doubt that in the prevention of communicable disease much could be done by a more intimate co-operation between the education and sanitary authorities. The prompt notification by teachers or school attendance officers of all cases of illness among school children, and the examination of all those patients so notified who were not already medically attended are measures that would lead to the discovery of many cases which now escape observation and consequently spread disease. The general adoption of such a scheme would greatly increase the work of the Health Department, but such an increase is inevitable if we wish to exercise a really effective control over the spread of communicable disease. Diphtheria and Membranous Croup. The number of cases notified in 1906 was 97 as compared with 63 in 1905, the attack-rate or number of cases notified per 1,000 61 population being T08. The number of fatal cases was 10, or 10'3 per cent, of the cases notified. The death-rate per 1000 population was 0.12; 65 patients, or 67 per cent, of the total cases notified, were removed to hospital. A thorough examination was made of the sanitary condition of every house in which a case of diphtheria occurred, and the following defects were discovered:— Drains defective 26 Soilpipesdefective 8 Water supply defective 7 Other defects 27 The following table shows the number of cases occurring each month in the various wards:— Month. 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. January 1 3 — — 1 1 2 8 February — — — — — — 1 1 March 1 — 1 1 2 2 1 8 April — — — — 2 1 1 4 May 1 2 1 — 1 1 — 6 June — 1 — — — 1 — 2 July 1 2 — — 3 2 — 8 August 1 2 — — — 1 3 7 September 2 1 1 1 3 2 — 10 October 2 2 3 1 6 — 1 15 November 1 1 — — 8 3 2 15 December 1 1 — — 8 2 1 13 Totals 11 15 6 3 34 16 12 97 62 Enteric Fever. The number of cases notified was 20 as compared with 17 in 1905 and 26 in 1904. The attack rate per 1000 population was 0.22. The number of fatal cases was 3, or 15 per cent, of the cases notified. The death-rate per 1000 population was 0.03; 12 patients, or 60 per cent, of the total cases notified, were removed to hospital. The sanitary condition of each house in which a case of Enteric Fever occurred was investigated and the following defects were discovered:— Drains defective 4 Soil pipes defective 3 Water supply defective 3 Other defects 7 The following table shows the number of cases occurring each month in the various wards: Month. 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. January — — — — — — — — February — — — — — — — — March — — — — — — — — April — 1 1 — — — — 2 May — 1 1 — — — — 2 June — 1 1 — — 1 — 3 July — — — — — — — — August — 1 1 — — — — 2 September — 3 — — 1 — — 4 October — — 1 — — — 1 2 November — — — 1 — — 1 2 December — 1 — — — 2 — 3 Totals — 8 5 1 1 3 2 20 63 A careful inquiry was made as to the source of infection in each case. In 9 instances it was found that the patient had been infected outside Hampstead. Two of these patients contracted the disease in America, two in Germany, and five in various places in England outside London. One of the latter patients infected a relative in Hampstead, and another patient, not included in the above groups, was probably infected at a dinner in the City. In the remaining nine instances the source of infection could not be definitely traced. Puerperal Fever. Two cases were notified, 1 of which proved fatal, as compared with 2 cases in 1905. Both of these cases occurred in Ward 1. Erysipelas. 52 cases were notified, and 3 deaths occurred, as compared with 42 cases and 3 deaths in 1905. The case mortality was 5.8 per cent. The attack rate per 1000 of the population was 0.58 and the death rate 0.03 Of the cases notified, 9 or 17 per cent., were removed to hospital. Seven patients were removed to the Hampstead Workhouse Infirmary. In each case an examination was made of the sanitary condition of the house, and in 20 instances defects of various kinds were discovered. 64 Cases of Erysipelas occurring in each Month and Ward during 1906. Month. 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 January 1 1 — 1 — 1 — 4 February — — — — — — — — March 2 — — — — 1 — 3 April 1 — 1 — 1 — — 3 May 5 2 — 2 — — 1 10 June 1 1 — — — 1 — 3 July 1 1 — — 2 1 — 5 August — — — — — 3 — 3 September — — 1 1 — 2 1 5 October 3 2 — — — 2 — 7 November 2 — — — — 4 — 6 December — — — 1 — 2 — 3 Totals 16 7 2 5 3 17 2 52 Continued Fever One case was notified during 1906 in October, from the Central Ward. 65 SEVEN PRINCIPAL EPIDEMIC DISEASES. The total number of deaths from these diseases amounted to 49, and were distributed as follows:— WARDS. Totals DISEASE. No. 1 (Town) No. 2 (Belsize) No. 3 (Adelaide) No. 4 (Central) No. 5 (West End) No. 6 (Kilburn) No. 7 (Priory) Small-pox — — — — — — — — Measles 2 — 1 — — 5 2 10 Scarlet Fever 2 — — — 1 1 1 5 Diphtheria and Membranous Croup 2 3 — — 3 1 1 10 Whooping Cough — 1 — — — 1 — 2 Fever — 1 — — 1 1 — 3 Diarrhœa 5 2 — 1 4 7 — 19 Totals 11 7 1 1 9 16 4 49 The death rate from the seven principal epidemic diseases was, therefore, 055 per 1000 of the population. In the following table a comparison is given of the annual death rates from these diseases in Hampstead, England and Wales, the 76 Great Towns, the 142 Smaller Towns, and England and Wales less these 218 Towns, during 1906:— 7 Principal Epidemic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhœa. England and Wales 1.73 0.00 0.27 0.10 0.17 0.23 0.09 0.87 76 Great Towns 2.24 0.00 0.40 0.12 0.19 0.28 0.09 1.16 142 Smaller Towns 1.71 — 0.22 0.09 0.17 0.20 0.09 0.94 England and Wales less the 218 Towns 1.18 0.00 0.14 0.08 0.16 0.19 0.09 0.52 Hampstead 0.55 —- 0.11 0.06 0.12 0.02 0.03 0.21 E 66 Detailed information concerning Small-pox, Scarlet Fever, Diphtheria, and Fever will be found under the heading of Notifiable Infectious Diseases on pages 57-63, but particulars concerning Measles, Whooping Cough, and Diarrhoea, to which notification does not apply, are given here. Year. Seven Principal Epidemic Diseases. Death rate per 1000 of the population. Measles. Death rate per 1000 of the population. Whooping Cough. Death rate per 1000 of the population. Diarrhoea. Death rate per 1000 of the population. 1901 0.77 0.12 0.29 0.04 1902 0.69 0.17 0.11 0.04 1903 0.49 0.09 0.18 0.05 1904 0.55 0.17 0.09 0.15 1905 0.43 0.09 0.11 0.02 1906 0.55 0.11 0.02 0.21 Measles. Ten deaths were recorded from this disease, as compared with 8 in 1905. The mortality was 0.11 per 1000 population. Measles is now included amongst the dangerous infectious diseases to which Sections 60-65, 68-70. and 72-74 of the Public Health (London) Act, 1891, apply. These sections extend the provisions relating to isolation and disinfection to measles, but they do not make the disease compulsorily notifiable. During the year 1906, 333 cases were brought to the knowledge of the Department, as compared with 376 in 1905. The sources of information were as follows:— Cases notified by medical practitioners 11 „ parents or guardians 87 „ school teachers 218 „ employers and others 8 „ M.A.B. when removing cases 5 Death Returns 4 333 67 In 52 cases it was found, on enquiry, that no doctor was in attendance. These 333 cases occurred in 221 houses:— In 139 houses there was 1 case in each house. In 59 „ „ were 2 cases „ In 17 ,, ,, ,, 3 ,, ,, In 5 ,, ,, ,, 4 „ ,, In 1 house „ „ 5 „ ,, Cases of Measles occurring in each Month and Ward during 1906. Month. 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 (Prioty) Totals. January 3 12 2 5 2 2 — 26 February — 1 1 — 1 15 8 26 March 2 — — — 3 4 6 15 April 2 5 — 4 — 30 3 44 May 5 5 10 28 1 16 11 76 June 41 1 — 3 2 6 5 58 July 58 3 — — — — — 61 August 1 — — — — — — 1 September 7 — — — — — — 7 October 8 — 1 — — — — 9 November 1 — — — — — — 1 December 1 2 4 2 — — — 9 Totals 129 29 18 42 9 73 33 333 Whooping Cough. There were 2 deaths from this disease in 1906, as compared with 17 in 1905. The mortality per 1000 population was 0.02. e 2 68 Diarrhœa. The number of deaths from this cause was 19, as compared with 2 in 1905. The death rate per 1000 of the population from this disease was 0.21. In the following table these deaths are arranged in months and Wards:— Month. 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. January — — — — — — — — February — — — — — — — — March — — — — — — — — April — — — — — — — — May 1 — — — — — — 1 June — — — — 1 — — 1 July — — — 1 — — 1 August — — — — 1 — — 1 September 3 2 — — 1 7 — 13 October — — — 1 — — — 1 November 1 — — — — — — 1 December — — — — — — — — Totals 5 2 — 1 4 7 — 19 Of these deaths 13 occurred among children under one year of age, and of the remainder, 4 were of children whose ages were registered as 1 year. 69 TUBERCULOSIS. The number of deaths from Tuberculosis in 1906 was 79. Of these, 57 deaths were due to pulmonary tuberculosis or phthisis, 9 to tubercular meningitis, 4 to intestinal tuberculosis, and 9 to other forms of the disease. The following table shows the number of deaths and the deathrates from tuberculosis, and from phthisis respectively since 1899. Year. Total deaths from Tuberculosis. Death rate per 1000 population. Phthisis deaths. Death rate per 1000 population. 1899 98 1.21 81 0.98 1900 92 1.13 69 0.85 1901 118 1.43 73 0.88 1902 97 1.16 73 0.87 1903 90 1.06 66 0.77 1904 102 1.18 73 0.84 1905 95 1.08 73 0.83 1906 79 0.88 57 0.64 The deaths from phthisis were distributed among the Wards as follows:— 1906. Ward. Area (Acres). Estimated Population middle of 1906. Phthisis Deaths. Phthisis Death Rate per 1000 of the Population. No. 1 (Town) - 686 13590 5 0.37 „ 2 (Belsize) - 271 14190 13 0.92 „ 3 (Adelaide) 325 10840 5 0.46 „ 4 (Central) - 312 10123 2 0.20 „ 5(WestEnd) 247 13790 8 0.58 „ 6 (Kilburn) - 195 16030 15 0.94 „ 7 (Priory) - 229 11070 8 0.72 The Borough - 2265 89633 *57 0.64 *One death from phthisis was non-distributable. 70 The following table shows the age distribution of the patients dying from consumption in Hampstead in the four years 1903, 1904, 1905, and 1906. 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 1906 1 — 8 45 3 57 Totals - 3 2 49 201 14 269 In 1902 a system of voluntary notification of Phthisis came into operation in Hampstead. The following table gives the number of patients notified in each year since 1902:— Year. No. of patients notified. 1902 51 1903 34 1904 39 1905 27 1906 35 Four of the notification certificates received during 1906 related to patients who had already been notified; the number of new cases notified was, therefore, 35, and of these 18 were males and 17 females. The notifications received were from the following sources:— Patients notified by the Poor Law Medical Officers - 12 Patients notified from the Hainpstead General Hospital 3 Patients notified from the Mount Vernon Hospital Out Patient department 8 Patients notified by private practitioners 12 Seven of the patients notified died during the year. In four cases death occurred within a month from the date of notification. 71 The homes of the patients notified are visited by Mrs. Fisher, who leaves a card of instructions as to the prevention of consumption, supplementing the printed directions with oral advice. This card is as follows:— BOROUGH OF HAMPSTEAD. public health department. Precautions Against Consumption. Consumption is an infectious disease. It is caused by a germ called the tubercle bacillus,which grows in the lungs of a consumptive patient in enormous numbers, and the sputum (spit) coughed up by the patient contains a great many of these germs. When this sputum is allowed to dry it may become powdered into a fine dust and be blown about in the air. Any persons breathing this air may take the germs into their lungs, and after a time become consumptive. This is how Consumption is spread from one person to another. A consumptive patient who does not take care to destroy his sputum before it becomes dry is a source of danger to other people and to himself, for he may re-infect himself by breathing his own dried sputum. A consumptive patient should on no account spit on the floor of any room, workshop, theatre, or other place where people assemble; or on the floor of any railway carriage, tram-car, or other public conveyance; or on a street pavement. Nor should the patient spit into an ordinary pocket handkerchief. The sputum soon dries in the pocket, and when the handkerchief is next used a cloud of infective dust may be scattered around the patient. At home the patient should spit into a piece of paper or clean rag, which should be at once burnt on the fire. If there is no fire the patient should spit into a jar, pocket spittoon or other vessel containing water or some fluid disinfectant to keep the sputum moist. The vessel should be emptied twice a day down the watercloset, and then thoroughly cleansed with boiling water before being again used. Outside the house the patient should spit into a pocket spittoon, which should contain a little water or fluid disinfectant, and should be kept perfectly clean. Or the patient may carry a number of pieces of soft paper, or clean rags to spit into. These after being used should never be carried loose in the pocket, but in a tobacco 72 pouch, sponge bag, or other waterproof receptacle. On returning home the paper or rags should be burnt, and the pouch or bag well washed with disinfectant. All persons who have a chronic cough should carry out the above precautions. The knives, forks, spoons,-plates, cups, &c., used by a consumptive patient should be put into boiling water immediately after use, and should never be used by another person. The patient's night-clothes, sheets, pillow-slips, &c., should not be mixed with the general washing of the family, nor sent to a public laundry, but should be boiled and then washed by themselves at home. A consumptive patient should, if possible, occupy a separate bedroom, or at least a separate bed. The rooms should have plenty of sunlight and be kept well ventilated and well lighted. The windows should always be open. Fresh air and sunlight will not only help the patient to recover, but will also help to prevent the other members of the family from becoming consumptive. Carpets, curtains and upholstery should not be used in a consumptive's room. If already in use they should be removed and disinfected. If the patient's clothes, pillows or bedclothes become soiled with sputum they should be at once disinfected by steam or washed with boiling water. The floor of a consumptive's room should be thoroughly washed with soap and water at least once a week and should always be kept free from dust. The floor should not be swept unless tealeaves moistened with disinfectant have first been scattered over it to prevent the dust from rising. The best way to remove the dust is to wipe the floor with a wet cloth. The articles of furniture, &c., in the room should be dusted with a damp duster. Dry dusting and sweeping may scatter infectious dust about the room and thus be a source of danger to the patient and to other persons. Every three months the walls should be rubbed down with dough which should then be burnt. Consumptives should not kiss on the lips. A male consumptive should not wear beard or moustache, but should be clean shaved. When it has been decided that anyone is suffering from Consumption the house should be thoroughly disinfected. On a request made in writing to the Health Department, disinfection will be carried out free of charge. Consumption was formerly thought to be an incurable disease. This is a great mistake. Recovery from consumption is not at all 73 uncommon. It depends largely upon the careful observance of the rules on this card. Other important points are:— Plenty of nourishing food. Abstinence from alcohol unless it is ordered by a doctor. What is good for the cure of Consumption is good for the prevention of Consumption. People who keep their windows open and their houses and bodies scrupulously clean, and abstain from the excessive use of beer, wine, or spirits are doing a good deal to keep away Consumption. G. F. McCLEARY, M.D., Medical Officer of Health Public Health Department, 7, Belsize Park Gardens, N.W. Disinfection of rooms and bedding was carried out at the homes of 25 of the patients notified, and in 3 instances the disinfection was repeated during the year. Disinfection is offered after the death of a phthisical patient whether the patient has been notified or not. The total number of premises disinfected during the year was 78. Much good work is done in Hampstead in relation to Phthisis by a joint Committee of the Hampstead Health Society and the Charity Organization Society. This Phthisis Committee, which works in co-operation with the Health Department, investigates cases of the disease and supervises and assists, not only the patients, but also their families. Patients are helped in various ways; sanatorium treatment is provided in some cases, and where this is impracticable the patient may be furnished with out-patient letters for the Consumption Hospital. Efforts are made to obtain suitable work for those patients who are able to work, and where necessary, assistance is given to the patient's family. The work of this Committee is of great value in the prevention of consumption in Hampstead. 74 III. Disinfection. Number of articles disinfected:— Beds 463 Mattresses 734 Palliasses 13 Bolsters 624 Pillows 1984 Blankets 2289 Sheets 1453 Counterpanes 894 Articles of Clothing 4976 Carpets 157 Linen articles 4055 Books 167 Miscellaneous 3565 Total 21374 Number of premises disinfected - 963 „ rooms, etc., disinfected - 1348 The Number of Premises disinfected during 1905 was 608, and the Number of Articles 12189. In addition to the foregoing, the following were destroyed upon request of the owners:— Beds 4 Mattresses 8 Bolster 1 Pillows 3 Sheet 1 Articles of Clothing 5 Linen Articles 2 Miscellaneous 6 Total 30 General Sanitary Administration. 77 The following is a tabulated statement of the sanitary work, etc., carried out during the year, so far as that work admits of tabulation:— Sanitary Works Carried Out. 1906 Houses or parts of houses cleansed 355 Dampness in houses or parts of houses abated 54 Dilapidated houses or parts of houses repaired 52 Inlets or surface drains trapped 22 Improperly constructed water closets altered 18 Defective water closets repaired or renewed 888 Water closets unstopped 11 Improperly placed water closets removed 19 External ventilation provided to water closets 52 Water closet accommodation provided 21 Soil pipes repaired, renewed, or ventilated 436 Improperly placed gully traps removed 14 Gully traps cleansed 24 Yards drained 18 Waste pipes of sinks disconnected from drains, trapped, or renewed 360 Waste pipes of lavatories disconnected from drains, trapped, or renewed 177 Waste pipes of baths disconnected from drains, trapped, or renewed 96 Water cisterns repaired or renewed 15 Accumulations or deposits of refuse, manure, &c., removed 477 Foul or defective dustbins or ashpits abolished 76 Foul drains cleansed 63 Defective drains amended or reconstructed 794 Drains unstopped 118 Rainwater pipes disconnected from drains 119 Rainwater pipes disconnected from soil pipes 26 Rainwater pipes repaired or renewed 108 Water supplies used for domestic purposes disconnected from the cistern for flushing the water closet 9 Houses provided with proper water supply 190 Roofs repaired 102 Gutterings repaired or renewed 49 Areas cleansed 16 Areas drained 5 Washhouse pavings repaired or renewed 16 Scullery pavings repaired or renewed 10 Animals ceased to be kept in such a manner as to be a nuisance 7 Cases of overcrowding abated 17 Underground rooms ceased to be occupied as dwellings 3 78 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 1 Spaces below floors in the basement or ground floors ventilated 7 Chimneys carried to a sufficient height — Ventilating pipes of drains carried to a sufficient height above windows 7 Fresh air inlets repaired or renewed 27 Separate and sufficient water closet accommodation provided for persons of each sex 1 Water closets cleansed 72 Water closets provided with a sufficient water supply 44 Flushing cisterns to water closets repaired or renewed 262 Water closets provided with means of constant ventilation 26 Sufficient water closet accommodation provided 3 Yard pavings repaired or renewed 194 Area pavings repaired or renewed 96 Defective or improper manure receptacles abolished 3 Manure receptacles provided 12 Dust receptacles provided 135 Covers to dust receptacles provided 10 Water cisterns cleansed 117 Water cisterns fitted with close fitting covers 61 Improperly placed water cisterns removed 12 Stable pavings repaired or renewed 21 Number of Inspections, &c., Made; Notices Served; and Letters, &c., Issued. 1903. 1904. 1905. 1906. Number of Inspections 8002 11927 11960 9089 „ Re-inspections 13865 12266 11491 12399 „ Intimation Notices issued 1037 908 711 845 „ Statutory Notices issued 366 479 211 300 „ Letters issued 2408 5211 4673 5261 Number of Notifications sent to "Head Teachers" of Schools respecting notified cases of infectious disease 417 792 Number of Notifications respecting cases of Measles 248 237 79 Houses Let in Lodgings. In 1905 the Council revised the bye-laws relating to houses let in lodgings, so as to provide for the serving of a notice upon the landlord before taking proceedings against him. This course became necessary in view of two decisions of the High Court which laid it down that bye-laws that did not provide for the serving of such a notice were bad. Unfortunately, however, the action of the Council in making a new bye-law invalidated the old bye-laws and consequently invalidated the registration of all houses registered under the old bye-laws. It became necessary, therefore, to begin the work of registration anew. At the end of 1905 the number of houses placed on the new register was 199, and in 1906 40 houses were added, making a total of 239 registered houses at the end of 1906. These figures are far from indicating the total number of houses in Hampstead that need to be dealt with under the provisions of the bye-laws relating to houses let in lodgings. At a moderate estimate the total number of such houses may be put down at from 800 to 1,000. The number, moreover, tends to increase, especially in the Kilburn Ward, where there is a growing tendency for houses originally intended for one family to become occupied as tenement houses. With the present sanitary staff it would be quite impossible to exercise an effective supervision over the number of houses I have indicated as calling for registration. The services ot at least one additional inspector will be necessary before the Health Department will be in a position to register and inspect an adequate number of tenement houses under the bye-laws, and so exercise that control of these houses which is, in my opinion, one of the chief sanitary needs of the Borough at the present time. Insanitary or Uninhabitable Dwellings. The following is a list of dwellings that were found, during the year, to be so insanitary as to require extensive structural alterations to make them reasonably fit for human habitation. It will be seen that in nearly every case the premises were stable dwellings. The close domestic proximity of horses and human beings in stable dwellings is not conducive to health, and it is only by the observance of certain conditions that these places can be made tolerable. Fortunately, however, the introduction of motor vehicles is gradually freeing Hampstead of many of these sources of nuisance and ill-health. 80 Structural alterations have been carried out under notice or voluntarily at the following premises:— Abbey Lane, 12. Alexandra Mews, la, 2, 5, 20. Belsize Park Mews, 7, 8, 14. Boundary Road, Stables 2. Canfield Place, 17. Daleham Mews, 17. Eresby Mews, 2. Eton Mews West, 2, 3. Eton Stables, 5, 8, 9. Fairfax Mews, 21, 39, 45. Frognal, "Florence Cottage.'' Golden Square, 9. Heath Street, Cornick's Cottages. King's College Mews, East, 1. King's College Mews, West, 4 Lancaster Stables, 3, 12. Loudoun Mews, 1. Providence Place, 11. Swiss Terrace Stables. Wavel Mews, 3, 6, 8. West End Lane Stables, 5a. West Hampstead Mews, 21. Winchester Mews, 13. Customs and Inland Revenue Acts. These Acts provide that the owners of premises that are let in dwellings of a certain class may claim exemption from inhabited house duty on producing a certificate from the Medical Officer of Health that the dwellings afford proper sanitary accommodation for the occupants. During the year applications for certificates under these Acts were received in respect to 92 dwellings, this number being 123 less than the number for which application was made in 1905. Upon receipt of an application for a certificate a detailed sanitary survey is made of the premises, and should any of the dwellings fail to reach the required standard of sanitation, a list of 81 requirements is drawn up and sent to the owner, and the certificate is only granted when these requirements are fulfilled. In every case the drains are required to stand the water test, and all gas stoves must be well ventilated into the open air by means of a properly constructed hood and shaft. The inspections necessitated by these applications throw a good deal of work upon the staff of the Health Department, but the improvements obtained are valuable. The Acts afford the means whereby the Council are able to secure a standard of wholesomeness in certain dwellings that could not be obtained in any other way. In 1906 the number of dwellings certified was 71, as compared with 218 in 1905. The following is a list of the dwellings certified, with the date of the certificate. It will be seen that the certified premises include the dwellings erected by the Council in Lower Cross Road. Table of Premises certified during 1906, shewing the number of dwellings therein, and date of certification. Premises. No. of Dwellings. Date of Certificate. 1906. 4, Belsize Parade, Haverstock Hill 3 24th January. 12, ,, ,, 3 24th January. 24, Gascony Avenue 4 16th February. 1, 2, 3, 4, 5, 6, 8, Rosemont Mansions, Lithos Road 7 21st June. 11, Belsize Parade, Haverstock Hill 3 24th July. 84, Iverson Road 3 11th August. 1, 2, 3, South Mansions, Gondar Gardens 3 12th September. 2, 3, 4, Kenmare Mansions, Gondar Gardens 3 12th September. 1-42, Park Dwellings, Lower Cross Road 42 27 th September. Underground Rooms. Underground rooms were found to be illegally occupied in five instances. The streets in which these rooms were found are as follows :— Mill Lane. Fleet Road Netherwood Street. Oman Road. Willow Terrace, New End. f 82 In each case the illegal occupation of the room was discontinued, but, in one case, only after legal proceedings had been taken. In this case the defendant was fined. One of the underground rooms dealt with forms part of the caretaker's quarters at a group of flats. This room was illegally occupied some time ago, but was vacated upon the owners receiving a notice from the Council. Late in last year, however, it was again discovered to be occupied, and notice was again served, and the owners agreed to carry out certain structural alterations to meet the requirements of the Council. Unfortunately it is by no means uncommon to find the caretakers of flat dwellings illegally put into occupation of underground rooms. In building flats the provision of dwelling accommodation for the caretaker seems occasionally to be disregarded. Certain undesirable underground rooms are constructed. which are originally stated to be intended to be used as store-rooms, but when the dwellings are occupied the rooms become the home of the caretaker. At the present time four underground dwellings of this kind are being dealt with by the Health Department. In one case the rooms were so dark that artificial light was necessary during the whole of the day. Drainage Work. The bye-laws of the London County Council that require that plans and written particulars of drainage construction and alteration shall be deposited with the Sanitary Authority, came into operation in August, 1903, and from that date to the end of 1906 the Council has approved of 220 plans for the drainage of new buildings, and 1787 plans for alterations, etc., to drains of existing premises. During the year 746 notices of drainage reconstruction or alteration were received, and in 578 cases the work necessitated the deposit of plans and written particulars. In 389 of these latter cases the work could not be delayed until the Council's approval of the plans had been received, and the prescribed "urgency" notice was therefore, submitted by the builders, and the plans, etc., deposited at a later date. Of the 578 notices of drainage alterations, etc., requiring the deposit of plans, 309 related to work that involved the entire 83 reconstruction of the drainage system. In 313 of the 578 drainage cases the work was carried out voluntarily, the number of instances in which voluntary complete reconstruction was carried out being 134. The voluntary work was chiefly done in connection with the larger houses in Hampstead, and in many cases the voluntary drainage reconstructions were of a very extensive character. The supervision of work of this kind occupies much of the Inspectors' time, and it is partly for this reason that it is found impossible to carry out a systematic house-to-house inspection. The defective state of the law relating to combined drainage did not inflict any considerable loss on the Hampstead ratepayers during the year. Combined drains are of two kinds: either they are "drains" repairable by the owner of the property, or they are "sewers" repairable by the ratepayers. But whether a combined drain is a "drain" or a "sewer" does not depend on any matter of sanitation, but on a legal technicality that often depends on some purely accidental circumstance, such as the inaccuracy of a drawing, etc. The effect of the law is that every year the ratepayers of London are obliged to provide a large sum—in some districts amounting to a penny rate—for the repair of drains, which by an extraordinary legal technicality have become ''sewers." The defects of the existing law relating to combined drainage have been pointed out again and again, and it is remarkable that no steps are taken to remedy what is undoubtedly a gross injustice to London ratepayers. During 1906, however, only one successful claim was made in Hampstead, and this was settled by the payment by the Council of £18. Only one of the combined drainage cases that occurred during the year involved legal proceedings. The circumstances in this case were so remarkable that it is worth while to state them in some detail. In December, 1905, the drains of No. 22, Agincourt Road were found to be defective. Intimation and Statutory Notices were served upon the owner, who gave an order to reconstruct the drains to Mr. R. T., who built the houses in 1893 and who still carries on business as a builder. When the work was completed the owner claimed to be reimbursed the sum of £38, alleging that the drain was a ''sewer," f 2 84 inasmuch as the rainwater from the roofs of Nos. 18 & 20 drained down a rainwater pipe which discharged over a gully in the rear of No. 22. Reference was then made to the drainage plans deposited by the builder, and duly approved by the Vestry on 22nd June, 1893. These plans show each house to be drained separately. As the case presented several difficult points the opinion of Counsel was taken, who advised (1) that the claim should be resisted on the ground that the owner could not take advantage of the wrongful act of his predecessor in title; that (2) notice should be served on the original builder to alter the drains in accordance with the plans; and that, (3) failing compliance, the Council should carry out the work and charge him with the cost. The claim was accordingly repudiated by the Council and nothing has since been heard of it. The Council then resolved:— "That the Medical Officer of Health and Senior Sanitary Inspector be authorised to enter upon the premises Nos. 18, 20 & 22, Agincourt Road, for the purposes of, and in accordance with the provisions of Section 82 of the Metropolis Local Management Act, 1855.'' Formal notice of intention to enter was then served on each of the occupiers; the drains were formally examined and found not to be in accordance with the plans. The result of the examination was reported to the Council who resolved:— 1. "That orders be made upon Mr. R. T. in respect of Nos. 18, 20 & 22, Agincourt Road, to alter and amend the drains and other works or apparatus connected therewith, so as to cause the premises to be drained in accordance with the original plans." 2. "That in default of these orders being complied with, the Borough Engineer be authorised to enter upon the premises and carry out the necessary works, the expenses incurred in so doing to be recovered from the said R. T." Notices were then served on Mr. R. T. personally in respect of each house. 85 Nothing was done to comply with the notices, consequently the Borough Engineer, after giving 24 hours' notice, entered and duly carried out the work, and sent a statement of the expenses incurred thereby to Mr. R. T. The expenses not being paid the Council took proceedings to recover the cost of the work, and were successful. Drainage of Schools. During the year the drains of the following schools were reconstructed according to an arrangement between the London County Council and the Managers of the Schools:— Hampstead School, Holly Bush Vale. Christ Church School, Hampstead Square. Trinity School, Finchley Road. Emmanuel School, Mill Lane. Complaints as to Sewer Ventilators. During the year, 86 complaints of smells from surface ventilators were received, as compared with 90 in 1905. This number does not include those complaints which were sent direct to the Borough Engineer. Copies of these 86 complaints were sent to the Borongh Engineer. During the year Webb's Patent Sewer Gas Destructor Lamps were fixed in the following situations:— Maygrove Road. Iverson Road, by Maygrove Road. Fordwych Road. The London County Council have provided an additional Webb's lamp at the junction of Willow Road and Christ Church Road, to ventilate the Fleet sewer. Reeves' Chemical Apparatus have been placed as follows:— Aldred Road. Mill Lane. Hillfield Road. Fordwych Road. 86 There is reason to believe that these ventilators have been of use in mitigating what is undoubtedly a serious nuisance in Hampstead. Certificates as to Water Supply. The number of Certificates issued during the year was 102, as compared with 105 in 1905. In two cases where premises were permitted to be occupied without the necessary Certificate having been obtained, legal proceedings were instituted, and in each case the defendant was fined £5 and costs. Public Mortuary. During the year the bodies of 87 persons were brought to the Mortuary as against 97 last year—45 by order of the Coroner, 25 by the Police, and 17 at the request of friends of the deceased persons. In 69 instances, or 79 per cent. of the bodies admitted, inquests were held, and in 50 instances, or 57 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 15 Suicide 18 Neglect at birth 4 Misadventure 3 Total 84 Three of the bodies received at the Mortuary were those of still born children. In 2 instances the bodies of persons who had died from infectious disease were brought to the Mortuary. 87 MORTUARY RECORD FOR THE YEAR, 1906. Bodies Admitted. No. of Post-Mortems. No. of Inquests. No. of Funerals from Mortuary. Month. Males, Females. Totals. Males. Females. Totals. January 3 4 7 3 4 7 7 7 February 4 3 7 4 1 5 6 6 March 6 2 8 3 1 4 6 7 April 2 4 6 1 2 3 3 6 May 8 3 11 4 3 7 9 10 June 5 6 11 2 4 6 11 10 July 7 1 8 3 1 4 6 7 August 4 1 5 3 1 4 4 4 September 3 4 7 — — — 1 6 October 6 2 8 6 1 7 7 7 November 4 3 7 — 3 3 7 6 December 1 1 2 — — — 2 1 Totals 53 34 87 29 21 50 69 77 88 Staff of the Public Health Department. In April, Mr. J. E. Stone, Third Clerk, resigned; and Mr. Percy T. Roberts was appointed in his stead. Mr. Heath, District Sanitary Inspector, resigned in July, on his appointment as one of H.M. Inspectors of Factories. Mr. Heath passed the examination for factory inspectors with great credit, being high in the list of successful candidates. The vacancy caused by Mr. Heath's resignation was filled by the appointment of Mr. A. Peverett, who was then a district sanitary inspector at Battersea. Housing. No action was taken during 1906 by the Council under Part I. or Part II. of the Housing of the Working Classes Act. The dwellings erected by the Council under Part III. of the Act in Lower Cross Road were opened for occupation in February. I am indebted to the Borough Engineer for the following particulars of the Dwellings. The dwellings provide accommodation for a total of 248 persons housed in three blocks, The following table shows the disposition of the 42 tenements in the blocks:— Two-roomed tenements. Three-roomed tenements. Four-roomed tenements. Block "A" 8 8 — Block "B" — — 10 Block "C" 4 12 — 12 20 10 Each tenement is provided with a scullery, larger than the usual tenement scullery, containing sink and coal bunker, and a w.c. placed as far as possible from the living rooms, with a ventilated lobby between. The rooms are well lighted, 8 feet 10 inches high in the clear, and better proportioned than in many dwellings, very narrow widths being avoided. The recognised minimum area has been observed on the ground floor, with rather 89 larger dimensions on the floors above; and the more rooms a tenement contains the larger the living rooms. The following table shews the average areas of rooms for the various sized tenements:— Living-rooms. Bedrooms. Four-roomed tenements 164 feet. 118 feet. Three-roomed tenements *170 feet. 110 feet. Two-roomed tenements 152 feet. 108 feet. *Note—About 12 feet superficial of these living-rooms is due to a passsageway to scullery being thrown into room, but the space is available for no purpose other than passage. Each tenement has two cupboards (one ventilated for food), and dresser shelving in addition. In regard to construction, all partitions other than brick are of breeze and cement concrete 3 inches thick, and all dividing floors and staircases of steel and concrete. The floors of living-rooms and bedrooms are finished with floor boards on battens nailed direct on to the concrete, and the staircases, landings, sculleries, and w.c.'s with granolithic paving. The walls of the staircases and landings are faced with a dado of salt-glazed bricks and flettons above. The scullery walls are rendered in cement for a height of 4 feet from the floor line, and all internal walls (except staircases and landings mentioned above) finished with washable distemper. Portable ranges (each with an oven and a boiler fed by cold water cistern) are fitted in the living rooms, and mantel registers in the bedrooms. The elevations are of Luton bricks at the base, with picked stock facings and red brick strings and arches above, and the top storey finished in rough cast. The roof covering for all the blocks is composed of tiles. The courtyard is paved with tar paving. 90 The rents charged for the various tenements are as follows:— 4-roomed tenements - - l1s. 6d. 3 99 99 - - 9s. 0d. 2 99 99 (Block "A" 6s. 9d. "C" 99 6s. 6d. Each tenement is provided with a gas stove, which in every case is freely ventilated to the open air by a properly constructed hood and shaft. The tenements have let readily and the excellent accommodation provided is much appreciated by the tenants. Sale of Food and Drugs Acts. The number of samples taken for analysis under the Sale of Food and Drugs Acts during the year was 413. The number certified by the Public Analyst to be adulterated was 20, or 4.8 per cent. of the total number. The corresponding percentage in 1905 was 1.9. 364 samples were purchased from Hampstead tradesmen, and 49 from persons residing without, but trading within the Borough. The percentages of adulterated samples in these two classes were 3.5 and 14.3 respectively. 16 samples were taken on Hampstead Heath on Bank Holidays, and of these 4, or 25 per cent., were adulterated. 23 samples were taken on Sundays, and the samples found to be adulterated were 2, or 8.7 per cent. The following table shows the articles of which samples were taken during the year, and the number found to be adulterated or of low quality:— 91 Article. No. Taken. Adulterated. Low Quality. Ale 1 — — Brawn (potted) 4 3 — Butter 104 4 1 Camphorated Oil 4 — — Cheese 21 — — Cocoa 4 — — Coffee 17 — — Cream of Tartar 3 — — Formalin (supplied by contract to Borough Council) 1 Glycerine 1 — — Ice Cream 5 — — Iodide of Potassium 2 — — Iodine Liquid (Fort) 1 — — Iodine, Tincture of 1 — — Jam 2 — — Lard 13 — — Lemonade 1 — — Lemon Squash 1 — — Lime Juice Cordial 1 — — Margarine 3 — — Meat (tinned) 5 — — Milk 200 13 1 Mustard 1 — — Olive Oil 1 — — Peas (preserved) 1 — — Pepper 2 — — Rum 2 — — Sulphur, Milk of 1 — — Sweets (coloured) 2 — — Tapioca 1 — — Tartaric Acid - 3 — — Tea 2 — — Whiskey 2 — — The following Table shows the number of samples analysed during each year, from 1902 to 1906. Year. Samples analysed. Number adulterated. Percentage adulterated. Fines and costs. £ s. d. 1901 306 6 1.9 13 15 0 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 1906 413 20 4.8 50 8 6 92 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) 49 2 4.0 No. 2 (Belsize) 58 4 6.8 No. 3 (Adelaide) 31 — — No. 4 (Central) 19 2 10.5 No. 5 (West End) 78 1 1.2 No. 6 (Kilburn) 82 2 2.4 No. 7 (Priory) 47 2 4.2 Totals 364 13 3.5 Of the 20 adulterated samples, 3 were of potted brawn which contained a preservative (Boracic Acid), but not in sufficient quantities as to make it at all likely that proceedings could be successfully taken. One sample of milk contained 21½ grains of Boracic Acid per gallon. Proceedings were taken against the vendor and a penalty of 40s. was inflicted. This is the first case in Hampstead in which proceedings have been taken for the addition of preservatives to milk, and it is only fair to the shopkeeper to add that as the result of an action he subsequently obtained damages of £100 from the firm who supplied the milk to him. In one case of milk adulteration, the vendor proved that he sold it in the same condition as supplied to him under a warranty, consequently the summons was withdrawn. In another case the milkman stated that the 17 per cent. deficiency of butter fat was accounted for by the fact that the cream of the milk had curdled during the hot weather and that subsequent straining had lowered the quality of the milk. This defence apparently satisfied the Magistrate, who merely ordered the defendant to pay the costs of the case. In another case the farmer's man who delivered the milk to the shopkeeper came into Court and admitted that he had added the 93 extraneous water which, to the extent of 20 per cent., was found in the milk. In this case the vendor was only ordered to pay the costs. Certain matters in connection with the adulteration of butter call for special mention. It is not generally known that a firm of dishonest scoundrels have lately started a thriving peripatetic business in adulterated butter in London. The agents of the firm drive round from house to house in small carts and supply householders with magarine under the name of ''country butter," charging 1s. per pound. The fraudulent trading is very difficult to deal with effectively. It is not easy to secure a sample according to the procedure prescribed by the sale of Food and Drugs Acts, and when after the exercise of some ingenuity a sample has been properly taken, the salesman gives a wrong name and address and is only captured, if at all, after the expenditure of a good deal of time and energy which can ill be spared from other work. Moreover, it is the practice of the firm continually to change their salesmen so that it is practically impossible to obtain a second conviction. The real name of the firm never, of course, appears in Court. The persons prosecuted are merely salesmen, but they always contend that they are trading on their own account. The present law against adulteration is quite inadequate to cope with this form of butter adulteration, and it is to be hoped that the Bill introduced by the Government this Session will give the Government Departments and local authorities effective powers to protect the public from fraud of this kind. There is much need of special powers to deal with itinerant vendors who give false names and addresses. Powers of this kind are particularly needed in Hampstead on Bank Holidays. During the summer of 1906 certain statements were made with great publicity in reference to American tinned meat, and the Health Committee ordered that twelve samples of tinned and potted meat should betaken, six for bacteriological and six for chemical examination. Six samples, three American and three British, were sent for bacteriological examination to the Lister Institute of Preventive Medicine, and all were certified to be practically sterile, the few organisms found, all of which were harmless, being stated to be probably due to accidental contamination. Six samples, three American and three British, were examined chemically by the Public Analyst, who certified that all were free from chemical preservatives except one 94 sample of potted brawn, prepared by an English firm, which contained boric acid in the proportion of six grains per pound. Two additional samples of English potted brawn were subsequently taken and both were certified by the Public Analyst to contain boric acid, the proportion of the preservative being five and a quarter, and one and three quarters of a grain per pound respectively. The Committee decided that these quantities of preservatives were not sufficient for legal proceedings to be taken with any prospect of success. Food Inspection. The following table shows the unsound or unwholesome food dealt with by your Inspectors during the year. Date. Premises. Food seized or surrendered. 1907. March 12th Flask Walk 1 trunk skate, about 5 stone June 11 th Broadhurst Gardens 2 tins potted lobster. July 13th Cricklewood Broadway About 7 lbs. strawberries. July 17th West End Lane 13 tins fruit (blackberries, tomatoes, etc.) July 18th Flask Walk 1 barrel crabs, about 6 doz. July 19th High Road 1 tin pineapple, 2 tins sardines. Oct. 25th Peebles Mews 1 trunk cod. Dairies and Milk Shops. At the end of the year 1905 there were 89 persons on the register as purveyors of milk, occupying 113 shops, as follows:— Dairies 51 Bakers and Confectioners 28 Restaurants and Coffee Shops 11 General Shops 23 and during the year the following additions were made to the register:— Persons registered as milk sellers, owing to change of Proprietorship 6 New premises opened as milkshops 5 95 The names of 5 persons, occupying 6 shops, who had discontinued selling milk were removed, so that at the end of the year there were 95 persons, occupying 112 shops, as follows :— Dairies - 52 Bakers and Confectioners 25 Restaurants and Coffee Shops 12 General Shops 23 426 inspections were made of premises where milk is sold. Table of sanitary works carried out at shops within the Borough where milk is sold:— Drains reconstructed and ventilated 5 Dustbins provided 2 Dustbins removed from improper positions 2 Flushing cisterns to water closets repaired or renewed 10 Gully traps cleansed 8 Lumber and refuse removed from premises 6 Premises or parts of premises cleansed and whitewashed 15 Dilapidated premises repaired (walls and ceilings) 2 Rainwater pipes and guttering repaired or renewed 5 Sinks provided 7 Soil pipes reconstructed 5 Waste pipes to sinks repaired or renewed and trapped 5 Water cisterns cleansed 3 Water closets cleansed 16 Water closets repaired or renewed 6 Water closets unstopped 2 Water supply disconnected from cistern and connected direct to main pipe 2 Yard and wash-house paving repaired or renewed 14 Yards cleansed 1 Ice Cream Shops. 107 inspections have been made during the year of the 72 shops n the Borough where ice cream is made or sold. 96 In addition to these, the barrows which stand in the streets and on Hampstead Heath on Bank Holidays have been inspected. In one instance a maker of ice cream in the Town Ward persisted in keeping his refrigerator in close proximity to a W.C. in spite of repeated warnings. Consequently proceedings were taken against him, under the London County Council (General Powers) Act, 1902, and the maximum penalty of £2 was inflicted No further cause of complaint has arisen on the same premises. Table of sanitary work carried out:— Premises or parts of premises cleansed and lime washed.3 Paving of yards repaired 4 Lumber, &c., removed from premises 3 Water closets cleansed 2 Water closets unstopped 1 Drains re-constructed 1 Rain-water pipes repaired 1 Dustbins provided 1 Cisterns cleansed 1 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 186 Confectioners 80 Grocers 95 Provision and Cheesemongers 27 Greengrocers and Fruiterers 36 Fishmongers 25 Fried Fish Shops 18 General Shops 78 545 97 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 - - - 131 Lime washing carried out - - 21 Paving repaired - - - - 2 Roof repaired - - - - 1 Gutter repaired - - - - 1 Flushing cistern to water closet renewed 1 Covers provided to dust bins - - 2 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. Complaints. During 1906, 1,077 complaints were made of the existence of insanitary conditions. A list of the matters of which complaint was made is given below:— Accumulations, offensive 6 „ of refuse 12 Animals, keeping of 13 ,, dead 10 Carpet beating 1 Dampness in premises 19 Dirty premises 22 Drains, bad condition of 41 , defective 21 ,, stopped 37 Dust, non-removal 82 Dust receptacles, foul or defective 15 „ absence of 7 „ improperly placed 3 Insanitary premises 21 Illness attributable to defective drains 24 G 98 Manure not removed 13 Overcrowded premises 18 Rats, nuisance from 5 Roadways, condition of 12 Road gullies stopped 5 Roofs, defective 7 Rubbish, burning 13 Smells 33 ,, on premises 22 ,, from road gullies 16 ,, „ sewer ventilators 86 „ „ stables 10 „ „ drains, &c., 25 „ „ water closets 12 „ „ manure 12 „ ,, dustbins 7 Smoke nuisances 9 Urinals, condition of 4 Unsound food 1 Vacant land, state of 8 Verminous condition of premises 5 Water closets, insufficient accommodation 3 ,, insanitary condition of 26 ,, stopped 6 ,, without water 3 „ „ proper flush 13 Water, absence of 7 „ cutoff 256 ,, leakage of 12 Water cisterns, dirty, &c. 6 Yard paving defective 2 Miscellaneous 86 Total 1077 Report on the Analytical Work of the Year 1906, by ALFRED W. STOKES, F.C.S., F.I.C., Public Analyst. 101 Analytical Laboratory, Town Hall, Paddington, W. January 31st, 1907. A short abstract of the analytical work of the year 1906 may be of interest. A total of 413 samples was analysed; these consisted of Milk 200 samples, Butter 104, Groceries 33, Cheese 21, Drugs 17, Lard 13, Tinned Meats 9, Ice Cream 5, Margarine 3, Spirits 4, Lemonade 3, and Beer 1. The adulterated samples consisted of Milk 13 and Butter 4. Three samples of Tinned Meat contained small quantities of preservative, but not sufficient to warrant a prosecution. It is very satisfactory to find not one of the Groceries or Drugs to be adulterated. The percentage of adulterated samples of all varieties was only 4'8 per cent., or just half the general percentage of adulterated articles in London. It is, however, considerably higher than was experienced in Hampstead the previous year; then only T9 per cent. of the articles were found to be adulterated. Of separate articles, 7.5 per cent. of the Milk samples and 4 per cent. of the Bu ters were found to be adulterated, as compared with 11 per cent. and 9.5 per cent. of these articles respectively in the whole of London. The mass of this limited adulteration at Hampstead is not due to resident traders, but to those coming from other districts on Bank Holidays and at other times. A total of £34 10s. Od. for fines and £15 18s. 6d. for costs was ordered to be paid into the Borough account. ALF. W. STOKES, F.C.S., F.I.C. Public Analyst. Factory and Workshop Act, 1901. 105 Factory and Workshop Act, 1901. The following part of this report is made pursuant to section 132 of the Factory and Workshop Act, 1901, which provides that "The Medical Officer of Health of every District Council shall in his Annual Report to them, report specifically on the administration of this Act in workshops and workplaces, and he shall send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State." There are 478 workshops in Hampstead, including 38 domestic workshops. The number of workplaces is 197, and there are 50 factories. The number of outworkers' premises is 72. The sanitary condition of all these premises is supervised by Mrs. Fisher and Inspector Hudson. A series of statistical tables has been framed by the Secretary of State "for the guidance and convenience of Medical Officers of Health in preparing that part of their Annual Report which relates to factories, workshops, workplaces, and home work." The tables will be found on pages 114-117. The following tables show the number of each class of workshops in each Ward of the Borough, the number of workrooms in the various workshops, and the number of persons of each sex employed therein:— 106 Workshops, Domestic Workshops and Workplaces 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) Totals. Art metal workers - 1 - 1 - - - 2 Bakers 4 3 3 4 8 6 7 35 Blind makers — 1 — 2 1 — 1 5 Bootmakers 14 12 7 3 12 24 12 84 Builders and carpenters 3 5 2 4 4 7 7 32 Cabinet makers and polishers 3 1 — 1 1 1 — 7 Carriage builders 3 1 — 1 1 1 5 12 Cycle makers and repairers 2 1 2 1 2 2 1 11 Dressmakers and ladies' tailors 36 13 14 18 32 66 31 210 Dyers and cleaners — 1 — - — 1 1 3 Embroiderers 1 1 — — 1 1 1 5 Engineers — 1 — 2 — — 1 4 Harness makers 2 - 3 1 1 — 1 8 Ironmongers 5 — 2 3 5 3 — 18 Lace makers and cleaners — — — 2 — 2 — 4 Laundries (Hand) 14 5 — — 3 10 7 39 Laundries (Steam) 1 3 — 1 — — 1 6 Mantlemakers — — — — — 1 — 1 Milliners 9 3 5 5 4 5 5 36 Miscellaneous 5 6 1 5 3 10 7 37 Monumental masons - — — 1 2 - 1 4 Motor manufacturers — — — 2 1 1 1 5 Needlewomen 2 1 1 - 1 3 1 9 Organ builders — — — — 1 — — 1 Outfitters — — — 4 — 3 3 10 Pianoforte key makers — 2 - - - - - 2 Pianoforte makers — 4 - - - - - 4 Picture frame makers 4 1 1 3 2 - 3 14 Smiths 3 2 — 1 1 3 1 11 Stained glass workers 1 — — - - 1 — 2 Tailors 3 6 4 4 6 18 5 46 Trunk makers — — — 1 - — — 1 Umbrella makers 1 — — - 1 1 1 4 Upholsterers 3 1 2 2 5 — 3 16 Watchmakers and jewellers 2 1 2 5 3 4 3 20 Wigmakers - - 1 2 2 - - 5 Totals 121 76 50 79 103 174 110 713 107 Nature and Number of Workshops, Domestic Workshops and Workplaces. Number and Sex of the Persons employed in Workshops. Trade or Business. No. of Premises. Workshops (other than Domestic Workshops). Number of Workrooms. No. of Employees. Domestic Workshops, Workplaces, etc. Males. Females Art metal workers 2 1 1 2 - 1 Bakers 35 35 47 129 1 - Blind makers 5 3 5 12 7 2 Bootmakers 84 45 53 92 — 39 Builders and carpenters 32 28 33 40 - 4 Cabinet makers and polishers. 7 5 5 8 — 2 Carriage builders 12 12 21 52 — — Cycle makers and repairers 11 11 17 26 — — Dressmakers and ladies' tailors 210 123 153 6 624 87 Dyers and cleaners 3 2 4 3 6 1 Embroiderers 5 2 2 — 7 3 Engineers 4 4 4 5 — — Harness makers 8 7 8 19 — 1 Ironmongers 18 18 19 28 — — Lacemakers and cleaners 4 2 2 — 5 2 Laundries (Hand) 39 6 21 3 51 33 Laundries (Steam) 6 6 19 20 257 — Mantlemakers 1 1 4 — 15 - Milliners 36 31 35 - 95 5 Miscellaneous 37 27 38 54 14 10 Monumental masons 4 4 6 21 — - Motor manufacturers 5 5 5 15 — - Needlewomen 9 1 1 — 2 8 Organ builders 1 1 1 4 — — Outfitters 10 9 46 5 235 1 Pianoforte key makers 2 1 1 2 — 1 Pianoforte makers 4 4 6 29 — — Picture frame makers 14 12 16 23 1 2 Smiths 11 11 11 30 — - Stained glass workers 2 2 3 5 — - Tailors 46 27 31 54 20 19 Trunk makers 1 1 1 3 - - Umbrella makers and repairers 4 — — — — 4 Upholsterers 16 10 14 20 7 6 Watchmakers and jewellers 20 16 17 32 - 4 Wigmakers 5 5 6 8 3 — Totals 713 478 656 750 1350 235 Inspection of Workshops (other than Bakehouses). The number of workshop inspections was 1,318, and in 64 instances it was necessary to serve notices to remedy defects discovered during inspection. The number of workrooms measured was 76. 108 Cleanliness. 16 workrooms were found on inspection to require cleansing; 11 of these were cleansed on the verbal request of the inspector, but in five cases it was necessary to serve a notice before the work was carried out. Ventilation and Warming. As in former years some considerable difficulty has been experienced in inducing workers to keep the windows or ventilators open. Nine workshops were found to be warmed by flueless gas stoves or naked gas burners; in eight cases the warming was made satisfactory by the provision of fires or gas stoves with proper flues to carry off fumes—one case was reported to H.M. Factory Inspector. In five other cases workrooms were found to be insufficiently warmed, gas burners being used in addition to fire or stove; the warming of these has been made satisfactory by the provision of additional fires or stoves. Overcrowding. Overcrowding of workshops was found in 11 instances. In two cases the overcrowding was abated immediately on the verbal request of the Inspector; in eight cases intimation notices were served, and in one case it was found necessary to serve a statutory notice because the overcrowding recurred. At each workshop a card in the following terms is left by the Inspector for each workroom, the required particulars being filled in by the Inspector after the workroom has been measured up and the necessary information obtained. Borough of Hampstead. Factory & Workshop Act, 1901. Publtc Health (London) Act, 1891. Address of Workshop Position of Workroom This Workroom has accommodation for persons. When overtime is being worked this Workroom has accommodation for persons only. 109 If this Workroom is used as a sleeping place as well as a Workroom, it has accommodation for persons only. Note.—The room must be efficiently ventilated at all times. G. F. McCleary, M.D., Medical Officer of Health. 7, Belsize Park Gardens, N.W. Section 133 of the Act provides that "when any woman, young person, or child is employed in a workshop in which no abstract of this Act is affixed as by this Act required, and the Medical Officer of Health of the District Council becomes aware thereof, he shall forthwith give written notice thereof to the Inspector for the district." Pursuant to this section 30 workshops were notified to H.M. Inspector of Factories. Bakehouses. At the end of 1906 there were 37 Bakehouses on the Register, 22 being underground, and 15 over ground. These numbers are the same as in the previous year. The Bakehouses have been kept under constant supervision during the year. The usual cleansing has been duly carried out twice in the year, and any defects found have been remedied. The following is a list of the Bakehouses on the Register at the end of the year:— BAKEHOUSES IN WARDS. Those marked * are underground bakehouses. Those marked † are factory bakehouses. No. 1 (Town) Ward— 57, Heath Street. 3, High Street. 67, do. 19, New End. (4) No. 2 (Belsize) Ward. 6, Fleet Road. *65, do. 2, Heathhurst Road. (3) No. 3 (Adelaide) Ward— *44, England's Lane. *90, Haverstock Hill. *2, King's College Road. (3) No. 4 (Central) Ward— *10, Belsize Park Terrace. *225, Finchley Road. *289, do. †307, do. *98, West End Lane. (5) 110 BAKEHOUSES IN WARDS—continued. No. 5 (West End) Ward— 160, Cricklewood Broadway. 110, do. do. 553, Finchlev Road. Field Lane School, Finchley Road. *43, Mill Lane. 44, do. 4, Munro Terrace, Fortune Green. 251, West End Lane. *279, do. (9) No. 6 (Kilburn) Ward— *63, Hemstal Road. No. 6 (Kilburn) Ward con.— *94, High Road, Kilburn. *354, do. *4, Kelson Street. 67, Kingsgate Road. *99, Palmerston Road. (6) No 7 (Priory) Ward— *202, Belsize Road. *228, do. *98, Boundary Road. *55, Fairfax Road. *93, do. *7, Fairhazel Gardens. *137, Finchley Road. (7) Bakehouses—Underground 22 ,, Above ground 15 Total 37 Workplaces. This term is not defined in the Factory Act, nor in the Public Health Act, and it is sometimes exceedingly difficult to decide whether certain premises are or are not " workplaces." Among the more important workplaces are the kitchens of restaurants, coffeehouses, etc., and the number of these places in Hampstead in 1905 was 50. In 1906, however, the use of two of these kitchens was discontinued, so that the number on the register at the end of last year was 48. These premises are kept under regular supervision by Inspector Hudson. The legal powers of the sanitary authority in relation to restaurant kitchens, and indeed to all places where food is prepared, are altogether inadequate, and, if as occasionally happens, the occupier insists on standing on his strict legal rights, regardless of the public health, the public may be exposed to considerable danger. There is much need of bye-laws to regulate the general sanitary condition of all premises where human food is prepared and sold. 111 The following is a list of the restaurant kitchens in the various wards of the Borough:— RESTAURANT KITCHENS IN WARDS. No. 1 (Town) Ward— Jack Straw's Castle, Hampstead Heath. 37, Heath Street. 63 & 65, do. 70, do. 109, do. Bull & Bush, North End. (6) No. 2 (Belsize) Ward— 2, Elm Terrace, Constantine Road. 2, Fleet Road. 25, do. 98, do. 106, do. 210, Haverstock Hill. 11, South End Road. 17, do. (8) No. 3 (Adelaide) Ward— 1, Adelaide Road. 143, do. 97, Haverstock Hill. 11, King's College Road. WinchesterHotel, Winchester Road. (5) No. 4 (Central) Ward— 14, Belsize Park Terrace. 17, do. 159, Broadhurst Gardens. 1, Canfield Place. 104, Finchley Road. 100, West End Lane. 1, Central Parade, do. (7) No. 5 (West End) Ward— 106, Cricklewood Broadway. 92, Fortune Green Road. West End Coffee House, West End Lane. 8, Cavendish Parade, West End Lane. (4) No. 6 (Kilburn) Ward— 188, High Road, Kilburn. 272, do. do. 308, do. do. 368, do. do. Towers' Coffee Rooms, Love- ridge Road. 96, Palmerston Road. (6) No. 7 (Priory) Ward— 21, Alexandra Road. 203, Belsize Road. 264, do. 274, do. 114, Boundary Road. 65, Fairfax Road. 115, Finchley Koad. 3, Goldhurst Terrace. 34, High Road, Kilburn. 43, Loudoun Road. Steer's Restaurant, Upper Avenue Road. Swiss Cottage Tavern, Upper Avenue Road. (12) Total 48 112 Home Work. The Factory Act provides that in certain trades, to be specified by the Home Secretary, the employers shall send to the sanitary authority, twice a year, lists giving the names and addresses of the out-workers employed by them. The trades so far specified by the Home Secretary are as follows:— 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; Brush making; and The making of stuffed toys. The number of lists received from employers was 108, and the number of addresses contained in the lists was 333. In 280 instances it was found that the addresses were outside Hampstead and in accordance with the Act they were sent to the Medical Officers of Health of their respective districts. The number of addresses of Hampstead workers received from the Medical Officers of Health of the districts in which the employers of these workers carried on business was 28. The total number of outworkers' premises in Hampstead is 72. Of these 2 are factories, 21 workshops, 11 domestic workshops, 2 workplaces, and in 36 cases only a single worker is employed on the premises. 113 Four cases of infectious disease occurred in houses inhabited by outworkers. 2 were cases of scarlet fever, 1 of typhoid fever, and 1 of erysipelas. The case of erysipelas was the only one, however, that actually occurred in an outworker's family. All four cases were immediately removed to hospital and the premises disinfected, and in no case was it found necessary to make an order to prohibit work from being given out to the premises. The Home Office table relating to outworkers will be found on page 116. The outworkers premises in Hampstead are kept under regular supervision. They are almost invariably found to be in a satisfactory condition, and any defects that are discovered are promptly remedied. Factories. The sanitation of factories is largely controlled by the Factory Inspectors, but duties of considerable importance devolve upon the Borough Council, who are responsible among other duties, for the administration of section 38 of the Public Health (London) Act, 1891. The section imposes upon the Council the duty of securing "suitable and sufficient accommodation in the way of sanitary conveniences" for the persons of both sexes employed in the Hampstead factories, workshops and workplaces. The following is a list of the different classes of factories in Hampstead:— FACTORIES. Art Metal Workers 2 Boot makers 1 Brewers 1 Builders 3 Butchers 5 Carpet beaters 2 Cigarette makers 1 Coach builders 1 Coffee roasters 4 Corn chandlers 1 Dairymen 2 Engineers 1 Joiners and plasterers 2 Manufacturing stationers 1 Monumental masons 1 Opticians 1 Photographic paper manufacturers 1 Pianoforte makers 1 Pianoforte string makers 2 Picture frame makers 1 Printers 10 Provision merchants 2 Stained glass makers 1 Steel grinders 1 Upholsterers 2 50 114 The five tables that follow have been framed by the Home Secretary "for the guidance and convenience of Medical Officers of Health in preparing that part of their Annual Report which relates to factories, workshops, workplaces, and homework." Factories, Workshops, Laundries, Workplaces and Homework. 1.—Inspection. Including Inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions (4) Factories (Including Factory Laundries) 204 7 — Workshops (Including Workshop Laundries) 1318 42 - Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 1842 64 7 Total 3364 113 7 115 2.—Defects Found. Particulars. Number of defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 71 71 - - Want of ventilation 5 5 - - Overcrowding 11 11 - - Want of drainage of floors 4 4 - - Other nuisances 236 236 - - Sanitary accommodation insufficient 7 7 - - unsuitable or defective 56 56 - - not separate for sexes 1 1 - 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) - - - - Other offences 9 4 5 - (Excluding offences relating to outwork which are included in Part 3 of this Report) Total 400 395 5 1 116 3.—Home work. NATURE OF WORK. Outworkers' Lists, Section 107. Number of Inspections of Outworkers' premises. Outwork in unwholesome premises, section 108. Outwork in infected premises, sections 109, 110. Lists received from Employers. Numbers of Addresses of Outworkers received from other Councils. Numbers of Addresses of Outworkers forwarded to other Councils. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Twice in the year. Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Wearing Apparel:— (1) making, &c. 84 219 8 12 28 202 - - 53 - - - - - - (2) cleaning and washing 4 22 1 2 — 23 — — 3 - — — — — — Lace, lace curtains and nets — — — — — — — — — — — — — — — Furniture and Upholstery 6 42 2 2 — 25 - - 13 - - - - - - Fur pulling - - - - - - - - - - - - - - - Umbrellas - 7 - - - 5 - - 1 - - - - - - Paper Bags and Boxes - — 1 18 — 16 — — 3 — — — — — - Brush making - - - - - - - - - - - - - - - Stuffed Toys - 3 - - - 3 - - - - - - - - - File making - - - - - - - - - - - - - - - Electro Plate 2 6 - - - 6 - - - - - - - - - Cables and Chains - - - - - - - - - - - - - - - Anchors and Grapnels - - - - - - - - - - - - - - - Cart Gear - - - - - - - - - - - - - - - Locks, Latches and keys - - - - - - - - - - - - - - - Total 96 299 12 34 28 280 — — 73 — — — — — — 117 4.- Registered Workshops. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Bakehouses 35 Bootmakers 49 Dressmakers and ladies' tailors 146 Laundries 6 Milliners 32 Tailors 33 Watchmakers and jewellers 17 OTHER 198 Total number of workshops on Register 516 5.—Other Matters. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:- Failure to affix Abstract of the Factory and Workshop Act (s. 133) 30 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector - Reports (of action taken) sent to H.M. Inspector - Other 7 Underground bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 22 Legal Proceedings. 121 Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department in 62 cases during the year. The chief facts relating to these proceedings are set out on pages 122-128, and are summarised below. The facts relate only to the cases that were heard and decided in 1906. No. of Prosecutions. Fines. Costs. £ S. d. £, s. d. Public Health (London) Act, 1891, and Byelaws made thereunder 27 26 12 0 10 18 6 MetropolisManagement Acts, and Bye-laws made thereunder 23 20 6 0 6 0 0 Sale of Food and Drugs Acts 25 55 10 0 11 9 0 London County Council (General Powers) Act, 1902 1 2 0 0 0 17 0 London County Council (General Powers) Act, 1904 1 - - Totals 77 104 8 0 29 4 6 122 Public Health (London) Act, 1891; and Bye-laws made thereunder Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 5 1905. 3rd Aug. 1906. 26th Jan. Marylebone Police Court, Mr. Plowden E.W., Paddington Non-compliance with Abatement Order Closing order made. 6 8th June. Do. Do. E.H., Dover Nuisance Summons withdrawn, work done, and 8s. costs paid. 6 1906. 9th Jan. Do. Do, F.H., St. Marylebone Do. Work done, summons withdrawn. 5 Do. 31st Jan. Hampstead Petty Sessions, Justices E.J.C., Hampstead Failure to obtain water certificate Fined £5. 5 Do. Do. Do. M.B.Co., Hampstead Do. Fined £5. 6 1905 20th July 2nd Feb Marylebone Police Court, Mr. Plowden F.H., St. Marylebone Non-compliance with Abatement Order Work done. Summons withdrawn on payment of 45s. costs. 1 1906. 1st May 30th May Hampstead Petty Sessions, Justices A.S., Willesden Non-registration as Purveyor of Milk Fined 10s. and 9s. costs. 5 Do. 1st June Marylebone Police Court, Mr. Plowden C.B. Willesden Do. Fined 10s. 5 Do. 8th June Do. J.G., Hampstead Contravention of Bye-law 14, Sec. 39(1) Fined 10s. and 2s. costs. 7 Do. Do. Do. T.H., St. Pancras Do. 2s. costs. 6 6th Mch. 29th June Marylebone Police Court, Mr. Paul Taylor J.W., Hampstead Allowing underground room to be occupied contrary to Act Fined £5. 6 1st May Do. Do. F.H., St. Matylebone Neglecting to make returns as to houses let in lodgings Returns made, and 3s. costs paid on each of the five summonses. 123 Public Health (London), Act 1891; and Bye-laws made thereunder—continued. Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 7 1906. 23rd Jan. 1906. 6th July Marylebone Police Court, Mr. Paul Taylor A.B., Tunbridge Wells, Kent Nuisance Abatement Order made and 6s. costs allowed. 5 1st May Do. Do. S.H., Islington Do. Abatement Order made and 6s. costs allowed. 2 26th June 25th July Hampstead Petty Sessions, Justices W.S., Wood Green Contravention of Bye-law 14, Sec. 39(1) Fined £1 and 5s. 6d. costs. 7 Do. 3rd Aug. Marylebone Police Court, Mr. Paul Taylor J.S. & Co., St. Pancras (1) Do. (2) Contravention of Bye-law 2, Sec. 39(1) Bye-laws complied with, and £1 15s. costs paid in each case. 1 21st Aug. 19th Sept. Hampstead Petty Sessions, Justices C.H., West Hendon Non-registration as Purveyor of Milk Fined 10s. and 11s. 6d. costs. 1 Do. Do. Do. C.W., Hendon Do. Summons not served. Withdrawn. 1 Do. Do. Do. H.S., St. Pancras Do. Fined £1 5s. and 6s. costs, or 7 days' imprisonment. 1 Do. Do. Do. F.T., Islington Do. Fined £15s.and 5s. 6d. costs, or 7 days' imprisonment. 1 Do. Do Do. E.B., Enfield Do. Fined 20s. and 12s. costs. 7 10th July 1 5th Oct. Marylebone Police Court, Mr. Plowden R.E., Hendon Nuisance Abatement Order made and 6s. costs allowed. 4 Do. Do. Do W.M., St. Marylebone Contravention of Bye-law 14, Sec. 39(1) Fined 20s. and 3s. costs. 124 Public Health (London) Act, 1891; and Bye-laws made thereunder—continued. Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 1 1906. 2nd Oct. 1906. 24th Oct. Hampstead Petty Sessions, Justices J.S., (trading as S. & Son) St. Marylebone (1) Contravention of Bye-law 2, Sec. 39(1) and (2) Bye-law 14, Sec. 39(1) Summonses withdrawn, penalty of £1 1s. and 2s. costs accepted on each. 7 10th July 23rd Nov. Marylebone Police Court, Mr. Plowden R.E., Hendon Non-compliance with abatement order Fined 40s. and 2s. costs. Metropolis Management Acts, and Bye laws made thereunder. 4 1905. 12th Oct. 1906. 19th Jan. Marylebone Police Court, Mr. Plowden G.D., Harrow Failing to deposit plans, &c. Plans deposited, summons withdrawn, and £1 costs paid. 5 1906. 23rd Jan. 11th May Do. L.L., Lambeth Do. Summons withdrawn, deposit made and 3s. costs paid. 5 1st May 8th June Do. J.G., Hampstead (1) Do. and (2) contravention of Bye-law 8, Sec. 202 (1) Fined 20s.and 2s. costs and (2) 2s. costs. 6 Do. Do. Do. J.P., Hampstead Failing to deposit plans, &c. Summons withdrawn, deposit made, and £1 1s. costs paid. 7 1st May 8th June Marylebone Police Court. Mr. Plowden T.H., St. Pancras (1) Failing to deposit plans, &c. (2) Contravention of Bye-law 11, Sec. 202 and (3) Bye-law 16, Sec. 202 Fined on (1) 5s. and 2s. costs, (2) 10s. and 2s. costs, (3) 10s. and 2s. costs. 4 12th June 6th July Marylebone Police Court, Mr. Paul Taylor C. & P., Hampstead Improperly constructing a drain and without giving notice Fined £10 and 2s. costs. 125 Metropolis Management Acts, and Bye-Laws made thereunder—continued. Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 2 1906. 26th June 1906. 25th July Hampstead Petty Sessions, Justices W.S., Wood Green Failing to deposit plans, &c. Fined £1 and 5s. 6d. costs. 7 Do. 3rd Aug. Marylebone Police Court, Mr. Paul Taylor J.S. & Co., St. Pancras Do. Plans deposited, and £1 15s. costs paid. 7 10th July 5th Oct. Marylebone Police Court, Mr. Plowden H.J.B., Hampstead Contravention of Bye-law 10, Sec. 202 Dismissed. 4 Do. Do. Do. W.M., St. Marylebone (1) Contravention of Bye-law 13, Sec. 202 (2) Bye-law 17, Sec. 202 and (3) Failing to deposit plans, &c. Summonses withdrawn, Work done. Plans deposited. 1 2nd Oct. 24th Oct Hampstead Petty Sessions, Justices J.S., (trading as S. & Son) St. Marylebone Failing to deposit plans, &c. Summons withdrawn, penalty of £1 1s. and 2s. costs accepted. 1 Do. Do. Do. G.K., Hampstead Do. Plans deposited before hearing. Fined 10s. and 4s. 6d. costs. 1 Do. Do. Do. Do. Do. Plans deposited before hearing. Fined 10s. and 4s. 6d. costs. 1 2nd Oct. Do. Do. Do. Do. Plans deposited before hearing. Fined 10s. and 4s. 6d. costs. 4 16th Oct 23rd Nov Marylebone Police Court, Mr. Plowden W.F.C., Paddington (1) Do. and (2) Erecting ventilating pipe not of proper weight Fined 20s. and 2s. costs on (1), and 10s. and 2s. costs on (2). 126 Metropolis Management Acts, and Bye-Laws made thereunder—continued. Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 7 1906. 30th Oct. 1906. 14th Dec. Marylebone Police Court, Mr. Plowden B. & B., Willesden (1) Constructing drain without giving notice & (2) Failing to deposit plans, &c. Withdrawn. Undertaking given to comply with Byelaws and fine of £3 and 4s. costs paid. Sale of Food and Drugs Acts. 2 1905. 14th Aug. 1906. 3rd Jan. Hampstead Petty Sessions, Justices G.E., Deptford (1) Selling milk with 10 per cent. of added water, and with 95 per cent. 1 ss than the proper amount of batter fat (2) Can improperly inscribed Fined £23 on (1), and £2 on (2), or three month's imprisonment. 6 1906. 9th Jan. 19th Jan. Marylebone Police Court, Mr. Plowden E.E.E., Hampstead Selling milk with 15 per cent. less than the proper amount of butter fat Fined £2 and 12s. 6d. costs. 1 29th Mch 25th April Hampstead Petty Sessions, Justices J.R., Hampstead Selling milk with 40 per cent. less than the proper amount of butter fat. Fined £2 and 20s. costs. 1 1st May 30th May Hampstead Petty Sessions, Justices A.S., Willesden (1) Selling milk with 11 per cent. of added water and 12 per cent. less than the proper amount of butter fat (2) Can improperly inscribed Fined £2 on (1), 10s. on (2), and 18s. costs. 5 1st May 1st June Marylebone police Court, Mr. Plowden C.B., Willesden Selling milk with 7 per cent. of added water Fined 20s. and 12s. 6d. costs 2 15th May 13th June Hampstead Petty Sessions, Justices H.C., Hampstead Selling milk with 15 per cent. less than the proper amount of butter fat Summons withdrawn, warranty proved. 127 Sale of Food and Drugs Acts—continued. Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 3 1906. 15th May 1906. 15th June Marylebone Police Court, Mr. Paul Taylor G. H., Willesden (1) Selling butter containing 54 per cent. of foreign fat (2) Selling margarine in unmarked wrapper (3) Selling margarine with more than 10 per cent. of butter fat Fined £10 and 16s. 6d. costs. 4 29th May 29th June Do. T. C., Hampstead Selling milk with 14 per cent. less than the proper amount of butter fat. Fined 20s. and 12s. 6d. costs. 1 29th May 4th July Hampstead Petty Sessions, Justices E. L., Hampstead Selling butter containing 86 per cent. of foreign fat (2) Selling margarine in unmarked wrapper Fined £2 and 20s. 6d. costs. 1 21st Aug. 19th Sept. Do. C. H., West Hendon Selling milk with 10 per cent. of added water, and with 77 per per cent. less than the proper amount of butter fat Fined 10s. and 11s. 6d. costs. 1 Do. Do. Do. C. W., Hendon Selling milk with 10 per cent. of added water, and with 79 per cent. less than the proper amount of butter fat Summons not served. Withdrawn. 1 21st Aug. 19th Sept Hampstead Petty Sessions, Justices H. S., St. Pancras Selling milk with 89 per cent. less than the proper amount of butter fat Fined £1 5s. and 10s. 6d. costs, or 7 days' imprisonment. 1 Do. Do. Do. F. T., Islington Selling milk with 89 per cent. less than the proper amount of butter fat Fined £1 5s. and 10s. 6d. costs, or 7 days' imprisonment. 128 Sale of Food and Drugs Acts— continued. Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 1 1906. 21st Aug. 1906. 19th Sept. Hampstead Petty Sessions, Justices E. B.. Enfield Selling milk with 20 per cent. of added water Fined 20s. and 13s. 6d. costs. 7 24th July 21st Sept. Marylebone Police Court, Mr. Paul Taylor A. W.. Hampstead Selling milk with 11 per cent. less than the proper amount of butter fat Fined 20s. and 12s. 6d. costs. 6 19th Sept 5th Oct. Marylebone Police Court, Mr. Plowden J. A., Hampstead Selling milk with 17 per cent. less than the proper amount of butter fat Ordered to pay 12s. 6d. costs. 6 Do 26th Oct. Do. R. G., Hampstead Selling milk containing 21½ grains of boric acid per gallon Fined £2 and 12s. 6d. costs. 4 27th Nov. 14th Dec. Do. W. H. & Son, Ltd. City Selling milk with 20 per cent. of added water Fined 20s. and 12s. 6d. costs. 5 Do. 19th Dec. Hampstead Petty Sessions, Justices J. D., Hampstead (1) Selling butter containing 71 per cent. of foreign fat (2) Selling margarine in unmarked wrapper Fined £2 and £1 0s. 6d. costs. London County Council (General Powers) Act, 1902. 1 15th May 13th June Hampstead Petty Sessions, Justices A. Y., Hampstead Storing ice creams in an improper place Fined 40s. and 17s. costs. London County Council (General Powers) Act, 1904. 2 15th May 3rd Aug. Marylebone Police Court Mr. Paul Taylor A. H., Romford Non-compliance with Notice to alter Urinal Adjourned, sine die, work in band (subsequently completed). Appendix. Tables. 131 TABLE I. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Vital Statistics of Whole Borough during 1906 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 Non-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.* Under 1 year of Age. At all Ages. N umber. Rate.* Number. Rate per 1000 Births registered. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1896 76216 1462 19.1 187 127.9 1308 17.1 548 472 80 916 12.0 1897 78549 1479 200 193 130.4 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 200 170 104.8 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 1049 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 1905 88142 1421 16.1 169 118.9 1089 12.3 464 350 84 823 9.3 Averages for years 1896-1905 82356 1499 18.2 178 118.7 1195 14.5 487 391 88 892 10.8 1906 89633 1437 160 139 96.8 1104 12.3 494 364 110 850 9.5 * 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 or 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 following pages. Area of Borough in acres (exclusive of area covered by water) 2253. Total population at all ages, 81,942. At Census of 1901 Number of inhabited houses, 11,294. Average number of persons per house, 7.2. 132 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. 116, Adelaide Road 3, Beaumont Street, W. 16, Beaumont Street, W. 32, Parkhill Road 11, Belsize Park Gardens Bethnal House Asylum 39, Boundary Road 41, Boundary Road,N.W. Consumption Hospital, Mount Vernon Brompton Hospital Brook Hospital 13, Bulstrode Street, W. 18, Crossfield Road 14, Bulstrode Street, W. Camberwell House Friedenheim, Upper Avenue Road Asylum Cancer Hospital, Chelsea Hampstead General Hospital, Hampstead Green Childrens' Hospital, Paddington Green. 4, Chivalry Road, S.W. City of London Lunatic Hampstead Workhouse, New End Asylum, Stone Colney Hatch Asylum 7, Colosseum Terrace, Hospital for Incurable Children, College Villas Road N.W. Devonshire Street, W. German Hospital, Dalston Infants' Hospital, 7, Denning Road Guy's Hospital Hanwell Asylum "Ravenswood,'' North Western Fever Hospital, Lawn Road Highgate Road Homoepathic Hospital, Gt. Ormond Street 53, Rosslyn Hill Hospital of St. John and St. Elizabeth, Marylebone St. Peter's Home, Mortimer Road Hospital for Women, Soho Square King's College Hospital Leavesden Asylum London Temperance Hospital 133 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. 55, Maida Vale, W. Middlesex Hospital National Hospital, Queen Square New Hospital for Women North West London Hospital Paddington Workhouse Royal Free Hospital St. Alban's Hospital St. Bartholomew's Hospital St. George's Hospital St. Luke's House, Kensington St. Marylebone, Workhouse St. Mary's Hospital St. Monica's Home, Brondesbury St. Pancras Workhouse St. Thomas' Hospital Salvation Army Maternity Home, Hackney 6, The Terrace, Camden Square 20, Torphichen Street, Edinburgh Tooting Bec Asylum University College Hospital Westminster Hospital Willesden Workhouse The Workhouse is within the Borough and situate at New End in No. 1 (Town) Ward. 134 TABLE II. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Vital Statistics of Separate Localities in 1906 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. a. b. c. d. a. b. c d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 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 109b0 194 116 21 1904 12970 195 12b 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 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 Averages of Years 1896 to 1905 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1906 13590 205 131 21 14190 187 127 8 10840 97 92 10 10123 95 83 3 13790 259 115 14 16030 444 197 41 11070 150 93 9 Notes.— Deaths of residents occuring 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; in 1904, 13 deaths of persons over 1 year of age, and 5 infantile deaths and 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. In 1906 there were 7 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. 135 TABLE III. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Disease Notified during the Year 1906. NOTIFIABLE DISEASE. Cases Notified in Whole Borough. Total Cases Notified in each Locality. No. 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 96 .. 20 48 16 11 .. 11 15 6 3 34 15 12 5 11 5 3 25 11 4 Membranous croup 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. Erysipelas 52 1 2 6 6 27 10 16 7 2 5 3 17 2 3 3 1 1 .. 1 .. Scarlet fever 385 1 88 249 31 16 .. 78 30 16 24 130 92 15 76 22 8 16 118 82 12 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 20 .. .. 5 2 13 .. .. 8 5 1 1 3 2 .. 3 4 1 .. 2 2 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever 1 .. . . 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. Puerperal fever 2 .. .. .. .. 2 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 557 3 111 309 55 69 10 107 60 29 34 168 128 31 84 39 18 22 143 97 18 The Workhouse is within the Borough, and is situate at New End in No. 1 (Town) Ward. 136 TABLE IV. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Causes of, and Ages at, Death during the Year 1906. 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 18 14 15 16 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 10 .. 10 .. .. .. .. 2 .. 1 .. .. 5 2 9 Scarlet Fever 5 .. 3 2 .. .. .. 2 .. .. .. 1 1 1 67 Whooping Cough 2 .. 2 .. .. .. .. .. 1 .. .. .. 1 .. .. Diphtheria and Membranous Croup 10 .. 7 3 .. .. .. 2 3 .. .. 3 1 1 33 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 3 .. .. 1 .. 2 .. .. 1 .. .. 1 1 .. 4 Other continued .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic Influenza 15 .. .. .. .. 4 11 1 2 3 2 2 3 2 1 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhoea 19 13 4 .. .. .. 2 5 2 .. 1 4 7 .. 6 Enteritis 11 5 2 .. 1 1 2 1 1 1 2 1 4 1 .. Puerperal Fever 1 .. .. .. .. 1 .. 1 .. .. .. .. .. .. 1 Erysipelas 3 1 .. .. .. 1 1 1 .. .. .. .. 2 .. 1 Other Septic diseases 6 .. 1 .. 1 1 3 .. 1 .. 1 2 1 1 4 Phthisis (Pulmonary Tuberculosis) 57 .. 1 .. 8 45 3 5 13 5 2 8 15 8 115 Other Tubercular diseases 22 5 6 5 2 4 .. 4 4 .. .. 2 11 1 29 Cancer, malignant disease 93 .. .. .. .. 49 44 15 3 14 7 19 17 18 44 Bronchitis 47 1 3 .. .. 10 33 5 10 4 2 8 13 5 8 Pneumonia 57 11 6 1 4 17 18 9 9 7 5 3 17 7 21 Pleurisy 1 .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. Other Diseases of Respiratory Organs 13 1 1 .. 1 4 6 2 1 6 .. 1 1 2 3 Alcoholism, Cirrhosis of Liver 14 .. .. .. .. 11 3 3 2 2 2 3 .. 1 6 Venereal diseases 3 2 .. .. .. 1 .. .. 1 1 .. .. 1 .. .. Premature birth 24 24 .. .. .. .. .. 6 1 .. .. 3 9 3 1 Diseases and accidents of parturition 6 .. .. .. 2 4 .. .. 2 1 2 .. 1 .. 1 Heart diseases 32 .. .. 2 .. 17 13 4 2 5 4 6 5 6 7 Accidents 19 3 3 1 1 5 6 1 4 .. 2 2 7 2 10 Suicides 7 .. .. .. 1 6 .. 1 1 1 1 1 2 .. 14 All other causes 370 45 11 8 13 116 177 61 63 39 49 45 72 32 109 All causes 850 111 60 23 34 300 322 131 127 92 83 115 197 93 494 Note.—It will be noted that the total number of deaths in the Ward distribution is 12 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.) Schedule A. EXTENDED TABLE IV. Causes of, and Ages at, Death during the Year 1906. Cause of Death. Ages. Wards. Total Deaths whether of "Residents" or "Non-residents" in Public Institutions in the Borough. Under 1. 1 and under 5. 5 and under 10. 10 and under 15. 15 and 20 and under 25. 25 and under 35. 35 and under 45. 45 and under 55 55 and under 65. 65 and under 75. 75 and under 85. 85 and upwards. All Ages. No. 1 (Town). No. 2 (Belsize). No. 3 No. 4. No. 5. (West End) No. 6 (Kilburn). No. 7 Non-distributable. Measles .. 10 .. .. .. .. .. .. .. .. .. .. .. 10 2 .. 1 .. .. 5 2 .. 9 Scarlet Fever .. 3 1 1 .. .. .. .. .. .. .. .. .. 5 2 .. .. .. 1 1 1 .. 67 Epidemic Influenza .. .. .. .. .. .. 1 .. 2 1 8 3 .. 15 1 2 3 2 .. 3 2 .. 1 Whooping Cough .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 .. 1 .. .. .. 1 .. .. .. Diphtheria .. 7 3 .. .. .. .. .. .. .. .. .. .. 10 2 3 .. .. 3 1 1 .. 33 Enteric Fever .. .. .. 1 .. .. 1 .. .. 1 .. .. .. 3 .. 1 .. .. 1 1 .. .. 4 Diarrhoea, Dysentery 11 4 .. .. .. .. .. .. .. .. 1 .. .. 17 4 2 .. 1 4 P .. .. 6 Epidemic Enteritis 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. .. .. .. 1 .. .. .. Syphilis 2 .. .. .. .. .. .. .. .. 1 .. .. .. 3 .. 1 .. .. .. 1 .. .. .. Erysipelas 1 .. .. .. .. .. 1 .. .. .. 1 .. .. 3 1 .. .. .. .. 9, .. .. 1 Puerperal Fever .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 1 Infective Endocarditis .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. 2 Other Allied Diseases .. 1 .. .. .. 1 .. .. .. .. 2 1 .. 5 .. 1 .. .. 2 1 .. 2 Rheumatic Fever .. .. .. 1 1 1 .. .. .. .. .. .. .. 3 1 1 .. .. .. 1 .. .. 1 Tuberculosis of Brain 3 4 2 .. .. .. .. .. .. .. .. .. .. 9 9 1 .. .. 1 g .. .. 5 Phthisis .. 1 .. .. 2 6 13 14 12 6 9 1 .. 57 5 13 .. 2 8 15 8 1 115 Abdominal Tuberculosis 1 .. 2 .. .. .. .. .. 1 .. .. .. .. 4 1 .. .. .. 1 9, .. .. 4 General Tuberculosis 1 .. 1 .. .. 1 .. .. 1 .. .. .. .. 6 1 2 .. .. .. 2 1 .. 11 Other forms Tuberculosis .. .. .. .. .. 1 1 1 .. .. .. .. .. 3 .. 1 .. .. .. 9, .. .. 9 Acute Alcoholism .. .. .. .. .. .. l 1 .. .. .. .. .. 2 .. 1 .. .. .. 1 .. 1 Chronic Alcoholism .. .. .. .. .. .. .. .. 1 1 .. .. .. 2 1 .. .. .. .. .. 1 2 Other Chronic Poisonings .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Osteo-arthritis .. .. .. .. .. .. .. .. .. 1 .. 1 .. 2 .. 1 .. .. .. .. .. 1 Gout .. .. .. .. .. .. .. .. .. .. 2 1 .. 3 1 .. .. 2 .. .. .. .. Cancer .. .. .. .. .. .. 1 8 14 26 29 14 1 93 15 3 14 7 19 17 18 .. 44 Diabetes Mellitus .. .. .. .. .. l .. 1 5 5 2 .. .. 14 3 1 2 1 2 4 1 .. 3 Anaemia .. 1 1 .. .. 1 .. 1 .. .. 1 .. .. 5 1 .. .. 2 .. 9, .. .. 1 Premature Birth 24 .. .. .. .. .. .. .. .. .. .. .. .. 24 6 1 2 .. 3 9 3 .. 1 Injury at Birth 4 .. .. .. .. .. .. .. .. .. .. .. .. 4 .. 1 .. .. .. .. 3 1 Debility at Birth 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. 1 .. .. 1 .. .. 1 Atelectasis 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. .. .. 1 .. .. .. Congenital Defects 5 1 .. .. .. .. .. .. .. .. .. .. .. 6 1 1 .. .. .. 9. 9 .. 1 Atrophy, Debility, Marasmus 14 2 .. .. .. .. .. .. .. .. .. .. .. 16 3 2 2 1 3 3 2 .. 15 Dentition 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. . . .. .. .. Rickets 1 1 .. .. .. .. .. .. .. .. .. .. .. 2 .. 2 .. .. .. .. .. 1 Old Age, Senile Decay .. .. .. .. .. .. .. .. .. 1 6 24 19 50 11 8 .. 7 2 14 6 .. 18 Convulsions 6 1 1 .. .. .. .. .. .. .. .. .. .. 8 2 .. .. 1 2 2 .. 1 1 Meningitis 4 2 1 .. .. .. .. .. .. .. .. .. .. 7 1 .. .. 1 3 2 .. .. 1 Encephalitis .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. 1 .. .. .. .. .. 1 Apoplexy .. .. .. .. .. .. .. .. .. 1 1 4 1 7 2 2 .. 1 2 .. .. .. Softening of Brain .. .. .. .. .. .. 1 .. 2 1 .. .. .. 4 .. 1 .. .. .. 2 1 .. 1 Hemiplegia .. .. .. .. .. .. .. .. .. 1 1 3 .. 5 2 1 .. 1 1 .. .. 1 General Paralysis of Insane .. .. .. .. .. .. .. .. 3 .. .. .. .. 3 .. 1 .. .. .. 2 .. .. Other forms of Insanity .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 .. .. .. .. .. .. .. Cerebral Tumour .. .. .. .. .. .. .. .. 1 3 .. .. .. 4 .. 1 .. 1 2 .. .. .. Epilepsy .. .. 1 .. 1 1 .. 1 .. .. 1 .. .. 5 .. .. .. 3 1 1 .. .. 1 Paraplegia .. .. .. .. .. .. .. .. .. .. 2 1 .. 4 .. 1 .. .. 1 . . .. 1 2 Other forms, Brain Diseases .. .. .. .. 1 .. .. 1 .. 2 1 l .. 6 .. 4 .. .. 1 1 .. 2 Otitis .. 1 .. .. .. .. 1 .. .. 1 .. .. .. 3 1 .. .. .. 1 .. 1 1 Pericarditis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Endocarditis .. .. 2 .. .. .. 5 3 4 5 5 5 .. 32 4 2 5 4 6 5 6 .. 6 Angina Pectoris .. .. .. .. .. .. .. .. .. 3 3 2 .. 8 l .. 2 2 1 1 1 .. .. Aneurism .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. 1 .. .. .. Senile Gangrene .. .. .. .. .. .. .. .. .. .. .. 1 3 1 .. .. .. .. .. 1 .. .. .. Embolism, Thrombosis .. .. .. .. .. .. .. .. 2 3 5 7 .. 17 6 1 3 2 2 2 .. 1 10 Other Diseases, Heart and Vessels .. .. 1 1 1 l .. 6 9 13 24 16 .. 75 8 12 8 14 9 17 7 .. 16 Laryngitis 1 1 • • .. 1 .. .. .. .. .. .. 1 .. 4 2 .. 2 .. .. .. .. 1 Other Diseases, Larynx & Trachea .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. 1 Acute Bronchitis 1 3 .. .. .. .. .. .. 2 2 3 1 12 2 .. 2 1 2 3 2 .. .. Chronic Bronchitis .. .. .. .. .. .. 1 2 5 11 13 3 35 8 10 2 1 6 10 3 .. 8 Lobar Pneumonia 1 1 1 .. 1 .. 1 2 2 1 4 2 1 17 .. 3 1 2 .. 7 .. .. 6 Lobular Pneumonia 5 5 .. .. 1 1 .. 1 5 1 3 1 23 4 3 3 2 1 7 3 .. 11 Pneumonia 5 .. .. 1 l .. 1 .. 3 3 3 .. 17 1 3 3 1 2 3 4 .. 4 Emphysema, Asthma 5 .. .. .. .. .. .. .. 1 2 1 .. 5 .. 1 2 .. 1 1 .. 1 Pleurisy .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. Other Diseases, Respiratory System .. .. .. .. .. 1 .. .. 1 1 1 .. 4 .. .. 2 .. .. 1 1 .. 1 Diseases of Mouth and Annexa .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. 1 .. .. .. .. .. 4 Diseases of Pharynx .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. 1 .. .. .. .. 1 Diseases of Œsophagus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Ulcer of Stomach and Duodenum .. .. .. .. .. 1 l .. 2 1 .. .. 5 1 3 1 .. .. .. .. 1 Other Diseases of Stomach 2 .. .. .. .. .. .. .. 2 2 .. .. 7 2 1 1 1 .. 2 .. .. 1 Enteritis 5 .. .. .. l .. .. .. 1 1 1 .. 11 1 1 1 2 1 4 1 .. .. Appendicitis .. .. 1 2 .. .. .. 1 2 .. .. .. 6 2 1 .. 1 .. 2 .. .. 2 Obstruction of Intestine .. .. .. .. .. .. .. 2 1 3 2 .. 8 2 2 1 .. 2 1 .. .. 1 Other Diseases of Intestine 1 .. .. .. .. .. .. .. .. 1 .. .. 2 .. .. .. .. .. , . 2 .. .. Cirrhosis of Liver .. .. .. .. .. .. 3 2 2 2 1 .. 10 2 1 2 2 3 .. .. 3 Other Diseases of Liver .. .. .. .. .. 1 .. 1 1 2 .. .. 5 .. 2 1 1 1 .. .. .. Peritonitis .. .. .. 1 .. 3 .. 2 .. .. .. .. 6 .. 1 .. 1 .. 3 1 .. 2 Other Diseases, Digestive System 2 .. .. .. .. .. .. .. 1 .. .. .. 4 2 .. .. 1 .. 1 .. .. 1 Diseases, Lymphatic System and Glands .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 .. .. .. .. .. .. .. Acute Nephritis .. 1 .. .. 1 1 .. .. .. 1 .. .. 4 .. .. .. 1 1 2 .. .. 4 Bright's Disease .. .. .. .. .. 1 1 2 8 9 6 .. 28 2 6 6 3 4 3 3 1 4 Calculus .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. Diseases of Bladder and Prostate .. .. .. .. .. .. .. .. .. 1 3 .. 6 1 2 2 .. .. .. .. .. Other Diseases, Urinary System .. .. .. .. .. .. .. .. 1 .. 1 .. 2 .. .. .. .. 1 1 .. .. 1 Diseases of Ovaries .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. 1 .. .. .. .. .. 1 Diseases of Uterus and Appendages .. .. .. .. .. 1 .. .. 2 .. .. .. 3 1 .. 1 .. .. 1 .. 1 Diseases of Breast .. .. .. .. .. .. .. .. .. .. 1 .. 1 1 .. .. .. .. .. .. .. Puerperal Mania .. .. .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. Puerperal Convulsions .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. Placenta Praevia, Flooding .. .. .. .. l .. 1 .. .. .. .. .. 2 .. 1 .. 1 .. .. .. .. Puerperal Thrombosis .. .. .. .. .. 1 1 .. .. .. .. .. 2 .. 1 1 .. .. .. .. 1 Arthritis, Ostitis, Periostitis .. 1 .. .. .. .. 1 .. .. 1 .. .. 3 .. 1 .. .. .. 1 1 .. 2 Other Diseases, Integumentary System .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. 1 .. .. .. .. .. Accidents and Negligence. .. .. .. .. .. In Vehicular Traffic .. .. .. .. .. .. .. 2 .. .. .. .. 2 .. .. .. .. .. 1 1 .. 1 On Railways .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 In Building Operations .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 .. .. .. .. .. 2 Burns and Scalds .. 2 1 .. .. .. .. .. .. .. .. .. 3 .. .. .. 1 1 1 .. .. 1 Poisons, Poisonous Vapours .. .. .. .. .. .. .. .. .. l .. .. 1 .. .. .. 1 .. .. .. .. Suffocation, Overlaid in Bed 2 .. .. .. .. .. .. .. .. .. .. .. 2 .. 1 .. .. .. 1 .. .. .. „ Otherwise .. .. .. .. l .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. 1 Falls not specified 1 1 .. .. .. .. .. .. 1 1 2 1 7 .. 1 .. .. 1 3 1 1 2 Weather Agencies .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. 1 Otherwise, not stated .. .. .. .. .. .. .. .. .. l .. .. 1 .. .. .. .. .. 1 .. .. 1 Suicides. .. .. .. .. .. By Poison .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. 1 .. .. 4 By Asphyxia .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. By Hanging and Strangulation .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. 1 By Drowning .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 .. .. .. .. .. .. .. 7 By Shooting By Precipitation from Elevated Places .. .. .. .. .. .. 1 1 1 .. .. .. .. 1 2 .. 1 1 1 .. .. .. .. 1 By other and unspecified methods.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 Ill-defined and unspecified causes 1 .. .. .. .. .. .. 1 1 .. .. .. 3 .. .. .. .. 1 .. 1 1 .. Totals 111 60 17 6 13 21 42 56 80 122 150 131 41 850 131 127 92 83 115 197 93 12 494 137 TABLE V. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health) Infantile Mortality in the Borough during the Year 1906. 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 26 11 4 5 46 14 9 6 5 8 7 5 2 3 2 4 111 Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. i. Common Infectious Diseases Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Chicken-pox .. .. .. .. .. .. .... .. .. .. .. .. .. .. .. .. .. Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria: Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ii. Diarrhœal. Diseases. Diarrhœa, all forms .. .. .. 1 1 2 2 .. .. 4 2 .. .. .. 2 .. 13 Enteritis, Mucoenteritis,Gastro enteritis .. 1 1 .. 2 1 .. .. .. .. .. .. .. .. .. .. 3 Gastritis, Gastrointestinal Catarrh .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. 2 iii. Wasting Diseases Premature Birth 12 6 .. 1 19 3 1 1 .. .. .. .. .. .. .. .. 24 Congenital Defects 1 1 1 1 4 .. 1 .. .. .. .. .. .. .. .. .. 5 Injury at Birth 4 .. .. .. 4 .. .. .. .. .. .. .. .. .. .. .. 4 Want of Breastmilk, Starvation .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Atrophy, Debility Marasmus 1 1 l 1 4 2 2 2 1 .. 2 .. .. 1 .. .. 14 iv. Tuberculous Diseases. Tuberculous Meningitis .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. 1 3 Tuberculous Peritonitis:Tabes Mesenterica .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Other Tuberculous Diseases .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 v. Other Causes. Erysipelas .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 Syphilis .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. 2 Rickets .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 Meningitis (not Tuberculous) .. .. .. .. .. .. .. 2 .. .. .. 1 1 .. .. .. 4 Convulsions 3 .. .. .. 3 .. 1 .. .. .. .. .. .. 1 .. .. 5 Bronchitis .. .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. 1 Laryngitis .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 Pneumonia 1 .. .. 1 2 1 .. 1 1 1 1 2 .. .. .. 2 11 Suffocation, 1 .. .. .. 1 1 .. .. .. .. .. 1 .. .. .. .. 3 Other causes 3 2 l .. 6 1 .. .. 3 .. 1 .. .. .. .. 1 12 26 11 4 5 46 14 9 6 5 8 7 5 2 3 2 4 111 Population estimated to middle of 1906, 89,633. Births in the year legitimate, 1,403. illegitimate, 34. Deaths in the year of legitimate infants, 106. illegitimate infants. 5. Deaths from all Causes at all Ages, 850. 138 The following Table was suggested by the Medical Officer of Health to the County of London in order to secure uniformity of tabulation in the annual reports of the Medical Officers of Health of the Metropolitan Boroughs. TABLE VI. PREMISES NUMBER OF PLACES. Number of inspections, 1906. Number of notices, 1906. Number of prosecutions, 1906. On register at end of 1905. Added in 1906. Removed in 1906. On register at end of 1906. Milk premises 113 5 6 112 426 6 — Cowsheds — — — — — — — Slaughter-houses 5 — . — 5 131 — — Other offensive trade premises — — — — — — — Ice cream premises 73 3 4 72 107 2 1 Registered houses let in lodgings 199 40 — 239 189 58 — Total number of Intimation Notices served for all purposes 845 Overcrowding— Number of dwelling rooms overcrowded 12 Number remedied 12 Number of notices issued 6 Number of prosecutions — Underground rooms— Number closed during year 3 Illegal occupation dealt with during year 5 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 — 139 TABLE VI.—continued. Customs and Inland, Revenue Acts-— Number of houses for which applications were received during year 17 Number of dwellings comprised therein 92 „ Certificates granted (houses) *11 „ „ refused — „ „ deferred †11 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. 8 (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. 9 (b) With respect to deposit of plans as to drainage, &c. 14 London County Council (General Powers) Act, 1904— Number of Notices served re premises. Sec. 20 — „ sanitary conveniences removed or altered. Sec. 22 1 „ fixed ashpits removed. Sec. 23 — Mortuaries— Total number of bodies removed 87 Total number of infectious bodies removed 2 * These 11 houses comprised 71 "dwellings." † These 11 houses comprised 34 "dwellings." 140 TABLE VII. 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. Noti6ab1e Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population. Deaths occurring. Death 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 33 0.39 58 0.69 1903 85197 1453 17.0 837 9.8 126 86.7 311 3.8 16 0.19 42 0.49 1904 86663 1445 16.7 892 10.3 161 111.4 301 3.5 20 0.23 48 0.55 1905 88142 1421 16.1 823 9.3 133 93.6 295 3.3 14 0.16 38 0.43 1906 89633 1437 16.0 850 9.5 111 77.2 557 6.2 22 0.25 49 0.55 TABLE VII. (1). Yital Statistics of No. 1 (Town) Ward. Number of occupied houses 1,616 At Census 1901. Population11,895 Average number of persons per house 7.36 Year. Population estimated to to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. 7 Principal Epidemic Diseases. Deaths Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population. Deaths occurring. Death 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 4 0.33 8 0.65 1903 12550 194 15.4 127 10.1 14 721 38 3.1 1 0.08 10 0.79 1904 12970 195 15.0 125 9.6 20 102.5 65 51 4 0.31 2 0.16 1905 13330 194 14.5 127 9.5 24 123.7 72 5.4 3 0.23 6 0.45 1906 13590 205 15.1 131 9.6 21 102.4 107 7.9 6 0.44 11 0.81 141 TABLE VII. (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 Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population, Number. Estimated rate per 1000 of the Population. Number Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population. Deaths occurring. Deaths 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 9 0.67 12 0.90 1903 13520 211 15.6 121 8.9 13 61.6 60 4.5 2 0.15 3 0.22 1904 13660 217 15.9 141 10.3 23 105.9 47 3.5 3 0.22 8 0.59 1905 13840 209 15.1 131 9.4 13 62.2 42 3.0 2 0.14 5 0.36 1906 14190 187 13.2 127 8.9 8 42.8 60 4.2 4 0.28 7 0.49 TABLE VII. (3). Vital Statistics of No. 3 (Adelaide) Ward. Number of occupied houses 5 7 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 Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population. Deaths occurring. Death 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 2 0.19 1903 10600 95 8.9 101 9.4 9 94.7 22 2.1 1 0.09 1 0.09 1904 10700 100 9.3 99 9.2 13 130.0 36 3.4 2 0.19 2 0.19 1905 10800 96 8.9 92 8.5 4 41.7 27 2.5 1 0.09 1 0.09 1906 10840 97 8.9 92 8.5 10 103.1 29 2.7 ... ... 1 0.09 142 TABLE VII. (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 infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population. Deaths occurring. Death 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 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 1 0.10 1906 10123 95 9.4 83 8.2 3 31.6 34 3.4 .. .. 1 0.10 TABLE VII. (5). Vital Statistics of No. 8 (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 Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population. Deaths occurring. Death 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 6 0.48 10 0.79 1903 12850 243 18.9 111 8.6 21 86.4 55 4.3 2 0.16 2 0.16 1904 13200 283 21.4 120 9.1 22 77.7 70 5.4 3 0.23 8 0.61 1905 13580 250 18.4 131 9.6 23 92.0 29 2.1 2 0.15 11 0.81 1906 13790 259 18.8 115 8.3 14 54.1 168 12.2 5 0.36 9 0.65 143 TABLE VII. (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 Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population. Deaths occurring. Death 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 11 0.73 23 1.52 1903 15370 417 27.1 184 11.9 39 93.5 59 3.9 3 0.19 15 0.97 1904 15550 408 26.2 206 13.2 54 132.3 43 2.8 8 0.51 25 1.61 1905 15790 426 26 .9 171 10.8 50 117.4 57 3.6 2 0.13 9 0.57 1906 16030 444 27.7 197 12.3 41 92.0 128 8.0 5 0.31 16 1.00 TABLE VII. (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 Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population. Deaths occurring. Death 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 1 0.09 3 0.28 1903 10950 194 17.7 116 10.5 21 108.2 43 4.0 3 0.27 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 3 0.27 5 0.45 1906 11070 150 13.5 93 8.4 9 60.0 31 2.8 2 0.18 4 0.36 144 TABLE VIII Vital Statistics of Hampstead, compared with England and Wales. Year. Birth rate per 1000. Natural increase [Hampstead] . Seven Principal Epidemic Diseases death rate per 1000. Notifiable Infectious 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 1.8 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 1906 16.0 27.0 587 0.55 1.73 6.2 9.5 15.4 * Excluding Chicken-pox.