HAMP 14 THE Metropolitan Borough of Hampstead. REPORT FOR THE YEAR 1908 OF THE Medical Officer of Health. G. F. McCLEARY, B.A., M.D., D.P.H. CONTENTS. PAGES Vital Statistics 9-23 Infantile Mortality 25-35 Infectious Diseases 37-59 General Sanitary Administration 61-92 Factory and Workshop Act, 1901 93-108 Report on Analytical Work 109-111 Legal Proceedings 113-121 Appendix — Tables 123-139 Index 141-143 a 2 5 PUBLIC HEALTH COMMITTEE, NOVEMBER, 1907-8. Ex-Officio. His Worship The Mayor (Mr. Councillor E. E. Lake) Chairman, Housing Committee. (Mr. Councillor A. W. Blessley) Chairman. Mr. Councillor J. P. R. Lyell. Mr. Alderman E. C. Andrews, M.D. Mr. Councillor G. Buckle. „ C. W. Cunnington, M.R.C.S., D.P.H. „ L. Farmer. „ J. I. Fraser. „ C. Hendrick (until January). C. L.Jupp. „ R. E. Lawrence (Miss) (from January). „ F. G. Neave. „ T. H. Nunn. „ J. T. Osier. „ E. C. Taylor, M.D. HOUSING COMMITTEE, NOVEMBER, 1907-8. Ex-Officio. His Worship The Mayor (Mr. Councillor E. E. Lake.) Chairman. Mr. Councillor A. W. Blessley. Mr. Councillor T. E. Ashenden. „ J. I. Fraser. C. L.Jupp. W. E. Lloyd. „ W. Pocock. „ I. A. Symmons. The Council on 21st May, 1908, decided that the Housing Committee should cease to exist as a separate Committee of the Council, and that its duties should be transferred to the Public Health Committee, which was appointed as a Committee for the purpose of the Acts in relation to such duties. 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT, 1908. 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. Miss E. G. Moynihan. Assistants to Inspectors. W. Larken. A. J. Brown. E. Stratton. 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. C lerk- Draughtsman. E. J. Cooper. Public Analyst. A. W. Stokes, F.C.S., F.I.C. Deputy Medical Officer of Health. Frank E. Scrase, F.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health. G. F McCleary, B.A , M.D., D.P.H. 7 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I have the honour to place before you my Annual Report for the year 1908. The vital statistics are chiefly remarkable for the low deathrate, the lowest ever recorded in Hampstead, and the comparatively low rate of infantile mortality. In the latter rate however, there are possibilities of a considerable further reduction, and this we may hope will be the result of the special efforts that are now being made in this direction. I would draw your special attention to the facts on pp. 84-88 relating to the samples of milk taken for bacteriological examination during 1907-8. The results of the examination demonstrate the urgent need for a thorough reform in the methods under which milk is supplied in this country. I am glad to acknowledge the excellent work of the staff of the Department throughout the year. My thanks are due also to the Chairman and the Members of the Public Health Committee for their continued support, which I have greatly valued. I have the honour to be, Ladies and Gentlemen, Your obedient Servant, G. F. McCLEARY, Medical Officer of Health. May, 1909. Vital Statistics. B 11 Summary of Vital Statistics for 1908. Population estimated to middle of 1908 92,654 Density 40.9 persons per acre Births 1,400 Birth-Rate 14.9 Marriages 622 Marriage-Rate 13.4 Deaths 803 Death-Rate 8.5 Infantile Mortality 69 per 1000 births Notifiable Infectious Diseases Attack-Rate 4.1 Notifiable Infectious Diseases Death-Rate 0.21 Death-Rate from the Seven Principal Epidemic Diseases 0.40 Population at Census, 1901 81,942 Inhabited Houses ,, ,, 11,294 Area of Borough 2,265 acres „ „ (excluding area covered by water) 2,253 acres b 2 13 POPULATION. The population of Hampstead at the middle of 1908 was estimated by the Registrar-General to be 92,654. The Registrar-General's estimate has been adopted in this report, and it forms the basis upon which the various rates have been calculated. It is arrived at by assuming that since the last census the population has increased at the same rate as in the last inter-censal period. The following is an approximate estimate of the population of the various Wards of the Borough:— Ward 1 (Town) 14,190 „ 2 (Belsize) 14,770 „ 3 (Adelaide) 10,860 „ 4(Central) 10,584 „ 5 (West End) 14,370 „ 6 (Kilburn) 16,670 „ 7 (Priory) 11,210 The Borough 92,654 The area of the Borough (including the area, twelve acres in extent, covered by water), is 2,265 acres, and the estimated number of persons to the acre is 40.9. The proportion of persons to the acre at the Census, 1901, was 36.17. At the Census of 1881 the number of persons per acre was 23; and in 1891 it was 30. MARRIAGES. According to the returns of the Registrar-General, 622 marriages were registered in the Borough during 1908; they were distributed in the four quarters of the year as follows:— 1st quarter 99 2nd „ 173 3rd 191 4th „ 159 Total 622 14 The total number of persons married in Hampstead during 1908 was 1,244, which is equivalent to a rate of 13.4 per 1,000 of the population, and is a decrease on that for the year 1907, when the marriages of 1,292 persons were registered, equivalent to a rate of 14.2 per 1,000 of the population. The following Table gives the marriage rates for the years 1898—1907, and the average rate for the decade:— Year. No. of persons married per 1,000 of the population. 1898 15.2 1899 14.0 1900 13.4 1901 13.2 1902 15.0 1903 14.0 1904 14.4 1905 13.6 1906 12.9 1907 14.2 Average for the decade 14.0 1908 13.4 BIRTHS. During the year, 1,355 births were registered in Hampstead, an increase of 14 as compared with the number, 1341, registered in the previous year. Of the total births, 701 were of male, and 654 of female children. The births registered in Hampstead do not comprise the total births belonging to Hampstead that occurred during the year. Forty-five births of children whose mothers were Hampstead residents occurred in 1908 in the principal lying-in institutions in other metropolitan boroughs, and the total number of births belonging to Hampstead was 1,400; and in accordance with the practice of the Registrar-General, I have taken this number as a 15 basis for the various rates that depend on the number of births occurring during the year. Illegitimate Births.—Out of the total of 1355 births registered in Hampstead, 29, or 21 per 1000, were those of illegitimate children. The Birth rate calculated on the number of births registered in the Borough, was 14.4 per 1,000 of the population, as compared with the rate of 14.7 per 1,000 in 1907, and 17.5, the average for the years 1898—1907. But when the birth-rate is calculated on the total number of births belonging to Hampstead, including those that took place without as well as within the Borough, the rate was 14.9. The following Table shows the birth-rates in 1908 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 26.5 76 Great Towns 27.0 142 Smaller Towns 26.0 England and Wales less the 218 Towns 26. 2 London 25.2 Hampstead 14. 9 The Table on page 139, shows the birth-rates for Hampstead as compared with those for England and Wales since 1875, and it will be noted that the rates show a steady decline. The following Table shows the Ward and sex-distribution of the births, and the birth-rate for each Ward: — 16 Ward. Births. Birth rate per 1000 of the population Males. Females. Total. No. 1 (Town) - 120 105 225 15.9 No. 2 (Belsize) 113 92 205 13.9 No. 3 (Adelaide) 50 43 93 8.6 No. 4 (Central)- 58 46 104 9.8 No. 5 (West End) 130 124 254 17.7 No 6 (Kilburn)- 201 192 393 23.6 No. 7 (Priory)- 63 63 126 11.2 The Borough - 735 665 1400 14.9 The Natural Increase of the population, i.e. the excess of births over deaths, was 597 in 1908. DEATHS The total deaths occurring in Hampstead during the year amounted to 995. Of these, however, no less than 311 were of persons not belonging to the Borough, while 119 residents of Hampstead died in outlying districts. The total number of deaths, therefore, amongst persons belonging to Hampstead amounted to 803. This is the lowest number of Hampstead deaths occurring in any year since 1894, when the number of deaths was 798. In that year, however, the population of Hampstead was less by nearly 20,000 persons than it was in 1908. Death-rate The death-rate, calculated upon the total number of deaths (whether of resident or non-resident persons) occurring in the Borough during the year, was 10.6 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 17 death-rate is found to be 8.5 per 1,000 of the population, as compared with the rate of 9 0 per 1,000 of the population in 1907. The average recorded death-rate for the 10 years 1896-1907 was 10.3, This is the lowest death-rate ever recorded in Hampstead, the next lowest being that of 9 0 in 1907. The following table shows the death-rates in 1908, 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 14.7 76 Great Towns 14.9 142 Smaller Towns 14.0 England and Wales, less the 218 Towns 14.7 London 13.8 Hampstead 8.5 The following are the death-rates for each of the wards:— WARD. Death-rate per 1,000 of the population. No. 1 (Town) 7.6 No. 2 (Belsize) 8.5 No. 3 (Adelaide) 7.2 No. 4 (Central) 7.7 No. 5 (West End) 8.4 No. 6 (Kilburn) 11.1 No. 7 (Priory) 8.3 In the table on page 139, 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. C 18 Table showing the Death-Rates from All Causes in the County of London, the City of London, and the Metropolitan Boroughs during the 53 Weeks of 1908. as calculated by the Registrar-General. DISTRICT. Death rate from all causes. Hampstead 8.5 Lewisham 11.0 Woolwich 11.4 Wandsworth 11.6 Battersea 12.2 Stoke Newington 12.3 Fulham 12.4 Paddington 12.4 Greenwich 12.6 City of Westminster 12. 6 Camberwell 12.7 Kensington 12.9 Hackney 13.2 Islington 13.2 Lambeth 13.3 Deptford 13.8 Hammersmith 14. 0 St. Marylebone 14.2 Chelsea 14.5 St. Pancras 14.7 Poplar 15.9 Southwark 16.3 Holborn 16.4 Stepney 16.4 Bethnal Green 17.1 Shoreditch 17.4 City of London 17.7 Finsbury 18.6 Bermondsey 18.8 County of London 13.8 19 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 79 deaths has been transmitted to the following extra-metropolitan districts. Abbey Wood. Alsager. Andover. Barnet. Beckenham. Bexley. Brentwood. Brighton. Canterbury. Cardiff. Carshalton. Cleveland. Crickhowell. Croydon. Cuckfield. Derby. Dover. Edenbridge. Edmonton. Elstree. Finchley. Gt. Yarmouth. Guernsey. Harrow. Hendon. Hornsey. Ilford. Isleworth. Leatherhead. Lee. Leyton. Lincoln. Manchester. Penge. Portsmouth. Reigate. Richmond. Rickmansworth. Southend. Southgate. Stowmarket. Stroud Green. Sudbury, Suffolk Warwick. Wembley. Weobley. West Ham. West Lavington. Willesden. Wimbledon. Windsor. Worthing. c 2 20 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:— Glasgow. Tottenham. Willesden. The number of deaths of Hampstead residents that occurred in public institutions was 250, or 311 per cent. of the total deaths, and the number of deaths occurring in workhouses or workhouse infirmaries was 87 or 10.8 per cent. of the total deaths. A list of the institutions in which the deaths occurred is given on page 21. 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 Tables IV. and V., pages 130 and 131. Age Periods Under 1 year. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards At all Ages Deaths 97 25 20 37 312 312 803 21 Deaths of Hampstead Residents in Public Institutions Institution. Totals Group Totals. Infirmaries and, Workhouses :— Hampstead Workhouse 83 St. Marylebone Infirmary 1 St. Pancras Infirmary, Highgate 1 87 St. Pancras Infirmary (South) 1 Strand Union Workhouse, Sheffield Street, W.C. 1 Hospitals :— Brooke House, Upper Clapton 1 Brompton Hospital 1 Cancer Hospital, Chelsea 1 Children's Hospital, Bethnal Green 1 Children's Hospital, Gt. Ormond Street 4 Children's Hospital, Paddington Green 3 Friedenheim Hospital, Upper Avenue Road 6 German Hospital, Dalston 1 Great Northern Hospital 1 Guy's Hospital 2 Hampstead General Hospital 18 Hospital of St. John & St. Elizabeth, St. Marylebone 1 Hostel of God, Clapham 1 Infants' Hospital, Vincent Square 2 93 London Hospital 1 London Temperance Hospital 5 Middlesex Hospital 6 New Hospital for Women 1 Queen Charlotte's Hospital 1 St. Bartholomew's Hospital 1 St. Luke's Hospital 1 St. Luke's House, Kensington 1 St. Mary's Hospital 17 St. Thomas's Hospital 2 University College Hospital 13 Westminster Hospital 1 Metropolitan Asylums Beard's Hospitals:— North Eastern Hospital 1 11 North Western Hospital 10 County and other Asylums:— Banstead Asylum 1 Cane Hill Asylum 1 Colney Hatch Asylum 4 Hanwell Asylum 3 Horton Asylum 1 21 Leavesden Asylum 2 Long Grove Asylum 1 Manor Asylum 2 Tooting Bee Asylum 6 Prisons: — H.M. Prison, Brixton 1 1 Elsewhere 37 37 250 The names of the Institutions that are situated in Hampstead are printed in heavy type 22 Senile Mortality. The deaths of persons of 65 years of age and upwards numbered 312, as compared with 303 in 1907. Of these, 58 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 130, 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 1,000 population in each of the eight years 1901-08. Year. No. of Deaths from Cancer. Death-rate per 1000 of the 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 1907 69 0.76 1908 84 0.91 The next table gives the anatomical distribution of the disease in each sex. It will be noted that a large proportion of the patients, 48 out of a total of 84 cases, were females. In 28 cases the patients were over 65 years of age. Situation. Males. Females. Totals. Tongue 3 – 3 Breast – 6 6 Thorax 1 2 3 Liver 3 6 9 Stomach 5 6 11 Uterus – 13 13 Abdominal organs 13 10 23 Other situations 11 5 16 Totals 36 48 84 23 Alcoholism. In 4 cases death was certified to be due to Alcoholism, and 12 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, 16, as compared with 17 in 1907, 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 133 deaths, as compared with 138 in 1907. Diseases of the Respiratory System. The total mortality from these diseases was 123, as compared with 138 in 1907. 20 deaths occurred in children under five years of age, and 69 in persons from 65 years upwards. Of the total deaths 55 were due to Pneumonia, 58 to Bronchitis, 3 to Pleurisy, and 7 to other diseases of the respiratory organs. Accident. 14 deaths were classified under this heading, as compared with 18 in 1907, 6 were due to falls, 2 to suffocation, both infants overlaid in bed, 1 to burns, 4 to street accidents, and 1 to another accident. Suicide. Ten persons committed suicide as against 12 in 1907. In 5 cases the cause of death was poisoning, 2 deaths were due to shooting, 1 to hanging, and 2 to cuts or stabs. 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. Infantile Mortality. 27 INFANTILE MORTALITY. The number of deaths under one year registered in Hampstead was 104, but of these 19 deaths occurred in children not belonging to the Borough, while 12 infants belonging to Hampstead died in public institutions in other parts of London. The number of deaths of Hampstead infants was therefore 97, a decrease of 1 as compared with the previous year. In the following table, these infantile deaths are distributed in Wards, under their respective causes. CAUSE OF DEATH. WARDS. Totals. No. 1 (Town). No. 2. (Belsize) No. 3 (Adelaide). No. 4 (Central). No. 5 (West End) No. 6. (Kilburn). No. 7 (Priory). Non-distributable. i. Common Infectious Diseases. 1 Small-pox .. .. .. .. .. .. .. .. .. 2 Chicken-pox .. .. .. .. .. .. .. .. .. 3 Measles .. .. .. .. .. .. .. .. .. 4 Scarlet Fever .. .. .. .. .. .. .. .. .. 5 Diphtheria (including Membranous Croup) .. .. 1 .. .. .. .. .. 1 6 Whooping Cough 1 1 .. .. 1 .. .. .. 3 ii. Diarrhœal Diseases. 7 Diarrhœa, all forms 1 .. 1 1 5 .. .. .. 8 8 Enteritis,Muco-enteritis, Gastro-enteritis ) 1 1 .. .. 2 3 1 .. 8 9 Gastritis, Gastrointestinal Catarrh .. .. .. .. .. .. .. .. .. iii. Wasting Diseases. 10 Premature Birth 1 1 1 .. 3 8 2 .. 16 11 Congenital Defects 1 .. 1 1 1 .. .. .. 4 12 Injury at Birth .. .. .. .. 1 1 .. .. 2 13 Want of Breast-milk, Starvation .. .. .. .. .. .. .. .. .. 14 Atrophy, Debility, Marasmus) 1 2 .. 2 3 4 2 .. 14 iv. Tuberculous Diseases. 15 Tuberculous Meningitis. .. .. .. .. .. .. .. .. .. 16 Tuberculous Peritonitis : Tabes Mesenterica .. .. .. .. .. .. .. .. .. 17 Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. v. Other Causes. 18 Erysipelas .. .. .. .. .. .. .. .. .. 19 Syphilis .. 1 .. .. .. .. .. .. 1 20 Rickets .. .. .. .. .. .. 1 .. 1 21 Meningitis (not Tuberculous) .. .. .. .. .. .. .. .. .. 22 Convulsions .. .. .. 1 .. 3 .. .. 4 23 Bronchitis .. 1 1 .. 1 2 2 .. 7 24 Laryngitis .. .. .. .. .. .. .. .. .. 25 Pneumonia 1 .. 1 1 2 2 2 .. 9 26 Suffocation, overlying .. 1 .. .. .. .. 1 .. .. 2 27 Other Causes 3 1 .. .. 7 6 • • .. 17 Totals 11 8 6 6 26 30 10 .. 97 28 The "Infantile Mortality," i.e., the number of deaths under one year per 1000 births was 69, this figure being calculated on the total number of births belonging to Hampstead, including those that occurred in lying-in institutions outside Hampstead. This is equal to the infantile mortality in 1907 calculated in the same way. The average rate for the years 1898-1907 was 99. 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 1907 69 1908 69 The following table shows a comparison of the infantile mortality rates in 1908 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 121 76 Great Towns 129 142 Smaller Towns 124 England and Wales less the 218 Towns 110 London 113 Hampstead 69 29 The following are the infantile mortality rates for each of the Wards: — WARD. Deaths of Infants under 1 year per 1000 births. No. 1 (Town) 48.8 No. 2 (Belsize) 39.0 No. 3 (Adelaide) 64.6 No. 4 (Central) 57.7 No. 5 (West End) 102.4 No. 6 (Kilburn) 76.3 No. 7 (Priory) 79.3 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 Hampstead rate is a long way below that in any other borough. 30 Table showing the Infantile Death Rates of the County of London, the City of London, and the Metropolitan Boroughs during the 53 Weeks of 1908, as calculated by the Registrar General. DISTRICT. Deaths under 1 year to 1000 Births Hampstead 69 Lewisham 86 Stoke Newington 92 City of London 92 Woolwich 94 Wandsworth 97 St. Marylebone 101 City of Westminster 102 Islington 102 Paddington 103 Camberwell 104 Lambeth 104 Battersea 106 Chelsea 107 St. Pancras 107 Holborn 113 Hackney 115 Fulham 116 Kensington 119 Greenwich 120 Hammersmith 120 Deptford 122 Poplar 123 Stepney 130 Southwark 131 Bethnal Green 132 Finsbury 133 Shoreditch 139 Bermondsey 144 County of London 113 31 The following Table, which is taken from the RegistrarGeneral's Annual Summary for 1908, gives the infantile mortality in the Metropolitan Boroughs in the years 1903-8. This Table clearly shows the favourable position Hampstead occupies among the London districts:— Boroughs. Deaths of Infants under One Year of Age to 1,000 Births. 1903. 1904 1905. 1906. 1907. Average. 1903-7. 1908. London 130 145 130 131 116 130 113 Paddington 113 129 117 105 109 115 103 Kensington 140 144 139 132 128 137 119 Hammersmith 135 148 130 136 117 133 120 Fulham 126 152 145 135 122 136 116 Chelsea 136 151 112 133 122 131 107 City of Westminster 116 116 106 110 102 110 102 St. Marylebone 132 132 128 117 101 122 101 Hampstead 86 110 92 77 69 87 69 St. Pancras 126 142 127 123 108 125 107 Islington 123 125 121 124 116 122 102 Stoke Newington 116 111 119 101 99 109 92 Hackney 121 147 132 119 112 126 115 Holborn 119 140 118 119 131 125 113 Finsbury 151 158 145 156 127 147 133 City of London 133 99 146 101 94 115 92 Shoreditch 168 184 163 166 152 167 139 Bethnal Green 140 155 148 155 137 147 132 Stepney 140 157 142 135 118 138 130 Poplar 152 152 151 152 123 146 123 Southwark 145 171 144 144 138 148 131 Bermondsey 156 170 147 153 123 150 144 Lambeth 134 147 124 131 120 131 104 Battersea 131 144 127 125 112 128 106 Wandsworth 109 121 118 122 100 114 97 Camberwell 122 143 122 130 115 126 104 Deptford 131 142 119 141 106 128 122 Greenwich 129 143 121 121 102 123 120 Lewisham 91 123 92 113 90 102 86 Woolwich 108 135 102 109 112 113 94 When compared with the 76 great towns and the 142 smaller towns Hampstead occupies a creditable position in respect of infantile mortality. Only one of the former towns (Hornsey) and two of the latter (Penge and Finchley) have rates lower than that of Hampstead. The rate in Hornsey was 62, in Penge 52, and in Finchley 61. The following is a list of the 76 great towns in which the infantile mortality was lower than 100 per 1,000 births. 32 Town Infantile Mortality. Town. Infantile Mortality. Hornsey 62 Northampton 96 Leyton 77 Tottenham 96 Hastings 81 Croydon 99 Bournemouth 83 Portsmouth 99 King's Norton 85 Reading 99 Handsworth (Staffs) 87 Willesden 99 Coventry 95 The following is a list of the 142 towns in which the infantile mortality was lower than 100 per 1,000 births:— Town. Infantile Mortality. Town. Infantile Mortality. Penge 52 Lancaster 87 Finchley 61 Hendon 89 Reigate 70 Hereford 89 Guildford 71 Hove 89 Bromley 74 Scarborough 90 Beckenham 76 Colchester 92 Rochester 78 Enfield 92 Peterborough 79 Salisbury 92 Ilford 80 Lincoln 94 Ealing 82 Oxford 94 Bath 83 Southend-on-Sea 94 Tunbridge Wells 83 Dover 95 Watford 83 Kingston-on-Thames 95 Wimbledon 83 Nuneaton 96 Gillingham 84 Twickenham 96 Royal Leamington Spa 84 Winchester 96 Erith 85 Bedford 98 Eastbourne 86 Poole 98 Cheltenham 88 Ramsgate 98 Wood Green 86 Gloucester 99 The measures for the prevention of infantile mortality that were described in my former reports were continued during the year with some extensions. There was a considerable development of the work of health visiting during the year. On October 22nd, 33 1908, a second lady sanitary inspector was appointed, one of whose duties it is to visit the homes of the poor to give instruction in the feeding and care of infants. In the latter part of the year a body of voluntary health visitors was formed in connection with the Hampstead Health Society to extend to West Hampstead the work that the Society for some time has been carrying out in the Town and Belsize Wards. The voluntary visitors work in co-operation with the Council's lady inspectors, and on a definite system. The first visit is paid by the Inspector and subsequent visits by the voluntary workers and there are periodical meetings of the visitors, official and voluntary, where cases are discussed and future work arranged. An important feature in a comprehensive scheme of infant health visiting is the provision of some means by which the progress of the babies may be ascertained. The most trustworthy method is periodical weighing of the baby, for the balance will often reveal the existence of unsatisfactory conditions that might escape other forms of examination. During the year the Health Society were able to make arrangements for the weighing of the babies who are supervised by the health visitors. Rooms have been placed at the disposal of the Society for this purpose at the Hampstead Provident Dispensary, New End, and at the Brondesbury and West Hampstead Creche, 36, Hemstal Road. The mothers are encouraged to bring their babies once a week to be weighed in order that their progress may be ascertained and that advice may be given. The weighing is carried out by the lady inspectors assisted by the voluntary vis tors. The system of infant health visiting which has been built up in Hampstead is worked on excellent lines, and has already been fruitful in results. The number of newly-born infants visited by the lady inspectors during 1908 was 457, and 96 re-visits were made, 18 of which were in respect of infants born in 1907. Of the 457 infants visited by the lady inspectors, 155 were visited during the first fortnight after birth, 144 during the second fortnight, and 121 in the second month. Of the 420 infants visited within the first two months after birth, 370 were found to be entirely breast fed, 25 to be partially breast fed, and 25 entirely hand fed. 47 of the infants visited lived in one-roomed tenements, 183 in two-roomed tenements, and 126 in three-roomed tenements. D 34 The work of health visiting in Hampstead was greatly facilitated in 1908 by the Notification of Births Act, which came into operation on March 9th. The chief provisions of this important Act are as follows:— (1) In the case of every child born in an area in which this Act is adopted it shall be the duty of the father of the child, if he is actuålly residing in the house where the birth takes place at the time of its occurrence, and of any person in attendance upon the mother at the time of, or within six hours after the birth, to give notice in writing of the birth to the Medical Officer of Health of the District in which the child is born in manner provided by this section. (2) Notice under this section shall be given by posting a prepaid letter or postcard addressed to the Medical Officer of Health at his Office or Residence, giving the necessary information of the birth within thirty-six hours after the birth, or by delivering a written notice of the birth at the Office or residence of the Medical Officer within the same time; and the Local Authority shall supply without charge addressed and stamped postcards containing the form of notice to any Medical Practitioner or Midwife residing or practising in their area, who applies for the same. (3) Any person who fails to give notice of a birth in accordance with this section shall be liable on summary conviction to a penalty not exceeding twenty shillings: Provided that a person shall not be liable to a penalty under this provision if he satisfies the court that he had reasonable grounds to believe that notice had been duly given by some other person. (4) The notification required to be made under this Act shall be in addition to and not in substitution for the requirements of any Act relating to the registration of births; and any registrar of births and deaths whose sub-district or any part thereof is situate within any area in which this Act is adopted shall at all reasonable times have access to notices of births received by the Medical Officer of Health under this Act, or to any book in which those notices may be recorded, for the purpose of obtaining information concerning births which may have occurred in his sub-district. (5) This section shall apply to any child which has issued forth from its mother after the expiration of the twenty-eight week of pregnancy, whether alive or dead. 35 The total number of births notified from the date the Act came into operation, March 9th, to December 31st, was 977, including the births of 30 stillborn infants. The total number of live births notified was 947, and the total number of live births that actually occurred during the same period, as ascertained from the registrar's lists was 1,070. The live births notified were, therefore. 88.5 per cent. of the live births actually occurring, and this result in the first year's working of the Act may, I think, be considered satisfactory. 305 births were notified by medical practitioners, 123 by midwives, 531 by parents, and 18 from other sources. The Act has been found of great value in Hampstead, but some years must elapse before its full benefit will be reaped. Infectious Diseases. 39 NOTIFIABLE INFECTIOUS DISEASES. The total cases of infections diseases notified numbered 383. This is equivalent to an attack-rate of 41 per 1,000 of the population. The following shows the number of cases of each disease notified:— Scarlet Fever 265 Enteric Fever 24 Diphtheria and Membranous Croup 55 Puerperal Fever 6 Erysipelas 33 The number of fatal cases was 20, equal to 5.2 per cent. of the cases notified. The deaths were distributed as follows:— DISEASE WARDS. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central.) No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). Scarlet Fever ... 1 ... ... 6 ... ... 7 Enteric Fever 1 ... ... ... 3 ... ... 4 Diphtheria and Membranous Croup ... ... 2 ... ... 2 1 5 Puerperal Fever ... ... ... 1 1 2 ... 4 Erysipelas ... ... ... ... ... ... ... ... Totals 1 1 2 1 10 4 1 20 The death rate from the notifiable infectious diseases was 0.21 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 1891-1908:— 40 TABLE shewing the attack rate and death-rate for the Borough from Smallpox, Diphtheria and Membranous Croup, Scarlet Fever, and Enteric Fever, during the years 1891-1908. 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 0.10 0.49 0.10 1892 0.01 - 1.92 0.38 0.73 0.04 4.51 0.07 0.69 0.03 1893 0.17 0.03 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 1905 - - 0.71 0.03 0.48 0.03 1.93 0.07 0.19 0.02 1906 - - 1.08 0.12 0.58 0.03 4.30 0.06 0.22 0.03 1907 0.01 - 1.13 0.07 0.63 0.01 3.45 0.05 0.21 0.02 1908 - - 0.59 0.05 0.36 - 2.86 0.07 0.26 0.04 41 Cases of Infectious Disease occurring in each Month during 1908. Disease. MONTHS. Totals. January. February. March. April. May. June. July. August. September. October. November. December. Scarlet Fever 30 28 24 19 26 14 14 12 15 33 31 19 265 Enteric Fever ... ... ... 2 ... 4 3 3 2 2 3 5 24 Diphtheria and Membranous Croup 7 4 8 7 4 3 2 4 9 1 5 1 55 Puerperal Fever ... ... 1 ... 2 ... ... ... ... 1 ... 2 6 Erysipelas 2 1 5 2 4 3 2 1 3 3 4 3 33 Totals 39 33 38 30 36 24 21 20 29 40 43 30 383 42 Cases of Infectious Disease occurring in each Ward during 1908. Disease. WARDS. Totals. No. 1 (Town) No. 2 (Belsize) No. 3 (Adelaide) No. 4 (Central) No. 5 (West End) No. 6 (Kilburn) No. 7 (Priory) Scarlet Fever 51 62 16 18 49 49 20 265 Enteric Fever 6 4 6 ... 6 1 1 24 Diphtheria and Membranous Croup 6 10 4 9 9 7 10 55 Puerperal Fever 1 ... ... 1 1 3 ... 6 Erysipelas 1 5 4 5 3 12 3 33 Totals 65 81 30 33 68 72 34 383 43 Small Pox. No case of Small Pox occured during the year. Vaccination. The table below gives some idea of the working of the Vaccination Act in Hampstead since 1900. I am indebted to the Vaccination Officer for the statistics in this table. Vaccination Statistics. Percentage of Births Registered. Un vaccinated. 13 (Cols. 6. 8, &9) 11.0 10.0 9.2 9.5 9.2 9.2 10.4 12.2 ... Not finally accounted for (including cases postponed ). 12 (Cols. 8 & 9) 8.7 7.4 7.4 7.4 6.8 6.4 8.0 7.8 ... Exempted by" Conscientious Objection" Certificates. 11 (Col. 6) 2.3 2.6 1.8 2.1 2.4 2.8 2.4 4.5 ... Successfully Vaccinated. 10 (Col. 3) 81.5 81.7 82.7 82.0 82.8 83.1 82.3 81.3 ... Remaining. 9 131 104 102 96 90 77 97 99 142* Vaccination Postponed. 8 11 7 11 11 8 14 18 5 32 Died Unvaccinated. 7 108 111 104 106 100 91 93 80 73 Number in respect of whom Declarations of "Conscientious Objection" have been received. 6 37 39 27 30 35 40 35 60 126 Had Smallpox. 5 ... ... ... ... ... ... ... ... ... Insusceptible of Vaccination. 4 13 15 18 IS 16 18 12 7 16 Successfully Vaccinated. 3 1323 1232 1255 1190 1197 1181 1183 1090 932 Births. 2 1623 1508 1517 1452 1446 1421 1438 1341 1321 Year. 1 1900 1901 1902 1903 1904 1905 1906 1907 1908 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 62 births, in respect of which no legal action as to vaccination has yet been taken. The rates for Columns 10-13 have therefore not been calculated. 44 Scarlet Fever. The number of cases of Scarlet Fever notified in each of the last eight years is set out below. Year. No. of Cases Notified. 1901 214 1902 251 1903 165 1904 159 1905 170 1906 385 1907 314 1908 265 The deaths from Scarlet Fever in 1908 were 7, as compared with 5 in the previous year. The number of cases and the number of deaths per 1000 of the population were 2.86 and 0.07 respectively, and the case mortality, or percentage of deaths to cases, was 2.6. The corresponding figures in 1907 were 3.45, 0.05 and 1.6 respectively. Of the cases notified, 2.26, or 85 per cent., were removed to hospital. The corresponding percentage in 1907 was 84. 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 47 Soil pipes defective 18 Water supplies defective 34 Other defects 48 The following table shows the number of cases occurring each month in the various wards:— 45 Month. WARDS. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No.7 (Priory). January 9 3 1 2 8 5 2 30 February 2 7 — 3 8 8 — 28 March 5 9 — 4 1 2 3 24 April 3 4 — 2 6 3 1 19 May 4 7 3 1 6 3 2 26 June 5 2 1 — 5 — 1 14 July 6 2 — — — 5 1 14 August 5 1 3 1 — 1 1 12 September 2 — 1 3 3 4 2 15 October 4 11 4 1 2 10 1 33 November 3 11 2 1 8 6 — 31 December 3 5 1 — 2 2 6 19 Totals 51 62 16 18 49 49 20 265 Diphtheria and Membranous Croup. The number of cases notified in 1908 was 55 as compared with 103 in 1907, the attack-rate or number of cases notified per 1,000 population being 0.59. The number of fatal cases was 5, or 9.1 par cent. of the cases notified. The death-rate per 1,000 population was 0.05; 44 patients, or 80 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:— 46 Drains defective 10 Soil pipes defective 3 Water supply defective 8 Other defects 15 The following table shows the number of cases occurring each month in the various wards:— Month. WARDS. Totals. No. 1 (Town). No. 2 (Belsize) No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No 7 (Priory). January - 1 3 - 1 - 1 1 7 February 1 1 - - - 1 1 4 March - - - 1 2 1 3 1 8 April - - 1 2 1 - 2 - 1 7 May - - 1 1 - - 1 - 1 4 June - - - - - - - - 3 3 July - - 1 - - - 1 - - 2 August - - - 2 2 - - - 4 September 1 2 - 2 2 - 2 9 October - - - - - 1 - - 1 November - 1 - 1 1 2 - 5 December - - - 1 - - - 1 Totals 6 10 4 9 9 7 10 55 Enteric Fever. The number of cases notified was 24 as compared with 19 in 1907 and 20 in 1906. The attack rate per 1000 population was 0.26. 47 The number of fatal cases was 4 or 16.7 per cent. of the cases notified. The death-rate per 1000 population was 0.04; 14 patients, or 58 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 3 Soil pipes defective 2 Water supply defective 2 Other defects 4 The following table shows the number of cases occurring each month in the various wards:— Month. WARDS. Totals. No. 1 (Town) No. 2 (Belsize) No. 3 (Adelaide) No. 4 (Central) No. 5 (West End) No. 6 (Kilburn) No. 7 (Priory) January - - - - - - - - February - - - - - - - - March - - - - - - - - April - 1 - - - 1 - 2 May - - - - - - - - June 1 - 3 - - - - 4 July 1 - - - 2 - - 3 August - - 2 - 1 - - 3 September 1 - - - 1 - - 2 October 2 - - - - - - 2 November 1 1 1 - - - - 3 December - 2 - - 2 - 1 5 Totals 6 4 6 - 6 1 1 24 48 A careful inquiry was made as to the source of infection in each case. In 9 instances it was found that the patient had clearly been infected outside Hampstead; one of these patients was infected in Canada, one in the United States, one in Brazil, one in Germany, and the remainder in various parts of England. In 3 other cases there was reason to suspect that the infection had been conveyed by oysters, while one person was infected from a previous case in the same house in Hampstead. In the remaining instances the source of infection could not be definitely traced. Puerperal Fever. 6 cases were notified, 4 of which proved fatal, as compared with 4 cases and 1 death in 1907. The ward distribution of the cases is as follows, 3 in Kilburn and 1 in each of the following:—Town, Central and West End. Erysipelas. 33 cases were notified, but no death occurred, as compared with 57 cases and 1 death in 1907. The attack rate per 1,000 of the population was 0.36. Of the cases notified, 8 or 24 per cent. were removed to hospital. Four patients were removed to the Hampstead Workhouse Infirmary, three to the St. Pancras Infirmary, and one to the Great Northern Central Hospital. SEVEN PRINCIPAL EPIDEMIC DISEASES. The total number of deaths from these diseases amounted to 38, and were distributed as follows:— 49 DISEASE. WARDS. Totals. 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 - 1 - 1 2 - - 4 Scarlet Fever - 1 - - 6 - - 7 Diphtheria and Membranous Croup - - 2 - - 2 1 5 Whooping Cough 2 1 1 - 1 - - 5 Fever 2 - - - 3 1 - 6 Diarrhœa 1 1 1 1 - 6 1 11 Totals 5 4 4 2 12 9 2 38 The death rate from the seven principal epidemic diseases was therefore, 0.40 per 1000 of the population. In the following table a comparison is given of the annual death rates from these diseases in Hampstead, London, England and Wales, the 76 Great Towns, the 142 Smaller Towns, and England and Wales less these 218 Towns, during 1908:— 7 Principal Epidemic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhœa. England and Wales 1.29 0.00 0.22 0.08 0.15 0.27 0.07 0.50 76 Great Towns 1.59 0.00 0.31 0.10 0.16 0.29 0.08 0.65 142 Smaller Towns 1.28 — 0.20 0.07 0.16 0.25 0.08 0.52 England and Wales less the 218 Towns 0.98 0.00 0.13 0.05 0.15 0.25 0.07 0.33 London 1.35 — 0.31 0.11 0.15 0.20 0.05 0.53 Hampstead 0.40 — 0.04 0.07 0.05 0.05 0.06 0.12 In this table 0 00 indicates that the deaths were too few to give a rate of 0.005; where no death occurred,—is inserted. Detailed information concerning Small-pox, Scarlet Fever, Diphtheria, and Fever will be found under the heading of Notifiable E E 50 Detailed information concerning Small-pox, Scarlet Fever, Diphtheria, and Fever will be found under the heading of Notifiable Infectious Diseases on pages 43-48, but particulars concerning Measles, Whooping Cough, and Diarrhoea, to which notification does not apply, are given here. Year. Seven Principal Epidemic Diseases. Measles. Whooping Cough. Diarrhœa. Death rate per 1000 of the population. Death rate per 1000 of the population. Death rate per 1000 of the population 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 1907 0.45 0.12 0.13 0.05 1908 0.40 0.04 0.05 0.12 Measles. Four deaths were recorded from this disease, as compared with 11 in 1907. The mortality was 0.04 per 1000 population, the mortality in 1907 being 0.12. 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 1908, 280 cases were reported to the Medical Officer of Health, as compared with 347 in 1907. The sources of information were as follows:— Cases notified by medical practitioners 10 „ parents or guardians 83 „ school teachers 181 „ employers and others 4 Death Returns 2 280 51 In 59 cases it was found, on enquiry, that no doctor was in attendance. These 280 cases occurred in 203 houses:— In 153 houses there was 1 case in each house. In 31 „ „ were 2 cases „ In 13 ,, ,, ,, 3 ,, ,, In 4 ,, ,, ,, 4 ,, ,, In 2 ,, ,, „ 5 ,, ,, The following table shows the number of reported cases of measles occurring each month in the various wards:— Month. WARDS. Totals. No. l (Town) No. 2 (Belsize) No. 3 (Adelaide) No. 4 (Central) No. 5 (West End) No. 6 (Kilburn) No. 7 (Priory) January — 16 — 1 — 1 — 18 February — 1 1 4 1 — 2 9 March 1 1 — 2 14 — 4 22 April — 5 — 3 3 1 2 14 May 1 — — — 5 — 1 7 June — — 2 5 75 22 4 108 July — — 1 7 67 13 2 90 August — — — — — — — — September 1 — — — — — — 1 October — — — — — — 2 2 November — — — — — 1 2 3 December — 1 — — — 5 — 6 Totals 3 24 4 22 165 43 19 280 E 2 52 Whooping Cough. There were 5 deaths from this disease in 1908, as compared with 12 in 1907. The mortality per 1000 population was 0.05. Diarrhœa. The number of deaths from this cause was 11, as compared with 5 in 1907. The death rate per 1000 of the population from this disease was 0.12. In the following table these deaths are arranged in months and Wards:— Month. WARDS. Totals. No. 1 (Town) No. 2 (Belsize) No. 3 (Adelaide) No. 4 (Central) No. 5 (West End) No . 6 (Kilburn) No. 7 (Priory) January — — — — — — — — February — — — 1 — — — 1 March — — 1 — — — — 1 April — — — — — — — — May — — — — — — — — June — — — — — — — — July — — — — — — — — August l — — — — 2 1 4 September — 1 — — — 2 — 3 October — — — — — 1 — 1 November — — — — — 1 — 1 December — — — — — — — — Totals 1 1 1 1 — 6 1 11 53 Of these deaths 8 occurred among children under one year of age, 1 was that of a child aged 110/12 years, the remaining 2 being those uf adults of 40 and 50 years of age respectively. TUBERCULOSIS. The number of deaths from Tuberculosis in 1908 was 84. Of these, 74 deaths were due to pulmonary tuberculosis or phthisis and 7 to tubercular meningitis. 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 1907 92 1.01 61 0.67 1908 84 0.91 74 0.78 The deaths from phthisis during 1908 were distributed among the Wards as follows:— Ward. Area (Acres). Estimated Population middle of 1908. Phthisis Deaths. Phthisis Death Rate per 1000 of the Population. No. 1 (Town) 686 14190 7 0.41 „ 2 (Belsize) 271 14770 16 1.08 „ 3 (Adelaide) 325 10860 4 0.37 „ 4 (Central) 312 10584 7 0.66 „ 5(WestEnd) 247 14370 9 0.63 „ 6 (Kilburn) 195 16670 21 1.26 „ 7 (Priory) 229 11210 7 0.62 The Borough 2265 92654 74* 0.78 * 3 deaths from phthisis were non-distributable. 54 The following table shows the age distribution of the patients dying from consumption in Hampstead in the six years 1903-1908. 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 1907 1 2 10 45 3 61 1908 — 2 14 55 3 74 Totals 4 6 73 301 20 404 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 1907 55 1908 30 One of the notification certificates received during 1908 related to a patient who had already been notified; the number of new patients notified was, therefore, 29, and of these 14 were males and 15 females. The notifications received were from the following sources:— Patients notified by the Poor Law Medical Officers 12 Patients notified from the Brompton Hospital Out- Patient department 1 Patients notified from the Mount Vernon Hospital Out Patient department 2 Patients notified from the Kilburn General Dispensary 3 Patients notified by private practitioners 12 55 Ten of the patients notified died during the year. In 6 cases death occured within a month from the date of notification. The homes of the patients notified are visited by Mrs. Fisher, the lady sanitary inspector, who leaves a card of instructions as to the prevention of consumption, supplementing the printed directions with oral advice. An inspection is made of the premises and any defects discovered are remedied. As far as possible the notified patients are revisited from to time and advised as to the precautions they should take, and in this way many patients have been kept under observation for years. Mrs. Fisher is very successful in establishing cordial relations with these consumptive patients and their families. They look upon her as a friend and welcome her visits. The work Mrs. Fisher is doing in Hampstead for the prevention of consumption is of great value and deserves high commendation. Disinfection of rooms and bedding was carried out at the homes of 23 of the patients notified, and in 4 instances the disinfection was repeated during the year. Disinfection is offered after the death or removal of a phthisical patient whether the patient has been notified or not. The total number of premises disinfected during the year was 123. The movement for the prevention of consumption in Hampstead owes much to the work of the Joint Phthisis Committee of the Hampstead Health Society and the Charity Organisation Society. The Committee came into being chiefly through the efforts of Councillor T. Hancock Nunn, who has throughout taken a keen and active interest in the prevention of tuberculosis. The Committee has organised a body of voluntary visitors, who assist Mrs. Fisher in visiting the notified cases, and who also visit a number of patients who are brought to the notice of the Committee by the clergy, district visitors and others. The visitors do much to educate public opinion as to the importance of taking proper precautions against the spread of the disease, and they report to the Committee any persons whom they suspect to be affected by tuberculosis. The Committee arrange for the medical examination of such persons, and in this way a number of early cases are brought to light which otherwise would probably 56 have escaped recognition until the disease had reached a more advanced stage, and the patient's chance of recovery greatly diminished or lost. The Committee affords material assistance to a considerable number of consumptive patients and their families every year. Some idea of the assistance thus afforded will be gathered from the following particulars:— Number of patients given prolonged sanatorium treatment 10 „ ,, provided with in-patient hospital letters 20 ,, „ provided with out-patient hospital letters 32 „ „ provided with convalescent ment 7 „ „ boarded out in the country or at the sea-side 4 „ „ provided with additional ment 18 „ „ assisted to remove into the country 2 „ „ provided with suitable work 1 „ „ otherwise assisted 27 In a number of cases where a consumptive patient is the breadwinner of the family, the Committee by assisting the family have enabled the patient to enter a hospital or sanatorium. The total number of consumptive patients assisted by the Committee in 1908 was 67. Of these 35 were notified cases that were brought to the notice of the Committee by the Medical Officer of Health. The Committee and the Health Department work in close co-operation. Mrs. Fisher attends the meetings of the Committee, and there is a constant interchange of information between the Committee and the Department. Voluntary notification of consumption has been in operation in Hampstead since 1902, but, as will be seen on reference to the table on page 54, the number of cases notified has hitherto been small. The situation with reference to notification has, however, been materially improved by the issue of the Public Health (Tuberculosis) 57 Regulations, 1908. These Regulations, which were issued by the Local Government Board on December 18th, 1908, and came in force on January 1st, 1909, provide for the compulsory notification to the Medical Officer of Health of cases of pulmonary tuberculosis, or consumption, occurring in Poor Law patients. The Regulations apply to patients receiving out-door relief as well as to those treated in institutions, and the obligation to notify is laid upon the district medical officers and upon the medical officers of Poor Law institutions. Relieving officers are also called upon to notify changes of address in patients who have been notified by the Poor Law doctors, and the superintendent officers of Poor Law institutions must notify the discharge of a notified consumptive patient from the institution and the address to which the patient is going. These Regulations have made a considerable increase in the number of cases notified. During the first three months of 1909, the total number of new cases notified was 28, as against 29 in the whole of the previous year. The Regulations give wide powers to local authorities to adopt measures for the prevention of the disease. These powers are set out in Article IX of the Regulations and are expressed as follows:— "A Council, on the advice of their Medical Officer of Health, in the case of a poor person in relation to whom a notification in pursuance of these Regulations has been posted to the Medical Officer of Health, may, for tbe purpose of preventing the spread of infection from Pulmonary Tuberculosis— (i.) Take all such measures, or do all such things as are authorised, in any case of infectious disease, or of dangerous infectious disease, by any enactment relating to public health, and as have reference to the destruction and disinfection of infected articles, or the cleansing or disinfecting of premises; (ii.) Take all such measures or do all such things as are appropriate and necessary for the safe disposal or destruction of infectious material, produced and discharged, as a result of Pulmonary Tuberculosis; and otherwise for the prevention of the spread of infection from any such material; (iii.) Afford or supply all such assistance, facilities, or articles as, within such reasonable limits as the circumstances of the case require and allow, will obviate, or remove, or diminish 4 58 the risk of infection arising from the conditions affecting the use or occupation of any room, when used or occupied by the poor person as a sleeping apartment; and (iv.) Furnish, for the use of the poor person, on loan, or otherwise, any appliance, apparatus, or utensil which will be of assistance for the purpose of any precaution against the spread of infection. A Council, on the advice of their Medical Officer of Health, may provide and publish or distribute in the form of placards, handbills, or leaflets, suitable summaries of information and instruction respecting Pulmonary Tuberculosis, and the precautions to be taken against the spread of infection from that disease." On March 4th, 1909, the Local Government Board issued an important Memorandum, prepared by Dr. Newsholme, the Medical Officer of the Board, which explains in considerable detail the appropriate action that can be taken by sanitary authorities under the powers conferred by the Regulations. In an accompanying letter the Board state that although the Regulations apply only to patients who come under the care of the Poor Law Medical Officers, the Memorandum has been extended so as to deal with preventive measures in respect of cases notified under a voluntary system. The Local Government Board have now taken an important forward step in the movement for the prevention of tuberculosis, and it is to be hoped that their initiative will secure a ready response from local authorities throughout the country. In Hampstead, although much has been done, there is great need for further effort, and I hope shortly to indicate the measures which appear to me to be specially required at the present time. In connection with the subject of Tuberculosis, I would call attention to the section of this report, pp. 84-88, that deals with the examination of a number of milk samples for tubercle bacilli. It will be seen that of the 76 samples examined in 1907-8, no less than 17, or 22.4 per cent, were found to contain virulent tubercle bacilli. 59 DISINFECTION. Number of articles disinfected:— Beds 231 Mattresses 693 Palliasses 22 Bolsters 421 Pillows 1464 Blankets 1902 Sheets 866 Counterpanes 674 Articles of Clothing 3156 Carpets 94 Linen articles 2999 Books 142 Miscellaneous 1159 Total 13823 Number of premises disinfected 733 „ rooms, etc., disinfected 1015 In addition to the foregoing, the following were destroyed upon request of the owners:— Beds 5 Mattresses 13 Palliasses 4 Bolsters 5 Pillows 21 Blankets 10 Sheets 5 Counterpanes 5 Articles of Clothing 27 Carpets 6 Linen Articles 25 Books 70 Miscellaneous 34 Total 230 During 1907, 873 premises, 1253 rooms, &c., and 21,315 articles were disinfected. General Sanitary Administration. 63 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. General Conditions— Houses or parts of houses cleansed 171 Dampness in houses or parts of houses abated 45 Dilapidated houses or parts of houses repaired 27 Overcrowding— Cases of, abated (rooms) after service of notice 6 „ „ „ without service of notice 3 Underground rooms— Permanently closed 3 Ceased to be occupied separately 4 Altered to comply with the Public Health Act 37 In process of alteration at end of year 10 Below floors— Spaces below floors in the basement or ground floors ventilated 31 Roofs — Repaired 112 Gutterings— Repaired or renewed 82 Rainwater pipes— Repaired or renewed 147 Disconnected from drains 104 „ „ soil pipes 22 Waste pipes - Waste pipes of sinks disconnected from drains 22 „ trapped 246 „ „ „ repaired or renewed 171 „ unstopped 9 „ „ lavatories disconnected from drains 4 „ „ „ trapped 206 „ „ „ repaired or renewed 81 „ „ „ unstopped 1 ,, ,, baths disconnected from drains 3 „ „ „ trapped 123 „ „ „ repaired or renewed 50 „ „ „ unstopped 12 64 Water supply— Houses provided with proper water supply 109 Water provided to upper floors of tenement houses 24 Water supplies used for domestic purposes disconnected from cisterns for flushing w.c.'s 1 Water cisterns— Repaired or renewed 9 Removed from improper positions 6 Cleansed 79 Fitted with close fitting covers 26 Waterclosets— Accommodation provided 2 Additional accommodation provided 13 Separate and sufficient accommodation provided for persons of each sex - Removed from improper positions 12 Provided with proper and sufficient external ventilation 29 Improperly constructed apparatus removed and new provided 51 Apparatus repaired or renewed 508 „ unstopped 26 „ cleansed 77 „ provided with proper water supply 11 Flushing cisterns repaired or renewed 221 Manholes— Repaired or renewed 75 Drains— Reconstructed 441 Repaired 295 Cleansed 108 Unstopped 85 Ventilated 57 Ventilating pipes— Ventilating pipes of drains carried to a sufficient height above windows 8 Ventilating pipes of drains repaired or renewed 16 Fresh air inlets repaired or renewed 44 Soil pipes— Repaired or renewed 304 Ventilated 38 Gullies and Surface drains— Gully traps removed from improper position 5 „ ,, cleansed 64 Inlets or surface drains trapped 8 65 Paving and draining Washhouses, Areas, Yards, &c.— Washhouse or scullery paving repaired or renewed 6 Areas cleansed 2 Area paving repaired or renewed 76 Areas drained 19 Yards or other open spaces paved 119 Paving of yards or other open spaces repaired or renewed 60 Yards or other spaces drained 30 Floors of buildings in which horses, &c., are kept, paved or repaired 15 Refuse and Receptacles— Dust bins provided 183 „ „ repaired 1 „ „ cleansed 12 Fixed ashpits removed 40 Accumulations or deposits of refuse removed 204 Manure receptacles provided 14 ,, ,, amended 20 Nuisances from the improper deposit of trade refuse abated 6 Animals— Nuisance from the improper keeping of animals abated 9 Number of Inspections, &c., Made; Notices Served; and Letters, &c., Issued. 1907 1908 Number of Inspections 9056 9657 „ Re-inspections 12044 12858 „ Intimation Notices issued 901 893 „ Statutory Notices issued 331 512 Letters issued 5372 6670 „ Notification sent to "Head Teachers" of Schools, respecting notified cases of infectious disease 565 414 „ Notifications respecting cases of Measles 218 84 Certificates as to Water Supply. The number of Certificates issued during the year was 47, as compared with 77 in 1907. 66 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 1908 the Council have approved of 310 plans for the drainage of new buildings, and 2976 plans for alterations, etc., to drains of existing premises. During the year 1908, 911 notices of drainage reconstruction or alteration were received, and in 652 cases the work necessitated the deposit of plans and written particulars. In 438 of these latter cases the work could not be delayed until the Council's approval of the plans had been received; in each of these cases the prescribed "urgency" notice was, therefore, submitted by the builders, the work put in hand forthwith and the plans, etc., deposited at a later date. Of the 652 notices of drainage alterations, etc., requiring the deposit of plans, 294 related to work that involved the entire reconstruction of the drainage system. In 427 of the 652 drainage cases the work was carried out voluntarily, the number of instances in which voluntary complete reconstruction was carried out being 140. 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. Combined Drainage. In many of the metropolitan boroughs, considerable sums of the ratepayers' money are expended every year in the repair of combined drains, which by a legal technicality have become "sewers" for which the ratepayers are responsible. Some idea of the amount of public money expended in this way may be gathered from the following table, which is extracted from a special report on combined drainage by Mr. A. Powel Coke, Chief Clerk to the St. Pancras Health Department. It should be stated, however, that this table does not represent the whole expenditure, because it appears that in some of the boroughs the cost under the head of combined drainage has not been separated from the cost of the general maintenance of sewers. 67 * These figures are approximate. † Incomplete total. ‡ Contributions to owners towards repair or reconstruction of combined drainage. F 2 Summary of Amounts paid in repairing or reconstructing Sewers due to Combined Drainage by the Metropolitan Borough Councils. Borough. 1899-00. 1900-1. 1901-2. 1902-3. 1903-4. 1904-5. 1905-6. 1906-7. 1907-8. Total. £ s. d. £ s. d. £. s, d. £ s. d. £ 5. 1. £ s. d. £ s. d. £ s. d. £ s. d. £ s. d. Battersea 2427 15 3 3151 0 5 1629 2 5 2343 4 10 2876 13 2 2127 0 0 1878 0 0 1405 0 0 1117 0 0* 18954 16 1 Bermondsey Average expe nditure £250 per annum No separate account kept — — 273 0 0 400 0 0* 2423 0 0† Bethnel Green 1150 8 6 1399 17 7 1125 19 5 2609 12 2 2741 3 9 1943 8 8 1997 13 5 1296 18 7 1237 15 0 15502 17 1 Camberwell 1436 0 0 2200 0 0 1308 0 0 700 0 0 900 0 0 1200 0 0 800 0 0 525 0 0 400 0 0 9469 0 0 Chelsea — — 50 6 0 98 16 0 - Nil 16 0 0 16 0 0 53 13 6 234 15 6† Deptford — — Total for years 1900-1904: 182 6 5 126 8 2 10 14 5 30 7 10 30 10 8 380 7 6† Finsbury Not available 33 0 0 32 8 11 15 0 0 15 0 0 69 0 0 81 0 0 40 0 0 127 0 0 412 8 11† Fulham 1020 9 I 407 8 0 1304 8 10 450 11 7 523 0 7 326 8 2 287 4 6 222 19 11 260 13 0 4803 3 8 Greenwich — — — Approximate expenditure 1904-1906 257 13 10 Nil Nil 257 13 10† Hackney Approximate expenditure £3000 per an num. — — — — — 27000 0 0* Hammersmith 142 1 5 191 19 9 210 7 4 102 2 11 110 4 8 80 16 11 56 9 5 59 5 5 127 19 8 1081 7 6 Hampstead — — — 200 0 0 150 0 0 100 0 0 32 0 0 37 0 0 Nil 519 0 0† Holborn — — — — — Nil Nil No separate account kept — Islington 3850 0 0 2852 5 3 3930 3 3 4877 12 2 4513 9 1 2995 0 0 4332 0 0 4369 0 0 2075 0 0 33794 9 9 Kensington — — — 130 15 4 24 0 0 59 0 0 10 0 0 111 13 1 Nil 335 8 5† Lambeth — — — 1184 4 7 1590 6 0 549 17 5 540 19 2 1105 0 11 1300 0 0* 6270 8 1† Lewisham Estima ted expendit ure for years 1900-1904: 1000 0 0 No separate account kept 1000 0 0† Paddington 2361 0 0 1754 0 0 1784 0 0 1367 0 0 1114 0 0 753 18 0 871 0 6 887 12 7 1036 2 10 11928 13 11 Poplar 1265 3 4 1575 0 2 1318 11 10 1870 8 3 1447 17 4 1096 19 6 1075 0 10 1033 14 8 431 9 7 11114 5 6 St. Marylebone No separate account kept — 7 14 0‡ 35 0 o‡ No separate account kept 42 14 0† St. Pancras 1931 12 9 4209 14 2 3512 3 7 5361 8 0 4001 12 5 1998 17 5 1489 2 7 1458 3 1 546 1 7 24508 15 7 Shoreditch 701 11 8 576 10 11 361 14 6 592 17 2 485 6 2 458 7 1 318 6 4 460 0 0 460 0 0* 4414 13 10* Southwark — — 1066 15 5 760 7 11 1160 2 4 711 4 1 877 6 2 1079 5 8 600 0 0* 6255 1 7† Stepney — — 774 19 1 815 18 1 740 5 5 1236 13 5 1229 7 9 1466 2 2 2178 14 8 8442 0 7† Stoke Newington — — 53 0 0 Unable to give figures 191 12 11 182 8 10 185 0 0' 612 1 9† Wandsworth Nil 186 8 11 134 2 10 514 19 10 178 8 2 175 11 7 70 19 5 Nil 86 6 10 1346 17 7 Westminster Estimated e xpenditure £ 250 per annum — — — — 2250 0 0* Woolwich 1220 7 0 332 3 0 879 11 4 1255 12 0 500 1 7 399 9 6 256 16 11 113 1 9 358 7 5* 5315 10 6 68 In the year 1907, at the initiative of the St. Pancras Borough Council, steps were taken by the Metropolitan Borough Councils to secure an amendment of the law relating to combined drainage in order to relieve the ratepayers of the heavy burden which the present admittedly defective state of the law imposes upon them. Conferences were held at the St. Pancras Town Hall on June 24th, and December 6th, 1907, and a Bill was prepared. On March 5th, 1908, the Bill was introduced into the House of Commons by Mr. W. H. Dickinson, M.P. for North St. Pancras, and was read a first time. The Bill was backed by the following members of Parliament:—Mr. Dickinson, Sir William Bull, Mr. Bowles, Sir William Collins, Mr. Crooks, Mr. T. Davies, Sir George Fardel 1, Mr. Claude Hay, Sir Henry Kimber, Earl Percy, Sir Albert Spicer, and Mr. Waterlow. The Bill is set out in full below. METROPOLITAN SEWERS AND DRAINS BILL. Memorandum. The object of this Bill is to amend the law relating to combined drainage. There are two kinds of combined drain, the "combined drain" which in law is a "drain," and the "combined drain" which in law is a "sewer." The former is repairable by the private owner; the latter by the public authority. In the opinion of builders, owners, and local authorities, combined drains were originally constructed as drains, and were mutually regarded as such until the retrospective case of "Travis v. Uttley" (1893), the effect of which has been to convert thousands of drains, which had been privately owned and privately maintained, into sewers vested in the local authorities, and maintainable at the expense of the ratepayers. The state of the law has been described by the Lord Chief Justice, who said in a recent decision, "It seems to me, as I have before pointed out, to be essential "that there should be some "amendment of the law upon this subject. The state of the "authorities is such that it appears to be impossible either to "reconcile the various decisions or to deduce from them any logical "rule." 69 Several provincial authorities, notably West Ham, Croydon, Carlisle, Leyton, Wood Green, Sheffield, &c., have been successful in obtaining the powers which the metropolitan local authorities ask for by this Bill. [8 Edw. 7.] Metropolitan Sewers and Drains. A Bill to Amend the Metropolis Management Acts with respect to Sewers and Drains. Be it enacted by the King's Most Excellent Majesty, by and with the advice and consent of the Lords Spiritual and Temporal, and Commons, in this present Parliament assembled, and by the authority of the same, as follows:— 1. In and for the purposes of the Metropolis Management Acts, 1855 to 1899, and the Public Health (London) Act, 1891, or any Act or Acts amending the same, the word "drain" shall be deemed to include any sewer or drain, whether constructed before or after the passing of this Act, with which two or more houses, buildings, or premises are, at the date of the passing of this Act, or may at any time thereafter be connected, or which is used or capable of being or intended to be used for the conveyance of the drainage of such houses, buildings, or premises directly or indirectly to any sewer which has been approved as such by the Metropolitan Commissioners of Sewers, the Metropolitan Board of Works, or the London County Council, but shall not include any sewer so approved as aforesaid. 2. This Act may be cited as the Metropolis Management Amendment Act, 1908, and shall be construed as one with the Metropolis Management Act, 1855, and the Acts amending the same The Bill was blocked by a few London members, and never reached a second reading. It will again be introduced this session, but there is little hope that it will fare better than last year. In Hampstead during 1908 many claims were made that combined drains were "sewers" repairable by the ratepayers, but all the claims were successfully resisted except three. In these cases owing to the absence of proper plans the Council were obliged to assume responsibility for the drains and repair them as "sewers." 70 Houses Let in Lodgings The number of houses registered as houses let in lodgings at the end of 1908, was 315, the same number as in 1907. The registered houses are situated chiefly in the following streets: — Fleet Road. Dunboyne Street. Fairfax Mews. Bolton Road. Netherwood Street. Linstead Street. Lowfield Road. Kelson Street. The number of tenement houses in Hampstead that might with advantage be dealt with under the bye-laws relating to houses let in lodgings is over 800, but hitherto the sanitary inspectors have been so much occupied with other work that it has been found impossible to keep anything like so large a number of houses under proper supervision. But now that an additional lady inspector has been appointed it will be possible to make a considerable increase in the number of houses placed upon the register. Uninhabitable or Insanitary Dwellings. The following is a list of dwellings that were found, during the year, to be so insanitary that extensive structural alterations were necessary to make them fit for human habitation. Most of the premises were, as was the case in former years, stable dwellings:— 7, 8, Abbey Lane. 3, Albert Mews. 15, Alexandra Mews. 14a, 51, Belsize Lane. 13a, Belsize Mews. 17, Church Lane. Weatherhall House Stables, Christ Church Road. 4, 10, Collas Mews. 8, 24, 26, 38, 52, 52a, Fairfax Mews. 1-5, Golden Yard. Ebenezer Chapel and Cottage, Kilburn Vale. 1-5, 22-30, Midland Cottages, Mill Lane. 71 1-6, Prince Arthur Buildings, Church Lane. 1, Regents Mews. Finney's Stables, 3a, Regents Park Road. 76, Upper Park Road. St. James' Cottage, Vale of Health. 13, West Hampstead Mews. 1, Williams' Mews. 11, 15, 17, 19, 21, Winchester Mews. 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 or abatement 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 of 56 dwellings, this number being 44 less than the number for which applications were made in 1907. 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 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 1908 the number of dwellings certified was 4, as compared with 12 in 1907. The following is a list of the dwellings certified, with the date of the certificate. 72 Premises. No of Dwellings. Date of Certificate. 1908 4, Holmdale Mansions, Holmdale Road 1 3rd March 1, 2, 3, Lyncroft House, Lyncroft Gardens 3 1st July Underground Rooms Fifty-four underground rooms were found to be illegally occupied during 1908, the streets in which the rooms were found being as follows:— Acol Road. Belsize Crescent. Bolton Road. Canfield Gardens. Compayne Gardens. East Heath Road. Fleet Road. Heath Drive. Heath Street. King's College Road. New End. West End Lane. 3 of these rooms were permanently closed, 4 ceased to be occupied separately, 37 were altered to comply with the Public Health Act, 10 were in process of alteration at the end of the year. 12 of the underground rooms dealt with during the year were occupied by the caretakers of flats. It is unfortunately by no means uncommon to find the caretakers of high-class flats housed in illegally occupied underground rooms, and surprise is sometimes expressed that the authorities should allow such rooms to be constructed. There is, however, nothing to prevent the construction of underground rooms that do not comply with the requirements of the Public Health Act relating to underground rooms; the offence consists in allowing such rooms to be separately occupied as a dwelling, and it is only by systematic inspection that the offenders can be detected and brought to book. Our experience in Hampstead in connection with underground rooms illustrates the importance of systematic house-to-house inspection, even in a superior residential district. Offences against the Public Health 73 Acts are by no means confined to areas occupied by the less fortunate members of the community. On May 27th, 1908, an important point in the law relating to underground rooms was decided in the Divisional Court on a case stated by the Hampstead Justices. The facts in this case were as folows: The owner of a block of residential flats in the Town Ward was prosecuted by the Borough Council for allowing the caretaker to occupy three underground rooms that did not comply with the requirements of the Public Health (London) Act, 1891, the rooms being deficient in height, light and ventilation, and in the provision of a proper area outside. Before the Justices, counsel for the defendant admitted that the rooms did not comply with the Act, but he took the technical point that the sanitary authority had known of the occupation for a period of more than six months, and therefore that by Jarvis's Act they were debarred from taking proceedings. The Justices upheld this view and dismissed the summons, but agreed to state a case. In the Divisional Court Mr. S. G. Turner appeared for the Council, and Mr. W. Stewart for the respondent. The Lord Chief Justice, in his judgment, said that the real point in the case was this: Had the rooms been occupied at any time during the six months immediately preceding the issue of the summons? If so, an offence had been committed for which proceedings could be taken. In this case it was admitted that the rooms had been so occupied. The appeal, therefore, must be allowed, with costs, and the case sent back to the Justices. Mr. Justice Darling added that Jarvis's Act limited the time during which proceedings could be taken to six months from the time when the matter arose. In this case the matter was continually arising. The six months' period was a moving period, and as each night passed a fresh offence arose on the front of the period, and one went off at the end. Complaints as to Sewer Ventilators. During the year, 70 complaints of smells from surface ventilators were received, as compared with 60 in 1907. This number does not include those complaints which were sent direct to the Borough Engineer. 74 Copies of these 70 complaints were sent to the Borough Engineer. During the year Webb's Patent Sewer Gas Destructor Lamps were fixed in the following situations:— Netherwood Street, by Kelson Street. Hemstal Road, by Lowfield Road. Sumatra Road, near Kingdon Road. Fairhazel Gardens, by Goldhurst Terrace. Broomsleigh Street, opposite the School. The importance of the problem of sewer ventilation was emphasized during the year 1908 by the publication, in the Annual Report of the Medical Officer of the Local Government Board, of an important report by Dr. F. W. Andrewes on "Micro-organisms present in sewer air and in the air of drains." Dr. Andrewes, it will be remembered, was engaged by the Borough Council in 1905 to investigate the air of the Hampstead sewers in order to determine whether the emanations from the ventilating grids, which were the subject of many complaints, were likely to cause disease. Prior to Dr. Andrewes' observation in Hampstead there was a fairly general concensus of opinion amongst bacteriologists that under ordinary conditions sewage does not give up its own specific bacteria to the air with which it is in contact. The earlier experiments had shown that sewer air contained fewer bacteria than fresh air, and such bacteria as were found in sewer air were shown to be of the same species as those found in fresh air. But since these experiments, which were made for the most part about fifteen years ago, great improvements have been effected in bacteriological technique, and Dr. Andrewes, in making his Hampstead observations, was able to employ methods of investigation that were much more refined and trustworthy than those upon which the earlier workers had to rely. His results threw grave doubt on the view then commonly held that "the bacteria of sewer air are derived only from the fresh air and not at all from the sewage." He obtained evidence that "sewer air may be the bearer of micro-organisms derived from sewage itself," and his observations led him to the following conclusions:— 75 Sewer air may possibly serve to carry organisms derived from sewage, though probably to a very limited extent. Since some infective diseases are sewage borne, there must exist a still more remote chance that they may be thus conveyed. I would add my opinion that where sewer air escapes freely into the open air, it is at once so freely diluted that the chance of disease being thus conveyed becomes almost negligible. It is further more than probable that the effect of sewer air escaping in concentrated form into houses is due as much, or more, to some traces of a chemical poison too minute for chemical recognition, than to any pathogenic micro-organisms which it may convey. The subsequent experiments carried out by Dr. Andrewes on behalf of the Local Government Board afford much stronger evidence than the Hampstead experiments did in disproof of the opinion that sewage organisms are not found in sewer air. This later evidence emphasizes the bacteriological importance of sewer air, and does not justify the optimistic view held by Dr. Andrewes in 1905. The conclusions he has now reached are expressed in the following extract from his report to the Local Government Board. Sufficient evidence has been brought forward in Sections III., IV., and V. of this report to justify the conclusion that under many ordinary circumstances characteristic sewage bacteria are to be found in the air of drains and sewers. The view, till recently current, that sewage does not readily give up its bacteria to sewer air is shown to be incorrect. The evidence is of more than one kind, and it all points in the same direction. (1) In Section III. I have shown that the streptococci of drain air when tested as to their biological characters, are found to correspond, almost in their entirety, with those of sewage and only to a slight extent with those which chiefly abound in fresh air. The types of streptococci which are most abundant in fresh air were not found in the air of sewers and drains. The evidence obtained from the streptococci of drain air in the City of London is in harmony with that previously obtained from the streptococci of the air of main sewers in Hampstead. (2) In Section IV. I have shown that bacilli of the colon group obtained from drain air, correspond essentially in their biological characters with those of sewage, and that such bacilli can only be obtained from fresh air with great 76 difficulty or not at all. The evidence obtained under this section from drain air in the City of London is far more convincing than that which I was able to obtain previously from the sewer air of Hampstead. (3) Lastly, it is shown that a test microbe, added in bulk to the contents of the drains under suitable conditions of splashing, can be recovered locally from the drain air in great numbers, and can also be recovered from the air at considerable distances (50 feet and 390 feet) from the point at which it was added to the sewage. From this evidence, no less than from that obtained by Major Horrocks, it may be taken as conclusively proved that under certain circumstances, at all events, sewage gives up its bacteria to sewer and drain air. Such bacteria may form but a small proportion of those present in sewer air: this is likely, for they would not otherwise have escaped detection by previous observers. But it is probable that the circumstances under which sewage gives up its bacteria are common and ordinary circumstances in sewer and drain construction, for the employment of selective culture media has enabled me to discover them wherever so far looked for in the air of drains and sewers. The importance of the subject is plain, for though the organisms which I have been able to detect in sewer air are not in themselves known to be prejudicial to health, being for the most part well-known saprophytes of the normal alimentary tract, yet their value is evident as indices of the possible presence of more harmful sewage-borne microbes. Dr. Andrewes is now engaged on a further series of observations, which, it is believed, will considerably strengthen the evidence of the bacteriological impurity of sewer air. These observations will shortly be published. It is interesting to note that the latest results of scientific research justify the attitude of those who have consistently held with the late Dr. Vivian Poore that "there is more in stinks than we wot of," and who have refused to allow the negative conclusions of an ill-developed bacteriological technique to minimise the importance of emanations of foul-smelling sewer gas. In view of the knowledge that has now been acquired it is eminently desirable that the whole question of sewer ventilation should be thoroughly reconsidered. 77 The Water Supply of Tenement Houses. One of the most important problems of London sanitation is the proper regulation of tenement houses. These in the great majority of cases are houses which, though now occupied by several families, were constructed for occupation by one family, and the sanitary arrangements and general domestic conveniences were designed accordingly. In London the poorer classes to a very large extent live in houses of this kind, and it is only in exceptional cases that any structural alterations have been made to adapt the houses for occupation by more than one family. The result is that the tenements lack many of the domestic conveniences and amenities that make up a home. Sanitary authorities are inadequately provided with powers to enforce structural alterations in houses that have become let in tenements, but recent enactments have led to improvements in this direction. The London County Council have made a bye-law that requires in tenement houses one water-closet for every twelve persons, and the London County Council (General Powers) Act, 1907, brings into force some important provisions relating to water supply. The question of water supply is particularly important. In many tenement houses the only water supply for the whole house is that drawn from a tap in the basement, and very few are provided with a separate tap for each tenement. There was formerly some doubt whether sanitary authorities were not empowered to require a separate water-supply to each tenement under section 48 (1) of the Public Health (London) Act, 1891, which provides as follows: An occupied house without a proper and sufficient supply of water shall be a nuisance liable to be dealt with summarily under this Act, and, if it is a dwelling house, shall be deemed unfit for human habitation. In 1905, however, an important decision was given in the Marylebone Police Court by Mr. Plowden, who in dismissing a case instituted by the Paddington Borough Council stated that the words "proper and sufficient" in the above section referred to the source of supply and not to the provision of taps within the house. In 1907 the London County Council placed the matter on a more satisfactory basis by securing the insertion of the following section in their Act of that year: 78 (78) For the purposes of section 48 (provisions as to house without proper water supply) of the Public Health (London) Act, 1891, a tenement house shall be deemed to be a house without a proper and sufficient supply of water unless there shall be provided on the storey or one of the storeys in which the rooms or lodgings in the separate occupation of each family occupying such house are situate a sufficient provision for the supply of water for domestic purposes. It is provided, however, that this section shall not apply to "any tenement house in respect of which it can be shown that any such provision for the supply of water as aforesaid is not reasonably necessary." During the year 1908 the above section was put in force, and the number of houses dealt with was 24. In each house a water tap and a glazed earthenware sink were provided on each floor. The provision of a sink is important, for without it the water tap might become a source of dampness and cause considerable damage to the house. The section of the General Powers Act quoted above makes no provision for a sink, and in some cases the owners having provided water taps refused to fix sinks beneath them. In these cases the house appeared to be without the "sufficient drain" required by section 73 of the Metropolis Management Act, 1855, and after the service of notices under that section the sinks were duly provided. During the year the sanitary regulation of tenement houses was further advanced by the London County Council (General Powers) Act, 1908, which contains the following section relating to accommodation for cooking of food—tenement houses frequently lack such accommodation. If at any time it appears to any sanitary authority that in any tenement house within their district sufficient and suitable accommodation for the cooking of food is not provided for the use of each family occupying such house on the storey or one of the storeys in which are situate the rooms or lodgings in the separate occupation of such family, such sanitary authority may cause notice to be served on the owner of such house requiring him within such reasonable time as may be specified in the notice to provide sufficient and suitable accommodation for the purpose aforesaid. 79 Unfortunately this section only applies to tenement houses that began to be occupied as such after the passing of the Act, and it can only have a very limited operation. Nevertheless it marks a distinct step in advance. The London County Council (General Powers) Bill, 1909, contains a similar section, enabling sanitary authorities to require proper accommodation for food storage in tenement houses, and it is to be hoped that this section will become part of the sanitary code for London. Hairdresser's Business. During the vear an application for a Certificate in respect of the suitability of his premises, was received from a Hairdresser. This was granted by the Council on 3rd December, and is the second Certificate of the kind which has been issued by the Council, the other having been issued in 1905. Public Mortuary. During the year the bodies of 78 persons were brought to the Mortuary as against 84 last year—40 by order of the Coroner, 15 by the Police, and 22 at the request of friends of the deceased persons. In 55 instances, or 70 per cent. of the bodies admitted, inquests were held, and in 40 instances, or 51 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 or Verdict. Number of Bodies received. Deaths from natural causes 49 Accidental deaths 11 Suicide 14 Neglect at birth 1 Misadventure 2 Total 77 One of the bodies received at the Mortuary was that of a still born child. 80 MORTUARY RECORD FOR THE YEAR, 1908. Bodies Admitted. No. of Post-Mortems. No. of Inquests. No. of Funerals from Mortuary. Month. Males. Females. Totals. Males. Females. Totals. January 4 3 7 4 2 6 7 6 February 4 5 9 — 2 2 3 8 March 5 1 6 3 — 3 4 6 April 8 3 11 3 — 3 4 9 May 4 2 6 3 — 3 5 6 June 3 2 5 1 2 3 4 5 July 5 1 6 3 1 4 6 6 August 5 1 6 3 — 3 5 6 September 5 — 5 3 — 3 4 5 October 5 1 6 2 — 2 5 5 November 2 — 2 2 — 2 2 2 December 4 5 9 4 2 6 6 9 Totals 54 24 78 31 9 40 55 73 81 Food Inspection. No seizures of unsound and diseased food were made during the year, but the following articles were voluntarily surrendered to the inspectors. Date. Premises. Food seized or surrendered. April 20th Hampstead Heath 2 barrow loads Walnuts. August 4th West End Lane 1 Salmon (15½ lbs.) Food Premises. Section 8 of the London County Council (General Powers) Act, 1908, contains the following important provisions relating to premises on which food is prepared or sold. (1) From and after the passing of this Act the following provisions shall apply to any room shop or other part of a building within the County in which any article whether solid or liquid intended or adapted for the food of man is sold or exposed for sale or deposited for the purpose of sale or of preparation for sale or with a view to future sale:— (a) No urinal water-closet earth closet privy ashpit or other like sanitary convenience shall be within such room shop or other part of a building or shall communicate therewith except through the open air or through an intervening ventilated space. (b) No cistern for supplying water to such rooms shop or other part of a building shall be in direct communication with and directly discharge into any such sanitary convenience. (c) No drain or pipe for carrying off foecal or sewage matter shall have any inlet or opening within such room shop or other part of a building. (d) No such room shop or other part of a building shall be used as a sleeping place and so far as may be reasonably necessary to prevent risk of the infection or contamination of any such article as aforesaid no sleeping place shall adjoin such room shop or other part of a building and communicate therewith except through the open air or through an intervening ventilated space. G 82 (e) Refuse or filth whether solid or liquid shall not be deposited or allowed to accumulate in any such room shop or other part of a building except so far as may be reasonably necessary for the proper carrying on of trade or business. (f) Due cleanliness shall be observed in regard to such room shop or other part of a building and all articles apparatus and utensils therein and shall be observed by persons engaged in such shop room or other part of a building. (2) If any person occupies or lets or knowingly suffers to be occupied any such room shop or other part of a building wherein any of the conditions prohibited by this Section exist or does or knowingly permits any act or thing therein in contravention of this Section he shall be liable on summary conviction to a fine not exceeding for a first offence twenty shillings and for every subsequent offence five pounds and in either case to a daily penalty not exceeding twenty shillings. Structural alterations are now being carried out in a number of premises in order to make the premises comply with the Act, and in my next Annual Report I shall be able to report fully on the subject. Inspection of Promises 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 61 Confectioners 61 Grocers 74 Provision and Cheesemongers 46 Greengrocers and Fruiterers 62 Fishmongers 27 Fried Fish Shops 10 General Shops 22 363 1,025 Inspections were made of these premises during the year and 75 Notices were served. 83 The Butter and Margarine Act, 1907. Section 1 of the above Act provides for the registration of "butter factories," which are defined to be "any premises on which by way of trade butter is blended, reworked or subjected to any other treatment, but not so as to cease to be butter." One butter factory was registered during the year. Slaughter Houses. There are five Slaughter houses in the Borough, and these have been regularly inspected during the year, the number of inspections made being 130. On the 13th 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. 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. Ice Cream. The sale of ice cream in London is controlled by sections 42 and 43 of the London County Council (General Powers) Act, 1902. There are 76 shops in the Borough in which ice cream is sold, and 133 inspections at these premises were made during the year. In addition to these, the barrows which stand in the streets, and on Hampstead Heath on Bank Holidays have been inspected. Table of sanitary work carried out:— Premises or parts of premises repaired, cleansed and limewashed 8 Yard paving repaired 2 Water closets renewed 2 Dustbins provided 2 Other defects remedied 3 g 2 84 Milk Supply. The number of persons registered as purveyors of milk is 93, and the number of premises on which milk is sold is 113. The difference in the two numbers is accounted for by the fact that some of the milk sellers occupy more than one shop. The premises on which milk is sold are as follows: — Dairies 55 Bakehouses and Confectioners 23 Restaurants and Coffee Shops 10 General Shops 25 Four of the registered milk sellers do not occupy shops, two being registered in reference to refreshment tents on Hampstead Heath on Bank Holidays, and two have milk rounds in the Borough but no shops. One milk seller was prosecuted and fined Five shillings and costs for selling milk without being registered. During the year 416 inspections were made of premises where milk is sold, and the following works were carried out:— Premises or parts of premises repaired, cleansed and limewashed 23 Water cisterns cleansed 5 Drains repaired or reconstructed 4 Soil pipes reconstructed 1 Water closets renewed 3 Water closets cleansed 4 Rain water pipes repaired or renewed 8 New sinks fixed 2 Yard paving repaired or renewed 8 Dustbins provided 10 Gullies cleansed 2 Nuisance from dampness abated 8 Other sanitary works 7 Particulars as to milk adulteration will be found in the section relating to the Sale of Food and Drugs Acts. Milk and Tuberculosis During the year 1907, the Royal Commission on Tuberculosis issued their second interim report, which contained the following 85 important statements relating to the danger arising from the consumption of tuberculous milk:— "There can be no doubt but that in a certain number of cases the tuberculosis occurring in the human subject, especially in children, is the direct result of the introduction into the human body of the bacillus of bovine tuberculosis; and there also can be no doubt that in the majority at least of these cases the bacillus is introduced through cows' milk. Cows' milk containing bovine tubercle bacilli is clearly a cause of tuberculosis and of fatal tuberculosis in man. "A very considerable amount of disease and loss of life, especially among the young, must be attributed to the consumption of cows' milk containing tubercle bacilli. The presence of tubercle bacilli in cows' milk can be detected, though with some difficulty, if the proper means be adopted, and such milk ought never to be used as food. There is far less difficulty in recognising clinically that a cow is distinctly suffering from tuberculosis, in which case she may be yielding tuberculous milk. The milk coming from such a cow ought not to form part of human food, and indeed ought not to be used as food at all. "Our results clearly point to the necessity of measures more stringent than those at present enforced, being taken to prevent the sale or the consumption of such milk." In view of the Royal Commission's report the Public Health Committee decided to ascertain how far the milk supply of Hampstead was tuberculous, and 25 samples of milk were taken in the year 1907, and submitted to the Lister Institute of Preventive Medicine for bacteriological examination. Of these samples, 4, or 16 per cent., were found to contain tubercle bacilli, and in view of this result the Committee decided that an additional 50 samples should be examined. As a matter of fact 51 samples were taken during 1908, an extra sample being added for a special reason, and these, together with the 25 samples examined in 1907, make a total of 76. Of these, 21 were taken on delivery at railway stations, 14 on delivery at various hospitals in Hampstead, 33 at milkshops, 86 and 8 on milk-rounds. A small proportion only of the milk consumed in Hampstead enters the borough by rail, and therefore the samples were not limited to those at railway stations. In nearly every case, however, the source of the supply was ascertained. Of the total 76 samples, 17, or 22.4 per cent., were found to contain virulent tubercle bacilli; 6 of these being taken at railway stations 3 at hospitals, 7 at milkshops, and one on a milk-round. In the case of each of the tuberculous samples the source of supply was ascertained, and the counties from which the tuberculous milk was supplied were as follows:—Bedfordshire, Buckinghamshire, Essex, Leicestershire, Northamptonshire, Oxfordshire, Somersetshire, Staffordshire and Wiltshire. The Borough Council have no power to stop the supply of tuberculous milk, but under the London County Council (General Powers) Act, 1907, the County Council are empowered to prohibit the supply of such milk within the County. Accordingly upon receipt of a report from the Lister Institute that a sample had been found to contain tubercle bacilli, I at once communicated the facts to the Medical Officer of Health of the County of London, and the officers of the County Council visited the farms from which the milk came and examined the cows. The number of such farms was 13, and five cows were discovered to be yielding tuberculous milk. Of these cows, two were stated to be slaughtered, and the other three put out of milk. The situation with regard to tuberculous milk has been considerably altered by the issue in the present year of the third interim report of the Royal Commission on Tuberculosis. Hitherto it has been generally held that a tuberculous cow will not give tuberculous milk unless the udder is affected with the disease. The experiments of the Royal Commission have now proved that this view is mistaken. Cows suffering from tuberculosis, but showno sign of disease of the udder, may yield milk containing tubercle bacilli in abundance, the bacilli being derived from the cow's excreta and from the matter discharged from the mouth and nostrils The conclusions of the Royal Commission on this point are contained in the following extracts from their third interim report:— 87 "Tuberculosis involving the udder is comparatively common in cows, and in such cases their milk always contains tubercle bacilli, and is therefore dangerous for human beings consuming it. It was, however, undecided what is the danger, if any, attaching to the milk of tuberculous cows in which the udder presents no evidence of disease. We therefore took the opportunity of making a number of observations and experiments bearing on this point. The experiments were made with the milk of cows which had contracted the disease in the natural way. None of the cows investigated showed any sign of disease of the udder during life, and in all, after slaughtering, the udder was carefully examined for tuberculous lesions and tubercle bacilli. No tuberculosis was found except in one case, in which one quarter of the udder showed four small nodules. These could not possibly have been detected during life. We found that the milk of cows obviously suffering from tuberculosis contained tubercle bacilli whether the milk was obtained in the ordinary way or was withdrawn from the teat by means of a sterilised catheter. The presence of tubercle bacilli in the milk of cows clinically recognisable as tuberculosis, confirms the opinion we expressed in our Second Interim Report that the milk of such cows must be considered dangerous for human beings. The experiments which we have carried out with regard to the infectivity of the faeces of tuberculous cows were dictated by knowledge of the fact that dirt of various kinds from cows and the cowshed is almost constantly present in milk as it reaches the consumer. Cows suffering from extensive tuberculosis of the lungs must discharge considerable numbers of bacilli from the air passages in the act of coughing, and some of the bacilli thus expelled may find their way into the milk. But our experiments indicate that the excrement of cows obviously suffering from tuberculosis of the lungs or alimentary canal must be regarded as much more dangerous than the matter discharged from the mouth or nostrils. We have found that even in the case of cows with slight tuberculous lesions tubercle bacilli in small numbers are discharged in the faeces, while as regards cows clinically tuberculous our experiments show that the faeces contain large numbers of living and virulent tubercle bacilli. The presence of tuberculous cows in company with healthy cows in the cowshed is therefore distinctly dangerous, as some of the tubercle bacilli which escape from their bodies in the excrement are almost certain to find their way into the milk." 88 The discoveries of the Royal Commission have added considerably to the difficulties of the milk problem. It has been demonstrated that tuberculosis of the udder has not the special importance that was formerly assigned to it, and that any form of tuberculosis in a milch cow must be regarded as dangerous to the public. Tuberculosis is very common in milch cows, and a considerable amount of the milk supplied to the public contains tubercle bacilli. It has been surmised that such milk is supplied chiefly to the poorer districts, but our experience in Hampstead does not confirm this. We have found that of the 76 samples of milk examined no less than 22.4 per cent. contained tubercle bacilli. It is evident that the danger arising from tuberculous milk is widespread, and can only be dealt with effectively by large and comprehensive measures. The Government have undertaken to deal with the question of milk supply on a national basis, but at the time of writing the promised Bill has not been introduced into Parliament. 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 508, and the number certified by the Public Analyst to be adulterated was 18, or 3.5 per cent. of the total number. The corresponding percentage in 1907 was 8.8; in 1906 it was 4.8. In addition 11 samples were certified to be of low quality. 409 samples were purchased from Hampstead tradesmen, and 99 from persons residing without, but trading within the Borough. The percentages of adultered samples in these two classes were 3.4 and 4 respectively. 13 samples were taken on Hampstead Heath on Bank Holidays, and of these 2, or 15.3 per cent., were adulterated. 38 samples were taken on Sundays; one of this number was found to be adulterated, and three were of low quality. 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:— 89 Article. No. Taken. Adulterated. Low Quality Ale 3 — — Butter 63 2 — Camphorated Oil 3 — — Cheese 15 — — Cocoa 6 — — Coffee 15 1 — Distilled Water 3 1 — Golden Syrup 2 — — Gregory's Powder 4 — — Iodine, Liniment of 2 — — Jam 9 — — Kidneys (Pigs) 2 — — Lard 11 — — Lemon Squash 2 — — Lime Water 3 — — Margarine 13 — — Milk 331 11 11 Olive Oil 2 — — Pork Pie 1 — — Rum 1 — — Sweets 5 — — Tea 2 — — Tripe 7 3 — Vinegar 2 — — Whiskey 1 — — Totals 508 18 11 The following table shows the number of samples analysed during each year, from 1902 to 1908, the number and percentage of the adultered samples, and the fines and costs recovered in legal proceedings:— Year. Samples analysed. Number adulterated. Percentage adulterated. Fines and costs. £ s. d. 1902 315 15 4.7 42 7 6 1903 366 14 3.8 37 3 0 1904 406 8 1.9 35 8 6 1905 414 8 1.9 33 15 0 1906 413 20 4.8 50 8 6 1907 407 36 8.8 49 18 6 1908 508 18 3.5 12 1 0 90 In 1908 the percentage of adulterated samples was considerably below that in either of the two preceding years, but it was higher than in the years 1004-5. The drop is probably due to some extent to the increase in the total number of samples taken. 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) 77 3 3.8 No. 2 (Belsize) 77 2 2.5 No. 3 (Adelaide) 19 — — No. 4 (Central) 15 — — No. 5 (West End) 66 4 6.0 No. 6 (Kilburn) 100 2 2.0 No. 7 (Priory) 55 3 5.4 Totals 409 14 3.4 Legal proceedings in respect of adulteration were instituted in 14 cases, and in 4 cases the vendors were cautioned. In 9 of the 14 prosecutions the defendants were convicted, and in 5 cases the summons was dismissed. In 3 of these 5 cases a conviction was not obtained because the defendants were successful in raising the warranty defence. In another case the identity of the defendant (a Bank Holiday itinerant milk seller) was a matter of some doubt, and the Bench decided to give him the benefit of the doubt and dismissed the summons. In the remaining unsuccessful prosecution the defendants were summoned for selling distilled water containing 5½ grains of extraneous matter per gallon, the extraneous matter consisting of carbonate of lime and dirt, and the summons was dismissed because the Bench had some doubt as to how the extraneous matter had got into the water. One prosecution had reference to a sample of milk deficient in fat to the extent of 42 per cent., which was sold from a refreshment tent erected on the Heath on Whit Monday by a philanthropic 91 society for the purpose of supplying the Bank Holiday crowd with non-intoxicating beverages. In this case the Council felt bound to deal with this society as they would have dealt with a tradesman in similar circumstances, and in view of the fact that the milk, although sold at the usual price, was seriously deficient in an important ingredient, it was decided to prosecute. The defendants in this case were fined five shillings, with twelve and sixpence in costs. Complaints. During 1908, 891 complaints were made of the existence of insanitary conditions. A list of the matters of which complaint was made is given below:— Accumulations, offensive 17 „ of garden and other refuse 10 Animals, improperly kept 23 ,, dead 10 Carpet beating and shaking 4 Dampness in premises 34 Dirty premises 16 Drains, bad condition of 20 ,, defective 33 ,, stopped 33 Dust, non-removal 70 Dust receptacles, foul or dilapidated 6 ,, absence of, or insufficient 44 Gipsies 4 Insanitary condition of premises 47 Illness attributable to defective drains 8 Manure not removed 11 Overcrowded premises 20 Rats, nuisance from 11 Roadways, condition of 20 Roofs and gutters, defective and leaky 9 Rubbish, nuisance from burning 8 Smells 20 ,, on premises 16 ,, from road gullies 15 ,, ,, sewer ventilators 70 „ ,, stables 6 „ „ drain, &c. 30 ,, „ water closets 9 ,, „ manure 13 Smoke nuisances 8 Urinals, condition of 6 92 Underground rooms, illegally occupied 1 Unsound food 1 Vacant land, insanitary state of 11 Verminous condition of premises 5 Water closets, accommodation insufficient or absence of 5 ,, defective or insanitary 14 ,, stopped 3 „ without water 8 „ ,, proper flush 10 Water, absence of 220 „ leakage of ., 9 Water cisterns, dirty, &c. 5 Yard paving defective 7 Miscellaneous 64 Total 1014 Factory and Workshop Act, 1901. 95 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." At the end of 1908 there were 517 workshops in Hampstead, including 47 domestic workshops.* Of these workshops 207 employ women only, 255 employ men only, and in 55 both men and women are employed. By far the most prevalent trade in these workshops is dressmaking; next in the order of frequency come bootmaking, tailoring, baking, and millinery, in the order named. The number of factories was 66. The number of outworkers' premises was 92. 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 105-108. 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: — * A "domestic workshop" is defined by section 115 of the Act to "mean a private house, room or place which, though used as a dwelling, is by reascn of the work carried on there a workshop within the meaning of this Act, and in which neither steam, water, nor other mechanical power is used in aid of the manufacturing process carried on there, and in which the only persons employed are members of the same family dwelling there." 96 Workshops, Domestic Workshops, Workplaces, etc., in Wards. Trade or Business WARDS Totals No. 1 (Town) No. 2 (Belsize) No. 3 (Adelaide) No. 4 (Central) No. 5 (West End) No. 6 (Kilburn) No. 7 (Priory) Bakers 4 3 3 4 8 6 7 35 Blind makers — — — 3 1 — 1 5 Bootmakers 13 13 6 3 12 23 11 81 Builders and carpenters 2 6 2 4 3 8 6 31 Cabinet makers and polishers 1 2 — 2 — — — 5 Carriage builders 3 1 — 1 1 1 3 10 Cycle makers and repairers 2 1 1 1 2 1 1 9 Dressmakers and ladi s' tailors 24 16 12 20 34 45 28 179 Dyers and cleaners — 2 — — — — 1 3 Embroiderers 1 1 — — — 1 1 4 Engineers — 1 — 2 — — 1 4 Florists — 1 1 1 — — 3 Harness makers 2 — 3 1 1 — 1 8 Ironmongers 4 — 1 2 5 3 — 15 Lace makers and cleaners — — 1 — — — — 1 Laundries (Hand) 8 — — — 3 4 7 22 Mantlemakers — — — — — 2 — 2 Milliners 8 3 5 4 3 6 6 35 Miscellaneous 6 4 1 7 5 8 8 39 Monumental masons — — — — 2 — 1 3 Motor manufacturers 1 — — 1 — 1 1 4 Needlewomen 3 — 1 — — 3 — 7 Outfitters — — — 2 2 3 3 10 Pianoforte key makers — 2 — — — — — 2 Pianoforte makers — 5 — — — — — 5 Picture frame makers 2 2 1 3 2 — 3 13 Sign Writers — — — — — 2 — 2 Smiths 3 2 — 1 1 3 1 11 Stained glass workers — — — — — 1 — 1 Tailors 4 4 4 4 6 22 7 51 Trunk makers — — — 1 — — — 1 Umbrella makers and repairers 1 1 — — 1 1 1 5 Upholsterers 4 1 3 1 5 2 3 19 Watchmakers and jewellers 2 2 3 3 4 4 3 21 Wigmakers 2 — 2 4 3 — 1 12 Totals 100 72 50 75 105 150 106 658 97 Workshops, Domestic Workshops, Workplaces, etc. Table showing Number of Businesses, Character of Workshops and Number of Persons employed. Trade or Business. No. of Premises. Workshops (other than Domestic Workshops) Number of Workrooms No. of Employees. Domestic Workshops, Workplaces etc. Males Females Bakers 35 35 47 128 1 — Blind makers 5 4 5 12 6 1 Bootmakers 81 47 53 104 — 34 Builders and carpenters 31 27 31 49 — 4 Cabinet makers and polishers 5 4 4 14 — 1 Carriage builders 10 9 15 33 — 1 Cycle makers and repairers 9 8 12 23 — 1 Dressmakers and ladies' tailors 179 118 143 7 577 61 Dyers and cleaners 3 1 1 1 1 2 Embroiderers 4 4 4 1 9 — Engineers 4 4 4 5 — — Florists 3 3 4 3 11 — Harness makers 8 7 8 14 — 1 Ironmongers 15 14 14 25 — 1 Lacemakers and cleaners 1 — — — — 1 Laundries (Hand) 22 8 24 5 53 14 Mantlemakers 2 1 2 — 13 1 Milliners 35 33 35 — 84 2 Miscellaneous 39 25 33 41 18 14 Monumental masons 3 3 3 17 — — Motor manufacturers 4 4 5 13 — — Needlewomen 7 — — — — 7 Outfitters 10 10 38 3 222 — Pianoforte key makers 2 — — — — 2 Pianoforte makers 5 4 7 45 — 1 Picture frame makers 13 11 14 19 1 2 Sign Writers 2 2 4 9 — — Smiths 11 10 10 27 — 1 Stained glass workers 1 — — — — 1 Tailors 51 31 36 71 41 20 Trunk makers 1 1 1 4 — — Umbrella makers and repairers 5 — — — — 5 Upholsterers 19 14 22 27 9 5 Watchmakers and jewellers 21 17 19 34 — 4 Wigmakers 12 11 13 13 17 1 Totals 658 470 611 747 1063 188 Inspection of Workshops (other than Bakehouses). The number of workshop inspections in 1908 was 1,208. 98 Cleanliness. Twenty workrooms were found on inspection to require cleansing; 16 of these were cleansed on the request of the Inspector, in two cases it was necessary to serve a notice before the work was carried out, and two cases were being dealt with at the end of the year. Ventilation and Warming. In 3 workshops the means of ventilation were found defective, and the defects were remedied. There is, unfortunately, a marked tendency for the workers to close all windows and other ventilating openings except in hot weather, and it is difficult to make them realise the importance of free ventilation. The inspectors make special efforts to educate the workers on this point, and to impress upon them the importance of fresh air. Considerable difficulty has been experienced in this respect, but some improvement have now been effected, especially in the case of the younger women workers. Means of warming were improved or provided in five cases. Three workshops were found to be warmed by gas stoves that were unprovided with flues to carry off the products of combustion. This is a contravention of section 6 of the Factory Act, in which it is laid down that the measures which in every factory and workshop "must be taken for securing and maintaining a reasonable temperature in each room in which any person is employed, must not interfere with the purity of the air of any room in which any person is employed." In these cases the warming arrangements were made satisfactory by the provision of fires or of gas stoves fitted with proper flues. Two workrooms were found without means of warming; in one case such means were provided, in the other the use of the room was discontinued and another room with a proper fireplace used instead. Overcrowding. All the workrooms in the workshops are measured by the inspectors, and the cubic space in each room is ascertained. The 99 maximum number of workers that can legally occupy the room is then calculated and this information set out on a card, supplied by the Council, which is hung up in each room. The number of legal occupants varies according as overtime is worked, or whether the room is used as a sleeping-room as well as a work-room. During 1908, 69 new work-rooms were measured. Overcrowding was found in 8 instances. In 3 cases, the overcrowding was abated immediately on the request of the Inspector, but in 5 cases this was not done until a written notice had been served. Abstract of the Act. Section 128 of the Factory Act provides that an Abstract of the Act "shall be affixed at the entrance of every factory and work-shop, and in such other parts thereof" as the factory inspector may direct, and 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 41 workshops and 3 factories were notified to H.M. Inspector of Factories. Bakehouses At the end of 1908 there were 37 Bakehouses on the Register, 22 being underground, and 15 over ground. One underground Bakehouse, which had been illegally opened in the latter part of 1907, was closed during the 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. Four inspections were made and 2 notices were served in respect of the Factory Bakehouses; and 76 inspections and 3 notices in respect of the Workshop Bakehouses. The following is a list of the Bakehouses on the Register at the end of the year: — H 2 100 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— *64, Belsize Lane, late 10, Belsize Park Terrace. *225, Finchley Road. *289, do. +307, do. *98, West End Lane. (5) No. 5 (West End) Ward— t60, Cricklewood Broadway. 110, do. do. 553, Finchley Road. Field Lane School, Hillfield 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. *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 101 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 1907 was 59. During 1908 two premises were removed from the register of kitchens, and 10 were added, leaving a total number of 67 on the register at the end of the year. These premises are kept under regular supervision. 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. 39, do. 57, do. 63 & 65, do. 70, do. 100, do. 102, do. 109, do. 3, High Street. 44, do. 67, do. Bull & Bush, North End. (13) No. 2 (Belsize) Ward— 2, Elm Terrace, Constantine Road. 2, Fleet Road. 25, do. 98, do. 106, do. 210, Haverstock Hill. 2, Heathhurst Road. 11, South End Road. 17, do. 8, Station Parade, South End Road. Railway Tavern, South End Green. (11) 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— 72, Belsize Lane, late 14, Belsize Park Terrace. 90, Belsize Lane, late 17, Belsize Park Terrace 159, Broadhurst Gardens. 1, Canfield Place. 104, Finchley Road. 225, do. 289, Finchley Road. 100, West End Lane. 254, do. 272, do. 280, do. 1, Central Parade, do. (12) 102 Restaurant Kitchens in Wards—continued. No. 5 (West End) Ward— 106, Cricklewood Broadway. 92, Fortune Green Road. 106, Mill Lane, 251, West End Lane. 327, do. 351, do. (6) No. 6 (Kilburn) Ward— 132, High Road, Kilburn. 188, do. do. 272, do. do. 308, do. do. 354, do. do. Towers' Coffee Rooms, ridge Road. 18, Netherwood Street. 96, Palmerston Road. (8) No. 7 (Priory) Ward— 121, Abbey Road. 21, Alexandra Road. 203, Belsize Road. 264, do. 274, do. 36, Boundary Road. 114, do. 65, Fairfax Road. 115, Finchley Road. 34, High Road, Kilburn. 43, Loudoun Road. Steer's Restaurant, Upper Avenue Road. (12) Total 67 The number of inspections of the above premises made during the year was 102, and eight notices were served. No prosecutions were instituted. 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 Home Secretary has from time to time specified certain trades to which these provisions apply, the latest list being that contained in the Home Work Order of May 23rd, 1907. The trades, specified in this order, 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; 103 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 or repairing of umbrellas, sunshades, parasols, or parts thereof; The making of artificial flowers; The making of nets other than wire nets; The making of tents; The making or repairing of sacks; The covering of racquet or tennis balls; The making of paper bags; The making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip, or similar material; The making of brushes; Pea picking; Feather sorting; The carding, boxing, or packeting of buttons, hooks and eyes, pins and hair pins. The making of stuffed toys; The making of baskets; And any process incidental to the above. The number of lists received from employers was 149, and the number of addreses contained in the lists was 483. In 412 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 persons stated to be Hampstead workers received from the Medical Officers of Health of the districts in which the employers of these workers carried on business was 63, but only 49 of these were really addresses of Hampstead outworkers. The total number of outworkers’ premises in Hampstead is 92. Of these 4 are factories, 53 are workshops (23 of these being domestic 104 workshops), 1 is a workplace, and in 34 cases only a single worker is employed on the premises. No cases of notifiable infectious disease occurred during 1908 in houses inhabited by outworkers. The outworkers' premises in Hampstead are kept under regular supervision. They are usually 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 relating to general sanitation 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 Manufacturing stationers 1 Bakehouses 2 Monumental masons 1 Boot makers 6 Motor workers 1 Brewers 1 Opticians 1 Builders 5 Photographic paper manufacturers 1 Butchers 5 Cabinet makers 1 Pianoforte makers 1 Carpet beaters 2 Pianoforte string makers 1 Chaffcutters 1 Picture frame makers 1 Coach builders 1 Printers 10 Coffee roasters 4 Provision merchants 2 Corn chandlers 1 Stained glass makers 1 Dairymen 2 Steel grinders 1 Engineers 2 Upholsterers 2 Joiners and plasterers 1 66 Laundries 6 105 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, Workplaces and Homework. 1.—Inspection of Factories, Workshops and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions (4) Factories 168 7 (Including Factory Laundries) Workshops 1208 24 (Including Workshop Laundries) Workplaces 698 21 - (Other than Outworkers' premises included in Part 3 of this Report) Total 2074 52 - 106 2.—Defects Found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Keferrcd to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts :— Want of cleanliness 32 35 — — Want of ventilation 3 3 — — Overcrowding 8 7 — — Want of drainage of floors — — — — Other nuisances 76 74 — — Sanitary accommodation (insufficient 4 4 — — unsuitable or defective 16 12 — — not separate for sexes 4 2 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) 1 1 — — Breach of special sanitary requirements for bakehouses (SS. 97 to 100) - — — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Total 144 138 — — Column (2) in the above table gives the number of defects found, and column (3) the number remedied during the year. The corresponding figures in the two columns are not identical, because in the case of some of the defects discovered near the end of the year, the work necessary to remedy the defects had not been completed, and column (3) includes some defects which were found at the end of 1907, and remedied in the following year. 107 3.—Home work. NATURE OF WORK.* Outworkers' Lists, Section 107. Inspections of Outworkers' premises. Outwork in unwholesome premises,Sec. 108 Outwork in infected premises Sections 109, 110 Lists received from Employers. Addresses of Outworkers. Notices served on Occupiers as to keepirg or sending lists. Prosecutions. Instances. Not'ces served. Prosecuiions. Instances. Orders made (S. 110). Prosecuiions (Sections 109,110). Sending Twice in the year. Sending Once in the year. Received from other Councils. Forwarded to other Councils. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors Workmen. Contractors Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Wearing apparel— (1) making, etc. 100 38 220 1 2 — 61 232 83 — — — — (2) cleaning and washing 10 28 — 1 2 — — 30 — — — — — — — Lace, lace curtains and nets 4 2 10 — — — 1 8 2 Artificial flowers - - - - - - - - - - - - - - - - - - Nets, other than wire nets - - - - - - - - - - - - - - - - - - Tents - - - - - - - - - - - - - - - - - - Sacks - - - - - - - - - - Furniture and upholstery 14 32 44 1 — 1 55 14 — — Fur pulling 1 1 - - - - 2 - - - - - - - - - - Feather sorting - - - - - - - - - - - - - - - - - - Umbrellas, etc. 6 10 7 1 14 - - - 2 - - _ Carding, etc., of butons, etc - - - - - - - - - - - - - - - - - - Paper bags and boxes 2 4 37 - - - - 37 - - - 2 - - - - - - Basket making 1 — - - - - 1 Brush making 1 - - - - - 1 - - - - - - - - - - Racquet and tennis balls - - 1 - - - - - - - - - - - - - - - Stuffed toys — 2 1 — 7 4 - 6 - - - - - - File making - - - - - - - - - - - - - - - - - - Electro-plate 6 16 5 3 5 — 26 1 — Cables and chains - - - - - - - - - - - - - - - - - - Anchors and grapnels - - - - - - - - - - - - - - - - - - Cart gear - - - - - - - - - - - - - - - - - - Locks, latches and keys — 3 3 - - - - 3 - - - - - - - - - - Pea picking - - - - - - - - - - - - - - - - - - Total 142 138 328 7 9 8 63+ 412 - - - 111 - - - - - - * In 11 of the lists that were sent in the occupiers gave out work of more than one of the classes specified in Column 1. These lists have been included in columns 2 or 5 against the principal class only, but the outworkers have been assigned in columns 3 and 4 or 6 and 7 into their respective classes. †This number includes 7 addresses not in Hampstead, 3 addresses of persons who no longer take homework, 1 address at which the name given was not known, 2 addresses of persons who had removed and whose new address could not be found, and one address of a person who died more than a year previously. 108 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Bakehouses 35 Bootmakers 47 Dressmakers and ladies' tailors 142 Laundries 8 Milliners 34 Tailors 39 Watchmakers and jewellers 17 Other 195 Total number of workshops on Register 517 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 44 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 - — Underground bakehouses (s. 101):— - Certificates granted during the year — In use at the end of the year 22 Report on the Analytical Work of the Year 1908, by ALFRED W. STOKES, F.C.S., F.I.C., Public Analyst. 111 Analytical Laboratory, Town Hall, Paddington, W. 19th January, 1908. A short summary of the year's work may be of interest. A total of 508 samples was analysed, comprising—Milk 331, Butter 63, Cheese 15, Margarine 13, Lard 11, Groceries 36, Drugs 17, Sweets 5, Prepared Meats 10, Beer 3, Spirits 2 and Lemon Squash 2. Amongst all of these only 11 samples of Milk, 2 of Butter, 3 of the Prepared Meats, 1 of the Groceries and 1 of the Drugs proved to be adulterated. Boric Acid was present in 3 samples of Tripe amongst the prepared Meats ; of the 15 samples of Coffee in the Groceries only 1 was found to contain chicory, while the only unsatisfactory drug was 1 distilled water. Comparing the adulteration in 1907 with that of this year we find that though 100 more samples were taken this year than in the previous year the total adulteration is less, being only 3½ per cent. as contrasted with 8½ per cent. in 1907. Milk shows 3.3 per cent. of adulterated samples this year as against 7.6 in 1907. Butter has 3.2 per cent. of adulterated samples, while the year 1907 had slightly less, 2.2 per cent. Thirty per cent. of the prepared meats were this year preserved by Boric Acid; last year the number reached 62 percent. It is very satisfactory to find the food so pure at Hampstead: generally throughout London three times as much adulteration is found. ALF. W. STOKES, F.C.S., F.I.C., Public Analyst. Legal Proceedings. 115 Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department in 69 cases during the year. The chief facts relating to these proceedings are set out on pages 161-121, and are summarised below. The facts relate only to the cases that were heard and decided in 1908. Statute or Bye-law. No. of Prosecutions. Fines. Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and Bye- laws made thereunder 32 66 10 0 83 10 0 MetropolisManagement Acts, and Bye-laws made thereunder - 13 8 10 0 10 18 0 Sale of Food and Drugs Acts 14 500 986 Totals - 69 80 0 0 103 16 6 116 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. 1 1908. 7th Jan. 1908 29th Jan. Hampstead Petty Sessional Court, Justices A. C., Hampstead Failing to remove manure Fined £5 and 2s. costs. 6 21st Jan. 21st Feb. Marylebone Police Court, Mr. Plowden R. E., Hendon Nuisance Order made to abate within 3 weeks, 6s. costs allowed 7 7th Jan. Do. Do. M. W., Ellesmere Port Non-compliance with order of Magistrate to abate nuisance Fined 10s. and 5s. costs. 7 26th Mar. 10th April Do. Do. Nuisance Work in hand and 10s. costs paid and summons withdrawn. 6 3rd Mar. Do. Do. J. A. & Sons, Ltd., Willesden Allowing house to he occupied without having obtained a watercertificate £1 1s. costs paid and summons withdrawn 6 31st Mar. Do. Do. E. B., Hampstead Nuisance Prohibition order made and 6s. costs allowed. 5 26th Mar. 15th April Hampstead Petty Sessional Court, Justices J.G., Hampstead Fixing new water closet pan, &c., without giving notice Fined £4 and 7s 6d. costs. 5 26th Mar. 12th June Marylebone Police Court, Mr. Denman J. E. S., Hammersmith Failure to maintain watercloset in proper repair Work done, 10s. 6d. costs paid and summons withdrawn 1 1907. 16th April 17th June Hampstead Petty Sessional Court, Justices E. O., Hampstead Allowing caretaker's rooms to be occupied contrary to the Act Fined £l l0s.and £10 10s. costs. 7 1908. 23rd June 3rd July Marylebone Police Court, Mr. Denman J. F.J., Poplar Removing fish offal in prohibited hours Fined 20s. and 2s. costs. 117 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. 5 1908. 23rd June 1908. 3rd July Marylebone Police Court, Mr. Denman J. w. c., Ltd., Kensington (i.) Constructing w.c. without giving notice and (ii) Constructing same so as to be a nuisance Withdrawn on work being altered and £3 3s. costs paid. 2 Do. 15th July Hampstead Petty Sessional Court; Justices W. D., City Nuisance Work in hand adjourned sine die. 1 Do. 22nd July Do. T. M B., City Non-registration as Purveyor of milk Fined 5s. and 2s. costs. 2 Do. Do. Do. E. H. D. R., Co., Marylebone Fixing new pedestal pan and trap Fined £2 and 4s. 6d. costs. 6 Do. 24th July Marylebone Police Court, Mr. Denman G. R., Ealing Non-compliance with order Work done and summons withdrawn on payment of 10s. 6d. costs 5 7th July Do. Do. O. S., Hampstead Failing to remove straw manure from stables Fined 20s. and 2s. costs. 6 Do. Do. Do. J.H., Hampstead Fixing new w.c. pan without giving notice. Fined 10s. and 2s. costs. 5 Do. 2nd Oct. Marylebone Police Court, Mr. Plowden G. W., Hampstead Neglecting to maintain ashpit Do. S Do. Do. Do. Do. Do. Do. 5 Do. Do. Do. Do. Do. Do. 2 29th Sept. 7th Oct. Hampstead Petty Sessional Court, Justices A. P. (alias S.), Shoreditch Non-registration as Purveyor of milk Summons dismissed, as identity not proved to satisfaction of Justices. 7 Do. 9th Oct. Marylebone Police Court, Mr. Plowden J. W. T., Willesden Fixing new w.c. pan and trap without giving notice Notice given and summons withdrawn on payment of 7s. costs. 118 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 1908. 3rd Mar. 1908. 14th Oct Hampstead Petty Sessional Court, Justices F. J. R., Westminster Allowing four underground rooms to be illegally occupied Fined £20 and £10 10s. costs. 1 Do. Do. Do. L. & C. B. Co., City Allowing six rooms to be illegally occupied Do 5 7th July 16th Oct Marylebone Police Court, Mr. Plowden G. W., Hampstead (i.) Nuisance (ii.) Yard and forecourt not properly paved Fined £5 on (i) and order made on (ii) 5 13th Oct 28th Oct Hampstead Petty Sessional Court, Justices W. H., Hampstead Fixing new w.c. pedestal without giving notice Notice given, 10s. 6d. costs paid and summons withdrawn. 2 22nd July 6th Nov. Marylebone Police Court, Mr. Plowden J.M., St. Pancras Nuisance Abatement Order made. 4 Do. 20th Nov. Do. H. B., Hampstead Do. Abatement Order made and 6s. costs allowed. 5 7th July 27th Nov. Do. E. F. W., St. Pancras Do. Abatement Order made and 8s. costs allowed. 5 29th Sept 9th Dec. Hampstead Petty Sessional Court, Justices J.& E. A. Hampstead Neglecting to pave yard properly Fined £2 and 7s. 6d. costs. 6 7th July 18th Dec. Marylebone Police Court, Mr. Plowden E. F. W., St. Pancras Do. Fined £2 and 2s. costs. 5 10th Nov 23rd Dec. Hampstead Petty Sessional Court, Justices H.C. B., Hampstead Nuisance Abatement Order made, and fine of 5s. and 10s. 6d. costs inflicted. 119 Metropolis Management Acts, 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. 6 1908. 7th Jan 1907. 1908. 31st Jan. Marylebone Police Court, Mr. Plowden. F. H., St. Marylebone Failing to deposit plans, etc Plans deposited £1 1s. costs paid and summons withdrawn. 5 10th Dec. 1908. Do. Do. A. B., Willesden (i.) Constructing drain without giving notice (ii.) Failing to deposit plans, etc. (iii.) Drain not bedded in concrete, (iv.) Drain not watertight Fined 5s. and 2s. costs on (i.), 5s. and 2s. (ii.). 10s. and 2s. (iii.), and 10s. and 2s. on (iv.) 1 12th May 17th June Hampstead Petty Sessional Court, Justices W. J. F., Paddington (i.) Failing to deposit plans, etc. (ii.) Non-compliance with bye-laws Fined £1 and £1 1s. costs on each summons 6 7th July 24th July Marylebone Police Court, Mr. Denman J. H.., Hampstead (i.) Fixing w.c. pan contrary to Bye-law 3 (ii.) Soil-pipe of improper weight (iii.) Waste pipe not of proper substance. Fined 10s. and 2s. costs on each summons 2 12th May Do. Do. G. L., Islington Failing to deposit plans, etc. Plans deposited and 10s. 6d. costs paid. 3 7th July 23rd Oct. Maryleboue Police Court; Mr. Plowden C. of L. B. Co., City Failing to pro vide a sufficient drain Work done and £5 5s. costs allowed 1 29th Sept. 28th Oct. Hampstead Petty Sessional Court; Justices W. A. H., St. Pancras Failing to deposit plans, etc. Fined £2 and 5s. 6d. costs. 5 22nd July Do. Do. R. A. P., Hampstead Failing to deposit plans, etc. Fined 20s. and 5s. 6d. costs. 2 29th Sept. 30th Oct Marylebone Police Court; Mr. Plowden W. A. H., St Pancras Failing to deposit plans, etc. Plans deposited, 10s. 6d. costs paid and summons withdrawn. 120 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 1908. 5th Nov 1908. 13th Nov. Marylebone Police Court; Mr. Plowden H. J. B. & Sons, Hampstead (i.) Failing to deposit plans, etc. (ii.) Doing work contrary to bye-laws Both summonses dismissed 1 27th Oct. 20th Nov. Do. J. W. T., Willesden (i.) Failing to deposit plans, (ii.), (iii.), & (iv.) Doing work contrary to bye-laws (i.) Fined 5s. and 2s. costs (ii.) Withdrawn (iii.) Do. (iv.) Fined 5s. and 2s. costs. Sale of Food and Drugs Acts. 6 1907. 26th Nov. 1908. 10th Jan. Marylebone Police Court, Mr. Plowden V. L., Hampstead Selling beef sausages containing 19½ grains of boric acid per 1b. Undertaking given not to use preservatives in future. £2 2s. cost paid and summons withdrawn. 6 Do. Do. Do. I. A., Hampstead Selling saveloys containing 21¾ grains of boric acid per 1b. Do. 5 9th April 1st May Do. T. R., Hampstead Selling tripe containing 1½ per cent. of boric acid or 105 grains per lb. Ordered to pay 12s. 6d. costs 2 12th May 5th June Marylebone Police Court, Mr. Denman R. D., St. Pancras Selling milk containing 6 per cent, of added water Warranty proved and summons dismissed. 2 Do. Do. Do. M. T., St. Pancras Do. Fined 20s. and 12s. 6d. costs. 5 Do. Do. Do. R. H., Hampstead Selling milk containing 7 per cent, less than the proper amount of butter fat Warranty proved and summons dismissed. 121 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 1908. 4th June 1908. 24th June Hampstead Petty Sessional Court, J ustices A. B., Hampstead Selling milk con taining 25 per cent, less than the proper amount of butter fat Fined £2 and 17s. costs. 7 4th June 3rd July Marylebone Police Court, Mr. Denman E. H., Hampstead Selling milk containing 5 per cent. of added water Fined 20s. and 12s. 6d. costs 1 23rd June 22nd July Hampstead Petty Sessional Court, Justices T. M. B., City Selling milk containing 42 per cent. less than the proper amount of butter fat. Fined 5s. and 12s. 6d. costs. 2 21st July 7th Aug. Marylebone Police Court, Mr. Plowden C. L. B., Hampstead Selling milk containing 18 per cent. .less than the proper amount of butter fat Do. 2 29th Sept. 7th Oct. Hampstead Petty Sessional Court, Justices A. P. (alias S.), Shoreditch Selling milk containing 20 per cent. of added water Summons dismissed,as identity not proved to satisfaction of Justices. 7 28th Sept 6th Nov. Marylebone Police Court, Mr. Plowden T. E. G., Hampstead Selling butter containing 1½ per cent. of water above the legal limit Fined 10s, and 12s. 6d. costs. 6 13th Oct. 13th Nov. Do. S. T. Co., Shoreditch Selling coffee with 48 per cent. of chicory Ordered to pay 12s. 6d. costs. 5 24th Nov. 23rd Dec. Hampstead Petty Sessional Court, J ustices R. H„ Hampstead Selling milk containing 8 per cent. less than the proper amount of butter fat Warranty proved and summons dismissed. Appendix. Tables. 125 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 1908 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. Number. Rate.* Number. Rate per 1000 Births registered. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 1898 80623 1516 18.1 198 130.6 1296 16.0 552 460 81 917 11.4 1899 80926 1576 19.5 206 130.7 1262 15.5 487 398 62 926 11.4 1900 81230 1621 20.0 170 104.8 1200 14.7 458 372 94 922 11.3 1901 82280 1506 18.3 155 102.0 1196 14.5 532 424 101 873 10.6 1902 83743 1516 18.1 155 102.2 1199 14.3 482 390 95 904 10.7 1903 85197 1453 17.0 155 106.7 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 1906 89633 1437 16.0 139 96.8 1104 12.3 494 364 110 850 9.5 1907 91137 1341 14.7 114 85.0 1056 11.6 472 330 91 817 9.0 Averages for years 1898-1907 84957 1483 17.5 166 111.9 1159 13.6 482 374 91 876 10.3 1908 92654 1355 14.4 104 76.7 995 10.6 442 311 119 803 8.5 * 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 for the purposes of these Tables are those into which persons are habitually received on account of sickness or infirmity, such as hospitals, workhouses and lunatic asylums. A list of the Institutions in respect of the deaths in which corrections have been made is given on the following pages. Area of Borough in acres (exclusive of area covered by water) 2253. Total population at all ages, 81,942. ) At Census Number of inhabited houses, 11,294. Average number of persons per house, 7 2. of 1901. 126 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. Institutions, the deaths in which have been distributed among the several localities in the Borough. 165, Adelaide Road 26, Belsize Avenue 74, Belsize Road Consumption Hospital, Mount Vernon Hospital for Incurable Children, College Villas Road 18, Crossfield Road Hampstead General Hospital, Hampstead Green North Western Fever Hospital, Lawn Road St. Peter's Home, Mortimer Road Hampstead Workhouse, New End 32 Parkbill Road 10, Rosslyn Hill 95 South Hill Park Friedenheim, Upper Avenue Road Aged Pilgrims' Asylum. Islington Banstead Asylum Brompton Hospital, Chelsea Brooke House, Upper Clapton Cancer Hospital, Chelsea Cane Hill Asylum Children's Hospital, Bethnal Green Children's Hospital, Gt. Ormond Street Children's Hospital, Paddington Green. Colney Hatch Asylum German Hospital, Dalston Great Northern Hospital Guy's Hospital Hanwell Asylum "Ravenswood," Highgate Road 12, Hinde Street, St. Marylebone H.M. Prison, Brixton Horton Asylum Hospital of St. John and St. Elizabeth, St. Marylebone Hostel of God, Clapham Infants' Hospital, Vincent Square Leavesden Asylum London Hospital London Temperance Hospital Long Grove Asylum, Epsom 127 TABLE I (continued). I. Institutions within the Borough receiving sick and infirm persons from outside the Borough. II. Institutions outside the Borough receiving tick and infirm persons from the Borough. III. Other Institutions, the deaths in which have been distributed among the several localities in the Borough. Manor Asylum, Epsom Medical and Surgical Home, 14, Endsleigh Gardens, N.W. Middlesex Hospital New Hospital for Women North Eastern Hospital Orphan Working School, Haverstock Hill. Queen Charlotte's Hospital St. Bartholomew's Hospital St. Luke's Hospital St. Luke's House, Kensington St. Mary's Hospital St. Marylebone Almshouses, St. John's Wood Terrace St. Marylebone Infirmary St. Pancras Infirmary, Highgate St. Pancras Infirmary (South) St. Pelagia's Home, 25, Bickerton Road, N. St. Thomas's Hospital Strand Union Workhouse, Sheffield Street, W.C. Tooting Bee Asylum University College Hospital Westminster Hospital The Workhouse for the Parish of Hampstead is within the Borough and situate at New End in No. 1 (Town) Ward. 128 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 1908 and Previous Years. Names of Localities. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. Population estimated to middle of each year. Births registered. Deaths at all ages. Deaths under 1 year. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 1898 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1899 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1900 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1901 11944 .. 142 26 12968 .. 139 29 10438 .. 98 9 9137 .. 60 9 12222 112 27 14838 .. 200 44 10733 .. 113 11 1902 12240 192 163 20 13280 239 135 18 10500 103 95 3 9233 110 71 11 12550 275 107 20 15100 435 219 45 10840 162 110 16 1903 12550 194 127 14 13520 211 121 13 10600 95 101 9 9357 99 60 8 12850 243 111 21 15370 417 184 39 10950 194 116 21 1904 12970 195 125 20 13660 217 141 23 10790 100 39 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 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 1907 13940 185 152 15 14410 205 114 13 10860 75 86 8 10397 108 68 9 14090 250 114 16 16310 391 179 28 11130 127 94 7 Averages of Years 1898 to 1907} .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1908 14190 217 108 11 14770 203 126 8 10860 88 78 6 10584 102 82 6 14370 244 121 26 16670 380 186 30 11210 121 93 10 Note.—The following deaths were not able to be classified in wards owing to a definite address not having been registered:— 1901 The deaths of 9 persons over 1 year of age 1902 „ 4 „ „ 1903 „ 16 „ ,, and 1 infantile death 1904 ,, 13 ,, ,, 5 „ deaths 1905 ,, 8 „ „ 1906 „ 7 „ „ 5 „ „ 1907 „ 8 „ „ 2 „ „ 1908 „ 9 „ „ 129 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 1908. 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.) Total Cases removed to Hospital. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 65. 65 and upwards. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous croup) 55 1 16 20 11 7 .. 6 10 4 9 9 7 10 5 9 3 6 6 6 9 44 Erysipelas 33 1 .. 3 5 19 5 1 5 4 5 3 12 3 .. 4 1 2 .. 1 .. 8 Scarlet fever 265 2 64 141 30 28 .. 51 62 16 18 49 49 20 46 59 7 16 42 41 15 226 Typhus fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric fever 24 .. 1 2 6 15 .. 6 4 6 .. 6 1 1 3 2 4 .. 4 .. 1 14 Relapsing fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal fever 6 .. .. .. 3 3 .. 1 .. .. 1 1 3 .. 1 .. .. .. 1 2 .. 4 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Totals 383 4 81 166 55 72 5 65 81 30 33 68 72 34 55 74 15 24 53 50 25 296 The Workhouse is within the Borough, and is situate at New End in No. 1 (Town) Ward. Isolation Hospitals are provided by the Metropolitan Asylums Board, and residents of Hampstead suffering from infectious disease are usually sent to the North Western Hospital, which is within the Borough, and is situate at Lawn Road, in No. 2 (Belsize) Ward. 130 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 1908. Causes of Death. Deaths at the subjoined ages of "Residents" whether occurring in or beyond the Borough. Deaths at all ages of "Residents" belonging to Localities whether occurring in or beyond the Borough. Total Deaths whether of "Residents" or "Non-residents" in Public Institutions in the Borough. All ages. Under 1 year. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 65. 65 and upwards. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 4 .. 2 .. 1 1 .. .. 1 .. 1 2 .. .. 3 Scarlet Fever 7 .. 3 3 .. 1 .. .. 1 .. .. 6 .. .. 49 Whooping Cough 5 3 2 .. .. .. .. 2 1 1 .. 1 .. .. 2 Diphtheria ("including Membranous croup) 5 1 3 1 .. .. .. .. .. 2 .. .. 2 1 44 Croup .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Fever Typhus .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric 4 .. .. 1 .. 3 .. 1 .. .. .. 3 .. .. 5 Other continued 2 1 .. .. .. 1 .. 1 .. .. .. .. 1 .. 1 Epidemic influenza 26 .. .. .. .. 7 19 3 2 5 4 3 6 .. 5 Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diarrhœa 11 8 1 .. .. 2 .. 1 1 1 1 .. 6 1 1 Enteritis 11 8 .. .. .. 2 1 2 2 .. .. 3 3 1 2 Puerperal Fever 4 .. .. .. 1 3 .. .. .. .. 1 1 2 .. 2 Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Phthisis (Pulmonary Tuberculosis) 74 .. .. 2 14 55 3 7 16 4 7 9 21 7 103 Other Tuberculous diseases 10 .. 4 4 .. 2 .. 2 .. 1 .. .. 5 2 9 Cancer, malignant disease 84 .. .. .. .. 47 37 13 11 8 9 15 20 8 42 Bronchitis 58 7 1 .. 1 8 41 12 7 10 4 6 13 6 19 Pneumonia 55 9 3 .. 1 20 22 2 8 5 7 9 12 11 17 Pleurisy Other Diseases of Respiratory 3 .. .. .. 1 .. 2 1 .. .. .. .. 1 1 1 Organs 7 .. .. .. 1 2 4 .. 2 1 1 1 1 1 1 Alcoholism, Cirrhosis of Liver 16 .. .. .. .. 14 2 1 4 1 4 3 1 2 4 Venereal diseases 3 1 .. .. .. .. 2 1 2 .. .. .. .. .. 3 Premature birth l6 16 .. .. .. .. .. 1 1 1 .. 3 8 2 .. Diseases and accidents of parturition 10 .. .. .. 1 9 .. 3 .. 1 .. .. 4 2 1 Heart diseases 38 .. .. 1 1 19 17 3 8 5 5 3 9 5 9 Accidents 14 2 1 .. 1 3 7 2 2 1 .. 3 5 1 14 Suicides 10 .. .. 1 1 7 1 1 2 1 1 1 3 1 9 All other causes 526 41 5 7 13 106 154 49 55 30 37 49 63 39 96 All causes 803 97 25 20 37 312 312 108 126 78 82 121 186 93 442 Note.—It will be noted that the total number of deaths in the Ward distribution is 9 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. Note.—The omission of a number denotes that no death was registered from that cause. Schedule A. EXTENDED TABLE IV. Causes of, and Ages at, Death during the 53 weeks ended 2nd January, 1909. No. Cause or Death. Ages. Wards. Total Deaths whether ot "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 under 20. 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 (Adelaide). No. 4. (Central). No. 5. (West End) No. 6 (Kilburn). No. 7 (Priory). Non-distributable. 2 Measles .. 2 .. .. .. 1 1 .. .. .. .. .. .. 4 .. 1 .. 1 2 .. .. .. 3 3 Scarlet Fever .. 3 2 1 .. .. 1 .. .. .. .. .. .. 7 .. 1 .. .. 6 .. .. .. 49 5 Epidemic Influenza .. .. .. .. .. .. .. 1 .. 6 5 5 9 26 3 2 5 4 3 6 2 .. 5 6 Whooping Cough 3 2 .. .. .. .. .. .. .. .. .. .. .. 5 2 1 1 .. .. .. .. 2 7 Diphtheria 1 3 1 .. .. .. .. .. .. .. .. .. 5 .. .. 2 .. .. 2 1 .. 44 8 Enteric Fever .. .. 1 .. .. .. 2 .. 1 .. .. .. .. 4 1 .. .. .. 3 .. .. .. 5 10 Diarrhœa, Dysentery 8 1 .. .. .. .. .. 1 1 .. .. .. .. 11 1 1 1 1 .. 6 1 .. 1 12 Other Allied Diseases 1 .. .. .. .. .. 1 .. .. .. .. .. .. 2 1 .. .. .. .. 1 .. .. 1 18 Syphilis 1 .. .. .. .. .. .. .. .. .. 2 .. .. 3 1 2 .. .. .. .. .. .. 3 22 Puerperal Fever .. .. .. .. 1 .. 3 .. .. .. .. .. .. 4 .. .. .. 1 1 2 .. .. 2 23 Pyaemia 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. 24 Infective Endocarditis .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 25 Other Allied Diseases 1 .. .. .. .. 1 .. .. .. .. .. .. .. 2 1 .. .. 1 .. .. .. .. 1 26 Rheumatic Fever .. .. 1 .. .. 1 1 .. .. .. .. .. .. 3 .... .. .. 1 .. 2 .. .. 2 27 Tuberculosis of Brain .. 4 1 2 .. .. .. .. .. .. .. .. .. 7 1 .. 1 .. .. 3 2 .. 1 30 Tuberculosis of Larynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 31 Phthisis .. .. 1 1 4 10 22 17 10 6 3 .. .. 74 7 16 4 7 9 21 7 3 103 32 Abdominal Tuberculosis .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 1 .. .. .. .. .. .. .. 2 33 General Tuberculosis .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. 1 34 Other forms Tuberculosis .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. 4 38 Hydatid Diseases .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 42 Chronic Alcoholism .. .. .. .. .. .. .. 2 1 1 .. .. .. 4 .. 1 .. 1 1 1 .. .. 3 45 Osteo-arthritis .. .. .. .. .. .. .. .. .. .. 2 .. .. 2 .. .. .. 1 1 .. .. 1 47 Cancer .. .. .. .. .. 3 3 13 28 29 8 .. 84 13 11 8 9 15 20 8 .. 42 48 Diabetes Mellitus .. .. .. .. 1 .. 1 1 .. 3 4 2 .. 12 3 2 1 2 1 2 1 .. 3 51 Anæmia .. .. .. .. .. .. .. .. 3 1 1 1 .. 6 2 1 2 .. 1 .. .. .. 2 52 Lymphadenoma .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. 63 Premature Birth 16 .. .. .. .. .. .. .. .. .. .. .. .. 16 1 1 1 .. 3 8 2 .. .. 54 Injury at Birth 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. 1 1 .. .. .. 55 Debility at Birth 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. 56 Atelectasis 3 .. .. .. .. .. .. .. .. .. .. .. .. 3 .. .. .. .. 1 2 .. .. .. 57 Congenital Defects 4 .. .. .. .. .. 1 .. .. .. .. .. .. 5 1 .. 1 1 2 .. .. .. 2 59 Atrophy, Debility. Marasmus.. 14 1 .. .. .. .. .. .. .. .. .. .. .. 15 1 2 .. 2 4 4 2 .. 1 61 Rickets 1 1 .. .. .. .. .. .. .. .. .. .. .. 2 1 .. .. .. .. .. 1 .. .. 62 Old Age, Senile Decay .. .. .. .. .. .. .. .. .. 1 10 12 11 34 3 9 5 2 4 4 4 3 13 63 Convulsions 4 1 .. .. .. .. .. .. .. .. .. .. .. 5 .. .. .. 1 .. 4 .. .. 1 64 Meningitis .. 1 .. 1 .. .. .. .. .. .. .. .. .. 2 .. 1 .. .. 1 .. .. .. 2 65 Encephalitis .. .. .. .. .. .. 1 .. .. 1 .. .. .. 2 .. .. .. .. .. .. 2 .. .. 66 Apoplexy .. .. .. .. .. .. .. 1 .. 4 3 1 1 10 .. 2 .. 2 3 1 1 .. 1 67 Softening of Brain .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. 1 .. .. .. .. 1 68 Hemiplegia .. .. .. .. .. .. .. .. .. .. 2 2 1 5 1 .. .. 1 1 1 1 .. .. 69 General Paralysis of Insane .. .. .. .. .. .. 1 2 .. 1 .. .. .. 4 .. .. 1 1 .. 2 .. .. .. 70 Other forms of Insanity .. .. .. .. .. .. .. .. 1 1 .. .. .. 2 .. .. 1 .. .. .. .. 1 .. 72 Cerebral Tumour .. 1 .. .. .. .. 1 .. .. .. .. .. .. 2 .. .. .. .. .. .. 2 .. .. 73 Epilepsy .. .. .. .. .. .. 1 .. .. .. 1 .. .. 2 2 .. .. .. .. .. .. .. .. 75 Locomotor Ataxy .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 76 Paraplegia .. .. .. .. 1 .. .. .. .. 1 .. 1 .. 3 .. 1 1 .. 1 .. .. .. 1 77 Other forms, Brain Diseases 1 .. .. .. .. .. .. 1 2 1 1 .. .. 6 1 1 .. 2 1 1 .. .. 3 78 Otitis .. .. .. 1 1 .. .. .. .. .. .. .. 2 .. 1 .. .. .. 1 .. .. 1 82 Endocarditis .. .. 1 .. .. 1 1 4 8 6 14 3 .. 38 3 8 5 5 3 9 5 .. 9 84 Angina Pectoris .. .. .. .. .. .. .. .. 1 1 .. .. 1 3 1 .. .. .. 1 1 .. .. .. 85 Aneurism .. .. .. .. .. .. .. 1 1 2 .. .. .. 4 .. 2 .. .. 1 • • 1 .. 1 86 Senile Gangrene .. .. .. .. .. .. .. .. .. .. 1 1 .. 2 .. 1 .. .. .. 1 .. .. 1 87 Embolism, Thrombosis .. .. .. .. .. 1 .. 2 .. 2 3 4 1 13 4 1 2 2 1 1 2 .. 4 88 Phlebitis .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. 1 .. .. .. .. .. .. .. 90 Other Diseases, Heart and Vessels 1 .. .. .. .. .. .. 4 5 14 25 15 8 72 11 15 5 7 11 13 10 .. 13 93 Other Diseases, Larynx & Trachea .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. 94 Acute Bronchitis 7 1 .. .. .. 1 .. .. 1 1 5 5 3 24 6 2 4 .. 5 4 3 .. 3 95 Chronic Bronchitis .. .. .. .. .. .. 1 1 2 2 8 12 8 34 6 5 6 4 1 9 3 .. 16 96 Lobar Pneumonia 1 .. .. .. .. 1 1 2 5 5 2 2 .. 19 .. 4 2 3 2 4 4 .. 6 97 Lobular Pneumonia 6 3 .. .. .. .. .. .. 1 1 1 6 3 21 1 3 2 1 6 4 4 .. 6 98 Pneumonia 2 .. .. .. .. .. 1 2 1 1 .. 4 4 15 1 1 1 3 1 4 3 1 5 99 Emphysema, Asthma .. .. .. .. .. .. .. 1 .. .. 2 1 .. 4 .. 1 1 .. .. 1 1 .. 100 Pleurisy .. .. .. .. .. 1 .. .. .. .. .. 1 1 3 1 .. .. .. .. 1 1 1 101 Other Diseases, Respiratory System .. .. .. .. .. 1 .. .. 1 .. .. 1 .. 3 .. 1 .. 1 1 .. .. .. 1 102 Diseases of Mouth and Annexa .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 103 Diseases of Pharynx .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 105 Ulcer of Stomach and Duodenum .. .. .. .. 1 .. .. 3 1 1 .. .. .. 6 1 2 1 2 .. .. .. .. 2 106 other Diseases of stomach 2 .. .. .. .. .. 1 .. .. .. .. 1 1 5 .. 2 .. .. 2 1 .. .. 1 107 Enteritis 8 .. .. .. .. .. .. 1 1 .. .. 1 .. 11 2 2 .. .. 3 3 1 .. 2 108 Appendicitis .. .. .. 1 1 3 .. 1 2 1 1 .. .. 10 2 .. 1 1 1 4 1 .. 8 109 Obstruction of Intestine 3 .. .. .. .. .. .. 1 1 .. 4 .. .. 9 3 2 .. 2 1 1 .. .. 5 111 Cirrhosis of Liver .. .. .. .. .. .. .. 1 1 8 2 .. .. 12 1 3 1 3 2 .. 2 .. 1 112 Other Diseases of Liver 1 .. .. .. .. .. .. .. .. .. 3 1 2 7 1 .. 1 1 2 1 1 .. 1 113 Peritonitis 1 .. .. .. .. .. .. .. 1 .. .. .. .. 2 1 .. .. .. 1 .. .. .. 3 114 Other Diseases, Digestive System 1 .. .. .. .. .. .. .. .. .. .. .. 1 2 1 .. 1 .. .. .. .. .. 1 115 Diseases. Lymphatic System and Gland .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. 1 .. .. .. .. .. 1 116 Acute Nephritis .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. 117 Bright's Disease .. .. .. 2 .. 1 .. 4 5 7 13 4 1 37 3 5 5 3 5 8 8 .. 10 118 Calculus .. .. .. .. .. .. 1 .. .. .. 1 .. .. 2 .. .. .. .. .. 1 1 .. .. 119 Diseases of Bladder and Prostate .. .. .. .. .. .. .. .. 1 1 1 2 .. 5 1 2 .. .. .. 2 .. .. 2 120 Other Diseases, Urinary System .. .. .. .. .. .. .. .. 1 .. .. .. 1 2 .. .. .. 1 .. .. 1 .. .. 122 Diseases of Ovaries .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. 123 Diseases of Uterus and Appendages .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 1 .. .. .. .. .. .. .. 2 126 Abortion, Miscarriage .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. 128 Puerperal Convulsions .. .. .. .. .. .. 3 .. .. .. .. .. .. 3 1 .. .. .. .. 1 1 .. .. 129 Placenta Praevia, Flooding .. .. .. .. .. .. 2 1 .. .. .. .. .. 3 .. .. 1 .. .. 2 .. .. .. 130 Puerperal Thrombosis .. .. .. .. .. 1 1 .. .. .. .. .. .. 2 1 .. .. .. .. .. 1 .. .. 131 Other diseases, Pregnancy and Childbirth .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. 1 132 Arthritis, Ostitis, Periostitis .. .. 1 .. .. .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. Accidents and Negligence. 139 In Vehicular Traffic .. .. .. .. .. 1 .. 1 .. .. 2 .. .. 4 .. 2 .. .. 1 1 .. .. 4 142 In Building Operations .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. 1 145 Burns and Scalds .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. 1 .. 4 147 Surgical Narcosis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 151 Suffocation, Overlaid in Bed 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. .. .. .. 1 .. .. .. 153 Falls not specified .. 1 .. .. .. .. .. .. .. .. 3 l 1 6 1 .. 1 .. 2 2 .. .. 3 155 Otherwise, not stated .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 suicides. 157 By Poison .. .. .. 1 .. .. 1 2 .. .. .. 1 .. 5 1 1 1 .. 1 1 .. .. 3 159 By Hanging and Strangulation .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. 160 By Drowning .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 4 161 By Shooting .. .. .. .. .. 1 .. 1 .. .. .. .. .. 2 .. 1 .. 1 .. .. .. .. 1 162 By Cut or Stab .. .. .. .. .. .. .. 1 .. 1 .. .. .. 2 .. .. .. .. .. 1 1 .. 1 169 Found Drowned .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. Totals 97 25 11 9 10 27 58 67 78 109 154 100 58 803 108 126 78 82 121 186 93 9 442 131 TABLE V. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Infantile Mortality during the Year 1908. 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 23 5 9 6 43 9 14 4 5 2 5 1 7 2 4 1 97 {Uncertified .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1. Common Infectious Diseases {Small-pox.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. {Chicken-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. {Measles .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. {Scarlet Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. {Diphtheria (includ{ing Membra{nous Croup) .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 {Whooping Cough .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. 1 .. 3 ii. Diarrhœal Diseases. {Diarrhœa, all {forms .. .. 1 .. 1 .. 1 .. .. 2 2 .. 1 .. 1 .. 8 {Enteritis, Muco{enteritis, Gastro{enteritis .. 1 1 .. 2 3 1 .. 1 .. .. .. .. .. 1 .. 8 {Gastritis, Gastro¬} {intestinal} {Catarrh} .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diseases {Premature Birth 13 1 1 .. 15 .. 1 .. .. .. .. .. .. .. .. .. 16 {Congenital Defects .. 1 .. .. 1 .. 2 .. 1 .. .. .. .. .. .. .. 4 {Injury at Birth 2 .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 {Want of Breast-} {milk, Starvation} .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. {Airophy, Debility} {Marasmus} .. 1 2 4 7 3 1 1 .. .. .. .. 1 1 .. .. 14 iv. Tuberculous Diseases. {Tuberculous} {Meningitis} .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. {Tuberculous} {Peritonitis:Tabes} .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. {Mesenterica} {Other Tubercu¬} {lous Diseases} .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. v. Other Causes. {Erysipelas .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. {Syphilis 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 {Rickets .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. 1 {Meningitis (not} {Tuberculous)} .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. {Convulsions 1 .. 1 .. 2 .. 1 1 .. .. .. .. .. .. .. .. 4 {Bronchitis .. .. .. .. .. .. 3 .. 1 .. .. 1 1 1 .. .. 7 {Laryngitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. {Pneumonia 1 .. .. 1 2 .. 1 1 .. .. 2 .. 2 .. 1 .. 9 {suffocation} {overlying } .. 1 1 .. 2 .. .. .. .. .. .. .. .. .. .. .. 2 {Other causes 5 .. 2 1 8 3 3 .. 1 .. 1 .. 1 .. .. .. 17 23 5 9 6 43 9 14 4 5 2 5 1 7 2 4 1 97 Population estimated to middle of 1908, 92,654. Births in the year legitimate, 1,326. illegitimate, 29. Deaths in the year of legitimate infants, 87. illegitimate infants, 10. Deaths from all Causes at all Ages, 803. K 2 132 TABLE VI. PREMISES. NUMBER OF PLACES. Number of inspections, 1908. Number of notices, 1908. Number of prosecutions, 1908. On register at end of 1907. Added in 1908. Removed in 1908. On register at end of 1908. Milk premises 114 4 5 113 416 15 — Cowsheds — — — — — — — Slaughter-houses 5 — — 5 130 — — Other offensive trade premises — — — — — — — Ice cream premises 78 6 8 76 133 3 — Registered houses let in lodgings 315 — — 315 243 11 — Total number of Intimation Notices served for all purposes 893 Overcrowding— Number of dwelling rooms overcrowded 9 Number remedied 9 Number of notices issued 6 Number of prosecutions — Underground rooms— Number closed during year 1 Illegal occupation dealt with during year 6 Insanitary houses— Number closed under the Public Health (London) Act, 1891 — „ „ Housing of the Working Classes Act — Shelters provided under Sec. 60 (4) of the Public Health (London) Act, 1891— — Number of persons accommodated during the year — Customs and Inland Revenue Acts— Number of houses for which applications were received during year - 11 Number of dwellings comprised therein 56 133 TABLE VI.—continued. Customs and Inland Revenue Accounts—continued. Number of Certificates granted (houses) *2 „ „ refused „ †2 „ „ deferred „ ‡8 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 2 (e) In connection with the removal of offensive matter, &c. 4 (f) As to cesspools and privies, removal and disposal of refuse, &c. 3 (g) For securing the cleanliness of tanks, cisterns, &c. — (h) With respect to water closets, earth closets, &c. 7 (i) With respect to sufficiency of water supply to water closets 1 Number of prosecutions under Dairies, Cowsheds and Milkshops Orders— Dirty milk utensils — Number of prosecutions under Bye-laws under Metropolis Management Acts— (a) With respect to drainage, &c. 12 (b) With respect to deposit of plans as to drainage, &c. 9 London County Council (General Powers) Act, 1903, Part VIII.— Number of prosecutions for breach of by-laws as to conveyance of dead horse through streets — *These 2 houses comprised 4 "dwellings." †These 2 houses comprised 7 "dwellings" ‡These 8 houses comprised 46 "dwellings." 134 TABLE VI.—continued. London County Council (General Powers) Act, 1904, Part IV.— Number of filthy articles purified (Sec. 19) — „ verminous rooms cleansed (Sec. 20) - 9 „ „ houses „ (Sec. 20) - 5 „ sanitary conveniences altered (Sec. 22) 3 „ „ „ removed (Sec. 22) — „ fixed ashpits removed (Sec. 23) — M ortuaries— Total number of bodies removed 78 Total number of infectious bodies removed — London County Council (General Powers) Act, 1907, Part XII., ana Sec. 48 Public Health (London) Act, 1891— Number of tenement houses in which additional water taps and sinks have been provided (Sec. 78) 24 135 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. 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 10C0 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 62 22 0.25 49 0.55 1907 91137 1341 14.7 817 9.0 98 73.1 498 5.5 15 0.16 41 0.45 1908 92654 1400 14.9 803 8.5 97 69.3 383 4.1 20 0.21 33 0.40 TABLE VII. (1). Vital Statistics of No. 1 (Town) Ward. Number of occupied houses 1,616 At Census 1901. Population 11,895 Average number of persons per house 7.36 Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable 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 72.1 38 3.1 1 0.08 10 0.79 1904 12970 195 15.0 125 9.6 20 102.5 65 5.1 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 1907 13940 185 13.3 152 10.9 15 81.1 105 7.5 2 0.14 3 0.22 1908 14190 225 15.9 108 7.6 11 48.8 65 4.6 1 0.07 5 0.35 136 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. Death 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 1907 14410 205 14.2 114 7.9 13 63.4 63 4.4 3 0.21 11 0.76 1908 14770 205 13.9 126 8.5 8 39.0 81 5.5 1 0.07 4 0.27 TABLE VII. (3). Vital Statistics of No. 3 (Adelaide) Ward. Number of occupied houses 1,657 At Census 1901. Population 10,395 Average number of persons per house 6.27 Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable 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 1907 10860 75 6.9 86 7.9 8 106.7 29 2.7 1 0.09 1 0.09 1908 10860 93 8.6 78 7.2 6 64.6 30 2.8 2 0.18 4 0.37 137 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 1907 10397 108 10.4 68 6.5 9 83.3 33 3.2 2 0.19 2 0.19 1908 10584 104 9.8 82 7.7 6 57.7 33 3.1 1 0.09 2 0.19 TABLE VII. (5). Vital Statistics of No. 5 (West End) Ward. Number of occupied houses 1,778 At Census 1901. Population 12,172 Average number of persons per house 6.84 Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable 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 1907 14090 250 17.7 114 8.1 16 64.0 153 10.9 4 0.28 9 0.64 1908 14370 254 17.7 121 8.4 26 102.4 68 4.7 10 0.69 12 0.84 138 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 1555??? 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 1907 16310 391 24.0 179 11.0 28 71.6 86 5.3 3 0.18 13 0.80 1908 16670 393 23.6 186 11.1 30 76.3 72 4.3 4 0.24 9 0.54 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 1003 10950 194 17.7 116 10.5 21 108.2 43 4.0 3 0.27 7 0.64 1004 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 1907 11130 127 11.4 94 8.4 7 55.1 29 2.6 • • • • 2 0.18 1908 11210 126 11.2 93 8.3 10 79.3 34 3.0 1 0.09 2 0.18 139 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 18.8 1888 20.5 31.2 616 1.0 1.8 — 10.6 17.8 1889 21.0 31.1 728 0.95 2.2 — 10.7 17.9 1890 21.9 30.2 613 1.5 2.1 — 13.1 19.1 1891 21.5 31.4 670 1.0 1.9 4.5 12.2 22.5 1892 20.4 30.5 591 1.7 1.8 8.0 12.4 19.0 1893 20.5 30.8 547 1.3 2.47 11.1 12.9 19.2 1894 19.6 29.6 674 1.4 1.76 6.2 10.8 16.6 1895 19.8 30.2 452 1.0 2.14 7.3 13.4 18.7 1896 19.1 29.7 546 1.8 2.18 7.8 12.0 17.1 1897 20.2 29.7 568 1.1 2.15 5.1 11.6 17.4 1898 18.1 29.4 599 1.4 2.22 5.7 11.4 17.6 1899 19.7 29.3 650 1.1 2.21 6.0 11.4 18.3 1900 20.0 28.7 699 1.0 2.0 5.8 11.3 18.3 1901 18.3 28.5 633 0.77 2.05 5.6 10.6 16.9 1902 18.1 28.6 612 0.69 1.64 *5.4 10.7 16.3 1903 17.0 28.4 616 0.49 1.46 *3.8 9.8 15.4 1904 16.7 27.9 553 0.55 1.94 *3.5 10.3 16.2 1905 16.1 27.2 598 0.43 1.52 3.3 9.3 15.2 1906 16.0 27.0 587 0.55 1.73 6.2 9.5 15.4 1907 14.7 26.3 524 0.45 1.26 5.5 9.0 15.0 1908 14.9 26.5 597 0.40 1.29 4.1 8.5 14.7 * Excluding Chicken-pox. INDEX. PAGE. Accident, Deaths from 23 Adulteration 88-91 Alcoholism 23 Analyses, Results of 88-91 Analytical Work, Report on 111 Applications for Redrainage 66 Area of Borough 13 Bacteriological Examinations 85-88 Bakehouses 99 Birth-Rate 15, 10 Births, Illegitimate 15 „ Number of 13-16 „ ,, in Wards 16 Butter and Margarine Act, 1907 83 By-Laws, Drainage Plan 66 Cancer 22 Circulatory System, Diseases of 23 Combined Drainage 66-69 Complaints received 91, 92 Customs and Inland Revenue Acts 71, 72 Dairies and Milkshops 84 Death-Rate 16-18 „ Infantile 28-32 Death returns 19 Deaths, at various ages 20 ,, Causes of 22 ,, in Public Institutions 21 ,, from seven principal Epidemic Diseases 49 „ Infantile 27 „ Non-resident 18, 21 „ Number of 16 „ Outlying 19, 20, 21 „ Senile Mortality 24 Diarrhœa 52, 53 Diphtheria 45, 46 Disinfection 59 Drainage Plan, By-laws 66 Drainage Work 66 Enteric Fever 46-48 Epidemic Diseases, Seven Principal, Death Rate 49 „ ,, Deaths from 48, 49 Erysipelas 48 Factories 104, 105 Factory and Workshop Act, 1901 95-108 Fever 46-49 142 PAGE. Food Inspection 81 Food Premises 81,82 Foodshops, Inspection of 82 Hairdressers' Businesses 79 Health Visiting 32-34 Homework 102-104, 107 Houses let in Lodgings 70 Housing Committee 5 Ice Cream 83 Infantile Mortality 25-35 Infants, advice as to rearing of 32-35 Infectious Diseases 37-59 ,, ,, Notifiable 39-48 ,, ,, ,, Attack Rate 39, 40 ,, ,, ,, Cases occurring 39 „ ,, ,, ,, „ in each Month 41 „ „ ,, ,, ,, „ Ward 42 „ „ „ Death Rate 39, 40 „ „ „ Deaths from 39 Insanitary and Uninhabitable Premises 70 Inspections and Re-Inspections of Premises 65 Laundries 96, 97, 108 Legal Proceedings 113-121 Local Government Board Tables 125-131 Marriage Rates, 1898-1908 14 Marriages, Number of 13 Measles 50, 51 Membranous Croup 45, 46 Metropolitan Sewers and Drains Bill 68, 69 Milk and Tuberculosis 84-88 Milk Supply 84 Milkshops and Dairies 84 Mortuary, Public 79, 80 Natural Increase of Population 16 Non-resident Deaths 19 Notifiable Infectious Diseases 39-48 Notification of Births Act, 1907 34, 35 Nuisances, Inspection of 65 Outlying Deaths, Returns of 20 Outworkers 102-104, 107 Persons per Acre 13 Phthisis, Pulmonalis 53-58 „ „ Voluntary Notification of 54-57 Population, Density of 13 „ Estimated to Middle of 1908 13 „ In Wards 13 ,, Natural Increase of 16 143 PAGE. Principal Epidemic Diseases 48-53 „ „ „ Death Rate 49 „ „ „ Deaths from 48, 49 Public Health Committee 5 „ „ (Tuberculosis) Regulations, 1908 57, 58 Puerperal Fever 48 Rearing of Infants 32-35 Redrainage Applications 66 Registered Houses 70 Respiratory System, Diseases of 23 Restaurant Kitchens 101-102 Sale of Food and Drugs Acts 88-91 Sanitary Administration, General 63-92 Scarlet Fever 14, 45 Senile Mortality 22 Sewer Air, Dr. Andrewes' Investigations 74-76 Sewers, Condition and Ventilation of 73, 74 Slaughter-houses 83 Small-pox 43 Staff of the Public Health Department 6 Suicide 23 Summary of Vital Statistics for 1908 11 Tenement Houses, Water Supply of 77 Tuberculosis 53-58 Underground Rooms 72, 73 Uninhabitable and Insanitary Premises 70 Vaccination 43 Vital Statistics 9-23 Water Supply, Certificates as to 65 ,, ,, In Tenement Houses 77 Whooping Cough 52 Workshops 96-108 Workplaces 96-108