HAMP 16 THE Metropolitan Borough of Hampstead. REPORT FOR THE YEAR 1909 OF THE Medical Officer of Health. G. F. McCLEARY, B.A., M.D., D.P.H. CONTENTS. PAGES Vital Statistics 9-25 Infantile Mortality 27-34 Infectious Diseases 36—57 General Sanitary Administration 59—84 Factory and Workshop Act, 1901 86- 98 Report on Analytical Work 99 — 101 Legal Proceedings 103—110 Appendix—Tables 112—127 Index 129—131 5 PUBLIC HEALTH COMMITTEE, NOVEMBER, 1908-9. Ex- Officio. His Worship The Mayor (Mr. Alderman E. Todd. Chairman. Mr. Councillor E. C. Taylor, M.D. 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. Eraser. ,, C. L. Jupp. ,, R. E. Lawrence (Miss). ,, J. P. R. Lyell. ,, F. G. Neave. ,, T. H. Nunn. ,, J. T. Osler. 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT, 1909. Senior Sanitary Inspector. W. G. Kershaw. Divisional Sanitary Inspectors. It. Geary, No. 1 District (Wards 1 and 2). C. II. Taylor, No. 2 District (Wards 3 and 7). A. Peverett, No. 8 District (Wards 4 and 5). J. Grimsley, 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. Hell. Clerks. W. Sell, First Clerk. F. S. Hill, Second Clerk. P. T. Roberts, Third Clerk. Clerk-Draughtman.. A. Narramore. 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. Mh. Mayor, Madam, and Gentlemen, I have the honour to place before you my Annual Report for the year 1909. The facts and figures in the report show that the high standard Hampstead has established in health matters was well maintained in 1909. In certain directions, however, there is still much need for further developments of our public health work on the lines I have endeavoured to indicate in the report. I am glad to acknowledge the excellent work of the Staff of the Public Health Department throughout the year. To the Chairman and the Members of the Public Health Committee my thanks are also due for their continued support. I have the honour to be, Mr. Mayor, Madam, and Gentlemen, Your obedient Servant, G. F. McCLEARY, Medical Officer of Health. Vital Statistics. 11 Summary of Vital Statistics for 1909. Population estimated to middle of 1909 94185 Density „ „ „ 41.6 persons per acre Births 1328 Birth-Rate 13.9 Marriages 680 Marriage-Rate 14.4 Deaths 839 Death-Rate 8.9 Infantile Mortality 74 per 1000 births Notifiable Infectious Diseases Attack-Rate 3.4 Notifiable Infectious Diseases Death-Rate 0.22 Death-Rate from the Seven Principal Epidemic Diseases 0.52 Population at Census, 1901 81942 Inhabited Houses „ „ 11294 Area of Borough 2265 acres „ (excluding area covered by water) 2253 acres 13 POPULATION. The population of Hampstead at the middle of 1909, was estimated by the Registrar-General to he 94185. 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) 14560 „ 2 (Belsize) 14990 „ 3 (Adelaide) 10940 „ 4 (Central) 10735 „ 5 (West End) 14650 „ 6 (Kilburn) 17010 „ 7 (Priory) 11300 The Borough 94185 The area of the Borough (including the area, twelve acres in extent, covered by water), is 2265 acres, and the estimated number of persons to the acre is 41.6. 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. Acording to the returns of the Registrar-General, 680 marriages were registered in the Borough during 1909 ; they were distributed in the four quarters of the year as follows:— 1st quarter 108 2nd „ 197 3rd „ 208 4th „ 167 Total 680 14 The total number of persons married in Hampstead during 1909 was 1-360, which is equivalent to a rate of 14.4 per 1000 of the population, and is an increase on that for the year 1908, when the marriages of 1244 persons were registered, equivalent to a rate of 13.4 per 1000 of the population. The following Table gives the marriage rates for the years 1899—1908, and the average rate for the decade:— Year. No. of persons married per 1000 of the population. 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 1908 13•4 Average for the decade 13•8 1909 14•4 BIRTHS. During the year, 1282 births were registered in Hampstead, a decrease of 73 as compared with the number, 1355, registered in the previous year. Of the total births 6.36 were of male, and 646 of female children. The births registered in Hampstead do not comprise the total births belonging to Hampstead that occurred during the year. Forty-six births of children whose mothers were Hampstead residents occurred in 1909 in the principal lying-in institutions in other metropolitan boroughs, and the total number of births belonging to Hampstead was 1328; and in accordance with the practice of the Registrar-General, I have taken this number as a basis for the various rates that depend on the number of births occurring during the year. 15 Illegitimate Births.—Out of the total of 1282 births registered in Hampstead, 43 or 33 per 1000, were those of illegitimate children. Birth-rate. The Birth rate calculated on the number of births registered m the Borough was 13•6 per 1000 of the population, as compared with the rate of 14•4 per 1000 in 1908, and 17•0, the average for the years 1899—1908. 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 is found to be 13•9. This is the lowest birth-rate ever recorded in Hampstead, the lowest rate in any previous year being 14•7 in 1907. The following Table shows the birth-rates in 1909 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 25•6 76 Great Towns 25•7 142 Smaller Towns 24•8 England and Wales 25•6 London 24•2 Hampstead 13•9 The Table on page 127 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 registration of births was first made compulsory in this country by the Births and Deaths Act, 1874, which came into operation in 1875. The year 1875 may, therefore, be regarded as the first year for which we possess complete birth statistics, and the birth-rate in that year in England and Wales was 35•4, and in Hampstead 22•6. In the following year, 1876, the birth-rate in England and Wales was the highest on record, viz.: 36•3, while in Hampstead the rate was 24•4,—a higher rate than has ever been recorded in Hampstead in one year except 1878, when the rate was 24•5. The birth-rate in England and Wales has fallen steadily from 36•3 in 1876 to 25•6 in 1909,—a decline of 29•5 per cent, in thirty-three years; while in Hampstead there has been a similar fall, except for the slight rise in 1878, from 24•4 in 1876 16 to 13.9 in 1909, or a decline of 43 per cent. In Hampstead the birthrate has undergone a greater proportionate decline than in England and Wales. The significance of the decline in the birth-rate has to some extent been masked by the marked decline in the death rate that has also occurred in the years under review. The death-rate has fallen in England and Wales from 20.9 in 1876 to 14•5 in 1909—a decline of 30•6 per cent.—and in Hampstead from l5•2 to 8•9 in the same years — a decline of 41•4 per cent. It is obvious, however, that the death-rate cannot be expected to decline indefinitely. Death cannot be prevented ; it can only be postponed. The present age-constitution of the population in this country is favourable to a low death-rate, but as the proportion of old persons in the population increases the death-rate will tend to rise. In France the death-rate has in several years exceeded the birth-rate, and the same result has been recorded in some parts of England. The Adelaide Ward in Hampstead affords an exampleTins Ward in 1909 had the low death-rate of 8 per 1000 population, but the birth-rate was only 7•6. The corresponding figures in 1907 were 7•9 and 6•9. Death being inevitable, there must always be a deathrate; but birth is not inevitable, and there is nothing in the nature of things to prevent the birth rate from falling to zero. The causes of the fall in the English birth-rate have been discussed in the recent Annual Reports of the Registrar-General, and the conclusion reached is that the fall is due to a decrease (1) in illegitimacy ; (2) in the marriage-rate; and (3) in the fertility of marriages, which again is due to (a) the greater proportion of older women in the population of married women at conceptive ages, and (b) the voluntary limitation of the family. The last, no doubt, is the chief cause that has been at work in the decline of the birth-rate. The following table shows the Ward and sex-distribution of the births, and the birth-rate for each Ward:— 17 Ward. Births. Birth rate per 1000 of the population. Males. Females. Total. No. 1 (Town) 94 102 196 13•5 No. 2 (Belsize) 105 99 204 13•6 No. 3 (Adelaide) 39 44 83 7•6 No. 4 (Central) 58 58 116 10•8 No. 5 (West End) 130 109 239 16•3 No. 6 (Kilburn) 157 184 341 20•0 No. 7 (Priory) 76 73 149 13•2 The Borough 659 669 1328 13•9 The Natural Increase of the population, i.e. the excess of births over deaths, was 489 in 1909. DEATHS. The total deaths occurring in Hampstead during the year amounted to 1057. Of these, however, no less than 334 were of persons not belonging to the Borough, while 116 residents of Hampstead died in outlying districts. The total number of deaths, therefore, amongst persons belonging to Hampstead amounted to 839. 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 11.1 per 1000 of the population; but after subtracting from the total deaths registered the deaths of non-resident persons dying in Hampstead, and adding the deaths of Hampstead residents who died outside the district, the recorded death-rate is found to be 8-9 per 1000 of the population, as compared with the rate of 8.5 per 1000 of the population in 1908. The average recorded death-rate for the 10 years 1899-1908 was 10.0. 18 The following table shows the death-rates in 1909, for England and Wales, the 70 Great Towns, the 142 Smaller Towns, England and Wales less these 218 Towns, London, and Harnpstead:— Death-rate per 1,000 of the population. England and Wales 14•5 76 Great Towns 14•7 142 Smaller Towns England and Wales, less the 218 13•9 Towns 14•5 London 14•0 Hampstead 8•9 The following are the death-rates for each of the wards:— WARD. Death-rate per 1,000 of the population. No. 1 (Town) 9•6 No. 2 (Belsize) 8•7 No. 3 (Adelaide) 8•0 No. 4 (Central) 5•9 No. 5 (West End) 8•0 No. 6 (Kilburn) 10•7 No. 7 (Priory) 9•8 In the table on page 127, the death-rates of Harnpstead 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:— 19 Table showing the Death-Rates from All Causes in the County of London, the City of London, and the Metropolitan Boroughs during the 52 Weeks of 1909, as calculated by the Registrar-General. DISTRICT. Death rate from all causes. Hampstead 8•9 Lewisham 10•3 Stoke Newington 11•3 Wandsworth 11•9 Woolwich 11•9 Fulham 12•0 Greenwich 12•2 Hackney 12•6 Paddington 12•9 Battersea 13•0 City of Westminster 13•1 Kensington 13•3 Camberwell 13•4 Deptford 13•6 Islington 14•0 Lambeth 14•1 Hammersmith 14•3 Chelsea 14•4 St. Marylebone 14•6 St. Pancras 14•8 Stepney 15•3 Holborn 15•6 Poplar 16•3 Bethnal Green 16•8 Southward 16•8 Bermondsey 18•8 Shoreditch 19•0 Finsbury 19•2 City of London 20•3 County of London 14•0 20 The death-rate in Hampstead in 1909, 8•9, was slightly higher than in 1908, when it was 8•5, the increase being due to the higher mortality from bronchitis and pneumonia among old persons, who form a considerable proportion of the population of the Borough. The deaths from these causes numbered 158 in 1909 as against 113 in 1908, the majority of the deaths occurring among persons over 65. The increased mortality must be attributed chiefly to the abnormally inclement weather during the first quarter of the year, especially in March, in which month the mean temperature was rather more than two degrees below the average. There were heavy snow-storms in the first week of 'March, and throughout the month the weather was unusually bad. Measles and Whooping Cough were exceptionally fatal in 1909, the deaths from these causes being 29 as compared with 9 in the previous year. Deaths of Non-residents. 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. Acton. Harrow. Aldershot Hendon. Alton. Hornsey. Asliby-de-la-Zouch. Ilford. Barnes. Leyton. Basingstoke. Lowestoft. Bognor. Newport, Mon. Canterbury. Pinner. Chichester. Plaistow. Chilterne, Codford. Purley. Ealing. Rainham. East Ham. Reading. Esher. St. Leonard's-on-Sea. Forest Gate. Southend-on-Sea. Halfkey. Southall. 21 Sudbury, Middlesex. West Norwood. Thornton Heath. Willesden. Tottenham. Windsor. Tunbridge Wells. Wisbeach. Twickenham. Woking-. UppinghamWood Green. Uxbridge. Woodford. Walthamstow. Worthing. Watford. Yarmouth, Great. Wealdstone. Information as to the deaths of 9 Hampstead residents was received from the Medical Officers of Health of the following districts, in which the deaths had occurred:— Appleby. Willesden. Merton. York. Reigate. The number of deaths of Hampstead residents that occurred in public institutions was 248, or 29.5 per cent, of the total deaths, and the number of deaths occurring in workhouses or workhouse infirmaries was 90, or 10.7 per cent. of the total deaths. A list of the institutions in which the deaths occurred is given on page 22. 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 118 and 119. Age Periods. Under 1 year. 1 to 5 5 to 15. 1 to 25. 25 to 65. 65 and upwards. At all Ages. Deaths 99 49 23 34 308 326 839 22 Deaths of Hampstead Residents in Public Institutions. Institution. Totals Group Totals. Infirmaries and Workhouses:- Hampstead Workhouse 84 90 St. Marylebone Infirmary 3 St. Pancras Infirmary 2 St. Pancras Workhouse 1 Hospitals:- Cancer Hospital 1 90 Childien's Hospital, Great Ormond Street 1 Children's Hospital, Paddington Green 1 Cottage Hospital, Willesden 1 French Hospital 1 Friedenheim Hospital, Upper Avenue Road 1 German Hospital, Dalston 1 Great Northern Central Hospital 4 Guy's Hospital 1 Hampstead General Hospital 25 Heart Hospital, Soho 1 Homeopathic Hospital 2 Hospital of St. John and St. Elizabeth, St. Marylebone 3 Infants' Hospital, Vincent Square 1 King's College Hospital 1 London Fever Hospital 1 London Hospital 1 London Temperance Hospital 3 Middlesex Hospital 8 Mount Vernon Hospital for Consumption 2 New Hospital for Women 1 Queen Charlotte's Hospital 2 St. Bartholomew's Hospital 4 St. George's Hospital 2 St. Luke's Hospital 2 St. Mark's Hospital 1 St. Mary's Hospital 11 Samaritan Free Hospital 1 University College Hospital 4 West London Hospital 1 Westminster Hospital 1 Metropolitan Asylums Board's Hospital:- North Western Hospital 10 10 County and other Asylums:- Banstead Asylum 2 25 Claybury Asylum 3 Colney Hatch Asylum 6 Earlswood Asylum 1 Hanwell Asylum 7 Horton Asylum 1 Leavesden Asylum 5 Elsewhere 33 33 248 The name of the Institutions that are situated in Hampstead are printed in heavy type. 23 Senile Mortality. The deaths of persons of 65 years of age and upwards numbered 326, as compared with 312 in 1908. Of these, 50 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 118, 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. As regards the other causes of death, the following require special mention. Cancer. The following table gives the number of deaths from cancer, and the death-rate per 1000 population in each of the nine years 1901-09. 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 1909 85 0•90 The next table gives the anatomical distribution of the disease in each sex. It will be noted that a large proportion of the patients, 54 out of a total of 85 cases, were females. In 33 cases the patients were over 65 years of age. 24 Situation. Males. Females. Total. Brain 1 - l Tongue 1 - l Larynx 2 - 2 Breast - 14 14 Thorax - 3 3 Esophagus 4 - 4 Liver 3 4 7 Stomach 7 8 15 Uterus - 7 7 Intestines 9 9 18 Other abdominal organs 2 3 5 Other situations 2 6 8 Totals 31 54 85 Alcoholism. In 3 cases death was certified to be due to Alcoholism, and 9 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, 12, as compared with 16 in 1908, 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 141 deaths, as compared with 133 in 1908. Diseases of the Respiratory System. The total mortality from these diseases was 170, as compared with 123 in 1908. 13 deaths occurred in children under five years of age, and 84 in persons aged from 65 years upward. 25 Of the total deaths 75 were clue to Pneumonia, 83 to Bronchitis, 3 to Pleurisy, and 9 to other diseases of the respiratory organs. The exceptionally high mortality from these diseases was due, as is pointed out on page 20, to the inclement weather that prevailed during the first quarter of the year. Accident. 18 deaths were classified under this heading, as compared with 14 in 1908, 8 were due to falls, 2 to suffocation (one an infant overlaid in bed), 2 to burns and scalds, 5 to street accidents, and 1 to another accident. Suicide. Six persons committed suicide as against 10 in 1908. In 2 cases the cause of death was poisoning, 1 death was due to shooting, 1 to hanging, 1 to drowning, and 1 to a fall from a window. Infantile Mortality. 29 INFANTILE MORTALITY. The number of deaths under one year registered in Hampstead was 111, but of these 20 deaths occurred in children not belonging to the Borough, while 8 infants belonging to Hampstead died in public institutions in other parts of London. The number of deaths of Hampstead infants was therefore 99, an increase of 2 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. No. 1 (Town). No. '2 (Belsize). No. 3 (Adelaide). No. 4 1 (Central). No. 5 ; (West End). No. 6 | (Kilburn). No. 7 (Priory). Non-distributable. Totals. i. Common Infectious Diseases. 1 Small-pox .. .. .. .. .. .. .. .. .. 2 Chicken-pox .. .. .. .. .. .. .. .. .. 3 Measles 1 .. .. .. .. 2 .. .. 3 4 Scarlet Fever .. .. .. .. .. .. .. .. .. 5 Diphtheria (including Membranous Croup) .. .. .. .. .. .. .. .. .. 6 Whooping Cough .. 1 1 .. 1 3 4 .. 10 ii. Diarrhœal Diseases 7 Diarrhoea, all forms 1 .. .. 2 .. .. .. .. 3 8 Enteritis, Muco-enteritis, Gastro-enteritis .. 1 .. .. 1 .. .. .. 2 9 Gastritis, Gastrointestinal Catarrh .. .. .. .. .. 1 .. .. 1 iii. Wasting Diseases 10 Premature Birth 3 2 2 .. .. 9 2 .. 18 11 Congenital Defects 1 .. .. 1 2 2 .. .. 6 12 Injury at Birth .. 3 .. .. 1 .. 1 .. 3 13 Want of Breast-milk, Starvation .. .. .. .. .. .. .. .. .. iv. Tuberculous Diseases 14 Atrophy, Debility, Marasmus 1 8 •• 14 15 Tuberculous Meningitis 1 2 .. 3 16 Tuberculous Peritonitis : Tabes Mesenterica .. 1 .. .. .. .. .. .. 1 17 Other Tuberculous Diseases .. .. .. .. 1 .. .. .. 1 v. Other Causes 18 Erysipelas .. 1 .. .. .. .. .. .. 1 19 Syphilis 2 .. .. .. .. 1 .. .. 3 20 Rickets 1 .. .. .. .. .. .. .. 1 21 Meningitis (not Tuberculous) .. .. .. .. .. 1 .. .. 1 22 Convulsions .. 1 .. .. .. .. .. .. 1 23 Bronchitis .. 1 .. .. 1 1 .. .. 3 24 Laryngitis .. .. .. .. .. .. .. .. .. 25 Pneumonia .. 3 .. .. 2 3 2 .. 10 26 Suffocation, overlying 1 .. .. .. .. .. .. .. 1 27 Other Causes .. 1 1 .. 3 4 2 .. 11 Totals 15 16 4 3 13 37 .. .. 99 30 The "Infantile Mortality," i.e., the number of deaths under one year per 1000 births was 74 as compared with the rate of 69 per 1000 births in 1908, this figure being calculated on the total number of births belonging to Hampstead, including those that occurred in lying-in institutions outside Hampstead. The average rate for the years 18991908 was 93. The following table shows the infantile mortality of Hampstead in each year since 1880:— 1880 140 1895 135 1881 136 1896 123 1882 99 1897 127 1883 98 1898 125 1884 143 1899 129 1885 110 1900 100 1886 131 1901 102 1887 107 1902 88 1888 110 1903 87 1889 122 1904 111 1890 122 1905 94 1891 l04 1906 77 1892 122 1907 69 1893 102 1908 69 1894 113 1909 74 The following table shows a comparison of the infantile mortality rates in 1909 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 1000 births. England and Wales 109 76 Great Towns 118 142 Smaller Towns 111 England and Wales less the 218 Towns 98 London 108 Hampstead 74 31 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) 76.5 No. 2 (Belsize) 78.4 No. 3 (Adelaide) 48.2 No. 4 (Central) 25.9 No. 5 (West End) 54.4 No. 6 (Kilburn) 108.5 No. 7 (Priory) 73.8 The infantile mortality rate in 1903 was slightly higher than in the previous year, the increase being chiefly due to an outbreak of whooping cough in the early part of the year, when the weather was exceptionally unfavourable to recovery. This disease caused 10 deaths in infants under one year in 1909 as against 3 in 1908. Three deaths from .Measles occurred among infants in 1909, there being no infantile death from this cause in 1908. The deaths from premature birth and congenital defects increased from 20 in 1908 to 24 in 1909. It is satisfactory to note that the deaths from diarrhœal diseases fell from 16 in 1908 to 6 in 1909. These are the diseases that are chiefly affected by the health visiting work that has been carried out in Hampstead in recent years, and the fall in the mortality from these diseases is evidence that this work is yielding satisfactory results. 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:— Table showing the Infantile Death Rates of the County of London, the City of London, and the Metropolitan Boroughs during the 62 weeks of 1909, as calculated by the registrar General. DISTRICT. Deaths under 1 year to 1000 Births. Hampstead 74 Lewisham 74 Stoke Newington 80 Woolwich 82 Wandsworth 86 City of Westminster 95 St. Marylebone 99 Camberwell 100 Greenwich 100 Paddington 100 Islington 101 Deptford 102 Hackney 102 Holborn 102 St. Pancras 102 Battcrsea 107 Chelsea 107 Fulhara 108 Lambeth 109 City of London 113 Kensington 113 Southwark 119 Stepney 119 Hamersmith 120 Bethnal Green 129 Poplar 129 Finsbury 131 Bermondsey 138 Shoreditch 140 County of London 108 32 33 The special measures for the prevention of infantile mortality that were described in my report for 1908, were continued and extended in operation during 1909. The Notification of Births Act was found of great value in promoting health visiting. This Act cime into operation in Hampstead on March 9th, 1908, and 1909 is the first year for which we possess a complete year's record of the working of the Act. The number of births notified daring the year 1909 was 1221, including the births of 28 stillborn infants. Deducting the latter we arrive at a total of 1193 live births notified, and the total number of live births that actually occurred during the year, as ascertained from the Registrar, was 1253. The live births notified were, therefore, 95.2 per cent. of the live births actually occurring. 325 births were notified by medical practitioners, 129 by midwives, 727 by parents, and 40 from other sources. The obligation to notify imposed by the Act is in addition to, and not in substitution for the obligation to register a birth which is imposed by the Registration Act. The notification must be made within 36 hours of the birth, but registration may be delayed for as long as six weeks after. The object of the Notification of Births Act is to supply the Medical Officer of Health with timely information of the births occurring in the district, so that where necessary the homes may be visited by the health visitors, and the Act is of little value where no health visiting system has been established. In Hampstead health visiting is carried out on well defined lines by the Council's lady sanitary inspectors, and by a body of voluntary visitors organised by the Hampstead Health Society. Many of the births notified in Hampstead do not, of course, require to be dealt with by the health visitors, and in respect of these no action is taken. In other cases the first visit is paid by one of the lady inspectors, Mrs. Fisher taking the births that occur in the Kilburn Ward, and Miss Moynihan the rest of the Borough. Subsequent visits are paid by the voluntary visitors, and the infants are kept under supervision during the whole of the first year of life. Periodical meetings of the visitors arc held, where cases are discussed and future work arranged. The mothers are encouraged to bring their babies regularly to be weighed. The baby-weighing takes place once a week at the Hampstead and North St. Pancras Day Nursery, 29, Pond Street, and at the Brondesbury and West Hampstead Day Nursery, 36, Hemstal Road. The weighing is carried out by the lady inspectors, assisted by the voluntary visitors. 34 One of the chief objects of the health visitors is to encourage breastfeeding, but in the poorer parts of Hampstead we have found instances where the mother, although anxious to continue nursing her baby, is unable to do so, owing to the fact that through poverty, she herself is insufficiently nourished. In order to meet cases of this kind the West Hampstead Infants' Committee of the Hampstead Health Society decided, with the sanction of the Society, to raise a fund to supply nursing mothers with milk and other food. This assistance is only given on certain conditions, one being that the baby should bo brought regularly to be weighed. The sum of money raised for this purpose during 1909 was comparatively small, but it was sufficient to enable the health visitors to add considerably to the value of their work. It is to be hoped that this side of our preventive work will be more developed during the present year. 676 newly born infants were visited by the lady inspectors during 1909, and 643 re-visits were paid, 193 of which were in respect of infants born in 1908. Of the 676 infants visited, 218 were visited within the first fortnight after birth, 188 in the second fortnight, 258 in the second month, 12 being visited later than the second month. Of the 664 babies visited within the first two months after birth, 539 were found to be entirely breast-fed, 64 to be partially breast-fed, and 61 entirely hand-fed; 83 of the babies visited lived in tenements of one room, 346 in tenements of two rooms, 231 in tenements of three rooms, 8 in tenements of more than three rooms, while in 8 cases the number of rooms was not ascertained. Infectious Diseases. 37 NOTIFIABLE INFECTIOUS DISEASES. The list of infectious diseases notifiable in London was increased during 1909 by an Order of the London County Council requiring the notification of cases of Anthrax, Glanders and Hydrophobia occurring in man. The Order came into force on April 26th, 1909, but no case of any of these diseases has yet been notified in Hampstead. Epidemic cerebro-spinal meningitis, or "spotted fever," was made notifiable in London, by an Order of the London County Council in 1907, but no case of the disease was notified in that year or in 1908. In 1909, however, 4 cases were notified. The total cases of infectious diseases notified numbered 325. This is equivalent to an attack-rate of 3.4 per 1000 of the population. The following shows the number of cases of each disease notified:— Scarlet Fever 241 Enteric Fever 13 Diphtheria and Membranous Croup 33 Puerperal Fever 5 Erysipelas 29 Epidemic Cerebro-spinal Meningitis 4 The number of fatal cases was 21, equal to 6.5 per cent. of the cases notified. The deaths were distributed as follows: — DISEASE. WARDS. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. \ (Central). No. 5 (West End). No. 6 (Kilburn) No. 7 (Priory). Totals. Scarlet Fever .. 2 .. .. 1 1 .. 4 Enteric Fever 1 1 2 1 .. .. .. 5 Diphtheria and Membranous Croup 1 1 .. .. .. 3 .. 5 Puerperal Fever 2 .. .. .. .. 1 . . 3 Erysipelas ... 1 .. .. .. .. .. 1 Epidemic Cerebro-spinal Meningitis .. .. 1 1 1 .. 3 Totals 4 5 2 2 2 5 .. 21 The death rate from the notifiable infectious diseases was 0.22 per 1000 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 1891-1909:- 38 TABLE showing the attack-rate and death-rate for the Borough from Smallpox, Diphtheria and Membranous Croup, Scarlet Fever, and Enteric Fever, during the years 1891-1909. 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. 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 1999 — 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 — 0.59 005 0.36 — 2.86 0.07 0.26 0.04 1909. — — 0.35 0.05 0.31 0.01 2.56 0.04 0.19 0.05 39 Cases of Infectious Disease occurring in each Month during 1909. Disease. MONTHS. Totals. January. February. March. April. May. June. July. August. September. October. November. December. Scarlet Fever 27 00 20 17 17 10 40 13 22 14 14 11 241 Enteric Fever 1 2 .. 2 2 .. 1 .. 3 1 .. l 13 Diphtheria and Membranous Croup 3 4 3 2 .. 2 2 3 5 .. 4 5 33 Puerperal Fever .. .. .. 1 1 .. .. 1 1 .. 1 .. 5 Erysipelas 3 1 3 3 4 2 .. 3 1 3 5 1 29 Epidemic Cerebro-Spinal Meningitis .. .. 1 .. 2 .. .. .. .. .. .. 1 4 Totals 34 37 27 25 26 20 43 20 32 18 24 19 325 40 Cases of Infectious Disease occurring in each Ward during 1909. 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 36 74 10 21 35 52 13 241 Enteric Fever 4 3 1 1 1 .. 3 13 Diphtheria and Membranous Croup 5 7 4 4 6 2 5 33 Puerperal Fever 4 .. .. .. .. 1 .. 5 Erysipelas 4 3 1 2 8 11 .. 29 Epidemic Cerebro-Spinal Meningitis .. 1 .. 1 1 1 .. 4 Totals 53 88 16 29 51 67 21 325 41 Small-pox. No case of Small-pox occurred 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 Year. Births. Successfully Vaccinated. Insusceptible of Vaccination. Had Smallpox. Number in respect of whom Certificates of "Conscientious Objection" have been received. Died Unvaccinated. Vaccination Postponed. Remaining, Percentage of Births Registered. Successfully Vaccinated. Exempted by "Conscientious Objection "Certificates. Not finally accounted for (including cases postponed). Unvaccinated. 1 2 3 4 5 6 7 8 9 10 11 12 13 1900 1623 1323 13 .. 37 108 11 131 (Col. 3) (Col. 6) (Cols. 8 & 9) (Cols. 6, 8, & 9) 81.5 2.3 8.7 11.0 1901 1508 1232 15 .. 39 111 7 104 81.7 2.6 7.4 10.0 1902 1517 1255 18 .. 27 104 11 102 82.7 1.8 7.4 9.2 1903 1452 1190 19 .. 30 106 11 96 82.0 2.1 7.4 9.5 1904 1446 1197 16 .. 35 100 8 90 82.8 2.4 6.8 9.2 1905 1421 1181 18 .. 40 91 14 77 83.1 2.8 6.4 9.2 1906 1438 1183 12 .. 35 93 18 97 82.3 2.4 8.0 10.4 1907 1341 1090 7 .. 60 80 5 99 81.3 4.5 7.8 12.3 1908 1321 1028 16 .. 127 78 6 66 77.8 9.6 5.7 15.1 1909 1295 972 19 .. 151 60 19 74* .. .. .. .. 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 35 births in respect of which no legal action as to vaccination has yet been taken. The rates for Columns 10. 13 ha\e therefore not been calculated. 42 Scarlet Fever. The number of cases of Scarlet Fever notified in each of the last nine 3'ears 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 1909 241 The deaths from Scarlet Fever in 1909 were 4 as compared with 7 in the previous year. The number of cases and the number of deaths per 1000 of the population were 2.56 and 0.04 respectively, and the case mortality, or percentage of deaths to cases was 1.6. The corresponding figures in 1908 were 2.86, 0.07, and 2.6 respectively. Of the cases notified, 211 or 87 per cent., were removed to hospital. The corresponding percentage in 190ft was 85. The high percentage of cases removed to hospital is a proof of the popularity of the Asylums Board's hospitals, for in no case was it found necessary to exercise compulsion, or even to bring much pressure to bear, to secure removal. Hospital isolation, quite apart from its public health aspect, is regarded by the public as affording a welcome escape for the other members of the family from the numerous disadvantages they would experience were the patient to remain at home. As will be gathered from the case mortality, Scarlet Fever existed during the year in a very mild form. Of the 241 patients notified only 4 died. This is, of course, a matter for congratulation on the whole, but it has the drawback that the presence of a mild type of the disease tends to bring about an increased prevalence, owing to the occurrence of unrecognised or "missed" cases, which are not isolated and so spread infection. During the year I received valuable information from school teachers of children absent from school owing to conditions suggestive of Scarlet Fever. Most of them I found on enquiry were suffering from nothing more than trivial ailments, but in nine cases the suspicion of Scarlet Fever was confirmed and the patients removed to hospital. In none of these 43 cases had a doctor been called in to attend the patient, the reason given by the parents being that they were not in a position to pay for medical attendance. 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 31 Water supplies defective 30 Other defects 60 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 4 11 2 — 3 6 1 27 February 3 4 — 1 5 17 — 30 March 3 2 l 2 1 11 — 20 April — 5 — 4 5 1 2 17 May 1 7 l 2 2 2 2 17 June 3 2 2 3 3 2 1 16 July 10 4 2 4 12 7 1 40 August 3 7 — — 2 1 — 13 September 1 16 — 4 — — 1 22 October 3 6 1 — — 2 2 14 November 1 6 1 1 — 2 3 14 December 4 4 — — 2 1 — 11 Totals 36 74 10 21 35 52 13 241 44 Diphtheria and Membranous Croup. The number of cases notified in 1909 was 33, as compared with 55 in 1908, the attack-rate, or number of cases notified per 1000 population, being 0.35. The number of fatal cases was 5, or 15.1 per cent. of the cases notified. The death-rate per 1000 population was 0.05; 16 patients, or 48 per cent. of the total cases notified, were removed to hospital. A thorough examination was made of the sanitary condition of every house in which a case of diphtheria occurred, and the following defects were discovered:— Drains defective 13 Soil pipes defective 4 Water supplies defective 5 Other defects 14 The following table shows the number of cases 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 — l — l l — — 3 February — — 2 l — — 1 4 March 1 l — l — 3 April — — 1 — 1 — — 2 May — — — — — — — — June 1 — — 1 — — 2 July — l — — — — 1 2 August 1 — — — 2 — — 3 September 1 2 1 — — — 1 5 October — — — — — — — — November — 1 — l — 1 1 4 December 1 1 — 1 — 1 1 5 Totals 5 7 4 4 6 2 5 33 45 One of the most satisfactory features of the Hampstead health statistics in 1909 is the diminished prevalence of Diphtheria. The number of cases of this disease notified in 1909, viz., 33, was considerably smaller than the corresponding number in any previous year, the next lowest figure being 55, which was recorded in 1908 and also in 1904. The following figures show the prevalence of Diphtheria in Hampstead since 1890, the vear in which the disease first became notifiable. Year. No. of cases notified. Year. No of cases notified. 1909 33 1899 106 1908 55 1898 131 1907 103 1897 100 1906 97 1896 189 1905 63 1895 112 1904 55 1894 96 1903 79 1893 158 1902 85 1892 136 1901 142 1891 88 1900 153 1890 96 The decrease becomes more apparent when instead of the number of cases, the case-rate, or proportion of cases notified per 1000 population is taken, as in the following table:— Years. No. of cases notified per 1000 population. 1909—1905 0.77 1904—1900 1.22 1899—1895 1.63 1894—1890 1.61 The diminished prevalence of Diphtheria may be regarded as one of the results of the sanitary improvements secured by the Borough Council in recent years, Diphtheria being a disease that is specially dependent upon insanitary surroundings. Enteric Fever. The number of cases notified was 13 as compared with 24 in 1908 and 19 in 1907. The attack rate per 1000 population was 0.19. The number of fatal cases was 5 or 38.5 per cent. of the cases notified. The death rate per 1000 population was 0.05; 6 patients, or 46 per cent. of the total cases notified, were removed to hospital. 46 The sanitary condition of each house in which a case of Enteric Fever occurred was investigated, and the following defects were discovered:— Drains defective 5 Soil pipes defective 3 Water supplies defective 4 Other defects 5 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 1 February — l — — — — 1 2 March _ — — — — — — — April 2 — — — — — — 2 May — — l — — — 1 2 June — — — — — — — — July — 1 — — — — 1 August — — — — — — — — September 1 1 — — 1 — — 3 October 1 — — — — — — 1 November — — — — — — — — December — — — l — — — 1 Totals 4 3 l l l — 3 13 47 A careful inquiry was made as to the source of infection in each case. In four instances it was found that the patient had clearly been infected outside Hampstead; one of these patients was infected in Scotland, one in Surrey, one in Suffolk, and one in Bucks. 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. 5 cases were notified, 3 of which proved fatal, as compared with 6 cases and 4 deaths in 1908. The ward distribution of the cases is as follows, 4 in No. 1 (Town), and 1 in No. 6 (Kilburn). Four of the cases were removed to hospital. Erysipelas, 29 cases were notified, and 1 death occurred, as compared with 33 cases and no deaths in 1908. The attack rate per 1000 of the population was 0.31. Of the cases notified, 2 or 7 per cent. were removed to hospital. One patient was removed to the Hampstead Workhouse Infirmary, and one to the Temperance Hospital. Epidemic Cerebro-Spinal Meningitis. This disease, which is popularly known as "Spotted Fever," was made notifiable throughout London by an Order of the London County Council in 1907, but neither in that year nor in 1908 was any case notified in Hampstead. In 1909, however, 4 cases were notified, all of which proved fatal. There is some difference of opinion whether this disease is infectious, and at the present time the evidence seems mostly in favour of the view that it is only infectious in a minor degree, if at all. If the disease is communicable from one person to another, it is probable that the infection is conveyed by some means that are yet unknown. A careful enquiry was made into each case that occurred in Hampstead, but in no case could any source of infection be discovered. Administratively, the disease was dealt with as if it were infectious, and disinfection was carried out after each case. 48 SEVEN PRINCIPAL EPIDEMIC DISEASES. The total number of deaths from these diseases amounted to 49, and 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) Small-pox — — — — — — — — Measles 4 3 — — 1 2 1 11 Scarlet Fever — 2 — — l 1 — 4 Diphtheria and Membranous Croup 1 1 __ 3 5 Whooping Cough 1 1 2 i l 6 6 18 Fever 1 1 2 2 1 1 — 8 Diarrhœa 1 — — 2 — — — 3 Totals 8 8 4 5 7 10 7 49 The death rate from the seven principal epidemic diseases was therefore, 0.52 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 1909:— 7 Principal Epidemic Diseases. Small-pox. Measles. Scarlet Fever. Diphtheria. Whooping Cough. Fever. Diarrhœa. England and Wales 1.12 0.00 0.35 0.09 0.14 0.20 0.06 0.28 76 Great Towns 1.42 0.00 0.48 0.11 0.15 0.24 0.06 0.38 142 Smaller Towns 1.08 — 0.33 0.09 0.16 0.17 0.06 0.27 England and Wales less the 218 Towns 0.80 0.00 0.21 0.06 0.14 0.16 0.06 0.17 London 1.31 0.00 0.48 0.08 0.13 0.26 0.03 0.33 Hampstead 0.51 — 0.12 0.04 0.05 0.19 0.06 0.03 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. 49 Detailed information concerning Small-pox, Scarlet Fever, Diphtheria, and Fever will be found under the heading of Notifiable Infectious Diseases on pages 41-47, but particulars concerning Measles, Whooping Cough, and Diarrhœa, to which notification does not apply, are given here. Year. Seven Principal Epidemic Diseases. Death rate per 1000 of the population. Measles. Death rate per 1000 of the population. Whooping Cough. Death rate per 1000 of the population. Diarrhœa. 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 1909 0.51 0.12 0.19 0.03 Measles. Eleven deaths were recorded from this disease, as compared with 4 in 1907. The mortality was 0.12 per 1000 population, the mortality in 1908 being 0.04. 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 the}' do not make the disease compulsorily notifiable. 50 During the year 1909, 283 cases were reported to the Medical Officer of Health, as compared with 280 in 1908. The sources of information were as follows: — Cases notified by medical practitioners 19 „ parents or guardians 67 ,, school teachers 155 „ employers and others 36 Death Returns 6 283 The cases are visited by lady inspectors, who instruct the mothers of the patients as to the measures that should be adopted for the isolation of the patient at home, there being no hospital accommodation for cases of Measles in London, other than that afforded by the Poor Law Infirmaries. The Inspectors in their visits lay stress on the fact that Measles is a serious disease, often ending fatally, that requires careful nursing and medical attendance. In every case the parents are urged to call in a doctor. Unfortunately the idea is prevalent that Measles is a disease of slight importance that calls for no special precautions, but the health visiting work of lady inspectors is having a good effect in dispelling this mistaken idea of Measles. More precautions are being taken against the spread of infection, and greater care is bestowed upon the patients. Disinfection is carried out after every case coming to the knowledge of the Medical Officer of Health. In 51 cases it was found, on enquiry, that no doctor was in attendance. The 283 cases occurred in 191 houses:— In 128 houses there was 1 case in each house. In 42 ,, ,, were 2 cases ,, In 15 ,, ,, ,, 3 ,, ,, In 5 ,, ,, ,, 4 ,, ,, In 1 house „ „ 6 „ 51 The following table shows the number of reported cases of Measles occurring each month in the various wards:— WARDS. Month. No. 1 (Town) No. 2 (Belsize) No. 3 (Adelaide) No. 4 Central No. 5 (West End) No. 6 (Kilburn) No. 7 (Priory) Totals. January 9 — 4 — 5 8 - 26 February 12 — 1 3 7 4 1 28 March 13 2 1 1 1 5 1 24 April 4 2 1 2 2 1 1 13 May 6 37 2 9 5 21 18 98 June 6 5 — 2 7 17 4 41 July - - - - 4 19 — 23 August - —- 1 — 1 7 — 9 September - – - - - - - - October - - - - - - 1 1 November - - — — 1 — 2 3 December 2 - — 1 — 12 2 17 Totals 52 46 10 18 33 94 30 283 Whooping Cough. There were 18 deaths from this disease in 1909, as compared with 5 in 1908, and 12 in 1907. The mortality per 1000 population was 0·19. Whooping Cough was prevalent in the early part of the year, when the weather was exceptionally cold and inclement. Under such conditions the disease tends to become complicated by pneumonia, and the patient's chances of recovery are considerably lessened. Unfortunately, Whooping Cough, like Measles, is popularly regarded as an 52 unimportant ailment, calling for no special care or management; but the health visiting work of the lady inspectors is gradually eradicating this popular error. Diarrhœa. The number of deaths from this cause was 3 as compared with 11 in 1908. The death rate per 1000 of the population from this disease was 0·03. These deaths occurred as follows—1 in No. 1 (Town) Ward in September, and 2 in No. 4 (Central) Ward in January and November. All these deaths occurred among children under one year of age. Tuberculosis. The number of deaths from Tuberculosis in 1909 was 75. Of these, 53 deaths were due to pulmonary tuberculosis or phthisis, 10 to tubercular meningitis and 6 to general tuberculosis. The following table shows the number of deaths and the death-rates 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 1909 75 0·80 53 0·56 53 The deaths from Phthisis during 1909 were distributed among the Wards as follows:— Ward. Area (Acres). Estimated Population middle of 1909. Phthisis Deaths Phthisis Death rate per 1000 of the Population. No. 1 (Town) 686 14560 6 0·41 „ 2 (Belsize) 271 14990 8 0·53 ,, 3 (Adelaide) 325 10940 3 0·27 ,, 4 (Central) 312 10735 3 0·28 „ 5 (West End) 247 14650 6 0·41 „ 6 (Kilburn) 195 17010 17 1·00 „ 7 (Priory) 229 11300 8 0·71 The Borough 2265 94185 53 0·56 * 2 deaths from phthisis were non-distributable. The following table shows the age distribution of the patients dying from consumption in Hampstead in the seven years 1903-1909. Age Period. Year. 0—5 5—15 15—25 25— 65 65— All AgeS. 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 1909 1 1 12 37 2 53 Totals 5 7 85 338 22 457 In 1902 a system of voluntary notification of Phthisis was adopted in Hampstead, and on January 1st, 1909, the Public Health (Tuberculosis) Regulations of the Local Government Board, which provide for the compulsory notification of cases of Phthisis occurring in Poor Law patients, came into operation. The following table gives the number of patients notified in each year since 1902:— 54 Year. No. of patients notified. 1902 51 1903 34 1904 39 1905 27 1906 35 1907 55 1908 30 1909 67 Seven of the notification certificates received during 1909 related to patients who had already been notified; the number of new patients notified was, therefore, 60, and of these 25 were males and 35 females. All these patients were Hampstead residents. The increase in the number of notified patients in 1909, is due to the operations of the Public Health (Tuberculosis) Regulations, 1908, which provide for the compulsory notification to the Medical Officer of Health of cases of 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. The total number of notifications received during the year, including duplicates, was 134, relating to 82 patients, of which 15 belonged to districts outside Hampstead. The number of notifications relating to Hampstead patients was 119, and of these 12 were made under the voluntary system of notification. The notifications were received from the following sources:— Private Practitioners 6 Hospitals and Dispensaries 6 Hampstead District Medical Officers 26 Medical Officer, Hampstead Workhouse 56 Medical Officers of outlying Poor Law Institutions on admission of Hampstead patients 2 Master of Hampstead Workhouse on Discharge of patients 22 Master of outlying Poor Law Institution on Discharge of patient to a Hampstead address 1 55 The foregoing figures refer exclusively to Hampstead patients: in addition, 15 notifications relating to patients belonging to other Districts were received from the following sources:— Medical Officer of Hampstead Workhouse on admission of patients from Mount Vernon Hospital belonging to other Districts 3 Medical Officers of outlying Poor Law Institutions on removal of patients to Hampstead Institutions 3 Masters of outlying Workhouses on removal of patients to Hampstead Institutions 6 Relieving Officers of outlying Unions on removal of patients to Hampstead Institutions 3 Sixteen of the patients notified died during the year. In 7 cases death occurred 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. Enquiries are made as to the source of infection, and these lead not infrequently to the discovery of other cases. As far as possible the notified patients are revisited from time 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 paid 303 visits to the homes of phthisis patients during the year, and her valuable work in this connection was much assisted by a body of voluntary health visitors organised by the Joint Phthisis Committee of the Hampstead Health Society, and the Hampstead Council of Social Welfare, to whose work I have referred in previous annual reports. These workers are specially useful in visiting a number of patients who, although not notified to the Medical Officer of Health, 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 have escaped 56 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. The assistance takes the form of providing sanatorium treatment, hospital treatment, additional nourishment, suitable work, etc. In a number of cases where a consumptive patient is the bread-winner of the family, the Committee by assisting the family have enabled the patient to enter a hospital or sanatorium. 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. Disinfection of rooms and bedding was carried out in the homes of 64 notified cases, and in 12 instances was repeated during the year. Disinfection is offered after the death or removal of a phthisical patient, whether a notified case or not. The total number of premises disinfected was 128. DISINFECTION. Number of articles disinfected:— Beds 282 Mattresses 532 Palliasses 25 Bolsters 385 Pillows 1231 Blankets 1440 Sheets 934 Counterpanes 633 Articles of Clothing 3310 Carpets 82 Linen articles 3083 Books 358 Miscellaneous 1293 Total 13588 Number of premises disinfected 732 „ rooms, etc, disinfected 1055 57 In addition to the foregoing, the following wore destroyed upon request of the owners:— Beds 3 Mattresses 17 Palliasses 2 Bolsters 5 Pillows 11 Blankets 2 Sheets 2 Counterpanes 3 Articles of Clothing 27 Carpets 3 Miscellaneous 33 Total 108 During 1908, 733 premises, 1015 rooms, &c., and 13,823 articles were disinfected, while 230 articles were destroyed. General Sanitary Administration. 61 Sanitary Works Carried Out. The following is a tabulated statement of the sanitary work, etc., carried out during the year, so far as that work admits of tabulation:— General Condition— Houses or parts of houses cleansed 192 Dampness in houses or parts of houses abated 98 Dilapidated houses or parts of houses repaired 82 Overcrowding— Cases of, abated (rooms) after service of notice 5 ,, ,, „ without service of notice 2 Underground rooms— Ceased to be occupied as separate dwellings 23 Below floors— Spaces below floors in the basement or ground floors ventilated 72 Roofs— Repaired 122 Gutterings— Repaired or renewed 122 Rainwater pipes— Repaired or renewed 178 Disconnected from drains 82 „ „ soil pipes 11 Waste pipes— Waste pipe of sinks disconnected from drains 1 „ „ „ trapped 364 „ „ „ repaired or renewed 308 „ ,, ,, unstopped 10 „ ,, of lavatories disconnected from drains 3 „ „ „ trapped 216 ,, „ ,, repaired or renewed 204 ,, „ of baths disconnected from drains 3 „ „ „ trapped 150 „ ,, „ repaired or renewed 125 Water supply— Houses provided with proper water supply 62 Water provided to upper floors of tenement houses 85 Water supplies used for domestic purposes disconnected from cisterns for flushing w.c.'s 1 62 Water cisterns— Repaired or renewed 8 Removed from improper positions 9 Cleansed 43 Fitted with close fitting covers 27 Water-closets— Accommodation provided 6 Additional accommodation provided 38 Separate and sufficient accommodation provided for persons of each sex 12 Removed from improper positions 8 Provided with proper and sufficient external ventilation 22 Improperly constructed apparatus removed and new provided 8 Apparatus repaired or renewed 587 ,, unstopped 21 ,, cleansed 70 ,, provided with proper water supply 14 Flushing cisterns repaired or renewed 300 Manholes— Repaired or renewed 108 Drains— Repaired or renewed 733 Cleansed 89 Unstopped 78 Ventilated 92 Ventilating pipes of drains— Carried to a sufficient height above windows 2 Repaired or renewed 35 Fresh air inlets repaired or renewed 60 Soil pipes— Repaired or renewed 338 Ventilated 32 Gullies and surface drains— Gully traps removed from improper positions 16 „ „ cleansed 31 Inlets or surface drains trapped 78 Paving and draining Washhouses, Areas, Yards, &c.— Washhouse or scullery paving repaired or renewed 9 Areas cleansed 13 Area paving repaired or renewed 93 Areas drained 22 Yards or other open spaces paved 126 Paving of yards or other open spaces repaired or renewed 93 Yards or other open spaces drained 36 Floors of buildings in which horses, &c., are kept, paved or repaired 7 63 Refuse and Receptacles— Dustbins provided 179 „ repaired 4 „ cleansed 9 Fixed ashpits removed 48 Accumulations or deposits of refuse removed 83 Manure receptacles provided 11 ,, ,, amended 46 Nuisances from the improper deposit of trade refuse abated 1 Animals— Nuisances from the improper keeping of animals abated 5 Number of Inspections, &c., Made; Notices Served; and Letters, &c., Issued. 1908 1909 — — Number of Inspections 9657 9237 „ Re-inspections 12858 12707 ,, Intimation Notices issued 893 781 „ Statutory Notices issued 512 660 ,, Letters issued 6670 5937 ,, Notifications sent to "Head Teachers" of Schools, respecting notified cases of infectious disease 414 494 ,, Notifications sent to Medical Officers of Health of other Boroughs respecting Hampstead children attending Schools in their districts — 110 „ Notifications sent to "Head Teachers" of Schools respecting cases of Measles 84 163 Certificates as to Water Supply. The number of Certificates issued during the year was 71, us compared with 47 in 1908. Drainage Work. The by-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 1909 the Council have approved of 360 plans for the drainage of new buildings, and 3709 plans for .alterations, etc., to drains of existing premises. 64 During the year 1909, 880 notices of drainage reconstruction or alteration were received, and in 733 cases the work necessitated the deposit of plans and written particulars. In 525 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 733 notices of drainage alterations, etc., requiring the deposit of plans, 286 related to work that involved the entire reconstruction of the drainage system. In 451 of the 733 drainage cases the work was carried out voluntarily, the number of instances in which voluntary complete reconstruction was carried out being 135. 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. During the year several claims were made by owners of property that certain defective combined drains were not legally "drains," for which the owners of the property were responsible, but "sewers," which the Council were under obligation to repair at the cost of the ratepayers. All these claims were successfully resisted. In one of the cases the facts were so unusual as to deserve special mention. In this case the matter arose in January, 1909, owing to the stoppage of the drain of a house in Parliament Hill. When the stoppage was removed it was found that the drain was so seriously defective as to require reconstruction, and the owner of the house claimed that this should be done by the Council at the cost of the ratepayers, because the drain conveyed drainage from the adjoining house, and was, therefore, in the eye of the law a "sewer." An inspection was made of the premises and it was found that the drain did in fact convey drainage from the adjoining house, the drainage consisting of rain water and waste water from a bath-room that had been built at the back of the premises. Reference was made to the original drainage plans that were deposited in 1868, when the houses were built, and these plans showed each house drained separately and not in combination. 65 Careful enquiries were made by Mr. Kershaw, who ascertained that each house was in fact separately drained in 1868, but that in 1886 the owner built a back addition to each house and connected the rain water and bath waste from both houses into the drain of one of the houses, no notice being given to the local authority. He subsequently sold the houses. The name and address of this former owner, who was still living, were ascertained, and the Council, in pursuance of their powers under section 76 of the Metropolis Local Management Act, 1855, entered the premises and caused the drains of the two houses to be disconnected, so that each drained separately in accordance with the plan originally approved by the local authority. The Council then took out two summonses against the person who had made the combination, one for making a drain without giving notice, the other to recover the cost incurred by the Council in disconnecting the drains. The Bench decided in favour of the Council in both cases, but owing to the lapse of time, imposed a nominal penalty of 5s., at the same time making an order for the cost of the work. Nothing more was heard of the claim that the drain was a "sewer." Houses Let in Lodgings. The number of houses registered as houses let in lodgings at the end of 1909, was 364, an increase of 49 on the number in 1908. The registered houses are situated chiefly in the following streets:— Bolton Road. Linstead Street. Dunboyne Street. Lowfield Road. Fairfax Mews. Netherwood Street. Fleet Road. Palmerston Road. Kelson Street. The number of tenement houses in Hampstead that might with advantage be dealt with under the by-laws relating to houses let in lodgings is considerably in excess of the number actually registered; but nothing is gained by registering houses that cannot be efficiently inspected, and the time of the inspectors is so much occupied with other work that it will be impossible without an increase in the present staff to cope with a large increase in the number of registered houses. The list of these houses is, however, steadily increasing, care being taken to select those houses that stand most in need of the operation of the by-laws. 66 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:— 12½, Alexandra Mews. and 6, Belsize Road Mews. 4, Oppidans Mews. 14, 15, and 18, 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 application for certificates under these Acts were received in respect of 96 dwellings, this number being 40 more than the number for which applications were made in 1908. 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 wholesomeness in certain dwellings that could not be obtained in any other way. In 1909, although 96 applications were made for the certificate of the Medical Officer of Health, no certificate was granted, since in no case was any attempt made to carry out the requirements upon which the certificate is based. Underground Rooms. The Public Health (London) Act, 1891, contains special provisions relating to underground rooms, an underground room being defined as 67 a room, the floor of which is more than three feet below the surface of the footway of the adjoining street, or of the ground adjoining or nearest, to the room. An underground room that is not occupied in conjunction with a room on any other floor of the same house must comply with certain conditions that are set out in detail in the Act; it must, for instance, be sufficiently protected against damp, properly lighted and ventilated, and provided with a fireplace with a proper chimney or flue, &c. An underground room that does not comply with these requirements is illegally occupied. During 1909 special attention was paid to the inspection of underground rooms, and 82 were found to be illegally occupied. These rooms were situated in the following streets:— Belsize Lane Mill Lane Canfield Gardens Netherwood Street Fitzjohn's Avenue Palmerston Road Fleet Road Quex Road Gardnor Road Heath Villas, Vale of Health Maygrove Road West End Lane. Of these rooms, 35 were altered to comply with the Public Health Act, and 14 were in process of alteration at the end of the year; 10 were vacated, and in 23 cases the tenants were able to occupy a room on an upper floor in conjunction with the underground rooms, which in this way were removed from the operation of the Act. In 4 cases it was found necessary to take legal proceedings to enforce compliance with the Act. In each case the defendant was convicted and fined. The powers of sanitary authorities in relation to underground rooms are greatly strengthened by section 17, sub-section 7, of the Housing, Town Planning, &c., Act, 1909. This sub-section, which does not come into operation until July 1st, 1910, enables the sanitary authority to close an underground room that is habitually used as a sleeping place, unless the room is on an average at least seven feet high, and complies with the regulations which the sanitary authority are empowered to make for securing the proper sanitary condition of such rooms. This new power will be found useful in certain parts where there are many underground rooms, which, although used as sleeping places, are occupied with rooms on upper floors, and are, therefore, exempt from the special requirements for underground rooms in the Public Health Act. 68 Seven 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. Housing, Town Planning, etc., Act. This Act is a measure of great importance, which in many ways improves and strengthens the law relating to public health. Some important parts of the Act are not administered by Metropolitan boroughs and do not therefore affect the work of the Council. Part II., which deals with town planning, is administered in London by the London County Council, and Part III., is exclusively confined to the appointment and duties of county medical officers of health. Considerable portions of Part I. are devoted to amending the procedure for the acquisition of land for housing purposes. The parts of the Act that immediately concern public health administration in Hampstead are contained in sections 14 to 21, inclusive, the chief provisions of which are as follows:— Section 14 provides that in any contract made after the passing of the Act for letting a house or part of a house at a rent not exceeding £40, there shall be implied a condition that the house is in all respects reasonably fit for human habitation; and this condition includes an undertaking that the house shall be kept by the landlord in all respects reasonably fit for human habitation. The sanitary authority are empowered to inspect such houses to ascertain whether this condition is fulfilled, and if it is not, the sanitary authority shall servo the landlord with a notice requiring him to execute such works as the authority shall specify as being necessary to make the house in all respects reasonably fit for human habitation. If the landlord fails to comply with the notice, the sanitary authority may enter and carry out the necessary works and recover the cost as a civil debt in the Police Court. Tin; landlord may appeal against the authority's notice, but the appeal 69 is not to a Court but to the Local Government Board. Section 17 places an obligation upon the sanitary authority to make from time to time inspection of their district to ascertain whether any dwelling house it unfit for human habitation, and the authority and their officers must comply with such regulations and keep such records as the Board may prescribe. The Board have not yet prescribed the regulations and records, but as they state in a memorandum on the Act that they attach much importance to this provision, no doubt these documents will soon be issued. If the authority think that any dwelling house is unfit for human habitation they may make a closing order on that house. The owner, within 14 days after the order is served upon him, may appeal to the Local Government Board. The provision is an important alteration of the law relating to closing orders. Hitherto the sanitary authority has been obliged to apply to a magistrate for a closing order, but under this Act, however, the sanitary authority make the closing order themselves, subject to an appeal to the Local Government Board. One of the most important provisions of the Act is that relating to underground rooms. Under the Public Health Act, underground rooms cannot be occupied separately as dwellings unless they comply with certain provisions which are specified in detail in the Act. These, however, do not apply if the rooms are occupied with a room or rooms on an upper floor. The new Act provides that every underground room that is habitually used as a sleeping place must be at least seven feet in height on an average from floor to ceiling and must comply with such regulations as the sanitary authority, with the consent of the Local Government Board may make. The Public Health Committee have considered the making of the regulations relating to underground sleeping rooms, and have recommended that the following regulations be submitted to the Local Government Board for approval:— (a) The room shall have at least three feet of its height above the surface of the street or ground adjoining or nearest to the room: Provided that, if the width of the area hereinafter mentioned be not less than the height of the room from the floor to the said surface of the street or ground, the height of the room above such surface may be less than three feet, but it shall not in any case be less than one foot, and the width of the area need not in any case be more than six feet. 70 (b) Every wall of the room shall be constructed with a proper damp course, and, if in contact with the soil, shall be effectually secured against dampness from that soil. (c) There shall be outside of and adjoining the room and extending along the entire frontage thereof and upwards from six inches below the level of the floor thereof an open area properly paved at least four feet wide in every part thereof: Provided that in the area there may be placed steps neceesary for access to the room, and over and across such area there may be steps necessary for access to any building above the Underground Room, if the steps in such case be so placed as not to be over or across any external window. (d) The said area and the soil immediately below the room shall be effectually drained. (e) If the room has a hollow floor, the space beneath it shall be sufficiently ventilated to the outer air. (f) Any drain passing under the room shall be properly constructed of a gas-tight pipe. (g) The room shall be effectually secured against the rising of any effluvia or exhalation, and for that purpose the site of the room shall be covered with a layer of good concrete, at least six inches thick, and smoothed on the upper surface. The concrete must be composed of clean gravel, broken hard brick, properly burnt ballast, or other approved hard material, well mixed with cement in the proportion of one of cement to eight of the other material. (h) There shall be appurtenant to the room the use of a water-closet and a proper and sufficient ash-pit. (i) The room shall be effectually ventilated. (j) The room shall have a fire-place with a proper chimney or flue. (k) The room shall have one or more windows opening directly into the external air with a total area clear of the sash-frames equal to at least one-tenth of the floor area of the room, and so constructed that one-half at least of each window of the room can be opened, and the opening in each case extends to the top of the window. The Water Supply of Tenement Houses. In my Annual Report for the year 1908, an account was given of the action taken in Hampstead during that year to improve the water supply of tenement houses under the powers conferred upon London sanitary authorities by section 78 of the London County Council (General Powers) Act, 1907. This section is a valuable addition to London's Sanitary Code. 71 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. It is difficult for the occupiers of these houses to practice the cleanliness that is essential for wholesome living. 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) 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 fcr 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 1909 the number of houses dealt with under this section was 85. In each house a water tap and a glazed earthenware sink were provided on each floor. The provision of a sink is important, 72 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. Pears have been expressed that these sinks might be misused and fouled and so become a source of nuisance. This, however, has not been our experience in Hampstead. The provision of water taps and sinks has led to an improvement in the sanitation of the premises, and has been much appreciated by the tenants. Staff of the Public Health Department. In the early part of 1909, Inspector Edmonds retired from the Council's service, and his District, No. 4, which is coterminous with the Kilburn Ward, was taken over by Inspector Grimsley, who had previously been in charge of No. 2 district, comprising Wards 3 and 7. To fill the vacancy the Council appointed Mr. C. H. Taylor, who began his duties on May 14th. During the year Mr. E. J. Cooper, resigned his post as Clerk-Draughtsman on his acceptance of an important appointment at the Hampstead Garden Suburb as Secretary to the Hampstead Tenants, Limited. Mr. H. C. Dobson was appointed to succeed Mr. Cooper, but he resigned in October and was succeeded by the present Clerk-Draughtsman Mr. A. Narramore. Public Mortuary. During the year the bodies of 85 persons were brought to the Mortuary as against 78 last year—53 by order of the Coroner, 14 by the Police, and 18 at the request of friends of the deceased persons. In 67 instances, or 79 per cent, of the bodies admitted, inquests were held, and in 37 instances, or 43 percent., post-mortem examinations were made. 73 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 45 Accidental deaths 17 Suicide 13 Neglect at birth 3 Misadventure 7 Total 8 74 MORTUARY RECORD FOR THE YEAR 1909. Bodies Admitted. Number of Post-Mortems. Number of Inquests. Number of Funerals from Mortuary. Month. Males. Females. Totals. Males. Females. Totals. January 5 3 8 4 2 6 7 7 February 6 3 9 3 .. 3 7 6 March 4 3 7 . . 3 3 7 6 April 2 3 5 .. .. 2 3 4 May 4 4 8 1 1 2 5 6 June 4 2 6 3 .. 3 4 6 July 2 2 4 .. 2 2 3 4 August 3 2 5 .. 1 1 4 5 September 2 2 4 .. 2 2 4 4 October 6 5 11 2 3 5 11 11 November 4 6 10 2 2 4 6 8 December 2 6 8 1 3 4 6 8 Totals 44 41 85 16 21 37 67 75 75 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. Jan. 7th Flask Walk 1 box Skate wings(about 6 stone) Jan. 13th High Road 45 lbs. Apples. 180 lbs. pears. April 21st Netherwood Sreet 1 box Tomatoes(about 9 lbs.) Sept. 20th Flask Walk 1 box Cod(57 lbs.) Slaughterhouses. There are fire slaughterhouses in the Borough, situated as follows:— 40, England's Lane; 17, High Street; 69, High Street; 242, Belsize Road ; 6, Fairfax Mews. The slaughterhouses were regularly inspected during the year, the number of inspections being 97. At the beginning of 1909 there was in each of the slaughterhouses a contravention of section 8 of the London County Council (General Powers) Act, 1908, there being one or more drain inlets inside the slaughterhouse. In four premises the necessary alterations were made in the early part of the year, and when the annual inspection of the Public Health Committee was made on October 4th it was decided to offer no opposition to the renewal of the licenses of the premises so altered. At the remaining slaughterhouse, that at 242, Belsize Road, no alterations had been made, but the occupier undertook to do what was necessary and submitted a plan showing the alterations he intended to carry out to make the place comply with the Act. The plan was appoved by the Committee, who in view of the undertaking given by the occupier, decided not to recommend opposition to the renewal of the license. After the Licensing Committee of the London County Council had held their meeting, however, the occupier refused to carry out the alterations, and the Council took proceedings against him for the contravention of Section 8 of the General Powers Act. The case was heard at the Marylebone Police Court on January 13th, 1910, 76 and the magistrate made an order for the necessary work to be carried out within 14 days, allowing the Council 12s. 6d. costs. The occupier decided to discontinue the use of the slaughterhouse rather than carry out the alterations, and the place has not been used for slaughtering since January, 1910. Milk Supply. The number of persons registered as purveyors of milk at the end of 1909 was 93, and the number of premises on which milk is sold was 115. 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 53 Bakehouses and Confectioners 23 Restaurants and Coffee Shops 13 General Shops 26 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. During the year 310 inspections were made of premises where milk is sold, and the following works were carricd out:— Premises or parts of premises repaired, cleansed and limewashed 16 Water cisterns cleansed 3 Water cisterns covered 1 Drains repaired or reconstructed 7 Drain inlets inside premises abolished 2 Soil pipes repaired or reconstructed 5 Water closets repaired or renewed 9 Water closets cleansed 5 Roofs repaired 2 Gutters and rain water pipes repaired or renewed 8 New sinks fixed 4 Waste pipes of sinks trapped, repaired or renewed 15 Yard paving repaired or renewed 9 Dustbins provided 7 Gullies cleansed 2 77 Section 5 of the London County Council (General Powers) Act, 1908, contains the following important provisions relating to milk premises:— 5.—(1) Notwithstanding anything contained in the Dairies Cowsheds and Milkshops Order of 1885 or in any subsequent order any sanitary authority may remove from the register kept by them of persons from time to time carrying on in their district the trade of cow-keepers dairymen or purveyors of milk or may refuse to enter upon such register the name of any person carrying on or proposing to carry on the trade of a dairyman or purveyor of milk upon premises which are in the opinion of such sanitary authority for any reason unsuitable for the sale of milk therein. Provided that for the purpose of this section premises shall not be deemed to be unsuitable for the sale of milk therein on any ground inconsistent with the provisions or requirements of any order or regulation made under any enactment for the time being in force and applicable to such premises. (2) Any person who thinks himself aggrieved by any decision of a sanitary authority under the provisions of this section may at any time within twenty-one days from the date of such decision appeal against the same to a court of summary jurisdiction and if on any such appeal it shall appear to the court that the premises of the person appealing are in all respects suitable for the sale of milk therein the court may make an order requiring such authority to enter upon or restore in the register the name of such person. This section confers upon Metropolitan sanitary authorities muchneeded powers, which, if properly enforced, will greatly improve the conditions under which milk is sold in London. At the time of writing the question is under consideration by the Council. 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 78 shops in the Borough in which ice cream is sold, and 167 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. 78 Table of sanitary work carried out at premises where ice cream is sold:— Premises or parts of premises repaired, cleansed and limewashed 5 Drains repaired or reconstructed 7 Soil pipes reconstructed 2 Water-closets renewed 2 ,, cleansed 6 Flushing cisterns to water-closets repaired 2 Waste pipes of sinks trapped, repaired or renewed 9 Roofs repaired 2 Rain-water pipes repaired 4 Yard paving repaired 5 Dustbins provided 2 Other defects remedied 2 Food Premises. Section 8 of the London County Council (General Powers) Act, 1908, which came into operation on August 1st, 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 fœcal 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 79 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. (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. These provisions place much-needed powers in the hands of London Sanitary Authorities to regulate the sanitation of places where food is stored. A systematic inspection of these places has been carried out by Inspector Hudson, and, in a considerable number of cases, conditions were found that were in contravention of the Act. During the year 19 premises were altered to comply with the Act, and many other premises are being so altered at the time of writing. The trades carried on at the premises altered in 1909 were as follows:— Butchers 2 Slaughterhouses 4 Restaurants 3 Grocers 3 Greengrocers 3 Fishmongers 2 Poulterers 1 Ice cream makers 1 Inspection of Premises where Food is Prepared or Stored (other than Bakehouses, Milk Shops, Eating Houses and Slaughterhouses). 80 The premises inspected during the year, together with the nature of the business carried on, were as follows:— Butchers and Pork Butchers 59 Confectioners 61 Grocers 74 Provision and Cheesemongers 46 Greengrocers and Fruiterers 62 Fishmongers 27 Fried Fish Shops 10 General Shops 22 361 682 Inspections were made of these premises during the year and 68 Notices were served. 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 506, and the number certified by the Public Analyst to be adulterated was 20, or 3.9 per cent. of the total number. The corresponding percentage in 1908 was 3.5; in 1907 it was 8.8. In addition, 19 samples were certified to be of low quality. 426 samples were purchased from Hampstead tradesmen, and 80 from persons residing without, but trading within the Borough. The percentages of adulterated samples in these two classes were 3.05 and 8.7 respectively. 22 samples were taken on Hampstead Heath on Bank Holidays, and of these 7, or 31.8 per cent. were adulterated, and one was of poor quality. 35 samples were taken on Sundays; one of this number was found to be adulterated, and three were of low quality. 81 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:— Article. Number taken. Adulterated. Low Quality. Butter 64 1 — Butter on Bread 14 6 — Cheese 15 — — Cocoa 9 1 — Coffee 22 1 — Cream 12 1 — Gin 1 1 — Glycerine 1 — — Jam 3 — — Lard 18 — — Magnesia, Citrate of 2 — — Margarine 5 — — Milk 328 9 19 Oatmeal 1 — — Olive Oil 3 — — Rum 1 — — Sago 2 — — Sweets 2 — — Tapioca 2 — - Whiskey 1 — — Totals 506 20 19 The following table shows the number of samples analysed during each year from 1903 to 1909, the number and percentage of the adulterated samples, and the fines and costs recovered in legal proceedings:— Year. Samples analysed. Number adulterated. Percentage adulterated. Fines and Costs. £ s. d. 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 1909 506 20 3.9 29 4 6 82 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) 86 5 5.8 No. 2 (Belsize) 71 1 1.4 No. 3 (Adelaide) 24 2 8.2 No. 4 (Central) 22 — — No. 5 (West End) 74 2 2.7 No. 6 (Kilburn) 87 1 1.1 No. 7 (Priory) 62 2 3.2 Totals 426 13 3.05 The following table shows the articles adulterated, nature of adulteration and the result of proceedings taken. No. of Sample. Article. How adulterated. Result of proceedings. 17 Milk 5 per cent. added water Fine £ s. d. Costs S. d. 2 0 0 12 6 55 Coffee 20 percent. chicory Cautioned by order of Public Health Committee. 86 Milk 11 per cent. deficient in butter fat Dismissed. Vendor proving warranty. £ s. d. S. d. 109 Milk 6 per cent. added water Fine 0 10 0 Costs 12 6 113 Butter 46 per cent. foreign fat ” 2 0 0 ” 12 6 122 Milk 15 percent. deficient in butter fat ” 0 2 6 ” 12 6 125 Milk 17 percent. deficient in butter fat ” 0 2 6 ” 12 6 140 Milk 20 per cent. deficient in butter fat ” 0 2 6 ” 12 6 150 Milk 2 per cent, deficient in butter fat ” 0 2 6 ” 12 6 154 Milk 94 percent.deficient in butter fat ” 5 0 0 ” 12 6 161 Butter on Bread 86 per cent. foreign fat ” 0 10 0 ” 12 6 83 No. of Sample Article. How adulterated. Result of Proceedings. £ s. d. s. d. 171 Butter on Bread 89 per cent. foreign fat Fine 1 0 0 Costs 12 6 173 Milk 13 per cent. deficient in butter fat ” 2 0 0 ” 12 6 304 Cocoa 30 per cent. sugar, 30 per cent. arrowroot ,, 3 0 0 ,, 12 6 320 Butter on Bread 83 per cent. foreign fat ,, 0 1 0 ,, 12 6 323 Butter on Bread 83 per cent. foreign fat ,, 0 1 0 ,, 12 6 324 Butter on Bread 84 per cent. foreign fat ,, 0 2 6 ,, 12 6 326 Butter on Bread 84 per cent. foreign fat ,, 0 2 6 ,, 12 6 426 Cream 28-7/10 grains of boric acid per pound ,, 0 10 0 ,, 12 6 606 Gin 5 per cent. of water above the legal limit No action. In addition to the above, a vendor of milk was fined £1 and 5s. costs for not having his name and address on the vehicle or receptacle from which the milk was being sold. One of the adulterated samples, in respect of which successful proceedings were instituted was taken in consequence of a complaint from a private source that the defendant made a practice of supplying his regular customers with adulterated goods, although any chance customer, who might possibly be an inspector's agent, was always supplied with the genuine article. Upon receipt of this information, arrangements were made for one of the inspector's agents to purchase various small articles at the defendant's shop for a sufficient length of time to induce the defendant to regard the agent as a regular customer. A sample was then taken for analysis and was found to be adulterated. In the case of one of the adulterated milk samples, the defendant produced a warranty, but was unable to satisfy the Court that he sold the milk in the same state as he received it. It was proved in evidence that the defendant's assistant had left the milk on his barrow at a street corner unattended while he had lunch, and the defendant was therefore unable to establish that the milk had not been tampered with. 84 Complaints. During 1909, 848 complaints were made of the existence of insanitary conditions. A list of the matters of which complaint was made is given below:— Accumulations, offensive 4 „ of garden and other refuse 6 Animals, improperly kept 17 „ dead 8 Dampness in premises 26 Dirty premises 13 Drains, bad condition of 23 „ defective 19 „ stopped 16 Dust, non-removal 84 Dust receptacles, foul or dilapidated 38 „ absence of, or insufficient 22 Insanitary condition of premises 27 Illness attributable to insanitary conditions 8 Manure not removed 3 Overcrowded premises 12 Rats, nuisance from 9 Roadways, condition of 10 Roofs and gutters, defective and leaky 11 Rubbish, nuisance from burning 6 Smells 35 „ on premises 15 „ from road gullies 1 „ „ sewer ventilators 51 „ „ stables 3 „ „ drains, &c. 24 „ ,, water closets 14 „ „ manure 5 Smoke nuisances 8 Underground rooms illegally occupied 7 Unsound food 2 Urinals, condition of 5 Vacant land, insanitary state of 7 Verminous condition of premises 11 Water, absence of 182 „ leakage of 11 Water cisterns,dirty, &c 7 Water closets, accommodation insufficient or absence of 1 „ defective or insanitary 20 „ stopped 5 „ without water 9 „ „ proper flush 7 Yard paving defective 2 Miscellaneous 54 Total 848 Factory and Workshop Act. 1901. 87 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 1909 there were 568 workshops in Hampstead, including 89 domestic workshops.* Of these workshops 238 employ women only, 281 employ men only, and in 49 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 65. The number of outworkers' premises was 93. A series of statistical tables has been framed by the Home Office "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 95-98. The following tables show the number of each class of workshops, together with the workplaces in the same trades, 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 reason 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 ihe same family dwelling there. 88 Workshops, Domestic Workshops, Workplaces, etc., in Wards. Trade or Business. WARDS. Ward I. Ward II. Ward III. Ward IV. Ward V. Ward VI. Ward VII. Totals. Bakers 4 3 3 4 8 6 7 35 Blind makers — — — 3 1 — 1 5 Bootmakers 12 16 6 3 11 20 11 79 Builders and carpenters 1 4 3 4 3 8 6 29 Cabinet makers and polishers 2 1 - 2 - - - 5 Carriage bnilders 2 2 - 1 1 1 2 9 Cycle makers and repairers 1 1 1 1 2 2 1 9 Dressmakers and ladies' tailors 24 15 14 20 29 43 27 172 Dyers and cleaners — 1 — — — — 1 2 Embroiderers 1 — 2 — — 1 1 5 Engineers — 1 — 2 — — 1 4 Florists — — 1 1 1 — — 3 Harness makers 2 — 2 1 1 — 1 7 Ironmongers 4 — 1 3 5 3 — 16 Lace makers and cleaners — 1 2 1 — — — 4 Laundries (Hand) 9 — — — 3 2 6 20 Mantlemakers — — — — — 2 — 2 Milliners 7 1 4 5 2 6 6 31 Miscellaneous 6 4 2 6 6 8 8 40 Monumental masons — — — — 2 — 1 3 Motor manufacturers 1 1 — 1 — 1 1 5 Needlewomen 1 — 1 1 1 3 — 7 Outfitters 2 2 2 5 — 3 3 17 Pianoforte key makers — 1 — — — — — 1 Pianoforte makers - 5 — — — — — 5 Picture frame makers 2 2 1 2 2 — 3 12 Sign writers — — — — — 2 — 2 Smiths 3 2 — 1 1 3 1 11 Stained glass workers - — — — — 1 — 1 Tailors 3 5 4 5 4 18 7 46 Trunk makers - - — 1 — — — 1 Umbrella makers and repairers 1 1 - - 1 1 1 5 Upholsterers 5 1 4 1 6 3 3 23 Watchmakers and jewellers 2 2 3 3 3 4 3 20 Wigmakers 2 - 2 3 4 — 1 12 Totals 97 72 58 80 97 141 103 648 89 Workshops, Domestic Workshops, Workplaces, etc. Table showing Number of Businesses, Character of Workshops and Number of Persons employed. Trade or Business. Number o Premises. Workshops (other than Domestic Workshops). Number of Workrooms. Number of Employees. Domestic Workshops, Workplaces etc. Males. Females Bakers 35 35 47 128 1 — Blind makers 5 4 7 9 8 1 Bootmakers 79 51 66 120 — 28 Builders and carpenters 29 24 31 45 — 5 Cabinet makers and polishers 5 5 5 13 — — Carriage builders 9 9 17 30 — — Cycle makers and repairers 9 6 10 16 — 3 Dressmakers and ladies' tailors 172 115 150 7 570 57 Dyers and cleaners 2 1 3 2 2 1 Embroiderers 5 5 5 1 11 — Engineers 4 4 4 5 — — Florists 3 3 4 2 7 — Harness makers 7 6 8 13 — 1 Ironmongers 16 15 15 34 — 1 Lacemakers and cleaners 4 2 1 — 1 2 Laundries (Hand) 20 10 37 3 69 10 Mantlemakers 2 1 4 — 17 1 Milliners 31 29 31 — 76 2 Miscellaneous 40 28 47 39 41 12 Monumental masons 3 3 3 16 — — Motor manufacturers 5 5 6 16 — — Needlewomen 7 1 5 — 6 6 Outfitters 17 16 42 8 232 1 Pianoforte key makers 1 — 1 1 — 1 Pianoforte makers 5 4 8 49 — 1 Picture frame makers 12 10 14 17 — 2 Sign writers 2 2 4 8 — — Smiths 11 10 11 28 — 1 Stained glass workers 1 - — — — 1 Tailors 46 29 40 81 45 17 Trunk makers 1 1 1 4 — — Umbrella makers and repairers 5 — 4 2 2 5 Upholsterers 23 16 30 34 8 7 Watchmakers and jewellers 20 18 20 38 — 2 Wigmakers 12 11 14 10 17 1 Totals 648 479 695 779 1113 169 90 Inspection of Workshops (other than Bakehouses). The number of workshop inspections in 1909 was 627. Cleanliness. Sixteen workrooms were found on inspection to require cleansing; 11 of these were cleansed on the request of the Inspector, in 5 cases it was necessary to serve a notice before the work was carried out. Ventilation and Warming. In 2 workshops the means of ventilation were found defective, and the defects were remedied. Additional ventilation in the form of a ventilating shaft was provided to one underground workshop. Means of warming were improved or provided in 7 cases. Six 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 5 cases the warming arrangements were made satisfactory by the provision of fires or of gas stoves fitted with proper flues, and one case was under notice at the end of the year. One workroom was found without means of warming, and such means were provided. Overcrowding. All the workrooms in the workshops are measured by the inspectors, and the cubic space in each room is ascertained. The 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 workroom. During 1909, 46 new workrooms were measured. Overcrowding was found in 13 instances. In 5 cases, the overcrowding was abated immediately on the request of the Inspector, but in 8 cases this was not done until a written notice had been served. 91 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 workshop, and in such other parts thereof" as the factory inspector may direct, and section 133 of the Act provides that "when any women, 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 14 workshops were notified to H.M. Inspector of Factories. Bakehouses. At the end of 1909 there were 37 Bakehouses on the Register, 22 being underground, and 15 above ground. 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. Seven inspections were made in respect of the Factory Bakehouses; and 36 inspections in respect of the Workshop Bakehouses. The following is a list of the Bakehouses on the Register at the end of the year:— Bakehouses in Wards. Those marked * are underground bakehouses. Those marked † are factory bakehouses. No. 1 (Town) Ward— 57, Heath Street. 3, High Street. 67, do. 19, New End. (4) No. 2 (Belsize) Ward. 6, Fleet Road. *65, do. 45, South End Road (3) (late 2 Heathhurst Road) No. 3 (Adelaide) Ward— *44, England's Lane. *90, Haverstock Hill. *2, King's College Road. (3) No. 4 (Central) Ward. *64. Belsize Lane. *225, Finchley Road. *289 do. †307, do. *98, West End Lane (5) 92 Bakehouses in Wards—continued. No. 5 (West End) Ward. †60, 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, Kings gate Road. *99, Palmerston Road. (6) No. 7 (Priory) Ward. *202, Belsize Road. *228, do. *98, Boundary Road. *55, Fairfax Road. *93, do. *7, Fairhazel Gardens. *137, Finchley Road (7) Bakehouses—Underground 22 „ Above ground 15 Total 37 Workplaces. This term is not defined in the Factory Act, nor in the Public Health Act, and it is sometimes exceedingly difficult to decide whether certain premises are or are not workplaces." Among the more important workplaces are the kitchens of restaurants, coffee-houses, etc., and the number of these places in Hampstead in 1908, was 67. During 1909, one restaurant kitchen was added to the register, and 6 were removed, leaving a total of 62 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. 57, do. 63 & 65, do. 70, Heath Street. 100, do. 3, High Street. 67, do. Bull & Bush, North End. (9) 93 Restaurant Kitchens in Wards—continued. No. 2 (Belsize) Ward— 2, Elin Terrace, Constantino Road. 2, Fleet Road. 25, do. 98, do. 106, do. 210, Haverstock Hill. 11, South End Road. 17, do. 45, do. (late 2, Heathhurst Road). 65, South End Road (late 8, Station Parade). Railway Tavern, South End Green. 19, Southampton Road. (12) No. 3 (Adelaide) Ward— 1, Adelaide Road. 143, do. 97, Haverstock Hill. 11, King's College Road Winchester Hotel, Winchester Road. (5) No. 4 (Central) Ward— 72, Belsize Lane. 90, do. 159, Broadhurst Gardens. 1a, Canfield Place. 104, Finchley Road. 225, do. 289, do. 100, West End Lane. 254, do. 272, do. 280, West End Lane. 1, Central Parade, do. (12) 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, Love- ridge Road. 96, Palmerston Road. (7) 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. Steer's Restaurant, Upper Avenue Road. (11) Total 62 The number of inspections of the above premises made during the year was 88, and 3 notices were served. 94 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 number of lists received from employers was 136, and the number of addresses contained in the lists was 416. In 363 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 32, but 2 of these had ceased to be outworkers. The total number of outworkers' premises in Hampstead is 93 Of these 6 are factories, 54 are workshops (21 of these being domestic workshops), 2 are workplaces, and in 31 cases only a single worker is employed on the premises. No cases of notifiable infectious disease occurred during 1909 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 (Loudon) 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. 95 The following is a list of the different classes of factories in Hampstead:— Factories. Art Metal Workers 2 Dairymen 2 Bakehouses 2 Laundries 6 Boot makers 7 Motor Workers 2 Builders 4 Printers 10 Butchers 6 Other trades 18 Carpet beaters 2 65 Coffee roasters 4 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. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories Including Factory Laundries) 73 - - Workshops (Including Workshop Laundries) 663 24 - Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 365 11 - Total 1101 35 - 96 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 19 16 - — Want of ventilation 9 8 1 — Overcrowding 14 14 - — Want of drainage of floors — — - — Other nuisances 28 17 1 - Sanitary accommodation insufficient 5 2 - — unsuitable or defective 9 8 - - not separate for sexes - — - - Offences under the Factory and Workshop Act: — Illegal occupation of underground bakehouse (S. 101) - — - — Breach of special sanitary requirements for bakehouses (SS. 97 to 100) - — - — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report) - - - - Total 82 65 2 — 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 been completed, and column (3) includes some defects which were found at the end of 1908, and remedied in the following year. 97 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 keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (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. 92 52 199 7 2 8 29 232 — — — 58 — — — — — — (2) cleaning and washing 4 13 — 1 2 1 1 16 — — — — — — — — — — Lace, lace curtains and nets 2 1 8 — — — 2 7 — — — 2 — — — — — — Artificial flowers — — — — — — — — — — — — — — — — — — Nets, other than wire nets — — — — — — — — — — — — — — — — — — Tents — — — — — — — — — — — — — — — — — — Sacks — — — — — — — — — — — — — — — — — — Furniture and upholstery 18 18 35 1 — 1 — 35 — — — 9 — — — — — — Fur pulling — — — — — — — — — — — — — — — — — — Feather sorting — — — — — — — — — — — — — — — — — — Umbrellas, etc — 11 — 1 — — — 11 — — — 1 — — — — — — Carding, etc., of buttons, etc. — — — — — — — — — — — — — — — — — — Paper bags and boxes 2 4 37 — — — — — — — — — — — — — — — Basket making — — — — — — — — — — — — — — — — — Brush making — — — — — — — — — — — — — — — — — — Racquet and tennis balls — — — — — — — — — — — — — — — — — — Stuffed toys 2 — 7 — — — — 7 — — — 1 — — — — — — File making — — — — — — — — — — — — — — — — — — Electro-plate 6 13 3 — — — — 16 — — — — — — — — — — Cables and chains — — — — — — — — — — — — — — — — — — Anchors and grapnels — — — — — — — — — — — — — — — — — — Cart gear — — — — — — — — — — — — — — — — — Locks, latches and keys — 1 — — — — — 1 — — — — — — — — — — Pea picking — — — — — — — — — — — — — — — — — — Total 126 113 289 10 4 10 32† 363 — — — 73 — — — — — — *In several of the lists that were rent 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 2 addresses of persons who no longer take homework. 98 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number (1) (2) Bakehouses 35 Bootmakers 61 Dressmakers and ladies' tailors 143 Laundries 16 Milliners 30 Tailors 40 Watchmakers and jewellers 19 Other 224 Total number of workshops on Register 568 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) 14 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 1 Reports (of action taken) sent to H.M. Inspector 1 Other 10 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 1909. BY ALFRED W. STOKES, F.C.S., F.I.C.. Public Analyst. 101 Analytical Laboratory, Town Hall, Paudinoton, W. 17th January, 1910. A short summary of the analyses for the year 1909, may be of interest. A total of 506 samples have been analysed. These comprised milk 328 samples, butter 64, butter-on-bread 14, cream 12, cheese 15, coffee 22, cocoa 9, general groceries 33, drugs 6, and spirits 3. The adulterated samples consisted of milk 9, cream 1, butter 1, butter-on-bread 6, cocoa 1, coffee 1, and spirits 1. The percentages for each article adulterated in Hampstead contrast very favourably with the averages for the Metropolis generally, as will be seen from the following table. Percentage of articles adulterated:— Milk. Butter. Cocoa. Coffee. All Articles. In Metropolis 11 95 1/5 11 6⅓ 11 In Hampstead 2¾ 1½ 2 4½ 4 The samples of butter-on-bread came mostly from strangers selling their goods during Bank Holidays on Hampstead Heath; some of the adulterated milk samples were obtained in the samewav. Notwithstanding this, it is very satisfactory to find that the adulterated samples in Hampstead are only about one-third as numerous as in the rest of London. The sum imposed as fines during the year amounted to £17 7s. 0d., carrying with them costs of £12 13s. 0d. ALF. W. STOKES, F.C.S., F.I.C., Public Analyst. Legal Proceedings. 105 Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department in 70 cases during the year. The chief facts relating to these proceedings are set out on pages 106-110, and are summarised below. The facts relate only to the cases that were heard and decided in 1909. Statute or Bye-law. Number of Prosecutions. Fines. Costs. £ s. d. £ a. d. Public Health (London Act, 1891, and Bve-laws made thereunder 19 14100 910 Metropolis Management Acts, and Bye-laws 31 11 0 0 29 5 6 made thereunder Sale of Food and Drugs 20 20 17 0 12 17 0 Acts Totals 70 46 7 0 51 3 6 106 Public Health (London) Act, 1891; and Bye-Laws made thereunder. Ward No. Date when proceediings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 3 1909. 19th Jan. 1909 29th Jan. Marylebone Police Court, Mr. Plowden. W. E., St. Marylebone Allowing underground rooms to be illegally occupied Fined £5 and 2s. costs. 1 6th May 9th June Hampstead Petty Sessional Court, Justices N.E.D.Co., Islington Selling milk without being registered Fined £2 and 12s. 6d. costs. 6 3rd June 11th June Marylebone Police Court, Mr. Plowden. J. B., Hampstead Allowing two underground rooms to be illegally occupied Fined 20s. and 2s. costs on one, and 10s. and 2s. costs on the other. 3 Do. Do. Do. T. C., Wandsworth Constructing water-closet so as to be a nuisance Fined 20s. and 2s. costs. 3 Do. Do. Do. S. E. F. M. WandsWorth Constructing water-closet without giving notice Fined 5s. and 2s. costs. 5 20th May Do. Do. E. F. W., St. Pancras Nuisance Nuisance abatedr 3s. costs paid and summons withdrawn. o 6th July 16th July Marylebone Police Court, Mr. Denman. J. P. B., Willesden Selling milk without being registered Dismissed. c 29th July 30th July Marylebone Police Court, Mr. Plowden. J. B., Hampstead Allowing two underground rooms to be illegally occupied Fined £1 and 2s. costs on each summons. 5 6th July 29th Oct. Do. A. C., Hampstead Depositing manure from a stable contrary to Bylaw 9, sec. 16 (1) Fined £1 and 2s. costs. 5 28th Sept. 17th Nov. Hampstead Petty Sessional Court, Justices. H. B., Hampstead (i.) Contravention of By-law 14, sec. 39 (1). (ii.) Contiavention of By-law 14, sec. 39 (1). Fined £1 and 5s. 6d. costs on (i.), and £1 and 5s. 6d. costs on (ii.). 7 26th Oct. 26th Nov. Marylebone Police Court, Mr. Plowden. J. W., Hampstead Keeping an animal in an unfit place Animal removed and summons withdrawn. 5 28th Sept. 1st Dec. Hampstead Petty Sessional Court, Justices H. B., Hampstead (i.) Nuisance, and (ii) Non-compliance with Notice Work done, summonses withdrawn and 10s. 6d. costs paid 107 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 1909. 20th J uly 1909. 13th Dec. Ha nip stead Petty Sessional Court, Justices S. P. & L., Holborn J. L., Hampstead C. B. K.. Hampstead Nuisance Abatement order made against each of the defendants and £2 2s. costs granted against each. 7 23rd Nov. 17th Dec. Marylebone Police Court, Mr. Plowden J. w., Hampstead Allowing (i.) front underground room and (ii.) back underground room to be illegally occupied (i.) Fined 10s. and 2s. costs, (ii.) Fined 5s. and 2s. costs. Metropolis Management Acts, and Bye-Laws made thereunder. 2 1908. 17th Dec. 1909. 8th Jan. Marylebone Police Court, Mr. Plowden. M. & Co., St Pancras (i.) Failing to deposit plans, etc. (ii.), & (iii), contravention of Drainage Bylaw 10 Withdrawn, on plans being deposited, work altered, and .£10. 10s. costs paid. 1 Do. 13th Jan, Hampstead Petty Sessional Court. Justices. R T., St. Pancras (i.) Failing to deposit plans, etc. (ii.) Contravention of Drainage Bylaw 10 Fined 20s. and 11s. costs. 2 1909. 28th Jan. 10th Feb. Do. G. D. B., Tottenham Constructing drain at 2 premises without giving notice. Fined 5s. on each summons, and £2 Vs. costs allowed. 6 11th Mar. 26th Mar. Marylebone Police Court. Mr. Plowden. J. B W., Willesden (i) Failing to deposit plans, etc. (ii.) Contravention of Drainage Bylaw 10 (iii.) Contravention of Drainage By-law 17, at two premises. Withdrawn, on plans being deposited, work altered, and .£3 3s. costs paid. 5 28th Jan. 31st Mar. Hampstead Petty Sessional Court. Justices. E. O., Hampstead (i.) Non-compliance with Drainage By-law 10. (ii.) Recovery of cost of executing work (i.) Withdrawn. (ii.) Order made for payment of debt and £5 5s. costs. 108 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 1909. 11th Feb 1909. 2nd April Marylebone Police Court, Mr. Plowden R. E., Hendon Failing to deposit plans, etc. Withdrawn, on plans being deposited, and 5s. costs paid. 7 20th May 11th June Do. H M., Fulham Con str ucting drain without giving notice Withdrawn on payment of 10s. 6d. costs. 14th Jan. Do. Do. S. & s., Willesden Failing to deposit plans, etc. (3 premises) Plans, etc., deposited. £1 Is. costs paid and summonses withdrawn. 6 14tli Jan. 2nd July Do. S. & S., Willesden Failing to deposit plans, etc. Plans deposited and summons withdrawn on payment of 5s. costs. 3 25th Mar. 9th July Do. A. K., Hampstead (i.) Failing to deposit plans, etc. (ii.) Contravention of Drainage By-law 10 Fined 10s. and 2s. costs on (i.) and £1 and 2s. costs on (ii.). 3 29th July 10th Sept. Marylebone Police Court, Mr. Denman C. K. R., City (i.) Failing to deposit plans, etc. (ii.) Contravention of Drainage By-laws Plans deposited, work done, summons withdrawn on payment of £3 3s. costs. 1 7th Oct. 20th Oct. Hampstead Petty Sessional Court, Justices W. S., Bermondsey Failing to deposit plans, etc. Fined £1 and 9s. costs. 3 21st Oct. 29th Oct. .Yarylebone Police Court, Mr. Plowden A. K., Hampstead Failing to deposit plans, etc. Plans, etc., deposited, and 10s. 6d. costs granted. 1 Do. 3rd Nov. Hampstead Petty Sessional Court, Justices W. S., Bermondsey (i.) Failing to deposit plans, etc. (ii.) Contravention of Drainage By-law 3 (iii.) Contravention of Drainage By-law 10 Fined £2 and 5s. costs on (i.), £1 and 5s. costs on (ii.) and £1 and 5s. costs on (iii.). 1 Do. Do. Do. W. S., Bermondsey (i.) Failing to deposit plans, etc. (ii.) Contravention of Drainage By-law 3 (iii.) Contravention of Drainage By-law 10 Fined £1 and 5s. costs on (i.), £1 and 5s. costs on (ii.) and £1 and 5s. costs on (iii,). 5 28th Sept 17th Nov. Do. H. B., Hampstead Failing to deposit plans, etc. Fined £1 and 5s. 6d. costs. 109 Sale of Food and Drugs Acts. Ward No Date when ings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 5 1908. 17th Dec. 1903. 13th Jan. Hampstead Petty Sessional Court. Justices. H. J.D., Hendon Selling milk containing 8 per cent. less than the proper amount of butter-fat Fined 20s. and 16s. 6d. costs. 1 1909. 14th Jan. 3rd Mar. Do. B. C. C., Ltd., Nottingham Selling distilled water containing per gallon 5£ grains of dirt or extraneous matter. Dismissed. 7 11th Mar. 2nd April Marylebone Police Court, Mr. Plowden. T. E. G.. Hampstead Selling milk containing 5 per cent. of added water Fined £2 and 12s. 6d. costs. 2 6th May 7 th May Marylebone Police Court, Mr. Francis. R. C. F., Hampstead Selling milk containing 11 per cent. less than the proper amount of butter-fat Warranty proved and summons dismissed. 1 6th M ay 9th June Hampstead Petty Sessional Court, Justices N.E.D.Co., Islington No name and address on vehicle, etc. Fined £1 and 2s. costs. 1 11th May Do. To. A. C. O., Hampstead Selling milk containing 6 per cent. of added water Fined 10s. and 12s. 6d. costs. 5 3rd June 18th June Marylebone Police Court, Mr. Plowden B. J., Hornsey Selling butter containing 46 per cent. foreign fat Fined 40s. and 12s. 6d. costs. 1 Do. 23rd June Hampstead Petty Sessional Court, J ustices M. D., Hampstead Selling milk containing 15 per cent. less than the proper amount of butter-fat Fined 2s. 6d. and 12s. 6d. costs. 1 Do. Do. Do. E. S., Hampstead Selling milk containing 17 per cent. less than the proper amount of butter-fat Fined 2s. 6d. and 12s. 6d. costs. 1 17th June 7th July Do. M. S. S., Hampstead Selling milk containing 20 per cent. less than the proper amount of butter-fat Fined 2s. 6d. and 15s. costs. 110 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 1909. 17th June 1909. 7th July Hampstead Petty Sessional Court, Justices A. J. K., Kensington Selling milk containing 94 per cent. less than the proper amount of butter-fat Fined £5 and 15s. costs or 14 days imprisonment. 2 Do. 9th July Marylebone Police Court, Mr. Plowden W. K., Walthamstow Selling milk containing 20 per cent. less than the proper amount of butter-fat Fined 2s. 6d. and 12s. 6d. costs. .5 Do. Do. Do. K. A. L., Hampstead Selling butter containing 8 6 per cent. of foreign fat Fined 10s. and 12s. 6d. costs. 1 17th June 14th July Hampstead Petty Sessional Court, J ustices F. C. T., Hampstead Selling butter containing 8 9 per cent. of foreign fat Fined £1 and 18s. costs. 6 6th July 16th July Marylebone Police Court, Mr. Denman J. P. B., Willesden Selling milk containing 13 per cent. less than the proper amount of butter-fat Fined £2 and 12s. 6d. costs. 6 29th J ul y 10th Sept. Do. N. D. Co., Ltd., Cardiff Selling milk from can or vehicle without name and address on can Fined £1 and 5s. costs. 3 Do. Do. Do. H. J. W., Hampstead Selling cocoa containing 30 per cent. of cane sugar and 20 per cent, of arrowroot Fined £3 and 12s. 6d. 1 28th Sept. 15th Sept. Hampstead Petty Sessional Court, Justices T. S., Waltliamstow Selling butter on bread containing 83 per cent. of foreign fat Fined ls. and 16s. costs. 1 Do. Do. Do. J. J. B., Stepney Selling butter on bread containing 83 per cent. of foreign fat Fined Is. and 16s. costs. 1 Do. Do. Do. G. J., Finsbury Selling butter on bread containing 84 per cont of foreign fat Fined 2s. 6d. and 16s. costs. 1 Do. Do. Do. A S., Shoreditch Selling butter on bread containing 84 per cent. of foreign fat Fined 2s. 6d. and 16s. costs. Appendix. Tables. 113 TABLE I. (Required by the Local Government Hoard to be used in the Annual Report of the Medical Officer of Health.) Vital, Statistics of Whole Borough during 1909 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. N limber. Rate.* Under 1 year of Age. At all Ages. Number. Rate.* Number. Rate per 1000 Birtlis registered Number. Rate* 1 2 3 4 5 6 7 8 9 10 11 12 13 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 14.5 532 421 101 873 10.6 1902 83743 1516 18.0 155 102.2 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 9o0 9.5 1907 01137 1341 14.7 114 85.0 1056 11.6 472 331 91 817 9.0 1908 92654 1355 14.4 104 76.7 995 10.6 442 311 119 803 8.5 Averages for years 1899-1908 86160 1467 17.0 157 107.0 1128 13.1 471 359 95 864 10.0 1909 94185 1282 13.6 111 92.8 1057 11.1 466 334 116 839 8.9 * 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 of all ages, 81,942. At Census Number of inhabited houses, 11,294. Average number of persons per house, 7.2. of 1901. 114 TABLE I. (continued). I. Institutions witliin the Borough receiving sick and infirm persons from outside the Borough. II. Institutions outside the Borough receiving sick and infirm persons from the Borough. III. Other Institutions, the deaths in which have been distributed among the several localities in the Borough. 165, Adelaide Road Aged Pilgrims' Asylum, Islington 74, Belsize Road Consumption Hospital, Mount Vernon Alexandra Nursing Home, 2, Turle Road, Banstead Asylum [N. Hampstead Workhouse, New End Hospital for Incurable Children, 30, College Crescent Battlebarrow Appleby 22, Beaumont Street Camber well House Asylum 32, Parkhill Road 4, Crossfield Itoad Cancer Hospital, Chelsea Cbildren's Hospital, 18, Crossfield Road Gt. Ormond Street Children's Hospital, 4, Fordwych Road Paddington Green Claybury Asylum Hampstead General Hospital, Hampstead Green Colney Hatch Asylum 6, Colosseum Terrace, St. Pancras Cottage Hospital, North-Western Fever Hospital, Lawn Road Willesden Earlswood Asylum French Hospital St. Peter's Home, Mortimer Road German Hospital, Dalston Great Northern Central 10, Rosslyn Hill Hospital 9, Grosvenor Gardens, W. Friedenheim, Upper Avenue Road Guy's Hospital Hanwell Asylum Heart Hospital, Soho Homoeopathic Hospital Horton Asylum Hospital of St. John and St. Elizabeth, St. Marylebone Infants' Hospital Vincent Square King's College Hospital Leavesden Asylum London Fever Hospital 115 TABLE I. (continued). I. Institutions within the Borough receiving sick and infirm persons from outside the Borough. II. Institutions outside the Borough receiving sick and infirm persons from the Borough. III. Other Institutions. the deaths in which have been distributed among the several localities in the Borough. London Hospital London Temperance Hospital Middlesex Hospital New Hospital for Women Queen Charlotte's Hospital St. Anne's House, Manor Road, N.E. St. Bartholomew's Hospital St. George's Hospital St. John's Lodge, Grand Drive, Merton St. Joseph's House, Kensington St. Luke's Hospital, Old Street St. Mark's Hospital St. Mary's Hospital St. Marylebone Infirmary St. Monica's Home, Brondesbury St. Pancras Infirmary St. Pancras Workhouse Samaritan Free Hospital The Priory, Putney The Retreat Asylum Tooting Bee Asylum University College Hospital West London Hospital Westminster Hospital 50, Weymouth Street, W. f The Workhouse for the Parish of Hampstead is within the Borough and situate at New End in No. 1 (Town) Ward. 116 TABLE II. (Required by the Local Government Hoard to be used in the Annual Report of the Medical Officer of Health.) Vital Statistics of Separate Localities in 1909 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 vear. 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 cf 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. a. a. b. d. a. b. c. d. a. b. c. d. a. b. c. d. a. b. c. d. 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 13663 217 141 23 10790 100 99 13 9503 90 62 11 13200 283 110 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 13 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 391 170 28 11130 127 94 7 1908 14190 217 108 11 14770 233 126 8 10860 88 78 6 10584 102 82 6 14370 244 121 26 16670 380 186 30 11210 121 93 10 Averages of Years 1899 to 1908 ... ... ... ... ... ... ... ... ... ... ... ... ... ..."... ... ... ... ... ... ... ... ... ... ... ... ... 1909 14560 189 140 15 14990 197 130 16 10940 80 88 4 10735 112 63 3 14650 230 118 13 17010 330 182 37 11300 144 111 11 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, and — infantile deaths. 1902 „ 4 „ „ ,, — ,, ,, 1903 „ 16 „ „ „ 1,, ,, 1904 ,, 13 „ „ „ 5 ,, ,, 1905 ,, 8 ,, ,, ,, - ,, ,, 1906 ,, 7 ,, ,, ,, 5 ,, ,, 1907 ,, 8 „ „ „ 2„ ,, ,, 1908 „ 9 ,, „ ,, — ,, ,, 1909 ,, 7 ,, ,, ,, - ,, ,, 117 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, 1909. NOTIFIABLE DISEASE:. Cases Notified in whole Borough. Total Cases Notified in each Locality. Number of Cases Removed to Hospital from each Locality. At all Ages. Under 1. At Ages—Years. 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). 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. 1 to 5. 5 to 15. 15 to 25 25 to 65. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous 33 .. 7 16 6 3 1 5 7 4 4 6 2 5 2 3 3 .. 4 1 3 16 Erysipelas 29 2 2 4 17 4 4 3 1 2 8 11 1 1 Scarlet Fever 241 36 102 31 12 36 74 10 21 35 52 13 33 a 4 13 27 51 12 211 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 13 .. 1 2 6 4 .. 4 3 1 1 1 .. 3 .. 1 .. .. .. .. 3 6 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 5 .. .. .. 2 3 .. 4 .. .. .. 1 .. 3 .. .. .. .. 1 .. 4 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Epidemic Cerebro-spinal Meningitis 4 1 1 2 .. .. .. .. 1 .. 1 1 1 .. .. 1 .. .. .. .. .. 1 Totals 325 3 4.5 184 49 39 5 53 88 16 29 51 67 21 40 77 7 14 31 53 18 240 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. 118 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 1909. 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) W ard 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 11 3 8 ... ... ... ... 4 3 ... ... 1 2 1 8 Scarlet Fever 4 ... 2 2 ... ... ... 2 ... ... 1 1 ... 34 Whooping Cough 18 10 6 2 ... ... ... 1 1 2 1 1 6 6 2 Diphtheria (including Membranous Croup) 5 ...2 1 1 ... 1 1 1 ... ... 3 ... ... 34 Croup ... ... ... ... ... ... ... ... ... ... ... ... ... ... Typhus ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fever Enteric 5 ... ... 1 2 2 ... 1 1 2 1 ... ... ... 1 Other continued 3 1 1 1 ... ... ... ... ... ... 1 1 1 ... 1 Epidemic Influenza 18 2 1 ... ... 6 9 4 5 1 2 3 1 2 4 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea 3 3 ... ... ... ... ... 1 ... ... 2 ... ... ... 1 Enteritis 8 3 2 ... ... ... 3 1 2 1 ... 1 3 ... 4 Gastritis 3 ... 2 ... ... 1 1 ... ... ... I 1 ... ... Puerperal Fever 3 ... ... ... 1 2 ... 2 ... ... ... ... 1 ... 1 Erysipelas 1 1 ... ... ... ... ... ... 1 ... ... ... ... ... Phthisis (Pulmonary Tuberculosis) 53 ... 1 1 12 37 2 6 8 3 3 6 17 8 99 Other Tuberculous Diseases 22 5 7 1 2 7 ... 2 3 1 ... 5 10 1 21 Cancer, malignant disease 85 ... ... ... 1 51 33 19 10 14 11 12 12 7 50 Bronchitis 83 3 2 l ... 19 58 19 14 11 5 12 12 9 21 Pneumonia 75 10 1 4 4 27 23 9 17 2 5 13 21 8 23 Pleurisy 3 ... ... ... 1 1 1 ... ... ... 1 1 ... 1 1 Other Diseases of Respiratory Organs 9 ... 1 ... ... 6 2 2 2 2 ... ... 1 2 7 Alcoholism, Cirrhosis of Liver 12 ... ... ... ... 5 7 2 1 2 1 2 4 ... 7 Venereal Diseases 4 3 ... ... ... 1 ... 2 ... ... ... ... 1 1 2 Premature Birth 18 18 ... ... ... ... ... 3 2 2 ... ... 9 2 5 Diseases and Accidents of Parturition 3 ... ... ... ... 3 ... 1 ... 1 ... ... 1 ... 1 Heart Diseases 36 ... 1 1 ... 18 16 7 4 3 2 6 7 6 7 Accidents 18 1 2 1 ... ... 9 6 2 2 1 2 5 ... 15 Suicides 6 ... ... ... ... 5 1 1 1 1 ... 1 ... 1 10 All other causes 30 36 4 7 10 113 160 45 50 38 27 46 66 56 104 All causes 839 99 49 23 34 308 226 140 130 88 63 118 182 111 466 Note.—It will be noted that the total number of deaths in the Ward distribution is 7 less than the total number of deaths at the ago periods. This is accounted for by the fact that in these cases a definite address was not registered. (Sen note at foot of TABLE II.) Schedule A. EXTENDED TABLE IV. Causes of, and Ages at, Death during the 52 weeks ended 1st January, 1910. No. Cause of Death. Ages. All Ages. Wards. Total Deaths whether of " Residents" or " Nonresidents " 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. 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 3 8 ... ... ... ... ... ... ... ... ... ... ... 11 4 3 ... ... 1 2 1 ... 8 3 Scarlet Fever ... 2 2 ... ... ... ... ... ... ... ... 4 ... 2 ... ... 1 1 ... ... 34 5 Epidemic Influenza 2 1 ... ... ... ... ... 2 1 2 2 6 1 18 4 5 1 2 3 1 2 ... 4 6 Whooping Cough 10 6 2 ... ... ... ... ... ... ... ... ... ... 18 1 1 2 1 1 6 6 ... 2 7 Diphtheria ... 2 1 ... 1 ... ... ... ... ... 1 ... ... 5 1 1 ... ... 3 ... ... ... 34 8 Enteric Fever ... ... 1 ... l ... 1 ... 1 ... ... ... ... 5 1 1 2 1 ... ... ... ... 1 10 Diarrhoea, Dysentery 3 ... ... ... ... ... ... ... ... ... ... ... 3 1 ... ... 2 ... ... ... ... 1 12 Other Allied Diseases 1 1 ... 1 ... ... ... ... ... ... ... ... ... 3 ... ... ... ... 1 1 ... ... 1 18 Syphilis 3 ... ... ... ... ... 1 ... ... ... ... ... ... 4 2 ... ... ... ... 1 1 ... 2 21 Erysipelas 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 22 Puerperal Fever ... ... ... ... ... 1 2 ... ... ... ... ... ... 3 2 ... ... ... ... 1 ... ... 4 23 Pyaemia ... ... 1 ... ... 1 ... 1 2 ... ... ... 5 ... ... ... 2 2 ... ... ... 2 24 Infective Endocarditis ... ... ... ... ... ... 3 1 ... ... ... ... 4 1 1 1 ... ... ... 1 ... 1 25 Other Allied Diseases 1 ... ... ... ... ... ... 2 ... 1 2 ... ... 6 1 1 ... ... 1 1 2 ... 1 27 Rheumatic Fever ... ... ... ... ... ... 1 ... ... 1 1 ... ... 3 ... 1 ... ... 2 ... ... ... 1 29 Tuberculosis of Brain 3 4 1 ... 1 ... ... 1 ... ... ... ... ... 10 1 ... ... ... 3 5 1 ... 4 31 Phthisis ... 1 ... 1 5 7 12 11 10 4 1 ... 1 53 0 8 3 3 6 17 8 2 99 32 Abdominal Tuberculosis 1 ... ... ... ... ... 1 ... ... ... ... ... ... 2 ... 1 ... ... ... 1 ... ... 4 33 General Tuberculosis 1 2 ... ... 1 ... 1 1 ... ... ... ... ... 6 1 1 ... ... 2 1 ... ... 8 34 Other Forms Tuberculosis ... 1 ... ... ... 2 1 ... ... ... ... 4 ... 1 ... ... ... 3 ... ... 5 41 Acute Alcoholism ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 42 Chronic Alcoholism ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 1 ... ... ... ... 1 ... ... 2 44 Other Chronic Poisonings ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 45 Osteo-Arthritis ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 1 ... ... 1 ... ... ... ... ... 46 Gout ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 ... ... ... ... 47 Cancer ... ... ... ... ... 1 4 8 12 27 25 6 2 85 19 10 14 11 12 12 7 ... 50 48 Diabetes Mellitus ... ... ... ... ... ... 1 ... 2 5 3 2 ... 13 ... 2 1 2 3 3 2 ... 2 51 Anaemia ... 1 ... ... ... ... ... ... ... 1 ... ... ... 2 ... 1 ... ... 1 ... ... ... 3 52 Lymphadenoma ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 1 ... ... 53 Premature Birth 18 ... ... ... ... ... ... ... ... ... ... ... 18 3 2 2 ... ... 9 2 ... 5 54 Injury at Birth 5 ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 3 ... ... 1 ... 1 ... 55 Debility at Birth 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... 1 ... ... ... 56 Atelectasis 4 ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... 1 2 1 ... ... 57 Congenital Defects 6 ... 1 ... ... ... ... ... ... ... ... ... 7 1 ... ... 1 3 2 ... ... 1 59 Atrophy, Debility, Marasmus 14 ... ... ... ... ... ... ... ... ... ... ... ... 14 5 1 ... ... ... 8 ... ... 8 61 Rickets 1 1 ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... ... 1 ... ... ... 62 Old Age, Senile Decay ... ... ... ... ... ... ... ... ... 1 4 18 15 38 5 5 4 2 4 8 10 ... 17 63 Convulsions 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 64 Meningitis 1 1 ... ... ... ... 1 1 1 1 ... ... ... 6 ... 1 2 1 ... 2 ... ... 3 65 Encephalitis ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 ... 1 66 Apoplexy ... ... ... ... ... ... ... ... ... 1 4 ... ... 5 ... ... ... ... 2 1 2 ... ... 67 Softening of Brain ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... ... ... ... ... ... 1 1 ... 68 Hemiplegia ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 1 ... 1 ... ... ... ... ... 69 General Paralysis of Insane ... ... ... ... ... ... 1 ... 3 1 ... ... ... 5 ... ... 2 ... 1 1 1 ... ... 70 Other forms of Insanity ... ... ... ... ... ... ... ... 1 1 2 1 1 6 1 1 ... 1 1 ... 1 1 ... 72 Cerebral Tumour ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 ... ... 1 ... ... ... 1 ... 2 73 Epilepsy ... ... ... ... ... ... 1 1 ... ... 1 1 ... 4 ... 3 ... ... ... ... 1 ... ... 75 Locomotor Ataxy ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... 1 ... ... ... ... 76 Paraplegia ... ... ... ... ... ... 1 1 1 1 ... 2 ... 6 2 ... ... ... 2 ... 2 ... 2 77 Other forms, Brain Diseases ... ... ... ... ... ... 3 1 ... 1 ... 2 ... 7 3 ... 2 1 ... 1 ... ... 2 78 Otitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 80 Diseases of Eye ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 ... ... 81 Pericarditis ::: ... ... l ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 82 Endocarditis ... 1 ... ... ... ... ... 5 4 9 5 10 1 35 7 4 3 2 5 7 6 1 7 84 Angina Pectoris ... ... ... ... ... ... ... ... 1 2 1 1 1 6 1 1 1 1 ... 1 1 ... ... 85 Aneurism ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... 1 86 Senile Gangrene ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 ... 1 87 Embolism, Thrombosis ... ... ... ... l ... 1 4 1 2 5 4 ... 18 3 2 3 ... 2 4 4 ... 4 88 Phlebitis ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... 90 Other Diseases, Heart and Vessels ... ... ... ... 3 1 2 3 2 13 24 23 7 78 13 13 16 5 9 16 12 ... 17 91 Laryngitis ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 94 Acute Bronchitis 3 2 ... ... ... ... ... 1 1 6 4 8 5 30 5 6 3 1 7 5 3 ... 3 95 Chronic Bronchitis ... ... ... 1 ... ... ... 2 3 6 20 18 3 53 14 8 8 4 5 7 6 1 18 96 Lobar Pneumonia 1 1 1 1 1 1 1 3 3 5 7 1 ... 26 4 5 1 4 3 7 2 ... 13 97 Lobular Pneumonia 8 6 2 ... ... ... ... 1 2 4 4 2 1 30 ... 8 1 1 8 8 4 ... 8 98 Pneumonia 1 ... ... ... ... 2 ... 3 1 4 2 5 1 19 5 4 ... ... 2 6 2 ... 2 99 Emphysema, Asthma ... ... ... ... ... ... ... 1 1 2 ... 1 1 6 2 1 2 ... ... ... 1 ... 4 100 Pleurisy ... ... ... ... 1 ... ... ... 1 ... 1 ... ... 3 ... ... ... 1 1 ... 1 ... 1 101 Other Diseases, Respiratory System ... ... ... ... ... ... ... ... 1 1 ... ... ... 2 ... ... ... ... ... 1 1 ... 3 102 Diseases of Mouth and Annexa ... 1 ... 1 ... ... ... ... ... ... ... ... ... 2 ... 1 1 ... ... ... ... ... 1 103 Diseases of Pharynx ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 105 Ulcer of Stomach and Duodenum... ... ... ... ... ... ... ... 1 2 1 ... 1 ... 5 1 1 ... 1 ... 2 ... ... 2 106 Other Diseases of Stomach ... 2 ... ... ... ... ... ... ... ... ... ... 1 3 1 ... ... ... 1 1 ... ... ... 107 Enteritis 8 2 ... ... ... ... ... ... ... ... 1 2 ... 8 1 2 1 ... 1 3 ... ... 4 108 Appendicitis ... ... 2 1 ... 2 2 2 ... ... 2 ... ... 11 4 1 2 2 ... ... 2 ... 5 109 Obstruction of Intestine 1 ... ... ... ... ... ... 1 ... ... ... 1 ... 3 ... 1 2 ... ... ... ... ... 3 111 Cirrhosis of Liver ... ... ... ... ... ... ... ... 1 2 4 2 ... 9 1 1 2 1 2 2 ... ... 4 112 Other Diseases of Liver ... ... ... ... ... ... ... ... ... 2 ... 3 ... 5 ... 1 2 ... ... ... 2 ... 2 113 Peritonitis ... ... ... ... ... ... 2 ... ... ... ... ... ... 2 ... ... ... ... 1 ... ... ... 1 114 Other Diseases, Digestive System ... ... ... ... ... ... 1 ... ... 1 ... ... ... 2 ... 1 ... ... ... 1 ... ... 1 115 Diseases. Lymphatic System and Glands ... ... ... ... ... 1 1 ... 1 ... 2 ... ... 5 2 ... ... 2 ... 1 ... ... 2 116 Acute Nephritis ... ... 1 ... ... 1 ... 1 ... ... ... ... ... 3 ... ... 1 ... 1 1 ... ... 2 117 Bright's Disease ... ... ... ... 1 ... ... 2 4 3 5 3 1 19 ... 2 2 2 3 5 5 ... 12 119 Diseases of Bladder and Prostate... ... ... ... ... ... ... ... ... ... 1 2 1 2 6 ... 1 1 1 2 1 ... ... ... 123 Diseases of Uterus and Appendages ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... ... 126 Abortion, Miscarriage ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 127 Puerperal Mania ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 131 Other Diseases, Pregnancy and Childbirth ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 137 Other Diseases, Integnmentary System ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 ... ... ... Accidents and Negligence. 139 In Vehicular Traffic ... ... 1 ... ... ... ... 1 1 ... 1 1 ... 5 1 1 1 1 ... 1 ... ... 3 140 On Railways ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 142 In Building Operations ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... 1 145 Burns and Scalds ... 1 ... ... ... ... ... ... ... ... ... ... 1 2 2 ... ... ... ... ... ... ... 5 147 Surgical Narcosis ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 151 Suffocation, Overlaid in Bed 1 ... • • • ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 152 „ Otherwise ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 153 Falls, not specified ... ... ... ... ... ... ... ... ... 1 3 3 ... 7 2 ... 1 ... 2 2 ... ... 3 155 Otherwise, not stated ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Suicides. 157 By Poison ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 ... 1 ... ... ... ... ... 1 4 159 By Hanging and Strangulation... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 160 By Drowning ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 161 By Shooting ... ... ... ... ... ... ... ... ... 1 1 ... ... 2 1 ... ... ... 1 ... ... ... 1 163 By Precipitation from Elevated Places ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... 164 By Crushing ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 169 Found Drowned ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... Totals 99 49 16 7 16 18 52 68 68 120 145 131 50 839 140 130 88 63 118 182 111 7 466 Note.—The omission of a number from the first column denotes that no death was registered from that cause. Note.—It will be noted that the total number of deaths in the Ward distribution is 7 less than the total number of deaths at the age periods. This is accounted for by the fact that in these caees a definite address was not registered. (See note at foot of Table II.) 119 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 Yeah 1909. 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 Montha. 10-11 Months. 11-12 Months. Total Deaths under 1 Year. All Certified 27 2 5 7 41 10 3 7 6 2 9 3 4 4 5 5 99 Causes Uncertified ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... i. Common Infectious Diseases Small-pox Chicken-pox Measles Scarlet Fever . Diphtheria (including Membranous Croup) WhoopingCougb ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... ... 1 ... 1 1 2 1 10 ii. Diarrhoea Diseases. Diarrhoea, all forms Enteritis, Muco-enteritis. Gastro enteritis Gastritis, Gastro intestinal Catarrh ... ... ... 1 1 1 1 ... ... ... ... ... ... ... ... ... 3 ... ... ... 1 1 ... ... ... ... ... ... 1 ... ... ... ... 2 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 iii. Wasting Diseases Premature Birth Congenial Defects Injury at Birth Want of Breastmilk, Starvation Atrophy, Debility Marasmus 10 " 1 1 12 1 ... 1 ... ... 1 ... ... ... ... ... 18 4 ... ... ... 1 ... ... 1 1 ... ... ... ... ... ... ... 6 5 . ... ... 5 ... ... ... ... ... ... ... ... ... ... ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 2 7 2 1 ... 2 ... 1 ... ... ... 1 ... 14 iv. Tuberculous Diseases Tuberculosis Meningitis Tuberculosis Peritonitis: Tabes terica Other Tuberculous Diseases ... ... ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 v. Other Causes Erysipelas Syphilis Rickets Meningitis (not Tuberculous Convulsions Bronchitis Laryngitis Pneumonia Suffocation, overlying Other causes ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... 1 2 ... ... ... ... ... 1 ... ... ... ... ... 8 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 2 1 1 ... 1 1 l 10 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 5 ... 1 ... 6 1 ... ... ... ... l ... 1 ... ... 1 11 27 2 5 7 41 10 3 7 6 2 9 3 4 4 5 5 99 Population estimated to middle of 1909, 94,185. Births in the year legitimate, 1,239 illegitimate. 43 Deaths in the year of legitimate infants, 88. legitimate infants, 11. Deaths from all Causes at all Ages, 839. 120 The following Table was suggested by the Medical Officer of Health to the County of London in order to secure uniformity of tabulation in the annual reports of the Medical Officers of Health of the Metropolitan Boroughs:— TABLE VI. PREMISES. NUMBER OF PLACES. Number of inspections, 1909. Number of notices, 1S09. Number of prosecutions, 1909. On register at end of 1908. Added in 1909. Removed in 1909. On register at end of 1909. Milk premises 113 4 2 115 310 21 - Cowsheds — — — — — — — Slaughter-houses 5 — — 5 97 5 — Other offensive trade premises — — — — — — — Ice cream premises - 76 4 2 78 167 7 — Registered houses let in lodgings 315 49 — 364 427 8 — Total number of Intimation Notices served for all purposes - 781 Overcrowding— Number of dwelling rooms overcrowded - - - - 7 Number remedied - - - - - - - - 7 Number of notices issued - - - - - - - 5 Number of prosecutions - - - - - - - — Underground rooms— Number closed during year - - - - - - — Illegal occupation dealt with during year - - - - 23 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 (Louden) Act, 1891— Number of persons accommodated during the year - - — 121 TABLE VI.—continued. Customs and Inland Revenue Act's— Number of houses for which applications were received during year 13 Number of dwellings comprised therein. 96 Number of Certificates granted (houses) — „ „ refused ( „ ) — „ „ deferred ( „ ) 13 Number of prosecutions under Bye-lows 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 1 (d) As to paving of yards, &c., of dwelling houses — (e) In connection with the removal of offensive matter, &c. — (f) As to cesspools and privies, removal and disposal of refuse, &c - (g) For securing the cleanliness of tanks, cisterns, &c. — (h) With repect to water-closets, earth closets. &c. 4 (i) With respect to sufficiency of water supply to waterclosets — Numter 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. 14 (b) With respect to deposit of plans as to drainage, &c. 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 13 houses comprised 96 " dwellings." 122 TABLE VI.— continued. London County Council (General Powers) Act, 1904, Part IV.— Number of filthy articles purified (Sec. 19) — „ verminous rooms cleansed (Sec. 20) 62 „ „ houses „ (Sec. 20) 21 ,, sanitary conveniences altered (Sec. 22) — „ „ „ removed (Sec. 22) — „ fixed ashpits removed (Sec. 23) 48 Mortuaries— Total number of bodies removed 85 Total number of infectious bodies removed — London County Council (General Powers) Act, 1907, Part XII., and See. 48 Public Health (London) Act, 1891 — Number of tenement houses in which additional water taps and sinks have been provided (Sec. 78) 85 123 TABLE VII. Vital Statistics of the Borough. Number of occupied houses 11,294 Population 81,942 At Census 1901. 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 i per 1000 of the Population. Number. Estimated rate per 10 0 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population. Deaths occurring. Death rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 83743 1516 18.1 904 10.7 133 87.7 460 5.4 33 0.39 58 0.69 1903 85197 1453 17.0 837 9.8 126 86.7 311 3.8 16 .019 42 0.49 1904 86633 1445 16.7 892 10.3 161 111.4 301 3.5 20 0.23 48 0.55 1905 88142 1421 16.1 823 9.3 133 93.6 295 3.3 14 0.16 38 0.43 1906 89633 1437 16.0 850 9.5 111 77.2 557 6.2 22 0.25 49 0.55 1907 91137 1341 14.7 817 9.0 98 73.1 498 5.5 15 0.16 41 0.45 1908 92654 1400 14.0 803 8.5 97 69.3 383 4.1 20 0.21 38 0.40 1909 94185 1328 13.9 839 8.9 99 74.5 325 3.4 21 0.22 49 0.52 TABLE VII. (1). Vital Statistics of No. 1 (Town) Ward. Number of occupied houses 1,616 Population 11,895 At Census 1901, Average number of persons per house .. 7.36 Year. Population estimated to middle of year, Births. Deaths. Infantile Leaths. 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 192 157 163 13.5 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 7.5 6 0.44 11 0.81 1907 13940 185 13.3 152 10.9 15 81.1 105 75 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 1909 14550 196 13.5 140 9.6 15 76.5 53 3.6 4 0.27 8 0.55 124 TABLE VII. (2). Vital Statistics of No. 2 (Belsize) Ward. Number of occupied houses 1,581 At Census, 1901. Population 2,915 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 13 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 1909 14990 204 13.6 130 8.7 16 78.4 88 5.9 5 0.33 8 0.53 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 1909 10940 83 7.6 88 8.0 4 48.2 16 1.5 2 0.18 4 0.37 125 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 95 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 l 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 1909 10735 116 10.8 63 5.9 3 25.9 29 2.7 2 0.19 5 0.47 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 rale 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 1901 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 1909 14650 239 16.3 118 8.0 13 54.4 51 3.5 2 0.14 7 0.48 126 TABLE VII. (6). Vital Statistics of No. 6 (Kilburn) Ward. Number of occupied houses 1,686 At Census 1910. 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 1C00 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 1901 15550 408 26.2 206 13.2 54 132.3 43 2.8 8 0.51 25 1.61 1905 15790 426 26.9 171 10.8 50 117.4 57 3.6 2 0.13 9 0.57 1906 16030 444 27.7 197 12.3 41 92.0 128 8.0 5 0.31 16 1.00 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 1909 17010 341 20.0 182 10.7 37 108.5 67 3.9 6 0.35 10 0.59 TABLE VII. (7). Vital Statistics of No. 7 (Priory) Ward. Number of occupied houses 1,677 At Census 1901. Population 10,689 Average number of persons per house 6.38 Year Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population. Deaths occurring. Death rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 10840 162 14.9 110 10.5 16 98.7 44 4.1 1 0.09 3 0.28 1903 10950 194 17.7 116 10.5 21 108.2 43 4.0 3 0.27 7 0.61 1904 10990 152 13.8 121 11.0 13 85.5 23 2.1 •• •• •• •• 1905 11040 133 12.0 103 9.3 14 105.3 44 3.9 3 0.27 5 0.45 1906 11070 150 13.5 93 8.4 9 60.0 31 2.8 2 0.18 4 0.36 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 1909 11300 149 13.2 111 9.8 11 73.8 21 1.9 •• •• 7 0.62 127 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 1909 13.9 25.6 489 0.52 1.12 3.4 8.9 14.5 * Excluding Chicken-pox. INDEX. PAGE. Accident, Deaths from 25 Adulteration 80-83, 101 Alcoholism 24 Analyses, Results of 80-83, 101 Analytical Work, Report on 99, 101 Applications for Redrainage 63, 64 Area of Borough 13 Bakehouses 91,92 Birth-Rate 15-17 Births, Illegitimate 15 ,, Number of 14 „ „ in Wards 17 Cancer 23 Circulatory System, Diseases of 24 Combined Drainage 64,65 Complaints received 84 Consumption 52-56 Customs and Inland Revenue Acts 66 Dairies 74, 75 Death-Rate 17-20 „ Infantile 27-34 Death returns 20, 21 Deaths, at various ages 21 „ Causes of 23-25 „ in Public Institutions 21, 22 ,, from seven principal Epidemic Diseases 48 „ Infantile 27-34 „ Non-resident 17, 20, 21 ,, Number of 17 „ Outlying 17, 21 „ Senile Mortality 23 Diarrhoea 52 Diphtheria 44, 45 Disinfection 56, 57 Drainage Work 63, 64 Enteric Fever 45-47 Epidemic Cerebro-Spinal Meningitis 47 Epidemic Diseases, Seven Principal, Death Rate 48 „ „ Deaths from 48 Erysipelas 47 Factories 87, 94-96 Factory and Workshop Act, 1901 86-98 Fever 45-47 130 PAGE. Food Inspection 75 Food Premises 78-80 Foodshops, Inspection of 78-80 Health Visiting 33, 34 Home Office Tables 95-98 Homework 87, 94 ,97 Houses let in Lodgings 65 Housing, Town Planning, etc., Act 68-70 Ice Cream 77, 78 Infantile Mortality 27-34 Infants, advice as to rearing of 33, 34 Infectious Diseases 36-57 „ „ Notifiable 37-47 „ „ „ Attack Rate 37 „ „ „ Cases occurring 37 „ „ „ „ „ in each Month 39 ,, ,, ,, „ ,, ,, ,,Ward 40 „ „ „ Death Rate 37 „ „ ,, Deaths from 37 Insanitary and Uninhabitable Premises 66 Inspections and Re-Inspections of Premises 63 Laundries 88-98 Legal Proceedings 103-110 Local Government Board Tables 113-119 Marriage Rates, 1899—1909 14 Marriages, Number of 13 Measles 49-51 Milkshops and Milk Supply 76, 77 Mortuary, Public 72-74 Natural Increase of Population 17 Non-resident Deaths 17, 20, 21 Notifiable Infectious Diseases 37-47 Notification of Births Act, 1907 33 Nuisances, Inspection of 63 Outlying Deaths 17, 21 Outworkers 87, 94, 97 Phthisis, Pulmonalis 52-56 „ „ Voluntary Notification of 53-56 Population, Density of 13 „ Estimated to middle of 1909 13 „ In Wards 13 „ Natural Increase of 17 Principal Epidemic Diseases 48 „ „ „ Death Rate 48 „ „ „ Deaths from 48 131 PAGE. Public Health Committee 5 „ „ (Tuberculosis) Regulations, 1908 53-56 Puerperal Fever 47 Rearing of Infants 33, 34 Redrainage Applications 63, 64 Registered Houses 65 Respiratory System, Diseases of 24, 25 Restaurant Kitchens 92,93 Sale of Food and Drugs Acts 80-83 Sanitary Administration, General 59-84 Scarlet Fever 42,43 Senile Mortality 23 Slaughterhouses 75, 76 Small-pox 41 Staff of the Public Health Department 6, 72 Suicide 25 Summary of Vital Statistics for 1909 11 Tenement Houses, Water Supply of 70-72 Tuberculosis 52-56 Underground Rooms 66-68 Uninhabitable and Insanitary Premises 66 Vaccination 41 Vital Statistics 9-25 Water Supply, Certificates as to 63 „ „ of Tenement Houses 70-72 Whooping Cough 51,52 Workshops 87-90, 95, 96, 98 Workplaces 88, 89, 92,95,96