HAMP 18 , THE Metropolitan Bormtgh of hamp$tead). REPORT FOR THE YEAR 1911 of the Mediical (Offticer of health). G. F. McCLEARY, B.A., M.D., D.P.H. CONTENTS. pages Vital Statistics 11- 26 Infantile Mortality 29-35 Infectious Diseases 39-65 General Sanitary Administration 69-88 Factory and Workshop Act, 1901 91-100 Report on Analytical Work 103 Legal Proceedings 107-111 Appendix—Tables 115-126 Index 127-129 5 PUBLIC HEALTH COMMITTEE, NOVEMBER, 1910-11. Ex- Officio. His Worship The Mayor (Mr. Councillor W. Woodward). Chairman. Mr. Councillor J. I. Fraser. Mr. Alderman E. C. Andrews, M.D. (until June, 1911). „ L. Farmer Miss Councillor M. E. Balkwill. Mr. Councillor V. II. le B. Blessley (appointed on the resignation of Dr. Andrews) „ G. Buckle. ,, C. W. Cunnington, M.R.C.S., D.P.H. „ C. J. Higginson J. H. North „ T. H. Nunn. „ E. A. O'Bryen. ,, E. S. Payne. „ A. B. Weaver. 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT, 1911. Senior Sanitary Inspector. W, G. Kershaw. Divisional Sanitary Inspectors. R. Geary, No. 1 District (Wards 1 and 2). C. II. Taylor, No. 2 District (Wards 3 and 7). A. Peverett, No. 3 District (Wards 4 and 5). J. Grimsley, No. 4 District (Ward 6). Special Sanitary Inspectors. F. H. Hudson. A. C. Townsend. Mrs. T. Fisher, M.A. Mrs. K. Roche. Assistants to Inspectors. W. Larken. E. Stratton. A. Edwards. Public Mortuary Keeper. W. Larken. Disin/cctors. T. Rider. G. Allaway. R. Bell. Clerks. W. Sell, First Clerk. F. S. Hill, Second Clerk. P. T. Roberts, Third Clerk. Clerk-Draughtsman. 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. 4 To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. MR. Mayor, Madam, and Gentlemen, I have the honour to place before you ray Annual Report for the year 1911. I would direct special attention to the part of the Report relating to Tuberculosis. In view of the provisions of the National Insurance Act relating to sanatorium benefit, the formulation of an effective scheme for the control of Tuberculosis has now become a matter of urgent importance. 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 1911. Population estimated to middle of 1911 85599 Density 37.8 persons per acre Births 1276 Birth-Rate 149 Marriages 696 Marriage-Rate 16.3 Deaths 847 Death-Rate 99 Infantile Mortality 82 per 1000 births Notifiable Infectious Diseases Attack Rate (excluding Chicken-pox) 40 Notifiable Infectious Diseases Death Rate 0.29 Death Rate from the Seven Principal Epidemic Diseases 0.59 Death-Rate from Consumption 0.65 Population at Census 1911 85510 Inhabited Houses 11294 Area of Borough 2265 acres „ „ (excluding area covered by water) 2253 acres 13 POPULATION. The twelfth Census of the population of the United Kingdom was taken on April 3rd, 1911, and the total number of persons returned as living in Hampstead at midnight on Sunday, April 2nd, 1911, was 85,510. This represents an increase of 3,568 on the total population as ascertained at the Census of 1901, and a rate of increase in the ten years of 4.4 per cent. The following table shows the population o1 Hampstead at each Census year, and the increase in each inter-censal period since the taking of the first English Census in 1801. Census Year. Census Population. Increase of Population per cent, during the ten years. 1801 4,343 — 1811 5,483 26 1821 7,263 32 1831 8,588 18 1841 10,093 17 1851 11,986 18 1861 19,104 59 1871 32,271 68 1881 45,436 40 1891 68,425 50 1901 81,942 20 1911 85,510 4.4 This table shows that the population of Hampstead increased considerably in every inter-censal period between 1801 and 1901, the increase being most marked in the thirty years between 1861 and 1891. The increase between 1901 and 1911 was comparatively small—the smallest, in fact, recorded in any decade since the first Census was taken. It was not anticipated by those acquainted with local conditions that the rate of increase in the ten years 1891-1901 would be maintained in the next decade, for comparatively few new houses have been built since 1901. The Registrar-General, however, based his estimate of the population on the assumption of an annual rate of increase equal to the mean rate in the period 1891-1901, and his estimate, which was 97,288, was found to be considerably in excess of the actual population. 14 In previous annual reports I have expressed the opinion that the Registrar-General's estimate of the population was too high, and the census results show that this opinion was justified. The various birth rates and mortality rates, etc., in previous years have been calculated on the basis of the estimated population, and as these estimates are now known to be too high, it follows that the rates based upon them were slightly too low. I have, therefore, re-calculated the rates for years intervening between the census years, basing them on populations re-estimated in the light of the census returns. Of the 29 metropolitan boroughs, including the City, 20 showed a decrease of population; Hampstead was one of the nine metropolitan boroughs in which there was an increase of population in the last inter-censal period. The following table shows the increase or decrease of population in each of the metropolitan districts:— 15 District. Population. Increase or decrease of population in inter-censal period. 1901. 1911. Increase. Decrease. Battersea 168,907 167,793 — 1,114 Bermondsey 130,760 125,960 — 4,800 Bethnal Green 129,680 128,282 — 1,398 Camberwell 259,339 261,357 2,018 — Chelsea 73,842 66,404 — 7,438 Deptford 110,398 109,498 — 900 Finsbury 101,463 87,9/6 — 13,487 Fulham 137,289 153,325 16,036 — Greenwich 95,770 95,977 207 — Hackney 219,110 222,587 3,477 Hammersmith 112,239 121,603 9,364 — Hampstead 81,942 85,510 3,568 Holborn 59,405 49,336 — 10,069 Islington 334,991 327,423 — 7,568 Kensington 176,628 172,402 — 4 226 Lambeth 301,895 298,126 — 3,769 Lewisham 127,495 160,843 33,348 — Paddington 143,976 142,576 — 1,400 Poplar 168,822 162,449 — 6,373 St. Marylebone 133,301 118,221 — 15,080 St. Pancras 235,317 218,453 — 16,864 Shoreditch 118,637 111,463 — 7,174 Southwark 206,180 191,951 — 14,229 Stepney 298,600 280,024 — 18,576 StokeNewiugton. 51,247 50,683 — 564 Wandsworth 231,922 311,402 79,480 Westminster 183,011 160,277 — 22,734 Woolwich 117,178 121,403 4,225 — Citv of London 26,923 19,657 — 7,266 The census was taken at the end of the first quarter of the year, but the population on which the statistics for the year are based is the mean population for the year, i.e., the population at the end of the second quarter. 16 It follows, therefore, that even in a census year the population which serves as a basis for the vital statistics of the year is an estimated, not an enumerated population. The population of Hampstead at the middle of 1911 was estimated by the Registrar-General to be 85,599, and this estimate has been adopted in this Report, and it forms the basis upon which the various rates have been calculated. At the time of writing the complete census returns for London have not been issued, and I am unable, therefore, to give the enumerated populations of the various wards. The following, however, is an approximate estimate of the population of each ward at the middle of 1911 :— Ward 1 (Town) 13820 „ 2 (Belsize) 13780 ,. 3 (Adelaide) 9950 ,, 4 (Central) 9859 ,, 5 (West End) 12850 „ 6 (Kilburn) 14920 „ 7 (Priory) 10420 The Borough 85599 The area of the Borough (including the area, twelve acres in extent, covered by water) is 2,265 acres, and the estimated number of persons to the acre is 37"8. The proportion of persons to the acre at the census 1901 was 30" 17. At the census of 1881 the number of persons per acre was 23, and in 1891 it was 30. 17 MARRIAGES. According to the returns of the Registrar-General, 690 marriages were registered in the Borough during 1911 ; they were distributed in the four quarters of the year as follows: — 1st quarter 135 2nd „ 177 3rd „ 205 4th ,, 179 Total 696 The total number of persons married in Hampstead during 1911 was 1392, which is equivalent to a rate of 16*3 per 1000 of the population, and is an increase on that for the year 1910, when the marriages of 1262 persons were registered, equivalent to a rate of 14"8 per 1000 of the population. The following Table gives the marriage rates for the years 1900—1909 and the average rate for the decade :— No. of persons married Year. per 1000 of the population. 1901 13.3 1902 15.3 1903 14.4 1904 15.0 1905 14.4 1906 13.8 1907 15.3 1908 14.7 .1909 16.0 1910 14.8 Average for the decade 14.7 1911 16.3 18 BIRTHS. During the year 1,199 births were registered in Hampstead, a decrease of 71 as compared with the number—1,270—registered in the previous year. Of the total births 593 were of male and 606 of female children. In addition, 80 births of children whose mothers were Hampstead residents occurred in the principal lying-in institutions in other metropolitan boroughs, and three of the births registered in Hampstead belonged to other districts, and should be deducted from the total. After these corrections have been made, the total number of births belonging to Hampstead is found to be 1,276, 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. Illegitimate Births.—Out of the total of 1,199 births registered in Hampstead, 37, or 29 per 1000 were those of illegitimate children. Birth-Rate. The birth-rate calculated on the number of births registered in the Borough was 14'0 per 1000 of the population, as compared with the rate of 15-7 per 1000 in 1910, and 16'2, the average for the years 1906—1910. 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 and excluding' those taking o O place in the Borough but belonging to other districts, the rate is found to be 14*9. This is the lowest birth-rate ever recorded in Hampstead, the lowest rate in any previous year being 15.6 in 1909. The highest birth-rate recorded in Hampstead was in the year 1878, when the rate was 24.5. Since then the rate has steadily declined. In England and Wales there has also been a marked reduction in the birth-rate, but the Hampstead figures show a greater proportionate decline. 19 The following table shows the Ward and sex-distribution of the births, and the birth-rate for each Ward:— Ward. Males. Births. Total. Birth-rate per 1000 ot' the population. Females, No. 1 (Town) 108 99 207 15.0 No. 2 (Belsize) 91 98 189 13.7 No. 3 (Adelaide) 36 46 82 8.2 No. 4 (Central) 49 43 92 9.3 No. 5 (West End) 99 117 216 16.8 No. 6 (Kilburn) 174 173 347 23.2 No. 7 (Priorj') 75 68 143 13.7 The Borough 632 644 1276 14.9 The Natural Increase of the population—i.e., the excess of births over deaths—was 429 in 1911. DEATHS. The total deaths occurring in Hampstead during the year amounted to 1,132. Of these, however, no less than 415 were of persons not belonging to the Borough, while 130 residents of Hampstead died in outlying districts. The total number of deaths, therefore, amongst persons belonging to Hampstead amounted to 847. 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 13'2 per 1000 of the population ; but after subtracting 20 from the total deaths registered the deaths of noil-resident persons dying in Hampstead, and adding the deaths of Hampstead residents who died outside the district, the recorded death-rate is found to be 9*9 per 1000 of the population, as compared with the rate of 9'7 per 1000 of the population in 1910. The average recorded death-rate for the 5 years 1906-10 was 9-8. 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) 9.7 No. 3 (Adelaide) 9.9 No. 4 (Central) 7.6 No. 5 (West End) 7.9 No. 6 (Kilburn) 12.0 No. 7 (Priory) 11.0 In the table on page 126 the death-rates of Hampstead may be compared with those of England and Wales since 1875. The following table, which is issued by the Registrar-General, shows the death-rate of Hampstead as compared with the rates of the County of London, the City of London, and the Metropolitan Boroughs :— 21 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 1911, as calculated by the Registrar-General. district. Death-rate from all causes. Hampstead 9.6 Lewisham 11.3 Wandsworth 12.0 City of Westminster 12.5 Woolwich 12.8 Stoke Newington 13.0 Paddington 13.3 Kensington 13.7 Battersea 14.3 Camberwell 14.3 Hackney 14.3 Fulham 14.4 Greenwich 14.7 Islington 14.9 Lambeth 14.9 City of London 15.1 St. Marylebone 15.1 Chelsea 15.5 St. Pancras 15.5 Deptford 15.6 Hammersmith 15.6 Holborn 15.7 Stepney 17.4 Bethnal Green 18.2 Bermondsey 18.4 Shoreditch 18.4 Poplar 18.9 Finsbury 19.8 Southwark 20.1 County of London 15.0 22 The death-rate in Hampstead in 1911—9.9—is the same as in 1909. In only three years, viz., 1907, 1908, and 1910, has a lower rate been recorded. Deaths of Non-Residents and Outlying Deaths. Of the 1,132 deaths that occurred in Hampstead, 415 were of persons belonging to other districts. On the other hand 130 Hampstead residents died outside Hampstead. Information of the outlying deaths is received from the Registrar-General, who issues to medical officers of health a quarterly return of deaths that occur outside the district. The number of deaths of Hampstead residents that occurred in public institutions was 237, or 28.0 per cent. of the total deaths, and the number of deaths occurring in workhouses or workhouse infirmaries was 74, or 8*7 per cent, of the total deaths. A list of the institutions in which the deaths occurred is given on pages 23 and 24. Deaths at Various Ages. The following table shows the number of deaths at the various age periods, the causes of such deaths being shown in Tables III. and IV., pages 117 and 118. Age Periods. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. All Ages. Deaths 105 27 20 25 32 112 212 314 847 Uncertified Deaths. The deaths of two Hampstead residents which took place during 1911, were not certified by registered medical practitioners, and in neither case was an inquest held. 23 Deaths of Hampstead Residents in Institutions. Institution. Totals. Group Totals. Infirmaries and Workhouses— Bromley Union Infirmary, Farnborough 1 74 Hampstead Workhouse 72 St. George's Infirmary, Fulham Road 1 Hospitals, Nursing Homes, etc.— 218, Adelaide Road 2 26, Belsize Avenue 2 121 73, Belsize Park Gardens 1 33, Belsize Square 1 Children's Hospital, Paddington Green 3 Day Nursery, 19, Beaumont Street, Toxteth Park 1 2, Dorset Square, N.W. 1 11, Duchess Street, W. 1 German Hospital 1 Great Northern Hospital 2 Hampstead Hospital 35 Home of Good Hope, Porchester Road, Bournemouth 1 Hospital of St. John and St. Elizabeth 1 Infants' Hospital 1 London Hospital 2 London Temperance Hospital 3 Lying-in Hospital, Endell Street, W.C. 2 19, Manchester Street, W. 1 Middlesex Hospital 8 Mount Vernon Hospital 4 National Hospital 2 7, Osnaburgh Terrace, N.W. 1 Queen Charlotte's Hospital 2 10, Rosslyn Hill 1 Royal Hospital for Incurables, Wandsworth 1 St. Barnabas' Home, 9, Lloyd Street, E.C. 1 St. Bartholomew's Hospital 1 St. Catherine's Hospital 1 St. George's Hospital 1 St. John's Lodge Nursing Home, Grand Drive, Merton 1 St. Joseph's Hospice, Hackney 2 St. Luke's House, Kensington 2 St. Mary's Hospital 13 St. Michael's Home, Axbridge 1 St. Peter's Home 1 97, South Hill Park 5 State Inebriate Reformatory 1 7, The Terrace, St. Pancras 1 University College Hospital 5 Warrington Lodge, Warrington Crescent, Paddington 2 Westminster Hospital 3 24 Deaths of Hampstead Residents in Institutions—con. Institution. Totals. Group Totals. Metropolitan Asylums Board's Hospitals— North Western Hospital 16 18 Park Hospital 1 Western Hospital l Asylums— Banstead Asylum 4 24 Betlilem Royal Hospital 1 Camberwell House Asylum 1 Claybury Asylum 3 Colney Hatch Asylum 5 Coton Hill Asylum 1 Hanwell Asylum 2 Leavesden Asylum 2 Middlesex County Asylum 1 Tooting Bee Asylum 3 Whitecroft Asylum, Isle of Wight 1 237 The names of the Institutions that are situated in Hampstead are printed in heavy type. Senile Mortality. The deaths of persons of 65 years of age and upwards numbered 314, as compared with 344 in 1910. CAUSES OF DEATH. The causes of death are given in Table III. of the Local Government Board's series of tables, see page 117, and are set out in more detail in the extended table facing page 117. 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 ten years 1902-11:— 25 Year. No. of Deaths from Cancer. Death-rate per 1000 of the population. 1902 91 1.10 1903 105 1.27 1904 85 1.02 1905 73 0.87 1906 93 l.11 1907 69 0.82 1908 84 0.99 1909 85 1.00 1910 90 1.06 1911 86 1.00 The next table gives the anatomical distribution of the disease in each sex. It will be noted that a large proportion of the patients—61 out of a total of 86 cases—were females. In 34 cases the patients were over 65 years of age. Situation. Males. Females. Total. Buccal cavity 4 3 7 Stomach, Liver, &c 10 13 23 Peritoneum, Intestines and Rectum 6 15 21 Uterus, &c. — 10 10 Breast — 15 15 Other, or unspecified organs 5 5 10 Totals 25 61 86 Alcoholism. In 7 cases death was certified to be due to alcoholism, and 8 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, 15, as compared with 14 in 1910, 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 26 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 119 deaths, as compared with 153 in 1910. Diseases of the Respiratory System. The total mortality from these diseases was 106, as compared with 130 in 1909. Thirty-one deaths occurred in children under five years of age, and 52 in persons aged from 65 years upwards. Of the total deaths 49 were due to pneumonia and bronchopneumonia, 39 to bronchitis, 6 to pleurisy, and 12 to other diseases of the respiralory organs. Accident. Twenty-two deaths were classified under this heading, as compared with 20 in 1910 ; 8 were due to falls, 4 to drowning, 3 to burns and scalds, 3 to street accidents, 1 to a fall from an aeroplane, and 3 to other accidents. Suicide. Fifteen persons committed suicide, as against 8 in 1910. In 6 cases the cause of death was poisoning, 1 death was due to hanging, 1 to asphyxia, 1 to drowning, 2 to bullet wounds in brain, and 4 to cut throat. Infantile Mortality. 29 INFANTILE MORTALITY. The number of deaths of Hampstead children under 1 year was 105, an increase of 24 as compared with the previous year. In the following table these infantile deaths are distributed in Wards under their respective causes:— CAUSE OF DEATH. WARDS. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). 1 Small-pox • • • • • • • • • • • • • • • • 2 Chicken-pox • • • • • • • • • • • • • • • • 3 Measles • • • • 1 • • • • 1 1 3 4 Scarlet Fever • • • • • • • • • • • • • • • • 5 Diphtheria and Croup • • • • • • • • • • • • • • • • 6 Whooping Cough 1 • • • • • • • • • • • • 1 7 Diarrhœa 2 1 1 2 • • 5 1 12 8 Enteritis 4 1 • • • • 1 4 • • 10 9 Tuberculous Meningitis • • • • • • 1 • • 1 • • 2 10 Abdominal Tuberculosis • • • • • • • • • • • • • • • • 11 Other Tuberculous Diseases 1 1 • • • • • • • • • • 2 12 Congenital Malformations • • • • • • • • • • • • 3 3 13 Premature Birth 4 3 • • 1 4 8 • • 20 14 Atrophy, Debility, and Marasmus • • 2 • • • • 4 3 • • 9 15 Atelectasis • • • • • • 1 • • • • • • 1 16 Injury at Birth 1 .. • • • • • • • • • • 1 17 Erysipelas • • • • • • • • • • • • • • • • 18 Syphilis 1 • • • • • • • • • • • • 1 19 Rickets • • • • • • • • • • • • • • • • 20 Meningitis (not Tuberculous) 1 • • 1 • • • • • • • • 2 21 Convulsions • • 1 • • 1 • • • • 1 3 22 Gastritis • • • • • • • • 1 • • • • 1 23 Laryngitis • • • • • • • • 1 • • • • 1 24 Bronchitis • • 1 • • • • • • 2 • • 3 25 Pneumonia (all forms) 2 4 2 • • • • 3 1 12 26 Suffocation, overlying • • • • • • • • • • • • • • • • 27 Other Causes 2 3 1 2 4 4 2 18 Totals 19 17 6 8 15 31 9 105 The "Infantile Mortality"—i.e., the number of deaths under one year per 1000 births—was 82, as compared with the rate of 60 per 1000 births in 1910, 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 19061910 was 70. 30 The following table shows the infantile mortality of Hampstead in each year since 1880:— 1880 140 1896 123 1881 136 1897 127 1882 99 1898 125 1883 98 1899 129 1884 143 1900 100 1885 110 1901 102 1886 131 1902 88 1887 107 1903 87 1888 110 1904 111 1889 122 1905 94 1890 122 1906 77 1891 104 1907 69 1892 122 1908 69 1893 102 1909 74 1894 113 1910 60 1895 135 1911 82 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) 91.8 No. 2 (Belsize) 90.0 No. 3 (Adelaide) 73.2 No. 4 (Central) 87.0 No. 5 (West End) 69.4 No. 6 (Kilburn) 89.3 No. 7 (Priory) 63.0 The infantile mortality rate in Hampstead in 1911 was considerably higher than in 1910, and higher than in any previous year since 1905. The cause of the increase is not far to seek, and is to be found in the exceptionally hot dry weather that prevailed during the third quarter of the year. In the London district the mean temperature during the quarter was 4½° above the normal. On four days in July, two days in 31 August, and one day in September, the temperature rose above 90°, and on August 9th the temperature rose to a higher level than at any previous time on record, reaching 100° at the Royal Observatory, Greenwich, and 94° at the Hampstead Meteorological Station near the Whitestone Pond at a height of 453 feet above mean sea level. The rainfall was unusually deficient, being only 45 per cent, of the normal in the London district. The second week in July was the sunniest week on record. Such weather, however desirable in other respects, is inimical to infant life, and gave rise to the high mortality of 1911. It is gratifying to note, however, that the mortality, though high, is considerably lower than in previous years with hot summers, such as 1899, and this result must be attributed to the preventive measures which local authorities have brought into operation during the past ten years. It has not infrequently been asserted in disparagement of those measures that the comparatively low mortality rates of the years 1902-1910 were due to the cold wet summers of those years, and that when a hot dry summer occurred the rate would rise to the high level of previous years. The experience of 1911 has proved the error of this pessimistic view. The summer of 1911 was the hottest on record, and yet the mortality amongst infants was considerably lower than it was in the hot weather of the years 1891-1901. This result justifies those who take an optimistic view of the prospect of reducing infantile mortality, and proves the value of the preventive measures that have been adopted during the past ten years. The measures for the prevention of infantile mortality may be classified into two groups: (1) those that improve the sanitary condition of the child's surroundings, and (2) those that improve the standard of personal care the child receives during the first few months of life. Among the sanitary improvements special importance must be attached to the hygienic paving of street carriage-ways with impermeable material, such as asphalte or tarred macadam, and the paving of the backyards and forecourts of dwellings. During the past five years the Council have paved a considerable number of streets with tarred macadam, and special attention has been paid to the paving of yards and forecourts, the bye-law made by the Council in 1907 being found valuable in enforcing this important work. In connection with the prevention of infantile mortality mention should be made of one valuuable sanitary reform which, however, has 32 been effected without the intervention of sanitary authorities. I refer to the gradual disappearance of the horse from London owing to the introduction of self-propelled vehicles. The motor is rapidly delivering London from its horse manure, which has for years constituted an intolerable nuisance, especially in hot weather. In Hampstead the improvement has been marked. During the past few years seven large stables which accommodated some hundreds of horses have been converted to other purposes, to the great advantage of the dwellers in the neighbourhood, and many mews-dwellings have been transformed almost beyond recognition. It is time that it should be realised that the presence of the horse in a large modern city is incompatible with cleanly civic life, and any measures that tend to hasten its disappearance should be welcomed by sanitary reformers. 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 as calculated by the Registrar-General, who gives a lower rate for Hampstead than the one based on my figures. It will be noted that Hampstead occupies a very favourable position when compared with other districts or with the whole of London:— 33 Table showing the Infantile Death-Rates of the Counts of London, the City of London, ant the Metropolitan Boroughs during the 52 Weeks of 1911, as calculated by the RegistrarGeneral. DISTRICT. Deaths under 1 year to 1000 Births. Hampstead 78 Woolwich 97 Stoke Newington 102 City of Westminster 103 Lewisham 104 St. Marylebone 108 Camberwell 109 Chelsea 109 St. Pancras 112 Holborn 115 Hackney 119 Wandsworth 122 Lambeth 123 Battersea 124 City of London 124 Fulham 125 Islington 127 Paddington 127 Greenwich 128 Kensington 133 Deptford 142 Southwark 144 Stepney 144 Hammersmith 146 Bethnal Green 151 Bermondsey 156 Finsbury 156 Poplar 157 Shoreditch 170 County of London 129 34 The preventive measures that are more concerned with personal hygiene than the hygiene of environment have been explained in previous Annual Reports. The most important work of this kind is a comprehensive system of health visiting, working on the information furnished by the Notification of Births Acts, 1907. This Act, which provides that all births shall be notified to the Medical Officer of Health within 36 hours of their occurence, is essential to the effective operation of any scheme of health-visiting on a large scale. The Notification of Births Act came into operation in Hampstead in March, 1908, and the year 1911 is the third for which we possess a complete annual record of the working of the Act. The number of births notified in 1911 was 1131, including 25 still-births, the number of livebirths notified being 1106. The total number of live-births occurring in Hampstead in 1911 was 1199, so that the number of live-births notified formed 92.2 per cent, of the number that actually occurred. 265 births were notified by medical practitioners, 131 by midwives, 689 by parents and 46 from other sources. The proportion of births notified in Hampstead is high—considerably higher than in most other districts. 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, while registration may be delayed for as long as six weeks after and is inadequate to supply the timely information necessary for effective health-visiting. In Hampstead a system of health-visiting under the Act 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. This system has been described in previous Annual Reports but it may be useful to repeat the description. The first visit is paid by one of the lady inspectors, the voluntary visitors are responsible for subsequent visits, and the infants are kept under supervision during the whole of the first year of life. Periodical meetings of the visitors are 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 St. Stephen's Rooms, 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, and, at 35 Hemstal Road, by Nurse Burnett, of the Ranyard Nurses, whose help has been found most valuable. One of the chief objects of the health visitors is to encourage breastfeeding, but in the poorer parts of Hampstead instances have been found 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. To meet cases of this kind the West Hampstead Infant's Committee of the Hampstead Health Society have formed a fund to supply nursing mothers with milk and other food. This assistance, which is only given on certain conditions, one being that the baby must be brought regularly to be weighed, has been found of great value in our work in Hampstead for the prevention of infantile mortality. The effect on the baby, as ascertained by periodical weighing, of the improved nutrition of the mother, has in many cases been marked. Maternal nutrition is an important factor in infant welfare, and it is through improving the nutrition and general health of the mothers in the poorer districts that we may most confidently hope to effect further reductions in the amount of ill- health and mortality among infants. A further development of this side of preventive work was made during the latter part of 1910 by Mrs. George Seaton, who made arrangements for supplying dinners for expectant and nursing mothers at the Day Nursery, 36, Hemstal Road. The dinners, which consist of meat, two vegetables, and a pudding, are served every week-day except Saturday, and any eligible woman with a proper recommendation may avail herself of this on payment of twopence. Some of the women are unable to pay even this small sum, and arrangements have been made for them to be supplied with free dinner tickets by health visitors and other responsible persons. 637 newly-born infants were visited by the lady inspectors during 1911, and 406 re-visits were paid. Infectious Diseases. 39 NOTIFIABLE INFECTIOUS DISEASES. The list of infectious diseases notifiable in London during 1911 is as follows: — Small-pox Continued Fever Cholera Puerperal Fever Diphtheria Anthrax Membranous Croup Hydrophobia Erysipelas Glanders occuring in Man Scarlet Fever Ophthalmia Neonatorum (from Epidemic Cerebro-spinal 13th March, 1911) Meningitis Polio-Myelitis (from 1st September, Plague 1911) Typhoid Fever Chicken-pox (for 3 months from Typhus Fever 22nd March, 1911) Relapsing Fever Information concerning Consumption will be found in the Tuberculosis Section (see pages 53-64). The total cases of infectious disease notified numbered 403. This is equivalent to an attack rate of 4.7 per 1000 of the population. The following shows the number of cases of each disease notified:— Scorlet Fever 125 Enteric Fever 13 Diphtheria and Membranous Croup 141 Puerperal Fever 6 Erysipelas 49 Ophthalmia Neonatorum 5 Polio-Myelitis 6 Chicken-pox 58 40 The number of fatal cases was 25, equal to 6.2 per cent. of the cases notified. The deaths were distributed as follows:— DISEASE. WARDS No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No, 6 (Kilburn), No. 7 (Priory). Totals. Enteric Fever • • • • 1 • • l • • 2 Diphtheria and Membranous Croup 7 1 1 . 2 6 • • 17 Erysipelas • • • • • • 1 1 • • • • 2 Puerperal Fever • • 1 • • • • 1 • • l 3 Polio-Myelitis .. • • 1 • • • • • • • • 1 Totals 7 2 3 1 5 6 1 25 The death-rate from the notifiable infectious diseases was 0.29 per 1000 of the population. 41 Cases, of Infectious Disease occurring in each Month during 1911 Disease. MONTHS. Totals. January. February. March. April. May. June. July. August. September. October. November. December. Scarlet Fever 11 3 11 5 6 4 8 11 7 14 24 21 125 Enteric Fever 2 3 .. .. .. .. 2 1 .. .. 2 .. 13 Diphtheria and Membranous Croup 6 14 5 6 5 14 11 10 15 12 16 24 141 Puerperal Fever 2 .. .. .. .. 1 .. 1 .. .. 2 .. 6 Erysipelas 5 7 3 1 3 3 3 .. 3 7 11 3 49 Ophthalmia Neonatorum .. .. .. .. .. 1 .. 1 1 2 .. .. 5 Polio-Myelitis .. .. .. .. .. .. .. .. 3 2 .. 1 6 Chicken-pox .. .. 13 31 8 6 .. .. .. .. .. .. 58 Totals 26 27 32 43 22 29 27 24 29 40 55 49 403 42 Cases of Infectious Disease occurring in each War during 1911. 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 13 44 9 9 13 25 12 125 Enteric Fever .. 4 i 3 2 2 1 13 Diphtheria and Membranous Croup 50 21 .. 9 17 29 9 141 Puerperal Fever .. 1 • • 1 2 i 1 6 Erysipelas 7 7 1 3 8 20 3 49 Ophthalmia Neonatorum • • • • • • • • • • • • • • 5 Polio-Myelitis 1 1 2 • • 2 • • • • 6 Chicken-pox 8 9 6 4 3 18 10 58 Totals 79 87 25 29 47 100 36 403 43 Small-pox and Chicken-pox. During the early part of the year an outbreak of small-pox occurred in East London, chiefly confined to Stepney, and in view of the possible spread of the disease the London County Council made chicken-pox a notifiable disease in the County of London for three months from March 22nd. The outbreak of small-pox, however, was soon got under control and died out. No case occurred in Hampstead. The total number of cases of chicken-pox notified in Hampstead during the three months was 58. Vaccination. The table below gives some idea of the working of the Vaccination Act in Hampstead since 1900. I am indebted to the Vaccination Officer for the statistics in this table. Vaccination Statistics. Percentage of Births Registered. Unvaccinated. 13 (Cols.6,8,& 9) 10.0 9.2 9.5 9.2 9.2 10.4 12.3 15.1 1 7.0 22.5 — Not finally accounted for (including cases postponed). 12 (Cols. 8 & 9) 74 7.4 7.4 6.8 64 8.0 7.8 5.7 5.3 5.4 — Exempted by "Conscientious Objection " Certificates. 11 (Col. 6) 2.6 1.8 21 2.4 2.8 2.4 4.5 9.6 11.7 17.1 — Successfully Vaccinated. 10 (Col. 3) 81.7 82.7 82.0 82.8 83.1 82.3 81.3 77.8 76.9 71.8 — Remaining. 9 104 102 96 90 77 97 99 66 63 66 108* Vaccination Postponed. 8 7 11 11 8 14 18 5 6 5 3 24 Died Unvaccinated. 7 111 104 106 100 91 93 80 78 61 58 56 Number in respect of whom Certificates of "Conscientious Objection'' have been received. 6 39 27 30 35 40 35 60 127 151 217 229 Had Small-pox. 5 .. .. .. .. .. .. .. .. .. .. Insusceptible of Vaccination. 4 15 18 19 16 18 12 7 16 19 14 9 Successfully Vaccinated. 3 1232 1255 1190 1197 1181 1183 1090 1028 996 911 773 Births. 2 1508 1517 1452 1446 1421 1438 1341 1321 1295 1269 1199 Year. 1 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 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 59 births in respect of which no legal action as to vaccination has yet been taken; the rates for Columns 10-13 have therefore not been calculated. 44 Scarlet Fever. The number of cases of scarlet fever notified in each of the last ten years is set out below. Year. No. of Cases Notified. 1901 214 1902 251 1903 165 1904 159 1905 170 1906 385 1907 314 1908 265 1909 241 1910 135 1911 125 No deaths occurred from scarlet fever in 1911. In 1910, 3 deaths occurred. The number of cases per 1000 of the population was 1.46. The corresponding figure in 1910 was 1.58. Of the cases notified, 93, or 74 per cent., were removed to hospital. The corresponding percentage in 1910 was 73. The total number of houses attacked was 98. Twelve houses had 2 cases each, one house had 3 cases, and another house had no less than 6 cases. In all these instances the subsequent cases took the infection directly or indirectly from the primary case. Throughout the year the type of scarlet fever in Hampstead was very mild, as is shown by the fact that no death occurred out of a total of 125 cases. Careful inquiries were made in each case, with a view to ascertaining the source of infection, and in 31 cases it was found that the patient had been infected by a previous case. Five cases were infected outside Hampstead, and four cases occurred among the staff of the NorthWestern Fever Hospital. Four cases were discovered by the Medical Officer of Health in consequence of information supplied by school teachers. 45 The following table shows the number of cases occuring 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 2 3 2 1 1 2 — 11 February 1 1 — 1 — — — 3 March 1 4 — — 3 1 2 11 April — 2 — 1 — 2 — 5 May 2 — — 1 — 3 — 6 June 1 2 — — — 1 — 4 July — 6 — — 1 1 — 8 August — 5 1 — 1 2 2 11 September 1 — 1 — 2 1 2 7 October 1 5 4 — 1 2 1 14 November 3 12 1 2 3 1 2 24 December 1 4 — 3 1 9 3 21 Totals 13 44 9 9 13 25 12 125 46 Diphtheria and Membranous Croup. The number of cases notified in 1911 was 141 as compared with 48 in 1910, the attack rate, or number of cases notified per 1000 population, being l.65. The number of fatal cases was 17, or 12.0 per cent. of the cases notified. The death-rate per 1000 population was 0.20; 108 patients, or 76 per cent. of the total cases notified, were removed to hospital. The following table shows the number of cases occurring in the various Wards:— WARDS. Months. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). Totals. January — — — l — 3 2 6 February l — — — l 9 — 14 March — — — 3 l 1 — 5 April — — — — 4 1 1 6 May — — 2 — 1 2 — 5 June 10 — 1 2 — 1 — 14 July 12 — — — 1 1 — 14 August 6 2 — — — 1 1 10 September 6 4 — 1 1 2 1 15 October 2 5 2 — 2 — 1 12 November 4 1 — 1 5 2 3 16 December 9 6 1 1 1 6 — 24 Totals 50 21 6 9 17 29 9 141 47 Diphtheria was unusually prevalent during 1911, the number of eases notified being higher than any annual number since the year 1901. The chief prevalence occurred in the Town Ward during the latter half of the year. The disease showed an exceptionally high degree of infectivity, secondary cases being common, while two families had no less than four cases each. In a considerable number of the cases it was possible to trace the source of infection to contact with a previous case. Three cases occurred among the staff of the North-Western Hospital of the Metropolitan Asylums Board. School attendance, in all probability, played a part in the spread of the disease. Class-rooms in which cases occurred were visited by the Medical Officers of the London County Council, and a considerable number of specimens were taken for bacteriological examination. Several apparently healthy children were found to be harbouring diphtheria bacilli in the throat or nose, and were excluded from school until a negative result had been obtained. In dealing with the disease considerable use was made of the facilities for bacteriological examination afforded by the Borough Council. The total number of specimens examined during the year was 157, of which 53 gave a positive, and 104 a negative result. In accordance with the Diphtheria Anti-toxin(London) Order, 1910, the Borough Council supply Anti-toxin free to medical practitioners for use for the poorer inhabitants of the Borough. Seven applications for Anti-toxin were received during the year, and 28,000 units were supplied. Enteric Fever. The number of cases notified was 13, as compared with 16 in 1910 and 13 in 1909. The attack-rate per 1000 population was 0.15. The number of fatal cases was 2, or 15.4 per cent. of the cases notified. The death-rate per 1000 population was 0.02; 9 patients, or 69 per cent. of the total cases notified, were removed to hospital. Eight specimens of blood from patients suspected to be suffering from enteric fever were submitted by the doctors in attendance for bacteriological examination, five specimens proving positive and three negative. 48 The following table shows the number of cases occuring in the various wards:— Month. WARDS. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 j (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). January — — l — — 1 — 2 February — 1 — l — — 1 3 March — — — — — — — — April — — — — — — — — May — — — — — — — — June — — — — — — — — July — — — 1 1 — — 2 August — 1 — — — — — 1 September — — — — — — — — October — l — — l l — 3 November — l — l — — — 2 December — — — — — — — — Totals — 4 l 3 2 2 1 13 As regards the source of infection, in two instances it was found that the patient had clearly been infected on the Continent. In three other cases the patients were members of the staff of the North-Western Fever Hospital, and were presumably infected in hospital. In the remaining instances the source of infection could not be traced. Puerperal Fever. Six cases were notified, three of which proved fatal, as compared with 2 cases and no deaths in 1910. 49 The cases occurred in the following Wards, one in No. 2(Belsize) Ward, one in No. 4(Central) Ward, two in No. 5(West End) Ward, one in No. 6(Kilburn) Ward, and one in No. 7(Priory) Ward. Erysipelas. Forty-nine cases were notified, and 2 deaths occurred, as compared with 32 cases and 1 death in 1910. The attack-rate per 1000 of the population was 0.57. Of the cases notified, 7, or 14 per cent., were removed to the Hampstead Workhouse Infirmary. The Metropolitan Asylums Board do not provide hospital accommodation for cases of erysipelas or puerperal fever, and the patients suffering from these diseases are unable to obtain hospital treatment except in Poor Law Infirmaries or Workhouses. Polio-Myelitis. This disease, which is popularly known as "Infantile Paralysis," became prevalent in Devonshire and Cornwall during the summer of 1911, and attracted considerable attention. The disease was made notifiable in a considerable number of districts, and in August the London County Council made an order making it notifiable in the County of London from September 1st, 1911, to March 12th, 1912. During the present year the County Council have made another order making Polio-Myelitis permanently notifiable in London. There is considerable evidence to show that the disease is communicable, but it is by no means clear how the infection is communicated. Six cases were notified during the year and one death occurred. Disinfection was carried out in each case Ophthalmia Neonatorum. The London County Council made an Order, which came into operation on March 13th, requiring the notification of Ophthalmia Neonatorum. This disease is one of the frequent causes of blindness, and therefore inflicts considerable loss on the community. Five cases were notified in Hampstead during the year, all of which occurred in the Kilburn Ward. In order to prevent the disease resulting in loss of eyesight it is necessary that the patient should be properly nursed, 50 and the chief object of notification is to facilitate the provision of skilled nursing. Of the five cases notified, one was already being nursed by a trained nurse, and in three cases the valuable services of the District Nurse were secured. All these cases made an excellent recovery. The mother of one patient refuse the services of the District Nurse, and as she shortly after left Hampstead I am unable to give the result of this patient's illness. SEVEN PRINCIPAL EPIDEMIC DISEASES. The total number of deaths from these diseases amounted to 51, 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 2 l — 1 3 3 14 Scarlet Fever — — — — — — — — Diphtheria and Membranous Croup 7 1 l — 2 6 — 17 Whooping Cough 1 — — — 1 1 — 3 Fever — — 1 — 1 — — 2 Diarrhæa 2 2 1 2 — 7 1 15 Totals 14 5 4 2 5 17 4 51 The death-rate from the seven principal epidemic diseases was therefore 0.59 per 1000 of the population. Year. 1902. 1903. 1904. 1905. 1903. 1907. 1908. 1909. 1910. 1911. Death-rate per 1000 of the population from the seven principal epi demic diseases. 0.70 0.51 0.58 0.45 0.58 0.49 0.45 0.38 0.54 0.59 51 Detailed information concerning small-pox, scarlet fever, diphtheria, and fever will be found under the heading of Notifiable Infectious Diseases, on pages 43-48, but particulars concerning measles, whooping cough, and diarrhæa, to which notification does not apply, are given below:— Measles. Fourteen deaths were recorded from this disease, this being equal to the number in 1910. The mortality was 0.16 per 1000 population, the mortality in 1910 being 0.15. Measles is now included amongst the dangerous infectious diseases, to which Sections 60-65, 68-70, and 72-74 of the Public Health (London) Act, 1891, apply. These sections extend the provisions relating to isolation and disinfection to measles, but they do not make the disease compulsorily notifiable. But although measles is not a notifiable disease, many cases are reported to the Medical Officer of Health by school teachers, parents and others. During the year 1911, 415 cases were reported, as compared with 642 in 1910. Measles was exceptionally prevalent in London during 1911, especially in the first half of the year, and as the type of disease was severe the mortality was very high. On March 13th the President of the Local Government Board held a Conference with the Metropolitan Medical Officers of Health to discuss the measures that might be taken against the disease. At this Conference a strong opinion was expressed that further hospital accommodation should be provided for cases for whom proper nursing and attention cannot be secured at home, and accordingly the Local Government Board arranged for the Metropolitan Asylums Board to receive cases of measles other than Poor Law cases, on the recommendation of the Medical Officer of Health of the district concerned. Previous to 1911, the only hospitals open to patients suffering from measles were the workhouse infirmaries, but in February, 1911, Poor Law patients were admitted to the Asylums Board hospitals, which later became available for other patients. Hospital treatment for measles on any practicable scale cannot be expected to exercise much effect in checking the spread of the disease, but it may do much to lessen the mortality by saving the lives of those patients for whose 52 recovery skilled nursing, plenty of good food and healthy surrounding are necessary, and who are unable to obtain these necessities in their own homes. The number of Hampstead patients removed to the Board's hospitals during the year was 44. Whooping Cough. Whooping Cough was much less prevalent in Hampstead during 1911 than in the two preceding years, the number of deaths being 3, as compared with 11 in 1910 and 18 in 1909. The mortality per 1000 population was 0-03. Like measles, whooping cough tends to become complicated by pneumonia, and the patients require to be carefully looked after, but unfortunately it is popularly regarded as a disease of slight importance. Hospital treatment is much needed in certain cases of whooping cough, and the Metropolitan Asylums Board now provide hospital accomodation for patients admitted through the Poor Law. Diarrhæa. The number of deaths from this cause was 15, as compared with 8 in 1910, the death-rate per 1000 of the population being 0.17. Twelve of these deaths occurred among children under one year of age. The increased mortality was due to the exceptionally hot weather that prevailed during the third quarter of the year. With one exception all the deaths took place in the months of July, August and September. 53 TUBERCULOSIS. The number of deaths from tuberculosis in 1911 was 70. Of these, 56 deaths were due to pulmonary tuberculosis or consumption. 7 to tubercular meningitis, and 7 to other forms of tuberculosis. The following table shows the number of deaths and the death, rates from tuberculosis and from consumption respectively since 1899:— Year. Total deaths from Tuberculosis. Deathrate per 1000 population. Deaths from Consumption. Deathrate per 1000 population. 1899 98 1.21 81 0.98 1900 92 1.13 69 0.85 1901 118 1.44 73 0.89 1902 97 1.18 73 0.89 1903 90 1.09 66 0.80 1904 102 1.23 73 0.88 1905 95 1.14 73 0.87 1906 79 0.94 57 0.68 1907 92 1.09 61 0.72 1908 84 0.99 74 0.87 1909 75 0.88 53 0.62 1910 80 0.94 58 0.68 1911 70 0.82 56 0.65 The deaths from consumption during 1911 were distributed among the Wards as follows:— Ward. Area (Acres). Estimated Population middle of 1911. Consumption Deaths. Consumption Death-rate per 1000 of the Population. No. 1 (Town) 686 13820 7 0.51 ,, 2 (Belsize) 271 13780 10 0.72 ,, 3 (Adelaide) 325 9950 3 0.30 ,, 4 (Central) 312 9859 3 0.30 „ 5 (West End) 247 12850 10 0.78 „ 6 (Kilburn) 195 14920 16 1.07 „ 7 (Priory) 229 10420 5 0.48 The Borough 2265 85599 56* 0.65 * 2 deaths from Consumption were non-distributable. 54 The following table shows the age distribution of the patients dying from consumption in Hampstead in the nine years 1903-1910:— Year. Age Period. All Ages. 0-5 5-15 15-25 25-65 65- 1903 — 1 14 46 5 66 1904 1 1 15 53 3 73 1905 1 — 12 57 3 73 1906 1 — 8 45 3 57 1907 1 2 10 45 3 61 1908 — 2 14 55 3 74 1909 1 1 12 37 2 53 1910 1 1 12 37 7 58 1911 1 1 5 44 5 56 Totals 7 9 102 419 34 571 In 1902 a system of voluntary notification of consumption was adopted in Hampstead, on January 1st, 1909, the Public Health(Tuberculos's) Regulations of the Local Government Board, which provide for the compulsory notification of cases of consumption occurring in Poor Law patients, came into operation, and on May 1st, 1911, compulsory notification was extended by the Public Health(Tuberculosis in Hospitals) Regulations, 1911, to all cases of consumption occurring in hospital patients. The following table gives the number of patientnewly notified in each year since 1902:— Year. No. of patients notified. 1902 51 1903 34 1904 39 1905 27 1906 35 1907 55 1908 30 1909 67 1910 77 1911 113 55 The total number of Hampstead patients notified during 1911 was 133, but 20 of these had been previously notified-3 in 1907, 1 in 1908, 7 in 1909 and 9 in 1910; the number of new patients notified was 113 and of those 59 were males and 54 females. The increase in the number of patients notified in the last three years is due to the operation of the instalments of compulsory notification provided by the Public Health(Tuberculosis) Regulations, 1908, and the Public Health (Tuberculosis in Hospitals) Regulations, 1911. The latter Regulations lay it down that the Council must provide a supply of printed copies of the notification forms to each hospital in the district, and the notification certificates must be sent to the medical officer of health of the district in which the hospital is situate. It then becomes the duty of the medical officer of health to send on the certificates relating to patients not belonging to his district to the medical officers of health of the districts to which they do belong, at the same time informing the medical officer of the hospital that he has done so. It is not infrequently a matter of some difficulty to ascertain the sanitary districts in which these patients live, for the address on the certificate, though possibly adequate for postal purposes, is insufficient to identify the sanitary district, and there appears to be no book of reference that gives adequate information of this kind. As the Mount Vernon Hospital for Consumption is situated in Hampstead the Regulations have materially increased the clerical work of the Public Health Department. During the eight months of the year the Regulations were in operation no less than 429 certificates were received from the Hampstead hospitals, chiefly from Mount Vernon, relating to patients belonging to other districts, and were forwarded to those districts. In addition 29 certificates relating to non-residents were sent to me in error and were forwarded to the proper districts. The total number of notification certificates(including duplicates) received during 1911 relating to Hampstead patients was 192, and of these 14 were made under the voluntary system, 93 under the Regulations of 1908, and 85 under the Hospital Regulations. 56 The notifications were received from the following sources:— Private Practitioners 12 Hospitals and Dispensaries 86 Hampstead District Poor Law Medical Officers 30 Medical Officer, Hampstead Workhouse 45 Medical Officers of outlying Poor Law institutions on admission of Hampstead patients 3 Master of Hampstead Workhouse on discharge of patients 13 Masters of outlying Poor Law Institutions on the discharge of patients to Hampstead addresses 2 Relieving Officer of an outlying district on removal of patient to Hampstead 1 192 The notified patients are visited by Mrs. Fisher, the lady sanitary inspector, who gives the necessary instruction in the precautions that a consumptive patient should observe to prevent the spread of the disease to others, and inquires into the source of infection. Mrs. Fisher made 304 visits to consumptive patients in 1911, in addition to 21 visits made after the death of the patient. To assist the work of the lady inspector a body of voluntary visitors, organised by the Joint Phthisis Committee of the Hampstead Health Society and the Hampstead Council of Social Welfare, works in close co-operation with the Public Health Department. In previous Annual Reports reference has been made to the valuable work of the Joint Committee, which is of special value in providing sanatorium treatment and material assistance in various ways for consumptive patients. Disinfection is carried out by the Public Health Department after a death from consumption, and, as occasion requires, during the life of a patient. The total number of premises disinfected in 1911 was 133. The Council arrange for the free bacteriological examination of specimens from suspected cases of consumption. In 1911 the total number of specimens examined was 31, of which 7 were positive and 24 negative. The Council provide consumptives with disinfectants and sputum flasks in suitable cases, and each consumptive patient receives a card containing printed instructions on the precautions to be observed by consumptives. This card is in the following terms:— 57 Precautions Against Consumption. Consumption is an infectious disease. It is caused by a germ called the tubercle bacillus, which grows in the lungs of a consumptive patient in enormous numbers, and the sputum(spit) coughed up by the patient contains a great many of these germs. When this sputum is allowed to dry it may become powdered into a line dust and be blown about in the air. Any persons breathing this air may take the germs into their lungs, and, after a time, become consumptive. This is how consumption is spread from one person to another. A consumptive patient who does not take care to destroy his sputum before it becomes dry is a source of danger to other people and to himself, for he may re-infect himself by breathing his own dried sputum. A consumptive patient should on no account spit on the floor of any room, workshop, theatre, or other place where people assemble; or on the floor of any railway-carriage, tram-car, or other public conveyance; or on a street pavement. Nor should the patient spit into an ordinary pocket handkerchief. The sputum soon dries in the pocket, and when the handkerchief is next used a cloud of infective dust may be scattered around the patient. At home the patient should spit into a piece of paper or clean rag. which should be at once burnt on the fire. If there is no fire the patient should spit into a jar, pocket spittoon or other vessel containing water or some fluid disinfectant to keep the sputum moist. The vessel should be erupted twice a day down the water-closet and then thoroughly cleansed with boiling water before being again used. Outside the house the patient should spit into a pocket spittoon, which should contain a little water or fluid disinfectant, and should be kept perfectly clean. Or the patient may carry a number of pieces of soft paper or clean rags to spit into. These after being used, should never be carried loose in the, pocket, but in a tobacco pouch, sponge bag, or other waterproof receptacle. On returning home the paper or rags should be burnt and the pouch or bag well washed with disinfectant. All persons who have a chronic cough should carry out the above precautions. The knives, forks, spoons, plates, cups, &c., used by a consumptive patient should be put into boiling water immediately after use, and should never be used by another person. The patient's night-clothes, sheets, pillow-slips, &c., should not be mixed with the general washing of the family, nor sent to a public laundry, but should be boiled and then washed by themselves at home. A consumptive patient should, if possible, occupy a separate bedroom, or at least a separate bed. The rooms should have plenty of sunlight and 58 be kept well ventilated and well lighted. The windows should always be open. Fresh air and sunlight will not only help the patient to recover but will also help to prevent the other members of the family from becoming consumptive. Carpets, curtains and upholstery should not be used in a consumptive's room. If already in use they should be removed and disinfected. If the patient's clothes, pillows or bedclothes become soiled with sputum they should be at once disinfected by steam or washed with boiling water. The floor of a consumptive's room should be thoroughly washed with soap and water at least once a week, and should always be kept free from dust. The floor should not be swept unless tea-leaves moistened with disinfectant have first been scattered over it to prevent the dust from rising. The best way to remove the dust is to wipe the floor with a wet cloth. The articles of furniture. &c., in the room should be dusted with a damp duster. Dry dusting and sweeping may scatter infectious dust about the room and thus be a source of danger to the patient and to other persons. Every three months the walls should be rubbed down with dough which should then be burnt. Consumptives should not kiss on the lips. A male consumptive should not wear beard or moustache, but should be clean shaved. When it has been decided that any one is suffering from consumption the house should be thoroughly disinfected. On a request made in writing to the Health Department disinfection will be carried out free of charge. Consumption was formerly thought to be an incurable disease. This is a great mistake. Recovery from consumption is not at all uncommon. It depends largely upon the careful observance of the rules on this card. Other important points are : — Plenty of nourishing food. Abstinence from alcohol unless it is ordered by a doctor. What is good for the cure of consumption is good for the prevention of consumption. People who keep their windows open and their houses and bodies scrupulously clean, and abstain from the excessive use of beer, wine or spirits, are doing a good deal to keep away consumption. G. F. McCleary, M.D. Medical Officer of Health. 59 The system of compulsory notification of consumption, that was introduced by the Local Government Board in their Regulations of 1908, has now been completed by the Public Health(Tuberculosis) Regulations, 1911, which came into operation on January 1st, 1912, and make all cases of consumption compulsorily notifiable. From the present year, therefore, sanitary authorities will be in a much better position than has hitherto been the case to form an idea of the prevalence and distribution of consumption in their districts. The Regulations not only bring into operation the general compulsory notification of consumption; they confer upon sanitary authorities important powers for the prevention of the disease. Article ix. provides that:— "For the purposes of these Regulations and of the Poor Law Regulations and of the Hospital Regulations a Council, on the advice of their Medical Officer of Health, may supply all such medical or other assistance, and all such facilities and articles as may reasonably be required for the detection of Pulmonary Tuberculosis, and for preventing the spread of infection and for removing conditions favourable to infection, and for that purpose may appoint such officers, do such acts and make such arrangements as may be necessary." These powers are in addition to those contained in section 75 of the Public Health(London) Act, 1891, which enable a sanitary authority to provide sanatorium accommodation. The position of the Borough Council in relation to the prevention of consumption has been greatly modified by the Regulations and also by the Finance Act, 1911, and the National Insurance Act, and it is important that the Council should now consider what preventive measures should be adopted in addition to those already in operation, In order to form an idea of the extent of the measures required we may refer to such evidence as is available of the prevalence of consumption in Hampstead. The following table gives the number of deaths from all forms of tuberculosis and from consumption, and the cases of Hampstead consumptives notified for the first time in each year since 1902:— 60 Year. All forms of tuberculosis. Deaths from consumption. Cases of consumption notified. 1902 97 73 51 1903 90 66 34 1904 102 73 39 1905 95 73 27 1906 79 57 35 1907 92 61 55 1908 84 74 30 1909 75 53 67 1910 80 58 77 1911 69 52 113 Consumption first became notifiable in Hampstead in 1902, when the Council instituted a system of voluntary notification. Only a small number of cases has been notified under this system, but with the introduction of compulsory notification the total number of cases has considerably increased. In the present year notifications will no doubt be received of practically all the consumptives that come under medical observation, but many patients do not seek medical advice in the early stages of the disease, and therefore, even with compulsory notification, the number of cases notified will fall considerably short of the number of patients actually suffering from consumption. To estimate the number of patients some authorities multiply the number of deaths by five, others by ten. The latter estimate, which is probably not far from the mark, gives the number of cases of consumption as over 500. This number does not include the patients suffering from other forms of tuberculosis. The special preventive measures against consumption now carried out by the Council have already been described, and to these measures must, of course, be added the Council's general sanitary work, which undoubtedly exercises an important influence upon tuberculosis. The foregoing table shows that although the mortality from consumption has decreased in Hampstead, the decrease has not been very considerable. There is evidently need for preventive measures in addition to those now in operation. In considering what measures should be adopted there are certain facts relating to the disease that should be borne in mind:— 61 1.—Consumption is an infectious disease, and every consumptive patient with expectoration produces the infection on a large scale. But the infection can readily be rendered harmless if the patient can be induced to adopt certain simple precautions. 2.—Susceptibility to infection is greatly increased if the persons exposed to infection live under conditions of privation and insanitation. 3.—In the early stage of the disease there is often a good prospect that the patient may be cured if properly treated. From these considerations it is evident that it is most important that the disease should be recognised at the earliest possible moment, not only that the patient may have a good prospect of cure, but also that he may have timely instruction in the precautions necessary to prevent the spread of infection to others. The best method of securing the early recognition of the disease is the establishment of the institution known as the Tuberculosis Dispensary, but which is preferably designated the Tuberculosis Clinic. In places where such a Clinic has been established it has been found that it has brought to light many cases of consumption that were not even suspected, and but for the Clinic would probably have not been recognised until the disease hud reached a comparatively advanced stage. The chief features of the work of the Tuberculosis Clinic are as follows : — 1.—To examine medically the inmates of a house in which a case of consumption lias occurred in order to ascertain whether any inmate has been infected. 2.—To instruct the patients in the necessary precautions against the spread of infection. 3.—To keep under medical supervision those patients who are unable to aiford the proluiiged medical attendance required in the case of a chronic disease like consumption. It has been found that the work of instructing a patient in the necessary precautions is much facilitated if he can be treated in a sanatorium for some weeks where he can be taught how to dispose of 62 his expectoration and to acquire a taste for an open air life. For this purpose the sanatorium is an essentia) feature of a complete scheme of prevention, and it has the additional advantage that it can, in a considerable number of cases, bring about a complete cure and restore the patient to active working life. In addition to the Clinic and the Sanatorium a complete scheme of prevention should provide hospital accommodation for advanced cases who cannot be treated at home with advantage to themselves or with safetv to the members of their families. Such cases are often dangerous sources of infection both from the enormous quantities of infection they produce and from their inability to attend to themselves properly. The institutions for the reception of such cases are often terme 1 " Homes for the Dying," bat this term is unfortunate, and it is preferable to substitute " Consumption Hospital." Turning now to the practical steps that the Council can take to prevent consumption, in addition to the work that is already carr ied out I would recommend the adoption of the following measures:— 1.—The establishment of a Tuberculosis Clinic. This would involve the services of a whole-time medical officer, a whole-time nurse, and either the engagement of a part-time dispenser, or preferably an arrangement with a local chemist to supply the necessary medicines. The establishment of a Tuberculosis Clinic need not involve any capital outlay, for the accommodation required will, I understand, be available at the Health Institute which it is hoped will shortly be established by the Ilampstead Council of Social Welfare, and the annual expenditure would, I estimate, fall well below £750. 2.—I would also recommend that the Council make arrangements with one of the sanatoria in the country that now receive patients from other metropolitan boroughs, for the reception of a number of Hampstead consumptives, chiefly in order that they might be trained in the precautions against infection. The cost of such accommodation at these sanatoria is 30s. per week per patient. At the present time 5 Metropolitan Boroughs provide sanatoria accommodation in this way,—one borough provides 10 beds, three boroughs provide 6 beds each, and one borough provides 3 beds. 63 3. Provision should also be made for advanced cases who arc too ill to move into the country, and for whom hospital accommodation is necessary in the district. At the present time such patients too frequently die in the Workhouse as paupars. The position of sanitary authorities in relation to tuberculosis has been modified by the Finance Act, 1911, and the National Insurance Act. Under the former a sum of a million and a half is made available for grants in aid to " sanatoria and other institutions for the treatment of tuberculosis." This sum must be " apportioned between England, Scotland, Ireland, and Wales in proportion to their respective populations ascertained in accordance with the returns of the census taken in the year 1911," but it is not provided that the apportionment between the localities of the country shall be according to population. If the amount were so apportioned, which is not at all probable, the sum available for Ilampstead would be £2836. The Insurance Act enables an Insurance Committee to agree " with any person or authority (other than a Poor Law Authority) that in consideration of the person or authority providing treatment in a sanatorium or other institution or otherwise for persons recommended by the Committee for sanatorium benefit, the Committee will contribute out of the funds available for sanatorium benefit towards the maintenance of the institution or provision of such treatment, such annual or other payment ... as may be agreed." I am unable to make anything like a precise estimate of the number of persons coming within the opci'ation of the Act in Ilampstead, for the Census returns for 1911 are not yet available, and it should be borne in mind that the Insurance Commissioners may extend sanatorium benefit to the dependents of insured persons. The question of the measures to be taken for the control of t uberculosis is, at the time of writing, under consideration by the Public Health Committee, who have deferred making any recommendations until the appearance of the report of the Advisory Committee appointed by the Chancellor of the Exchequer to consider the whole question of the control of tuberculosis, including the administration of the sanatoriun. benefit. Phthisis : Sanatorium and Hospital Accommodation. (This Statement it required by the Locn1 Government Board.) Classes for which accommodation is provided. By whom provided. Where situated. Total number of Beds. How are patients selected ? Are patients under the care of a Resident Medical Officer ? What charge, if any, is made for the use of Beds ? Do the Sanitary Authority use— (1) their Isolation Hospital, or (2) their Small-pox Hospital, for cases of Phthisis ? Do the Sanitary Authority reserve Beds in any Phthisis Sanatorium: If so. how many, and in what Sanatorium ? Do the Sanitary Authority provide portab'e open-air Shelters or Tents ? (a) Early cases Mount Vernon Hospital Hampstead 70—75 (for early and intermediate cases) By the Hospital Regulations Yes None (b) Intermediate cases Hampstead Guardians Hampstead Workhouse 32 (for early, intermediate, and advanced cases) By Poor Law Regnlations; according to their needs No No fixed charge, but the Board expect patients to contribute according to their means, up to 10s. weekly The Authority has no such hospital The Hampstead Corporation have endowed twobedsinthe Mount Vernon Hospital No (c) Advanced cases Friedenlieim Hospital Avenue Road, Hampstead 20—30 (for advanced cases) By the Medical Officer of the Hospital No Varying amounts up to £2 2s. Od. weekly Have the Council, or any Private Body, provided }No. a Dispensary ? If so, give particulars. 64 65 DISINFECTION. Number of articles disinfected :— Beds 233 Mattresses 586 Palliasses 4 Bolsters 404 Pillows 1302 Blankets 1543 Sheets 769 Counterpanes 575 Articles of Clothing 2625 Carpets 79 Linen articles 2649 Books 240 Miscellaneous 1039 Total 1204S Number of premises disinfected 858 ,, rooms, &c., disinfected 1167 In addition to the foregoing, the following were destroyed upon request of the owners : — Beds 9 Mattresses 8 Bolsters 6 Pillows 14 Blankets 7 Sheets 4 Counterpanes 5 Articles of Clothing 2 Carpets 3 Miscellaneous 5 Total 63 During 1910, 831 premises, 1008 rooms, &c., and 9637 articles were disinfected, while 174 articles were destroyed. General Sanitary Administration. 69 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 Conditions— Houses, or parts of houses, cleansed 2.31 Dampness in houses, or parts of houses, abated 121 Dilapidated houses, or parts of houses, repaired 41 Overcrowding— Cases of, abated (rooms) after service of notice 12 ,, ,, ,, without sendee of notice 4 Underground rooms — Entirely ceased to be occupied as dwellings. . 11 Illegal occupation discontinued 12 Structural works carried out 80 Below floors— Spaces below floors in the basement or ground floors ventilated 73 Roofs— Repaired 118 Gutterings— Repaired or renewed 82 Rainwater pipes— Repaired or renewed 127 Disconnected from drains 41 „ „ soil pipes 7 Waste pipes — Waste pipes of sinks disconnected from drains 1 „ trapped 433 „ „ ,, repaired or renewed 355 „ unstopped 3 ,, „ of lavatories trapped 173 ,, „ ,, repaired or renewed 238 „ „ „ unstopped 6 ,, ,, of baths disconnected from drains 2 „ trapped 140 „ „ ,, repaired or renewed 190 Water supply— Reinstated 7 Water and sinks provided to upper floors of tenement houses 105 70 Water cisterns— Repaired or renewed 10 Cleansed 39 Fitted with close-fitting covers 19 Water-closets — Accommodation provided 7 Additional accommodation provided 14 Removed from improper positions 8 Provided with proper and sufficient external ventilation 12 Improperly constructed apparatus removed and new provided 5 Apparatus repaired or renewed 790 ,, unstopped 14 ,, cleansed 35 ,, provided with proper water supply 4 Flushing cisterns repaired or renewed 184 Manholes— Repaired or renewed 151 Drains — Repaired or renewed 778 Cleansed 80 Unstopped 42 Ventilated 71 Ventilating pipes of drains— Carried to a sufficient height above windows 8 Repaired or renewed 97 Fresh-air inlets repaired or renewed 86 Soil pipes— Repaired or renewed. . 413 Ventilated 8 Gullies and surface drains— Gully traps removed from improper positions 10 ,, „ cleansed 5 Inlets or surface drains trapped 1 Paving and draining Washhouses, Areas, Yards, &c.— Washhouse or scullery paving repaired or renewed 13 Areas cleansed 2 71 Paving and draining Washhouses, Areas, Yards, &c.—con. Area paving repaired or renewed 90 Areas drained 34 Yards or other open spices paved 107 Paving of yards or other open spaces repaired or renewed 137 Yards or other open spaces drained CO 00 Floors of buildings in which horses, &c., are kept, paved or repaired 13 Refuse and Receptacles— Dustbins provided 251 ,, repaired 2 Fixed ashpits removed 24 Accumulation or deposits of refuse removed 137 Manure receptacles provided 8 ,, ,, amended 4 Nuisances from the improper deposit of trade refuse abated 2 Animals — Nuisances from the improper keeping of animals abated 6 Number of Inspections, &c., Made; Notices Served; and Letters, &c., Issued. 1910. 1911. Number of Inspections 8650 9572 ,, Re-inspections 12757 14598 ,, Intimation Notices issued 762 993 ,, Statutory Notices issued., 682 812 ,, Letters issued 5493 6310 ,, Notifications sent to "Head Teachers" of Schools respecting notified cases of infectious disease 332 426 ,, Notifications sent to Medical 96 74 Officers of Health of other Boroughs respecting stead children attending schools in their districts „ Notifications sent to " Head Teachers " of Schools repecting cases of measles 285 173 72 Certificates as to Water Supply. The number of certificates issued during the year was 22, as compared with 30 in 1910. The Water Supply of Tenement Houses. In former Annual Reports an account was given of the action taken to improve ihe 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, which empowers the sanitary authority to require a proper and sufficient supply of water on each storey of a tenement house that is separately occupied. In many London tenement houses the only water supply available is from a tap in the basement or yard, and it is not surprising that in such houses the tenants of the upper floors practice a strict economy in the use of water, even to the extent of falling short of any decent standard of cleanliness. A plentiful supply of pure water is one of the first requisites of a healthy life, but in many tenement houses this requisite is not fulfilled, nor until the General Powers Act of 1907 was passed had sanitary authorities any power to insist on its fulfilment. This Act, however, has led to a considerable improvement. The number of houses dealt with in Hampstead during the last four years is as follows:— 1908 24 1909 85 1910 99 1911 105 In each house a water-tap and a glazed earthenware sink were provided on each floor. These alterations have been greatly appreciated by the tenants, and have had a beneficial effect in improving the general sanitary condition of the houses. 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 till the end of 1911 the Council have approved of 455 plans for the drainage of new buildings, and 5325 plans for alterations, etc., to drains of existing premises. 73 During the year 1911,906 notices of drainage reconstruction or alteration were received, and in 778 eases the work necessitated the deposit of plans and written particulars. In 494 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 778 notices of drainage alterations, etc., requiring the deposit of plans, 341 related to work that involved the entire reconstruction of the drainage system. In 420 of the 778 drainage cases the work was carried out voluntarily, the number of instances in which voluntarily complete reconstruction was carried out being 134. The voluntary work was chiefly done in connection with the larger houses in Hampstead, and in many cases the voluntary drainage reconstructions were of a very extensive character. In the majority of cases the drains were laid in iron pipes, iron being found the most durable material. It is the practice of the Council to insist on the use of iron pipes in the case of all drains that run under a building. This requirement is enforced, if necessary, by an order made under the Metropolis Management Acts. Combined Drainage. During the year the Council, as in previous years, received a number of claims that certain defective combined drains, for which notices had been served were " sewers," which the Council were under legal obligation to repair at the cost of the ratepayers. In all these cases except one the Council were able sucessfully to resist the claim and to show that the drains in question were really "drains" for which the owners of the property were responsible. In one case, however, the Council were advised that the claim could not be resisted, and the combined drain was relaid as a " sewer" at a cost of £35. The Cleansing of School Children. During the year the Council entered into an agreement with the London County Council for the cleansing of school children infested with vermin, the arrangement being that the Council should carry out the cleansing and that the County Council should pay 2s. per chil do 74 the number of cleansings required during one month. The upper part of the building now used by the Distress Committee was fitted up as a Cleansing Station, but it was not brought into use until the early part of 1912. Houses Let in Lodgings. The number of houses registered as houses let in lodgings at the end of 1911 was 425, 61 houses being added to the register in 1911. The registered houses are situated chiefly in the following streets : — Bolton Road King's College Mews East. o o Broomsleigh Street. Kingsford Street. Canfield Place. Kingsgate Road. Dunboyne Street. Linstead Street. Fairfax Mews. Lower Cross Road. Fleet Road. Lowfield Road. Iverson Road. Nether wood Street Kelson Street. Palmerston Roal. Customs and Inland Revenue Acts. These Acts provide that the owners of premises that are let in dwellings of a certain class may claim exemption or abatement from inhabited house duty on producing a certificate from the Medical Officer of Health that the dwellings afford proper sanitary accommodation for the occupants. During the year applications for certificates under these Acts were received in respect of 12 dwellings, this number being 39 less than the number for which applications were made in 1910. No dwellings were certified during the year, the owners deciding to forego the exemption rather than carry out the works necessary to obtain the certificate. Housing, Town Planning, etc., Act. This Act imposes upon Sanitary Authorities certain duties of great importance. One of the most important of these is the duty laid upon every Sanitary Authority by Section 17 (1) of the Act "to cause to be made from time to time inspection of their district with a view to ascertain whether any dwelling-house therein is in a state so dangerous or injurious to health as to be unfit for human habitation, and for that purpose it shall be the duty of the Local Authority, and of every Officer of the Local Authority, to comply with such regulations and to keep such records as may be prescribed by the Local Government Board." 75 In November, 1910, the Council considered these Regulations and decided to appoint an additional Sanitary Inspector partly to carry out the work in connection with the Regulations, and partly to supervise houses let in lodgings. Mr. Townsend, of Bermondsey, was appointed, his appointment was confirmed in April, 1911, and he entered upon his duties on May 8th. One house, No. 83, Palmerston Road, was represented by the Medical Officer of Health under Section 17 of the Act as unfit for habitation, and on January 12th the Council made a closing order on the house. The owner, Mr. William Arlidge, appealed to the Local Government Board and the Board held a public Local Inquiry on May 24th, and, on July 29th, made an order confirming the Council's closing order, and charging the appellant with the costs incurred by the Board, which amounted to £5 l1s. l1d. On July 10th, the owner asked the Council to determine the closing order, and the Council, at their meeting on July 27th, authorised the Medical Officer of Health and the Senior Sanitary Inspector to make an inspection of the house in order to ascertain whether it had been made fit for habitation. At this inspection it was found that nothing had been done to the house since the Inspector of the Local Government Board had made his inspection at the time of the public local inquiry on May 24th. The Council, therefore, decided on October 5th to refuse to determine the closing order, and against this decision Mr. Arlidge appealed to the Local Government Board. All this time, however, notwithstanding the closing order, the house was occupied by a caretaker and his family, including several children and the Council decided to apply for an ejectment order. The application was made to Mr. Plowden at the Marylebone Police Court on November 17th, when it was proved that the Council had made a closing order, that the order had been duly confirmed by the Local Government Board, that notice of the order had been served on the caretaker on October 9th, and that he was still occupying the house. Mr. Sydney Turner, on behalf of the Council, submitted that as the Local Government Board had confirmed the closing order, the order became operative on the date of confirmation, viz.: July 29th. Mr. Curtis Bennett, on behalf of Mr Arlidge, contended that the order had 76 not become operative, since there was a further appeal to the Board that had not yet been determined, and that according to Section 39 (2) of the Act the proceedings for ejectment should not have been taken. Mr. Turner, in reply, held that the appeal against the closing order had been determined, and that, therefore, the order had become operative, and the proceedings were in accordance with the Act. The appeal against tbe Council's refusal to determine the closing order was another matter, which did not concern the present proceedings. Mr. Plowden said the really important thing for him to consider was this : Is the house sanitary ? If that question were answered in the affirmative, it would be unfair to eject the occupiers. Mr. Curtis Bennett said he was prepared to call evidence to prove that the house was sanitary, but Mr. Turner declined to call any witnesses on this point, for, he submitted, the question of the fitness of the house for habitation was not one for the Court to determine; that was entirely a matter for the Local Government Board, who had already given their decision. He respectfully submitted that the only course open to the Court was to convict. Mr. Plowden said that nothing on earth could take from him his right to adjourn a case, and he adjourned this case until the Local Government Board had decided the appeal against the Council's refusal to determine the closing order. He would not order the tenants to quit the house unless he was satisfied that it was insanitary. On December 8th the Local Government Beard held a public local inquiry in connection with Mr. Arlidge's appeal against the Council's refusal to determine the closing order, and on 28th February, 1912, the Board made an order dismissing the appeal. 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. 7 7 The Council have made the following Regulations, which were approved by the Board on July 5th, 1911:— HOUSING, TOWN PLANNING, &c., ACT, 1909. Reoulations. Prescribed, under section 17 (7) of the above Act, by the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Hampstead, with which a room habitually used as a sleeping place, the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room, shall comply :— (а) Such room shall have in every part thereof 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, or be not less than six feet, the height of the room above such surface may be less than three feet but not in any case less than one foot. (б) Every wall of such room shall be constructed with a proper damp-proof course, and if in contact with the soil shall be effectually protected against dampness from that soil by means of a vertical damp-proof course or otherwise. (c) There shall be outside of and adjoining such room and extending along the entire frontage thereof and open upwards from six inches below the level of the floor thereof an area properly paved and effectually drained at least three feet wide in every part and of a mean width not less than four feet—Provided that in the area there may be placed steps necessary for access to the room ami over and across such area there may be steps necessary for accass to any building above the room if the steps in each case be so placed as not to be over or across any external window of the room. (d) The subsoil of the site of such room shall be effectually drained by means of a subsoil drain properly trapped and ventilated wherever the dampness of the site renders such a precaution necessary. (e) The space, if any, beneath the floor of such room shall bo provided with adequate means of ventilation. If) Every drain passing under any such room, other than a drain for the drainage of the subsoil of the site of the room, shall be properly constructed of a gas-tight pipe. (ff) Such room shall be effectually protected against the rising of any effluvia or exhalation by means of a layer of asphalte or of good cement concrete at least six inches thick, or four inches thick if properly grouted, laid upon the soil of the site of the entire room, or in some equally effectual manner; and such concrete shall be composed of clean gravel, broken 78 hard brick, properly burnt ballast, or other suitable hard material, well mixed with cement in the proportion by measure of one part of cement to not more than eight parts of the other material. (h) Every such room which is without a tire-place and a flue properly constructed and properly connected with such fire-place shall be provided with special and adequate means of ventilation by a sufficient aperture or air shaft which shall provide an unobstructed sectional area of 54 square inches at the least, and every part of which shall be not less than six feet above the level of the floor of the room. (i) Such room shall have one or more windows opening directly into tli3 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 onehalf at least of every such window can be opened and that the opening may in every cass extend to the top of the window. A special inspection was made of basement houses in certain selected streets with a view to ascertain whether any of the basement rooms ware occupied in contravention of the Act. The following streets were selected for this inspection :— Ainger Road King's College Road Belsize Road Kingsgate Road Bolton Road Lawn Road Carlingford Road Mill Lane Denning Road Palmerston Road Finchley Road South Hill Park Fitzjohns Avenue Upper Park Road Fleet Road Willow Road Gascony Avenue The total number of houses inspected was 171. 93 rooms were found to be occupied in contravention of Section 17 of the Housing, Town Planning, &c., Act. Of these 93 rooms, 88 were also occupied contrary to the provisions of the Public Health (London) Act, 1891. The structural defects and the number of rooms in which the defects were found were as follows:— Want of proper area 85 „ ,, damp-proof courses 45 Space beneath floor insufficiently ventilated 77 Site not concreted 59 Defective drains 58 79 In 12 eases the illegal occupation of the rooms was discontinued, in 80 cases the structural work necessary to make them comply with the law were either completed or were well in hand before the end of the year, and in one case, a servant's bedroom in the basement of a house in Fitzjohns Avenue, the works were not completed by the end of the year, and the Council made a closing order in 1912. Public Mortuary. During the year the bodies of 84 persons were brought to the Mortuary, as against 87 last year—45 by order of the Coroner, 14 bv the Police, and 25 at the request of friends of the deceased persons. In 60 instances, or 71 per cent, of ths bodies admitted, inquests were held, and in 41 instances, or 49 per cent., post-mortem examinations were made. The following table indicates the causes of death of the persons whose bodies were received into the Mortuary : — [####]Cause of Death or Verdict. Number of Bodies received.[/####] Deaths from natural causes 48 Accidental deaths 16 Suicide 10 Neglect at birth 3 Misadventure 5 Found dead 2 Total 84 80 MORTUARY RECORD FOR THE YEAR, 1911. Bodies Admitted. No. of Post-Mortems. No of Inquests. No. of Funerals from Mortuary. Month. Males. Females. Totals. Males. Females. Totals. January 7 4 11 5 4 9 10 11 February 3 3 6 — — — 1 6 March 3 — 3 3 — 3 3 3 April 5 4 9 3 2 5 8 8 May 4 1 5 1 — 1 3 5 June 2 1 3 1 — 1 3 3 July 5 5 10 1 2 3 4 10 August 8 2 10 4 — 4 7 10 September 2 4 2 2 1 3 4 6 October 3 4 7 2 1 3 3 7 November 4 3 7 4 1 5 7 7 December 2 5 7 — 4 4 7 7 Totals 48 36 84 26 15 41 60 83 81 Food Inspection. No seizures of unsound and diseased food were made during the year, but the following articles were voluntarily surrendered to the Inspectors. Date. Premises. Food seized or surrendered. May 13th High Road Carcase of veal (54½ lbs.) June 6th Hampstead Heath Churn of Sour Milk. Aug. 11th Broomsleigh Street Trunk of Haddock. Oct. 31st Netherwood Street Meat trimmings (7lbs). Slaughterhouses. There are four slaughterhouses in the Borough, situated as follows:—40, England's Lane; 17, High Street; 69, High Street; 6 Fairfax Mews. The slaughterhouses were regularly inspected during the year, the number of inspections being 81. In December it was found that the quarterly lime-washing had not been carried out at one slaughterhouse. Notice was served and the neccessary work was carried out by the end of the month. Food Premises. Section 8 of the London County Conncil (General Powers) Act, 1908, contains provisions that considerably increase the power of sanitary authorities to regulate the sanitary condition of places where food is prepared or sold. The section, which has been set out in full in previous Annual Reports, provides, among other things, that there shall be no drain inlet in any room where food is prepared or sold, that no sanitary convenience shall be within such a room or in direct communication with it, and that such a room shall be kept clean and not used as a sleeping place. During 1909 and 1910 a systematic inspection of these places was made, and in a considerable number of cases conditions in contravention of the Act, were found. In 1909 and 1910 the total number of premises altered in order to comply with the Act was 19 and 52 respectively, as set out in the Reports for those years. In 1911 the number of premises dealt with was 60. Of these places 36 were found to have drain inlets in rooms where food was prepared or sold, in 54 premises the drains were 82 defective, in seven structural defects other than drainage defects of various kinds were present, and 49 premises needed cleansing. The places were dealt with as follows:—in 34 instances the drains were entirely, and in 20 instances partially, reconstructed; in 36 instances improperly placed drain inlets were removed, with or without re-drainage; in 7 instances more or less extensive structural alterations, other than drainage alterations, were carried out; and 49 premises were thoroughly cleansed under notice. The trades carried on and the alterations made on the premises dealt with in 1911 were as follows:— Trades. No. of Premises DRAINAGE. PREMISES. Entire reconstruction Partial reconstruction Drain openings removed. Cleansed Structurally altered. Butcher 11 7 4 8 8 - Confectioner 5 3 1 3 4 2 Dairy 7 3 3 3 6 Fishmonger 3 2 1 1 3 - Greengrocer 10 6 2 6 8 - Grocer & Provision Merchant 12 6 5 7 8 4 Restaurants 6 5 — 4 6 1 Other Trades 6 2 4 4 6 - Totals 60 34 20 36 49 7 The food premises inspected during the year, together with the nature of the business carried on, were as follows:— Butcher and Pork Butcher 64 Confectioner 98 Grocer 70 Provision and Cheesemonger 47 Greengrocer and Fruiterer 74 Fishmonger 32 Fried Fish Shops 10 General Shops 25 420 83 787 inspections were made of these premises during the year and 114 notices were served. This list does not include bakehouses, milk shops, restaurants, and slaughterhouses, to which reference is made elsewhere. Milk Supply. The number of persons registered as purveyors of milk at the end of 1911 was 82, and the number of premises on which milk is sold was 103. The difference in the two numbers was accounted for by the fact that some of the milksellers occupy more than one shop. The premises on which milk is sold are as follows:— Dairies 52 Bakehouses and Confectioners 23 Restaurants and Coffee Shops 11 General Shops 17 Three of the registered milksellers do not occupy shops, 2 being registered in reference to refreshment tents on Hampstead Heath on Bank Holidays, and one has a milk round in the Borough but no shop. During the year 549 inspections were made of premises where milk is sold, 35 notices were served, and the following works were carried out:— Premises or parts of premises repaired, cleansed, and limewashed 37 Water cisterns cleansed 2 Drains repaired or reconstructed 9 Drain inlets inside premises abolished 5 Soil pipes reconstructed 2 Water-closets repaired or renewed 8 Water-closets cleansed 15 Roofs repaired 4 New sinks fixed 1 Yard paving repaired or renewed 10 Dustbins provided 3 Gullies cleansed 2 Other defects remedied 5 84 Section 5 of the London County Council (General Powers) Act, 1908, empowers sanitary authorities in London to remove from the register of milksellers any cowkeeper, dairyman, or purveyor of milk, who is carrying on his trade on premises unsuitable for the sale of milk, and to refuse to enter any such person upon the register. In pursuance of these powers the Council refused three applications for registration, the places in respect of which the applications were made being general shops in which the milk would have been sold with a variety of articles, the presence of which would have rendered the milk liable to contamination The occupier of one registered general shop voluntarily discontinued the sale of milk after being convicted under the Sale of Food and Drugs Acts. The number of general shops selling milk has been reduced from 26 in 1909 to 17 in 1911. Ice Cream. The sale of ice cream in London is controlled by Sections 42 and 43 of the London County Council (General Powers) Act, 1982. There are 82 shops in the Borough in which ice cream is sold, and 314 inspections of these premises were made during the year. In addition to these, the barrows which stand in the streets, and on Hampstead Heath on Bank Holidays, have been inspected. Table of sanitary work carried out at premises where ice cream is sold:— Premises or parts of premises repaired, cleansed and limewashed 20 Drains repaired or reconstructed 7 Soil pipes reconstructed 3 Water-closets renewed 5 „ cleansed 7 Flushing cisterns to water-closets repaired 3 Waste pipes of sinks trapped, repaired, or renewed 4 Water cisterns cleansed 2 Yard paving repaired 3 Dustbins provided 3 Other defects remedied 4 85 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 512, and the number certified by the Public Analyst to be adulterated was 15, or 2.9 per cent. of the total number. The corresponding percentage in 1910 was 2.3; in 1909 it was 3.9. In addition, 16 samples were certified to bo of low quality. 418 samples were purchased from Hampstead tradesmen, and 94 from persons residing without, but trading within, the Borough. The percentages of adulterated samples in these two classes were 1.4 and 9.5 respectively. Thirteen samples were taken on Hampstead Heath on Rank Holidays, and of these 6 or 46.1 per cent. were adulterated, and one was of poor quality. Forty-six samples were taken on Sundays; one of this number was found to be adulterated. All the samples were taken with the formalities prescribed by the Acts, except two, which were taken informally. These two informal samples were found to be genuine. 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:— Articles. Number taken. Adulterated. Low Quality. Butter 98 - - Cheese 12 — — Cocoa 18 — — Coffee 27 — — Cream 3 1 — Dripping 2 — — Lard 26 — — Margarine 9 — — Milk 311 14 16 Olive Oil 2 — — Sugar 4 — — Totals 512 15 16 86 The following table shows the number of samples analysed during each year from 1905 to 1911, 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. 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 1910 506 12 2.3 25 6 0 1911 512 15 2.9 26 16 0 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) 64 l 1.5 No. 2 (Belsize) 73 l 1.3 No. 3 (Adelaide) 15 l 6.6 No. 4 (Central) 17 — — No. 5 (West End) 87 — — No. 6 (Kilburn) 103 2 1.9 No. 7 (Priory) 59 1 1.6 Totals 418 6 1.4 87 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. 80 Cream 17½ grains of boric acid per pound Cautioned by order of Public Health Committee. £ s. d. s. d. 91 Milk 8 per cent. deficient in butter-fat Fine 0 10 0 Costs 12 6 92 Milk 7 per cent. deficient in butter-fat „5 0„12 6 119 Milk 36 per cent. deficient in butter-fat „ 1 0 0 „ 14 6 158 Milk 37 per cent. added water „ 10 0 0 including costs, or one month's imprisonment. 175 Milk 7 per cent. deficient in butter-fat Dismissed. Vendor proving warranty. 204 Milk 8 per cent. deficient in butter-fat Dismissed. Vendor proving warranty. 224 Milk 96 per cent. deficient in butter-fat Vendor absconded. Summons not served. £ s. d. £ s. d. 225 Milk 22 per cent. deficient in butter-fat Fine 5 0 0 including costs, or one month's imprisonment. 226 Milk 16 per cent. deficient in butter-fat Fine 1 0 0 including costs. 338 Milk 11 per cent. added water „ 0 10 0 Costs 0 19 6 342 Milk 8 per cent. added water „ 0 2 6 „ 0 15 0 369 Milk 9 per cent. deficient in butter-fat „ 0 1 0 „ 0 16 0 415 Milk 10 per cent. added water No fine ,, 0 14 6 429 Milk 17 per cent. added water „ „ 3 3 0 88 Complaints. During 1911, 830 complaints were made of the existence of insanitary conditions. A. list of the matters of which complaint was made is given below:— Accumulations, offensive 9 ,, of garden and other refuse 8 Animals, improperly kept 24 „ dead 7 Dampness in premises 29 Dirty and dilapidated premises 24 Drain, bad condition of 25 „ defective 18 ,, stopped 18 Dust, non-removal 70 Dust receptacles, foul or dilapidated 85 „ absence of, or insufficient 19 Insanitary condition of premises 41 Illness attributable to insanitary conditions 15 Manure not removed 4 Overcrowding and improper mixing of the sexes 28 Rats, nuisance from 12 Roadways, bad condition of 4 Roofs and gutters, defective and leaky 11 Rubbish, nuisance from burning 9 Smells 28 „ on premises 30 „ from road gullies 9 „ „ sewer ventilators 69 „ „ stables 3 „ „ drains, &c. 28 ,, „ water-closets 11 „ „ manure 10 Smoke nuisances 10 Underground rooms illegally occupied 1 Unsound food 6 Vacant land, insanitary state of 5 Verminous condition of premises 8 Water, absence of 116 „ leakage of 7 Water cisterns, dirty, &c. 4 Water-closets, accommodation insufficient or absence of 5 „ defective or insanitary 28 ,, stopped 6 „ without water 12 „ „ proper flush 8 Yards unpaved and existing paving defective 3 Miscellaneous 61 Total 928 Factory and Workshop Act, 1901. 91 Factory and Workshop Act, 1901. This part of the 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 1911 there were 458 workshops on the register, of which 31 were domestic workshops. Excluding the latter, there were employed in the workshops 826 males and 1,087 females. Dressmaking is the trade chiefly carried on in the Hampstead workshops, and next in order of frequency come bootmaking, tailoring, baking and millinery. The following table shows the number of each class of workshops, the number of workrooms, and the number of persons of each sex employed. Workshops, and Domestic Workshops. Trade or Business. Workshops other than Domestic Workshops. Domestic Workshops. Total number of Workshops. Number of Work shops. Number of Work rooms. Number of Employees. Males. Females. Bakers 34 40 127 - - 34 Blindmakers 4 7 12 7 - 4 Bootmakers 45 49 87 - - 45 Builders and carpenters 20 23 32 - - 20 Cabinetmakers and polishers 3 9 163 - - 3 Carriage builders 7 16 30 — — 7 Cycle makers and repairers 5 8 15 — — 5 Dressmakers and ladies' tailors 113 141 11 565 13 126 Florists 2 3 12 13 — 2 Harness makers 5 6 12 — — 5 Ironmongers 13 13 30 — — 13 Laundresses 7 19 3 53 — 7 Mantlemakers 2 5 - 17 — 2 Milliners 30 33 - 132 1 31 Monumental masons 2 2 15 - — 2 Motor makers 4 5 15 — — 4 Outfitters 7 26 7 184 — 7 Pianoforte makers 2 4 26 — — 2 Picture frame makers 10 12 18 — - 10 Sign writers 2 3 8 — — 2 Smiths 11 11 25 — — 11 Tailors 35 44 62 50 10 45 Upholsterers 14 19 39 2 1 15 Watchmakers and jewellers 14 15 25 — — 14 Wigmakers 13 19 12 34 — 13 Miscellaneous 23 33 40 30 6 29 Totals 427 565 826 1087 31 458 92 Workshop Inspection. The following particulars relate to the workshop inspections made during 1911, bakehouse inspections being omitted. The total number of inspections made during the year was 740, as against 594 in the previous year. Cleanliness. Fourteen workrooms were found on inspection to require cleansing; 8 of these were cleansed on the request of the Inspector, and in 6 cases it was necessary to serve a notice before the work was carried out. Ventilation and Warming. In seven workshops the means of ventilation were found to be nadequate, and proper means were provided. One workshop was found to be warmed by a gas stove unprovided with a flue 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." The stove was replaced by one with a proper flue. 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 1911, 68 new workrooms were measured. Overcrowding was found in 2 instances. 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 woman, young person, or child is employed in a workshop in which no abstract of this Act is affixed as by this Act required, and the Medical Officer of Health of the 93 District Council becomes aware thereof, ho shall forthwith give written notice thereof to the Inspector for the district." The object of this section is to secure that all new workshops in which protected persons are employed, discovered by the officers of the local authority shall be brought to the notice of the Factory Inspector, who supplies the occupiers of workshops with the abstracts of the Act. The occupier of a workshop is under legal obligation to give notice of his occupation of the workshop to the Factory Inspector within a month after it has begun, but owing to ignorance of the law, and for other reasons this obligation is frequently left unfulfilled, and the inspector is informed of the occupation by the local Medical Officer of Health. Pursuant to this section 35 workshops were notified to H.M. Inspector of Factories as being without the abstract as required. Bakehouses. At the end of 1911 there were 37 occupied bakehouses on the register, 21 being underground, and 16 above ground. Three of the bakehouses situated above ground use power and are therefore factories Seventeen inspections were made in respect of the factory bakehouses, 182 inspections in respect of the workshop bakehouses, and 10 notices were served. Towards the end of the year an underground room was found to be used as a bakehouse, and as it had not been so used at the passing of the Factory Act of 1901 the occupier was informed that the use of the room as a bakehouse was illegal, and the occupation was discontinued in the early part of the present year. One of the certified underground bakehouses became unoccupied during 1911, thus reducing the number of underground bakehouses from 22 to 21. 94 The following is a list of the occupied 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 (Tows) Ward— 110, Cricklewood Broadway. 57, Heath Street. 553, Finchley Road. 3, High Street. Field Lane School, Hillfield 67, do. Road. 19, New End.(4) *43, Mill Lane. No. 2 (Belsize) Ward— 44, do. 6, Fleet Road. 4, Munro Terrace, Fortune *65, do. Green. 45, South End Road. (3) 251, West End Lane. (late 2, Heathhurst Road). *279, do. (9) No. 3 (Adelaide) Ward— No. 6 (Kilburx) Ward— *44, England's Lane. *63, Hemstal Road. *90, Haverstock Hill. *94, High Road, Kilburn. *2, King's College Road. (3) 354 do. *4, Kelson Street. No. 4 (Central) Ward 67, Kingsgate Road. *64, Belsize Lane. *99, Palmerston Road. (6) *225, Finchley Road. No. 7 (Priory) Ward- *289, do. *202, Belsize Road. †307, do. *228, do. *98, West End Lane. *98, Boundary Road. †2, Broadhurst Gardens. (6) *93, Fairfax Road. No. 5 (West End) Ward— *7, Fairhazel Gardens. †60, Cricklewod Broadway. *137, Finchley Road. (6) Bakehouses—Underground 21 „ Above ground 16 Total 37 95 Workplaces. This term is not defiined 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 1910 was 66. During 1911, 8 restaurant kitchens were added to the register, making a total of 74 on the register at the end of the year. These premises are kept under regular supervision, the number of inspections being 171 and the number of notices served 15. The following is a list of the restaurant kitchens in the various wards of the Borough:— Restaurant Kitchens in Wards. No. 1 (Town) Ward- 19, Southampton Road. Jack Straw's Castle, Ilampstead 74, Upper Park Road. Heath. Railway Tavern, South End 37, Heath Street. Green. (12) 57, do. 63 & 65, do. No. 3 (Adelaide) Ward— 70, do. 1, Adelaide Road, 100, do. 143, do. 102, do. 97, Haverstock Hill. 108, do. 11, King's College Road. 109, do. Cosy Nook, Regent's Park Road. 3, High Street. Winchester Hotel, Winchester 42, do. Road. 67, do. 27, Winchester Road (7) Bull & Bush, North End (13) No. 4 (Central) Ward- No. 2 (Belsize) Ward— 72, Belsize Lane. 2, Elm Terrace, Constantine Road. 90, do. 2, Fleet Road. 159, Broadhurst Gardens. 25, do. 1a, Canfield Place. 98, do, 104, Finchley Road. 106, do. 225, do. 210, Haverstock Hill. 289, do. 11, South End Road. 52, Lymington Road. 17, do. 100, West End Lane. 45, do. (late 2, Heath- 272, do. hurst Road). 280, do. (11) 96 Restaurant Kitchens in Wards.—continued. No. 5 (West End) Ward— No. 7 (Priory) Ward— 106, Cricklewood Broadway. 121, Abbey Road. 92, Fortune Green Road. 21, Alexandra Road. 106, Mill Lane. 203, Belsize Road. 251, West End Lane. 264, do 291, do. 274, do. 295, do. 36, Boundary Road. 327, do. 114, do. 351, do. (8) 65, Fairfax Road. No. 6 (Kilburn) Ward— Finchley Road. 132, High Road, Kilburn. 115, do. 188, do. do. 133a, do. 272, do. do 34, High Road, Kilburn 308, do. do. 48, do. do. 354, do. do. Steer's Restaurant, Upper 145, Iverson Road. Avenue Road (14) Towers' Coffee Rooms, Love- ridge Road. Total 74 18, Netherwood Street. 96, Palmerston Road. (9) 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 134 and the number of addresses contained in the lists was 351. In those instances where it was found that the addresses were outside Hampstead, in accordance with the Act they were sent to the Medical Officers of Health of their respective districts. The total number of outworkers' premises in Hampstead is 87. Of these 5 are factories, 52 are workshops (19 of these being domestic workshops), 1 is a workplace, and in 29 cases only a single worker is employed on the premises. 97 Factories, The sanitation of factories is largely controlled by the Factory Inspectors, but duties of considerable importance relating to general sanitation devolve upon the Borough Council, who are responsible, among other duties, for the administration of Section 38 of the Public Health (London) Act, 1891. The section imposes upon the Council the duty of securing ''suitable and sufficient accommodation in the way of sanitary conveniences "for the persons of both sexes employed in the Hampstead factories, worshops, and workplaces. The following is a list of the different classes of factories in Hampstead:— Art Metal Workers 2 Dairymen 2 Bakehouses 3 Laundries 6 Bootmakers 10 Motor Works 7 Builders 4 Printers 10 Butchers 7 Other trades 16 Carpet Beaters 2 74 Coffee Roasters 5 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) 103 5 — Workshops (Including Workshop Laundries) 922 20 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 2190 169 - Total 3215 191 — 98 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 Act:— Want of cleanliness 93 94 - - Want of ventilation 8 8 - - Overcrowding 3 3 - - Want of drainage of floors 3 3 - — Other nuisances 51 50 — — Sanitary accommodation insufficient 2 2 — — unsuitable or defective 11 11 — — not separate for sexes 3 3 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) 1 — — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) — — — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) — — — — Total 175 174 — — Column (2) in the above table gives the number of defeats found, and column (3) the number remedied during the year. The correspending figures in the two columns are not identical, because in the case of some of the defects discovered near the end of the year, the work necessary to remedy the defects had not been completed and column (3) includes some defects which were found at the end of 1910 and remedied in the following year. 99 3.—Home Work. NATURE OF WORK.* Outworkers' Lists, Section 107. Outwork in unwholesome premises, Sec. 108. Outwork in infected premises. Sections 109, 110. Lists received from Employers. 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. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers. Lists. Outworkers. Contractors. Workmen. Con0tractors. Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Wearing Apparel— (1) making, etc 102 43 178 2 — 4 — — — — — — — — — (2) cleaning and washing 14 29 2 — — — — — — — — — — — — household linen — — — — — — — — — — — — — — — Lace, lace curtains and nets — — — 1 — 4 — - - - - - - - - Curtains and furniture hangings — — 4 — — — — — — — — — — — — Furniture and upholstery 10 17 17 1 — 4 — — — — — — — — — Electro-plate — — — 1 3 — — — — — — — — — — File making — — — — — — — — — — — — — — — Brass and brass articles — — — — — — — — — — — — — — — Fur pulling — — — — — —— — — — — — — — — — Cables and chains — — — — — — — — — — — — — — — Anchors and grapnels — — — — — — — — — — — — — — — Cart gear — — — — — — — — — — — — — — — Locks, latches and keys — — 1 — — — — — — — — — — — — Umbrellas, etc. — 7 1 1 — 1 — — — — — — — — — Artificial flowers — — — — — — — — — — — — — — — Nets, other than wire nets — — — — — — — — — — — — — — — Tents — — — — — — — — — — — — — — — Sacks — — — — — — — — — — — — — — — Racquet and tennis balls — — — — — — — — — — — — — — — Paper bags and boxes 2 — 30 — — — — — — — — — — — — Brush making — — — — — — — — — — — — — — — Pea picking — — — — — — — — — — — — — — — Feather sorting — — — — — — — — — — — — — — — Carding, etc., of buttons, etc. — — 1 — — — — — — — — — — — — Stuffed toys — — — — — — — — — — — — — — — Basket making — — — — — — — — — — — — — — — Total 128 101 234 6 3 13 - - - - - - - - - *In the case of those occupiers who gave out work of more than one of the classes specified in Column 1, and subdivided their lists in such a way as to show the number of workers in each class of work, the list has been included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers have been assigned in columns 3 and 4 (or 6 and 7) into their respective classes. 100 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. (1) N umber (2) Bakehouses 34 Bootmakers 45 Dressmakers and ladies' tailors 126 Laundries 7 Milliners 31 Tailors 45 Watchmakers and jewellers 14 Wigmakers 13 Other 143 Total number of workshops on Register 458 5.—Other Matters. Class (1) Number (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 35 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Act, 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 7 Underground bakehouses (s. 101):— Certificates granted during the year - In use at the end of the year 21 Report on the Analytical Work of the Year 1911. by ALFRED W. STOKES, F.C.S., F.I.C., Public Analyst. 103 Analytical Laboratory, Town Hall., Paddington, w. 24th January, 1912. A short abstract of the Analytical work of the year 1911 may be of interest. The samples numbered 512; consisting of Milk, 311, Butter 99, Groceries 99, and Cream 3. Only 14 samples of Milk, or 4½ per cent., were found to be adulterated, and 1 sample of Cream was found to contain Boric Acid as a preservative. Not one of the Groceries (comprising such articles as tea, cocoa, coffee, &c.) was found to be adulterated. All the samples were taken under the strict requirements of the adulteration acts except two samples of Butter which were found to be pure. Taking all samples together the adulteration shows only 2.9 per cent.; this is very close to the 2.75 per cent. of the previous year. In London generally the proportion is about 8½ per cent., so that Hampstead compares well with the rest of London. The total fines for the year amounted to £18 8s. 6d. with costs also of £8 7s. 6d. ALF. W. STOKES, F.C.S., F.I.C., Public Analyst. Legal Proceedings. 107 Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department in 47 cases during the year. The chief facts relating to these proceedings are set out on pages 108-111, and are summarised below. The facts relate only to the cases that were heard and decided in 1911. Statute or By-law. Number of Prosecutions. Fines Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and By-laws made thereunder 17 13 0 0 27 7 6 Metropolis Management Acts, and By-laws made thereunder 17 5 0 0 14 16 4 Sale of Food and Drugs Acts 13 17 12 0 9 5 6 Totals 47 35 12 0 51 9 4 108 Public Health (London) Act, 1891, and By-laws made thereunder. Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 3 1910. 6th Dec. 1911. 20th Jan. Marylebone Police Court, Mr. Plowden J. H. H., Hampstead Nuisance Order to abate within 14 days and £3 3s. costs granted 7 6th Oct. 24th Feb. Do. G. C., St. Marylebone Allowing two underground rooms to be illegally occupied Work done summonses withdrawn, and £1 1s. costs paid 7 17th Nov. 17th Mar. Do. C.F., Willesden Nuisance Order to abate within 14 days, £2 2s. costs allowed, and ordered to pay £3 14s. cost of opening up 3 1911. 12th Jan. 21st April Do. G. H. D., Westminster Nuisance Order made to abate nuisance within one month, and 10s. 6d. costs allowed 1 18th May 1st June Hampstead Petty Sessional Court, Justices A. P., Shored itch Dirty milk glasses Fined £2 4 9th Mar. 2nd June Marylebone Poiice Court, Mr. Paul Taylor M. T. Hampstead Nuisance Nuisance abated, £2 14s. cost of opening up, and £1 1s. costs paid and summons withdrawn 3 12th Jan. 30th June Marylebone Police Court, Mr. Plowden G. H. D., Westminster Non-compliance with Magistrates' Order with reference to nuisance Fined £4 10s. and 13s. costs 7 1st June 28th July Marylebone Police Court, Mr. Denraan E. G , Hove Nuisance Work done, 10s. 6d. costs paid, and summons withdrawn 6 26th Sept. 6th Oct. Marylebone Police Court, Mr. Paul Taylor E. S., Willesden Non-compliance with By-laws as to Houses let in Lodging in respect of W.C. Fined £6 10s. and 12s. 6d. costs 6 Do. Do. Do. Do. Failing to register 2 premises as houses let in lodgings Forms sent in, 10s. costs paid, and summonses withdrawn 109 Public Health (London) Act, 1891, and By-laws made thereunder—con. Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 5 1911. 29th June 1911. 11th Oct. Hampstead Petty Sessional Court, Justices H. B., Hampstead Nuisances (2 premises) Order made to abate forthwith, and £5 5s. costs allowed 3 19th Oct. 27th Oct. Marylebone Police Court, Mr. Paul Taylor M.C.E., Hampstead Nuisance Order made to abate within seven days, and 6s. costs allowed 5 19th Oct. 6th Nov. Do. C. C. P., Stoke Newington Nuisance Order made to abate nuisance within 28 days, and £5 5s. costs allowed Metropolis Management Acts, and By-laws made thereunder. l 1910. 3rd Nov. 1911. 15th Feb. Hampstead Petty Sessional Court, Justices E. H. D. R. Co., St. Marylebone Failing to deposit plans, etc. Fined 20s. and £3 3s. costs 7 Do. 7th April Maryylebone Police Court, Mr. Plowden J. A. R., Paddington Failing to deposit plans, etc. Plans deposited, 10s. costs paid, and summons withdrawn 7 1911. 6th April 5th May Marylebone Police Court, Mr. Francis W. H. P., Paddington Failing to deposit plans, etc. Summons dismissed without costs 6 13th July 21st July Marylebone Police Court, Mr. Denman A. E. Ltd , City (i) Constructing drain without giving notice (ii) Doing work contrary to Drainage Bylaw 4 (iii) Failing to deposit plans, etc. Work altered, plans deposited, £3 3s. costs paid, and summonses withdrawn 5 26th Sept. 6th Oct. Marylebone Police Court, Mr Paul Taylor R. E., Hendon Failing to deposit plans, etc. Plans deposited, £1 1s. costs paid, and summons withdrawn 7 Do. Do. Do. Do. Do. Withdrawn 1 5th Oct. 11th Oct. Hampstead Petty Sessional Court, Justices T. R., Hampstead (i) Do. (ii) Contravention of Drainage Bylaw 4 (iii) Do. (i) Fined £1 (ii) Fined £1 (iii) Fined £1 and £l 18s. 6d. costs 110 Metropolis Management Arts, and By-laics 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. 6 1911. 24th Oct. 1911. 6th Nov. Marylebone Police Court, Mr. Paul Taylor C. H., Croydon (i) Failing to deposit plans, etc. (ii) Contravention of the 1855 Act (i) Fined 10s. and £2 2s. costs (ii) Fined 10s. and 2s. costs 2 5th Oct. 17 th Nov. Marylebone Police Court, Mr. Plowden A. R. M„ Hendon Failing to deposit plans, etc. Plans deposited. 10s. 6d. costs paid and summons withdrawn 4 2nd Nov. 1st Dec. Do. R. K., Hampstead (i) Failing to deposit plans, etc. (ii) Contravention of the 1855 Act Plans deposited, work done, £1 5s. 4d. costs paid, and summonses withdrawn 6 24th Oct. 15th Dec. Do. C. H , Croydon Failing to deposit plans, etc. Plans deposited. £1 1s. costs paid, and summons withdrawn Sale of Food and Drugs Acts. 2 1911. 23rd Mar. 1911. 21st April Marylebone Police Court, Mr. Plowden J. W., St. Pancras Selling milk containing 8 per cent, less than the proper amount of butter-fat Fined 10s. and 12s. 6d. costs 6 Do. Do. Do. G. H. W. S., Hampstead Selling milk containing 7 per cent, less than the proper amount of butter-fat Fined 5s. and 12s. 6d. costs 1 6 th April 3rd May Hampstead Petty Sessional Court, Justices J. B. W., St. Pancras Selling milk containing 36 per cent less than the proper amount of butter-fat Fined 20s. and 14s. 6d. costs 1 18th May 1st June Hampstead Petty Sessional Court, Justices A. P., Shoreditch Selling milk containing 37 per cent. added water Fined £10 or two months' imprisonment 2 18th May 9th June Marylebone Police Court, Mr. Paul Taylor E. E., Hampstead Selling milk containing 7 per cent less than the properamount of butter-fat Warranty proved and summons dismissed 111 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. 7 1911. 1st June 1911. 30th June Marylebone Police Court, Mr. Plowden T. J. D., Willesden Selling milk containing 8 percent. less than the proper amount of butter-fat Warranty proved and summons dismissed 1 20th June 12th July Hampstead Petty Sessional Court, Justices A. H., Islington Selling milk containing 16 per cent. less than the proper amount of butter-fat Fined £1 1s., including costs 1 Do. Do. Do. H. F., Hampstead Selling milk containing 22 per cent. less than the proper amount of butter-fat Fined £5, including costs, or two months' imprisonment 1 20th Sept. Do. M. W., Paddington Selling skim milk containing 11 per cent, added water Dismissed, in consequence of conviction in case below 1 Do. Do. C. H. WM Paddington Do. Fined t'l 9s. 6d.. including coats 1 20th June 18th Oct. Do. T. S., Fulham Selling skim milk containing 11 per cent, added water Fined 2s. 6d. and 15s. costs 1 19th Oct. 8th Nov. Do. E. K., Hampstead Selling milk containing 9 per cent. less than the proper amount of butter-fat Fined 1s. and 16s. costs 5 7th Nov. 6th Dec. Do. T. B., Willesden Selling milk containing 10 per cent. added water Ordered to pay 14s. 6d. costs 3 16th Nov. 8th Dec. Marylebone Police Court, Mr. Plowden E D. C., Holborn Selling milk containing 17 per cent. added water Ordered to pay £3 3s. costs Appendix. Tables. 115 TABLE I. (Required by the Local Government Board to be used in the Annual lleport of the Medical Officer of Health.) Vital Statistics of Whole Borough during 1911 and Previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the Borough. Transferable Deaths. † Nett Deaths belonging to the Borough. Uncorrected Number. Nett. Number. Rate. of Non residents registered in the Borough. of Residents not registered in the Borough. Under 1 Year of age. At all Ages. Number. Rate per 1.000 Nett Births. Number. Rate. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1906 83780 1437 1437 17.1 1104 13.2 364 110 111 77.2 850 10.1 1907 84130 1341 1359 16.1 1056 12.5 330 91 98 73.1 817 9.7 1908 84480 1355 1400 16.6 995 11.8 311 119 97 69.3 803 9.5 1909 84830 1282 1328 15.6 1057 12.5 334 116 99 74.5 839 9.9 1910 85210 1270 1340 15.7 1071 12.6 350 108 81 60.4 859 9.7 1911 85599 1199 1276 14.9 1132 13.2 415 130 105 82.3 847 9.9 t Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. Area of Borough in acre3 (exclusive of area covered by water), 2253. Total population at all ages, 85,510. ) At Census of 1911 Is umber of inhabited houses, 11,294. Average number of persons per house, 7.6. 116 TABLE II. (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 1911. notifiable disease. Number of cases notified. Total Cases Notified in each Ward. Total Cases removed to Hospital. At all Ages. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 141 .. 39 73 15 13 1 .. 50 21 6 9 17 29 9 108 Erysipelas 49 .. 2 5 12 8 18 4 7 7 1 3 8 20 3 6 Scarlet Fever 125 .. 27 65 15 17 .. 1 13 44 9 9 13 25 12 93 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 13 .. 1 3 2 4 3 .. .. 4 1 3 2 2 1 9 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 6 .. .. .. 2 4 .. .. .. .. 1 2 1 1 5 Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Phthisis Under Tuberculosis Regulations, 1908 46 .. 1 9 7 21 8 .. 14 6 4 2 3 13 4 46 Under Tuberculosis Regulations, 1911 67 .. .. 4 18 39 6 .. 13 12 3 6 9 19 5 39 Others (Voluntary System) 11 .. 1 2 1 6 1 .. .. .. .. 1 .. 10 .. 2 Ophthalmia Neonatorum 5 5 .. .. .. .. .. .. .. .. .. .. .. 5 .. .. Polio-Myelitis 6 1 2 1 .. 2 .. .. 1 1 2 .. 2 .. .. 1 Chicken-pox 58 .. 17 33 7 1 .. .. 8 9 6 4 3 18 10 .. Totals 527 6 90 195 79 115 37 5 106 105 32 38 59 142 45 309 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. EXTENDED TABLE III. Causes of, and Ages at Death during the Year 1911. No. Causes of Death. All Ages. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the Borough. Total Deaths whether of "Residents" or " Nonresidents " in Institutions in the Borough. Under 1 year. 1 and under 2 years, i 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified 845 105 27 20 25 32 112 212 312 543 Uncertified 2 ... ... ... ... ... ... ... 2 ... 1 Enteric Fever 2 ... ... ... ... 1 ... 1 ... 10 6 Measles 14 3 5 3 2 1 ... ... ... 67 7 Scarlet Fever ... ... ... ... ... ... ... ... ... 28 8 Whooping Cough 3 1 2 ... ... 2 9 Diphtheria. Croup 17 ... ... 8 7 1 1 ... ... 56 10 Influenza 7 1 ... ... ... ... 1 3 2 2 14 Dysentery 1 ... ... ... ... ... 1 ... ... ... 18 Erysipelas 2 ... ... ... ... ... ... 1 ... 2 20 Pyaemia, Septicoemia 8 1 ... ... 1 ... 4 2 ... 10 25a Actinomycosis ... ... ... ... ... ... ... ... ... 1 28 Pulmonary Tuberculosis (not acute) 52 ... ... ... 1 4 27 15 5 99 29 Acute Phthisis, Acute Miliary Tuberculosis) 4 l ... ... ... 1 1 1 ... 4 30 Tuberculous Meningitis 7 2 3 2 ... ... ... ... ... 2 31 Tuberculosis of Peritoneum and Intestines 1 ... ... 1 ... ... ... ... ... 2 32 Tuberculosis of Spinal Column 2 ... ... ... 1 ... 1 ... ... 5 33 Tuberculosis of Joints ... ... ... ... ... ... ... ... ... 1 34 Tuberculosis of other Organs 1 ... ... ... ... 1 ... ... ... ... 35 Disseminated Tuberculosis 3 1 ... ... ... 1 1 ... ... 8 37 Syphilis 2 1 ... ... 1 ... ... ... ... 1 39 Cancer of the Buccal Cavity 7 ... ... ... ... ... 1 4 2 5 40 Cancer of the Stomach, Liver, Ac. 23 ... ... ... ... ... 1 14 8 12 41 Cancer of the Peritoneum, Intestines, and Rectum 21 ... ... ... ... ... ... 11 10 4 42 Cancer of the Female Genital Organs 10 ... ... ... ... ... ... 8 2 4 43 Cancer of the Breast 15 ... ... ... ... ... 4 4 7 12 45 Cancer of other or unspecified organs 10 ... ... ... ... ... 2 3 5 12 46 Other tumours (situation undefined) 1 ... ... ... ... ... ... ... 1 2 47 Rheumatic Fever 6 ... ... ... 2 2 ... 2 ... 3 48 Chronic Rheumatism, Osteo-Arthritis, Gout 3 ... ... ... 2 1 1 50 Diabetes 10 ... ... ... ... ... 2 4 4 3 51 Exophthalmic Goitre 1 ... ... ... ... 1 ... ... ... 1 53 Leucocythaemia, Lymphadenoma 2 ... ... 1 1 ... ... ... ... ... 54 Anaemia, Chlorosis 7 ... ... ... ... ... ... 5 2 ... 55 Other general diseases 1 ... ... ... ... ... 1 ... ... ... 56 Alcoholism (acute or chronic) 7 ... ... ... ... ... 3 3 1 ... 61a Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... 1 61b Posteria Basal Meningitis 1 ... ... 1 ... ... ... ... ... 2 61c Meningitis (other forms) 6 2 2 ... 1 ... ... ... 1 6 62 Locomotor Ataxy 1 ... ... ... ... ... ... 1 ... ... 63a Other diseases of the Spinal Cord 8 ... ... ... ... l ... l 6 1 63b Acute Polio-Myelitis 1 ... ... ... ... ... 1 ... ... ... 64 Cerebral Haemorrhage, Apoplexy 41 1 ... ... ... 1 1 14 24 2 65 Softening of the Brain 4 ... ... ... ... ... ... ... 4 ... 66 Paralysis 7 ... ... ... ... ... 1 ... 6 2 67 General Paralysis of the Insane 9 ... ... ... ... ... 4 5 ... ... 68 Other forms of Mental Alienation 4 ... ... ... ... ... 1 3 ... 1 69 Epilepsy 2 ... ... ... ... ... 2 ... ... ... 71 Infantile Convulsions 3 3 ... ... ... ... ... ... ... 1 74 Other diseases of the Nervous System 6 ... ... ... ... l ... 2 3 1 76 Diseases of the Ears 1 1 ... ... ... ... ... ... ... 3 77 Pericarditis 3 2 ... ... ... ... 1 ... ... 1 78 Acute Endocarditis 4 ... ... ... ... ... 3 1 ... 3 79a Valvular Disease of the Heart 19 ... ... ... ... 1 2 8 8 8 79b Fatty Degeneration of the Heart 9 ... ... ... ... ... 2 3 4 ... 79c Other Organic Disease of the Heart 36 ... ... ... ... 1 3 11 21 16 80 Angina Pectoris 8 ... ... ... ... ... ... 2 6 ... 81 Diseases of the Arteries 23 ... ... ... ... ... ... 8 15 2 82 Embolism and Thrombosis 16 ... ... ... ... ... 2 5 9 7 83 Diseases of the Veins 1 ... ... ... ... ... ... 1 ... 1 86 Diseases of the Nasal Fossæ 1 ... ... ... ... l ... ... ... ... 87 Diseases of the Larynx 2 1 ... 1 ... ... ... ... ... ... 88 Diseases of the Thyroid Body 2 ... ... ... ... ... ... ... 2 ... 89 Bronchitis 39 3 3 ... 1 ... 1 2 29 7 90 91 Broncho-Pneumonia 22 10 4 3 1 ... 2 ... 2 8 92 Pneumonia 27 2 2 ... ... l 2 8 12 14 93 Pleurisy 6 ... 1 ... ... ... ... 3 2 2 94 Pulmonary Congestion 4 ... 1 ... ... ... ... ... 3 ... 96 Asthma 1 ... ... ... ... ... ... ... 1 ... 97 Pulmonary Emphysema 2 ... ... ... ... ... ... 1 1 ... 100 Diseases of the Pharynx, Tonsilitis ... ... ... ... ... ... ... ... ... 2 102 Perforating Ulcer of the Stomach 7 ... ... ... ... ... 3 4 ... 3 103 Other Diseases of the Stomach 4 1 ... ... ... ... ... ... 3 1 104 Diarrhoea and Enteritis (under two years of age) 24 22 2 ... ... ... ... ... ... 1 105 Diarrhoea and Enteritis (two years of age and over) 11 ... ... ... ... ... 2 2 7 1 108 Appendicitis 8 ... ... ... 1 2 4 1 ... 7 109 Hernia, Intestinal Obstruction 9 ... ... ... ... ... 1 4 4 7 110 Other Diseases of the Intestines 1 ... ... ... ... ... 1 ... ... ... 111 Acute Yellow Atrophy of the Liver 1 ... ... ... ... ... ... ... 1 ... 113 Cirrhosis of the Liver 8 ... ... ... ... ... ... 6 2 4 114 Biliary Calculi 3 ... ... ... ... ... ... 1 2 ... 115 Other Diseases of the Liver 4 ... ... ... ... ... ... 2 2 ... 117 Peritonitis 1 ... ... ... 1 ... ... ... ... ... 118 Other Diseases of the Digestive System 1 ... ... ... ... ... ... 1 ... ... 119 Acute Nephritis 1 ... ... ... ... ... ... 1 ... ... 120 Bright's Disease 39 ... ... ... 1 1 4 15 18 10 122 Other Diseases of the Kidney and Annexa 3 1 ... ... 1 ... ... ... 1 2 125 Diseases of the Urethra, Urinary Abscess, &c. 2 ... ... ... ... ... ... 1 1 ... 126 Diseases of the Prostate 2 ... ... ... ... ... ... 1 1 1 128 Uterine Haemorrhage (Non-Puerperal) 1 ... ... ... ... ... 1 ... ... ... 129 Uterine Tumour (Non-Cancerous) 2 ... ... ... ... ... 1 1 ... 1 130 Other Diseases of the Uterus 2 ... ... ... ... ... 1 1 ... 1 136 Other Accidents of Childbirth 1 ... ... ... ... ... 1 ... ... 1 137 Puerperal Fever 3 ... ... ... ... 1 2 ... ... 3 138 Puerperal Albuminuria and Convulsions 1 ... ... ... ... ... 1 ... ... ... 139 Puerperal Phlegmsia, Alba Dolens, Embolism, and Sudden Death 1 ... ... ... ... ... 1 ... ... ... 142 Gangrene 8 ... ... ... ... ... ... 1 7 8 143 Carbuncle, Boil 1 1 ... ... ... ... ... ... ... 1 145 Diseases of the Integumentary System 3 1 ... ... ... ... ... ... 2 ... 146 Diseases of the Bones ... ... ... ... ... ... ... ... ... 1 150 Congenital Malformations 3 3 ... ... ... ... ... ... ... ... 151a Premature Birth 20 20 ... ... ... ... ... ... ... 2 151b Infantile Atrophy, Debility, and Marasmus 10 9 1 ... ... ... ... ... ... 5 152 Other Diseases peculiar to early infancy 4 4 ... ... ... ... ... ... ... 1 153 Lack of care 5 5 ... ... ... ... ... ... ... ... 154a Senile Dementia 5 ... ... ... ... ... ... 5 1 154b Senile Decay 39 ... ... ... ... ... ... 1 38 18 155 Suicide by Poison 6 ... ... ... ... 2 2 1 1 2 156 Suicide by Asphyxia 1 ... ... ... ... ... ... ... 1 ... 157 Suicide by Hanging or Strangulation 1 ... ... ... ... ... ... 1 ... ... 158 Suicide by Drowning 1 ... ... ... ... ... ... 1 ... ... 159 Suicide by Firearms 2 ... ... ... ... ... 2 ... ... ... 160 Suicide by Cutting or Piercing Instruments 4 ... ... ... ... ... ... 3 1 2 167 Burns (Conflagration excepted) 3 ... 1 ... ... 1 ... 1 ... 4 169 Accidental Drowning 4 ... ... ... 2 ... 2 ... ... ... 172 Injury by Fall 7 1 ... ... ... l 1 ... 4 2 175 Injury by other crushing (Vehicles, Railways, Landslides, &c.) 5 ... ... ... ... 3 2 ... ... 2 179 Effects of Heat 1 ... ... ... ... ... ... ... 1 ... 186 Other Violence 2 1 ... ... ... ... 1 ... ... 1 188 Syncope, Sudden Death 1 ... ... ... ... ... ... ... 1 ... 189 Ill-defined causes 2 ... ... ... ... ... ... ... 2 ... Totals 847 105 27 20 25 32 112 212 314 543 Note.—The omission of a number from the first column denotes that no death was registered from the cause of death to which the number relates. 117 TABLE III. (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 Yeah 1911. causes of death. Nett deaths at the subjoined ages of "Residents," whether occurring within or without the Borough. Total Deaths, whether of "Residents" or " Non-residents" in Institutions in the Borough. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified 845 105 27 20 25 32 112 212 312 543 Uncertified 2 ... ... ... ... ... ... ... 2 ... Enteric Fever 2 ... ... ... ... 1 ... 1 ... 10 Small-pox ... ... ... ... ... ... ... ... ... ... Measles 14 3 5 3 2 1 ... ... ... 67 Scarlet Fever ... ... ... ... ... ... ... ... ... 28 Whooping Cough 3 1 2 ... ... ... ... ... ... 2 Diphtheria and Croup 17 ... ... 8 7 1 1 ... ... 56 Influenza 7 1 ... ... ... ... 1 3 2 2 Erysipelas 2 ... ... ... ... 1 ... 1 ... 2 Cerebro-Spinal Fever ... ... ... ... ... ... ... ... ... 1 Phthisis (Pulmonary Tuberculosis) 56 1 ... ... 1 5 28 16 5 103 Tuberculous Meningitis 7 2 3 2 ... ... ... ... ... 2 Other Tuberculous Diseases 7 1 ... 1 1 2 2 ... ... 15 Rheumatic Fever 6 ... ... ... 2 2 ... 2 ... 3 Cancer, malignant disease 86 ... ... ... ... ... 8 44 34 49 Bronchitis 39 3 3 ... 1 ... 1 2 29 7 Broncho-Pneumonia 22 10 4 3 1 ... 2 ... 2 8 Pneumonia (all other forms) 27 2 2 ... ... 1 2 8 12 14 Other Diseases of Respiratory Organs 18 1 2 1 ... 1 ... 4 9 2 Diarrhoea and Enteritis 35 22 2 ... ... ... 2 2 7 2 Appendicitis and Typhlitis 8 ... ... ... 1 2 4 1 ... 7 Alcoholism 7 ... ... ... ... ... 3 3 1 ... Cirrhosis of Liver 8 6 2 4 Nephritis and Bright's Disease 40 ... ... ... 1 1 4 16 18 10 Puerperal Fever 3 ... ... ... ... 1 2 ... ... 3 Other accidents and diseases of Pregnancy and Parturition 3 ... ... ... ... ... 3 ... ... 1 Congenital Debility and Malformation, including Premature Birth 33 32 1 ... ... ... ... ... ... 7 Violent Deaths, excluding Suicide 22 2 1 ... 2 5 6 1 5 9 Suicides 15 ... ... ... ... 2 4 6 3 4 Other Defined diseases 357 24 2 2 6 6 39 96 182 125 Diseases ill-defined or unknown 3 ... ... ... ... ... ... ... 8 ... 847 105 27 20 25 32 112 212 314 543 118 TABLE IV. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Infant Mortality, 1911. Next Deaths from stated Causes at various Ages under One Year of Age. cause of death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 1 Month. 1-3 Months. 3 6 Months. 6-9 Months. 9-12 Months. Total Deaths under 1 Year. All Causes Certified 26 2 7 4 39 15 15 21 15 105 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 1 2 3 Scarlet Fever ... ... ... ... ... ... ... 1 ... ... Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... 1 ... 1 Diarrhoea 1 ... ... ... 1 3 1 5 2 12 Enteritis ... ... ... 1 1 ... 6 ...2... 1 10 Tuberculous Meningitis ... ... ... ... ... ... ... 2 ... ... Abdominal Tubercu losis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... 2 ... 2 Congenital Malformations . 1 ... ... ... 1 ... ... 1 1 3 Premature Birth 12 ... 4 2 18 2 ... ... ... 20 Atrophy, Debility and Marasmus 2 1 1 ... 4 4 1 ... ... 9 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 Erysipelas ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... 1 ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... 2 ... ... 2 Convulsions 1 ... ... ... 1 1 1 ... ... 3 Gastritis ... ... ... ... ... 1 ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... 1 1 Bronchitis ... ... 1 ... 1 1 ... ] ... 3 Pneumonia (all forms) ... 1 ... ... 1 1 2 4 4 12 Suffocation, overlying ... ... ... ... ... ... ... ... ... ... Other causes 7 ... 1 1 9 2 1 2 4 18 26 2 7 4 39 15 15 21 15 105 Nett Births in the year legitimate, 1,239 illegitimate, 37 Nett Deaths in the year of legitimate infants, 94. illegitimate infants, 11. 119 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 V. PREMISES. NUMBER OF PLACES. Number of inspections, 1911. Number of notices, 1911. Number of prosecutions, 1911. On register at end of 1910. Added in 1911. Removed in 1911. On register at end of 1911. Milk premises 107 4 8 103 549 35 - Cowsheds - - - - - - - Slaughterhouses 4 — — 4 81 1 — Other offensive trade premises - - - - - - - Ice cream premises 83 3 4 82 314 36 — Registered houses let in lodgings 364 61 — 425 748 86 8 Total number of Intimation Notices served for all purposes 993 Overcrowding — Number of dwelling rooms overcrowded 16 Number remedied 16 Number of notices issued 12 Number of prosecutions — Underground rooms— Number closed during year 11 Illegal occupation dealt with during year 93 Insanitary houses— Number closed under the Public Health (London) Act, 1891 — „ „ Housing of the Working Classes Act — Shelters provided under See. 60 (4) of the Public Health (London) Act, 1891 — Number of persons accommodated during the year — 120 TABLE V.—continued. Customs and Inland Revenue Arts— Number of houses for which applications were received 6 Number of dwellings comprised therein 12 Number of Certificates granted (houses) — „ „ refused ( „ ) — „ „ deferred ( „ ) † 6 Number of prosecutions under By-lairs 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) For the prevention of keeping of animals in such a manner as to be injurious to health - (d) As to paving of yards, &c., of dwelling houses — (e) In connection with the removal of offensive matter, &e. — (f) As to cesspools and privies, removal and disposal of refuse, &c. - (g)) For securing the cleanliness of tanks, cisterns, &c. — (h) With respect to water-closets, earth-closets, &c. — (i) With respect to sufficiency of water supply to waterclosets — Number of prosecutions under Dairies, Cowsheds and Milkshops Orders— Dirty milk utensils 1 Number of prosecutions under By-hues under Metropolis Management Acts— (a) With respect to drainage, &c. 6 (b) With respect to deposit of plans as to drainage, &c. 10 London County Council (General Powers) Act, 1903, Part VIII.— Number of prosecutions for breach of by-laws as to conveyance of dead horse through street - † These 6 houses comprised 12 "dwellings." 121 TABLE V—continued. London County Council (General Powers) Act, 1904, Tart IV.— Number of filthy articles purified (Sec. 19) — „ „ „ destroyed (Sec. 19) - ,, verminous rooms cleansed (Sec. 20) 96 „ „ houses „ (Sec. 20) 46 „ sanitary conveniences altered (Sec. 22) — „ „ ,, removed (Sec. 22) — „ fixed ashpits removed (Sec. 23) 24 Mortuaries — Total number of bodies removed 84 Total number of infectious bodies removed — London County Council (General Powers) Act, 1907, Part XII., and Sec. 48 Public Health (London) Act, 1891— Number of tenement houses in which additional water taps and sinks have been provided (Sec. 78) 105 122 TABLE VI. Vital Statistics of the Borough. (The rates and estimated populations in the following tables have been corrected in view of the returns obtained at the Census of 1911.) 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 82380 1516 18.4 904 11.0 133 87.7 460 5.6 33 0.40 58 0.70 1903 82730 1453 17.6 837 10.1 126 86.7 311 3.7 16 0.19 42 0.51 1904 83080 1445 17.4 892 10.7 161 111.4 301 3.6 20 0.24 48 0.58 1905 83430 1421 17.0 823 9.9 133 93.6 295 3.5 14 0.17 38 0.45 1906 83780 1437 17.1 850 101 111 77 .2 557 6.6 22 0.26 49 0.58 1907 84130 1359 16.1 817 9.7 98 73. 1 498 5.9 15 0.18 41 0.49 1908 81480 1400 16.6 803 9.5 97 69.3 383 4.5 20 0.24 38 0.45 1909 84830 1328 15.6 889 9.9 99 74.5 325 3.8 21 0.25 49 0.58 1910 85210 1340 15.7 829 9.7 81 60.4 233 2.8 13 0.16 45 0.54 1911 85599 1276 149 847 9.9 115 82.3 345 4.0 25 0.29 51 0.59 TABLE VI. (1). Vital Statistics of No. 1 (Town) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. 7 Principa Epidemic Diseases. Deaths. Number. Eptimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Kate per 1000 Births. Cases occurring i (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 12120 192 15.8 163 13.4 20 104.1 64 5.3 4 0.33 8 0.66 1903 12310 194 15.7 127 10.3 14 72.1 38 3.1 1 0.08 10 0.81 1904 12500 195 15.6 125 10.0 20 102 5 65 5.2 4 0.32 2 0.16 1905 12690 194 153 127 10.0 24 123.7 72 5.7 3 0.24 6 0.47 1906 12870 205 15.9 131 10.2 21 102.4 107 8.3 6 0.47 11 0.85 1907 13070 185 14.1 152 11.6 15 81.1 105 8.0 2 0.15 3 0.23 1908 13250 225 17.0 108 8.1 11 48.8 65 4.9 1 0.07 5 0.37 1909 13430 196 14.6 140 10.4 15 76.5 53 3.9 4 0.30 8 0.59 1910 13610 199 146 118 8.7 15 75.4 25 1.8 1 0.07 1 0.07 1911 13820 207 15.0 133 9.6 19 91.8 71 5.1 7 0.51 14 1.01 123 TABLE VI. (2). Yital Statistics of No. 2 (Belsize) Ward. 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 13030 239 183 135 104 18 75'3 94 72 9 0*69 12 092 1903 13110 211 16-1 121 92 13 60 4*6 9 0*14 3 0*23 1904 13200 217 ie-4 141 I0'7 23 105*9 47 3*6 S 0*23 8 0*61 1905 13280 209 15-7 131 9-9 13 622 42 3*2 9 0*15 5 0'38 IPOfi 13370 187 14 0 127 9'5 8 42'8 60 4-5 4 0-30 1907 13450 205 15-2 114 85 13 634 63 4-7 3 0*22 11 0-S2 1908 13530 205 15-1 126 9\3 8 39() 81 60 1 0-07 4 0'29 1909 13610 204 150 130 95 16 78-4 88 65 5 037 8 059 1910 13710 •-'07 15 1 119 8-7 9 43'5 49 36 »> 011 8 058 1911 13780 189 1.3-7 135 97 17 900 78 57 2 014 5 036 TABLE VI. (3). Yital Statistics of No. 3 (Adelaide) Ward. ct o <D . ci si a v .5 ^ C.2 Crs fa no o CH 1 Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. 0) -Q £ P z Estimated rate per 1000 of the Population. V £ 1 j Estimated rate ! per 1000 of the Population. o rQ s 3 fc . f- at: o3 ca Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population. ti a '2H M d y 0 0 CO A ci <0 P Death-rate per 1000 of the Population. 0) & £ z, Estimated rate per 1000 of the 1 Population. 1902 10350 103 99 95 96 3 29*1 40 8-9 2 019 2 0-19 1903 10310 95 92 101 9-8 9 94 7 22 21 1 0 10 1 010 1904 10260 100 97 99 96 13 1300 36 3.5 2 0-19 2 019 1905 10220 96 9*4 92 90 4 417 27 2-6 1 0.10 1 o-o 1906 10170 97 9 5 92 90 10 103-1 29 2 8 1 0-10 1907 10120 75 7-4 86 8-5 8 106*7 29 29 i o-io 1 010 1908 10070 93 9*2 78 7*7 6 64-6 30 30 2 0-20 4 040 1901 1P040 83 8*3 88 8*8 4 48 2 16 1-6 2 ()-2o 4 0-40 1910 10000 96 96 78 7-8 o 20-8 22 2 I 010 2 0.20 1911 9950 82 8-2 99 99 6 73-2 19 1-9 3 030 4 040 124 TABLE VI. (4). Vital Statistics of No. 4 (Central) Ward. 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. Kate 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 9190 110 12.0 71 7.7 11 100.0 40 4.3 ... ... ... ... 1903 9260 99 10.7 60 6.5 8 80.8 34 3.7 4 0.43 4 0.43 1904 9330 90 9.6 62 6.6 11 122.2 17 1.8 ... ... 2 0.21 1905 9400 113 120 60 6.4 5 44.2 24 2.5 1 0.11 1 0.11 1906 9470 95 10.0 83 8.8 3 31.6 34 3.6 ... ... 1 0.10 1907 9540 108 11.3 68 7.1 9 83.3 33 3.4 2 0.21 2 0.21 1908 9010 104 10.8 82 8.5 6 57.7 33 3.4 1 0.10 2 0.20 1909 9G80 110 12.0 63 6.5 3 25.9 29 3.0 2 0.21 5 0.52 1910 9770 105 10.7 82 8.4 8 76.2 23 2.9 2 0.20 2 0.20 1911 9859 92 9.3 75 7.6 8 87.0 25 2.5 1 0.10 2 0.20 TABLE VI. (5). Vital Statistics of No. 5 (West End) Ward. c3 o> o . H 9 .3 >> lo OT3 |1 &o o Ph 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 12250 275 22 4. 107 8-7 20 721 102 8-3 0-49 10 082 1903 12320 213 19-7 111 90 21 864 55 4*5 2 016 2 0-16 190-1 12380 283 22-8 120 9-7 22 77-7 70 5*6 3 024 8 0'65 1905 12150 250 20'1 131 10 5 23 920 29 23 2 0* 16 11 0-88 1906 12510 250 20-7 115 9-2 14 54'1 1G8 13-4 5 0-40 9 0-72 1907 12580 250 199 114 91 16 64 0 153 12-2 4 0-32 9 071 1908 12640 254 20'1 121 96 26 102-4 68 5-4 10 0-79 12 0-95 1909 12700 239 18-8 118 9-3 13 54'I 51 40 2 010 7 0.55 1910 12770 216 16-9 121 95 17 78-7 41 34 4 0 31 13 1 02 1911 12850 216 168 102 79 15 69-4 44 34 5 039 5 0.39 125 TABLE VI. (6). Vital Statistics of No. 6 (Kilburn) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infections Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per l000 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 14790 435 29.4 219 14.8 45 103.4 76 5.1 11 0.74 23 1.55 1903 14800 417 28.2 184 12.4 39 93.5 59 4.0 3 0.20 15 1.01 1904 14810 408 27.5 206 13.9 54 132.3 43 2.9 8 0.54 25 1.69 1905 14820 426 28.7 171 11.5 50 117.4 57 3.8 2 0.13 9 0.61 1906 14840 444 29.9 197 13.3 41 92.0 128 8.6 5 0.34 16 1.08 1907 14850 391 26.3 179 12.0 28 71.6 86 5.8 3 0 20 13 0.87 1908 14880 393 26.4 186 12.5 30 76.3 72 4.8 4 0.27 9 0.60 1909 14890 341 229 182 12.2 37 108.5 67 4.5 6 0.40 10 0.67 1910 14900 379 25.4 192 12.9 24 63.3 52 3.5 3 0.20 17 1.14 1911 14920 317 23.2 179 12.0 31 89.3 82 5.5 6 0.40 17 1.14 TABLE VI. (7). Vital Statistics of Na. 7 (Priory) Ward. 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 p opulation. 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 10650 162 15.2 110 10.3 16 98.7 44 4.1 1 0.94 3 0.98 1908 10620 194 18.3 116 10.9 21 108.2 43 4.0 3 0.28 7 0.66 1904 10600 152 14.3 121 11.4 13 85.5 23 2.2 .. .. .. .. 1905 10570 133 12.6 103 9.7 14 105.3 44 4.2 3 0.28 5 0.47 1906 10550 150 14.2 93 8.8 9 60.0 31 2.9 2 0.19 4 0.38 1907 10520 127 12.1 94 8.9 7 55.1 29 2.7 .. .. 2 0.19 1908 10500 126 12 0 93 8.8 10 79.3 34 3.2 1 0.09 2 0.19 1909 10480 149 14.2 111 10.6 11 73.8 21 2.0 .. .. 7 0.67 1910 10150 138 13.2 111 10.6 6 43.5 13 1.2 .. .. 2 0.19 1911 10420 143 13.7 115 11.0 9 63.0 26 2.5 1 0.09 4 0.38 126 Table VII. Vital Statistics of Hampstead, compared with England and Wales. Year. Birth rate per 1000. Natural increase Hampstead. Seven Principal Epidemic Diseases deathrate per 1000. Notfiable Infectious disease rate per 1000 Hampstead. General death-rate per 1000. Hampstead. England and Wales. Hampstead. England and Wales. Hampstead. England and Wales. 1875 1 22.6 35.4 394 3.4 12.5 22.7 1876 21.4 36.3 367 — 3.1 — 15.2 20.9 1877 24.0 35.0 413 — 2.7 — 13.7 20.3 187S 24.5 35.6 409 —- 3.4 — 14.8 21.6 1879 22.8 34.7 365 - 1.9 — 1.3.2 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 80 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 0.78 2.05 5.6 10.6 16.9 1902 18.4 28.6 612 0.70 1.64 *5.6 11.0 16.2 1903 17.6 28.4 616 0.51 1.46 *3.8 10.1 15.4 1904 17.4 27.9 553 0.58 1.94 *3.6 10.7 16.2 1905 17.0 27.2 598 0.45 1.52 3.5 9.9 15.2 1906 17.1 27.0 587 0.58 1.73 6.6 10.1 15.4 1907 16.1 26.3 524 0.49 1.26 5.9 9.7 15.0 1908 16.6 26.5 597 0.45 1.29 4.5 9.5 14.7 1909 15.6 25.6 489 0.58 1.12 3.8 9.9 14.5 1910 15.7 24.8 511 0.54 0.99 2.7 9.7 13.4 1911 14.9 24.4 429 0.59 1.9 *4.0 9.9 14.6 * Excluding Chicken-pox, which was notifiable during certain periods of these years. INDEX. PAGE Accident, Deaths from 26 Adulteration 85-87 Alcoholism 25 Analyses, Rasults of 85-87 Analytical Work, Report on 103 Anti-toxin 47 Area of Borough 16 Bacteriological Examinations 47 Bakehouses 93, 94 Birth-Rate 18 Births, Illegitimate 18 ,, Number of 18 „ „ in Wards 19 Cancer 24 Census Statistics 15 Chicken-pox 43 Circulatory System, Diseases of 26 Cleansing of School Children 73 Combined Drainage 73 Complaints Received 88 Consumption 53.64 Customs and Inland Revenue Acts 74 Dairies 83, 84 Death-Rate General 20 ,, Infantile 29 Death Returns 22 Deaths at various ages 22 „ Causes of 24.26 „ in Public Institutions 23,24 ,, Non-resident 22 „ Number of 19 „ Outlying 22 „ Uncertified 22 Diarrhoea 52 Diphtheria 46, 47 Disinfaction 65 Drainage Work 72, 73 Enteric Fever 47, 48 Epidemic Diseases, Principal Deaths, and Death-Rate 50 Erysipelas 49 128 PAGE Factories 97 Factory and Workshop Act, 1901 91-100 Fever 47,48 Food Inspection 81 Food Premises 81-83 Health Visiting 34, 35 Home Office Tables 97-100 Homework 96,99 Houses Let in Lodgings 74 Housing, Town Planning, etc., Act, 1909 74-79 Ice Cream 84 Infantile Mortality 29-35 Infectious Diseases 39-65 ,, „ Notifiable 39-50 „ „ „ Attack-Rate 39 „ „ „ Deaths and Death-Rate 40 Inspections and Re-inspections of Premises 71 Legal Proceedings 107-111 Local Government Board Tables 64, 115-118 Marriages, Number of 1911, and rates 1901-1911 17 Measles 51 Milkshops and Milk Supply 83, 84 Mortuary, Public 79, 80 Natural Increase of Population 19 Non-resident Deaths 22 Notifiable Infectious Diseases 39-50 Notification of Births Act, 1907 34 Nuisances, Inspection of 71 Ophthalmia Neonatorum 49,50 Outlying Deaths 22 Outworkers 96-99 Polio-myelitis 49 Population, Density of 16 „ Estimated to middle of 1911 13 „ InWards 16 ,, Natural Increase of 19 Principal Epidemic Diseases 50-52 „ ,, „ Deaths and Death-Rate 50 Public Health Committee 5 Puerperal Fever 48 Pulmonary Tuberculosis 53-64 Respiratory System, Diseases of 26 Restaurant Kitchens 95,96 Sale of Food and Drugs Acts 85-87 129 PAGE Sanitary Administration, General 69-88 Scarlet Fever 44,45 Senile Mortality 24 Slaughterhouses 81 Small-pox 43 Staff of the Public Health Department 6 Suicide 26 Summary of Vital Statistics 11 Tenement Houses, Water Supply of 72 „ „ Registration of 74 Tuberculosis 53-64 Uncertified Deaths 22 Underground Rooms 76-79 Vaccination 43 Vital Statistics 11-26 Water Supply, Certificates as to 72 „ „ of Tenement Houses 72 Whooping Cough 52 Workshops 91-94 Workplaces 95,96