HAMP 19 THE Metropolitan Borough of Hampstead. REPORT FOR THE YEAR 1914. OF THE Medical Officer of Health, FRANK E. SCRASE, F.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Lond.) CONTENTS. pages. SECTION A. Natural and Social Conditions of the Borough (including a review of the Vital Statistics, etc.) 9—30 ,, B. Sanitary Circumstances of the Borough 31—66 ,, C. Sanitary Administration of the Borough 67—72 ,, D. Prevalence of and Control over Acute Infectious Diseases 73—102 ,, E. Prevalence of and Control over Tuberculosis 103-122 „ F. Investigation of other diseases 123—130 ,, G. Means for preventing Mortality in Childbirth and in Infancy 131—140 „ H. Vital Statistics of the Borough, etc. 141—154 ,, I. Legal Proceedings 155—162 APPENDIX Report of the Public Analyst on the Analytical Work of the Year 163—166 INDEX 167—169 5 PUBLIC HEALTH COMMITTEE. NOVEMBER, 1913-14. Ex- Officio. His Worship The Mayor. (Mr. Alderman E. A. O'Bryen, .J.P.) Chairman. Mr. Councillor A. B. Weaver. Miss Councillor M. E. Balkwill. Mr. Councillor G. Buckle. „ F. C. Channing. ,, C. W. Cunnington, M.R.C.S., D.P.H „ J. I. Eraser. „ C. J. Higginson. „ J. H. North. „ T. H. Nunn. „ E. S. Payne. „ W. H. "Warner. „ R. J. J. Willis 7 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N. W. Ist June, 1915. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Madam, and Gentlemen, I have the honour to submit to you the Annual Report on the Public Health and Sanitary Condition of the Borough of Hampstead for the year 1914. In preparing this Report, I have re-arranged the order of the subject-matter, so as to bring it into conformity with the order of subjects suggested by the Local Government Board. In presenting this review of the work of the Public Health Department for 1914, I wish to thank the Council and the Chairman and Members of the Public Health Committee for the kindly support and encouragement they have ever given me. I desire also to express my appreciation of the earnest efforts of the members of the staff of the Department whilst according me their assistance and able co-operation. I have the honour to be, Mr. Mayor, Madam, and Gentlemen, Your obedient Servant, FRANK E. SCRASE, Medical Officer of Health. SECTION A. Natural and Social Conditions of the Borough (including a review of the Vital Statistics, etc.). 11 Summary of Vital Statistics for 1914. Population estimated to middle of 1914 86,731 Density „ „ „ 8.3 persons per acre Births 1273 Birth-Rate 14.7 Marriages 825 Marriage Rate 19.0 Deaths 913 Death-Rate 105 Infantile Mortality 72 per 1000 births Notifiable Infectious Diseases Attack Rate (excluding Tuberculosis) 6.7 Notifiable Infectious Diseases Death Rate „ 0.26 Death-Rate from the Principal Epidemic Diseases 0.39 Death-Rate from Pulmonary Tuberculosis 0.66 Death-Rate from All Forms of Tuberculosis 0.82 Census, 1911. Population 85,495 Buildings used as Dwellings 11,976 Ordinary Dwelling Houses 10,062 Total families or separate occupiers 18,625 Area of Borough 2265 acres „ „ (excluding area covered by water) 2253 acres 13 Physical Features and General Character of the Borough. I have not infrequently been asked by people from different parts of the country and from abroad, for advice as to the desirability of Hampstead as a residential district, and as to its suitability in respect of certain diseases. The following brief notes on the climatic and geological condition of Hampstead, may, therefore, be of use to any such persons who may be contemplating residence in the Metropolis. Hampstead's position is upon a hill, which raises it considerably above other parts of London. The meteorological station which has been built upon the covered reservoir of the Metropolitan Water Board adjoining the White Stone Pond is 450 feet above mean ordnance data. The height of the ground at the foot of the Flag-staff is 438 feet. The lowest parts of the Borough are at Chalk Farm and Kilburn Priory, the former 100 feet, and the latter 101 feet, above sea level. To its elevation, Hampstead, owes its climatic conditions which are in most respects superior to the remainder of London. Hampstead's chief advantages are,—that its sunshine is greater, and its extremes of temperature are less than other parts of London. Sunshine.—That Hampstead possesses marked advantages in the matter of bright sunshine has often been informally commented upon, but only in recent years has the amount of sunshine been scientifically recorded, the first record being taken in 1909, in which year the Hampstead Scientific Society installed a recorder on the summit of the Heath. The following figures show at a glance the superiority of the district to its neighbours, and by inference, its relative freedom from fogs and smoke ; this is especially noticeable during the winter months. These figures indicate the hours of sunshine recorded in different districts of the Metropolis, and it will be seen that at Hampstead more sunshine was recorded than at the other districts, with the exception of Greenwich, but I have reason to believe that the position of the Hampstead recorder causes Hampstead to be somewhat unfairly treated in the matter of sunshine records, and that on clear dry evenings the record may belower than the actual sunshine that existed. Moreover, the amount of sunshine recorded on Hampstead Hill can be shown to be in many instances greater than that of seaside places where people go for sunshine and fresh air, two commodities of which they would have obtained more had they stayed at home. 14 Mean Hours per Day of Bright Sunshine. Mouth. Greenwich. Hampstead. Kew. Tottenham. Westminster. Camden Square. January 0.67 0.94 0.84 0.65 0.28 0.51 February 3.79 2.71 2.93 1.43 2.68 2.04 March 2.83 2.63 2.81 2.61 2.42 2.55 April 7.73 7.67 7.27 7.10 7.20 7.07 May 6.74 6.90 6.52 6.74 6.10 6.03 June 8.90 8.97 8.50 9.07 8.33 7.90 July 5.77 5.48 5.13 5.45 5.42 4.81 August 5.94 5.68 5.58 5.77 5.35 5.42 September 6.80 7.27 6.63 6.77 5.97 5.90 October 2.16 2.26 2.32 1.97 1.97 1.84 November 2.13 2.17 2.17 2.03 1.37 1.63 December 1.29 1.01 1.29 0.63 0.97 0.87 Total 54.75 53.69 51.99 50.24 48.06 46.60 The total actual hours of sunshine represented by the above figures, are as follows :— Greenwich. Hampstead. Kew. Tottenham . Westminster. Camden Square. 1657.1 1631.5 1576.8 1529.3 1460.0 1416.2 Temperature.—The extremes of temperatures recorded in Hampstead are less than the rest of London, and this, again, is due to its elevation. In cool weather, should the wind be calm, the summit of the Heath will be found to be warmer than the adjacent low-lying land, the explanation being that cold air is heavier than warm air, and consequently will accumulate in the valleys and leave the higher lands comparatively warmer. Should there be much wind on, the nights will be colder in the high land than in the valleys. The mean temperature of Hampstead as a whole is lower than the rest of London. In hot weather it is found that Hampstead is cooler than any other place in the vicinity, this being due to the fact that there is always breeze on the hill which keeps the temperature down, while its elevation also aids radiation. During that never-to-be-forgotten August of 1911, when 100 degrees were registered at Greenwich, Hampstead did not registered a higher temperature than 94 degrees, this latter is the highest temperature ever recorded in 15 Hampstead, and corresponds to a wave of terrific heat which occured in that year. Working out the average of recorded temperatures one finds that the summit of the Heath is on the average 2 degrees less than London on a whole. Rainfall.—The average rainfall at Hampstead has been computed at 26 inches, about 2 inches in excess of the London area, or approximately 8 per cent, more than London as a whole, Standing on a hill, however, away from the river, would appear to give it considerable immunity from thunderstorms, these being much less frequent here than in the Thames valley where the major portion of them culminate. Soil.—Hampstead Hill is formed by a huge elevation in the bed of the deposit known as London clay, which forms the whole of the mass up to about 360 feet above sea level. This great cone of earth supports an extensive cap of sand in places 80 feet thick, known as Bagshot sands. Down below the London clay occurs deposits of gravel and sand known as the Woolwich and Reading beds and Thanet sands, and below all again the chalk. Few people realise that Hampstead Heath is really a sandy waste, and that it is to the presence of its sandy cap that Hampstead is indebted for the Heath itself. This sandy cap is what is known as an " outlier " of a vast sheet of sand that extends over a large portion of Surrey, Hants, and Berkshire. The Bagshot sands are, for the most part, unfruitful from an agricultural point of view, and Hampstead Heath has remained a Heath probably because its fertility was insufficient to make it worth while enclosing, or, in other words, it possibly saved it from the land-grabber until laws were brought into effect which made it the property of the people. The atmosphere is dry and bracing, and the prevailing winds south-west and mild. The effect of the climate on the health of its citizens is reflected in its death-rate. Ilampstead's is the lowest deathrate in London, and is lower than that of some places to which people go in search of health. At the last Census 2,736 persons, or 3.2 per cent, of the total population were over 70 years of age. This demonstrates that the age of the inhabitants is high, and that we have a great many old people, yet in spite of this our death-rate as a whole is lower than that of any other district in London, and our infantile mortality rate for 1914 stands at the exceedingly low figure of 72 per 1,000 births 16 the rate for London as a whole is 104). The inference is that both to aged people and to those of tender years the climate of Harapstead is benign. Many people have sought advice as to the suitability of Hampstsad for cases of rheumatism, sciatica, lumbago, etc. My experience is that Hampstead compares favourably with any other place in the British Isles as regards these diseases, which seem to be affected mostly by their immediate environment, such as dampness of houses, or of dryness of the soil and atmosphere. The policy of the Hampstead Public Health Department for years has been to render all houses in the neighbourhood as dry as possible, by insisting upon the concreting of all sites and the damp-coursing of all walls. The height and the gradients of Hampstead allow of a well-nigh perfect system of drainage and sewerage. All these have reduced to a remarkable degree the height of the sub-soil water, in fact to such a great extent has this drying-out of the land been carried out that within the memory of many of the inhabitants of the Borough, old streams, such as the Kilbourne on the west side, the Fleet on the east side, the Chalybeate Spring in "Well Walk and the Conduit Spring in Fitzjohn's Avenue, have practically dried out and ceased to flow. To anyone, therefore, who, by circumstances, is compelled to veside in London, I cannot do better than advise them to choose Hampstead for their place of residence. A very clear and valuable description of the locality has been prepared under the auspices of the Hampstead Scientific Society, and published by Fisher Unwin, of Adelphi Terrace, entitled " Hampstead Heath; " and to those who may wish to go more fully into the Geology and Natural History of Hampstead, I would recommend the perusal of this exceedingly interesting volume. Population. The Registrar General's provisional estimate of the population of Hampstead at the middle of 1914, based upon the results of the Censuses of 1901 and 1911 was 86,731. This estimate has been adopted in the Report, and it forms the basis upon which the various rates have been calculated. The last census showed that in the Adelaide and Priory Wards the population was decreasing, and this fact, together with the demolitions 17 in connection with the railway widening to which reference was made in my last Annual Report, has been borne in mind in forming the estimates of the "Ward populations. The following is an approximate estimate of the population of each Ward at the middle of 1914 :— Ward 1 (Town) 14,400 „ 2 (Belsize) 14,100 „ 3 (Adelaide) 9,730 „ 4 (Central) 10,061 „ 5 (West End) 13,100 „ 6 (Kilburn) 15,300 „ 7 (Priory) 10,040 The Borough 86,731 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 38.3. The proportion of persons to the acre at the Census of 1911 was 37.7. At the Census of 1881 the number of persons per acre was 23, in 1891 it was 30, and 1901 it was 36. Natural Increase of Population. The natural increase of the population—i.e., the excess of births over deaths in 1914 was 360, as compared with 374 in the previous year. Reference to Table VII., page 153, shows the decline in the natural increase in our population that has occurred in recent years. The greatest natural increase of which we have record occurred in 1889. The figure for that year was nearly equalled by that of 1900, but since this latter date the decline has continued, until the lowest figure recorded has been reached in the year now under review ; thus, a continuously falling birth-rate means a continual rising of the mean age of the population. Marriages. According to a return kindly furnished to me by the Superintendent Registrar of Hampstead, it appears that 825 marriages were registered in the Borough during 1914. 18 The total number of persons married in Hampstead during 1914 was 1,650, which is equivalent to a rate of 19.0 per 1000 of the population. This is the highest marriage-rate that has obtained for very many years, and I am informed by the Superintendent Registrar that this increase is due in no small measure to the number of marriages that took place of sailors and soldiers. In 1913, the marriages of 1,286 persons were registered, equivalent to a rate of 14.9 per 1000 of the population. The following Table gives the marriage rates for the year: 1902—1912, and the average rate for the decade, 1904—1913. Year. No. of persona married per 1000 of the population. 1904 15.0 1905 14.4 1906 13.8 1907 15.3 1908 14.7 1909 16.0 1910 14.8 1911 16.3 1912 15.0 1913 14.9 1914 Average for the decade 15.0 19.0 Births. During the year, 1,213 births were registered in Hampstead, a decrease of 45 as compared with the number—1,258—registered in the previous year. Of the total births 610 were of male and 603 of female children. In addition, 63 births of children whose mothers were Hampstead residents occurred in lying-in institutions, etc., outside the Borough, and three of the births registered in Hampstead belonged to other districts, and should be deducted from the total. This information is supplied to me at the close of the year by the Registrar-General, with whom an arrangement has been made for furnishing me with quarterly returns giving details of the births of children whose mothers were Hampstead residents, that occur outside Hampstead, but in the Metropolis. After these corrections have been made, the nett number 19 of births belonging to Hampstead is found to be 1,273 as compared with 1,325 in 1913—a decrease of 52, 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. Still-Births. Still-births are required to be notified to Medical Officers of Health under the provisions of the Notification of Births Act, 1907. This Act applies to any child born after the expiration of the twenty-eighth week of pregnancy, whether alive or dead. Calculated on the total number of births notified, the still-births for the year 1914 represent a percentage of 2.4. The actual numbers of still-births notified in each year since 1909 are as follows:—1909, 28; 1910,21; 1911,25; 1912,28; 1913,23; 1914,24. At present, still-births are not required by law to be registered, as is the case with the births of children born alive. Birth-Rate. Calculated on the number of births registered in the Borough the birth-rate was 14.0 per 1000 of the population, as compared with the rate of 14.3 per 1000 in 1913. 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 place in the Borough, but belonging to other districts, the rate is found to be 14.7, as compared with the rate of 15.0 in 1913, and 15.2, the average for the years 1909-1913. This rate of 14.7 is the lowest ever recorded in Hampstead, the next lowest being that for the years 1911 and 1912, when the rate was 14.9. 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, notwithstanding the fact that the marriage rate has not declined in recent years, but has remained constant up to 1913 at about 15 per 1000. 20 The following table shows the Ward and sex-distribution of the live-births, and the birth-rate for each Ward :— Ward. Births. Birth-rate per 1000 of the population. Males. Females. Total. No. 1 (Town) 73 79 152 10.5 No. 2 (Belsize) 114 81 195 13.8 No. 3 (Adelaide) 46 42 88 9.0 No. 4 (Central) 31 53 84 8.3 No. 5 (West End) 119 137 256 19.5 No. 6 (Kilburn) 196 189 385 25.2 No. 7 (Priory) 59 54 113 11.2 The Borough 638 635 1273 14.7 In connection with this table, a comparison with the death-rates in Wards, given on page 22 is interesting. It will be seen that Hampstead depends for its natural increase practically on the West End and Kilburn Wards; while the Town, Belsize, Central, and Priory Wards just manage to hold their own, and the Adelaide Ward fails to do so, the birth rate for that Ward being 9.0, and the death rate 10.2. Illegitimate Births. Out of the total of 1,273 births 55, or 43 per 1000, were those of illegitimate children ; 22 of these were born outside the Borough, chiefly in lying-in institutions. I append a table of the illegitimate births occurring in the Borough for the past twelve years, by which it will be seen that the illegitimate 21 birth-rate for 1914 presents a marked improvement over the two preceding years. Year. Number of illegitimate births. Illegitimate birth-rate per 1000 births registered. 1902 39 25.7 1903 42 28.9 1904 42 29.1 1905 35 24.6 1906 34 24.0 1907 43 32.0 1908 29 21.0 1909 43 33.0 1910 36 28.0 1911 37 29.0 1912 76 59.3 1913 73 55.1 1914 55 43.2 Deaths. The total deaths registered in Hampstead during the year amounted to 1,145. Of these, however, no less than 420 were of persons not belonging to the Borough, while the deaths of 188 residents of Hampstead who died in outlying districts were also registered during the year. Information of the deaths of Hampstead residents that occur outside the Borough is furnished by the Registrar-General. The total number of deaths, therefore, amongst persons belonging to Hampstead amounted to 913. Death-Rate.. The death-rate, calculated upon the total number of deaths (whether of resident or non-resident persons) registered in the Borough during the year, was 13.2 per 1000 of the population; but after subtracting from the total deaths registered, the deaths of non-resident persons dying in Hampstead, and adding the deaths of Hampstead residents who died outside the district, the recorded death-rate is found to be 10.5 per 1000 of the population, as compared with the rate of 10.8 per 1000 of the population in 1913. The average recorded death-rate for the five years 1909-1913 was 10.1. 22 The following are the death-rates for each of the Wards : - WARD. Death-rate per 1000 of the population. No. 1 (Town) 9.1 No. 2 (Belsize) 10.0 No. 3 (Adelaide) 10.2 No. 4 (Central) 7.5 No, 5 (West End) 10.7 No. 6 (Kilburn) 13.8 No. 7 (Priory) 10.9 In the table on page 153 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, and the Metropolitan Cities and Boroughs :— 23 Table showing the Death — Rates from All Causes in the County of London, the City of London, and the Metropolitan Boroughs during 1914, as calculated by the Registrar-General. DISTRICT. Death-rate from all causes. Hampstead 10.4 Wandsworth 10.9 Lewisham 10.9 City of Westminster 12.6 Paddington 13.0 Kensington 13.1 Stoke Newington 13.1 Battersea 13.3 Fulham 13.4 City of London 13.4 Chelsea 13.5 Camberwell 13.7 Woolwich 13.8 St. Marylebone 13.8 Hammersmith 13.9 Hackney 13.9 Deptford 14.4 Lambeth 14.6 Greenwich 14.7 Islington 15.2 St. Pancras 15.6 Bethnal Green 16.0 Holborn 16.1 Stepney 16.5 Poplar 17.1 Bermondsey 17.4 Southwark 17.8 Shoreditch 19.0 Finsbury 19.6 County of London 14.4 Note. —The rate stated by the Registrar-General differs from that as calculated by me This is accounted for by the fact that the Registrar-General's figures have not yet been completely corrected for transferable deaths. 24 Deaths at Various Ages. The following table shows the number of deaths at the various uge periods, the causes of such deaths being shown in Tables III. and IV., pages 145 and 146. 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 91 17 21 25 33 117 239 370 913 It is interesting to note how with the increasing age of the population, the proportion of deaths at ages of 25 and upwards have also increased in recent years. Year. DEATHS AT AGES Totals. under 25 25 and upwards 1911 209 638 847 1912 190 671 861 1913 209 742 951 1914 187 726 913 Uncertified Deaths. The deaths of 2 Hampstead residents in 1914, were " uncertified." According to the instructions of the Registrar-General, all deaths certified by registered medical practitioners and all inquest cases are classed as " certified," and any other deaths are regarded as " uncertified." Deaths in Institutions. The number of deaths of Hampstead residents that occurred in institutions was 298 or 32.8 per cent, of the total deaths of residents. 91 deaths took place in workhouses or workhouse infirmaries, equivalent to 30 per cent. of the deaths in institutions or 10 per cent. of the total deaths of Hampstead residents. 25 The following is a list of the institutions, and the number of deaths which occurred in each: — Deaths of Hampstead Residents in Institutions. Institution. Totals. Group Totals. Infirmaries and Workhouses— Hampstead Workhouse 86 91 St. James Infirmary, S.W. 1 St. Pancras Infirmary, N.W. 2 1 St. Marylebone Infirmary. W. 2 Hospitals, Sanatoria, Nursing Homes, etc.— 143, Abbey Road 3 All Hallows Hospital, Ditchingham 1 Friedenheim, Avenue Road 9 Bath Road Nursing Home 1 73. Belsize Park Gardens 1 188, Belsize Road 1 33, Belsize Square 3 34, Belsize Square 1 British Home and Hospital for Incurables 1 Bethlem Royal Hospital 1 6, Beaumont Street, W. 1 Brooke House, Upper Clapton 1 Brompton 2 Convalescent Home for Children, Grosvenor Place 1 6, Colosseum Terrace 1 Children's Hospital, Great Ormonde Street, W. 4 Children's Hospital, Paddington Green 1 Charing Cross Hospital 1 Central London Throat and Ear Hospital 1 Cottage Hospital, Harlesden Road 1 Fallow Court Home, North Finchley 1 80, Fordwych Road 2 Great Northern Hospital 1 German Hospital, Dalston 1 Guy's Hospital 3 Hampstead General Hospital 23 12, Hemstal Road 1 Holloway Sanatorium, Virginia Water 2 Homoeopathic Hospital 2 Hospital for Women, Soho 1 Hospital of St. John and St. Elizabeth 4 Hostel of God, Clapham 1 Infants' Hospital, Vincent Square, W. 1 12, Lancaster Place 1 London Fever Hospital 1 London Temperance Hospital 3 London Hospital 3 19, Manchester Square, W. 1 Manna Mead. The Grove, Greenwich 1 3, Merton Road 1 Metropolitan Convalescent Home, Bexhill 1 Metropolitan Ear, Nose and Throat Hospital 1 Middlesex Hospital 15 26 Deaths of Hampstead Residents in Institutions—cord. Institution. Totals. Group Totals. Hospitals, Sanatoria, Nursing Homes, etc.—cont. Mundeley Sanatorium, Gimingham 1 166 Northumberland House, Stoke Newington 1 Nursing Home, Clarence Road. Bognor 1 32, Parkhill Road 1 Peckham House 1 216, Portsdown Road, W. 1 Putney Hospital 1 Queen Mary's Hospital 1 10, Rosslyn Hill 3 Royal Waterloo Hospital 1 Royal Sea Bathing Hospital 1 St. Bartholomew's Hospital 4 St. Bernard Home, 39, Brunswick Road, Hove 1 St. Catherine's Hospital, Ramsgate 1 St. George's Hospital 2 St. Luke's Hospital 2 St. Luke's House, 14, Pembridge Square W. 4 St. Mary's Hospital 8 St. Thomas's Hospital 2 1, Sandwell Crescent 3 97, South Hill Park 1 Southend Borough Sanatorium 1 7, The Terrace, St. Pancras 2 University College Hospital 5 4, Upper Wimpole Street, W. 2 Victoria Nursing Home, Harrogate 1 14, Warrington Lodge, Paddington 1 69, Warrington Crescent, Paddington 1 Westminster Hospital 1 West London Hospital 2 Metropolitan Asylums Board's Hospitals— Eastern 2 12 Northern 1 North Eastern 2 Northwestern 6 Western 1 Asylums— Banstead 2 29 Berkshire 1 Brentwood, South Weald 1 Camberwell House 2 Claybury 3 Colney Hatch 5 Coppice 1 Dartford Heath 1 Hanwell 6 Leavesden 1 Long Grove 1 Manor 1 Tooting Bee 4 298 27 Causes of Death. The causes of death are given in Table III. of the Local Government Board's series of tables, see page 145. The mortality from the various communicable diseases is given in the section of the Report devoted to those diseases, see pages 75-100 and 105-122. 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 twelve years 1903-14 :— Year. No. of Deaths from Cancer. Death-rate per 1000 of the population. 1903 105 1.27 1904 85 1.02 1905 73 0.87 1906 93 1.11 1907 69 0.82 1908 84 0.99 1909 85 1.00 1910 90 1.06 1911 86 1.00 1912 102 1.19 1913 100 1.14 1914 114 1.31 Of the 114 deaths from cancer, 68 were of females and 46 of males, but on this point it must be borne in mind that the population of the Borough was found at the census to consist of 52,688 females and 32,807 males, and thus for this year Cancer was more frequent in males than in females. In 42 cases the patients were over 65 years of age. The next table gives the anatomical distribution of the disease in each sex. The next table gives the anatomical distribution of the disease in each sex. Situation. Males. Females. Total. Buccal cavity 8 2 10 Stomach, Liver, &c. 13 IT 30 Peritoneum, Intestinesand Rectum 12 17 29 Genital Organs 2 11 13 Breast — 11 11 Other, or unspecified, organs 11 10 21 Totals 46 58 114 28 Alcoholism. In 1 case 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, 9, as compared with 18 in 1913, but this is certainly an under-statement of the total mortality that may be directly attributed to this drug. A true return of the mortality from Alcoholism and Venereal disease will not be forthcoming until some radical alteration takes place in the method of death certification. I feel sure that if the system of notification of births was extended to the notification of deaths, and the medical attendant was required to notify deaths and their causes to the Medical Officer of Health, we should have a much more reliable guide to the death-rate from causes such as Alcoholism and Venereal disease. Organic Heart Disease. This accounted for 97 deaths, as compared with 104 in 1913. Diseases of the Respiratory System. The total mortality from these diseases was 115, as compared with 145 in 1913. Twenty-one deaths occurred in children under five years of age, and 59 in persons aged from 65 and upwards. Of the total deaths, 45 were due to bronchitis, 59 to pneumonia, and 11 to other diseases of the respiratory organs. Violent Deaths (excluding Suicide.) Twenty-five deaths were classified under this heading, as compared with 21 in 1913. Two were due to poisoning, 2 to burns, 6 to falls, 5 to injuries caused by being knocked down by motor vehicles, 1 to injuries caused by being knocked down by a railway train, 1 to syncope induced by bathing, 1 to a machinery accident, 1 to shock following a severe operation necessitated by an accident that occurred on a barge, and 6 to suffocation. Of the 6 deaths due to suffocation 4 were those of children in bed with their parents; the children's ages being 2 days, and 8, 9 and 11 weeks respectively. 29 Injuries at the War. One death was the result of a bullet wound reeeived at the War. Suicide. Eight persons committed suicide, as against 12 in 1913. In 2 cases the cause of death was poisoning, 1 death was due to strangulation, 2 to bullet wounds from pistols or revolvers, 1 to cut throat, and 2 to drowning. SECTION B. Sanitary Circumstances of the Borough 33 Sanitary Inspections, etc. Number of Sanitary Inspections, etc., Made; Notices Served; Letters, etc., Issued, and Sanitary Works carried out. 1913 1,914 Number of Inspections 9,786 9,467 „ Re-inspections 15,619 13,333 „ Intimation Notices issued 1,258 1,046 „ Statutory Notices issued 938 815 „ Letters issued 8,347 7,172 „ Notifications sent to "Head Teachers" of Schools respecting notified cases of infectious disease 540 862 „ Notifications sent to Medical Officers of Health of other Boroughs respecting Hampstead children attending schools in their districts 32 62 „ Notifications sent to "Head Teachers" of Schools repecting cases of measles 188 104 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 400 Dampness in houses, or parts of houses, abated 185 Dilapidated houses, or parts of houses, repaired 106 Overcrowding— Cases of, abated (rooms) after service of notice 6 „ „ „ without service of notice 4 Underground rooms — Illegal occupation discontinued 28 Structural works carried out 52 Below floors — Spaces below floors in the basement or ground floors ventilated 186 Roofs— Repaired 145 34 Gutterings— Repaired or renewed 169 Rainwater pipes— Repaired or renewed 199 Disconnected from drains 12 „ „ soil pipes 4 Waste pipes— Waste pipes of sinks disconnected from drains 24 „ „ „ trapped 442 ,, „ ,, repaired or renewed 258 „ „ „ unstopped 6 „ „ of lavatories disconnected from drains 8 „ „ „ trapped 196 „ „ „ repaired or renewed 190 „ „ „ unstopped 1 „ „ of baths disconnected from drains 13 „ ,, „ trapped 208 ,, ,, „ repaired or renewed 155 „ „ „ unstopped Water supply — Re-instated 13 Water and sinks provided to upper floors of tenement houses 101 Water supply used for domestic purposes disconnected from cisterns for flushing w.c's. 1 Water cisterns— Repaired or renewed 5 Removed from improper positions 40 Cleansed 58 Fitted with close-fitting covers 44 Water-closets— Accommodation provided 9 Additional accommodation provided 30 Separate and sufficient accommodation provided for persons of each sex 1 Removed from improper positions 33 Provided with proper and sufficient external ventilation 45 Improperly constructed apparatus removed and new provided 52 Apparatus repaired or renewed 592 ,, unstopped 17 35 Water-closets—con. Apparatus cleansed 37 „ provided with proper water supply 34 Flushing cisterns repaired or renewed 303 Manholes— Repaired or renewed 625 Drains— Repaired or renewed 785 Cleansed 75 Unstopped 51 Ventilated 133 Ventilating pipe of drains— Carried to a sufficient height above windows 12 Repaired or renewed 65 Fresh-air inlets repaired or renewed 172 Soil pipes— Repaired or renewed 335 Ventilated 31 Gullies and surface drains— Gully traps removed from improper positions 49 „ „ cleansed 15 Inlets or surface drains trapped 11 Paving and draining Washhouses, Areas, Yards, &c. Washhouse or scullery paving repaired or renewed 38 Areas cleansed 5 Area paving repaired or renewed 180 Areas drained 37 Yards or other open spaces paved 191 Paving of yards or other open spaces repaired or renewed 168 Yards or other open spaces drained 83 Floors of buildings in which horses, &c., are kept, paved or repaired 47 Refuse and Receptacles— Dustbins provided 282 „ repaired 1 „ cleansed 1 Fixed ashpits removed 37 36 Refuse and Receptacles—con. Accumulation or deposits of refuse removed 162 Manure receptacles provided 3 ,, ,, amended 1 Nuisances from the improper deposit of trade refuse abated 3 Animals— Nuisances from the improper keeping of animals abated 8 Drainage Work The Bye-laws of the London County Council which 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 1914 the Council have approved 578 plans for the drainage of new buildings, and 7,778 plans for alterations, etc., to drains of existing premises. Daring the year 1914, 865 notices of drainage reconstruction or altei'ation were received, and in 786 cases the work necessitated the deposit of plans and written particulars. In 25 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 786 notices of drainage alterations, etc., requiring the deposit of plans, 339 related to work that involved the entire reconstruction of the drainage system. In 418 cases the work was carried out voluntarily, the number of instances in which voluntary complete reconstruction was carried out being 112. This class of work was chiefly in connection with the larger houses in the Borough, and in many cases the voluntary drainage reconstructions were of a very extensive character. In 294 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. Cleansing Station. During the year, 226 school children, 9 children under school age, and 4 other persons were cleansed at the cleansing station by the 37 Borough Council's Attendant, and while this was in progress their clothing was thoroughly disinfected by being passed through the steam chambers. Certificates at to Writer Supply. The number of certificates issued during the year was 16, as compared with 18 in 1913. These certificates are issued in pursuance of Section 48 of the Public Health (London) Act, 1891, which provides that new houses, or houses rebuilt, shall not be occupied as dwellinghouses until the sanitary authority have certified that they have a proper and sufficient supply of water. 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 20 dwellings, this number being 2 less than the number for which applications were made in 1913. Twentytwo dwellings were certified during the year, the owners having carried out the works necessary to obtain the certificate. In two cases the applications were received in 1913, but the necessary works were not completed until after the close of the year. PREMISES. No. of Dwellings. 2, 3, 6, 8, 9, 10, Belsize Parade, Haverstock Hill 18 187, Sumatra Road 2 20, Belsize Grove 2 Upon receipt of application for a certificate under the above Acts, an extensive and exhaustive examination is made of the premises, and a schedule of requirements is served upon the person making the application. Smoke Nuisances. During the year, observations in this connection were kept in 38 instances by the sanitary inspectors. In 2 cases intimation notices were sent, and in 1 instance it was found necessary to serve a statutory notice. 38 Rag Flock Act, 1911. In my last annual report I pointed out that the decisions of the High Court which had been given in regard to this Act had practically rendered that Act inoperative so far as Hampstead was concerned. Additional decisions have been given this year but they all trend in the same direction. It is a matter for regret that an Act which promised to be one of the most useful enactments so far as domestic sanitation was concerned should have produced such disappointing results. It woidd have been no hardship to anyone to have compelled them to destroy any dirty rag flock in whatever form it might have found its way into the home. Only one sample was taken during the year, and that was upon request of a ratepayer who had purchased a new flock mattress, but I am glad to be able to report that the analysis showed that the flock conformed to the regulations in every respect. Public Mortuary. During the year, the bodies of 80 persons were brought to the mortuary, being 27 less than the number in 1913,—44 by order of the Coroner, 17 by the Police, and 19 at the request of friends of the deceased persons. In 57 instances (or 71 per cent. of the bodies admitted) inquests were held, and in 37 instances (or 46 per cent.) post-mortem examinations were made. The following table indicates the causes of death of the persons whose bodies were received into the Mortuary:— Causes of Death or Verdict. Number of Bodies received. Deaths from natural causes 43 Accidental deaths 16 Suicide 9 Misadventure 6 Wilful Murder 1 Open Verdict 3 Total 78 Two of the bodies received at the Mortuary were those of still-born children, and in one case where an open verdict was returned the body was so decomposed that it was impossible to ascertain whether the child was born alive or not, or to which sex it belonged. 7 O 39 Mortuary Record for the Year 1914. Bodies Admitted. No. of Post-Mortems. No. of Inquests. No. of Funerals from Mortuary. Month. Male. Female. Total. Male. Female. Total. January 5 3 8 4 2 6 6 8 February 7 4 11 3 2 5 8 11 March 4 2 6 1 1 2 5 6 April 2 5 7 1 2 3 5 7 May 6 3 9 4 3 7 9 9 June 2 2 4 — 1 1 2 4 July 1 1 2 1 — 1 1 2 August 4 — 4 3 — 3 4 4 September 2 3 5 2 — 2 2 5 October 6 1 7 2 — 2 6 7 November 5 4 10 1 2 3 8 10 December 5 2 7 2 — 2 3 7 Totals 49 30 * 80 24 13 37 59 80 *The body of a child admitted in November was so decomposed that it was impossible to ascertain to which sex it belonged. 40 Complaints. During 1914, 724 complaints were made of the existence of insanitary conditions. A list of the matters of which complaint was made is given below:- Accumulations 18 Animals improperly kept 10 „ dead 7 Dampness in premises 33 Dirty and dilapidated premises 29 Drains, bad condition of 18 „ defective 15 „ stopped 19 Dust, non-removal 68 Dust receptacles, foul or dilapidated 48 „ absence of, or insufficient 6 Insanitary condition of premises 42 Illness attributable to insanitary conditions 12 Manure not removed 8 Overcrowding and improper mixing of the sexes 14 Rats, nuisance from 9 Roofs and gutters, defective and leaky 7 Rubbish, nuisance from burning 8 Smells 30 „ on premises 28 „ from road gullies 13 „ „ sewer ventilators 42 „ „ stables 2 „ „ drains, etc. 26 „ „ water-closets 7 „ „ manure 3 Smoke nuisances 20 Underground rooms illegally occupied 5 Verminous condition of premises or persons 1 Water, absence of 73 „ leakage of 10 Water cisterns, dirty, &c. 7 Water-closets, accommodation insufficient or absence of 6 „ defective or insanitary 23 „ stopped 4 Yards, unpaved and existing paving defective 3 Miscellaneous 119 793 41 Premises and Occupations controlled by Bye-Laws or Regulations. Houses Let in Lodgings. The number of houses registered as houses let in lodgings at the end of 1914 was 405. The registered houses are situated chiefly in the following streets: — Holton Road King's College Mews East Broomsleigh Street Kingsford Street Canfield Place Kingsgate Road Dunboyne Street Linstead Street Fairfax Mews Lower Cross Road Fleet Road Lowtield Road Iverson Road Netherwood Street Kelson Street Palraerston Road The alterations in the Bye-laws governing these premises, rendered necessary in view of Section 16 of the Housing, Town Planning, etc., Act, 11)09, are still the subject of negotiation between the Borough Council and the Local Government Board. Offensive Businesses. None of the businesses to which Section 19 of the Public Health (London) Act, 1891, relates are carried on in the Borough with the exception of slaughtering of cattle. There are four slaughterhouses, situated as follows 40, Englands Lane; 1? and 69, High Street, and 6, Fairfax Mews. Food. Milk Supply. The number of persons registered as purveyors of milk at the end of 1914 was 73, and the number of premises on which milk is sold was 98. The difference in the two numbers was accounted for by the fact that some of the milk-sellers occupy more than one shop. The premises on which milk is sold are as follows:— Dairies 52 Bakehouses and Confectioners 19 Restaurants and Coffee Shops 10 General Shops 17 Two of the registered milk-sellers do not occupy shops, being registered in reference to refreshment tents on Hampstead Heath on Bank Holidays. 42 During the year, 395 inspections were made of premises where milk is sold, 28 notices were served, and the following works were carried out:— Premises or parts of premises repaired, cleansed, and limewashed 29 Drains repaired or reconstructed 12 Rainwater pipes and gutters renewed 5 Soil pipes reconstructed 3 Water-closets repaired or renewed 9 Water-closets cleansed 10 New sinks fixed. 3 Waste pipes to sinks trapped and renewed 12 Yard paving repaired or renewed 12 Dustbins provided 6 Cisterns cleansed 5 Other defects remedied 14 Section 5 of the London County Council (General Towers) Act, 1908, empowers Sanitary Authorities in London to remove from the register of milk sellers, 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. The proprietor of a general shop applied to be registered as a milk-seller, but his application was refused on the ground that his premises were unsuitable for the storage of milk. The number of general shops on the register is now 17. Other Foods. Food Inspection. The following articles of unsound or diseased food were seized or, voluntarily surrendered to the inspectors during the year. Date. Premises. Food seized or surrendered. Jan. 1st Netherwood Street 1 box greens. May 5th South End Road 6½ lbs. beef. Dec. 2nd Upper Park Road 2 lbs. oranges. Dec. 10th Flask Walk 5½ stone whiting. Dec. 12th High Road, Kilburn 35 lbs. figs and 2½ lbs. medlars. 43 During the year, on Bank Holidays or upon other special occasions, the sanitary inspectors have been on duty on the Heath inspecting food and taking samples for analysis. It has been found, as in previous years, that the food exposed for sale 011 these festival days is, generally speaking, of a wholesome character, the only cases of complaint being against the itinerant or casual vendor of milk. Food Premises. Section 8 of the London County Council (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. This 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. These places are in-pected from time to time, and in a considerable number of cases conditions in contravention of the Act have been found. In 1911, 1912, and 1913 the total number of premises altered in order to comply with the Act was 60, 37, and 71 respectively, as set out in the Reports for those years. I11 1914 the number of premises dealt with was 92. Of these places, 7 were found to have drain inlets in rooms where food was prepared or sold; in 36 premises the drains were defective ; in 76, structural defects, other than drainage defects of various kinds, were present; and 45 premises needed cleansing. The places were dealt with as follows:—in 24 instances the drains were entirely, and in 12 instances partially, reconstructed; in 7 instances improperly placed drain inlets were removed, with or without redrainage; in 76 instances minor defects were remedied; and 45 premises were thoroughly cleansed under notice. 44 The trades carried on, and the alterations made on the premises dealt with in 1914, were as follows:— Trades. No. of Premises DRAINAGE. PREMISES. Entire reconstruction Partial reconstruction Drain openings removed. Cleansed Other defects remedied Butcher 13 - l - 3 13 Confectioner 15 4 l — 5 12 Dairy 5 2 l 3 5 Fishmonger 6 1 l — 3 5 Greengrocer 6 2 — l 4 4 Grocer & Provision Merchant 21 3 3 2 12 16 Restaurants 4 2 1 — 4 3 Other Trades 22 10 4 3 11 18 Totals 92 24 12 7 45 76 It became necessary to issue a summons in regard to one of the premises occupied by a baker and confectioner, and the result of these proceedings has been most salutary. The food premises inspected during the year, together with the nature of the business carried on, were as follows:— Butchers and Pork Butchers 65 Confectioners 99 Grocers 68 Provision and Cheesemongers 42 Greengrocers and Fruiterers 75 Fishmongers 31 Fried Fish Shops 11 General Shops 23 414 830 inspections were made of these premises during the year, and 73 notices were served. This list does not include bakehouses, milk shops, restaurants, and slaughterhouses, to which reference is made elsewhere. 45 Vendors of Fried Fish. The County Council have taken a further step this year in the direction of securing that the food supply of London shall be dealt with under sanitary conditions, by making bye-laws relating to the businesses of Vendor of Fried Fish and Fish Curer. There are no fish curers in the Borough, but the following is a list of the vendors of fried fish, and these will now be kept under systematic inspection. No. 1 (Town) Ward— No. 6 (Kilburn) Ward — 7, Flask Walk. 132, High Road. 2, New End Square. 84, Kingsgate Road. No. 2 (Bklsize) Ward— 89, do. 106, Fleet Road. 32, Netherwood Street. 70, Upper Park Road. 95, Palmerston Road. No. 5 ( West End) Ward- No.7,(PRIORY) WARD- 1a, Broomsleigh Street. 6A, West End Lane 86, Mill Lane. (13) 1, Munro Terrace, Fortune Green Road. Ire Cream. The sale of ice cream in London is controlled by Sections 42 and 43 of the London County Council (General Powers) Act, 1902. There are 83 shops in the Borough in which ice cream is sold, and 208 inspections of these premises were made during the year, and 27 notices were served for the remedying of defects. 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 19 Drains repaired or reconstructed 6 Soil pipes repaired or reconstructed 3 Water-closets repaired or renewed 6 cleansed 11 Flushing cisterns repaired or renewed 5 Waste pipes of sinks trapped, repaired, or renewed 10 Yard paving renewed 6 Dustbins provided 6 New sinks provided 2 Roofs, gutters, and rainwater pipes repaired 4 Refuse removed 7 Other defects remedied. 8 46 Bakehouses At the end of 1914, there were 35 occupied bakehouses on the register, 20 being underground, and 15 above ground. Three of the bakehouses situated above ground and one underground use power, and are therefore factories. Sixteen inspections were made in respect of the factory bakehouses, 120 inspections in respect of the workshop bakehouses, and 4 notices were served. The following is a list of the occupied Bakehouses on the Register at the end of the year:— No. 1 (Town) Ward— Field Lane School, Hillfield 3, High Street. Road. 67, do. * 43, Mill Lane. 26, New End. (3) 44, do. No. 2 (Belsize) Ward— 4- Munro Terrace, Fortune 6, Fleet Road. Green- * 05 ,do 251, West End Lane. 45, South End Road. (3) *279, do (9) No. 3 (Adelaide) Ward— No. 6 (Kilburn) Ward— *† 44, England's Lane. *63, Hemstal Road. *90, Haverstock Hill. *94, High Road, Kilburn. *2, King's College Road. (3) *354, do. No. 4 (Central) Ward— *4, Kelson Street. *64, Belsize Lane. 67, Kingsgate Road. *225, Finchley Road. *99, Palmerston Road. (6) † 307, do. 7 (Priory) Ward— *98, West End Lane. *202, Belsize Road. † 2, Broadhurst Gardens. (5) *228 do No. 5 (West End) Ward— *98, Boundary Road. † 60, Cricklewood Broadway. *93, Fairfax Road. 110, do. * 7, Fairhazel Gardens. 553, Finchley Road. * 137, Finchley Koad. (6) Those marked * are underground bakehouses. Those marked f are factory bakehouses. Bakehouses—Underground 20 ,, Above ground 15 Total 35 47 Restaurant Kitchens, etc. The total number of these premises on the register at the end of 1914 was 67. They are kept under regular supervision, the number of nspections being 93 and the number of notices served 6. The following is a list of the restaurant kitchens, etc., in the various wards of the Borough. No. I (Town) Ward— Winchester Hotel, Winchester Jack Straw's Castle, Hampstead Road. Heath. 25, Winchester Road. (7) 37, Heath Street. No. 4 (Central) Ward— 03 & 65, do. 72, Bel size Lane. 70, do. 90, do. 100, do. 159, Broadhurst Gardens. 102, do. 1a, Canfield Place. 108, do. 104, Finchley Road. 3, High Street. 225, do. 42, do. 52, Lymington Road. 67, do. 100, West End Lane. Bull & Bush, North End. (11) 272, do. No. 2 (Belsize) Ward— 280, do. (10) 2, Elm Terrace, Constantino Road. No. 5 West End) Ward— 25, Fleet Road. 92, Fortune Green Road. 98, do. 106, Mill Lane. 210, Haverstock Hill. 251, West End Lane. 11, South End Road. 291, do. 21, do. 295, do. 45, do. 327, do. 65, do. 351, do. (7) 19, Southampton Road. No. 6 (Kilburk) Ward — Railway Tavern, South End 132, HighRoad, kilburn Green. (10) 272, do. do. No. 3 (Adelaide) Ward—308,do. do. I, Adelaide Road. 354 ,do. do. 143, do. 145, Iverson Road. 97, Haverstock Hill. Towers' Coffee Rooms, Love- 11, King's College Road. ridge Road. Cosy Nook, Regent's Park Road. 18, Netherwood Street. (7) 48 Restaurant Kitchens, etc. —con. No. 7 (PrioRy) Ward— 98, Finchley Road. 121, Abbey Hoad. 115, do. 21, Alexandra Road. 133a, do. 203, Belsize Road. 169a, do. 264, do. 34, High Road, Kilburn. 274, do. 48, do. do. 36, Boundary Road. 12, Swiss Terrace. (15) 114, do. — 65, Fairfax Road. Total Meat Inspection, etc. The meat supply of the Borough is good, and it is very seldom that unsound meat is seized by or surrendered to the sanitary inspectors. Slaughterhouses. The licensed slaughterhouses, four iu number, were regularly inspected during the year, the number of inspections being 43. The quarterly limewashing has been carried out. During the year in the course of inspections the following matters requiring attention were remedied immediately upon their being brought to the notice of the occupiers :— Ceiling dilapidated, 1. W ater-closet defective, 1. Water-closets foul, 2. Accumulation of refuse, 1. 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 32, or 6.2 per cent, of the total number. The corresponding percentage in 1913 was 3.7; in 1912, 2 3. In addition, 12 samples were certified to be of low quality. 411 samples were purchased from Ilampstead tradesmen, and 10 from persons residing without, but trading within the Borough. The percentage of adulterated samples in these two classes were 3.6 and 161 respectively. Six samples were taken on Hampstead Heath on Bank Holidays, and of these, 1 was adulterated and 1 was of low quality. 49 36 samples were taken on Sundays, 5, or 13.8 per cent. of these were adulterated. 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 121 4 l Cheese 14 — — Cocoa 20 2 — Coffee 17 — - Cream 13 1 - Epsom salts 2 — — Lard 43 — — Lemon squash 1 — — Margarine 5 — — Milk 272 22 11 Olive oil 1 — — Pork pie 1 1 - Salmon & Shrimp paste 1 1 - Sausages 1 1 - Totals 512 32 12 The following table shows the number of samples analysed during each year from 1908 to 1914, 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. 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 1912 506 12 2.3 16 15 0 1913 506 19 3.7 38 16 0 1914 512 32 6.2 22 8 6 50 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) 66 l 1.5 No. 2 (Belsize) 67 3 4.4 No. 3 (Adelaide) 19 — — No. 4 (Central) 20 — — No. 5 (West End) 87 6 6.8 No. 6 (Kilburn) 92 4 4.3 No. 7 (Priory) 60 1 1.6 Totals 411 15 3.6 The following table shows the articles adulterated, nature of adulteration, and the results of proceedings taken:— No. of Sample. Article. How adulterated. Result of proceedings. 7 Milk 34 per cent. deficient in butter-fat Fine 5s. Costs 12s. 6d. 31 „ 8 per cent. deficient in butter-fat Summons dismissed. Vendor proving warranty. 45 Pork pie 4 1/5 grains Boric acid per pound Vendor cautioned. 46 Sausages 6 3/10 grains Boric acid per pound Do. do. 56 Milk 7 per cent. deficient in butter-fat Summons dismissed. Vendor proving warranty. 84 „ 10 per cent. deficient in butter-fat Do. do. 102 „ 4 per cent. deficient in butter-fat Fine £1. Costs 19s. 6d. 112 „ 7 per cent. deficient in butter-fat Summons withdrawn. 142 Cocoa 40 per cent. sugar, 25 per cent. sago Fine £2. Costs 12s. 6d. 51 No. of Sample. Article. How adulterated. Result of proceedings. 162 Milk 11 per cent. added water These samples all procured from one Farmer. No fine. Costs £10. 163 „ 5½ „ „ 168 „ 6½ „ „ 169 „ 11 „ „ 170 „ I6½ „ „ 171 „ 17½ „ „ 174 „ 21½ „ „ 175 „ 3 „ „ 176 „ 6 „ „ 177 „ 7½ „ „ 188 „ 7 „ „ 189 „ 8½ „ „ 190 „ 4½ „ „ 186 Salmon & Shrimp paste 5 6/10 grains Boric acid per pound Vendor cautioned. 194 Milk 6 per cent. deficient in butter-fat Fine 5s. Costs 12s. 6d. 269 Cream 17½ grains Boric acid per pint Summons dismissed. 310 Milk 8 per cent. added water Fine £3. Costs 17s 0d. 392 Butter 1 per cent. of water in excess of legal limit Informal sample. Noaction. 394 „ 50 per cent. foreign fat Do. do. 402 Milk 40 per cent. deficient in butter-fat Do. do. 428 Cocoa 40 per cent. sugar, 25 per cent. starch Do. do. 469 Butter 70 per cent. foreign fat Do. do. 476 „ 35 „ „ Fine £110d. Costs 14s. 6d. It will be seen by the note against, samples Nos. 162-190 that they were all procured from one farmer. A sample of milk was obtained from a dairyman carrying on business in Hampstead, which upon analysis was found to be adulterated. He then made a recpiest for the milk supplied to him by a certain farmer to be sampled as it arrived at the railway station. Arrangements were accordingly made, and samples were taken upon successive days. Upon analysis it was found that whereas the afternoon milk was genuine, a very large precentage of the morning churns contained added water. The circumstances were very remarkable, because when the later samples were obtained the farmer knew that the earlier samples had been taken, and also that they 52 contained added water; but although he was delivering every churn under a guarantee and warranty to the effect that the milk was pure and unadulterated, he apparently took no steps to sift the matter, and suggested that the water must have been added during the time the milk was in the charge of the railway company. This is an explanation which has frequently been advanced by farmers, when milk has been found to be adulterated upon its arrival in London from the country, and it was felt that in justice to the railway company some special steps should be taken. Accordingly, the Senior Sanitary Inspector, in company with the representative of the local firm, went down to the farm in the early morning, and unbeknown to the persons handling the milk kept it under observation from the time it left the farm until the time it was put upon the railway, and then accompanied the churns the whole way to Hampstead. Upon its arrival, a sample was taken by Inspector Hudson and this was found to contain added water. It was thus proved conclusively that the adulteration took place at the farm. Further enquiries into the matter revealed the fact that the farmer supplying the milk occupied two farms, the management of the one from which the milk in question came being in the hands of a manager. It was established beyond doubt that the farmer had not, personally, any knowledge of the adulteration, and in view of this fact the Magistrate inflicted no penalty. The case, however, is of special interest in illustrating the way in which warranties are given and milk delivered without any attempt being made by those who have made themselves responsible under the warranty to assure themselves that the milk is delivered within the terms of the contract; and yet the mere existence of such a warranty would prevent any proceedings taken against persons retailing the adulterated milk from being brought to a successful issue. It is a matter for congratulation that Parliament has at last passed legislation amending the law relating to the "warranty defence," but until experience has been obtained as to the practical working of the new provisions, it is impossible to foretell how far they will be effectual in protecting the interest of the unfortunate consumer. Warranty Defence. Proceedings necessitated in regard to the adulteration of milk were dismissed in 3 instances owing to the vendor successfully proving a warranty. 53 Milk and Cream Regulations 1912, These Regulation?, made in pursuance of the Public Health (Regulations as to Food) Act, 1907, place a definite restriction on the use of preservatives by producers, retailers and others concerned in the milk and cream trade. No preservative is now permitted to be added to milk in any case, nor is any preservative allowed to be added to crean. which is sold as cream. The regulations, however, do not prohibit the sale of cream containing boric acid, borax, or a mixture of these preservative substances, or hydrogen peroxide provided (1) that it is sold, not as cream, but as " preserved cream," and (2) that the vessel in which it is sold bears a declaration, in the prescribed form, showing tho amount and nature of the particular preservative added. The addition to cream of any other preservative substances than those mentioned is prohibited. The object of the regulations in regard to cream is to secure tha preserved cream sold in compliance with the regulations shall be distinguished at all stages of sale from cream to which no preservative h is been added ; this distinction is important in the interests of the public generally, and particularly in the interests of infants and invalids. Report for the year ended 31st December, 1914, of Administration in connection with the Public Health (Milk and Cream) Regulations, 1912. 1.—Milk; and Cream not sold as Preserred Cream. (a) (b) Number of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. Milk 272 — Cream 10 2 Nature of preservative in each case in column (6) and action taken under the regulations in regard to it— One sample was found on analysis to contain 0.20 per cent. Boric Acid. The firm was written to for an explanation, which was submitted by them. The Public Health Committee, after considering the matter, authorised legal proceedings to 54 be taken against the vendor. The magistrate dismissed the summons on the ground that the fault was due to the carelessness of an assistant who had disobeyed the firm's instruction as to labelling receptacles. The second sample was found, on analysis, to contain a mere trace of Boric Acid. No action was taken. 2.—Cream sold as Preserrred Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the labels as to preservatives were correct:— (i) Correct statements made 2 (ii) Statements incorrect — Total 2 One sample was also sold unlabelled (but with a verbal notice), but did not contain an excess of Boric Acid; see (c). (b) Determinations made of milk fat in cream sold as preserved cream:— (i) Above 35 per cent. 3 (ii) Below 35 per cent. — Total 3 (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V (1) and the proviso in Article V (2) of the regulations have not been observed - One sample of unlabelled cream was delivered to the inspector with a verbal notice that it was preserved. Upon analysis it was found to contain 0·37 per cent. of Boric Acid. (d) Particulars of each case in which the regulations have not been complied with, and action taken:— In the case above quoted the vendor was written to (Article VII of Milk and Cream Regulations), and his explanation was received. No further action was taken. 55 3.— Thickening substances. (a) Any evidence of their addition to cream or to preserved cream Ni1. (b) Action taken where found Nil. 4. — Other observations (if any). Percentage of Preservative found in each sample of cream or preserved cream where this has been determined, and also the percentage indicated on the Statutory label:— Offiicial No. Sample. Analyst's Report. Percentage on Statutory Label. 273 Preserved Cream 0·17 per cent. Boric Acid Not exceeding 0·5 percent. Boric Acid. 289 0·28 " " 293 " 0·37 No label. This sample is referred to above. See Section 2 (c and d). 269 Cream 0·20 No label. 404 " A mere trace „ " Housing. Dwellings unfit for Habitation. 83, Palmerston Road. The question of this house has been under consideration now since it was represented as unfit for human habitation, by my predecessor on 20 th December, 1910. On 15th, 16th and 18th June, 1914, the appeal of the Local Government Hoard against the decision of the Court of Appeal was heard in the House of Lords. On the 20th July the House of Lords reversed the decision of the Court of Appeal, and on October 15th the Order of the King's Bench Division was restored by order of the House of Lords and made an Order of the High Court of Justice. The matter is still the subject of litigation. 1-7, Peebles Mews. On 21st August the Local Government Board's decision was issued confirming the Closing Orders made in respect of these premises, and during the present year Demolition Orders have been made. 56 The following premises have been dealt with during 1914: — Represented. Closing Order made. Remarks. 97 & 99, Mill Lane 10th Feb. 19th Feb. Demolition Orders made 12th Nov. and premises pulled down 101 & 103, Heath Street 10th Feb. 19th March Premises voluntarily demolished Dairy House, South End Green 14th July 23rd July ditto. 8, Woodchurch Road 21st Oct. 29th Oct. Premises empty Grove, Woodbine and Hope Cottages, North End 1st Dec. 10th Dec. ditto. Table required by Article V. of the Housing (Inspection of District) Regulations, 1910, made by the Local Government Board, under the Housing, Town Planning, etc., Act, 1909. (Excluding Underground Rooms.) Number of dwelling-houses inspected under and for the purposes of Section 17 of the Act of 1909 14 „ of dwelling-houses which on inspection were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation 14 „ of representations made to the Borough Council with a view to the making of closing orders *9 ,, of closing orders made 9 ,, of dwelling-housing, the defects in which were remedied without the making of closing orders 5 ,, of dwelling houses which, after the making of closing orders, were put into a fit state for human habitation — * Of these 9 premises, 5 were voluntarily demolished, and 4 were empty at the close of the year. General character of the defects found to exist. Arrangements for preventing the contamination of water supply 7 Closet accommodation 5 Drainage 14 57 General character of the defects found to exist— con. Conditions of dwelling-houses in regard to:— Light 7 Free circulation of air 7 Dampness 9 Cleanliness 3 Conditions of yards or out-houses in regard to:— Paving 6 Drainage 9 Sanitary condition — Arrangements for the deposit of refuse and ashes 9 Any defects in other matters which may tend to render the dwelling-houses dangerous or injurious to the health of the inhabitants 9 In addition, 2 premises were scheduled for inspection but were burnt out before the survey was made. Underground Rooms. The following statement sets forth the action taken during 1914 in regard to underground rooms that were found to be illegally occupied. No. of Houses. No. of rooms found to be occupied in contravention of Sec. 17 of Housing, Town Planning, etc., Act, 1909. No. of these rooms that were also occupied contrary to the provisions of the Public Health (London) Act, 1891. Illegal occupations discontinued Structural works necessary to make rooms comply either completed or well in hand before the end of the year. No. of Rooms. Represented by Medical Officer of Health under Sec. 17. Closing Orders made by Council, under Sec. 17. 66 80 41 28 52 11 10 The structural defects, and the number of rooms in which the defects were found, were as follows:— Want of Proper Area. Want of proper Damp-proof Courses. Space beneath floor insufficiently ventilated. Site not Concreted. Defective Drains. 62 58 54 53 54 58 The Writer Supply of Tenement Houses. The action taken in Hampstead during 1914 to improve the water supply of tenement houses under the powers conferred upon London Sanitary Authorities by Section 78 of the London County Council (General Powers) Act, 1907, which empowers the sanitary authority to require a proper and sufficient supply of water in each storey of a tenement house that is separately occupied, has resulted in the provision of water taps and glazed earthenware sinks in 101 houses. Prior to the passing of the London County Council (General Powers) Act, 1907, London Sanitary Authorities had no power to insist on the provision of adequate water supply in tenement houses. This Act, however, has been the means by which this great improvement has been effected. The number of houses dealt with in Hampstead during the last seven years is as follows:— 1908 24 1909 85 1910 99 1911 105 1912 152 1913 115 1914 101 681 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." 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 59 the duty of securing "suitable and sufficient accommodation in the way of sanitary conveniences" for the persons of both sexes employed in the Hampstead factories, workshops, and workplaces. The following is a list of the different classes of factories in Hampstead: — Art Metal Workers 2 Bakers 4 Bootmakers 10 Builders 4 Butchers 7 Carpet Beaters 2 Coffee Roasters 5 Dairymen 2 Laundries 5 Motor Works 7 Printers 11 Other trades 17 76 The number of inspections made was 198, and 6 notices were served. Workshops. At the end of 1914 there were 439 workshops on the register, of which 28 were domestic workshops. Excluding the latter, there were employed in the workshops 811 males and 824 females. Dressmaking is a trade chiefly carried on in the Hampstead workshops, and next in order of frequency come tailoring, bootmaking, baking and millinery. During the year 816 inspections were made, 28 notices were served, and one prosecution. 60 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. DomesticWork shops. Total number of Workshops. Number of Workshops. Number of Workrooms. Number of Employees. Males. Females. Bakers 31 36 122 — — 31 Blindmakers 4 7 9 7 — 4 Bootmakers 35 38 72 — 1 36 Builders and carpenters 17 20 23 — — 17 Cabinetmakers and polishers 2 8 162 1 1 3 Carriage builders 6 14 29 — — 6 Corset makers 3 4 — 10 3 Cycle makers and repairers 6 8 14 2 - 6 Dressmakers and ladies' tailors 97 116 6 406 14 111 Engineers 3 3 3 - — 3 Florists 3 4 10 5 — 3 Harness makers 5 7 12 — — 5 Ironmongers 14 16 35 — — 14 Laundresses 6 14 2 24 - 6 Milliners 27 27 - 84 1 28 Monumental masons 2 2 17 - - 2 Motor makers 5 8 20 - - 5 Outfitters 9 32 7 183 1 10 Pi anoforte makers 2 4 40 - - 2 Picture frame makers 10 12 15 - - 10 Sign writers 2 6 11 - — 2 Smiths 11 11 24 - - 11 Tailors 39 47 82 27 7 46 Upholsterers 21 26 46 9 1 22 Watchmakers and jewellers 12 13 21 - - 12 Wigmakers 14 19 14 27 — 14 Miscellaneous 25 37 55 39 2 27 Totals 411 539 811 824 28 439 Inspections. The following particulars relate to the workshop inspections made during 1914, bakehouse inspections being omitted. The total number of inspections made during the year was 696, as against 508 in the previous year. Cleanliness. Nineteen workrooms were found on inspection to require cleansing; 13 of these were cleansed on the request of the inspector, and 4 under notice ; while 2 workrooms were vacated. Ventilation and Warming. In 11 workshops the means of ventilation was found to be inadequate; 9 were rendered satisfactory, and 2 cases were standing over at the end of the year, the workshops being empty. 61 In 5 cases the unsatisfactory conditions were caused by gas stoves used for the heating of irons being unprovided with a flue to carry off the products of combustion ; and proper hoods and flues were fixed. In the other 4 cases suitable means were taken to improve the conditions complained of. In order to secure these alterations it was found necessary to serve 5 notices. In 6 cases the means of warming were found to be unsatisfactory. Two of these were improved on request, and 4 were reported to H.M. Inspector of Factories. 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 is set out on a card supplied by the Council, which is hung up in each room. The legal number of occupants varies according as overtime is worked, or whether the room is used as a sleeping room as well as a workroom. During 1914, 25 new workrooms were measured. Overcrowding was found in 4 instances; in 3 cases it was immediately abated on the request of the Inspector, but in one case it was necessary to serve a notice. 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 or 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 District Council becomes aware thereof, he 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, 14 workshops and 1 factory were notified to H.M. Inspector of Factories as being without the abstract required. 62 Workplaces. This term is not defined in the Factory Act, nor in the Public. Health Act, and it is sometimes exceedingly difficult to decide whether certain places are or are not "workplaces." During the year, 1,204 inspections were made of all the "workplaces" in the Borough, and 18 notices were served. Among the more important workplaces are the kitchens of restaurants, coffee-houses, &c., and the number of these places in Hampstead at the close of 1914 was 67. The list of restaurant kitchens, etc., will be found on page 47-48, in the section dealing with " Food." 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 109, and the number of addresses contained in the lists was 281. 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 out-workers' premises in Hampstead is 71. Of these, 5 are factories, 39 are workshops (15 of these being domestic workshops), 1 is a workplace, and in 26 cases only a single worker is employed on the premises. 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, Workshop's, and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 198 6 — Workshops (Including Worshop Laundries) 816 28 l Workplaces (Other than Outworkers premises included in Part 3 of this Report) 1204 18 — Total 2218 52 l 63 2.—Defects found in Factories, Workshops, and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Keterred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts:— Want of cleanliness 19 20 - — Want of ventilation 11 9 - - Overcrowding 4 4 — - Want of drainage of floors — — - - Other nuisances 33 32 - - Sanitary accommodation insufficient 3 2 - — unsuitable or defective 4 4 - - not separate for sexes - - - - Offences under the Factory and Workshop Act: — Illegal occupation of underground bakehouse (s. 101) - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) - - - - Other offences 7 7 5 — (Excluding offences relating to outwork, which are included in Part 3 of this Report) • Total 81 78 5 - Column (2) in the above table gives the number of defects found, and column (3) the number remedied during the year. The corresponding figures in the two columns are not identical, because in the case of some of the defects discovered near the end of the year, the work necessary to remedy the defects had not been completed, while on the other hand defects which had been found in 1913 were remedied in 1914. 64 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. Outworkers Outworkers. Lists Contractors. Workmen. Lists Contractors. Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 #] Wearing Apparel— (1) making, &c. 68 29 115 3 1 3 — — — — — — — — — (2) cleaning and washing 12 24 3 2 3 — — — — — — — — — — Household linen 6 5 14 - - - - - - — — — — — — Lace, lace curtains and nets - - 2 - - - - - - - - — — — — Curtains and furniture hangings 10 6 10 - — — — — — — — — — — — Furniture and upholstery 6 15 5 - — — — — — — — — — — — Electroplate — 3 — — — — — — — — — — — File making — — — — — — — — — — — — — — Brass and brass articles — 1 3 — — — — — — — — — — — — Fur pulling — — — — — — — — — — — — — — — Cables and chains — — — — — — — — — — — — — — — Anchors and grapnels — — — — — — — — — — — — — — — Cart gear — — — — — — — — — — — — — — — Locks, latches and keys — — 2 — — — — — — — — — — — — Umbrellas, &c, — 7 2 — — — — — — — — — — — — Artificial flowers — — — — — — — — — — — — — — — Nets other than wire nets — — — — — — — — — — — — — — — Tents — — — — — — — — — — — — — — — Sacks — — — — — — — — — — — — — — — Racquets and tennis balls — — — — — — — — — — — — — — — Paper, &c., boxes, paper bags Brush making 2 — 28 — — — — — — — — — — — — Pea picking — — — — — — — — — — — — — — Feather sorting — — — — — — — — — — — — — Carding, &c., of buttons, &c. — — — — — — — — — — — — — — — Stuffed toys — — — — — — — — — — — — — — — Basket making Chocolates and sweetmeats — — — — — — — — — — — — — — — Cosaques, Christmas crackers, Christmas stockings, &c. — — — — — — — — — — — — — — — Textile weaving — — — — — — — — — — — — — — — Total 104 87 187 5 4 3 — — — — — — — — — 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 maybe) against the principal class only, but the outworkers have been assigned in columns 3 and 4 (or 6 and 7) into their respective classes. ♦ The figures in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year, and of the entries of names of outworkers in those lists. 65 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Bakehouses 31 Bootmakers 35 Dressmakers and ladies' tailors 97 Laundries 6 Milliners 27 Tailors 39 Watchmakers and jewellers 12 Wigmakers 14 Other 150 Total number of workshops on Register 411 5.—Other Matters. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133,1901) 15 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5, 1901) Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 6 Other — Underground Bakehouses (s. 101) in use at the end of the year 20 SECTION C. Sanitary Administration of the Borough. 69 Staff of the Public Health Department, March, 1915. Sanitary Inspectors. W. G. Kershaw, Senior Inspector. R. Geary, No. 1 District (Wards 1 and 2), W. F. Horniblow, No. 2 District (Wards 3 and 7), Dicisional A. Peverett, No. 3 District (Wards 4 and 5), Inspectors. J. Grimsley, No. 4 District (Ward 6), F. H. Hudson, Sale of Food and Drugs Acts, and Factory and Workshop Act. A. C. Townsend, Housing of the Working Classes, and Housing, Town Planning, etc., Act. Mrs. T. Fisher, M.A., Factory and Workshop Act ; Infectious Disease ; and Tuberculosis Regulations. Mrs. K. Roche, Notification of Births Act, and Infectious Disease. 3 Assistants to Inspectors. Public Mortuary. W. Larken, 63, Flask Walk, Keeper. Disinfecting and Cleansing Stations. T. Rider, G. Allaway, and R. Bell, Disinfectors. Mrs. Rider, Attendant at Cleansing Room. Tuberculosis Dispensary. H. A. Sansom, M.D. (Lond.), Acting Tuberculosis Medical Officer. Miss G. Goodchild, Nurse. Clerical Staff. 4 Clerks and I Clerk-Draughtsman. Public Analyst. A. W. Stokes, F.C.S., F.I.C. Medical Officer of Health. Frank E. Scrase, F.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Lond.) 70 The following members of the Staff of the Department went on active service during 1914, and still are with the Colours :— Mr. A. C. Townsend, Sanitary Inspector. Mr. W. F. Horniblow, do. Mr. T. Rider, Disinfector. Mr. A. Edwards, Sanitary Inspectors' Assistant. Mr. W. Larken, do. do. and Mortuary Keeper. Miss G. Goodchild, Tuberculosis Nurse. Mr. B. C. Harley, Clerk. Inspector Townsend's district consisted of those sections of the Borough comprising tenement houses occupied by the working classes. Messrs. Geary, Grimsley and Peverett, district inspectors, took over the inspection of such of these houses as are situated in their own districts. District Inspector Geary in addition to his ordinary duties also took charge of Ward 3 (Adelaide) which comprises part of Inspector Horniblow's district. The Senior Sanitary Inspector took over the work in the remainder of Inspector Horniblow's district, consisting of Ward 7 (Priory). In addition to this he made the necessary inspections in connection with the Special Housing Inquiry in the Town Ward. Inspector Hudson took over the supervision of sanitary work at food places and workshops. Mrs. Fisher undertook the duties of the Dispensary Nurse. A temporary Clerk was appointed to assist the clerical staff. Two men have been temporarily transferred from the Works Department to act as sanitary inspectors' assistants and as disinfector. The deputy mortuary keeper (who is also an assistant to the sanitary inspectors) took over the care of the mortuary. By these arrangements the work of the department has been maintained, and although the Council authorised the appointment of temporary inspectors, the necessity for this has been obviated by the existing Officers undertaking the discharge of the duties of their colleagues who are on service. The military authorities have been given every assistance, and the information and various reports that have been asked for have been readily supplied. On certain occasions the Medical Officer of Health has been asked to inspect and advise on the adaption of Mount Vernon Hospital as a 71 Military Hospital, and also on several of the auxiliary hospitals under the Red Cross Society which are established in the Borough. During 1914 Dr. J. King Patrick resigned his appointment as Tuberculosis Medical Officer, and pending the approval of the new dispensary scheme, Dr. H. A. Sansom has acted as Tuberculosis Officer. Chemical and Bacteriological Work. The chemical analysis carried out by the Public Analyst during the year is referred to at length on page 165, and the Analyst's Report will be found on page 165. The total number of samples analysed during 1914 was 512. The following is a summary of the bacteriological work performed by the Lister Institute of Preventive Medicine in respect of specimens from suspected cases of Diphtheria and Enteric Fever; and at the Borough Council's Tuberculosis Dispensary in connection with cases of consumption:— Positive. Negative. Total. Diphtheria 109 289 398 Enteric Fever 11 3 14 Consumption 69 210 279 189 502 691 In addition 2 specimens of sputum which proved negative, were examined at the Lister Institute. SECTION D. Prevalence of and Control over Acute Infectious Diseases. 75 Notifiable Infectious Diseases (excluding Tuberculosis). Information concerning Tuberculosis will be found in the Tuberculosis Section (see pages 105-122). The list of infectious diseases notifiable in London under Section 55 of the Public Health (London) Act, 1891, during 1914, was as follows:— Small-pox Typhus Fever Cholera Relapsing Fever Diphtheria Continued Fever Membranous Croup Puerperal Fever Erysipelas Anthrax occuring in Man Scarlet Fever Hydrophobia Epidemic Cerebro-spinal Glanders Meningitis Ophthalmia Neonatorum Plague Polio-Myelitis Typhoid or Enteric Fever The total cases of infectious diseases notified (excluding Tuberculosis) numbered 583. This is equivalent to an attack rate of 6·7 per 1000 of the population. The following shows the number of cases of each disease notified:— Diphtheria and Membranous Croup 224 Erysipelas 44 Scarlet Fever 278 Enteric Fever 16 Puerperal Fever 7 Polio-Myelitis 2 Ophthalmia Neonatorum 12 Of these, Enteric Fever, Small-pox, Scarlet Fever and Diphtheria are deemed to be the principal epidemic diseases (together with Measles and Whooping Cough, to which notification, however, does not apply). These six principal epidemic diseases are referred to on page 94. 76 The number of fatal cases was 23, but of these two were cases of Enteric Fever and three of Diphtheria that, for various reasons were not notified to me as cases of infectious disease. The deaths of these persons, however, were allocated to Hampstead. The 18 notified fatal cases were equal to 3·9 per cent. of the total cases notified. The deaths were distributed as follows:— DISEASE. WARDS Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). 'No. 6 (Kilburn). No. 7 (Priory). Diphtheria and Membranous Croup l 3 .. 2 .. 4 1 11 Erysipelas 1 .. .. .. .. 1 .. 2 Scarlet Fever l 1 .. .. .. .. .. 2 Enteric Fever l 1 .. .. .. 1 .. 3 Puerperal Fever l 1 .. .. 1 .. .. 3 Polio-Myelitis l .. .. .. .. .. 1 2 Totals 6 6 .. 2 1 6 2 23 The death-rate from the notifiable infectious diseases, including the five deaths above referred to, was 0·26 per 1000 of the population. 77 Cases of Infectious Disease occurring in each Month during 1914. Disease. MONTHS. Totals. January February. March. April. May. June. July. August. September. October. November. December. Diphtheria and Membranous Croup 11 23 52 9 6 9 5 10 19 53 19 8 224 Erysipelas 3 5 6 3 3 4 5 .. 2 4 3 6 44 Scarlet Fever 18 17 23 27 27 26 16 25 33 22 27 17 278 Enteric Fever 5 2 .. .. 2 2 . . . . 1 1 2 1 16 Puerperal Fever 2 1 1 .. .. .. .. .. 1 .. 2 .. 7 Polio-Myelitis .. .. .. • • .. .. 1 .. .. .. 1 .. 2 Ophthalmia Neonatorum .. .. 2 1 2 2 .. 1 2 .. 1 1 12 Totals 39 48 84 40 40 43 27 36 58 80 55 33 583 78 Cases of Infectious Disease occurring in each Ward during 1914. 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) Diphtheria and Membranous Croup 95 27 9 10 17 42 24 224 Erysipelas 8 8 3 2 6 12 5 44 Scarlet Fever 25 43 14 13 39 121 23 278 Enteric Fever 1 6 1 1 3 3 1 16 Puerperal Fever 1 2 1 .. 1 2 .. 7 Polio-Myelitis .. 1 .. .. .. .. 1 2 Ophthalmia Neonatorum 1 2 .. .. 2 6 1 12 Totals 131 89 28 26 68 186 55 583 79 Small-pox. No case of Small-pox occurred in Hampstead during the year. Vaccination. The table below gives some idea of the working of the Vaccination Act in Hampstead since 1900. I am indebted to the Vaccination Officer for the statistics in this table. Vaocination Statistics. Year. Births. Successfully Vaccinated. Insusceptible of Vaccination. Had Small-pox. Number in respect of whom Certificates of "Conscientious Objection "have been received. Died Unvaccinated. Vaccination Postponed. Remaining. Percentage of Births Registered. Successfully Vaccinated. Exempted by " Conscientious Objection" Certificates. Not finally accounted for (including cases postponed). Unvaccinated. 1 2 8 4 S 6 7 8 9 10 11 12 13 (Col. 3) (Col. 6) (Cols. 8& 9) (Cols. 6,8, & 9. 1901 1,508 1,232 15 .. 39 111 7 104 81·7 2·6 7·4 10·0 1902 1,517 1,255 18 .. 27 104 11 102 82·7 1·8 7·4 9·2 1903 1,452 1,190 19 .. 30 106 11 96 82·0 2·1 7·4 9·5 1904 1,446 1,197 16 .. 35 100 8 90 82·8 2·4 6·8 9·2 1905 1,421 1,181 18 .. 40 91 14 77 83·1 2·8 6·4 9·2 1906 1,438 1,183 12 .. 35 93 18 97 82·3 2·4 8·0 10·4 1907 1,341 1,090 7 60 80 5 99 81·3 4·5 7·8 12·3 1908 1,321 1,028 16 127 78 6 66 77·8 9·6 5·7 15·1 1909 1,295 996 19 151 61 5 63 76·9 11·7 5·3 17·0 1910 1,269 911 14 217 58 3 66 71·8 17·1 5·4 22·5 1911 1,199 830 9 229 58 6 67 69·2 19·1 6·1 25·2 1912 1,232 826 10 249 46 7 94 67·0 20·2 8·2 28·4 1913 1,237 776 5 298 59 18 81 62·7 24·1 8·0 32·1 1914 1,218 626 6 309 57 21 199* — — — — 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 82 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. 80 It will thus be seen from this table that for the period 1905 to 1913 the percentage of children vaccinated has declined from 83.1 to 62.7, this being equivalent to a decrease of 24 per cent. The number of unvaccinated persons must be therefore rapidly increasing, and during the past few years have added a not inconsiderable number to the unvaccinated population, the presence of whom is a factor of which public health administrators must never lose sight. Diphtheria and Membranous Croup. The number of cases notified in 1914 was 224, as compared with 116 in 1913, the attack-rate, or number of cases notified per 1000 population being 2.58, as compared with the rate of 1.34 in the previous year. The number of the notified cases proving fatal was 8, or 3.6 per cent. of the cases notified, as against 2.6 per cent. in 1913. The deathrate per 1000 population, calculated on the total deaths of notified and un-notified cases, which numbered 11, was 0.13 ; 200 patients, or 88 per cent. of the total cases notified, were removed to hospital. During the early part of the year an outbreak of Diphtheria occurred at the Royal Soldiers' Daughters' Home, Rosslyn Hill. This institution, which contained 160 girls and approximately 25 staff, had been remarkably free from infectious disease prior to 20th November, 1913. On that date a case of scarlet fever occurred and was removed, and the usual disinfection was carried out. No other cases of that disease occurred. The usual inspection following infectious disease was made by the lady sanitary inspector, and as a result I personally visited this Home and drew up a schedule of works that I deemed would be necessary to perfect its sanitary condition. The general hygiene of the Home was not satisfactory; it was a large roomy building with grounds, and there was no question of overcrowding, but the buildings were old-fashioned and had undergone deterioration through age. To carry out the list of recommendations which I submitted to the Committee of the Home considerable structural alterations were required. While this was under consideration, diphtheria began to appear, the first case being notified on November 30th. On December 4th a second case was reported, and during the remainder of that month 4 other cases occurred. In January, 1914, three cases were reported, and 11 in February. 81 The presence of so much of this disease and the general condition of the throats in the establishment led me to urge the necessity of wider measures. The majority of the cases in February were discovered as a result of swabbing which was freely carried out during this month. In conjunction with the medical staff of the Home, and with the sanction of the Public Health Committee and of the Committee of the Home it was decided to swab the throat of every person in the building to discover what I felt must be present, that was, a number of "carrier" cases. It was arranged to place the matter in the hands of Dr. Embleton, bacteriologist and pathologist of University College Hospital, the Public Health Committee agreeing to pay £20 as a contribution to the cost of these proceedings. Dr. Embleton attended at, the Home on February 26th, and he then decided that he would personally conduct the swabbing which should include everyone in the building. It was also decided that the swabbing should be done within four hours, and no child who had been swabbed should be allowed to mix with those that had not been swabbed until the final swabbing was completed, and that the report should be a report to the Borough Council. On the following day, February 27th, all the inmates of the Home were injected with anti-toxin, this being supplied by the Borough Council and conducted by the medical staff of the institution. The report of the bacteriologist was submitted on February 28th, and was of such an important character that I think it useful to print the report in full, together with the recommendations of Dr. Embleton for dealing with the matter : 24, Weymouth Street, W. February 28th, 1914. Report on the Throats of the Inmates of the Royal Soldiers' Daughters' Home, Rosslyn Hill, Hampstead. I examined the throats of the inmates on February 26th, 1914, and made cultures from the throats and suspicious nasal cases, with the following results:— The results are put in four headings: — 1st. Klebs Loeffler Bacillus, characteristic in all its morphological features; the diphtheria bacillus. 2nd. Diphtheroid Bacilli, which are intermediate in their morphological characteristics between the true diphtheria bacillus and the true Hoffman's Bacillus. These bacteria should be regarded with the gravest suspicion, since, as a matter of practical experience, they may be the infecting organisms in definite diphtheria infection. 3rd. The classical Hoffman's Bacillus. 4th. The other predominating organisms. I examined the throats of the inmates 011 February 26th, 1911, and made cultures from the throats and suspicious nasal cases, with the following results:— The results are put in four headings: — 1st. Klebs Loeffler Bacillus, characteristic in all its morphological features ; the diphtheria bacillus. 2nd. Diphtheroid Bacilli, which are intermediate in their morphological characteristics between the true diphtheria bacillus and the true Hoffman's Bacillus. These bacteria should be regarded with the gravest suspicion, since, as a matter of practical experience, thev may be the infecting organisms in definite diphtheria infection. 3rd. The classical Hoffman's Bacillus. 4th. The other predominating organisms. b2 Initials. Age. Klebs Loeffler Bacillus. Diphtheroid Bacilli. Hoffman's Bacillus. Other predominating Organisms. Remarks. E. H. 15 ... ... ... Staphylococci ... Micrococcus catarrhalis ... M. G. 14 ... + + Streptococci ... A. B. 10 ... ... + „ ... M. S. 12 ... ... ... „ ... B. D. 15 ... ... + few „ ... M. L. 10 ... ... + ... Tonsils enlarged W. B. 14 ... ... + Streptococci ... M. N. 9 + + + „ ... C. McG. 10 ... + + „ ... K. P. 11 ... + + ... Tonsils enlarged M. C. 8 ... ... + Streptococci „ E. M. 11 ... ... ... „ „ A. T. 13 ... ... ... Staphylococci ... A. A. 10 + ... + „ Tonsils enlarged A. H. 15 ... ... + Streptococci ... M. H. 8 ... ... + ... ... H. W. 10 ... ... ... Staphylococci ... C. W. 11 + + + ... ... M. M. 12 ... ... + Streptococci ... F. C. 10 + ... + „ Tonsils enlarged M. W. 7 ... ... + „ ... A. R. 14 ... ... ... „ Tonsils enlarged A. P. 10 ... ... ... Staphylococci ... Streptococci ... E. H. 8 ... ... ... Staphylococci ... V. H. 6 ... ... ... Staphylococci ... Streptococci C. C. 12 ... ... ... Staphylococci ... Streptococci ... A. W. 16 + + ... Streptococci Tonsils enlarged. A. V. 16 ... + ... Streptococci ... Micrococcus catarrhalis ... E. A. 11 ... + + ... Membrane G. C. 9 + ... + ... ... I. H. 14 ... ... + Streptococci ... M. L. 9 ... ... ... Streptococci ... Staphylococci Tonsils enlarged W. C. 12 ... ... + Streptococci ... M. H. 10 ... + ... „ Tonsils enlarged W. K. 11 ... ... ... ... ... M. S. 9 ... ... + Streptococci ... A. McG. 12 ... + + ... ... D. M. 9 ... ... ... Staphylococci ... Streptococci Tonsils enlarged M. W. 14 ... ... + Streptococci Tonsils enlarged L. K. ... ... ... ... ... ... (away) D. V. 11 ... ... ... Streptococci ... Staphylococci ... J. T. 10 ... ... ... Staphylococci ... M. F. 10 ... ... ... Streptococci ... Staphylococci ... M.H. 13 ... + + Streptococci ... J. D. 7 ... ... + „ ... 83 Initials. Age Klebs Loeffler Bacillus. Diphtheroid Bacilli. Hoffman 8 Bacillus. Other predominating Organisms. Remarks. R. B. 15 ... ... + Staphylococci ... E. R. 16 ... + + Streptococci ... R. W. 10 ... ... ... Staphylococci ... (nasal) (throat) + ... + Micrococcus catarrhalis ... Streptococci ... H. H. 13 ... + ... „ ... R. G. 10 ... ... ... „ Tonsils enlarged W. J. 12 + + + ... „ M. H. 7 ... + + ... ... L. B. 10 ... + ... Micrococcus catarrhalis ... Streptococci ... E. H. 6 ... ... + Streptococci ... D. D. 14 ... + + Staphylococci ... few Micrococcus catarrhalis ... D. D. 15 ... ... + Streptococci ... M. W. 8 ... ... + Staphylococci ... Micrococcus catarrhalis ... I. S. (Hosp.) 15 ... ... ... Streptococci ... Staphylococci ... G. F. 9 Staphylococci ... L. R. 8 ... ... ... Staphylococci Tonsils enlarged E. W. 12 + ... + Streptococci Membrane V. E. 11 ... ... ... Staphylococci Streptococci ... B. T. 12 ... ... ... Streptococci Tonsils enlarged N. A. 15 ... ... ... Staphylococci ... E.B. ... ... ... ... ... ... (away) C. B. 9 ... ... ... Streptococci ... A. R. 11 ... + ... Staphylococci ... Streptococci ... L. B. 16 + + + „ ... D. H. 15 + + + „ Membrane D. L. 15 ... + + ... ... E. C. 14 ... + ... Streptococci Tonsils enlarged R. T. 9 ... ... ... Staphylococci ... L. G. 7 ... + + Streptococci ... B. C. 9 ... + ... „ ... V. H. 15 ... + + „ ... A. S. 10 ... ... ... Micrococcus catarrlialis ... Staphylococci ... B. B. 11 + + + ... ... J. F. 14 ... + + Streptococci ... U. S. 12 ... + ... „ Tonsils enlarged M. P. 15 ... ... + „ ... G. C. 9 ... + + „ ... E. B. 16 + ... + „ ... E. D. 10 ... ... + „ ... A. G. 15 + + + „ ... V. B. 10 ... ... ... Staphylococci Tonsils enlarged L. W. 9 ... + + Streptococci ... M. B. 16 ... ... + „ ... K. L. 14 ... ... + „ ... E. P. 14 ... ... + „ ... M. B. 14 + ... + ... ... D. R. 8 ... ... + Staphylococci ... 84 Initials. Age Klebs Loeffler Bacillus. Diph- theriod Bacilli. Hoffman's Bacillus. Other predominating Organisms. Remarks. A. M. 10 ... ... ... Staphylococci ... Streptococci ... L. J. 13 ... + ... Streptococci ... N. B. 14 ... ... + Staphylococci Tonsils enlarged H. G. 16 ... ... + Streptococci ... D. H. 13 ... ... ... Streptococci ... Micrococcus catarrhalis ... D. K. 10 ... ... + Streptococci ... T. P. 16 ... ... + Streptococci ... Staphylococci ... A. K. 10 ... + ... Streptococci Tonsils enlarged D. C. 14 ... ... ... „ ... D. G. 10 ... ... ... Staphylococci ... Streptococci ... E. C. 14 ... ... ... Staphylococci ... M. C. 10 ... ... + Micrococcus catarrhalis ... D. M. 12 ... + + Staphylococci Tonsils enlarged M. W. 14 ... ... + Streptococci „ (Hosp.) I. H. 9 ... + ... Staphylococci ... V. H 12 .. ... + Streptococci ... W. P. 14 ... ... + „ ... S. C. 11 ... ... + „ Tonsils enlarged M. L. 11 ... + + „ ... J. H. 11 ... ... + Staphylococci ... G. W. ... ... ... ... Staphylococci ... Streptococci ... K. R. 11 + + + „ ... L.M. 11 ... ... + „ . . . W. D. 7 ... + + „ . . . A. G. . . . . . . + + „ Tonsils enlarged V. L. 12 . . . + + „ ... I. F. 12 . . . . . . + „ . . . D. G. 16 . . . + + „ . . . D. S. 11 . . . ... + „ Tonsils enlarged P. M. 10 . . . + + . . . . . . I. M. 10 . . . + . . . Streptococci . . . E. W. 12 . . . . . . + „ . . . E. H. 11 . . . . . . + „ ... V. P. 12 ... ... + „ ... I. K. 10 ... ... + Streptococci ... V. L. 13 ... ... + „ Tonsils enlarged E. C. 16 + ... ... Streptococci ... Micrococcus catarrhalis ... V.B. 12 ... ... + Streptococci ... Staphylococci ... A. L. 14 ... + ... Streptococci Tonsils enlarged H. P. 14 ... ... + „ ... V. D. ... ... ... + „ ... G. G. 16 ... + + „ ... G. K. 8 ... + + Streptococci ... R. H. 10 + + ... ... ... I. L. 10 ... ... + Micrococcus catarrhalis ... Streptococci ... L. K. ... ... ... Staphylococci Tonsils enlarged A. B. 14 + + + Streptococci Membrane 85 Initials. Age. Klebs Loeffler Bacillus. Diphtheriod Bacilli. Hoffman's Bacillus. Other predominating Organisms. Remark. N. R. 16 ... ... ... Staphylococci ... Staff, Ac. Miss S. ... ... ... + Streptococci ... „ C. ... ... ... + „ ... „ R. ... ... + + „ ... „ D. ... ... + ... „ .. „ H. ... ... ... + „ ... „ B. ... ... ... + „ ... „ W. ... ... + + ... ... Sister S. ... ... ... + Streptococci ... Miss W. ... ... ... + Staphylococci ... „ H ... ... ... ... Streptococci .. „ J. ... ... ... + „ ... „ S. ... + + + „ Tonsils enlarged „ A. ... ... ... + ... ... „ C. ... ... + ... Streptococci ... Nurse B. ... ... + ... „ ... Miss S. ... ... ... + „ ... „ L. ... + + + „ .. „ D. ... ... ... + „ ... Sergt. P ... ... + + „ ... Mrs. P. ... ... + + ... Tonsils enlarged L. P. ... ... ... ... ... ... B. P. ... ... ... + Streptococci ... Staphylococci Tonsils enlarged M. P. ... ... ... ... Streptococci ... Staphylococci Tonsils enlarged Summary. Almost without exception the throats examined were relaxed or showed signs of infection. In five of the cases definite membrane patches were seen. These patients were:— e. a., e. w , d. h., a. B., and one person in the first dormitory visited, whose name was not taken through a clerical error. In thirty-seven of the cases there were markedly enlarged tonsils. In twenty-two cases the true diphtheria bacillus was found, showing all the classical morphological characteristics. In forty-three cases the diphtheroid bacillus described above was found, where the Klebs Loeffler Bacillus was absent. 86 Practically all the throats examined showed the presence of streptococci and Hoffman's Bacillus. Suggested procedure for dealing with the state of affairs. 1. Cases to be notified— (a) All those in which a true diphtheria bacillus is present; (b) All cases in which a membrane and diphtheroid bacilli are present; (c) All cases showing diphtheroid bacilli and constitutional symptoms. 2. Cases for isolation— (a) All cases showing the diphtheroid bacilli not given under the previous heading. 3. The remaining cases. Showing Hoffman and streptococci are to have vigorous antiseptic treatment of the throats. The isolated cases are not to be allowed to mix with the other inmates of the school until their throats have been declared free from the infecting organisms after a thorough bacteriological examination. Dennis Emhleton, M.A., M.B. The total number of cases that were notified as the result of this swabbing was twenty-seven. In addition, the Bacteriologist's report classed forty girls as suspicious. These cases were dealt with by sending the twenty-seven notified cases to the Metropolitan Asylum Board's Hospital, and the forty suspicious cases were isolated in the School buildings of the Home for observation and for anti-toxin treatment. None of these latter forty cases showed any sign of ill-health. From that time onward until 10th March the disease was represented by one case only. Two cases occurred on the 12th, one on the 18th, two on the 20th, and one on the 21st. The Committee decided to empty the building as soon as possible, and endeavours were made to secure a building elsewhere in order that the inmates might be transferred for such time as was necessary to permit of the renovations to the building which had already been agreed upon. The authorities of the Home having negotiated for a temporary residence elsewhere, and arrangements having been made for the use of an unused school building in the south-west of London, I again 87 arranged for Dr. Embleton, of University College, to examine the throats of all the inmates. This was done on Monday, 23rd March, and his report was to the effect that (he throats of the inmates appeared very much better than when swabbed on February 28th ; bacteriologically also there was a marked improvement. The swabbing showed, however, that there were 14 cases in which the diphtheria (Kleb's Lueffler bacillus) was present; these were promptly removed to Hospital and thorough disinfection carried out, The remaining inmates being clinically and bacteriologically free from diphtheria were transferred on March 25th to their temporary Home, and full information of the occurrence of the disease was forwarded to the Medical Officer of Health of Wandsworth, in whose district the temporary Home was situated, and arrangements were made for a private medical practitioner to take over the care of the children. In my opinion the continued presence of diphtheria at the Home was due to the " carrier " cases, which were not found until the complete swabbing took place. It would be difficult, and probably very unfair, to say that the condition of the building bred diphtheria de noro, but the fact that there were so many sore throats, and the presence of streptococci, apart from diphtheria clearly points to an unsatisfactory sanitary and hygienic condition connected with the building that had caused the inmates to be susceptible to diphtheria, and to make it a suitable ground to flourish once the disease had been introduced. The total number of cases of diphtheria that occurred was 68. The subsequent history of the children removed to their temporary home is interesting. From the time that they were removed only a single case of diphtheria occurred among them ; there were no fresh cases of sore throat after their removal; the general health of the children improved very much, and during the two months prior to their return to Hampstead they were in perfect health. The Committee of the buildings at Rosslyn Hill grasped the matter in a bold spirit. The Home has undergone a thorough and complete renovation at the cost of many thousands of pounds, and it would be difficult to find any sanitary defects in these buildings or grounds at the present time. The children returned to Hampstead in February, 1915. Since then no case of notifiable infectious disease has occurred among children or staff, and the health of the children has been excellent. 88 The following figures show the prevalence of diphtheria in Hampstead since 1890, the year in which the disease first became notifiable. Year. No. of Cases notified. Year. No. of Cases notified. Year. No. of Cases notified. 1914 224 1905 63 1896 189 1913 116 1904 55 1895 112 1912 155 1903 79 1894 96 1911 141 1902 85 1893 158 1910 48 1901 142 1892 136 1909 33 1900 153 1891 88 1908 55 1899 106 1890 96 1907 103 1898 131 1906 97 1897 100 The mortality figure from this disease in 1914 is the lowest ever recorded in Hampstead. The mortality from this disease from 1901-1914 is set out in the following table:— Year. No. of Cases notified. Deaths among Notified Cases. Diphtheria Death-rate per 1000 population. No. Percentage of Cases notified. 1901 142 18 12.6 0.21 1902 85 10 11.7 0.11 1903 79 10 12.6 0.12 1904 55 5 9.0 0.06 1905 63 3 4.7 0.03 1906 97 10 10.3 0.12 1907 103 6 5.8 0.07 1908 55 5 9.1 0.05 1909 33 5 15.1 0.05 1910 48 6 12.5 0.06 1911 141 17 12.0 0.20 1912 155 17 11.0 0.20 1913 116 3 2.6 0.03 1914 224 8 3.6 0.13 89 The following table shows the number of cases notified in the various Wards:— Months. WARDS. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). January 6 1 2 1 — l — 11 February 12 3 — — l 7 — 23 March 48 — — — l 2 1 52 April 1 3 — — l 4 — 9 May — 1 2 — l 2 — 6 June 3 4 — 1 — 1 — 9 July — 2 — — 2 - 1 5 August 6 — — — 1 3 — 10 September 3 7 1 3 1 1 3 19 October 7 4 2 5 6 13 16 53 November 7 1 2 — 1 6 2 19 December o 1 — — 2 2 1 8 Totals 95 27 9 10 17 42 24 224 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. Several applications for anti-toxin were received during the year, and 152,000 units were supplied, chiefly in connection with the outbreak of Diphtheria at the Royal Soldiers' Daughters' Home. The total number of specimens examined during the year was 398, of which 109 gave a positive, and 289 a negative result. 90 Erysipelas. Forty-four cases were notified, and 2 deaths occurred, as compared with 32 cases and 2 deaths in 1913. The attack-rate per 1000 of the population was 0.50. Of the cases notified, 5 or 11 per cent., were removed to the Hampstead Workhouse Infirmary. The Metropolitan Asylums Board do not provide hospital accommodation for cases of erysipelas, and patients suffering from this disease are unable to obtain hospital treatment except in Poor Law Infirmaries. Scarlet Fever. The number of cases of scarlet fever notified in each of the last 14 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 1912 101 1913 198 1914 278 It will be noticed from the above table that there was a considerable increase in the number of cases notified. The number of cases per 1000 of the population was 3.20; the corresponding figure in 1913 was 2.29; 2 cases, or 0.7 per cent. of those notified, proved fatal; the death-rate per 1000 population was 0.02. In the preceding year 4 deaths occurred from this disease, equivalent to a rate of 2 per cent, of cases notified, or 0.04 per 1000 population. Of the cases notified, 241, or 87 percent., were removed to hospital. The corresponding percentage in 19 13 was 80. 91 Careful inquiries were made in each case, with a view to ascertaining the source of infection. Twelve of the cases occurred among the staff of the North- Western Fever Hospital, as compared with 8 in 1913. The following table shows the number of cases occurring in the various wards. Month. WARDS. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (priory). January 3 3 l — 5 2 4 18 February 2 2 l — 1 10 1 17 March 2 1 — — 8 12 — 23 April 1 3 3 2 3 15 — 27 May 1 6 4 2 2 7 5 27 June 1 9 2 1 5 8 — 26 July 11 2 1 3 2 7 - 16 August 1 1 — — 1 19 3 25 September 3 2 — 3 2 20 3 33 October 3 3 — 1 4 9 2 22 November 4 7 — — 2 9 5 27 December 3 4 2 1 4 3 — 17 Totals 25 43 14 13 39 121 23 278 Enteric Fever. The number of cases notified was 16 as compared with 14 in 1913, and 9 in 1912. The attack-rate per 1000 population was 0.18. One of the cases notified proved fatal, or 6.2 per cent. of the cases notified. Two other deaths from this disease were allocated to Hampstead which 92 were notified in other districts. When these deaths are included it will be found that the death-rate per 1000 population was 0.03; 12 patients, or 75 per cent. of the total cases notified, were removed to hospital. Fourteen specimens of blood from patients suspected to be suffering from enteric fever were submitted by the doctors in attendance, for bacteriological examination, eleven specimens proving positive and three negative. The following table shows the number of cases occurring in the various wards.— Month. WARDS. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). January — 3 l — 1 — — 5 February — 1 — — _ l — 2 March - - - - — - - - April - - - - - - - - May — 1 — — — 1 2 J une — — — 1 l — — 2 July - - - - - - - - August - - - - - - - - September - - - - - - 1 1 October - - - - - l — 1 November 1 — — — l - — 2 December — 1 - - - - - 1 Totals 1 6 l l 3 3 1 16 93 Puerperal Fever. Seven cases were notified, 3 which proved fatal, as compared with 1 case that terminated fatally in the previous year. The Ward distribution of the cases was as follows:—Town 1, Belsize 2, Adelaide 1, West End 1, Kilburn 2. All the cases were removed from their homes. The hospitals of the Metropolitan Asylums Board are now available for the reception of a limited number of puerperal fever cases, which, however, must be recommended for admission by the Medical Officer of Heath. This arrangement was sanctioned by the Local Government Board on 20th August, 1912. Epidemic Cerebro-Spinal Meningitis. This disease, popularly known as "Spotted Fever," is now one of the notifiable diseases. No case was notified during 1914. The last case in Hampstead occurred in 1912. Acute Polio-Myelitis or Acute Polio-Encephalitis. This disease, which, although it occurs in adults as well as children, is Dopularly known as " Infantile Paralysis," was, by an order of the L'tndon County Council, made permanently notifiable in the County of London from March 13th, l912. There is considerable evidence to show that the disease is communicable, but it is by no means clear how the infection is communicated. Two cases were notified during the year, both of which proved fatal. The cases were as follows:— Female, aged 18 years, notified in July. Scholar at a High School. Illness commenced with pain in shoulder blades, arms and back of neck; left arm first paralysed, then right arm. There was no sensory paralysis. Respiratory paralysis occurred twelve hours before death, which took place in sixty hours from the appearance of the first symptoms. Patient was not removed to hospital. Disinfection was carried out in this case. Male, aged 6 years, notified in November. Schoolboy. Illness commenced with vomiting. Both arms were paralysed and later the respiratory muscles. Patient was removed to hospital, where death occurred within four days from onset of illness. 94 Ophthalmia Neonatorum. (Inflammation of the Eyes of the Newly-born.) The London County Council made an Order, which came into operation on March 13th, 1911, requiring the notification by medical practitioners of Ophthalmia Neonatorum. This disease is one of the frequent causes of blindness, and therefore inflicts considerable loss on the community. Twelve cases were notified in Hampstead during the year. All cases reported are promptly visited by a lady sanitary inspector. In order to prevent the disease resulting in loss of eyesight it is necessary that the patient should be properly nursed, and the chief object of notification is to facilitate the provision of skilled nursing. A further step was taken in the attempt to check this disease by the Public Health (Ophthalmia Neonatorum) Regulations, 1914, which were issued by the Local Government Board on 5th February, 1914, and came into operation on 1st April, 1914. Ophthalmia Neonatorum is therein defined as " a purulent discharge from the eyes of an infant, commencing within twenty-one days of the date of its birth." Under the provisions of these Regulations medical practitioners, when notifying cases of Ophthalmia Neonatorum under the Public Health (London) Act, 1891, are required to supplement the information usually given on the ordinary infectious disease notification certificate forms by particularsrelating to:(1) Date of Birth; (2) Name and address of parent or other person, if any, having charge of the child ; and (3) Date of onset of disease. By Article VI. of these Regulations it is provided that " every certified midwife who has reasonable grounds for supposing that a child upon whom she is in attendance or whom she is called in to visit in the course of her practice is suffering from Ophthalmia Neonatorum, shall, unless the case has been already notified by a medical practitioner, forthwith make and sign a notification of the case in form set out in the Schedule of these Regulations, and shall transmit the notification to the Medical Officer of Health for the District within which the place of residence of the parent or other person, if any, having charge of the child is situate at the date of notification." Principal Epidemic Diseases. The principal epidemic diseases to which reference is here made are: — Enteric Fever Scarlet Fever Small-Pox Whooping Cough Measles Diphtheria 95 All of these, with the exception of Measles and Whooping; Cough, are notifiable diseases, and detailed information concerning them will be found under the heading of Notifiable Infectious Diseases, on pages 75-94, but particulars concerning Measles and Whooping Cough, to which compulsory notification does not apply, are given in the following page. The total number of deaths from the principal epidemic diseases amounted to 34, and the death-rate was 0.39 per 1000 of the population. 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) Enteric Fever 1 l — — — l — 3 Small-pox - - - - - - - - Measles 1 l — — - — — 2 Scarlet Fever 1 l - - - - - 2 Whooping Cough 5 1 — l 3 6 — 16 Diphtheria and Membranous Croup 1 3 — 2 — 4 l 11 Totals 9 7 — 3 3 11 1 34 Measles. Two deaths were recorded from this disease, as compared with 21 in 1913. The mortality was 0.02 per 1000 population, the mortality in 1913being 0.24. Since 1903, measles has been included among 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 donot make the disease compulsorily notifiable. However, many cases are reported by school teachers, parents and others. During the year 1914,. 142 cases were reported, as compared with 276 in 1913. 96 The Metropolitan Asylums Board now receive into their hospitals cases of measles on the recommendation of the Medical Officer of Health, who is required to furnish the Board with certain particulars regarding the case. 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 recovery skilled nursing, plenty of good food and healthy surroundings, are necessary, and who are unable to obtain these necessities in their own homes. The total number of Hampstead patients removed to the Board's hospitals during the year was 7. Most of the cases of measles arc reported to the Medical Officer of Health, principally by school teachers, and the following is a list of the sources of information :— Cases notified by medical practitioners 2 ,, school teachers 122 „ employers and others 17 From deaths returns 1 142 The 142 cases occurred in 99 houses. In 73 houses there was 1 case in the house. ,,17 „ there were 2 cases ,, ,, 2 ,, ,, 3 ,, ,, ,, 2 ,, ,, 3 ,, ,, ,, 21 house ,, 5 ,, ,, 97 The following table shows the number of reported cases of measles occurring each month in the various 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 — — — — l — — 1 February — 1 — 1 — — — 2 March — 3 - - - - - 3 April — - - — — — — — May - - - - - - 1 1 June - - - - - - 1 1 July 1 2 1 — — l — 5 August — — — — — — — — September — 14 2 — — l 1 18 October 1 46 — 1 — — — 48 November 36 5 - - - - - 41 December 14 3 1 2 — 2 — 22 Totals 52 74 4 4 1 4 3 142 In 34 cases, or 24 per cent. of the reported cases, no doctor was in attendance. The total number of visits paid to measles cases during 1914 by the two lady inspectors was 125. 98 In the following table the deaths at all ages from measles are set out in Wards in each year since 1901:— YEAR. WARDS. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No 5 West End). No. 6 (Kilburn). No. 7 (Priory). 1901 — 1 - - - - - l 1902 — 2 - - 4 8 l 15 1903 6 — — — - 1 l 8 1904 — 3 - I 3 8 — 15 1905 1 2 - - 4 - l 8 1906 2 — 1 — - 5 2 10 1907 2 4 - - 1 2 1 11 1908 — 1 I 2 — - 4 1909 4 3 — - 1 2 1 11 1910 - 4 - - 3 7 - 14 1911 4 2 l - 1 3 3 14 1912- 1 4 - - 2 4 - 11 1913 2 - l 3 5 7 3 21 1914 1 1 - - - - - 2 Totals 23 27 4 5 26 47 13 145 Nearly all the deaths from measles occur among children under five years of age. In addition to the mortality, it must be remembered that the health of many children who do not succumb is considerably injured. If parents and others having the care of children would only realise the serious consequences that may ensue if this complaint is too 99 lightly regarded, a great saving of child life would be effected. During the fourteen years above referred to, 1901-1914, it will be seen that 145 deaths occurred from measles. The total deaths from Scarlet Fever during the same period only amounted to 52. The mortality from measles should not strictly be limited to those who die at or immediately after the disease. Measles is a frequent fore-runner of Tuberculosis, and endeavours are made by this Department to get all children who have had measles to visit the Tuberculosis Dispensary within three months of the attack, so that anything like commencing Tuberculosis may be detected. Of the cases that come to my knowledge and arc visited by the Council's lady inspectors, about 24 per cent are found not being medically attended. The leaflet issued by the Council has been distributed during the year. The chief objects of the leaflet are to bring home to people the necessity for not regarding measles merely as a trivial ailment, and for taking due precautions for the prevention of the spread of the disease. Whooping Cough. Sixteen deaths occurred from whooping cough, as against 10 in 1913. The mortality per 1000 population was 0.18. 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. As in the case of measles, however, the total number of deaths from this disease (which chiefly occurs among young children) during the period 19011914 was 155: this greatly exceeds those that were due to Scarlet Fever, which only amounted to 52. The necessity for not lightly regarding cases of whooping cough is urged strongly in the leaflet that the Borough Council publish. The total number of visits paid to cases of whooping cough during 1914 by the two lady inspectors was 228. The Metropolitan Asylums Board now provide hospital treatment for suitable cases of whooping cough that are recommended by the Medical Officer of Health. The number of Hampstead patients removed to the Board's Hospitals during the year amounted to 32. 100 The deaths at all ages from whooping cough since 1901 are arranged in the following table in Wards: — YEAR. WARDS. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). 1901 3 1 2 l 8 8 1 24 1902 4 2 — — — 2 2 10 1903 3 1 — — — 9 2 15 1904 — 1 — l 2 3 — 8* 1905 2 1 1 — 6 6 1 17 1906 — 1 — — — 1 — 2 1907 — 2 — — 4 5 1 12 1908 2 1 1 — 1 — — 5 1909 1 1 2 l 1 6 6 18 1910 — 2 — — 3 5 1 11 1911 1 - — — 1 1 — 3 1912 1 — l 1 1 — 4 1913 3 2 2 l — — 2 10 1914 5 1 — l 3 6 - 16 Totals 25 16 8 6 30 53 16 155* * One death in 1904 was non-distributable. 101 Disinfection. Number of articles disinfected:— Beds 461 Mattresses 937 Palliasses 69 Bolsters 673 Pillows 1,997 Blankets 2,369 Sheets 1,484 Counterpanes 970 Articles of Clothing 5,796 Carpets 86 Linen Articles 4,398 Books 435 Miscellaneous 1,713 Total 21,388 Number of premises disinfected 1,050 ,, rooms, etc., disinfected 1,177 In addition to the foregoing, the following were destroyed upon request of the owner:— Beds 7 Mattresses 16 Bolsters 6 Pillows 13 Blankets 7 Sheets 10 Counterpanes 2 Articles of Clothing 22 Carpets — Miscellaneous 13 Linen Articles 31 Total 127 During 1013,904 premises, 1,278 rooms, etc., and 15,309 articles were disinfected, while 109 articles were destroyed. 102 The amount of disinfection carried out by the Council has increased considerably in late years, and this is in no small measure due to the practice of the Council to disinfect after all cases of measles coming to the notice of the Sanitary Authority, and the clothes, etc., of verminous school children and others undergoing cleansing at the cleansing station. Disinfection is also carried out upon request in cases of noninfectious illness, a small charge being made. The number of cases where such disinfection was carried out was 235, the amount received in fees for this work being £55 2s. 6d. With regard to measles, the London County Council in the early part of 1903 obtained the approval of the Local Government Board for the inclusion of measles amongst the dangerous infectious diseases in so far as Sections 60-65, 68-70 and 72-74, Public Health (London) Act, 1891, apply. These sections, while they do not make the disease compulsorily notifiable, extend to it the provisions relating to isolation and disinfection. During the year I have received information respecting 142 cases of measles, and in all of these cases disinfection was carried out. SECTION E. Prevalence of and Control over Tuberculosis. 105 Tuberculosis. Deaths. The number of deaths from tuberculosis in 1914 was 71. Of these, 57 deaths were due to pulmonary tuberculosis or consumption, 8 to tuberculous meningitis, and 6 to other forms of tuberculosis. The following table shows the number of deaths and the deathrates from all forms of tuberculosis and from consumption respectively since 1899:— Year. Total deaths from Tuberculosis. Deathrate per 1000 Population. Deaths from Consumption. Deathrate per 1000 Population. Cases of Consumption notified. 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 51 1903 90 1.09 66 0.80 34 1904 102 1.23 73 0.88 39 1905 95 114 73 0.87 27 1906 79 0.94 57 0.68 35 1907 92 1.09 61 0.72 55 1908 84 0.99 74 0.87 30 1909 75 0.88 53 0.62 67 1910 80 0.94 58 0.68 77 1911 70 0.82 56 0.65 113 1912 77 0.88 64 0.74 183 1913 61 0.71 49 0.56 300 1914 71 0.82 57 0.66 172 The deaths from consumption and from all forms of tuberculosis during 1914 were distributed among the wards as follows:— Ward. Area (Acres). Estimated Population middle of 1914. Consumption. Tuberculosis (All Forms.) Deaths. Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Population. No. 1 (Town) 686 14,400 5 0.35 6 0.42 ,, 2 (Belsize) 271 14,100 11 0.78 11 0.78 ,, 3 (Adelaide) 325 9,730 2 0.20 3 0.31 „ 4 (Central) 312 10,061 6 0.60 7 0.69 „ 5 (West End) 247 13,100 14 107 15 1.14 ,, 6 (Kilburn) 195 15,300 13 0.85 20 1.31 „ 7 (Priory) 229 10,040 5 0.50 8 0.80 The Borough 2,265 86,731 57* 0.66 71* 0.82 * 1 death from consumption was non-distributable. 106 The death-rate from pulmonary tuberculosis in the Borough and in each Ward per 10,000 population since 1902, is as follows:— Year. DEATHS PER 10,000 POPULATION. Borough. No. 1 Town Ward. No. 2 Belsize Ward. No. 3 Adelaide Ward. No. 4 Central W ard. No. 5 West End Ward.. No. 6 Kilburn Ward. No. 7 Priory Ward. 1902 8.9 14.0 11.5 6.8 5.4 4.9 10.8 6.6 1903 8.0 8.9 9.9 1.0 4.3 9.7 12.2 4.7 1904 8.8 10.4 9.1 7.8 1.1 6.5 14.8 8.5 1905 8.7 7.9 7.5 3.9 6.4 8.8 17.5 6.6 1906 6.8 3.9 9.7 4.9 2.1 6.4 10.1 7.6 1907 7.2 9.9 7.4 2.0 5.2 7.1 10.8 5.7 1908 8.7 5.3 11.8 4.0 7.3 7.1 14.1 6.7 1909 6.2 4.5 5.9 3.0 3.1 4.7 11.4 7.6 1910 6.8 4.4 5.8 5.0 3.1 8.6 10.7 7.6 1911 6.5 5.1 7.2 3.0 3.0 7.8 10.7 4.8 1912 7.4 3.6 5.1 9.1 6.1 9.3 9.3 9.6 1913 5.6 7.6 3.5 4.0 — 5.3 11.6 2.9 1914 6.5 3.5 7.8 2.0 6.0 10.7 8.5 5.0 It will be seen that the rates for the Kilburn Ward are in nearly every year higher than those of other wards, but, in considering these, it should be remembered that most of the poorer inhabitants of the Borough live in this district. Families whose incomes are lessened by the ill-health of the breadwinner naturally migrate to those streets where less expensive lodgings may be obtained. During 1914, however, the death-rate for the West End Ward was higher than that for the Kilburn Ward. This, I take to be due to an exceptionally heavy death-rate in the West End Ward for that year, and should be regarded rather as a coincidence, though one must always bear in mind that one of the poorest districts of our Borough—the Broomsleigh Street area— is situated in the West End Ward. 107 The number of new eases of tuberculosis in this ward that have been notified to me during 1914 is much in excess of those in other districts of the Borough, but the factors above referred to should be borne in mind in this connection, as in the case of the death-rates from pulmonary tuberculosis. The following table shows the age distribution of the patients dying from consumption in Hampstead in the twelve years 1903-1914:— 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 5 44 5 56 1912 2 2 13 45 2 64 1913 — 1 4 39 5 49 1914 - 2 10 42 3 57 Totals 9 14 129 545 44 741 It is clear from the foregoing that the majority of the deaths from Pulmonary tuberculosis occur at the principal wage-earning periods of life. The following table shows the deaths during the past twelve years arranged in percentages at the various age-periods : — Percentage to total Age period. pulmonary tuberculosis deaths. 0-5 1.2 5-15 1.9 15—25 17.5 25—65 73.5 65— 5.9 108 The deaths from all forms of non-pulmonary tuberculosis in the same period are distributed in age-periods as follows:- Year. Age Periods. 0—5 5—15 15-25 25—65 65— All Ages. 1903 12 4 2 5 1 24 1904 18 3 3 5 — 29 1905 11 2 3 5 1 22 1906 11 5 2 4 — 22 1907 20 3 - 6 2 31 1908 4 4 — 2 — 10 1909 12 1 2 7 — 22 1910 7 5 2 4 4 22 1911 9 1 2 2 — 14 1912 8 1 2 2 — 13 1913 4 4 1 3 — 12 1914 7 4 2 1 — 14 Totals 123 37 21 46 8 235 It will be observed that, of the deaths from non-pulmonary tuberculosis, a very large proportion occur among children under the age of five years. Of the various forms of tuberculosis classified under the heading of non-pulmonary tuberculosis, tuberculous meningitis claims a considerable proportion. The number of deaths from tuberculous meningitis and from all forms of non-pulmonary tuberculosis since 1911 are as follows:— Year. Deaths from all forms of Non-Pulmonary Tuberculosis. Deaths from Tuberculous Meningitis. 1911 14 7 1912 13 8 1913 12 6 1914 14 8 109 Notification. The following table gives the number of patients newly notified in each year since 1902:— Year. Persons Newly Notified. Total. Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. (Notifiable from 1st February, 1913.) 1902 51 - 51 1903 34 - 34 1904 39 - 39 1905 27 - 27 1906 35 - 35 1907 55 - 55 1908 30 - 30 1909 67 - 67 1910 77 - 77 1914 113 - 113 1912 183 - 183 1913 244 56 300 1914 142 30 172 The following table gives an analysis of the total number of new cases of tuberculosis that were notified to me during the year (excluding notifications relating to admissions and discharges to and from Institutions on Forms C & D of patients not previously known to my Department). Age-periods (years). 0—1 1—5 5—10 10—15 15—20 20—25 25—35 35—45 45—55 55—65 65 and upwards Totals. Pulmonary Males — 2 — 2 3 6 11 13 8 5 — 50 „ Females — — 2 3 2 14 26 14 5 S 5 74 Non-pulmonary Males 2 3 2 — 3 1 1 1 — — — 13 ,, Females 2 —— 2 1 2 2 1 1 I — — 12 Totals 4 5 6 6 10 23 39 29 14 8 5 149 110 In addition to these 149 cases, the following other cases, previously notified elsewhere, were brought to my notice for the first time in 1914: — Pulmonary. Non-pulmonary. Total. Form C (admission to intitutions from Hampstead addresses) 8 4 12 Form D (discharge from institutions to Hampstead addresses) 10 1 11 18 5 23 The total number of tuberculous I lamp stead residents newly notified during the year was, therefore, 172. The increase in the number of patients notified in recent years is due to the operation of the instalments of compulsory notification. Notification of consumption was inaugurated in Hampstead in 1902, when a system of voluntary notification was adopted. This voluntary system remained in operation until the present Regulations came into force on 1st February, 1913. Compulsory notification commenced on 1st January, 1909, when the Public Health (Tuberculosis) Regulations, which provided for the compulsory notification of cases of consumption occurring in Poor Law patients, came into operation. On 1st May, .1911, compulsory notification was extended by the Public Health (Tubercidosis in Hospitals) Regulations, 1911, to all cases of consumption occurring in hospital patients; and notification was extended, generally, by the Public Health (Tuberculosis) Regulations, 1911, which came into operation on 1st January, 1912. These regulations were replaced in 1913 by those now in force, which came into operation on 1st February, and which apply to all forms of tuberculosis. The total number of persons notified in 1914 as suffering from tuberculosis was 221, but 49 of these had been notified prior to 1914. Of the 221 cases, 133 were pulmonary, and 38 non-pulmonary. The total number of cases brought to my knowledge for the first time in 1914 was 172, i.e., 142 pulmonary, and 30 non-pulmonary. 97 of the 172 were non-insured, 66 were insured under the National Insurance Act, and in 9 cases the information could not be ascertained. Pulmonary Tuberculosis.—Of the 183 cases, 41 had been previously notified in former years, and of the remaining 142,19 were not, properly speaking, " Hampstead " residents, 15 being institution cases—the 111 others being here temporarily as guests (refugees, etc.). The number of new "Hampstead" patients notified for the first time in 1914 was, therefore, 123—of these, 56 were males and 67 females. Non-pulmonary Tuberculosis.—Of the 38 non-pulmonary cases, 8 had been previously notified. Four of the remaining 30 cases were not, properly speaking, "Hampstead" residents, 2 beiug institution cases, and 2 here temporarily as guests. The number of Hampstead cases brought to my notice for the first time in 1914 was therefore 26, —13 males and 13 females. It will bo noted that the number of new eases occurring among "Hampstead" residents notified during the year 1914 differs from the number of new cases referred to elsewhere in the Report. This is accounted for by the fact that, in accordance with the terms of the Public Health (Tuberculosis) Regulations, 1912, some cases were newly notified to me who were not, properly speaking, "Hampstead" residents, but the certificates in respect of whom I was bound to accept. .Such for instance were : — Persons discharged from outlying institutions to institutions in the Borough. Casuals of no home, admitted to Hampstead Workhouse Infirmary. The total number of notification certificates (including duplicates) received during 1914 relating to Hampstead patients suffering from various forms of tuberculosis was 292, i.e., 249 pulmonary and 43 non-pulmonary. In accordance with the terms of the regulations, I keep a register containing the full particulars set out in each notification received by me; and also at the end of each week a statement of all notifications received during the week is sent to the County Medical Officer of Health. The notes of the investigations made in each case are carefully indexed and filed, and a most valuable record of tuberculosis in the Borough is thus being compiled, which is found to be of assistance in the steps which are taken to control the disease. The notifications were received from the following sources:—- Pulmonary Cases. Non-pulmonary Cases. Private Practitioners 101 14 Hospitals and Dispensaries Medical Officers of Sanatoria— 34 14 On admission of patients 36 3 On discharge of patients 31 5 112  Pulmonary Cases. Non-pulmonary Cases. Poor Law District Medical Officers 8 2 Medical Officer of Hampstead Workhouse Infirmary— On admission of patients 20 3 On discharge of patients 3 1 Medical Officers of Institutions in Hampstead on admission of patients from other districts 10 Medical Officers of outlying Poor Law Institutions — On admission of patients 3 — On discharge of patients 1 1 Medical Officers of Asylums 2 — 249 43 Housing Condition of Cases. In the course of investigating the 142 new cases of pulmonary tuberculosis, and the 30 new cases of non-pulmonary tuberculosis, they were found to be living under the following conditions :— Number of persons in family. Pulmonary Cases. Non-Pulmonary Cases. Occupying 1 room. Occupying 2 rooms. Occupying 3 rooms. Occupying 4 rooms. Occupying more than 4 rooms. Occupying 1 room. Occupying 2 rooms. Occupying 3 rooms. Occupying 4 rooms. Occupying more than 4 rooms.  1 6 l — — — — — — — — 2 3 3 6 I 4 — — — — l 3 1 5 — 4 7 1 — l — 2 4 1 5 5 1 11 — 2 l 1 2 5 — 2 3 1 5 — 1 1 1 1 6 — 1 3 2 1 — 1 l 2 — 7 — — — 1 2 — — l 1 — 8 — 1 — — 1 — — — — — 9 — 1 1 — 1 — — l — — 10 — — — 1 1 — — — — — 11 — — — — — — — — — — 12 — — — — — — — — — 1 11 19 18 11 33 1 4 6 5 7 92 23 113 In addition to above— Boarding-house inmates 5 — Nursing Home inmate 1 — Guefts or Dependents in other families 5 2 In Situations 16 3 Inmates of Institutions 15 2 No information 8 — 142 30 The unsatisfactory home conditions found upon investigating the new cases of tuberculosis notified in 1914 were as follows: — Unsatisfactory Home Conditions. Pulmonary Cases. Non-Pulmonary Cases. Overcrowding 3 l Inadequate Ventilation 8 l Inadequate Lighting 3 — Dampness 4 l Unhealthy Underground Rooms 1 — Other Insanitary Conditions 8 3 As regards the sleeping arrangements of the new cases notified the following particulars were elicited:— Number of persons, one of whom was suffering from Tuberculosis, sleeping in one room. Pulmonary Cases. Non-Pulmonary Cases. 1 56 9 2 36 7 3 14 8 4 9 4 5 1 - 6 2 1 Totai.s 118 29 Sleeping in Shelter 1 — Inmates of Institutions 15 1 No information 8 — 142 30 114 Occupations. The following is an analysis of the occupation of the cases notified as tuberculous:— Occupation. Pulmonary Cases. Non-pulmonary Cases. Baker's roundsman 1 - Boot repairer 1 - Bricklayer 1 — Cabinet maker 1 — Cardboard maker 1 - Carman 2 — Charwoman 2 - Cinematographer 1 - Clerk 12 1 Coffee-stall keeper 1 - Commission agent 1 - Commercial traveller 1 1 Companion 1 — Confectioner 1 - Designer 1 — Dock labourer 1 — Domestic servant 20 3 Draughtsman 1 — Dressmaker 2 — Engineer 1 1 Forewoman at Factory 1 — Gardener 1 — Governess — 1 Hawker 2 — Housewife 18 1 Joiner — 1 Laundress 2 — Masseuse 1 — Medical practitioner 3 — Milk carrier 2 — Motor man 1 — Musician 1 — Navvy 1 — Nurse (domestic) 1 — ,, (hospital) 1 — 115 Occupations —continued. Occupation. Pulmonary Cases- Non-pulmonarv Cases. Organiser 1 — Poor law officer 1 — Porter at flats 1 — School child 4 9 Schoolmaster 1 — Shipping agent 1 — Shop Assistant 7 — Sister in Convent 1 — Soldier (ex) 1 — Solicitor 1 1 Tailor's cutter 1 — Tutor 1 — Warehouseman 1 — No occupation 13 11 Retired 2 — Institution Cases 12 — No information 5 — 142 30 Removal of Cases. Of the cases of pulmonary tuberculoses newly notified in 1914, 55 were removed, 34 to Sanatoria, 3 to Hospitals, 14 to the Infirmary, and 4 to Nursing Homes. Thirteen of the newlv notified cases of non-pulmonary tuberculosis were removed, 11 to Hospitals, Homes and Sanatoria, and 2 to the Infirmary. Of the pulmonary cases notified prior to 1914, 19 were removed, 11 to Sanatoria, 1 to Hospital, and 7 to the Infirmary. Three cases of non-pulmonary tuberculosis notified in 1913 were removed to Hospitals, Homes, &c. Preventive and Curative Measurers. The action taken by the Public Health Department during the vear has followed the lines indicated in my Annual Reports for 1912 and 1913. Upon my receiving a notification, Mrs. Fisher, one of the 116 Council's lady sanitary inspectors, who has had special experience in this work, visits the patient and reports fully to myself upon the case and the home conditions. Each report is carefully considered, and the Medical Officer of Health decides if the case is a suitable one for treatment and visiting by the Tuberculosis Medical Officer and dispensary staff. When a patient applies to the dispensary, the subsequent treatment and home visiting is left to the staff of the dispensary ; otherwise a case is kept under the immediate control of the Medical Officer of Health. In either case the necessary instructions are given in the precautions that a patient should take, and a copy of the card of advice issued by the Council is given. The Council provide suitable consumptives with sputum flasks and with disinfectant. Should a patient leave the Borough, the fact is notified to the Medical Officer of Health of the district to which the patient removes, and such information as I think is desirable that he should receive concerning the case, is at once forwarded. This arrangement, while ' being of assistance to other Medical Officers of Health, also saves patients the necessity of again supplying information concerning their illness, etc., to the Officers of the district to which they remove. 620 visits to pulmonary cases and 92 to non-pulmonary cases, were made during the year by the lady sanitary inspector. The Council arrange for the free bacteriological examination of specimens sent by medical practitioners from suspected cases of consumption. In 1914, the total number of specimens examined for medical practitioners was 120, of which 25 were positive, and 95 negative Now that the Tuberculosis Dispensary is open this work is undertaken at the Dispensary. Disinfection is carried out during the lifetime of patients, and also after death. The total number of premises so disinfected during 1914 was 177. The Municipal Tuberculosis Dispensary, etc. The constitution of the Dispensary which is housed in a portion of the Health Institute at Kilburn, was set out at length in my report for 1913. 117 The question of the staffing of the Dispensary was raised during 1914 by the resignation of the Tuberculosis Medical Officer in June, and an Acting Tuberculosis Medical Officer—Dr. H. A. Sansom —was appointed pending further arrangements. It was felt that, with the decreasing number of cases of tuberculosis notified, and in view of the amount of work found by experience to be available for the Dispensary, a whole-time Tuberculosis Medical Officer was not necessary. It, therefore, appeared to be advisable to consider the question of making arrangements for the treatment of Hampstead residents at neighbouring dispensaries, or, in the alternative, the possibility of making such arrangements as would permit of the work being performed by a part-time Officer. After considerable deliberations, tentative arrangements were made for linking up the Dispensary with the Mount Vernon Hospital. Briefly, this arrangement will provide for a Visiting Physician of the Hospital to act as Tuberculosis Medical Officer, and in addition for Hampstead residents who are unable to go to the Dispensary to attend at the outpatients' department of the hospital at Fitzroy Square, which is easily accessible from that part of the Borough furthest from the Dispensary. Should the London County Council arrange with the authorities of the Hospital for the provision of beds at Northwood for un-insured tuberculous persons, there will be established an admirable continuity of treatment under the same physician, but, even should the London County Council not arrange for beds in Northwood, the two endowed beds there belonging to the Borough, still will be available for Hampstead persons. The draft scheme is now being considered by the various central authorities, and if agreed to will be brought into existence in the present year. 118 Report on the work of the Hampstead Municipal Tuberculosis Dispensary from 1st January to 31st December, 1914. During the year 455 persons have applied for treatment, and of these 73 were found to be tuberculous and were dealt with at the dispensary as their circumstances demanded. Table I. shows the number of applications for each individual month, and indicates the proportion of insured persons under the National Insurance Act who applied for treatment, and the number of these who were found to be tuberculous. Table I. Total Number of Applications made during year 1914. Month. Tuberculous. Non-Tuberculous. Totals. Insured. NonInsured. Total. Insured. NonInsured. Total. Insured. NonInsured. Totals. January 3 6 9 4 35 39 7 41 148 February 4 2 6 2 32 34 6 34 40 March 5 6 11 6 44 50 11 50 61 April 4 4 8 4 10 14 8 14 22 May 5 2 7 10 28 38 15 30 45 June 4 5 9 8 39 47 12 44 56 July 1 2 3 5 20 25 6 22 28 August 2 1 3 2 16 18 4 17 21 September 2 1 3 — 62 62 2 63 65 October 4 1 5 — 23 23 4 24 28 November 3 2 5 2 18 20 5 20 25 December 3 1 4 3 9 12 6 10 16 Totals 40 33 73 46 336 382 86 369 455 119 Table II. Sex and Age distribution of the 455 applicants. Table II. shows the age and sex distribution of the applicants for treatment, and also exhibits the incidence of tuberculosis at each age group. It is interesting as showing the large proportion of children under 15 who were examined (228, or 50 per cent.). Of these 8, or 3.5 per cent. were found to be suffering from pulmonary tuberculosis, and 5, or 2.2 per cent. from non-pulmonary tuberculosis. It is obviously of the greatest importance in the attempt to eradicate tuberculosis to bring under review for examination purposes as many children and adolescents as possible, as in the detection of early cases among this class of the community lies one of our most useful preventive measures. Age. 0—1 2—5 6—15 16—25 26—35 36—45 46—55 56—65 66 & over All Ages Sex. m. f. Both M. F. Both M. F. Both M. F. Both M. f. Both M. F Both M. F. Both M. F. Both M. F. Both M. F. Both  Total Examined 3 4 7 40 32 72 72 77 149 34 38 72 20 51 71 26 25 51 9 15 24 2 2 4 2 3 5 208 247 455 Pulmonary Tuberculosis — — — 1 — 1 3 4 7 6 12 18 4 18 22 8 5 13 3 1 4 — 1 1 — — — 25 41 66 Non-Pulmonary Tuberculosis — — — — 1 1 — 4 4 2 — 2 — — — — — — — — — — — — — — — 2 5 7 Non-Tuberculous 3 4 7 39 31 70 69 69 138 26 26 52 16 33 49 18 20 38 6 14 20 2 1 3 2 3 5 181 201 382 Percentage of Pulmonary Tuberculosis — — — 2 — 1 4 5 5 18 32 25 20 35 31 31 20 25 33 7 17 — 50 25 — — — 12 17 14 120 Number of Persons Treated. During the year the following patients, new and old, have beentreated:— Insured:— Pulmonary 41 Non-pulmonary 2 43 Non-Insured:— Pulmonary 67 Non-pulmonary 8 75 Total — 118 Table III. shows the proportion of males, females, and children treated, taking insured and non-insured patients together. Table III. Pulmonary and Non-pulmonary. Males. Females. Children under 14. Total. Pulmonary 26 54 28 108 Non-pulmonary 2 2 6 10 Totals 28 56 34 118 Attendance:— The attendances made by these patients for treatment during the year were:— Insured 773 Non-insured 1,140 1,913 In addition the following patients attended for the purposes of observation:— Insured 6 Non-insured 51 — 57 The attendances made by these were:— Insured 20 Non-insured 387 407 121 Contact. — During the year 195 contracts were examined, and 9 of these (5 per cent.) were found to be suffering from pulmonary tuberculosis, and were treated at the dispensary. Home Visits. — Visits to the homes of the patients are undertaken by the Tuberculosis Medical Officer and the Nurse, and have for their object (a) the supervision and education of the consumptive patients, and (b) treatment of such cases as are unable, on account of the severity of their case, or for other reasons, to attend at the dispensary. During the year the following domiciliary visits have been made:— Tuberculosis Medical Officer 540 Nurse 729 1,269 Patients discharged.— During the year 49 patients were discharged. Their condition on discharge was as follows:— Referred back to Panel Doctor 22 Much improved 20 Improved 5 No physical sounds 2 49 In addition, the following patients were dealt with as indicated:— Sent to Sanatoria, Hospitals, Convalescent Homes (other than Poor Law), etc. 36 Sent to Workhouse Infirmary 4 Left District 2 Ceased attending 34 76 Bacteriological Examination of Sputa.—The following specimens were examined in the laboratory, including specimens sent by medical practitioners practising in the Borough:— Positive 69 Negative 210 279 122 Table IV. Total, Attendances. The following table shows the total attendances of persons at the dispensary for all purposes during the period:— January 469 February 434 March 391 April 344 May 358 June 333 July 257 August 165 September 237 October 157 November 163 December 151 3,459 SECTION F. Investigation of other diseases. 125 Diarrhœa and Enteritis. The deaths at all ages from diarrhoea and enteritis in Humpstead during 1914 numbered 16. Of these, 7 occurred during the tirst year of life, and 2 in the second year. The deaths in the 1st, 2nd, 3rd and 4th quarters of the year were as follows:—4, 1, 10, 1. The deaths from these diseases at various age-periods in the last three years is as follows:— Year. 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. All ages. 1911 22 2 — — — 2 2 7 35 1912 2 — — — — 2 4 7 15 1913 13 1 2 — — 1 1 — 18 1914 7 2 1 1 — 1 2 2 16 Totals 44 5 3 1 — 6 9 16 84 The following are the deaths from diarrhœa and enteritis during the past ten years: — 1905 17 1910 15 1906 30 *1911 35 1907 14 1912 15 1908 22 1913 18 1909 11 1914 16 * This was a year of extra heat. The various efforts to combat diarrhœa and enteritis, especially among young children, have been continued during the past year. The principal lines upon which the sanitary authority has proceeded were enumerated in my last annual report. The leaflet that I prepared on "The Prevention of Summer Diarrhœa" was issued during the year, and distributed as far as possible. A special effort was made in July in co-operation with the Infants' Health Committees of the Hampstead Health Society with the object of placing a copy of the leaflet in the hands of every mother of a child born within the preceding twelve months. 126 The leaflet is in the following terras: — BOROUGH OF HAMPSTEAD. Public Health Department. The Prevention of Summer Diarrhoea. Summer Diarrhœa is a very fatal disease occurring principally among young children. Hand-fed infants are much more likely to suffer from it than those who are being breast-fed. Breast-fed babies are much more rarely attacked, and it is most important, therefore, not to wean babies during the hot weather. If the baby is bottle-fed, follow the directions given in the leaflet (Advice on the Hearing of Infants) published by the Borough Council, a copy of which will be supplied to you upon application at the Town Hall. Diarrhœa is so rapidly fatal among infants, that whenever it commences medical advice must be obtained at once. Call in the doctor immediately, and inform the Medical Officer of Health at the Town Hall. Whilst sending for the doctor, stop giving the baby milk. Until the doctor has arrived, give egg-water made in the following way:—Beat up the white of a raw fresh egg with a clean fork; after beating, mix with half-a-pint of water which has been boiled and allowed to get cold ; mix well and add half-a-spoonful of white sugar. You may allow the child to partake of this freely every two hours. If the baby is breast-fed keep the nipples clean, washing them before and after feeding the baby. If bottle-fed, be scrupulously clean with the bottle and teat. In no case use a bottle with a tube. Wash your hands carefully after changing baby. Rinse out the napkin at once in cold water, and boil it. Remember the disease is catching and may be conveyed by the hands to other children, therefore, the nails of both mother and child should be kept short and clean. A soiled napkin if left lying about may attract flies and so further spread the disease. Do not use any milk if you have the slightest suspicion that it is not quite fresh. In hot weather boil all milk as soon as you receive it. The cleanliness of the home and its surroundings and the careful protection of food from flies are the best possible way of avoiding the disease, which is mainly caught from contaminated food. All parts of the house must be freely ventilated and kept as clean as possible by washing and damp-dusting. No refuse should be allowed to remain in or about the house. Burn all you can on the kitchen fire, and place the remainder in the dust-bin with a closefitting lid. Keep the yard well swept and washed down. All water-closets with defective flushes, or obstructions in the drainage, should be at once reported to the Medical Officer of Health. If the dust is not regularly removed, report at once to the Town Hall. 127 Leave no food uncovered. In hot weather all food must be protected from flies ; they are frequent carriers of the disease. Frank E. Scrase, F.R.C.S., D.P.H., Medical Officer of Health. Public Health Department, Town Hall, Haverstock Hill, N.W. The danger of leaving food exposed to contamination by flies is now well established, and it behoves everyone, therefore, to take all possible precautions in this respect. It is also very important that refuse which may be the feeding-ground or breeding-ground of flies should not be allowed to remain lying about. This matter has for some time received considerable attention, and has been the subject of highly interesting reports. From observations that have been made, it appears that a high degree of infection is found among flies obtained from the neighbourhood of decaying animal matter, and also amongst those caught near manure. Other evidence has incriminated house flies as carriers of infection, and has shown how food may be infected upon which flies alight after having fed upon infective substances, whether typhoid, cholera, or diarrhoea stools. It would, of course, be unwise unduly to blame flies for the conveyance of infection in diarrhœal or other diseases, but much may be done in eliminating possible sources of danger by the destruction of flies, by the prevention of food from contamination, and by due attention to the disposal and removal of refuse. As I have indicated in the leaflet above referred to, personal hygiene counts for much, particularly where young children and their food are concerned. While stress, therefore, is properly laid upon the necessity for maintaining the dwelling-house and its environment in a proper sanitary condition, the importance of due cleanliness in the individual and the interior of the home must always be kept in view. Upon the authority of the Public Health Committee, a leaflet has been drawn up on the subject of flies, of which the following is a copy : 128 BOROUGH OF HAMPSTEAD. Don't have Flies in your House. They are among the most filthy things known. They are born in filth, they live in it, and they carry it about. Flies are maggots before they are flies, and could not exist but for the presence of filth, such as dead animals and decayed refuse. Flies carry thousands of disease germs with them, and by contaminating your food may cause serious illness. From the time a fly's egg is laid until the time when it becomes a full grown fly is little more than a week. Don't let refuse linger about long enough for this. The cleaner the house and its surroundings, the less flies there will be. Dirty houses have many flies. Don't eat where flies are, or shop where flies are tolerated. Cover all food. especially milk. HOW TO GET RID OF FLIES. Don't allow any dirt to collect in rooms, or allow decayed matter to be about the back yard. Dust-bins must be kept covered. If the dust is not removed regularly, or if the back yard is unpaved and filthy, write to the Medical Officer of Health. Any manure near your house should be removed every day. Catch the flies that enter your house. Use sticky fly papers. A good poison for flies is the following:- One teaspoonful of formalin to a half-pint of water, or milk and water, and a little sugar. Pat it in saucers with a small piece of bread in the saucer for the flies to alight on and drink. If there is no dirt, there are no flies. Many flies mean careless house-keeping. Copies of this handbill may be obtained on application at the PUBLIC HEALTH DEPARTMENT, Town Hall, Haverstock Hill. N.W. FRANK E. SCRASE, Medical Officer of Health. 129 Venereal Diseases. No attempt has been made in this Report to collate statistics relating to these diseases from the death returns supplied to me. As I pointed out in a previous Annual Report, the present system of registration of death is very largely to blame for the unsatisfactory nature of much of the information supplied and for the vague and general indefinite character of the language in which some of the certificates are couched. How far preventive action in regard to venereal disease can be undertaken by Sanitary Authorities is a debateable point, but that the evil is great cannot be denied, although it is not fully recognised owing to the social convention of silence on the subject. In his last published Annual Report the Medical Officer of the Local Government Board states : — " The serious extent to which syphilis affects the national health is not generally realised. It is an important cause of arterial degeneration and of heart disease; the chief, if not the only cause of locomotor ataxy and general paralysis of the insane, as well as of various forms of skin and bone diseases." In November, 1913, a Royal Commission was appointed to inquire into the prevalence of these diseases, their effects on the general health, and the means by which those effects can be alleviated or prevented. This Commission is still sitting, but I feel sure in my own mind that the Report of the Commission when it is issued will contain some recommendations of far-reaching character in respect of death certification for, as I have repeatedly urged, the improvement in death certification is a sine qua non to any effective action in controlling these diseases (vide Annual Report, 1912, page 21). SECTION G. Means for preventing Mortality in Childbirth and in Infancy. 133 Child Welfare and Infantile Mortality. Maternity and Child Welfare. This subject has been given careful consideration during the year. On July 30th the Local Government Board addressed a circular letter to Sanitary Authorities intimating that grants would be distributed by them in aid of the expenditure of local authorities and voluntary agencies in respect of institutions or other provision for maternity and child welfare. This grant is in aid of expenditure in respect of clinics, dispensaries, or other institutions primarily concerned with the provision of medical and surgical advice and treatment, as well as in respect of the salaries of health visitors and other officers engaged for this work. The Board stated that more extended and systematic measures than have hitherto been generally adopted are necessary, and they expressed the hope that the grant of assistance from the Exchequer would stimulate those local authorities who had not yet taken action, to give the matter their earnest consideration and would encourage those already engaged in work to develop it still further. The circular letter further stated that up to the present local authorities, in their infant welfare work, had concerned themselves more especially with the child in its first year of life; but that the matter was, however, one which needed to be dealt with on a more comprehensive basis, and it was clearly desirable that there should be continuity in dealing with the whole period from before birth until the time when the child was entered upon a school register, i.e., the register of a public elementary school, nursery school, creche, day nursery, school for mothers, or other school. It was intimated that extension of the existing work was accordingly needed in two directions; on the one hand it was necessary that measures should be taken for securing improved anti-natal and natal conditions, and on the other, provision should be made for continuing the work in relation to children beyond the first year of life. A memorandum, which had been prepared by the Board's Medical Officer with a view to assisting the formulation of schemes of extending the work already undertaken, and setting forth in outline the matters needing consideration in the preparation of a comprehensive schemes was enclosed, and this memorandum obviously contemplated that medical advice and, where necessary, treatment should be continuously and 134 systematically available for expectant mothers and for children till they were entered on a school register, and that arrangements should be made for home visitation throughout this period. It was also announced that grants would be available for Schools for Mothers. The Board stated that in a complete scheme on this subject the following elements would be comprised, each of which would, in this connection, be organised in its direct bearing on infantile health, viz.:— 1.—Arrangements for the local supervision of Midwives. 2.—Arrangements for anti-natal conditions. 3.—Arrangements for natal conditions. 4.—Arrangements for post-natal conditions. A Special Sub-Committe of the Public Health Committee was appointed to consider the subject, and to enquire how far the matters referred to were in operation—wholly or partially—and whether any arrangements suggested by the Board and not at present in operation in the Borough could with advantage be instituted, and a report was submitted to the Board giving full details of the work that is being done in Ilampstead in this connection. The opportunity was taken of pointing out the real source of danger which exists in the presence of unskilled and untrained nurses, who are to some extent working with or after medical practitioners, and it was suggested that their elimination or effective control would be a great improvement. The Board was informed of the scheme that has been framed in this Borough, which permits of the systematic advice, supervision and treatment of all infants from birth up to the age of five years. By co-operation with the Provident Dispensaries, all children on the books of the Dispensaries under school age are to be medically examined by one of the staff of the Provident Dispensaries, and a full report of the child's physical condition submitted to a Committee appointed to consider it. This supervision is on a par with the medical supervision of school children after five years, and the arrangements entered into also include the treatment by the Provident Dispensary of any defects found. Twothirds of the contribution to the Dispensary are to be paid by the parents, and one-third by the Council of Social Welfare, who, in addition to this one-third, pay the whole of the cost of regular supervision and operations 135 if such are necessary. It is a matter for regret however, that up to the present only a few have availed themselves of these facilities, but it is to be hoped that in course of time many more children will be entered in the Dispensaries and be kept under medical supervision. In this connection it should be borne in mind that many of the young children needing to be visited are members of families, who for one reason or another, will not or cannot join a dispensary, and for these some further arrangement is needed if they are to receive the undoubted benefit that attaches to periodical medical inspection, especially when part of the cost is borne by philanthropic agencies, as is the case where the benefits of the dispensaries have been taken advantage of. The visitation of all suitable cases of children up to school age would obviously entail a very considerable amount of extra work, and could not properly be performed with the present staff, who, however, make such efforts as are possible without encroaching unduly on their existing duties. It is, however, found to be almost impossible to restrict the supervision of infants entirely to those under one year of age. On the one hand expectant mothers are constantly asking for help and advice, while on the other hand, the younger children,—the formerly carefully watched and weighed infants—cannot be ignored when visits are paid to new additions to the family, and interest in the two year old —" the baby you used to weigh is not uncommon, though the time at the disposal of the existing staff does not permit of much of the necessary work in this direction being attempted. Important as the first year of life is, the preceding months, and immediately succeeding years are also of vital importance to the health of the future citizen. In a Borough like Hampstead, no child should begin school life with any disease or physical defects that could have been prevented or mitigated during the first five years of life by any action that ought properly to have been undertaken. A little effort spent in this direction on young children will, in all probability, result in the diminution of the number of physically unsound workers and potential parents. Preventible illnesses causing absence from school are responsible for a considerable waste of money, and should be almost unknown among children born and reared in Hampstead. That there is room, however, for much improvement in the health and physicial condition of the children is borne out strikingly in the following statement which I am able to submit through the courtesy 136 of Dr. W. H. Hamer, County Medical Officer of Health and School Medical Officer. The particulars given are those of defects found among the "entrant" group of Hampstead elementary school children during 1914. These are children who have just begun school attendance and are usually about five or six years of age. At this age the examination of the eyes is limited to the detection of disease; the visual acuityis not tested. The figures relate to 773 childreu. Of these, there were 288 children or 37 per cent. (147 boys and 141 girls) in whom no defect was noted by the doctor, leaving 485 children or 63 per cent. (239 boys and 246 girls) of whom this could not be said. The number of children referred for medical treatment was 241 or 31 per cent. (130 boys and 111 girls.) Defects noted at Physical examinations of Entrant Group of Elementary School Children. Number examined: Boys 386, Girls 387. defect. boys. girls. No. of cases where defect was noted. No. of cases referred for medical treatment. No. of cases where defect was noted. No. of cases referred for medical treatment. Skin diseases 11 6 7 2 Defective teeth 156 71 173 72 Tonsils enlarged 44 33 48 27 Adenoid growths 27 21 Others defects of Nose or Throat 9 2 9 2 Cervical orsub-maxillary glands enlarged 16 6 16 3 Eye diseases 15 11 8 4 Ear disease 4 3 4 3 Defective hearing 1 — 2 1 Speech defects 3 — 3 — Heart disease or defect 8 — 6 — Anaemia 6 2 5 2 Lung complaints 15 5 18 4 Nervous diseases 5 1 4 1 Phthisis — — — — Other tubercular disease 2 — 1 — Rickets 5 1 8 2 Deformities 2 — 5 2 Malnutrition 1 1 4 4 Other defects (including digestive complaints, urinary diseases, hernia, etc.) 13 4 11 4 137 By the notification of Births Act, 1907, all births are required to be notified to the Medical Officer of Health within 36 hours of their occurrence. 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 of Births Act came into operation in Hampstead in March, 1908, and the year 1914 is the sixth for which we possess a complete annual record of the working of the Act. The number of births notified in 1914 was 1223, including 30 still-births, the number of live-births notified being 1193. The total number of live-births occurring in Hampstead in 1914 was 1213, so that the number of live-births notified formed 98.3 per cent. of the number that actually occurred, this being a very satisfactory percentage. 307 births were notified by medical practitioners, 198 by midwives, 610 by parents and 78 from other sources. Of the births notified to the Medical Officer of Health a proportion occur among the well-to-do, but of the remaining number—about 850— 765 (90 per cent.) were visited. In this connection 360 re-visits were also made. The visit of the lady inspector, which is made soon after the birth of an infant, enables her to observe obvious sanitary defects in the home or its arrangements, to advise in matters of health, and often to advocate the seeking of medical advice when such is necessary. When the mother is able to get about, she is invited to bring her baby to the Mothers' Welcome at the Health Institute. Here she may obtain advice as regards the rearing of children, and have her child weighed so that its general condition may be watched. Mrs. hoche, one of the Council's Health Visitors, attends the meetings of the Infants' Committees (East and West) of the Hampstead Health Society, and there informs the Committees of those mothers who, in her opinion, need befriending and helping. The weighing of babies takes place as follows :— On Wednesdays, between 2.30 and 4.30, at the Health Institute, Kingsgate Road. On Thursdays, between 2.30 and 4.0, at St. Stephen's Rooms, Pond Street. On Fridays, between 2.30 and 4.0 at Emmanuel Parish Hall, Broomsleigh Street. 138 Where conditions of ill-health are partly due to poverty and ignorance, some improvement is frequently brought about by the efficient help of the various charitable agencies which work in close co-operation with the Public Health Department. The Infants' Visitors' Committees of the Hampstead Health Society, besides their invaluable work of visiting and befriending mothers during the first year of the life of their infants, provide milk and oatmeal where the father is, unfortunately, out of work. The Invalid Children's Aid Association, of whose executive committee the lady inspector is a member, gives most efficient and kindly aid in getting suitable cases removed to the country or seaside, and in providing extra nourishment and clothing for delicate and ailing children. Mortality Among Young Children. In the following table i.s shown the infantile mortality rate, and the death-rate among children under five years of age. The former rate has been calculated on the usual basis, while the latter rate has been obtained by calculations based upon the number of deaths of children under five years of age, and the number of children born in the year mentioned and in the four preceding years. Year. Deaths of Infants under 1 year of age. Deaths of Children under 5 years of age. No. Rate per 1000 births. No. Rate per 1000 children born in the year and in preceding four years. 1001 155 102 233 30·2 1902 133 88 195 25·2 1903 126 87 177 23·1 1904 181 111 226 30·0 1905 133 94 189 25·7 1906 111 77 171 23·5 1907 98 69 154 21·7 1908 97 69 122 17·3 1909 99 74 148 21·3 1910 81 60 132 19·2 1911 105 82 152 22·7 1912 79 62 131 19·8 1913 91 69 149 22·7 1914 91 72 129 20·0 139 Infantile Mortality. The number of deaths of Hampstead children under 1 year was 91, being the same number as occurred in 1913. 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 .. .. .. .. .. 2 4 Scarlet Fever .. .. .. .. .. .. .. .. 5 Whooping Cough 4 .. .. 1 1 4 .. 10 6 Diphtheria and Croup .. .. .. .. .. .. .. .. 7 Erysipelas .. .. .. .. .. .. .. .. 8 Tuberculous Meningitis 1 .. 1 .. 1 .. 1 4 9 Abdominal Tuberculosis .. .. .. .. .. 1 .. 1 10 Other Tuberculous Diseases .. .. .. .. .. .. .. .. 11 Meningitis (not Tuberculous) .. 1 .. .. 1 1 .. 3 12 Convulsions .. .. 1 1 .. .. .. 2 13 Laryngitis .. .. .. .. .. .. .. .. 14 Bronchitis .. .. .. .. 2 .. .. 2 15 Pneumonia (all forms) .. .. .. .. .. 2 2 4 16 Diarrhœa .. .. .. .. .. 1 1 2 17 Enteritis .. .. .. .. .. 3 2 5 18 Gastritis .. .. .. .. .. .. .. .. 19 Syphilis .. 1 .. .. .. 1 .. 2 20 Rickets .. .. .. .. .. .. .. .. 21 Suffocation, overlying .. .. .. .. .. 2 2 4 22 Injury at Birth .. .. .. .. 1 .. .. 1 23 Atelectasis .. .. .. .. .. .. .. .. 24 Congenital Malformations .. 1 .. 2 2 1 6 25 Premature Birth 3 4 1 2 3 .. 2 15 26 Atrophy, Debility, and Marasmus 1 2 .. .. 5 5 5 18 27 Other Causes 4 .. 1 •• 2 3 .. 10 Totals 14 9 5 4 18 25 16 91 The "Infantile Mortality "—i.e., the number of deaths under one year per 1000 births —was 71.5, as compared with the rate of 68.7 per 1000 births in 1913, 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 19091913 was 69.5. 140 The following table shows the infantile mortality of Hampstead in each year since 1880, and it will be seen that the lowest rate occurred in the year 1912. 1880 140 1892 122 1904 111 1881 136 1893 102 1905 94 1882 99 1894 113 1906 77 1883 98 1895 135 1907 69 1884 143 1896 123 1908 69 1885 110 1897 127 1909 74 1886 131 1898 125 1910 60 1887 107 1899 129 1911 82 8188 110 1900 100 1912 62 1889 122 1901 102 1913 69 1890 122 1902 88 1914 72 1891 104 1903 87 Deaths among Legitimate and Illegitimate Infants. I have prepared the following figures to show the great difference that exists in the infantile death-rates of legitimate and illegitimate children under one year of age. I have prepared the following figures to show the great difference that exists in the infantile death-rates of legitimate and illegitimate children under one year of age. Year. Legitimate Infants. Infantile death rate per 1000 births. Illegitimate Infants. Infantile death-rate per 1000 births Births. Deaths. Births. Deaths. 1906 1,403 106 75 34 5 147 1907 1,298 85 65 43 13 302 1908 1,326 87 66 29 10 345 1909 1,239 88 71 43 11 256 1910 1,233 71 57 36 10 278 1911 1,239 94 76 37 11 297 1912 1,207 68 56 74 11 149 1913 1,252 73 58 73 18 246 1914 1,218 77 63 55 14 254 The excessive death-rate among illegitimate children still continues, and the matter is one of great difficulty to deal with. There seems to be little that will serve as a substitute for true maternal care, but special attention is now being given to all illegitimate births that come under our notice as occurring among Hampstead women. SECTION H. Vital Statistics of the Borough, etc. 143 TABLE I. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Vital. Statistics of Whole Borough during 1914 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 1909 84,830 1,282 1,328 15•6 1,057 12•5 334 116 99 74•5 839 9•9 1910 85,210 1,270 1,340 15•7 1,071 12•6 350 108 81 60•4 829 9•7 1911 85,599 1,199 1,276 14•9 1,132 13•2 415 130 105 82•3 847 9•9 1912 85,966 1,224 1,281 14•9 1,106 12•9 387 142 79 61.7 861 10•0 1913 86,346 1,258 1,325 15•0 1,273 14•5 474 153 91 68•7 951 10•8 1914 86,731 1,213 1,273 14•7 1,145 13•2 420 188 91 71•5 913 10•5 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 acres (land and inland water), 2265. Total population at all ages, 85,495. At Census Total families or separate occupiers, 18,625. of 1911. 144 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 1914. notifiable disease. Number of cases notified. Total Cases Notified in each Ward. Total Cases removed to Hospital. At all Ages. Under 1. 1 and under 5. At Ages—Years. 45 and under 65. 65 and upwards. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). 5 and under 15. 15 and under 25. 25 and under 45. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera, Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 224. 1 26 154 28 13 2 .. 95 27 9 10 17 42 24 200 Erysipelas 44 1 2 .. 3 11 23 .. 8 8 5 5 5 6 7 8 Scarlet Fever 278 1 36 162 51 23 2 .. 25 43 14 13 39 121 23 241 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 16 .. .. 1 4 8 3 .. 1 6 1 1 3 3 1 12 Relapsing Fever. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 7 .. .. .. 1 6 .. .. 1 2 1 .. 1 2 .. 7 Cerebro-spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Polio-Myelitis 2 .. .. 1 1 .. .. .. .. 1 .. .. .. .. 1 1 Ophthalmia Neonatorum 12 12 .. .. .. .. .. .. 1 2 .. .. 2 6 1 3 Pulmonary Tuberculosis (1) 142* .. 2 7 30 73 25 5 32 17 16 7 19 32 19 55* Other forms of Tuberculosis (2) 30* 4 5 7 8 5 1 .. 3 3 2 2 5 13 2 13* Totals 755 19 71 332 129 139 56 9 166 109 48 38 91 225 78 5.0 Isolation Hospitals are provided by the Metropolitan Asylums Board, and residents of Hampstead suffering from infectious disease (excluding Tuberculosis) were chiefly removed to the North-Western Fever Hospital, which is within the Borough, and is situate at Lawn Road, in No. 2 (Belsize) Ward. Persons suffering from Pulmonary Tuberculosis were removed to institutions in various parts of the country. * These figures relate only to cases notified for the first time in 1914. (1) Of these 142 cases, 124 were notified on Form A, 8 on Form and 10 on Form D. (2) Of these 30 cases, 25 were notified on Fo. m A, 4 on Form C, and 1 on Form D. 145 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 Year 1914. 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 (a) 911 91 17 21 24 33 117 238 370 553 Uncertified 2 ... ... ... 1 ... ... 1 ... ... 1. Enteric Fever 3 ... ... ... ... 1 2 ... ... 19 2. Small-pox ... ... ... ... ... ... ... ... ... ... 3. Measles 2 2 ... ... ... ... ... ... ... 12 4. Scarlet Fever 2 ... ... ... ... 1 1 ... ... 27 5. Whooping Cough 16 10 1 4 1 ... ... ... ... 13 6. Dinhtheria and Croup 11 ... 1 4 5 ... 1 ... ... 65 7. Influenza 13 ... ... 1 ... ... ... 3 9 3 8. Erysipelas 2 ... ... ... ... ... 1 ... 1 1 9. Phthisis (Pulmonary Tuberculosis) 57 ... ... ... 2 10 29 13 3 90 10. Tuberculous Meningitis 8 4 ... 1 2 1 ... ... ... 8 11. Other Tuberculous Diseases 6 1 ... 1 2 1 1 ... ... 9 12. Cancer, malignant disease 114 ... ... ... ... ... 9 63 42 69 13. Rheumatic Fever 2 ... ... ... ... ... ... 2 ... 1 14. Meningitis (b) 9 3 1 ... 1 ... 3 1 ... 8 15. Organic Heart Disease 97 1 ... ... 1 1 5 38 51 17 16. Bronchitis 45 2 1 2 ... ... 2 9 29 9 17. Pneumonia (all forms) 59 4 5 4 ... 1 8 11 26 27 18. Other Diseases of Respiratory Organs 11 1 1 1 ... ... 1 3 4 1 19. Diarrhœa and Enteritis(c) 16 7 2 1 1 ... 1 2 2 9 20. Appendicitis and Typhlitis 12 ... ... ... 3 3 ... 6 ... 10 21. Cirrhosis of Liver 8 ... ... ... ... ... 2 4 2 1 21a. Alcoholism 1 ... ... 1 ... ... ... ... ... ... 22. Nephritis and Bright's Disease 35 ... ... ... 1 ... 4 17 13 15 23. Puerperal Fever 3 ... ... ... ... ... 3 ... ... 9 24. Other accidents and diseases of Pregnancy and Parturition 4 ... ... ... ... ... 4 ... ... 3 25. Congenital Debility and Malformation, including Premature Birth 40 39 1 ... ... ... ... ... ... 11 26. Violent Deaths, excluding Suicide 25 5 ... ... 1 4 2 6 7 23 26a. Injuries received at War 1 ... ... ... ... ... 1 ... ... ... 27. Suicide 8 ... ... ... ... 2 3 3 ... 2 28 Other Defined Diseases 301 11 4 1 5 7 34 58 181 90 29. Diseases ill-defined or unknown 2 1 ... ... ... 1 ... ... ... 1 Totals 913 91 17 21 25 33 117 239 370 553 Sub Entries. Included in above figures. 14 (a) Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... ... ... 28 (a) Poliomyelitis 2 ... ... ... 1 1 ... ... ... ... All " Transferable Deaths" of residents, i.e., of persons resident in the Borough who died outside it, have been included with the other deaths in columns '2-10. Transferable deaths of nonresidents, i.e., of persons resident elsewhere in England and Wales who died in the Borough have in like manner been excluded from these columns. (a) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as 44 Certified all other deaths are regarded as " Uncertified." (b) Exclusive of " Tuberculous Meningitis " (see Title 10), but inclusive of Cerebro-spinal Meningitis, (c Title 19 is used for deaths from Diarrhoea and Enteritis at all ages. 146 TABLE IV. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Infant Mortality, 1914. Nett Deaths from stated Causes at various Ages under One Year of Age. causes of death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 and under 6 Months. 6 and under 9 Months. 9 and under 12 Months. Total Deaths under 1 Year. All Causes Certified 22 3 8 5 38 22 12 10 9 91 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 2 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... 4 ... 2 4 10 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 2 2 ... 4 Abdominal Tubercu losis (a) ... ... ... 1 1 ... ... ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous. ... ... ... ... ... 1 1 1 ... 3 Convulsions 1 ... ... ... 1 ... ... 1 ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... ... 1 1 2 Pneumonia (all forms) ... ... ... ... ... 1 2 1 ... 4 Diarrhœa ... ... ... ... ... 1 ... 1 ... 2 Enteritis 1 ... 1 1 3 1 1 ... ... 5 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... 1 1 1 ... ... ... 2 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 1 ... ... ... 1 3 ... ... ... 4 Injury at Birth ... 1 ... ... 1 ... ... ... ... 1 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations (6) 1 ... 1 ... 2 2 1 1 ... 6 Premature Birth 9 ... 3 1 13 2 ... ... ... 15 Atrophy, Debility and Marasmus 6 2 1 ... 9 5 3 ... 1 18 Other causes 3 ... 2 1 6 1 2 ... 1 10 Totals 22 3 8 5 38 22 12 10 9 91 Nett Births in (legitimate, 1,218 Nett Deaths in legitimate infants, 77. the year illegitimate, 55 the year of illegitimate infants, 14. (a) Under Abdominal Tuberculosis have been included deaths from Tuberculous Peritonitis and Enteritis and from Tabes Mesenterica. (b) The total deaths from Congenital Malformations, Premature Birth, Atrophy. Debility and Marasmus, equal the total in Table III, under the heading Congenital Debility, and Malformation including Premature Birth. Want of Breast Milk has been include 1 under Atrophy and Debility. 147 TABLE V. (This 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.) PREMISES. Number on register at end of 1913. Number added in 1914. Number removed in 1914. On register at end of 1914. Number of inspections 1911. Number of prosecutions, 1914. Cowsheds — — — — — — Milkshops 102 — 4 98 395 — Houses let in lodgings 369 36 — 405 524 — Ice cream premises 81 7 5 83 208 — Slaughter-houses — Number of inspections 43 „ of notices nil Offensive Trades — Number of inspections nil „ of notices nil Smoke Nuisances— Number of observations 38 ,, of nuisances and complaints 20 „ of notices 3 ,, of summonses nil Housing of the Working Classes— Number of houses inspected 14 „ dealt with under section 15 of the Housing, Town Planning, etc., Act, 1909 nil „ of representations 9 ,, of closing orders 9 ,, of houses remedied without closing orders 5 , remedied after closing orders nil ,, of houses demolished (These houses were demolished after closing orders had been made) 5 ,, in respect of which closing orders had been made, empty at end of year . 4 148 TABLE V.—continued. Underground Rooms — Number illegally occupied 80 ,, closed or illegal occupation discontinued 28 „ where necessary works completed or in hand 52 Overcrowding— Number of rooms overcrowded 10 „ remedied 10 „ of prosecutions nil Cleansing— Number of adults cleansed 4 „ of children cleansed (9 of these under school age) 235 „ of rooms cleansed 30 ,, of premises cleansed 16 Water supply to tenement houses— Number of premises supplied 101 ,, of prosecutions nil Inland Revenue Act {applications for certificates)— Number of houses 8 ,, of tenements included therein 20 „ of applications granted—8 houses comprising 22 dwellings „ refused nil „ deferred or withdrawn nil Sale of Food — Number of premises used, other than ice-cream premises, milkshops, cowsheds 414 „ of inspections 830 Disinfection Shelter - Number of persons accommodated nil Mortuary— Number of bodies received 78 ,, of infectious bodies nil 149 10,062 At Census 1911. 67,146 6.7 Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases (excluding Tuberculosis). Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases notified (excluding Chicken-pox). Attack-rate per 1000 of the Population. Deaths occurring. Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Population. 82,380 1,516 18•4 904 11•0 133 87•7 460 5•6 33 0•40 73 0•89 82,730 1,453 17•6 837 10•1 126 86•7 311 3•7 16 0•19 66 0•80 83,080 1,445 17•4 892 10•7 161 111•4 301 3•6 20 0•24 73 0•89 83,430 1,421 17•0 823 9•9 133 93•6 295 3•5 14 0•17 73 0•87 83,780 1,437 17•1 850 10•1 111 77•2 557 6•6 22 0•26 57 0•68 84,130 1,359 16•1 817 9•7 98 73•1 498 5•9 15 0•18 61 0•72 84,480 1,400 16•6 803 9•5 97 69•3 383 4•5 20 0•21 74 0•88 84,830 1,328 15•6 839 9•9 99 74•5 325 3•8 21 0•25 53 0•62 85,210 1,340 15•7 829 9•7 81 60•4 233 2•8 13 0•16 58 0•68 85,599 1,276 14•9 847 9•9 105 82•3 345 4•0 25 0•29 56 0•65 85,966 1,281 14•9 861 10•0 79 61•7 320 3•7 25 0•29 64 0•74 86,346 1,325 15•0 951 10•8 91 68•7 374 4•3 13 0•15 49 0•56 86,731 1,273 14•7 913 10•5 91 71•5 583 6•7 23 0•26 57 0•66 TABLE VI. (1). Vital Statistics of No. 1 (Town) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infections Diseases (excluding Tuberculosis). Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases notified (excluding Chicken-pox). Attack-rate per 1000 of the Population. Deaths occurring. Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Population. 1902 12,120 192 15•8 163 13•4 20 104•1 64 5•3 4 0•33 17 1•40 1903 12,310 194 15•7 127 10•3 14 72•1 38 3•1 1 0•08 11 0•89 1904 12,500 195 15•6 125 10•0 20 102•5 65 5•2 4 0•32 13 1•04 1905 12,690 194 15•3 127 10•0 24 123•7 72 5•7 3 0•24 9 0•9 1906 12,870 205 15•9 131 10•2 21 102•4 107 8•3 6 0•47 5 0•39 1907 13.070 185 14•1 152 11•6 15 81•1 105 8•0 2 o•15 13 0•99 1908 13,250 225 17•0 108 8•1 11 48•8 65 4•9 1 0•07 7 0•53 1909 13,430 196 14•6 140 10•4 15 76•5 53 3•9 4 0•30 6 0•45 1910 13,610 199 14•6 118 8•7 15 75•4 25 1•8 1 0•07 6 0•44 1911 13.820 207 15•0 133 9•6 19 91•8 71 5•1 7 0•51 7 0•51 1912 14,040 183 13•0 135 9•6 12 65•5 47 3•3 2 0•14 5 0•36 1913 14.250 201 13•8 161 11•1 1.1 54•7 61 4•3 3 0•21 11 0•76 1914 14,400 152 10•5 130 9•1 14 92•1 131 9•1 6 0•42 5 0•35 150 TABLE VI. (2). Vital Statistics of No. 2 (Belsize) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases (excluding Tuberculosis). Pulmonary Tuberculosis. Number, Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases notified (excluding Chicken- pox) Attack-rate per 1000 of the population. Deaths occurring. Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Population. 1902 13,030 239 18•3 135 10•4 18 75•3 94 7.2 9 0.69 15 1.15 1903 13,110 211 16•1 121 9•2 13 61•6 60 4.6 2 0.14 13 0.99 1904 13,200 217 16•4 141 10•7 23 105•9 47 3.6 3 0.23 12 0.91 1905 13,280 209 15•7 131 9•9 13 62•2 42 3.2 2 0.15 10 0.75 1906 13.370 187 14•0 127 9•5 8 42•8 60 4.5 4 0.30 13 0.97 1907 13,450 205 15•2 114 8•5 13 63•4 63 4.7 3 0•22 10 0.74 1908 13,530 205 15•1 126 9•3 8 39•0 81 6.0 1 0•07 16 1.18 1909 13,610 204 15•0 130 9•5 16 78•4 88 6.5 5 0•37 8 0.59 1910 13,710 207 15•1 119 8•7 9 43•5 49 3.6 2 0•14 8 0.58 1911 13.780 189 18•7 135 9•7 17 90•0 78 5.7 2 0•14 10 0.72 1912 13,830 188 13•6 127 9•2 8 42•5 62 4.5 4 0•29 7 0.51 1913 14,000 214 15•0 126 8•8 16 74•7 52 3.7 5 0•35 5 0.35 1914 14,100 195 13•8 141 10•0 9 46•1 89 6.3 6 0•42 11 0.78 TABLE VI. (3). Yital Statistics of No. 3 (Adelaide) Ward. Year. Population estimated to middle of year. Births. Deaths, Infantile Deaths. Notifiable Infectious Diseases (excluding Tuberculosis). Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number, Estimated rate per 1000 of the Population. Number. Rate per 1000 Births, Cases notified (excluding Chicken-pox). Attack-rate per 1000 of the Population. Deaths occurring. Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Population. 1902 10,350 103 9.9 95 9.6 3 29.1 40 3.9 2 0.19 7 0.68 1903 10,310 95 9.2 101 9.8 9 94.7 22 2.1 1 0.10 1 0.10 1904 10,260 100 9.7 99 9.6 13 130.0 36 3.5 2 0.19 8 0.78 1905 10,220 96 9.4 92 9.0 4 41.7 27 2.6 1 0.10 4 0.39 1906 10,170 97 9.5 92 9.0 10 103.1 29 2.8 .. .. 5 0.49 1907 10,120 75 7.4 86 8.5 8 106.7 29 2.9 1 0.10 2 0.20 1908 10,070 93 9.2 78 7.7 6 64.6 30 3.0 2 0.20 4 0.40 1909 10,040 83 8.3 88 8.8 4 48.2 16 1.6 2 0.20 3 0.30 1910 10,000 96 9.6 78 7.8 2 20.8 22 2.2 1 0.10 5 0.50 1911 9,950 82 8.2 99 9.9 6 73.2 19 1.9 3 0.30 3 0.30 1912 9,930 117 11.8 77 7.7 6 51.3 24 2.4 1 0.10 9 0.91 1913 9,780 97 9.7 99 9.9 9 92.8 27 2.8 ... ... 4 0.40 1914 9,730 88 90 99 10.2 5 56.8 28 2.9 ... ... 2 0.20 151 TABLE VI. (4). Vital Statistics of No. 4 (Central) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases (excluding Tuberculosis). Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Hate per 1000 Births. Cases notified 'excluding Chicken-pox). Attack-rate per 1000 of the Population. Deaths occurring. Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Population. 1902 9,190 110 12.0 71 7.7 11 100.0 40 4.3 ... ... 5 0.54 1903 9,260 99 10.7 60 6.5 8 80.8 34 3.7 4 0.43 4 0.43 1904 9,330 90 9.6 62 6.6 11 122.2 17 1.8 ... ... 1 0.11 1905 9,400 113 12.0 60 6.1 5 44.2 24 2.5 1 0.11 6 0.64 1906 9,470 95 10.0 83 8.8 3 31.6 34 3.6 ... ... 2 0.21 1907 9,540 108 11.3 68 7.1 9 83.3 33 3.4 2 0.21 5 0.52 1908 9,610 104 10.8 82 8.5 6 57.7 33 3.1 1 0.10 7 0.73 1909 9,680 116 12.0 63 6.5 3 25.9 29 3.0 2 0.21 3 0.31 1910 9,770 105 10.7 8i 8.4 8 76.2 28 2.9 2 0.20 3 0.31 1911 9,859 92 9.3 75 7.6 8 87.0 25 2.5 1 0.10 3 0.30 1912 9,876 97 9.8 76 7.7 4 41.2 29 2.9 1 0.10 6 0.61 1913 9,996 91 8.9 84 8.2 6 65.9 38 3.8 ... ... ... ... 1914 10,061 84 8.3 76 7.5 4 47.6 26 2.6 2 0.23 6 0.60 TABLE VI. (5). Vital Statistics of No. 5 (West End) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases (excluding Tuberculosis). Pulmonary Tuberculosis. Number. Estimated rate per 1C00 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases notified (excluding Chicken-pox). Attack-rate per 1000 of the Population. Deaths occurring. Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Population. 1902 12,250 275 22.4 107 8.7 20 72.1 102 8.3 6 0.49 6 0.49 190S 12,320 243 19.7 111 9.0 21 86.4 55 4.5 2 0.16 12 0.97 1904 12,38(1 283 22.8 120 9.7 22 77.7 70 5.6 3 0.24 8 0.65 1905 12,450 250 20.1 134 10.5 23 92.0 29 2.3 2 0.16 11 0.88 1906 12,510 259 20.7 115 9.2 14 54.1 168 13.4 5 0.40 8 0.64 1907 12,580 210 19.9 114 9.0 16 64.0 153 12.2 4 0.32 9 0.71 1908 12,640 254 20.1 121 9.6 26 102.4 68 5.4 10 0.79 9 0.71 1909 12,700 239 18.8 118 9.3 13 54.1 51 4.0 2 0.16 6 0.47 1910 12,770 210 16.9 121 9.5 17 78.7 44 3.4 4 0.31 11 0.86 1911 12,850 216 16.8 102 7.9 15 69.4 44 3.4 5 0.39 10 0.78 1912 12,890 226 17.5 126 9.8 13 57.5 65 5.0 10 0.77 12 0.93 1913 13,050 240 18.0 145 10.9 11 45.8 59 4.5 1 0.07 7 0.53 1914 13,100 256 19.5 140 10.7 18 70.3 68 5.2 1 0.08 14 1.07 152 TABLE VI. (6). Vital Statistics of No. 6 (Kilburn) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infections Diseases (excluding Tuberculosis) Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases notified (excluding C hicken-pox). Attack-rate per 1000 of the Population. Deaths occurring. Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Population. 1902 14,790 435 29.4 219 14.8 45 103.4 76 5.1 11 0.74 16 1.08 1903 14,800 417 28.2 184 12.4 39 93.5 59 4.0 3 0.20 18 1.22 1904 14,810 408 27.5 206 13.9 54 132.3 43 2.9 8 0.54 22 1.48 1905 14.820 426 28.7 171 11.5 50 117.4 57 3.8 2 0.13 26 1.75 1906 14,840 444 29.9 197 13.3 41 92.0 128 8.6 5 0 .31 15 1.01 1907 14,850 391 26.3 179 12.0 28 71.6 86 5.8 3 0.20 16 1.08 1908 14,880 393 26.4 186 12.5 30 76.3 72 4.8 4 0.27 21 1.41 1909 14.890 341 22.9 182 12.2 37 108.5 67 4.5 6 0.40 17 1.14 1910 14,000 379 25.4 192 12.9 24 63.3 52 3.5 3 0.20 16 1.07 1911 14,920 347 23.2 179 12.0 31 89.3 82 5.5 6 0.40 16 1.07 1912 15.000 353 23.5 188 12.5 26 73.6 70 4.7 6 0.40 14 0.93 1913 15,200 354 22.8 213 13.7 25 70.6 110 7.2 3 0.19 18 1.16 1914 15,300 385 25.2 212 13.8 25 64.9 186 12.1 6 0.40 13 0.85 TABLE VI. (7). Vital Statistics of No. 7 (Priory) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases (excluding Tuberculosis) Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases notified (excluding Chicken-pox). Attack-rate per 1000 of the Population. Deaths occurring. Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Population. 1902 10.650 162 15.2 110 10.3 16 98.7 44 4.1 1 0.94 7 0.66 1903 10,620 194 18.3 116 10.9 21 108.2 43 4.0 3 0.28 5 0.47 1904 10,600 152 14.3 121 11.4 13 85.5 23 2.2 .. .. 9 0.85 1905 10,570 133 12.6 103 9.7 14 105.3 44 4.2 3 0.28 7 0.66 1906 10,550 150 14.2 93 8.8 9 60.0 31 2.9 2 0.19 8 0.76 1907 10.520 127 12.1 94 8.9 7 55.1 29 2.7 .. .. 6 0.57 1908 10,500 126 12.0 93 8.8 10 79.3 34 3.2 1 0.09 7 0.67 1909 10,480 149 14.2 111 10.6 11 73.8 21 2.0 .. .. 8 0.76 1910 10,450 138 13.2 111 10.6 6 43.5 13 1.2 .. .. 8 0.76 1911 10.420 143 13.7 115 11.0 9 63.0 26 2.5 1 0.09 5 0.48 1912 10,400 117 11.1 115 10.9 7 59.8 28 2.2 1 0.09 10 0.96 1913 10,070 128 12.5 117 11.4 12 93.7 27 2.7 1 0.10 3 0.29 1914 10,040 113 11.2 110 10.9 16 141.6 55 5.5 2 0.20 5 0.50 153 TABLE VII. Vital Statistcs of Hampstead, compared with England and Wales. Year. Birth rate per 1000. General death-rate per 1000. Natural increase Hampstead. Notifiable Infectious disease rate per 1000 Hampstead. Hampstead. England and Wales. Hampstead. England and Wales. 1875 22•6 35.4 12.5 22.7 394 — 1876 24•4 36.3 15.2 20.9 367 — 1877 24•0 35.0 13.7 20.3 413 — 1878 24•5 35.6 14.8 21.6 409 — 1879 22.8 34.7 13.2 20.7 365 — 1880 24.1 34.2 12.6 20.5 521 — 1881 23.8 33.9 12.7 18.9 502 — 1882 23.6 33.8 13.0 19.6 546 — 1883 23.8 33.5 11.2 19.5 685 — 1884 22.0 33.6 12.5 19.5 554 — 1885 21.2 32.9 11.5 19.0 593 — 1886 21.0 32.8 12.2 19.3 554 — 1887 21.9 31.9 11.0 18.8 628 — 1888 20.5 31.2 10.6 17.8 616 — 1889 21.0 31.1 10.7 17.9 728 — 1890 21.9 30.2 13.1 19.1 613 — 1891 21.5 31.4 12.2 22.5 670 4.5 1892 20.4 30.5 12.4 19.0 591 8.0 1893 20.5 30.8 12.9 19.2 547 11.1 1894 19.6 29.6 10.8 16.6 674 6.2 1895 19.8 30.2 13.4 18.7 452 7.3 1896 19.1 29.7 12.0 17.1 546 7.8 1897 20.2 29.7 11.6 17.4 568 5.1 1898 18.1 29.4 11.4 17.6 599 5.7 1899 19.7 29.3 11.4 18.3 650 6.0 1900 20.0 28.7 11.3 18.3 699 5.8 1901 18.3 28.5 l0.6 16.9 633 5.6 1902 18.4 28.6 11.0 16.2 612 *5.6 1903 17.6 28.4 10.1 15.4 616 *3.8 1904 17.4 27.9 10.7 16.2 553 *3.6 1905 17.0 27.2 9.9 15.2 598 3.5 1906 17.1 27.0 10.1 15.4 587 6.6 1907 16.1 26.3 9.7 15.0 524 5.9 1908 16.6 26.5 9.5 14.7 597 4.5 1909 15.6 25.6 9.9 14.5 489 3.8 1910 15.7 24.8 9.7 13.4 511 2.7 1911 14.9 24.4 9.9 14.6 429 *4.0 1912 1.9 23.8 10.0 13.3 420 3.7 1913 15.0 23.9 10.8 13.7 374 4.3 1914 14.7 23.8 10.5 14.0 360 6.7 * Excluding Chicken-pox, which was notifiable during certain periods of these years. Excluding notifications of Pulmonary Tuberculosis 1902-1913, and all forms of Tuberculosis since 1913. SECTION I. Legal Proceedings. 157 Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department in 34 cases during the year. The chief facts relating to these proceedings are set out on pages 158-161, and are summarised below. The facts relate only to the cases that were heard and decided in 1914. Statute or By-law. Number of Prosecutions. Fines. Costs. Public Health (London) Act, 1891, and Bye-laws made thereunder 11 £ s. d. £ S. d. 1 0 0 8 18 0 Metropolis Management Acts, and Bye-laws made thereunder 5 2 5 0 10 1 6 Sale of Food and Drugs Acts 12 21 10 0 14 18 6 Butter and Margarine Act, 1907 1 . . 1 8 0 Public Health (Regulations as to Food) Act, 1907 2 5 0 0 0 16 0 Housing, Town Planning, etc., Act, 1909 1 . . 0 10 6 London County Council (General Powers) Act, 1908 2 1 0 0 5 14 6 Totals 34 30 15 0 42 7 0 158 Public Health (London) Act, 1891, and Bye-law made thereunder. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials of Defendant and District. Offence. Result of Hearing. 1913 27th Nov. 1914 30th Jan. Marylebone Police Court. Mr. Paul Taylor Owner Nuisance Order made to abate within three months, and 10s. 6d. costs allowed. 16th Dec. 13th Mar. do. E. C., Humpstead Nuisance Order made to abate within 21 days and 6s. costs allowed. 1st Dec, 27th Mar. Marylebone Police Court. Mr. Plowden Owner Nuisance Order made to abate within 6 weeks and £1 Is. Od. costs paid. 1st Dec. 1st April Hampstead Police Court. Justices J.W.T, City Nuisance Work in hand, £1 1s. Od. costs paid and summons withdrawn. 1914 27th Jan. 29th April do. A.J. B., St. Pancras Nuisance Work done, 10s. 6d. costs and summons withdrawn. 14th May 19th June Marylebone Police Court. Mr. Paul Taylor F. W. L., Hampstead Contravention of Bye-law 14 made under Public Health (London) Act Plans deposited and s u mmonses withdrawn on payment of £1 is. costs. 1913 1st Dec. 24th July do. H. W. C., Herts. R. K., St. Pancras Non-compliance with Magistrate's order to abate nuisance Work done, £3 3s. Od. costs paid and summons withdrawn. 1914 28th May 6th Nov. do. S. & S., Willesden Nuisance Fined £1 and £1 ls. 0d. costs and one month's abatement order made. 17th Nov. 4th Dec. do. J. P. T., Lambeth (i) Contravention of Bye-law 14 Section 39 (I) (ii) Contravention ot Section 42 2s. costs allowed. 2s costs allowed. 29th Oct. 18th Dec. do. W. J., Holborn Nuisance Summons dismissed with £5 5s. costs. 159 Metropolis Management Acts, and Bye-laws made thereunder. Date when proceedings ordered. Date of Heaving. Court, and Name of Magistrate. Initials of Defendant and District. Offence. Result of Hearing. 1914 14th May 1914 19th June Marylebone Police Court. Mr. Paul Taylor F. W. L., Hampstead Non-deposit ot plans, etc. Plans deposited and summonses withdrawn on payment of £2 2s. costs. do. 24th July do. A., de la H., Hampstead Non-deposit of plans, etc. Work improperly done amended, 10s. 6d. costs paid and summons withdrawn. 9th July 13th Nov. do. E. N., Bayswater Non - compliance with Council's Order Fined £2 and £5 5s, costs 17tb Nov. 4th Dec. do. J. P. T., Lambeth (i) Non-deposit of plans (ii) Contravention of Section 8 Metropolis Management Act, 1855 Fined 5s. and £2 2s. costs. 2s. costs allowed. Sa/c of Food and Drags Acts 1314 22nd Jan. 191. 28th Jan. Hampstead Police Court. Justices C. K., Hampstead Selling butter containing 7 per cent, of water over an i above the legal limit Fined ,£5 and £1 8s. costs, (See also page 160) 22nd Jan. 30th Jan. Marylebone Police Court. Mr. Paul Taylor H. D., Hampstead (i) Selling butter containing 88 percent, foreign fat (ii) Selling margarine in unmarked wrapper Fined £10 and 14s, 6d, costs. 5th Feb. 20th Feb. do. W. T. L., Hampstead Selling milk 34 per cent, deficient in butterfat Fined 5s. and 12s. 6d. costs. 19th Feb. 13th Mar. do E. E., Hampstead Selling milk 8per cent deficient in butter-fat Warranty proved, summons dismissed. 5th Mar. 27th Mar. Marylebone Police Court. Mr. Plowden G. A. O., St. Pancras Selling milk 7 per cent, deficient in butter-fat Warranty proved, summons dismissed. 2nd April 29th April Hampstead Police Court. J ustices. A. C. o., Hampstead Selling milk 4 per cent, deficient in butter-fat Fined £1 and 19s. 6d. costs. 160 Sale of Food and Drugs Acts—continued. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials of Defendant and District. Offence. Result of Hearing. 1914 :2nd April 1914 29th April| Ham p stead Police Court. Justices. R. K., Hampstead Selling milk 10 per cent, deficient in butterfat. Warranty proved and summons dismissed. do. 1st May Marylebone Police Court. Mr. Mead J. R.,Ltd., Hampstead Selling milk 7 per cent, deficient in butter-fat Summons withdrawn owing to proceedings against the farmer. 30th April 15th May Marylebone Police Court. Mr. Denman A. H. B., Hampstead Selling cocoa taining 40 per cent, sugar and 25 per cent, sago Fined £2 and 12s. 6d. costs. 14th May 12th June Marylebone Poiice Court. Mr. Paul Taylor H. W. P., Buckinghamshire. 13 summonses for selling milk in course of delivery at West Hampstead Station (Metropolitan Railway) containing from 3 per cent, to 21½ per cent. of added water Ordered to pay £10 10s. 0d. costs. do. 19th June do. S. P., St. Marylebone Selling milk 6 per cent, deficient in butter-fat Fined 5s. and 12s. 6d. costs. 8th Aug. 23rd Sept. Hampstead Police Court. Justices D. J., St. Pancras Selling milk containing 8 percent. of added water Fined ,£3 and 17s. costs. Butter and Margarine Act. 1914 22nd Jan. 1914 28th Jan. Hampstead Police Court. Justices. C. K., Hampstead Contravention of the Butter and Margarine Act, 1907 Fined £3 and ill 8s. costs. (See also page 159) London County Council (General Powers) Act, 1908. 1914 22nd Jan. 1914 30th Jan. Marylebone Police Court. Mr. Paul Taylor A. B , Ltd. Hampstead Contravention of Section 8 Cleansing work done, £3 3s. costs paid and summons withdrawn. 8th Oct. 18th Nov. Hampstead Police Court. Justices M., Ltd , Hampstead Contravention of Section 8 Fined £1 and £2 lis. 6d. costs. 161 Public Health (Regulations as to Food) Act, 1907. Date when proceedings ordered. Date of Hearing. Court and Name of Magistrate. Initials of Defendant and District. Offence. Result of Hearing. 1914 22nd Jan. 1914 11th Feb. Hampstead Police Court. Justices J. R., Ltd., Hampstead Contravention of Public Health (Milk and Cream) Regulations, 1912 Fined £5 and 16s. costs. 9th July 22nd July do. J. R., Ltd., B ampstead Selling cream contrary to the Milk and Cream Regulations, 1912 Summons dismissed. Housing, Town Planning, etc., Act, 1909. 1913 24th July 191 13th Mar. Marylebone Police Court. Mr. Paul Taylor T. G., Hampstead Non-compliance with Closing Order made by the Council Order made to comply and 10s. 6d. costs allowed. APPENDIX. Report of the Public Analyst on the Analytical Work of the Year. 165 Analytical Laboratory, Town Hall, Partington, W. 13th January, 1915. An abstract of the year's analytical work may be of interest. No less than 512 samples have been analysed comprising Milk, 272; Butter, 121; Lard, 43; Cocoa, 19; Coffee, 18; Cheese, 14; Cream, 13; Margarine, 5; Epsom Salts, 2; and 1 each of Sausages, Pork Pie, Shrimp Paste, Olive Oil ajid Lemon Squash. Of these, 22 samples of Milk, or 8 per cent. ; 4 samples of Butter, or 3⅓ per cent.; 1 of Cream, or 7½ per cent.; 2 of Cocoa, or 10 per cent, proved to be adulterated, while the samples of Sausages, Pork Pie and Shrimp Paste contained preservatives, though not in sufficient quantities to warrant prosecution. Taking all the articles together, 6¼ per cent, of them were found to be adulterated; this is rather larger than the average for the previous year, which was 3¾ per cent. This slight increase is due, I think, to the taking of test samples; by this method the sources of adulteration are found and the fraudulent vendor is not put upon his guard. ALF. W. STOKES, F.C S., F.I.C., Public Analyst. INDEX. PAGE Acute Polio-myelitis or Polio-cnccphalitis 93 Adulteration 48-52 Alcoholism 28 Analyses, Results of 48-55 Analytical Work, Report on 163-165 Anti-toxin 89 Area of Borough 11 Bacteriological Work 71 Bakehouses 46 Birth-Rate 19 Births, Illegitimate 20, 21 „ Number of 18 „ ,, in Wards 20 Cancer 27 Cerebro-Spinal Meningitis 93 Chemical Work 71 Childbirth and Infancy, Means for preventing Mortality in 131-140 Cleansing Station 36 Complaints Received 40 Consumption (see Tuberculosis.) Customs and Inland Revenue Acts 37 Dairies 41 Death-Rate, General 21, 22 „ Infantile 139, 140 Deaths at various ages 24 „ among Legitimate and Illegitimate Infants 140 „ Causes of 27-29 „ in Public Institutions, etc. 24-26 „ Non-resident 21 „ Number of 21 „ Outlying 21 „ Uncertified 24 Diarrhoea aud Enteritis 125-128 Diphtheria 80-89 Disinfection 101-102 Drainage Work 36 Enteric Fever 91, 92 Epidemic Cerebro-Spinal Meningitis(see Cerebro-Spinal Meningitis.) Epidemic Diarrhoea (see Diarrhoea.) Erysipelas 90 Factories 58, 62, 63 168 PAGE Factory and Workshop Act, 1901 58 Flies 127, 128 Food 41-55 Food Premises and Food Inspection 43, 44 Fried Fish Vendors 45 Health Visiting 133-138 Home Office Tables (Factory and Workshop Act, 1901) 62-65 Homework (see Outworkers.) Houses Let in Lodgings (see Tenement Houses.) Housing of the Working Classes Acts, 1890—1909 55-57 Housing (Inspection of District) Regulations, 1910 56, 57 Housing, Town Planning, etc., Act, 1909 55, 56 Ice Cream 45 Infancy and Childbirth, Means for preventing Mortality in 131-140 Infantile Mortality 139, 140 Infectious Diseases Acute, Prevalence of and Control over 75 „ „ „ Attack-Rate 75 „ „ „ Deaths and Death-Rate 76 ,, „ „ Non-notifiable 95-100 Legal Proceedings 155-162 Local Government Board Tables 143-146 Marriages, Number of, 1914, and rates 1904-14 17,18 Measles 95-99 Meat inspection and Slaughter-houses 48 Milk and Cream Regulations, 1912 53-55 Milk Supply and Milksliops 41,42 Mortuary, Public 38 Natural increase of population (see Population.) Non-residents, Deaths of (see Deaths.) Notification of Births Act, 1907 137 Ophthalmia Neonatorum 91 Outlying Deaths (see Deaths.) Outworkers 62, 64 Polio-myelitis acute, or Polio-encephalitis acute (see Acute Poliomyelitis or Polio-enceplialitis.) Population, Density of 17 „ Estimated to middle of 1914 16 „ In Wards 17 „ Natural Increase of 17 Premises and Occupations controlled by Bye-laws or Regulations 41 Preservatives in Milk and Cream 53-55 169 PAGE Public Health Committee 5 Public Health (Milk and Cream) Regulations, 1912 53-55 Public Health (Regulations as to Food) Act, 1907 53 Puerperal Fever 93 Rag Flock Act, 1911 38 Respiratory System, Diseases of 28 Restaurant Kitchens 47,48 Sale of Food and Drugs Acts 48 Sanitary Inspections, etc. 33-40 Scarlet Fever 90, 91 Senile Mortality 24 Slaughterhouses 48 Small-pox 79 Smoke Nuisances 37 Staff of the Public Health Department 69-71 Still-births 19 Suicide 29 Summer Diarrhoea 125-128 Tenement Houses, Bye-laws 41 „ „ Registration of 41 „ „ Water Supply of 58 Tuberculosis, Prevalence of and Control over 103-122 Tuberculosis Dispensary 116-122 Typhoid Fever (see Enteric Fever.) Underground Rooms 57 Vaccination 79 Venereal Disease 129 Verminous Persons 102, 148 Verminous Premises 148 Vital Statistics 11, 141-152 Violent Deaths 23 Warranty Defence 51, 52 Water Supply, Certificates as to 37 „ „ of Tenement Houses 58 Whooping Cough 99, 100 Workshops 59-63, 65 Workplaces 62, 63 Young Children, Mortality among 138