HAMP21 THE Metropolitan Borough of Hampstead. REPORT for the year 1916, OF THK i Medical Officer of Health, FRANK E. SCRASE, F.R.C.S. lEng.), L.R.C.P. (Lond.l, D.P.H. (Lond.) CONTENTS. PAGFS SECTION' A.—Natural and Social Conditions of the Borough (including a review of the Vital Statistics, etc.) 5— n B.—Sanitary Administration and Circumstances of the Borough ... ... ... n—23 „ C.—Prevalence of and Control over Acute Infectious Diseases ... ... ... ... 23—28 „ D.—Prevalence of and Control over Tuberculosis 28—33 E.—Means for preventing Mortality in Children... 33—35 F.—Vital Statistics of the Borough, etc. ... 36—45 „ G.—Legal proceedings ... ... ... 46 APPENDIX I.—Report of the Public Analyst on the Analytical Work of the Year ... ... ... 47 II.—Report of the Tuberculosis Medical Officer on the work of the Tuberculosis Dispensary ... 48 2 PUBLIC HEALTH COMMITTEE, NOVEMBER, 1915-16. Ex-officio : HIS WORSHIP THE MAYOR (Mr. Alderman E. A. O'Bryen J.P.). Chairman : Mr. Councillor R. J. J. Willis. Miss Councillor M. E. Balkwill. Mr. Councillor G. Buckle. Mr. „ C. W. Cunnington, „ ,, A. W. George. m.r.c.s., d.p.h. m.r.c.s., l.r.c.p. „ „ ]. I. Eraser. C. J. Higginson. „ „ T. H. Nunn. „ ,, E. S. Payne. „ „ W. H. Warner. ,, ,, A. B. Weaver. R. H. H. Cust. Staff of the Public Health Department : Sanitary Inspectors : W. G. Kershaw, Senior Inspector. R. Geary (Wards 1 & 2) *W. E. Horniblow (Wards 3 & 7) divisional A. Peverett (Wards 4 & 5). *J. Grimsley (Ward 6) Inspectors. F. H. Hudson, Sale of Food and Drugs Acts and Factory and Workshop Acts. *A. C. Townsend, Housing of the Working Classes, and Housing, Town Planning, Sc., Acts. Mrs. T. Fisher, m.a., Factory & Workshop Acts & Tuberculosis Regulations. Miss F. Hall, Infectious Diseases. Health Visitor: Mrs. K. Roche. Notification of Births Act. Assistants to Inspectors : *Edwards, *Deverell. Public Mortuary : *W. Larken, 63, Flask Walk, Keeper. E. Stratton, Deputy Keeper. Disinfecting and Cleansing Stations : *T. Rider, G. Allaway and R. Bell, Disinfectors. Mrs. Rider, Attendant at Cleansing Room. A. L. Gibbons, Temporary Disinfector. Tuberculosis Dispensary : J. F. Halls Dally, m.d., m.r.c.p. (London) m.r.c.s., l.r.c.p.(Lond ), Tuberculosis Medical Officer. *Miss G. Goodchild, Nurse. Miss N. Taylor, Temporary Nurse. Clerical Staff: W. Sell, Clerk. *F. Hill, Clerk. * *B. C. Harley, Clerk. *B. Harley, Clerk. *R. Pollock, Clerk-Draughtsman. Temporary Clerks : Miss E. Blakeman. Miss K. Geary. Public Analyst : A. W. Stokes, f.C.S., f.l.c. Medical Officer of Health : Frank E. Scrase, f.r.c.s. (Eng.), l.r.c.p. (Lond.). d.p.h. (Lond.). * These members of the Staff are on Service with His Majesty's Forces. * * Killed on Active Service. 3 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W. 10th Jnly, 1917. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Madam, and Gentlemen, I have the honour to place before you the Medical Officer of Health's Report for the year 1916. From motives of economy and in accordance with the wishes of the Local Government Board, the report this year is brief. This is done to save labour and printing ; it must not be taken as indicating any relaxation of the means usually adopted for safe-guarding the Public Health. These measures have been efficiently maintained, and, as the Report shows, the health of the Borough is highly satisfactory. I wish to thank the Council and the Chairman and members of the Public Health Committee for the kindly support and encouragement that they always give me. I desire also to express my appreciation of the earnest efforts of the Members of the staff (permanent and temporary) 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. 4 INDEX. page Acute Polio-myelitis or Polioencephalitis 25 Alcoholism 38 Analytical Work, Report on 47 Anti-toxin 24 Area of Borough 5 Bacteriological Work 24 Bakehouses 15 Births 6. 7, 33, 36, 41, 42, 43, 44 Cancer 9, 38 Cerebro-Spinal-Meningitis 25,38 Cleansing Station 13 Complaints 13 Customs and Inland Revenue Acts 13, 40 Dairies 14 Deaths 7, 8,9, 10,11. 36,38, 41, 42, 43,44 Diarrhoea and Enteritis 28, 38 Diphtheria 24,37,38 Disinfection 27 Drainage Work 12 Enteric Fever 25. 37, 38 Erysipelas 25, 37, 38 Factories 20, 21, 23 Food Premises and Food Inspection 14. 15, 16 Fried Fish Vendors 15 Health Visiting 33, 34 Housing 19, 20, 40 Ice Cream 15 Infantile Mortality 33, 34, 35, 38 Infectious Diseases 23, 24, 25, 26, 27, 28, 37, 41, 42, 43, 44 page Legal Proceedings 46 Marriages 6 Measles 26,27,37,38 Milk Supply and Milkshops 14, 18, 40 Mortuary, Public 13. 40 Opthahnia Neonatorum 25. 37,38 Outworkers 22 Population 6,40.41 Public Health Committee 2 Puerperal Fever 25, 37, 38 Respiratory System, Diseases of 38 Restaurant Kitchens, etc. 16 Sale of Food and Drugs Act 16,17, 18, 40 Sanitary Inspections, etc 11, 12 Scarlet Fever 25, 37. 38 Slaughterhouses 16,40 Small-pox 24. 37, 38 Smoke Nuisances 13,40 Staff of Public Health Department 2 Tenement Houses 14, 20, 40 Tuberculosis 28, 29,30, 31,32, 37,38,41, 42. 43- 44 Tuberculosis Dispensary 32, 33, 48 Underground Rooms 40 Vaccination 24 Verminous Premises & Persons 13 Vital Statistics 5. 36, 37, 38, 39, 40, 41. 42,'43. 44, 45 Water Supply 20 Whooping Cough 28, 38 Workshops & Workplaces 20, 21, 22,23, Young Children, Mortality among . 33, 34, 35 5 Section A. NATURAL AND SOCIAL CONDITIONS OF THE BOROUGH. SUMMARY OF VITAL STATISTICS FOR 1916. Population estimated to middle of 1916 81,470 Density 36.1 persons per acre Births 1,164 *Birth-Rate 13. 1 Marriages 727 Marriage-Rate 17.8 Deaths 862 Death-Rate 10.5 Infantile Mortality 62.7 per 1000 births Notifiable Infectious Diseases Attack-Rate (excluding Measles and Tuberculosis) 3.5 do. do. do. do. (including Measles and Tuberculosis) 17.2 Notifiable Infectious Diseases Death-Rate (excluding Measles and Tuberculosis) .08 do. do. do. do. (including Measles and Tuberculosis) 1.08 Death-Rate from the Principal Epidemic Diseases .12 Death-Rate from Pulmonary Tuberculosis .67 Death-Rate from All Forms of Tuberculosis .98 CENSUS, 1911. Population 85,495 Buildings used as Dwellings 11,976 Ordinary Dwelling Houses 10,062 Area of Borough 2265 acres „ „ (excluding area covered by water) 2253 acres * By direction of the Registrar-General this rate has been calculated upon a population of 88,641. 6 POPULATION. The Registrar-General's provisional estimate of the population of Hampstead at the middle of 1916, based upon the Censuses of 1901 and 1911, together with the returns made under the National Registration Act 1915, was 81,470. This estimate has been adopted in this Report and, with the exception of the birth rates, it forms the basis upon which the various rates have been calculated. By the direction of the Registrar General the birth rates have been calculated upon the estimated population of 88,641. MARRIAGES. According to the return kindly furnished to me by the Superintendent Registrar of Hampstead, it appears that 727 marriages were registered in the Borough during 1916. The following Table gives the marriage rates for the years 1907-1916:— Year. Rate. Year. Rate. 1907 15.3 1912 15.0 1908 14.7 1913 14.9 1909 16.0 1914 19.0 1910 14.8 1915 23.2 1911 16.3 1916 17.8 BIRTHS. During the year 1,051 births were registered in Hampstead, a decrease of 171 as compared with 1,222 registered in the previous year. In addition 114 births of children, whose mothers were Hampstead residents, occurred outside the Borough in Lying-in Institutions, etc. 1 birth registered in Hampstead belonged to another District and must be subtracted from the total. After these corrections have been made the net number of births belonging to Hampstead was 1164, as compared with 1,327 in 1915, a decrease of 163. The following table shows the Ward and sex-distribution of the live-births, and the birth-rate for each Ward, calculated upon the estimated population of 1914:— Ward. Births. Birth-rate per 1000 of the population. Males. Females. Total. No. 1 (Town) 64 68 132 9.7 No. 2 (Belsize) 97 92 189 14.3 No. 3 (Adelaide) 57 47 104 11.4 No. 4 (Central) 50 43 93 9.8 No. 5 (West End) 115 96 211 17.0 No. 6 (Kilburn) 156 153 309 21.3 No. 7 (Priory) 65 61 126 13.3 The Borough 604 560 1164 13.1 7 Illegitimate Births. Of the total 1,164 births, 76 or 65.2 per 1,000 were those of illegitimate children. 46 of these were born outside the Borough, chiefly in Lying-in Institutions. The following Table shows the illegitimate births which have occurred in the Borough during the years 1902-1916:— Year. Number of illegitimate births. Illegitimate birth rate per 1,000 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 1915 81 61.0 1916 76 65.2 DEATHS. The death rate, calculated upon the total number of deaths (whether resident or non-resident persons) registered in the Borough during the year, was 12.6 per 1,000 of the population, but after subtracting those of non-resident persons dying in the Borough and adding the deaths of Hampstead residents who died outside the District the recorded death-rate is found to be 10.5 per 1,000 of the population. The following are the death-rates for each of the Wards:— Ward. Death-rate per 1.000 of the population. No. 1 (Town) 10.3 No. 2 (Belsize) 9.6 No. 3 (Adelaide) 10.4 No. 4 (Central) 10.2 No. 5 (West End) 9.4 No. 6 (Kilburn) 12.4 No. 7 (Priory) 11.2 The Borough 10.5 In the table on page 45 the death-rates of Hampstead may be compared with those of England and Wales since 1875. The following table shows the death-rate of Hampstead as compared with the rates of the County of London, and the Metropolitan Cities and Boroughs :— 8 Table showing the Death-rates from All Causes in the County of London, the City of London, and the Metropolitan Boroughs during 1916. District. Death-rate from all causes. Hampstead 10.5 Wands worth 11.7 Lewisham 11.8 Woolwich 12.3 Stoke Newington 12.6 Fulham 12.9 Camberwell 13.6 City of Westminster 13.7 Hackney 13.8 Battersea 13.9 Hammersmith 14.0 Paddington 14.3 Stepney 14.6 Lambeth 14.8 City of London 15.0 Chelsea 15.1 Deptford 15.1 Bethnal Green 15.2 Islington 15.3 Greenwich 15.4 Kensington 15.4 St. Pancras 15.5 St. Marylebone 16.0 Poplar 16.2 Sonthwark 17.1 Bermondsey 17.4 Holborn 17.5 Shored itch 18.7 Finsbury 19.3 County of London 14.3 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 and it is also based on 19/5 population. Deaths at Various Ages. The following table shows the number of deaths at the various age periods, the causes of such deaths being shown in Tables III. & IV. Age Periods. Under 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 73 11 10 18 24 87 244 395 862 9 Deaths at Ages. Year. Under 25. 25 and upwards. Totals. 1912 190 671 861 1913 209 742 951 1914 187 726 913 1915 207 787 994 1916 136 726 862 Deaths in Institutions. The number of deaths of Hampsteacl Residents which occurred in Institutions was 291 or 33.7 per cent, of the total deaths of residents. 84 deaths took place in Workhouses or Workhouse Infirmaries, equivalent to 28.8 per cent, of the deaths in institutions. Causes of Death. The causes of death are given in Table 3 at the end of the Report. The deaths from Cancer call for special consideration. The following Table gives the number of deaths from Cancer and the death-rate per 1,000 of the population in each of the years 1903-1916. Year. No. of Deaths from Cancer. Death rate per 1000 of the population. Year. No. of Deaths from Cancer. Death-rate per 1 000 of the population. 1903 105 1.27 1910 90 1.06 1904 85 1.02 1911 86 1.00 1905 73 0.87 1912 102 1.19 1906 93 1.11 1913 100 1.14 1907 69 0.82 1914 114 1.31 1908 84 0.99 1915 118 1.44 1909 85 1.00 1916 113 1.38 Of the 113 deaths from Cancer, 76 were females and 37 males. 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. In 47 cases the patients were over 65 years of age. The next Table gives the anatomical distribution of the disease in each sex. Situation. Males. Females. Total. Buccal cavity 4 — 4 Stomach, Liver, &c. 9 15 24 Peritoneum, Intestines and Rectum 8 19 27 Genital Organs 4 17 21 Breast — 12 12 Other, or unspecified, organs 13 12 25 Totals 38 75 113 10 The following is a list of the Institutions and the number of deaths which occurred in each :— Deaths of Hampstcad Residents in Institutions. Institution. Total. Infirmaries and Workhouses. Camberwell Workhouse 1 Paddington Workhouse 1 Poplar Workhouse 1 St. Marylebone Workhouse 8 St. Marylebone Infirmary 73 Hospitals, Sanatoria Nursing Homes. 35 Adamson Road 3 Abingdon Sanatorium 1 8 Alexandra Road 1 26 Belsize Avenue 1 33 Belsize Square . 4 34 Belsize Square 1 Bethnal House 1 Brompton Hospital, Chelsea 2 3 Beaumont Street. Marylebone 1 Battersea General Hospital 1 Childrens Hospital Paddington 3 Charing Cross Hospital 2 Cancer Hospital, Chelsea 1 Children's Hospital, Great Ormonde Street 2 Camberwell House 2 Consumption Hospital, Kensington 1 Clapham Maternity Hospital 1 City of London Lying-in Hospital 3 Chelsea Hospital for Women 1 Downs Sanatorium 1 6 Dennington Park Road 2 Darenth Industrial Colony 1 Devonshire Hospital. Fairfield 1 29 Devonshire Street, Marylebone 1 Epileptic Colony 1 Ewell Epileptic Colony 1 East Anglican Sanatorium 1 25 Ferncroft Avenue 1 27 Ferncroft Avenue 1 So Fordwych Road 3 French Hospital 1 Florence Nightingale Home, St. Marvlebone 1 Finchley Road, St. Marylebone 1 Gothic House, Brent St.. Hendon 1 German Hospital. Dalston 1 146 Great Portland St.. Marylebone 1 Guy's Hospital . 1 Hampstead Hill Gardens 1 5 Heath Hurst Road 1 Hospital of St. John and Elizabeth 1 Hoinoepathic Hospital 1 Hampstead General Hospital 24 King's College Hospital 1 57 King Henry's Road I London Hospital 3 12 Lancaster Place 1 London Temperance House 2 1 Little Union Place, Marylebone 1 Middlesex Hospital 10 Mandeville Place. Marylebone 1 Mortimer Street, St. Marylebone 1 Institution. Total. Hospitals, &c., continued. Mental Nursing Home, Clapton 1 Metropolitan Convalescent Institution. Walton 2 Mailings Farm Sanatorium 1 Northumberland House, Stoke Newington 1 New Hospital for Women 1 "Northcourt " College Crescent 1 Nursing Home. Treganwell Road, Minehead 1 216 Poitsdown Road, Paddington 1 Prince of Wales General Hospital, Tottenham 1 Queen Charlotte's Hospital 5 Queen Alexandra Hospital 1 Royal Hospitable for Incurables 1 To Rosslyn Hill 1 " Ravenswood," Highgate Road, St. Pancras 1 Sanatorium Free Hospital 2 St. George's Hospital 1 St. George's Home, Chelsea 1 St. Columba's Hospital 9 St. Bartholomew's Hospital 2 St. Mary's Hospital 2 St. Peter's Home 1 St. Luke's House, Kensington 1 St. Thomas's Home 1 St. Joseph's Hospital. Hackney 1 St. Catherine's Hospital, Ramsgate 1 97 South Hill Park 1 36 St. George's Square, St. Pancras 1 The Priory, Putney 1 299 Trinity Road, Wandsworth 1 University College Hospital 6 White Lodge Nursing Home. Knole Road. Bournemouth 1 29 Wimpole Street 1 West London Hospital 1 7 Wadham Gardens 1 Warrington Lodge, Paddington 1 M.A.B. Hospitals. North Western Hospital 4 Asylums. Banstead Asylum 4 Coltiev Hatch 6 Cane Hill 2 Clavbury 1 Dartford Heath 1 East Sussex County Asylum. Hellingly 1 Fountain Temperance 2 Hanwell 11 Levesden 2 Long Grove 1 Manor 1 Nethune 1 Tooting Bee 12 11 TOTALS. Infirmaries and Workhouses 84 Hospitals, Sanatoria, Nursing Homes, etc. 158 M.A.B. Hospitals 4 Asylums 45 291 Violent Deaths (excluding Suicide). 32 deaths were classified under this heading as compared with 33 in 1915. Of these 2 were due to burns ; 9 to falls ; 5 to injuries caused by being knocked down by vehicles ; 2 to drowning and 5 to suffocation. Suicide. 4 persons committed suicide as compared with 11 in 1915. In 1 case the cause of death was poisoning, 2 deaths were due to cutting of the throat, and 1 to bullet wounds from a pistol. Section B. SANITARY ADMINISTRATION AND CIRCUMSTANCES OF THE BOROUGH. SANITARY INSPECTIONS, &c 1916 Number of Inspections 6626 „ Re-inspections 9585 „ Intimation Notices issued 567 „ Statutory Notices issued 395 Notifications sent to " Head Teachers " of Schools respecting notified cases of infectious disease 271 Notifications sent to Medical Officers of Health of other Boroughs respecting Hampstead children attending schools in their districts 52 „ Notifications sent to " Head Teachers " of Schools respecting cases of Measles 698 12 The following is a tabulated statement of the sanitary work, &c., carried out during the year, so far as that work admits of tabulation :— General Conditions— Houses, or parts, cleansed 311 Dampness in houses, or parts abated 170 Dilapidated houses, or parts of houses, repaired 166 Ovcrcrowdi ng— Cases of, abated (rooms) after service of notice — Cases of, abated (rooms) without service of notice 3 Underground Rooms— Illegal occupation discontinued 22 Structural work carried out 8 Below floors— Spaces below floors in basement or ground floors ventilated 169 Hoofs repaired 232 Gutterings repaired or renewed 224 Rainwater pipes— Repaired or renewed 192 Disconnected from drains . 18 Disconnected from soil pipes 16 Sinks disconnected from drains 8 Sinks trapped 313 Sinks repaired or renewed 235 Sinks unstopped 1 1 Lavatories disconnected from drains 3 Lavatories trapped 200 Lavatories repaired or renewed 157 Baths disconnected from drains 12 Baths trapped 179 Baths repaired or renewed 730 Water supply re-instated 17 Water and sinks provided to upper floors of tenement houses 174 Water cisterns repaired or renewed 9 Removed from improper positions 8 Cleansed 91 Fitted with close-fitting covers 66 Water-closet accommodation provided 12 Additional accommodation provided 38 Removed from improper positions 16 Provided with proper and sufficient external ventilation 6 Improperly constructed apparatus removed and new provided 8 Apparatus repaired or renewed 350 Apparatus unstopped 16 Apparatus cleansed 47 Apparatus provided with proper water supply 38 Flushing cisterns repaired or renewed 252 Manholes repaired or renewed 334 Drains repaired or renewed 288 Drains cleansed 55 Drains unstopped 69 Drains ventilated 102 Ventilating pipes of drains— Carried to a sufficient height above windows 22 Repaired or renewed 35 Fresh-air inlets repaired or renewed 123 Soil pipes repaired or renewed 255 Gullies and surface drains— Gully traps removed from improper positions 34 Gully traps cleansed 15 Inlets or surface drains trapped 7 Paving and draining washhouses, areas, yards, &c.— Washhouse or scullery paving repaired or renewed 28 Areas cleansed 18 Area paving repaired or renewed 153 Areas drained 13 Yards or other open spaces paved 88 Paving of yards or otheropen spaces repaired or renewed 123 V'ards or other open spaces drained 31 Floors of buildings in which horses. &c.. are kept, paved or repaired 3 Refuse and receptacles— Dustbins provided 152 Fixed ashpits removed 44 Accumulation or deposits of refuse removed 195 Manure receptacles provided 2 Manure receptacles amended 1 Nuisances from the improper deposit of trade refuse abated 6 General— Nuisances from the improper keeping of animals abated 5 Nuisances from mortar mill abated 1 Drainage Work- Since the Bye-laws of the London County Council which require the deposit of plans and particulars came into operation in August 1903, 605 plans for the drainage of new buildings and 8603 plans for the alteration and reconstruction of drains in existing premises have been received. During 1916, 364 Notices of drainage work were received. 348 of these necessitated the deposit of plans and particulars. 115 related to the entire reconstruction of the drainage system. 13 Cleansing Station. During 1916 201 children and 4 adults were cleansed at the Cleansing Station by the Council's Attendant, and while this was in progress their clothes were thoroughly disinfected. Customs and Inland Revenue Acts. During the year applications for certificates under these Acts were received in respect of 33 dwellings, this number being 9 more than the number for which applications were made in 1915. Smoke Nuisances. During the year observations were made in 7 instances by the Sanitary Inspectors. One Intimation Notice was sent. Public Mortuary. During the year the bodies of 97 persons were brought to the mortuary—58 by order of the Coroner, 9 by the Police, and 30 at the request of friends of deceased persons. In 21 instances inquests only were held, and in 46 instances post mortem examinations were made and inquests followed. The following table indicates the causes of death of the persons whose bodies were received into the Mortuary:— Number of Bodies Received. Cause of Deatli or Verdict Deaths from Natural Causes 56 Accidental Deaths 21 Suicide 6 Misadventure 9 Wilful Murder 0 Open Verdict 5 Total 97 Complaints. During 1910, 430 complaints were were made of the existence of insanitary conditions, relating to 545 nuisances as follows :— Accumulations 19 Animals improperly kept 9 Animals dead 4 Dampness in premises 53 Dirty and dilapidated premises 31 Drains defective 39 ,, stopped 37 Dust, non-removal 70 Dust receptacles, foul or delapidated 24 ,, absence of, or insufficient 7 Insanitary condition of premises 12 Manure not removed 3 Overcrowding 7 Rats, nuisance from 5 Roofs and gutters, defective and leaky 28 Rubbish Nuisance from burning 2 Carried forward 350 Brought forward 350 Smells on premises 22 Smells from Sewer Ventilators 5 Smells from drains, etc. 8 Smells from manure . 9 Smoke nuisances 4 Verminous conditions 10 Water, absence of 59 Water, leakage of 7 Water-cisterns, dirty &c. 2 Water-closets, insufficient or absence of 3 Water-closets, defective 13 Water-closets, stopped 4 Yards, unpaved and existing paving defective 5 Miscellaneous 38 Food, unsound 6 Total 545 14 Houses Let in Lodgings. The number of houses let in lodgings on the Register at the end of 1916 was 405. The alterations in the Bye-laws governing these premises, rendered necessary in view of Section 10 of the Housing. Town Planning, &c., Act, 1909, are still the subject of negotiation between the Borough Council and the Local Government Board. 705 Inspections and re-inspections have been made during the year of the houses on the Register. Milk Supply. 71 persons occupying 95 premises have been registered as purveyors of milk, comprising 51 dairies, 19 bakehouses and confectioners, 10 restaurants and coffee shops and 15 general shops. During the year 256 inspections were made, 12 Notices were served and the following works were carried out :— Di'ains repaired or re-constructed 2 Premises repaired, cleansed and limewashed 18 Roofs and rain water pipes repaired 6 Water closets repaired or renewed 3 Water closets cleansed 4 Waste pipes to sinks trapped and renewed 2 Yard paving repaired or renewed 5 Dustbins provided 4 Refuse removed 5 Other defects remedied 6 Other Foods. The following food was seized or voluntarily surrendered to the inspectors during the year :— Food Seized or Date. Premises. surrendered. January 27th Mansfield Road 8½ lbs Tomatoes. October 13th Flask Walk 4 stone, Cod. The food exposed for sale on Saturdays, Sundays and upon Bank Holidays is under the constant supervision of the Sanitary Inspectors. Food Premises. Section 8 of the London County Council General Powers Act, 1908, considerably increases the power of sanitary authorities to improve the conditions of places where food is prepared or sold. In 1916 the number of premises dealt with was 50. Of these 3 were found to have drain inlets inside ; in 11 the drains were defective ; in 41 structural defects of various kinds were present ; 23 premises needed cleansing. To remedy these conditions, the following work was carried out :—In 6 instances the drains were entirely, and in 4 instances partially reconstructed ; in 3 instances drain inlets were removed ; in 44 instances minor defects were remedied and 19 premises were thoroughly cleansed under notice. 15 Fried Fish Shops. The following is a list of the Fried Fish Shops in the Borough. These are now kept under systematic inspection. Belsize Ward 10G Fleet Road and 70 Upper Park Road. West end Ward la Broomsleigh Street; 86 Mill Lane and 1 Munro Terrace. kilburn Ward 132 High Road ; 89 Kingsgate Road and 95 Palmerston Road. Ice Cream. There are 72 shops in the Borough in which Ice Cream is soldIn regard to these, 164 inspections and 11 notices were served dui ing the year. In addition, the barrows standing in the street and on Hampstead Heath on Bank Holidays, have been inspected. The following Sanitary work has been carried out during the year:— Premises repaired, cleansed or limewaslied 23 Drains repaired or reconstructed 4 Soil Pipes ditto 1 Water closets repaired or renewed 4 „ cleansed 5 Waste pipes of sinks trapped, repaired or renewed 5 Yard paving repaired 5 Dustbins provided 4 Roofs, Gutters and rain water pipes repaired 3 Refuse removed 4 Bakehouses. At the end of 1916 there were 36 occupied bakehouses on the register, 21 being underground and 15 above ground. Five of the bakehouses situated above ground and four underground use power, and are therefore factories. Twenty-one inspections were made in respect of the factory bakehouses, 115 inspections in respect of the workshop bakehouses and 8 notices were served. The following is a list of the occupied bakehouses on the Register at the end of the year :— Town Ward 3 & 67 High Street and 26 New End. Belsize Ward 6 & *65 Fleet Road and 45 South End Road. Adelaide Ward *†44 England's Lane, *90 Haverstock Hill and *2 King's College Road. Central Ward *64 Belsize Lane, *225, *289 and †307 Finchley Road, *98 West End Lane and †2 Broadhurst Gardens. 16 West End Ward †60 & 110 Cricklewood Broadway,†553 Finchley Road, Field Lane School, Hillfield Road, *4.3 & 44 Mill Lane, †4 Munro Terrace, Fortune Green, and 251 & *279 West End Lane. Kilburn Ward *63 Hemstal Road, *94 & *354 High Road, Kilburn, *4 Kelson Street, 67 Kingsgate Road and *†99 Palmerston Road. Priory Ward *202 & *228 Belsize Road, *†98 Boundary Road, *†93 Fairfax Road, *7 Fairhazel Gardens and *137 Finchley Road. Those marked * are underground bakehouses. Those marked † are factory bakehouses. Bakehouses—Underground 21 ,, Above ground 15 Total 36 Restaurant Kitchens, &c. The total number of these premises on the register at the end of 1916 was 66. They are kept under regular supervision. 144 inspections have been made and 16 notices served during the year. Meat Supply. The Meat Supply of the Borough is good and in no case has any unsound or diseased meat been found by the Sanitary Inspectors during the year. Slaughter Houses. There are 4 Licensed Slaughter Houses in the Borough, situated at 40 England's Lane, and 17 and 69 Higli Street and 6 Fairfax Mews. These have been regularly inspected during the year; 61 inspections having been made. The quarterly limewashing has been duly carried out. Sale of Food and Drugs Act- 506 samples were taken for analysis during the year. The number certified to be adulterated was 11 or 2.1 per cent, of the total number, as against 7.7 in 1915 and 6.2 in 1914. 5 samples were certified to be of low quality. 453 samples were purchased from Hampstead tradesmen and 53 from tradesmen coming from other districts. The percentage of adulterated samples in the two classes was 1.8 and 5.6 respectively. 24 samples were taken on Sundays :—none were adulterated, but two were of low quality. 17 The following table shows the articles of which samples were taken during the year :— Articles. No. taken. Adulterated. Low Quality. Baking Powder 3 - - Butter 90 1 — Cheese 16 — — Cocoa 44 3 — Coffee 47 — — Cream 13 1 — Dripping 1 — - Egg powder 3 — — Flour 3 — — Lard 48 — — Margarine 18 — — Milk 213 6 5 Mustard 1 — — Pepper 2 — — Salaspin 1 — — Sugar 2 — — Sweets 1 - - Totals 506 11 5 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. 110 Cocoa 85½c/o sugar and sago Informal sample Purchased from same vendor. 115 Cocoa 87%sugar and sago Fine £2, Costs £2 6s. 174 Milk 16% deficient in butter-fat Fine £.2, Costs 10/6 195 Cream 20 grains of boric acid per pint Fine £5, No Costs 202 Milk 20% deficient in butter-fat Summons dismissed. Warranty proved 228 Milk 27% deficient in butter-fat Summons dismissed. Warranty proved 263 Milk 2% deficient in butter-fat Informal sample 301 Cocoa 43%sugar and sago Informal sample 311 Butter 1 % excess of water about legal limit Informal sample 443 Milk 91⅓% deficient in butter-fat Summons dismissed 494 Milk 15% deficient in butter-fat Fine £1, Costs 10/6 One Vendor was fined 10/- for not having name and address on vehicle or receptacle. 18 Milk and Cream Regulations, 1912. The object of these Regulations is to secure that cream containing preservative shall be distinguished at all stages of sale from cream to which no preservative has been added. The following samples of Milk and Cream not sold as preserved cream, were taken during the year:— 1.—Milk ; and Cream not sold as preserved Cream. (a)—Number of samples examined for the presence of a preservative. (b)—Number in which a preservative was reported to be present. Milk 213 - Cream 12 1 One of the above samples contained 20 grains of boric acid per pint. An explanation was obtained from the vendor. After receipt of explanation legal proceedings were instituted, resulting in a fine of £5. 2.—Cream sold as Preserved Cream. (a) Samples submitted for analysis to ascertain if the statements on the labels as to preservatives were correct :—1. Correct statements made, 1 ; 2. Statements incorrect, nil. (&) Determinations made of milk fat in cream sold as preserved cream:—1. Above 35 per cent., 1; 2. Below 35 per cent., nil. (c) Instances where (apart from analysis) the requirements as to labelling of preserved cream in Article V (1) and the proviso in Article V (2) of the Regulations have not been observed :— nil. (d) Particulars of each case in which the regulations have not not been complied with, and action taken :—nil. 3.—Thickening substances. (a) Addition to cream or to preserved cream, nil; (b) Action taken where found, nil. 4.—Other observations (if any), nil. Percentage of Preservative found in each sample where this has been determined, and also the percentage indicated on the Statutory label:— Official No. Sample. Analyst's Report. Percentage on Statutory label. 190 Preserved Cream Genuine Not exceeding 0·5 % Boric Acid 195 Cream 20 grains of boric acid per pint No label 19 HOUSING. Dwellings unfit for Habitation. 83, Palmerston Road. This house was represented as being unfit for human habitation by my predecessor, Dr. McCleary, on the 20th December, 1910, and the Closing Order was made by the Council on the 12th January 1911, since when it has been the subject of continuous litigation. It has been referred to year by year in my previous reports. The following shows the further proceedings which jiave taken place during the year under review :— 1916. Jan. 12th. Defence delivered in the pending Chancery Action. Jan. 25th. Public Local Enquiry held by Inspector of the Local Government Board at the Town Hall in regard to the above appeals. Mr. Arlidge was represented by Counsel and was supported by Alderman Woodward, Councillor Warner and other witnesses. May 26th. Letter received dated 26th May from the Local Government Board, forwarding a copy of a letter addressed to Mr. Arlidge's Solicitors, stating that the Board's conclusion is that the house No. 83 Palmerston Road, has not been made fit for human habitation and setting out the works necessary to remedy the dampness in the walls and asking to be informed within one month whether Mr. Arlidge is prepared to carry out such works. Sept. 6. Letter from the Local Government Board forwarding draft Order proposed to be made on Mr. Arlidge's appeals against refusal to determine and Demolition Order and asking for observations thereon. Sept. 22nd. Observations sent to the Board. Oct. 7th. Letter from the Local Government Board enclosing print of Order made by the Board confirming the refusal and Demolition Order subject to the basement rooms being structurally closed before the 31st December, 1916, (as in terms of the draft Order submitted to the Council on 6th September). Oct. 26th. Motions by Mr. Alderman Woodward and Mr. Councillor Warner for leave to inspect M.O.H. report to Public Health Committee dated 1st June, 1916, and observations sent to the Local Government Board on Draft Order as above when consideration of motions deferred by the Council. Nov. 28th. Rule Nisi granted on application of Mr. Alderman Woodward to shew cause why the Council should not grant inspection. 20 84 & 85 Palmerston Road. These houses belong to the same owner as No. 83, and the Council have authorised me to make a survey and examination for the purpose of determining whether any powers under the Housing Act should be exercised in regard to these premises. Up to the present I have not been able to effect an entry. 1 to 7 Peebles Mews. The Local Government Board have made an Order in regard to the above premises intimating their willingness to quash the Demolition Orders provided certain essential works are carried out and the premises used for some purpose other than for human habitation, but so far alterations have not been made and the premises remain closed. No action has been taken during the year in regard to the following houses, all of which remain closed :— Closing Order Represented. made. Woodbine Cottage 1.12.14 10.12.14 Grove Cottage 1.12.14 10.12.14 Hope Cottage 1.12.14 10.12.14 8 Woodchurch Road 20.10.14 29.10.14 The following premises have been dealt with during 1916:— Closing Order Represented. determined. 23 Worsley Road 23.3.15 2.3.16 117 Abbey Rd. (2 Rooms) 23.3.15 20.7.1 6 4 Lowfield Road 3.5.15 27.4.16 2 Lowfield Road 20.7.16 18.4.16 . Demolition Represented. Order. 5 & 6 Fairfax Yard 5.10.15 14.11.16 The Water Supply of Tenement Houses. During 1916, the powers conferred by Section 78 of the L.C.C. General Powers Act. 1907, have been exercised in regard to 63 houses, making a total of 833 houses which have been dealt with in Hampstead since the Act came into force. Factories and Workshops Act. Whilst maintaining careful supervision of the sanitary conditions of the workshops and workplaces, due regard has been paid to the altered conditions now pertaining. In many establishments women have taken the place of men, so that establishments are now employing both sexes when they formerly employed one. The Local Government Board in a letter upon this subject dated 14th June, 1915, suggested that endeavours should be made to re-arrange things as to obviate the expense of providing double sanitary accomodation. These arrangements would be only temporary during the War. This suggestion was adopted and adhered to. 21 At the end of 1916 there were 379 workshops on the Register, of which 31 were domestic workshops. Excluding these, there were 543 males and 563 females employed therein. During the year 514 inspections were made and 26 notices served. TRADE OR BUSINESS. No. of Workshops. Workshops other than Domestic Workshops. Domestic Workshops. Total No. of Workshops. No. of Workrooms. No. of Employees. Males. Females Bakers 27 29 77 3 - 27 Blindmakers 3 5 6 5 — 3 Bootmakers 36 40 65 — — 36 Builders and Carpenters 17 20 22 — — 17 Cabinet Makers and Polishers 2 6 22 — 1 3 Carriage Builders 5 13 15 — — 5 Corset Makers 3 3 — 6 — 3 Cycle Makers and Repairers 4 8 10 2 — 4 Dressmakers & Ladies Tailors. 70 78 4 230 10 80 Florists 3 4 9 5 — 3 Harness Makers 4 7 12 — — 4 Ironmongers 14 14 25 — — 14 Laundresses 4 11 2 28 — 4 Milliners 20 20 — 45 2 22 Monumental Masons 2 2 15 - — 2 Motor Makers 4 5 14 — — 4 Outfitters 8 30 4 136 — 8 Pianoforte Makers 2 4 27 — — 2 Picture Frame Makers 10 12 21 — — 10 Sign Writers 2 5 8 3 — 2 Smiths 10 10 20 — — 10 Tailors 24 31 48 29 13 37 Upholsterers 19 24 34 11 1 20 Watchmakers and Jewellers 12 12 1 — — 12 Wigmakers 13 16 8 22 — 13 Miscellaneous 30 40 58 38 4 34 Totals 348 449 543 563 31 379 Inspections : (excluding bakehouses) 378 Cleanliness : Workrooms requiring cleansing 2 Warming and ventilation : Workshops inadequately ventilated 2 Warming unsatisfactory 3 Overcrowding : Workrooms overcrowded 1 Abstract and Factory Act not exhibited : Workshop 21 22 Workplaces. 919 inspections of workplaces were made during the year and 48 notices were served. Homework. 80 lists of outworkers were received from employers. These contained 224 entries. There are 81 outworkers' premises in Hampstead. *Nature of Work. Outworkers' Lists, Section 107. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions Sending Twice in the year. Sending Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Outworkers.† Lists. Outworkers Lists. Contrac tors. Workmen. Contrac tors. Workmen. 1 2 3 4 5 6 7 8 9 10 Wearing Apparel- (1) making, &c. 42 30 60 7 2 11 — — — (2) cleaning & washing 12 22 2 — — — - — — Household linen 6 1 9 2 2 — — — — Lace, lace curtains & nets — — 4 — 1 — — — — Curtains & furniture hngs 4 10 4 1 2 — — — - Furniture and upholstery 4 8 4 — 1 — — — - Electro-plate — — — — — — — — — File making — — — — — — — — — Brass and brass articles — — 4 — 1 — — — — Fur Pulling — - — — — — — — — Cables and Chains — — — — — — — — — Anchors and Grapnels — — — — — — — — — Cart Gear — — — — — — — — — Locks, latches and keys — — 2 — — — — — — Umbrellas. &c — 4 — — 1 — — — — Artificial flowers — — — — — — — — — Nets, other than wire nets — — — — — — — — — Tents — — — - — - — — — Sacks — — — — — — — — — Racquet and tennis balls — — — — — — — — — Paper. etc., boxes, paper bags 2 - 39 - - - - - - Brush making — — — - — — - — — Pea picking — — — - — - — — — Feather sorting — — — — — — — — — Carding &c.,of buttons &c. — — — — — — — — — Stuffed toys — — - — — — — — — Basket making — — — — — — — — — Chocolates and sweetmts Cosaques, Christmas — — — — — — — — — Crackers, Christmas Stockings, etc. — - - - - - - - Textile weaving — - — — — — — — — Total 70 75 128 10 10 11 — — — Outwork in unwholesome premises, Sec. 108. Nil; Outwork in infected premises, Sees. 109— 110. Nil. c In the case of those occupiers who gave out work of more than one of the classes specified in Column 1, and subdivided their lists in such a way as to show the number of workers in each class of work, the list has been included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers have been assigned in columns 3 and 4 (or 6 and 7) into their respective classes. † The figures tn 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. 23 Registered Workshops. Workshops on the Register (s. 131) at the end of year. No. Bakehouses 27 Bootmakers 36 Dressmakers and ladies' tailors 80 Laundries 4 Milliners 22 Tailors 37 Watchmakers and jewellers 12 Wigmakers 13 Other 117 Total number of workshops on Register 348 Other matters. Class (1) No. (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) 21 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 — Reports (of action taken) sent to H.M. Inspector — Other 2 Underground Bakehouses (s. 101) in use at the end of the year 21 Section C. PREVALENCE OF & CONTROL OVER ACUTE INFECTIOUS DISEASES. NOTIFIABLE INFECTIOUS DISEASES (EXCLUDING TUBERCULOSIS). The list of Infectious Diseases notifiable in London during 1916, was as follows :— Small-pox Typhoid or Enteric Fever. Cholera. Typhus Fever. Diphtheria. Relapsing Fever. Membranous Croup. Continued Fever. Erysipelas. Puerperal Fever. Scarlet Fever. Anthrax Epidemic Cerebro. Hydrophobia Occurring in Man. Spinal Meningitis. Glanders Plague. Ophthalmia Neonatorum. Polio-Myelitis. Measles. German Measles. 24 Bacteriological Work. The following is a Summary of the Bacteriological Work performed by the Lister Institute:— Positive. Negative. Total. Diphtheria 43 167 210 Enteric Fever 2 3 5 Cases of Infectious Disease occurring in each month during 1916. Disease MONTHS. Totals. January. February. March. April. May. June. July. August. September. October. November. December. Diphtheria & Membranous Croup 6 7 8 8 8 16 9 4 11 4 9 8 98 Erysipelas 4 2 5 6 3 1 2 4 1 5 4 3 40 Scarlet Fever 15 8 14 35 6 11 3 5 9 10 9 8 133 Enteric Fever 1 1 1 — — — 1 — 2 — — — 6 Puerperal Fever — — — 1 — — 1 — — — — — 2 Polio-Mvelitis — — — — — — — — — — — — — Ophthalmia Neonatorum — — — — — — 2 2 — 1 1 — 7 Epidemic Cerebrospinal Meningitis — 1 — 3 — — — — — — — — 4 Measles 40 38 40 56 42 23 32 27 5 8 5 9 325 German Measles 43 40 96 148 121 35 26 13 7 7 7 15 558 Totals 109 97 164 257 18o 87 76 55 35 35 35 43 1173 Small-Pox. No cases of small-pox occurred in Hampstead during the year. Vaccination. Of the 1051 births recorded 701 were sucessfully vaccinated. In 8 cases the children were insusceptible of vaccination. In regard to 226 Certificates of Conscientious Objection were obtained ; 48 died before vaccination was performed ; 17 cases of vaccination were postponed and 53 remained to be dealt with. 1 am indebted to the Vaccination Otficer for these statistics. Diphtheria and Membranous Croup. The number of cases notified in 1916 was 98, as compared with 130 in 1915. The attack rate, or number of cases notified per 1,000 of the population was 1.02 compared with the rate of 1.59 in the previous year. The number of cases notified proving fatal was 2, or 2 per cent, of the cases notified, as against 7.69 per cent, in 1915. The death-rate per 1,000 of the population, calculated on the total deaths was 0-02. 76 patients, or 58-4 per cent, of the cases notified were removed to hospital. In accordance with the Diptheria Anti-toxin (London) Order, 1910, the Borough Council supply anti-toxin free to medical practitioners for use for the poorer inhabitants of the Borough. 25 Erysipelas 40 cases were notified, but no deaths occurred, as compared with with 52 cases in 1915. The attack rate, per 1,000 of the population, was .49. Of the cases notified 7, or 17.6 per cent, were removed to the Hampstead Workhouse Infirmary or Nursing Homes- Scarlet Fever. 132 cases of scarlet fever were notified during the year. The number of cases per 1,000 of the population was 1.61 ; the corresponding figure in 1915 being 2.34. Of the cases notified 118 or 89 percent, were removed to hospital. Enteric Fever. The number of cases notified was 6. The attack rate per 1,000 of the population was .07. None of the cases notified proved fatal. Puerperal Fever. 2 cases were notified both of which proved fatal. Epidemic Cerebro-Spinal Meningitis. This disease popularly known as "spotted fever," was made notifiable on 15th August, 1912. During 1916, 4 cases were notified, 2 of whom died. The mode of infection in this disease is not clear, although the disease is epidemic in character. The war would seem to have made the disease more prevalent and special care was taken of all the cases which occurred in the Borough. Acute Polio-Myelitis. No case of this disease occurred during the year. Ophthalmia Neonatorum. 7 cases were notified during the year. In no case was there any evidence of really bad nursing nor was any permanent injury left. With proper nursing arrangements the complaint would rarely ever occur. Principal Epidemic Diseases- Enteric Fever. Scarlet Fever. Small-pox. Whooping Cough. Measles. Diphtheria. All of these, with the exception of whooping cough, are notifiable diseases. The total number of deaths from the principal epidemic diseases amounted to 10 and the death-rate was 0.12 per 1,000 of the population. 26 Measles and German Measles. On the 1st January, 1916, the Notification of Measles and German Measles Order, 1915, came into operation. Parents or guardians are now required to notify to the Medical Officer of Health the occurrence of all cases of these diseases unless already notified by a doctor in attendance. Notice of tliis obligation has been publicly posted throughout the Borough. During 1916, 325 cases of Measles and 558 cases of German Measles were notified. Arrangements are being made by the Council for the provision of nursing and medical assistance in necessitous cases but these had not been completed at the close of the year. It is hoped that the effect of this Order will be to ultimately reduce the attack and death rates and to prevent many of the complications which up till now have unquestionably been responsible for some of the diseases from which people have suffered and died in after years. One death was recorded from Measles as compared with 16 in 1915. The mortality was 0.01 per 1,000 of the population, the mortality in 1915 being 0.19. The following tables show the number of notified cases of Measles and German Measles occurring each month in the various Wards Measles. 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 8 4 1 4 5 15 3 40 February 9 3 4 1 4 5 12 38 March 4 — 4 1 6 15 10 40 April 4 — 8 7 4 11 17 56 May 2 3 2 3 7 11 14 42 June 8 2 2 2 — 8 1 23 July 5 19 5 — — 1 2 32 August 1 23 1 — 1 1 — 27 September — 3 9 — — — — 5 October 3 4 1 — — — — 8 November 2 1 — 9 — — — 5 December 2 3 3 — 1 — — 9 Totals 48 70 33 20 28 67 59 325 27 German Measles. Month. No. I (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). Totals. January 13 3 4 3 16 4 43 February 9 2 1 2 6 13 7 40 March 19 7 16 13 12 17 12 96 April 34 24 29 16 13 12 20 148 May 16 13 10 23 23 18 18 121 June 9 4 5 6 6 1 4 35 July 2 6 2 5 6 1 4 26 August 3 4 2 1 3 13 September 2 1 1 1 2 — — 7 October 2 1 2 1 1 7 November 1 1 2 3 7 December 1 3 4 4 1 2 — 15 Totals 110 67 72 78 75 84 72 558 Disinfection. No. of Articles Disinfected. No. of Articles Destroyed. Beds 259 Beds 3 Mattresses 699 Mattresses 7 Palliasses 7 Blankets 1 Bolsters 459 Miscellaneous 1 Pillows 1696 Blankets 2110 Sheets 961 Counterpanes 903 Articles of Clothing 3614 Carpets 24 Linen Articles 2089 Books 180 Miscellaneous 1214 Total 14205 Total 12 Number of premises disinfected 1793 „ rooms, etc., ,, 1522 The amount of disinfection carried out by the Council lias increased enormously in late years. In the near future the Council will undoubtedly have to consider the reorganisation of the arrangements and an increase in the disinfecting staff. 28 Whooping Cough. Seven deaths occurred from Whooping Cough us against 8 in 1915. The mortality rate per 1000 of the population was '08. Diarrhoea and Enteritis. The deaths at all ages from diarrhoea and enteritis in Hampstead during 1916 numbered 8. Of these (i occurred during the first year of life. The deaths in the 1st, 2nd, 3rd, and 4tli quarters of the year were as follows :—2,0,2,4. The deaths from these diseases at various age periods in the last five years is as follows :— Year. Under 1 year. I and uuder 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. 1912 2 9 4 7 15 1913 13 1 2 1 1 18 1914 7 2 1 1 1 2 2 16 1915 14 — 1 — — 2 — 1 18 1916 6 9 8 Totals 42 3 4 1 — 6 7 12 75 The following are the deaths from diarrhoea and enteritis in recent years :— 1906 30 1911 35 1907 14 1912 15 1908 22 1913 18 1909 11 1914 16 1910 15 1915 18 1916 8 Section D. PREVALENCE OF AND CONTROL OVER TUBERCULOSIS. The number of deaths from tuberculosis in 191G was 80. Of these 55 deaths were due to pulmonary tuberculosis, 13 to tuberculous meningitis and 12 to other forms of tuberculosis. 29 The following table shows the number of deaths and the deathrates from all forms of tuberculosis and from consumption respectively since 1 899 :— Year. Total deaths from Tuberculosis. Death-rate per 1,ooo population. Deaths from Consumption. Death-rate per 1,000 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 1.14 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 0.81 49 0.56 300 1914 71 0.82 57 0.66 172 1915 71 0.86 48 0.58 172 1916 80 0.98 55 0.67 244 The deaths from consumption and from all forms of tuberculosis during 1916 were distributed among the wards as follows :— Ward. Area (Acres). Estimated Population middle of 1916. Consumption Tuberculosis (All Forms). Deaths. Death-rate per 1000 of the population Deaths. Death-rate per 1000 of the population. No. 1 (Town) 686 13510 13 .96 16 1.18 „ 2 (Belsize) 271 13200 6 .45 9 .68 „ 3 (Adelaide) 325 9100 5 .54 6 .65 „ 4 (Central) 312 9450 3 .31 5 .52 „ 5 (West, End) 247 12340 5 .40 10 .81 „ 6 (Kilburn) 195 14440 20 1.38 27 1.86 „ 7 (Priory) 229 9430 3 .31 7 .74 The Borough 2265 81470 55 .67 80 .98 30 The following table shows the age distribution of patients dying from Pulmonarv Tuberculosis in Hampstead in the fourteen years 1903—1916. Year. 0—5 Age Period. All Ages. 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 ] 12 37 2 53 1910 1 1 12 37 7 58 1911 1 1 5 44 5 56 1912 2 2 13 45 2 64 1913 1 4 39 5 49 1914 __ 2 10 42 3 57 1915 1 7 37 3 48 1916 — 4 11 37 3 55 Totals 9 19 147 619 50 844 The deaths from all forms of Non-Pulmonary Tuberculosis was 25 in 1916,distributed in age periods as follows: — 0-f) 10; 5-15 4 : 15-25 4 ; 25-65 7. over 65-0. The total number of notification certificates (including duplicates) received during 1916, relating to Hampstead patients was 382, i.e. :—324 Pulmonary and 58 Non-Pulmonary cases. In accordance with the terms of the Regulations, a Register is kept in which the full particulars of each notification are set out. A weekly statement of these is sent to the County Medical Officer. The notes of investigations are indexed and filed and comprise a full record of Tuberculosis in the Borough. This is of great assistance in the efforts which are beine taken to control the disease. The unsatisfactory home conditions found upon investigating the new cases of Pulmonary Tuberculosis notified in 1916 were as follows :— Unsatisfactory Home Conditions. Pulmonary Cases. Non-Pulmonary Cases. Overcrowding 1 1 Inadequate Ventilation 9 5 Inadequate Lighting 7 2 Dampness 3 2 Other Insanitary Conditions 6 3 31 Occupations. The following is an analysis of the occupation of the cases notified as tuberculous during 1916 :— Occupation. Pulmonary NonPulmonary. Occupation. Pulmonary. Pulmonary. Acetylene Welder l — Instrument Maker 1 — Actress l — Insurance Officer 1 — Artist l — Invalided from — Bacteriologist l — Navy 2 — Barmaid i — Journalist 1 — Bookbinder l — Labourer 1 — Bootmaker l — Laundress 1 — Builder'sForeman l — Leather worker... 1 — Caretakers 2 — Lithographer 1 — Carpenter 1 — Merchants 6 — Charwoman 1 — Milk Carrier 1 — Children's Nurse 1 — Munition Worker 1 — Clerks 11 2 Nurses 2 1 Companion 1 — Organist 1 — Cooper 1 — Photographer ... — 1 Domestic Servants 23 8 Police Constables Printers 2 2 1 Drayman 1 Porters 2 — Dressmakers 2 — Post Office Employees — Electrician — 1 3 — Engineers 2 — Postmen 2 — Errand Boy 1 — School If) 20 Ex-Soldiers 13 — Shop Assistants... 7 — Fitters 2 Singer... 1 — Furrier's Forewoman 1 — Students 4 — Tailors 3 — Gardener 1 Taxi Drivers 1 — Governess 1 — Translator 1 Hairdresser 1 — Vulcanite Turner 1 Housewives 29 1 No occupation 7 11 Housemistress at — No information 22 1 School 1 Total number of Pulmonary Cases 193 Total number of Non-Pulmonary Cases 51 Removal of Cases. Of t,he cases of Pulmonary Tuberculosis newly notified in 1916, 73 were removed : 57 to Sanatoria (of these 36 were insured and 21 non-insured persons), 5 to Hospitals, 10 to Infirmaries and 1 to a Home. 18 of the newly notified cases of non-pulmonary tuberculosis were removed : 8 to Hospitals and Sanatoria and 3 to the Infirmary : 7 to Nursing or other Homes. Of the pulmonary cases notified prior to 1916, 17 were removed : 8 to Sanatoria, 3 to Hospital, 5 to the Infirmary and 1 to a Home. 1 non-pulmonary case notified in 1913 was removed to Hospital. Of the pulmonary cases notified in 1916, 12 were of persons already dead or dying and in 14 other cases the patients did not survive the year under review. 32 Pulmonary Cases. Of the 193 cases notified, 53 were beyond the scope of the Department (25 cases being in institutions, 16 leaving Hampstead within a short time and 12 being dead or dying), 5 were out-patients of Hospitals, 19 in-patients at Hospitals, Sanatoria or the Infirmary. 45 were being treated by private doctors and 71 attended the Dispensary. Non-Pulmonary Cases. Of the 51 cases, 14 were beyond the scope of the Department, 19 being dead or dying, 3 having left Hampstead and 2 being Institution cases. 3 were out-patients at Hospitals, 5 in-patients at Hospitals or the Infirmary, 10 were being treated by private doctors and 19 attended the Dispensary. Preventive and Curative Measures. During the year no effort has been relaxed by the Department on account of Tuberculosis. Disinfection has been carried out in all cases ; re-disinfection in many cases. There is a far greater tendency oil the part of the public now to inquire for disinfection and re-disinfection after Tuberculosis. Some people seem inclined to carry it to extremes and on more than one occasion people have refused to take a house in Hampstead where Consumption has occurred unless the Borough has disinfected the whole of the house ; people not being merely content with that portion of the house occupied solely by the patient. The Municipal Tuberculosis Dispensary The action taken by the Department during 1916 varies little from the preceding year. The same routine is gone through in each case. The Public Health Department supervises the preventive side and the Tuberculosis Dispensary the clinical side. Our efforts have been hindered by the absence of Nurse Goodchild on active service, but a temporary part-time nurse obtained from the Kilburn and West Hampstead District Nursing Association has been quite satisfactory. With the return of a full-time nurse I am of opinion the work of the district will be enhanced. During the year the agreement arrived at with Mount Vernon Hospital, for linking up the tuberculosis work of the Borough with that hospital, has been in operation. Briefly the agreement with Mount Vernon is as follows :— That in consideration of payments made by the Council to the hospital, the hospital undertakes : To nominate a junior member of their visiting staff as the tuberculosis medical officer of the Borough of Hampstead. This appointment to be annual. The officer will be a part time officer and will fulfil all the duties of the tuberculosis medical officer as outlined by the interim report of the Departmental Committee and the Order of the Local Government Board dated July 26th, 1912. 33 He is responsible for all the clinical work of the Borough and is in charge of the Tuberculosis Dispensary. He undertakes all the bacteriological and pathological work necessary. Although clinically uncontrolled, he is in all other respects under the direction of the Medical Officer of Health and forms part of his staff. During the existence of this agreement, the Hospital grant to the Council the use of their premises in Fitzroy Square as a consultation centre or for special pathological work or for special form of treatment which may be necessary, and the Tuberculosis Medical Officer has also the right of consulting with other members of the visiting staff of Mount Vernon Hospital in any case in which he deems a consultation would be of benefit to his patient. A report on the work of the Municipal Tuberculosis Dispensary is submitted by the Tuberculosis Medical Officer (see Appendix II. page 48). Section E. MEANS FOR PREVENTING MORTALITY IN CHILDREN AND IN INFANCY. Notification of Births. 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. This is in addition to the usual registration with the Registrar of Births. In 1916, 984 births were notified, including 29 still birtlis. .'513 were notified by medical practitioners. 234 by midwives, 304 by parents and 133 from other sources. In 779 cases the parents were visited, and 112 re-visits were made. When the mother is able to get about she is visited by a Health Visitor employed by the Borough Council and invited to bring her baby to one of the three Weighing Centres which are at work in the Borough. 34 The following Table gives briefly the work done at each Centre :— Health Institute. Einmaime Hall. I.yndhurst Hall. Total. No. Weighed 390 75 202 667 Total Attendances 2770 547 1059 4376 Average attendance 36 11 20 67 Highest attendance on one day 69 20 33 — Maximum attendance of any one infant 35 41 42 Thus it will be seen that of the 984 births notified during 1916 no less than 667 attended the Weighings, which is undoubtedly a high percentage of the births of the Borough, considering that such a large number of our babies are born in well-to-do families. In order to cope with the increased numbers attending, from June onwards two weighing days were held at the Health Institute instead of one. Mortality among Young Children. The following table shows the Infantile Mortality rate and the Death rate among children under tive years of age. The latter rate is calculated upon a period of tive years. Year. Deaths of Infants under i year of age. Deaths of children under 5 years of age. No. Rate per 1ooo Births, No. Rate per 1ooo Children born in the year and in preceding 4 years. 1901 155 102 233 30.2 1902 133 88 195 25.2 1903 126 87 177 231 1904 161 111 226 300 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 1915 101 76 144 22.2 1916 73 62 94 14.7 35 Deaths among Legitimate and Illegitimate Infants. The death rate among illegitimate children is a matter of great difficulty to deal with. Illegitimate children seldom receive the same maternal care that is bestowed upon legitimate children, and that they should be looked after as well as circumstances will permit is important, and to ensure this, special attention is now being given to all illegitimate births which come under our notice. 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. Illegitimate Infants. Births. Deaths. death-rate per i.ooo births. Births. Deaths. death-rate periooo births. 1906 1403 106 75 34 5 147 1907 1298 85 65 43 13 302 1908 1326 87 66 29 10 345 1909 1239 88 71 43 11 256 1910 1233 71 57 36 10 278 1911 1239 94 76 37 11 297 3 912 1207 68 56 74 11 149 1913 1252 73 58 73 18 246 1914 1218 77 63 55 14 254 1915 1246 82 65 81 19 234 1916 1088 65 59 76 8 105 The following table shows the infantile mortality of Hnmpstead in each year since 1880, and it will be seen that the lowest rates occurred in the years 1912 & 1916 :— 1880 140 1893 102 1906 77 1881 136 1894 113 1907 69 1882 99 1895 135 1908 69 1883 98 1896 123 1909 74 1884 143 1897 127 1910 60 1885 110 1898 125 1911 82 1886 131 1899 129 1912 62 1887 107 1900 100 1913 69 1888 110 1901 102 1914 72 1889 122 1902 88 1915 76 1890 122 1903 87 ] 916 62 1891 104 1904 111 1892 122 1905 94 36 Section F. VITAL STATISTICS OF THE BOROUGH, ETC. TABLE 1. (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 1916 and the Six Previous Years. Year. Population estimated to middle of each year. Births. Total Deaths Registered in the Borough. Transferable DEATHSt Nett Deaths Belonging to the Borough. r Uncorrected Number. Nett. of Non-residents registered in the Borough. of Residents not registered in the Borough. Under 1 Year of age At all ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1910 85210 1270 1340 15.7 1071 12.6 350 108 81 60.4 829 9.7 1911 85599 1199 1276 14.9 1132 13.2 415 130 105 82.3 847 9. 9 1912 85960 1224 1281 14.9 1106 12.9 387 142 79 61.7 861 10.0 1913 86346 1258 1325 15.0 1273 14.5 474 153 91 68.7 951 10.8 1914 86731 1213 1273 14.7 1145 13.2 420 188 91 71.5 913 10.5 1915 81760 1222 1327 16.2 1228 14.5 442 245 101 76.1 994 12. 1 1916 81470 1051 1164 13.1 1027 12.6 381 254 73 62.7 862 10. 5 + "Transferable Deaths " are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than trat in which they resided. Area of Borough in acres (exclusive of area covered by water), 2253. Total population at all ages, 85,495. ] Total number of buildings used as dwellings, 11,976. Average number of persons per house, 71 At Census of 1911. Number of ordinary dwelling houses, 10,062. Average number of persons per house, 6 7. 37 TABLE II. (Required bv 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 1916. Number of Cases Notified. Total Cases Notified in each Ward. Total Cases removed to Hospital. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Notifiable Disease. At all Ages. Under 1. . 1 & under 5. 5 & under 15 15 & under 25 25 & under 45 45 & under 65 65 and upwards. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera, Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 98 ... 24 42 14 13 4 1 21 25 11 5 10 19 6 76 Erysipelas 40 1 ... 4 2 11 15 7 7 6 3 2 4 13 4 7 Scarlet Fever 133 ... 24 76 25 7 1 ... 12 30 13 7 18 ...47 8 1 18 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 6 ... ... 2 1 2 ... ... 2 1 2 ... ... ... 1 3 Relapsing Fever (Continued Fever) ...... ... ... ... ... ... ... ... ... ... ...... ... Puerperal Fever 2 ... ... ... 2 ... ... ... i ... 1 ......... ... ... ... Cerebro-spinal Meningitis 4 ... 3 ... ... ... ... ... 1 ... 1 2 ... 4 Polio-Myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 7 6 ... ... 1 ... ... ... 1 ... ... 2 3 1 Pulmonary Tuberculosis (1) 193 1 1 8 43 107 29 4 26 31 42 1 6 21 39 18 73 ; Other forms of Tuberculosis (2) 51 1 7 23 6 12 2 ... 8 8 ... 4 10 17 4 18* Measles 325 13 70 141 59 38 4 ... 48 70 33 20 28 67 59 10 German Measles 558 4 60 260 127 98 9 ... 1 10 67 72 78 75 84 72 5 Totals 1417 26 186 559 280 288 66 12 236 239 177 132 169 291 173 314 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 r arts of the country. * These figures relate only to cases notified for the first time in 1916. (1) Of these 193 cases, 152 were notified on Form A, 2 on Form B, 17 on Form C. and 22 on Form D. (2) Of these 51 cases, 46 were notified on Form A, 2 on Form B, 2 on Form C. and 1 on Form D. 38 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 year 1916. Causes of Death. Nett Deaths at the subjoined ages of " Residents," whether occuring 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. I5 and under 25 years. 25 and under 4 5 years. 15 and under 65 years. 65 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified (a) 862 73 ii 10 18 24 87 244 395 420 Uncertified 1 Enteric Fever ... ... ... ... ... ... ... ... ... 7 2 Small-pox ... ... ... ... ... ... ... ... ... 3 Measles 1 ... ... ... ... ... ... ... 8 4 Scarlet Fever ... ... ... ... ... ... ... 18 5 Whooping-cough 7 5 ... i ... ... ... ... ... 6 6 Diphtheria and Croup 2 ... ... i 1 ... ... ... ... 73 7 Influenza ... 20 ... ... ... 1 2 ...17 8 Erysipelas ... ... ... ... 9 Phthisis (Pulmonary Tuberculosis) 55 ... ... 4 11 20 17 3 72 10 Tuberculous Meningitis 13 1 ... "5 2 1 1 ... ... 7 11 Other Tuberculous Diseases 12 1 ... 2 3 3 3 ... 13 12 Cancer, malignant disease 113 ... ... ... 1 ... 12 47 ...53 81 13 Rheumatic Fever ... ... ... ... ... ... — ... 14 Meningitis (6) 6 ... ... i 1 ... 3 ... 15 Organic Heart Disease 100 ... ... ... ... 1 5 37 57 11 16 Bronchitis — 64 3 ...... ... ... ... 1 14 46 13 17 Pneumonia (all forms) 63 8 ... 1 .1 ... 6 15 27 6 18 Other Diseases of Respiratory Organs 6 ... ... ... ... ... ... 5 1 18 19 Diarrhoea and Enteritis (c) 8 6 ... ... ... ... ... ... 2 2 20 Appendicitis and Typhlitis 1 ... ... ... ... ... ... ... ... ... 21 Cirrhosis of Liver 9 ... ... ... ... ... 5 ... 21a Alcoholism 1 ... ... ... ... ... 1 ... 3 22 Nephritis and Bright's Disease ••• 32 ... ... ... ... 3 13 16 7 23 Puerperal Fever 2 ... ... ... ... 2 ... ... ... 1 24 Other accidents and diseases of Pregnancy and Parturition 5 ... ... ... ... ... ... ... ... 1 25 Congenital Debility and Malformation, including Premature birth 28 27 ... 1 ... ... ... ... ... 8 26 Violent Deaths, excluding Suicide 32 9 ... 2 "i 2 8 io 17 27 Suicides 4 ... ...... ... 1 2 1 2 28 Other Defined Diseases 265 13 1 3 "4 25 69 150 54 29 Diseases ill-defined or unknown 13 ... ... _i_ 1 3 8 2 Sub-Entries, included in above figures. 862 73 11 10 18 24 87 244 395 420 14 (a). Cerebro-spinal Meningitis 2 ... ... 1 1 ... ... ... ... 9 28 («). Polio-Mvelitis 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 non-residents, 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 esses are classed as " 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. 39 TABLE IV. <Required by the Local Government Hoard to be used in the Animal Report of the Medical Officer of Health.) INFANT MORTALITY, 19U6. Nett Deaths from Stated Causes at various Ages under One Year op 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 months and under 6 months 6 months and under 9 months 9 months and under 12 months. Total Deaths under 1 year. All Causes Certified 29 6 4 2 41 16 21 12 11 101 Uncertified Small-pox ... ... ... ... ... ... ... ... ... ... [ Chicken-pox ... ... ... ... ... ... ... ... ... ... J Measles ... ... ... ... ... ... ... ... ... ... "| Scarlet Fever ... ... ... ... ... ... ... ... ••• ... (Whooping Cough ... ... ... ... ... ... 1 1 ... 5 Diphtheria & Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... [Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 -) Abdominal Tuberculosis (a) ... ... ... ... ... ... ... ... ... 1 (Other Tuberculous Diseases ... ... 1 ... 1 ... ... ... ... I Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... Convulsions 1 1 ... ... 2 ... ... ... ... ... Laryngitis ... ... ... ... ... ... ... ... ... 3 Bronchitis ... 1 ...... ...... 1 ... 1 ... ... 3 Pneumonia (all forms) ... ... ... ... ... ... 3 3 1 8 i Diarrhoea ... ... ... ... ... ... 2 1 ... 3 1 Enteritis ... 2 ... ... 2 ... 1 ... ... 3 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... 1 1 ... ... 1 ... 2 Rickets- ... ... ... ... ... ... ... ... ... ... Suffocation, overlying ... ... ... ... ... ... ... ... ... Injury at Birth 9 ... ... ... 9 ... ... ... ... 9 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 (Congenital Malformations (b) ... 1 1 ... 2 1 1 1 ... 5 Premature Birth 9 3 ... ... 12 1 ... ... ... 1 3 Atrophy, Debility, Marasmus 4 1 ... ... 6 2 3 ... ... 11 Other causes 1 ... 1 ... 2 1 3 ... ... 6 Totals 25 9 3 2 39 7 15 8 4 73 Nett Births in the year: legitimate, 1088 ; illegitimate 76. Nett Deaths in the year of: legitimate infants, 65 ; illegitimate infants, 8. (а) Under Abdominal Tuberculosis have been included deaths from Tuberculosis Peritonitis and Enteritis and from Tabes Mesenterica. (б) 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 Premati re Birth. Want of Breast Milk has been included under Atrophy and Debility. 40 TABLE Y. (This tabic was suggested by the Medical Officcr of Health to the Comity of Loudon in order to sccurc uniformity of tabulation in the Annual Reports of the Medical Officers of Health of the Metropolitan Boroughs). PREMISES. Number on register at end of 1915 Number added in 1916. Number removed in !9I6. On register at end of 1916. Number ol inspections 1916. Number of prosecutions, 191 6 Cowsheds — — — — — Milkshops 98 l 4 95 256 — Houses let in lodgings 405 — — 405 705 — Ice cream premises 81 1 10 72 164 — Slaughter-houses.—Number of inspections, (11 ; notices, nil. Offensive Trades.—Number of inspections, 10 ; notices 2. Smoke Nuisances.—Number of observations, 7 ; nuisances and complaints, 3 ; notices, 1 ; summonses, nil. Housing of the Working Classes.—Number of houses inspected, 6 ; dealt with under section 15 of the Housing, Town Planning, etc.. Act, 1909, nil ; representations 4 ; closing orders, 4 : houses remedied without closing orders, nil ; remedied after closing orders, 1 ; houses demolished, nil ; in respect of which closing orders had been made, 1 Demolition Order made, 2 still pending. Underground Rooms.—Number illegally occupied. 21 : closed or illegal occupation discontinued, 21. Overcrowding.—Number of rooms overcrowded, 4 ; remedied. 4 ; prosecutions, nil. Cleansing.—Number of adults cleansed, 4 : children cleansed, 201 ; rooms or premises cleansed, 33. Water Supply to Tenement Houses.—Number of premises supplied, 63; prosecutions, nil. Inland Revenue Act (applications for certificates).—Number of houses, 17 ; tenements included therein, 33; applications granted, 3—houses comprising 6 dwellings : refused, 14 ; deferred or withdrawn, nil. Sale of Fond.—Number of premises used, other than ice-cream premises, milkshops and cowsheds, 476 ; inspections, 1007. Disin fection Shelter.-—Number of persons accommodated, nil. Mortuary.—Number of bodies received, 97 ; infectious bodies, nil. 41 TABLE VI. Vital Statistics of the Borough. Number of ordinary dwelling houses ... 10,062 | At Census 1911. Population ... ... ... ... ... 85,495 Average number of persons per house ... 8.4 In these Tables the Birth-rate is calculated upon a Population of 88,641. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. iNotihablelnfectiousDis eases (excluding Tuber culosis and Measles). PulmonaryTuber culosis. Number. Estimated rate per lOoO of the Population. Number. Estimated rate per 1000 of the Population. Number. Hate per 1000 Births. Cases notified. Attack-rate per 1000 of the Population. Deaths occurring. I Death-rate per 1000 of the Population. De.it hs. Death-rate per 1000 of the Population. 1902 82,380 1,516 18.4 904 11.0 33 87.7 460 5 6 33 0.40 73 0.89 1903 82,730 1,453 17.6 837 10.1 126 86.7 3' 1 37 16 0.19 66 0.80 1904 83,080 1, 445 17. 4 892 10.7 161 111.4 301 3 6 20 0.24 73 0.89 1905 83,430 1,421 17.0 823 9.9 133 93.6 295 3.5 14 0.17 73 0.87 I9O6 83,780 1,437 17.1 850 10.1 111 77.2 557 66 22 0.26 57 0.68 1907 84,130 1,359 16.1 817 9.7 98 73.1 498 5.9 15 0.18 (11 0.72 1908 84,480 1,400 16.6 803 9.5 97 69.3 383 45 20 0.24 74 0.88 1909 84,830 1,328 15.6 839 9.9 99 74.5 325 3.8 21 0.25 53 0.62 1910 85,210 1,340 15.7 829 9.7 81 60.4 233 28 13 0.16 58 0.68 191I 85,599 1,276 14.9 847 9.9 105 82.3 345 40 25 0.29 56 0.65 1912 85,966 1,281 14.9 861 10.0 79 61.7 320 37 25 0.29 64 0.74 19I3 86,346 1,325 15.0 951 10.8 91 68.7 374 43 13 0.15 49 0.56 1914 86,731 1,273 14.7 913 10.5 91 71.5 583 67 23 0.26 57 0.66 1915 81,760 1,327 15.3 994 12.1 101 76.1 425 5.1 17 0.20 48 0.58 1916 81,470 1,164 13.1 862 1O.5 73 62.7 290 35 7 008 55 0.67 TABLE VI (1). Vital Statistics of No. 1 (Town Ward). Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. NotifiablelniectiousDiscases (excluding Tuberculosis and Measles). Puln>onarvTuber ! culosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per I ooo Births. Cases notified. Attack-rate per 1000 of the Population. Deaths occurring. Death-rate iper 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 0.79 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.o 2 0.15 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 11 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 1915 13,550 157 10.9 147 10.8 17 108.2 86 6.3 1 0.07 5 0.36 1916 13,510 132 9.7 140 10.3 7 53.0 44 3.2 1 0.07 13 0.96 42 TABLE VI. (2). Vital Statistics of No. 2 (Belsize) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. NotihablelnieetiousDiseast s (excluding Tuberculosis and Measles.) Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the j Population. Number. Rate per 1000 births. Cases notified. 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 15 115 19°3 13,110 211 16.1 121 9.2 13 61.6 60 4.6 2 0.14 13 099 1904 13,200 217 16.4 141 10.7 23 105.9 47 3.6 3 0.23 12 O'ul 19°5 13,280 209 15.7 131 9.9 13 62.2 42 3.2 2 0.15 10 075 1906 13,370 187 14.0 127 9.5 8 42.8 60 4.5 4 0.30 13 097 1907 13,45° 205 15.2 114 8.5 11 63.4 63 4.7 0.22 10 0 74 1908 13,530 205 15.1 126 9.3 8 39.0 81 6.0 1 0.07 16 r 18 1909 13,610 204 15.0 130 9.5 16 78.4 88 6.5 5 0.37 8 o'59 1010 I3,71O 207 15.1 119 8.7 9 43.5 49 3.6 2 0 .14 8 058 1911 13,780 189 13.7 135 9.7 17 90.0 78 5.7 2 O.14 10 0 72 1912 13,830 188 13.6 127 9.2 8 42.5 62 4.5 4 0.29 7 051 1913 14,000 214 I5.0 126 8.8 16 74.7 52 3.7 5 0.35 5 0-35 1914 14, 1OO 195 13.8 141 1o.o 9 46.1 89 6.3 6 0.42 11 078 1915 13,250 317 22.4 144 10.8 12 37.8 65 4.90 4 0.30 6 °'45 1916 13,200 189 14.3 127 9.6 7 37.0 63 4.7 2 0.15 6 0'45 TABLE VI. (3). Vital Statistics of No. 3 (Adelaide) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. X oti hable 1 n tectiousDi s eases (excluding Tuberculosis and Measles). 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. Attack-rate per 1000 of the Population. Deaths occurring.J 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 I 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 1031 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 1O,OOO 96 9.6 78 7.8 2 20.8 22 2.2 r 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 9.0 99 10.2 5 56.8 28 2.9 ... 2 0.20 1915 9,150 77 7.9 104 11.3 5 64.9 30 3.2 2 0.21 2 0.21 1916 9,100 104 11.4 95 10.4 12 115.3 30 3.3 i 0.11 5 o.54 43 TABLE YI. (4). Vital Statistics of No. 4 (Central) Ward. Year. Population estimated to middle of year. 1 Births. Deaths. Infantile Deaths. Notifiablelnt'ectiousDiseases (excluding Tuberculosis and Measles). 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. Attack-rate per 1000 of the Population. Deaths occurring ] Death-rate per 1000 of the Population. Deaths. Death-rate per rooo of the Population. 1902 9,190 1 10 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 6.4 5 44.2 24 2.5 1 0.11 6 0.64 1906 9.470 95 10.0 «3 8.8 3 31.6 34 3.6 2 0.21 1907 9,54o 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 3.4 1 0.10 7 0.73 1909 9,681 Il6 12.0 63 6.5 3 25.9 29 3.0 2 0.2 I 3 0.31 1910 9,770 1°5 10.7 82 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 0.20 6 0 .60 1915 9,500 91 9.0 92 9.7 4 42.5 34 3.5 2 0.21 6 0.62 1916 9,450 93 9.8 97 10.2 4 43.0 14 1.4 3 0.31 TABLE YI. (5). Vital Statistics of No. 5 (West End) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Noti hablelniectiousDiseases (excluding Tuberculosis and Measles.) Pulmonary Tuberj culosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases notified. Attack-rate per iooo 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 1903 12.320 243 19.7 111 9.0 21 86.4 55 4.5 2 0.16 12 0.97 1904 12,380 283 22.8 1 20 9.7 22 77.7 7o 5.6 3 0.24 8 0.65 1905 12.450 250 20.1 131 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 12,580 250 19.9 114 9.1 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 12,770 216 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 13,05° 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 1915 12,390 218 16.6 151 12.1 13 59.6 72 5.8 3 0.24 11 0.88 1916 12,340 211 17.0 117 9.4 10 47.4 35 2.8 1 0.08 5 0.40 44 TABLE VI. (6). Vital Statistics of No. 6 (Kilburn Ward). Year. Population estimated to middle of Year. Births. Deaths. Infantile Deaths. NotihablelnlectiousDistases (excluding Tuberculosis and Measles). Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1ooo of the Population. Number. Rate per 1ooo births. Cases notified. Attack-rate per 1000 of the Population. Deaths occur ring. Death-rate per 1ooo of the Population. Deaths. Death-rate per 1ooo 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 0.34 15 1.01 1907 14,850 391 26.3 179 12.5 28 71.6 86 5.8 3 0.20 l6 1.08 1908 14,880 393 26.4 l86 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 14,900 379 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 l6 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 0.85 1914 15,300 385 25.2 212 13.8 25 64.9 186 12.1 6 0.40 13 0.85 1915 14,440 329 21.5 230 15.8 40 121.5 98 6.7 3 0.20 11 0.76 1916 14,440 309 21.3 180 12.4 28 906 84 5.8 20 1.38 TABLE VI. (7). Vital Statistics of No 7 (Priory) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. NotitiablelnfectiousDiseases (excluding Tuberculosis and Measles). culosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1ooo births. Cases notified. Attack-rate per 1000 of the Population. Deaths occurring. Death-rate per 1ooo 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 _ 1915 9,480 138 13.7 126 13.2 10 72.4 40 4.2 2 0.21 7 o.73 1016 9,430 126 13.3 106 11.2 5 39.6 20 2.1 2 0.21 3 0.31 45 TABLE VII. Vital Statistics of Hampstead, compared with England and Wales. Birth-rate per 1000. General death-rate per 1000. Natural increase Hampstead. Notifiable Infectious disease rate per 1000. tHampstead. Year. 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 .0 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 19.2 517 111 1894 19.6 29.2 10.8 16.5 674 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 10.6 16.9 633 5.6 1902 18.4 28.6 11.0 16.2 612 *5.6 1903 1 7.4 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 1 7.1 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 16.6 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 14.9 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 1915 15.3 21.8 12.1 14.8 333 *5.1 1916 13.1 21.6 10.5 14.0 302 **14-2 ° Excluding Chicken-pox, which was notifiable during certain periods of these years. t Excluding notifications of Pulmonary Tuberculosis 1 902-1913, and all forms of Tuberculosis since 1913. Measles and German Measles became notifiable on 1st January, 1916, and is included in the rate in the last column. This rate cannot be compared with previous years—excluding Measles and German Measles the rate is 3 05. 46 Section G. LEGAL PROCEEDINGS. Legal proceedings were taken by the Council in connection with the work of the Health Department in 21 cases during the year. The chief facts relating to these proceedings are summarised below. The facts relate only to the cases that were heard and decided in 1916. Statute or Bye-Law. No. of Prosecutions. Fines. Costs. £ s. d £ s. d. Public Health (London) Act, 1891, and Bye-laws made thereunder 11 29 10 0 6 0 0 Metropolis Management Acts, and Bye-laws made thereunder — — — — — — — Sale of Food and Drugs Act 7 10 0 0 3 7 0 Housing, Town Planning, etc., Act, 1909 — — — — — — — Factory and Workshop Act 1 2 0 0 L.C.C. General Powers Act, 1908 1 2 0 0 — — — Milk and Cream Regulations 1 5 0 0 — — — Total 21 48 10 0 9 7 0 47 Appendix I. REPORT OF THE PUBLIC ANALYST ON THE ANALYTICAL WORK OF THE YEAR. Analytical Laboratory, Town Hall, Haddington, W. January, 1917. A resume of the analytical work of the year 1916 may be of interest. The total number of samples analysed was 506. These comprised Milk 213, Butter 90, Lard 48, Margarine IS, Coffee 47, Cream 13, Cocoa 44, Cheese 16 and General Groceries, 17. Six samples of Milk, or per cent, were found to be adulterated ; strange to say, no watered samples were discovered, in all cases these were deficient in cream. Only 1 sample of butter amongst the 90 was found to be defective and that had only an excess of water of 1 per cent. Of the 44 samples of cocoa, 3 contained sago-starch and sugar. Of the 13 samples of cream 1 had been preserved with Boric Acid without due notice. Taking all the samples together only 2-l were adulterated. This is, I believe, a purity unmatched by any other Borough taking as many samples. It excels the average of the previous year at Hampstead when 7-7 per cent, of the samples were adulterated. As food gets scarcer and dearer the temptation to adulterate it will, I fear, get greater. I have the honour to remain, Yours obediently, ALF. W. STOKES, Public Analyst. 48 Appendix II. Tuberculosis Dispensary, 73, Dynham Road, N.W. 6. To the Mayor, Aldermen and Councillors of the Metropolitan Borough tf Hampstead. Mr. Mayor, Madam and Gentlemen, I have the honour to submit a report on the working of the Tuberculosis Dispensary for the period from January 1st to December 31st, 1916 (inclusive). By reason of War, economy in paper and printing this Annual Report is necessarily brief, and it is only possible to mention a few of the more salient features. The total number of new applicants was 230, exclusive of contacts, divided as follows :— Males. Females. Children. Insured 58 32 — Non-insured 18 30 92 Of these 79 were found to be tuberculosis, 86 were regarded as suspicious and have been kept under observation and 65 were decided to be definitely non-tuberculous. The total number of new persons who have been under treatment and observation for all forms of Tuberculosis during the period is 165. Males. Females. Children. Total. Contacts examined 6 40 54 100 No. of these found tuberculous14 ,, non-tuberculous 44 ,, suspicious 42 The total number of attendances for treatment during the period is as follows :— At Dispensary 1,392 At Fitzroy Square 127 1,519 49 Home Visits Tuberculosis Medical Officer 6 Nurse 362 368 Bacteriological examinations: Specimens of sputum examined, Positive 44 Negative 93 Total 137 Of these 73 were sent for examination by medical practitioners in the Borough. Forty-one cases were sent by the London Insurance Committee for the purposes of Part III. of Form S.B.I., i.e., application for Sanatorium Benefit; 28 of these were sent to various Sanatoria and 13 were recommended for Domiciliary benefit. In addition 3 reports (Form C) were made to the London County Council on persons who had treatment at a Sanatorium under their scheme for non-insured persons. Certain suitable cases have been treated with tuberculin, whilst others have been placed under the more modern method of treatment with Intensive Nascent Iodine. From the economic point of view in relation to public health, this latter remedy offers many and important advantages. Practically all cases of pulmonary and other forms of tuberculosis which have not reached too advanced a stage and amenable to this form of treatment, which, for out-patient and dispensary work, has to a large extent avoided the necessity for sanatorium treatment, since the patients are able to remain at home, and for the most part to carry on full work and earn their livelihood, while effective treatment is still being actively carried on. For the bulk of the population Sanatorium treatment is at best only educational, statistics showing that stay in Sanatorium is not sufficiently prolonged in most cases to secure permanent arrest of the disease, as is evidenced by recurrence at varying periods, often short, after discharge from Sanatorium. 50 Hence, intensive iodine treatment affords results of striking economic value, since the cost of expensive upkeep of institutions and grants from charitable societies are, in large measure, done away with. The total number of patients discharged 93 46 Non-tuberculosis. 47 including all forms of tuberculosis discharged with disease arrested. Of these 47 only 4 have returned with recurrence of the malady within the first five months of 1917. For the year 1916 the death-rate in Hampstead from consumption was less than one per thousand (0'98), the total number of deaths being 80. The Tuberculosis (Domiciliary Treatment in England) Order issued by the Local Government Board on the 19th September, 1916, prescribes the manner in which the treatment of insured persons recommended for sanatorium benefit in the form of domiciliary treatment is to be undertaken. The Hoard is now planning a systematic carrying out of the provisions of the Order by the Consulting Tuberculosis Officers in a uniform manner throughout the County of London. With the National Insurance Committee difficulties have arisen, owing to failure, through alleged lack of funds, to meet its obligations in respect of provision of Sanatorium treatment, for which domiciliary treatment is in many cases proffered as a substitute. For insured persons there is urgent need of institutional beds for the segregation of advanced and infective cases. As regards non-insured individuals, the London County Council had made a small but definite beginning in this direction, by the setting aside of 12 beds for advanced cases, and further adequate extension of this praiseworthy effort is much to be desired. In Hampstead nothing can be done at present to secure admission of suitable children to Open Air Schools, since the London County Council maintains only two Open Air Schools, both of which are in the S.E. District of London, and, owing to the limited accommodation available, it is not possible to arrange for the admission of children living in districts north of the Thames. Especially under the present condition arising out of the great War it is of paramount importance to care for and maintain the health of the younger generation, and the weakly ill-nourished children of school age liable to develop 51 culosis, those with chronically "weak lungs " the result of bronchitis or one of the acute specific fevers in early life, as well as others in whom glandular tuberculosis it already manifest, would derive valuable help for the future by the removal of such weighty handicaps to eugenic progress. "The nation marches on the feet of little children." Of bad housing and overcrowding it is less necessary to speak in Hanipstead than in many of the less healthily situated municipalities, since already much has been done to mitigate these and other potent secondary causes of tuberculosis and in connection with these latter causes, I welcome this opportunity of expressing my indebtedness to the Hampstead Council of Social Welfare through the medium of the Joint Tuberculosis Care Committee, for much valuable assistance in following up cases brought forward, amelioration of the home conditions (by practical relief when necessary), and in facilities for admission to Convalescent Homes or Special Institutions when required. Finally, lest any should be tempted by results achieved to slacken their endeavours in ti e constant struggle against the "Great White Plague," it is only needful to bear in mind that "Consumption is now as widespread in London as was Smallpox in the 18tli century each year disabling 150.000 persons." I have the honour to remain, Mr. Mayor, Madam and Gentlemen, J. F. HALLS DALLY, M.A., M.D., B.C. Cantab., M.R.C.P. Lond. 7,uberculosis Medical Officer.