HAMP 22. THE Metropolitan Borough of Hampstead. REPORT for the year 1918, OF THE Medical Officer of Health, FRANK E. SCRASE, F.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Lond.) CONTENTS. pages SECTION A.—Natural and Social Conditions of the Borough (including a review of the Vital Statistics, etc.) 5—15 „ B.—Sanitary Administration and Circumstances of the Borough 15—29 „ C.—Prevalence of and Control over A.cute Infectious Diseases 30—34 „ D.—Prevalence of and Control over Tuberculosis 34—40 „ E.—Maternity and Child Welfare 40—46 ,, F-—Vital Statistics of the Borough, etc. 47—56 „ G.—Legal proceedings 57 APPENDIX.—Report of the Public Analyst ou the Analytical Work of the Year 58 3 PUBLIC HEALTH COMMITTEE. NOVEMBER, 1917-18. Staff of the Public Health Department. Sanitary Inspectors: W. G. Kershaw, Senior Sanitary Inspector. R. Geary ( Wards 1 & 2). W. F. 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, etc., Acts. Mrs. T. Fisher, m.a., Factory and Workshop Acts and Tuberculosis Regulations. Miss F. Hall, Infectious Diseases. Hedlth Visitor: Mrs. K. Roche, Notification of Births Act and Maternity and Child Welfare Act. Assistants to Inspectors : "Edwards, Martin. Public Mortuary: *W. Larkin, 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. (Loud.), m.r.c.s., l.r.c.p. (Lond.) Tuberculosis Medical Officer. *Miss B. Lovelace, Nurse. Clerical Staff: *W. Sell, *F. S. Hill, and *R. Pollock. (Temporary) Miss E. Blakeman, Miss K. Geary, Mrs. Holman, Mrs. E. Ellis Fermor. Public Analyst: A. W. Stokes, f.c.s., f.i.c. Medical Officer of Health : Frank E. Scrase, f.r.c.s. (Eng.), l.r,c.p. (Lond.), d.p.h. (Lond.). * These members of the Staff were on Service with His Majesty's Forces. Ex-Officio: HIS WORSHIP THE MAYOR (Mr. Alderman E. A. O'Bryen, J.P.). Chairman: Mr. Councillor C.W. Cunninoton, m.r.c.s., d.p.h. Miss Councillor M. E. Balkwill. Mr. Councillor G. Buckle. Mr. ,. R. H, H. Cust. ,, ,, A. W. George, Mrs. ,, Dow. m.r.c.s., l.r.c.p. Mr. „ J. I. Fraser. „ „ T. H. Nunn. ,, ,, C. J. R. MacFadden, m.d., c.m. „ „ H. R. Smith. „ E. S. Payne. „ R. J. J. Willis. 4 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W. 3. 3rd June, 1919. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit to you the Annual Report for the year 1918. The year 1918 has been an active one, and the duties have been carried out under difficulties due to the War, and its attendant abnormal conditions. The work of the Department, however, has been fully maintained, and Hampstead again records the lowest death rate of any London Borough. In presenting this review of the work of the Public Health Department for 1918, I wish to thank the Council and the Chairman and Members of the Public Health Committee for the kindly support and encouragement they have ever given me. I desire also to express my appreciation of earnest efforts of the members of the Staff of the Department whilst according me their assistance and able co-operation. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, FRANK E. SCRASE, Medical Officer of Health. Section A. NATURAL AND SOCIAL CONDITIONS OF THE BOROUGH. SUMMARY OF VITAL STATISTICS FOR 1918. for Birth-Rate 80,466 Population estimated to middle of 1918 for Death_Rate 71.815 Density 31.7 persons per acre Births 895 Birth Rate 11.1 Marriages 745 Marriage-Rate 9.2 Deaths 1027 Death-Rate 143 Infantile Mortality 77 Death-Rate from the Principal Epidemic Disease 0.40 Death-Rate from Pulmonary Tuberculosis 1.04 Death-Rate from All Forms of Tuberculosis 1.24 Census, 1911. Population 85,495 Buildings used as Dwellings 11,976 Average number of persons per house 71 Ordinary Dwelling Houses 10,062 Average number of persons per house 6-7 Area of Borough 2265 acres „ „ (excluding area covered by water) 2253 acres 6 POPULATION. The following estimates prepared by the Registrar-General of population have been adopted in this Report for the calculation of the death-rate and birth-rate of the Borough for the year 1918:— For the death-rate 71,815 „ birth-rate 80,466 The "death rate population" excludes all non-civilian males, whether serving at home or abroad. This, it is state 1, is necessary for the purposes of local death-rates, because it has proved impossible to transfer the deaths of non-civilians to their areas of residence or to deal in any other satisfactory manner with the local mortality of this element in the population. The "birth-rate (and marriage-rate) population," on the other hand, is intended to include all the elements of the population contributing to the birth and marriage rates. It consists therefore of the "death-rate (or civilian) population "plus all non-civilians enlisted from this Borough, whether serving at home or abroad. For the first year on record Hampstead had no natural increase in population, i.e., excess of births over deaths; the number of nett deaths exceeding the nett births by 132. I have prepared the following estimates of the population of each Ward based upon the figures quoted above:— Ward. Estimated Population for calculating death rate. Estimated Population for calculating birth-rate and marriage rate No. 1 (Town) 11600 13000 fro. 2 (Belsize) 11500 12900 No. 3 (Adelaide) 8315 9366 No. 4 (Central) 8300 9200 No. 5 (West End) 10800 12000 No. 6 (Kilburn) 12500 14000 No. 7 (Priory) 8800 10000 The Borough 71815 80466 7 MARRIAGES. According to the return kindly furnished to me by the Superintendent Registrar of Hampstead, it appears that 745 marriages were registered in the Borough during 1918, as compared with 708 in the preceding year. The following Table gives the marriage rates for the years 19081918:— 1908 14.7 1913 14.9 1909 16.0 1914 19.0 1910 14.8 1915 23.2 1911 16.3 1916 17.8 1912 150 1917 9.3 1918 9.2 BIRTHS. During the year 799 births-410 males and 389 females—were registered in Hampstead, as compared with 998 registered in the previous year, being a decrease of 199. Of the 799 births, 22 males and 14 females—were of children who could not be deemed to belong to Hampstead. In addition, 132 births of children—60 males and 72 females — whose mothers were Hampstead residents, occurred outside the Borough in Lying-in Institutions, etc. The nett number of births belonging to Hampstead was therefore 895—448 males and 447 females—as compared with 1,123 in 1917, and being a decrease of no less than 228. The following are the birth rates for each of the Wards and for the whole Borough :— WARD. Birth-rate per 1,000 of the population. No. 1 (Town) 8.8 No. 2 (Belsize) 11.5 No. 3 (Adelaide) 10.3 No. 4 (Central) 7.5 No. 5 West End) 10.3 No. 6 (Kilburn) 17.2 No. 7 (Priory) 10.0 The Borough 11.1 The rate of 11.1 is the lowest recorded for Hampstead since Civil Registration began. 8 In the Table on page 56 the birth-rates of Hampstead may be compared with those of England and Wales since 1891. Illegitimate Births. Forty-four of the 799 births registered in the Borough were of illegitimate children. Of the total 895 births belonging to Hampstead, 98 or 109 per 1,000 births registered were those of illegitimate children. 52 of these were born outside the Borough, chiefly in Lying-in Institutions. The rate per 1000 births in 1917 was 63.2. This subject is also referred to in the Section relating to Maternity and Child Welfare. DEATHS. The recorded death rate is the rate obtained by calculating the number of "nett" deaths per 1000 of the population. From the total deaths of civilians registered is deducted the number who were nonresident persons, and, after subtracting these, the number of deaths of Hampstead residents who died outside the Borough is added. The total nett deaths during 1918 was 1,027, or 14.3 per 1000 of the population, as compared with 10.8 in the preceding year. One of the deaths registered during the year was uncertified. This is the highest death rate recorded since 1878, when the rate was 14.8. The following are the death-rates for each of the Wards:— WARD. Death-rate per 1.000 of the population. No. 1 (Town) 13.5 No. 2 (Belsize) 13.5 No. 3 (Adelaide) 14.3 No. 4 (Central) 11.9 No. 5 (West End) 15.0 No. 6 (Kilburn) 18.0 No. 7 (Priory) 12.5 The Borough 14.3 In the table on page 56 the death-rates of Hampstead may be compared with those of England and Wales since 1891. 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:— 9 Table showing the Death-Rates from All Causes in the County of London, the City of London, and tub Metropolitan Boroughs during 1918. DISTRICT. Death-rate from all causes. Hampstead 14.3 Lewisham 14.8 Wandsworth 15.2 Woolwich 15.6 City of Westminster 16.5 Hammersmith 17.3 Fulham 17.5 Kensington 17.8 Deptford 18.0 Stoke Newington 18.1 Camberwell 18.3 Battersea 18.7 St. Marylebone 18.7 City of London 18.8 Hackney 18.9 Paddington 19.2 Lambeth 19.3 Greenwich 19.5 Chelsea 19.5 Islington 20.5 Stepney 20.9 Bermondsey 22.2 St. Pancras 22.3 Holborn 22.7 Poplar 22.7 Southwark 23.5 finsbury 23.9 Bethnal Green 23.9 Shoreditch 24.2 County of London 19.2 10 The number of deaths of Hampstead residents which occurred in Workhouses or Workhouse Infirmaries was 93, or 9 per cent, of the total deaths of residents. 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 II. and III. Age Periods. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 15 and under 65 years. 65 and upwards All Ages. Deaths 69 18 22 32 67 191 257 371 1027 Causes of Death. The causes of death are given in Table II. at the end of the Report. Cancer. 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 1913 —1918. Year. No. of Deaths from Cancer. Death-rate per 1000 of the population. 1913 100 1.14 1914 114 1.31 1915 118 1.44 1916 113 1.38 1917 107 1.41 1918 105 1.46 Of the 105 deaths from Cancer, 72 were females and 33 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 46 cases the persons were over 65 years of age. 11 The next table gives the anatomical distribution of the disease in each sex. Situation. Males. Females. Total. Buccal cavity 5 2 7 Stomach, Liver, &c. 6 14 20 Peritoneum, Intestines and Rectum 10 20 30 Genital Organs 3 12 15 Breast — 13 13 Other, or unspecified, organs 9 11 20 Totals 33 72 105 Diarrhœa and Enteritis. Of the total deaths at all ages from Diarrhœa and Enteritis in Hampstead during 1918, which numbered 13, 8 took place among children under one year of age. The deaths from these diseases at various age periods in the last seven years is as follows:— Year. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 5 and under 45 years. 45 and under 65 years. 65 years and upwards. All ages. 1912 2 — — — — 2 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 — — — — — — 2 8 1917 9 — — — — — 1 2 12 1918 8 — — — - — 3 2 13 Totals 59 3 4 1 — 6 11 16 100 Principal Epidemic Diseases. All of these, with the exception of whooping cough, are notifiable diseases, and information concerning them is set out in Section "C ' of this Report, The total number of deaths from the principal 12 epidemic diseases is as follows; the death-rate was 0.40 per 1000 of the population. Enteric Fever 3 Scarlet Fever 3 Small-pox — Whooping Cough 15 Measles 1 Diphtheria 7 Tuberculous. The mortality from Tubercular Diseases is dealt with in Section "D" of this Report. Child Mortality. The deaths of children under five years of age are referred to in Section "E" and those of infants are set out in detail in Table III., page 49. Violent Deaths (exc udmg Suicide). 14 deaths were classified under this heading as compared with 24 in 1917. Of these 5 were due to falls; 3 to injuries caused by being knocked down and run over by vehicles; 2 to drowning; 1 under anesthetic; 1 to coal gas poisoning, and 2 were due to explosion of bombs dropped from enemy aircraft. Suicide. 10 persons committed suicide as compared with 7 in 1917. In 1 case death was due to cutting of the throat; 1 from wounds inflicted with a piece of glass; 1 from poisoning; 1 to bullet wounds from a pistol; 2 from hanging; 2 from drowning; 1 irom fall from window and 1 from coal gas poisoning. Influenza. During 1918 no less than 162 deaths of persons belonging to Harapstead were directly attributed to Influenza. This number is equivalent to 15.8 per cent, of the nett deaths, and is mainly responsible for our comparatively high death-rate of last year. No other one disease was responsible for so many deaths, for it must be remembered that ind rectly many other deaths were properly attributable to this cause. As the disease is not notifiable, it is' not possible accurately to state what dimensions the epidemic assumed, but that it was widespread and general is evi lent from the information obtained, and is corroborated in some measure by the distribution of deaths in the various wards when the various populations are remembered. 13 The following table shows the deaths from influenza arranged in Wards Wards. Deaths from Influenza. Population. Death-rate per 1000 of the population No. 1 (Town) 19 11600 1.64 No. 2 (Belsize) 18 11500 1.56 No. 3 (Adelaide) 19 8315 2.28 No. 4 (Central) 18 8300 2.17 No. 5 (West End) 26 10800 2.40 No. 6 (Kilburn) 45 12500 3.60 No. 7 (Priory) 17 8800 1.93 The Borough 162 71815 2.25 The following table gives the deaths from Influenza in ag periods in recent years :— Year. Under 1. 1—5. 5—15. 15—25 25—15. 45-65. 65—. Total. 1914 .. 1 .. .. .. 3 9 13 1915 1 .. .. .. 3 8 11 23 1916 .. .. .. .. 1 2 17 20 1917 .. .. .. .. 1 4 10 15 1918 1 7 11 31 62 29 21 162 During the first three quarters of the year few deaths occurred— practically nine-tenths of the 162 deaths taking place in the last quarter of the year, as will be seen from the following table:— 14 Week ending. No. of deaths occurring. Week ending. No. of deaths occurring. Jan. 1—5 2 Oct. 5 2 „ 12 2 „ 12 2 „ 19 1 „ 19 6 „ 26 1 „ 26 13 Feb. 2 1 Nov. 2 23 „ 23 1 9 23 March 9 1 „ 16 15 „ 23 1 „ 23 18 June 1 1 „ 30 13 „ 8 1 Dec. 7 9 „ 15 2 „ 14 7 „ 29 6 „ 21 4 July 20 3 „ 28 2 „ 27 1 „ 28—31 1 The deaths of Hampstead "residents" from Influenza in 1918 occurred at ages and among sexes as follows :— Age Sex. . Male. Female. Under 1 .. 1 1 1—2 .. 2 2 2—5 3 2 5 5—15 3 8 11 15—25 12 19 31 25—45 21 41 62 45—65 11 18 29 65— 8 13 21 58 104 162 These figures relate to Hampstead "resident" civilians only. Sailors, soldiers, airmen, and "non-residents" are not included. The whole epidemic will be dealt with by me later in a Special Report. No pronounced occurrence of the disease among females can be deduced from these figures when it is remembered that, at the age 15 periods at which most of the deaths occurred, it may quite safely be estimated that there are more than two females to every male. Leaflets and posters containing precautionary advice were distributed in the Borough through the usual channels, and arrangements were made with the local nursing associations whereby the Borough Council undertook to pay fees on an agreed scale for the nursing of cases of Influenza or its complications, as well as for cases of Influenzal Pneumonia and acute primary Pneumonia. The provisions of the Public Health (Influenza) Regulations, which were framed with a view to improving the hygienic condition of the cinematograph theatres, were put into force. All places of entertainment were considered at great length by the Committee. It was found that eight different premises came within the scope of the Regulations, and the Medical Officer of Health was instructed to visit personally, inspect, and report upon each of the premises. As a result, the Committee decided in the case of two places to relax the Regulations; in two others to modify them by insisting only upon a twenty minutes' interval instead of thirty minutes. In two places 110 relaxation was allowed, and two were shut up. The epidemic was dealt with in all ways as energetically as the sanitary staff could effect, but their efforts, in common with those of other sanitary authorities, were nullified to a great extent by peculiar circumstances prevailing at the time. Thus, the food supply was abnormal and not altogether satisfactory, whilst the spread of the outbreak was without doubt greatly aided by the most unparalled crowding of buses and tubes which took place at the end of 1918. Section B. SANITARY ADMINISTRATION AND CIRCUMSTANCES, &c., OF THE BOROUGH. A tabular statement of the sanitary supervision of the Borough is given in Table IV. ou page 50. The following subjects, however, call for special meution:— 16 Drainage Works. Since the Bye-laws of the London County Council which require the deposit of plans and particulars came into operation in August, 1903, 606 plans for the drainage of new buildings and 9,020 plans for the alteration and reconstruction of drains in existing premises have been received. During 1918, 165 deposits of plans and particulars relating to redrainage work, etc., were made. Cleansing Station. During 1918, 669 children and 130 adults were cleansed at the Cleansing Station by the Council's Attendant, and whilst 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 11 dwellings. The total number of dwellings in relation to which certificates were issued was 2. Smoke Nuisances. During the year observations were made in 14 instances by the Sanitary Inspectors, but no intimation notices were necessary to be served. Public Mortuary. During the year the bodies of 58 persons were brought to the mortuary—32 by order of the Coroner, 16 by the Police, 1 by the Military Authorities, and 9 at the request of friends of deceased persons. In 9 instances inquests only were held, and in 35 instances postmortem examinations were made and inquests followed. The following table indicates the causes of death of the persons whose bodies were received into the Mortuary. Cause of Death or Verdict Number of Bodiet received. Deaths from natural causes 34 Accidental deaths 4 Suicide 7 Open Verdict 2 Deaths from enemy aircraft bomb 2 One body taken to St. Paneras for enquiry 1 Misadventure 4 Total 54 17 3 bodies were removed to the St. Pancras Mortuary, and 2 were those of still-born children. Complaints. During 1918, 602 complaints were made of the existence of nuisances, etc. Milk Supply. 59 persons occupying 90 premises have been registered as purveyors of milk, comprising 45 dairies, 19 bakehouses and confectioners, 13 restaurants and coffee shops, and 13 general shops. During the year 269 inspections were made and 6 notices were served. Food. The following is a list of food seized or voluntarily surrended during the year. Date. Premises. Food. Cwts qrs lbs. Quantity. Feb. 25th High Road, Kilburu Herrings 1 1 0 Haddocks 0 1 4½ Bloaters 0 2 20 April 17th West End Lane Herrings — 1 case. May 25th South End Road Beef — 15 stone. ,, 25 th England's Lane „ 0 0 11 „ 25th King's College Road „ 0 0 30 5 „ 28th Fairfax Road „ 0 0 10 June 5tli England's Lane „ — 1 Fore- quarter „ 17 th Finchley Road Bacon 2 3 0 „ 20th South Hill Park Beef 0 2 2 „ 27 th Finchley Road Bacon 0 1 1 July 10 th „ Mackerel — 4 st. 6½ lbs. „ 13th King's College Road Beef — 12 st. 7 lbs. „ 22nd Fiuchley Road Rabbits — 25. ,, 23rd South End Road Bacon 0 1 21½ „ 23rd New End Condensed Milk — 2½ barrels. „ 26th Swiss Terrace Bacon 0 1 22 Aug. 10th High Road, Kilburu Beef 0 3 21 „ 12th Finchley Road Bacon 0 0 9½ „ 15th South End Road „ 1 0 18 „ 16th High Road, Kilburn Mackerel — 7 boxes. „ 24th South Hill Park Beef — 7 stone. „ 24 th Fiuchley Road Bacon 0 1 12 Sept. 4th High Road, Kilburn „ 0 0 16 „ 11th Fairfax Road „ 0 0 2½ „ 17th West End Lane Cheese 0 0 1½ 2 tins. „ 17th „ Condensed Milk — Oct. 8tli „ Cheese 0 0 10½ 1 tin. „ 8th „ Milk — „ 15th England's Lane Beef 0 1 13½ „ 17th South Hill Park „ 0 1 10 „ 26th Finchley Road Duck - One. 18 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. During 1918, the food premises have been under constant supervision, and in 11 instances notices were served to abate insanitary conditions. 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 106, Fleet Road. West End Ward 36, 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 sold. In regard to these it may be mentioned that the Ice Cream (Restriction) Order, 1917, prohibited the manufacture of Ice Cream. Bakehouses. At the end of 1918, there were 35 occupied bakehouses on the register, 19 being underground, and 16 above ground. Six of the bakehouses situated above ground and four underground use power, and are therefore factories. Twenty inspections were made in respect of the factory bakehouses, 82 inspections in respect of the workshop bakehouses, and 5 notices were served. The following is a list of the occupied bakehouses on the Register at the end of the year:— Town Ward 67, High Street and 26, New End. Belsize Ward 6 and *65 Fleet Road and 45 South End Road. Adelaide Ward *†44, England's Lane and *2, King's College Road. 19 Central Warm.. *64, Belsize Lane, *225, *289 and †307 Fincliley Road, *98 and 250 West End Lane and †2, Broadhurst Gardens. « West End Ward †60 and 110, Cricklewood Broadway, †553, Finchley Road, Field Lane School, Hillfield Road, *43 & 44, Mill Lane, †4, Munro Terrace, Fortune Green, and 251 and *279 West End Lane. Kilbuhn Ward *63, Hemstal Road, *94, †218 and *354, High Road, Kilburn, *4, Kelson Street, 67, Kingsgate Road, * † 99, Palmerston Road. Priory Ward. *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 19 „ Above ground 16 Total 35 Restaurant Kitchens, etc. The total number of these premises on the register at the end of 1918 was 63. They are kept under regular supervision, 138 inspections have been made and 4 notices served during the year. Meat Supply, The Meat Supply of the Borough is on the whole go d, and in only eleven cases 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, High Street and 6 Fairfax Mews. 20 Sale of Food and Drugs Act. 508 samples were taken for analysis during the year. The number certified to be adulterated was 13, or 2.5 per cent, of the total number, as against 13 in 1917 and 2.1 in 1916. 5 samples were certified to be of low quality. 482 samples were purchased from Hampstead tradesmen and 26 from tradesmen coming from other districts. The percentage of adulterated samples in the two classes was 2.2 and 7.6 respectively. 21 samples were taken on Sundays. 3 of these were adulterated and two were of low quality. The following table shows the articles of which samples were taken during the year :— Articles. Number taken Adulterated. Low Quality Ale 1 - - Arrowroot 2 — — Butter 47 — - Cocoa 65 — - Coffee 50 — — Cheese 7 — - Cream 1 — - Dripping 5 — — Flour 22 — — Honey 3 - — Jam 1 - — Lard 31 — — Margarine 43 — — Milk 171 12 5 Mustard 14 1 — Oatmeal 7 — — Pepper 11 — — Rice flour 3 — — Rice, ground 11 — — Sausages 1 — — Sugar 6 — - Tapioca 1 — — Tea 3 — — Vinegar 1 — — Wheat, flaked 1 - — Totals 508 13 5 21 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.  27 Milk 6 per cent. deficient in fat Costs £3 3s. 31 ,, 8 per cent. deficient in fat Dismissed. Warranty proved. 39 ,, 30 per cent. deficient in fat 43 ,, 4 per cent. added water Fined £2. Costs £2 2s 134 ,, 38 per cent. deficient in fat Dismissed. Warranty proved. 161 ,, 12 per cent. deficient in fat 254 ,, 7½ per cent. added water 270 ,, 47 per cent. deficient in fat 386 ,, 10 per cent. deficient in fat 409 Mustard 20 per cent. wheaten flour Informal sample. 432 Milk 6 per cent. added water Dismissed. Warranty proved. 451 ,, 10 ,, ,, Fined £10. Costs 477 ,, 9 ,, ,, Informal sample. In the case of the last sample (No. 477), the vendor refused to supply a sample for analysis, pouring the contents of the can into the drain. An informal sample, which was found to be adulterated, was obtained from his previous customer. He was prosecuted under the Food Orders for destroying milk, and was fined £20 and one guinea costs. 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. 22 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 171 Cream 1 - 2.—Cream sold as Preserved Cream. (а) Samples submitted for analysis to ascertain if the statements on the labels as to preservatives were correct:— 1. Correct statements made, nil. 2. Statements incorrect, nil. (b) Determinations made Of milk fat in cream sold as preserved cream:—1. Above 35 per cent., nil 2. Below 35 per cent., nil. (c) Instances where (apart from analyses) 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 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 whore this has been determined, and also the percentage indicated on the Statutory label Official No. Sample. Analyst's Report. Percentage on Statutory label.  – – – – That part of the Regulations relating to Cream was not enforced owing to the Orders of the Food Controller prohibiting the sale of cream. 23 The Water Supply of Tenement Houses. During 1917, the powers conferred by Section 78 of the L.C.C. General Powers Act, 1907, have been exercised in regard to 27 houses, making a total of 890 houses which have been dealt with in Hampstead since the Act came into force. HOUSING. In view of the great and increasing importance of this subject, the Council decided that a Housing Committee should be formed, and of this Committee Mr. Councillor H. R. Smith was elected Chairman. An endeavour has been made to ascertain what were the conditions in 1918 under which the working classes were housed, and as a result of the investigations then made the following facts and figures were elucidated, and were presented to the Committee:— Tenement houses, rooms over shops, and stables, etc. 910 Say average lettings 3 to each house equals 2,730 dwellings for 2,500 would be a safer estimate). In addition to the above there are 923 assessments of dwelling rooms which are rated as "small property" at a rateable value not exceeding £20. This total of 923 includes Wells Buildings, Campden Buildings, Albany Buildings, and such like big blocks of model dwellings, each set of rooms being rated separately. The approximate population in such houses occupied by persons of the working classes is 28,000. Assuming that all the population who are living more than two in a room are overcrowding, then at least 5,547 people are living in an overcrowded condition. The so-called "working-class population" of the Borough being roughly estimated at 30,000, then investigation appears to indicate that the same conditions pertain as did in 1911, as the number of houses with overcrowding in them equals approximately one fifth of the number investigated. This brings the following figures :— Working-class .population 28,000 Number more than two per room, therefore overcrowded 5,547 Average number of families in a tenement house 3 24 It would therefore appear that the number of houses required is about 400. Table required by Article V. of the Housing (Inspection of District) Regulations, 1910, made by the Local Government Board under the Housing, Town Planning, &c., Act, 1909. (Excluding underground rooms). The information in paragraph (b) to (f) relate only to premises referred to in paragraph (a). Section 17, Housing Act, 1909:— (a) No. of dwelling houses which on inspection were con- sidered to be in a state so dangerous or injurious to health as to be unfit for human habitation 4 (b) No. of representations made with a view to the making of Closing Orders 4 (e) No. of Closing Orders made 4 (d) No. of dwelling houses, the defects in which were remedied without the making of Closing Orders — (e) No. of dwelling houses which after the making of Closing Orders were put info a fit state for human habitation — (f) General character of the defects found to exist — Structurally unfit, dilapidated, and in an insanitary condition. 25 Statement showing steps taken in 1918, in connection with premises "represented in 1918 or previous years" by the Medical Officer of Health under the Housing Acts, 1890-1909. Premises. Representation. Closing Order. Demollition Order. Date of Committee. Whether (a) unfit for habitation, (b) an obstructive building. Statute under which action taken. Date of Council. Statute under which action taken. Date of Council. Statute under which action taken. Remarks.  7, Abbey Lane 53-1-17 (a) Sec. 17 Housing Town Planning,&c.. Act, 1909. 1-2-17 Sec. 17 Housing Town Planning, &c., Act, 1909. 17-1-18 Housing, Town Planing, &C., Act, 1909 Premises pulled down 8, „ 23-1-17 (a) Do. 1-2-17 Do. 5-12-18 Do. 12, „ 5-2-18 (a) Do. 14-2-18 Do. 3, Fleet Mews 23-7-18 (a) Do. 1-8-18 Do. 4, „ 23-7-18 (a) Do. 1-8-18 Do. 5, „ 23-7-18 (a) Do. 1-8-18 Do. 32, Netherwood Street 16-10-17 (a) Do. 25-10-17 Do. Question of demolition deferred for 3 months on 10-10-18; the Owner- representing that he was taking all necessary steps to render premises fit for habitation. Town Ward Scheme. On 20th December, 1917, I represented 75 premises in the Town Ward to the London County Council under Tart I of the Housing of the Working Classes Act, 1890, In March, 1918, a reply was received from the County Council referring to my representation as to the unhealthy condition of houses in nine separate areas in the Town Ward and stating that they were not prepared to undertake a scheme for the improvement of the areas under Part I of the Act of 1890, as, in their opinion, the size and condition of the areas were not such as to be considered as being of general importance to the County and that the areas could be dealt with in a more satisfactory manner than by means of a scheme under Part I. This reply of the London County Council was reported to the Borough Council on May 9th, who resolved:— " That it appears to the Council (being the local authority) that the closeness, narrowness, and bad arrangement or bad 26 dition of the buildings in the areas referred to, or the want of light, air, ventilation or proper conveniences, or any other sanitary defect in the buildings is dangerous or prejudicial to the health of the inhabitants either of the said buildings or of the neighbouring buildings, and that the demolition or the reconstruction and re-arrangement of the said buildings or some of them is necessary to remedy the said evils, and that the areas comprising those buildings, and the yards, out-houses, and appurtenances thereof, and the site thereof, is too small to be dealt with as an unhealthy area under Part I of the Housing of the Working Classes Act, 1890." The Borough Council also decided that a scheme should be prepared for the improvement of the said areas on the lines of the report of the Medical Officer of Health. This is now in progress; a special architect has been engaged who has presented a scheme to the Housing Committee for their approval. Houses let in Lodgings. The number of houses let in lodgings, or occupied by members of more than one family, on the Register at the end of 1918 was 405. During the year 781 inspections and re-inspections have been made. Factory and Workshop Act, 1901. Whilst maintaining careful supervision of the sanitary conditions of the workshops and workplaces, due regard was paid to the altered conditions pertaining. In many establishments women took the place of men, so that establishments employed both sexes when they formerly employed one only. 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 accommodation. These arrangements were intended to be only temporary during the War, and the suggestion of the Board which was adopted has been adhered to. Section 132 of the Factory and Workshp Act, 1901, requires every Medical Officer of Health in his Annual Report specially to report on the administration of the Act, and the five tables that follow were framed by the Home Secretary with a view to such reports being made upon uniform lines, 27 Factories, Workshops, Workplaces and Homework. 1. — Inspection of Factories, Workshops, and Workplace. Including Inspect ions made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions  (1) (2) (3) (4) Factories (Including Factory Laundries) 62 2 — Workshops (Including Workshop Laundries) 208 21 — Workplaces (Other than Outworkers premises included in Part 3 of this Report) 1194 63 — Total 1464 86 — 2.—Defects found in Factories, Workshops, and Workplaces. Particulars. Number of Defects. Number of Prosecution.  Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Act:— Want of cleanliness 10 8 — - Want of ventilation 4 3 — - Overcrowding — — — — Want of drainage of floors — — — - Other nuisances — — — - Sanitary accommodation insufficient — — — - unsuitable or defective — — — - not separate for sexes — — — - Offences under the Factory and Workshop Act: — Illegal occupation of underground bakehouse (s. 101) - - - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) - - - Other offences (Excluding offences relating to outwork, which are included in Part 3 of this Report) - - - - Total 14 11 — - 28 3.—Home- Work. 65 lists of outworkers were received from employers. These contained 161 entries. There are 83 outworkers' premises in Hampstead, 6 being Factories, 23 Workshops, 13 Domestic Workshops and 41 single workers. •NATURE OF WORK. 1 Outworkers' Lists, Section 107. Lists received from Employers. Sending Twice in the year. Sending Once in the year. Lists 2 Outworkers† Conractors, 3 Workmen. 4 Lists. 5 Outworkers. Conractors. 6 Workmen. 7 Wearing Apparel— (1) making, &c. 38 31 48 5 2 4 (2) cleaning and washing 10 11 2 — — — Household linen 2 — 1 Lace, lace curtains and nets — — 2 — — — Curtains and furniture hangings 6 2 12 — — — Furniture and upholstery 2 2 7 — — — Electro-plate — — 2 — — — Brass and brass articles — — 2 — — — Locks, latches and keys — — 2 — — — Umbrellas, &c. — 4 — — — — Paper, &c., boxes, paper bags 2 — 15 — — — Total 60 50 105 5 2 4 Notices served on occupiers as to keeping or sending lists of Outworkers, Nil; Prosecutions in relation to Outworkers' Lists, Nil. Outwork in unwholesome premises, Sec. 108, Nil; Outwork in infected premises, Sees. 109— 110, Nil. * 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 in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year, and of the entries of names of outworkers in those lists. 4.—Registcred Workshops. Workshops on the Register (s. 181) at the end of the year. Number.  (1) (2) Bakehouses 25 Bootmakers 29 Dressmakers and ladies' tailors 61 Tailors 32 Other 179 Total number of workshops on Register 326 29 5.—Other Matters. Class. Number.  (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133) 4 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) Notified by H.M. Inspector Reports (of action taken) sent to H.M. Inspector – Other - Underground Bakehouses (s. 101, 1901) in use at the end of the year 25 Workplaces Among the more important workplaces are the kitchens of restaurants, coffee-houses, &c. During the year 1,104 inspections were made and 63 notices were served. At the end of 1918 there were 326 workshops on the Register, of which 30 were domestic workshops. Excluding these, there were 456 males and 491 females employed therein. During the year 208 inspections were made and 21 notices served. Trade or Business. Workshops other than Domestic Workshops. Number of Workshops, Number of Workrooms. Number of Employees. Males. Females. Domestic Workshops. Total number of Workshops. Bakers 25 25 69 4 — 25 Blindmakers 3 5 5 4 — 3 Bootmakers 29 32 51 — — 29 Builders and carpenters 17 18 20 — — 17 Cabinetmakers and polishers 2 6 22 1 1 3 Carriage builders 4 9 13 — — 4 Cycle makers and repairers 3 6 6 — — 3 Dressmakers and ladies' tailors 50 52 2 160 11 61 Harness makers 3 7 14 11 — 3 Ironmongers 13 13 23 — — 13 Laundresses 4 11 2 28 — 4 Milliners 12 12 — 16 1 13 Monumental masons 2 2 14 — — 2 Motor makers 10 13 27— — 10 Outfitters 7 19 1 61 — 7 Pianoforte makers 2 4 12— — 2 Picture frame makers 10 12 12 — — 10 Sign writers 1 3 2 4 — 1 Smiths 10 10 18 — — 10 Tailors 21 28 36 28 11 32 Upholsterers 17 22 24 15 1 18 Watchmakers and jewellers 11 12 19 — — 11 Wigmakers 9 9 2 15 — 9 Miscellaneous 31 44 62 144 5 36 Totals 296 374 456 491 30 326 36 Section C. PREVALENCE OF AND CONTROL OVER ACUTE INFECTIOUS DISEASES. Notifiable Infectious Diseases (excluding Tuberculosis). The list of Infectious Diseases notifiable in London during 1918, was as follows:— Small-pox Typhus Fever Cholera Relapsing Fever Diphtheria Continued Fever Membranous Croup Puerperal Fever Erysipelas Anthrax Occuring in Man Scarlet Fever Hydrophobia Epidemic Cerebro-spinal Glanders Meningitis Ophthalmia Neonatorum Plague Measles Polio-Myelitis (Acute) German Measles Typhoid or Enteric Fever Bacteriological Work. The following is a summary of the Bacteriological work performed by the Lister Institute:— Positive. Negative. Total.  Diphtheria 41 169 210 Enteric Fever — 1 1 Cases of Infectious Disease occurring in each month during 1918. DISEASE. MONTHS. 1 Totals.  January. February. March. April. May. June. July. August. September. October. November. December. Diphtheria and Membranous Croup 13 15 9 13 6 9 11 7 6 13 3 4 109 Erysipelas 2 2 9 4 2 2 1 3 3 2 2 3 28 Scarlet Fever 10 4 6 5 3 6 1 1 1 3 8 3 51 Enteric Fever 1 1 1 1 — 2 1 1 1 — 3 12 Polio-Myelitis - - - - - - - - 1 - - - 1 Ophthalmia Neonatorum - 8 - - 1 - - - - - 1 - 5 Epidemic Cerebrospinal Meningitis - 1 - – 1 2 Measles 56 94 95 45 31 15 43 17 11 20 17 16 460 German Measles 10 9 23 19 28 7 5 1 — 4 2 6 114 Totals 92 127 137 87 72 39 63 30 23 44 33 35 782 31 Small-pox. No case of small-pox occurred in Hampstead during the year. In the early part of the year cases of small-pox occurred in the County, and, in view of the fact that mild forms of this disease are liable to be mistaken for chicken-pox, the County Council informed the Borough Council on 23rd March that they had made an Order, as a "case of emergency, requiring the notification of cases of chicken-pox up to 30th June. The Local Government Beard also communicated with the Council urging the great importance of adequate and immediate steps being taken to deal with the outbreak. The Borough Council authorised the Medical Officer of Health, under the Public Health (Small-pox Prevention) Regulations, 1917, to vaccinate or re-vaccinate contacts. Vaccination. Of the births recorded 507 were successfully vaccinated. In 8 cases the children were insusceptible of vaccination. In regard to 142 Certificates of Conscientious Objection were obtained ; 33 died before vaccination was performed; 23 cases of vaccination were postponed and 86 remained to be dealt with. I am indebted to the Vaccination Officer for these statistics. Diphtheria and Membranous Croup. The number of cases notified in 1918 was 109, as compared with 131 in 1917. The attack rate, or number of cases notified per 1,000 of the population was 1.52 compared with the rate of 1.73 in the previous year. The number of cases notified proving fatal was 7, or 6.4 per cent. of the cases notified, as against 3 per cent. 1917. 102 patients, or 93 per cent. of the cases notified were removed to hospital. In accordance with the Diphtheria Anti-toxin (London) Order, 1910, the Borough Council supply anti-toxin free to medical practitioners for use for the poorer inhabitants of the Borough. Erysipelas. 28 cases were notified, and no death occurred, as compared with 27 cases in 1917, none of which proved fatal. The attack rate per 1000 of the population was 0.39, as compared with the rate of 0.35 in 1917. Of the cases notified, 26 or 98 per cent were removed to the Workhouse Infirmary or Nursing Homes. 32 Scarlet Fever. 51 cases of scarlet fever were notified during the year, as compared with 60 in 1917. The number of cases per 1000 of the population was 0.71, 3 proving fatal; the corresponding figure in 1917 being 0.79. Of the cases notified 44 or 86 per cent. were removed to hospital. Enteric Fever. The number of cases notified was 12. The attack rate per 1,000 of the population was 0.17, as compared with the rate of 0.15 in 1916. 1 of the cases notified proved fatal. Puerperal Fever. No case of this disease occurred during the year. Epidemic Cerebro-spinal Meningitis. During 1918, 2 cases were notified, but neither proved fatal. In 1917, 6 cases were notified, 1 proving fatal. Acute Polio-Myelitis. One case of this disease occurred in the person of a child aged 3 3/12 years, resulting temporarily in partial paralysis of the right arm and leg, and loss of speech. Ophthalmia Neonatorum. 5 cases were notified during the year and investigated by the Health Visitor. One of the cases was notified by a certified Midwife. One case was removed to hospital. In no case was the services of a nurse required in the home. Measles and German Measles. Compulsory notification of Measles and German Measles came into operation on January 1st, 1916. 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. During 1918 460 cases of Measles and 114 cases of. German Measles were notified. In 1917 the figures were 1,257 and 946 respectively. 33 One death was recorded from Measles, as compared with 10 in 1917. The age periods of the persons attacked are shown in Table I. on page 47. In 40 cases of Measles a nurse was supplied at the cost of the Borough Council. 24 cases of Measles and 4 cas s of German Measles were removed to hospital. The following tables show the number of notified cases of Measles and German Measles occurring each month in the various Wards:— Measles. Month. WARDS. Totals.  No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). . No. 4 (Central). No. 5 (West End). No. 6 1 (Kilburn). No. 7 (Priory). January 17 17 3 4 7 3 5 56 February 38 24 8 10 8 2 4 94 March 47 14 10 19 3 1 1 95 April 11 15 5 7 — 6 1 45 May 3 11 5 4 2 2 4 31 June 1 6 1 1 — 2 4 15 July 1 18 14 1 1 2 6 43 August 3 4 — — 1 — 9 17 September - 1 — 1 — 2 5 11 October - 13 — — 1 4 2 20 November 2 - 3 3 1 1 — 17 December .- 1 1 1 3 7 3 16 Totals 125 131 50 51 27 32 44 460 34 German Measles. MONTH. WARDS. Totals.  No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No 5 (West End). No. 6 (Kilburn). No. 7 (Priory). January 2 l l 5 - 1 - 10 February 1 3 I 1 2 1 9 March 5 6 I 7 3 1 23 April 5 3 7 1 1 1 l 19 May 7 8 3 2 3 2 3 28 June 1 1 5 7 July 1 2 — — 1 - 1 5 August 1 — — — - - - 1 September - - - - - - - - October 2 - - 2 4 November 1 - - 1 - 2 December 1 1 1 1 - 1 1 6 Total 27 24 15 17 11 8 12 114 35 in the following table these 361 cases have been analysed as to sex and age, and it will be noticed that 51'8 per cent. were aged between 25 and 45. 0—1. 1—5. 5—10. 10—15. 15—20. 2.-25. 25—15. 35--45. 45—55- 55- 65. Over 65. Total.  Pulmonary males ... - 1 7 4 7 14 46 48 18 15 3 163 ,, females ... — - 6 4 8 14 10 34 17 5 — 128 N on- Pulmonary males ... 1 1 8 7 1 5 4 2 — 29 ,, females ... 1 5 5 6 6 4 5 5 1 2 1 41 2 7 26 21 22 32 96 91 36 24 4 361 Of the cases newly notified during 1918, 13 were of persons already dead or dying, and in 25 other cases the patients did not survive the year under review. Of the total new cases in 1918 the number who have attended the Municipal Tuberculosis Dispensary is 170. The number of cases notified in 1918 and previous years are as follows :— Year. Persons newly notified. Total.  Pulmonary Tuberculosis Voluntarily notifiable 1902; Compulsorily notifiable 1912. Non-Pulmonary Tuberculosis (Notifiable from 1st February, 1913). 1902 51 - 51 1903 34 — 34 1904 39 — 39 1905 27 — 27 1906 35 — 35 1907 55 — 55 1908 30 — 30 1909 67 — 67 1910 77 — 77 1911 113 — 113 1912 183 — 183 1913 244 56 300 1914 142 30 172 1915 172 48 220 1916 193 51 244 1917 256 52 308 1918 291 70 261 The total number of cases of Tuberculosis known to the Department at the close of 1918 was 996. 36 Occupations. The following is an analysis of the occupations of the new cases notified as tuberculous during 1918:— Occupation. Pulmonary Cases. NonPulmonary Cases. Pulmonarv NonPulmonary . Cases.  Occupation. Cases. Accountant 3 1 Lift Hand 1 1 Advertising Contractor 1 _ Mail Cart Driver 1 — Manufacturer 2 — Aeroplane Fitter 1 — Market Porter 1 — Army Officer 2 — Medical Practitioner 3 — Ex-Army Officer 1 — Medical Student 2 — Architect 1 — Merchant 7 — Artist 4 1 Milk Carrier 2 — Baker 1 — Motor Mechanic 3 1 Bank Manager 1 — Munition Worker 9 — Bookmaker 1 — Nurse 1 — Butcher 2 — Odd work 1 — Caretaker 2 1 Plumber 1 — Carman 2 — Police Constable 1 — Carpenter 2 — Radiographer 1 — Cashier 3 — Railway employee 2 — Charwoman 1 — Road sweeper 1 — Civil Servant 3 — Scholar 1 — Clerk 19 2 School Matron 2 — Commercial Traveller 2 - Secretary 3 — Shop Assistant 4 — Company Director 1 — Shopkeeper and Compositor 3 — Manager 5 — Dentist 1 1 Sister of Charity 1 — Domestic Servant 18 5 Society Entertainer 1 — Draughtsman 1 — Soldier 1 — Dressmaker 1 1 Stockbrocker 1 — Dyer and Cleaner 1 — Student 2 — E-Sailor 3 — Surveyor — 1 Ex-Soldier 28 3 Tailor 1 — Flower and Feather Buyer 1 Teacher 3 — Telephonist 1 — Furrier 2 — Translator 1 — Groundsman 1 — Upholsterer 1 — Housewife 44 7 Violinist 1 — Insurance Agent and Collector 5 - Waiter 2 — Warehouseman 2 — Jewellery Trade 1 — No Occupation 28 17 Journalist — 1 No Information 4 — Laboratory Assistant 1 — Leather Worker 1 — - - Letter Carrier 2 — 291 70 37 The following cases, notified prior to 1918, were also removed. Pulmonary. Non-Pulmonary  To Sanatoria (insured) 14 — To Sanatoria (non-insured) 9 — To Hospitals 1 — To Infirmaries — 1 To Nursing or other Homes 2 3 26 4 Deaths from Tuberculosis. The number of deaths from Tuberculosis in 1918 was 89. Of these 75 were due to Pulmonary Tuberculosis, 6 to Tubercular Meningitis, and 8 to other forms of Tuberculosis. The following table shows the age distribution of patients dying from Pulmonary Tuberculosis in Hampstead since 1903 :— Year. 0-5 Age Period. 65— All Ages.  5—15 15—25 25—65 1903 - 1 14 46 5 66 1904 1 1 15 53 3 73 1905 1 — 12 57 3 73 1906 1 — 8 45 3 57 1907 1 2 10 45 3 61 1908 — 2 14 55 3 74 1909 1 1 12 37 2 53 1910 1 1 12 37 7 58 1911 1 1 5 44 5 56 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 1917 - — 21 47 1 69 1918 1 1 11 59 3 75 Totals 10 20 179 725 54 988 The death from all forms of Non-Pulmonary Tuberculosis in 1918 were distributed in age periods as follows:—0-5, 4; 5-15, 3; 15-25, 2 ; 25-65, 3 ; 65 and upwards, 1. 38 The following table shows the number of deaths and the deathrates from all forms of Tuberculosis and from Pulmonary Tuberculosis respectively since 189.9:— Year. Total deaths from Tuberculosis. Deathrate per 1000 Population. Deaths from Pnlmonary Tuberculosis. Deathrate per 1000 Population. Cases of Pulmonary Tuberculosis 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 0.58 220 1916 80 0.98 55 0.67 244 1917 85 1.12 69 0.91 308 1918 89 1.24 75 1.04 361 The deaths from Pulmonary Tuberculosis and from all forms of Tuberculosis during 1918 were distributed among the wards as follows:— Ward. Area (Acres). Estimated Population middle of 191S. Pulmonary Tuberculosis. Tuberculosis (All Forms.) Deaths. Death-rale per 1000 of the Population. Deaths. Death-rate per 1000 of the Population.  No. 1 (Town) 686 11,600 11 0.95 15 1.30 ,, 2 (Belsize) 271 11,500 9 0.79 10 0.87 ,, 3 (Adelaide) 325 8,315 11 1.32 11 1.32 ,, 4 (Central) 312 8,300 7 0.84 9 1.08 „ 5 (West End) 247 10,800 12 1.11 14 1.30 ,, 6 (Kilburn) 195 12,500 18 1.44 22 1.76 „ 7 (Priory) 229 8,800 7 0.80 8 0.92 The Borough 2,265 71,815 75 1.04 89 1.24 39 The Municipal Tuberculosis Dispensary. In the following tabular statement some idea may be gained of the work done in connection with the Dispensary since its inception. The number of patients actually under treatment, and the number of persons under review, fluctuates from time to time. At the close of 1918 the former numbered 98, and the latter 195. Year. No. of New Applicants. No. of New Applicants treated. No. of Contacts examined. Total Attendances of all kinds. Total No. of Home Visitis paid by Tuberculosis Medical Officer and Dispensary Nurse. 1913 455 191 204 2808 1013 1st Feb to 31st Dec. 1914 455 118 195 1913 1269 1915 308 146 158 899 459 1916 230 165 100 1519 368 1917 383 183 113 1682 766 1918 371 105 124 1821 298 Return required by the Local Government Board, London County Council and London County Insurance Committee as to work carried out in connection with the Tuberculosis Dispensary for the period from 1st January—31st December, 1918. (This Return relates only to persons residing in the area served by the Dispensary in accordance with the scheme of the Metropolitan Borough Council.) Insured. Non-insured. M. P. Children under 16. M. F. Totals.  1. (a) Number of persons examined for the first time during the above period at or in connection with the Dispensary 74 38 136 10 73 371 (b) Number included under 1 (a) who were found to be suffering from Pulmonary Tuberculosis 50 20 8 27 38 143 (c) Number included under 1 (a) who were found to be suffering from NonPulmonary Tuberculosis 3 5 15 - - 24 (d) Number included under 1 (a) who were found to be non-tuberculous 16 11 99 18 29 173 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 5 l 14 6 31 40 Insured. Non-insured. Totals.  (a) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under 1 (a) 355 1466 1821 (b) Number of the above attendances at which systematic physical examinations and records were made 183 458 641 3. Number of visits to patients at their own homes by the Dispensary Medical Officer in connection with the supervision of home conditions Nil. 1 1 4. Number of visits to patients at their own homes by the Dispensary Nurse in connection with the supervision of home conditions and "following up" 68 229 297 5. Number of persons suffering from or suspected to be suffering from Tuberculosis referred to the Hospital to which the Dispensary is affiliated - - - 6. Number of consultations with the— (a) Medical Adviser of the Insurance Committee - - - (b) Consulting Physicians at the Hospital to which the Dispensary is affiliated - - - (c) Practitioners at the homes of patients 7. Number of written reports concerning individual patients made to— (a) Public Authorities 49 13 62 (b) Practitioners - 8. Number of specimens of sputum examined 54 99 153 Section E. MATERNITY AND CHILD WELFARE. The continued decline in the birth-rate has become a serious menace to the national life, and in this decline Hampstead bears a part. Our highest birth-rate was 24 5, recorded in 1878 ; and since 1900 the rate has never risen above 20 per 1,000. The rate for 1918—11.1— marks yet another sharp drop. The possibilities of the declining birth-rate being counteracted by a lower death-rate, are limited. We cannot expect to see the present death-rate of the Borough reduced very much, but it is quite possible for the birth-rate to decrease to a much lower figure than even the rate of 11.1 for 1918. While, therefore, every effort should be made in the campaign for saving child life, it must be remembered that lives saved are only deaths postponed at best, 41 But while the scope of the activities of Sanitary Authorities in the matter of the declining birthrate is very limited, the conservation of the lives and health of the children who are born, is one with which we are able in a large measure to take vigorous action. Hampstead has for years been keenly alive to the value of ante-natal work as well as to the importance of infant welfare, and the Maternity and Child "Welfare Act, 1918, found us fully prepared to exercise the powers which it conferred upon us. Section 1 of the Act, which is as follows, is capable of wide interpretation:— "Any local Authority within the meaning of the Notification of Births Act, 1907, may make such arrangements as may be sanctioned by the Local Government Board for attending to the health of expectant mothers and nursing mothers and of children who have not attained the age of five years and are not being educated in schools recognised by the Board of Education; provided that nothing in this Act shall authorise the establishment by any local Authority of a general domiciliary service by medical practitioners." The Borough Council having determined to exercise their powers under the Act, a Committee consisting of seven members of the Council and of two persons interested in Maternity and Child Welfare, not members of the Council, was appointed. Of this Committee, Mr. Councillor C. J. MacFadden, M.D., was elected Chairman, and its activities will be further noted in succeeding Annual Reports But while every endeavour is being made by this and other Sanitary Authorities, and by societies and individuals who realise the great importance of the work, the fact cannot be ignored that our educational and other efforts will always fall short of success, unless we are assured of the co-operation of the mother. "One good mother is worth a hundred schoolmasters." and the sound advice offered by the Health Officers is of little avail unless actively supported by the mother. It is obvious, therefore, that the education of the mother is a very important factor in this matter. Samuel Smiles truthfully wrote many years ago, "The physical health of the rising generation is entrusted to woman by Providence ; and it is in the physical nature that the moral and mental nature lies enshrined. It is only by acting in accordance with the natural laws, which, before she can follow, 42 woman must needs understand, that the blessings of health of body, and health of mind and morals, can be secured at home. Without a knowledge of such laws the mother's love too often finds its recompense only in a child's coffin." The work of the Ante-Natal Clinic, formed in the early part of 1917, has made considerable progre-s during the year. In connection with the work of getting expectant mothers to attend the Clinic, Mrt. Roche, the Council's Lady Health Visitor, paid ninety visits during the year. The report of Dr. Mary Kidd, M.B. (Lond.l, the Medical Officer in Charge of the Clinic, is as follows:— "Report of the Medical Officer in Chare. ox the Work of the Ante-Natal Clinic for the Year 1918. Maternity Clinic, 73, Dynham Road, Kilburn, N. W. Number of Clinics held 83 Number of new cases seen 56 Number of old cases seen 149 Total attendances 205 The Clinic had only come into being a few months before the beginning of the period with which I deal. For a recently started Clinic (comparatively speaking) the attendance has, on the whole, been good. I am greatly indebted to the Borough Health Visitors for making the existence of the Clinic known, and for sending me a great many patients. Two of the midwives in the Borough have also sent me expectant mothers for advice and treatment from time to time. The range of one's activities seems to grow as the work develops. One does not only give advice and treatment for the large number of minor disorders of pregnancy (such as dyspepsia, morning vomiting, anæmia, and varicose veins), but one also has to enter, in many cases into the question of how each mother is getting proper nourishment for herself and, incidentally, for the child that is coming. In many cases alas! one finds that the mother is going short herself so as to let her children have enough food. This at once necessitates one getting into touch with the War Pensions Committee (in the case of a soldier's wife) and getting an extra allowance for her of five shillings weekly, or 43 else with the Hampstead Council of Social Welfare (who have been most kind in allowing dried milk in several cases), and latterly, with our own Borough Council Authorities. These have been allowing "assisted" milk to those expectant and nursing mothers who cannot pay the enormous price charged for milk nowadays. During the last three months of pregnancy the expectant mothers are allowed an extra meat ration or a double fat ration upon producing a certificate signed by me or another medical man or woman in the Borough. Then, passing on in one's review, I have been able to get a cretain amount of free dental treatment carried out by kind arrangement of the Hampstead Council of Social Welfare. I cannot over emphasize the importance of this part of the work, for nearly all the mothers are suffering from decayed teeth, and of these a majority show some degree of pyorrhoea and dyspepsia. Large quantities of mouth wash have been used with bencficial results in these cases. Then it has been a great help to be so closely connected with the Tuberculosis Medical Officer in one's work. I have sent him several tubercular "suspects" from time to time, and they have resulted in at least three cases of very early phthisis being "caught" and treated as early as it is possible to "catch " them. I am glad to say that systematic Health visiting of the expectant mothers has lately been started by Mrs. Roche. In conclusion, I have to acknowledge the great help and assistance I have received in the work at the Clinic from Dr. Scrase, Dr. Halls Dally, and Dr. Crookshank, the Nurse at the Clinic, and the Health Visitors (especially Mrs. Roche). I should also like to thank the Hampstead Council of Social Welfare (especially Miss Doxsey and Miss Capper) for their kind assistance, and the War Pensions Committee. (Signed) Beatrice Mary Kidd, M.B. (Loud)." The next link in the chain following up the Ante-Natal Clinic is the helpful call of the Council's Lady Health Visitor, Mrs. Roche, who visits shortly after information of the birth has been received. By the Notification of Births Act, 1907, all births must 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. 44 In 1918 seven still births were notified, in addition to the live births. In 647 cases the parents were visited, and 270 re-visits were made; 155 visits were also paid in relation to ailments of children, etc. Notifications in respect of the 799 births in the Borough were received from the following sources:—150 from midwives, 487 from parents or doctors, and 162 from nurses and others. When the mother begins to get about, if the case is considered to be one which would profit by attending at a Weighing Centre, she is invited to bring her baby to be weighed. At the Centres, in addition to the actual registering of the baby's weight, the opportunity of giving advice is taken advantage of. The following figures indicate the work done at the Weighing Centres during the year:— Weighing Centres. No. of Hampstead infants weighed. Total attendances of all infants. whether Hampstead or not. No. of deaths. Rate per 1,000 infants attending. Town district 69 665 l 14 South Hampstead 61 1,485 0 — West Hampstead 58 598 1 17 Kilburn district. 263 2,685 5 19 Totals 451 5,433 7 15 As far as is possible, cases of illness among babies seen at the Centres are referred to the family, or other, doctor ; or to a children's hospital. Babies are not weighed until they are one month old. The number of infants weighed, 451, is equivalent to 50 per cent, of the nett births for the year. Mortality Among Young Children. Th following table shows the Infantile Mortality rate and the Death rate among children under five years of age. The latter rate is calculated upon a period of five years:— 45 Year. Deaths of Infants under 1 year of age. Deaths of Children under 5 years of age. No. Rate per 1000 births. No. Rate per 1000 children born in the year and in preceding four years. 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 1917 90 80 122 19.6 1918 69 77 109 18.8 Deaths among Legitimate and Illegitimate Infants. The following comparative tables indicate the great disproportion in the deaths of legitimate and illegitimate infants:— Year. Legitimate Infants. Death rate per 1000 births. Illegitimate Infants. Death-rate per 1000 births Births. Deaths. Births. Deaths. 1908 1,326 87 66 29 10 345 1909 1,239 88 71 43 n 256 1910 1,233 71 57 36 10 278 1911 1,239 94 76 37 11 297 1912 1,207 68 56 74 11 149 1913 1,252 73 58 73 18 246 1914 1,218 77 63 55 14 254 1915 1,246 82 65 81 19 234 1916 1,088 65 59 76 8 105 1917 1,052 74 70 71 16 225 1918 797 56 70 98 13 132 In spite of the special attention now being given to all illegitimate births which come under our notice, it will be seen that the deathrate among these children is very high. In view of the increase in the number of illegitimate children in recent years, it is important that all possible steps should be taken to reduce this high death-rate. For the year under review the illegitimate births represented a rate of no less than 109 per 1,000 births, or, broadly speaking, one in every ten. 46 Table showing the Infantile Death-Rates in the County of London, the City of London, and the Metropolitan Boroughs during 1918. DISTRICT. Deaths under 1 year per 1000 Births. Lewisham 72 Hampstead 77 Chelsea 88 Kensington 91 Stoke Newington 93 Wandsworth 95 Lambeth . 97 Deptford 98 Battersea 99 Camberwell 102 St. Pancras 102 Hammersmith 102 Woolwich 106 Westminster 108 Finsbury 109 Fulham 109 Islington 110 Poplar 110 Hackney 112 St. Marylebone 113 Stepney 113 Paddington 116 Greenwich 118 Southwark 126 Bethnal Green 129 Bermondsey 134 Holborn 147 City of London 158 Shoreditch 163 County of London 108 47 Section F. VITAL STATISTICS OF THE BOROUGH. TABLE I. Cases of Infectious Disease Notified during the Year 1918. NOTIFIABLE DISEASE. Number of cases notified. Total Cases Notified in each Ward. Total Cases removed to Hospital. At all Ages. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Diphtheria (including Membranous Croup) 109 2 23 57 13 14 .. .. 22 15 13 7 9 30 13 102 Erysipelas 28 .. .. 1 6 10 8 3 5 8 1 2 3 9 .. 2 Scarlet Fever 51 .. 8 25 15 3 .. .. 11 13 9 5 5 6 2 44 Enteric Fever 12 .. .. 2 3 4 3 .. 3 2 3 1 1 2 .. 7 Cerebro-spinal Meningitis 2 .... 1 1 .. .. .. .. 1 1 .. .. .. .. .. 2 Polio-Myelitis 1 .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. .. Ophthalmia Neonatorum 5 5 .. .. .. .. .. .. .. 1 2 .. .. 2 .. 1 Pulmonary Tuberculosis 291 .. 1 21 43 168 55 3 35 42 54 6 50 74 30 84* Other forms of Tuberculosis .. 70 2 6 26 11 19 5 1 9 3 13 2 13 21 9 14* Measles 460 15 135 248 39 21 2 .. 125 131 50 51 27 32 44 24 German Measles 111 5 12 49 31 15 1 1 27 24 15 17 11 8 12 4 Totals 1143 29 187 430 161 254 74 8 238 240 160 91 120 184 110 284 Isolation Hospitals are provided by the Metropolitan Asylums Board, and residents of Hampstead suffering from infectious disease (excluding Tuberculosis) were chiefly removed to the North-Western Fever Hospital, which is within the Borough, and is situate at Lawn Road, in No. 2 (Belsize) Ward. Persons suffering from Pulmonary Tuberculosis were removed to institutions in various parts of the country. *These figures relate only to cases notified for the first time in 1918. 48 TABLE II. Causes of, and Ages at, Death during the Year 1918. CAUSES OF death. Nett deaths at the subjoined ages of "Residents," whether occurring within or without the Borough. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 1. Enteric Fever M 3 ... ... ... ... ... 1 2 ... F ... ... ... ... ... ... ... ... ... 2. Small-pox M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 3. Measles M ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... 1 4. Scarlet Fever M ... ... ... ... ... ... ... ... ... F 3 ... ... 1 ... 2 ... ... ... 5. Whooping Cough M 7 5 i 1 ... ... ... ... ... F 8 2 3 3 ... ... ... ... ... 6. Diphtheria and Croup M 3 ... ... 1 2 ... ... ... ... F 4 ... 1 1 1 1 ... ... ... 7. Influenza M 58 ... ... 3 3 12 21 11 8 F 104 1 2 2 8 19 41 18 13 8. Erysipelas M 1 ... ... ... ... ... ... ... 1 F ... ... ... ... ... ... ... ... ... 9. Phthisis (Pulmonary Tuberculosis) M 40 ... 1 ... ... 3 23 11 2 F 35 ... ... ... 1 8 19 6 1 10. Tuberculous Meningitis M 3 ... ... ... 2 ... ... ... 1 F 3 ... ... 2 ... ... ... 1 ... 11. Other Tuberculous Diseases M 3 l ... 1 ... 1 ... ... ... F 5 ... ... ... 1 l 2 ... 1 12. Cancer, malignant disease m 33 ... ... ... ... ... 2 10 21 F 72 ... ... ... ... l 10 36 25 13. Rheumatic Fever m 1 ... ... ... ... ... ... 1 ... F 2 ... ... ... 2 ... ... ... ... 14. Meningitis (A) m 1 ... ... ... ... ... 1 ... ... F ... ... ... ... ... ... ... ... ... 15. Organic Heart Disease m 14 ... ... ... ... 2 4 7 31 f 59 ... ... ... ... 1 6 21 31 16. Bronchitis M 20 ... ... ... ••• ... 1 6 13 F 29 1 ... 1 ... ... 2 5 20 17. Pneumonia (all forms) M 37 4 4 l 2 ... 5 11 10 F 60 3 3 3 4 7 13 11 16 18. Other Diseases of Respiratory Organs M 7 ... ... ... ... ... 2 3 2 F 7 ... ... ... ... ... 1 3 3 19. Diarrhoea and Enteritis (B) M 8 5 ... ... ... ... ... 2 1 F 5 3 ... ... ... ... ... 1 1 20. Appendicitis and Typhlitis M 1 ... ... ... 1 ... ... ... ... F 8 ... ... ... 2 1 3 2 ... 21. Cirrhosis of Liver M 3 ... ... ... ... ... ... 2 i F 2 ... ... ... ... ... ... 1 1 2 1a Alcoholism M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 22. Nephritis and Bright's Disease m 18 ... ... ... ... 1 ... 6 11 F 18 ... ... ... 2 ... ... 6 10 23. Puerperal Fever M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 24. Other accidents and diseases of Pregnancy and Parturition M ... ... ... ... ... ... ... ... ... F 2 ... ... ... ... ... 2 ... ... 25. Congenital Debility and Malformation, including Premature Birth M 11 10 1 ... ... ... ... ... ... F 19 18 ... ... ... ... ... 1 ... 26. Violent Deaths, excluding Suicide M 7 ... ... 1 ... 1 1 2 2 F 7 ... ... ... ... ... 1 1 5 27. Suicide M 7 ... ... ... ... 1 1 3 ... F 3 ... ... ... ... 1 I 1 2 28. Other Defined Diseases M 119 10 1 1 ... 2 12 36 57 F 136 6 1 ... 1 2 16 30 80 29. Diseases ill-defined or unknown M ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... All { causes { M 435 35 8 9 10 23 74 113 163 F 592 34 10 13 22 44 117 144 203 Totals 1027 69 18 22 32 67 191 257 371 Sub Entries. 14 (a) Cerebro spinal Meningitis ... ... ... ... ... ... ... ... ... Included in above figures. 28 (a) Poliomyelitis ... ... ... ... ... ... ... ... ... 49 TABLE III. Infant Mortality, 1918. Nett Deaths from stated Causes at various Ages under One Year of Age. causes of death. Under 1 Week. 1-2 Weeks 2-3 Weeks 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 and under 6 Months. 6 and under 9 Months. 9 and under 12 Months. Total Deaths under 1 Year. All Causes {Certified 19 2 4 ... 25 10 19 4 10 68 {Uncertified 1 ... ... ... 1 ... ... ... ... 1 1. Small-pox ... ... ... ... ... ... ... ... ... ... 2. Chicken-pox ... ... ... ... ... ... ... ... ... ... 3. Measles ... ... ... ... ... ... ... ... ... ... 4. Scarlet Fever ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... 2 3 ... 2 7 6. Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... 7. Erysipelas ... ... ... ... ... ... ... ... ... ... 8. Tuberculous Me ningitis ... ... ... ... ... ... ... ... ... ... 9. Abdominal Tuberculosis (a) ... ... ... ... ... ... ... 1 ... 1 10. Other Tubercu lous Diseases ... ... ... ... ... ... ... ... ... ... 11. Meningitis (not Tuberculons) ... ... ... ... ... ... ... ... ... ... 12. Convulsions ... ... ... ... ... ... 1 ... ... 1 13. Laryngitis ... ... ... ... ... ... ... ... ... ... 11 Bronchitis ... ... ... ... ... 1 ... ... ... 1 15 Pneumonia (all forms) ... ... ... ... ... ... 1 1 5 7 16. Diarrhoea ... ... ... ... ... ... 4 ... ... 4 17. Enteritis ... ... ... ... ... 1 2 1 ... 4 18. Gastritis ... ... ... ... ... ... 2 ... ... 2 19. Syphilis ... 1 ... ... 1 2 1 ... ... 4 20. Rickets ... ... ... ... ... ... ... ... ... ... 21. Suffocation, overlying ... ... ... ... ... ... ... ... ... ... 22 Injury at Birth 1 ... ... ... 1 ... ... ... ... 1 23. Atelectasis 2 ... ... ... 2 ... ... ... ... 2 24. Congenital Malformations (b) 6 ... ... ... 6 ... ... ... 1 7 25 Premature Birth 7 ... 3 ... 10 2 ... ... ... 12 26. Atrophy, Debility and Marasmus 3 ... ... ... 3 2 4 ... ... 9 27. Other causes 1 1 1 ... 3 ... 1 1 2 7 Totals 20 2 4 ... 21 10 19 4 10 69 Nett Births in { legitimate, 797 Nett Deaths in {legitimate infants, the year { illegitimate, 98 the year of {illegitimate infants, 13 (а) Under Abdominal Tuberculosis have been included deaths from Tuberculous Peritonitis and Enteritis and from Tabel 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, a.nd Malformation including Premature Birth. Want of Breast Milk has been included under Atrophy and Debility 50 TABLE IV. Statement of information, and of sanitary work accomplished, Sec., during 1918. Total number of Inspections, 3054. Re-inspections, 5784. ,, Intimation Notices, 336. Statutory Notices, 107. ,, deposits of plans and particulars for redrainage work, &c., 165. ,, Complaints of insanitary conditions received and investigated, 602. Smoke Nuisances — Number of nuisances and complaints 2 ,, of observations 14 ,, of notices — ,, of summonses — Hoaxing of the Working Clauses— Number of houses inspected 4 ,, dealt with under section 15 of the Housing, Town Planning, etc., Act, 1909 nil ,, of representations 4 ,, of houses remedied without closing orders — ,, of closing orders 4 ,, remedied after closing orders — „ of houses demolished — Other details — No. on Register. No. of Inspections. No. of Notices. No. oi Frosecut ons. Houses let in Lodgings 405 781 121 — Common Lodging Houses — — — — Underground Rooms — Number illegally occupied 24 ,, closed or illegal occupation discontinued 18 „ of prosecutions — Overcrowding— Number of rooms overcrowded 12 ,, remedied 12 ,, of prosecutions — 51 Cleansing- Number of adults cleansed 130 ,, of children cleansed 669 „ of rooms or premises cleansed — Water supply to tenement houses— Number of houses dealt with 27 „ of tenements supplied 27 „ of prosecutions — Bakehouses— Factories. Workshops. Number on Register 10 (4 under ground) 25 (15 underground) ,, of Inspections 20 82 „ of Notices — 5 „ of Prosecutions — — Sale oj Food, &c. — Milkshops. Ice-cream. Premises. Restaurant Kitchens. Slaughter-houses Cowsheds. Fried Fish Shops. Offensive Trades. Other Premises. Number on Register 90 72 63 4 nil. 6 — 465 ,, of Inspections 269 86 138 35 21 — 1872 „ of Notices 6 — 4 — — — 11 ,, of Prosecutions — — — — — — Disinfection Shelter - Number of persons accommodated — Customs and Inland Revenue Acts— Number of houses for which certificates asked 5 „ of dwellings contained therein 11 ,, of houses certified 1 ,, of dwellings contained therein 2 Public Mortuary— Number of bodies admitted 58 52 TABLE V. Vital Statistics of the Borough. In these Tables the Birth-rate for 1918 is calculated upon a Population of 80,400. Number of ordinary dwelling houses 10,062 At Census 1911. Population 85,495 Average number of persons per house 8.4 Year Population estimated to middle of year. Births. Deaths. Infantile Deaths. Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Kate per 1000 Births. Deaths. Death-rate per 1000 of the Population. 1902 82,380 1,516 18.4 904 110 133 87.7 73 0.89 1903 82,730 1,453 17.6 837 10.1 126 86.7 66 0.80 iy04 83,080 1,445 17.4 892 10.7 161 111.4 73 0.89 1905 83,430 1,421 17.0 823 9.9 133 93.6 73 0.87 1906 88,780 1.437 17.1 850 10.1 111 77.2 57 0.68 1907 84,130 1,359 16.1 817 9.7 98 73.1 61 0.72 19.18 84,480 1,400 16.6 803 9.5 97 69.3 74 0.88 1909 84.830 1.328 15.6 839 9.9 99 74.5 53 0.62 .910 85,210 1,340 15.7 829 9.7 81 60.4 58 0.68 19U 85,599 1,276 14.9 847 9.9 105 82.3 56 0.65 1912 85,966 1.281 14.9 861 10.0 79 61.7 64 0.74 1913 86,346 1,325 15.0 951 10.8 91 68.7 49 0.56 1914 86,731 1,273 14.7 913 10.5 91 71.5 57 0.66 1915 81,760 1,327 15.3 994 12.1 101 76.1 48 0.58 ]9i«; 81,470 1,164 13.1 862 10.5 73 62.7 55 0.67 191? 75,649 1,123 13.3 922 10.8 90 80.1 69 0.91 1918 71,815 895 11.1 1,027 14.3 69 77 75 1.04 TABLE V. (1). Vital Statistics of No. 1 (Town) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Deaths. Death-rate per 1000 of the Population. 1902 12,120 192 15.8 163 13.4 20 104.1 17 1.40 1903 12,310 194 15.7 127 10.3 14 72.1 11 0.89 1904 12,500 195 15.6 125 10.0 20 102.5 13 1.04 1905 12,690 194 15.3 127 10.0 24 123.7 9 0.79 1906 12,870 205 15.9 131 10.2 21 102.4 5 0.39 . 1907 13,070 185 14.1 152 11.6 15 81.1 13 0.99 1908 13,250 225 17.0 108 8.1 11 48.8 7 0.53 1909 13,430 196 14.6 110 10.4 15 76.5 6 0.45 1910 13,610 199 14.6 118 8.7 15 75.4 6 0.44 1911 13,820 207 15.0 133 9.6 19 91.8 7 0.51 1912 14,040 183 13.0 135 9.6 12 65.5 5 0.36 1913 14,200 201 13.8 161 11.1 11 54.7 11 0.76 1414 14,400 152 10.5 130 9.1 14 92.1 5 0.35 1915 13,550 157 10.9 147 10.8 17 108.2 5 0.26 1916 18,510 132 9.7 140 10.3 7 53.0 13 0.96 1917 12,593 143 10.3 143 11.2 12 83.9 14 1.11 1918 13,000 115 8.8 157 13.5 13 113.0 11 0.95 53 TABLE V. (2). Vital Statistics of No. 2 (Belsize) Ward. 1###]Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Deaths. Death-rate per 1000 of the Population. 1902 13,030 239 18.3 135 10.4 18 75.3 15 1.15 1903 13.110 211 16.1 121 9.2 13 61.6 13 0.99 1904 13,200 217 16.4 141 10.7 23 105.9 12 0.91 1905 13,280 209 15.7 131 9.9 13 62.2 10 0.75 1906 13 370 187 14.0 127 9.5 8 42.8 13 0.97 1907 13,450 205 15.2 114 8.5 13 63.4 10 0.74 1908 13,530 205 15.1 126 9.3 8 39.0 16 1.18 1909 13,610 204 15.0 130 9.5 16 78.4 8 0.59 1910 13,710 207 15.1 119 8.7 9 43.5 8 0.58 1911 13,780 189 13.7 135 9.7 17 90.0 10 0.72 1912 13,830 188 13.6 127 9.2 8 42.5 7 0.51 1913 14,000 214 15.0 126 8.8 16 74.7 5 0.35 1914 14,100 195 13.8 141 10.0 9 46.1 11 0.78 1915 13,250 317 22.4 144 10.8 12 37.8 6 0.45 1916 13,200 189 14.3 127 9.6 7 37.0 6 0.45 1917 12,283 185 13.6 132 10.6 13 70'2 11 0.89 1918 12,900 149 11.5 155 13.5 7 47.0 9 0.79 TABLE V. (3). Vital Statistics of No. 3 (Adelaide) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Hate per 1C00 j Births. Deaths. Death-rate per 100) of the Population. 1902 10,350 103 9.9 95 96 3 29.1 7 0.68 1903 10.310 95 9.2 101 9.8 9 94.7 1 0.10 1904 10,260 100 9.7 99 9.0 13 130.0 8 0.78 1905 10,220 96 9.4 92 9.0 4 41.7 4 0.39 1906 10,170 97 9.5 92 9.0 10 103.1 5 0.49 1907 10,120 75 7.4 86 8.5 8 106.7 2 0.20 1908 10,070 93 9.2 78 7.7 6 64.6 4 0.40 1909 10,040 83 8.3 88 8.8 4 48.2 3 0.30 1910 10,000 96 9.6 78 7.8 2 20.8 5 0.50 1911 9,950 82 8.2 99 9.9 6 73.2 3 0.30 1912 9,930 117 11.8 77 7.7 6 51.3 9 0.91 1913 9,780 97 9.7 99 9.9 9 92.8 4 0.40 1914 9,730 88 9.0 99 10.2 5 56.8 2 0.20 1915 9,150 77 7.9 104 11. 3 5 64.9 2 0.21 1916 9,100 101 11.4 95 10.4 12 115.3 5 0.54 1917 8,383 114 11.9 109 81.1 7 61.4 6 0.71 1918 9,366 97 10.3 119 14.3 6 61.8 11 1.32 54 TABLE V. (4). Vital Statistics of No. 4 (Central) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. N umber. Estimated rate per 1000 of the Population. Number. Hate per 1000 Births. Deaths. Death-rate per 1000 of the Population. 1902 9,190 110 12.0 71 7'7 11 I00.0 5 0.54 1903 9,260 99 10.7 60 6.5 8 80.8 4 0.43 1904 9,330 90 9.6 62 6.6 11 122.2 1 0.11 1905 9.400 113 12.0 60 6.4 5 44.2 6 0.64 1906 9,470 95 10.0 83 8.8 3 31.6 2 0.21 1907 9,540 108 11.3 68 7.1 9 83.3 5 0.52 1908 9,610 104 10.8 82 8.5 6 57.7 7 0.73 1909 9,680 116 12.0 63 6.5 3 25.9 3 0.31 1910 9,770 105 10.7 82 8.4 8 76.2 3 0.31 1911 9,859 92 9.3 75 7.6 8 87.0 3 0.3O 1912 9,876 97 9.8 76 7.7 4 41.2 6 0.61 1913 9,996 91 8.9 84 8.2 6 65.9 ... ... 1914 10,061 84 8.8 76 7.5 4 47.6 6 0.60 1915 9,500 91 9.0 92 9.7 4 42.5 6 0.62 1916 9,450 93 9.8 97 10.2 4 43.0 3 0.31 1917 8,733 69 6.9 76 8.8 2 28.9 ... 1918 9,200 69 7'5 99 11.9 5 72.5 7 0.84 TABLE V. (5). Vital Statistics of No. 5 (West End) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Deaths. Death-rate per 1000 of the Population. 1902 12,250 275 22.4 107 8.7 20 72*1 6 0.49 1903 12,320 243 19.7 111 9.0 21 86.4 12 0.97 1904 12,380 283 22.8 120 9.7 22 77.7 8 0.65 1905 12,450 250 20.1 131 10.5 23 92.0 11 0.83 1906 12,510 259 20.7 115 9.2 14 54.1 8 0.64 1907 12,580 250 19.9 114 9.1 16 64.0 9 0.71 1908 12,640 254 26.1 121 9.6 26 102.4 9 0.71 1909 12,700 239 18'8 118 9'3 13 54.1 6 0.47 1910 12,770 216 16.9 121 9.5 17 78.7 11 0.86 1911 12,850 216 16.8 102 7'9 15 69.4 10 0.78 1912 12,890 226 17.5 126 9.8 13 57.5 12 0.93 1913 13,050 240 18.0 145 10.9 11 45.8 7 0.53 1914 13,100 256 19.5 140 10 7 18 70.3 14 1.07 1915 12,390 218 16.6 151 12.1 13 59.6 11 0.88 1916 12,340 211 17.0 117 9.4 10 47.4 5 0.40 1917 11,473 221 17.3 137 11.0 13 58.8 13 1.13 1918 12,000 124 10.3 162 15.0 10 80.6 12 1.11 55 TABLE V. (6). Vital Statistics of No. 6 (Kilburn) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Pulmonary Tuberculosis. Number. Estimated rate per l000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Deaths. Death-rate per 1000 of the Population. 1902 14,790 435 29.4 219 14.8 45 103.4 16 1.08 1903 14,800 117 28.2 184 12.4 39 93.5 18 1.22 1904 14, 810 108 27.5 200 13.9 i 54 132 .3 22 1 .48 1905 14,820 426 28.7 171 11.5 50 117.4 26 1.75 1906 14,840 444 29.9 197 13.3 41 92.0 15 1.01 1907 14,850 391 26.3 179 12. 5 28 71.6 16 1.08 1908 14,880 393 26.4 186 12.5 30 76.3 21 1.41 1909 14,890 341 22. 9 182 12.2 37 108..5 17 1.14 1910 14,900 379 25.4 192 12.9 24 63.3 16 1.07 1911 14,920 347 23.2 179 12.0 31 89.3 16 1.07 1912 15,000 353 23.5 188 12.5 26 73.6 14 0.93 1913 15,200 354 22.8 213 13.7 25 70.6 18 1.16 1914 15,300 385 25. 2 212 13.8 25 64.2 13 0.85 1915 14,440 329 21.5 230 15.8 40 121.5 11 0.76 1916 14,440 309 21.3 180 12.4 28 90.6 20 1.38 1917 13,472 280 18'9 208 15.2 37 132.1 17 1. 26 1918 14,000 241 17.2 225 18.0 21 87.1 18 1.44 TABLE V. (7). Vital Statistics of No. 7 (Priory) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Deaths. Death-rate per 1000 of the Population. 1902 10.650 162 15.2 110 10.3 16 98.7 7 0.66 1903 10,620 194 18.3 116 10.9 21 108.2 5 0.47 1904 10,600 152 11.3 121 11.4 13 85.5 9 0.85 1905 10,570 133 12.6 103 9.7 14 105.3 7 0.66 1906 10,550 150 14.2 93 8.8 9 60.0 8 0.76 1907 10, 520 127 12.1 94 8.9 7 55.1 6 0.57 1908 10,500 126 12.0 93 8.8 10 79.3 7 0.67 1909 10.480 149 14.2 111 10.6 11 73.8 8 0.76 1910 10,450 138 13.2 111 10.6 6 43.5 8 0.76 1911 10.420 143 13.7 115 11.0 9 63.0 5 0.48 1912 10,409 117 11.1 115 l6.9 7 59.8 10 0.96 1913 10,070 128 12.5 117 11.4 12 93.7 3 0.29 1914 10,040 113 11.2 110 10.9 16 141.6 5 0.50 1915 9 .480 138 13.7 126 13.2 10 72.4 7 0.73 1916 9,430 126 13.3 106 11.2 5 39.6 3 0.31 1917 8,712 111 11.2 117 13.6 6 54.0 8 0.91 1918 10,000 100 10.0 110 12.5 7 70.0 7 0.80 56 TABLE VI. Vital Statistics of Hampstead, compared with England and Wales. Year. Birth rate per 1000. General death-rate per 1000. Natural increase Hampstead. Hampstead. England and Wales Hampstead. England and Wales. 1891 21.5 31.4 12.2 22.5 670 1892 20.4 30.5 12.4 19.0 691 1893 20.5 30.8 12.9 19.2 547 1894 19.6 29.6 10.8 16.6 674 1895 19.8 30.2 13.4 18.7 452 1896 19.1 29.7 12.0 17.1 546 1897 20.2 29.7 11.6 17.4 568 1898 18.1 29.4 11.4 17.6 599 1899 19.7 29.3 11.4 18.3 650 1900 20. 0 28.7 11.3 18.3 699 1901 18.3 28.5 10.6 16.9 633 1902 18.4 28.6 11.0 16.2 612 1903 17.6 28.4 10.1 15.4 616 1904 17.4 27.9 10.7 16.2 553 1905 17.0 27.2 9.9 15.2 598 1906 17.1 27.0 10.1 15.4 587 1907 16.1 26.3 9.7 15.0 524 1908 16.6 26.5 9.5 14.7 597 1909 15.6 25.6 9.9 14.5 489 1910 15.7 24.8 9.7 13.4 511 1911 14.9 24.4 9.9 14.6 429 1912 14.9 23.8 10.0 13.3 420 1913 15.0 23.9 10.8 13.7 374 1914 14.7 23.8 10.5 14.0 360 1915 15.3 21.8 12.1 14.8 333 1910 13.1 21.6 10.5 14.0 302 1917 13.3 17.8 10.8 14.4 201 1918 11.1 17.7 14.3 17.6 —132 57 Section G. LEGAL PROCEEDINGS Legal proceedings were taken by the Council in connection with thework of the Health Department in 28 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 1918. Statute or By-law. Number of Prosecutions. Fines Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and Bye-laws made thereunder 9 15 0 0 14 16 0 Metropolis Management Acts, and Bye-laws made thereunder 8 17 0 0 5 5 0 Sale of Food and Drugs Acts 11 46 18 0 11 2 0 Total 28 78 18 0 31 3 0 58 Appendix. REPORT OF THE PUBLIC ANALYST ON THE ANALYTICAL WORK OF THE YEAR. Analytical Laboratory, Town Hall, Paddington, W. January, 1918. During the year 1918 the number of articles analysed under the Food and Drugs Adulteration Acts was 508. These comprised Milk 171 samples, General Groceries 155, Cereals 47, Butter 48, Margarine 42, Lard 31, Dripping 7, and Cheese 7. Only 12 samples of Milk and 1 of Mustard proved to be adulterated. This gives for all articles during the year 2½ per cent. of samples adulterated; the previous year showed 2.1-10 per cent. of adulterated articles. That this high standard of purity should have been maintained during so long a period of limited supply and high prices speaks well for the honesty of the tradesmen of Hampstead. I have the honour to remain, Yours obediently, ALF. W. STOKES, Public Analyst.