HAMP 25 THE Metropolitan Borough of Hampstead. REPORT for the year 1919, 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 Circumstances of the Borough 16—25 „ C.— Food 26—42 „ D.—Prevalence of and Control over Infectious Diseases 43—61 „ E.—Maternity and Child Welfare 62—85 „ F.—Sanitary Administration 86—87 „ G.—Housing 88—106 „ H.—Vital Statistics 107—111 3 His Worship the Mayor (Mr. Alderman J. I. Fraser, j.p.) ex-officio member of all Committees. PUBLIC HEALTH COMMITTEE. Chairman: Mr. Councillor C. W. Cunninoton, m.r.c.s., d.p.h. Miss Councillor Balkwill Mr. Gouucillor T. H. Nunn Mr. „ G. Buckle „ „ E. S. Payne Mrs. „ Dow, b.a. „ „ H. R. Smith Mr. „ A. W. George, m.r.c.s., l.r.c.p. „ „ P. E. Vizard „ „ C. J. R. MacFadden, m.d., c.m. „ „ R. J. J. Willis Sub committees:-Drainage Plans, Tuberculosis, Venereal Diseases. MATERNITY AND CHILD WELFARE COMMITTEE. Chairman: Mr. Councillor C. J. R. MacFadden, m.d., c.m. Members of the Council. Miss Councillor Balkwill Mrs. Councillor Dow, b.a, Mr. „ C. W. Cunnington, Mr. „ T. H. Nunn m.r.c.s., d.p.h. „ „ R. J. J. Willis. Persons not Members of the Council. (Appointed in pursuance of Section 2 (2) of the Maternity and Child Welfare Act, 1918 Mrs. Rocke Mrs. Stewart. HOUSING COMMITTEE. Chairman: Mr. Councillor H. R. Smith. Mr. Alderman T. Greenhill Mrs. Councillor Dow, b.a. „ „ J. C. Swinburne-Hanham, j.p. Mr. ,, C. Hall Miss Councillor Balkwill ,, ,, P. G. Howard Mr. „ V. H. Blessley „ „ W. P. Newman „ „ G. Buckle „ „ T. H. Nunn „ „ H. G. Cocke „ „ G. H. Paine „ „ C. W. Cunniugton, m.r.c.s., „ „ W. J. Spriggs d.p.h. (resigned in March.) „ „ R. J. J. Willis. Staff of the Public Health Department, 1919. Sanitary Inspectors: W. G. Kershaw, Senior Sanitary Inspector. R. Geary (Wards 1 & 2). W. F. Horniblow (Wards 3 & 7). A. Peverett (Wards 4 & 5). J. Grimslev (Ward 6). Divisional Inspectors. F. H. Hudson, Sale of Food and Drugs Acts, and Factory and Workshop Acts. A. C. Townsend, Housing Acts. Mrs. T. Fisher, m.a., Factory and Workshop Acts and Tuberculosis Regulations. Miss F. Hall, Infectious Diseases. Health Visitor: Mrs. K. Roche, Notification of Births Act and Maternity and Child Welfare Act. Assistants to Inspectors: W. Larkin, A. Edwards, E Stratton. Public Mortuary: W. Larkin, 63, Flask Walk, Keeper. E. Stratton, Deputy Keeper. Disinfecting and Cleansing Stations: T. Rider, G. Allaway, R. Bell, and A. L. Gibbons, Disinfectors. Mrs. Rider, Attendant at Cleansing Room. Tuberculosis Dispensary: J. F. Crookshank, m.d. (Lond.). m.r.c.p. (from Jan. to Sept.), Tuberculosis Medical Officer. A. J. Scott Pinchin, m.d. (Lond.), m.r.c.p. (Lond.) (from Oct.) Miss M. Lowen, Nurse. Pre-Maternity Clinics: Miss Mary Kidd, m.b. (Lond.), Medical Officer in Charge. Miss M. Lowen, Nurse. Clerical Staff: W. Sell, F. S. Hill. (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. Scrasc, f.r.c.s. (Eng.), l.r.c.p. (Lond.), d.p.h. (Lond.). 4 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W. 3. 20th April, 1920. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I have the honour to place before you my Annual Report for the year 1919. The various sections with their subject matter are arranged in accordance with the Memorandum of the Ministry of Health, dated January, 1920, as far as these relate to matters appertaining to the Borough. On page 58 I have incorporated a Report received from Dr. A. J. Scott Pinchin on the work of the Tuberculosis Dispensary; and on page 71 will be found a Report submitted by Dr. Mary Kidd on the work of the Ante-Natal Clinics for the year 1919. With four exceptions, all members of the Staff who were away on War Service have now returned to their duties. Of the four exceptions, Lieutenant B. C. Harley (Clerk) and Private C. Deverell (Assistant to Sanitary Inspectors) made the supreme sacrifice. Lieutenant B. C. Harley was killed in action, and Private C. Deverell was long reported missing, and his ultimate fate is unknown. Of the two other Clerks, C. B. Harley was severely wounded and elected not to return to the service of the Borough; while R. Pollock (ClerkDraughtsman) found other employment. I desire to take the opportunity of expressing my thanks to the Council, especially to the Chairmen and Members of the Public Health Committee, the Housing Committee, and the Maternity and Child Welfare Committee, for the support and sympathetic consideration they have afforded me. I am also deeply indebted to all members of the Staff of the Department, both permanent and temporary, who have carried out their work in a satisfactory and efficient manner, and have at all times afforded me their loyal and unselfish co-operation. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, FRANK E. SCRASE, Medical Officer of Health. 5 Section A. NATURAL AND SOCIAL CONDITIONS OP THE BOROUGH. SUMMARY OF VITAL STATISTICS FOR 1919. Population estimated to middle of 1919 for Birth-Rate 91,682 for Death Rate 88,012 Density 38.9 persons per acre Marriages 777 Marriage-Rate 17.0 Births 1,156 Birth-Rate 12.6 Deaths 1,036 Death Rate 11.8 Infantile Mortality 83 Death-Rate from the principal Epidemic Disease 0.16 Death-Rate from Pulmonary Tuberculosis 0.64 Death-Rate from All Forms of Tuberculosis 0.82 Census, 1911. Population 85,495 Buildings used as Dwellings 11,976 Average number of persons per house 7.1 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 1919:— For the birth-rate 91,682 „ death-rate 88,012 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. The "death rate population" excludes all non-civilian males, whether serving at home or abroad. This, it is stated, 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 natural increase in population, i.e., excess of births over deaths was 120. I have prepared the following estimates of the population of each Ward based upon the figures quoted above:— Ward. Estimated Population for calculating birth-rate and marriage rate Estimated Population for calculating death rate. No. 1 (Town) 14600 14100 No. 2 (Belsize) 14500 14000 No. 3 Adelaide) 10982 10112 No. 4 (Central) 10800 10200 No. 5 (West End) 13600 13200 No. 6 (Kilburn) 15700 15600 No. 7 (Priory) 11500 10800 The Borough 91682 88012 7 The physical features and general character of the Borough were set out at some length in my Annual Report for the year 1914. Briefly, it may be stated that Hampstead's position on a hill raises it considerably above other parts of London. Tho height of the ground at the foot of the Flag-Staff at the summit of the Heath is 438 feet, while the lowest parts of the Borough are at Chalk Farm and Kilburn Priory, the former 100 and the latter 101 feet above sea level. Hampstead Hill is formed by a huge elevation in the bed of the deposit known as London clay, which forms the whole of the mass up to about 360 feet above sea level. This great cone of earth supports an extensive cap of sand in places 80 feet thick, known as Bagshot sands. Down below the London clay occurs deposits of gravel and sand known as the Woolwich and Reading beds and Thanet sands, and below all again the chalk. Few people realise that Hampstead Heath is really a sandy waste, and that it is to the presence of its sandy cap that Hampstead is indebted for the Heath itself. This sandy cap is what is known as an "outlier" of a vast sheet of sand that extends over a large portion of Surrey, Hants, and Berkshire. The Bagshot sands are, for the most part, unfruitful from an agricultural point of view, and Hampstead Heath has remained a Heath probably because its fertility was insufficient to make it worth while enclosing. The atmosphere is dry and bracing, and the prevailing winds south-west and mild. The Borough is one of the healthiest and most popular for private residence of all the London Boroughs and adjoining districts. MARRIAGES. According to the return kindly furnished to me by the Superintendent Registrar of Hampstead, it appears that 777 marriages were registered in the Borough during 1919, as compared with 745 in the preceding year. The following Table gives the marriage rates per 1,000 of the population for the years 1909-1919:— 1909 16.0 1914 19.0 1910 14.8 1915 23.2 1911 16.3 1916 17.8 1912 15.0 1917 18.7 1913 14.9 1918 18.5 1919 17.0 8 BIRTHS. During the year 1,064 births-545 males and 519 females—were registered in Hampstead, as compared with 799 registered in the previous year Of the 1,064 births, 43 males and 49 females—were of children who could not be deemed to belong to Hampstead. In addition, 184 births of children—93 males and 91 females —whose mothers were Hampstead residents, occurred outside the Borough in Lying-in Institutions, &c. The nett number of births belonging to Hampstead was therefore 1,156—595 males and 561 females—as compared with 895 in 1918, and being an increase of no less than 261. The following are the birth rates per 1,000 of the population for each of the Wards, the Borough, London, and England and Wales:— No. 1 (Town) Ward 10.2 No. 2 (Belsize) „ 13.5 No. 3 (Adelaide) „ 8.8 No. 4 (Central) „ 9.3 No. 5 West End) „ 12.9 No. 6 (Kilburn) „ 18.8 No. 7 (Priory) „ 12.3 The Borough 12.6 London 18.3 England and Wales 18.5 The rate of 12 6 is the lowest recorded for Hampstead since Civil Registration began, with the exception of the rate of 11.1 in 1918. This may not appear clear in view of the fact that the number of births increased by no less than 261; but against this increase of births must be put the large increase in population which took place between 1918 and 1919, this being no less than 11,216. The subject of the decline in the birth-rate is one of great importance, and calls for serious consideration. The highest birthrate recorded in Hampstead was in the year 1878, when the rate was 24.5. Since then the rate has steadily declined. Throughout England and Wales there has also been marked reduction of the birth-rate, but the Hampstead figures show a greater proportionate decline. It behoves the nation, and indeed, the Empire, to realise that one of the real bases of riches lies finally in the stock of healthy children, 9 The effort that is made to-day in the direction of the saving of all infant life—including even the almost totally unfit—must not he allowed to blind us to the great issues also at stake indicated by the rapidly declining birth-rate. If the birth-rate of legitimate children were calculated upon the number of married females of conceptive ages instead of upon the whole population, I am of opinion the decline would be found to be much more marked. Of two great causes of the decline of the birth-rate, voluntary limitation of families is outside the scope of the Health Authorities' activities, but one cause, namely, venereal disease can and is being grappled with. It behoves everyone who is interested in the subject of the declining birth-rate, as well as the health of the nation at large, to make themselves informed on this subject of venereal disease. Never in the history of the present generation has it been so important. Lectures are given periodically on this subject, and information will also be readily supplied from the Public Health Department if applied for, both as regards education on the subject and on the way to obtain treatment for anyone suffering from venereal disease. In the Table on page 111 the birth-rates of Hampstead may be compared with those of England and Wales since 1891. Illegitimate Births. Of the 1,064 births registered in the Borough 53 were of illegitimate children. Of the total 1,156 nett births belonging to Hampstead, 117 or 101 per 1,000 births registered were those of illegitimate children. 54 of these were born outside the Borough, chiefly in Lying-in Institutions, while 10 occurring within the Borough were considered not to be Hampstead children. The rate per 1000 births in 1918 was 109. 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 10 resident persons, and, after subtracting these, the number of deaths of civilian Hampstead residents who died outside the Borough is added. The total nett deaths during 1919 was 1,036, or 11.8 per 1000 of the population, as compared with 14.3 in the preceding year. The following are the death-rates per 1000 of the population for each of the Wards, the Borough, London, and England and Wales:— No. 1 (Town) Ward 12.0 No. 2 (Belsize) „ 11.3 No. 3 (Adelaide) „ 12.8 No. 4 (Central) „ 11.5 No. 5 (West End) „ 10.5 No. 6 (Kilburn) „ 12.9 No. 7 (Priory) „ 11.1 The Borough 118 London 13.4 England and Wales 13.8 In the table on page 111 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:— 11 Table showing the Death-Rates from All Causes in the County of London, the City of London, and the Metropolitan Boroughs during 1919. DISTRICT. Death-rate from all causes. Hampstead 11.8 Wandsworth 11.2 Lewisham 11.4 Fulham 12.1 Woolwich 12.2 Camberwell 12.4 Hammersmith 12.6 Battersea 12.7 Stoke Newington 12.7 Deptford 12.8 Paddington 13.0 Hackney 13.0 St. Pancras 13.2 Greenwich 13.5 Bermondsey 13.7 Westminster, City of 13.9 Bethnal Green 13.9 London, City of 14.0 Islington 14.1 Stepney 14.4 Poplar 14.4 Chelsea 14.6 Lambeth 14.6 Kensington 14.9 Southwark 14.9 Finsbury 15.2 St. Marylebone 15.2 Shoreditch 15.7 Holborn 16.2 County of London 13.4 12 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 the Tables on pages 15 and 83. Age Periods. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards All Ages. Deaths 96 13 11 25 47 153 287 404 1036 Causes of Death. The causes of death are given in the Table at the end of this Section. 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 1914—1919. Year. No. of Deaths from Cancer. Death-rate per 1000 of the population. 1914 114 1.31 1915 118 1.44 1916 113 1.38 1917 107 1.41 1918 105 1.46 1919 123 1.40 Of the deaths from Cancer, 71 were females and 52 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 52 cases the persons were over 65 years of age. The next table gives the anatomical distribution of the disease in each sex. 13 Situation. Males. Females. Total. Buccal cavity 6 1 7 Stomach, Liver, &c. 16 14 30 Peritoneum, Intestines and Rectum 10 21 31 Genital Organs 3 22 25 Breast — 7 7 Other, or unspecified, organs 17 6 23 Totals 52 71 123 Diarrhoea mid Enteritis. Of the total deaths at all ages from Diarrhoea and Enteritis in Hampstead duriug 1919, which numbered 21, 16 took place among children under one year of age. The deaths from these diseases at various age periods in recent years is as follows:— Year. Under 1 year. 1 and under 2 yeara. 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. 1914 7 2 l l - l 2 2 16 1915 14 — l — — 2 — 1 18 1916 6 2 8 1917 9 — — — — — 1 2 12 1918 8 - - - - - 3 2 13 1919 16 l - - - 2 2 21 Totals 60 2 3 l — 3 8 11 88 Principal Epidemic Diseases. All of these, with the exception of whooping cough, are notifiable diseases, and information concerning them is set out in Section "D" of this Report. The total number of deaths from the principal epidemic diseases is as follows; the death-rate was 0.16 per 1000 of the population. Enteric Fever — Scarlet Fever 2 Small-pox — Whooping Cough — Measles 5 Diphtheria 7 14 Tuberculosis. 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." Violent Deaths (excluding Suicide). 20 deaths were classified under this heading as compared with 14 in 1918. Among other causes, 7 were due to falls; 2 to injuries caused by being knocked down or run over by trains; 2 by crushing in lifts, and 5 by street accidents. Suicide. 10 persons committed suicide, being the same number as in 1918. Among other causes, 2 deaths were due to poisoning; 3 from hanging; and 1 from burns. 15 Causes of Death at Different Periods of Life during the Year 1919. 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 ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 2. Small pox M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 3. Measles M 4 ... 1 2 ... 1 ... ... ... F 1 ... 1 ... ... ... ... ... ... 4. Scarlet Fever M 2 ... ... 2 ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 5. Whooping Cough M ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... 6. Diphtheria and Croup M 5 ... ... 1 3 ... ... ... 1 F 2 ... ... 1 ... ... ... 1 ... 7. Influenza M 37 2 ... ... ... ... 19 7 9 F 58 1 1 1 ... 9 26 10 10 8. Erysipelas M ... ... ... ... ... ... ... ... ... F 3 ... ... ... ... ... 1 ... 2 9. Pulmonary Tuberculosis M 32 ... ... ... ... 3 15 11 3 F 24 ... ... ... 1 10 7 6 ... 10. Tuberculous Meningitis M 3 1 1 ... 1 ... ... ... ... F ... ... ... ... ... ... ... ... ... 11. Other Tuberculous Diseases M ... ... ... ... ... ... ... ... ... F 13 ... ... ... 1 2 6 3 1 12. Cancer, malignant disease M 52 ... ... ... ... ... 4 25 23 F 71 ... ... ... ... ... 8 34 29 13. Rheumatic Fever m 2 ... ... ... 1 ... 1 ... ... F 1 ... ... ... 1 ... ... ... ... 14. Meningitis (A) M 1 ... ... ... ... 1 ... ... ... F 1 ... ... ... ... ... 1 ... ... 15. Organic Heart Disease m 70 ... ... ... 3 3 6 24 34 F 66 ... ... ... ... ... 6 18 42 16. Bronchitis M 34 ... 1 ... 1 ... ... 12 20 F 35 1 ... ... ... ... ... 2 32 17. Pneumonia (all forms) M 30 8 3 ... 1 ... 2 7 9 F 34 3 ... ... 2 6 5 9 9 18. Other Respiratory Diseases M 9 ... ... ... ... ... 1 3 5 F 14 ... ... ... ... ... 1 6 7 19. D iarrhœa, &c. (B) 11 9 7 ... ... ... ... ... 2 ... F 12 9 ... 1 ... ... ... ... 2 20. Appendicitis and Typhlitis M 4 ... ... ... ... 1 1 1 1 F 2 ... ... ... ... ... 1 1 ... 1. Cirrhosis of Liver M 4 ... ... ... ... ... ... 2 2 F 2 ... ... ... ... ... 1 ... 1 21a. Alcoholism m ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... 22. Nephritis and Blight's Disease m 19 ... ... ... ... ... 1 6 12 F 12 ... ... ... ... ... 3 6 3 23. Puerperal Fever m ... ... ... ... ... ... ... ... ... F 2 ... ... ... ... ... 2 ... ... 24. Parturition apart from puerperal fever M ... ... ... ... ... ... ... ... ... F 2 ... ... ... ... 1 1 ... ... 25. Congenital Debility, &c. m 25 24 1 ... ... ... ... ... ... F 17 15 ... ... ... 1 ... 1 ... 26. Violence, apart from Suicide m 14 ... ... 2 3 1 1 6 1 F 6 2 ... ... ... ... 1 2 1 27. Suicide M 6 ... ... ... ... 2 1 1 2 F 4 ... ... ... ... 1 1 1 1 28. Other Defined Diseases M 135 9 2 ... 4 1 11 42 66 F 156 14 2 1 3 4 19 38 75 29. Causes ill-defined or unknown m 1 ... ... ... ... ... ... ... 1 F ... ... ... ... ... ... ... ... ... All causes m 498 51 9 7 17 13 63 149 189 F 538 45 4 4 8 34 90 138 215 Totals 1036 96 13 11 25 47 153 287 104 All "Transferable Deaths" of residents, i.e., of persons resident in the Borough who died outside it, have been included. 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. (A) Exclusive of "Tuberculous Meningitis" (see Title 10), but inclusive of Oerebro-spinal Meningitis. (B) Title 19 is used for deaths from Diarrhoea and Enteritis at all ages. 16 Section B. SANITARY CIRCUMSTANCES OP THE BOROUGH. Scavenging. During 1919 great and growing difficulty has been experienced by the Works Committee in disposing of the house refuse. For some years now, the whole of our refuse has been disposed of at shoots, and these at present seem impossible to obtain. The matter has received full and earnest consideration by the Works Committee and Council during the year, and a plan for crushing has been agreed to. For this purpose a site has been secured and tenders for the erection of the necessary plant obtained. The matter is being pushed on with all possible dispatch. Sanitary Inspection of Borough. Statement of information, and of sanitary work accomplished, &c., daring 1919. Total number of Inspections, 5321. Re-inspections, 9546. „ Intimation Notices, 666. Statutory Notices 346. „ deposits of plans and particulars for redrainage work, &c., 449. „ Complaints of insanitary conditions received and investigated, 1414. Smoke Nuisances— Number of nuisances and complaints 2 „ of observations 57 „ of notices 2 „ of summonses 1 Housing of the Working Classes— Number of houses inspected 6 „ of representations by householders — „ of houses included in such representations — „ of representations by Medical Officer of Health 6 „ of houses included in such representations 6 „ of houses remedied without closing orders — „ of closing orders 6 „ of houses included in such closing orders 6 17 Number of closing orders determined — „ of demolition orders 2 „ of houses demolished— (a) in pursuance of orders — (b) voluntarily — „ buildings demolished — „ of houses dealt with under section 15 of the Housing Act, 1909 — Obstructive Buildings — Number of representations under section 38, Housing Act, 1890 — „ representations still under consideration — Number of orders for repairs issued under section 28, Housing Act, 1919 — „ of houses repaired by Borough Council — „ of houses closed on notice by owner that they could not be made fit — Total number of houses in the Borough 12099 Number of houses occupied by the Working Classes— Tenement houses 830 Rooms over shops, stables, &c. 80 Other small assessments (less than £20 a year) 923 1833 Number of houses for the Working Classes— (a) erected during 1919 — (b) in course of erection — Other Details— Closing orders confirmed 3 Work in hand at end of year at premises under closing orders 3 No. on Register. No. of Inspections. No. of Notices. No. of Prosecutions. Houses let in Lodgings 405 707 112 — Common Lodging Houses — — — — Underground Rooms— Number illegally occupied 35 „ closed or illegal occupation discontinued 35 „ of prosecutions — 18 Sale of Food, &c.— Milkshops. Ice-cream. Premises. Restaurant Kitchens. Slaughter-houses. Cowsheds. Fried Fish Shops. Offensive Trades. Other Premises. Number on Register 85 72 63 4 nil. 8 nil. 495 „ of Inspections 315 108 182 32 16 1945 „ of Notices 9 7 6 2 — 15 „ of Prosecutions — — — — — — Overcrowding— Number of rooms overcrowded 10 „ remedied 10 „ of prosecutions — Cleansing— Number of adults cleansed 34 „ of children cleansed 840 „ of rooms or premises cleansed 30 Water supply to tenement houses— Number of houses dealt with 63 „ of tenements supplied 115 „ of prosecutions — Bakehouses— Factories. Workshops. Number on Register 11 (5 underground) 25 (14 underground) „ of Inspections 26 54 „ of Notices — 12 „ of Prosecutions — — Disinfection Shelter- Number of persons accommodated — Customs and Inland Revenue Acts— Number of houses for which certificates asked 2 „ of dwellings contained therein 6 „ of houses certified 1 „ of dwellings contained therein 4 Public Mortuary— Number of bodies admitted 56 19 Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department in 17 cases during the year. The facts relate only to the cases that were heard and decided in 1919. Statute or By-law. N umber of Prosecutions. Fines. Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and Bye-laws made thereunder 9 30 0 0 9 4 0 Metropolis Management Acts, and Bye-laws made thereunder 2 12 0 0 1 1 0 Sale of Food and Drugs Acts 4 19 0 0 2 12 6 Housing Acts 2 2 0 0 2 2 0 Total 17 63 0 0 14 19 6 In addition to the matters mentioned in the foregoing statement, the following subjects call for special mention:— 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 9,469 plans for the alteration and reconstruction of drains in existing premises have been received. During 1919,449 deposits of plans and particulars relating to redrainage work, etc., were made. Cleansing Station. During 1919, 840 children and 34 adults were cleansed at the Cleansing Station by the Council's Attendant, and whilst this was in progress their clothes were thoroughly disinfected. The County Medical Officer of Health and School Medical Officer has kindly supplied me with the following statistics relating to action taken in respect to the cleanliness of Hampstead elementary school children in 1919. It is noteworthy to find that, out of 28,199 examinations made, in no less than 10,002 cases, or 35 per cent., verminous conditions were found to exist. Cleanliness of Elementary School Children in Hampstead in 1919. Number of examinations made 28,199 Number found verminous (including nitted heads, and verminous bodies and clothing) 10,002 20 Analysis of Action taken under L.C.C. Cleansing Scheme. Number of children re examined (followed up from figures shown above) 5,519 Number found verminous at this examination, and parents notified 633 Cleansed by parents 387 Attended station voluntarily for cleansing 159 Parents warned by service of statutory notice under Children Act, 1908 78 Voluntary attendances at station after Statutory Notice served 30 Conveyed for compulsory cleansing 40 Customs and Inland Revenue Acts. During the year applications for certificates under these Acts were received in respect of 6 dwellings. The total number of dwellings in relation to which certificates were issued was 4. Smoke Nuisances. During the year observations were made in 56 instances by the Sanitary Inspectors and 2 notices were necessary to be served. Public Mortuary. During the year the bodies of 56 persons were brought to the mortuary—31 by order of the Coroner, 12 by the Police, and 13 at the request of friends of deceased persons. In 30 instances inquests were held, and in 25 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 Bodies received. Deaths from natural causes 30 Accidental deaths 8 Suicide 9 Open Verdict 2 Wilful murder (newly born female child) 1 Misadventure 2 Neglect at Birth 2 Total 54 In addition to these 54 bodies, the fœtal bodies of two male children wore also brought to the Mortuary. Disinfecting Station. During the year 1,589 houses or parts of houses were disinfected, together with their contents, while in addition all infected articles of clothing, &c., were suitably dealt with. Premises and Occupations which can be controlled by Bye-laws or Regulations. A reference to bye-laws in regard to houses let in lodgings will bo found in the section relating to "Housing." 21 Regulations in respect of underground sleeping roams (Housing and Town Planning, &c., Act, 1909, sect. 17 (7), were approved by the Council and the Local Government Board in 1911; they are in the following terms:— REGULATIONS. Prescribed, under section 17 (7) of the above Act, by the Mayor, Aldermen, and Councillors of the Metropolitan Borough of Hampstead, with which a room habitually used as a sleeping place, the surface of the floor of which is more than three feet below the surface of the part of the street adjoining or nearest to the room, shall comply (a) Such room shall have in every part thereof at least three feet of its height above the surface of the street or ground adjoining or nearest to the room —Provided that if the width of the area hereinafter mentioned be not less than the height of the room from the floor to the said surface of the street or ground, or be not less than six feet, the height of the room above such surface may be less than three feet, but not in any case less than one foot. (b) Every wall of such room shall be constructed with a proper dampproof course, and if in contact with the soil shall be effectually protected against dampness from that soil by means of a vertical damp-proof course or otherwise. (c) There shall be outside of and adjoining such room and extending along the entire frontage thereof and open upwards from six inches below the level of the floor thereof an area properly paved and effectually drained at least three feet wide in every part, and of a mean width not less than four feet— Provided that in tlie area there may be placed steps necessary for access to the room, and over and across such area there may be steps necessary for access to any building above the room if the steps in each case be so placed as not to be over or across any external window of the room. (d) The subsoil of the site of such room shall be effectually drained by means of a subsoil drain properly trapped and ventilated wherever the dampness of the site renders such a precaution necessary, (e) The space, if any, beneath the floor of such room shall be provided with adequate means of ventilation. (f) Every drain passing under any such room, other than a drain for the drainage of the subsoil of the site of the room, shall be properly constructed of a gas-tight pipe. (g) Such room shall be effectually protected against the rising of any effluvia or exhalation by means of a layer of asphalte or of good cement concrete at least six inches thick, or four inches thick if properly grouted, laid upon the soil of the site of the entire room, or in some equally effectual manner; any such concrete shall be composed of clean gravel, broken hard brick, properly burnt ballast, or other suitable hard material, well mixed with cement in the proportion by measure of one part of cement to not more than eight parts of the other material. (h) Every such room which is without a fire-place and a flue properly constructed and properly connected with such fire-place shall be provided with special and adequate means of ventilation by a sufficient aperture or air shaft which shall provide an unobstructed sectional area of 54 square inches at the least, and every part of which shall be not less than six feet above the level of the floor of the room. (i) Such room shall have one or more windows opening directly into the external air with a total area clear of the sash frames equal to at least onetenth of the floor area of the room, and so constructed that one-half at least of every such window can be opened, and that the opening may in every case extend to the top of the window. Section 132 of the Factory and Workshop 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, 22 Factories, Workshops, Workplaces and Homework. 1.—Inspection of Factories, Workshops, and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 4 — — Workshops (Including Workshop Laundries) 183 3 — Workplaces (Other than Outworkers premises included in Part 3 of thid Report) 1945 15 — Total 2132 18 — 2.—Defects found in Factories, Workshops, and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Act:— Want of cleanliness 5 5 — — Want of ventilation 7 7 — — 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) 1 — — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) — — — — Other offences (Excluding offences relating to outwork, which are included in Part 3 of this Report) 2 2 — — Total 15 14 — — * This matter was sub judice at the close of the year. 23 3.—Home-Work, 66 lists of outworkers were received from employers. These contained 180 entries. There are 95 outworkers' premises in Hampstead, 6 being Factories, 26 Workshops, 21 Domestic Workshops and 42 single workers. NATURE OF WORK. Outworkers' Lists, Section 107. Lists received from Employers. Sending Twice in the year. Sending Once in the year. Outworkers† Outworkers. Lists Contractors. Workmen. Lists. Contractors. Workmen. 1 2 3 4 5 6 7 Wearing Apparel— (1) making, &c. 32 23 61 7 7 9 (2) cleaning and washing 10 11 1 1 4 — Household linen 4 2 11 1 — 1 Lace, lace curtains and nets — — 2 — — — Curtains and furniture hangings 4 3 7 — — — Furniture and upholstery 4 1 11 1 — 1 Electroplate — — 5 — — — Brass and brass articles — — 1 — — — Locks, latches and keys — — 2 — — — Umbrellas, &c. — — — — 2 — Paper, &c., boxes, paper bags 2 — 15 — — — Total 56 40 116 10 13 11 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. 103, Nil; Outwork in infected premises, Sees. 109110, 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.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. (1) Number. (2) Bakehouses 25 Bootmakers 29 Dressmakers and ladies' tailors 66 Tailors 42 Other 190 Total number of workshops on Register 352 24 5.—Other Matters. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133) 28 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 5 Reports (of action taken) sent to H.M. Inspector 1 Other — Underground Bakehouses (s. 101, 1901) in use at the end of the year 20* * Including one illegally occupied. Factories. The sanitation of Factories is largely controlled by the Factory Inspectors, but Borough Councils are responsible, among other duties, for the administration of Section 38 of the Public Health (London) Act, 1891, which requires the provision of suitable and sufficient accommodation in the way of sanitary conveniences for the persons of both sexes employed therein. The following is a list of the different classes of Factories in Hampstead:— Art Metal Workers 2 Dairymen 2 Bakehouses 11 Laundries 2 Bootmakers 15 Motor Workers 6 Builders 4 Printers 10 Butchers 7 Other Irades 24 Carpet Beaters 2 — Coffee Roasters 5 90 Workshops. At the end of 1919 there were 352 workshops on the Register, of which 32 were domestic workshops. Excluding these, there were 25 501 males and 440 females employed therein. During the year 183 inspections were made and 3 notices served. Trade or Business. Workshops other than Domestic Workshops. Domestic Workshops. Total number of Workshops. Number of Workshops, Number of Workrooms. Number of Employees. Males. Females. Bakers 25 25 66 6 - 25 Blindmakers 3 5 5 3 — 3 Bootmakers 29 32 51 — — 29 Builders and carpenters 14 15 17 — — 14 Cabinetmakers and polishers 2 6 22 1 1 3 Carriage builders 6 12 15 — - 6 Cycle makers and repairers 3 6 10 — — 3 Dressmakers and ladies' tailors 55 58 5 208 11 66 Harness makers 3 7 14 11 — 3 Ironmongers 13 13 24 — — 13 Laundresses 3 9 1 18 — 3 Milliners 16 16 — 20 2 18 Monumental masons 2 2 14 - — 2 Motor makers 10 13 26 - — 10 Outfitters 8 23 1 63 — 8 Pianoforte makers 2 4 12 — - 2 Picture frame makers 10 12 12 - — 10 Sign writers 2 5 7 — — 2 Smiths 9 9 17 — — 9 Tailors 30 34 50 27 12 42 Upholsterers 19 24 38 9 1 20 Watchmakers and jewellers 11 11 14 - - 11 Wigmakers 9 9 1 17 — 9 Miscellaneous 36 48 79 47 5 41 Totals 320 398 501 440 32 352 Domestic Workshops. These premises have been defined as a private room or dwelling where a trade process is carried on by the members of the family residing therein. As stated in the preceding table, the number of domestic work, shops known to the Department is 32. Workplaces. These are places which do not come within the definition of Factories or Workshops, but where persons assemble to do work of some kind or other. Among the more important workplaces are the kitchens of restaurants, coffee-houses, &c. During the year 1945 inspections were made and 15 notices were served. 26 Section C. FOOD. Milk Supply. 54 persons occupying 85 premises have been registered as purveyors of milk, comprising 45 dairies, 18 bakehouses and confectioners, 11 restaurants and coffee shops, and 11 general shops. During the year 315 inspections were made and 9 notices were served. Milk (Mothers and Children) Order, 1918. In accordance with the instruction of the Ministry of Health, as stated in paragraph 4 of their circular No. 23, dated 14th October, 1919, the following information is given:— "This Order, dated 8th February, 1918, was made by the Food Controller under the Defence of the Realm Regulations, and bv paragraphs 1 and 2 it provided that:— "Any local authority within the meaning of the Notification of Births Act, 1907, may, and, when required by the Local Government Board, shall arrange for the supply of food and milk for expectant mothers and nursing mothers and of milk for children under 5 years of age, subject to such conditions as may from time to time be prescribed by the Food Controller. "Until further notice, the following conditions shall be observed:— "The quantities of food and milk to be supplied shall not in any case exceed the amount certified to be necessary by the Medical Officer of Health, or the Medical Officer of a Maternity or Child Welfare Centre working in co-operation with the Local Authority, or by a person authorised in that behalf by either of such Medical Officers, or by some other person appointed by the Local Authority for this purpose. "In necessitous cases in which the Medical Officer of Health or the Medical Officer of a Maternity or Child Welfare Centre working in co-operation with the Local Authority or any person authorised in that behalf by either of such Medical Officers or by some other person appointed by 27 the Local Authority for this purpose, certifies that the provision of food or milk is necessary, food or milk may be supplied free or may be sold at less than cost price." The requisite powers and duties for the discharge of the functions assigned by this Order were conferred by the Local Government Board upon the Borough Council by their Order, The Local Authorities (Food Control) Order (No. 1), 1918, dated 8th February, 1918, and in a covering letter, dated 9th February, 1918, the Board drew the attention of the Council to these Orders. These Orders remained in force until 22nd December, when they were superceded by the Milk (Mothers and Children) Order, 1919, and The Local Authorities Milk (Mothers and Children) Order, 1919. These two latter Orders re-enacted those Orders with the following modifications:— (a) The Order related to milk only and not to food. (b) The power of the Local Government Board to require local authorities to make arrangements for the supply of milk was omitted. (e) Local authorities were empowered to supply milk free or at less than cost price not merely in necessitous cases but also where such a supply is necessary because of the retail price of milk in any area. Tho quantity of milk to be supplied was specified to be the same as that stated in the Local Government Board Circular of 9 th February, 1918. The effect of the Order therefore was to empower local authorities to supply milk to expectant and nursing mothers and young children without previously obtaining the consent of the Ministry of Health (as required by the Maternity and Child Welfare Act, 1918, in respect of distribution carried out under that Act) free or under cost price where some person authorised by the local authority certified this to be necessary by reason of the retail price of milk in its district. It should be understood that the Maternity and Child Welfare grant distributed by the Ministry of Health is limited to the cost of any food, including milk, distributed to necessitous cases occurring among expectant and nursing mothers, and children under five years of age, who are certified by the Medical Officer of the Centre, or by the Medical Officer of Health, to be in need of the food or milk. It does not apply to any other class of the community. 28 The Borough Council early in the year gave instructions for the Borough to be circulated upon the subject of the scheme for the supply of milk to necessitous mothers and children under five, and the Medical Officer of Health was empowered to put into operation a scheme he had prepared. The Council further resolved that it should be "left to the discretion of the Medical Officer of Health as to the amount to be supplied, and as to the dealing with the applications received." During the year the following amounts of money were voted by the Council—£200, £25, £100, and £750. It was estimated that the last-named figure would carry over until the first meeting of the Council in January. In pursuance of Clause 8 of the Ministry's letter of October 14th, a circular letter was sent to all medical practitioners, nurses, midwives, and others, directing attention to the Borough Council's scheme, which had already been advertised widely. The number of families assisted has fluctuated, being affected by the current price of milk and to some degree by economic conditions. During June and July the number of families being helped dropped to 17, while the highest number, 173, was experienced in December. A remarkable rise in the number of applicants took place when milk rose to l1d. and Is. per quart. The following Table gives an analysis of the cases being helped in December:— Details of Families assisted with Milk in December, 1919. Minimum Maximum. Average. Percentage of total cases assisted. Wife and one child. £ s. d. £ s. d. £ s. d. Income 1 6 0 2 0 0 1 10 0 6 Rent 0 5 0 0 12 6 0 8 8 Man, wife, and one child. Income 0 16 0 2 15 0 1 18 7 9 Rent 0 7 0 0 11 0 0 8 8 Man, wife, and tiro children. Income 0 12 0 3 10 0 2 6 9 23 Rent 0 2 6 0 13 0 0 8 1 Man, wife, and three children. Income 1 10 0 3 17 0 2 13 9 22 Rent 0 4 6 0 16 0 0 9 6 Man, trite, and four children. Income 2 0 0 4 5 0 3 0 4 22 Rent 0 5 0 0 18 6 0 9 0 Carried forward 82 29  Brought forward 82 £ s. d. £ s. d. £ s. d. Wife and five children. Income 2 0 0 3 0 0 2 10 0 2 Rent 0 7 10 0 13 6 0 10 8 Man. wife, and five children Income 1 5 0 4 10 6 2 15 3 11 Rent 0 5 0 0 13 6 0 8 8 Man. wife, and six children. Income 2 0 0 3 10 0 2 15 0 2 Rent 0 6 0 0 13 0 0 9 6 Man, wife, and seven children. Income 2 0 0 — — 1 Rent 0 9 0 — — Wife. and seven children. Income 2 18 6 — — 1 Rent 0 14 0 — — Man. wife, and eight children. Income 3 17 0 — — 1 Rent 0 6 6 — — 100 The Council adopted the scale of income which the Medical Officer of Health drew up governing the grant of assistance, and also agreed to the prescribed amounts of milk that had been suggested by the Ministry of Health for children under, or over, 18 months, and for expectant or nursing mothers. These arc as follows:— Weekly income below which help is given:— 1 Parent 35s. 2 Parents 40s. For each of the first 3 children 15s. For the 4th child and others 10s. Amount of Milk allowed:— For children under 18 months, not more than 11/2 pints daily. For children between 18 months and 5 years not more than 1 pint daily. For expectant and nursing mothers 1 pint daily. An application form was framed; and two other forms which comprised the order for milk, the recipients receipt, the daily record of milk delivered and the invoice. The following is a copy of these documents:— 30 No............. Date of expiration of Milk Order............................. Borongh of Hampstead PUBLIC HEALTH DEPARTMENT. Town Hall, Haverstock Hill, Hampstead, N.W. 3. MATERNITY AND CHILD WELFARE ACT, 1918. Application Form for Milk at Reduced Rate. Name of Applicant Married or Single.. Address Rent Total Income of family from all sources Occupation of breadwinner Name and Address of Employer Children (names and ages) Pre-Maternity Clinic attended (if any) Infant Welfare Centre attended (if any) Name and Address of Milkman Daily Consumption of Milk REMARKS.................................................. Signature of Head of Family (it is necessary that the husband, if at home, should sign this application.) Please state if husband is living elsewhere. Date 19 This Form when completed to be sent to the Medical Officer of Health at the Town Hall. 31 No Borough of Wampstead. FORM A. Public Health Department, Town Hall, Haver»tock Hill, N.W, 8. 19 Maternity and Child Welfare Act, 1918. To Of. Please supply to Mrs of ..pints of Milk daily during the weeks ending 19 , and charge the whole cost to the Borough Council. No goods other than Milk are to be supplied to this Order. This form is to be sent to me as soon as the milk has been supplied and the Customer's signature obtained. Medical Officer oj Health. I hereby acknowledge having received the Milk. Signature INVOICE. 19 Milk supplied, free of cost, to the above-named person to the value of during the weeks ending 19 t Signature and Address of Retailer Certified Correct, Medical Officer of Health. Date 19 . This Order In no way limits the amount of Milk that may be supplied; it is only an intimation of the quantity lor which the Council will pay. 32 FORM "A" (BACK). Date. Day. Quantity of Milk supplied free of cost. Date. Day. Quantity of Milk supplied free of cost. 19 19 Sunday Sunday Monday Monday Tuesday Tuesday Wednesday Wednesday Thursday Thursday Friday Friday Saturday Saturday Total Total Date. Day. Quantity of Milk supplied free of cost. Date. Day. Quantity of Milk supplied free of cost. 19 19 Sunday Sunday Monday Monday Tuesday Tuesday Wednesday Wednesday Thursday Thursday Friday Friday Saturday Saturday Total Total 33 No Borough of Wampstead. FORM B. Public Health Department, Town Hall, Haverstock Hill, N.W. 3. 19 . Maternity and Child Welfare Act, 1918. To Of- r I beg to inform you that under the terms of their Scheme for the supply of assisted Milk, the Borough Council are prepared to pay half the cost of pints of milk supplied by you to Mrs of during the weeks ending 19 . Please, therefore, supply her with pints of Milk daily ; collect half the cost from her, and charge the other half to the Borough Council. No goods other than Milk are to be supplied to this Order. This Form is to be sent to me as soon as the Milk has been supplied and the Customer's signature obtained. Medical Officer of Health. I hereby acknowledge having received the Milk, Signature INVOICE. 19 . Total value of Milk supplied to the above-named person during the weeks ending 19 Proportion paid by the Customer ... : : Proportion to be paid by the Borough Council ... : : Signature and Address of Retailer Certified Correct, Medical Officer of Healili. Date 19 This Order in 110 way limits the amount of Milk that may be supplied; it is only art intimation of the quantity for which the Council will assist in the payment. 34 FORM B (BACK). Date. Day. Quantity of Milk supplied. Amount paid by Customer. Date. Day. Quantity of Milk supplied. Amount paid by Customer. 19 19 Sunday Sunday Monday Monday Tuesday Tuesday Wednesday Wednesday Thursday Thursday Friday Friday Saturday Saturday Total Total Date. Day. Quantity of Milk supplied. Amount paid by Customer. Date. Day. Quantity of Milk supplied. Amount paid by Customer. 19 19 Sunday Sunday Monday Monday Tuesday Tuesday Wednesday Wednesday Thursday Thursday Friday Friday Saturday Saturday Total Total 35 The Borough Council provides food other than milk for expectant and nursing mothers, where recommended by the Medical Officer in charge of the Pre-Maternity Clinics or by the Health Visitor. Arrangements have beeu made with tradesmen to supply food to the Council's order, and with eating houses to supply dinners to expectant and nursing mothers; this latter seems the best and most popular way with the mothers; it has the advantage of ensuring that the woman herself eats the food, which is not always certain in other cases. The Ministry are prepared to pay grants not exceeding one-half of approved net expenditure involved in the supply of food and milk in this connection. The following is a specimen of the order forms employed:— Bororough of Wampstead. Public Health Department, Town Hall, Haverstock Hill, N.W. 3. 19 . Maternity and Child Welfare Act, 1918. To Of. "• Please supply to Mr of the following articles of food during the weeks ending 19 , and charge the whole cost to the Borough Council, viz.:— No food other than that specified is to be supplied to this Order. This Form is to be sent to me as soon as the goods have been supplied and the Customer's signature obtained. Medical Officer of Health. I hereby acknowledge having received the food specified above. Signature INVOICE. 19 . Food supplied, free of cost, to the above-named person during the weeks ending 19 Name of Food. Quantity. Cost. s. d. Signature and Address of Retailer certified C'oekect, Medical Officer of Health. Date 19 , This Order in 110 way limits the amount of Food tliat may be supplied ; it is only an intimation of the quantity for which the Council will pay. 36 Other Foods. The following is a list of food seized or voluntarily surrendered during the year. Date. Premises. Food. Quantity. Jan. 2nd West End Lane Cheese 35 lbs. „ 2nd „ Jam 2 lbs. „ 6th Haverstock Hill Eggs 360 „ 20th Cricklewood Broadway Jam 38 lbs. „ 20th „ Milk 5 tins. Feb. 17th High Road, Killburn Brussels Sprouts 12½ bags, 28 lbs.each. „ 17th Finchley Road Eggs 163 „ 20th South End Road Cod Fish 130 lbs. „ 22nd Kingsford Street Eggs 720 „ 26th Finchley Road Rabbits 70 Mar. 5th „ Beef 16 stone 6 lbs. „ 15th „ Milk 13 tins. „ 14th „ 3 Fowls 14 lbs. (total) May 10th Fleet Road Dates 142 lbs. „ 14th Mill Lane „ 144 lbs. „ 19th High Street Beef, hind-quarter 10½ stone. „ 20th Netherwood Street Cheese 17 lbs. „ 27th High Street Butter 7½ lbs. „ 30th Fleet Road Dates 73 lbs. Aug. 8th England's Laue Beef 10 lbs. „ 12th High Road, Kilburn „ 20 lbs. „ 12th „ Eggs 8 Sept. 5th Finchley Road Rabbits 25 „ 17th High Road, Brondesbury Eggs 114 Salmon 13 tins. Sardines 2 tins. Condensed Milk 14 tins. Apricots 1 tin. „ 20th Finchley Road Rabbits 19. „ 22nd Providence Place Bacon 163 lbs. „ 15th Finchley Road Frozen Rabbits 16 Oct. 31st Boundary Road Bacon 61 lbs. Nov. 3rd High Road, Kilburn „ 84 lbs. „ 11th „ Eggs 362 „ 11th „ Corned Beef 18 lbs. Dec. 2nd „ Bacon 30 lbs. „ 10th „ 13 tins Tomatoes, 20 tins Condensed Milk, 6 tins Sardines, 222 Eggs, 9 Rabbits „ 24th Cricklewood Broadway Bacon 40 lbs. 29th High Road, Kilburn Bacon 15 lbs. „ 30th New End Bacon 4 lbs. „ 31st South End Road Plaice 3 stone. 37 Food Premises. Section 8 of the London County Council (General Powers) Act, 1908, very consideraby increases the power of Sanitary Authorities to improve the conditions of food premises. The following are the clauses of the Section :— (1) From and after the passing of this Act the following provisions shall apply to any room, shop, or other part of a building within the County in which any article, whether solid or liquid, intended or adapted for the food of man is sold or exposed for sale, or deposited for the purpose of sale, or of preparation for sale or with a view to future sale:— (a) No urinal, water-closet, earth closet, privy, ashpit, or other like sanitary convenience shall be within such room, shop, or other part of a building, or shall communicate therewith except through the open-air or through an intervening ventilated space. (b) No cistern for supplying water to such room, sh p, or other part qf a building shall be in direct communication with and directly discharge into any such sanitary convenience. (c) No drain or pipe for carrying off foecal or sewage matter shall have any inlet or opening within such room, shop, or other part of a building. {d) No such room, shop, or other part of a building shall be used as a sleeping place, and so far as may be reasonably necessary to prevent risk of the infection or contamination of any such article as aforesaid no sleeping place shall adjoin such room, shop, or other part of a building and communicate therewith except through the open air or through an intervening ventilated space. (e) Refuse or filth, whether solid or liquid, shall not be deposited or allowed to accumulate in any such room, shop, or other part of a building, except so far as may be reasonably necessary for the proper carrying on of trade or business. If) Due cleanliness shall be observed in regard to such room, 38 shop, or other part of a building, and all articles, apparatus and utensils therein, and shall be observed by persons engaged in such room, shop, or other part of a building. (2) If any person occupies or lets, or knowingly suffers to be occupied any ^uch room, shop, or other part of a building wherein any of the conditions prohibited by this Section exist, or does or knowingly permits any act or thing therein in contravention of this Section, he shall be liable on summary conviction to a fine not exceeding for the first offence twenty shillings, and for every subsequent offence five pounds, and in either case to a daily penalty not exceeding twenty shillings. During 1919 all food premises have been supervised. In 15 instances notices were served before insanitary conditions were abated. Butter Factories, and Wholesale Dealers in Margarine. No additional premises were registered during the year as a Butter Factory. The only Butter Factory at present registered is that occupied by the Express Dairy Co., Ltd., at 25 and 27, Heath Street. During 1919 the following Wholesale Dealers in Margarine were registered in respect of the undermentioned premises :— Messrs. Lipton, Ltd., 59, High Street. „ 68, High Street (from July to Sept. only). ,, 312, High Road, Kilburn. •„ 48, Cricklewood Broadway. „ 134, Finchley Road. Messrs The Maypole Dairy Co., Ltd., 304, High Road, Kilburn. The other dealers previously registered are as follows :— Home & Colonial Stores, Ltd., 88, Cricklewood Broadway. „ 140, High Road, Kilburn. „ 80, High Street. „ 252, West End Lane. Fried Fish Shops. The following is a list of the Fried Fish Shops in the Borough. These are now kept under systematic inspection :— Town Ward .. 7, Flask Walk, and 2, New End Square. Bfxsize Ward . . 106, Fleet Road. West End Ward.. 1a,BroomsleighStreet,and 1,MunroTerrace. Kilburn Ward .. 132, High Road; 89, Kingsgate Road and 95, Palmerston Road. 39 Ice Cream. There are 72 shops in the Borough in which Ice Cream is sold. Bakehouses. At the end of 1919, there were 36 occupied bakehouses on the register, 19 being underground, and 17 above ground. Six of the bakehouses situated above ground and five underground use power, and are therefore factories. Twenty-six inspections were made in respect of the factor}' bakehouses, 54 inspections in respect of the workshop bakehouses, and 12 notices were served. The following is a list of the occupied bakehouses on the Register at the end of the year:— Town AVard .. 39, Heath Street, 67, High Street and 26, New End. Bei,si/e Ward .. 6 and *6-5 Fleet Road and 45 South End Road. Adelaide Ward *f44, England's Lane and *2, King's College Road. Central Ward. . *64, Belsize Lane, *225, *289 and f307 Finchley Road, *98 and 250 West End Lane and f2, Broadhurst Gardens. West End AVard f60 and 110, Cricklewood Broadway, f553 Finchley Road, Field Lane School, Hillfield Road, *43 & 44, Mill Lane, f4, Munro Terrace, Fortune Green, and 251 and *279 West End Lane. Kilritrn Ward. . *63, Hemstal Road, *94, f218 and *f354, High Road, Kilburn, *4, Kelson Street, 67, Kingsgate Road, * f 99, Palmerston Road. Priory Ward. . . *228, Belsize Road, *f98, Boundary Road. *f93, Fairfax Road, *7, Fairhazel Gardens, and *137, Finchley Road. Those marked * are underground bakehouses. Those marked f are factory bakehouses. Bakehouses—Underground . . 19 „ Above ground .. 17 Total .. 36 40 Restaurant Kitchens, etc. The total number of these premises 011 the register at the end of 1919 was 63. They are kept under regular supervision, 182 mspecions have been made and 6 notices served during the year. Meat Supply, The Meat Supply of the Borough is on the whole good, and in only six 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. Sale of Food and Drugs Act. 504 samples were taken for analysis during the year. The number certified to be adulterated was 5, or per 1 cent, of the total number, as against 25 in 1918. 1 sample was certified to be of low quality. 474 samples were purchased from Hampstead tradesmen and 30 from tradesmen coming from other districts. The percentage of adulterated samples in the two classes was 0'84 and 3'3 respectively. The following table shows the articles of which samples were taken during the year :— Articles. Number taken. Adulterated. Low Quality Butter 44 - - Camphorated oil 2 — — Cheese 14 — — Cocoa 26 — — Coffee 25 — — Cream 2 — — Dripping 1 — — Flour (self-raising) 3 — — Lard 44 — — Margarine 37 — — Milk 286 5 1 Mustard 4 — — Pepper 7 - — Rice, ground 2 - — Sago 1 — — Sausages 2 — — Tea 2 — — Vinegar 2 - — Totals 504 5 1 41 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. 12 Milk 14 per cent, deficient in fat Fined£2. Costs£1 lis 6d. 18 „ 9 per cent, added water No proceedings. 139 „ 6 per cent, added water Fined £2. Costs 12s. 6d. 191 „ 22 per cent, deficient in fat Fined £15. Costs 10s. 6d. 296 „ 5 per cent, added water No proceedings. Informal sample. Sample No. 18.—In this case it was found that milk was adulterated before reaching retailer. A sample was taken in course of delivery by Middlesex County Council, who took action against Farmer. Sample No 191.—In this case defendant appealed at Clerkenwell Sessions. The appeal was upheld, but no costs allowed. Warranty Defence. The Borough Council in October once again re-affirmed its opinion in relation to the " Warranty " defence on receipt of a letter from the Battersea Borough Council. The Member of Parliament for Hampstead was asked to support the suggested endeavour to amend the anomalous position at present obtaining. As was recently pointed out by a Metropolitan Police Court magistrate, the " Warranty" defence constitutes a difficulty in securing a good supply of pure milk, because, as the law now stands, analysts may analyse and Borough Councils may prosecute, but no good can or will be done until the obvious remedies are applied, the first being the abolition of the defence of warranty altogether, making the retailer liable and letting him seek his remedy against his vendor and the railway company. This Rorough Council as long ago as 1904 called the attention of the Local Government Board and the Board of Agriculture to the difficult and anomalous position of local authorities in administering the Sale of Food and Drugs Acts, owing to the use, or abuse, of warranties, and 42 urged the introduction of amending legislation to prevent that evasion of the Acts of Parliament which the " Warranty" defence makes possible. In Hampstead during recent years many prosecutions in relation to the sale of Milk deficient in inilk-fat ranging as high as 47 per cent, have failed on account of the "Warranty" defence, and proceedings in respect of adulteration by the adding of water have similarly failed. It is to be hoped that in the near future this obstacle in the way of our endeavours to secure a pure milk supply will be removed. 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. That part of the Regulations relating to Cream was not enforce l during part of the year, owing to the Orders of the Food Controller prohibiting the sale of cream. The following samples of milk and Cream not sold as preserved milk and cream, were taken during the vear:— 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 286 - Cream 1 - 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, one. 2. Statements incorrect, nil. (b) Determinations made of milk fat in cream sold as preserved cream ;—1. Above 35 per cent., one. 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. 43 3.—Thickening substances. (a) Addition to cream or to preserved cream, nil; (6) Action taken when 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. 268 Cream. Genuine. Not exceeeding 0.5. Section D. PREVALENCE OF AND CONTROL OVER INFECTIOUS DISEASES. 1.—Notifiable Infectious Diseases (including Tuberculosis). The following is a list, alphabetically arranged, of the infectious diseases which were compulsorily notifiable in Hampstead during 1919. Anthrax Cerebro-Spinal Meningitis, acute Cholera Continued Fever Diphtheria Dysentery Ecephalitia Lethargica, acute Enteric Fever Erysipelas German Measles Glanders Hydrophobia Malaria Measles Alembranous Croup Ophthalmia Neonatorum Plague Pneumonia, acute influenzal Pneumonia, acute primary Polio-Encephalitis, acute Polio-Myelitis, acute Puerperal Fever Relapsing Fever Scarlatina Scarlet Fever Small-pox Trench Fever Tuberculosis, all forms Typhoid Fever Typhus Fever No cases of the following notifiable diseases were reported during the year:— Anthrax, Cholera, Continued Fever, Glanders, Hydrophobia, Plague, Polio-Eiicephalitus, Relapsing Fever, Small-pox, Trench Fever, 44 Cases of Infectious Disease Notified during the Year 1919. 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. Cerebro-spinal Meningitis, acute 1 .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. 1 Diphtheria 76 2 10 36 14 1o 3 1 9 25 12 7 7 14 2 63 Dysentery 8 .. .. .. 3 5 .. .. .. .. .. 1 .. 5 2 .. Encephalitis Lethargica, acute 2 .. .. 1 .. .. 1 .. .. .. .. 2 .. .. .. .. Enteric Fever 7 .. .. .. 1 3 3 .. 1 1 2 1 .. 2 .. 2 Erysipelas 41 .. .. 2 9 11 11 8 8 5 1 6 2 16 3 5 Malaria 25 .. .. .. 6 13 3 3 2 8 .. 1 5 6 3 6 Measles 650 23 255 322 21 27 2 .. 128 43 25 60 138 198 58 24 •German Measles 172 .. 24 80 41 24 3 .. 28 23 21 37 22 18 23 4 Ophthalmia Neonatorum 11 11 .. .. .. .. .. .. 1 .. 1 1 .. 7 1 1 Pneumonia.. 73 3 .. 8 5 32 10 15 10 17 6 11 6 15 8 7 Polio-Myelitis, acute 3 .. 2 .. .. 1 .. .. .. 1 .. .. 1 1 .. 2 Puerperal Fever 2 .. .. .. .. 2 .. .. .. .. .. 1 1 .. .. .. Scarlet Fever 116 .. 18 68 20 10 .. .. 25 27 9 8 23 12 12 91 "Tuberculosis, Pulmonary 165 .. 1 14 36 95 19 .. 24 26 11 10 25 47 22 74 Tuberculosis, Non-Pulmonary 48 1 5 21 8 7 3 .. 9 7 3 3 5 16 5 15 Totals 1400 40 315 555 165 240 58 27 245 183 91 149 235 358 139 295 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 1919. 45 Cases of Infectious Disease occurring in each month during 1919. DISEASE. MONTHS. Totals. January. February. March. April. May. June. July. August. September. October. November. December. Cerebro Spinal Meningitis __ 1 1 Diphtheria 12 3 10 1 3 4 3 3 3 10 11 13 76 Dysentery — — — 2 1 — 1 3 1 — — — 8 Encephalitis Letharica (Acute) 1 1 2 Enteric Fever — - — — 1 1 1 — 2 2 7 Erysipelas 1 7 3 4 3 — 2 2 3 3 8 5 41 Malaria 1 1 1 9 2 2 6 2 1 25 Measles 24 68 32 106 144 135 52 15 8 25 37 9 650 German Measles 8 19 22 45 31 14 9 1 8 i 6 5 172 Ophthalmia Neonatorum .. 2 _ 3 1 1 1 1 • 2 11 Pneumonia — 36 15 3 4 2 3 4 3 3 73 Polio-Myelitis (Acute) — — — — — 1 1 1 3 Puerperal Fever — — — — — 1 1 2 Scarlet Fever 5 2 4 11 5 5 8 7 9 26 14 20 116 Tuberculosis Pulmonary 6 14 24 14 13 12 21 4 14 18 8 17 165 Tuberculosis NonPulmonary 7 6 4 10 3 4 3 2 2 3 4 48 Totals 64 117 136 209 209 181 111 45 52 104 96 76 1400 Acute Encephalitis Lethargica, Acute Polio-Encephalitis. These diseases were rendered compidsorily notifiable for the period of one year by Regulations which came into force on January 1st, 191.9. The Order of the Local Goveniment Board was designed to secure the notification of cases of an infectious disease which occurred in epidemic form in the early spring of 1918. The cases were described as presenting a "group of unusual cerebral symptoms, resembling those of a rare disease called Botulism, which is associated with the consumption of infected food." The illness displayed the characters of an acute general disease associated frequently with progressive languor, apathy, and drowsiness passing into lethargy, with muscular weakness passing into more or less complete disablement, and with various paralyses, chiefly of muscles of the eyes and face. 4b Malaria, Dysentery, Trench Fever, Acute Primary Pneumonia, and Acute Influenzal Pneumonia. These diseases were made compulsorily notifiable by the Public Health (Pneumonia, Malaria, Dysentery, &c.) Regulations, 1919, which came into operation on March 1st, 1919. The following duties, inter alia, are placed upon the Medical Officer of Health :— Article VII.—Upon the receipt of a notification under these Regulations, or on becoming aware in any other way of a case or suspected case of Malaria, or Dysentery, or Trench Fever, or Acute Primary Pneumonia, or Acute Influenzal Pneumonia, to make such inquiries and take such steps as are necessary or desirable for investigating the source of infection, for preventing the spread of infection, and for removing conditions favourable to infection, and if a Medical Practitioner is not in attendance on the patient, to take such steps as are necessary or desirable for ascertaining the nature of the case. Article VIII.—On becoming aware of the occurrence of— (а) a case of Trench Fever, or (б) a case of Malaria in which he has reason to believe that the infection was contracted in the United Kingdom immediately to send to the Ministry of Health the name and address of the patient. On becoming aware of an outbreak of Dysentery immediately to send to the Ministry of Health the names and addresses of the persons affected, and thereafter such particulars as the Ministry may require with regard to cases occurring subsequently ; and also to send the like information to the County Medical Officer of Health. Article IX —In every case of Malaria, Trench Fever, or Dysentery to take such steps as appear to be necessary and practicable to secure the treatment of the case in a suitable hospital, unless satisfied that treatment elsewhere than in a hospital will be carried out with all such precautions as are necessary to prevent the spread of the disease. Malaria. Article X.—In every case of Malaria in which he considers that action is liccessary to prevent the spread of infection, he shall take all practicable steps to ensure that the person suffering from Malaria— (]) is supplied with efficient mosquito netting (2) receives necessary quinine treatment (3) receives proper advice as to the continuation of quinine treatment in order to prevent relapses, and (4) receives proper advice as to the precautions to be taken to prevent the spread of infection. 47 Article XI.—On the occurrence of two or more cases of Malaria in which the infection has, in the opiuion of the Medical Officer of Health, been contracted within the Borough, the Borough Council may and if required by the Ministry of Health shall appoint and pay a Medical Practitioner approved by the Ministry who shall— (1) make systematic visits to houses where Malaria has occurred or where risk of Malaria infection arises, and shall offer to examine persons therein who are suspected of being infected with Malaria and shall endeavour to obtain material for microscopic examination in order to determine whether malarial infection is present, and ("2) secure that effective measures are taken to prevent the spread of infection by the administration of quinine, by the use of mosquito netting, and by the destruction of mosquitos, and otherwise. Dysentery. Article XII.—(1) In any case of Dysentery in connection with which he is of opinion after inquiry that such a course is necessary to prevent the spread of infection, he may by notice in writing require that (until a further notice is given revoking the first mentioned notice on the ground that the risk of infection is removed)— (а) the person specified in the notice shall discontinue any occupation connected with the preparation or handling of food or drink for human consumption. (б) children in the care or charge of any person specified in the notice shall not be sent to school. (c) suitable measures to be specified in the notice shall be taken with respect to cleansing, disinfection, disposal of excreta, destruction of flies, and prevention of contamination of articles of food or drink for human consumption. (2) The notice may be addressed to the head of the family to which the patient belongs, or to any person in charge of or in attendance on the patient, or to any other person in the building or place of which the patieut is an inmate, or to the occupier of the building or place. Article XIII.—(1) If he has grounds for suspectiug that any person who is employed in any trade or businoss concerned with the preparation or handling of food or drink for human consumption is a carrier of dysentery infection, he may give notice in writing to the responsible manager of the trade or business concerned certifying that for the purpose of preventing the spread of the disease he considers it necessary to make a clinical examination of such suspected person, and the responsible manager and all other persons concerned shall give to him all reasonable assistance in the matter, (2) If from the result of any such examination, or from bacteriological or protozoological examination of material obtained at any such examination, 48 or from any other evidence which he may deem sufficient for the purpose, he is of opinion that the specified person is a carrier of dysentery infection, he may give a notice in writing to that effect to the responsible manager and to the suspected person with a view to preventing, during a period to be specified in such notice, the employment of the person to whom the notice relates in the conduct of the trade or business, or in any other trade or business concerned with the preparation or handling of food or drink for human consumption. Trench Fever. Article XIV.—(1) In any case of Trench Fever in which he is satisfied that it is necessary, he may, by notice in writing, require— (а) that such measures as may be specified by him shall be immediately taken to his satisfaction to obtain the complete destruction of lice on the person and clothing of every occupant of the building, and to secure the destruction of lice or their products in the building : (б) the temporary segregation, for a period to be specified in the notice, of other inmates in the building or of other persons recently in contact with the patient until their persons and clothing have been completely freed from lice. (2) The notice may be addressed to the head of the family to which the patient belongs, or to any person in charge of or in attendance on the patient, or any other person in the building of which the patient is an inmats, or the occupier of the building, and also to a porson with whom the patient has recently been in contact. Enteric Fever. Article XV.—The provisions of Articles XII. and XIII. of these Kegulations apply and have effect with the necessary modifications in any case of Enteric Fever occurring and to any person residing or employed in the Borough in regard to whom the Medical Officer of Health has grounds for suspecting that such person is a carrier of enteric fever iufection in like manner and circumstances as those provisions respectively apply and have effect in any case of Dysentery and to any person suspected to be a carrier of dysentery infection. Typhut Fever and Relapsing Fever. Article XVI.—The provisions of Articles VIII. and XIV. of these Regulations apply and have effect with the necessary modifications in any case of Typhus Fever or of Relapsing Fever occurring in like manner as those provisions apply in any case of Trench Fever. Duties of Local Authorities. Article XIX.—Authorises the Borough Council to provide or contract for the provision of medical assistance for any person suffering from any of the diseases mentioned in the Regulations in need of such assistance, and the same Article provided that " where any suitable hospital or place for the 49 reception of the sick is provided within the District of a Local Authority, or within a convenient distunes of such District, any parson who is suffering from Malaria, or Dysentery, or Trench Fever, and is without proper lodging or accommodation, or is lodged in a room occupied by more than one family, or is on board any ship, vessel, or boat, or is lodged in any common lodging house, or is in any place where such person cannot be effectively isolated so as to prevent the spread of the disease, may, on a certificate signed by the Medical Officer of Health, and with the consent of the superintending body of such hospital or place, bo removed to such hospital or placc at the cost of the Local Authority." No special clause was inserted in the regulations to provide for hospital treatment for London patients by a Central Body. It appeared to me that for every Sanitary Authority in London to provide its own hospital accommodation was a wasteful procedure and one not calculated to prove the most efficient. I therefore communicated with the Clerk of the Metropolitan Asylums Board on the subject of the Board receiving suitable cases of these diseases that might occur in the Borough into their hospitals. This, the Board agreed to do as a temporary measure, pending an authoritative decision on the point; and on 29th April, 1919, the Local Government Board issued "The Metropolitan Asylums (Trench Fever, Malaria and Dysentery) Order, 1919," empowering the Managers of the Metropolitan Asylums Board, on the recommendation of the Medical Officer of Health, to admit persons suffering from these diseases to their hospitals. I shall be glad if medical practitioners will note that ex-soldiers can be treated for Malaria, Dysentery, or any tropical disease, at the extensive Clinic which has been opened by the Red Cross Society at 12a, Lyndhurst Road. Cerebro Spinal Meningitis, Acute. The only case that arose in 1919, occured in the person of a male, aged 21, who was removed to hospital. The contacts were bacteriologically examined with a negative result. Diphtheria and Membranous Croup. The number of cases notified in 1919 was 76, as compared with 109 in 1918. The attack rate, or number of cases notified per 1,000 of the population was 0.86 compared with the rate of 1.52 in the previous year. The number of cases notified proving fatal was 7, or 9.2 per cent, of the cases notified, as against 6.4 per cent. 1918. 63 patients, or 83 per cent, of the cases notified were removed to hospital. 50 In accordancc 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. In 165 instances, examination of specimens in suspected cases was made at the Lister Institute, 27 giving a positive, and 138 a negative result. Encephalitis Lethargica, Acute. Two cases occurred in females aged 9 and 53. Both were nursed at home. One completely recovered, but in the other instance chronic neurotic conditions were somewhat accentuated. Enteric Fever. The number of cases notified was 7 as compared with 12 in 1918. The attack rate per 1,000 of the population was 0.08, as compared with the rate of 0.17 in 1918. None of the cases notified proved fatal. Two cases were removed to hospital. Three specimens were examined during the year, all proving negative. Erysipelas. 41 cases were notified, and no death occurred, as compared with 28 cases in 1918, none of which proved fatal. The attack rate per 1000 of the population was 0.47, as compared with the rate of 0.39 in 1918. Of the cases notified, 5 or 12 per cent, were removed to the Workhouse Infirmary or Nursing Homes. Measles and German Measles. Details concerning cases of these diseases will be found in the Section relating to Maternity and Child Welfare. Ophthalmia Neonatorum. Polio-Myelitis. Puerperal Fever. Details of these cases will be found in the Section relating to Maternity and Child Welfare. Scarlet Fever. 116 cases of scarlet fever were notified during the year, as compared with 51 in 1918. The number of cases per 1000 of the population was 1.3; the corresponding figure in 1918 being 0.71. Three cases proved fatal as compared with 3 in 1918. Of the cases notified 91, or 78 per cent., were removed to hospital. 51 Small-pox. No case of small-pox occurred in Hampstead during the year. Vaccination. Of the total births dealt with by the Vaccination Officer, amounting to 1,066, in 1919, 457 were successfully vaccinated. In 8 cases the children were insusceptible of vaccination. In regard to 235 Certificates of Conscientious Objection were obtained; 48 died before vaccination was performed; 24 cases of vaccination were postponed and 294 remained to be dealt with. I am indebted to the Vaccination Officer for these statistics. Provision for Isolation of "Contacts." I had endeavoured, unsuccessfully, for some time to obtain a house or premises to be used for the isolation of small-pox or other infectious disease contacts (in the event of an outbreak of such a disease), and it being considered essential that such accommodation should be readily available, the Council gave authority for the disused shed adjoining the Disinfecting Station in the electricity yard to be fitted as a cleansing station, the necessary alterations thereto to be made to make it suitable for this purpose. By this rearrangement the existing cleansing station which occupies the cottage shelter in the corner of the electricity yard (adjoining Lithos Passage) and the remainder of that building will be able to be utilized, should occasion arise, as a shelter for small-pox and other infectious disease contacts and also for the temporary housing of poor persons during the disinfection of their goods or rooms. Tuberculosis. During the year 1919, 213 new cases of Tuberculosis were notified, 165 being cases of Pulmonary Tuberculosis, and 48 other forms of the disease. In the following table these 213 cases have been analysed as to sex and age, and it will be noticed that 48 per cent, were aged between 25 and 45. 0—1. 5—10. 10—15. 15—20. 2U—25. 25—35. 35—45. 45—55. 55-65. Over 65. Total. -5. 1- Pulmonary males - - 4 4 2 9 29 20 8 2 - 78 ,, females — 1 1 5 5 20 20 16 6 3 - 87 Non-Pulmonary males 2 7 6 4 1 2 — — 0 - 24 ,, females 1 3 6 5 1 2 3 •2 1 - 1 24 1 6 18 20 12 32 64 38 15 7 - 213 52 Of the cases newly notified during 1919, 8 were of persons already dead or dying, and in 18 other cases the patients did not survive the year under review. Of the total new cases in 1919 the number who have attended the Municipal Tuberculosis Dispensary is 106. The number of cases notified in 1919 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 70 361 1919 . . 165 48 213 The total number of cases of Tuberculosis known to the Department at the close of 1919 was 949. 53 Occupations. The following is an analysis of the occupations of the new cases notified as tuberculous during 1919:— • Occupation. Pulmonarj Cases. NonPulmonary Cases. Occupation. Pulmonary Cases. NonPulmonary Cases. Actor 1 Manufacturer 1 1 Artist 2 Mechanic 2 — Charwoman 2 Medical Student — 1 Clerka and Secre tariea 16 2 Merchant 2 — Nurse 2 1 Commercial Police Constable 2 — Traveller 1 — School Children 15 26 Companion 1 — Shop Assistant 7 — Dairy Foreman 1 — Sister of Charity 3 — Domestic Servant 11 3 Solicitor 1 — Draughtsman 2 — Spectacle Maker 1 — Dressmaker 2 — Tailor *— 1 Engineer 2 — Tea Packer 1 — Ex-Naval Officer 1 — Teacher 5 — Ex-Sailor 1 Ticket Collector 1 — Ex-Soldier .34 3 Waitress 1 — Ex-W.R.A.F. 1 1 No Occupation 14 6 Gardener 2 — No Information 2 1 Housewife 22 1 Journalist 2 - - Labourer 1 1 165 48 Removal of Cases. Of the newly notified cases in 1919, 89 were removed. Pulmonary. Non-Pulmonary To Sanatoria (insured) 35 2 To Sanatoria (non-insured) 12 — To Hospitals 18 3 To Infirmaries 6 2 To Nursing or other Homes 3 8 74 15 54 The following cases, notified prior to 1919, were also removed. To Sanatoria (insured) Pulmonary. Non-Pulmonary. 16 l To Sanatoria (non-insured) 9 — To Hospitals 10 3 To Infirmaries 5 — To Nursing or other Homes 3 1 - 43 5 Deaths from Tuberculosis. The number of deaths from Tuberculosis in 1919 was 72. Of these 56 were due to Pulmonary Tuberculosis, 3 to Tubercular Meningitis, and 13 to other forms of Tuberculosis. The following table shows the age distribution of patients dying from Pulmonary Tuberculosis in Hampstead since 1903:— Year. Age Period. All Ages. 0—5 5—15 15—25 25—65 65— 1903 1 14 46 5 66 1904 1 1 15 53 3 73 1905 1 — 12 57 3 73 1906 1 — 8 45 3 57 1907 1 2 10 45 3 61 1908 — 2 14 55 3 74 1909 1 1 12 37 2 53 1910 1 1 12 37 7 58 1911 1 1 5 44 5 56 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 1919 1 13 39 3 56 Totals 10 21 192 764 57 1044 The deaths from all forms of Non-Pulmonary Tuberculosis in 1919 were distributed in age periods as follows:—0-5, 2; 5-15, 2; 15-25, 2; 25-65, 9; 65 and upwards, 1. 55 The following table shows the number of deaths and the deathrates from all forms of Tuberculosis and from Pulmonary Tuberculosis respectively since 1899:— 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 92 113 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 0.56 244 1914 71 0.82 57 0.66 142 1915 71 0.86 48 0.58 172 1916 80 0.98 55 0.67 193 1917 85 1.12 69 0.91 256 1918 89 1.24 75 1.04 291 1919 72 0.82 56 0.64 165 The deaths from Pulmonary Tuberculosis and from all forms of Tuberculosis during 1919 were distributed among the wards as follows:— Ward. Area (Acres). Estimated Population middle of 1918. Pulmonary Tuberculosis. Tuberculosis (All Forms.) Deaths. Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Populaton. No. 1 (Town) 686 14,100 10 0.71 13 0.92 ,, 2 (Belsize) 271 14,000 9 0.64 12 0.86 ,, 3 (Adelaide) 325 10,112 6 0.39 6 0.39 „ 4 (Central) 312 10,200 4 0.39 6 0.59 ,, 5 (West End) 247 13,200 11 0.83 13 0.98 „ 6 (Kilburn) 195 15,600 11 0.70 15 0.96 „ 7 (Priory) . 229 10,800 5 0.46 7 0.65 The Borough 2,265 88,012 0 56 0.64 72 0.82 56 Tuberculosis Care Committee. On 29th May, the Clerk to the London County Council wrote to the Borough Council referring to the arrangements made by them for the establishment of Interim Tuberculosis Care Committees in London, and suggesting that, as the difficulties experienced during the war had largely disappeared, Borough Councils should establish permanent Tuberculosis Care Committees on the lines indicated by the Local Government Board in April, 1915. The Tuberculosis Sub-Committee had before them particulars of the composition and work, &c., of the Joint Tuberculosis Committee of the Hampstead Council of Social Welfare, which had acted since 1915 as the interim Tuberculosis Care Committee of the London County Council; and, after consideration, the Sub-Committee suggested that the Public Health Committee shoidd recommend the Borough Council to form a permanent Tuberculosis Care Committee. The Borough Council resolved— 1. That a permanent Tuberculosis Care Committee should be established. 2. That such Committee should be constituted on the lines of the (hen existing Interim Tuberculosis Care Committee, and 3. That the bodies represented on the Interim Committee should be asked if they would be prepared to act, through their representatives, on the permanent Committee. At the close of the year the question of the Composition of this Committee was still under consideration. The Municipal Tuberculosis Dispensary. Under the scheme for affiliating the Municipal Dispensary with the Hampstead General Hospital, Dr. F. G. Crookshank was appointed as Tuberculosis Medical Officer, and held office (temporarily) pending the signing of the agreement by the Hospital, and confirmation by the Ministry of Health. Dr. Crookshank resigned in September, and Dr. A. J. Scott Pinchin, a member of the Staff of the Hospital, was appointed in his stead, taking up the duties of the office on November 1st. Under the arrangements by which the Tuberculosis Dispensary is linked up with the Hampstead General Hospital, the Tuberculosis Medical Officer —who is one of the Staff of that Hospital—can avail himself of facilities offered by the hospital such as consultations with Consulting Physicians, X ray examinations, bacteriological examinations, etc., for which the Borough Council make a special payment. 57 The Borough Council possess the right to use two endowed beds at the Hampstead General Hospital, and two at the Mount Vernoa Hospital at Northwood. In the following tabular statement some idea may be gained of the work done in connection with the Dispensary since its inception. The total number or individuals actually under treatment during the year was 498. Year. No. or New Applicants. No. of New Applicants treated. No. of Contaots examined. Total Attendances of all kinds. Total No. of Home Visits paid by Tuberculosis Medical Officer and the Nurse. 1913 1st Feb. to 31st Dec. 455 191 204 2808 1013 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 1919 296 85 57 1543 215 The following Report is submitted by A. J. Scott Pinchin, M.D. (Lond.), M.R.C.P., Tuberculosis Medical Officer:— Report of the Tuberculosis Medical Officer for the year, 1919. Return required by the Local Gocernment Board, Loudon 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, 1910. (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. F. 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 90 36 96 7 67 296 (b) Number included under 1 (a) who were found to be suffering from Pulmonary Tuberculosis 36 19 5 2 26 88 (c) Number included under 1 (a) who were found to be suffering from NonPulmonary Tuberculosis 4 1 17 3 25 (d) Number included under 1 (a) who were found to be non-tuberculous 13 8 31 3 12 67 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 37 8 43 2 26 116 58  Insured. Non-insured. Totals. 2. (o) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under 1 (a) 537 1006 1543 (6) Number of the above attendances at which systematic physical examinations and records were made 345 438 783 3. Number of visits to patients at their own homes by the Dispensary Medical Officer in connection with the supervision of home conditions 10 1 11 4. Number of visits to patients at their own homes by the Dispensary Nurse in connection with the supervision of home conditions and " following «P" 87 117 204 *5. Number of persons suffering from or suspected to be suffering from Tuberculosis referred to the Hospital to which the Dispensary is affiliated 10 9 19 6. N umber of consultations with the— (a) Medical Adviser of the Insurance Committee (b) Consulting Physicians at the Hospital to which the Dispensary is affiliated ... 10 9 19 (c) Practitioners at the homes of patients 11 11 7. Number of written reports concerning individual patients made to— (a) Public Authorities 126 32 158 (&) Practitioners 18 12 30 8. Number of specimens of sputum examined 62 121 186 * In addition, 9 persona suffering from, or suspected to be suffering from, diseases other than Tuberculosis were referred to the Hospital to which the Dispensary is affiliated. The work of the Tuberculosis Clinic during the past year is summarised in the preceding figures. As I personally am only responsible for the last two months of the year, I am unable to make any considerable remarks on the work done during the year. I found the difficulties of taking over the Clinic were much simplified by the Careful and methodical way in which the work had been conducted by Dr. Crookshank and Dr. Archibald in the interregnum; and, as far as one is able to judge, the Clinic as a whole has run as smoothly and efficiently as is possible. During the last few years tbe civilian figures of the treated and examined cases have been much altered by the cases submitted for examination by the National Service Boards for an opinion, and since the Armistice by the cases of Tuberculosis or suspects submitted by the War Pensions Committee, this is now a gradually reducing figure, and the next year will be of interest as giving a better idea of the ante and post-war incidence of the disease. 59 One has noticed in one's work about London, that whereas during the war the general condition of the poorer class children materially improved, both as regards nutrition and clothing, there seems a tendency now to be getting back again to the pre-war conditions. This wants careful watching, as it is a material factor in the incidence of Tuberculosis on the child. Our liason with the Hampstead General Hospital has worked very smoothly ; not only am I indebted to the Surgeons at the Out-Patient Department for valuable advice and treatment of cases, but also to the Honorary Staff of the In-patients for taking into hospital urgent Nontubercular cases as well as non-urgent cases which they have taken in for observation and an opinion. I have also used the X Ray Department considerably, and have to thank the Radiologist for his excellent radiograms and reports. The patients marked for Sanatorium and Hospital treatment under the Insurance Committee and London County Council schemes have been got away without any undue waiting ; moreover, these bodies have been very good in advancing the position of one or two cases where it was especially urgent that the removal of the patient should be immediate. 1 have found my association with the City of London Chest Hospital of great service to me, as. the Resident Medical Officer there has been able on several occasions to arrange for the admission of cases at once instead of having to place them on the rota, in an acute case the advantage of this both to the patient and relatives is obvious. Our principal problem remains the early cases who do not know they are infected, and the advanced cases. The former, owing to the assiduity of our sanitary inspector, Mrs. Fisher, and health visitor, Mrs. Roche, for whose excellent work I am grateful, we are keeping in check. The importance of this work of following up contacts is well exemplified by a recent case at this dispensary, three contact members of a family, one of whom lived in . the countiy, being found to be badly infected. In the latter case I am glad to say that there is now a beginning of progress in the matter of providing beds for advanced cases. 60 Dr. Kidd, the Medical Officer in charge of the Borough Council's Pre-Maternity Clinics, has submitted to us several cases for observation. The importance of the influence of child bearing, both pathologically and socially, on the tuberculous patient is so great that the importance of keeping the two Clinics in close touch is patent. The successful working of a Dispensary is to no small extent dependent on the Tuberculosis Nurse, and I consider that in that respect we are very fortunate in having the services of our present Nurse. Lastly, and in 110 means least, I have to thank our Medical Officer of Health, Dr. Scrase, for his kind and helpful advice and opinion on anything which one submits to him. A. J. Scott Pinchin, M.D. (Lond.), M.R.C.P. (2) Non Notifiable Acute Infectious Disease. Chicken-pox. Cases of this disease are not now notifiable, the County Council's Order, made as a case of emergency, requiring the notification of cases of chicken-pox, having lapsed 011 June 30th, 1919. Influenza. The steps taken in 1918 at the beginning of the outbreak, and referred to in my Annual Report for that year, were continued until the cessation of the epidemic. The following table shows the deaths in 1919 from influenza arranged in Wards :— Wards. Deaths from Influenza. Estimated Population. Death-rate per 1000 of the population No. 1 (Town) 18 14100 1.3 No. 2 (Belsize) 12 14000 0.8 No. 3 (Adelaide) 6 10112 0.6 No. 4 (Central) 18 10200 1.7 No. 5 (West End) 15 13200 1.1 No. 6 (Kilburn) 16 15600 1.0 No. 7 (Priory) 10 10800 0.9 The Borough 95 88012 1.1 61 The following table gives the deaths from Influenza in age periods in recent years:— Year. Under 1. 1—5. 5—15. 15-25 25—45. 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 1919 3 2 9 45 17 19 95 The deaths of Hampstead "residents" from Influenza in 1919 occurred at ages and among sexes as follows:— Age Sex. Total. Male. Female. Under 1 2 l 3 1—2 .. l 1 2—5 .. 1 1 5—15 .. .. .. 15—25 .. 9 9 25—45 19 26 45 45-65 7 10 17 65— 9 10 19 37 58 95 These figures relate to Hampstead "resident" civilians only. Sailors, soldiers, airmen, and "non-residents " are not included. Measles, German Measles, Whooping Cough. Information respecting these diseases will be found in the section relating to Maternity and Child Welfare. 62 Section E. MATERNITY AND CHILD WELFARE. Considerable activity has been displayed on this subject during the year under review. In March, a let'er was received from the Local Government Board referring to the report of their Inspector after a recent visit to Hampstead. The Board expressed themselves as being glad to hear of the good work which was being carried out at the Ante-Natal Clinic, and hoped the Council would continue to make every effort to develop this work and extend the home visiting of expectant mothers. They also suggested that the Council should consider the possibility of opening another AnteNatal Clinic to serve the Eastern side of the Borough. On May 9th, 1919, I presented to the Committee a comprehensive report on the subject, and in view of the great importance of the matter and of the subsequent events that transpired, I have deemed it well to reprint in e.rtenso the proposals for extending and improving the work which occurred in the report named. These were as follows:— "Proposals for Extending and Improving the Work. I. Clinic.—Among the most urgent matters needing consideration at the present time is the extension of the work of the Ante-Natal Clinic, both by increasing the clientele on the Western Side of the Borough, and by establishing a Clinic on the Eastern side. I hold the Ante-Natal Clinic to be probably the most promising factor in the whole scheme as matters exist to-day. Among the causes of infantile deaths, the most prominent class of all is a group of diseases which lead to the very early death of the child. Thus, 25 of our 62 infant deaths in 1918, or 4 j per cent., died in the first month of their lives, and principally from diseases which must be attacked prior to birth if the child is to have a fair chance. Ante-Natal work, and AnteNatal work alone, can reach them; the ordinary work of a Weighing Centre cannot. A large proportion of this class die before the time comes for them to attend a Centre. Acting in accordance with the instructions of the Committee, I have viewed certain premises on the Eastern side of the Borough with a view to immediate and future action. Whatever is done in the future, premises are needed on the Eastern side for this purpose at once. Together with your Chairman, and the Chairman of the Public Health Committee, I have inspected the Out-Patient Department of the Hampstead General Hospital and a shop No. 59, South End Road. Either of these would suit our need, but I am of the opinion that No 59, South End Road is the most suitable. It is at present rented by the Borough Council at a rental of £60 per annum as a National Kitchen; but occupation for that purpose is likely to* cease shortly, and I have arranged for immediate notice to be given me when it is no longer needed as a Kitchen. If these premises can be obtained they would provide satisfactory accommodation in a suitable position. Their adaptation for the purpose of a Dispensary or 63 Clinic would be exceptionally easy, and the provision of a Waiting Room, Consulting Room, and two Dressing Rooms could be made at small cost, and I would recommend that the Committee take steps to secure the reversion of the tenancy of these premises for the purpose of an AnteNatal Clinic The estimated cost of establishing a Clinic here would be as follows— £ A aptation and Equipment of premises 150 Maintenance for eight months to end of present financial year 120 Total £270 2. Centre.—This term is oi.e ordinarily given to a place where some or all of the various works connected with Maternity and Child Welfare are carried out, and it appears to me that, given premises commodious enough, the larger the number of activities carried out at the Centre, the greater will be the amount of success likely to be achieved. The Hampstead Centre weighed in 1918, 450 Hampstead babies. This is 50 per cent, of the nett births of the Borough, and if one lefers to the record it will be seen that Kilburn is far ahead of the rest, and it is also interesting to note that a greater number of Hampstead babies attended the Centre in the Town Ward than in Lisburn Road. The number of deaths among these 450 babies was 7, and their infantile mortality rate was 15 per 1, 00 as against 69 for the whole Borough. The various services carried out in Hampstead have achieved considerable success, but not perhaps so much as if they were more co-ordinated, or, so to speak, blended. Thus, I am of opinion, that if upon the Eastern side of the Borough a Day Nursery,an Infant Welfare Centre, an Ante-Natal Clinic and a Clinic for the medical treatment of cases found needing it were housed under one roof, and as such closely co-ordinated with the work of the Nursing Associations, further success would attend their endeavours, and new fields of effort would b, opened. Such a combination would allow of larger and more commodious premises being utilised, one section would strengthen the other and add to their clientele, and would render new fields, such as the provision of cots much easier and more likely to be successful, and I would certainly advise the Commit lee to consider it. The provision of cots is an important question. It not infrequently happens that infants are encountered who do not thrive although attending a Centre, and yet who are not ill enough to go to a Hospital; and the use of these cots should be restricted to cases of nutritional disorder, and cases needing observation. The Board's grant being available for the provision of cots or beds for children up to five years of age, it is open to the Council to contract with a Hospital for this purpose; the cost per cot in that case would be about £50 per annum. If, however, premises suitable can be secured I believe better results would be obtained by establishing cots in connection with the existing Centres, rather than by contracting with the Hospitals. But the experiment should be only a small one at first, probably six or eight cots would be sufficient for Hampstead. 64 The question of premises for such a purpose out-lined above is a difficult and all important one; for to centralise the various activities on the Eastern side into one Centre necessitates a commolious and wellappointed budding. The need just now is greater on the Eastern side of the Borough than on the West; the Eastern Day Nursery badly wants new premises, and I have considered sundry means as to how the need may be met. To obtain, on the Eastern side of the Borough, premises capable of accommodating the voluntary bodies and activities controlled under the Council's management, it is either necessary to build or rent suitable buildings. Building at the present time is an extremely difficult matter and the Board do not favour it, but should the Committee consider such a course advisable, a site might be obtained on the land of the Public Library in Worsley Road. The vacant space immediately available is 100 feet by 40, and I understand that a portion of the site occupied by the Library building might also be acquired. To aid the Committee in their decision I submit for your consideration a block plan, and a plan and elevation of what is practicable upon it. To render this position entirely suitable, access should be obtained from Downshire Hill as well as Worsley Road, and I have been in communication with the owners of Nos. 14 and 14a, Downshire Hill to ascertain if this is possible. In reply they state they are willing to enter into negotiations for the sale of either or all their properties. The property necessary to aquire would be that immediately opposite the junction of Keat's Grove and Downshire Hill and which abuts on the Library land. The plan of the Library Site will demonstrate my meaning. Should however, the Committee decide that to purchase or lease premises is more desirable, I would suggest their consideration of " Rosslyn Lodge," Lyndhurst Road. This property is now used as a hospital for wounded soldiers, accommodating one hundred' It is isolated and eminently suitable, and the premises are large enough to contain all our activities. It is advantagously situated and constructed, being possessed of two floors only. It has, moreover, ample space (1¾ acres), and would make an ideal Centre. There are difficulties, chiefly financial but I fancy not insuperable. Before going into further details I should like to await the Committee's opinion on the question of the principles involved:— 1. Is centralization of activities desirable? 2. Is the renting or purchasing of premises desirable? 3. Is the building of premises desirable ? Personally, I am of opinion that centralization is advisable, and that further, for the present to rent premises would be the best course. 1 would recommend therefore that the Committee do consider the questions mentioned above and if they decided favourably upon either course of action, they should instruct me to approach the owner or owners of the premises with a view to obtaining possession. 3. Provision of Midwijery.—During the year 1918, 895 babies were born to Hampstead mothers. Of these, 647 may be accepted as born 65 to working class or lower middle class mothers, and they were attended as follows:— Confinements at Home : — 246 attended by a doctor and an unknown nurse. 83 attended by a doctor, and with a nurse from a Nursing Association. 115 attended by certified midwives. 71 attended by Queen Charlotte's Hospital Midwife. Confinements in Hospitals, &c.: — 39 confined in Queen Charlotte's Hospital. 70 confintd in other hospitals, homes, &c. 23 confined in Poor Law Instutions. There has been from time to time considerable difficulty in some of our poorer districts in obtaining attendance during confinements. Medical attendance for poor class midwifery is not easy to obtain, and the practising midwives do not always supply the deficiency. During 1918 medical aid was culled in by midwives in six urgent cases, and the doctor's fees were paid by the Borough Council. The Board are anxious to secure an efficient midwifery service throughout the country. They are also of opinion that the status of the midwife should be raised, and that competent trained women devoting themselves to this service should be adequately remunerated. Hitherto, midwifery has not been attempted by the Nursing Associations ; their rule that none of their nurses should attend a case without a doctor has restricted their efforts to maternity nursing alone. They have also been deterred by the cost, and fear of a loss on the working of the midwives. If the two Nursing Associations would undertake midwifery, and provide properly trained and efficient midwives, they would fulfil a much felt want and relieve the position as regards confinement to no small extent. I have communicated with both Associations, and they are w illing to undertake the work provided the Borough Council would help them in case of loss on the innovation, and this the Council could do by undertaking to idemnify the Nursing Associations against such loss. If each Association appointed one midwife at a salary of £140 per annum, it is highly improbable that in her first year she would earn more than £40, leaving £100 for the Council to make good on each salary, and I therefore recommend that, subject to the following conditions:— 1. That the midwives are competent and approved by us. 2. That their services are available for all women who need them. 3. That the ordinary fee of the district is charged, and that it is only reduced or remitted when the circumstances of the case justify this action. 4. That the Council may, if they desire, be represented upon the Committee of Management of the Nursing Associations. 5. That it be understood that their staff are to be subject to instructions from the Council. the Council should guarantee the Nursing Associations against a loss on the working of their midwives, and I estimate the cost to the 66 Council for the eight months, that is, to the end of the present financial year, to be £133. Confinements in hospitals, either for normal or abnormal cases, has never been such a big question in Hampstead as in some of the neighbouring Boroughs; thus during 1918, 109 Hampstead residents were confined in hospitals other than Poor Law Institutions, and of these 39 were confined in Queen Charlotte's Hospital. The Board's grant is available for the aid of such facilities, and it appears to me desirable that the Borough Council should aid the funds of Queen Charlotte's Hospital provided satisfactory arrangements could be made in respect of letters of admission, &c. I have been in communication with the Hospital and they propose the following arrangement, that:— " The Council agrees to pay to the Hospital ten shillings for every patient resident in the Borough who may be admitted to the Hospital, and in return they receive Letters of Recommendation to enable them to recommend patients for admission to the Hospital, one Letter being issued for every £6 contributed, which is the estimated cost of each patient." Seeing that the number of Hampstead patients is approximately 40, this would entail an annual grant of £20, in return for which we would receive three letters of admission, which might be put at the disposal of the Ante-Natal Clinic for use in abnormal and urgent cases. I would, therefore, recommend that the Council enter into an agreement as mentioned above with Queen Charlotte's Hospital and I estimate the annual cost at £24, or tor the remaining eight months of the present financial year £1G. 4. Creches and Day Nurseries. —Except for the Eastern Creche being badly housed no help seems to be necessary in regard to either of the Hay Nurseries in the Borough. Both seem to be provided with sufficient funds, the Board of Education make a very substantial grant to both. If the Committee should favourably consider either of these suggestions I have put forward under the heading of Centres, then it would be desirable to offer the Pond,Street Creche accommodation within that Centre, and they have indicated their willingness to avail themselves of the same if offered at an equitable rent. Except for this I have no recommendation to make in respect of these Institutions. 5. Food.—As previously stated, the Council has already voted a sum of £200 for supplying milk at a low rate or free to expectant and nursing mothers, and to children up to five years of age. This has been utilised as follows :— Number of families assisted from 1st February to 30th April — 101. Cost incurred—£141 l(5s. 5d. Average cost per week—£10 18s. 2d. On May 1st the price of milk dropped from 10d. to 7d. per quart, and the number of applicants for assisted milk has decreased markedly. I am of opinion that althongh the provision for the supply of milk should continue, no further elaboration of the scheme is necessary at present, and that £80 will suffice to meet the amount for the next six months. I would therefore recommend that the Committee should advise 67 the Council to vote a further sum of £25 for the provision of milk and food for expectant and nursing mothers and childern up to five years of age. 6. Convalescent Home", &c.—The Board's circular indicates that their grant of 50 per cent, is available also for — 1. The provision of accommodation in convalescent homes for nursing mothers and for children under five years of age. 2. The provision of homes and other arrangements for attending to the healih of children of widowed, deserted and un-married mothers, under five years of age. 3. Experimental work for the health of exp. ctan' and nursing mothers and of infan's and children under five years of age carried out by Local Authorities or voluntary agencies with the approval of the Board. These are imporiant branches of the same subject, to which further consideration might be given before any recommendations are submitted to the Council. I have recently been given to understand that a movement is on foot to grapple with the question indicated in item 2 of this list, and should this materialise the Borough Council should give all possible aid in fuithering their endeavours, for, as I have stated, the illegitimate child is one of the chief causes of our infantile mortality. I am making inquiries as to the experience of other authorities in these matters, and hope to report on the subject at a later date. Meanwhile, I would suggest that these are pioneer works for which the energies of the voluntary bodies are eminently suited. I have the honour to be, Mr. Chairman, Ladies and Gentlemen, Your obebient servant, FRANK E. SCRASE, f.r.c.s. (Eng.), d p.h.(Lond). Medical Officer of Health. " The proposals in paragraphs 1, 2, 3, and 5 of the Report for extending and improving the work were approved by the Borough Council on 15th Mav and 19th June, 1919. The Ante-Natal Clinic at No. 59, South End Road, to serve the eastern portion of the Borough, was opened in August, and has been approved by the Ministry of Health pending the provision of other premises for the purpose. The propositions set out in paragraph 3 were duly incorporated in an arrangement with the Nursing Associations, each of which now employs a fully trained certificated Midwife, a portion of whose salary is guaranteed by the Council; and the suggested arrangement with Queen Charlotte's Hospital was also duly entered into. The total amount voted by the Council for the supply of free or assisted milk during the year was £1,075, and details of the arrangements made are stated in the Section of this Report relating to Food. 68 With refereucc to proposal No. 2, the Committee decided that centralization of activities was desirable, and on 19th June they informed the Borough Council:— " (a) That they had had under consideration a report, dated 9th May, of the Medical Officer of Health, on the working of the Maternity and Child Welfare Act, and such report had been circulated to the members of the Council. (b) That in order to obtain premises capable of housing most of the activities of the Council, they had instructed the Medical Officer of Health to approach the owner of certain premises with a view to obtaining possession of the same." A further report was presented in due course by the Committee to the Council as follows :— " Rosslyn Lodge " Scheme. " (a) That they had under consideration the question of housing some of the activities of the Committee on the eastern side of the Borough in one building, as suggested in the Medical Officer of Health's report of 9th May, 1919, and, after careful consideration, were of opinion that the premises known as " Rosslyn Lodge," Lyndhurst Road, would form a very suitable centre. (A) That the Medical Officcr of Health had informed them that these premises, held on lease from the Ecclesiastical Commissioners (31 years to run), were used as an Auxiliary Military Hospital; that they were loaned for the duration of the War to the British Red Cross Society, and the lessee would be loth to disturb the Hospital until after Christmas. (r) That they had viewed the house and grounds and had ascertained that the house was well and substantially built and in very fair condition of repair; that the initial items of expenditure would be the cost of adaptation and ordinary decorative cleaning ; that the accommodation comprises :— First Floor. Nine bed rooms, two bath rooms, and three other rooms. Ground Floor. Four large rooms, a very large fine entrance hall, and a suite of very spacious domestic offices with a conservatory and winter garden as an annexe. 69 Outbuildings. Consisting of well-appointed slables for five horses, two coachhouses, and harness room, which would make three or four big garages; and a suite of five living rooms over. This latter building is quite detached from the main buildings, and stands at the corner of the grounds abutting on Lyndhurst Road. JJr.C.'s, &c. There is also a one time motor garage now converted into a sanitary block for the hospital. Grounds. The grounds consist of about one and threequarter acres of land, kitchen garden, shrubbery, &c., on which the Red Cross Society has erected two annexes, one a terra cotta building with asbestos roof, twenty feet by ninety feet, and one a wooden hut, twenty feet by sixty feet. These structures are the property of the owner and included in the price asked. (d) That the premises are large enough to cover a number of the activities which came within the scope of this Committee. (e) That the London County Council have expressed their ness to rent a portion of it as an open-air school, making an entrance to such portion through Rosslyn Park Mews; that this portion would include the two annexes above referred to, and about half the site; that they would provide all their own stands and equipment. (f) That the authorities of the Day Nursery in Pond Street, who were very hard pressed for room, had expressed their willingness to rent a portion of the premises; that they were in a position to leave their present house at any time and would only be too pleased to take accommodation in these premises. It is suggested that they should occupy the top floor with a room in the servant's offices. (g That the large entrance hall and the four big rooms surrounding it could advantageously accommodate a Child Welfare Centre, and Ante-Natal Clinic, &c., whilst the rooms over the stable block could be let as a flat or could be utilised as caretakers' lodging; that the porlion of the building, which is now the 70 coachhouse, could be advantageously let as garages, or a portion could be adapted at comparatively small cost as a Tuberculous Dispensary. (A) That on a rental basis the cost of the first year was estimated to be as follows:— £ s. d. Rent 350 0 0 Rates, Taxes, &c. 200 0 0 Coal and Light 30 0 0 Repairs 50 0 0 Garden 25 0 0 Caretaking and Cleaning, &c. 150 0 0 Miscellaneous 39 0 0 Telephone 6 10 0 Total £850 10 0 That this was based on the assumption that the place was put into good condition when taken over; that if purchased £250 should be allowed for adaptation and repairs, as a considerable amount of labour was necessary to clear the overgrowth of saplings and shrubs ; that this would make the repairs account for several years very low; that as against this expenditure various sums could be placed to the credit account from the London County Council, the Pond Street Day Nursery, and others. Taking these sums into account the adverse balance would amount to approximately £260. Of this loss, the Ministry of Health, if they approve the scheme, would pay half, leaving £130 per annum to be borne by the Council and debited to any Child Welfare or kindred activities that may be housed in the building." The Committee recommended that they " be authorised to negotiate for the acquisition of Rosslyn Lodge for the purpose of a 'Centre' for the eastern portion of the Borough, and to approach the various bodies mentioned to ascertain what sums they would be prepared to pay by way of rent for the portions of the buildings and land to be reserved for them." Prior to the moving of this resolution in the Council on 17th July, 1919, by the Chairman of the Maternity and Child Welfare 71 Committee, no word of adverse criticism had been advanced against the proposal either in the Committee or outside, but, unfortunately for the scheme, at the meeting of the Council, a totally unexpected opposition was made by one member of the Maternity and Child Welfare Committee, and, by a small majority, the recommendation was lost. The Committee having carefully reconsidered the matter, decided to again submit their report and recommendation. On the day before the following Council meeting, however, information was received that the owner of the premises had made other arrangements for the disposal of the property, and the recommendation was therefore withdrawn. Needless to say, it is a matter of great regret to me that the Council did not see its way to give the Committee the authority to proceed) for which they asked. The Rosslyn Lodge site always appeared to me to be one of the best sites in Hampstead for a Maternity and Child Welfare Centre. It would solve several difficulties and provide the citizens with facilities that they have badly wanted for some years, and still need. The following table gives some record of the work of the Borough Council's Health Visitor:— Number of Visits paid :— 1918 1919 1918 1919 First Visits. TOtal visits To Expectant Mothers To Infants under 60 32 90 52 one year of age 647 770 917 977 The Council's Lady Health Visitor, Mrs. Roche, 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. In 1919, 24 still births were notified in addition to the live births. Notifications in respect of 1094 births in the Borough were received from the following sources:—219 from midwives, 745 from parents or doctors, and 130 from nurses and others. Mortality Among Young Children. The following table shows the Infantile Mortality rate and the 72 Death rate among children under five years of age. The latter rate is calculated upon a period of five years:— Deaths of Infants under 1 year of age. Deaths of Children under 5 years of age. Year. No. Rate per 1000 births. No. Rate per 1000 children born in the year and in preceding tour 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 1919 96 83 120 21.2 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 11 256 1910 1,233 71 57 36 10 278 1911 1,239 94 76 37 11 297 1912 1,207 68 66 74 11 149 1913 1,252 73 58 73 18 246 1914 1,218 77. 63 55 11 254 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 1919 1,039 77 74 117 19 162 It will be observed that the death-rate among illegitimate children is very high. In calculating this rate, only those infants definitely known to be illegitimate have been deemed to be such. All foundlings and babies found dead have been counted as legitimate. For the year under review the births of illegitimate infants represented a rate of no less than 101 per 1,000 births, or, broadly speaking, one in every ten, 73 Table showing the Infantile Death-Rates in the County of London, the City of London, and the Metropolitan Boroughs during 1919. DISTRICT. Deaths under 1 year per 1000 Births. Lewisham 60 Stoke Newington 64 Wandsworth 72 Battersea 73 Stepney 79 Chelsea 80 Hampstead 813 Camberwell 82 Hackney 82 Poplar 83 Fulham 83 Bethnal Green 84 Deptford 85 Lambeth 85 Woolwich 85 Islington 86 St. Pancras 86 Finsbury 86 St. Marylebone 89 Westminster, City of 89 Greenwich 92 Bermondsey 92 Paddington 92 Holborn 94 Suuthwark 95 Hammersmith 99 Kensington 102 Shoreditch 104 London, City of 105 County of London 85 74 It would be idle to contend that the position of the Borough in the Infant Mortality table is a satisfactory one. We were for years at the head of the table, and at one time achieved an infant mortality rate as low as 62. For the last few years, however, Hampstead's position has become progressively worse, and it has never stood so low in the table. In all other stages of life Hampstead maintains its position. The rate of infant mortality is the only exception, and the fact that a baby born in Hampstead has less chance of surviving to the age of one year than if it were born either in Lewisham, Stoke Newington, Wandsworth. Battersea, Stepney, or Chelsea, is a matter that calls for the closest investigation and renewed effort. The following are the infantile death-rate per 1000 births for each of the Wards, the Borough, London, and England and Wales:— WARD. Rate per 1.000 births. No. 1 (Town) 87 No. 2 (Belsize) 102 No. 3 (Adelaide) 103 No. 4 (Central) 49 No. 5 (West End) 68 No. 6 (Kilburn) 81 No. 7 (Priory) 84 The Borough 83 London 85 England and Wales 89 - In considering these ward-rates the smallness of the figures concerned must be borne in mind, thus the actual number of infant deaths were as follows:— Town Ward 13 Belsize ,, 20 Adelaide „ 10 Central „ 5 West End „ 12 Kilburn „ 24 Priory „ 12 75 The average infantile mortality rate in Hampstead for the years 1902-1918 was 77 per 1000 births. In order to attack, with any marked measure of success, the mortality occurring among young children, it is necessary to appreciate what are the most frequent causes of death, and how far, and in what measure, they may best be combated. In addition to the foregoing table the following statement has been prepared in order to show at what age-periods infantile deaths occur, and what proportion of those who die during their first year of life succumb in the first month, or in the first week of existence. Of the total infantile deaths in the Borough during the period 1905-1919, amounting to 1,414, no less than 606, or 43 per cent., died within the first month, and 390, or 27 per cent., died within seven days of birth. The deaths of infants under one week were certified to be due to the following causes:— Meningitis, not Tubercular 2 Convulsions 12 Pneumonia 2 Diarrhœa and Enteritis 3 Syphilis 1 Suffocation—Overlaying 9 Injury at Birth 42 Atelectasis 10 Congenital malformations 36 Premature birth 173 Atrophy, Debility, and Marasmus 38 All other causes 62 390 The following Table shows the percentage of infant deaths occurring under one month of age, calculated on the total number of infants dying before completing one year:— 76 Percentage of Infant deaths occurring under one month, calculated on the total number of Infants dying. Year. 1905 40.6 Average of 5 years. 1906 41.4 1907 40.8 41.7 1908 44.3 1909 41.4 1910 47.0 1911 37.1 1912 39.2 41.8 1913 44.0 1914 41.7 1915 40.6 1916 53.4 1917 46.7 45.7 1918 37.8 1919 50.0 The fact that so large a percentage of the deaths occurred within the first month indicates that here is a period of life needing far more attention than has hitherto been given. It is satisfactory to note that the Borough Council is making some effort in this direction—having already established pre-maternity clinics, which are attended by the Dispensary Nurse, appointed a part-time lady doctor, a whole time health visitor, and made arrangements for the provision of free or assisted milk and food for expectant and nursing mothers and children under five years of age. The keenness of those engaged by the Council in work connected with Maternity and Child Welfare has been well maintained during the year. All are convinced of the great importance of the work, and impressed with the need for further extensions and developments The Act of 1918, as I pointed out in my Annual Report of last year, is capable of wide interpretation. Section I. is as follows:— "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 77 authorise the establishment by any local Authority of a general domiciliary service by medical practitioners." An account of the steps taken by the Borough Council to supply food and milk to expectant and nursing mothers and children under five years of age, is given in the Section relating to Food. While practically all the present activities of the Public Health Department, tending as they do to improve the public health generally, must in some measure, more or less directly, make for physical improvement in the health of mothers and children, it is quite apparent to even a casual observer that much more remains to be undertaken. Aided by our increased knowledge and experience we must utilise new ways and means, supplementing, as far as possible without lessening parental responsibility. It is, of course, fully recognised that the children's welfare is the primary concern of the parents, but it is evident that the State must, where necessary, still more and more supplement parents' endeavours when the healthy future of the coining generation is concerned, for it is rapidly becoming more realised that healthy children are a nation's greatest asset. The Medical Officer of Health and School Medical Officer of the London County Council has favoured me with a statement of the results of Medical Inspection in Elementary Schools in Hampstead in 1919. These figures afford subject-matter for serious consideration; they clearly indicate that much yet remains to be done if the Borough Council is effectually to supervise the child life of Hampstead up to the time that the children are of school age. The subject deserves careful study, for while, as might be expected, of the Hampstead children examined only 0.2 per cent required treatment for malnutrition, compared with 0.5 in all London, it is somewhat surprising, for instance, to find that 31.8 per cent. of Hampstead scholars examined required treatment for defective teeth, as compared with 25.6 for all Loudon. It is to be hoped that the further development by the Borough Council of the work in connection with maternity and child welfare will lead to an appreciable improvement in the health of the young children. 78 Medical Inspection of Elementary Schools in Hampstead in 1919. Entrants. Age 8. Age 12. Total and percentage. Corresponding percentage for all London. Boys. Girls. Boys. Girls. Boys. Girls. Number examined .. 291 278 288 304 280 281 1,722 Per cent. 195,162 Skin Disease f 9 5 7 2 5 3 31 1.8 1.9 (x) 6 4 5 1 5 3 24 1.4 1.4 Teeth Defective (x) 87 93 93 106 80 89 548 31.8 25.6 Tonsils enlarged f 46 46 36 37 20 20 205 11.9 12.8 Adenoids f 25 27 18 12 5 3 90 5.2 4.7 Tonsils or Adenoids (x) 18 16 15 15 5 5 74 4.3 6.1 Other Nose and Throat f 9 12 7 6 7 4 45 2.6 2.0 (x) 5 6 4 2 2 2 21 1.2 0.6 Glands of Neck f 51 27 35 42 21 15 191 11.1 7.3 (x) 3 3 5 3 3 2 19 1.1 0.4 Eye Disease f 13 19 4 12 6 2 56 3.3 3.2 (x) 8 10 2 8 1 2 31 1.8 1.9 Vision Defective f Not tested 79 90 53 58 280 24.3 21.5 (x) 33 54 33 39 159 13.8 11.9 Ear Disease f 12 11 5 10 7 5 50 2.9 2.2 (x) 7 7 2 5 4 4 29 1.7 1.4 Hearing Defective f 7 4 1 3 4 6 25 1.5 1.0 (x) 1 2 1 — 1 1 6 0.3 0.4 Speech Defects f 3 — — — 1 — 4 02 0-5 (x) — — — — — — — — 0.0 Heart Defects f 8 6 10 12 12 13 61 3.5 3.4 f — 1 3 1 1 1 7 0.4 0.2 Anæmia f 12 18 11 10 21 10 82 4.8 3.5 (x) 4 4 4 1 4 6 23 1.3 1.3 Lung Complaints f 17 19 12 7 8 5 68 3.9 4.6 (excluding Phthisis) (x) 4 5 3 4 1 2 19 1.1 1.4 Nervous Complaints f 4 8 5 1 10 1 29 1.7 1.1 (x) — — — 1 3 — 4 0.2 0.2 Phthisis f — 1 1 1 2 5 0.3 0.2 (x) — — — 1 1 2 4 0.2 0.1 Other Tubercular Disease f 1 1 2 2 6 0.3 0.3 (x) — — — — — 1 1 0.1 0.1 Rickets f 6 3 6 1 1 — 17 1.0 1.7 (x) — — 3 1 — — 4 0.2 0.1 Deformities f 4 1 2 8 5 17 37 2.1 1.6 (x) 2 1 — 2 3 5 13 0.8 0.5 Malnutrition f 5 — — — 1 — 6 0.3 1.0 (x) 3 — — — — — 3 0.2 0.5 Other Defects f 18 9 11 5 9 19 71 4.1 3.3 (X) 6 4 6 4 6 11 37 2.1 1.8 f = defect found; (x)= requiring treatment. 79 Infant Mortality, 1919. 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. 1. Small-pox ... ... ... ... ... ... ... ... ... ... 2. Chicken-pox ... ... ... ... ... ... ... ... ... ... 3. Measles ... ... ... ... ... ... ... ... ... ... 4. Scarlet Fever ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... ... ... ... ... ... 6. Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... 7. Erysipelas ... ... ... ... ... ... ... ... ... ... 8. Tuberculous Meningitis ... ... ... ... ... ... ... 1 ... 1 9. Abdominal Tuberculosis (a) ... ... ... ... ... ... ... ... ... ... 10. Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... 11. Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... 12. Convulsions ... ... ... ... ... ... ... ... ... ... 13. Laryngitis ... ... ... ... ... ... ... ... ... ... 14. Bronchitis ... ... ... ... ... ... ... ... 1 1 15. Pneumonia (all forms) ... 2 ... ... 2 4 3 1 1 11 16. Diarrhœa ... 1 ... ... 1 1 1 ... ... 3 17. Enteritis ... ... ... ... ... ... ... ... ... ... 18. Gastritis ... ... ... ... .. 2 6 1 4 13 19. Syphilis ... ... ... ... ... ... ... ... ... ... 20. Rickets ... ... ... ... ... ... ... ... ... ... 21. Suffocation, overlying ... ... ... ... ... ... ... ... ... ... 22 Injury at Birth ... ... ... ... ... ... ... ... ... ... 23. Atelectasis ... ... ... ... ... ... ... ... ... ... 24. Congenital Malformations (b) 2 ... 2 ... 4 ... ... ... ... ... 25. Premature Birth 13 2 ... ... 15 4 ... ... ... 6 26. Atrophy, Debility and Marasmus ... 2 3 ... 5 8 1 ... ... 14 27. Other causes 16 3 1 ... 20 5 1 1 1 28 Totals 31 10 6 ... 47 24 14 4 7 96 Nett Births in (legitimate, 1030 Nett Deaths in (legitimate infants, 77. the year illegitimate, 117 the year of illegitimate infants, 19. and Enteritis and from Congenital Malformationd, Prematre Birth, Atrophy, Debility and (b) The total deaths from Congenital Malformations, Premature Birth, Atrophy Debility and Malformation including Premature Birth. Want of Breast Milk has been included under Atrophy and Debility. The following information specially asked for in the Memorandum of the Ministry is furnished in relation to the incidence of puerperal fever, ophthalmia neonatorum, measles, whooping cough, diarrhœa, polio-myelitis, &c. 80 Puerperal Fever. Two cases were notified, both attended by doctors and trained nurses. Neither patient was removed to hospital. One case proved fatal. Ophthalmia Neonatorum. Eleven cases were notified. One case was removed to the Infirmary. Of the remainder, in 8 cases both eyes were affected, and in two cases one eye only. Of these 10 cases, one was removed from the Borough, and the remaining 9 made a complete recovery. As regards the nursing of the children, in 8 of the cases the services of the Nurses of the District Nursing Associations were utilised. One case as stated above was removed to the Infirmary, and the child who was removed from the Borough was attending an ophthalmic hospital. Measles and German Measles. Compulsory notification of Measles and 'German Measles, which came into operation on January 1st, 1916, was rescinded at the end of 1919, by the Public Health (Measles and German Measles) Regulations, 1915, Rescission Order, 1919. In communicating the effect of this Order to the local medical profession, their attention was drawn to the arrangements made by the Borough Council whereby the services of a fully trained nurse supplied by the District Nursing Associations are available in suitable cases; and also to the possibility of patients being removed to hospitals should the home condi'ions preclude their being properly isolated and nursed. During 1919, 650 cases of Measles and 172 cases of German Measles were notified. In 1918 the figures were 460 and 114 respectively. Five deaths occurred from Measles in 1919, as compared with one death in 1918. The age periods of the persons attacked are shown in the Table on page 44. In 196 oases of Measles and 2 of German Measles a nurse was supplied at the cost of the Borough Council. 24 cases of Measles and 4 cases of German Measles were removed to hospital. 81 Whooping Cough. As it is not considered necessary to make cases of this disease compulsorily notifiable, no definite information is available as to the exact number of cases that occur; our chief source of knowledge is derived from the School Teachers Notifications of children absent from school either on account of their suffering from the disease, or of its existence in the houses in which they reside. The Borough Council has for several years issued a pamphlet, drawn up by the Medical Officer of Health, containing advice in the care of children suffering from this disease. Arrangements are in existence whereby the nursing facilities of the two Nursing Associations are available without cost to the parents, and in special circumstances cases are received into the isolation hospitals of the Metropolitan Asylums Board. It is hoped that our efforts may in some measure at all events permanently reduce the mortality from this disease. In 1919, fortunately, no death occurred under this head. The following statement shows the deaths since 1906 from Whooping Cough occurring at various age periods. During these years no death occurred at an age exceeding fifteen years:— YEAR. Under four weeks. Four weeks and under one year. One year and under five years. Five years and under fifteen years. Total. 1906 .. .. 2 .. 2 1907 1 5 6 .. 12 1908 .. 3 2 .. 5 1909 .. 10 6 2 18 1910 1 4 6 .. 11 1911 .. 1 2 .. 3 1912 .. 1 2 1 4 1913 1 4 5 .. 10 1914 .. 10 5 1 16 1915 .. 3 4 1 8 1916 .. 5 2 • • 7 1917 .. .. 1 .. 1 1918 .. 7 8 .. 15 1919 .. .. .. .. .. 82 Diarrhœa and Enteritis. During the year 16 deaths from Diarrhoea and Enteritis occurred among Hampstead children under 2 years of age. The following table gives a comparison in the death-rates from these diseases in Hampstead, London, and England and Wales during 1919:— Death-rate per 1000 births. Hampstead 13.83 London 16.22 England and Wales 9.59 Polio-myelitis, acute. Three cases were notified, 2 occurring in male children aged 2½ and 3 years respectively, and 1 in the person of a female aged 26. No case was removed to hospital. In only 1 case, that of the child aged 3 years, was there any permanent disability resulting, in this instance there being slight paralysis of the left leg. Pre-Maternity Clinics. The work of the Ante-Natal Clinics has continued to make progress during the year. The Western Clinic at the Health Institute was formed in the early part of 1917, and the Eastern Clinic at 59, South End Road was opened in August 1919. Dr. Mary Kidd, the Medical Officer in Charge of the Clinics submit the following report:— Annual Report of the Medical Officer to Pre-Maternity Clinics, January 1st, 1919, to December 3lst, 1919. This year has shown a steady increase in the number of patients attending the Clinics. It was deemed by the Borough Council advisable to open a Clinic on the Hampstead Heath side of the Borough in addition to the one on the Kilburn side, as the Kilburn Clinic is so inaccessible to expectant mothers living on the Hampstead Heath side. Accordingly a Clinic was started in this latter neighbourhood in August last. The attendances at it have been good on the whole. 83 In consequence, in has only been possible to hold one Clinic a week, at Kilburn, instead of two as formerly. Number of Clinics held 106 Number of new patients attending 117 Number of old patients attendances 387 Total attendances 504 The average number of patients attending each Clinic is thus nearly 5. 84 Table of Cases dealt with at the Pre-Maternity Clinics in 1919. Nature of Case. Number. Cured. Relieved. No f urther report on. Further remarks on. Bronchitis 6 3 2 1 — Tubercular suspect 2 — — 1 1 still under treatment at Tuberculosis Dispensary. Early Phthisis 4 — — — Under treatment at Tuberculosis Dispensary. 1 arrested; 3 improved greatly. Chronic Rhinitis 1 — 1 — — Mitral Stenosis 2 — 1 — I not doing well, ment as an in-patient at Hampstead Gen. Hospital. Rheumatism (muscular) 7 4 1 2 — Headaches and Neuralgia 3 1 1 1 — Anæmia and Debility 9 2 5 2 — Hyperthyroidism 1 — — 1 Has gone into the country. Hystero - epileptoid Fits 1 — 1 — — Dyspepsia 17 8 6 3 — Constipation only 3 — 2 1 — Morning sickness as chief trouble 8 6 — 2 — Hæmatemesis 1 — — 1 — Gastric Ulcer 1 — 1 — — Ventral Hernia 1 — 1 — Welton & Curtis belt provided and gave great relief. Intestinal Parasites 2 1 — 1 — Varicose Veins only 8 — 4 4 Crepe bandages provided free in all cases. Pseudo-cyesis 1 — — — Patient's delusion persisted until after the time that she expected to be confined. Threatened Abortion 7 — — —- 3 went to full time (two of these cases were specific in origin); 3 miscarried; I going on well when last heard of. Missed Abortion 1 — — — Dead fœtus removed at Queen Charlotte's Hospital. Inevitable Abortion 1 — — — Sent to Endsleigh Street Hospital. Retroversion of Gravial Uterus 1 — — — Replaced successfully. Patient went to full time. Premature painful uterine contractions 2 — — — No treatment seemed to relieve the pains much. Contracted Pelvis 3 — — 1 1 induction at Queen Charlotte's; 1 premature labour. (Induction was being considered here, but fortunately labour came on a month sooner). Onset of Climacteric 1 — — — — Post-natal cases 3 — — — — Not Ante-natal cases 3 — — — — Normal cases 16 — — — — Influenza 1 — — — — 85 As regards treatment for these cases. It has been a great help in one's work to be so closely associated with the Tuberculosis Dispensary and the doctors there have been most helpful in seeing cases in which phthisis was suspected and in advising as to their treatment. In none of the four cases in which early phthsis was definitely diagnosed during pregnancy, was it possible to persuade the mother to leave her family and go to a sanatorium after the birth of the child. A few weeks by the seaside was the utmost that could be arranged for the patient to have, after the birth of her child. At both the Clinics medicine is supplied free to the patients. This has been a great, help in treating the numerous cases of dyspepsia and anaemia, &c. In practically all the cases of dyspepsia carious teeth are present. In several cases, too, the teeth were few in number, thus rendering mastication difficult. I have been sending cases to the Dental Clinic at the Health Institute in Dynham Road, for treatment, but we are now shortly going to have our own Dental Clinic. Some arrangement will have to be made I think, whereby the mothers can obtain dentures at a reduced rate, on a system of weekly payments. So often I find that the real reason at the back of a mother's mind for refusing to part with some septic and discolored stumps is that she has no means of replacing her teeth by false ones. As regards the two cases of threatened abortion in which specific disease was present, I persuaded one patient to go to St. Mary's Hospital Paddington, for injections of salvarsan with most satisfactory results. It was not possible to persuade the other patient to undergo treatment by injections. I accordingly treated her with mercurial treatment by the mouth for some months and the results have been excellent. As regards the post-patal cases, two were unmarried mothers. In one case early phthisis developed and I sent her on to the Tuberculosis Dispensary. In another case, perimetritis was present. In the third case (a married mother), specific disease was present and I sent her on to the Garrett Anderson Hospital for Women. The cases that were not ante-natal were sent on to the latter institution also. Attendances of patients after their confinements. I always try to get the patients to come up once or t wice when they are about again, after the baby is born. In a large number of cases, this is done. Frequently it is necessary to give the mother a tonic after the severe strain she has been through. I have had four cases of subinvolution of the uterus, three after a full time pregnancy and one after a miscarriage. 86 The Queen's Jubilee Nurses have been very helpful in giving a course of hot Lysol douches to each of these patients, at my suggestion. Health visiting of patients. This has been undertaken during the last year, most ably and sympathetically by Mrs. Roche. I cannot speak too strongly of her excellent work in this direction. Co-operation with Midwives By a special arrangement, the Queen's Jubilee Nurses in this Borough are undertaking maternity work for the Borough Council. They send me up all the cases that they have booked beforehand, during pregnancy, to see. A few patients have also been sent to me by private midwives in the Borough. Supply of" assisted milk." The assisted milk scheme in this Borough during the last year, when milk has been so dear, has been of the greatest assistance in maintaining the nutrition of the expectant mothers. Under the scheme, milk is supplied at half price to expectant and nursing mothers, and in a few very needy cases it is given free. (Signed) Beatrice Mary Kidd, March, 1920. M.B. (Lond.) Section F. SANITARY ADMINISTRATION Sanitary Inspectors. A list of the staff, with the duties allotted to them, is detailed on page 3. The work of the staff is set out in Section B. The arrangements for chemical and bacteriological work are as follows : — Chemical analysis is in practically all cases undertaken by the Borough Analyst, Mr. A. W. Stokes, and details of the work done in 1919 will be found in the section of this report relating to Food. Bacteriological examinations are carried out by the Lister Institute of Preventive Medicine, excepting examinations of material for detection of tubercle bacilli, which are performed by the hospital to which the Municipal Dispensary is affiliated, who also make any necessary X ray examinations. 87 The following is a summary of the bacteriological work carried out during the year:— At the Lister Institute. Positive. Negative. Total. Diphtheria 27 138 165 Enteric Fever — 3 3 At the Hampstead General Hospital (To which the Dispensary is affiliated.) Number of specimens of sputum examined 186 REPORT OF THE PUBLIC ANALYST ON THE ANALYTICAL WORK OF THE YEAR Analytical Laboratory, Town Hall, Paddington, W. Reviewing the analytical work of the year we find that there were analysed: milk, 286 samples, general groceries, 70; butter, 44; lard, 44; margarine, 37; cheese, 14; flour, 3; cream, 2; drugs, 2 ; and sausages, 2. A total of 504 samples. Of all of these there proved to be adulterated only 5 samples, all of which were milk. Taking all the samples together, less than 1 per cent. were found to be adulterated, the actual percentage being 0.99. This is the lowest percentage for any year during which I have been your analyst. For the previous year, 1918, the adulterated samples reached 2½ per cent. The Borough is particularly fortunate in its food supply. I do not think there is another Borough in London that so consistently maintains the-purity of its articles. Apparently it is the higher prices paid this year for food that have taken away the inducement for adulteration. No doubt the work of the Food Control Committee has also contributed to this happy result. I have the honour to remain, Yours obediently, ALF. W. STOKES, Public Analyst. 88 Section G. HOUSING. The Housing problem has become more acute during the year under review. The situation which was already sufficiently serious to call for action by the Legislature on wide and comprehensive lines, became aggravated by the return of demobilised Service men. The Housing Committee, while attempting all that lay within their power in the matter of the provision of housing accommodation, found their activities restricted and hampered in various ways. Indeed, the necessity for making Closing Orders, with a view to the ultimate improvement of premises, was a matter for serious consideration owing to the great difficulty of the persons who would thus be dishoused finding other accommodation. So far as the Town Ward Scheme was concerned, the Committee came to the conclusion that it would be imperative to provide housing accommodation for the population to be dis-housed when the first section of property included in the scheme was dealt with; and it was with this object in view that the vacant land in New End, known as the "Workhouse Garden," occupied by the Board of Guardians, and later, the South End Green site, was taken into consideration as a possible site on which housing facilities could be provided for the people living in houses comprised in the Town Ward Scheme in respect of which Closing Or.'ers were to be made. It is obvious that the "Housing Question," in the widest sense of the term, will not and cannot be solved by the erection of buildings on all the available sites in London and other large towns; or by the maisonetting of suitable houses, or by the application of Closing Orders to insanitary premises. The former plan, while it provides housing accommodation, also increases the denseness of the population, and to increase the number of persons per acre in large towns already crowded, may be neither desirable nor wise. Again, rigorously to apply Closing Orders to insanitary premises when practically no other accommodation is available, is no real remedy for the evil. For each local sanitary authority to attempt to put into operation its own housing schemes, however relatively small, is of course good to a limited degree; but the great housing question can only be dealt with properly in its entirety by other means, in addition to local improvements in existing houses and sites, such as comprehensive schemes of 89 transport, the removal of large factories, works, &c., not essential to the economic life of individual towns, into country districts where Garden Cities can be planned in which the housing of the workers may be effected; and by other and far-reaching measures; in short, by large, well thought-out schemes, having as their ultimate object the re-population of the country side. Much is hoped for from the Housing, Town Planning, &c., Act, which became law during 1919, and if, as a result of the application of its provisions, a very much greater proportion of the population ultimately is housed in healthy homes with healthy surroundings, a great stride forward will have been made towards the creation of a healthy and happy England. The proper housing of the working classes, and indeed of other sections of the community as well, is certainly one of the most important problems before us, bound up indissolubly as it is with the reduction of tuberculosis and of infantile mortality and sickness, the increase of true temperance, and, gene-ally, the improvement of the health and morality of the mass of the people. The contents and arrangements of the pages that follow are in accordance with the suggestions contained in the Memorandum issued by the Ministry of Health. I.—General Housing Conditions. (1) Number of Houses.—The total number of ordinary dwelling houses in the Borough at the census of 1911 was 10,062, and the total number of buildings used as dwellings 11,976. The average number of persons in each was 6.7 and 7.l respectively. During the nine years 1911-1919, 123 new houses were certified by the Medical Officer of Health under Section 48 of the Public Health (London) Act, 1891, but none of these were definitely built for the "working classes" in the generally accepted definition of the words. Owing to the crowded state of so many of the houses, and the amount of subletting that has taken place in the Borough, it is extremely difficult to estimate the number of houses for the "working classes" that exist with any reasonable degree of accuracy. 90 (2) Population. — The population estimated by the RegistrarGeneral has been accepted for the purposes of our local statistics. As set out on page 6, these are as follows:—" Birth-rate population" 91,682, "Death-rate population" 88,012. These are, if anything, an under-estimate of the actual figures. (3) (a) Extent of Shortage or Excess of Houses.—The estimated shortage in the number of houses is 400. (3) (b) Measures taken or contemplated to meet the shortage.—These are referred to in the pages that follow. II.—Overcrowding. (1) Extent.—In calculating this, all the population living more than two in a room are assumed to be overcrowded. Our investigations would indicate that approximately 6,000 people or 2,000 families are living in in overcrowded condition. (2) Causes. —The causes of the present overcrowding are due mainly to the shortage of houses generally, and to some degree to the non-effectiveness of the bye-laws relating to houses intended or used for occupation by the working classes. (3) Measures taken or contemplated to deal with overcrowding.—In the present exceptional conditions it is extremely difficult and often inexpedient to deal drastically with every case of overcrowding, but when the schemes which the Council have now in hand are materialised much more may be done to reduce the congestion which undoubtedly exists. The principal schemes which the Housing Committee which was set up in 1918 have considered are as follows:— Town Ward scheme.—This contemplates the erection of model dwellings and the subsequent demolition of 71 houses and reconstruction upon the sites. South End Green.—This scheme provides for 4 blocks of dwellings comprising 22 one-bedroom flats, 64 two-bedroom flats, and 42 threebedroom flats. For this scheme a site of 3¼ acres of land has been secured at South End Green, plans have been prepared and approved, and tenders received. This is the most advanced scheme of any in our Borough. 91 Kilburn Vale area.—This scheme contemplates the acquisition and reconstruction of the area known as Kilburn Vale, about 2¼ acres in extent. This site has been surveyed, and a tentative plan prepared by the Architect and submitted to the Housing Committee. Westbere Road and Avenue Farm areas. —Schemes and plans have been considered for building upon the whole of these areas, comprising 11 and 44 acres respectively. These, together with the Kilburn Yale area, are still a matter of negotiation with the Housing Board. (4) Principal cases of overcrowding dealt with during tte year and action taken.— In 10 instances the overcrowding found to exist was remedied, chiefly by rearrangement of the inhabitants in their rooms. III.—Fitness of Houses. (1) (a) General standard of housing in the distric; (b) General character of the defects found to exist in unfit houses.—The majority of houses in Hampstead are of a very good standard, but there are a number of exceedingly old and worn out premises needing attention. There are, too, several streets which were built by speculative builders, and these houses are becoming a matter for serious consideration, and, if necessary, steps should be taken to prevent deteriorating into "slum" property. This question is dealt with in a Special Report, which is reprinted in the pages that follow. (2) Action taken as regards unfit houses under (a) the Public Health Acts, (b) the Housing Acts. (Note the detailed statistics as to action under the Housing Acts are to be found in the appendices.) (See also Special Report, page 101). 92 Statement showing steps taken in 1919, in connection with premises "represented in 1919 or previous years" by the Medical Officer of Health under the Housing Acts. Representation. Closing Order. Demolition Order. Premises. Date of Committee. Whether (a) unfit for habitation, (b) an obstructive building. Statute under which action taken. Date of Council. Statute under wnich action taken. Date of Council. Statute under which action taken. Remarks. 5, Kilburn Vale 31-3-19 (a) Housing, Town Planning, &c., Act, 1909. 17-4-19 Housing, Town Planning, &c., Act, 1909. Appeal lodged with Ministry of Health 18/9/19.Closin Order confirmed by Ministry of Health, 31/12/19 6, ,, ,, (a) Do. ,, Do. 7, ,, „ (a) Do. ,, Do. 17, Maygrove Road 8-5-19 (a) Do. 15-5-19 Do. In hand 16, New End Square 26-5-19 (a) Do 19-6-19 Do. 1-12-19 Housing, Town Planing, &c., Act, 1909 Do. 8, Woodchurch Road 20-10-14 (a) Do. 28-10-14 Do. 29-9-19 Do. 15/6/1915. Question of demolition considered and deferred. Appeal made against Demolition Order. 49, Downshire Hill 11-11-19 (a) Do. 20-11-19 Do. In hand (3)—Difficulties in remedying unfitness, special measures taken, and any suggestions in the matter. (See Special Report, page 101.) IV. Unhealthy Areas. (1) Action taken as - regards areas represented before the beginning of the year under Part I. or Part II. of the Housing Act of 1890. Kilburn Vale Area.— Represented on 8th June, 1903, under Part I. Housing of the Working Classes Act, 1890. This area, which has been the subject of much consideration since it first came under review, shortly after the Borough Council was created in 1900, was again considered in detail during the year. 91 On 8th May I submitted the following report to the Housing Committee:— 8th May, 1919. To the Chairman and Members of the Housing Committee. Mr. Chairman, Ladies and Gentlemen, Kilburn Vale Area. In accordance with instructions I beg to report upon the Kilburn Vale Area, as follows:— The name Kilburn Vale Area has been applied, usually, to that area lying between West End Lane, Abbey Lane, London General Omnibus Co.'s Depot, and Providence Place. Its approximate area is 51,460 square feet or 1 acre and 29 poles. When it first came under review in about 1900, it consisted of 66 small cottages and houses namely:— Abbey Lane, 1 to 13. West End Lane, 6, 6a, 8a, 8, 10, 12, 14. Kilburn Vale, 1 to 16, and Chapel Keeper's House. King's Cottages, 1 to 6 . Munden Cottages, 2, 3 and 4. Edward Terrace, 1 to 6. William Terrace, 1 to 6. Providence Place, 1 to 9, and Providence Cottage. In 1903 the area was represented to the Loudon County Council by Dr. Littlejohn, the then Medical Officer of Health, under section 4 of Part I. of the Housing Act, who thereupon resolved that the scheme was not of general importance to the County, and recommended that it should be dealt with by the Borough Council under Part 2 of the Housing Act of 1890. The Borough Council did not take steps to bring about arbitration on this point but on June 6, 1905, the Housing Committee of the Borough Couneil referred the Area to the Public Health Committee to be dealt with under the Public Health (London) Act, 1891. Much work has taken place upon this area under the powers of the Public Health Act, but more significant is the action that has been taken by the Public Health Committee under the Housing and Town Planning, &c., Act, 1909, by means of Closing Orders, &c. Since that date;— 6 houses have been pulled down and rebuilt, viz.:— 2, 3, 4, Munden Cottages. 6 and 6a, West End Lane. 11, Abbey Lane. 94 6 houses have been pulled down and the sites are still vacant, viz.:— 13, 14, 15, 16, Kilburn Vale. 2 houses are now in course of demolition, viz.:— 7, 8, Kilburn Vale. 3 houses are under Closing Orders, but these are not yet operative:— 5, 6, 7, Abbey Lane. 10 houses in addition have been thoroughly overhauled, viz.:— 1 to 9, Providence Place and Providence Cottage. But in spite of these proceedings, the area still remains a collection of very old houses badly arranged and close and confined in their general condition. The total number of occupied houses is 49 at the present time and the population is 234, namely, 88 males, 99 females, and 47 children under ten years of age and in spite of the demolitions that have taken place the number of people residing on the area is well over 200 to the acre. In my opinion the area is a suitable one for an improvement scheme and the position is one where additional accommodation is needed. To clear the area is very desirable from a sanitary point of view. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant, (Sgd.) FRANK E. SCRASE, Medical Officer of Health. This Report was considered by the Committee, who instructed me to prepare schemes for dealing with the Area and certain adjoining land. The following Report was presented to the Committee:— 30th June, 1919. To the Chairman and Members of the Housing Committee. Mr. Chairman, Ladies and Gentlemen, re Kilburn Vale Area. In accordance with your instructions I beg to further report on the Kilburn Vale Area as a housing site. My former report simply dealt with the Kilburn Vale Area as it is and the conditions that now exist. To consider the site as one for a Housing Scheme it would be much more advantageous to take in the land lying to the east of Abbey Lane than restricting oneself to the 1 acre 29 poles, which was dealt with in my report of May 8th and is that portion lying to the west of Abbey Lane. This would include taking in a piece of land ¾ of an acre in extent, upon which are situated six old houses and five workshop dwellings. They are, I understand, short leaseholds, having only a few years to run. If this were done a total area or 2¼ acres would be available. 95 This site would be most economically developed by enlarging Abbey Lane to a 40 feet roadway, joining Belsize Road and West End Lane, and by setting back Providence Place 32 feet from the centre of that thoroughfare and 64 feet on the West End Lane front. The land available would be most advantageously used by three blocks of tenements, each block to contain 24 tenements, making a total of 72, with an aggregate of 388 rooms. This would be 32 to the acre. It could be thus made to house a larger number of people than are now living upon it. I submit a plan to illustrate the suggestions made. I am, Mr. Chairman, Ladies and Gentlemen, Your obedient Servant. FRANK E. SCRASE, Medical Officer of Health. In view of the prohibitive price of the land the Committee felt that it was not practicable to deal with the Art a by means of a Scheme, but referred it to the Medical Officer of Health to deal with the various premises individually. The Ministry of Health, however, expressed the view that the Area should be dealt with and the matter is now under consideration. (Reference is made to this on page 91). Numbers 5, 6 and 7 Kilburn Vale, were "represented" in March 1919, and the Closing Orders in respect of these premises which had been appealed against, were duly confirmed by the Ministry. Silver Street Area. Certain premises which were "represented" in 1903 under Part 2 of the Act of 1890, and which we were described as the Silver Street Area, came under review again in connection with the Town Ward Scheme—to which reference is made later. The premises in Silver Street were included in premises comprising the Town Ward Areas, the official representation of which, by the Medical Officer of Health, was considered by the London County Council early in the year, who resolved that they were not prepared to undertake a scheme for the improvement of the areas under Part I of the Housing of the Working Classes Act, 1890, as in their opiuion the size and condition of the areas were not such as to be considered as being of general importance to the County, the areas being able to be dealt with in a more satisfactory manner than by means of a scheme under Part I of the Act. 96 The Borough Council thereupon resolved—That it appears to the Council (being the local authority) that the closeness, narrowness, and bad arrangement or bad condition 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 of some of them is necessary to remedy the said evils, and that the areas comprising those buildings, and the yards, outhouses and appartenances 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. (This subject is further referred in paagraph (VI) General and Miscellaneous, on page 97). (2) Particulars of, and action taken as regards, areas represented during the year Areas represented—nil. (3) Information as to complaints made during the year that areas were unhealthy and action taken Complaints of unhealthy areas—nil. (V) By-laws relating to houses let in lodgings, and to tents, vans, sheds, &c. (1) As to working of existing by laws, and (2) As to need for new by-laws or revision of existing by-laws. The question of the revision of our bye-laws was again considered, and a sub-committee was appointed to review the bye-laws. This sub-committee recommended that the draft bye-laws, as provisionally approved by the Borough Council on 19th March, 1914, should again be submitted to the Local Government Board for approval, they being of opinion that the proposed clause whereby houses were exempted from the operation of the bye-laws until registered by Resolution of the Borough Council was much preferable to the exemption clause in the Board's Model Bye-laws which dealt with the question of "exemption" from a "rent-limit" point of view. While the subject was under review, the Housing, Town Planning, &c., Bill of 1919 was under discussion in Parliament, and it was proposed that as respects the County of London, bye-laws for houses of this class should be made by the London County Council, and observed and 97 enforced by the Council of each Metropolitan Borough, except the clauses relating to stability and prevention of and safety from fire. In view of this provision, and the further clause that bye-laws so made shall supersede our existing bye-laws, the Borough Council asked the County Council to allow them to see any draft bye-laws which they proposed to make for tenement houses. The number of houses let in lodgings, or occupied by members of more than one family, on the Register at the end of 1919 was 405. During the year 707 inspections and re-inspections have been made, and 112 notices were served. The Water Supply of Tenement Houses During 1918, the powers conferred by Section 78 of the L.C.C. General Powers Act, 1907, have been exercised in regard to 63 houses, involving 115 tenements, making a total of 953 houses which have been dealt with in Hampstead since the Act came into force. (VI) Generally and Miscellaneous. Generally, an account of any action bearing on the public health not covered by the the above particulars, which has been taken during the year by the local authority in connection with overcrowding, insanitary property, and housing, whether under the Housing Acts or the Public Health Acts. Town Ward Scheme.—On 17th April the Committee reported to the Council:— "That they have had under consideration the question of utilising certain sites in the Town Ward for carrying out Housing Schemes. " That such sites are situated as follows:— Golden Square Golden Yard Silver Street Streatley Place Stamford Place Flask Walk. and previously have been the subject of reports by the Public Health Committee in pursuance of a reference from the Council." The Borough Council authorised the Committee to engage an Architect to draw up reports and plana of these sites; and to submit sketch plans, sections and elevations of the proposed buildings. The Architect was also asked to report upon the "Workhouse Garden Site," New End. This report, with plans, was considered by the Committee on 8th May, 1919. 98 The Ministry of Health having approved of the site, the Council on 17th July authorised the Committee to go forward with the acquisition of the land and the erection of dwellings. However, on 25th August, the Ministry of Health wrote to the Borough Council stating that the Ministry had received a communication from the Guardians of Hampstead with reference to the use of the New End Site for housing purposes; stating that the question had been referred to the Poor Law Branch, and that, in view of the present uncertainty us to the ultimate use which may be made of the Hampstead Workhouse, the Ministry thought it advisable that the Borough Council should defer consideration of the site for the present. To this course the Housing Committee did not agree, and a deputation of its members was appointed to wait upon the Ministry on the subject. The Ministry, however, decided that it was undesirable to proceed with this Scheme at that time, and they therefore were of opinion that no useful purpose would be served by the suggested Deputation. The Town Ward scheme, so far as it concerned the remodelling of the Golden Square site and adjoining premises had been materially affected by the action of an owner of part of the properties who himself carried out extensive alterations. The Committee had therefore decided to confine their activities in this particular locality to Silver Street, it being proposed that the population to be dis-housed while the property was being rebuilt should have the first opportunity of removing to the dwellings to be erected on the site known as the "Workhouse Garden" in New End; but in view of the Ministry's communication, as detailed above, the matter has been postponed pending further developments. South End Green.— The ground partly occupied as a fair was considered as a possible housing site. The owners, the London and North-Western Railway Company, on being approached with a view to the acquisition of the land, offered it to the Borough Council for £4,750, which offer was accepted. The approval of the site by the Ministry having been obtained, the Council's architect was instructed to prepare plans, and these have been agreed upon with the Ministry and approved by the Borough Council. When the buildings are erected here, it will be possible to offer accommodation to occupants of the scheduled houses in the Town Ward, 99 and the insanitary areas there can then be dealt with and the sites used for further housing. Netherwood Street area.—The streets comprising this area have come under review during the year. Special reports were made to the Committee as to the housing conditions of the inhabitants of Netherwood Street, Palmerston Road, Kelson Street, and Linstead Street. It was found, however, that although much crowding existed, the amount of illegal overcrowding—judging by the standard of cubic air space required by the bye-laws relating to tenement houses—was comparatively small, and the Committee did not recommend any further action. Frognal sites.—The agents for the owners of "Frognal Hall" and "Priory Lodge" estates approached the Council in August, stating that, in view of the very serious housing difficulty, huts might be erected upon the land. The Housing Committee decided that it was not desirable to place huts upon this ground, but the owners were communicated with on the subject of the acquisition of the land for housing purposes. The price asked for the land, however, was considered to be so high as to render the site unavailable for housing purposes. Lower Cross Road and Lawn Road sites.—The possibility of utilising sites on land belonging to the Midland Railway Co. at these roads was also considered. The company having been approached on the matter, wrote on 1st August, stating that the Council's application to take a portion of their land had been considered, and stating that they had a scheme under consideration which would involve the construction of a third tunnel under the land in question, and that this being so they were not prepared to agree to any scheme involving the erection of houses on the land, which to a considerable extent would be affected by engineering operations when the tunnel was made. There were also considerable difficulties in the way of the proper development of the land in Lawn Road, and finally the consideration of the site was not proceeded with. "Cholmley Lodge" Site, West Hampstead.—The possibility of utilising this property as a housing site was considered, and after receiving a report from the District Valuer, the Committee gave instructions for the London Housing Board to be approached. The matter is still under consideration. 100 Use of Huts for Temporary Housing.—The Committee went very carefully into the question of erecting huts upon vacant land in order to deal temporarily with the housing difficulty, but came to the opinion that the cost of purchasing huts, conveyance, carrying out of necessary drainage and sewerage works, and general laying out, would be too prohibitive to warrant any action being taken in the matter. Conversion of Houses into Flats.—In order to increase the housing accommodation available, the Housing Committee took into consideration the question of the conversion of suitable houses into flats and maisonettes. Thirty-two properties were selected, which were considered to be suitable for conversion. The Committee communicated with the London Housing Board on the matter, and representatives of the Board attended before and conferred with the Committee. The London Housing Board having expressed their willingness to negotiate for the purchase and conversion of these houses, and to hand them over to the Council when ready for occupation, the Council decided to request the London Housing Board to exercise on behalf of the Council the powers of the Council under Section 12 of the Housing, Town Planning, &c., Act, 1919, such dwelling accommodation, as and when provided, to be taken over by the Council as part of the Housing Scheme. The Council also decided to approach the Ministry of Health with a view to obtaining their consent for the Council to fix the best rents obtainable, according to the district, up to £120 per annum. Demolition of Dwelling-houses.—Upon a recommendation of the Housing Committee the Council passed the following resolution:— "That, in view of the existing famine in housing accommodation, in the opinion of the Council the demolition of any dwellinghouse for the purpose of providing a site for a place of amusement or for business purposes should be prohibited unless the consent of the Ministry of Health has been first obtained, such consent being subject to any conditions as to re-housing persons displaced as the Ministry may consider desirable." The Council informed the Ministry of Health, the London Housing Board, and the London County Council of their resolution. 101 Survey of the Borough. Consequent upon the request of the Ministry of Health for a report concerning the steps being taken in connection with the housing question and the dealing with insanitary property, an inspection was made of certain parts of the Borough. The Ministry was supplied, inter alia, with two lists of properties, one a list of areas which are being, or may have to be, dealt with as unhealthy under Part I. or Part II. of the Act of 1890, and the other a list of insanitary houses (other than houses in unhealthy areas) which arc seriously defective but which can be made habitable. The first list contained addresses of 259 dwellings with a population of 1,018, and the other, 643 dwellings with a population of The action taken in respect of these dwellings will be reported upon in the Annual Report for 1920, but I have thought it well to append here the Special Report which I prepared at the close of the year in relation to the two lists of houses :— Public Health Department, Town Hall, Haverstoch Hill, Hampstead, N.W. 5. 3rd January, 1920. To the Chairman and Members of the Housing Committee. Mr. Chairman, Ladies and Gentlemen, Repairing of Houses, Structural Alterations of Existing Houses, or Acquisition of Existing Houses. With reference to the above subject and to the list of houses which I have submitted to this Committee, I desire to bring the matter forward for your consideration in order that the policy of the Committee may be defined and the necessary procedure for dealing with the question may be put upon a regular basis. The Committee will remember that I have submitted two lists of houses; one, that of those premises which cannot be made reasonably fit in all respects for human habitation, and the other a list of houses which though below the standard compatible with health yet can be made, either by ordinary cleansing and renovations or by structional alterations, in all respects reasonably fit for human habitation. It is to this latter that I wish to refer. This list, when presented to you, contained 643 premises, and will, I believe, be augmented as time goes on and further houses are found to be in a condition which calls for action under section '28 of the Housing Act, 1919. The sections which particularly deal with this matter are sections 28, 26 and 12 of the Act of 1919, and later 1 wish to call your attention to section 36 of the Act of 1909 and its application to this question. 102 In the first case, taking section 28 of the Act of 1919, it will be noted that this section is an amendment to an extension of sections 14 and 15 of the Act of 1909, and these in turn are extensions of section 75 of the Housing Act of 1890. They were commonly called the "implied contract" sections, and the procedure under them was so cumbersome as to make them extremely difficult to put into operation Thus, section 75 of the Act of 1890 provides that in any contract for the letting of a house or part of a house at a rent in London not exceeding £20, there was an implied condition that at the commencement of the holding the house was in all respects reasonably fit for human habitation. By section 12 of the Act of 1903 this condition takes effect notwithstanding any agreement to the contrary, and such an agreement would be void. The Act of 1909 by section 14 extends the provision of section 75 to a rental of' £40 for houses in London and section 15 implies a condition in the letting of such houses that the landlord shall throughout keep them in all re»pects reasonably lit for human habitation. Section 15 of the Act of 1909 empowers a local authority if it appears to them that that the landlord does not keep the house lit for habitation, to require necessary works to be executed by a notice served upon the laudlord. The landlord then has the option to close the house, but if he does not inform the local authority within a specified time that he has decided to close the house and fails to carry out the works, the local authority may do the work themselves and recover from the landlord in a Court of Summary Jurisdiction. The landlord has an appeal to the Ministry both against the notice and the demand for recovery of expenses, but he has no right of appeal to the Courts. The Act of 1909 applied to house during human occupation, but the Act of 1919 now contains in section 28 a proviso for the repair of houses during human occupation or not and this provision applies generally to houses suitable for occupation by the working classes without any limitation as to rental or values whatever. If the owner of such a house fails to put or keep it in all respects fit for occupation, the local authority may serve notice upon him requiring him to execute the necessary works forthwith. The owner is only given the option of closing the house for human occupation if it is not capable of being rendered fit for human habitation. If he does not comply with the Order the local authority may themselves do the work and recover the co3t from him. Similarly, if the owner or anyone having an interest in a lodging house or house divided into tenements for the working classes fails to execute works required by the by-laws for such houses, the local authority may themselves do the work and recover the cost. I would point out that section 27 of the Act contains altogether a new departure If a house exists which, owing to change in the neighbourhood cannot be let as a single tenement, but can be readily let if divided into two or more tenements, not necessarily for the working classes, and the provisions of the lease do not admit of such conversion, then the local authority may seek from the County Court an order for varying the conditions of the lease in order to allow the house to be converted. Section 26 of the Act of 1919 is much simpler and places the onus of carrying out the work on the person defined as the owner in the Public Health Act of 1875 103 which is identical with the definition of owner in the Public Health (London) Act, 1891. In dealing with houses under this Section it does not appear clear to me that you have any power to call upon the owner for large structural alterations, which are essential if they are to be brought up to the standard now regarded as reasonable for the working classes. There arc a number of streets in the Borough which contain houses of the type once let to one family, and now occupied by two or more families and to make them self-contained sanitary temements for the working classes requires that something should be added to these houses in the nature of raising the back addition to the top storey or the provision of a new back addition where none exists at all, so that each tenement may have its own sanitary convenience' larder, water, &c., under their own control. This can only be brought about in one or two ways, by negotiation with the owner or action under section 28 of the Act of 1919. If this fails then you must consider whether you will take any action under section 12 and acquire the houses and carry out the necessary work yourselves and afterwards, own, control and administer the property. It is here important to bear in mind that our bye-laws for houses let in lodgings were made originally by the late Vestry in 1894, and we have failed to get our bye-laws redrafted; and. these old bye-laws have been proved to be bad in law. Under section 26 of the Act of 1919 the County Council have to make bye-laws for these houses, and these bye-laws must decide in most cases the requirements which will be made in regard to such houses as come within the scope of section 28 of the Act of 1919. It would, therefore, appear advisable to begin action in the first place with those houses which do not require structural alteration, and that the urgency of a properly approved code of bye-laws be urged upon the County Council in order that we may consider all houses which come under their scope. Where structural alterations, such as the extension of or the provision of back additions is needed to houses, so as to make them in all respects self contained tenements, I am of opinion that you will effect very little, unless this authority is prepared to take over the houses or do the work. The work of survey and specification will be so great that it would be extremely helpful if the Committee will formulate their policy at once in order that the work may be tickled in stages. The work to be done in this way under this section involves a particularly accurate system of procedure, because where the sanitary authority does the work in default of the owner the cost thereof must be recovered when the work is completed, and therefore it is of vital importance that the procedure should be strictly in accordance with the Act, and the money so spent amply secured. There must be no legal defect in the proceedings that would jeopardise your power of recovering the money spent. For this purpose I would draw your attention to section 36(3) of the Act of 1909, which is the section giving power of entry for the purpose of the Housing Acts. The section is plain; it states that any person authorised in writing, stating the particular purpose or purposes for which the entry is authorised by the local authority or the Ministry, may at all reasonable times, on giving 21 hours' notice to the occupier and to the owner (if known) of his intention, enter any house, premises, or buildings for he purpose of survey and examination where it appears to the local authority or the 104 Ministry that survey and examination is necessary, in order to determine whether any powers under the Housing Acts should be exercised. Having regard to the terms of this section, I think it is clear that you must specifically authorise your officers to enter, in each case, and your resolution must state the purpose for which the entry is authorised. The owner and occupier must than have 24 hours' notice of the intention to enter. When this has been completed and the result reported to you, it then becomes your duty to direct notice to be served upon the owner calling upon him within a reasonable time, not less than 21 days, to carry out such work as may be necessary to make the premises in all respects fit for human habitation. Against the requirements of this notice the owner has a right of appeal to the Ministry, and if he makes default in complying with it the only remedy is for you to enter and carry out the work. It is, therefore, obvious that the notice must take the form of a complete specification of works, which can be considered iu detail, and what is a reasonable time in which suoh works can be completed must be decided upon. If this system be carried out, your proceedings will be recorded in such a form as cannot be questioned at any subsequent stage, and considering the large amount of capital that will be involved, I think it is highly desirable that it should be done in this way. The work will impose upon the Department a very considerable amount of work of a responsible and highly technical character, and you must expect that the progress made in dealing with these houses will be of a gradual character. For the purpose of this work I have had prepared a report sheet for every house scheduled in the list already submitted to you and attached to this report, and am arranging this according to urgency, so that the list may always be before you in that order, and that you may appreciate what is involved. The survey when completed, specifications prepared, and notices served, must become part of a general scheme of administration, and the Committee must decide what arrangements they are prepared to make for carrying out the work if default is made in complying with the notices, whether it be done by direct labour under the Borough Engineer or by open tender from selected builders. Which ever way is chosen, I have small doubt that the duty of carrying out the work in a very large number of houses will fall upon the Council, for I am of opinion, that there are many owners who will avail themselves of this method of getting the work done. As soon as the work is completed, proceedings for recovering the amount spent, together with interest at the rate of 5 per cent., can be commenced. Section 28 (4) empowers the local authority to declare any such expenses to be paid by monthly or annual instalments extending over a period not exceeding 30 years, with interest at the rate of 5 per cent. per annum. This procedure, together with the state of finance at the present time, is for the Committee to consider, and although it may appear unreasonable that the Council should be expected to find this money at a rate that is less than it can be borrowed at the bank, it appears to me that the Act intends that the Council should in these cases finance the improvement in the homes of the working 105 classes. My own impression is that there are large numbers of houses owned by people whose circumstances are such that to find the necessary capital is wellnigh impossible, and when one regards the financial assistance which the Government proposes to give in the case of the erection of new houses, the inference conveyed would appear to be that any such assistance by the Council in connection with this section should be borne by the ratepayers as a whole in the interest of the poorer section of the community. I would, therefore, recommend— That the Committee should decide whether they will take action under section 28 of the Act of 1919, and, if they decide in the affirmative, to formulate their plan of action under the following headings:— (1) To appoint the Medical Officer of Health and the Sanitary Inspectors as Officers under the Housing Acts, and to consider the question of authorising them to enter for the purpose of survey, examination, &c., as provided for in Section 35 of the Act of 1909. (2) To consider whether they will take any action under Section 12 of of the Act of 1919. (3) To consider what arrangements should be made for carrying out the work by the local authority (either by direct labour or by tender) in cases of default by the owner. (4) To consider the necessary financial arrangements and staff for carrying out the work. (5) To urge upon the London County Council to draft the bye-laws under Seotion 26 of the Act of 1919 respecting houses divided into separate tenements. I am, Mr. Chairman, Ladies, and Gentlemen, Your obedient Servant, FRANK E. SCRASE, Medical Officer of Health. (VII.) APPENDICES. Statistics for the 12 months ended 31st December, 1919. (1) Number of dwelling-houses in respect of which complaints were made that they are unfit for human habitation:— (a) By householders Nil. (b) in the case of rural parishes, by Parish Councils (2) Action under Section 17 of the Housing Act of 1909:— (a) Number of dwelling-houses inspected under and for the purpose of the Section 6 (b) Number of dwelling-houses which were considered to be unfit for human habitation 6 106 (c) Number of dwelling-houses the defects in which were remedied without the making of Closing Orders 3 (3) Action under Section 28 of the Housing Act of 1919:— (ft) Number of Orders for repairs issued nil (b) Number of cases in which repairs carried out by the local Authority nil (c) Number of dwelling-houses voluntarily closed on notice by owner that they could not be made tit without reconstruction nil (4) Closing Orders:— (a) Number of representations made to the local Authority with a view to the making of Closing Orders 6 (b) Number of Closing Orders made 6 (c) Number of dwelling-houses in regard to which Closing Orders were determined on the houses being made fit for human habitation nil (5) Demolition Orders:— (a) Number of Demolition Orders made 2 (b) Number of houses demolished in pursuance of Demolition Orders nil (6) Number of dwelling-houses demolished voluntarily:- (7) Obstructive buildings:— (a) Number of representations made (Section 38 of the Housing Act of 1890) nil (b) Number of buildings demolished — (c) Number of representations still under tion — (8) Staff engaged in housing work with, briefly, duties of each officer:— Medical Officer of Health. Senior Sanitary Inspector. All Sanitary Inspectors, one of whom was specially appointed upon the passing of the Act of 1909. 107 Section 1. VITAL STATISTICS OF THE BOROUGH. TABLE V. Vital Statistics of the Borough. In these Tables the Birth-rule for 1919 is calculated upon a Borough Population of 91,682. 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. Rate per 1000 Births. Deaths. Death-rate per 1000 of the Population. 1902 82,380 1,516 18.4 904 11.0 133 87.7 73 0.89 1903 82,730 1,453 17.6 837 10.1 126 80.7 66 0.80 1904 83,080 1,445 17.4 892 10.7 161 111.1 73 0.89 1905 83.130 1 421 17.0 823 9.9 133 93.6 73 0.87 1906 83,780 1,437 17.1 850 10.1 111 77.2 57 0.08 1907 84,130 1,359 16.1 817 9.7 98 73.1 61 0.72 1908 84.480 1,4 0 16.6 803 9.5 97 69.3 71 0.88 1909 81,830 1,328 15.6 839 9.9 99 71.5 58 0.62 1910 85,210 1,310 15.7 829 9.7 81 60.4 58 0.68 1911 85,599 1,276 14.9 847 9.9 165 82.3 50 0.05 1912 85,966 1,281 14.9 861 10.0 79 61.7 64 0.74 1913 86,316 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 0.78 1916 81.470 1,164 13.1 862 10.5 73 62.7 55 0.67 1917 75,649 1,123 13.3 922 10.8 90 80.1 69 0.91 1918 71.815 895 11.1 1,027 14.8 69 77.1 75 1.01 1919 88,012 1,156 12.6 1,036 11.8 96 83.0 50 0.64 TABLE V. (1). Vital Statistics of No. 1 (Town) Ward. Year Population estimated to ' middle of year. Births. Deaths. Infantile Deaths. Pulmonary Tubereulosis. 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 14.6 140 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 0.6 1913 14,250 201 13.8 161 11.1 11 54.7 11 0.76 1914 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 13,510 132 9.7 140 10.3 7 53.0 13 0.96 1917 12,593 143 10.3 143 11.2 12 83.9 14 I.11 1918 13,000 115 8.8 157 13.5 13 113.0 11 0.95 1919 14,600 149 10.2 170 12.0 13 87.2 10 0.71 108 TABLE V. (2). Vital Statistics of No. 2 (Belsize) 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 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 22.1 144 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 1919 14,500 196 13.5 159 11.3 20 102.0 9 0.64 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. Rate per 1000 Births. Deaths. Death-rate per 1000 of the Population 1902 10,350 103 9.9 95 9.6 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 9.6 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 61.9 2 0.21 1916 9,100 104 11.4 95 10.4 12 115.3 5 0.54 1917 8,383 114 11.9 109 31.1 7 61.4 6 0.71 1918 9,366 97 10.3 119 14.3 6 61.8 11 1.32 1919 10,982 97 8.8 130 12.8 10 103. 8 6 0.39 109 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. Number. 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 11 100.0 5 0.54 1903 9,260 99 10.7 60 6.5 8 80.8 4 0.43 1901 9,330 90 9.6 62 6.6 11 122.2 1 0.11 1905 9.400 113 12.0 60 6.1 5 14.2 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 0.30 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 8.3 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 1919 10,800 101 9.3 117 11.5 5 49.5 4 0.39 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 0.88 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 20.1 121 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 17.5 125 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 9.1 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 1919 13,600 175 12.9 139 10.5 12 68.5 12 0.83 110 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 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Hate 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 14,800 417 28.2 184 12.4 39 93.5 18 1.22 1904 14,810 408 27.5 206 13.9 54 132.3 22 1.'48 1905 14,840 426 28.7 171 11.5 50 117.4 26 1.75 1906 14,840 441 29.9 197 13.3 41 92.0 15 1.01 1907 14,850 391 22.3 179 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 64.9 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 14,0 0 241 17.2 225 18.0 21 87.1 18 1.44 1919 15,700 296 18.8 201 12.9 24 81.1 11 0.70 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 14.3 121 11.4 13 85.6 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 10,400 117 11.1 115 10.9 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 72.1 7 0.73 1916 9,130 126 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 1919 11,500 142 12.3 120 11.1 12 84. 5 5 0.46 111 TABLE VI. Vital Statistics of Hampstead, compared with England and Wales. Year. Birth rate per 1000. General death-rate per 1000. Natural increase stead. 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 19.0 591 1893 20.5 30.8 1 2.9 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 17.1 270 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 1916 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 17.0 —132 1919 12.6 18.5 11.8 13.8 + 120