HAMP 28 THE Metropolitan Borough of Hampstead. REPORT for the year 1921, 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.).. 7-15 ,, B.—Sanitary Circumstances of the Borough 16-29 „ C.—Food 30-41 „ D.—Prevalence of and Control over Infectious Diseases 42-62 ,, E.—Maternity and Child Welfare 63-77 „ F.—Sanitary Administration 78 & 79 „ G.—Housing 80-88 ,, H.—Vital Statistics 89-9 INDEX 93.95 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. J. R. MacFadden, m.d., c.m. Mr. Alderman 6. Buckle Miss Councillor Fawcett ,, ,, G. W. H. Budd (Resigned in May) Mrs. „ Monro, j.p. Mr. Councillor J. A. A. Atkin Mr. „ T. H. Nunn „ „ C.W. Cunnington, m.r.c.s., d.p.h. „ „ H.R.Smith ,, ,, R. H. H. Cust, m.a., j.p. „ „ H. W. Snow Mrs. „ Dow, b.a. ,, ,, J. C. Staines (from May) Sub-Committees Drainage Plans, Tuberculosis, Venereal Diseases. MATERNITY AND CHILD WELFARE COMMITTEE. Members of the Council. Chairman: Mrs. Councillor Dow, b.a. Mrs. Councillor Arnholz Mrs. Councillor Fisher Mr. „ C. W. Cunnington, Mr. „ C. J. R. MacFadden, m.d., m.R.c.s., d.p.h. ,, ,, Monro, j.p. [c.m. ,, „ R. H. H. Cust, m.a., J.p. ,, ,, T. H. Nunn Miss ,, Fawcett ,, „ E. C. Taylor, m.d., m.s. Persons not Members of the Council. (Appointed in pursuance of Section 2 (2) of the Maternity and Child Welfare Act. 1918.) Lady H. K. Thompson Mrs. E. Grundy Mrs. J. Rocke Mrs. E, Stewart HOUSING COMMITTEE. Chairman: Mr. Councillor H. R. Smith. Mr. Alderman G. Buckle Mrs. Councillor Fisher Mrs. Councillor Arnholz Mr. „ F. B. Glover Mr. „ Belfour „ ,, F. G. Howard „ ,, V. H. Blessley Mrs. ,, Monro, j.p. ,, ,, R. H. H. Cust, m.a ., j.p. Mr. „ W.P.Newman Mrs. ,, Dow, b.a. „ „ W. J. Spriggs Mr. ,, E. J. Duveen ,, ,, E. C. Taylor, m.d., m.s. Miss „ Fawcett Sub-Committees—Insanitary Property ; Plans. Staff of the Public Health Department, 1921. Sanitary Inspectors: W. G. Kershaw, Senior Sanitary Inspector. R. Geary (Wards 1 & 2). W. F. Horniblow (Wards 3 & 7). Divisional J. Grimsley( Wards 4 & 5). A C. Townsend ( Ward 6). Inspectors. F. H. Hudson, Sale of Food and Drugs Acts, and Factory and Workshop Acts. A. Peverett, Housing Acts. Mrs. T. Fisher, m.a., Factory and Workshop Acts and Tuberculosis Regulations. Miss F. Hall, Infectious Diseases (Resigned in May). Asistants to Inspectors: W. Larkin, A Edwards, E Stratton, R. Martin. Public Mortuary: W. Larkin, 63, Flask Walk, Keeper. E. Stratton, Deputy Keeper. Disinfecting and Cleansing Stations: T. Rider, R. Bell, and W. Bell, Disinfectors. Mrs. Blanden, Attendant at Cleansing Station. Tuberculosis Dispensary: A. J. Scott Pinchin, m.d. (Lond.), m.r.c.p. (Lond.), Tuberculosis Medical Officer Miss M. Lowen, Nurse. Health Visitors: Mrs. K. Roche Mrs. I. G. Steward Miss A. .Kennedy Pre-Maternity Clinics: Miss Mary Kidd, m.b. (Lond.), Medical Officer in Charge. Public Analyst: A. W. Stokes, f.c.s., f.i.c. Dental Clinics: (Tuberculosis Dispensary and Maternity and Child Welfare. C. O. Gray, l.d.s., r.f.p.s., Dentist. Clerical Staff: A.J. Richards, C. W. Francis, Miss E. Blakeman, R. H. Box, W. Sell, F. S. Hill. Medical Officer of Health : Frank E. Scrase, f.b.c.s. (Eng.), l.r.c.p. (Lond.), d.p.h. (Lond.). Note.—The Medical Officer of Health and all Sanitary Inspectors are appointed as Officers under the Housing Acts. 5 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. 11th April, 1922. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mb. Mayor, Ladies and Gentlemen, I have the honour to place before you my Annual Report for the year 1921. The taking of the Census during the year 1921 renders it necessary to calculate our vital statistics on a figure considerably lower than the estimated population of 1920. This comes about by reason of the decennial Census originally arranged for 24th April being delayed until June 19th, and, whilst the returns for the country are, as a whole, fairly comprehensive, it would appear that the statistics for certain localities, of which Hampstead is one, have been considerably affected by the postponement and by other causes. The population of the Borough at the Census 1911 was 85,495; the recent Census records that the number of people who slept in Hampstead on Sunday, June 19th, was 86,080 an increase over the 1911 figure of 585 only. When one calls to mind the great problem that empty houses constituted in the previous Census year and compares it with the acute housing problem which exists to-day, in spite of extensive maisone'ting and sub-letting, it appears to me to be obvious that many residents must have been away from Hampstead when the 1921 Census was taken. Moreover, in 1919, when the population was rationed, upwards of 96,000 people were put upon rations. The Report of the Tuberculosis Medical Officer on the Tuberculosis work generally will be found on page 55; and on page 72 is the Report of the Medical Officer in charge of the Pre-Maternity Clinics. The year has been a very busy one for all members of the Staff whether engaged in duties appertaining to the general public health, tuberculosis, maternity and child welfare, or housing sections of the Department, 6 The additional duties continually being referred to Public Health Authorities have been previously commented on, and as the range of preventive and remedial measures widens, this must necessarily occur. This ever-widening scope of the activities of the Department is reflected in the changes which have taken place in the Staff. For instance two additional Health Visitors have been appointed. I am glad to be able to report that, generally speaking, our endeavours are appreciated by the inhabitants of the Borough, and during 1921 the duties of the Department have been carried out with more than usual smoothness; and when one realises that the Department rarely comes into contact with the public, unless it is on some subject irksome to the persons concerned, this is a matter for congratulation. I desire to express my gratitude to the Chairman and Members of the Public Health, Housing, and Maternity and Child Welfare Committees, for the sympathetic support that I have received from them, and also to the Staff of the Department for their loyal help willingly given at all times. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, FRANK E. SCRASE, Medical Officer of Health. 7 Section A. NATURAL AND SOCIAL CONDITIONS OF THE BOROUGH. SUMMARY OP VITAL STATISTICS FOR 1921. Population estimated to middle of 1921 86,890 Density 38 persons per acre Marriages 708 Marriage-Rate 16.3 Births 1,342 Birth-Rate 15.4 Deaths 973 Death-Rate 11.2 Deaths of Infants under 1 year 88 Infantile Mortality Rate 65.5 Death-Rate from the principal Epidemic Diseases 0.59 Death-Rate from Pulmonary Tuberculosis 0.72 Death-Rate from All Forms of Tuberculosis 0.82 Population at Census 1921 86,080 Area of Borough 2263 acres „ „ (excluding area covered by water) 2253 acres 8 POPULATION. The deferred Census of the population was taken on Sunday, 19th June, 1921, and the total number of persons returned as living in Hampstead was 86,080. This represents an increase of 585 on the total population as ascertained at the Census of 1911. The following table shows the population of Hampstead at each Census year, and the increase in each inter-censal period since the taking of the first English Census in 1801. Increase of Population Census Year. Census Population, per cent, during the ten years. 1801 .. 4,343 .. — 1811 .. 5,483 .. 26 1821 .. 7,263 .. 32 1831 .. 8,588 .. 18 1841 .. 10,093 .. 17 1851 .. 11,986 .. 18 1861 .. 19,104 .. 59 1871 .. 32,271 .. 68 1881 .. 45,436 .. 40 1891 .. 68,425 .. 50 1901 .. 81,942 .. 20 1911 .. 85,510 .. 4.4 1921 .. 86,080 .. 0.68 This table shows that the population of Hampstead increased considerably in every inter-censal period between 1801 and 1901, the increase being most marked in the years between 1851 and 1891. The Census of 1921 was originally chosen for the night of the 24th April, and while the 19th June, the date on which the postponed enumeration actually took place, is not an ordinary holiday date, still, the habit of going out of town for the week end is especially common in June, so that it is obvious that the Census population of the Borough is considerably lower than our normal population, for it should be remembered that in November, 1919, upwards of 96,000 people in the Borough were put upon rations. In view of these facts, and of the acute housing difficulty, I still am of opinion that our normal population is approximately 100,000. In accordance with the prevailing custom I have adopted the Registrar-General's estimate for the purposes of this Report, and this was calculated to have been 86,890 at the middle of the year 1921. 9 I have prepared the following estimates of the population of each Ward. Ward. Estimated Population. No. 1 (Town) 14,200 No. 2 (Belsize) 14,000 No. 3 (Adelaide) 10,000 No. 4 (Central) 10,090 No. 5 (West End) 13,000 No. 6 (Kilburn) 15,100 No. 7 (Priory) 10,500 The Borough 86,890 The natural increase in population, i.e., excess of births over deaths, was 369. Physical Features and General Character of the Borough. The major portion of the Borough of Hampstead is situated on a hill, and this has often led to the mistaken idea that the whole of Hampstead consists of high land. This is not so, for whilst the summit of the hill at the Flagstaff is 438 feet above sea-level, large districts at Chalk Farm and Kilburn are flat, and are only approximately 100 feet above sea level. The mass of the hill is clay, covered on its upper parts by a large bed of sand, known as Bagshot sands. This cap of sand is an out-lier of the much greater stretches which extend over a large portion of Surrey, Hampshire and Berkshire. Hampstead is one of the healthiest of the London Boroughs. It is almost entirely residential; well-to-do people comprising the majority of the population; the two districts of Kilburn and Fleet Road, however, are entirely working class. The atmosphere is dry and bracing; tuberculosis and rheumatic cases do well here. MARRIAGES. According to the return kindly furnished to me by the Superintendent Registrar of Hampstead, it appears that 708 marriages were registered in the Borough during 1921, as compared with 859 in the preceding year. 10 The following Table gives the marriage rates per 1,000 of the population for the years 1911-1921 :— 1911 16.3 1916 17.8 1912 15.0 1917 18.7 1913 14.9 1918 18.5 1914 19.0 1919 17.0 1915 23.2 1920 16.6 1921 16.3 BIRTHS. During the year 1,498 births—761 males and 737 females—were registered in Hampstead, as compared with 1,594 registered in the previous year. Of the 1,498 births,—180 males and 171 females—were of children who could not be deemed to belong to Hampstead. In addition, 195 births of children—99 males and 96 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, 1,342—680 males and 662 females—as compared with 1,566 in 1920, and being a decrease of no less than 224. These births were distributed among the various Wards as follows:—No. 1 (Town) 178, No. 2 (Belsize) 197, No. 3 (Adelaide) 133, No. 4 (Central) 112, No. 5 (West End) 211, No. 6 (Kilburn) 364, and No. 7 (Priory) 147. 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 12.5 No. 2 (Belsize) ,, 14.1 No. 3 (Adelaide) ,, 13.3 No. 4 (Central) „ 11.1 No. 5 (West End) „ 16.2 No. 6 (Kilburn) „ 24.1 No. 7 (Priory) „ 14.0 The Borough 15.4 London 22.3 England and Wales 22.4 11 Illegitimate Births. Of the total 1,342 nett births belonging to Hampstead, 83 or 62 per 1,000 births were those of illegitimate children. 39 of these were born outside tho Borough, chiefly in Lying-in Institutions, while 12 occurring within the Borough were considered not to be Hampstead children. The rate per 1000 births in 1921 was 56. This subject is referred to in the Section relating to Maternity and Child Welfare, on pages 63-77. DEATHS. The "recorded" death rate is the rate obtained by calculating the number of "nett" deaths per 1000 of the population. From the total deaths of civilians registered is deducted the number who were nonresident persons, and, after subtracting these, the number of deaths of civilian Hampstead residents who died outside the Borough is added. The total nett deaths during 1921 was 973, or 11.2 per 1000 of the population, as compared with 9.4 in the preceding year. These deaths were distributed among the various Wards as follows:—No. 1 (Town) 147, No. 2 (Belsize) 143, No. 3 (Adelaide) 119, No. 4 (Central) 102, No. 5 (West End) 146, No. 6 (Kilburn) 204, and No. 7 (Priory) 112. 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 10.3 No. 2 (Belsize) „ 10.2 No. 3 (Adelaide) „ 12.0 No. 4 (Central) „ 10.1 No. 5 (West End) „ 11.2 No. 6 (Kilburn) „ 13.5 No. 7 (Priory) „ 10.7 The Borough 11.2 London 12.4 England and Wales 12.1 12 Deaths at Yarious Ages. The following table shows the number of deaths at the various age periods, the causes of such deaths being shown in the Table on page 15. Sex. 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 under 75 years. 75 and upwards All Ages. M. 51 8 8 12 14 57 113 101 89 453 F. 37 12 10 18 18 64 126 96 139 520 88 20 18 30 32 121 239 197 228 973 It will be seen that 44 per cent. of the deaths occurring were of persons aged 65 and upwards. Detailed information concerning the deaths of infants under one year of age is given in the Section relating to Maternity and Child Welfare, on pages 63-77. 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 in each of the years 1914-1921. Year. No. of Deaths from Cancer. Year, No. of Deaths from Cancer. 1914 114 1918 105 1915 118 1919 123 1916 113 1920 120 1917 107 1921 134 Of the deaths from Cancer, 79 were females and 55 males. On this point it must be borne in mind that the population of the Borough was found at the census of 1911 to consist of 52,688 females and 32,807 males. In 60 cases the persons were over 65 years of age. 13 The next table gives the anatomical distribution of the disease in each sex:— Situation. Males. Females. Total. Tongue 4 - 4 Oesophagus 8 1 9 Stomach 2 3 5 Liver and Gall Bladder 3 4 7 Intestines 7 6 13 Rectum 3 9 12 Uterus — 14 14 Breast — 16 16 Other organs 28 26 54 Totals 55 79 134 Diarrhœa and Enteritis. Of the total deaths at all ages from Diarrhœa and Enteritis in Hampstead during 1921, which numbered 24, 16 took place among children under two years of age. 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 deaths from the principal epidemic diseases in recent years are as follows: — Year. Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diph heria 1919 .. .. 5 2 .. 7 1920 2 .. 8 4 6 5 1921 1 .. 4 5 6 35 The death-rate from these causes in 1921 was 0.59 per 1000 of the population. 14 Tuberculosis. The mortality from Tubercular Diseases is dealt with in Section "D" of this Report, on pages 48-61. Infant and Child Mortality. The deaths of infants and of children under five years of age are referred to in Section "E," on pages 63-77. Violent Deaths (excluding Suicide). 22 deaths were classified under this heading as compared with 19 in 1920. The causes of death were as follows:—3 were due to falls indoors, 2 to falls out of doors and 1 to fail from window; 4 to injuries caused by being knocked down or run over by motor or.tram cars, etc., 2 to'motor cycle accidents, 1 (an infant) to overlying, 1 to heat apoplexy, 3 to clothes catching fire, 1 to poisoning, 1 to abortion, 1 to results of gunshot wound in action 4½ years previously, 1 to drowning, and 1 to diving accident at the Swimming Baths. Suicide. 11 persons committed suicide, this being the same number as in 1920. The causes of death were as follows:—Drowning, 3; cut throat, 1; fall from window, 2; gas poisoning, 1; decapitation—jumped in front of train, 1 ; poisoning, 2; pistol shot, 1. 15 Causes of Death at Different Periods of Life during the Yeah 1921. 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 and under 75 1 years. 75 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 1. Enteric Fever m ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... 1 ... ... ... ... 2. Small-pox m ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 3. Measles M 1 1 ... ... ... ... ... ... ... F 3 1 1 1 ... ... ... ... ... ... 4. Scarlet Fever M 2 ... ... ... 1 ... 1 ... ... ... F 3 ... 2 ... ... 1 ... ... ... ... 5. Whooping Cough m 3 3 ... ... ... ... ... ... ... ... f 3 1 1 1 ... ... ... ... ... ... 6. Diphtheria m 17 1 4 6 5 1 ... ... ... ... F 18 ... 2 6 3 1 ... 1 ... ... 7. Influenza m 15 1 ... ... ... l ... 8 3 2 F 15 ... ... 2 1 i 1 3 5 2 8. Encephalitis lethargica m 3 ... ... 1 ... ... 1 1 ... ... F 1 ... ... ... ... ... 1 ... ... ... 9. Meningococcal Meningitis m ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 10, Tuberculosis of respiratory system m 34 ... ... ... ... 4 17 11 2 ... F 30 ... ... ... 1 6 14 6 3 ... 11. Other Tuberculous Diseases m 1 ... ... ... 1 ... ... ... ... ... F 6 1 ... ... ... 1 3 1 ... ... 12. Cancer, malignant disease m 55 ... ... ... ... ... 3 23 20 9 F 79 ... ... ... ... ... 9 39 18 13 13. Rheumatic Fever M 2 ... ... ... ... ... ... 2 ... ... F 2 ... ... ... 1 ... 1 ... ... ... 14. Diabetes M 3 ... ... ... ... ... ... 2 1 ... F 10 ... ... ... ... 1 1 3 1 4 15. Cerebral haemorrhage. d&c. M 19 ... ... ... ... ... 1 1 9 8 F 33 ... ... ... ... ... 2 4 13 14 16. Heart Disease M 55 ... ... ... ... ... 3 12 26 14 F 70 ... ... ... ... ... 3 16 2i 30 17. Arterio-sclerosis M 16 ... ... ... ... ... ... 5 4 7 F 11 ... ... ... ... ... ... 1 4 6 18. Bronchitis M 23 ... 1 ... ... ... ... 4 8 10 f 30 ... 1 ... ... ... ... 10 5 14 19. Pneumonia (all forms) M 34 6 ... ... 1 2 8 7 4 6 F 31 2 2 ... 1 1 2 6 7 10 20. Other Respiratory Diseases M 8 ... 1 ... 1 ... 1 3 ... 2 F 4 ... ... ... ... ... 1 2 1 ... 21. Ulcer of Stomach or Duodenum M 3 ... ... ... ... ... ... 3 ... ... F 5 ... ... ... ... ... 3 2 ... ... 22. Diarrhœa, &c. M 13 9 ... ... ... ... 1 I ... 2 f 11 ... 1 ... ... ... ... 1 ... 3 23. Appendicitis and Typhlitis M 2 ... ... ... ... ... 2 ... ... ... F 2 ... ... ... ... ... ... 1 ... 1 24. Cirrhosis of Liver m 1 ... ... ... ... ... ... ... 1 ... F ... ... ... ... ... ... ... ... ... ... 25. Acute and Chronic Nephritis M 16 ... ... ... ... ... 3 6 2 5 F 12 ... ... ... ... 1 2 4 3 2 26. Puerperal Sepsis M ... ... ... ... ... ... ... ... ... ... F 3 ... ... ... ... ... 3 ... ... ... 27. Other accidents & diseases of pregnancy, and parturition m ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... 1 ... ... ... 28. Congenital Debility and malformation, premature birth M 19 19 ... ... ... ... ... ... ... ... F 23 23 ... ... ... ... ... ... ... ... 29. Suicide m 4 ... ... ... ... ... ... 2 2 ... f 7 ... ... ... ... 1 4 2 ... ... 30. Other Deaths from Violence M 12 1 ... ... 2 5 ... 2 1 1 F 10 ... ... ... 1 1 2 4 ... 2 31 Other Defined Diseases m 92 11 1 1 1 1 16 20 18 23 F 96 3 2 ... 5 2 11 20 15 38 32. Causes ill-defined or unknown M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... All causes M 453 51 8 8 12 14 57 113 101 89 F 520 37 12 10 18 18 64 126 96 139 Totals 973 88 20 18 30 32 121 239 197 228 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 elsewhfre in England and Wales who died in the Borough have in like manner been excluded. 16 Section B. SANITARY CIRCUMSTANCES OF THE BOROUGH. Scavenging. During 1921 arrangements for dealing with house refuse by crushing were completed, and two machines supplied by the Patent Lighting Crushing Company were then put into operation at the Blackburn Road site adjoining the Metropolitan Railway. This has enabled the Borough Engineer's Department to deal with approximately 40 tons per day. The crushed refuse has been disposed of to farmers in the country through the medium of a contractor. From the experience we have gained of this method of treating house refuse it appears to be clear that the crushing of house refuse can be carried out by London Boroughs without nuisance arising. The total amount of refuse collected averages about one hundred tons a day, and the Works Committee have under consideration the question of extending the pulverising plant to deal with the whole of the refuse. Sanitary Inspection of Borough. Much of the work of the Staff of the Department, which is of great value in maintaining and improving the standard of sanitation of the Borough, does not readily admit of tabulation and cannot be reported upon in that manner; but the following Statement and information affords some indication of the work performed. There are 11,194 houses in the Borough, and of these approximately 1,833 are occupied by members of the working classes. Total number of Inspections, 6513. Re-inspections, 11546. „ Intimation Notices, 1104. Statutory Notices 731. „ deposits of plans and particulars for redrainage work, &c., 535. „ Complaints of insanitary conditions received and investigated, 942. General Conditions — Houses or parts of houses cleansed 562 Dampness in houses or parts of houses abated 298 Dilapidated „ „ „ repaired 416 17 Overcrowding— Rooms found overcrowded 2 Overcrowding abated (rooms) after service of notice 2 „ „ without service of notice — Underground Rooms— Found illegally occupied 16 Closed or illegal occupation discontinued 16 Belotc Floors— Spaces below floors in the basement or ground floors ventilated 206 Roofs— Roofs repaired 349 Gutterings— Gutterings repaired or renewed 295 Rainwater Pipes — Rainwater pipes repaired or renewed 398 „ „ disconnected from drains 43 „ „ „ „ soil-pipes 8 Waste Pipes— "Waste pipes of sinks disconnected from drains 2 „ trapped 459 „ ,, repaired or renewed 291 „ „ unstopped 6 „ of lavatories disconnected from drains — „ „ trapped 244 „ „ repaired or renewed. . 210 „ „ unstopped — „ of baths disconnected from drains — „ trapped 208 „ „ repaired or renewed 170 „ „ unstopped . 12 Water Supply— Water supply re-instated 9 Water provided to floors of tenement houses 132 No. of tenement houses dealt with 82 Sinks provided to upper floors of tenement houses 117 Water supplies used for domestic purposes disconnected from cisterns for flushing w.c.'s 3 18 Water Cisterns— Water cisterns repaired or renewed 8 „ removed from improper positions 39 „ cleansed 130 „ fitted with close fitting covers 81 Water Closets— Water closet accommodation provided 7 Additional water closet accommodation provided 34 Separate and sufficient water closet accommodation provided for persons of each sex 2 Water closets removed from improper positions 15 „ provided with proper and sufficient external ventilation 29 Improperly constructed water closet apparatus removed and new provided 9 Water closet apparatus repaired or renewed . . 589 „ „ unstopped. . 7 „ „ cleansed . . 16 „ „ provided with proper water supply 60 „ flushing cisterns repaired or renewd 60 Drains— Drains repaired or renewed 97 „ cleansed 61 „ unstopped 32 „ ventilated 78 Manholes— Manholes repaired or renewed 391 Ventilating Pipes— Ventilating pipes of drains carried to a sufficient height above windows 19 „ „ „ repaired or renewed 76 Fresh air inlets repaired or renewed 168 Soil Pipes— Soil pipes repaired or renewed 336 ,, ventilated 26 Gullies and Surface Drains — Gully traps removed from improper positions . . 41 „ cleansed 4 Inlets or surface drains trapped 15 19 Paving and draining Washhouses, Areas, Yards, &c.— Washhouse or scullery paving repaired or renewed 47 Areas cleansed 14 Area paving repaired or renewed 187 Areas drained 41 Yards or other open spaces paved. . 85 Paving of yards or other open spaces repaired or renewed. 272 Yards or other open spaces drained 62 Floors of buildings in which horses, &c., are kept; paved or repaired 9 Refuse and Receptacles — Dust bins provided 489 „ repaired 1 ,, cleansed — Fixed ashpits removed 30 Accumulations or deposits of refuse removed 880 Manure receptacles provided 23 „ „ amended — Nuisances from the improper deposit of trade refuse abated 2 Animals — Nuisances from the improper keeping of animals abated 5 Smoke Nuisances— Number of nuisances and complaints 3 „ of observations 33 „ of notices 1 „ of summonses — Cleansing— Number of adults cleansed 29 „ of children cleansed or re-cleansed 1460 „ of verminous rooms or premises cleansed 53 Disinfecting - Number of houses or parts of houses and contents disinfected 1583 ,, of persons accommodated at Shelter — Customs and Inland Revenue Acts— Number of houses for which certificates requested 2 ,, of dwellings contained therein 9 „ of houses certified — „ of dwellings contained therein — Public Mortuary— Number of bodies admitted 51 20 Increase of Rent and Mortgage Interest (Restrictions) Acts— Number of certificates applied for 89 „ „ issued 69 „ „ refused 20 Sale of Food, &c. Bakehouses— Factories. Workshops. Number on Register 21 (12 underground] 19 (9 underground) „ of Inspections 50 31 „ of Notices — — „ of Prosecutions — — Milkshops. Ice-cream. Premises. Restaurant Kitchens. Slaughter-houses. Cowsheds. Fried Fish Shops. Offensive Trades. Other Food Premises] Number on Register 86 68 63 4 nil. 11 nil. 515 „ of Inspections 271 161 194 26 45 1554 „ of Notices 8 - 5 1 - 20 „ of Prosecutions - - — - - — Housing Acts. For action taken under these Acts see Section "G." In addition to the matters mentioned in the foregoing Statement, the following subjects call for special mention : — Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department in 30 cases during the year. The facts relate only to the cases that were heard and decided in 1921. Statute or By-law. Fines. Coats. £ s. d. £ s. d. Public Health (London) Act, 1891, and Bye-laws made thereunder 76 0 0 33 8 6 Metropolis Management Acts, and Bye-laws made thereunder 20 0 0 2 12 6 Total 96 0 0 36 1 0 21 Drainage Works. The Bye-laws of the London County Council, which require the deposit of plans and particulars, came into operation in August, 1903. During 1921, 535 deposits of plans and particulars relating to drainage and other sanitary work, and 16 relating to drainage, etc., of new buildings were approved. Cleansing Station. During 1921, 29 cleansings of adults and 1,460 cleansings of children were carried out at the Cleansing Station, in the Electricity Station Yard, Lithos Road, by the Council's Attendant, and whilst this was in progress their clothes were thoroughly disinfected. Customs and Inland Revenue Acts. During the year applications for certificates under these Acts were received in respect of 2 houses containing a total of 9 dwellings but no certificates were issued. Increase of Rent and Mortgage Interest (Restrictions) Acts 1919 and 1920. During the year 89 applications have been made for certificates under these Acts, and 69 certificates were issued and 20 refused. Smoke Nuisances. During the year observations were made in 33 instances by the Sanitary Inspectors, and one notice was served. Public Mortuary. During the year the bodies of 51 persons were brought to the mortuary—24 by order of the Coroner, 19 by the Police, 6 at the request of friends of deceased persons, and 2 by order of the Medical Officer of Health. In 39 instances inquests were held, and in 28 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. 22 Cause of Death or Verdict Number of Bodies received. Deaths from natural causes 27 Accidental deaths 4 Open Verdict 3 Misadventure 4 Wilful Murder 1 Neglect at Birth 1 Suicide—Fall from window 1 Poisoning 3 Drowning 1 Cut throat 3 Felo de se 1 Total 49 In addition to these 49 bodies, the bodies of two still-born children was also brought to the Mortuary. Disinfecting Station. During the year l,583 houses or parts of houses, together with their contents were disinfected, while in addition all infected articles of clothing, &c., were suitably dealt with. Certificates as to Water Supply. Under the terms of Section 48 of the Public Health (London) Act, 1891, it is provided that a newly erected or rebuilt house shall not be occupied as a dwelling house until it is certified as possessing a proper and sufficient supply of water. During the year applications were received in respect of eight new houses and certificates were granted in all eases. Water Supply to Tenement Houses. In many tenement houses it is found that the only water supply for the whole house is that drawn from the tap in the basement, and whenever such a condition is discovered proper and sufficient supply is required to be provided upstairs. The authority for demanding this very necessary provision is contained in Section 78 of the London County Council (General Powers) Act 1907, and since the passing of this measure many tenement houses have been dealt with under the e powers. During 1921,132 tenements in 82 houses were provided with proper and sufficient water supply. 23 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 be found in the section relating to "Housing." Underground Rooms. During the year 16 underground rooms were found to be illegally in use, and were suitably dealt with. The required standard to which such rooms must conform, if used for sleeping purposes, is laid down in the Public Health (London) Act, 1891, and in the Regulations made by the Borough Council under section 17 (7) of the Housing, Town Planning, &c., Act, 1909. Rats and Mice (Destruction) Act, 1919. Under the provisions of this Act it is a punishable offence for any parson to fail to take such steps as may from time to time be necessary and reasonably practicable for the destruction of these pests on or in any land, building, etc , of which he is the occupier, or preventing such land, building, etc., from becoming infested with rats or mice. During the year all complaints concerning these pests have been investigated. In the majority of instances it has been found that the infestation is due to faulty drains, the origin of the vermin being the sewers. In a few cases complaints have arisen from small colonies of rats having taken up their abode in gardens. The occupiers have always been advised and assisted, and supplied with poison in suitable cases. In all instances the rats have been got rid of. Flooding in Kilburn. Flooding recurred in Kilburn again during the year, and on this occasion the Public Health Committee resolved to support a representation by the Works Committee to the London County Council on the subject. It was felt that work for the enlargement of the main sewer might be most suitably undertaken by the County Council as a means of providing work for the unemployed, apart from the urgency of the general question of the prevention of flooding. Sanitary Accommodation for Visitors to Hampstead Heath. The great need for sanitary accommodation in the vicinity of the summit of the Heath has not yet been met The matter was again 24 considered by the Borough Council in October, and an urgent appeal was made to the County Council to provide such accommodation to meet the requirements of the great number of persons who visit Hampstead Heath not only on Bank Holidays but every day, especially on Saturdays and Sundays. It was further pointed out to the County Council that the early undertaking of the work would provide employment for the unemployed. That such accommodation is urgently needed does not admit of argument, and since the opening of the Tube Railway this provision has become an absolute necessity. The inconvenience caused to visitors must be great, while the condition of the Heath is in places rendered objectionable. The provision of the required accommodation is now the subject of negotiation between the County Council and the Borough Council. FACTORY AND WORKSHOP ACT, 1901. Section 132 of the Act requires every Medical Officer of Health in his Annual Report specially to report on the administration of the Act, and five tabulated statements were framed by the Home Secretary with a view to such reports being made upon uniform lines. Administration. The supervision of these premises is largely controlled by the Factory and Workshop Acts; and in London by the Public Health (London) Act, 1891. For the purpose of their duties with respect to workshops and workplaces under the Acts, the Borough Council and their officers are given by section 125 of the Factory and Workshop Act, 1901, the same powers of entry, inspection, taking legal proceedings, or otherwise, as are possessed by Factory Inspectors. Under section 131 of the Act of 1901 it is the duty of the Borough Council to keep a Register of all Workshops situate within their district. 25 1. —Inspection of Factories, Workshops, and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries) 132 5 — Workshops (Including Workshop Laundries) 406 16 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 1403 20 — 1941 41 — Total 2.—Defects found in Factories, Workshops, and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Ret erred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Act:— Want of cleanliness 96 96 — — Want of ventilation 10 10 — — Overcrowding 1 1 — — Want of drainage of floors — — — — Other nuisances 39 39 — — Sanitary accommodation { insufficient — — — — { unsuitable or defective 4 4 — — { not separate for sexes 2 2 — — Ofences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) 1 1 — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) Other offences (Excluding offences relating to outwork, which are included in Part 3 of this Report) — — — — Total 153 153 — — 26 3.—Home Work. 74 lists of outworkers were received from employers. These contained 197 entries. NATURE OF WORK. Outworkers' Lists, Section 107. Lists received from Employers. Sending Twice in the year. Sending Once in the year. Outworkers† Lists Outworkers Lists Contractors. Workmen. Contractors. Workmen. 1 2 3 4 5 6 (1) Wearing Apparel— (a) making, &c. 44 35 56 4 1 30 (b) cleaning and washing 8 20 — 1 2 — (2) Making-up, ornamenting, finishing and repairing of table linen, bed linen, or other household linen (including in the term linen articles of cotton or cotton and linen mixtures) and any process incidental thereto 4 5 1 — — — (3) Making, ornamenting, mending, and finishing of lace and of lace curtains and nets 2 6 4 — — — (4) Making of curtains and furniture hangings and any process incidental thereto 6 6 5 — — — (5) Cabinet and furniture making and upholstery work — 3 — ... — ... (6) Making of Electro-plate — 2 2 — — — (7) Making of files — — — — — — (8) Manufacture of brass and of any articles or parts of articles of brass (including in the term brass any alloy or compound of copper with zinc or tin) — 2 2 — — — (9) Fur-pulling — — 2 — — — (10) Making of iron and steel cables and chains — — — — — — (11) Making of iron and steel anchors and grapnels — — — — — — (12) Making of cart gear, including swivels, rings, loops, gear-buckles, mullin bits, hooks, and attachments of all kinds — — — — — — (13) Making of locks, latches, and keys — — 2 — — — (14) Making or repairing of umbrellas, sunshades, parasols, or parts thereof 2 4 4 1 1 — (15) Making of artificial flowers — — — — — — (16) Making of nets other than wire nets — — — — — — (17) Making of tents — — — — — — (18) Making or repairing of sacks — — — — — — (19) Covering of racquet or tennis balls — — — — — — (20) Making of paper bags — — — — — — (21) Making of boxes or other receptacles or parts thereof made wholly or partially of paper cardboard, chip, or similar material 2 — 6 — — — (22) Making of brushes — — — — — — (23) Pea picking — — — — — — (24) Feather sorting — — — — — — (25) Carding, boxing, or packeting of buttons hooks and eyes, pins, and hair pins — — — — — — (26) Making of stuffed toys — — — — — — (27) Making of baskets — — — — — — (28) Manufacture of chocolate or sweetmeats — — — — — — (29) The making or filling of cosaques, Christmas crackers, Christmas stockings, or similar articles or parts thereof — — — — — — (30) The weaving of any textile fabric — — — — — — Total 68 83 84 6 4 30 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, Secs. 109 — 110, Nil. * In the case of those occupiers who gave out work of more than one of the classes specified in Column 1, and subdivided their lists in such a way as to show the number of workers in each class of work, the list has been included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers have been assigned in columns 3 and 4 (or 6 and 7) into their respective classes. † The figures in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year, and of the entries of names of outworkers in those lists. 27 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Bakers 18 Bootmakers 41 Dressmakers and ladies' tailors 54 Tailors 46 Upholsterers 15 Other trades 192 Total number of workshops on Register 366 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— 36 Failure to affix Abstract of the Factory and Workshop Acts (s. 133) 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 3 Reports (of action taken) sent to H.M. Inspector 3 Other 4 Underground Bakehouses (s. 101.) in use at the end of the year 20 Factories. The following is a list of the different classes of Factories in Hampstead:— Bayers 21 Laundries 2 Bootmakers 18 Metal Workers 7 Builders 4 Motor Workers 23 Butchers 6 Opticians 3 Carpet Beaters 2 Printers 11 Coffee Roasters 5 Other trades 20 Dairymen 4 126 132 inspections were made during the year and 5 notice weres served 28 Workshops. At the end of 1921 there were 366 workshops on the Register, and in addition 26 domestic workshops. Excluding these latter, there were 528 males and 561 females employed in the workshops. During the year 406 inspections were made and 16 notices served. Trade or Business. Workshops other than Domestic Workshops. Number of Workshops, Number of Workrooms. Number of Employees. Males. Females. Domestic Workshops. Total number of Workshops. Bakers 18 18 32 10 — 18 Blindmakers 4 6 6 5 — 4 Bootmakers 40 40 67 — 1 41 Builders and carpenters 18 22 35 — — 18 Carriage builders 3 6 8 — — 3 Confectioners 2 6 — 36 — 2 Corset makers 2 3 — 6 — 2 Cycle makers and repairers 2 6 7 3 — 2 Dressmakers and ladies' tailors 50 59 1 235 4 54 Harness makers 3 4 13 1 — 3 Ironmongers 8 8 18 — — 8 Laundresses 3 9 3 20 — 3 Milliners 21 21 — 51 5 26 Monumental masons 2 3 16 — — 2 Motor makers and repairers16 25 58 1 — 16 Outfitters 7 26 2 81 — 7 Pianoforte makers 4 6 26 — — 4 Picture frame makers 11 14 17 — — 11 Sign writers 3 5 5 4 — 3 Smiths 8 8 16 — — 8 Tailors 34 39 57 45 12 46 Upholsterers 15 18 26 10 — 15 Watchmakers and jewellers 12 12 17 — — 12 Wigmakers 11 11 4 23 2 13 Miscellaneous 43 58 94 30 2 45 Totals 340 433 528 561 26 366 Domestic Workshops. As stated in the preceding table, the number of domestic workshops known to the Department is 26. Workplaces. Among the more important workplaces in Hampstead are the kitchens of restaurants, coffee-houses, &c. During the year 1403 inspections were made and 20 notices were served. Home Work. Certain specified classes of work done at the homes of the workers are controlled by virtue of special clauses in the Factory and 29 Workshop Act, 1901. The object of this supervision is to prevent home work being done in insanitary dwellings, or in premises where there is dangerous infectious disease. Every occupier of a factory, workshop, or place from which home work is given out, and contractors employed by them, are required to keep lists showing the names and addresses of their home workers. The occupiers are required to send to the local authority on or before 1st February and 1st August in each year copies of such lists. Upon receipt of these lists, the names and addresses of home workers residing in the districts of other sanitary authorities are forwarded to the Medical Officers of Health concerned. 30 Section C. FOOD. Milk Supply. The number of premises in respect of which persons are registered as purveyors of milk is 86, comprising 42 dairies, 18 bakehouses and confectioners, 13 restaurants and coffee shops, and 13 general shops. Daring the year 271 inspections were made and 8 notices were served. Milk. On 22nd March the Milk (England and Wales) Order, 1921, was issued by the Food Controller, and on 24th March the Local Authorities (Milk) Order, 1921, was issued by the Ministry of Health. These Orders had reference to the control of the sale of "Grade A (Certified)" or "Grade A" milk, which may not be sold except under and in accordance with a licence granted by or under the Ministry of Health. The addition of colouring matter or water to milk or cream, and the sale of milk or cream to which colouring matter or water had been added, was also prohibited. By the Board of Trade's Order, of 24th June, the definition of milk was extended so as to include "skimmed" and "separated" milk in the term "milk" so far as the prohibition of the addition of colouring matter is concerned. "Grade A (Certified)" or "Grade A" milk must be produced under specially clean and hygienic conditions from a herd free from tuberculosis, and certain conditions governing its purity, freedom from pollution, etc., are necessary to be complied with. Although considerably belated and limited in its scope, this attempt to stop the sale of milk infected with the tubercle bacillus, is very welcome. It was as long ago as February, 1907, that the second interim report of the Royal Commission on Tuberculosis was issued, in which it was stated, inter alia : — "There can be no doubt but that in a certain number of cases the tuberculosis occurring in the human subject, especially in children, is the direct result of the introduction into the human body of the bacillus of bovine tuberculosis; and there also can be no doubt that in the majority at least of these cases the bacillus is introduced through cows' milk. Cows' 31 milk containing bovine tubercle bacilli is clearly a cause of tuberculosis and of fatal tuberculosis in man. A very considerable amount of disease and loss of life, especially among the young, must be attributed to the consumption of cows' milk containing tubercle bacilli. The presence of tubercle bacilli in cows' milk can be detected, though with some difficulty, if the proper means be adopted, and such milk ought never to be used as food. There is far less difficulty in recognising clinically that a cow is distinctly suffering from tuberculosis, in which case she may be yielding tuberculous milk. The milk coming from such a cow ought not to form part of human food, and indeed ought not to be used as food at all. Our results clearly point to the necessity of measures more stringent than those at present enforced, being taken to prevent the sale or the consumption of such milk." It is a matter for regret that while large sums have been spent in the campaign against tuberculosis, this well-known source of infection has not been effectively dealt with. So far as London is concerned, the London County Council, in pursuance of their powers under the London County Council (General Powers) Acts, takes certain action in this matter and the analysis of samples of milk from many English Counties, taken by them at London railway stations, demonstrates the lamentable fact that milk containing tubercle bacilli is still being sent to London. It would appear that, in the words of the Royal Commission's Report previously quoted, there is a necessity of "measures more stringent than those at present enforced being taken to prevent the sale or the consumption of such milk." Public Health (Milk and Cream) Regulations, 1912 and 1917. These Regulations aim at securing that cream containing prservative shall be distinguished at all stages of sale from cream to which no preservative has been added. It is no longer permitted in any case to add preservative to milk. The Ministry of Health require the Medical Officer of Health to report on the administration of the above-mentioned Regulations, and for convenience the report has been drawn up under the following headings:— 32 Report for the Year ended 31st December, 1921. 1.—Milk; and Cream not sold as preserved Cream. (a)—Number of samples examined for the presence of a preservative. (b)—Number in which preservative was reported to be present, and percentage of preservative found in each sample. Milk 320 Nil. Cream 12 Nil. Nature of preservative in each case in column (6) and action taken under the Regulations in regard to it, nil. 2.—Cream sold as Preserved Cream, 3. (а) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct 3. 1. Correct statements made, 3. 2. Statements incorrect, nil. 3. Percentage of preservative Percentage stated on found in each sample— Statutory label- 0.40, 0-32, 0.33 per cent. 0.50, 0.40, 0.40, per cent. by by weight weight. (b) Determinations made of milk fat in cream sold as preserved cream ;—1. Above 35 per cent., 3. 2. Below 35 per cent., nil. (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V (1) and the proviso in Article V (2) of the Regulations have not been observed :—nil. (d) Particulars of each case in which the regulations have not been complied with, and action taken :—nil. 3.—Thickening substances. (а) Any evidence of their addition to cream or to preserved cream, nil. (б) Action taken where found, nil. 4.—Other observations (if any), nil. Milk (Mothers and Children) Order, 1919. The effect of this Order is to empower the local authority to 33 supply milk to expectant and nursing mothers and young children free or under cost price, where some person authorised by the local authority certifies this to be necessary by reason of the retail price in its district. The grant from the Ministry in this matter is limited to necessitous cases. The amount of milk towards which the Council contribute is based upon the following scale:— For children between 3 months and 18 months, in exceptional cases 1½ pints daily, when special medical certificate is required. For children under 3 years, 1 pint daily. For children between 3 years and 5 years, one pint daily, when a special medical certificate is required. For expectant or nursing mothers, one pint daily. The Committee, on 12th April, 1921, again considered the question of this supply of milk, and formed the opinion that the amount of help given should be reduced, except in those cases where the milk is given free. Upon their recommendation the Council, on 28th April, decided that in future they would only pay any excess in the price of milk over and above six pence per quart, with the exception of those cases in which the milk is supplied free. At the same meeting of the Council the scale of income under which assistance was given was amended with a view to curtailing the number of those who benefitted by the scheme. The reduction in income was as follows:— Scale of Income adopted 20th Nov., 1919. and amended 25th Nov., 1920. For 2 parents 40s., incl. rent For each of first 3 children 15s., do. For the 4.th child and others 10s., do. Scale of Income adopted 28th April, 1921. For 2 parents 40s., incl. rent For each of first 2 children 10s., do. For the 3rd and other children 7s. 6d. each, do. The Ministry of Health, however, disagreed with this scale, and 34 requested the Borough Council to adopt the scale then in force at Stepney. This scale, which was ultimately adopted on 27th October, is as follows:— No. in family. SCALE OF INCOME (after deduction of rent) adopted for applicants for assistance. FREE MILK. Scale per head. Scale per family. ASSISTED (Half-Price). Scale per head. Scale per family. s. d. £ s. d. s. d. £ s. d. 1 16 0 0 16 0 18 0 0 18 0 2 13 0 1 6 0 14 6 1 9 0 3 10 6 1 11 6 11 6 1 14 6 4 96 1 18 0 10 6 220 5 8 6 2 26 96 276 6 80 280 90 2 14 0 7 80 2 16 0 90 330 8 80 340 90 3 12 0 A further considerable reduction was made upon receipt of the Ministry of Health's letter, dated 26th August. In this letter was communicated the decision of the Ministry that for the remaining six months of the financial year ended 31st March, 1922, the Borough Council's expenditure in this connection should be equivalent to not more than 5 per cent, of their expenditure on milk in the year 1st April, 1920—31st March, 1921, of which expenditure the Ministry would pay 50 per cent. This great reduction in the amount of money to be expended precluded much assistance being given in the form of milk to children, and it was agreed to expend the funds available primarily in the provision of food and dinners for necessitous expectant and nursing mothers, as, in the opinion of the Maternity and Child Welfare Committee, the provision of such food and dinners was of paramount importance. Although at a later date it was understood that the Minister of Health had decided not to proceed further in the matter of this latest reduction, the Committee did not again expand their scale of assistance but continued along the lines indicated in the Ministry's letter of 26th August. The following statement gives in tabular form an account of the 35 milk given, either free or assisted, in each month of 1921. The amount paid by the Council during the year in rendering this assistance was £1544 18s. 1d.:— Month. Number of families being helped Number receiving Assisted Milk. Free Milk. Price of Milk per quart. Rate of help given by Council. d. January 237 135 102 11 February 256 139 117 11 March 257 159 98 11 April 204 90 114 10 Council paid half the cost in "assisted" cases May 121 13 108 8 June 115 9 106 8 July 117 12 105 8 August 133 11 122 9 September 126 15 111 9 October 29 1 28 9 Council paid excess over 6d. per quart in "assisted" cases November 33 3 30 9 December 37 4 33 9 Council paid half the cost in "assisted" cases Food (other than Milk). 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 been made with tradesmen to supply food to the Council's order; and with proprietors of eating houses to supply dinners to expectant and nursing mothers. This latter seems the best way; it has the advantage of ensuring that, the woman herself eats the food, which is not always certain in other cases. There is, however, very considerable difficulty in getting the women to attend at a public eating house, especially expectant mothers, and by the end of the year, of all the expectant and nursing mothers to whom assistance in the way of food was given, only one could be pursuaded to go to a public restaurant. The amount paid by the Council during 1921 for this assistance was £226. The Ministry of Health are prepared to pay grants not exceeding one half of approved nett expenditure involved in this connection. 36 The following table shows the number of persons receiving free dinners or other food (excluding milk) during each month of the year:— Month. Number of women receiving help. Dinners. Other Food (e.g., Oatmeal, Cocoa). January 7 9 February 10 11 March 14 10 April 10 9 May 9 18 June 8 24 July 9 20 August 7 33 September 9 36 October 10 28 November 3 23 December 1 29 Unsound Food Seized or Surrendered. The following is a list of food seized or voluntarily surrendered during the year:— Beef, corned, 6 lbs. Chutney, 4 bottles. Fish, 25 stone 2 lbs. Flour, 1715 packets. Meat, potted, 2 jars. Onions, 4 jars. Rabbits, 54, and 1 cwt. 40 lbs. Tinned foods — Beef, 7 tins. Cream, 12 „ Fish, 19 „ Fruit, 112 „ Milk, 27 „ Vegetables, 1 tin. Other, 2 tins. Food Premises. Section 8 of the London County Council (General Powers) Act, 1908, very considerably increased the power of Sanitary Authorities to improve and maintain the condition of food premises. These 37 premises are kept under constant supervision by the Special Food Inspector. During 1921 all food premises have been supervised. In 20 instances notices were served before insanitary conditions were abated. Butter Factories and Wholesale Dealers in Margarine. No premises were registered during the year as a Butter Factory. During 1921 no Wholesale Dealers in Margarine were registered in respect of the undermentioned premises:— The other dealers previously registered are as follows:— Home & Colonial Stores, Ltd., 88, Cricklewood Broadway. „ 182, Finchley Road. „ 140, High Road, Kilburn. „ 80, High Street. „ 252, West End Lane. Messrs. Lipton, Ltd., 48, Cricklewood Broadway. „ 134, Finchley Road. „ 312, High Road, Kilburn. „ 59, High Street. Messrs. The Maypole Dairy Co., Ltd., 304, High Road, Kilburn. Messrs. Pearks' Dairies. Ltd., 6, Nether wood Street. 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. Belsize Ward 106, Fleet Road, 70, Upper Park Road. West End Ward 1a, Broomsleigh Street, 74, Mill Lane and 1, Munro Terrace. Kilburn Ward 132, High Road; 68 and 89, Kingsgate Road 95, Palmerston Road. Ice Cream. There are 68 shops in the Borough in which Ice Cream is sold. The question of further control of ice cream vendors, and premises upon which ice cream is manufactured, was considered during the year in consequence of a letter being received from the London County Council. It was agreed that it would be very advantageous if such vendors were compelled to be registered as is the case with milksellers. 38 Bakehouses. At the end of 1921 there were 40 occupied bakehouses on the register, 21 being underground, and 19 above ground. 10 of the bakehouses situated above ground and 12 underground use power, and are therefore factories. 50 inspections were made in respect of the factory bakehouses, and 31 inspections were made in respect of the workshop bakehouses. The following is a list of the occupied bakehouses on the Register at the end of the year:— Factory Bakehouses. Aboveground. Underground. No. 1 (Town) Ward. 3, High Street Nil. No. 2 (Belsize) Ward. 6, Fleet Road 65, Fleet Road 45, South End Road No. 3 (Adelaide) Ward. Nil. 44, England's Lane No. 4 (Central) Ward. 2, Broadhurst Gardens 225, Finchley Road. 307, Finchley Road No. 5 (West End) Ward 60, Cricklewood Broadway 43, Mill Lane 110, do. 279, West End Lane 553, Finchley Road 4, Munro Terrace, Fortune Green No. 6 (Kilburn) Ward. 218, High Road, Kilburn 94, High Road, Kilburn 354, do. 4, Kelson Street 99, Palmerston Road No. 7 (Priory) Ward. Nil. 228, Belsize Road 98, Boundary Road 93, Fairfax Road Workshop Bakehouses. No. 1 (Town) Ward. 39, Heath Street Nil. 67, do. 67, High Street 26, New End 39 Workshop Bakehouses (con.) Aboveground. Underground. No. 2 (Belsize) Ward. Nil. Nil. No. 3 (Adelaide) Ward. Nil. 2, King's College Road No. 4 (Central) Ward. 250, West End Lane 64, Belsize Lane 289, Finchley Road 98, West End Lane No. 5 (West End) Ward. Field Lane School, 489, Finchley Road (Structural Hillfield Road alterations in progress to 44, Mill Lane transfer bakehouse to above- 251, West End Lane ground) No. 6 (Kilburn) Ward. 67, Kingsgate Road 63, Hemstal Road No. 7 (Priory) Ward. Nil. 202, Belsize Road 7, Fairhazel Gardens 137, Finchley Road Restaurant Kitchens, etc. The total number of these premises on the register at the end of 1921 was 63. They are kept under regular supervision, 194 inspections have been made and 5 notices served during the year. Meat Supply. The Meat Supply of the Borough is on the whole good. A list of the unsound food seized or surrendered is shown in detail on page 36. Slaughter Houses. There are 4 Licensed Slaughter Houses in the Borough, situated at 40, England's Lane, 17 and 69, High Street and 6 Fairfax Mews. Licensed Slaughter Houses:—In 1914 there were 4; in Jan. 1920, 4 ; and in Dec., 1921, 4. There is no public abattoir in the Borough. 40 Sale of Food and Drugs Act. 504 samples were taken for analysis during the year. The number certified to be adulterated was 8, or 1.58 per cent. of the total number, as against 0.39 in 1920. 2 samples were certified to be of low quality. 474 samples (8 of which were adulterated), were purchased from Hampstead tradesmen and 30 from tradesmen coming from other districts. The following table shows the articles of which samples were taken during the year :— Articles. Number taken. Adulterated. Low Quality. Butter 45 1 — Camphorated Oil 2 — — Cheese 3 — — Cocoa 17 — — Coffee 5 — — Cornflour 3 — — Cream 15 — — Curry Powder 1 — — Dripping 2 — — Epsom Salts 1 — — Flour 7 — — Ginger Wine 1 1 — Glauber Salts 1 — — Glycerine 1 — — Honey 2 — — Jam 4 — — Lard 23 — — Margarine 2 — — Milk 320 1 1 Milk, Condensed 3 — — Mince-meat 4 2 I Mustard 2 — __ Oatmeal 4 — Olive Oil 2 — — Pepper 8 — — Potash, Iodine of 1 — — Raisin Wine 1 1 — Rice, Ground 2 — — Sausages 4 1 — Spice, Mixed 1 — — Sugar 9 — — Tartaric Acid 1 — — Vinegar 7 1 — Totals 504 8 2 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. 156 Vinegar 9¾ per cent, added water Cautioned. 164 Milk 25 per cent, deficient in fat Dismissed. Warranty proved. 413 Butter 1¾ per cent, excess water Summons withdrawn. 452 Sausages 12 grains per lb. boric acid Cautioned. 487 Mincemeat 3 grains per lb. salicylic acid Cautioned. 494 Ginger wine 3½ grains per pint salicylic acid Cautioned. 499 Raisin wine 1 grain per pint salicylic acid Cautioned. 500 Mincemeat 2½ grains per lb. salicylic acid Cautioned. "Warranty" Defence. During 1921 a dairyman was prosecuted by the Council for selling milk which was 25 (twenty-five) per cent. deficient in fat, but the warranty defence was successfully proved, and the summons was dismissed. 42 Section D. PREVALENCE OP AND CONTROL OVER INFECTIOUS DISEASES. 1 .—Notifiable Infectious Diseases. The following is a list, alphabetically arranged, of the infectious diseases which were compulsorily notifiable in Hampstead during 1921:— Anthrax Ophthalmia Neonatorum Cerebro-Spinal Meningitis, Plague acute Pneumonia, acute influenzal or Cholera acute primary Continued Fever Polio-Encephalitis, acute Diphtheria Polio-Myelitis, acute Dysentery Puerperal Fever Encephalitis Lethargica, Relapsing Fever acute Scarlatina Enteric Fever Scarlet Fever Erysipelas Small-pox Glanders Trench Fever Hydrophobia Tuberculosis, all forms Malaria Typhoid Fever Measles Typhus Fever Membranous Croup No cases of the following notifiable diseases were reported during the year:— Anthrax Hydrophobia Cerebro-Spinal Membranous Croup Meningitus, acute Polio encephalitis, acute Cholera Polio myelitis, acute Continued Fever Relapsing Fever Glanders Trench Fever Typhus Fever. 48 Cases of Infectious Disease Notified during the Year 1921. 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 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 408 7 66 254 48 27 6 .. 36 66 11 14 137 128 16 360 Dysentery 2 .. .. .. 1 .. .. .. .. 1 .. .. .. 1 .. 1 Encephalitis Lethargica, acute 10 .. .. 1 2 4 3 .. 3 4 .. 2 1 .. .. 6 Enteric Fever 10 .. .. 2 4 3 1 .. 1 3 1 .. 3 2 .. 6 Erysipelas 25 3 2 2 5 3 6 4 3 6 1 3 4 7 1 4 Malaria 3 .. .. .. 2 1 .. .. .. .. .. 2 .. .. 1 2 Measles 175 8 60 97 6 4 .. .. 11 27 45 3 33 28 28 5 Ophthalmia Neonatorum 8 8 .. .. .. .. .. .. 1 1 .. .. 1 2 3 1 Pneumonia 54 1 3 10 11 17 10 2 12 8 8 3 3 11 9 11 Polio-encephalitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Polio-Myelitis, acute .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 3 .. .. .. .. 3 .. .. .. 1 .. 1 1 .. .. 3 Scarlet Fever 371 3 50 235 45 35 3 .. 49 76 25 37 47 108 29 318 Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. *Tuberculosis, Pulmonary 103 .. .. 4 24 61 14 .. 14 15 17 10 12 18 17 88 *Tuberculosis, Non-Pulmonary 55 2 4 26 8 12 3 .. 7 4 3 3 6 22 10 24 Totals 1227 32 185 631 156 170 46 7 137 212 111 78 248 327 114 829 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 Tuberculosis when removed were sent to institutions in various parts of the country. * These figures relate only to cases notified for the first time in 1921. 44 Cases of Infectious Disease occurring in each month during 1921. DISEASE. MONTHS. January. February. March. April. May. June. July. August. September. October. November. December. Totals. Cerebro Spinal Meningitis (Acute) — — — — — — — — — — — — — Diphtheria 24 15 34 10 34 15 13 10 46 77 68 62 408 Dysentery 1 — — — — — — — — — 1 — 2 Encephalitis Lethargica (Acute) 5 1 2 1 — — — — — — — 1 10 Enteric Fever 2 — 2 2 — — 1 - 1 2 — — 10 Erysipelas 3 3 1 1 2 l 2 3 2 7 25 Malaria 1 — _ 1 1 3 Measles .. 11 12 35 16 11 1 2 3 1 — 15 68 175 Ophthalmia Neonatorum 1 2 1 — — 1 1 — 1 1 — — 8 Pneumonia 4 7 9 6 9 1 1 3 — 3 5 6 54 Polio-encephalitis — — — — — — — Polio-Myelitis (Acute) — — — — — — — — — — — v — Puerperal Fever 1 1 — 1 — 3 Scarlet Fever 33 19 22 20 23 31 21 14 39 58 39 52 371 Small-pox — — — — — — — — — — Tuberculosis Pulmonary 14 8 14 14 8 6 9 5 7 7 3 8 103 Tuberculosis NonPulmonary 7 3 4 7 4 7 4 3 9 2 5 — 55 Totals 103 70 123 80 90 63 54 41 106 154 138 205 1227 Diphtheria and Membranous Croup. The number of cases notified in 1921 was 408, as compared with 162 in 1920. The attack rate, or number of cases notified per 1,000 of the population, was 4.7. The number of cases notified proving fatal was 35, or 8 6 per cent. of the cases notified, as against 5, or 3.1 per cent, in 1920. 360 patients, or 88 per cent. of the cases notified, were removed to hospital. In accordance with the Diphtheria Anti-toxin (London) Order, 1910, the Borough Council supply anti-toxin free to medical practitioners for use for the poorer inhabitants of the Borough. In 826 instances examination of specimens in suspected cases was made at the Lister Institute, 158 giving a positive, and 668 a negative result. It will be seen from the foregoing figures that the number of cases that occurred during the year was unusually high, and that a large proportion of these occurred in the Kilburn and "West End Wards. Towards the end of the third quarter of the year the disease became very 45 prevalent in the Kilburn area, and a number of deaths occurred. The outbreak in the district was sudden and was of unusual virulence, with an unusually high case mortality (at one time 50 per cent.) The majority of children who died were found early and removed promptly and were put upon the danger list at the Metropolitan Asylums Board's Hospitals immediately upon removal. All our fatal cases received large doses of anti-toxin serum, but the majority were regarded as hopeless by the Hospital Authorities immediately they were seen. Everything that could be thought of was done to check the outbreak which slowly subsided, but spread just as widely over the West End Ward ; in that district, however, the cases were of a much less severe type, and the mortality there much lower. At my suggestion the County Medical Officer of Health and School Medical Officer caused periodical examinations to be made of scholars attending certain schools in the infected areas around Netherwood Street and Broomsleigh Street, and lists of the results were sent to me, while the Head Teachers continued to notify me, as usual, of all children absent or excluded from school on account of illness. These children were "followed up" by the Health Visitors and Sanitary Officers, and wherever possible the parents were persuaded to place them under medical supervision. In the course of combating the outbreak, difficulty was experienced in dealing with the disease through the fact that in many cases the parents were too poor to pay for the services of a doctor, and "suspects" and "contacts" and cases bacteriological only in nature were found to be without medical attendance and treatment. I brought the matter before the Sanitary Authority who approved of my suggestion that I should be authorised to provide a temporary supply of medicine and medical assistance at the cost of the Borough Council for the poorer inhabitants of the Borough. Under this scheme, where a family had a regular medical attendant, but were in the present instance unable to pay for his services, such doctor was asked by me to examine the "suspects" and "contacts," &c., to swab where necessary and to certify the cases discovered. He was also asked to give such subsequent treatment (including the injection of anti-toxin supplied free by the Borough Council) as he deemed to be necessary. Arrangements were also made with certain medical practitioners for their services to be called in at the expense of the Council in cases of "suspects," &c., where the family had no regular medical attendant. The milk supply of the district was considered as a possible source of the outbreak, but a bacteriological examination failed to reveal any evidence in favour of this. 46 The large number of cases occurring in the Town Ward is due to an outbreak which occurred in an Orphanage situated in that Ward, and the number of cases occurring there was 13. Encephalitis Lethargica, Acute. 10 cases were reported and 4 deaths occurred. 6 of the patients were removed to hospital and 4 were nursed at home. 6 of the patients made a total recovery, 1 partially recovered, and 3 died. Enteric Fever. The number of cases notified was 10 as compared with 23 in 1920. The attack rates per 1,000 of the population was 0.11. One case, or 10 per cent., proved fatal as compared with 1 death, or 4 per cent., in 1920. In 2 instances examinations of specimens were made with negative results at the Lister Institute. Erysipelas. 25 cases were notified, as compared with 39 cases in 1920. The attack rate per 1000 of the population was 0.29. Of the cases notified, 4, or 16 per cent., were removed to New End Hospital or Nursing Homes. Scarlet Fever. 371 cases of scarlet fever were notified during the year, as compared with 253 in 1920. The number of cases per 1000 of the population was 43. 5 cases, or 1.3 per cent., proved fatal as compared with 4, or 1.6, in 1920. Of the cases notified, 318, or 86 per cent., were removed to hospital. In the Autumn an outbreak occurred at an Institution in the Belsize Ward, this accounting for the high number of cases in that Ward. As will be seen from the statistics, the disease was unusually prevalent in the Kilburn Ward, no less than one-third of the total number of cases occurring there. Small-pox. No case was notified during the year. Vaccination. Of the total births dealt with by the Vaccination Officer, amounting to 1500, in 1921, 730 were successfully vaccinated. In 8 cases the children were insusceptible of vaccinnation. In regard to 403, certificates of Conscientious Objection were obtained; 60 died before vaccination was performed; 41 cases of vaccination were postponed, and 258 remained to be dealt with. 47 I am indebted to the Vaccination Officer for these statistics. By virtue of the Public Health (Small-pox Prevention) Regulations, 1917, the Medical Officer of Health is empowered to perform vaccination. It was not necessary for me to exercise this authority during the year. Provision for Isolation of "Contacts." 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 utilised, 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. Malaria, Dysentery, Trench Fever, Acute Primary Pneumonia, and Aoute Influenzal Pneumonia. Malaria. Three cases were notified, as compared with eight in 1920; all were removed to hospital. Dysentery. Two cases were notified, as compared with one in 1920; one patient was removed to hospital. Acute Primary and Acute Influenzal Pneumonia. 54 cases were notified, as compared with 75 in 1920; 11 of which were removed to hospital. Measles, Ophthalmia Neonatorum, Polio-Myelitis, and Puerperal Fever. Details of these cases will be found in Section E relating to Maternity and Child Welfare, on pages 63-77. VERMINOUS CONDITIONS. Information concerning the work done at the Borough Council's Cleansing and Disinfecting Stations in connection with verminous persons and their belongings will be found in Section B relating to Sanitary Circumstances of the Borough. Venereal Diseases. Under the terms of the Public Health (Venereal Diseases) Regulations, 1916, the Authority for the Administrative County of London (excluding the City of London) is the London County Council. The Public Health Committee appointed a sub-committee in connection with this subject, and Mr. Councillor R. H. Hobart Cust., M.A., J.P., was elected Chairman. 48 TUBERCULOSIS. Notification. During the year 1921, 158 new cases of Tuberculosis were notified, 103 being cases of Pulmonary Tuberculosis, and 55 other forms of the disease. In the following table these 158 cases have been analysed as to sex and age, and it will be noticed that 46 per cent. were aged between 25 and 45. 0—1. 1—5. 5—10. 10—15. 15—20. 20—25. 25—35. 35—45. 45-55- 55-65. Over 65. Total. Pulmonary males 1 2 2 8 19 15 8 2 — 57 „ females — — 1 — 2 12 16 11 1 3 — 46 Non-Pulmonary males — 3 l3 2 2 1 1 1 1 1 25 ,, females 2 1 9 2 2 3 5 5 1 — — 30 2 4 24 6 8 24 41 32 13 6 — 158 Of the 158 cases notified, 103 were pulmonary and 55 non-pulmonary 16 were dead or dying at time of notification 27 were in hospital, sanatoria or other institution 5 removed from Hampstead almost immediately after notification 3 were out-patients of Hospitals 16 were attended by private doctors only 91 attended the Dispensary. The number of cases notified in recent years are as follows :— Year. Persons newly notified. Total. Pulmonary Tuberculosis (Voluntarily notifiable 1902; Compulsorily notfiable 1912.) Non-Pulmonary Tuberculosia (Compulsorily Notifiable from 1st February, 1913). 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 1920 118 53 171 1921 103 55 158 49 Occupations. The following is an analysis of the occupations of the new cases notified as tuberculous during 1920:— Occupation. Pulmonary Cases. NonPulmonary Cases. Occupation. Pulmonary Cases. NonPulmonary Cases. Accountant 1 — Housewives 12 5 Artists 2 — Labourers 2 — Bill poster 1 — Laundress 1 — Carman 1 — Machinist 1 — Charwomen 2 1 Mechanics 2 — Chauffeurs 1 — Merchants 2 — Cleaners 1 — No occupation 6 12 Clerks 6 — Porters 2 — Commercial Traveller 1 - Printer's reader 1 - Road sweeper 1 - Dentists 3 - School children 3 25 Domestic Servants 17 5 Secretaries 2 — Dressmakers 1 2 Shop Assistants 2 1 Engineers 2 — Stencil cutter 1 — Ex-Officers 1 1 Tobacconist 1 — Ex-service men 14 2 Upholsterer 1 — French polisher 1 — Violin maker 1 — Furniture dealer — 1 Watch maker 1 — Gas fitter 1 — No Information 3 — Gas meter collector 1 — Hairdresser 1 — 103 55 Removal of Cases. Of the newly notified cases in 1921, 112 were removed. Pulmonary. Non-Pulmonary. To Sanatoria (non-insured) 34 3 To Hospitals 35 12 To Infirmaries 15 4 To Nursing or other Homes 4 5 88 24 The following cases, notified prior to 1921, were also removed. Pulmonary. Non-Pulmonary. To Sanatoria (non-insured) 10 3 To Hospitals 20 — To Infirmaries 7 — To Nursing or other Homes 1 — 38 3 DEATHS. The number of deaths from Tuberculosis in 1921 was 71. Of 50 these, 63 were due to Pulmonary Tuberculosis, 4 to Tubercular Meningitis, and 4 to other forms of Tuberculosis. The deaths from Pulmonary Tuberculosis and from all forms of Tuberculosis during 1921 were distributed among the wards as follows:— Ward. Area (Acres). Estimated Population middle of 1921. Deaths from Pulmonary Tuberculosis. Deaths from Tuberculosis (All Forms.) No. 1 (Town) 686 14,200 11 2 „ 2 (Belsize) 271 14,000 7 3 ,, 3 (Adelaide) 325 10,000 8 1 „ 4 (Central) 312 10,090 3 1 ,, 5 (West End) 247 13,000 9 - „ 6 (Kilburn) 195 15,100 11 — „ 7 (Priory) 229 10,500 14 1 The Borough 2,265 86,890 63 8 The number of deaths from Pulmonary Tuberculosis and from A1l Forms of Tuberculosis in recent years are as follows:— Year. Deaths from Pulmonary Tuberculosis. Deaths from Tuberculosis (All Forms.) 1912 64 77 1913 49 61 1914 57 71 1915 48 71 1916 55 80 1917 69 85 1918 75 89 1919 56 72 1920 41 55 1921 63 71 51 Pulmonary Tuberculosis. The following table shows the age distribution of patients dying from Pulmonary Tuberculosis in Hampstead in recent years:— Year. Age Period. All Ages. 0-5 5-15 15—25 25—65 65— 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 1920 — 2 8 27 4 41 1921 - 2 10 47 4 63 Totals 1 14 95 374 29 513 Non-pulmonary Tuberculosis. The deaths from all forms of Non-Pulmonary Tuberculosis in 1921 were distributed in age periods as follows:—0-5. —; 5-15, 1 ; 15-25, 2; 25-65 5. Prevention, Treatment, &c, Staff engaged on Tuberculosis Work.—The staff specially engaged on work directly connected with Tuberculosis consist of the following:— 1. —Tuberculosis Medical Officer, a part-time Officer who acts as an Assistant to the Medical Officer of Health for tuberculosis work. This Officer is given a responsible share of the control, under the administrative direction of the Medical Officer of Health, of the whole of the tuberculosis work within the Borough. 2.—Lady Sanitary Inspector, the major portion of whose time is occupied in visiting cases, inspecting home conditions, etc. 3.—Tuberculosis Nurse who attends at the Dispensary at all times when the Tuberculosis Medical Officer is present to act under his instructions; and who pays home visits to cases attending the Dispensary. She also attends at the Dental Clinic attached to the Dispensary. 52 4.—Clerk who attends at the Dispensary on three half days per week for the purpose of undertaking clerical work, compiling returns, filing, etc. 5.—Dentist who conducts one session per week for tuberculous patients. In considering the question of dealing with Tuberculosis, whether by "Dispensary," or by other means, it should be borne in mind that there are certain well-established cardinal lines along which sound progress can be made. Thus for example, two very important factors in the campaign against tuberculosis are the proper housing of the people and the provision of Homes for advanced highly infectious cases. Three principal lines of combating the disease are (1) Prevention, (2) Treatment and (3) After-care; and notwithstanding all that has been achieved in these directions hitherto, it must be confessed that the results have fallen short of what was expected of them. The subject of After-Care is perhaps the most difficult of all, being involved as it is in social and other problems; but until our system of care and after-care is so developed as to enable us effectively to hold the ground won by our methods of treatment, we cannot remain satisfied. Too often the "arrested" case is compelled to return to the undesirable or crowded tenement and to the unsuitable occupation which probably tended to cause the disease in the first place. I am of opinion that the subject of "After-care" is equally important to any other line of action. The Care Committee that will undertake to educate a patient during treatment and after treatment is doing an essential work towards his permanent recovery. It is by no means light or easy work: patients are refractory and difficult and from this arises a cjnsiderable number of failures to effect permanent cures. It is a harsh saying but nevertheless true that "no fool was ever cured of consumption." To educate the patient and combat that folly is the work of a sympathetic Care Committee. Revision of existing Scheme for the Dispensary Treatment of Tuberculosis in Hampstead. In consequence of a survey which had been made of the existing arrangements in London as to the organisation of schemes for dispensary 53 treatment of tuberculosis, the Ministry of Health, on 3rd December, 1920, requested the Borough Council to reconsider its dispensary soheme, and to submit a revised scheme to the London County Council and to the Ministry of Health at the earliest possible date in order that it might come into operation on May 1st, 1921. The scheme in operation at that time needed less amendment than those in force in some other districts, as the Tuberculosis Dispensary in Hampstead is entirely a Municipal Dispensary. It was inaugurated in connection with the Borough Memorial to the late King Edward VII, although grants in aid are received from the Ministry of Health, the London County Council and the London County Insurance Committee. In this Borough, the work of the Dispensary had from its inception been co-ordinated with the prevention work of the Public Health Department. Amongst the alterations outlined by the Ministry, it was suggested that the arrangements between the Borough Council and the London County Insurance Committee and the Hospital with which the Dispenary was linked up (i.e. the Hampstead General Hospital) should be extended only until the 30th April, 1921. After careful consideration the Borough Council adopted an Amended Scheme for the Dispensary Treatment of Tuberculosis. This Scheme came into operation on 1st May, and it would appear from the years' working under it, that ample provision is made for the needs of the Borough. It must always be remembered too, that the efforts of the Borough Council in the crusade against Tuberculosis are not limited to the work of the Dispensary, or to patients attending the Dispensary. Many cases in a Borough such as Hampstead do not come within the scope of a Municipal Dispensary: they are in fairly good conditions under their own medical advisers, and they have no need to avail themselves of the facilities and aids offered by the Dispensary. In all these cases, nevertheless, though they do not come within the orbit of the Dispensary, a visit is made and the homes inspected by Officers of the Public Health Department; the medical attendant is interviewed where necessary in order to secure the examination of "contacts," etc., and to be educated as to the facilities we give to medical practitioners in making diagnosis and conducting treatment. Again I always like to think that the whole work of the Public Health Department is directed against tuberculosis. I cannot 54 disassociate a campaign for better housing conditions, more houses, clean milk, and good drainage, from the fight against tuberculosis—they are immediately and intimately connected Dental treatment for persons attending the Tuberculosis Dispensary.— The following is a statement of attendances, etc, at the dental clinic held in the Tuberculosis Dispensary:— Insured. Non-insured. Total. New applicants 9 18 27 Old cases 27 89 116 Totals 36 107 143 The number of free consultations was 110. Assistance is given by the Council to those persons who are unable to pay the full cost of their treatment and dentures, according to their means. Separate Beds and Shelter for Tuberculosis Patients.—In pursuance of the authority contained in the Public Health (Prevention and Treatment of Disease) Act, 1913, the Borough Council supply on loan single beds and bedding in order to effect the separation of infectious cases of tuberculosis. The usual practice is to arrange for the double-bed previously used to be sold, and a single bed to be provided in lieu thereof. Thus, by the Council loaning a separate bed, two single beds are provided instead of one double-bed. Up to the end of the year, the Council have purchased and loaned out five beds and sets of bedding. In addition, the Shelter owned by the Council, has been loaned out to suitable cases. Beds in Sanatorium and in Hospital.—The Borough Council possess the right to use two endowed beds at the Mount Yernon Hospital at Northwood; and two beds at the Hampstead General Hospital, Haverstock Hill, Hampstead, which latter would be available for surgical tuberculosis. 55 Report of the Tuberculosis Medical Officer for the Year 1021. Insured. Non-insured. Totals. M. F. Children under 16. M. F. 1. (a) Number of persona examined for the first time during the above period at or in connection with the Dispensary 117 38 192 13 119 479 (6) Number included under 1 (a) who were found to be suffering from Pulmonary Tuberculosis 58 22 2 2 31 115 (c) Number included under 1 (a) who were found to be suffering from NonPulmonary Tuberculosis 2 2 33 - 6 43 (d) Number included under 1 (a) who were found to be non-tuberculous 56 13 153 11 79 312 (e) Number included under 1 (a) in whom the diagnosis was found to be doubtful 1 1 4 - 3 9 Insured. Non-insured. Totals. 2. (a) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under 1 (a) 670 1657 2327 (b) Number of the above attendances at which systematic physical examinations and records were made 474 724 1198 3. Number of visits to patients at their own homes by the Dispensary Medical Officer in connection with the supervision of home conditions 29 19 48 4. Number of visits to patients at their own homes by the Dispensary Nurse in connection with the supervision of home conditions and "following up" 125 267 392 5. Number of consultations with the— (a) Medical Adviser of the Insurance Committee - - - (b) Practitioners at the homes of patients 14 — 14 6. Number of written reports concerning individual patients made to— (a) Public Authorities 188 104 292 (b) Practitioners 70 49 119 7. Number of specimens of sputum examined 149 122 271 Number of visits to patients at their own homes by the Lady Sanitary Inspector in connection with the supervision of homo conditions and "following up," 1,156. 56 Home visiting of Ex- Service tuberculoid men.—The following information for the year 1921, required by the Ministry of Health, is submitted:— 1. Number of discharged men visited 94 2. Total number of visits of this kind 252 3. Proportion of number of visits to such cases to total number of visits to tuberculous cases 18 per cent. The death-rate from tuberculosis in the Borough shows, as expected, an increase on the very low figure recorded last year. I do not consider that we need regard this as in any way signifying an increase of tuberculosis in the district. Tuberculosis is a disease so much influenced by seasonal conditions and the incidence of other diseases, that the only fair method of comparison is to take the average of a number of years; i.e., a period sufficient to cover the expectation of life of a patient with declared tuberculosis. The influenza epidemic of 1917 and 1918 undoubtedly was the determining factor in the early death of a large number of consumptives, whose death otherwise one would have expected in the following years. Thus, the deaths in 1917 and 1918 show a decided rise at 85 and 89 respectively, and in the following two years a sharp fall to 72 and 55. The live yearly averages up to and including 1920 are as follows:— 1906-1910=82; 1911-1915=70; 1916-1920=76. During the last seven years, the statistics for the community have been considerably raised by the importation of disease, which normally we should not have; in the return of ex-service men, who contracted tuberculosis in the army or who had quiescent disease which was activated by army service. The total deaths from pulmonary tuberculosis for the year 1921 was 63; of these 12 were discharged soldiers. At the present time 94 discharged soldiers suffering with this disease are resident in this district. The number of cases of tuberculosis known to the Department at the end of 1921 totals 969=698 pulmonary and 271 non-pulmonary. It is instructive to note that the deaths from non-pulmonary tuberculosis for the past five years are as follows:—16; 14; 16; 14; 8. The assumption, therefore, that the average death-rate is continuing to fall is, I think, justified. 57 Hampstead, perhaps more than any other town Borough, is influenced as regards the apparent incidence of tuberculosis by its heathy situation and reputation; sufferers with the disease regard the district as a suitable place for residence, and moreover a large number of domestics are employed; of the adults notified as suffering with tuberculosis last year—22 were domestic servants. Shortage of employment, high rents and difficulties of living generally, have caused under-nutrition and ailments that may well be reflected in statistics of later years. The following tables show the housing conditions under which the newly notified cases were found to be living. The tables may be read as follows:—taking as an example the first line of the one relating to Pulmonary Cases. There were 8 instances in which 1 person (the patient) was found to be living in one room; there were 6 instances in which 2 persons (one of whom was the patient) were found to be living in one room:— Pulmonary Cases. No. of Rooms per Tenement. Number of Persons in Tenement. 1 2 3 4 5 6 7 8 9 1 8 6 1 - - - - - - 2 — 4 2 3 2 2 - - - 3 — 2 9 3 2 — 3 — — 4 — 4 4 2 1 1 2 1 2 More than 4 - 3 - 6 4 3 - - - Non-Pulmonary Cases. No. of Rooms per Tenement. Number of Persons in Tenements. 1 2 3 4 5 6 7 8 9 11 1 1 - 3 2 - 1 - - - - 2 - - 2 3 2 - 2 - - - 3 - 2 3 6 5 3 1 - - - 4 - - 1 - 1 1 - - - - More than 4 — — 1 - 1 - 2 - 1 1 58 Until economic conditions become more balanced this state of things is likely to continue. The tendency as regards Sanatorium benefit trends towards the acceptance of early cases only, as the statistics show that, in later cases, the percentage of recoveries is small; though this is necessary from an economic standpoint it is unfortunate from point of view of treatment as there are a considerable number of chronic, fairly advanced cases who, with occasional help improve and are able to continue a light occupation for years. Advanced cases remain a considerable problem to the Tuberculosis Officer; during the past year 26 cases ha ve had to be referred to the Infirmary, one constantly feels the necessity for a home for advanced cases situated in the Borough. Another type of case which calls for recognition is the tubercular expectant mother; at a time when the disease is particularly liable to gain ground sanatorium treatment is unobtainable. When we turn to the children the picture is brighter. There can be no doubt that a large percentage of the children of the poorer classes have been infected with tuberculosis; under certain conditions there is a tendency for this disease to become active; the badly termed pretubercular stage; if the child be caught at this period and given prolonged convalescent treatment the change in the general condition is often wonderful and one appears to be successful in stopping the invasion. The work of the Invalid Children's Aid Association in this respect cannot be over-estimated, here indeed we are stepping in the right direction, by increasing the resistence of the child, enabling it to overcome the defects of its environment, and giving it a chance of a healthy adult life. I feel deeply indebted to Miss Spalding, the Local Secretary, for the interest and trouble she has taken in getting the children into suitable Homes. To exemplify the value of the work done in this district I cannot do better than quote the figures of the Children dealt with during the year—32 Children were sent away; some of these for as long as seven months; taking the total period of Convalesence provided it is found to amount to no less than 343 weeks. It is my endeavour to be present at the meetings of the Interim Care Committee concerning tuberculosis cases, their information 59 regarding the social condition of the patient is of value to myself, whilst on the other hand I am able to help them as regards the probable course and present condition of the patient. They have been most helpful in investigating and helping cases in which I have asked their assistance, and it is with pleasure that I express my appreciation of their aid. From the ideal point of view a Tuberculosis Dispensary should only receive cases suspected before their attendance of being tubercular, and referred from Doctors, Hospitals, or elsewhere. Practically, a large number of non-tuberculous patients present themselves, either they have no doctor, cannot afford one, or have been recommended by friends, and do not appreciate the specific character of the Department but regard it in the usual sense of Dispensary. A certain number of these cases are acute and require immediate admission to hospital; I have admitted in this way several cases to the Hampstead General Hospital and City of London Hospital for Chest Disease, with which I am in touch; the other cases are either referred to the local practitioner, or if they cannot afford this I have seen them at the Out-Patient Department of the Hampstead Hospital. Attention of the Department was called by the London County Council to the fact that too much money was being expended on the drug account; in compliance with this instruction I have materially reduced the drugs and oil and malt given, I estimate that the drug account for the current financial year will be well under half of the previous year. Partly this is due to decreasing prices, but mainly to extreme care in supplying medicines, &c., but it has to be remembered that the regular attendance of patients is much more difficult to ensure if they are receiving no medicine. During the past year 153 cases have been admitted to Sanatorium, Hospitals, &c., through the London County Council and other sources as against 118 in the preceding 12 months, and we have been very fortunate in this respect, it is to be feared that economy propaganda and reduced grant for Sanatoria benefit must result in fewer cases getting accepted in the coming year, and as mentioned above this reduction must be at the expense of the more advanced cases. The statistical tables explain in detail the work carried out at your dispensary during the year. 60 From notifications received in the year 1921, 2-50 potential Contacts accrued. During the year 192 Contacts have been examined:— Non-Tuberculous. Tuberculous. Doubtful. Male. Insured 24 20 3 1 Non-Insured 4 4 0 0 Female. Insured 12 4 7 1 Non-Insured 44 37 5 2 Children 108 91 15 2 A word of explanation is advisable as to the definition of a contact: lack of uniformity in the cases grouped under this heading leads to widely different results as to the number of positive cases from various dispensaries. At this Dispensary it is the custom to call every case a Contact which comes from a family in which there is a notified case of tuberculosis; and this obtains whether the case comes at the request of the Dispensary or is sent by the Practitioner as a case of tuberculosis. In the following tabular statement some idea may be gained of the work done in connection with the Dispensary since its inception:— Year. No. of New Applicants. No. of New Applicants treated. No. of Contacts examined. Total Attendances of all kinds. Total No. of Home Visits paid by Tuberculosis Medical Officer and the Nurse. 1913 455 191 204 2808 1013 1st Feb. to 31st Dec. 1914 455 118 195 1913 1269 1915 308 146 158 899 459 1916 230 165 100 1519 368 1917 383 183 113 1682 766 1918 371 105 124 1821 298 1919 296 85 57 1543 215 1920 384 221 112 2625 104 1921 479 127 192 2327 440 Number of visits to patients at their own homes by the Lady Sanitary Inspector in connection with the supervision of home conditions and "following up," 1516. 61 The number of patients being dealt with at any one time, varies of course; but during the year the number of individual patients dealt with was 717. During the year 57 cases have been referred by 31 medical practitioners in the district for an opinion and have been reported on by letter or telephone. 14 personal consultations have been held with practitioners. 24 cases have been referred to the out-patient department of the Hampstead General Hospital:— 14 to medical out-patients. 6 to Throat Department. 4 to surgical out-patients for an opinion. In addition to this 36 cases have been sent to Hampstead General Hospital for X rays, and 9 cases were admitted to that Hospital. In conclusion, I should like to thank Dr. Scrase for his help and advice; and the Lady Sanitary Inspector, Nurse, and Clerk, for the efficient way in which they have carried out their duties. A. J. SCOTT-PINCHIN, M.D. (Lond.), M.R.C.P. 62 Report of the Medical Officer o f Health (continued). (2) Non-Notifiable Acute Infectious Disease. Influenza. Of the non-notifiable acute infectious diseases, Influenza is the only one that calls for special mention. During the year 30 deaths occurred. Their allocation was as follows:—Town Ward, 5; Belsize Ward, 3; Adelaide Ward, 4; Central Ward, 3; West End Ward, 3; Kilbum Ward, 6; Priory Ward, 6. 63 Section E. MATERNITY AND CHILD WELFARE. ANTE-NATAL. Ante-Natal Clinics for Expectant Mothers. Two Clinics for expectant mothers are in existence: one at 73, Dynham Road, Kilburn, and one at 27, Pond Street. Kilburn Clinic.—Held at the Municipal Dispensary, 73, Dynham Road, N.W. 6. This was started in June, 1917, and is open on Monday afternoons and on Thursday mornings. The average attendance at each session was 2 new cases and 8 old cases. Pond Street Clinic. —The Clinic was temporarily housed in shop premises—59, South End Road—which had been approved as a temporary measure by the Ministry of Health. It was opened in August, 1919, and is open on Thursday afternoons. On 29th September, 1921, the Clinic was removed to premises at 27, Pond Street, occupied by the Hampstead and North St. Pancras Day Nursery, the Committee of that voluntary body having offered the Council four convenient rooms at a suitable rental. The average attendance at each session was 1 new case and 5 old cases. Both these Clinics are staffed and managed entirely by the Borough Council. The Report of the Medical Officer in charge, Dr. Mary Kidd, will be found on page 72. Maternity Hospital Beds to which complicated cases can be removed. The Borough Council pays a subsidy per case for every Hampstead woman confined in Queen Charlotte's Hospital, and in return receives letters of admission. 36 Hampstead women were confined in Queen Charlotte's Hospital in 1921. NATAL. Assistance to ensure the mother having skilled and prompt attendance during confinement at home. Skilled Maternity Nursing.—By our agreements with the two Nursing Associations this can be obtained for cases in any part of the Borough. Both Nursing Associations have fully trained nurses 64 appointed to attend maternity cases, and any woman can have a fully trained nurse attend her together with her own doctor. A fee is chargcd the patient, which is in accordance with her means and may be nothing in very poor cases. The Council guarantee each of the Associations against the loss, up to £100, on the working of the Maternity Nurses. The number of cases thus nursed by the Associations during 1921, was:— 76 by the Kilburn and West Hampslead District Nursing Association; 21 by the Hampstead District Nursing Association. Midwives.—Arrangements have been made with both Nursing Associations for the provision of a properly skilled and registered midwife. The Borough Council guarantee each of the Associations against the loss, up to £100, on the working of the midwives. The fees charged the patient have been carefully considered in reference to the midwives' fees prevailing in the district, and have been graduated £0 as not to undercut the practising midwives. The number of cases attended by the Midwives of the Associations during 1921 was:— 104 by the Kilburn and West Hampstead District Nursing Association; 6 by the Hampstead District Nursing Association. POST-NATAL. Treatment in a Hospital of complications arising- after Parturition, whether in the mother or in the infant. The Borough Council has two endowed beds in the Hampstead General Hospital, which can be utilised for the purpose of providing hospital accommodation for the mother. As regards beds for infants, there are two classes of cases that may require treatment in a hospital—(a) Children who are ill and have an ascertained definite disease, and (b) Children who although not actually suffering from any nameable disease, yet are failing to thrive, and need to be placed somewhere where skilled and trained supervision can be exercised. These latter beds have been designated by the name 65 of "observation cots," to distinguish them from the beds for cases of well-defined illness. The Borough Council has made arrangements with "Northcourt Hospital," College Crescent, whereby suitable cases may be admitted. The parents are assessed according to their means and up to the present little difficulty has been found in collecting their quota of the cost. Systematic Home Visitation and Provision of Advice, etc., for Infants at Infant Welfare Centres. This work is undertaken in conjunction with the Hampstead Council of Social Welfare. All home visiting is carried out solely by the Borough Council's Health Visitors, of whom there are three, allotted to districts as follows:— Approximate District. District A No. 1 (Town); No. 5 (West End); and part of No. 4 (Central) Wards—Miss Kennedy. „ B No. 2 (Belsize); No. 3 (Adelaide); and parts of No. 4 (Central) and No. 7 (Priory) Wards—Mrs. Steward. „ C No. 6 (Kilburn); and part of No. 7 (Priory) Wards—Mrs. Roche. The duty of attending at the Pre-Maternity Clinics, Dental Clinic, and Infant Welfare Centres has been apportioned among the Health Visitors. The following table gives a record of the work of the Borough Council's Health Visitors:— Number of first visits to infants under one year 991 „ re-visits „ „ 1408 „ first visits to expectant mothers „ „ 91 „ re-visits „ „ 51 ,, visits to children over one year „ 1172 „ visits re infant deaths „ 77 „ infectious disease „ 1278 „ verminous conditions „ 3 „ verminous conditions reported by London County Council 20 Carried forward 5091 66 Brought forward 5091 Number of attendances at Infant Welfare Centres 225 „ „ Borough Council's Dental Clinic 54 „ „ Ante-Natal Clinic 113 „ complaints investigated 14 ,, applications for assistance investigated 205 „ unclassified visits 209 „ Invalid Childrens' Aid Association Committees attended 8 Total 5919 Cases removed to Catherine Gladstone Convalescent Home, Mitcham 9 Cases removed to "Northcourt" Hospital 19 General. Crêche.—There are two Crêches in the Borough, one in Pond Street and one in Hemstal Road. Both are excellent institutions, and during 1921 have done good work. They are run entirely by voluntary bodies. During the year the Council made a grant-in-aid of £100 to the Brondesbury and West Hampstead Crêche. Convalescent Homes. Arrangements have been made by the Borough Council whereby beds are available in the Catherine Gladstone Home, Mitcham, for women recovering from confinement. Both mother and babe are admitted, or the mother alone if the baby did not survive. Dental Clinic. The following is a statement of attendances, etc., at the Clinic held at 73, Dynham Road, Kilburn:— Women. Children. Total. New applicants 71 6 77 Old cases 272 4 276 Totals 343 10 353 Number of free consultations, 71. The Borough Council assists those persons who cannot afford to pay the whole cost of their dentures. 67 Nursing Facilities. By arrangements made with both Nursing Associations their nurses are available for cases of Measles, Whooping Cough, Epidemic Diarrhoea, Ophthalmia Neonatorum, Acute primary or acute influenzal Pneumonia and Influenza, and also for certain other diseases of adults not connected with this section. During 1921, 50 cases of these diseases were nursed by the Kilburn and West Hampstead District Nursing Association, and 11 by the Hampstead Nursing Association under the agreement with the Borough. SUPPLY OF FOOD (INCLUDING MILK). An account of the steps taken by the Borough Council to supply food and milk to expectant and nursing mothers and to children is given in the Section relating to Food, on page 32. STAFF. Early in the year it was decided to engage the services of an Investigation Officer and Clerk. Mr. Dewhurst, an Official of the Middlesex County Insurance Committee, was appointed to the post and undertook the investigation of all applications for assistance in the matter of milk and food, etc. The great reduction, however, that took place in the help afforded, very materially reduced the amount of this Officer's work, and when later in the year he secured another appointment the position was not filled, but arrangements were made for the inquiries to be conducted by a member of the staff of the department. NOTIFICATION OF BIRTHS ACT, 1907. 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 their usual registration with the Registrar of Births. The following statement shows the source of information, etc., of live births notified during 1921. As births have to be notified much sooner than registered, the total number notified differs from the number registered:— Notified by midwives 547 „ parents 401 „ doctors 405 „ nurses and others 159 1512 68 In 118 cases the notification was not made until I had drawn the attention of the responsible person to the omission. During the year 44 still-births were notified, as follows:— Notified by midwives 17 „ parents 7 „ doctors 17 „ nurses and others 3 44 DEATHS. In the following tables the 88 infantile deaths have been classified according to diseases in age-periods and in Wards:- Next Deaths from stated Causes ax 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 ... ... ... ... ... 1 ... ... ... 1 4. Scarlet Fever ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... 1 1 1 1 4 6. Diphtheria and Croup ... ... ... ... ... ... ... ... 1 1 7. Erysipelas ... ... 1 ... 1 1 ... ... ... 2 8. Tuberculous Meningitis ... ... ... ... ... ... ... ... 1 1 9. Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... 10. Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... 11. Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... 12. Convulsions 1 ... ... 1 2 ... ... 1 ... 3 13. Laryngitis ... ... ... ... ... ... ... ... ... ... 14. Bronchitis ... ... ... ... ... ... ... ... ... ... 15. Pneumonia (all forms) ... ... ... ... ... ... 2 5 1 8 16. Diarrhoea and Enteritis 1 ... ... ... 3 2 8 1 1 15 17. 18. Gastritis ... ... ... ... ... ... 1 ... 1 2 19. Syphilis ... ... ... ... ... 1 ... ... ... 1 20. Rickets ... ... ... ... ... ... ... ... ... ... 21. Suffocation,overlying ... ... ... ... 1 ... ... ... ... 1 22. Injury at Birth ... ... ... ... ... ... ... ... ... ... 23. Atelectasis 1 ... ... ... 1 ... ... ... ... 1 21. Congenital Malformations 4 ... 2 ... 6 ... 2 ... ... 8 25. Premature Birth 15 2 2 ... 19 2 1 ... ... 22 26. Atrophy, Debility and Marasmus 1 2 1 1 5 5 2 ... ... 12 27.Other causes I ... ... ... 1 1 2 1 1 6 Totals 24 4 6 5 39 14 19 9 7 88 Nett Births in the year legitimate M. 632 F. 627 illegitimate M. 48 F. 35 Nett Deaths in the year of legitimate infants M. 38 F. 33 illegitimate infants M. 13 F. 4 Want of Breast Milk has been included under No. 26, Atrophy and Debility. 69 Deaths from stated Causes under One Year of Age, arranged in Wards. CAUSES OF DEATH. No. 1 (Town). No. 2 (Belaize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilbum). No. 7 (Priory). Total. 1. Small-pox ... ... ... ... ... ... ... ... 2. Chicken-pox ... ... ... ... ... ... ... ... 3. Measles ... ... ... ... ... ... 1 1 4. Scarlet Fever ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... 1 ... 1 2 ... 4 6. Diphtheria and Croup ... ... ... ... ... 1 ... 1 7. Erysipelas ... 1 ... ... ... 1 ... 2 8. Tuberculous Meningitis 1 ... ... ... ... ... ... 1 9. Abdominal Tuberculosis ... ... ... ... ... ... ... ... 10. Other Tuberculous Diseases ... ... ... ... ... ... ... ... 11. Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... 12. Convulsions 1 ... 1 ... 1 ... ... 3 13. Laryngitis ... ... ... ... ... ... ... ... 14. Bronchitis ... ... ... ... ... ... ... ... 15. Pneumonia (all forms) 1 1 ... ... 1 3 2 8 16. Diarrhoea 4 1 1 2 3 4 ... 15 17. Enteritis 18. Gastritis ... ... ... ... ... ... 2 2 19. Syphilis ... ... 1 ... ... ... ... 1 20. Rickets ... ... ... ... ... ... ... ... 21. Suffocation, overlying ... ... ... ... 1 ... ... 1 22. Injury at Birth ... ... ... ... ... ... ... ... 23. Atelectasis ... ... ... ... ... 1 ... 1 24. Congenital Malformations 1 1 1 1 2 1 1 8 25. Premature Birth 4 4 2 4 2 5 1 22 26. Atrophy, Debility and Marasmus 2 4 2 1 1 1 1 12 27. Other causes 3 ... 1 ... ... 2 ... 6 Total Death 17 12 10 8 12 21 8 88 Total Births 178 197 133 112 211 364 147 1312 70 The infantile death-rate per 1000 births for each of the Wards, the Borough, London, and England and Wales is as follows:— WARD. Rate per 1 000 births. No. 1 (Town) 95 No. 2 (Belsize) 61 No. 3 (Adelaide) 75 No. 4 (Central) 71 No. 5 (West End) 56 No. 6 (Kilburn) 57 No. 7 (Priory) 54 The Borough 65 London 80 England and Wales 83 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 17 Belsize „ 12 Adelaide „ 10 Central „ 8 West End „ 12 Kilburn „ 21 Priory „ 8 Mortality in the first four weeks of life. 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:— Percentage of Infant deaths occurring under one month, calculated on the total number of Infants dying. Year. Average of 5 years. 1905 40•6 41•7 1906 41•4 1907 40•8 1908 44•3 1909 41•4 1910 47•0 41•8 1911 37•1 1912 39•2 1913 44•0 1914 41•7 1915 40•6 45•7 1916 53•4 1917 46•7 1918 37•8 1919 50•0 1920 54•7 1921 44•3 71 Mortality among Young Children. The following table shows the Infantile Mortality rate and the death rate among children under five years of age. The latter rate is calculated upon a period of five years:— Year. Deaths of Infants under 1 year of age. Deaths of Children under 5 years of age. No. Rate per 1000 births. No. Rate per 1000 children born in the year and in preceding four years. 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 1920 75 48 101 17•1 1921 88 65 126 20•7 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 legitimate Dirtbs. Illegitimate Infants. Death-rate per 1000 illegitimate births. Births. Deaths. Births. Deaths. 1908 1,326 87 66 29 10 345 1909 1,239 88 71 43 n 256 1910 1,233 71 57 36 10 278 1911 1,239 94 76 37 11 297 1912 1,207 68 56 74 11 149 1913 1,252 73 58 73 18 246 1914 1,218 77 63 55 14 254 1915 1,246 82 65 81 19 234 1916 1,088 65 59 76 8 105 1917 1,052 74 70 71 16 225 1918 797 56 70 98 13 132 1919 1,039 77 74 117 19 162 1920 1,478 62 42 88 13 148 1921 1,259 71 56 83 17 205 72 Report of the Medical Officer in charge of the Pre — maternity Clinics for the year 1921. Western Clinic. Eastern Clinic. Number of new cases 202 66 Number of attendances of old cases 843 256 Number of sessions 100 52 Average number of attendances at each session 10 6 Number of Mothers sent to Convalescent Home 8 1 In September of last year the Clinic in South End Road was transferred to new and very comfortable quarters at the Creche in 27, Pond Street. The mothers have appreciated the change and also the fact that a needlework centre has been started there by Miss Kennedy, the health visitor in charge. Flannel and wool are retailed at cost price and patterns are provided. Miss Kennedy gives instructions how to cut out flannel garments for the babies by the aid of these patterns. A large number of more or less normal cases have been seen, in all about thirty, chiefly at Kilburn. This is accounted for chiefly by the fact that the Jubilee Nurses in that District have been most successful in persuading those mothers who have engaged them for their confinement to come to see me for advice beforehand. I cannot over emphasize the importance of this action, as so much of the midwifery in Kilburn is undertaken by the Jubilee Nurses and the closer the liason between them and the Ante-Natal Clinic the better. At first sight it might seem unnecessary for normal cases to attend the Clinic. The answer to that is, that a case which seems apparently normal for most of the time before the confinement may develop abnormalities during the last month or two, or in the post-natal period; also, one is enabled to give much advice on the hygiene of the antenatal period to these mothers. 73 Twenty-five attended for the first time after their babies were born. These cases consisted chiefly of mild degrees of sub-involution and prolapse and greatly benefited by the treatment. A few women attended for trouble with lactation of one sort or another and were cured, although in one case, the trouble was so serious that the baby had to be weaned. One of these post-natal cases was found to be suffering from an abdominal condition needing surgical interference. She was sent to the Royal Free Hospital and a colopexy and appendicectomy has been successfully performed and she will, I hope, be greatly relieved in the future. A few women attended who were found not to be ante-natal cases. These were mostly suffering from anaemia and were passed on to Hospitals, finally, for further treatment. Two cases of women who were very anxious to bear a living child and had hitherto not been able to, were successfully treated and healthy babies were born. A third patient who had had frequent disappointments and had only been able to rear one child beyond the age of 3 months, was also successfully treated. Her child is now 10 months old and healthy. Five cases of threatened miscarriage were successfully treated and living children were born. In two of these cases a blood examination indicated that a special treatment should be given—one of these patients was sent to Thavies Inn Hospital for her confinement. In a number of cases a special examination of the blood seemed to be indicated by the patient's history. This was carried out in conjunction with the Royal Free Hospital in twenty-one instances. There were five cases of contracted pelvis. One was sent to Queen Mary's Hospital for induction; two went to Queen Charlotte's for their confinement; and two had their babies at home under the care of doctors and the Jubilee Nurses. One case of post-maturity was encountered and was sent to New End Hospital, where an induction of labour was successfully carried out. As regards the more serious complications of pregnancy. Two cases of severe albuminuria have been encountered during the last year. One was a case of chronic nephritis and still-birth followed. In the other case some toxaemic symptoms were present: by consultation with Queen Charlotte's Hospital, however, these were happily averted and a healthy child was born. 74 In two cases an attack of acute appendicitis occurred, following on an old chronic condition. One patient was sent to New End Hospital, where she was successfully operated on and a healthy child was born. The other patient was sent to Hampstead General Hospital and a successful operation took place. Further details are not to hand of this case as the woman has removed from the District. Two cases of mitral stenosis and one of mitral regurgitation attended during the ante-natal period. One of the first named cases was passed on to the Hampstead General Hospital for special treatment, as she was rather a severe type of the disease. She has done very well and has had a healthy baby and does not seem the worse for it. The other case was not so severe and was sent to the country for a long rest and change and was given tonic treatment. Several cases of suspected phthisis were sent to the Tuberculosis Medical Officer. He is keeping some of these under observation and treatment. One case of phthisis occurred which was successfully treated. In three cases there was reason to apprehend during the antenatal period that ophthalmia-neonatorum might follow afterwards in the child. Appropriate treatment was given by myself and the District Nurses with very satisfactory results to the babies subsequently born. In a fourth case there was a history of ophthalmia neonatorum in a former child and a similar course of treatment was given to that just referred to and the next baby was healthy in every respect. As regards the less serious complications of pregnancy. Pendulous abdomen occurred in seven cases and the condition was greatly relieved by crepe bandages. Varicose veins occurred in a large number of cases and were successfully treated by crepe bandages. We have been able to recover a certain amount of the cost of these bandages. Inguinal hernia occurred in two cases. One of these I referred to the Hampstead General Hospital for advice and treatment. Morning Sickness occurred in a large number of cases and entire relief was soon obtained in the majority. Anaemia was present in about thirty women to a marked extent and was, on the whole, successfully treated. 75 Haemorrhoils occurred in twelve cases and were relieved by appropriate treatment. A very definite diathesis in which nerves and sleeplessness form predominant features was also observed in ten women and very good results were obtained by a combination of sedative and tonic treatment. In two women, sore nipples occurred during pregnancy and were successfully dealt with. A large number of patients were referred for treatment to the Dental Clinic. The patients who have been sent there are very grateful for the dental treatment received and say how ranch better they feel after it. Several old patients have been to see me, suffering from various ailments, and I have passed them on to other Hospitals for treatment. The supply of milk to expectant and nursing mothers continues to greatly help their health and to promote the habit of breast feeding. I regret that the level of weekly family income (below which this free milk can be given to mothers) has had to be so greatly lowered, owing to the insistent need for national economy. In consequence, a mother has to be very necessitous before she receives the pint of free milk daily, and thus a class of very hardworking and deserving mothers, who are just struggling along at poverty level on the small weekly but regular wage earned by their husbands, have to go without milk. As these are just the people that the Milk (Mothers and Children) Order was designed to help one regrets all the more that the help has had to be withdrawn in so many instances. The Convalescent Home treatment at the Catherine Gladstone Home at Mitcham has been greatly appreciated by those mothers who have been able to go there with their babies, and the gain to their health has been great. My thanks are due to Mrs. Stewart and Mrs. Simmonds, who have so kindly presided over the tea at the two Clinics for all this past year and I think that the mothers would like to add their thanks to mine for this voluntary and ungrudging service. (Signed) MARY KIDD, M.B. (Lond.) 76 Report of the Medical Officer of Health (continued). The following information concerning the diseases:—Puerperal Fever, Ophthalmia Neonatorum, Measles, Whooping Cough, Diarrhœa and Enteritis, and Polio-myelitis is asked for by the Ministry of Health in their Memorandum of February, 1921. Puerperal Fever. Three cases of puerperal fever were notified in 1921, as compared with one in 1920. All were removed to hospital. Ophthalmia Neonatorum. Eight infants were notified, all by medical practitioners. The right eye only was affected in 2, the left eye only in 2, and both eyes in 4 babies. The services of a Nurse from the District Nursing Association were utilised for 6 infants, and no permanent injury resulted from the disease. The remaining two were hospital cases. Measles. This disease is compulsorily notifiable in Hampstead under the provisions of The Metropolitan Borough of Hampstead (Measles) Regulations, 1920. Early in the year now under review a Conference was called by the London County Council to consider the subject of more effectively dealing with Measles. At this Conference the importance of trained nursing assistance being made available in every case was emphasised. This fact had been already appreciated in Hampstead, where arrangements have for some time been in operation whereby the trained Nurses of the District Nursing Associations are available. In view of the small amount of hospital accommodation available for cases of Measles, and of the fact that comparatively few children escape attack by Measles, the value of such nursing facilities is great. Such measures will, undoubtedly, have an effect upon the mortality rate, but no action that a Sanitary Authority can take is likely totally to prevent the spread of Measles, for the disease is of a highly infectious nature in its early stages, when it resembles a cold, and diagnosis is not easy. With careful medical and nursing skill, however, the complications following Measles, that often cause death, may be avoided, or sooner recognised and combated. The Borough Council has made arrangements with both Nursing Associations whereby the services of a fully-trained Nurse may be obtained free of charge to the parents. 77 During the year 175 cases were notified to the Department. This disease is compulsorily notifiable in the Borough, but information of many cases is received from Head Teachers of Schools. In 30 cases the services of the nurses of the District Nursing Associations were made use of. 5 cases were removed to hospital. 4 deaths from Measles occurred during the year, all of these being children under five years of age. German Measles. Cases of this disease ceased to be compulsorily notifiable on 1st January, 1920. Whooping Cough. Cases of this disease are not compulsorily notifiable, our chief source of knowledge is derived from the School Teachers' notifications. 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. The number of deaths from this disease in the year was six, all being children under five years of age. 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 1921: — Death-rate per 1000 births. Hampstead 9.5 London 21.3 England and Wales 15.5 78 Section F. SANITARY ADMINISTRATION. Sanitary Inspectors. A list of the Sanitary Inspectors, with the duties allotted to them, is detailed on page 3. The work of the staff is indicated in some measure in Section B. During the year 6,513 inspections were made by the Sanitary Inspectors, and 11,546 re-inspections made. 1,104 Intimation and 731 Statutory Notices were served. Chemical and Bacteriological Work. The arrangements for this 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 1921 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 bacteriologist of the Hainpstead General Hospital This Institution also makes any necessary X-ray examinations. The following is a summary of the bacteriological work carried out during the year:— At the Lister Institute. Positive. Negative. Total. Diphtheria 158 668 826 Enteric Fever — 2 2 At the Hampstead General Hospital Number of specimens of sputum examined 40 231 271 79 REPORT OF THE PUBLIC ANALYST ON THE ANALYTICAL WORK OF THE YEAR. Analytical Laboratory, Town Hall, Paddington, W. 2nd February, 1922. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies, and Gentlemen, Reviewing the analytical work of the past year we find a total of 504 samples were analysed. Of these, 323 were milk samples, only 1 of which was adulterated. Butter showed 45 samples, of which only 1 was adulterated. Drugs numbered 7, all genuine. The total percentage of defective samples amounted to only 1½ per cent. This is a purity of Food and Drugs excelled by no other Borough taking a similar number of samples. I have the honour to remain, Yours obediently, ALF. W. STOKES, Public Analyst. 80 Section G. HOUSING. I.—General Housing Conditions in the Borough. (1) General Housing Conditions.—The Housing problem is still acute though probably not so much as in 1920. Housing accommodation is very difficult to obtain in Hampstead to-day, the letting of houses has practically ceased in the Borough, and only a few houses are sold and that at a high rate. In the working-class districts the density of the population and the number of persons per house is greater than I have ever known it. (2) (a) Extent of shortage or excess of houses and (b) Measure taken or contemplated to meet any shortage.—As previously stated, the pressure on existing housing accommodation in Hampstead can best be relieved by building operations elsewhere and by improved means of transport, &c. (3) Information as to any important changes in population during the year or anticipated in the future.—There does not appear to be any likelihood of much variation in the near future in the population either as regards their manner of housing or social status. II.—Overcrowding. (1) Extent.—It is not uncommon to assume that any of the population who are living more than two in a room are overcrowded. This has always been the assumption in Hampstead, and although I regret that as the Census figures are not yet published, no accurate information on this subject can be given, yet I am of opinion there is more overcrowding than has been ever known. (2) Causes.—As already stated, the overcrowding is the result, principally, of the increased population without any corresponding increase in dwellings. (3) Measures taken or contemplated for dealing with overcrowding.— During the year rapid progress was made with the Council's Scheme at South End Close. Of the 140 flats comprised in 4 blocks which the Council are erecting there, 40 became occupied. The full detailed account of this Scheme was contained in my last Annual Report. These 4 blocks of flats will be completed within 1922, and will provide additional accommodation for from 400 to 500 people. (4) Principal cases of overcrowding during the year and action taken — Of the cases of overcrowding discovered during the year, in only one 81 case did the Couucil have to take legal action; the rest of the cases were remedied by a re-arrangement of the people in their rooms. I hope that by the time the new bye-laws for tenement houses are approved, the housing problem will have so diminished as to render it possible to call for the abatement of all the cases of overcrowding, which will inevitably be found whenever a house-to-house inspection is undertaken. III.—Fitness of Houses. (1) (a) General standard of housing in the district.—Hampstead is a high-class residential district, but in it there are a few very old wornout houses and many premises that need extensive repairs and constant supervision. (b) General character of the defects found to exist in unfit houses.— The chief defects are of two classes:—(i) Crowded premises with insufficient light and air that can only be effectively dealt with by demolition and re-construction and (ii) dilapidated and worn-out premises. (c) How far defects are due to the lack of proper management and supervision by owners. —There is in some houses lack of proper management and supervision by owners, and this is more evident when the owner does not live in the district. (2) General action taken as regards unfit houses under (a) the Public Health (London) Act, 1891 (b) the Housing Acts. (NOTE.—The detailed statistics as to action under these Acts will be given in the appendices). The procedure adopted is as follows:—After an inspection has been made by the Housing Inspector, a schedule of defects is prepared and submitted to the owner of the premises so that negotiations may bo made concerning the best means of remedying the insanitary conditions. Reasonable compromises have been effected, and as the information that follows shows much good work has been done. A few owners refused to carry out the necessary alterations, etc., in this quasi-voluntary manner and these have been reported to the Public Health Committee who ordered that Statutory Notices under the Public Health Act should be served upon the recalcitrant owners. The Council has served no Statutory Schedules under Section 28 of the Housing Act, 1919. 315 premises have been dealt with bv this means in 1921. 117 have been restored to a proper condition of repair at an estimated cost of £6,372. 80 Section G. HOUSING. I.—General Housing Conditions in the Borough. (1) General Housing Conditions.—The Housing problem is still acute though probably not so much as in 1920. Housing accommodation is very difficult to obtain in Hampstead to-day, the letting of houses has practically ceased in the Borough, and only a few houses are sold and that at a high rate. In the working-class districts the density of the population and the number of persons per house is greater than I have ever known it. (2) (a) Extent of shortage or excess of houses and (b) Meamre taken or contemplated to meet any shortage.—As previously stated, the pressure on existing housing accommodation in Hampstead can best be relieved by building operations elsewhere and by improved means of transport, &c. (3) Information as to any important changes in population during the year or anticipated in the future.—There does not appear to be any likelihood of much variation in the near future in the population either as regards their manner of housing or social status. II.—Overcrowding. (1) Extent.—It is not uncommon to assume that any of the population who are living more than two in a room are overcrowded. This has always been the assumption in Hampstead, and although I regret that as the Census figures are not yet published, no accurate information on this subject can be given, yet I am of opinion there is more overcrowding than has been ever known. (2) Causes.—As already stated, the overcrowding is the result, principally, of the increased population without any corresponding increase in dwellings. (3) Measures taken or contemplated for dealing with overcrowding.— During the year rapid progress was made with the Council's Scheme at South End Close. Of the 140 flats comprised in 4 blocks which the Council are erecting there, 40 became occupied. The full detailed account of this Scheme was contained in my last Annual Report. These 4 blocks of flats will be completed within 1922, and will provide additional accommodation for from 400 to 500 people. (4) Principal cases of overcrowding during the year and action taken — Of the cases of overcrowding discovered during the year, in only one 81 case did the Council have to take legal action; the rest of the cases were remedied by a re-arrangement of the people in their rooms. I hope that by the time the new bye-laws for tenement houses are approved, the housing problem will have so diminished as to render it possible to call for the abatement of all the cases of overcrowding, which will inevitably be found whenever a house-to-house inspection is undertaken. III.—Fitness of Houses. (1) (a) General standard of housing in the district.—Hampstead is a high-class residential district, but in it there are a few very old wornout houses and many premises that need extensive repairs and constant supervision. (b) General character of the defects found to exist in unfit houses.— The chief defects are of two classes:—(i) Crowded premises with insufficient light and air that can only be effectively dealt with by demolition and re-construction and (ii) dilapidated and worn-out premises. (c) How far dejects are due to the lack of proper management and supervision by owners. —There is in some houses lack of proper management and supervision by owners, and this is more evident when the owner does not live in the district. (2) General action taken as regards unfit houses under (a) the Public Health (London) Act, 1891 (b) the Housing Acts. (NOTE.—The detailed statistics as to action under these Acts will be given in the appendices). The procedure adopted is as follows:—After an inspection has been made by the Housing Inspector, a schedule of defects is prepared and submitted to the owner of the premises so that negotiations may bo made concerning the best means of remedying the insanitary conditions. Reasonable compromises have been effected, and as the information that follows shows much good work has been done. A few owners refused to carry out the necessary alterations, etc., in this quasi-voluntary manner and these have been reported to the Public Health Committee who ordered that Statutory Notices under the Public Health Act should be served upon the recalcitrant owners. The Council has served no Statutory Schedules under Section 28 of the Housing Act, 1919. 315 premises have been dealt with bv this means in 1921. 117 have been restored to a proper condition of repair at an estimated cost of £6,372. 82 At 107 the work is in progress, and the estimated amount already expended on repairs in connection with these is £2,637, making a total of £9,009. In 71 instances the owners have been communicated with and have promised to put the necessary work in hand. In 20 instances no action has yet been taken by the owners. Of the 315 premises dealt with, 249 were in the list of 643 houses that were reported to the Housing Committee as being below the standard compatible with health but which could be made reasonably fit for human habitation, and 66 were in the list of unhealthy areas. In the case of four premises inspected, it was found that their condition was such that the only course was to recommend that Closing Orders should be made when opportunity offers. The following list gives some idea of the nature of the work accomplished:— Empty underground rooms made fit for use 2 Lofts converted into bedrooms 4 New washhouses built 5 Additional ventilation to bedrooms and sculleries 17 Additional w.c. accommodation provided 2 Rooms, staircases and w.c. apartments cleansed and repaired 679 Dampness in rooms abated and floors ventilated and repaired 100 Windows and doors repaired 412 Handrails and balusters repaired 30 Coppers repaired or renewed 32 Larders provided 122 Coal sheds or receptacles provided 8 Fireplaces and ranges repaired or renewed 93 New sinks provided 42 Roofs, gutters and rainwater pipes repaired or renewed 179 Drains, soil pipes and ventilating pipes repaired or renewed 64 Gully traps removed from improper positions 19 Waste pipes of sinks trapped, repaired or unstopped 37 Water provided to upper floors of tenement houses 12 Water cisterns cleansed, repaired or removed from improper positions, or water taken off main supply 26 W.C. apparatus repaired or renewed 90 83 W.C. removed from improper positions or provided with external ventilation 13 Paving of yards and forecourts repaired or renewed 28 Dust bins provided 45 Accumulations of refuse removed 14 External repairs: pointing walls, repairing windows, sills, steps, &c. 41 Internal and external woodwork painted 26 Miscellaneous repairs 13 The foregoing does not represent the total amount of work done in the direction of improving the housing of the population, for much of the general sanitary work of the Department is devoted entirely to the improvement of dwelling houses, but the procedure indicated above has proved by its results to be of such value as to merit further and prolonged trial. In view of the great amount of clerical work involved in the preparation of schedules, keeping of records, &c., it was found necessary to add to the clerical staff, and in March, 1921, Mr. C. W. Francis was appointed as Housing Clerk. Progress in dealing with this class of property is not as rapid as could be wished, but it has to be remembered that owing to prevailing conditions it is found much more expedient to get the necessary work done by negotiation rather than by exerting our legal powers under the Housing Acts. As a matter of fact the law as contained in the various Housing Acts relating to procedure in dealing with insanitary property is somewhat involved ; and in addition it has not been found to be practicable to put Closing Orders on premises, because of the lack of accommodation for tenants who would have been displaced. No progress has been made during the year in the demolition of insanitary areas, and apart from the erection by the Borough Council of the buildings at South End Green, very little additional accommodation has been provided. Beyond the few sites remaining unbuilt on in the Borough, the housing question in Hampstead is now largely one of dealing with worn-out or dilapidated premises; and of adapting existing accommodation to the altered conditions of letting; thus ensuring that proper sanitary arrangements are made for the extra number of families now living in houses originally intended for one family, and to preventing overcrowding as far as possible. 84 Statement showing steps taken in 1921, in connection with premises "represented in 1921 or previous years" by the Medical Officer of Health under the Housing Acts. Premises. Representation. Closing Order. Demolition Order. Remarks. Date of Committee. Whether (a) unfit for habitation, (5) an obstructive building. Statute under which action taken. Date of Council. Statute under which action taken. Date of Council. Statute under which action taken. 1-4, Willow Road - - - — — — — To be dealt with by a Scheme under Part II Housing Act, 1919. Resolution of Council 27/1/21. 186, Belsize Road 26-1-20 (a) Sec. 17 Housing, Town Planning, &c., Act, 1909. 29-1-20 Housing, Town Planning, &c., Act, 1909 30-7-20 Housing, Town Planning &c., Act, 1909 Top floor let while Closing Order operative. Legal proceedings ordered by Council 24/2/21 under Sec. 32 Housing Act, 1919. Closing and Demolition Orders determined by Council 28/7/21. 8, Woodchurch Road 20-10-14 (a) Do. 28-10-14 Do. 29-9-19 Do. Two top floors let while Closing Order operative. Legal proceedings ordered by Council 31/3/21 under Sec. 32 Housing Act, 1919. Certificate as to satisfactory completion of works ordered to be issued by Council 26/4/21. Order of Ministry of Health 17/6/21 quashing Demolition Order. 8a, West End Lane 5-7-20 (a) Do. 29-7-20 Do. 26-5-21 Do. Operation of Demolition Order suspended for one month 26/5/21. Closing and Demolition Orders determined by Council 28/7/21. 1-7, Peebles Mews 17-6-13 (a) Do. 26-6-13 Do. 23-3-15 Do. 20th April, 1921, Minister of Health stated he was prepared to defer his formal decision on the Demolition Order Appeal for a further period of three months. 28th July—Plans of alterations deposited and approved. 6th Sept.—Letter from Ministry asking to be informed when necessary works have been carried out to satisfaction of Council so that they may issue an Order preventing the Demolition Orders taking effect so long as no part of the premises are used for human habitation. 85 Premises. Representation. Closing Order. Demolition Order. Remarks. Date of Committee. Whether (a) unfit for habitation, (b) an obstructive building. Statute under which action taken. Date of Council. Statute under which action taken. Date of Council. Statute under which action taken 16. Parliament Hill 23-2-20 (a) Sec. 17 Housing, Town Planning, &c., Act, 1909. 26-2-20 Housing, Town Planning, &c., Act, 1909. 29-11-20 Housing, Town Planning &c., Act, 1909. No appeal having been lodged against Demolition Order, three months allowed to Owner after Order had became operative in which to demolish the building having expired; and premises not rendered fit for habitation, Ministry of Health issued an order confirming the Demolition Order Premises demolished. 89, Broomsleigh Street 26-1-20 (a) Do. 20-1-20 Do. 30-7-20 Do. Letter from Ministry of Health 6/5/21, stating that as the three months allowed in which to render premises fit for habitation had expired, and premises not made fit, the Minister would issue an Order confirming the Demolition Order. Letter from Ministry of Health 26/8/21, confirming Demolition Order. Council on 29/9/21 decided to take proceedings to enforce Magistrate's Order of 15/7/20 directing tenants to vacate premises. 175, Belsize Road 36-1-20 (a) Do. 29-1-20 Do. 30-7-20 Do. Council 30/6/21 resolved to determine Closing Order upon Ministry of Health quashing the Demolition Order. 13, Southampton Road 11-7-21 (a) Do. 28-7-21 Do. - Do. Council 29/9/21 resolved to serve notice on occupiers to vacate within 21 days. Owner taking legal action for possession of premises. 10, New End 23-2-20 (a) Do. 26-2-20 Do. 24-11-21 Do. Owner in negotiation with intending purchaser (3) Difficulties in remedying unfitness, special measures taken, or suggested, including, for example, any special action taken to secure improved management oj property by owners; the gradual carrying out of repairs according to agreed arrangements: or any special method of dealing with unfit back-to-back houses, or other types of insanitary property.—The difficulties met with have been much the same as in previous years. The demand for house room exceeds the supply. We are deprived of the very potent weapon of the Closing Order except in empty property, of which latter there is none. The arrangements made for the gradual carrying out of plans are referred to in the preceding paragraph, No. 2. 86 (4) Conditions, so far as they effect housing, as regards water supply, closet accommodation, and refuse disposal, together with measures taken during the year in these matters.—Whenever houses let to several families are disoovered without water supply to the upper floors, notices are served requiring a supply of water to be provided. During the year 82 houses were dealt with, and 132 separate water supplies were provided. Premises where the water closet accommodation is found to be insufficient are also dealt with. During 1921 extra water closet accommodation was provided in 34 instances. IY.—Unhealthy Areas. Information as to complaints received or representations made and action taken in regard to unhealthy areas, under Part I or Part II of the Housing Act of 1890.—No additional unhealthy areas were "represented" during 1921, nor were complaints received concerning them. V.—Bye-laws relating to houses, to houses let in lodgings, and to tents, vans, sheds, etc. (1) As to working of existing Bye-laws, and (2) As to need for new lye-laws or revision of existing Bye-laws.—The new Bye-laws for houses let in lodgings have not yet been issued: they are urgently needed and I hope they will be approved in 1922. The responsibilty for framing these bye-laws is, by the Housing Act of 1919, placed upon the County Council. VI.—APPENDICES. HOUSING CONDITIONS. STATISTICS FOR THE 12 MONTHS ENDED 31st DECEMBER, 1921. 1.—GENERAL.[/##] (1) Estimated population 86,890 (2) General death-rate 11.2 (3) Death-rate from tuberculosis 0.82 (4) Infantile mortality, rate per 1000 births 65.5 (5) Number of dwelling-houses of all classes 11,194 (6) Number of working-class dwelling-houses 1833 (7) Number of new working-class dwellings erected 140 2.—UNFIT DWELLING-HOUSES. I.—Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 4,806 87 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 315 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 69 II.—Remedy of Defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 315 III. - Action under Statutory Powers. A. Proceedings under Section 28 of the Housing, Town Planning, &c., Act, 1919. No Statutory Notices served ; unofficial Notices only; vide page 81. (1) Number of dwelling-houses in respect of which notices were served requiring repairs (2) Number of dwelling-houses which were rendered fit— (a) by owners (b) by Local Authority in default of owners (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1104 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 1104 (b) by Local Authority in default of owners - 88 C.—Proceedings under Section 17 and 18 of the Housing, Town Planning, &c., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 1 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 4 (4) Number of dwelling-houses in respect of which Demolition Orders were made 2 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 1 (6) Number of Demolition Orders quashed 4 3.—UNHEALTHY AREAS. Areas represented to the Local Authority with a view to Improvement Schemes under (a), Part I., or (4), Part II., of the Act of 1890:- (1) Name of area Nil. (2) Acreage — (3) Number of working-class houses in area Nil. (4) Number of working-class persons to be displaced (See also paragraph IV., "Unhealthy Areas" preceding, for fuller details.) Nil. 4.—SECTION 25, HOUSING ACT, 1919. Number of houses not complying with the building byelaws erected with consent of the Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 - 5.—STAFF. Staff engaged on housing work, with, briefly, the duties of each officer:— (1) Medical Officer of Health—General supervision and direction. (2) One Housing and Sanitary Inspector—Specially detailed for Housing work. Note.—All the Sanitary Inspectors have been duly appointed as "Housing" Inspectors. (3) One Clerk, whose principal duties are connected with Housing work. 89 Section H. VITAL STATISTICS OF THE BOROUGH. Vital Statistics of the Borough. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 1902 1,516 904 133 87.7 73 1903 1,453 837 126 86.7 66 1904 1,445 892 161 111.4 73 1905 1,421 823 133 93.6 73 1906 1,437 850 111 77.2 57 1907 1,359 817 98 73.1 61 1908 1,400 803 97 69.3 74 1909 1,328 839 99 74.5 53 1910 1,340 829 81 60.4 58 1911 1,276 847 105 82.3 56 1912 1,231 861 79 61.7 64 1913 1,325 951 91 68.7 49 1914 1,273 913 91 71.5 57 1915 1,327 994 101 76.1 48 1916 1,164 862 73 62.7 55 1917 1,123 922 90 80.1 69 1918 895 1,027 69 77.1 75 1919 1,156 1,036 96 83.0 56 1920 1,566 860 75 47.9 41 1921 1,342 973 88 65.5 63 Vital Statistics of Ho. 1 (Town) Ward. Year. Number of Births. Number cf Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Bate per 1000 Births. 1902 192 163 20 104.1 17 1903 194 127 14 72.1 11 1904 195 125 20 102.5 13 1905 194 127 24 123.7 9 1906 205 131 21 102.4 5 1907 185 152 15 81.1 13 1908 225 108 11 48.8 7 1909 196 140 15 76.5 6 1910 199 118 15 75.4 6 1911 207 133 19 91.8 7 1912 183 135 12 65.5 5 1913 201 161 11 54.7 11 1914 152 130 14 92.1 5 1915 157 147 17 108.2 5 1916 132 140 7 53.0 13 1917 143 143 12 83. 9 14 1918 115 157 13 113.0 11 1919 149 170 13 87.2 10 1920 208 112 7 33.6 4 1921 178 147 17 95.5 11 90 Vital Statistics of No. 2 (Belsize) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis Number. Rate per 1000 Births. 1902 239 136 13 75.3 15 1903 211 121 13 61.6 13 1904 217 141 23 105.9 12 1905 209 131 13 62.2 10 1906 187 127 8 42.8 13 1907 205 114 13 63.4 10 1908 205 126 8 39.0 16 1909 201 130 16 78.4 8 1910 207 119 9 43.5 8 1911 189 135 17 90.0 10 1912 188 127 8 42.5 7 1913 214 126 16 74.7 5 1914 195 141 9 46.1 11 1915 317 144 12 37.8 6 1916 189 127 7 37.0 6 1917 185 132 13 70.2 11 1918 149 155 7 47.0 9 1919 196 159 20 102.0 9 1920 213 132 9 42.2 7 1921 197 143 12 61.0 7 Vital Statistics of No. 3 (Adelaide) Ward Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 1902 103 95 3 29.1 7 1903 95 101 9 94.7 1 1904 100 99 13 130.0 8 1905 96 92 4 41.7 4 1906 97 92 10 103.1 5 1907 75 86 8 106.7 2 1908 93 78 6 64.6 4 1909 83 88 4 48.2 3 1910 96 78 2 20.8 5 1911 82 99 6 73.2 3 1912 117 77 6 51.3 9 1913 97 99 9 92.8 4 1914 88 99 5 56.8 2 1915 77 104 5 64.9 2 1916 104 95 12 115.3 6 1917 114 109 7 61.4 6 1918 97 119 6 61.8 11 1919 97 130 10 103.8 6 1920 161 109 6 37.3 3 1921 133 119 10 75.2 8 91 Vital Statistics of No. 4 (Central) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 1902 110 71 11 100.0 5 1903 99 60 8 80.8 4 1904 90 62 11 122.2 1 1905 113 60 5 44.2 6 1906 95 83 3 31.6 2 1907 108 68 9 83.3 5 1908 104 82 6 57.7 7 1909 116 63 3 25.9 3 1910 105 82 8 76.2 3 1911 92 75 8 87.0 3 1912 97 76 4 41.2 6 1913 91 84 6 65.9 ... 1914 84 76 4 47.6 6 1915 91 92 4 42.5 6 1916 93 97 4 43.0 3 1917 69 76 2 28.9 ... 1918 69 99 5 72.5 7 1919 101 117 5 49.5 4 1920 131 91 7 53.4 2 1921 112 102 8 71.4 3 Vital Statistics of No. 5 (West End) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis Number. Rate per 1000 Births. 1902 275 107 20 72.1 6 1903 2 43 111 21 86.4 12 1904 283 120 22 77.7 8 1905 250 131 23 92.0 11 1906 259 115 14 54.1 8 1907 250 114 16 64.0 9 1908 254 121 26 102.4 9 1909 239 118 13 54.1 6 1910 216 121 17 78.7 11 1911 216 102 15 69.4 10 1912 226 126 13 57.5 12 1913 240 145 11 45.8 7 1914 256 140 18 70.3 14 1915 218 151 13 59.6 11 1916 211 117 10 47.4 5 1917 221 137 13 58.8 13 1918 124 162 10 80.6 12 1919 175 139 12 68.5 12 1920 268 119 16 60.0 6 1921 211 146 12 56.9 9 92 Vital Statistics of No. 6 (Kilburn) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 1902 435 219 45 103.4 16 1903 417 184 39 93.5 18 1904 408 206 54 132.3 22 1905 426 171 50 117.4 26 1906 444 197 41 92.0 15 1907 391 179 28 71.6 16 1908 393 186 30 76.3 21 1909 341 182 37 108.5 17 1910 379 192 24 63.3 16 1911 347 179 31 89.3 16 1912 353 188 26 73.6 14 1913 354 213 25 70.6 18 1914 385 212 25 64.2 13 1915 329 230 40 121.5 11 1916 309 180 28 90.6 20 1917 280 208 37 132.1 17 1918 241 225 21 87.1 18 1919 296 201 24 81.1 11 1920 408 172 19 47.7 14 1921 364 204 21 57.7 11 Vital Statistics of No. 7 (Priory) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. N umber of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 1902 162 110 16 98.7 7 1903 194 116 21 108.2 5 1904 152 121 13 85.5 9 1905 133 103 14 105.3 7 1906 150 93 9 60.0 8 1907 127 94 7 55.1 6 1908 126 93 10 79.3 7 1909 149 111 11 73.8 8 1910 138 111 6 43.5 8 1911 143 115 9 63.0 5 1912 117 115 7 59.8 10 1913 128 117 12 93.7 3 1914 113 110 16 141.6 5 1915 138 126 10 72.4 7 1916 126 106 5 39.6 3 1917 111 117 6 54.0 8 1918 100 110 7 70.0 7 1919 142 120 12 84.5 5 1920 177 95 11 62.1 5 1921 147 112 8 54.4 14 93 INDEX. PAGE. Analytical Work, Report on 40,79 Anti-toxin, Diphtheria 44 Area of Borough 7 Bacteriological Examinations. 78 Bakehouses 38 Births 10 Births, Illegitimate 11 Cancer 12 Census Statistics 5 Cleansing Station 21 Complaints Received 16 Consumption (see Tuberculosis) — Customs and Inland Revenue Acts 21 Dairies 30 Deaths 11 Dental Clinics 54,66 Diarrhœa and Enteritis 13,77 Diphtheria 44 Disinfection 22 Drainage Work 21 Dysentery 47 Encephalitis Lethargica, acute 46 Enteric Fever 46 Epidemic Diarrhœa 77 Epidemic Diseases, Principal, Deaths and Death-Rate 13 Erysipelas 46 Factory and Workshop Act, 1901 24 Flooding in Kilburn 23 Food 30 Food Premises 36 Fried Fish Shops 37 German Measles 77 Hampstead Heath, Sanitary Accommodation 23 Health Visiting 65 Home Office Tables (Factory and Workshop Act, 1901) 25 Homework 26,28 Houses Let in Lodgings (see Tenement Houses) — Housing 80 Ice Cream 37 94 Infantile Mortality 68 Infectious Diseases 42 Influenza 62 Legal Proceedings 20 Margarine, Wholesale dealers 37 Malaria 47 Marriages 9 Measles 76 Meat Supply 39 Maternity and Child Welfare 63 Milk (Mothers and Children) Order, 1919 32 Milkshops and Milk Supply 30 Mortuary, Public 21 Notification of Births Act, 1907 67 Nursing, facilities 67 Offensive Trades 20 Ophthalmia Neonatorum 76 Outworkers 26,28 Pneumonia, Acute primary 47 Population 8 Population, Natural Increase of 9 Pre-Maternity Clinics 72 Principal Epidemic Diseases 13 Public Health Committee 3 Public Health (Milk and Cream) Regulations, 1912 and 1917 31 Puerperal Fever 76 Rats and Mice (Destruction) Act, 1919 23 Rent Restrictions Acts 21 Restaurant Kitchens. 39 Sale of Food and Drugs 20,40 Sanitary Inspection, &c. 16 Scarlet Fever 46 Scavenging 16 Slaughterhouses 39 Small-pox 46 Smoke Nuisances 21 Staff of the Public Health Department 3 Still-Births 68 Suicide 14 Summary of Vital Statistics 7 Tenement Houses 86 Trench Fever 47 Tuberculosis 48 95 Tuberculosis Dispensary 55 Tuberculous Milk 30 Underground Rooms 23 Unsound Food 36 Vaccination 46 Venereal Disease 47 Verminous Persons and Premises 21 Vital Statistics 7 Violent Deaths 14 Warranty Defence 41 Water Supply, Certificates as to 22 Water Supply of Tenement Houses 22 Whooping Cough 77 Young Children, Mortality among 68