HAMP 26 THE Metrtropolitan Borough of Hampstead. REPORT for the year 1922, 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 I.—General Statistics 5 2.—Extracts from Vital Statistics of the Year 5-18 3.—Notifiable Diseases during the Year .. 19-27 4.—Causes of Sickness 27 5.—Summary of Nursing Arrangements, Hospitals, and other Institutions available for the Borough 27-33 6.—Laboratory Work 33 7. —Sanitary Administration 34-54 8. —Public Health Staff 54-56 9. —Housing 56-63 INDEX 73-75 3 His Worship the Mayor (Mr. Councillor F. G. Howard, j.p.) ex-ojicio member of all Committees. PUBLIC HEALTH COMMITTEE. Chairman: Mr. Councillor C. J. R. Mac Fadden, m.d., c.m. Mr. Alderman G. Buckle Mrs. Councillor Monro. j.p. Mr.Councillor J, A. A. Atkin Mr. T. H. Nunn, m.A. 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 Miss Fawcett, b.sc Sub-committtet : —Drainage plans. Tuberculosis, Venereal Diseases. MATERNITY AND CHILD WELFARE COMMITTEE. Member of the ouncil. Chairman: Mrs. Councillor Dow. b.a. Mis. Councillor Arnholz Mr. Couucillot C. J. R. Mac Faddcii. m.d., Mr. R. H. H. Cust, M.A., J.P. Mrs. Monro, j.p. c m. Miss Fawcett, B.sc. Mr. „ T. H. Nuun. m.a. Mis. Fisher „ „ 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. Rocko Mrs. E, Stewart HOUSING COMMITTEE. Chairman: Mr. Councillor H. R, Smith. Mr. Alderman G. Buckle Mr. Councillor F. B. Glover Mrs. Councillor Arnholz Mrs. „ Monro, J. p. Mr. „ V. H. Blessley Mr. „ W. P. Newman W. C. Chaney H. R. Smith „ R. H. H. Cust, M.A., j.p. W. J. Spriggs Mrs. „ Dow, B.A. „ „ J. C. Staines Mr. „ E. J. Duveen „ E. C. Taylor, m.d., M.s. Mrs. „ Fisher Sub-Committees— Insanitary Property ; Plans. 4 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W. 3. 17th April, 1923. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gnetlemen, I have the honour to present to you my Aunual Report for the year 1922. It is compiled in accordance with the Ministry of Health's directions, conveyed in their Circular No. 359, issued on January 10th, 1923. This accounts for its unusually small size and the restricted amount of information it contains. Still, I trust it contains a complete epitome of the health activities for 1922, a year which was not distinguished by any remarkable event in a Public Health sense. The summary on page 5 gives the vital statistics in an easily understandable form, and shows that our Borough fully maintains its position as one of the healthiest urban districts in the kingdom. I would like to take the opportunity of expressing my thanks to the Council, especially to the Chairmen and Members of the Public Health, Housing, and Maternity and Child Welfare Committees, for the support and sympathetic consideration they have afforded me. I desire also to place on record my appreciation of the work of the Staff of the Department, who have at all times accorded me their loyal and unselfish co-operation. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, FRANK E. SCRASE, Medical Offrttr of Health. 5 Section t. General Statistics. Area of Borough 2265 acres (excluding area covered by water 2253 acres) Population Census, 1921 86,153 Number of inhabited houses ditto 12,557 Number of families or separate occupiers, ditto 21,520 Rateable Value, 1st April, 1922. £1,152,027 Sum represented by a penny rate. £4,690 1s. 6d Summary of Vital Statistics for 1922. Population cstimated to middle of 1922 86,920 Density 38 persons per acre. Marriages 718 Marriage-Rute 16.5 M. F. Totals Births 595 615 1210 80 1,290 Legitimate Illegitimate 40 40 Birth-Bate 14.8 Deaths 970 Death Rate 11.1 Deaths of Infants under 1 year 72 Infantile Mortality Rate 56 Maternal Deaths-No. of women dying in, or in consequence of, childbirth At home In hospital. I .. _ (1) From Sepsis (2) Other Causes 1 2 6 1 2 Deaths from Tuberculosis of the Respiratory System 52 Death-Bate from ditto 0.60 Deaths from All Forms of Tuberculosis 69 Death-Bate from ditto 0.79 6 POPULATION. In accordance with the prevailing custom, I have adopted the Registrar-General's estimate of the population for the purposes of this Report,and this was calculated to have been 86,920 at the middle of the year 1922. 1 have prepared the following based upon the Census figures, of the population of each Ward. Ward. Estimated Population. No. 1 (Town) 12,900 No. 2 (Belsize) 14,000 No. 3 (Adelaide) 10,450 No. 4 (Central) 9,550 No. 5 (West End) 13,600 No. 6 (Kilburn) 15,720 No. 7 (Priory) 10,700 The Borough 86,920 The Returns of the Census of 1921 are now published, and in view of their great interest I append the following statistics showing the age and sex distribution of the population. On the night of the Census 4,429 rooms were recorded as being vacant, and when, in addition to the population represented by this figure, ii is remembered that many citizens were away from home, but as other members of the family remained at home their rooms were not counted as being vacant, it will be realised that my original estimate of the population of 100,000 was fairly accurate. These facts should, therefore, be borne in mind when the various rates that have been calculated upon these Census figures are considered. The sex percentages when the Census was taken, were 38.6 males and 61.4 females. Population at Ages (Quinquennial Groups) and Marital Conditions. Age last Birthday. Persons. Males. Percentages. Females Males. Females. Total. Single. Single. Widowed. Divorced. I Married. Widowed. Divorced. Total. Married. Sex Percentages. 61.4 38.6 86,153 33,253 16,814 997 49 52,900 16,084 85 Age Per centages. All Ages No. 15,393 31,755 4,976 3.0 0.2 % 100.0 50.6 46.3 0.1 100.0 60.0 9.4 100.0 100.0 - 30.4 2,480 4,899 - - - 2,419 2.419 - - 7.5 4.6 0-4 2.480 - 5-9 5,351 2,664 2.664 - - - 2,687 2,687 - - 8.0 5.1 - 10—14 5,437 2,545 2,545 - - _ 2,892 2,892 - - - 7.7 5.5 15—19 6,728 2.569 2,564 5 - - 4.159 4,115 43 1 7.7 7.9 - 20-24 8,092 2,574 2,276 2 - 4,749 24 1 7-7 10.3 296 5,518 744 1,474 3 5,467 3,497 8 8.6 10.3 2,826 18 1 ,874 8,293 1,331 88 25—29 30-34 7,788 2,762 784 1,957 13 8 5,026 2,521 2,339 156 10 8.4 9.5 2,313 35—39 7,197 2,605 502 2,060 36 7 4,592 2,017 248 14 7.9 8 .7 40-44 6,585 2,472 364 2,056 43 9 4,113 303 19 7.1 7.8 1,594 2,197 6,120 328 1,934 63 5 428 10 7.0 7.2 45-49 2,330 3,790 1,444 1,908 274 1,730 1,627 63 50—54 5,440 2,102 93 5 3,338 1,192 511 8 6.3 55-59 4,636 1,773 193 1,460 117 3 2,863 967 1,296 593 7 5.3 5.4 60-64 1,403 148 1,127 661 875 672 3 4.2 4.2 3,614 127 1 2,211 65-69 2,533 980 114 716 145 5 1,553 434 481 636 2 2.9 2.9 70-74 1,728 146 1 1,087 580 2 1.9 2.1 641 62 432 256 249 75-79 953 324 28 197 97 2 629 174 90 365 - 1.0 1.2 80— 84 526 146 10 69 67 - 380 94 39 247 - 0.4 0.7 85—89 177 - 20 - 131 26 7 98 - 0.2 46 26 0.1 0.1 90—94 45 8 2 3 3 37 14 1 22 - 0.0 - 95 and over 11 3 2 - 1 - 8 2 1 5 - 0.0 0.0 Total Population. Privat Families and Dwellings. Area in Statute Acres (Land and Inland Water). 1911. 1921. Private Families. Population in Private Families. Structurally Separate Dwellings occupied. Rooms occupied. Rooms per Person. Persons. Persons. Males. Females. Persons per Acre. b c g h l Cols. a a e f i j k The Borough 1.41 86,153 33,253 52,900 38 21,520 14,322 112,570 85,495 80,050 2,265 Wards: 13,795 693 12,852 4,588 8,264 17,224 No. 1. Town 19 3,065 11,838 2,263 1.45 13,755 No. 2. Belsize 270 13,562 50 1,960 16,382 5,298 8.264 3,164 11,516 1.42 9,954 No. 3. Adelaide 3,637 6,756 33 2,554 9,480 1,912 16,239 318 10,393 1.71 No. 4. Central 9,502 9,828 30 8,609 1,787 314 3,080 6,422 2,032 15,591 1.81 5,695 17,803 248 12,822 13,558 7,863 55 3,4 51 13,153 2,656 No. 5. West End 1.35 187 14, 912 8.704 84 6,965 4,396 15,365 14,703 No.6. Kilburn 15,669 1,927 0.96 3,990 6,627 No. 7. Priory 235 10,429 46 2,858 10,089 14,628 10,617 1,817 1.45 Private Family.- Any person or group of persons in separate occupation of any premises or part of premises ie treated as a separate family for Census purposes. Private families comprise all such families with the exception of those enumerated in (i) Institutions or (ii) business establishments or boarding-houses. Structurally separate Dwellings are denned as any room or sets of rooms, Intended or used for habitation, having separate access either to the street or to a common Landing or staircase. Thus each flat In a block of flats is a separate unit; a private house which has not been structurally subdivided is similarly a single unit whether occupied by one family or by several families, But where a private house has been subdivided into maisonettes or portions,each having its frout door opening on to the street or on to a common landing or staircase to which visitors have access, then each such portion is treated as a separate unit. Rooms. For the purpose of the Census the rooms enumerated are the usual living rooms. Including bedrooms and kitchens, but excluding scuĺeries, landings, lobbies, closets, bathrooms, or any warehouse, office, or shop rooms. Section 2. EXTRACTS PROM VITAL STATISTICS OP THE YEAR. MARRIAGES. According to the return kindly furnished to me by the Superintendent Registrar of Hampsted, it appears that 718 marriages were registered in the Borough during 1922, as compared with 708 in the preceding year. The following Table gives the marriage rates per 1,000 of the population for the years 1911-1921 : — 1912 15.0 1917 18.7 1913 14.9 1918 18.5 1914 19.0 1919 17.0 1915 23.2 1920 16.6 1916 17.8 1921 16.3 1922 16.5 BIRTHS. In the following Table the births for 1922 have been analysed according to sex, etc.:— BIRTHS. MALES. FEMALES. TOTALS. Legitimate. Illegitl- Total. Legitimate. Total. Legitimate. mate. Total. Illegitimate. 649 35 684 662 Registered in the Borough 36 698 1311 71 1382 Number who could not be deemed to belong to Hampstead 124 137 144 17 161 13 268 30 298 Number occurring outside the Borough whose mothers were Hampstead residents 70 18 97 21 118 39 88 167 206 595 40 635 615 40 655 1210 80 1290 Net number belonging to Hampgtead, 1922 48 632 Net Births, 1921 680 627 35 662 1259 83 1341 9 10 The 1290 net births were distributed among the various Wards as follows:—No. 1 (Town) 161, No. 2 (Belsize) 202,No. 3 (Adelaide) 149), No. 4 (Central) 85, No. 5 (West End) 223, No. 6 (Kilburn) 303, and No. 7 (Priory) 167. 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) „ 14.4 No. 3 (Adelaide) „ 14.2 No.4 (Central) „ 8.9 No.5 (West End) „ 16.4 No. 6 (Kilburn) 19.3 No. 7 (Priory) „ 15.6 The Borough 14.8 London 21.0 England and Wales 20.6 The natural increase in population, i.e., the excess of births over deaths, was 320. Legitimate and Illegitimate Births and Birth Rate. Of the total 1,290 net births belonging to Hampetead, 1,210 were those of legitimate and so of illegitimate children, the latter being at the rate of 62 per 1,000 births.39 of the Hampstead illegitimate infants were born outside the Borough, chiefly in Lying-in Institutions NOTIFICATION OF BIRTHS ACT, 1907. By the Notification of Births Act, 1907, all births occurring in the Borough must be notified to the Medical Officer of Health within 36 hours. 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 1022. As births have to be notified luueh sooner than registered, the total number notified differs from the total number registered. Notified by midwives 473 „ parents 357 „ doctors 386 „ nurses and others 162 1378 11 In 93 cases the notification was not made until I had drawn the attention of the responsible person to the omission. During the year 38 still-births were notified, as follows: — Notified by midwives 17 „ parents 2 „ doctors 14 „ nurses and others 5 DEATHS. The "recorded" death-rate is the rate obtained by calculating the number of " net " deaths per 1000 of the population. From the total deaths of civilians registered is deducted the number who were nonresident peisons, and, after subtracting these, the number of deaths of civilian Hampstead residents who died outside the Borough is added. The total net deaths during 1922 was 1)7(1, or 1M per 1000 of the population, as compared with 11.2 in the preceding year. These deaths were distributed among the various "Wards as follows:—No. 1 (Town) 130, No. 2 (Beleize) 151, No. 3 (Adelaide) 121, No. 4 (Central) 113, No. 5 .West End) 138, No. G (Kilburn) 202, and No. 7 (Priory) 110. 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 10.1 No. 2 (Belsize) „ 10.8 No. 3 (Adelaide) „ 11.6 No. 4 (Central) „ 11.8 No. 5 (West End) „ 10.1 No. 6 (Kilburn) „ 12.8 No. 7 (Priory) 10.7 The Borough 11.1 London 13.4 England and Wales 12.9 12 Causes of Death at Different Periods ok Life during the Year 1922. CAUSES OF DEATH. Net 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 years. 75 years and upwards. 2 4 6 9 10 12 1 3 5 7 8 11 M ... ... ... 1 1. Enteric Fever 1 ... ... ... ... ... F 2 1 1 ... ... ... ... ... ... ... 2 Small-pox M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... M 4 2 1 1 ... ... 3. ... ... ... ... 2 2 F ... ... ... ... ... ... 4. Scarlet Fever ... ... M 1 ... ... 1 ... ... ... ... ... ... ... F 1 ... ... ... ... ... 1 ... ... 5. Whooping Cough M 1 ... 1 ... ... ... ... ... ... ... 1 F ... 1 ... ... ... ... ... ... ... 6. Diphtheria M 11 ... 1 5 5 ... ... ... ... ... F 8 2 3 ... 3 ... ... ... ... ... 7. Influenza M 12 1 ... 2 ... 3 5 ... 1 ... F 26 1 2 1 5 9 4 4 ... ... 8. Encephalitis lethargica 1 M 2 ... ... ... ... 1 ... ... ... F ... ... ... ... ... ... ... ... ... ... 9. Meningococcal Meningitis M 2 1 ... 1 ... ... ... ... ... ... F ... ... ... ... ... ... 1 ... ... 8 ... 17 M 33 ... ... ... 1 5 2 ... 10. Tuberculosis of respiratory system F 19 ... 1 5 7 6 ... ... ... ... 10 1 2 3 1 11. Other Tuberculous Diseases M 1 ... ... 2 ... F. 7 ... 1 1 ... 1 1 3 ... 25 ... 6 12. Cancer, malignant disease M 50 ... ... ... ... 2 17 ... 17 F 85 ... 7 49 12 ... ... ... ... M 49 13. Rheumatic Fever ... ... ... ... ... ... ... ... ... F 2 ... ... ... ... 2 ... ... ... ... M 2 3 14. Diabetes 5 ... ... ... ... ... ... ... F 10 ... ... 1 2 4 3 ... ... ... 16 7 5 4 15. Cerebral hæmorrhage, &c. M ... ... ... ... ... ... 11 F 22 ... ... ... ... 2 4 5 ... M 66 ... 3 11 20 15 17 16. Heart Disease ... ... ... 26 F 77 ... 1 5 22 23 ... ... .. M ... 10 4 17. Arterio sclerosis 16 ... ... ... ... ... 2 F 15 ... ... ... .. 2 4 9 ... ... M 1 4 10 11 18. Bronchitis 28 2 ... ... ... ... 5 19 F 34 3 1 ... 6 ... ... ... 19. Pneumonia (all forms) M 36 7 1 6 13 4 3 ... ... 2 F 30 2 ... 1 ... ... 7 12 5 3 2 20. Other Respiratory Diseases M ... 1 ... 2 2 7 ... 1 ... 1 F 8 ... ... 1 ... ... 3 3 .. 4 M 9 ... ... 3 2 ... 21. Ulcer of Stomach or Duodenum ... ... ... F 2 3 ... ... 1 ... ... ... ... ... M 7 3 1 ... 1 2 ... ... 22. Diarrhœa, &c. ... ... 4 2 1 1 F ... ... ... ... ... ... 23. Appendicitis and Typhlitis M 1 1 ... ... ... ... ... ... ... ... F ... 3 ... ... ... 2 ... 1 ... ... M 6 ... ... 5 1 ... 24. Cirrhosis of Liver ... ... ... ... F 4 ... 1 3 ... ... ... ... ... M ... 25. Acute and Chronic Nephritis 13 ... 1 1 6 2 2 ... ... 1 F ... 1 ... 3 ... 2 4 13 ... ... 3 13 26. Puerperal Sepsis M ... ... ... ... ... ... ... ... F 3 1 2 ... ... ... ... ... ... ... 27. Other accidents & diseases of pregnancy, and parturition M ... ... ... ... ... ... ... ... ... ... F 3 ... 1 2 ... ... ... ... .. ... ... M ... 19 19 ... ... ... 28. Congenita Debility and malformation, premature birth ... ... ... F 11 11 ... ... ... ... ... ... ... ... ... M ... 5 1 29. Suicide 9 ... ... 2 1 ... F 3 ... ... ... ... 2 1 ... ... ... 30. Other Deaths from Violence M 11 1 1 3 ... ... ... 4 2 F ... 11 1 1 . 1 ... 1 2 1 5 ... 31. Other Defined Diseases M 90 13 1 8 26 17 23 ... 1 F 2 19 96 ... 4 ... ... 20 19 32 ... 32. Causes ill-defined or unknown M .. ... ... ... ... .. ... ... ... F 1 ... ... 1 ... ... ... ... ... ... M 466 49 5 14 12 14 135 97 81 All causes 59 F 504 23 8 7 12 12 63 142 100 137 970 72 26 122 13 21 24 277 197 218 Totals All" Transferable Deaths" of residents, i.e., of persons resident in the Borough who died outside it, have been included. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who died in the Borough have in like manner been excluded. 13 The following diseasee and causes of death call for special mention :— Maternal Deaths. Number of women dying in, or in consequence of, child-birth : — (1) From Sepsis at home 1 in hospital 2 (2) Other Causes at home 2 in hospital 1 Infantile Mortality, Deaths of infante under one year of age and rate per 1000 births:— No. 59 Legitimate. Illegitimate. Total. Rate per 1000 legitimate births. 49 No. 13 Rate per 1000 illegitimate births. 162 No. 72 Rate per 1000 births. 56 In the following table the 72 infantile deaths have been classified according to diseases in age-periods and in Wards: — 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. Small-pox ... ... ... ... ... .. ... ... ... ... ... 2 2. Chicken-pox ... ... ... ... ... ... ... ... ... Measles ... ... 1 1 . ... ... ... ... 4. Scarlet Fever ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... 6. Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... 7. Erysipelas ... ... ... ... ... ... ... ... ... ... 8. Tuberculous Meningitis ... ... ... ... ... ... ... 1 1 ... 9. Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... 10. Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... 11. Meningitis (not Tuberculous) ... 1 ... ... ... 1 ... ... ... ... 1 12. Convulsions 1 1 ... ... ... ... 1 1 4 13. Laryngitis ... 1 ... ... ... ... ... ... ... ... 14. Bronchitis 2 1 ... ... ... ... ... 1 1 5 15. Pneumonia (ail forms) ... 1 1 2 2 2 2 9 ... ... ... ... ... 3 2 5 ... ... ... ... 16. Diarrhœa and 17. Enteritis Gastrits ... ... ... ... ... 2 ... 2 ... ... 19. Syphilis ... 1 1 ... ... 1 ... ... ... ... 20. Rickets ... 1 ... ... ... ... ... ... ... ... ... 21. Suffocation,overlying ... ... ... ... ... ... ... ... ... 22. Injury at Birth 3 ... 3 ... 3 ... ... ... ... ... 23. Atelectrasis 3 ... 3 ... ... 3 ... ... ... ... 24. Congenital Malformations 2 ... ... 2 ... 1 .. ... ... 1 17 25. Premature Birth 13 2 ... 4 1 22 2 ... 26. Atrophy, Debility and Marasmus ... 3 1 4 1 ... ... ... ... 5 ... 27. Other causes 1 1 2 1 1 ... ... 1 1 6 Totals 26 2 3 34 14 10 6 3 8 72 Want of Breast Milk has been included under No. 26, Atrophy and Debility. legitimate M. 595 Net Deaths in the year of legitimate infants M. 39 Net Births in the year F. 615 F. 20 iĺegitimate M. 40 M illegitimate infants 10 F. 40 F 3 14 No. 1 (Town). No. 3 (Adelaide). No. 1 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). No. 2 (Belsize). Total. CAUSES OF DEATH. 1. Small-pox ... ... ... ... ... ... ... ... 2. Chicken-pox ... ... ... ... ... ... ... ... 3. Measles 1 2 ... ... ... ... 1 ... 4. Scarlet Fever ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... ... ... ... ... ... 6. Diphtheria and Croup ... ... ... ... ... ... ... ... ... 7. Erysipelas ... ... ... ... ... ... ... ... 8. Tuberculous Meningitis ... ... ... ... 1 ... 1 ... 9. Abdominal Tuberculosis ... ... ... ... ... ... ... ... 10. Other Tuberculous Diseases ... ... ... ... ... ... ... ... 11. Meningitis (not Tuberculous) 1 1 ... ... ... ... ... ... 12. Convulsions 2 1 1 ... 4 ... ... ... 13. Laryngitis ... ... ... ... ... ... ... 14. Bronchitis ... ... ... ... ... 2 2 1 5 15. Pneumonia (all forms) 2 1 1 1 1 2 1 9 16. Diarrhœa 17. Enteritis ... 1 2 1 ... 1 ... 5 18. Gastritis ... ... ... ... ... ... 2 2 19. Syphilis 1 1 ... ... ... ... ... ... 20. Rickets ... ... ... ... ... 21. Suffocation, overlying ... ... ... ... ... ... ... ... ... .. ... 22. Injury at Birth 2 3 ... ... ... ... 1 23. Atelectasis ... 1 ... 1 1 3 ... ... ... ... 1 1 3 24. Congenital Malformations ... ... 1 25. Premature Birth ... 4 6 4 4 4 22 ... ... 1 26. Atrophy, Debility and Marasmus ... ... 1 3 5 ... ... 2 1 3 6 27. Other causes ... ... ... ... Total Deaths 11 10 6 9 6 14 16 7 2 Total Births 161 202 149 85 223 303 167 1290 Want of Breast Milk has been included under No. 20, Atrophy and Debility. Table showing deaths and death-rates of legitimate and illegitimate infants:— Year. Legitimate Infante. Death rate per 1000 legitimate births. Illegitimate Infants. Death-rate per 1000 illegitimate births. Births. Deaths. Births. Deaths. 1910 71 57 36 10 278 1,233 94 1911 1,239 76 37 11 297 1912 68 74 11 149 1,207 56 1913 1,252 73 58 73 18 246 77 63 1914 1,218 55 14 254 1915 1,246 82 65 81 234 19 65 59 1916 1,088 76 8 105 74 70 71 16 225 1917 1,052 797 56 70 98 13 132 1918 1919 1,039 77 117 19 162 74 1,478 62 88 13 148 1920 42 1921 1,259 71 56 83 17 205 1,210 49 80 13 162 1922 59 15 Table showing deaths and death-rates of infants and of children under five years of age:— 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 62 1912 79 131 19.8 1913 69 149 22.7 91 91 72 129 20.0 1914 101 22.2 1915 76 144 73 62 94 14.7 1916 1917 90 80 122 19.6 1918 69 77 109 18.8 1919 96 83 120 21.2 1920 75 48 101 17.1 88 65 126 1921 20.7 1922 106 72 56 16.9 Table showing the Infantile Death-Rates in the Metropolitan Cities and Boroughs and in the County of London during 1922: — Deaths under 1 year per 1000 births. Deaths under 1 year per 1000 births. District. District. - - - - 54 Hammersmith 71 Lewisham Westminster, City 54 Hackney 72 Deptford Greenwich 56 74 Hampstead 56 St. Pancras 74 Lambeth 58 Islington 77 Camberwell London, City 61 78 Wandsworth 61 Poplar 79 Woolwich 62 Southwark 79 Stepney Chelsea 66 79 66 Finsbury 82 Holborn Stoke Newington 66 Kensington 82 Bethnal Green St. Marylebone 68 90 69 Bermondsey 101 Battersea Fulham 69 Shoreditch 102 County of London Paddington 69 74 18 Meansles. This disease is compulsorily notifiable in Hampstead under the Borough of Hampstead (Measl9s) Regulations, 1920. During 1922, 887 cases were notified and deaths occurred. Whooping Cough, This disease is not compulsorily notifiable in Hampstead; our principal source of information of the occurrence of cases is the Head Teachers of Schools Two deaths were due to Whooping Cough in 1922. Diarrhœa and Enteritis. Of the total deaths at all ages from Diarrhoea and Enteritis in Hampstead during 1922, which numbered 11, 6 took place among children under two years of aye. Principal Epidemic Diseases. All of these, with the exception of whooping cough, are notifiable diseases, and information concerning them is set out in Section "3" of this Report. The deaths from the principal epidemic diseases in recent years are as follows: — Year. Enteric Small Pox Measles, Bcarlet Fever. Whooping Cough. Diphtheria 1919 .. .. 5 2 7 .. 1920 2 8 4 6 5 .. 1921 1 .. 4 5 6 35 1922 3 6 19 .. 2 2 The death-rate from these causes in 1922 was 0.22 per 1000 of the population. In addition to the foregoing, a brief mention of the following may be of interest. Cancer. The following- Table gives the number of deaths from Cancer in each of the years 1914—1922 :— No. of Deaths from Cancer. No. of Deaths from Cancer. Year. Year. 1919 123 1914 114 1915 118 1920 120 1916 113 1921 134 107 1922 135 1917 1918 105 17 Of the deaths from Cancer, 85 were females and 50 males. Tn 52 eases the persons were over years of age. On this point it must be borne in mind that the population of the Borough was found at the census of 1921 to consist of 52,900 females and 33,253 male. The next table gives the anatomical distribution of the disease in each sex :— Situation. Males. Females. Total. - Tongue 1 1 Oesophagus 3 - 3 7 6 13 Stomach Liver and Gall Bladder 4 4 8 9 Intestines 7 16 7 Rectum 5 12 12 12 Uterus - Breast 24 24 - 23 Other organs 23 46 135 85 50 Totals Violent Deaths (excluding Suicide). 22 deaths were classified under this heading, being the same number as in 1921. The causes of death were as follows:—5 were due to falls indoors, 1 to a fall out of doors and 2 to falls from a wit.dow; 4 to injuries caused by being knocked down, run over or crushed by motor vehicles, 2 to clothes catching fire, 1 to burns, 1 to drowning, 2 to escaping gas, 1 to being run over by train, 2 to food impaction in throat, and 1 to heart failure at an operation where an anaesthetic was employed. Suicide. 12 persons committed suicide, as compared with 11 in 1921. The causes of death were as Follows : — Drowning,3; gas poisoning, 3 ; poisoning, 4; bullet wound 1 ; burns 1. Venereal Diseases, Until a different method of registering the causes of death is instituted it will be impossible to form an estimate of the number of deaths due to venereal diseases. That this number is larger than the present system of registration shows there can be no doubt; and if to it is added the number of deaths that are due to the long-delayed sequela . 18 of venereal diseases, and the mis-carriages and still-births so many of which are attributable to venereal diseases, it will be apparent that this is a matter that demands serious consideration. While there is a division of opinion on the question of notification of venereal diseases, it does not appear that any reasonable objection could be taken to the extension of the notification of birth to that of death — the doctor notifying the cause of death to the Medical Officer of Health direct ; the procedure being quite distinct from registration by the relative. I think it is safe to assume that if this were done the number of deaths that could be attributed to ven real diseases would be considerably larger than what appears to be the case from the present mode of registration. 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. On 7th July a meeting, convened by His Worship the Mayor, was held at the Town Hall, to consider what educational or other measures can be taken in the Borough in the campaign against Venereal Diseases. The meeting was attended by representatives of the clergy, doctors, social workers and others, and was addressed by Professor Winifred Cullis, O.B.E.,D.Sc.; Dr. Mary Douie, and E. B. Turner, Esq., F.R.C.S. It was resolved "That it is desirable that the present Propaganda Committee recognised by the National Council for Combating Venereal Diseases be augmented by members invited by the Borough Council," and the Borough Council at its meeting on 27th July decided to invite certain persons to join the existing Propaganda Committee. By this means it is hoped that the Local Propaganda Commit tec will be strengthened in their work. The Chairman of the Committee is Mr. Councillor R. H. Hobart Cust, M.A., J.P., who had also been Chairman of the Venereal Diseases Sub-Committee of the Public Health Committee, which Sub-Committee automatically ceased from the date of the enlargement of the local Propaganda Committee. 19 Section 3. Notifiable Diseases during the Year. The following is a list, alphabetically arranged, of the diseases which were compulsorily notifiable in Hampstead during 1922:— Anthrax Ophthalmia Neonatorum Cerebro-Spinal Meningitis, acute Plague Pneumonia, acute influenzal or acute primary Cholera Continued Fever Polio-Encephalitis, acute Polio-Myelitis, acute Diphtheria Dysentery Puerperal Fever Encephalitis Lethargica, acute Relapsing Fever Scarlatina Enteric Fever Scarlet Fever Erysipelas Small-pox Glanders Trench Fever Hydrophobia Tuberculosis, all forms Typhoid Fever Malaria Measles Typhus Fever Membranous Croup No cases of the following notifiable diseases were reported during the year : — Anthrax Plague Polio encephalitis, acute Cholera Polio myelitis, acute Continued Fever Relapsing Fever Dysentery Smallpox Glanders Trench Fever Hydrophobia Membranous Group Typhus Fever. Notifiable Diseases during the Year. NOTIFIABLE DIBEABE. Total cases notified in age-periods. Total Cases Notified in each Ward. Cases admitted to Hospital. Total Deaths. Ward No. 1 Ward No. 2 Ward No 3 (Adelaide). Ward .No. 4 (Central). Ward No. 5 (West End). Ward No. 6 Ward No.7 At all Ages. At Ages Under 1. 2 and under 3. 20 and 65 and over. 1 and under 2. 3 and under 4. 5 and under 10. 35 and under 45 45 and under 65. 10 and under 15 4 and under 5. 15 and under 20. Cerebro-spinal Meningitis, acute 1 .. .. .. .. .. .. .. 1 .. 1 1 .. .. 1 .. .. .. .. .. .. .. 15 12 14 8 78 42 18 28 6 3 19 43 12 33 97 12 209 19 Diphtheria 227 3 .. 11 Encephalitis Letbargica, acute 2 .. .. .. .. .. 1 1 .. .. .. 1 .. 1 2 1 .. .. .. 2 .. .. Enteric Fever (including Paratyphoid) 1 2 4 1 2 3 5 .. .. .. 2 .. .. .. .. .. .. .. .. 2 .. .. .. Erysipelas 18 .. 1 .. 1 3 9 2 3 4 2 3 1 2 3 5 .. .. .. .. .. 1 .. .. 1 .. .. .. Malaria .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. Measles 887 27 84 91 70 84 431 54 23 14 8 1 .. 58 163 46 81 163 309 67 40 6 Ophthalmia Neonatorum 9 9 .. .. .. .. 2 1 1 9 .. .. .. .. .. .. .. 2 .. 3 .. .. Pneumonia 98 2 2 3 1 9 4 1 21 22 20 13 14 22 18 6 15 18 5 15 14 .. Puerperal Fever 3 .. .. .. .. 3 .. .. 3 2 .. .. .. .. .. .. .. 2 .. 1 .. 84 32 46 .. 81 218 Scarlet Fever 260 - — .. 2 14 14 5 51 10 2 24 46 21 18 47 23 2 .. 33 .. .. .. 1 29 10 8 1 5 4 3 13 6 13 52 .. 3 8 33 17 .. .. 1 6 26 7 8 39 49 .. .. .. 1 .. 6 2 10 6 10 7 8 .. .. M. F. (a) Pulmonary Total 101 .. .. .. .. 1 1 72 50 2 9 55 17 16 14 15 15 10 13 20 14 ... 2 .. 1 1 4 2 2 3 1 1 .. 2 2 .. 4 9 10 1 1 1 8 18 16 1 .. .. 3 2 2 5 1 2 .. 4 1 .. 3 2 3 3 4 9 .. .. M F. (b) Non-Pulmonary Total 4 2 8 2 6 3 1 4 2 11 7 13 34 2 1 1 1 6 4 3 .. 19 Coinpulsorily notifiable in Hampstead under the Borough of Hampstead (Measles) Regulations, 1920 These figures relate only to cases notified for the first time in 1922. A reference to the question of efficiency of notification of Tuberculosis will be found on page 22. 21 The following information relating to Ophthalmia Neonatorum is compiled at the special request of the Ministry of Health. Ophthalmia Neonatorum. Total cases notified by medical practitioners 7 midwives 2 Number treated at home 7 „ in hospital 2 Vision unimpaired 9 „ impaired nil. Total Blindness nil. Number of Deaths nil. Only 1 of the mothers had attended at the Council's Pre-Maternity Clinic. In this ease the mother was advised by the Medical Officer in charge to attend a special clinic for treatment, but did not do so. Small-pox. No case was notified during the year. Vaccination. Of the total births dealt with in 1922, by the Vaccination Officer, amounting to 1382, 743 were successfully vaccinated. In 5 cases the children were insusceptible of vaccination. In regard to 361, certificates of Conscientious Objection were obtained; 37 died before vaccination was performed; 26 cases of vaccination were postponed, and 210 remained to be dealt with. I am indebted to the . Vaccination Officer for these statistics. TUBERCULOSIS. Notification. During the year 1922, 135 new cases of Tuberculosis were notified, 101 being eases of Pulmonary Tuberculosis, and 34 other forms of the disease. In the following table these 135 eases have been analysed as to sex and age, and it will be noticed that 43 per cent, were aged between 25 and 45. the most active years of life : — 0-1 1-5 5—10. 10- 15. 15-20 20-25 25 -35. 35-45. 45-55. 55—65. Over 65. Total. - 1 3 6 2 Pulmonary males females - 12 17 10 1 52 - - 1 1 6 9 17 7 6 2 49 - - 3 1 - Non-Pulmonary males 2 4 2 2 1 2 1 18 - 2 females - 4 2 - 1 4 1 1 1 16 - 7 7 6 23 40 13 6 2 11 19 1 135 22 Of the new eases notified in 1922:— 13 were dead or dying at time of notification 28 were patients in hospitals, sanatoria or other institutions. 3 removed from Hampstead almost immediately after notification 4 were out-patients of hospitals 20 were attended by private doctors only 67 attended the Dispensary. From this analysis it will be seen that just half the number of notified cases attended the Dispensary, the rest scarcely coming within its scope at all, though of course the action of the Public Health Department extends to them wherever possible. I cannot but conclude that a number of the 13 who were dead or dying at the time of notification should have been notified earlier. Nome cases are admittedly difficult, such as one who was a Christian Scientist, and a general practitioner was only called in at the last moment. Still there are some cases thai should be notified earlier, and I would appeal to the practitioners of the Borough to see that the number be further reduced. with reference to the question of efficiency of notification of Tuberculosis, the following figures pertain:— The deaths of non-notified cases of Tuberculosis numbered 16, and the total tuberculosis deaths 69; the ratio of non-notified tuberculosis deaths to total tuberculosis deaths being 1 in 4. In addition, 9 cases were first known to the Medical Officer of Health within a period of one month of death, 7 within three months and 1 within six months. After careful consideration of the notifications of the past year I have formed the opinion that from 20 to 25 per cent, of the cases only become known to the Public Health Department upon the approach of or on the actual occurrence of death, my experience is that the hospitals and institutions are more to blame than the general practitioners, and that there are certain cases in which non-notification or late notification is excusable, such as the following:— People arriving in the Borough in a moribund condition. Difficult diagnosis, the actual nature of ease being found only at death. Doctor only called in when patient wns in extremis. 23 These inevitable causes of non-notification reduce the number of cases not notified by doctors to about 10 to 15 per cent. By inquiry among medical practitioners, I have been given the following reasons why cases ere not notified, or notification is delayed:— (a) Some medical men prefer to wait until a positive sputum result is obtained; (b) the belief by the doctors that the case has been previously notified by some other practitioner. The tendency of both the incidence and death-rate from tuberculosis is slowly downwards, and the time seems to have arrived when other efforts might be made in (he work of coping with this disease. A much needed provision is an institution for advanced eases; this would be practically a Home for the dying though some other name, such as Home of Rest would be advisable. It is imperative that the advanced and highly infectious case should be removed from its close association with other people ; at present the dealing with this class of case is often most difficult. Also I am of opinion that much good would ensue from the establishment of an open-air school for delicate md suspected children. I believe that such a school would prove of great utility. I should like to see every child, who is under observation by the Tuberculosis Medical Officer as a "suspect," sent to such a school until the suspicion is removed or the reason for the delicacy ascertained. Prolonged attendance at the Dispensary would be unnecessary as the child would be kept under observation at School. The number of cases notified in recent years are as follows:— Total. Year. Persons newly notified. Pulmonary Tuberculosis (Voluntarily) notifiable 1902; (Compulsorily notifiable 1912.) Non-Pulmonary Tuberculosis Compulsorily Notifiable from 1st February, 1913). 1913 56 244 300 142 30 172 1914 48 1915 172 220 193 51 1916 244 1917 256 52 308 70 1918 291 361 1919 48 213 165 1920 118 53 171 103 1921 55 158 101 34 135 1922 24 At the present time 80 discharged soldiers suffering with tuberculosis are resident in Hampstead. The number of cases of tuberculosis known to the Department at the end of 1 922 totals 937—691 pu'monary and 246 non-pulmonary. Occupations. The following is an analysis of the occupations of the new cases notified as tuberculous during 1922:— Pulmonary Cases. Non- Pulmonary Cases. Occupation. Fulmonary Cases. Non- Pulmonary Cases. Occupation. 1 - Actors 1 Milliners - Army pensioners 5 Office porters 2 - - Auctioneers 1 Pattern Card Mounters - 1 - 1 - Barmaids Bus Drivers 2 - Photographers 1 - Clerks 14 2 1 Plumbers - Company Directors Compositors 1 1 - Police Constables - 2 - Postmen 1 - Restaurant workers 1 Dentists 1 - - 12 2 Secretaries 1 - Domestic Servants Dressmakers 3 2 1 School children 10 Ex-Officers 1 - 4 1 - 1 Shop Assistants 1 Hairdressers 2 - Sign writers Housewives 6 2 Students 3 Labourers 1 - Tailors - 1 Laundresses 1 - Teachers 5 - Librarians 1 Trained Nurses - 1 - Managers 2 - Valets 1 - Mechanics 1 6 4 No occupation 10 Merchants 3 - No Information 4 - Metal workers 1 1 Milk Roundsmen 101 34 1 - Removal of Cases. Of the newly notified cases in 1922, 85 were removed: — Pulmonary. Non-Pulmonary. Pulmonary. 31 To Sanatoria Pulmonary. 2 To Hospitals 25 7 To Infirmaries 12 2 To Nursing or other Homes 4 2 72 13 The following cases, notified prior to 1922, were also removed. Pulmonary. Non -Pulmonary 10 Non-Pulmonary To Sanatoria To Hospitals 9 3 To Infirmaries 10 2 To Nursing or other Homes 3 - 32 6 25 DEATHS. The number of deaths from Tuberculosis in 1022 was 69. Of these, 50 were duo to Pulmonary Tuberculosis, 8 to Tubercular Meningitis, and 11 to other forms of Tuberculosis. The deaths from Pulmonary Tuberculosis and from all forms of Tuberculosis duriug 1922 were distributed among the wards as follows: — Total deaths from All Forms of Tuberculosis. Deaths from Pulmonary Tuberculosis. Deaths from other Forms of Tuberculosis. Ward. Area (Acres). No. 1 (Town) 686 17 13 4 „ 2 (Belsize ) 271 7 2 9 „ 3 (Adelaide) 325 5 1 6 „ 4 (Central) 5 312 3 2 „ 5 (West End) 247 8 8 - „ 6 (Kilburn) 195 11 8 19 „ 7 Priory) 229 3 2 5 50 The Borough 2,265 19 69 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 49 5 3 1914 - 2 10 42 57 1915 1 7 37 3 48 - 37 1916 - 4 11 3 55 1917 - - 21 47 1 69 1 1918 1 11 59 3 75 13 1919 - 1 39 3 56 1920 8 27 4 41 - 2 1921 - 2 10 47 4 63 10 1922 - 1 37 2 50 1 15 411 31 563 105 Totals 26 Prevention, Treatment, &c. Stuff engaged on Tuberculosis Work, —The staff specially engaged on work directly connected with Tuberculosis consists of the following:— 1.—Administrative Tuberculosis Medical Oficer; the Medical Officer of Health. 2. — Tuberculosis Medical Officer, a part-time Officer who acts as an Assistant to the .Medical Officer of Health for tuberculosis work, whose report will be found in the Appendix. 3.- Lady Sanitary Inspector, the major portion of whose time is occupied in visiting cases, inspecting home conditions, etc. 4.—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. 5.—Clerk, who attends at the Dispensary on three half-days per week for the purpose of undertaking clerical work, compiling returns, filing, etc. 6.—Dentist, who undertakes dental work for tuberculous patients. Tuberculosis Care Committee. The Permanent care Committee has now been coustituted as follows, viz. : — The following 19 members were appointed — 6 members of the Borough Council. 5 members of the Hampstead Council of Social Welfare. 2 members representing the London County Council (3 were invited). 2 members representing the Board of Guardians. 1 member representing the London Insurance Committee. 2 members representing the Invalid Children's Aid Association. 1 member representing the Local War Pensions Committee. together with— The Medical Offieer of Health The Tuberculosis Medical Officer Ex-Officio. The Lady Sanitary Inspector (Tuberculosis Health Visitor) 27 It was decided that— (a) Permanent Officers of the Borough Council and of the Council of Social Welfare sh should attend in an advisory capacity. (b) The Care Committee should furnish quarterly reports (or more- often it required) including statistics and statements of cases helped, &c., and as to attendances of members of the Council. (c) The Chairman of the Committee should be elected from among the members of such Committee. Separate Beds and Shelter for Tuberculous Patient. —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 infections cases of tuberculosis. The usual practice is to arrange for the double-bed previously used to be sold, and a single bed t< i be provided in lieu thereof. Thus, by the Council loaning a separate bed, two single beds are provided instead of one double-bed. 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. Section 4. Causes of Sickness. There was no particular cause of sickness in the Borough during 1922 which calls for special mention. Section 5. Summary of Nursing- Arrangements, Hospitals, and other Institutions available for the Borough. Professional Nursing in the Home. (a) General. The Borough is well served by two excellently managed Nursing Associations; the Hampetead District Nursing Association, 25, Heathhurst Road, and the Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road. Both Associations provide skilled nurses for the sick poor. 28 (b) For Infectious Diseases. By arrangements made between the two Nursing , Associations and the Borough Council, nursed are available for cases of Measles, Whooping Cough, Epidemic Diarrhoea, Ophthalmia Neonatorum, Acute Primary or Acute Influenzal Pneumonia, Influenza, Malaria, Dysentery or Trench Fever. The Borough Council pays a fee for each visit paid by the nurse. During 1922, 46 cases were nursed under this arrangement by the Kilburn and West Hampstead District Nursing Association, and 32 by the Hampstead District Nursing Association. (c) For Maternity Cases, by agreements between the two Nursing Associations and the Borough Council, skilled maternity nursing can be obtained for cases in the Borough. Both Associations have fully trained nurses appointed to attend maternity cases, and any woman can have a fully trained nurse attend her together with her own doctor- A fee is charged 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 1922, was:— 62 by the Kilburn and West Hampstead District Nursing Association ; 21 by the Hampstead District Nursing Association. M DWIVES. The total number of midwives practising in Hampstead is 30. Arrangements have been made by the Borough Council 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 to as nut to undercut the practising midwives. The number of cases attended by the Midwives of the Associations during 1922 was :— 92 by the Kilburn and West Humpstead District Nursing Association ; 7 by the Hampstead District Nursing Association. 29 Clinics and Treatment Centres. Maternity Centre (Consultation and Treatment). Pre-Maternity Clinics for Expectant Mothers. Established and controlled by the Borough Council. Held at 27, Pond Street on Thursdays at 2.30 p.m., and at 73 Dynham Road on Mondays at 2. : 30 p.m., and Tursdays at 10 a.m. The following statement has been compiled from information supplied by Dr. Mary Kidd, the Medical Officer in charge of the Pre-Maternity Clinics. Work at the Borough Council Pre-Maternity Clinics. Western Clinic. Eastern Clinic. Number of new applicants 202 62 „ attendances of old cases 783 264 „ clinics held 100 52 Average number of attendances at each Clinic 10 6 Number of mothers sent to Convalescent Home 3 2 Number of patients referred to Dental Clinic 67 25 Of the 264 new applicants, 45 were found to be not eligible ; and of the remainder 57 were normal cases, 139 slightly abnormal, 18 serioasly abnormal and 5 connected with venereal diseases. The following is an analysis, by the Doctor in charge of the Pre-Maternity Clinics, of the .slightly and seriously abnormal cases: — Analysit of Antc-Natal Cases. Vomiting 27 Albuminuria 3 Flatulent Dyspepsia 11 Chronic Nephritis 1 Marked Constipation 18 Bacilluria 1 Piles 2 1 Contracted Pelvis 4 Contracted Outlet Rheumatism 1 Urticaria 1 Breech Presentation (version done beforehand at Hospitals) Marked Anaemia 19 2 Tachycardia 2 Myocardial Weakness 2 Retroverted Gravid Uterus Unhealthy Vaginal Discharge (needing special treatment) 1 Mitral Regurgitation 1 Mitral Stenosis 4 Pretubercular 6 17 Tubercular Glands of Neck 1 Marked Paginal Prolapse Appendicitis 1 Phthisis 2 1 1 Varicose Veins 9 Ante-Partium Hæmorrhage Missed Abortion Lax Abdominal Wall (needing bandage) 2 10 Miscarriages 2 Hydramnios 1 157 Mastitis 2 Total Marked Sleeplessness 1 30 The 4 cases of contracted pelvis were referred to suitable Hospitals for in-patient treatment during their confinement and were all satisfactorily delivered. The case of appendicitis was referred to the Hampstead General Hospital for examination ; the mother gave birth to a healthy child a few months after the operation. All the new cases were carefully inquired into, and 15 women who were suspected of being infected with venereal diseases were suitably dealt with. Although six had had children in whom symptoms of ophthalmia neonatorum appeared, none of the 15 cases has given birth to an infant who has been notified as suffering from ophthalmia. The following table gives a record of the work of the Borough Council Health Visitors, who work in connection with the Infant Welfare Centres of the Hampstead Council of Social Welfare, in 1922 : — Number of first visits to expectant mothers 150 re-visits „ „ 150 „ first visits to infants under one year 1021 „ re-visits „ 1442 „ visits to children over one year 1418 „ visits re infant deaths 96 1597 „ infectious disease „ „ verminous conditions 1 „ „ verminous conditions reported by London County Council 80 „ attendances at Infant Welfare Centres 300 „ „ Borough Council's Dental Clinic 56 „ „ „ Pre-Maternity Clinics 152 „ complaints investigated 22 „ applications for assistance investigated 112 „ unclassified visits 231 6828 Total Milk (Mothers and Children) Order, 1919. The number of families being helped by the Council during the year under this Order varied from 32 to 61. The cost to the Borough Council was £190 for milk and £120 for other food. The help that has been afforded under the scheme in force for administering this fund has been of great assistance to poor families, 31 Milk or food is granted either free or at half cost, to expectant and nursing mothers and infants under two years of age, where the scale of income falls below a certain standard. Infant Welfare Centres. Established and controlled by the Hampstead Council of Social "Welfare. Held at 5 premises in various parts of the Borough. Day Nurseries, Established and controlled privately Held at 27 & 29, Pond Street and 36, Hemstal Road. School Clinics. School Medical Service, etc., arranged by London County Co uncil Tuberculosis. Tuberculosis Dispensary established and controlled by the Borough Council. Sessions held at the Dispensary, 73, Dynham Road. Venereal Diseases. Clinics arranged by London County Council; no clinic situated in the Borough. Dental Clinics. One in connection with Infant Welfare Centres, established and controlled by the Hampstead Council of Social Welfare. One in connection with Pre-Maternity Clinics and one in connection with Tuberculosis Dispensary. Both these latter established and controlled by the Borough Council. Summary of work carried out at Hampstead Borough Council's Dental. Clinics during 1922. Number of Sessions held Tuberculosis. Maternity. 51 51 Patients Attendances 118 244 Number of Fillings 31 83 Number of Scalings 13 36 Number of teeth extracted 74 233 With Gas 7 18 Extraction cases With Local Anæsthetic 24 60 Without Anæsthetic - - Number of Dentures (including repairs) 18 19 4 3 Number of Dressings and Root treatment 14 8 Number for Advice 32 Hospitals provided or subsidised by the Borough Council or by the London County Council. (1) Tuberculosis. The Borough Council possess the right to use two endowed bods at the Mount Vernon Hospital at Northwood; and two beds at the Hampstead General Hospital. Haverstock Hill, Hampstead, which latter would be available for surgical tuberculosis. Residential Institutional Treatment provided by the London County Council. (2) Maternity. 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. 73 Hampstead women were confined in Queen Charlotte's Hospital in 1922. Arrangements were in operation during 1922 wherebv beds were available in the Catherine Gladstone Home, Mitcham, for women recovering from confinement. Both mother and baby were admitted, or the mother alone if the baby did not survive. Unfortunately, the Home ceased to accept our cases towards the end of the year, but during 1922, 5 mothers and 5 babies were admitted. 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. (3) Children. The beds referred to in the preceding paragraph are available in special cases for children. As regards infants who are ill and have a definite disease, or who although not actually suffering from any nameable disease, yet are failing to thrive, and need to be placed under skilled and trained supervision, the Borough Council has made arrangements with " Northcourt Hospital," College Crescent, whereby suitable cases may be admitted. During 1922,26 children were -cut to that Institution under this arrangement, the Borough Council paying the Hospital a fixed rate per bed per week, and the patients In ing asssesed according to their means. (4) Fever Provided by the Metropolitan Asylums Board, (5) Small- pox (6) Other e.g., Diphtheria, Enteric Fever ditto Institutional Provision. There are Homes one for each of these; established in the Borough by Voluntary (Committees For Unmarried .Mothers For Illegitimate Infants 33 Ambulance Facilities. Provided by the Metropolitan Asylums Board. (a) For infectious cases. The Ambulance of the Hampstead General Hospital, and those of the St. John's Ambulance Association are available. (b) For non-infectious and accident cases The Ambulances of the Metropolitan Asylums Board are also available upon due notice being given. Section 6. LABORATORY WORK. 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 Hampstead General Hospital. This latter also makes any necessary X-ray examinations. The following is a summary of the bacteriological work carried out during the year :— ~ b —~ J * Positive. Negative. Total. Diphtheria 446 590 144 Enteric Fever 4 4 - Specimens of Sputum 54 216 270 39 X-Ray Examinations were made. LIST OF ADOPTIVE ACTS, BYE-LAWS, AND LOCAL REGULATIONS RELATING TO THE PUBLIC HEALTH, IN FORCE IN THE BOROUGH, WITH DATE OF ADOPTION. Bye-Laws under .Section 16 (1) Public Health (London) Act, 1891. 16 (2) „ „ 39 (1) „ „ 39 (2) „ „ 50 „ „ „ „ 202 Metropolis Management Act, 1855. Regulations „ 17 (7) Housing (Town Planning) &c, Act, 1909. 34 Section 7. SANITARY ADMINISTRATION. Work of Sanitary Intpectors. Total number of Inspections, 6326. Re-inspections, 13603. Intimation Notices, 896. Statutory Notices 731. „ deposits of plans and particulars for redrainage work, &c, 630. „ Complaints of insanitary conditions received and investigated, 659. The following Statement and Information affords some indication of the work performed by the Sanitary Inspectors. Much of the work of the Staff of the Department, however, 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 this manner. General Conditions — Houses or parts of houses cleansed (excluding verminous rooms) 668 Dampness in houses or parts of houses abated 241 Dilapidated „ „ „ repaired 463 Overcrowding— Rooms found overcrowded 10 Overcrowding abated (rooms) after service of notice 8 „ „ without service of notice 2 Underground Rooms— Found illegally occupied 20 Closed, illegal occupation discontinued or made to conform 20 Below Floors — Spaces below floors in the basement or ground floors ventilated 112 Roofs — Roofs repaired 348 Gutterings— Gutterings repaired or renewed 338 35 Rainwater Pipes— Rainwater pipes repaired or renewed 322 „ „ disconnected from drains 158 „ „ „ „ soil-pipes 3 Watte Pipes — Waste pipes of sinks trapped 455 „ „ repaired or renewed 307 „ „ unstopped 9 „ of lavatories trapped 260 „ „ repaired or renewed 182 „ „ unstopped 8 „ of baths disconnected from drains 3 trapped 224 „ „ repaired or renewed 153 „ „ unstopped 2 Water Supply — Water supply re-instated 12 Water certificates issued for new houses, Sec. 48, Public Health (London) Act, 1891 5 Water provided to floors of tenement houses 117 No. of tenement houses dealt with 95 Sinks provided to upper floors of tenement houses 138 No. of tenement houses dealt with 116 Sinks provided in addition to above 218 Lavatory basins provided 196 Baths provided 134 Water Cisterns — Water cisterns repaired or renewed 17 „ removed from improper positions 27 „ cleansed 129 „ fitted with close fitting covers 44 Water Closets — Water closet accommodation provided 6 Additional water closet accommodation provided 67 Water closets removed from improper positions 24 „ provided with proper and sufficient external ventilation 28 36 Water Closets — continued — Improperly constructed water closet apparatus removed and new provided 31 Water closet apparatus repaired or renewed 507 „ „ unstopped 4 „ „ cleansed 12 „ „ provided with proper water supply 40 „ flushing cisterns repaired or renewed 311 Drains — Drains repaired or renewed 627 „ cleansed 75 „ unstopped 37 „ ventilated 78 Manholes — Manholes repaired or renewed 280 Ventilating Pipes — Ventilating pipes of drains carried to a sufficient height above windows 7 „ „ „ repaired or renewed 78 Fresh air inlets repaired or renewed 151 Soil Pipes — Soil pipes repaired or renewed 293 ventilated 24 Gullies and Surface Drains — Gully traps removed from improper positions 45 „ cleansed 37 Inlets or surface drains trapped 5 Paving and drainage of Washhouses, Areas, Yards, &c. — Washhouse or scullery paving repaired or renewed 51 Areas cleansed 17 Area paving repaired or renewed 193 Areas drained 46 Yards or other open spaces paved . 125 Paving of yards or other open spaces repaired or renewed 194 Yards or other open spaces drained 43 Buildings in which horses, &c., are kept; floors paved or repaired 1 37 Refuse and Rece ptacles— Dust bins provided 465 „ repaired 1 Fixed ashpits removed 6 Accumulations or deposits of refuse removed 759 Nuisances from the improper deposit of trade refuse abated 1 Animals - - Nuisances from the improper keeping of animals abated 2 Smoke Nuisances — Number of nuisances and complaints 1 „ of observations 72 „ of notices - „ of summonses - Personal Cleansing — Number of cleansings of adults 13 „ of cleansings of children 1469 Cleansing — Number of verminous rooms or premises cleansed 45 Disinfection - Number of houses or parts of houses and contents disinfected 2693 „ of persons accommodated at Shelter - Customs and Inland Revenue Acts- Number of houses for which certificates requested 10 „ of dwellings contained therein 12 „ of houses certified 2 „ of dwellings contained therein 4 Public Mortuary- Number of bodies admitted 64 Increase of Rent and Mortgage Interest (Restrictions) Acts — Number of certificates applied for 48 „ „ issued 30 lii addition to the foregoing; a summary of the work of the Housing Inspectors will be found in Section 9 relating to Housing. Public Mortuary. During the year the bodies of 64 persons were brought to the mortuary —38 by order of the Coroner, 15 by the Police, and 11 at the request of friends of deceased persons. In 53 instances inquests 38 were held, and in 14 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. Number of Bodies received. Cause of Death or Verdict Deaths from natural causes 38 Accidental deaths 3 Open Verdict 2 Misadventure 3 Alcoholic Poisoning 1 Neglect at Birth 1 Suicide —Fall under train 3 Poisoning 5 Drowning 2 Cut throat 1 Hanging 1 Burning 1 Pistol Shot 1 Total 62 In addition to these 62 bodies, the bodies of two still-born children were also brought to the Mortuary. Rats and Mice (Destruction) Act, 1919. During the year various complaints concerning these pests were received and investigated. The occupiers were advised and assisted as far as possible, and supplied with poison to help in eradicating the vermin. The Public Health Committee considered a communication from the Ministry of Agriculture suggesting concerted action between Local Authorities for the destruction of rats and mice. The Committee requested the Borough Engineer to see that all disused sewers and drains are effectively sealed up ; and gave instructions for the sewers to be baited during " Rat Week " which commenced on 6th November. The poison employed was a preparation of Barium Carbonate. In addition, posters and handbills were distributed dealing with the subject of extermination of rats, and the local Chemists were supplied with the prescriptions of suitable forms of rat poison. 39 Inspection of Places where Food is Prepared, &c. These premises are kept under constant supervision by the Council's Special Food Inspector, and their general sanitary condition is good. The following table summarises the work done in this connection during 1922:— Number of Premises. On Register. No. of Inspections. No. of Notices. No. of Prosecutions. 261 88 13 Milkshops - Ice-cream Premises 68 150 3 - 63 187 Restaurant Kitchens 6 - Slaughterhouses 2 44 - - Cow Sheds Nil. - - - Fried Fish Shops 9 36 2 - Offensive Trades Nil. - - - 522 1460 Other Food 18 - Bakehouses:— 12 2 76 Factories— 2 Underground 10 Aboveground 31 Workshops — r 8 - Underground Aboveground 10 - Of the number of bakehouses mentioned above it will be noted that 22 are factory bakehouses and 18 are workshop bakehouses. During the year two bakers were prosecuted for not maintaining due cleanliness at their premises, Both were convicted and fined, one £43 and £10 10s. costs, and the other £33 and £2 2s. od. costs. Buffer Factories—No premises in the Borough are registered as Butter Factories. Wholesale Dealers in Margarine- Various wholesale dealers are on the register in respect of 9 premises. Unsound Food Seized or Surrendered. The following is a list of food seized or voluntarily surrendered during the year: — Beef, 15 stone. Fish, 3 stone cat fish, 2 boxes mackerel. Tinned food. Milk, 19 tins. 40 Number and Condition of Slaughterhouses. The slaughterhouses in the Borough have been four in number since 1910. These were situated at 40, England's Lane, 17 and 69, High Street, and 6, Fairfax Mews. On the question of the renewal of the licences for these Slaughterhouses coming before the Public Health Committee of the Borough Council it was resolved to oppose the renewal of the licences for two of the premises, and to call the attention of the County Council to the fact that nothing had been slaughtered in one of the remaining two for nine years. As the result of these objections, one applicant withdrew his application altogether. Of the remaining two, the Appeal Committee of the London County Council refused the licence of one where no slaughtering had taken place for years, but dismissed the appeal in respect to the second. There are now only two slaughterhouse! in the Borough, viz., Nos. 17 and 69 High Street. There is no public abattoir in the Borough. Arrangements for disinfection and disinfestation and the extent of their use. The Borough Council's Disinfecting and Cleansing Stations are situated in the yard of the Electric Lighting Station, and are in close proximity to each other. The Disinfecting Station is well equipped with an up-to-date Washington-Lyons apparatus, with a of 3 men. The collection of infected or infested material is carried out by two Electric Vans. The Cleansing Station is situated in a small cottage devoted entirely to this purpose. The cottage is away from all public thoroughfares, but a small railway footpath runs past the door. It consists of three rooms, two downstairs and one upstairs, with a lavatory on each floor. It was originally built as an Isolation Station, but is admirably situated for the purpose of a Cleansing Station. During 1922, 2693 disinfections of houses or parts of houses were carried out together with their contents, while in addition all infested articles of clothing, etc , were suitably dealt with. Thirteen cleansings of adults and 1469 cleansings of children were carried out by the Council's Attendant, and whilst this was in progress their clothes were thoroughly disinfected by being passed through the disinfecting apparatus. 41 Action taken with regard to Dairies, Cowsheds and Milkshops. The Special Food Inspector supervises the dairies and milkshops ; there are now no cowsheds in the Borough. The number of premises in respect of which persons are registered as purveyors of milk is 88, comprising 42 dairies, 16 bakehouses and confectioners, 18 restaurants and coffee shops, and 12 general shops. During the year 261 inspections were made and 13 notices were served. Milk and DairieS (Amendment) Act, 1922. The provisions of this Act, except section 3, came into operation on the 1st September, 1922, and the following are among the chief clauses of this measure:— Section 2 empowers a local authority under certain conditions to refuse to register a retail purveyor of milk, or to remove such a person from the register. Section 2 (2) empowers the Court before whom any retailer is convicted of an offence relating to milk or dairies, in addition to any other penalty, to remove him from the register for such period as the Court may think fit. The removal from the register may be absolute or in respect of specified premises ; this will enable the Authority or the Court to distinguish between cases in which the defect is one of general methods and those in which it has relation only to the suitability of particular premises or the methods practised thereat. Section 3 continued, with modifications, the provisions as to the grading of milk which were contained in orders made by the Food Controller and the Ministry of Health under the Ministry of Food (Continuance) Act, 1920. These Orders were continued in force until the Ist January, 1923, when the provisions of Section 3 came into operation. The section provides that milk may not be sold as "Certified," "Grade A," "Pasteurised," or under any other prescribed designation, except in accordance with a licence granted by the Minister or with his authority. The conditions governing the use of these designations are laid down in the following Order: — Milk (Special Designations) Order, 1922, made under Section 3 of the Milk and Dairies (Amendment) Act, 1922. This Order was issued on 9th December, 1922, and came into operation on 1st January, 1923. By its provisions Metropolitan 42 Borough Councils are authorised to grant licences to any person other than a Producer, to .sell milk as "Certified," "Grade A (Tuberculin tested)," "Grade A," and "Pasteurised." Such licences may be suspended or revoked if any of the conditions set out in the Order upon which the licence is granted are not being complied with by the Distributor. In every case, except that of "Pasteurised" milk, it will be necessary for the Sanitary Authority to ascertain the source of supply and then to satisfy themselves that the corresponding licence has been issued to the Producer by the County or County Borough Council concerned. In the case of "Certified" milk, a licence may ordinarily be issued without further inquiry. In the case of " Grade A (Tuberculin tested)" and "Grade A "milk the Sanitary Authority must verify that the Distributor has an efficient arrangement for bottling, and that, until after bottling, the milk is being dealt with in a part of the premises separate from other milk, and should also arrange for an examination of the caps and seals proposed to be used, and should require the applicant to have one or more samples of the milk submitted to bacteriological examination at his own expense. The Ministry suggest that the Sanitary Authority should also take samples of milk from time to time and arrange for them to be submitted to bacteriological examination. The Public Health Committee have given authority for such examinations to be made. Section 4 continues and extends the provisions of an existing Order of the Food Controller. The section prohibits the addition of any colouring matter or water, or re-constituted milk, or skimmed or separated milk, to milk intended for sale. This will enable Local Authorities to deal with cases in which such additions are made for fraudulent purposes but difficulty is experienced in proving that the mixture is sold as milk. The section also prohibits the sale of re-constituted milk as milk. Section 5 imposes a heavy penalty on any person who sells the milk of a cow suffering from tuberculosis of the udder where it is proved that he knew, or could have ascertained by ordinary care, that the cow was suffering from that disease. The maximum penalty for a second or subsequent offence is a fine of £100 or imprisonment with or without hard labour for a period of six months, or both such fine and imprisonment. The importance of this clause cannot be over-estimated, the need for action being very great. As the result of the analysis of many 43 samples of the milk supply of London, the London County Council has proved that milk infected with the tubercle bacillus still is being sent into the Metropolis. Action taken under the Sale of Food and Drugs Acts and the Milk and Cream Regulations. Bale of Food and Drugs Act. 504 samples were taken for analysis during the year. The number certified to be adulterated was 27, or 5.3 per cent, of the total number, as against 1.58 in 1921. 444 samples (24 of which were adulterated), were purchased from Hampstead tradesmen and 60 (3 of which were adulterated) from tradesmen coming from other districts. The following table shows the articles of which samples were taken during the year: — Articles. Number taken. Adulte rated, - Butter 30 Cheese 8 - - Cocoa 29 8 - Coffee 22 1 Cream Dripping 4 - 11 Drugs 2 Fish-paste 4 - Flour 5 - Honey 2 - Jam 4 - Lard 7 - Margarine 15 - Milk 310 6 Milk, Condensed 5 - Mince-meat 2 - Peas, Tinned 22 16 8 Pepper - 1 Raisin Wine 1 Sausages 1 1 Spinach, Tinned 2 - - Tea 1 - 3 Vinegar Totals 27 504 44 The increase in the number of adulterated samples is due, mainly, to the fact that 22 samples of tinned peas were analysed for the purpose of ascertaining whether a preservative was present or not. As will be noted, in 16 cases enumerated in the following table, sulphate of copper was found to be present in quantity varying from one to two and-a-half grains per lb. Summonses were issued in the first case against the vendors of samples No. 155, 157 and 162. Sample No. 157 contained 1 grain of copper sulphate per lb.; this was the first case that was brought before the Hampstead Bench of Magistrates and the summons was dismissed Following this dismissal the other two summonses were withdrawn. The position as preservatives in food is unsatisfactory from all points of view, especially that of the Sanitary Authorities and the traders. There are, of course, many Sanitary Authorities administering the Acts, and there are many Justices of the Peace adjudicating upon them, and a variety of standards seem to pertain. In view of the widespread practice of adding preservatives to foodstuffs, I am of opinion it would be of great benefit to all concerned if some legal decision could be arrived at as to what preservatives should be added to food, and if any, to what extent. Matters would be very much facilitated if the findings of the Royal Commission on the use of Preservatives were made legally enforceable. 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. 8 per cent, deficient in fat Informal sample. 72 Milk 119 Peas, tinned Cautioned by Borough Council. 2 grains sulphate of copper per lb. 123 Sausages No fine, costs £1 1s. 15 grains boric acid per lb. „ 146 Milk Trace of annatto, also ½ of 1 pur cent, added water 154 Cautioned by Borough Council. Peas, tinned 2¼ grains sulphate of copper per lb. 155 „ 1½ Summons withdrawn. Summons dismissed. 157 „ 1 45 Article. How adulterated. No. of Sample. Result of proceedings. Cautioned by Borough Council. 158 Peas, tinned 1½ grains sulphate of copper per lb. 159 „ 2¼ „ „ 160 1¾ „ Peas, bottled 162 2 Summons withdrawn. Peas, tinned 163 Cautioned by Borough Council. „ 1½ „ 1½ 164 „ „ 1¾ 165 „ „ „ 168 1 „ 2¼ 171 „ 2½ „ 179 „ 180 1¾ „ „ 2 182 „ 60 per cent, deficient of amount Iodide of Potassium prescribed 195 Doctor's Prescription Informal sample. 216 59 per cent, deficient of amount Iodide of Potassium prescribed „ „ 234 Milk 17 per cent, deficient in fat Dismissed, warranty proved. Defendant fined £5 for not being registered as a milkseller. 263 „ 24 Dismissed, warranty proved. 309 Cream 0.29 per cent, boric acid Cautioned by Borough Council. 401 11 per cent, deficient in fat Fine £2, costs £1 1s. Milk 473 „ Fine £3, costs £2 2s. 8 500 Raisin wine 2 grains salicylic acid per pint Cautioned by Borough Council. 46 In addition to the foregoing, two samples of Margarine were sold in wrappers which were not marked in accordance with the requirements of Margarine Acts. Also in one case, Margarine was exposed in a shop for sale without being labelled. The Council instituted proceedings against the vendors who were fined £1 Os. Od. and £1 1s. od. costs in each of the three cases. " Warranty" Defence. During 1922 two dairymen were prosecuted by the Council for selling milk 17 (seventeen) and 24 (twenty-four) per cent, deficient in fat, but the warranty defence was successfully proved in each case, and the summonses were dismissed. Public Health [Mill; and Cream) Regulations, 1912 and 1917. These Regulations aim at securing that cream containing preservative shall be distinguished at all stages of sale from cream to which no preservative has been added, but while correct labelling is required by the Regulations, they permit, under such conditions, the addition of a greater amount of preservative than was contemplated by the Departmental Committee appointed in 1899 to inquire into the use of preservatives and colouring matters in the preservation and colouring of food. This Departmental Committee recommended "That the only preservative which it shall be lawful to use in cream be boric acid or mixture of boric acid and borax, and in amount not exceeding 0.25 per cent, expressed as boric acid." Labelling was prescribed by the Regulations of 1912, but no amount was specified which might be allowed. In 1917 the Ministry issued further Regulations adding to those of 1912 the fact that preserved cream might contain boric acid in amount not exceeding 0.4 per cent or 28 grains to the lb. and requiring declaratory Labels to be affixed stating that it was not suitable , for infants and invalids. Even so amended the Regulations are misleading, because vendors might think that up to 0.4 per cent was a legal addition, whereas actions in the High Court have proved that it is not legal. When the Regulations of 1917 were issued by the Ministry of Health the accompanying letter stated that the question of boric acid in cream was to be the subject of investigation by a small expert Committee and that the Regulations of 1917 were to be considered as interim Regulations, Daring the year the Borough Council supported the action 47 of the Kensington Borough Council who asked the Ministry to appoint the Committee of experts in order that the amount of boric acid which may be put into cream should be definitely agreed upon. 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:— Report for the Year ended 31st December, 1922. 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. 310 Milk Nil. 15 Cream 1 0.29 per cent. Nature of preservative in each case in column (b) and action taken under the Regulations in regard to it. 0.29 per cent, boric acid. Vendor gave written explanation and was officially cautioned. 2. —Cream sold as Preserved Cream, 7. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct 7. 1. Correct statements made, 7. 2. Statements incorrect, nil. 3. Percentage of preservative found in each sample — 0.25, 0.29, 0.29 0.30, 0.32, 0.36 0.36, per cent, by weight Percentage stated on Statutory label- - 0.40, per cent, by weight. (b) Determinations made of milk fat in cream sold as preserved cream: —1. Above 35 per cent., 7. 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. (a) Any evidence of their addition to cream or to preseryed cream, nil (b) Action taken where found, nil. 4, —Other observations (if any), nil. 48 REPORT OF THE PUBLIC ANALYST ON THE ANALYTICAL WORK OF THE YEAR. Analytical Laboratory, Town Hall, Paddington, W. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies, and Gentlemen, A short summary of the analytical work of the year 1922 may be of interest. The chief articles amongst the 504 samples analysed were milk 315, butter 30, cocoa 29, cream 22, preserved peas 22, Margarine 15, and drugs 11. Only 6 samples of milk, or 1.9 per cent.; cream, 1 or 4½ per cent.; drugs 2, or 18 per cent.; preserved peas 16, or 72¾ per cent.; margarine 2, or 131/3 per cent.; proved to be adulterated. It is very satisfactory to find that no sample of butter or of general groceries, not noted above, was adulterated. For all articles taken together this year, the adulteration was 5¾ per cent.; the previous year it was only 1½ per cent. The number this year was largely swollen by the colouring matter in the preserved peas. I have the honour to remain, Yours obediently, ALF. W. STOKES, Public Analyst. Action taken with a view to Smoke Abatement. During the year, observations were made in 72 instances by the Sanitary Inspectors, but it was not found necessary to serve any notices . offenders were interviewed by the Inspectors and warned as to the future. 49 Miscellaneous. 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. The supervision of these premisee is largely controlled by the Factory and Workshop Acts; and in London by the Public Health (London) Act, 1801. 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. 1.—Inspection of Factories, Workshop, and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries) 181 9 - Workshops (Including Workshop Laundries) 466 10 - Workplaces (Other than Outworkers' premises included in Part 3 of this Report 1042 21 - 40 1689 Total - 50 2.— Defect found in Factories, Workshops, and Workplaces. Number of Defects. Found. Remedied. (3) Referred to H.M. Inspector. (4) Number of Prosecutions. (5) Particulars. (1) Nuisances under the Public Health Act:— 86 86 - - Want of cleanliness Want of ventilation 4 1 4 - Overcrowding 3 3 - - Want of drainage of floors 2 2 1 - Other nuisances 37 37 - - Sanitary accommodation insufficient unsuitable or defective not separate for sexes - - - - 10 10 - - - - - - Offences under the Factory and Workshop Act: — Illegal occupation of underground bakehouse (s.101) - - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) - - - 4 Other offences (Excluding offences relating to outwork, which are included in Part 3 of this Report) 4 4 - 6 146 - Total 146 3. — Home Work (Outworkers). Certain specified classes of work done at the homes of the workers are controlled by virtue of special clauses in the Factory and 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. 51 82 lists of outworkers were received from employers. These contained 148 entries. Outworkers' Lists, Section 107. Lists received from Employers. Sending Twice in the year. Sending Once in the year. NATURE OF WORK. 1 Lists 2 Outworkerst Lists. 5 Outworkers Contractors. 3 Workmen. 4 Contractors. 6 Workmen. (1) Wearing Apparel— (a) making, &c. (b)cleaning and washing 15 67 6 2 50 16 4 3 6 15 - - Making-up, ornamenting, finishing and repairing of table linen, lied linen, or other household linen (including in the term linen articles of cotton or cotton and linen mixtures) and any process incidental thereto - 5 - 2 4 - (3) Making, ornamenting, mending, and finishing of lace and of lace curtains and nets - 2 - - - - (4) Making of curtains and furniture hangings and any process incidental thereto 1 1 1 4 3 - (5) Cabinet and Furniture making and upholstery work 3 - - - 2 - (6) Making of Electro-plate - 1 - - - - (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) - 1 - 1 - - (9) Fur-pulling - 1 - - - - (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-bnckles. mullin bits, hooks, and attachments of all kinds - - - - - - (13) Making of locks, latches, and keys - - - - - - (14) Making or repairing of umbrellas, sunshades, parasols, or parts thereof 2 2 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 6 - - - - 2 (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 there of - - - - - - (30) The weaving of any textile fabric - - - - - - 16 68 30 83 14 19 Total Notices served on occupiers as to keeping or sending lists of Outworkers, Nil; Prosecutions in relation to Outworkers' Lists, Nil. Outwork in unwholesome premises, Sec. 103, Nil; Outwork in infected premises, Sees. 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 maybe) against the principal class only, but the outworkers have been assigned in columns 3 and 4 (or 6 and 7) into their respective classes. The figures in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year, and of the entries of names of outworkers in those lists 52 4. — Registered Workshops. Workshops on the Register (s. 131) at the end of the year. 1) Number. (2) Bakers 18 Bootmakers 46 Dressmakers and ladies' tailors 58 Milliners 21 Tailors 38 Upholsterers 21 Other trades 145 Total number of workshops on Register 347 5.— Other Matter. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories — Failure to affix Abstract of the Factory and Workshop Acts (s. 1.33) 25 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts is. 5) Notified by H.M Inspector - Reports (of action taken) sent to H.M. Inspector 3 Other - 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 : — Bakers 22 Laundries 2 Bootmakers 18 Metal Workers 6 Builders Motor Makers and Repairers 3 20 Opticians Butchers 6 3 Carpet Beaters 2 Printers 11 Coffee Roasters 5 Wood Sawyers 3 Dairymen 4 Other trades 17 122 181 inspections were made during the year and 9 notices were served, 55 Workshops. At the end of 1922 there were 345 workshops on the Register, including 34 domestie workshops. Excluding these latter, there were 573 males and 499 females employed in the workshops. During the year 466 inspections were made and li» notices served. Trade or Business. Workshops other than Domestic Workshops. Domestic Workshops. Total number of Workshops. Number of Workshops. Number of Workrooms. Number of Employees. Males. Females. Bakers 18 18 34 15 - 18 Basketmakers 2 4 40 - - 2 Blindmnkers 3 4 7 2 - 3 Bootmakers 38 38 84 - 8 46 Builders and carpenters 18 23 40 - - 18 Confectioners 2 7 13 25 - 2 Corset makers 3 4 - 8 1 4 Cycle makers and repairers 2 6 8 3 - 2 Dressmakers and ladies' tailors 53 61 2 195 5 58 Harness and trunk makers 6 6 20 1 - 6 Ironmongers 6 6 13 - - 6 Laundresses Laundresses 3 9 3 14 - 3 Milliners 19 1? _ 47 2 21 Monumental masons 2 2 18 - - 2 Motor makers and repairers 11 17 39 - - 11 Outfitters 7 26 3 73 - 7 Pianoforte makers 2 6 54 - - 2 Picture frame makers 11 13 18 - 1 12 Photographers 6 8 3 11 1 6 Smithss 5 5 11 - - 5 Tailors 28 33 51 28 10 38 Upholsterers cabinetmakers 19 24 40 12 2 21 Watchmakers and jewellers 12 12 20 - - 12 Wigmakers 11 12 2 26 2 13 Miscellaneous 26 35 50 39 3 29 Totals 313 398 573 499 34 347 LEGAL PROCEEDINGS. Legal proceedings were taken by the Council in connection with the work of the Health Department in 66 eases during the year. The facts relate only to the eases that were heard and decided in 1022. 54 Statute or By-law. Fines Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and Bye-laws made thereunder 53 15 0 56 9 0 Metropolis Management Acts, and Byelaws made thereunder 12 2 0 1 3 0 Sale of Food and Drugs Acts 7 0 0 2 2 0 Housing Acts 10 0 0 - Factory and Workshop Acts 4 0 0 6 6 0 London County Council (General Powers) Acts 87 16 0 8 18 0 Total 174 13 0 74 18 0 Section 8. PUBLIC HEALTH STAFF, 1922. (Arranged according to the Ministry of Health's instructions, 10th January, 1923). Sanitary Inspectors. Senior Sanitary Inspector: W.G. Kershaw— Cert. Sanitary Inspectors' Examination Board. Diploma of Sanitary Inspectors' Association Examination Board. Diploma of Worshipful Company of Carpenters (Sanitary Building Construction). Cert. City and Guilds Plumber's Work. 1st Class Honours' Grade. District Sanitary Inspectors Wards 1 and 2 .. *R. Geary—Cert. Sanitary Inspectors' Examination Board. Cert, of Registration for Practical Plumber's Work, Worshipful Company of plumbers. Cert. City and Guilds, Building Construction (Elem.) Plumber's Work (1st Class), and Honours. Hygiene and Phis. (1st Class). Diploma Indenture of Apprenticeship, Plumber's Work. 55 District Sanitary Inspectors continued :- Wards 4 and 5 .. *J. Grimsley— Cert. Sanitary Inspectors' Examination Board. „ Royal Sanitary Institute, Meat and other Foods. „ Advanced Sanitary Science. „ „ Practical Plumbing. „ Brickwork. „ Masonary „ Sheet Metal Workers. „ Building Construction. Indenture Apprenticeship Practical Plumber. Wards 3 and 7 .. *W. F.Horniblow-Cert. Sanitary Inspectors' Examination Board. „ Royal Sanitary Institute. Meat and other Foods Inspector of Nuisances. Ward 6 .. .. *A. C. Towneend—Cert. Sanitary Inspectors' Examination Board, „ Royal Sanitary Institute, Meat and other Foods. Special Housing and Sanitary Inspectors : Eastern District. *A. Peverett—Cert. Sanitary Inspectors Examination Board. „ Royal Sanitary Institute. Meat and other- Foods Western District. *A. C. Townsend—(As above). Special Sanitary Inspector Sale of Food and Drugs Acts Orders and Regulations Milk and other Food Factory and Workshop Acts Factory and Workshop Acts Tuberculosis Regulations *F. H. Hudson—Cert, Sanitary Inspectors' Examination Board „ Royal Sanitary Institute, Meat and other Foods. *Mrs. T. Fisher—Natural Sciences Tripos, Cambridge. M.A. Trinity College, Dublin. Cert. Sanitary Inspectors' Examination Board. „ Royal Sanitary Institute. Inspector of Nuisances. Diploma National Health Society. Assistants to Inspectors. W.Larkim. Edwards,E Stratton. R. Martin Public Mortuary Mortuary Keeper -W. Larkin. 63, Flask Walk. Deputy Keoper—E. Stratton Disinfecting and Cleansing Stations Disinfectors—T. Rider, R. Bell, W. Bell Cleansing Station Attendant—Mrs. Blanden Tuberculosis Dispensary Assistant Medical Officer of Health ) and Tuberculosis Medical Officer ) *A.J.Scott Pinchin, M.D. (Loud.), M.R.C.P. (Lond.). Nurse—*Miss M. Lowen, Cert, for Medical anil Surgical Nursing. Maternity clinics Medical Officer in Charge—* Miss Mary Kidd, M.B. (Lond.). Dental clinics: In connection with Tuberculosis Dispensary and Maternity and Child Welfare). Dentist—*C. O. Gray, L.D.S., R.F.P.S Health Visitors : *Mrs. K. Roche—cert. Sanitary Inspectors' Examination Board ; Diploma National Health Society: Children's Hospital Nursing Certificate. *Mrs (I.G. Steward—C.M.B. : General Nursing Experience. *Mişs A. Kennedy —Health Visitor's Certificate ; Children's Hospital Nursing Certificate. 56 Public Analyst A. W. Stokes, F.c.s., F.I.C. Clerical .staff H H. Lewis, C. W. Francis, 'Miss E. Blakeman, R. H. Box, W Sell Chief Clerk—F.S. Hill. Medical Officer of Health; and Administrative Medical Officer, Tuberculoid, and Maternity and child Welfare. *Frank E.Scramse.F.R.c.s, Eng.). L..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. * Contribution to salary made under Public Health Acts or Exchequer grants All the Officers give their whole-time to their duties with the exception of the Tuberculosis Medical Officer, the Medical Officer in charge of the Pre-Maternity Clinics, and the Public Analyst. Section 9. HOUSING. In the following .statement is tabulated a list of work accomplished under the direction of the Housing Inspectors. In addition to this should be borne in mind the improvements carried out by the Sanitary Inspectors much of which has a direct bearing upon the better housing of the population. Work accomplished by the Hoaxing Inspectors during 1922. Underground rooms illegally occupied, discontinued 1 New sculleries and washhouses built 4 Additional ventilation to bedrooms and sculleries 23 Rooms, staircases and w.c. apartments cleansed and repaired 949 Dampness in rooms abated and floors ventilated and repaired 137 Windows and doors repaired 607 Handrails and balusters repaired 54 Coppers repaired and renewed 65 Larders provided 208 Coal sheds and receptacles provided or repaired 15 Fireplaces and ranges repaired or renewed 191 New or repaired sinks 14 Drains, soil pipes and ventilating pipes repaired or renewed 68 Roofs, gutters and rainwater pipes I repaired or renewed 201 Gully traps removed from improper positions 7 Waste pipes of sinks trapped, repaired or unstopped 36 57 Lavatory basins or baths repaired 8 Water and sinks provided to upper floors of tenement houses 18 Water cisterns cleansed, repaired or removed from improper positions, or water taken off main supply 57 W.C. apparatus repaired, renewed or unstopped 72 W.C. removed from improper positions or provided with external ventilation 3 Paving of yards and forecourts repaired or renewed 53 Dust bins provided 54 Accumulations of refuse removed 9 External repairs: pointing walls, repairing windowsills, steps, &c. 63 Internal and external woodwork painted 37 Manholes repaired or renewed 22 Miscellaneous repairs 17 The following information is required by the Ministry of Health to be set out in this Report. Number of new houses erected during the year:— (a) Total. During 1922, 12 new houses were brought into rating in the Borough. (b) At part of a municipal housing scheme. All the remaining tenements at South End Close were occupied during the year; and the council's scheme for providing these 140 separate tenements in 4 blocks of buildings has now been completed. 1.—UNFIT DWELLING HOUSES. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts 1,531 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 161 (3) Number of dwelling-houses found to be in it state so dangerous or itijurious to health as to be unfit for human habitation 1 (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 1187 58 2.—Remedy of Defects without Service of formal Notices. Number of defective dwelling-houses rendered tit in consequence of informal action by the Local Authority or their officers 162 The following tabular statement shows the progress that has been made with the two lists of properties supplied to the Ministry of Health, consequent upon the survey of the Borough which was undertaken in 1919 at their request. These lists comprised areas which might have to be dealt with as unhealthy, under Part I or II of the Housing Act, 1890; and other insanitary houses which, although seriously defective, could be made habitable. Premises in areas whitch are bing or may have to be dealt with as jun healthy , under Part I or II of the Housing Act.lß9o Estimated cost of work executed. Insanitary houses (other than houses in unhealthy areas) Which are seriously Defective,but which can be made habitable. Estimated cost of work executed Total No. of houses dealt with. Total No. of premises included in report on Survey of Borough 259 (population 1018) ) 643 (population 5870) 902 No. restored to a sanitary condition in 1921 23 £1393 94 £4979 117 No. restored to a sanitary condition in 1922 21 £683 141 £5451 162 Remaining at Ist Jan., 1923 215 - 408 - 623 In respect of 200 premises out of the 623 remaining to be dealt with, schedules have been served during 1922, but the works had not been completed at the end of the year. As will be seen by the table, of the 162 premises completed during the year 141 were in the list of 643 houses that were reported to the 59 Housing Committee as being below the standard compatible with health but which could be made reasonably fit for human habitation, and 21 were in the list of unhealthy areas. On the Ist January, 1923, there were 423 premises out of the original 902 still remaining to be dealt with. The procedure adopted is as follows : —After an inspection has been made by a Housing Inspector, a schedule of defects is forwarded to the owner of the premises, on which basis negotiations are conducted as to the best means of remedying the insanitary conditions. Reasonable compromises are effected, and as is shown by the information that follows, much work has been achieved by this means. Those few owners who refused to carry out the necessary alterations etc., in this quasi-voluntary manner have been reported to the Public Health Committee who ordered that Statutory Notices under the Public Health Ad should be served upon the recalcitrant owners. The Council has served no Statutory Schedules under section 28 of the Housing Act, 1919). 3. Action under Statutory Powers. A. Proceedings under Section 28 oj the Housing, Town Planning, &c., Act, 1919. No Statutory Notices served ; unofficial Notices only. (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 896 60 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 896 (b) by Local Authority in default of owners 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 1 (4) Number of dwelling-houses in respect of which Demolition Orders were made (5) Number of dwelling-houses demolished in pursuance of Demolition Orders (6) Number of Demolition Orders quashed 7 Staff specially detailed for Housing Work. In February, a seen id Sanitary Inspector, Mr. A. C. Townsend was transferred to the jurisdiction of the Housing Committee to assist in expediting the work of dealing with insanitary property. The Borough was divided into two districts by an imaginary lino drawn down the centre of Finchley Road, the eastern portion being allotted to Inspector Pcverett and the western portion to Inspector Townsend. Unhealthy Areas. No additional unhealthy areas were "represented" during 1922, nor did the areas previously reported upon again come before the Council. These arras are as follows :— Town Ward Areas (including Corniek's Yard, Flask Walk (2 sites), Golden Yard, Silver Street, Stamford Place, Streatley Place). In this instance the question was deferred us the result of an interview between Official of the .Ministry of Health and the Chairman of the Housing Committee of the Borough Council — Mr. Councillor 11. Smith. 61 Kilburn Vale Area. Nothing further arose on this area ;it being stated by the Chairman of the Housing Committee that the Ministry did not desire us to proceed with this scheme. Westbere Road. The question of the utilisation of this si to was considered by the Housing Committee in 1921 who decided to take no further action. This resolution still stands, and, presumably the site will be developed by private enterprise. Housing of Private Families. The following table shows the state of the housing of private families; and the rooms occupied, together with the percentage of families living in various units of occupation. It will be noted how the density of population is becoming greater in the smallersized tenements, and less acute in tenements of more than six rooms ; this is accounted for by the house-shortage and by a downward economic pressure. TENEMENTS AT CENBUB, 1921. l. room. 2 rooms. 3. rooms. 5. rooms. 6-7 rooms. 8—9 rooms. 10 room and over. 4. rooms. Total private families 2,018 2,842 4,194 2,957 1,833 2,575 1,824 3,277 Population in private families 3,066 7,919 14,064 10,645 6,991 10,372 8,406 18,587 Rooms occupied 2,018 5,684 12,582 11,828 9,165 16,582 15,423 39,290 Percentage of families living in various units of occupation — — At Census of 1921 9·4 13·2 19·5 13·7 8·5 12·0 8·5 15·2 1911 6·9 13·1 16·1 9·8 6·4 12·9 11·9 22·9 It is obvious from the facts disclosed by these Census figures that many of our citizens are living under conditions which, although possibly in many cases are not " illegal," yet must, in the nature of things, tend to be " immoral," owing to the highly undesirable crowding together of the sexes ; especially in those cases where young 62 people at about the age of adolescence are forced to share a room with older people. Again ; where the number of tenements in a house is unduly increased, the difficulties of providing a separate water-closet, water supply, and food storage accommodation for each family become almost insuperable. At the Census of 1911, 52 per cent, of the private families were living in tenements of five rooms or less, while at the Census of 1921 this number had increased to 64, equivalent to an increase of 23 per cent. The percentage of private families in 6-roomed tenements and upwards had correspondingly decreased from 48 per cent, in 1911 to 36 per cent, in 1921. Overcrowding. It is difficult, without making special inquiries in that direction, to form a close estimate of the extent of the overcrowding in Hampstead, but there is no doubt that considerable overcrowding does exist. I have extracted certain statistics from the Census Returns showing the number of private families occupying tenements of five rooms and under, where the customary standard of not more than two persons per room is exceeded. Where such conditions obtain, overcrowding is deemed to exist. The table may be read as follows, taking as an example the first line : —there were in 1911, 103 instances where 3 persons were living in 1 room while in 1921 the corresponding number was 158. Overcrowding as ascertained at Census of 1921. No. of Persons in Family. Number of Private Families occupying the following number of rooms :— 1 room. 2 rooms. 3 rooms. 4 rooms. 5 rooms. 1911. 1921. 1921. 1911. 1921. 1911. 1911. 1921. 1911. 1921. .. .. .. .. .. .. .. .. 3 103 158 45 4 49 .. .. .. .. .. .. .. .. 5 12 18 205 168 .. .. .. .. .. .. 111 6 5 9 94 .. .. .. .. .. .. 7 1 2 49 40 143 126 .. .. .. .. 8 .. .. 11 17 75 58 .. .. .. .. 9 ... .. 8 4 35 27 36 28 .. .. 26 .. 10 .. .. 2 15 10 8 3 5 4 .. 11 .. .. .. .. 8 7 10 4 12 .. .. 1 3 .. 2 2 3 .. 1 13 .. .. .. .. .. .. 2 .. .. .. 63 Statement shotting steps taken in 1922, in connection with premises "represented in 1921 or previous years" by the Medical Officer of Health under the Housing Acts. Premises. Bepresentation. closing Order. Demolition orderr. Remarks. Whether unfit for habitation, an obstructive building. statute under which action taken. Date of Council. Statute and er which action taken. Date of committee. Statue under which action taken. Council. 13 Southampton Road 24-7-21 - closing Order determined Determined 11-7-21 (a) Sec. 17 Housing, Town Planning, &C, Act, 1909. Housing. Town Planing .&c., Act, 1909. - (a) - - 5, Alexandra Road 28-9-22 25-9-22 Do. Do. - Premises converted Into a Motor Garage. Demolition Order quashed 24/8/22 1-7, Peebles 17-0-13 (a) Do. 26-6-13 Do. 23-3-15 Housing, Town Planning &c, Act, 1909 Section 10. VITAL STATISTICS OF THE BOROUGH. The Borough. Number of Births. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number of Deaths. Number. Rate per 1000 Births. Year. 73 1902 1,516 904. 133 88 1903 1,453 837 126 87 66 892 161 7 3 1904 1445 111 73 1905 1421 823 133 94 1906 1,437 850 77 57 111 1907 1,359 817 98 73 61 1908 1400 803 97 69 74 1909 1,328 839 99 74 53 1910 1,340 829 60 58 81 1911 1,276 847 105 82 56 1912 1,281 861 79 62 64 1913 1,325 951 91 69 49 1914 1,273 913 91 71 57 1,327 994 101 48 1915 76 1916 1,164 862 73 63 55 1,123 922 69 1917 90 80 75 1918 895 1,027 69 77 1919 1,156 96 83 56 1,036 1920 1566 860 75 48 41 1921 1,342 973 88 65 63 1922 1,290 970 72 56 50 64 No. 1 (Town) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 1902 192 163 20 104 17 1903 194 127 14 72 11 1904 195 125 20 102 13 1905 194 127 24 124 9 1906 205 131 21 102 5 1907 185 81 152 11 13 1908 225 108 49 7 11 1909 6 196 140 15 76 1910 199 118 15 75 6 207 19 1911 133 92 7 1912 183 135 12 65 5 1913 201 11 161 55 11 1914 152 130 14 92 5 1915 157 147 17 108 5 140 1916 132 7 53 13 1917 143 12 84 14 143 1918 115 157 13 113 11 1919 149 13 87 170 10 208 1920 142 7 34 4 1921 178 147 17 95 11 1922 161 130 11 68 13 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 75 135 18 15 1903 211 121 13 62 13 1904 217 141 23 106 12 1905 131 62 209 13 10 1906 187 127 8 43 13 1907 205 13 63 10 114 1908 205 126 8 39 16 1909 204 16 78 130 8 1910 207 119 9 43 8 1911 189 135 17 90 10 1912 188 127 8 42 7 1913 214 126 16 75 5 1914 195 141 9 46 11 144 12 38 6 1915 317 127 1916 189 7 37 6 1917 185 132 13 70 11 1918 149 155 7 47 9 1919 196 159 20 102 9 1920 132 9 213 42 7 143 1921 197 12 61 7 1922 151 49 202 10 7 67 No. 3 (Adelaide) Ward Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis Rate per 1000 Births. Number. 1902 103 95 3 29 7 1903 95 101 95 1 9 1904 100 99 13 130 8 1905 96 92 4 42 4 1906 17 92 10 103 5 1907 75 86 6 107 2 6 1908 93 78 65 4 83 1 909 88 4 48 3 96 78 2 1910 21 5 1911 82 99 6 73 3 6 51 1912 117 77 9 1013 97 99 9 93 1 99 1914 88 5 57 2 77 1915 104 5 65 2 95 12 115 1916 104 5 1917 114 109 7 61 6 1918 97 6 62 11 119 1919 97 130 10 104 6 161 109 6 37 3 1920 1921 133 119 10 75 8 1922 149 6 40 5 121 No. 4 (Central) Ward. Number of Births. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number of Deaths. Number. Rate per 1000 Births. Year. 1902 110 71 11 100 5 1903 99 60 8 81 4 1904 90 62 11 122 1 1905 113 60 5 44 6 32 1906 95 83 3 2 1907 108 68 9 83 5 104 82 1908 6 58 7 1909 116 63 3 26 3 1910 105 82 8 76 3 1911 92 75 8 87 3 1912 97 76 4, 41 6 1913 91 84 6' 66 6 1914 84 76 4 48 6 1915 91 92 4 42 6 43 93 97 4 3 1916 29 1917 69 76 2 7 1918 69 99 5 72 7 1919 101 117 5 49 4 1920 131 91 7 53 2 1921 112 102 8 71 3 1922 85 113 9 106 3 66 No. 5 (West End) Ward. Year. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis Number of Births. Number. Rate per 1000 Births. 6 1902 275 107 20 72 1903 243 111 21 86 12 120 22 78 8 1904 283 1905 250 131 23 92 11 1906 14 54 8 259 115 64 9 1907 250 114 16 1908 254 121 26 102 9 13 54 6 1909 239 118 1910 216 121 17 79 11 1911 216 102 15 69 10 1912 226 126 13 57 12 11 1913 240 145 46 7 1914 140 18 70 14 256 1915 218 13 60 11 151 1916 211 117 10 47 13 1917 221 137 13 59 13 1918 124 162 10 81 12 1919 175 139 12 68 19 1920 268 119 16 60 6 1921 211 146 19 57 9 1922 223 138 6 27 8 No. 6 (Kilburn) Ward. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number of Births. Number of Deaths. Year. Rate per 1000 Births. Number. 1902 435 219 45 103 16 1903 417 184 39 93 18 1904 408 206 54 132 22 1905 426 171 50 117 26 1906 444 197 41 92 15 1907 391 179 28 71 16 1908 393 186 30 76 21 1909 341 182 37 108 17 1910 379 192 24 63 16 1911 347 179 31 89 16 1912 353 188 26 74 18 1913 354 213 25 71 18 1914 385 212 25 65 13 1915 329 230 40 121 11 1916 309 180 28 91 20 1917 280 208 37 132 17 1918 241 225 21 87 18 1919 296 201 24 81 11 1920 408 172 19 48 14 1921 364 204 21 58 11 1922 303 202 16 53 11 69 No. 7 (Priory) Ward. Number of Births. Year, Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Rate per 1000 Births. Number. 1902 110 16 99 162 7 1903 152 116 21 108 5 1904 152 121 13 85 9 1905 133 103 14 105 7 1906 150 93 9 60 8 1907 127 94 7 55 6 1908 126 93 10 79 7 1909 149 111 11 74 8 1910 138 111 6 43 8 1911 143 115 9 63 5 1912 117 115 7 60 10 1913 128 117 12 94 3 1914 113 110 16 142 5 1915 138 126 10 72 7 1916 126 106 5 40 3 1917 111 117 6 54 8 1918 100 110 7 70 7 1919 142 120 12 84 5 1920 177 95 11 62 14 1921 147 112 8 54 14 1922 167 115 14 84 3 Report of the Tuberculosis Medical Officer for the Year 1922. Municipal Tuberculosis Dispensary. Number Under observation at the Dispensary on Jan. 1st pending diagnosis. Examined for the first time during the year. Total. Buffering from Tuberculosis. Not suffering from Tuberculosis. Under observation at the Dispensary on Dec.31st pending diagnosis. Ceased attendance before completion of diagnosis. Pulmonary. Non- Pulmonary M. 2 89 91 87 5 47 2 All persons (including " Contacts.") Adults - F. 14 161 175 34 8 120 10 3 M. 22 9 109 118 90 4 2 6 - Children under 15 F. 86 92 6 80 3 - 3 31 71 41 337 19 Total 445 476 8 - 10 - 22 1 Adults M. 33 33 - 6 - - (b)"Contacts" (included in (a) F. 4 61 65 53 5 3 Children under 15 M 6 65 71 10 54 1 - 3 64 60 1 1 F. 67 - 4 2 (c) Insured persons (included in (a) ). M. 1 22 - 52 53 25 5 F. 4 37 41 19 2 16 4 3 I.—Number of patients under treatment or super vision (excluding persons under observation or domiciliary treatment) on the 31st December , ... 6. Number of repoits received from Insurance Practitioners In respect of insured patients under domiciliary trea tment during the year 195 1 434 2. Total number of attendances of ) Insured patients at the Dispensary during > the year ... ... ... ... ) Uninsured 7. — Number of persons referred to affiliated hospital for consultation Not affiliated 1304 8. —Number of consultations with I Insured ... medical practitioners at the homes of patients (Uninsured 4 2A. —Number of the above attendances at which systematical physical examinations and records were made ... .. ... ... 1073 8 9. —Number of other visits paid by Tuberculosis Officer to the homes of patients 3, —Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 62 139 10. —Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 4. —Number of cases in which the period of observation vation at the Dispensary exceeded two months 23 943 11.—Number of specimens of sputum examined in connection with the work of the Dispensary. J. — Number of insured patients under domiciliary treatment on December 31st Not accertainble. 185 *Insured persons under domicilary treatment by insurance practitioner, are excluded, even though they may attend the dispensary at intervals for examination or consultation. All insured persons in the dispensary area who are actnally receiving domiciliary treatment from Insurance practititioncrs are included, Irrespective of the date upon which they were placed under domiciliary treatment and of any attendance at the dispensary. 69 Heme visitting of Ex-Service tuberculous mm. —The following inform ation for the year 1922, required by the Ministry of Health, is submitted :— 1. Number of discharged men visited 85 2. Total number of visits of this kind . . 363 3. Proportion of number of visits to such cases to total number of visits to tuberculous cases . . 18 - 6 per cent. An analysis of the statistics for Tuberculosis during the past year is of considerable interest. The notifications are less by 23. Pulmonary notified cases are 2 less than last year; the main fall being in nonpulmonary forms; 21 less than last year. I think that this is due to the more general recognition of the fact that all cases of chronic enlargement of the glands of the neck are not Tubercular; but that many are due to infected conditions of the tonsils; and also to the intensive campaign which has been carried on in the schools against enlarged tonsils; there is no doubt that chronic enlargement of the glands of the neck has decreased enormously of recent years. The death rate shows an improvement on last year; deaths from pulmonary Tuberculosis being lower by 13. This is a very pleasing fall, especially when we take into consideration the fact that, of the deaths from pulmonary forms, no less than 14 were ex-service men. The average yearly deaths for the ten years prior to 1922 is : — 1912-1921 Pulmonary 57-7 Total all forms 73-3 1922 „ 50-0 „ 69-0 At the present time 85 discharged soldiers Buffering with tuberculosis are resident in Hampstead; 9 less than last year. 28 ex-service men were admitted during the year. Of the notifications during the year 14 were domestic servants, a figure of some importance as it lowers the number of potential contacts; there usually being no contacts in these cases. Of the cases attending the Dispensary for the first time during 1922, 11 have died, whilst of the total cases notified during that year 25 have died. One of the great difficulties in the treatment of tuberculosis amongst the poorer classes lies in the fact that removals are so frequent. Of 459 72 cases who have been on the dispensary books since June 1921, a period of 18 months, 60 have been discharged—(quiescent). 61 have removed. 49 have died. The problem of the registration of Tuberculous patients is a difficult one; it is more or less necessary to have the good will and agreement of the patient in order to keep in touch; i.e., when a patient moves ho should notify the Dispensary he attends in order that he may be transferred to the Office of Health in the district to which he is moving. Until the benefits which accrue to the patient on notification are equal to the domestic disturbance caused, this is never likely to be carried out thoroughly. There is no trouble in keeping in touch with ex-service men as they have to attend a Dispensary with some degree of regularity on account of their pension and allowances, and would run the risk of losing these if they did not attend. The fact that a patient is known to be suffering with Tuberculosis makes life more difficult for him apart from the disease itself; and the more we advertise the infectivity of the disease the more difficult becomes the lot of the patient. It is the tuberculous patient who often has to sink to the worst housing conditions, food is often inadequate and the infection of other members of the family becomes a probability rather than a possibility. I much regret the regulation which now prevents us from keeping contacts under observation for prolonged periods ; for it is not a case of whether the child has active tuberculosis or not, but rather is it likely to become active if the child is left alone; it is obviously better to prevent it becoming active than to treat it at considerably more expense after it has become so. I am convinced that during past years at the Dispensary, owing to careful watching and treatment of children in this condition, and to the invaluable help of the Invalid Children's Aid Association, we have consolidated the health of many children, and I am sure the extra expense and labour entailed has been justified. The decrease in numbers of attendances has been mainly due to the regulations as to the time a 73 patient shall attend if not actively Tuberculous. I have again to express my appreciation of the help rendered by the Invalid Children's Aid Association, through their local secretary, Miss Harrison; 17 children have been sent away for a total period of 147 weeks ; and also to the Interim Care Committee who have helped me in many cases. During the past year 44 cases have been admitted to Sanatorium by the London County Council. It is a matter for regret that the patients are often kepi waiting so long for admission ; five weeks is a long period in the case of a domestic servant, and in the case of a working man it is even more serious, often meaning that he will go on working when he should not; the patient usually attends the doctor because the disease has become active and this is the very time when early treatment is valuable ; one can often trace marked advance in the disease in 5 or 6 weeks. I hope now the new Sanatoria are open that the waiting period will be materially reduced. From notifications received in the year 1922, 160 potential Contacts accrued. During the year 223 Contacts have been examined. Of these, 101 were eases which had accrued as contacts during the year. That is to say, that 63 per cent, of the contacts of cases notified and attending the Dispensary, have attended. Of the residue man y are contacts of cases notified last year, but who have attended this year, and a good number are contacts of cases who have not attended the Dispensary as they were admitted direct to Hospital or died before attending. Non-Tuberculous. Tuberculous. Doubtful. Male. Insured 21 14 6 1 Non-Insured 12 8 4 0 Female. Insured 16 15 1 0 Non-Insured 45 38 6 1 Children . 129 114 14 1 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 72 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:— No. of New Applicants No. of New Applicants treated. No. of Contacts examined Total Attendances of all kinds. Year. 455 191 204 2808 1913 1st Feb. to 31st Dec. 1914 118 195 1913 455 158 1915 308 146 899 230 165 100 1916 1519 1917 383 183 113 1682 371 105 1918 124 1821 1919 296 85 57 1543 1920 384 221 112 2625 1921 479 127 192 2327 113 1922 445 223 1738 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 679. During the year 67 cases hare been referred by 32 medical practitioners in the district for an opinion, and have been reported on by letter or telephone. 12 personal consultations have been held with practitioners. 15 eases have been referred to the out-patient department of the Hanipstead General Hospital: — 10 to medical out-patients. 5 to Throat Department. In addition to this, 39 cases have been sent to Hampstead General Hospital for X rays, and 6 cases were admitted to that Hospital. To conclude, I have to thank Dr. Scrase for his help and advice ; and the Staff of the Dispensary for their good will and the keen way in which they have carried out their duties. A. J. SCOTT-PINCHIN, M.D. (Lond.), M.R.C.P. 73 INDEX. PAGE. Ambulance Facilities 33 Analytical Work, Report on 48 Ante-Natal Clinics, Report on 29 Area of Borough 5 Bacteriological Examinations 33 Bakehouses 39 Births 9 Cancer 16 Census Statistics 6 Cleansing Station 40 Clinics 29-31 Complaints Received 34 Consumption (see Tuberculosis). - Customs and Inland He venue Acts 37 Dairies 41 Deaths 11 Dental Clinics 31 Diarrhoea and Enteritis 16 Diphtheria 16 Disinfection 40 Drainage Work 34 Encephalitis Lethargica, acute 20 Enteric Fever 16 Epidemic Diarrhoea 16 Epidemic Diseases, Principal, Deaths and Death-Kate 16 Erysipelas 20 Factory and Workshop Act, 1901 49-53 Food and Food Premises 39 Fried Fish Shops 39 Health Visiting 30 Home Office Tables I factory and Workshop Act, 1901) 49-52 Homework 50,51 Hospitals 32 Housing 3, 56-63 Ice Cream 39 Infantile Mortality 13 Infectious Diseases 19 74 PAGE. Laboratory Work 33 Legal Proceedings 53,54 Margarine, Wholesale dealers ... 39 Malaria 20 Marriages. 9 Maternity and Child Welfare 30, 28-32 Measles 16 Midwives 28 Milk (Mothers and Children) Order, 1919 30 Milk and Milkshops 41 Mortuary, Public 37 Notification of Births Act, 1907 ... 10 Nursing, facilities 27 Offensive Trades 39 Ophthalmia Neonatorum 21 Outworkers (see Home workers) - Pneumonia, Acute primary 20 Population 5-8 Population, Natural Increase of 10 Pro-Maternity Clinics 29 Principal Epidemic Diseases 16 Public Health Committee 3 Public Health (Milk and Cream) Regulations, 1912 and 1917 46,47 Puerperal Fever 20 Rats and Mice (Destruction) Act, 1919 38 Rent Restrictions Acts 37 Restaurant Kitchens... 39 Sale of Food and Drugs 48-48 Sanitary Inspection, &c. 34,56 Scarlet Fever 20 Overcrowding 62 Slaughterhouses 40 Small-pox 21 Smoke Nuisances 48 Staff of the Public Health Department 54-56 Still-Births 11 Suicide 17 Summary of Vital Statistics 5 Treatment Centres ... 29 Tuberculosis 21 Tuberculosis Dispensary 68-72 Tuberculosis Medical Officer, Report of 68-72 75 PAGE. Tuberculous Milk 41-43 Underground Rooms... 34 Vaccination 21 Venereal Disease 17, 31 Verminous Persons and Premises 40 Vital Statistics 5 Violent Deaths 17 Warranty Defence 46 Water Supply, Certificates as to 35 Water Supply of Tenement Houses 35 Whooping Cough 16 Young Children, Mortality among 15