THE Metropolitan Borough of Hampstead. REPORT for the year 1923, 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 1.—General Statistics 5 „ 2.—Extracts from Vital Statistics of the Year 5-19 „ 3.—Notifiable Diseases during the Year 20-31 „ 4.—Causes of Sickness 31 „ 5.—Summary of Nursing Arrangements, Hospitals, and other Institutions available for the Borough 31-35 „ 6.—Laboratory Work 36 „ 7.—Sanitary Administration 36-60 „ 8. —Public Health Staff 60-62 „ 9.—Housing 62-68 „ 10.—Vital Statistics of the Borough 69-72 APPENDIX I.—Report of the Tuberculosis Medical Officer 74-78 „ II.—Report of the Medical Officer in charge of Pre- Maternity Clinics 79-81 „ III.—Report of the Public Analyst 82 INDEX 83-85 3 His Worship the Mayor (Andrew T. Taylor, Esq., j.p., l.c.c.) ex-officio member of all Committees. PUBLIC HEALTH COMMITTEE. Chairman: Mr. Councillor Herbert Marnham. Mr. Alderman G. Buckle Mr. Councillor C. J. R. MacFadden, o.b.e., m.d., c.m. Mrs. Councillor Monro, j.p. „ Councillor J. A. A. Atkin „ „ C.W. Cunnington, m.r.c.s., d.p.h. Mr. „ T. H. Nunn, m.a. „ „ R. H. H. Cust, m.a., j.p. „ „ H. W. Snow Mrs. „ Dow, b.a. „ „ J. C. Staines Mr. „ W. S. George, m.d., b.s., m.r.c.s., l.r.c.p. Sub-Committees: —Drainage Plans and Tuberculosis. MATERNITY AND CHILD WELFARE COMMITTEE. Members of the Council. Chairman: Mrs. Councillor Fisher. Mrs. Councillor Arnholz Miss Councillor Glover Mr. „ S. A. Boyd, m.s., m.b., f.r.c.s. Mr. Councillor C. J. R. MacFadden, o.b.e., (Eng.) m.d., c.m. Mr. „ R. H. H. Cust, m.a., j.p. Mrs. „ Monro, j.p. Mrs. „ Dow, b.a. Mr. „ T. H. Nunn, m.a. Mr „ W. S. George, m.d., b.s., m.r.c.s., l r.c.p. Persons not Members of the Council. (Appointed in pursuance of Section 2 (2) of the Maternity and Child Welfare Act, 1918.) Lady H. K. Thompson Mrs. E. Grundy Mrs. J. Rocke Mrs. E. Stewart HOUSING COMMITTEE. Chairman: Mr. Alderman R, J. J. Willis. Mr. Alderman G. Buckle Mrs. Councillor Maddox Mrs. Councillor Arnholz Mr.„ H. Marnham Mr. „ V. H. Blessley „ „ E. L. Moore „ „ S. A. Boyd, m.s., m.b., f.r.c.s. „ „ W.P.Newman (Eng.) „ R. H.H. Cust, m.a., j.p. „ H. S. Salter „ G. W. Dawson „ W. J. Spriggs Mrs. „ Dow, b.a. „ B. S. Townroe Mrs. „ Fisher Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W. 3. 18th March, 1924. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report for the year 1923. It is prepared in accordance with the directions contained in Circular 451, dated 15th December, 1923, of the Ministry of Health; and the order of the Sections is that suggested in the Ministry's Circular. Also following the instructions of Circular 269, dated 28th December, 1921, this Report is compiled as an Ordinary Report, and its shortness and conciseness results from the endeavour to comply with the Ministry's suggestion that it should be published not later than the middle of April. Our statistics for the year will be found summarised on page 5, and a comparison with last year shows that the health of the Borough has been well maintained, both the general death rate and the infantile death rate showing a reduction. Especially is this marked in the infantile mortality rate, which reached the phenomenally low figure of 42 per 1000 births. This is the lowest we have ever attained; it is the lowest in London, and is a rate more favourable than I should have conceived possible a few years ago. 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 Officer of Health. 5 Section I. General Statistics. Area of Borough 2265 acres (including 12 acres covered by water). 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, 1923 £1,160,694 Sum represented by a penny rate £4,708 14s. 0d. Section 2. Extracts from Vital Statistics for 1923. Population estimated to middle of 1923 87,410 Density 38 persons per acre. Marriages 684 Marriage-Rate 15.6 M. F. Totals Births Legitimate 600 562 1162 Illegitimate 30 46 76 1,238 Birth-Rate 14.1 Deaths 947 Death-Rate 10.8 Maternal Deaths - No. of women dying in, or in consequence of, childbirth I At home In hospital. (1) From Sepsis — 2 (2) Other Causes 1 1 4 Deaths of Infants under 1 year of age: — Legitimate 42 Illegitimate 12 Total 54 Infantile Mortality Rate (Registrar-General's figure) 42 per 1000 births. Deaths from Measles (all ages) 2 „ Whooping Cough (all ages) 4 „ Diarrhœa (under 2 years of age) 10 Deaths from Tuberculosis of— The Respiratory System 51 Death-Rate 0.58 Deaths from All Forms of— Tuberculosis 58 Death-Rate 0.66 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 87,410 at the middle of the year 1923. I have prepared the following estimates, based upon the Census figures, of the population of each Ward. Estimated Population. Ward. No. 1 (Town) 13,000 No. 2 (Belsize) 14,050 No. 3 (Adelaide) 10,500 No. 4 (Central) 9,610 No. 5 (West End) 13,700 No. 6 (Kilburn) 15,800 No. 7 (Priory) 10,750 The Borough 87,410 The sex percentages at the Census of 1921 were 38.6 males and 61.4 females. Marriages. According to the return kindly furnished to me by the Superintendent Registrar of Hampstead, it appears that 684 marriages were registered in the Borough during 1923, as compared with 718 in the preceding year. The following Table gives the marriage rates per 1,000 of the population for the years 1911-1921:— 1913 14.9 1918 18.5 1914 19.0 1919 17.0 1915 23.2 1920 16.6 1916 17.8 1921 16.3 1917 18.7 1922 16.5 1923 15.6 7 Births. In the following Table the births for 1923 have been analysed according to sex, etc.: — FEMALES. TOTALS. MALES. BIRTHS. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. 28 1371 658 686 647 38 685 1305 66 Registered in the Borough Add number occurring outside the Borough whose mothers were Hampstead residents 102 19 35 16 83 205 170 87 103 745 1475 44 789 730 57 787 101 1576 Deduct number who could not be deemed to belong to Hampstead 145 14 159 313 25 168 179 338 11 630 562 76 Net number belonging to Hampstead, 1923 Ne Births, 1922 30 46 608 1162 1238 600 595 655 1210 1290 635 615 40 80 40 The 1238 net births were distributed among the various Wards as follows: —No. 1 (Town) 164, No. 2 (Belsize) 156,No. 3 (Adelaide) 141, No. 4 (Central) 90, No. 5 (West End) 215, No. 6 (Kilburn) 333, and No. 7 (Priory) 139. 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 12.6 No. 2 (Belsize) „ 11.1 No. 3 (Adelaide) „ 13.4 No. 4 (Central) „ 9.4 No. 5 (West End) „ 15.7 No. 6 (Kilburn) „ 21.1 No. 7 (Priory) „ 12.9 The Borough 14.1 London 20.2 England and Wales 19.7 The natural increase in population, i.e., the excess of births over deaths, was 291. Legitimate and Illegitimate Births and Birth Rate. Of the total 1,238 net births belonging to Hampstead, 1,162 were those of legitimate and 76 of illegitimate children, the latter being at the rate of 65 per 1,000 births. 35 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 the year. As births have to be notified much sooner than registered, the total number notified differs from the total number registered. Notified within 36 hours. Notified after 36 hours. Total Notified. Notified by midwives 522 — 522 „ parents 232 64 296 „ doctors 351 — 351 „ nurses and others 180 — 180 1285 64 1349 In the great majority of those cases where the notification was not made until after 36 hours had elapsed, I had to draw the attention of the responsible person to the omission. During the year 34 still-births were notified, as follows:— Notified by midwives 12 „ parents 5 „ doctors 12 „ 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 persons, and, after subtracting these, the number of deaths of civilian Hampstead residents who died outside the Borough is added. The total net deaths during 1923 was 947, or 10.8 per 1000 of the population, as compared with 970 in the preceding year. These deaths were distributed among the various Wards as follows:—No. 1 (Town) 139, No. 2 (Belsize) 147, No. 3 (Adelaide) 128, No. 4 (Central) 98, No. 5 (West End) 149, No. 6 (Kilburn) 180, and No. 7 (Priory) 106. 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 10.7 No. 2 (Belsize) „ 10.5 No. 3 (Adelaide) „ 12.2 No. 4 (Central) „ 10.2 No. 5 (West End) „ 10.9 No. 6 (Kilburn) „ 11.4 No. 7 (Priory) „ 9.9 The Borough 10.8 London 11.2 England and Wales 11.6 Causes of Death at Different Periods of Life during the Year 1923. - Arranged in the form of the short List of Causes adopted by the Registrar-General in consultation with the Ministry of Health. CAUSES OF DEATH. Net deaths at the subjoined ages of "Residents," whether occurring within or without the Borough. 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. Sex. All ages. Under 1 year. 4 5 6 7 8 9 10 11 12 1 2 3 1. Enteric Fever ... ... M ... ... ... ... ... ... ... ... 1 ... 1 F 2 ... ... ... ... ... ... M ... ... ... ... ... ... ... 2. Small-pox ... ... ... F ... ... ... ... ... ... ... ... ... ... 3. Measles M ... ... ... ... ... ... ... ... ... ... F 2 ... ... 2 ... ... ... ... ... ... 4. Scarlet Fever M ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... 1 ... ... ... ... 5. Whooping Cough M 3 2 1 ... ... ... ... ... ... 1 ... F 1 ... ... ... ... ... ... 6. Diphtheria M 5 1 2 2 ... ... ... ... ... ... 3 2 ... F ... ... 1 ... ... ... ... 2 7. Influenza M 9 ... ... ... 4 2 1 ... F 8 2 1 1 4 ... ... ... ... ... 8. Encephalitis lethargica M 1 ... ... ... ... 1 ... ... F 1 1 ... ... ... ... ... ... ... ... 9. Meningococcal Meningitis M 1 ... 1 ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 10. Tuberculosis of respiratory system M 33 ... ... ... 5 15 13 ... ... ... F 18 ... 1 13 4 ... ... ... ... ... 1 11. Other Tuberculous Diseases M 2 ... ... ... 1 ... ... ... ... 5 1 3 ... 1 ... F ... ... ... ... 3 30 21 7 12. Cancer, malignant disease M 61 ... ... ... ... ... 37 F 97 1 2 10 20 27 ... ... ... 1 1 ... 13. Rheumatic Fever M 2 ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 8 3 3 2 14. Diabetes M ... ... ... ... ... F 7 ... 1 ... 3 1 2 ... ... ... ... ... 9 7 4 15. Cerebral hæmorrhage. &c. M 20 ... ... ... ... F 30 1 ... 1 6 4 18 ... ... ... 53 4 9 23 17 16. Heart Disease M ... ... ... ... ... 12 24 35 F 80 2 7 ... ... ... 17 Arterio-sclerosis M 13 ... 5 4 4 ... ... ... ... ... 2 9 23 F 34 ... ... ... ... ... ... 18. Bronchitis M 22 ... 6 8 7 1 ... ... ... 8 17 F 29 ... 1 ... ... ... ... 3 20 1 1 1 1 3 4 5 1 19. Pneumonia (all forms) M 3 33 2 2 14 F 5 1 ... 6 3 ... 20. Other Respiratory Diseases M 5 ... ... 1 ... 2 ... 2 ... ... 2 4 F 10 1 ... ... ... 1 2 21. Ulcer of Stomach or Duodenum 5 ... ... 1 4 ... ... M ... ... 2 1 1 F ... ... ... ... ... ... ... 22. Diarrhœa, &c. M 9 6 1 . 1 1 ... ... ... ... F 1 2 10 3 ... ... ... 1 3 ... 23. Appendicitis and Typhlitis M 6 2 ... ... 4 ... ... ... ... ... 1 ... 1 1 1 F 4 ... ... ... ... M 5 ... ... 1 4 ... ... 24. Cirrhosis of Liver ... ... F ... ... ... ... ... ... ... ... ... 25. Acute and Chronic Nephritis M 23 1 ... ... ... 6 6 10 ... F 17 ... 2 4 6 5 ... ... ... ... 26. Puerperal Sepsis M ... ... ... ... ... ... ... ... ... ... 2 2 F ... ... ... ... ... ... ... ... 27. Other accidents & diseases of pregnancy, and parturition M ... ... ... ... ... ... ... ... ... 2 ... ... 2 ... ... F ... ... ... ... 28. Congenital Debility and malformation, premature birth M 11 ... ... ... ... ... 11 ... ... ... F 8 7 1 ... ... ... ... ... ... ... M 10 ... ... ... ... 1 4 3 ... 29. Suicide 2 2 F 11 ... ... ... ... 7 ... ... 30. Other Deaths from Violence M 9 ... 1 ... 2 1 ... 2 2 1 1 2 4 1 7 F 15 ... ... ... ... 31 Other Defined Diseases M 81 6 ... 3 3 5 6 21 17 20 3 3 10 26 13 36 F 96 5 ... ... 32. Causes ill-defined or unknown 1 1 ... M ... ... ... ... ... F 1 ... ... ,L_ 1 ... ... ... ... ... M 418 30 7 10 15 43 131 102 75 All causes 5 F 529 24 1 9 17 64 119 94 197 4 Totals 947 54 6 11 19 32 107 250 196 272 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 Wale who died in the Borough have in like manner been excluded. 11 Centenarian. The death of a female aged 100 years, was registered during the year. Causes of Death. The incidence of the chief causes of mortality shows very plainly in a tabular list of the six principal death-causing diseases in 1923; it will be noted that Cancer is now well ahead of every other disease, and is three times as destructive as tuberculosis:— Cancer 158 Heart disease 133 Respiratory disease 119 Tuberculosis 58 Cerebral hæmorrhage, &c. 50 Arterio-sclerosis 47 The following diseases 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 - in hospital 2 (2) Other Causes at home 1 in hospital 1 Infantile Mortality. Deaths of infants under one year of age and rate per 1000 births:— Legitimate. Illegitimate. Total. No. Rate per 1000 legitimate births. No. Rate per 1000 illegitimate births. No. Rate per 1000 births. 42 36 12 158 54 44 In the following tables 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. 6 and under 9 Months. 9 and under 12 Months. Total Deaths under 1 Year. 3 and under 6 Months. 1. Small-pox ... ... ... ... ... ... ... ... ... ... 2. Chicken-pox ... ... ... ... ... ... ... ... ... ... 3. Measles ... ... ... ... ... ... ... ... ... ... 4. Scarlet Fever ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... 2 1 3 ... ... ... ... ... 6. Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... 7. Erysipelas ... ... ... ... ... ... ... ... ... ... 8. Tuberculous Meningitis ... ... ... ... ... ... ... 1 1 ... 9. Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... 10. Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... 11. Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... ... ... 12. Convulsions 2 1 1 ... ... ... ... ... ... 2 13. Laryngitis ... ... ... ... ... ... ... ... ... ... 14. Bronchitis ... ... ... ... 1 ... ... 1 ... 2 ... 15. Pneumonia (all forms) 1 1 1 1 8 ... ... ... 3 2 2 1 ... ... ... 2 2 1 8 16. Diarrhœa and 17. Enteritis 18. Gastritis ... ... ... 1 ... 1 ... ... ... ... 19. Syphilis ... ... ... ... ... ... ... ... ... ... 20. Rickets ... ... ... ... ... ... ... ... 21. Suffocation, overlying ... ... ... ... ... ... ... ... ... ... ... ... 22. Injury at Birth 4 ... ... ... 4 ... ... ... ... 4 23. Atelectasis 1 ... ... 1 ... ... 1 ... ... ... 24. Congenital Malformations 3 2 ... ... ... 3 1 1 ... 7 25. Premature Birth 5 ... 1 6 6 ... ... ... ... ... 26. Atrophy, Debility and Marasmus 2 ... ... ... 2 1 2 ... ... 5 3 1 5 27. Other causes 1 ... ... 1 1 ... 7 Totals 19 4 2 1 26 9 8 6 5 54 Want of Breast Milk has been included under No. 26, Atrophy and Debility. Net Births in the year legitimate illegitimate M. 600 F. 562 M. 30 F. 46 Net Deaths in the year of legitimate infants illegitimate infants M. 22 F. 20 M. 8 F. 4 No. 1 (Town). No. 2 (Belsize). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). No. 3 (Adelaide). CAUSES OF DEATH. Total. ... ... ... ... ... 1. Small-pox ... ... ... 2. Chicken-pox ... ... ... ... ... ... ... ... 3. Measles ... ... ... ... ... ... ... ... 1. Scarlet Fever ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... 1 ... 1 1 ... 3 6. Diphtheria and Croup ... ... ... ... ... ... ... ... 7. Erysipelas ... ... ... ... ... ... ... ... 8. Tuberculous Meningitis ... ... ... ... ... 1 ... 1 9. Abdominal Tuberculosis ... ... ... ... ... ... ... ... 10. Other Tuberculous Diseases ... ... ... ... ... ... ... ... 11. Meningitis (not Tuberculous) ... ... ... ... ... ... ... ... 12. Convulsions ... 1 ... 1 ... ... ... 2 13. Laryngitis ... ... ... ... ... ... ... ... 14. Bronchitis ... ... ... ... ... 1 ... 1 15. Pneumonia (all forms) ... ... 2 2 3 1 8 ... 16. Diarrhœa , i . A. ' : 1 1 1 4 1 8 17. Enteritis ... ... 18. Gastritis ... 1 ... 1 ... ... ... ... 19. Syphilis ... ... ... ... ... ... ... ... 20. Rickets ... ... ... ... ... ... ... ... ... ... 21. Suffocation, overlying ... ... ... ... ... ... 2 22. Injury at Birth ... ... 1 ... 1 4 ... 23. Atelectasis ... ... ... ... 1 ... 1 24. Congenital Malformations 1 ... 1 1 ... 2 2 7 25. Premature Birth ... 1 ... ... ... 2 3 6 26. Atrophy, Debility and Marasmus 2 5 3 ... ... ... 27. Other causes 1 1 1 ... 1 2 7 1 6 6 3 16 11 54 6 Total Deaths 6 164 156 141 90 215 333 139 1238 Total Births Want of Breast Milk has been included under No. 26, Atrophy and Debility. Table showing deaths and death-rates of legitimate and illegitimate infants:— Legitimate Infants. Death rate per 1000 legitimate births. Illegitimate Infants. Death-rate per 1000 illegitimate births. Year. Deaths. Births. Deaths. Births. 1910 10 71 57 36 278 1,233 1911 76 37 11 297 1,239 94 1912 1,207 68 56 74 11 149 58 1913 1,252 73 73 18 246 1914 1,218 77 55 254 63 14 1915 1,246 82 65 81 19 234 1916 1,088 76 8 105 65 59 1917 1,052 74 70 71 16 225 1918 797 56 70 98 13 132 1919 1,039 117 162 77 74 19 1920 1,478 62 88 13 148 42 71 1921 1,259 56 83 17 205 1922 1,210 59 49 80 13 162 1923 42 36 76 12 158 1,162 Table showing deaths and death-rates of infants and of children under five years of age:— Deaths of Infants under 1 year of age. Deaths of Children under 5 years of age. Year. No. Rate per 1000 births. No. Rate per 1000 children born in the year and in preceding four years. 1910 81 60 132 19.2 82 1911 105 152 22.7 1912 79 62 131 19.8 1913 91 69 149 22.7 1914 91 72 129 20.0 1915 101 76 144 22.2 1916 73 62 94 14.7 1917 90 80 122 19.6 1918 69 77 109 18.8 1919 96 83 120 21.2 1920 75 48 101 17.1 1921 88 65 126 20.7 1922 72 56 106 16.9 1923 54 44 71 10.8 The following table, taken from the statistics of the Registrar- General, shows the Infantile Mortality in the Metropolitan Cities and Boroughs, the County of London, and England and Wales during the 52 weeks ended 29th December, 1923:— Deaths under 1 year per 1000 births. District. Hampstead 42 St. Pancras 63 Woolwich 43 Fulham 63 Lewisham 45 Hammersmith 63 Westminster, City 46 Islington 66 Stoke Newington 48 Paddington 68 Battersea 48 St. Marylebone 68 Wandsworth 52 Southwark 68 Chelsea 55 Bethnal Green 69 Camberwell 56 Kensington 71 Deptford 58 Bermondsey 73 Hackney 58 Holborn 76 Lambeth 58 Shoreditch 80 59 London, City 81 Poplar Finsbury 60 County of London 60 England and Wales 69 Greenwich 62 63 Stepney 15 Tuberculosis. Information concerning deaths from Tuberculosis will be found on pages 28 and 29. Measles. This disease is compulsorily notifiable in Hampstead under the Borough of Hampstead (Measles) Regulations, 1920. During 1923, 209 cases were notified and 2 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 Four deaths were due to Whooping Cough in 1923. Diarrhœa and Enteritis. Nineteen deaths at all ages from Diarrhoea and Enteritis occurred in 1923, of which 10 took place among children under two years of age. Principal Epidemic Diseases. All of these, with the exception of whooping cough, are notifiable diseases, and information concerning them is set out in Section 3 of this Report. The deaths from the principal epidemic diseases in recent years are as follows:— Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Year. Diphtheria .. .. 5 2 .. 1919 7 1920 2 .. 8 4 6 5 1921 1 4 6 35 .. 5 1922 3 .. 6 2 2 19 1923 2 .. 8 2 1 4 In addition to the foregoing, a brief mention of the following may be of interest:— 16 Cancer. The following Table gives the number of deaths from Cancer in each of the years 1914—1923:— No. of Deaths from Cancer. Year. 1914 114 1919 123 - - 1915 118 1920 120 - - 1916 113 1921 134 - - 1917 107 1922 135 - - 1918 105 1923 158 - - Of the fatal cases, 97 were females and 61 males. In 75 cases the persons were over 65 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 males. The anatomical distribution of the deaths in each sex was as follows:— Total. Males. Situation. Females. 3 Oesophagus 4 7 6 Stomach 14 20 7 Liver and Gall Bladder 4 11 7 Intestines 3 10 20 Rectum 10 30 Uterus - 12 12 Breast - 18 18 5 Ovary - 5 Other organs 19 26 45 61 97 158 Totals In view of the great and increasing amount of suffering and death due to this disease and the public concern at its prevalence, the Ministry of Health on 14th August, 1923, issued a very interesting and important Memorandum on the subject of Cancer. This Memorandum was drafted by the Departmental Committee on Cancer, appointed by the Minister of Health, who has also directed the medical intelligence service of the Ministry to keep in touch with developments of Cancer investigation. The Ministry also undertakes the prosecution of researches of an epidemiological and statistical character, both at home and internationally, in regard to Cancer. The Memorandum 17 points out that it is unnecessary, in view of the foregoing remarks, to state that the Ministry of Health, as the central public health authority in England and Wales, is fully alive to the importance of this subject. In the present state of our knowledge we do not possess any specific means of producing immunity against Cancer, as we have against Smallpox, nor have we any specific means of curing the disease as in the cases of Malaria and Syphilis. In all these directions much valuable research work is being done. On the subject of the extent of Cancer mortality and its increase, it may be stated that in the space of two generations the recorded mortality has trebled. It has long been matter for discussion to what extent this increase has been due to improved diagnosis and more accurate certification of cause of death. There can be little doubt that these factors have been contributory, but unfortunately it has now to be recognised that they will not account for the whole of the recorded increase. An increase of mortality attributed to Cancer is the common experience of modern civilisation. The frequency with which different parts of the body are attacked by fatal Cancer differs greatly in different countries. In this country the tendency is for deaths from Cancer to occur later in life than formerly, and this change has been going on, at least amongst females, for many years. The most rapid increase is occurring in extreme old age. With regard to proclivity to Cancer, in a broad sense, liability to this disease is not an attribute to any particular social class, profession, or occupation. It is to be inferred, therefore, that the occurrence of Cancer depends, to an important degree, on personal predisposing factors, but hereditary predisposition has not at present been proved to be of any practical importance. The Memorandum further points out the following : —That it cannot be asserted with scientific authority that the use of any particular article of food increases the liability to Cancer or prevents it from appearing; that no known drug or preparation will prevent its appearance or cure it when present; and that no danger of Cancer has been proved to result from inhabiting houses or districts in which Cancer happens to have been exceptionally common; and there is no evidence to show that Cancer is an infectious or contagious disease. Although, so far, we have no "scientific authority" in support of the preceding statements, which are more "negative" than " positive," it must be remembered that our limited knowledge does not warrant any dogmatic statement on these points. 18 On the question of chronic irritation as a determining factor in the appearance of Cancer, one certain fact is that it frequently follows on chronic or prolonged irritation. Not all tissues, however, are equally liable in this respect, hut the liability of Cancer to follow chronic irritation of many different types is remarkable, and leads to the supposition that beneath them all there lies some common factor — as yet unrecognised—which is fundamental to the passage of a chronic inflammatory and non-cancerous condition into one that is definitely cancerous. As regards the preventive treatment of the disease there are at least some provocative causes which can be guarded against. Since Cancer occurs more commonly in certain sites, it is prudent to notice and remove causes of chronic irritation in these sites. Apart altogether from Cancer, people should attend to these conditions in the exercise of common care for their general health and fitness. In this category, for example, and for reasons just given, come the removal of rough stumps of teeth or replacement of badly fitting dentures; a change of habit if pipe-smoking is found to produce soreness on the same spot of the lip or tongue; an alteration of clothing which causes irritation of particular regions of the body—for example, the breast; the avoidance of constipation and other like matters, On the same basis the possibility of establishing a chronic irritation in a region liable to Cancer gives an additional reason for obtaining advice and treatment in disorders of the stomach, bowels, etc. Since early diagnosis obviously depends upon co-operation between doctor and patient, medical advice should be sought at once by those who experience any abnormality likely to indicate the occurrence of Cancer, or which may be the precursor of the disease. Above all, sufferers should not waste time or money by trying quack remedies, which at best are useless, and at worst aggravate the disease. The Public Health Committee having considered the Memorandum of the Ministry, resolved that a copy should be sent to every doctor practising in the Borough, and I have been favoured with the opportunity of discussing the question with the Local Branch of the British Medical Association. This was with the view of eliciting from the practitioners if they were of opinion that any action or co-operation between the practitioners and the Borough Council would 19 be of any help in combating the disease. The matter was fully discussed, and briefly the opinion of the meeting was as follows:— That the only action of the nature indicated above likely to be of any utility was propaganda and the spreading of information regarding the disease among the medical profession and the public. The matter is still under discussion, and at least one powerful voluntary body has offered to co-operate. Deaths from Violence (excluding Suicide). 24 deaths were classified under this heading as compared with 22 in 1922. The causes of death were as follows:—3 due to murder, 8 to being knocked down or run over by motor vehicles, 1 to drowning, 11 to falls, and 1 to burns. Suicide. 21 persons committed suicide, as compared with 12 in 1922. The causes of death were as follows:—Gas poisoning, 7; drugs, 5; revolver or pistol shot, 2; under trains, 3; jumping out of window, 2; drowning, 1; cut throat, 1. Venereal Diseases. Under the terms of the Public Health (Venereal Diseases) Regulations, 1916, the London County Council is the Authority for the Administrative County of London (excluding the City). There is a Local Propaganda Committee in the Borough which seeks by means of lectures, and in other ways, to combat the evil. The problem is a most difficult one, and there are several aims to be kept in view, such as:—(a) The cure of the sufferers; (b) The dissemination of information concerning the diseases. But while methods are being discussed, and measures applied that do not adequately deal with the situation, the diseases are being carried down from one generation to another, and although I agree that notification in the present state of public opinion is neither practicable nor advisable, still, I think that eventually some form of notification must be adopted. Until public opinion is so moulded, I am of opinion that more good is likely to accrue from propaganda than from any other action. 20 Section 3. Notifiable Diseases during the Year. The following is a list, alphabetically arranged, of the diseases which were compulsorily notifiable in Hampstead during 1923:— Ophthalmia Neonatorum Anthrax Cerebro-spinal Meningitis, acute Plague Pneumonia, acute influenzal or acute primary Cholera Continued Fever Polio-Encephalitis, acute Polio-Myelitis, acute Diphtheria Dysentery Puerperal Fever Relapsing Fever Scarlatina Encephalitis Lethargica, acute Enteric Fever Scarlet Fever Small-pox Erysipelas 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 Cholera Polio encephalitis, acute Continued Fever Relapsing Fever Dysentery Smallpox Glanders Trench Fever Hydrophobia Typhus Fever. Membranous Croup I am glad to have this opportunity of stating how much I appreciate the cordial co-operation of the medical practitioners of Hampstead with the work of the Public Health Department. Most of the cases of infectious disease that are removed for isolation, are sent to hospital by the doctors, thus effecting a considerable saving of 21 valuable time, which must of necessity be lost if removal is left until the Sanitary Authority becomes aware of the existence of the case. During the year the expert of the London County Council and myself have on several occasions been called in to see doubtful cases of small-pox. None, however, proved to be small-pox. That the local medical profession should thus be in harmony with the preventive work of the Council is a matter for congratulation, for preventive and curative medicine cannot be divorced from each other without great loss to both services. The tendency in recent years for the public health service to include special branches of work which, while preventive, yet of necessity trenches upon the curative also, has been met in Hampstead without friction between the practitioners and the Council. As an instance of this I would refer specially to the Municipal Tuberculosis Dispensary and to the Specialist in charge, whose valuable work, both preventive and curative, is carried on in complete accord with the general practitioners. Notifiable Diseases during the Year. Total Cases Notified in each Ward. Total cases notified in age-periods. Total deaths in age-periods. Cases admitted to Hospital. At Ages—Years. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). At all Ages. At all Ages. NOTIFIABLE DISEASES. 65 and over. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 15. 45 and under 65. Under 1. 5 and under 10. 15 and under 20. 20 and under 35. Under 1. 2 and under 3. 3 and under 4. 4 and under 5. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 10 and under 15. 1 and under 2. 1 1 1 Cerebro-spinal Meningitis, acute 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 85 1 3 4 5 26 14 11 15 4 1 1 18 18 7 5 18 16 3 85 8 1 2 1 3 1 .. .. .. .. ... Encephalitis Lethargica, acute 5 2 1 2 2 1 2 4 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever (including Paratyphoid) 4 3 3 7 2 1 10 1 1 5 2 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 22 3 7 9 3 2 3 5 1 1 8 2 7 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 1 1 Malaria 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. †Measles 209 8 10 11 9 16 93 36 11 12 3 45 57 10 32 30 27 8 10 2 1 1 .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 1 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 8 .. .. .. .. .. .. .. .. .. .. .. .. .. 48 2 1 3 2 3 7 12 9 2 8 2 6 15 7 7 11 2 Pneumonia 9 .. .. .. .. .. .. .. .. .. .. .. Polio Myelitis, acute 2 2 2 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 5 1 3 1 1 1 .. 4 .. .. .. .. .. 3 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 25 Scarlet Fever 172 2 8 12 18 64 34 14 14 5 1 37 35 10 16 38 11 153 1 1 .. .. .. .. .. .. .. .. .. .. 561 10 14 23 25 39 189 87 39 62 36 22 15 113 126 36 63 83 106 34 278 28 .. 1 3 1 1 5 1 .. 3 † Compulsorily notifiable in Hampstead under the Borough of Hampstead (Measles) Regulations, 1920. 23 In view of the housing problem that exists, it is obvious that the domestic overcrowding must have an adverse influence on the incidence of notifiable diseases. To take, for instance, one-roomed tenements in the Borough. At the Census of 1921, there were 153 cases in which 3 persons lived in such tenements, 49 cases in which 4 persons so lived, 18 cases where 5 persons were housed in one room, and a few other cases where the crowding conditions were worse. In the course of our investigations we have found as many as 8 persons, 2 adults and 6 children, living and sleeping in one room. In two-roomed tenements, there were 168 cases in which 5 persons lived in such tenements, 94 cases in which 6 persons so lived, 40 cases in which 7 persons were housed in two rooms, and a few other cases where the crowding conditions were worse. It is possible that in many of these instances the persons all slept in one of their two rooms, the other room being used as a living room and kitchen. Much the same state of affairs obtains in tenements comprising more rooms than those already quoted. It is fairly obvious that a person sickening with an infectious disease will more readily infect others in such circumstances, and especially is this so when the disease is one that principally affects young children. To the cost of housing and kindred schemes for improving the health of the populace must be added the cost of the maintenance of extra cases of infectious diseases which might not have occurred but for the way in which the population is crowded together. Ophthalmia Neonatorum. The following information relating to this disease is given at the special request of the Ministry of Health. The mother of the one case notified had not attended at the Borough Council's Pre-Maternity Clinic. 24 Total cases notified by medical practitioners 1 „ „ midwives — Number treated at home 1 „ in hospital — Vision unimpaired 1 „ impaired — Total Blindness — Number of Deaths — Small-pox. No case was notified during the year. Vaccination. Of the total births dealt with in 1923, by the Vaccination Officer, amounting to 1370, 767 were successfully vaccinated. In 3 cases the children were insusceptible of vaccination. In regard to 211, certificates of Conscientious Objection were obtained; 38 died before vaccination was performed; 27 cases of vaccination were postponed and 324 remained to be dealt with. I am indebted to the Vaccination Officer for these statistics. Tuberculosis—Notification. During the year 1923, 124 new cases of Tuberculosis were notified, 88 being cases of Pulmonary Tuberculosis, and 36 other forms of the disease. The following statistical table, prescribed by the Ministry of Health, gives an analysis of the newly notified cases and deaths during 1923:- Tuberculosis. Total New Cases in age-periods notified for the first time in 1923, Total New Cases Notified in each Ward. Cases admitted to Hospital. Total Deaths in age-periods of Old and New Cases. At Ages—Years. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No 6 (Kilburn). Ward No. 7 (Priory). At all Ages. 65 and upwards. Under 1. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 25. 25 and under 35. 35 and under 45. 5 and under 10. 10 and under 15. 20 and under 25. 25 and under 35. 35 and under 45. 55 and under 65 65 and upwards. 1 and under 5. 45 and under 55. 55 and under 65. Under 1. 1 and under 5. 15 and under 20. 45 and under 55. - 3 8 15 12 7 3 6 7 5 2 7 13 8 29 33 4 1 6 9 8 5 - - - - — - - - - 1 1 6 14 9 6 1 2 7 6 6 7 7 4 30 18 1 6 7 3 1 1 - - - 3 - - - - - 2 - 6 6 2 - 2 1 1 1 3 4 1 2 2 6 3 12 2 1 1 - — - - - - - - - - 1 3 2 4 1 1 1 2 5 1 3 5 1 7 5 1 1 2 1 - - - - - - - - - - - - 1 6 9 3 6 20 31 24 15 5 4 21 18 12 10 16 31 16 78 58 1 1 5 4 12 16 12 6 1 - - A reference to the question of efficiency of Notification of Tuberculosis will be found in the followiog page. Of the new cases notified in 1923:— Pulmonary. Nonpulmonary. 5 5 were dead or dying at time of notification. 3 7 were patients in hospitals. 2 — „ sanatoria. 5 1 infirmaries. 2 1 „ institutions. 6 - removed from Hampstead almost immediately after notification. 5 3 were out-patients of hospitals. 14 7 were attended by private doctors only. 46 12 attended the dispensary. 88 36 From this analysis it will be seen that nearly half the number of notified cases actually attended the Dispensary, while others were dealt with by the Tuberculosis Medical Officer elsewhere. The deaths of non-notified cases of Tuberculosis numbered 6, and the total tuberculosis deaths 58; the ratio of non-notified tuberculosis deaths to total tuberculosis deaths being 1 in 9. It is imperative that the advanced and highly infectious case should be removed from its close association with other people, and an institution for such cases is still a much-needed provision. An open-air school for delicate md suspected children is also very much needed. Every child, who is under observation by the Tuberculosis Medical Officer as a "suspect," should be sent to such a school until the suspicion is removed or the reason for the delicacy ascertained. The number of cases notified in recent years are as follows: — Persons newly notified. Pulmonary Tuberculosis (Voluntarily notifiable 1902; Compulsorily notifiable 1912.) Year. Non-Pulmonary Tuberculosis (Compulsorily Notifiable from Ist February, 1913). Total. 1913 244 56 300 1914 142 30 172 1915 172 48 220 1916 193 51 244 1917 256 52 308 1918 291 70 361 1919 165 48 213 1920 118 53 171 1921 103 55 158 1922 101 34 135 1923 124 88 36 At the present time 88 discharged soldiers suffering with tuberculosis are resident in Hampstead. The number of cases of tuberculosis known to the Department at the end of 1923 totals 895—648 pulmonary and 247 non-pulmonary. Occupations. The following is an analysis of the occupations of the new cases notified as tuberculous during 1923:— Occupation. Pulmonary Cases. Non- Pulmonary Cases. Army Pensioners 9 1 Artists 1 — Butchers 1 — Carmen 1 — Chauffeurs 3 — Civil Servants 1 — Clerks 9 2 Commercial Travellers 1 — Domestic Servants 13 3 Dressmakers 1 1 Electricians 2 — House Painters 1 — Housewives 13 1 Laboratory Assistants — 1 Labourers 1 — Laundry Proprietors 1 — Lecturers — 2 - - Line Etchers 1 — Medical Practitioners 1 — Merchants 1 1 Plasterers 1 — Porters 1 — Road Sweepers 1 - Scholars 1 11 Secretaries 2 — Shop Assistants 5 1 Students 2 - Sisters of Mercy 1 — Teachers 2 — Telegraphists 1 — Vulcanisers - 1 Washers 1 — No occupation 9 10 No Information - 1 88 36 Of the 88 cases of Pulmonary Tuberculosis newly notified in 1923:— 26 were treated at Sanatoria 13 insured 13 non-insured 15 „ Poor Law Institution 11 „ 4 „ 27 „ Hospitals 14 „ 13 „ 5 „ Nursing or other Homes All non-insured Of the 36 cases of Non-pulmonary Tuberculosis newly notified in 1923:— 9 were treated at Sanatoria 1 insured 8 non-insured 5 „ Poor Law Institution 1 „ 4 „ 10 „ Hospitals 3 „ 7 „ 2 „ Nursing or other Homes Non-insured. The following cases, notified prior to 1923, were also removed. Pulmonary. Insured. Non- Insured. Non-Pulmonary, Insured. Non- Insured. To Sanatoria 6 4 1 1 To Hospitals 7 2 - - To Poor Law Institutions 3 4 2 2 To Nursing or other Homes — 2 — — Deaths. The number of deaths from Tuberculosis in 1923 was 58. Of these, 51 were due to Pulmonary Tuberculosis and 7 to other forms of Tuberculosis. The deaths from Pulmonary Tuberculosis and from all forms of Tuberculosis during 1923 were distributed among the wards as follows:— Total deaths from All Forms of Tuberculosis. Deaths from other Forms of Tuberculosis. Deaths from Pulmonary Tuberculosis. Area (Acres). Ward. No. 1 (Town) 686 10 1 11 „ 2 (Belsize) 271 10 10 - „ 3 (Adelaide) 325 6 2 8 „ 4 (Central) 312 5 1 6 „ 5 (West End) 247 8 8 - „ 6 (Kilburn) 10 195 7 3 „ 7 (Priory) - 229 5 5 The Borough 2,265 51 7 58 29 Pulmonary Tuberculosis. The following table shows the age distribution of persons dying from Pulmonary Tuberculosis in recent years: — Age Period. All Ages. Year. 0-5 5—15 15—25 25—65 65— 1913 5 49 1 4 39 - 1914 2 10 42 3 57 - 1915 1 7 37 3 48 - 1916 4 11 37 3 55 - 1917 21 47 1 69 - - 1 1918 1 11 59 3 75 1919 1 13 39 3 56 - 1920 2 8 27 4 41 - 1921 2 10 47 4 63 - 1922 1 10 37 2 50 - 1923 6 45 - 51 - - Totals 1 15 111 456 31 614 Non-Pulmonary Tuberculosis. The age distribution of persons dying from Non-Pulmonary Tuberculosis in 1923 is as follows:— Under 1 year 1 2—5 years 1 15—25 „ 3 45—65 „ 1 65—75 „ 1 Prevention, Treatment, &c. Staff engaged on Tuberculosis Work. —The staff specially engaged on work directly connected with Tuberculosis consists of the following:— 1.—Administrative Tuberculosis Medical Officer; 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 Appendix I. 3.—Lady Sanitary Inspector, the major portion of whose time is occupied in visiting cases, inspecting home conditions, etc. 30 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 first meeting of the new Committee was held on 28th February. The Rev. H. J. Marshall, M.A., was elected Chairman and Mr. Councillor T. Hancock Nunn, M.A., Hon. Secretary. The following form the Committee:— 6 members of the Borough Council. 5 members of the Hampstead Council of Social Welfare. 2 members representing the London County Council. 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. The Medical Officer of Health The Tuberculosis Medical Officer Ex-Officio. The Lady Sanitary Inspector (Tuberculosis Health Visitor) At its meeting on 20th December, 1923, the Borough Council agreed, subject to the approval of the Ministry of Health, to add to the Care Committee a representative of the local ex-Service Benevolent Committee, through whom grants are available from the United Services Fund for ex-Service men and their families suffering from tuberculosis. The Care Committee is required to furnish to the Borough Council quarterly reports (or more often if required) including statistics and statements of cases helped, &c., and as to attendances of such of its members as arc Councillors. The Borough Council makes a small grant towards the expenses of the Committee. 31 Separate Beds and Shelter for Tuberculous Patients. In pursuance of the authority contained in the Public Health (Prevention and Treatment of Disease) Act, 1913, the Borough Council supply on loan single beds and bedding in order to effect the separation of infectious cases of tuberculosis. The usual practice is to arrange for the double-bed previously used to be sold, and a single bed to be provided in lieu thereof. Thus, by the Council loaning a separate bed, two single beds are provided instead of one double-bed. The Council have purchased and loaned out six beds and sets of bedding. In addition, the Shelter with its bed 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 1923 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 Hampstead 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. The Borough Council subsidises the work of the Associations. (b) For Infectious Diseases. By arrangements made between the two Nursing Associations and the Borough Council, whereby the Council contribute towards the expenses of the Associations, nurses are available for cases of Measles, Whooping Cough, Epidemic Diarrhœa, Ophthalmia Neonatorum, Acute Primary or Acute Influenzal Pneumonia, Influenza, Malaria, Dysentery or Trench Fever. During 1923, 14 cases were nursed under this arrangement by the Kilburn and West Hampstead District Nursing Association, and 7 by the Hampstead District Nursing Association. 32 (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. During 1923, 48 cases were thus nursed by the Kilburn and West Hampstead District Nursing Association, and 17 by the Hampstead District Nursing Association. Midwives. The total number of midwives practising in Hampstead is 27. 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 so as not to undercut the practising midwives. During 1923, 96 cases were attended by the Midwives of the Kilburn and West Hampstead District Nursing Association, and 3 by the Hampstead District Nursing Association. Clinics and Treatment Centres. Maternity and Child Welfare Centres (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 Thursdays at 10 a.m. The Report of Dr. Mary Kidd, the Medical Officer in charge of of Pre-Maternity Clinics will be found in Appendix II. Work of the Borough Council Health Visitors. The following table gives a record of the work of the Borough Council Health Visitors, who work in conjunction with the Infant Welfare Centres of the Hampstead id Council of Social Welfare, in 1923: — 33 Number of first visits to expectant mothers 143 „ re-visits „ „ 129 „ infants under one year visited the first time 941 „ re-visits to infants under one year 1590 „ visits to children over one year 2178 „ visits re infant deaths 51 „ „ infectious disease 673 „ „ verminous conditions 9 „ verminous conditions reported by London County Council 63 „ attendances at Infant Welfare Centres 299 „ „ Borough Council's Dental Clinic 51 „ „ „ Pre-Maternity Clinics 152 „ complaints investigated 10 „ applications for assistance investigated 138 „ unclassified visits 240 Total 6667 Milk (Mothers and Children) Order, 1919. The number of families helped at any one time by the Council during the year under this Order varied from 43 to 73. The cost to the Borough Council was £309 for milk and £168 for other food. This figure does not include administration expenses. The help that has been afforded under the scheme in force for administering this fund has been of great assistance to poor famlie s Milk or food is granted either free, or at half cost, to expectant and nursing mothers and infants under three 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 Council. 34 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 1923. Maternity Tuberculosis. Number of Sessions held 51 44 Patients Attendances 387 25 Number of Fillings 71 6 Number of Scalings 50 2 Number of teeth extracted 342 16 With Gas 29 4 Extraction cases With Local Anæsthetic 85 1 Without Anæsthetic — 1 Number of Dentures (including repairs) 39 3 Number of Dressings and Root treatment . 11 1 Number for Advice 47 4 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 beds 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. 75 Hampstead women were confined in Queen Charlotte's Hospital in 1923. 35 The Council, on 22nd March, agreed to arrangements being made with St. Mary's Convalescent Home, Birchington-on-Sea, Kent, for the admission of 4 convalescent mothers and infants, or mothers alone. 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 1923, 23 children were sent to that Institution under this arrangement, the Borough Council paying the Hospital a fixed rate per bed per week, and the patients being asssesed according to their means. (4) Fever (5) Small-pox (6) Other, e.g., Diphtheria, Inst itUtional Provision. For Unmarried Mothers For illegitimate Infants Ambulance Facilities. (a) For infectious cases. ( b) For non-infectious and accident cases Provided by the Metropolitan Asylums Board ditto There are Homes, one for each of these, established in the Borough by Voluntary Committees. The Borough Council makes a grant towards the expenses of the Foster Home for Illegitimate Infants. Provided by the Metropolitan Asylums Board. The Ambulance of the Hampstead General Hospital, and those of the St. John's Ambulance Association are available. The Ambulances of the Metropolitan Asylums Board are also available upon due notice being given. 36 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:— Positive. Negative. Total. Diphtheria 22 302 324 Enteric Fever — 2 2 Specimens of Sputum 59 240 299 35 X-Ray Examinations were made. Diphtheria Anti-toxin is obtainable at any hour by day or night from the Town Hall, and also from the North-Western Fever Hospital, Lawn Road. During 1923, 219,000 units were supplied from the Public Health Department Section 7. Sanitary Administration. List of adoptive Acts, Bye-l ates, 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. Tabular summary of the work of the Sanitary Department during 1923. Total number of Inspections, 6111. Re-inspections, 11387. „ Intimation Notices, 925. Statutory Notices 704. 37 Total number of deposits of plans and particulars for redrainage work, &c., 635. „ Complaints of insanitary conditions received and investigated, 754. The following Statement and Information under Article 19 of the Sanitary Officers' Order, 1922, 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) 625 Dampness in houses or parts of houses abated 255 Dilapidated „ „ „ repaired 611 Overcrowding— Rooms found overcrowded 3 Overcrowding abated (rooms) after service of notice 3 „ „ without service of notice — Underground Rooms — Found illegally occupied 21 Closed, illegal occupation discontinued, or made to conform 21 Below Floors— Spaces below floors in the basement or ground floors ventilated 141 Roofs — Roofs repaired 344 Gutterings— Gutterings repaired or renewed 340 Rainwater Pipes— Rainwater pipes repaired or renewed 477 „ „ disconnected from drains 100 „ „ „ „ soil-pipes 4 38 Waste Pipes— Waste pipes of sinks disconnected from drains 2 trapped 407 „ „ repaired or renewed 240 „ „ unstopped 4 of lavatories disconnected from drains 2 „ „ trapped 339 „ „ repaired or renewed 227 unstopped 2 „ of baths disconnected from drains 13 „ „ trapped .. 240 „ „ repaired or renewed 166 „ „ unstopped 4 Water Supply— Water supply re-instated 11 Water, certificates issued for new houses, Sec. 48, Public Health (London) Act, 1891 6 Additional water supply provided to tenement houses 48 No. of tenement houses dealt with 40 Additional sinks provided to tenement houses 65 No. of tenement houses dealt with 50 Sinks provided (in addition to above) 255 Lavatory basins provided 221 Baths provided 168 Water Cisterns— Water cisterns repaired or renewed 10 ,, removed from improper positions 23 „ cleansed 80 „ fitted with close fitting covers 31 Water Closets — Water closet accommodation provided 6 Additional water closet accommodation provided 67 Separate and sufficient provided for each sex 1 Water closets removed from improper positions 19 „ provided with proper and sufficient external ventilation 48 Improperly constructed water closet apparatus removed and new provided 16 39 Water Closets—continued— Water closet apparatus repaired or renewed 514 unstopped 1 „ „ cleansed 4 „ „ provided with proper water supply 39 „ flushing cisterns repaired or renewed 327 Drains— Drains repaired or renewed 537 „ cleansed 81 „ unstopped 50 „ ventilated 71 Manholes— Manholes repaired or renewed 315 Ventilating Pipes— Ventilating pipes of drains repaired or renewed 49 Fresh air inlets repaired or renewed 124 Soil Pipes— Soil pipes repaired or renewed 249 „ ventilated 15 Gullies and Surface Drains— Gully traps removed from improper positions 45 „ cleansed 5 Inlets or surface drains trapped 22 Paving and drainage of Washhouses, Areas, Yards, &c. — Washhouse or scullery paving repaired or renewed 23 Areas cleansed 14 Area paving repaired or renewed 190 Areas drained 48 Yards or other open spaces paved 105 Paving of yards or other open spaces repaired or renewed. 222 Yards or other open spaces drained 67 Buildings in which horses, &c, are kept; floors paved or repaired 1 Refuse and Receptacles— Dust bins provided 569 Fixed ashpits removed 3 Accumulations or deposits of refuse removed 780 Manure receptacles amended 2 Nuisances from the improper deposit of trade refuse abated 1 40 Animals- Nuisances from the improper keeping of animals abated 6 Smoke Nuisances— Number of nuisances and complaints 5 „ of observations 20 „ of notices 1 „ of summonses — Personal Cleansing— Number of cleansings of adults 23 „ of cleansings of children 1017 Cleansing— Number of verminous rooms cleansed 36 Disinfection- Number of houses or parts of houses and contents disinfected 1352 „ of verminous rooms disinfected 23 „ of persons accommodated at Shelter — Customs and Inland Revenue Acts— Number of houses for which certificates requested 2 „ of dwellings contained therein 5 „ of houses certified 1 „ of dwellings contained therein 2 Public Mortuary— Number of bodies admitted 60 Increase of Rent and Mortgage Interest (Restrictions) Acts— Number of certificates applied for 47 „ „ issued 33 In addition to the foregoing; a summary of the work of the Housing Inspectors will be found in Section 9 relating to Housing. Underground Rooms. The required standard to which such rooms must conform, if separately occupied, is prescribed in the Public Health (London) Act, 1891, and if used habitually for sleeping purposes in the Regulations made by the Borough Council under the Housing Act, 1909. In the latter part of the year a special inquiry was made, at the request of the London County Council, into the question of these rooms, and the following information was elicited:— 41 Number of basements used for dwelling purposes 4,313 „ basement dwellings with ceilings at or below street level 126 „ „ in which the width of area in street does not exceed 3 feet 3,031 „ „ in which the width of area in street does not exceed 4 feet 519 „ „ which have been made to conform to the requirements of Sec. 96, Public Health (London) Act, 1891 616 Drainage Bye-laws. Amending bye-laws made by the London County Council on 23rd October. 1923, were confirmed at a subsequent meeting of the County Council held on 30th October, 1923. These were approved by the Minister of Health on 2nd January, 1924, and after that date the following proviso to byelaw 11 in the Drainage Bye-laws, that is to say:— "Provided that in any case where it shall be necessary to construct such soil pipe within such building he shall construct such soil pipe in drawn lead with proper wiped plumbers' joints and so as to be easily accessible," was repealed and the following proviso substituted therefor:— "Provided that in any case where it shall be necessary to construct such soil pipe within such building and he shall construct such soil pipe of cast iron, he shall cause such pipe to be coated on both the inside and the outside with Dr. Angus Smith's solution or with some other equally suitable material as a preservation against corrosion," and the following proviso to bye-law 17 in the Drainage Bye-laws, that is to say: — "Provided that in any case where it shall be necessary to construct such ventilating pipe within a building he shall construct such ventilating pipe in drawn lead," was repealed and the following proviso substituted therefor:— "Provided that in tiny ease where it shall be necessary to construct such ventilating pipe within a building and he shall construct such ventilating pipe of cast iron, he shall cause such pipe to be coated on the inside with Dr. Angus Smith's solution or with some other equally suitable material as a preservation against corrosion." 42 Public Conveniences. It is very satisfactory to note that a scheme for the provision of the much needed convenience for women in or near the High Road, Kilburn, has been adopted by the Borough Council after protracted negotiations with the London County Council and the Willesden Urban District Council, which latter Authority has agreed to pay halt the cost of election and maintenance. A site has been obtained abutting upon "Grangeway," just off the High Road. The Borough Council has also adopted two other schemes, one for providing accommodation for men and women at West End Green; and one for men only and the Cemetery staff at Fortune Green. The question of the provision of a convenience for women near the Finchley Road Metropolitan Railway Station, and one for both sexes at Chalk Farm is under consideration. A certain amount of limited accommodation for women has been provided by the London County Council in an enclosure at the top of Heath Street, near the White Stone Pond, which will be greatly appreciated by visitors to Hampstead Heath. Public Mortuary. During the year the bodies of 60 persons were brought to the mortuary —39 by order of the Coroner, 17 by the Police, and 4 at the request of friends of deceased persons. In 56 instances inquests were held, and in 46 instances postmortem examinations were made and inquests followed. The following table indicates the causes of death of the persona whose bodies were received into the Mortuary. Cause of Death or Verdict Number of Bodies received. Deaths from natural causes 31 Accidental deaths 5 Misadventure 1 Neglect at Birth 3 Suicide—Fall under train 2 Poisoning (7 gas poison) 11 Drowning 1 Cut throat 2 Pistol Shot 1 Wilful Murder 2 Felo-de-Se 1 Total 60 43 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 exterminating the vermin. 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 1923:— No. of premises on Register. No. of Inspections. No. of Notices. No. of Prosecutions. Milkshops 89 210 11 - Ice-cream Premises 68 136 2 - Restaurant Kitchens 61 164 5 - Slaughterhouses 2 20 - ˉ - ˉ Cow Sheds Nil. - - - Fried Fish Shops 11 44 3 - Offensive Trades Nil. - - - Other Food Premises 523 1348 16 - Bakehouses:— I I J I Factories— Underground 11 52 2 Aboveground 9 - Workshops— L Underground 7 36 2 11 Aboveground - Of the number of bakehouses mentioned above it will be noted that 20 are factory bakehouses and 18 are workshop bakehouses. Two new workshop (above ground) bakeries have been opened during the year: — 8a & 8b, Canfield Gardens, 68, High Street. The following bakehouses are out of use:— 110, Cricklewood Broadway (above ground). Factories 354, High Road, Kilburn (under ground). 251, West End Lane (above ground). Workshops 289, Finchley Road (under ground). 44 Butter 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. Businesses of Fried Fish Vendors and Rag and Bone Dealers. Under the terms of Sec. 114, Public Health (London) Act, 1891, and Sec. 9, London County Council (General Powers) Act, 1908, the County Council made bye-laws with respect to these businesses. As stated above, there are 11 Fried Fish Shops in the Borough. There are also 2 premises where the business of a dealer in Rags and Bones is carried on. All these premises are kept under supervision by the Food Inspector. Number and Condition of Slaughterhouses. There are now only two slaughterhouses in the Borough, viz., Nos. 17 and 69, High Street. There is no public abattoir in the Borough. New bye-laws made by the London County Council were confirmed by the Minister of Health on 7th December, 1923. These bye-laws have for their object the regulation of the business with a view to more humane procedure. Unsound Food Seized or Surrendered. The following is a list of food seized or voluntarily surrendered during the year:— Fish, 3 stone 13 lbs. mackerel, 10 stone haddock. Poultry, 3 chickens, 1 turkey. 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. The Disinfecting Station is equipped with a Washington-Lyons apparatus, with a staff of 3 men. The collection of infected or infested material is carried out by two Electric Vans. 45 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. During 1923, 1352 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. Twenty-three cleansings of adults and 1017 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. During the latter part of the year a special effort was made by the Public Health Department to render more effective the work of cleansing undertaken at the Borough Council's Cleansing Station. All families, where any of the children had been cleansed more than five times in the current year, were specially written to; and these letters advising and urging all the members of the family who might be infected (including the parents and children not of school age) to attend at the Cleansing Station were followed up by visits from the Health Visitors. The facilities of the Disinfecting Station were placed at the disposal of those families who were willing to undergo a thorough cleansing, the intention ibeing that all personal clothing, bedding, &c., should be disinfected at the same time as the cleansing, thus enabling the families to make a clean fresh start. During the few months in 1923 in which this experiment was tried, 45 families who came within the orbit of this arrangement were approached with a view to special endeavours being made to eradicate verminous conditions. In 21 cases a definite refusal was made, in someinstances a denial being made of the conditions complained of. It does not necessarily follow that those who refuse to come for treatment are the only offenders against a reasonable standard of cleanliness,for some of those who readily come to the Cleansing Station when requested, attend a far greater number of times than those who raise objections. Still,it is hoped by steady persuasion and propaganda 46 work, to inculcate into these people a desire to conform to a higher standard of cleanliness than at present obtains. Action taken with regard to Dairies, Cowsheds and Milkshops. The 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 89, comprising 43 dairies, 14 bakehouses and confectioners, 16 restaurants and coffee shops, and 16 general shops. During the year 210 inspections were made and 11 notices were served. Milk and Dailies (Amendment) Act, 1922. This Act postponed, until the 1st September, 1925, the operation of the Milk and Dairies Consolidation Act, 1915, but, in the meantime, it. imposed upon Local Authorities the obligation of compiling two new registers of milk dealers, one wholesale and one retail, and empowered them, under certain conditions, to refuse to register a retail purveyor of milk, or to remove a person already registered from the register. Section 3 authorised the Minister of Health to make Orders and issue licences in regard to the sale of milk under special designations, and the Minister accordingly issued the Milk (Special Designations) Order, 1922, prescribing the terms and conditions subject to which licences may be granted by Sanitary Authorities to distributors for the sale of milk as "Certified," "Grade A (Tuberculin Tested)," "Grade A" or "Pasteurized,"—the Order also provided for the taking of samples of milk from time to time for submission to bacteriological examination. An amending Order was subsequently issued suspending the operation of the Order relating to "Pasteurized" milk until 1st July, 1923, owing to the difficulties which appear to have arisen in regard to the installation of the necessary plant. Later, the Milk (Special Designations) Order, 1923, was issued, which came into operation on July 1st. This Order revoked the earlier Orders, and embodied certain amendments of their detailed provisions. The new Order did not, however, alter the general scheme of grading then in operation, but provided for some relaxation of the conditions under which licences may be granted for the sale of "Grade A" milk, and "Pasteurised" milk. 47 Milk (Special Designations) Order, 1923. Graded Milk. Licences for sale of Graded Milk issued, &c., during 1923. Number of Licences refused, revoked or suspended. Total number of Licences in force at end of the year. Number of Licences issued. Purpose of Licence. Observations. Distribution of "Certified" milk 28 28 .. 6 6 (Shops, not bottling establishments) .. Distribution of "Grade A (Tuberculin Tested)" milk Production of "Grade A" milk .. .. .. Distribution of "Grade A" milk .. .. .. Pasteurization of "Pasteurized" milk .. .. .. Distribution of "Pasteurized milk .. .. .. Supplementary Licences 2 2 .. The following licences were issued on the dates mentioned: — 25th January, 1923. Express Dairy Co., Ltd., for the sale of "Certified" milk and "Grade A" milk at the following premises:— 42, England's Lane 569, Finchley Road 25, Heath Street 124a, Finchley Road 242, Haverstock Hill Wildwood Dairy, North End Road Messrs. J. Richards, Ltd., for the sale of "Certified" milk at the following premises:— 41, England's Lane 96, West End Lane 68, Fortune Green Road 221, West End Lane 63, Mill Lane 277, West End Lane 27, Winchester Road 102, Finchley Road 91, Fairfax Road 309, Finchley Road 56, Belsize Lane 473, Finchley Road 28, King's College Road 83 Haverstock Hill 62, Rosslyn Hill 61, Gayton Road 76, Heath Street 7, Fleet Road 48 Messrs. Welford & Sons, Ltd., for the sale of "Certified" milk at the following premises:— 230, Belsize Road 336, High Road, Kilburn 68, Cricklewood Broadway 22nd February. G. T. Morgan for the sale of "Certified" milk at 122, Boundary Road. Supplemental licences were issued by the Council, on the dates specified, to the undermentioned firms authorising them to sell milk in the Borough from addressess outside the district, viz.: — 22nd March. Lord Rayleigh's Dairies, Ltd., 12, Great Russell Street, W.C. 1, in the Borough of Holborn. Licensed to sell "Certified" milk in Hampstead. 26th April. Manor Farm Dairy Ltd., 39, High Road, East Finchley, and 98, High Street, North Finchley, Urban District of Finchley. Licensed to sell "Pasteurised" milk in Hampstead. Action taken under the Sale of Food and Drugs Acts and the Milk and Cream Regulations. Sale of Food and Drugs Acts. The Report of the Public Analyst will be found in Appendix III. 505 samples were taken for analysis during the year. The number certified to be adulterated was 20, or 3.9 per cent, of the total number, as against 5.3 in 1922. 479 samples (18 of which were adulterated), were purchased from Hampstead tradesmen and 26 (2 of which were adulterated) from tradesmen coming from other districts. 49 The following table shows the articles of which samples were taken during the year: — Number taken. Adulterated, etc. Articles. Baking Powder 4 - Butter 44 - Cake 5 1 Cheese 11 - Cocoa 24 - Coffee 15 - Cream 39 1 Dripping 2 - Drugs 29† 7* Flour 10 - Honey 2 - Jam 7 - Lard 24 - Margarine 25 - Milk 206 2 6 Milk, Condensed - Mustard 4 - Mince-meat 4 1 Meat-paste 6 1 Pepper 7 - Rice 6 - Sausages 7 4 Spice 2 - 4 Tapioca - Tea 1 - 2 Vinegar 10 Wine 1 1 Totals 505 20 Of these 29 samples, 24 were compounded drugs prescribed under the National Health Insurance Act. The remaining 5 were not "prescription" cases. These 7 samples reported above were so inaccurately compounded that it was decided to institute proceedings. In the remaining 17 cases the degree of error varied slightly from the quantities specified in the prescription. The following table shows the articles adulterated, &c., nature of adulteration, and the results of proceedings taken: — No. of Sample. Article. How adulterated, &c. Result of proceedings. 9 Ginger Wine 3 grains salicylic acid per pint Cautioned by Borough Council. 58 Fined £2, costs, £2 2s. Drug 59 Fine £1. „ 67 Dismissed. Costs £4 4s. „ Not compounded strictly in accordance with the prescription 68 „ Dismissed. Costs £5 5s. against Borough Council. Dismissed. 110 „ 111 „ „ 112 „ „ 120 Vinegar 5 per cent, added water Fine 10s., costs £1 1s. 122 Milk 15½ „ Fine £8, costs £2 2s. 140 16 „ „ Dismissed under Probation of Offenders Act. Costs £1 1s. Wood Vinegar 154 Milk 8 per cent. deficient in fat Dismissed. Warranty proved. 236 0.24 per cent. boric acid Cautioned by Borough Council. Pork Sausages 237 Salmon & Shrimp Paste 0.3l per cent. boric acid „ 411 Cream 2 grains boric acid per lb. „ 419 57 „ „ Fine £3, costs £3 3s. Pork Sausages 435 14 „ Cautioned by Borough Council. „ 471 Madeira Cake 5 „ „ „ Mince Meat 2½ grains salicylic acid per lb. 481 „ 492 13½ grains boric acid per lb. „ Pork Sausages 51 In addition to the above, three samples of milk were reported to be of poor quality. Also two samples of margarine were sold in wrappers which were not marked in accordance with the Margarine Acts. The Ceuncil instituted proceedings against the Vendors, one was fined £1 and one guinea costs, and the other 1s. and 12s. 6d. costs. "Warranty" Defence. During 1923 one dairyman was prosecuted by the Council for selling milk 8 per cent, deficient in fat, but the "Warranty" defence was successfully proved and the summons was dismissed. Preservatives Of the samples analysed during 1923 preservatives were found to be present in ginger wine, pork sausages, salmon and shrimp paste, Madeira cake, mimcemeat and cream. The largest amount of boric acid found was 57 grains to the lb. in a sample of pork sausage. On the subject of the use of preservatives, generally, it may be stated that the Public Health Committee gave careful consideration to this matter in the early part of 1923, and in view of existing conflicting opinions as to what preservatives (if any) may be used in foodstuffs and the extent to which they may be employed, together with the widely different legal decisions arrived at on the prosecution, by various local authorities, of vendors of foodstuffs containing preservatives, the Committee formed the opinion that it was extremely desirable, in the interest both of vendor and consumer, that a definite decision as to the use of preservatives in food should be arrived at—a decision embodying a standard to be adopted uniformly— and upon their recommendation the Borough Council urged upon the Ministry of Health the importance of a Bill being introduced into Parliament to alter the Food Adulteration Acts in the following respects:— (i) To provide that notification must be given, to the purchaser, of any chemical preservative and the amount contained in any food sold for human consumption. (ii) To define what substances may be used as preservatives and the maximum amounts that may be added to foods sold for human consumption. Condensed Milk. On 1st May, 1923, the Minister of Health made the Public Health (Condensed Milk) Regulations, 1923, which came into operation on 1st November. "Condensed milk" is therein describe 1 as milk or skimmed milk which has been concentrated by the removal of part of 52 its water, whether with or without the addition of sugar, and includes the article commonly known as "evaporated milk," but does not include the article commonly known as "dried milk" or "milk powder." "Skimmed milk" includes separated or machine-skimmed milk. The Regulations prohibit the sale of condensed milk unless it (1) is contained in a tin or other receptacle labelled in the prescribed manner, and (2) contains not less than the following percentages of milk fat and milk solids:— Decription of Condensed Milk. Percentage of milk fat. Percentage of all milk solids, including fat. Full cream, sweetened or unsweetened 9.0 31.0 Skimmed sweetened 26.0 Skimmed unsweetened — 20.0 An important point in the matter of the prescribed labelling is the fact that the labels on the Condensed Machine-Skimmed Milk (or Condensed Skimmed Milk) must include the statement that the contents of the tins are "Unfit for Babies." The Borough Council has appointed the Medical Officer of Health and all the Sanitary Inspectors as Officers for the purpose of enforcing the Regulations. During the year 6 samples of condensed milk were submitted for analysis and found to comply with the label on the tins. Dried Milk. On November 5th, 1923, the Minister of Health made the Public Health (Dried Milk) Regulations, 1923, which will come into operation on 1st May, 1924. "Dried Milk" is therein described as "milk, partly skimmed milk, or skimmed milk, which has been concentrated to the form of powder or solid by the removal of water." Article 4 requires dried milk to be sold in a tin or other receptacle labelled in the manner prescribed by the Regulations, and provides that it must contain not less than the following percentages of milk fat, namely:— (i) In the case of milk described as "dried full cream milk," not less than 26 per cent. (ii) „ „ "dried three-quarter cream milk," not less than 20 per cent. 53 (iii) In the case of milk described as "dried half cream milk," not less than 14 per cent.; and (iv) „ „ "dried quarter cream milk," not less than 8 per cent. The labels prescribed are to indicate clearly that (i) is "Dried Full Cream Milk," and must state what is the equivalent of the contents in milk; and that (ii) —(iv) are "Dried Partly Skimmed Milk (¾,½ or ¼ Cream)." These latter labels must also state that the contents of the tin "Should not be used for babies except on medical advice," and must indicate what is the equivalent of the contents in pints of ¾,½ or ¼ cream milk. In the case of skimmed milk, that is to say, dried milk containing less than 8 per cent, of milk fat, the label must state that the contents are "Dried Machine-Skimmed Milk (or Dried Skimmed Milk)"; are "Unfit for babies," and must indicate what is the equivalent of the contents in pints of skimmed milk. For the purpose of these Rules the terms "Milk," "¾ cream milk," "½ cream milk," and "¼ cream milk" mean milk containing not less than the following percentages of milk fat and milk solids, that is to say— Milk Fat. Milk Solids (including fat). Milk 3.6 12.4 ¾ cream milk 2.7 11.6 ½ cream milk 1.8 10.8 ¼ cream milk 0.9 9.9 and "Skimmed Milk" means milk which contains not less than 9 per cent. of milk solids other than milk fat. It is important to note that except in the case of "Dried full cream milk," the tins must plainly show that the contents are not suitable for babies. The Borough Council has appointed the Medical Officer of Health and all the Sanitary Inspectors as Officers for the purpose of enforcing the Regulations. Public Health (Milk 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. It is no longer permitted in any case to add preservative to milk. 54 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, 1923. 1.—Milk; and Cream not sold as preserved Cream. (a) —Number of samples examined for the presence of a preservative. (b) —Number in which preservative was reported to be present, and percentage of preservative found in each sample. Milk 206 Nil. 30 Cream 1 0.03 per cent. Nature of preservative in each case in column (b) and action taken under the Regulations in regard to it. 0.03 per cent, boric acid. Vendor gave written explanation and was officially cautioned. 2.—Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the label as to preservatives were correct 9. 1. Correct statements made, 9. 2. Statements incorrect, nil. 3. Percentage of preservative found in each sample— 0.12, 0.25, 0.30, 0.30, 0.30, 0.31, 0.35, 0.35, 0.35 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., 9. 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 preserved cream, nil. (b) Action taken where found, nil. 4. —Other observations (if any), nil. Action taken with a view to Smoke Abatement. During the year, observations were made in 20 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. Miscellaneous. Factory and Workshop Acts. Section 132 of the Act of 1901 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 premises is largely controlled by the Factory and Workshop Acts; and in London by the Public Health (London) Act, 1891. For the purpose of their duties with respect to workshops and workplaces under the Acts, the Borough Council and their officers are given by section 125 of the Factory and Workshop Act, 1901, the same powers of entry, inspection, taking legal proceedings, or otherwise, as are possessed by Factory Inspectors. Under section 131 of the Act of 1901 it is the duty of the Borough Council to keep a Register of all Workshops situate within their district. 1. —Inspection of Factories, Workshops, and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) 115 Factories (Including Factory Laundries) 6 - Workshops (Including Workshop Laundries) 752 13 - 16 Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 970 - Total 1837 35 - 2.—Defects found in Factories, Workshops, and Workplaces. Particulars. (1) Number of Defects. Number of Prosecutions. (5) Found. (2) (3) Remedied. (3) (4)Referred to H.M. Inspector. (4) Nuisances under the Public Health Act:— I i Want of cleanliness 81 81 - - Want of ventilation 7 7 - - Overcrowding 5 5 - - Want of drainage of floors - - - - 43 40 3 - Other nuisances insufficient unsuitable or defective not separate for sexes 5 - - - Sanitary accommodation 10 10 - - 11 - - - Offences under the Factory and Workshop Act 1901:— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) - - - - Other offences - 3 3 - (Excluding offences relating to outwork, which are included in Part 3 of this Report) Total 165 143 6 - 3.—Home Work (Outworkers). Certain specified classes of work done at the homes of the workers are controlled by 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. *NATURE OF WORK. Outworkers' Lists, Section 107. Lists received from Employers. Sending Twice in the year.† Sending Once in the year. Lists 2 Outworkers Lists 5 Outworkers 3 Con- tractors. 4 Workmen. 6 Con- tractors. 7 Workmen. (1) Wearing Apparel- (a) making &c. 54 32 81 11 6 20 (b) cleaning and washing 6 11 1 2 2 - (2) Making-up, ornamenting, finishing and repairing of table linen, bed linen, or other household linen (including in the term linen articles of cotton or cotton and linen mixtures) and any process incidental thereto (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 4 1 2 1 - 1 (5) Cabinet and furniture making and upholstery work 2 4 2 - - - (6) Making of Electro-plat - - 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 3 - - - (9) Fur-pulling - - - - - - (10) Making of iron and steel cables and chains — — - — - - (11) Making of iron and steel anchors and grapnels - - - - - - (12) Making of cart gear, including swivels, rings, loops, gear-buckles, mullin bits, hooks, and attachments of all kinds — — — - - - (13) Making of locks, latches, and keys — - — - - — (14) Making or repairing of umbrellas, sunshades, parasols, or parts thereof - 3 5 — - - (15) Making of artificial flowers — — 1 — - - (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 — 2 - — — - (21) Making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip, or similar material 2 — 3 — — — (22) Making of brushes — — — - — - (23) Pea picking — — — - - - (24) Feather sorting — - — — - — (25) Carding, boxing, of packeting of buttons, hooks and eyes, pins, and hair pins - — — - — - (26) Making of stuffed toys — — — — — - (27) Making of baskets — — — - - - (28) Manufacture of chocolate or sweetmeats — — — — — - (29) The making or filling of cosaques, Christmas crackers, Christmas stockings, or similar articles or parts thereof — — — — — - (30) The weaving of any textile fabric — — — — — - Total 72 56 104 14 8 21 Notices served on occupiers as to keeping or sending list 3 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 may be) against the principal class only, but the outworkers have been assigned in columns 3 and 4 (or 6 and 7) into their respective classes. The figures in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year, and of the entries of names of outworkers in those lists. 36 lists were received twice in the year. The names of Outworkers that were repeated in the duplicated Returns have not been counted twice. 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 53 Milliners 18 46 Tailors Upholsterers 21 Other trades 150 Total number of workshops on Register 352 5.—Other Matters. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories: — Failure to affix Abstract of the Factory and Workshop Acts (s. 133 Act of 1901) 27 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Acts (s. 5 Act of 1901) Notified by H.M. Inspector 2 Reports (of action taken) sent to H.M. Inspector 2 Other - Underground Bakehouses (s. 101 Act of 1901) in use at the end of the year 18 Factories. The following is a list of the different classes of Factories in Hampstead:— Bakers 21 Launderers 2 Bootmakers 18 Metal Workers 2 Builders 3 Motor Makers and Repairers 19 Opticians Butchers 6 1 Carpet Beaters 2 Printers 11 Coffee Roasters 5 Wood Sawyers 3 Dairymen 4 Other trades 17 Engineers 3 117 115 inspections were made during the year and 6 notices were served. Workshops. At the end of 1923 there were 304 workshops on the Register, including 48 domestic workshops. Excluding these hitter, there were 545 males and 510 females employed in the workshops. During the year 752 inspections were made and 13 notices served. Number of Workshops. Number of Workrooms. Number of Employees. Domestic Workshops. Males. Females. Bakers 18 18 34 17 — 18 Basketmakers 2 4 40 - - 2 Blindmakers 3 4 7 2 - 3 Bootmakers 38 39 70 2 8 46 Builders and carpenters 19 24 42 — — 19 Carriage builders 2 3 4 - - 2 Confectioners 3 11 5 35 — 3 Corset makers 3 3 - 11 1 4 Dressmakers 46 51 — 165 7 53 Harness and trunk makers 5 6 19 1 - 5 Ironmongers 6 6 13 - - 6 Laundresses 3 10 4 17 — 3 Knitters 2 3 — 27 4 6 Milliners 16 18 — 44 2 18 Monumental masons 2 2 18 - - 2 Motor makers and repairers 10 17 36 - - 10 Outfitters 6 21 3 72 — 6 Pianoforte makers 2 6 54 — — 2 Picture frame makers 11 12 17 - 2 13 Photographers 7 11 3 13 - 7 Smiths and metal workers 7 7 18 - - 7 Tailors 30 35 59 36 16 46 Umbrella makers 3 5 3 3 — 3 Upholsterers & cabinetmakers 19 25 43 12 2 21 Watchmakers and jewellers 12 12 20 — — 12 Wigmakers 10 11 5 25 2 12 Miscellaneous 19 24 28 28 4 23 Totals 304 388 545 510 48 352 No. of Workrooms measured 26 Legal Proceedings. Legal proceedings were taken on certain occasions in 1923 by the Council, in connection with the Health Department, under the various Acts of Parliament and By-laws and Regulations made thereunder The fines and costs imposed were as follows:— Total number of workshops. Workshops other than Domestic Workshops. Trade or Business. 60 Statute or By-law. Fines. Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and Bye-laws made thereunder 72 10 0 126 5 6 Metropolis Management Acts, and Byelaws made thereunder 20 2 6 125 4 6 Housing Acts 2 0 0 3 3 0 Sale of Food and Drugs Acts 18 11 0 21 12 6 Total 113 3 6 276 5 6 Section 8. Public Health Staff, 1923. (Arranged according to the Ministry of Health's instructions, 15th December, 1923). Senior Sanitary Inspector: *W. G. Kershaw—Cert. Sanitary Inspectors' Examination Board. Diploma of Sanitary Inspectors Association Examination Board, and 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: Registration for Practical Plumber's Work, Worshipful Company of Plumbers: City and Guilds, Building Construction (Elem.): Plumber's Work (1st Class), and Honours: Hygiene and Phis. (1st Class), and Diploma Indenture of Apprenticeship, Plumber's Work. Wards 4 and 5 *J. Grimsley—Cert. Sanitary Inspectors' Examination Board: Royal Sanitary Institute, Meat and other Foods: Advanced Sanitary Science and Practical Plumbing: Brickwork: Masonry: Sheet Metal Workers: Building Construction, and Indenture Apprenticeship Practical Plumber. Wards 3 and 7 *W. F. Horniblow-Cert. Sanitary Inspectors' Examination Board: Royal Sanitary Institute, Meat and other Foods: and Inspector of Nuisances. Ward 6 *A. C. Townsend —Cert. Sanitary Inspectors' Examination Board and Royal Sanitary Institute, Meat and other Foods. 61 Special Housing and Sanitary Inspectors: Eastern District. *A. Peverett —Cert. Sanitary Inspectors' Examination Board: and 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 *F. H. Hudson—Cert. Sanitary Inspectors' Examination Board: and Royal Sanitary Institute, Meat and other Foods. Factory and Workshop Acts Tuberculosis Regulations *Mrs. T. Fisher—Natural Sciences Tripos, Cambridge. M.A. Trinity College, Dublin. Cert. Sanitary Inspectors' Examination Board: and Royal Sanitary Institute, Inspector of Nuisances. Diploma National Health Society. Assistants to Inspectors. W. Larken, A Edwards, E Stratton, R. Martin. Public Mortuary: Mortuary Keeper—W. Larken,63, Flask Walk. Disinfecting and Cleansing Stations: Disinfectors—T. Rider, R. Bell, W. Bell. Cleansing Station Attendant —Mrs. Blanden. Tuberculosis Dispensary: Tuberculosis Medical Officer and Assistant Medical Officer of Health for Tuberculosis Work *A. J. Scott Pinchin, m.d. (Lond.), m.r.c.p. (Lond.). Nurse—*Miss M. Lowen, Cert, for Medical and Surgical Nursing. "Registered Nurse," Nurses Registration Act, 1919. Pre-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. *Miss A. Kennedy—Health Visitor's Certificate; Children's Hospital Nursing Certificate. Public Analyst: A.W Stokes, f.c.s., f.i.c. Clerks: H. H. Lewis, C. W. Francis, *Miss E. Blakeman, R.H. Box, W. Sell. Chief Cler K—F.S. Hill. 62 Medical Officer of Health; and Administrative Medical Officer, Tuberculosis, and Maternity and Child Welfare. *Frank E. Scrase, f.r.c.s.(Eng.). l.r.c.p.(Lond.), d.p.h.(Lond.). Note.—The Medical Officer of Health and all Sanitary Inspectors are appointed as Officers under the Housing Acts. * 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. The continued scarcity of housing accommodation is not limited to Hampstead; it is common to the whole country. It is in my opinion the most pressing need of the present day, and calls for continual effort on the part of the Health Staff to ameliorate conditions; to prevent houses from becoming derelict, streets from becoming "slummy"; and to incite the people themselves to greater efforts to personal and domestic hygiene. It is safe to say that an adequate solution of the housing question is the foundation of all social progress. One cannot disassociate health from housing—they are inextrieable. We have been fairly successful in maintaining the high standard of former years in this Borough, but only by continuous and neverrelaxing pressure. There is a persistent tendency on the part of both owner and tenant to let things slide, and it is against this continuous tendency that our chief efforts must be directed. We must maintain our attack upon the insanitary areas until we improve them out of existence; but Hampstead cannot hope to do much by the actual provision of new buildings, few, if any, sites being now available in the Borough. 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 Distriet Sanitary Inspectors much of which has a direct bearing upon the better housing of the population. 63 Work accomplished by the Housing Inspectors during 1923. Underground rooms illegally occupied, discontinued or made to conform 3 New sculleries and washhouses built 7 Additional ventilation to bedrooms and sculleries 74 Rooms, staircases and w.c. apartments cleansed and repaired 1058 Verminous rooms cleansed 17 Dampness in rooms abated and floors ventilated and repaired 173 Windows and doors repaired 451 Handrails and balusters repaired 53 Coppers repaired and renewed 80 Larders provided 186 Coal sheds and receptacles provided or repaired 7 Fireplaces and ranges repaired or renewed 157 New or repaired sinks and lavatory basins or baths 68 Drains, soil pipes and ventilating pipes repaired or renewed 76 Drains cleansed and unstopped 9 Roofs, gutters and rainwater pipes repaired or renewed 272 Gully traps removed from improper positions 15 Waste pipes of sinks trapped, repaired or unstopped 62 Water and sinks provided to upper floors of tenement houses 29 water cisterns cleansed, repaired or removed from improper positions, or water taken off main supply 61 W.C. apparatus repaired, renewed or unstopped 94 17 W.C. removed from improper positions or provided with external ventilation Paving of yards and forecourts repaired or renewed and drained 76 Dust bins provided 60 Accumulations of refuse and fixed ashpits removed 6 External repairs: pointing walls, repairing windowsills, steps, &c. 83 Internal and external woodwork painted 61 Manholes repaired or renewed 42 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 27. Also 2 blocks of flats each containing 6 dwellings. 64 (b) With State assistance under the Housing Acts, 1919, or 1923. (i) By the Borough Council Nil. (ii) By other bodies or persons Nil. Inspection of the Borough, Section 17 (1) Housing Act, 1909, and Housing (Inspection of District) Regulation, 1910. Premises inspected with a view to ascertaining whether they are in a state so dangerous or injurious to Health as to be unfit for human habitation. The following information incorporates that which is required by Article V of the above-named Regulations to be included in this Annual Report. The general character of the defects found to exist were those usually associated with neglected or worn-out properties, with stable dwellings, or with houses now occupied by more families than they were originally intended to house. 1.—UNFIT DWELLING HOUSES. Inspection. (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,137 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 239 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (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 617 2.—Remedy of Defects without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their Officers 218 65 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 which are being or may ha ve to be dealt with as unhealthy, under Parts I or II of the Housing A ct, 1890. 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. 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 No. restored to a sanitary condition in 1923 46 £1045 172 £6025 218 Remaining at 1st Jan., 1923 169 - 236 - 405 In respect of 221 premises out of the 405 remaining to be dealt with, schedules have been served during 1923, but the works had not been completed at the end of the year. On the 1st January, 1924, there were, therefore, 184 premises out of the original 902 still remaining to be dealt with. As will be seen by the table, of the 218 premises completed during the year, 172 were in the list of 643 houses that were reported to the Housing Committee as being below the standard compatible with health, 66 but which could be made reasonably fit for human habitation, and 46 were in the list of unhealthy areas, containing 259 premises. 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 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 Act 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 of the Housing, Town Planning, &c., Act, 1919. (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. No Statutory Notices served; unofficial Notices only. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 925 (2) Number of dwelling-houses in which defects were remedied— (a) by owners 925 (b) by Local Authority in default of owners 67 C. —Proceedings under Sections 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 6 (2) Number of dwelling-houses in respect of which Closing Orders were made 6 (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 determined 1 Staff specially detailed for Housing Work. The Borough is divided into two districts by an imaginary line drawn down the centre of Finchley Road. There are two Sanitary Inspectors and one Clerk specially detailed for housing work. Unhealthy Areas. No additional unhealthy areas were "represented" during 1923. With regard to the areas previously reported upon:— Town Ward Areas (including Cornick's Yard, Flask Walk (2 sites), Golden Yard, Silver Street, Stamford Place. Streatley Place). The various sites comprising these Town Ward Areas again came under consideration during the year. In the case of Cornick's Cottages, the Housing Committee authorised survey and examination to be made of the premises under Sec. 36 (c), Housing Act, 1909. The 4 Cottages were subsequently "represented" by the Medical Officer of Health as being in a state so dangerous or injurious to health as to be unfit for human habitation, and on 26th April the Council made a Closing Order on each of the premises. The question of dealing with the site, generally, is under consideration. 68 Stamford place and buildings in Heath Street. The Borough Engineer was instructed to prepare certain particulars; but, at a later date, it was resolved that no further action should be taken at present. Flask Walk (2 sites), Golden Yard, Silver Street, Streatley Place. These sites were viewed by a sub-committee during the year but no definite action has been taken to deal with them. No further action has been taken by the Borough Council during the year with Kilburn Vale Area or Westbere Road Site. Statement showing steps taken in 1923, in connection with premises "represented in 1923 or previous years" by the Medical Officer of Health under the Housing Acts. Represented under Sec. 17 of the Housing Act, 1909, as unfit for habitation. Closing Order. Premises. Remarks. Date Served. Date of becoming operative. Date of Committee. Date of Council. - - 89, Broomsleigh Street - - July, 1923. Owner fined £2 and £3 3s. costs for allowing rooms to be occupied while Orders operative on premises. - - - 5, Alexandra Road - 17-1-23. Occupier given 21 days' notice to cease using back basement as sleeping room. Notice complied with. - - - 9, Greville Road - Demolition Order determined, 25-1-23 Premises now in order. 26-4-23 8-5-23 23-5-23 Closing Order determined 28-6-23. Premises now in order. 157, Fellows Road 9-4-23 47-49, Adelaide Road 5-3-23 22-3-23 23-3-23 9-4-23 The occupier of No. 47, a caretaker, given 21 days to vacate premises from 8-5-23. 31-12-23. I remises are being made fit for human habitation. 1, 2, 3 and 4, Cornick's Cottages, Cornick's Yard 9-4-23 26-4-23 8-5-23 23-5-23 Notice served on occupiers of Nos. 2 and 4 on 25-10-23 to vacate within one month. Nos. 1 and 2 unoccupied. 15, Fairfax Road 9-7-23 26-7-23 30-7-23 28-12-23 Closing Order appealed against on 6-8-23. Ministry dismissed appeal on 13-12-23. - - - - 4, Harley Road Council on 26-7-23 gave authority for survey and examination to be made. Action deferred. - 68, Haverstock Hill 12-11-23 29-11-23 19-12-23 19-12-23 - - 3-12-23 20-12-23 5, Agamemnon Road — - - 10, New End - - Premises are being made fit for human habitation. 69 Section 10. VITAL STATISTICS OF THE BOROUGH. The Borough. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 1902 88 1,516 904 133 73 1903 1,453 837 66 126 87 1904 1,445 892 161 111 73 133 94 73 1905 1,421 823 1906 1,437 850 111 77 57 1907 1,359 817 98 73 61 1908 1,400 803 97 69 74 1,328 99 74 1909 839 53 1910 1,340 829 81 60 58 1911 847 105 82 56 1,276 1912 1.281 861 79 62 64 1913 1,325 951 69 49 91 1914 1,273 913 91 71 57 1915 1,327 994 101 76 48 1916 1,164 862 73 63 55 1917 1,123 922 90 80 69 1918 895 1,027 69 75 77 1919 1,156 1,036 96 83 56 1,566 860 75 48 41 1920 1921 1,342 973 88 65 63 1922 1,290 970 72 56 50 1923 1,238 947 54 44 51 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 104 17 163 20 192 1903 194 127 14 72 11 1904 195 125 20 102 13 1905 194 127 124 9 24 1906 205 131 21 5 102 1907 185 15 13 152 81 1908 225 108 11 49 7 1909 196 140 15 76 6 1910 199 118 15 75 6 1911 207 133 19 92 7 1912 183 135 12 65 5 1913 201 161 11 55 11 1914 152 130 14 92 5 147 108 5 1915 157 17 1916 132 140 7 53 13 143 12 84 14 1917 143 1918 115 157 13 113 11 149 170 13 87 10 1919 1920 208 142 7 34 4 178 147 17 95 11 1921 1922 161 11 68 130 13 1923 164 139 6 36 10 70 No. 2 (Belsize) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Rate per 1000 Births. Number. 18 1902 239 135 15 75 1903 211 121 13 62 13 1904 217 106 12 141 23 1905 209 131 13 62 10 1906 187 127 8 43 13 1907 205 114 13 63 10 1908 205 126 8 39 16 1909 204 130 16 78 8 1910 207 119 9 43 8 1911 189 135 17 90 10 1912 127 8 42 7 188 1913 214 126 16 75 5 1914 195 141 9 46 11 1915 317 144 12 38 6 1916 189 127 7 37 6 1917 132 13 70 185 11 1918 149 155 7 47 9 1919 196 159 20 102 9 1920 213 132 9 42 7 197 143 7 1921 12 61 1922 202 151 10 49 7 1923 156 147 6 10 38 No. 3 (Adelaide) Ward Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 1902 3 29 103 95 7 1903 95 101 95 1 9 1904 100 99 13 130 8 1905 96 92 4 42 4 5 1906 97 92 10 103 1907 75 8 107 2 86 1908 93 78 6 65 4 1909 83 88 4 48 3 1910 2 21 5 96 78 1911 82 99 6 73 3 1912 117 77 6 51 9 1913 97 99 9 93 4 1914 88 99 5 57 2 1915 77 104 5 65 2 1916 104 12 115 95 5 1917 114 109 7 61 6 1918 6 11 97 119 62 1919 97 130 10 104 6 1920 6 161 109 37 3 1921 133 119 10 75 8 6 1922 149 121 40 5 1923 141 128 6 42 6 71 No. 4 (Central) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 71 11 1902 110 100 5 1903 99 60 8 81 4 62 11 122 1 1904 90 1905 113 60 5 44 6 95 83 3 32 2 1906 1907 108 68 9 83 5 1908 104 82 6 58 7 1909 63 3 26 3 116 1910 105 82 8 76 3 8 87 3 1911 92 75 1912 97 76 4 41 6 1913 91 84 6 66 ... 1914 4 48 6 84 76 92 4 42 1915 91 6 97 1916 93 4 43 3 69 76 2 29 1917 ... 72 7 1918 69 99 5 101 117 5 49 4 1919 7 53 2 1920 131 91 102 8 71 3 1921 112 106 3 1922 85 113 9 1923 90 98 3 33 5 No. 5 (West End) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 20 1902 107 6 275 72 111 21 86 12 1903 243 22 78 1904 283 120 8 1905 250 131 23 92 11 1906 259 115 14 54 8 1907 250 16 64 9 114 1908 254 121 26 102 9 118 13 54 6 1909 239 121 17 79 11 1910 216 1911 216 102 15 69 10 1912 13 57 12 226 126 1913 240 145 11 46 7 1914 256 140 18 70 14 151 1915 218 13 60 11 211 117 10 47 5 1916 1917 137 13 59 13 221 1918 162 10 81 12 124 139 12 68 12 1919 175 1920 119 16 60 6 268 211 12 57 9 1921 146 1922 223 138 6 27 8 6 8 1923 215 149 28 72 No. 6 (Kilburn) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 103 1902 435 219 45 16 1903 417 39 93 18 184 132 1904 408 206 54 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 89 31 16 1912 353 188 26 74 14 1913 354 213 25 18 71 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 14 48 364 1921 204 21 58 11 1922 303 202 16 53 11 1923 333 180 16 48 7 No. 7 (Priory) Ward. Year. Number of Births. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number of Deaths. Number. Rate per 1000 Births. 1902 110 16 99 7 162 194 5 1903 116 21 108 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 117 94 128 12 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 70 7 100 110 7 1919 142 120 84 5 12 1920 177 95 11 62 5 1921 147 112 8 54 14 115 14 84 1922 167 3 1923 139 106 11 79 5 APPENDICES. Appendix I.—Report of the Tuberculosis Medical Officer and Assistant Medical Officer of Health for Tuberculosis Work. Appendix II.— Report of the Medical Officer in charge of Pre- Maternity Clinics. Appendix III.—Report of the Public Analyst. Municipal Tuberculosis Dispensary. Number of Under observation at the Dispensary on Jan. 1st pending diagnosis. Examined for the first time during the year. Total. Suffering 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. Report of the Tuberculosis Medical Officer. Adults 2 6 48 2 1 (a) All persons (including "Contacts.") M. 91 36 93 6 F. 10 152 162 43 3 105 5 Children under 15 M. 5 93 98 13 82 2 1 - F. 3 86 89 8 76 5 - - Total 20 442 79 30 311 14 8 422 APPENDIX I. M. 1 29 2 1 23 2 1 Adults 28 (b) "Contacts" (included in (a) ) F. 5 64 69 7 1 58 1 2 Children under 15 M. 5 51 56 - 4 49 2 1 F. 1 56 57 - 5 51 1 - 1 76 31 5 39 1 (c) Insured persons (included in (a)). M. 75 - F. 42 24 4 46 18 - 1 3 I.—Number of patients under treatment or super- vision (excluding persons under observation or domiciliary treatment) on the 31st December* 129 6.—Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 6 2. —Total number of attendances of patients at the Dispensary during the year Insured 457 7. —Number of persons referred to hospital for con- sultation 75 Uninsured 1077 8. —Number of consultations with medical practitioners at the homes of patients Insured 7 Uninsured 5 3. —Number of the above attendances at which systematical physical examinations and records were made 991 9.—Number of other visits paid by Tuberculosis Officer to the homes of patients 48 4, —Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 115 10, —Number of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 2264 5.—Number of cases in which the period of obser- vation at the Dispensary exceeded two months 19 11.—Number of specimens of sputum examined in connection with the work of the Dispensary 299 *Insured persons under domicilary treatment by Insurance practitioners, are excluded, even though they may attend the dispensary at intervals for examination or consultation. 75 A complete summary of the work done at the Tuberculosis Dispensary during the past year is contained in the tabular statement at the beginning of this report. There is again a pleasing fall in both the notification rate and, a more important figure, in the deaths, which stands this year at 51 pulmonary and 7 non-pulmonary, a fall of 12 non-pulmonary and a rise of 1 pulmonary. The death rate from tuberculosis being dependent to some con- siderable degree to the incidence of other diseases during the year in review, it is not to be expected that every year a like fall will be recorded, but the average trend of recent years is downwards. Deaths from tuberculosis due to War Service are very much lower than last year —4 compared to 14. This figure is naturally a gradually reducing one. Potential contacts* accruing during the year, of cases attending Dispensary, number 159. Of these 103 have been examined- 65 per cent. of the total. We regard this as a very satisfactory figure, which has been attained only by a very intensive campaign by the Lady Sanitary Inspector and Dispensary Nurse. In certain cases whole families appear to be tuberculized. The condition is latent, and one is not justified in notifying them, but it is one's endeavour in such families to keep the members of it under observation at regular intervals. In the early part of the year the Hampstead Board of Guardians kindly appointed me as Hon. Consulting Physician for Tuberculosis to the New End Hospital. This has enabled me to see many cases I should not otherwise have seen, and also to get several cases into the Hospital who would have been unwilling to go. I have to thank Dr. Reade, the Medical Superintendent, for his helpful co-operation. Since I have been on the consulting staff I have visited the Hospital 18 times, and have seen 180 patients. During the year Professor Dreyer produced a new tuberculin, of which a great deal was hoped. Owing to the kindness of Captain Douglas, of the Medical Research Council, we were able at an early date to use the vaccine. My experience, both at New End and at the *By a "contact" is meant a case which comes from a family in which there is a notified case of Tuberculosis. 76 City of London Hospitals, is not favourable, and personally I have ceased to use it, and 1 fear that our armamentarium against tuberculosis has not been increased, as we hoped, on its introduction. In the past year three cases have occupied the two beds at Northwood, and I have taken four into the City of London Hospital. 11 have been taken as in-patients at the Hampstead General Hospital and 24 to the Out-patient Department of that Hospital, 36 X-Rays have been taken, 14 cases have been admitted to New End Hospital. 66 cases have been sent by 40 Doctors, for advice or treatment, and 12 consultations with doctors, at the patients' homes, have been held. It will be noticed that the total attendances at the Dispensary are less. This is due to the desire of the L.C.C. that cases should not be watched for prolonged periods, but it will also be seen that systematic examinations have increased, the proportion being 991 to 1534 attendances. Cases have been removed to sanatorium or hospital by the L.C.C. without undue waiting, and they have very kindly made special arrangements for several patients, at my request. The Sociological aspect of tuberculosis remains a problem of the greatest import. Conditions in London are changing. Large houses are being broken into fiats and converted into boarding-houses and small hotels. It would appear that, as in New York, the number of inhabitants living in boarding-houses and hotels will steadily increase. In the cheaper type of house, and even in the more expensive ones, on occasions, many difficulties are raised from the Public Health point of view. Obvious difficulties in regard to notification and disinfection, while the advanced case is turned out and has nowhere to go to. This problem is too large to be more than touched upon. Next, we are commencing to suffer from our intensive campaign as to the infectivity of tuberculosis. The employer of labour will not have a tuberculous man. His fellow-workmen shun him The lodginghouse keeper wont take him in. In fact, there is every excuse for him concealing the fact until the disease is too advanced to do anything for him. 77 I feel that we have got as far as we shall get on the present lines, and until the State takes the large view as regards this disease, the fall in incidence will decrease only by slow degrees. One would like to see homes for advanced cases in every district. These should be comfortable, with not more than 4 or 6 beds to a ward, amply staffed, and with considerable latitude to the patient. Lest these homes came to be regarded as homes for the dying, other cases should be taken in for shorter periods. I would like to see the ailing child of every tuberculous patient, certainly on the death of the same, sent into the country for six months or until health is established. Good examples are numerous, mostly due to the good offices of the Invalid Children's Aid Association. A girl of 13 had been nursing her mother who died of tuberculosis. She was then brought to the Dispensary. She was not definitely tuberculous, but very suspicious, and this child, after six months in the country, had gained 1½ stones, and her health was consolidated. Lastly, an idea possibly Utopian, but probably economic in the large aspect, any member of the industrial army who falls to this disease, should have the same advantages as the military pensioner, and should be looked after by the State if he has tubercle bacilli in the sputum. Only in this way does it seem possible to have adequate control of the patient and his contacts, and of those who, by concealing their disease, infect the community. Home visiting of Ex-Service tuberculous men.—The following inform- ation for the year 1923, required by the Ministry of Health, is submitted:— 1. Number of discharged men visited 79 2. Total number of visits of this kind 369 3. Proportion of number of visits to such cases to total number of visits to tuberculous cases 15.4 per cent. 78 In the following tabular statement some idea may be gained of the work done in connection with the Dispensary since its inception:— Year. No. of New Applicants. No. of New Applicants treated. No. of Contacts examined. Total Attendances of all kinds. 1913 1st Feb. to 31st Dec. 455 191 204 2808 1914 455 118 195 1913 308 158 899 1915 146 1916 230 165 1519 100 1917 383 183 113 1682 1918 371 105 124 1821 1919 296 85 57 1543 384 221 1920 112 2625 1921 127 2327 479 192 1922 445 113 223 1738 120 199 1923 422 1534 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 614. I have to thank the Dispensary Staff for their efficient and keen work, and Dr. Scrase for his helpful consideration. A. J. SCOTT-PINCHIN, M.D. (Lond.), M.R.C.P. (Lond.). 79 APPENDIX II. Report of Medical Officer in Charge of Pre-Maternity Clinics Western Clinic. Eastern Clinic. Number of sessions held 101 51 Average attendance per session 9 7 Number of new cases 197 88 Number of attendances of old cases 764 296 Number of cases referred to Dental Clinic 30 72 1 Number of cases referred to Convalescent Home 3 Of the 285 new applicants, 17 were found not to be eligible, and in 12 it was doubtful whether they were so. Of the remainder, 46 were normal cases, 140 were slightly abnormal, 32 seriously abnormal, 5 were connected with venereal disease, and 33 attended for the first time after confinement. Analysis of Slightly and Seriously Abnormal Pre-Maternity Cases. Morning Sickness 29 Varicose Veins 26 Dyspepsia 11 Varicose Veins and Phlebitis Gastric Ulcer 2 1 Constipation 25 Varicose Ulcer of Leg 1 Lax Abdominal Wall (needing bandage) Threadworms 1 Piles 2 13 Anæmia 9 Inguinal Hernia 1 Mitral Stenosis 2 Marked Endocervicitis 9 Bronchitis 2 Ret rover ted gravid uterus 4 Pre-tubercular 1 Threatened Miscarriage 6 Alveolar abscess 1 Miscarriage (not averted) 6 Cervical adenitis 1 Ante-Partum Hæmorrhage 1 Hypertrophic rhinitis 1 Breech Presentation 2 Albuminuria 4 Contracted Pelvis 9 Toxaemia of Pregnancy 2 The cases attending for the first time after confinement showed— anæmia, 10; constipation, 2; piles, 1; persistent lochia, 4; menorr- hagia, 3; prolapse, 3; incontinence, 1; difficulty with breast feeding, 2; varicose veins, 1; pretubercular state, 1; pleurodynia, 1; neuralgia, 1; influenza, 1. Two of the cases were quite normal in every way. 80 A gratifying feature in the last year is the increased number of expectant mothers attending at the Eastern Clinic. The number has risen to 88, as compared with 62 in 1922 and 66 in 1921. The attendances at the Western Clinic are keeping well up to the mark, so that we have now arrived at a state of things, in Hampstead, where nearly a quarter of the expectant mothers in each year are attending the Pre-Maternity clinics. One is also very glad to note that only one case of ophthalmia neonatorum has been notified in the Borough in 1923, as compared with 9 in 1922 and Bin 1921. I think that this happy condition of affairs may be partly attributed to two causes:— (a) To the routine application of a silver preparation to the eyes of new born babies, by the midwife, immediately after birth, in a large number of cases, e.g.:—in the midwifery practice of the Queen Victoria Jubilee Nurses. (b) To the preventive work that is being carried out at the Pre Maternity clinics in this connection. Any suspicious cases (where it is thought that the disease may occur in babies after birth) have been referred to the Consulting Ante-Natal Clinic at the Royal Free Hospital, for special tests to be made. When, as a result of this, treatment is found to be necessary, the case is referred to the Special Department at the same Hospital. In this way I think that we have been able to save at least 2 cases from occurring during the last year, and shall probably find that two others have been saved in the near future. Blood tests have been carried out in conjunction with the Royal Free Hospital in 22 cases, the specimens being taken at the Pre- Maternity Clinic. By this means it has been possible to find 2 mothers where a special form of treatment was indicated during pregnancy. These women were referred to two different hospitals for the treatment, and healthy children were subsequently born. In one of these cases a series of still-births had preceded the birth of the healthy child. The routine examination for pelvic contraction has been continuously practised during the year. Two of the womon whom I had advised to go into New End, so that induction of labour might be performed, decided, after all, not to go there, but to have their confinements at home instead. In both cases, difficult and instrumental labours resulted, and one of the mothers lost her baby when it was a few hours old. 81 In a case where a mother who was expecting her first baby, a breech presentation was diagnosed during the last month of pregnancy, and arrangements were made for external version to be done at New End Hospital, where she was going for her confinement. For one of the two mothers who were suffering with valvular heart disease, I was able to arrange with the Medical Superintendent at the same Hospital to admit her for a few weeks' rest before the confinement was due. This was carried out with very beneficial results to the mother and baby. Miss Kennedy, our health visitor at the Eastern Clinic, has retailed 60 yards of pure flannel at cost price to the expectant mothers attending there, so as to enable them to make little garments for their future babies. She keeps a set of new and up-to-date patterns and shows the mothers how to make them. She has herself cut out little garments, and as this has entailed a considerable amount of overtime on her part I should like to acknowledge the help so ungrudgingly given in this respect. Many thanks are also due to Mrs. E. Stewart, one of the Co-opted members of the Maternity and Child "Welfare Committee, and to Mrs. Simmonds, for their kind and continuous help at the Cinics in preparing tea for the mothers. (Signed) MARY KIDD, M.B. (Lond.) 82 APPENDIX III. Report of the Public Analyst. Analytical Laboratory, Town Hall, Paddington, W. 11th January, 1924. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies, and Gentlemen, A short review of the work of the year 1923 may be of interest. Dealing with the principal articles we find that only 20 samples of the 505 submitted were found to be defective. Milk showed only 2 samples out of 212, or less than 1 per cent., to be adulterated. Only one sample of cream out of 39 was found to be improperly dosed with preservative. Of the 29 samples of drugs, 7 proved to be badly compounded. Of 7 samples of sausages 4 were found to contain boric acid. 2 samples of vinegar out of the 10 purchased were found to be watered. 25 samples of margarine were obtained, but only two were found to be unlabelled. Taking all samples for the year 1923, the total adulteration was only 3.9; this is even lower than the 5.3 for the year 1922. I do not know of any Borough showing a greater freedom from adulteration. I have the honour to remain, Yours obediently, ALF. W. STOKES, Public Analyst. 83 INDEX. PAGE. Ambulance Facilities 35 Analytical Work, Report on 82 Ante-Natal Clinics (see Pre-Maternity Clinics) - Area of Borough 5 Bacteriological Examinations 36 Bakehouses 43 Births 78 Cancer 16 Care Committee (see Tuberculosis) - Census Statistics 5 Cleansing Station 40,45 Clinics 32,34 Complaints Received 37 Condensed Milk 51 Consumption (see Tuberculosis) — Conveniences 42 Customs and Inland Revenue Acts 40 Dairies 46 Deaths 8-19 Dental Clinics 34 Diarrhœa and Enteritis 15 Diphtheria 22 Disinfection 40,44 Drainage By-laws 41 Dried Milk 52 Encephalitis Lethargica, acute 22 Enteric Fever 22 Epidemic Diarrhœa 15 Epidemic Diseases, Principal Deaths 15 Erysipelas 22 Factory and Workshop Act, 1901 55-58 Food and Food Premises 43,44 Fried Fish Shops 43,44 Health Visitors, Work of 32,33 Home Office Tables (Factory and Workshop Act, 1901) 55,58 Homework 56,57 Hospitals 34,35 Housing 3, 62-68 84 PAGE. Ice Cream 43 Infantile Mortality 11-14 Infectious Diseases 20-23 Institutions for Unmarried Mothers and Infants 35 Laboratory Work 36 Legal Proceedings 59,60 Margarine, Wholesale dealers 44 Malaria 22 Marriages 6 Maternal deaths 11 Maternity and Child Welfare 3 Measles 15 Midwives 32 Milk and Cream Regulations 53,54 Milk Graded 46 Milk (Mothers and Children) Order, 1919 33 Milk and Milkshops 43,46 Mortuary, Public 42 Notification of Births Act, 1907 8 Nursing, facilities 31,32 Offensive Trades 43 Ophthalmia Neonatorum 23 Outworkers (see Homeworkers) 56,57 Pneumonia, Acute primary 22 Polio Myelitis, Acute 22 Population 6 Population, Natural Increase of 7 Preservatives 51 Pre-Maternity Clinics 82, 79-81 Principal Epidemic Diseases 15 Public Health Committee 3 Puerperal Fever 22 Rags and Bones dealers 44 Rats and Mice (Destruction) Act, 1919 43 Rent Restrictions Acts 40 Restaurant Kitchens 43 Sale of Food and Drugs 48-53 Sanitary Inspection, &c. 36,37 Scarlet Fever 22 Overcrowding 37 Sanitary Inspectors, Work of 36-40 Slaughterhouses 43-44 Small-pox 24 Smoke Nuisances 55 Staff of the Public Health Department 60-62 Still-Births 8 85 PAGE. Suicide 19 Summary of Vital Statistics 5 Treatment Centres 32-34 Tuberculosis 24-30 Tuberculosis Care Committee 30 Tuberculosis Dispensary 74,78 Tuberculosis Medical Officer, Report of 74-78 Underground Rooms 37,40 Vaccination 24 Venereal Diseases 19 Verminous Persons and Premises 40,45 Vital Statistics 5, 69-72 Violent Deaths 19 Warranty Defence 51 Water Supply, Certificates as to 38 Water Supply of Tenement Houses 38 Whooping Cough 15 Young Children, Mortality among 14