AC 4351 HAMP 29 THE Metropolitan Borough of Hampstead. REPORT for the year 1924, of the Medical Officer of Health. FRANK E. SCRASE, F.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Lond.). Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W. 3. F. P. Lewingdon, Printer, 26 & 27, Eversholt Street, Camden Town N W. Borough of Hampstead With the Medical Officer of Health's Compliments. Public Health Department, Town Hall, Haverstock Hill, N. W. 3. THE Metropolitan Borough of Hampstead. REPORT for the year 1924, of the Medical Officer of Health. FRANK E. SCRASE, F.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Lond.). Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W. 3. 2 CONTENTS. pages SECTION 1.—General Statistics 5 ,, 2.—Extracts from Vital Statistics of the Year 5—23 ,, 3.—Notifiable Diseases during the Year 23—31 „ 4.—Causes of Sickness 32 „ 5. —Summary of Nursing Arrangements, Hospitals, and other Institutions available for the Borough 32—45 „ 6.—Laboratory Work 45,46 „ 7.—Sanitary Administration 46—74 „ 8.—Public Health Staff 75,76 „ 9.—Housing 76—85 ,, 10.—Vital Statistics of the Borough 86—89 APPENDIX I.—Report of the Tuberculosis Medical Officer 92—97 „ II.—Report of the Medical Officer in charge of Pre- Maternity Clinics 99—103 „ III.—Report of the Public Analyst 106 INDEX 107—119 3 His Worship the Mayor (Mr. Alderman F. G. Howard, j.p.) 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.h. „ „ C.W. Cunnington, m.r.c.s., d.p.h. Councillor Mrs. Monro, j.p. „ Councillor J. A. A. Atkin Mr. Councillor T. H. Nunn, m.a. „ „ R. H. H. Cust, m.a., j.p. „ „ H. W. Snow Councillor Mrs. Dow, b.a. „ „ J. C. Staines Mr. Councillor 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: Councillor Mrs. Fisher. Councillor Mrs. Arnholz Councillor Miss Glover Mr. Councillor S. A. Boyd, m.s., m.b., f.r.c.s. Mr. Councillor C. J. R. MacFadden, o.b.e., m.d., c.m. Mr. „ R. H. H. Cust, m.a., j.p. Councillor Mrs. Monro, j.p. Councillor Mrs. Dow, b.a. Mr. Councillor T. H. Nunn, m.a. Mr Councillor 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.) Miss G. Macdonald Mrs. M. I. MacFadden Mrs. E. Stewart Lady H. K. Thompson Sub-Committees(a) Applications for Assistance, and (b) Deaths of Children under 2 years of age and Maternal Deaths. HOUSING COMMITTEE. Chairman: Mr. Alderman R, J. J. Willis. Mr. Alderman G. Buckle Councillor Mrs. Maddox „ ,, W. J. Spriggs Mr. Councillor H. Marnham Councillor Mrs. Arnholz „ K. L. Moore Mr. Councillor S. A. Boyd, m.s., m.b., f.r.c.s. „ „ W. P, Newman „ „ R.H.H. Cust, m.a., j.p. „ „ H.S.Salter „ „ G. W. Dawson „ „ H. R. Smith Councillor Mrs. Fisher „ „ B. S. Townroe Mr. Councillor J. Jones 4 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W. 3. 21 st April, 1925. 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 1924. It is brief in accordance with the instructions of the Ministry of Health, issued on 18th December, 1924, wherein was indicated the minimum information which should be given. A summary of the statistics for the year 1924 will be found on page 5, and, if they are compared with those for the preceding year, it will be seen that the health of the Borough is maintained at a high standard, though it is to be regretted that there is a small rise in the general death-rate and a fall in the birth-rate. This latter appears to be steadily tending towards the pre-war level. The infantile mortality rate shows a rise from 42 to 50 per 1,000 births. A glance at the table on page 12 will show that the class of diseases called congenital diseases—premature birth, debility, marasmus, etc., accounted for nearly the whole of this rise, there being in this class 32 deaths as against 18 in the preceding year. On this point I would like to call attention to the work of the Maternity and Child Welfare Committee and its Sub-Committee on Infant Deaths and Maternal Mortality, details of which are given on pages 37—44. I feel sure that any further reduction in infant mortality must be arrived at along such lines as are detailed in that portion of this Report. The first year's work of the Sub-Committee justifies the belief that these are the right lines on which to proceed. Whilst studying life tables and statistics, it is always well to keep in mind the fact that the people are at present living under abnormal conditions in respect of employment and housing; and it is difficult to maintain infant welfare at as high a standard as formerly whilst the home conditions are often such as to mitigate against the success of our efforts. My thanks are due to the Council; especially to the Chairmen and Members of the Public Health, Housing, and Maternity and Child Welfare Committees, for the help and consideration they have always afforded me during their terms of office, and I should like to take the opportunity of expressing my appreciation of the work of the Staff of the Department during the year under review. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, FRANK E. SCRASE, Medical Officer of Health. 5 Section 1. 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, 1924 £1,175,167 Sum represented by a penny rate £4,752 17s. 2d. Section 2. Extracts from Yital Statistics for 1924. Population estimated to middle of 1924 87,600 Density 39 persons per acre. Marriages 677 Marriage-Rate 15.4 M. F. Totals Birth Legitimate 559 546 1105 1,186 Illegitimate 41 40 81 Birth-Rate 13.5 Deaths 1029 Death-Rate 11.7 Maternal Deaths No. of women dying in, or in consequence of, childbirth At home In hospital. (1) From Sepsis 1 (2) Other Causes 2 3 Deaths of Infants under 1 year of age:— Legitimate 55 Illegitimate 11 Total 66 Infantile Mortality Rate per 1,000 births 56 Deaths from Measles (all ages) 6 „ Whooping Cough (all ages) 4 „ Diarrhoea (under 2 years of age) 10 Deaths from Tuberculosis of— The Respiratory System 58 Death-Rate 0.66 Deaths from All Forms of— Tuberculosis 70 Death-Rate 0.80 6 Population. In accordance with the prevailing custom, I have adopted the Registrar-General's estimate of the population for the purposes of this Report, and this was calculated to have been 87,600 at the middle of the year 1924. I have prepared the following estimates, based upon the Census figures, of the population of each Ward. Ward. Estimated Population. No. 1 (Town) 13,030 No. 2 (Belsize) 14,090 No. 3 (Adelaide) 10,520 No. 4 (Central) 9,630 No. 5 (West End) 13,730 No. 6 (Kilburn) 15,830 No. 7 (Priory) 10,770 The Borough 87,600 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 677 marriages were registered in the Borough during 1924, as compared with 684 in the preceding year. The following Table gives the marriage-rates per 1,000 of the population for the years 1914-1924: — 1914 - 19.0 1919 - 17.0 1915 - 23.2 1920 - 16.6 1916 - 17.8 1921 - 16.3 1917 - 18.7 1922 - 16.5 1918 - 18.5 1923 - 15.6 1924 - 15.4 7 Births. In the following Table the births for 1924 have been analysed according to sex, etc.:— BIRTHS. MALES. FEMALES. TOTALS. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Registered in the Borough 634 37 671 640 32 672 1274 69 1343 Add number occurring outside the Borough whose mothers were Hampstead residents 88 13 101 83 19 102 171 32 203 722 50 772 723 51 774 1445 101 1546 Deduct number who could not be deemed to belong to Hampstead 163 9 172 177 11 188 340 20 360 Net number belonging to Hampstead, 1924 559 41 600 546 40 586 1105 81 1186 Net Births, 1923 600 30 630 562 46 608 1162 76 1238 The 1186 net births were distributed among the various Wards as follows:—No. 1 (Town) 149, No. 2 (Belsize) 145, No. 3 (Adelaide) 149, No. 4 (Central) 91, No. 5 (West End) 179, No. 6 (Kilburn) 316, and No. 7 (Priory) 157. 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 11.4 No. 2 (Belsize) „ 10.3 No. 3 (Adelaide) „ 14.2 No. 4 (Central) „ 9.4 No. 5 (WestEnd) „ 13.0 No. 6 (Kilburn) „ 19.9 No. 7 (Priory) „ 14.6 The Borough 13.5 London 18.7 England and Wales 18.8 The natural increase in population, i.e., the excess of births over deaths, was 157. 8 Legitimate and Illegitimate Births and Birth Rate. Of the total 1,186 net births belonging to Hampstead, 1,105 were those of legitimate and 81 of illegitimate children, the latter being at the rate of 68 per 1,000 births. 32 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 the births notified during the year. As live births have to be notified much sooner than registered, the total number notified differs from the total number registered. The registration of still births has not yet been made compulsory. Notified within 36 hours. Notified after 36 hours. Total Notified. Live Births. Still Births. Live Births. Still Births. Live Births. Still Births. Notified by midwives 505 8 — — 505 8 „ parents 224 5 58 — 282 5 „ doctors 360 8 — — 360 8 „ nurses and others 175 5 — — 175 5 1264 26 58 — 1322 26 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. 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 1924 was 1,029 or 11.7 per 1000 of the population, as compared with 947 in the preceding year. These deaths 9 were distributed among the various Wards as follows:—No. 1 (Town) 138, No. 2 (Belsize) 164, No. 3 (Adelaide) 121, No. 4 (Central) 133, No. 5 (West End) 126, No. 6 (Kilburn) 206, and No. 7 (Priory) 141. 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 10.6 No. 2 (Belsize) „ 11.6 No. 3 (Adelaide) „ 11.5 No. 4 (Central) „ 13.8 No. 5 (West End) „ 9.2 No. 6 (Kilburn) „ 13.0 No. 7 (Priory) „ 13.1 The Borough 11.7 London 12.1 England and Wales 12.2 10 Causes of Death at Different Periods of Life during the Year 1924.—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. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and under 75 years. 75 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 1. Enteric Fever M 1 ... ... ... ... ... ... 1 ... ... F 2 ... ... ... ... ... 2 ... ... ... 2. Small-pox M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 3. Measles M 3 ... 1 1 1 ... ... ... ... ... F 3 ... 1 2 ... ... ... ... ... ... 4. Scarlet Fever M ... ... ... ... ... ... ... ... ... ... F l ... ... 1 ... ... ... ... ... ... 5. Whooping Cough M 2 1 1 ... ... ... ... ... ... ... F 2 1 ... 1 ... ... ... ... ... ... 6. Diphtheria M 2 ... 2 ... ... ... ... ... ... ... F 1 ... ... ... 1 ... ... ... ... ... 7. Influenza M 16 1 ... ... ... ... 1 10 3 1 F 29 ... 1 ... ... 2 5 5 5 11 8. Encephalitis lethargica M 2 ... ... ... ... ... 1 ... 1 ... F 4 ... ... ... ... ... 2 ... 2 ... 9. Meningococcal Meningitis M ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... 1 ... ... ... ... 10, Tuberculosis of respiratory system M 33 ... ... ... ... 4 21 7 1 ... F 25 ... ... ... 1 5 10 8 1 ... 11. Other Tuberculous Diseases M 6 ... 1 1 l 1 1 1 ... ... F 6 ... ... l ... ... 1 3 ... 1 12. Cancer, malignant disease M 61 ... ... ... 1 ... 2 23 20 15 F 90 ... ... ... ... ... 8 46 19 17 13. Rheumatic Fever M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... 14. Diabetes M 5 ... ... ... ... ... ... 2 3 ... F 5 ... ... ... ... ... ... 3 1 l 15. Cerebral hæmorrhage, & c. M 19 ... ... ... ... ... ... 8 3 8 F 37 ... ... ... ... ... 1 7 15 14 16. Heart Disease M 72 ... ... ... 1 1 7 28 18 17 F 81 ... ... ... ... 3 6 18 26 29 17. Arterio-sclerosis M 25 ... ... ... ... ... 1 6 5 13 F 29 ... ... ... ... ... ... 5 6 18 18. Bronchitis M 26 2 ... ... ... 1 l 4 3 15 F 31 1 ... ... 1 ... 1 7 10 11 19. Pneumonia (all forms) M 41 4 3 3 l ... 4 9 7 10 F 36 2 2 1 ... 1 1 8 8 13 20. Other Respiratory Diseases M 8 ... ... ... ... ... 3 i 2 2 F 9 ... ... ... ... ... 2 2 ... 5 21. Ulcer of Stomach or Duodenum M 5 ... ... ... ... 1 1 ... 3 ... F 1 ... ... ... ... ... ... 1 ... ... 22. Diarrhoea, &c. M 11 7 1 ... ... 1 ... ... 2 ... F 5 2 ... ... ... ... ... 2 ... 1 23. Appendicitis and Typhlitis M 8 ... ... 1 ... 2 2 3 ... ... F 5 ... ... ... ... ... 1 3 ... 1 24. Cirrhosis of Liver M 5 ... ... ... ... ... 1 3 ... 1 F 3 ... ... ... ... 1 ... 2 ... ... 25. Acute and Chronic Nephritis M 15 ... ... ... ... 1 ... 8 2 4 F 8 ... ... ... ... ... 1 2 1 1 26. Puerperal Sepsis M ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... 1 ... ... ... 27. Other accidents & diseases of pregnancy, and parturition M ... ... ... ... ... ... ... ... ... ...... F 2 ... ... ... ... ... 2 ... ... ... 28. Congenital Debility and malformation, premature birth M 18 18 ... ... ... ... ... ... ... ... F 14 14 ... ... ... ... ... ... ... ... 29. Suicide M 4 ... ... ... ... ... 1 3 ... ... F 6 ... ... ... ... 1 4 1 ... ... 30. Other Deaths from Violence M 5 ... ... ... l 2 ... 1 1 ... F 10 ... ... ... l 1 ... 3 3 2 31. Other Defined Diseases M 77 8 1 ... 4 1 3 20 21 19 F 112 5 ... 3 5 4 20 24 21 30 32. Causes ill-defined or unknown M ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... All causes M 470 41 10 6 10 15 50 138 95 105 F 559 25 4 9 9 19 68 150 117 158 Totals 1029 66 14 15 19 34 118 288 212 263 All "Transferable Deaths" of residents, i.e., of persons resident in the Borough who died outside it, have been included. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who died in the Borough have in like manner been excluded. 11 Old Age. Five persons died during the year aged 90, two were aged 91, four were aged 92, and one attained the age of 94. 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 1924: — Heart disease 153 Cancer 151 Respiratory disease 151 Tuberculosis 70 Cerebral haemorrhage, &c. 56 Arterio-sclerosis 54 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 1 (2) Other Causes at home — in hospital 2 Infantile Mortality. Deaths of infants under one year of age and rate per 1000 births:— Legitimate. Illegitimate. Total. No. Rate per 1000 No. Rate per 1000 No. Rate per 1000 legitimate births. illegitimate births. births. 55 50 11 136 66 56 12 In the following tables the 66 infantile deaths have been classified according to diseases in age-periods and in Wards:— CAUSES OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 and under 6 Months. 6 and under 9 Months. 9 and under 12 Months. Total Deaths under 1 Year. 1 Small-pox ... ... ... ... ... ... ... ... ... ... 2. Chicken-pox ... ... ... ... ... ... ... ... ... ... 3. Measles ... ... ... ... ... ... ... ... ... ... 4. Scarlet Fever ... ... ... ... ... ... ... ... ... ... 5. Whooping Cough ... ... 1 ... 1 ... 1 ... ... 2 6. Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... 7. Erysipelas ... ... ... ... ... ... ... ... ... ... 8. Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... 9. Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... 10. Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... 11. Meningitis (not Tuberculous) 1 ... ... ... 1 ... 2 ... 1 4 12. Convulsions ... ... ... ... ... 1 ... 1 ... 2 13. Laryngitis ... ... ... ... ... ... ... ... ... ... 14. Bronchitis 1 ... ... ... 1 1 ... ... ... 2 15.Pneumonia (all forms) ... ... ... ... ... ... 1 1 4 6 16. Diarrhœa and ... ... 1 1 2 2 4 ... ... 8 17. Enteritis ... ... 1 ... ... ... ... ... 18. Gastritis ... ... 1 ... l ... ... ... ... 1 19. Syphilis ... ... ... ... ... ... ... ... ... ... 20. tickets ... ... ... ... ... ... ... ... ... ... 21. Suffocation,overlying ... ... ... ... ... ... ... ... ... ... 22. Injury at Birth 6 ... ... ... 6 ... ... ... ... 6 23. Atelectasis ... 1 ... ... 1 ... ... ... ... 1 24. Congenital Malformations 1 ... ... ... 1 1 ... ... 1 3 25, Premature Birth 12 ... ... 1 13 1 1 ... ... 15 26. Atrophy, Debility and Marasmus 3 1 ... ... 4 6 3 1 ... 14 27. Other causes 1 ... 1 ... 2 ... ... ... ... 2 Totals 25 2 4 2 33 12 12 3 6 66 Want of Breast Milk has been included under No. 26, Atrophy and Debility. Net Births in the year legitimate illegitimate M. 559 F. 546 M. 41 F. 40 Net Deaths in the year of legitimate infants illegitimate infants M. 33 f. 22 M. 8 F. 3 13 CAUSES OF DEATH. No, 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). Total. 1. Small-pox ... ... ... ... ... ... ... ... 2. Chicken-pox ... ... ... ... ... ... ... 3. Measles ... ... ... ... ... ... ... 4. Scarlet Fever ... ... ... ... ... ... ... 5, Whooping Cough ... 2 ... ... ... ... 2 6. Diphtheria and Croup ... ... ... ... ... ... ... 7. Erysipelas ... ... ... ... ... ... ... 8. Tuberculous Meningitis ... ... ... ... ... ... ... ... 9. Abdominal Tuberculosis ... ... ... ... ... ... ... ... 10.Other Tuberculous Diseases ... ... ... ... ... ... ... ... 11. Meningitis (not Tuberculous) ... ... 1 ... 1 2 ... 4 12. Convulsions ... 1 ... ... ... 1 ... 2 13. Laryngitis ... ... ... ... ... ... ... ... 14. Bronchitis ... ... ... ... ... 2 ... 2 15. Pneumonia (all forms) 1 1 1 ... ... 3 ... 6 16. Diarrhœa ... l 3 1 l 1 1 8 17. Enteritis 18. Gastritis ... ... l ... ... ... ... 1 19. Syphilis ... ... ... ... ... ... ... ... 20. Rickets ... ... ... ... ... ... ... ... 21. Suffocation, overlying ... ... ... ... ... ... ... ... 22. Injury at Birth 1 ... 1 2 1 1 ... 6 23. Atelectasis ... ... ... ... ... ... 1 1 24.Congenital Malformations 1 ... ... ... ... 1 1 3 25. Premature Birth 1 2 l ... 1 6 4 15 26. Atrophy, Debility and Marasmus ... 2 2 1 3 5 1 14 27. Other causes ... ... ... ... 1 1 ... 2 Total Deaths 4 9 10 4 8 23 8 66 Total Births 149 145 149 91 179 316 157 1186 Want of Breast Milk has been included under No. 26, Atrophy and Debility. Table showing deaths and death-rates of legitimate and illegitimate infants:— Year. Legitimate Infants. Death rate per 1000 legitimate births. Illegitimate Infants. Death-rate per 1000 illegitimate births. Births. Deaths. Births. Deaths. 1910 1,233 71 57 36 10 278 1911 1,239 94 76 37 11 297 1912 1,207 68 56 74 11 149 1913 1,252 73 58 73 18 246 1914 1,218 77 63 55 14 254 1915 1,246 82 65 81 19 234 1916 1,088 65 59 76 8 105 1917 1,052 74 70 71 16 225 1918 797 56 70 98 13 132 1919 1,039 77 74 117 19 162 1920 1,478 62 42 88 13 148 1921 1,259 71 56 83 17 205 1922 1,210 59 49 80 13 162 1923 1,162 42 36 76 12 158 1924 1,105 55 50 81 11 136 14 Table showing deaths and death-rates of infants and of children under five years of age:— Year. Deaths of Infants under 1 year of age. Deaths of Children under 5 years of age. No. Rate per 1000 births. No. Rate per 1000 children born in the year and in preceding four years. 1910 81 60 132 19.2 1911 105 82 152 22.7 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 1924 66 56 95 14.3 The following table, taken from the statistics of the RegistrarGeneral, shows the Infantile Mortality Rate in the Metropolitan Cities and Boroughs, the County of London, and England and Wales during the 53 weeks ended 3rd January, 1925. This is a different period to that covered by my Annual Report; but the table is useful for comparative purposes. District, Deaths under 1 year per 1000 births. District. Deaths under 1 year per 1000 births. Lewisham 47 Hampstead 52 Stoke Newington 56 Wandsworth 56 City of Westminster 58 Hackney 60 Battersea 62 Chelsea 63 Woolwich 65 Islington 66 Lambeth 66 Camberwell 70 Poplar 71 Southwark 71 Fulham 72 Hammersmith 72 St. Pancras 73 Deptford 74 Greenwich 74 Stepney 75 Kensington 76 Bermondsey 77 Bethnal Green 78 Finsbury 78 Paddington 78 St. Marylebone 78 Holborn 83 Shoreditch 83 London, City 115 County of London 69 England and Wales 75 15 Tuberculosis. Information concerning deaths from Tuberculosis will be found on pages 29 and 30. Measles. This disease is compulsorily notifiable in Hampstead under the Borough of Hampstead (Measles) Regulations, 1920. During 1924, 1226 cases were notified and 6 deaths occurred, four in Hospital and two at home. The following information is submitted in relation to the 6 cases which proved fatal. In two of the four instances in which death occurred in Hospital, the patients, aged two and four years respectively, were ill with Pneumonia when removal took place. One case was removed by the doctor's orders and one on the advice of the Health Visitor. One of the four cases removed was an unnotified case discovered by the Health Visitor. Of the two fatal cases which were nursed at home, in one instance the Health Visitor's offer to obtain the services of a Jubilee Nurse was accepted and in one instance was refused. Both patients were medically attended. With regard to the early notification of the fatal cases, in one instance notification was unfortunately delayed; the existence of the case was brought to the knowledge of the Health Visitor when investigating a case in another family in the house. The patient was subsequently removed to Hospital and died there. The secondary cause of death in all six cases was Bronchopneumonia. 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 1924. 16 Diarrhœa and Enteritis. Sixteen deaths at all ages from Diarrhoea and Enteritis occurred in 1924, 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:— Year. Enteric Fever. Small Pox. Measles. Scarlet Fever. Whooping Cough. Diphtheria 1919 .. .. 5 2 .. 7 1920 2 .. 8 4 6 5 1921 1 .. 4 5 6 35 1922 3 .. 6 2 2 19 1923 2 .. 2 1 4 8 1924 3 .. 6 1 4 3 In addition to the foregoing, a reference to the following may be of interest:— Cancer. The following Table gives the number of deaths in sexes from Cancer in each of the years 1906—1924:— Number of Deaths from Cancer. N umber of Deaths from Cancer. Year. Males. Females. Total. Year. Males. Females. Total. 1906 28 65 93 1916 38 75 113 1907 17 52 69 1917 37 70 107 1908 36 48 84 1918 33 72 105 1909 31 54 85 1919 52 71 123 1910 32 58 90 1920 44 76 120 1911 25 61 86 1921 55 79 134 1912 32 70 102 1922 50 85 135 1913 44 56 100 1923 61 97 158 1914 46 58 114 1924 61 90 151 1915 42 76 118 17 With reference to the greater number of deaths occurring among females, it should 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 question of site of the disease is very important. Taking England and Wales as a whole, in women malignant growths of the uterus and breast form far the largest contributor to the total mortality from Cancer. The two most frequent sites in males are the stomach and intestines. The next tables give the anatomical distribution of the deaths from Cancer in each sex:— Males. Situation. 1920. 1921. 1922. 1923, 1924. Tongue 1 4 1 — — Oesophagus 5 8 3 4 4 Stomach 8 2 7 14 7 Liver and Gall Bladder 7 3 4 4 2 Intestines 6 7 7 3 8 Rectum 6 3 5 10 5 Other organs 11 28 23 26 35 Totals 44 55 50 61 61 Females. Situation. 1920. 1921. 1922. 1923. 1924. Tongue 3 — — — — Oesophagus 3 1 — 3 — Stomach 6 3 6 6 6 Liver and Gall Bladder 11 4 4 7 10 Intestines 6 6 9 7 13 Rectum 6 9 7 20 3 Uterus 11 14 12 12 13 Breast 13 16 24 18 14 Other organs 17 26 23 24 31 Totals 76 79 85 97 90 18 The number of deaths from Cancer according to age-periods in recent years are as follows : — Year. Total. Under 25 25 and under 45. 45 and under 65- 65 and upwards. 1906 93 — 9 40 44 1907 69 1 8 32 28 1908 84 — 6 41 37 1909 85 1 12 39 33 1910 90 l 8 39 42 1911 86 — 8 44 34 1912 102 — 6 48 48 1913 100 3 8 46 43 1914 114 — 9 63 42 1915 118 2 9 61 46 1916 113 1 12 47 53 1917 107 1 8 58 40 1918 105 1 12 46 46 1919 123 — 12 59 52 1920 120 1 9 57 53 1921 134 — 12 62 60 1922 135 — 9 74 52 1923 158 3 13 67 75 1924 151 1 10 69 71 The important Memorandum and Circular No. 426, issued by the Ministry of Health in 1923, was supplemented during the year by two valuable Circulars and Memoranda. Circular No. 476, with Memorandum No. II., was issued on 6th March, and related to the effects of radium and X-rays upon normal and cancerous tissues. In this Circular it was stated that the Departmental Committee on Cancer had considered it essential to obtain reviews which summarised and brought into focus the position of modern knowledge and practice in regard to different aspects of Cancer, its causation, prevention and treatment; and that they were obtaining these reviews by the work of their own members, by special sub-committees, and in other ways as the case required, drawing freely in the process on the assistance of physicians, surgeons, pathologists and other experts, whose invaluable aid they gratefully acknowledged. In pursuance of this policy, with Circular No. 496, dated 19th May, Memo. No. III. was issued, relating to Cancer of the breast and the results of surgical operation in connection with this condition. This Memo, reviews the general position at which surgery has arrived in the case of this form of Cancer, and states certain facts which the public should recognise if operative treatment is to yield the success which, in favourable circumstances and under modern conditions, it is capable of yielding. 19 On 31st July Memo. IV. was issued, dealing with Experimental Cancer Research and of the broad conclusions, negative as well as positive, which seem to be deducible up to now from the several branches of this work. During the year Conferences were held at the Town Hall between representatives of the local division of the British Medical Association and of the Public Health Committee. These representatives were as follows :— Councillors:—J. A. A. Atkin, R. H. Hobart Cust, m.a., j.p., and J. C. Staines. Doctors:— Sidney A. Boyd, D. H. Fraser, o.b.e., m.c., and W. Stanley George. At these Conferences the desire of the medical profession to co-operate with the efforts of the Borough Council was manifest, and at the suggestion of the Medical Officer of Health various matters of interest were discussed, including inter alia:— The question of disinfection. The need for diagnostic aid to local practitioners. The advisability of issuing leaflets and posters. The question of the sufficiency of hospital beds for advanced cases. The final recommendations of the Conference, endorsed by the Public Health Committee, were approved by the Borough Council on 24th July. They were as follows : — (1) re Disinfection or Destruction of Articles used by Cancer Patients:— (a) That the Medical Officer of Health be authorised to offer disinfection after all deaths from cancer. (4) That it be left to the discretion of the Medical Officer of Health as to whether the existing charges for this service should be made in the case of the poorer residents of the Borough. (c) That when the bedding or clothing has been fouled by discharge the residents be advised to allow such bedding to be burned. (2) re Propaganda. (a) That propaganda work among medical men be left entirely to the local profession to arrange. (b) That propaganda work among the public at large be commenced by the cautious distribution of a leaflet. 20 (c) That the leaflet drawn up by the Medical Officer of Health, carefully revised by the Conference and approved by the Committee, be adopted by the Council. (d) That such leaflet be distributed by means of:— i. Medical Practitioners. ii. Chemists. iii. Public Libraries. iv. Nursing Associations, Adult Schools, "Women's Guilds, &c. (e) That, if considered necessary, an advertisement concerning the facilities offered for disinfection and destruction of infected articles be issued in the local press, together with an intimation that a leaflet on the subject of Cancer may be obtained on application. It was also Resolved— That, with reference to the question of the need for diagnostic aid to local medical practitioners, and the question of the sufficiency of hospital beds for advanced cases, it would appear that no action at the present time on the part of the Borough Council in this direction was needed. The Public Health Committee placed on record their appreciation of the help afforded in the consideration of this important subject by the three representatives of the local division of the British Medical Association, Dr. Sidney A. Boyd, Dr. D. II. Fraser, o.b.e., m.c., and Dr. W. Stanley George. The leaflet referred to is in the following terms: — BOROUGH OF HAMPSTEAD. Advice and Information Concerning Cancer. Although medical knowledge at present is limited in regard to Cancer, the following points are now generally agreed upon:— It is advisable, upon the development of symptoms which may point to a possibility of Cancer, to obtain medical advice without delay. Valuable time may be lost in following the advice of unqualified persons or in applying quack remedies. 21 Cancer rarely develops in young persons, but at middle life both men and women should consult their doctor if any unusual or unnatural conditions occur. The early stage of Cancer is often not painful—do not wait until pain occurs. Among other conditions, prompt attention should be paid to the following:— 1. Unusual swellings which develop slowly with little or no pain, but which persist and increase in size. 2. Sores on the tongue or mouth which do not heal in a short time and which may tend to bleed easily. 3. Unusual loss of blood from any part of the body. 4. Persistent indigestion, or chronic constipation, with loss of weight and general weakness. 5. Moles, warts or other swellings on any part of the body, which perhaps have existed for years but have commenced to increase in size. Any or all of these troubles may quite possibly be due to causes other than Cancer. By seeking medical advice, however, on the one hand fears may be set at rest and needless anxiety saved, or, on the other hand, the condition, if cancerous, may be treated while there is a reasonable chance of cure. It is not uncommon for persons who have done so, and acted upon such advice, to live healthily for many years. The origin of Cancer is not yet known; but it is generally held that the following are among the contributory causes:— Decayed or broken teeth, or badly fitting dental plates, which irritate the cheek, gums, or tongue. Smoking (clay pipes especially) if it produces irritation of the mouth, lips, or tongue ; or Any similar form of chronic irritation. Destruction of Bedding, Clothing, etc., and Disinfection of Rooms. The Borough Council will undertake, upon request, to disinfect rooms, bedding, clothing, etc., used by Cancer patients, and to destroy all bedding, clothing, etc., which has been fouled by discharges. 22 This leaflet has been prepared by representatives of the Public Health Committee in conjunction with the local Medical Profession, and is issued with the authority of the Borough Council. Frank E. Schase, f.r.c.s. (Eng.), l.r.c.p. (Lond.), d.p.h. (Lond.), Medical Officer of Health. Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. Advertisements were subsequently inserted in the local Press calling attention to the matter of the destruction of bedding, clothing, etc., and disinfection of rooms ; and to the fact that a copy of the leaflet could be obtained at the Town Hall or at any Public Library in the Borough. Deaths from Violence (excluding Suicide). 15 deaths were classified under this heading, as compared with 24 in 1923. The causes of death were as follows:—8 to being knocked down or run over by motor vehicles, 6 to falls, and 1 from shock (accident in room). Suicide. 10 persons committed suicide, as compared with 21 in 1923. The causes of death were as follows:— Gas poisoning, 5 ; drugs, 2 ; under train, 1; jumping out of window, 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). The scheme of the County Council for the diagnosis and treatment of venereal disease has for its objects:— (i) The provision of adequate facilities for the diagnosis and treatment of venereal diseases in voluntary hospitals and other institutions. (ii) The provision for medical practitioners practising in the County of London of laboratory facilities for aid in diagnosis and treatment ; the supply to medical practitioners of salvarsan or its substitutes for the treatment of patients; the provision of instruction for medical practitioners and students; and the co-ordination of the work of the hospitals, the public health services and medical practitioners. 23 (iii) The publication and dissemination of information, and the giving of instruction on matters relating to venereal diseases and their treatment (publicity and propaganda work). There is a Local Propaganda Committee associated with a Voluntary Body in the Borough which seeks by means of lectures, and in other ways, to combat these diseases. Section 3. Notifiable Diseases during the Year. The following is a list, alphabetically arranged, of the diseases which were Compulsorily notifiable in Hampstead during 1924:— Anthrax Cerebro-Spinal Meningitis, acute Cholera Continued Fever Diphtheria Dysentery Encephalitis Lethargica, acute Enteric Fever Erysipelas Glanders Hydrophobia Malaria Measles Membranous Croup Ophthalmia Neonatorum Plague Pneumonia, acute influenzal or acute primary Polio-Encephalitis, acute Polio-Myelitis, acute Puerperal Fever Relapsing Fever Scarlatina Scarlet Fever Small-pox Trench Fever Tuberculosis, all forms Typhoid Fever Typhus Fever No cases of the following notifiable diseases were reported during the year:— Anthrax Cholera Continued Fever Dysentery Glanders Hydrophobia Membranous Croup Plague Polio-Encephalitis, acute Relapsing Fever Small-pox Trench Fever Typhus Fever. 24 Notifiable Diseases during the Year. NOTIFIABLE DISEASES. Total cases notified in age-periods. Total Cases Notified in each Ward. Cases admitted to Hospital. Total deaths in age-periods. At all Ages. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). At all Ages. At Ages—Years. Under 1. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Under 1. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Cerebro-spinal Meningitis, acute 2 .. .. .. .. .. .. 1 .. 1 .. .. .. .. 1 .. 1 .. .. .. 1 2 .. .. .. .. .. .. 1 .. 1 .. .. .. Diphtheria 92 .. 5 7 7 8 20 12 11 20 2 .. .. 13 36 5 3 17 14 4 82 3 .. 2 .. .. .. 1 .. .. .. .. .. .. Encephalitis Lethargira, acute 7 .. .. .. .. .. .. 1 .. 2 1 1 2 2 1 2 .. .. .. 2 3 6 .. .. .. .. .. .. .. .. 1 2 .. 3 Enteric Fever 11 .. .. 1 .. .. .. .. 1 3 3 2 1 2 1 1 3 2 1 1 8 3 .. .. .. .. .. .. .. .. 1 1 1 .. Erysipelas 15 .. .. .. .. .. .. .. .. 5 2 7 1 1 7 2 1 2 .. 2 4 1 .. .. .. .. .. .. .. .. 1 .. .. .. Malaria 3 .. .. .. .. .. .. .. .. 2 1 .. .. .. 1 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. † Measles 1226 38 85 104 146 172 427 130 54 55 12 2 1 204 153 92 151 227 262 137 80 6 † 2 2 .. 1 1 .. .. .. .. .. .. Ophthalmia Neonatorum 7 7 .. .. .. .. .. .. .. .. .. .. .. .. 1 1 .. 2 .. 3 5 .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia, acute influenzal or acute primary 116 3 3 7 1 2 4 1 13 20 15 26 21 18 15 19 10 14 25 15 19 27 1 .. .. .. 1 .. 1 2 6 79 Polio Myelitis, acute 5 .. .. .. 2 1 1 .. .. 1 .. .. .. 2 .. .. .. .. .. 1 5 1 .. .. .. 1 .. .. .. .. .. .. .. .. Puerperal Fever 4 .. .. .. .. .. .. .. 1 2 1 .. .. .. 1 .. .. .. 2 1 3 1 .. .. .. .. .. .. .. .. .. 1 .. .. Scarlet Fever 150 .. 1 6 9 12 55 33 13 19 2 .. .. 24 41 5 16 29 22 13 131 1 .. .. .. .. 1 .. .. .. .. .. .. .. 1638 48 94 125 165 195 507 178 93 130 39 38 26 266 258 129 185 293 328 179 341 51 1 4 2 1 2 3 1 1 6 10 8 12 t Compulsorily notifiable in Hampstead under the Borough of Hampatead (Measles) Regulations, 1920. 25 Ophthalmia Neonatorum. The following information relating to this disease is given at the special request of the Ministry of Health. Total cases notified by medical practitioners 7 „ „ midwives — Number treated at home 2 „ in hospital 5 Vision unimpaired 7 „ impaired — Total Blindness — Number of Deaths — Small-pox. No case was notified during the year. Vaccination. Of the total births dealt with in 1924 by the Vaccination Officer amounting to 1343, 741 were successfully vaccinated. In 12 cases the children were insusceptible of vaccination. In regard to 261, certificates of Conscientious Objection were obtained; 38 died before vaccination was performed; 33 cases of vaccination were postponed, and 258 remained to be dealt with. I am indebted to the Vaccination Officer for these statistics. The steady increase in the number of citizens unprotected by vaccination against small-pox, continues year by year. There can be be no doubt but that comparative immunity for so many years from this loathsome disease has largely robbed it of its terrors. There does not appear, however, to be much likelihood of a change in public opinion on this question unless we are visited by an outbreak, in which case the large unvaccinated population would prove to be a grave danger to the community. Tuberculosis. Notification. During the year 1924, 125 new cases of Tuberculosis were notified, 100 being cases of Pulmonary Tuberculosis, and 25 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 1924:- 26 Tuberculosis. Total New Cases in age-periods notified for the first time in 1924. Total New Cases Notified in each Ward. Cases admitted to Hospital. Total Deaths in age-periods of Old and New Cases. At all Ages. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). At all Ages. At Ages—Years. Under 1. 1 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and upwards. Under ]. 1 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 25. 25 and under 35. 35 and under 45. 45 and under 55. 55 and under 65. 65 and upwards. Pulmonary M. 52 — — — 1 4 8 16 14 6 2 1 8 10 2 4 7 13 8 32 33 — — — — — 4 8 13 7 — 1 F. 48 — — 1 2 2 12 16 4 7 4 — 6 9 7 6 9 6 5 36 25 — — — 1 3 2 6 4 5 3 1 Non- Pulmonary M. 10 — 3 2 1 1 — 3 — — — — 2 3 — 1 2 1 1 7 6 — 2 1 — 1 — 1 — 1 — F. 15 — 1 1 3 1 3 3 1 2 — — 1 2 2 2 3 4 1 10 6 — 1 — — — — 1 — 2 1 1 Totals 125 — 4 4 7 8 23 38 19 15 6 1 17 24 11 13 21 24 15 85 70 — 3 1 1 4 6 16 17 15 4 3 A reference to the question of efficiency of Notification of Tuberculosis will be found on the following page. 27 Of the new cases notified in 1924:— Pulmonary. Nonpulmonary. 8 4 were dead or dying at time of notification. 10 5 were patients in hospitals. 6 — „ sanatoria. 2 — „ infirmaries. 4 2 „ institutions. 3 — removed from Hampstead almost immediately after notification. 2 2 were out-patients of hospitals. 22 2 were attended by private doctors only. 51 13 came within the orbit of the Dispensary Scheme, either by attending themselves or their contacts attending for examination. 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 8, and the total tuberculosis deaths 70 ; the ratio of non-notified tuberculosis deaths to total tuberculosis deaths being 1 in 9*. Closely akin to non-notified fatal cases is the question of those patients who are not notified until they reach a very advanced stage of the disease. This unfortunate aspect of what must in some cases be " late " notification is indicated by the following table:— 1920. 1921. 1922. 1923. 1924. Total deaths, all forms of Tuberculosis.. 55 72 71 58 70 No. notified within one month of death 2 12 9 5 9 No. notified within three months of death 4 7 7 6 7 No. notified within six months of death 3 10 1 4 4 It is most important 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 greatly-needed and much overdue provision. An open-air school for delicate and suspected children is another very urgent need. Every child, who is under observation by the * In addition to the 8 non-notified cases, a further 9 cases were notified only at death. 28 Tuberculosis Medical Officer as a " suspect," should be sent to such a school until the suspicion is removed or the reason for the delicacyascertained. The number of cases notified in recent years is as follows:— Year. Persons newly notified. Pulmonary Tuberculosis (Voluntarily notifiable 1902; Compulsorily notifiable 1912). Non-Pulmonary Tuberculosis (Compulsorily notifiable from 1st 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 88 36 124 1924 100 25 125 At the present time 72 discharged soldiers suffering with tuberculosis are resident in Hampstead. The number of cases of tuberculosis known to the Department at the end of 1924 totals 842—647 pulmonary and 195 non-pulmonary. Occupations. The following is an analysis of the occupations of the new cases notified as tuberculous during 1924:— Occupation. Pulmonary Cases. NonPulmonary Cases. Occupation. Pulmonary Cases. NonPulmonary Cases. Army and Navy Pensioners 5 — Labourers 4 — Laundress 1 — Artists 3 — Leather Worker 1 — Bootmaker 1 — Messenger 1 — Bricklayer 1 — Motor Bus Driver 1 — Carpenter 1 — Nurse 1 — Case Maker — 1 Plumber 1 — Chartered Accountant 1 — Police Constable 1 — Chauffeurs 2 1 School Children 3 7 Clerks 7 1 Shop Assistants 6 — Commercial Traveller 1 — Shop Keepers 2 — Directors 2 — Solicitors 2 — Domestic Servants 12 2 Sorter, Post Office 1 — Draughtsman 1 — Storekeepers 2 — Dressmakers 1 1 Student 1 — Factory hands 2 — Teacher 1 — Fireman on railway 1 — Ticket Collector — 1 French Polisher 1 — Undertaker — 1 Gardener — 1 Violinist 1 — House Painters 2 — Waitress — 1 Housewives 18 2 No occupation 6 6 Journalist 1 — Laboratory Assistant 1 — 100 25 29 Of the 100 eases of Pulmonary Tuberculosis newly notified in 1924:— 27 were treated at Sanatoria 11 insured 16 non-insured 6 „ Poor Law Institutions 3 „ 3 „ 32 „ Hospitals 14 „ 18 „ 3 „ Nursing or other Homes, non-insured Of the 25 cases of Non-pulmonary Tuberculosis newly notified in 1924 5 were treated at Sanatoria 1 insured 4 non-insured 2 ,, Poor Law Institution 1 „ 1 „ 9 ,, Hospitals 3 „ 6 ,, 2 „ Nursing or other Homes non-insured. The following cases, notified prior to 1924, were also removed. Pulmonary. Non-Pulmonary. Insured. NonInsured. Insured. NonInsured. To Sanatoria 12 3 — — To Hospitals 6 2 — — To Poor Law Institutions 5 — — — To Nursing or other Homes 1 1 — — Deaths. The number of deaths from Tuberculosis in 1924 was 70. Of these, 58 were due to Pulmonary Tuberculosis and 12 to other forms of Tuberculosis. The deaths from Pulmonary Tuberculosis and from all forms of Tuberculosis during 1924 were distributed among the Wards as follows:— Ward. Area (Acres). Deaths from Pulmonary Tuberculosis. Deaths from other Forms of Tuberculosis. Total deaths from All Forms of Tuberculosis. No. 1 (Town) 686 7 2 9 „ 2 (Belsize) 271 10 3 13 „ 3 (Adelaide) 325 7 1 8 „ 4 (Central) 312 8 1 9 „ 5 (West End) 247 7 1 8 „ 6 (Kilburn) 195 15 3 18 „ 7 (Priory) 229 4 1 5 The Borough 2,265 58 12 70 30 Pulmonary Tuberculosis. The following table shows the age distribution of persons dying from Pulmonary Tuberculosis in recent years:— Year. Age Period. All Ages. 0—5 5—15 15—25 25—65 65— 1913 — 1 4 39 5 49 1914 — 2 10 42 3 57 1915 — 1 7 37 3 48 4916 — 4 11 37 3 55 1917 — — 21 47 1 69 1918 1 1 11 59 3 75 1919 — 1 13 39 3 56 1920 — 2 8 27 4 41 1921 — 2 10 47 4 63 1922 — 1 10 37 2 50 1923 — — 6 45 — 51 1924 — 1 9 46 2 58 Totals 1 16 120 502 33 672 Non-Pulmonary Tuberculosis. The age distribution of persons dying from Non-Pulmonary Tuberculosis in 1924 is as follows:— Under 1 year — 1—2 years 1 2—5 „ 2 5—15 „ 1 15—25 „ 1 25—45 „ 2 45—65 „ 4 65—75 „ — 75— „ 1 Prevention, Treatment, &c. Staff engaged on Tuberculosis Work. —The Borough Council staff specially engaged on work directly connected with Tuberculosis consists of the following:— 1.—Administrative Tuberculosis Medical Officer: the Medical Officer of Health. 31 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. 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. Tuberculosis Care Committee. The Care Committee is not a Committee of the Borough Council, although the Council nominates six of its members to serve on the Committee, together with the Medical Officer of Health, Tuberculosis Medical Officer and Lady Sanitary Inspector as ex-officio members. 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 are Councillors. 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. 32 Section 4. Causes of Sickness. The outstanding feature among causes of sickness during 1924 was the epidemic of Measles that occurred early in the year. The disease, fortunately, was of a fairly mild type; during the whole year only 6 deaths occurring from this complaint, while 1226 cases were notified under the Borough of Hampstead (Measles) Regulations, 1920. 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 Infections 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 Diarrhoea, Ophthalmia Neonatorum, Acute Primary or Acute Influenzal Pneumonia, Influenza, Malaria, Dysentery or Trench Fever. During 1924,165 cases were nursed under this arrangement by the Kilburn and West Hampstead District Nursing Association, and 40 by the Hampstead District Nursing Association. (c) For Maternity Cases. By agreements between the two Nursing Associations and the Borough Council, skilled maternity nursing can bo 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 foe 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 33 Maternity Nurses. During 1924, 58 cases were thus nursed by the Kilburn and West Hampstead District Nursing Association, and 23 by the Hampstead District Nursing Association. Midwives. The total number of midwives practising in Hampstead is 40. 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 1924, 79 cases were attended by the Midwives of the Kilburn and West Hampstead District Nursing Association, and 6 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 Pre-Maternity Clinics, will be found in Appendix II. 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. Tuberculosis. Tuberculosis Dispensary established and controlled by the Borough Council. Sessions held at the Dispensary, 73, Dynham Road. 34 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 1924. Maternity. Tuberculosis Number of Sessions held 53 — Patients Attendances 499 29 Number of Fillings 89 1 Number of Scalings 70 — Extraction cases- Number of teeth extracted. 283 15 With Gas 12 1 With Local Anaesthetic 108 4 Without Anaesthetic — — Number of Dentures (including repairs) 36 2 Number of Dressings and Root treatment 71 4 Number for Advice 47 7 Number of Denture visits 66 11 Number of New Patients 88 4 Hospitals provided ok subsidised by the Borough Council ok 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. Queen Charlotte's Hospital.—The Borough Council contributes towards the cost of beds in Queen Charlotte's Hospital, which are available for Hampstead residents. 102 Hampstead women were confined there in 1924. 35 New End Hospital.—The Borough Council maintains a maternity ward at this Hospital for patients who can contribute to the cost of their maintenance. (3) Children. The beds referred to in paragraph (1) 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. Children who need minor operations are also admitted under this arrangement. During 1924, 44 children were sent to that Institution in pursuance of this agreement, the Borough Council paying the Hospital a fixed rate per bed per week, and the patients being assessed according to their means. (4) Fever (and Diphtheria) Provided by the Metropolitan Asylums (5) Small-pox Board, (6) Other. The Borough Council has two endowed beds in the Hampstead General Hospital, which can be utilised for the purpose of providing hospital accommodation for mothers or children. St. Mary's Convalescent Home, Birchington-on-Sea. During the year, the arrangements whereby, in return for a contribution of £7, the Council were entitled to send seven patients into the Home during 1924 on payment of a weekly charge of 15s. for mother and infant or 10s. for mother only, were revised. In view of the great benefit to mothers derived from convalescent treatment, it was thought desirable to ensure such treatment for all cases in which it was considered to be necessary, and for that purpose to reserve a bed at such Home for the period April to September (inclusive) which would entitle the Council to make its own arrangements for the admission of cases; at a cost to the Council of £25, plus a weekly charge of 10s. for mother and infant, or 5s. for a mother only. The Borough Council at its meeting on 1st May confirmed this arrangement, which was subsequently sanctioned by the Ministry of Health. 36 Arrangements were subsequently made with the Home for the admission of mothers and infants until the end of the year, the Council subscribing a further sum of £5 in return for five letters of admission, the original weekly charge being reverted to. During 1924, 10 of our mothers and babies were sent to Birchington. Institutional Provision. For Unmarried Mothers For Illegitimate Infants 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. Ambulance Facilities. (a) For infectious cases Provided by the Metropolitan Asylums Board. (b) For non-infectious and accident cases The Ambulances of the London County Council and those of the St. John's Ambulance Association are available for accident cases. The Ambulances of the Metropolitan Asylums Board are available for noninfectious cases. Work of the Borough Council Health Visitors. The following table gives a record of the work of the Borough Council Health Visitors in 1924, who work in conjunction with the Infant Welfare Centres of the Hampstead Council of Social Welfare:— Number of first visits to expectant mothers 132 „ re-visits „ „ 106 „ infants under one year visited for the first time 838 ,, re-visits to infants under one year 1363 ,, visits to children over one year 2214 „ visits re deaths of infants under two years of age 73 „ „ infectious disease 1432 „ attendances at Borough Council's Pre-Maternity Clinics 152 „ „ „ „ Dental Clinic 54 „ „ Infant Welfare Centres 290 ,, complaints investigated 13 ,, applications for assistance visited 242 „ unclassified visits 320 Total 7229 37 Supply of Milk for Expectant and Nursing Mothers and for Infants, Ministry of Health Circular 185, dated 31 st March, 1921. The number of families helped at any one time by the Council during the year under this Scheme varied from 59 to 95. The cost to the Borough Council was £156 3s. 0d. for milk and £149 14s. 6d. 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 families. 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. General Survey and Supervision of the health of expectant and nursing mothers and of children under five years of age. As far back as October, 1923, I suggested to the Maternity and Child Welfare Committee that a special Sub-Committee should be appointed for the purpose of enquiring into infant deaths, and the Maternity Committee then resolved to appoint such a Sub-Committee, the reference being to enquire into the death of every infant under two years of age. The Sub-Committee appointed consisted of the three medical members of the Maternity and Child Welfare Committee—Drs. Boyd, George, and MacFadden, with the Chairman—Councillor Mrs. Fisher —ex-officio. It was further resolved that the Health Visitors should attend the meetings of the Sub-Committee, prepared to report on all deaths of infants under two years of age which had occurred in their respective districts. It has, for some time past, been the duty of the Health Visitors to investigate and specially report to me upon all deaths of infants under two years of age ; but it was net until January, 1924, that each case was thus investigated by a Committee. The nature of the Sub-committee's investigations is indicated by the Inquiry form used by them, which is as follows: Inquiry by Sub-Committee of Maternity and Child Welfare Committee into the Death of a Child under Two Years of Age. Name of Child : Legitimate or Illegitimate: Occupation of Father : Occupation of Mother : 38 Date of Birth : Where born : Home address (if birth occurred elsewhere): Home conditions : No. in family, excluding this child No. of rooms for living or sleeping: Sanitary environment : Pre-maternity Clinic attended : Date of first visit : Date of last visit : Remarks : Was expectant mother assisted with milk and food ? If she worked during pregnancy, how long before confinement did she cease work ? Details of Investigation by Health Visitor after Birth Notification : (Information from Health Visitor's Record Card.) Bottle fed or breast fed : Were mother and child assisted with milk and food ? Remarks : Particulars of subsequent visits by Health Visitor : (Information from Health Visitor's Record Card.) Remarks : Infant Welfare Centre attended : Date of first visit: Date of last visit : Remarks : If no Centre attended, or attendance ceased, reason therefore : Particulars of Fatal Illness. Onset of illness : (date, etc.) Dates of Health Visitor's calls during illness : What action taken by Health Visitor : e.g-.—Nurse provided; Hospital facilities offered; arrangements for medical supervision : Any special report furnished, and to whom: Doctor's name and address: When summoned: Nurse's name and Institution: When summoned: Date of Death: Where died: Home address (if death occurred elsewhere): Cause of death: Health Visitor's comments on case, environment, etc.: Finding of Sub-Committee on case: (Additional steps that might have been taken. Any point of child's life not covered by Borough Maternity and Child Welfare Scheme.) This method was pursued until, in June, 1924, the Ministry issued a most important report, entitled "Maternal Mortality, associated with Child Bearing," by Dame Janet Campbell, Senior Medical Officer of the Ministry of Health for Maternity and Child Welfare. The Report was considered at length by the Maternity and Child Welfare Committee and, in consequence, there was added to the reference of the Sub-Committee the investigation of maternal deaths and stillbirths. The Committee has, therefore, been working for the whole of the year 1924, and it is now possible to review the work for that year. 39 Thus—the Committee have considered in detail:— 83 deaths of infants under 2 years of age, 3 maternal deaths, 26 still-births, and the result of their investigations may be summarised as follows :— The 83 infant deaths were certified to be due to the following:— Cause of Death, No. of Deaths. Premature birth 14 Pneumonia 13 Marasmus 10 Enteritis 7 Injury at birth 5 Bronchitis 5 Congenital malformation 4 Measles 2 Whooping Cough 2 Diphtheria 2 Convulsions 2 Syphilis 2 Meningitis 3 Tuberculous Meningitis 1 Gastritis 1 Suffocation 1 Atelectasis 1 Vincent's Angina 1 Septiæcmia 1 Cerebral hæmorrhage 1 Otitis Media 1 Epilepsy 1 Cellulitis of scrotum 1 Asphyxia, accelerated by haemorrhage from untied umbilical cord 1 Pelvic abcess, following appendicitis 1 Total 83 Of this number, 70 were legitimate infants and 13 were illegitimate. 40 It may be interesting here to re-state— No. of Births of Hampstead children registered during 1924:— Legitimate 1105 Illegitimate 81 The Committee came to the following conclusions, that:— In 17 instances the cases were not within the scope of the Borough Council facilities for various reasons, chiefly economical or geographical; thus — some of the deaths occurred in the families of well-to-do people, where all medical and and nursing assistance was to hand. Some were cases of children born elsewhere, in nursing homes, etc., who died before returning to their homes. In 18 cases the Sub-Committee had no remarks to make, the reasons for the deaths being apparent, and the death certificates self-explanatory. In 32 cases it appeared that all the Borough Council facilities were utilised, the mothers attending our Pre-maternity Clinics and afterwards the Infant Welfare Centres. In 6 cases the facilities offered were not utilised. These appeared to belong to that class where the mothers will not, for some reason or other, attend any centre or clinic. In one of these there existed overcrowded home conditions, which the SubCommittee were of the opinion contributed to the death. In 4 cases the Sub-Committee were of the opinion that, had the mother attended the Pre-maternity Clinic, steps could have been taken to prevent premature birth and subsequent death. In 1 case death might have been prevented had continuous medical treatment been pursued. In 1 case anti-syphilitic treatment would have altered the result. In 2 cases the Committee considered the death certificates too vague for them to form an opinion In 2 cases the Committee were of opinion that something might have been done to obviate the deaths had earlier information of the illnesses of the children been available. 41 Maternal deaths considered by the Sub-Committee:— 1. Patient died at New End Hospital—death certified as being due to "Nephritis of pregnancy—6 days—and acute dilatation of stomach." This case died on the 22nd March, the baby having died two days previously from "Prematurity." 2. This patient died at Queen Charlotte's Hospital. Death certified as being due to "shock following difficult labour, acute cardiac failure." 3. Patient died at the North-Western Fever Hospital. Death certified as being due to "Puerperal Septicæmia." This case had attended the Borough Councils Pre-maternity Clinic. There seemed to be nothing the Borough Council could have done in respect of Nos. 1 and 2. With regard to No. 3, a great deal of trouble was taken to ascertain the cause or origin of the infection. The doctor who was in charge was severely critical of the nurse; but, as she was not a qualified nurse, little could be done. I have always deemed it a disappointing fact that, although we provide a fully trained nurse for any case requiring one, more advantage is not taken of the facility. The advice has been frequently given to doctors and the laity; but, in spite of everything, many people prefer the old type of untrained woman. Also, this case, while attending the Borough Council's Pre-maternity Clinic, was found to be suffering from Venereal Disease, and this was thought to have had something to do with the subsequent disaster. Still-Births. With regard to still-births, it is well here to call attention to the fact that still-births are not registerable at any time ; but are notifiable if births occurs after the 28th week of pregnancy. There is no obligation on the part of anyone to notify before that. The still-births which are notified to me represent only a small proportion of the total loss of life which occurs during the nine months of pregnancy. The notifications of the 26 still-births gave no information on which any opinion could be formed as to the causes of the still births, and I decided to invoke the aid of the doctors and midwives in obtaining some further insight into the cause of the still-births. 42 For this purpose, I circularised the following letter, which is selfexplanatory:— "I am investigating the question of still-births for statistical and other reasons. It is a subject, respecting which I find it extremely difficult to get information. I should be glad if you could give me any help in the matter. During the year 1924 the following case was notified to me by you as occurring in your practice:— Would you mind telling me what, in your opinion, was the cause of the still-birth? For instance, was it due to:— (a) difficult labour? (b) mal-presentation? (c) specific disease in the parents? (d) kidney or heart disease in the parents? (e) any other cause? I should also be grateful of any suggestions you may care to make as to the prevention of still-births generally." It is an interesting point to note that in not one of the 26 cases did I receive a rebuff (at the time I thought this probable). In fact, answers received from the general practitioners were all of a friendly nature and, in some cases, contained suggestions which were most helpful. I like to record this fact, because it sometimes happens that any action like this is regarded as being officious or interfering. From the replies received, it was found that the causes of the 26 still-births were as follows:— 6 mal-presentation. 5 difficult labour. 4 macerated foetus. 2 premature birth. 1 contracted pelvis. 1 undeveloped twin. 1 anencephalic monster. 1 mother suffering from acute septicaemia. 1 age of mother—over 40. 1 child had been dead for several days, cause unknown. 3 no information obtainable—occurred in nursing homes. 43 Two of the mothers in these cases had attended the Borough Council's Pre-maternity Clinic. Among the volunteered suggestions made by the general practitioners were the following:— (a) "The commonest cause of still-birth is difficult labour, including mat-presentation, which should be preventable by ante-natal measurements, though contraction is extraordinarily difficult to detect." (b) "It should be a condition of the employment of midwives that, in all cases attended by them alone, the mother should be seen by a medical practitioner, or the medical officer of an institution, at least once, not less than a month prior to the term. This practice might perhaps afford greater security than exists at present against abnormalities remaining undetected untit too late to be dealt with by the most satisfactory methods." (c) "Ante-natal care and, if possible, anticipating difficult labour and acting accordingly." and (d) "Treatment of specific disease prior to labour." From a midwife came a suggestion that in any midwife's case attending the Pre maternity Clinic, it should be a rule that the doctor in charge should communicate the information direct to the midwife and not to the patient. In regard to this suggestion, the Committee were of opinion that it would be far better for the midwife to attend with her patient and hear what the doctor at the Clinic had to say. During the Committee's consideration of still-births, it was much commented upon that such a large number of the still-births were due to mal-presentation, difficult labour, contracted pelvis, all of which mean much the same thing, and the Committee were of the opinion that the cause of the still-births, as revealed by the list, emphasizes the importance of examining the mothers prior to labour. They were also of opinion that it would be of considerable help if skilled obstetrical help was available for any practitioners attending cases of grave difficulty. 44 Among the Sub-Committee's recommendations are the following:— (a) That the two Creches in the Borough be asked to co-operate with the Borough Council, by reporting to them immediately any children who appear to be ill, or who are refused by the Creches because of ill-health. (b) That certain mothers be strongly advised to attend the Borough Council's Pre-Maternity Clinic in any subsequent pregnancies. (c) That anti-syphilitic treatment bo commenced as soon as possible in certain cases. (d) That certain certifying doctors be asked for further information. (e) That in difficult cases the services of a skilled obstetrician should be available for the help of the general practitioners. Pre-Maternity Clinics. With a view to making the existence of these Clinics more widely known, a leaflet has been prepared in the following terms and circulated in the Borough through suitable channels. This leaflet is in the following terms:— BOROUGH OF HAMPSTEAD. Advice to Expectant Mothers. Maternity is a perfectly natural condition and if proper care is observed, no trouble or danger need be feared. The period during which a mother is expecting her baby is, however, sometimes fraught with considerable trouble and distress; and occasionally the lives of both mother and child may be in danger. Every expectant mother should consult a doctor some months before the date of the confinement. Most things can be put right if taken in time; and to help expectant mothers, the Borough Council has established Clinics where 45 they may attend so that anything likely to give rise to trouble may be detected and put right. A lady doctor is in charge and she will welcome any expectant mother who cares to come and ask her advice on any subject connected with her condition. The Clinics arc entirely free—there is no charge except where a mother may require such things as belts or bandages, in which case they will be supplied to her at wholesale rate or less than cost price. Milk and food for expectant mothers during the last three months of pregnancy are supplied in necessitous cases on application being made to the Medical Officer of Health. All women who are not being attended by a doctor, but are thinking of entering a hospital or institution, or are going to be attended by a midwife, are strongly advised to avail themselves of the facilities of these Clinics. 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 28 249 277 Enteric Fever — 6 6 Specimens of Sputum 56 271 327 48 X-ray Examinations were made. 46 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 1924, 245,500 units were supplied from the Public Health Department. Section 7. Sanitary Administration. List of adopt ire Acta, Bye-laws, and Local Regulations relating to the Public Health, in force in the Borough, icith date of adoption. Bye-Laws under Sections 16 (1), 16 (2), 39 (1), 39 (2) and 50 Public Health (London) Act, 1891. Bye-Laws under Section 202 Metropolis Management Act, 1855. Regulations under Section 17 (7) Housing (Town Planning) &c., Act, 1909. Tabular summary of the work of the Sanitary Department during 1924. Total number of Inspections, 6220. Re-inspections, 11415. „ Intimation Notices, 920. Statutory Notices 715. Total number of deposits of plans and particulars for redrainage work, &c., 681. „ Complaints of insanitary conditions received and investigated, 697. The following Statement and Information under Article 19 of the Sanitary Officers' Order, 1022, affords some indication of the work 'performed by the Sanitary Inspectors. Much of the work of the Staff of the Department, which its 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) 714 Dampness in houses or parts of houses abated 228 Dilapidated „ „ „ repaired 553 47 Overcrowding— Rooms found overcrowded 7 Overcrowding abated (rooms) after service of notice 7 „ „ without service of notice — Underground Rooms — Found illegally occupied 13 Closed, or illegal occupation discontinued 6 Made to conform 7 Below Floors— Spaces below floors in the basement or ground floors ventilated 140 Roofs— Roofs repaired 413 Gutterings— Grutterings repaired or renewed 435 Rainwater Pipes— Rainwater pipes repaired or renewed 453 „ ,, disconnected from drains 31 ,, ,, soil-pipes 3 Waste Pipes— Waste pipes of sinks disconnected from drains 16 „ „ trapped 507 „ „ repaired or renewed 346 ,, „ unstopped 3 ,, of lavatories disconnected from drains 8 „ „ trapped 416 ,, ,, repaired or renewed 310 ,, ,, unstopped 1 ,, of baths disconnected from drains 16 „ „ trapped 315 „ „ repaired or renewed 230 Water Supply— Water supply re-instated 9 Water certificates issued for new houses, Sec. 48, Public Health (London) Act, 1891 8 Additional water supply provided to tenement houses 70 No. of tenement houses dealt with 48 48 Water Supply—continued — Additional sinks provided to tenement houses 88 No. of tenement houses dealt with 57 Sinks provided (in addition to above) 425 Lavatory basins provided 332 Baths provided 223 Water Cisterns— Water cisterns repaired or renewed 9 „ removed from improper positions 10 „ cleansed 89 „ fitted with close fitting covers 35 Water Closets— Water closet accommodation provided 13 Additional water closet accommodation provided 82 Separate and sufficient provided for each sex 5 Water closets removed from improper positions 13 „ provided with proper and sufficient external ventilation 82 Improperly constructed water closet apparatus removed and new provided 2 Water closet apparatus repaired or renewed 560 „ „ unstopped 24 „ „ cleansed 29 „ „ provided with proper water supply 49 „ flushing cisterns repaired or renewed 404 Drains— Drains repaired or renewed 514 „ cleansed 84 „ unstopped 51 „ ventilated 72 Manholes— Manholes repaired or renewed 353 Ventilating Pipes— Carried to a sufficient height above windows 3 Ventilating pipes of drains repaired or renewed 34 Fresh air inlets repaired or renewed 143 49 Soil Pipes— Soil pipes repaired or renewed 290 „ ventilated 34 Gullies and Surface Drains— Gully traps removed from improper positions 17 „ cleansed 12 Inlets or surface drains trapped 18 Paving and drainage of Washhouses, Areas, Yards, &c.— Washhouse or scullery paving repaired or renewed 26 , Areas cleansed 6 Area paving repaired or renewed 181 Areas drained 48 Yards or other open spaces paved 83 Paving of yards or other open spaces repaired or renewed 269 Yards or other open spaces drained 57 Buildings in which horses, &c., are kept; floors paved or repaired 4 Refuse and Receptacles — Dust bins provided 632 „ ,, cleansed 1 Fixed ashpits removed 10 Accumulations or deposits of refuse removed 787 Nuisances from the improper deposit of trade refuse abated 1 Animals — Nuisances from the improper keeping of animals abated (fowls 8, cat 1) 9 Smoke Nuisances— Number of nuisances and complaints 1 „ of observations 2 ,, of notices — „ of summonses — Personal Cleansing— Number of cleansings of adults 4 „ of cleansings of children 910 « Cleansing — Number of verminous rooms cleansed 37 ,, houses concerned 16 50 Disinfection— Number of houses or parts of houses and contents disinfected 2009 „ of verminous rooms disinfected 35 „ of persons accommodated at Shelter — Customs and Inland Revenue Acts— Number of houses for which certificates requested 3 „ of dwellings contained therein 8 „ of houses certified 2 „ of dwellings contained therein 5 Public Mortuary— Number of bodies admitted 50 Increase of Rent and Mortgage Interest (Restrictions) Acts— Number of certificates applied for 33 ,, „ issued 24 In addition to the foregoing, a summary of the work of the Housing Inspectors will be found in Section 9 relating to Housing. The Exemption of Railway Companies' premises from control by Sanitary Authorities. On 16th May, 1924, in the King's Bench Division (Divisional Court), a judgment of very far-reaching effect was given bearing on the above subject. The case was argued before the Lord Chief Justice of England, Mr. Justice Roche, and Mr. Justice Branson. Mr. A. Macmorran, K.C., and Mr. S. G. Turner (instructed by Mr. A. P. Johnson, Town Clerk), appeared on behalf of the Appellants, the Hampstead Borough Council; and Sir John Simon, K.C., M.P., Mr. Eustace Hills, K.C., and Mr. Alfred Tylor (instructed by Mr. H. L. Thornhill, Solicitor, Euston Station, N.W.I), appeared on behalf of the Respondents, the London, Midland & Scottish Railway Company and the Contractors, Messrs. John Cochrane & Sons, Ltd. Briefly stated, the question at issue was whether the Railway Company, by reason of the powers given to them by their Special Act, were exempt from by-laws made by the London County Council under Sec. 202 of the Metropolis Management Act, 1855, enforced by the Borough Council. 51 The Judgment was as follows : — The Lord Chief Justice: To deal first for the moment with the case of Kershaw v. London, Midland & Scottish Railway Company, that is a case stated by the learned Stipendiary Magistrate sitting at Marylebone. It arises out of two Informations preferred by the Appellant, the Senior Sanitary Inspector for the Metropolitan Borough of Hampstead, against the Respondents, the London, Midland & Scottish Railway Company, upon which two summonses were granted. It is not necessary that I should read more than one. The first is "that they, the Respondents, did fix a water closet in the right hand apartment of a Indies' convenience at South Hampstead Station on the street level of such premises and did connect the same to a soil-pipe which is itself in connection with another water closet and did fail to cause the trap of such water closet to be ventilated contrary to Drainage Bye-law No. 17 in that behalf made by the London County Council in pursuance of the Metropolis Management, Act, 1855, Section 202." The second summons is like unto it, except that, I think, "left-hand" is substituted for " right-hand." It is not necessary that I should recapitulate the facts of the case. I refer only to one somewhat important finding of fact which appears in paragraph 10 (H) xxx. The learned Magistrate found as a fact "that the exercise by the Appellant of the rights conferred upon the Borough Council by the Metropolis Management Act, 1855, and by the Bye-laws made thereunder, would or might cause inconvenience and/or danger to the working by the Railway Company of the traffic on their lines; but the exercise by the Appellant of the said rights with reference to the said water-closets would not have caused any such inconvenience or danger." Having heard the evidence, the learned Magistrate dismissed the Informations, and this Case is stated in order to raise the question whether the learned Magistrate was right in the opinion expressed in it, that each of the contentions of the Respondents upon the facts proved before him was right. He found not merely that one of those contentions was right; but that all of them were right. They are as follows: "That the interference with and control of the Respondent's premises and works involved in the exercise of the powers of the Metropolis Management Act, 1855, hereinbefore mentioned, are inconsistent with the powers conferred upon the Respondents by the London and North Western Railway Act, 1912, 52 and therefore the said powers have no application to the premises and works of the Respondents"; secondly, "That the power to make byelaws conferred on the London County Council by Section 202 of the of the Metropolis Management Act, 1855, and by Section 40 of the Local Government Act, 1888, so far as the same involves interference with or control of the premises and works of the Respondents, is inconsistent with the powers conferred upon the Respondents by the London and North Western Railway Act, 1912, and therefore to the extent aforesaid the said bye-laws have no application to the premises and works of the Respondents"; and thirdly and finally, "The powers claimed and exercised by the Appellant as aforesaid are inconsistent with the provisions of Section 16 of the Railways Clauses (Consolidation) Act, 1845, incorporated with the London and North Western Railway Act, 1912, under which the Respondents have power to construct such works of the nature specified in the said section as they think proper." The question whether the learned Magistrate was right in this case is the question which has been often raised under different special Acts: whether the special Act is inconsistent with the general Act so as to produce the result that it is to the special Act, and not to the general Act, that you must look in order to ascertain the law relating to the matter. The alleged inconsistency here is clearly formulated in the three-fold contention of the present Respondents. The argument for the Appellant, which has been put with great force, as is only to be expected from Mr. Macmorran, is that, in order to ascertain whether there is a kind of inconsistency relied upon, one ought to look, not to the Statutes alleged to be inconsistent, and to the powers by those Statutes respectively conferred, but at particular bye-laws, on the one hand, and in this case at particular conveniences, as they are called, on the other hand, with special reference in each case to the individual question whether in the particular case referred to the work might or might not have been carried out in fact in such a way as to comply with the particular bye-law. In my opinion, that is not merely a novel proposition, but a proposition which cannot be sustained. It appears to me to be in conflict with the principles laid down in a long series of cases, including, for example, the case of the City and South London Railway Company v. London County Council, reported in 1891, 2 King's Bench, at page 513, and not least to the case of the Surrey Commercial Docks v. Bermondsey Corporation, reported in 1904, 1 King's Bench, at 53 page 474. Of course, every decision turns upon the particular facts with which the decision has to do; hut I cannot help thinking that the Judgment in the latter case, turning as it did upon the facts contained in that case, has a peculiar and singular appositeness to the present case. I agree, therefore, with the Judgment of the learned Magistrate in substance, for the reasons which he gives, and I think this appeal ought to be dismissed. When I say, "for the reasons which he gives," perhaps I ought to add the words "founded as they are upon the important facts found in the Case." With regard to the rest of these cases, I observe on the first page of the Judgment of the learned Magistrate these words: "It is agreed that the legal position is the same as if the Railway Company had done the work themselves, and I treat the matter as if the Railway Company were the actual Defendants in all the Summonses." A certain difference has been indicated between the position of the Limited Company, John Cochrane & Co., Ltd., and the position of the Railway Company itself. In my opinion, the difference is immaterial, and the principle applicable to the one case is applicable to the two remaining cases. I am of opinion that, upon the true application of the relevant principle, each one of these three appeals ought to be dismissed. Mr. Justice Roche: I agree, and have nothing to add. Mr. Justice Branson: I agree. Sir John Simon: Your Lordships will allow the costs of the Respondents ? The Lord Chief Justice : Yes. 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. During the year 6 underground rooms were closed or the illegal occupation was discontinued, and in 7 cases the rooms were made to conform to the required standard. Rats and Mice (Destruction) Act, 1919. During the year, various complaints concerning these pests were received and investigated. The occupiers of the premises concerned were advised and assisted as far as possible, and supplied with poison to help in exterminating the vermin. 54 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 1924:— No. of Premises on Register. No. of Inspections. No. of Notices. No. of Prosecutions. Milkshops 89 194 5 _ Ice-cream Premises 68 121 9 — Restaurant Kitchens 61 148 9 — Slaughterhouses 2 16 — — Cow Sheds Nil. - Fried Fish Shops 9 36 - — Offensive Trades Nil. — - — Other Food Premises 523 1180 15 — Bakehouses:— Factories— Underground 15 67 5 — Above ground 11 Workshops— Underground 5 46 9 — Above ground 9 Of the number of bakehouses mentioned above it will be noted that 26 are factory bakehouses and 14 are workshop bakehouses. One workshop (underground) bakehouse was illegally opened during the year; but the business is being transferred to suitable adjacent above ground premises. The following bakehouses are out of use:— Factories—110, Cricklewood Broadway (aboveground). 251, West End Lane (aboveground). Workshops 289, Finchley Road (underground). 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. 55 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 9 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. Unsound Food Seized or Surrendered. The following is a list of food seized or voluntarily surrendered during the year:— 30 lb. Corned Beef. 1 tin Prawns (7¾ lbs.). 27 cwt. Onions. 4 cwt. 3 qrs. 4 lbs. Potatoes. 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, 13 bakehouses and confectioners, 18 restaurants and coffee shops, and 15 general shops. During the year 194 inspections were made and 5 notices were served. Milk and Dairies (Amendment) Act, 1922. This Act imposes upon Local Authorities the obligation of compiling two 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. 56 Milk and Dairies (Amendment) Act, 1922, and the Milk (Special Designations) Order, 1923. Graded Milk. Licences for sale of Graded Milk issued, &c., during 1924. Purpose of Licence. Number of Licences issued. Number of Licences refused, revoked or suspended. Total number of Licences in force at end of the year. Observations. Distribution of "Certified" milk 22 .. 22 Distribution of "Grade A (Tuberculin Tested) " milk 6 .. 6 (Shops, not bottling establishments) Production of "Grade A " milk .. .. .. Distribution of "Grade A" milk .. .. .. Pasteurization of milk .. .. .. Distribution of "Pasteurized " milk .. .. .. Supplementary Licences 4 .. 4 These licences related to the following: — Express Dairy Co., Ltd.—to sell "Certified" milk and "Grade A (tuberculin tested)" milk in connection with the following premises:— 42, England's Lane 124a, Finchley Road 569, Finchley Road 242, Haverstock Hill 25, Heath Street Wildwood Dairy, North End Messrs. J. Richards, Ltd.—to sell "Certified" milk in connection with the following premises:— 56, Belsize Lane 41, England's Lane 91, Fairfax Road 309, Finchley Road 473, Finchley Road 7, Fleet Road 83 Haverstock Hill 59, New End 62, Rosslyn Hill 96, West End Lane 27, Winchester Road Messrs. Welford & Sons, Ltd.—to sell "Certified" milk in connection with the following premises:— 230, Belsize Road 68, Cricklewood Broadway 336, High Road, Kilburn 57 Mr. G. T. Morgan—to sell "Certified" milk in connection with 122, Boundary Road. Mr. E. D. Morgan—to sell "Certified" milk in connection with 57, Hemstal Road. Lord Rayleigh's Dairies, Ltd.—supplementary licence to sell (i) "Certified" milk and (ii) "Grade A (tuberculin tested) "milk in the Borough. Manor Dairy, Ltd., East Finchley—supplementary licence to sell "Certified" and "Pasteurised" milk in the Borough. The principal conditions applying to the various classes of milk under the Milk (Special Designations) Order, 1923, are as follows: — "Certified" Milk is required to be produced from cows which have passed the tuberculin test and veterinary examination. This test and examination must be made at intervals of 6 months, and every animal added to the herd must be tested immediately before admission. The milk must be bottled on the farm and must not contain more than 30,000 organisms per c.c., or any coliform organism in 0.1 c.c. "Grade A (Tuberculin tested)" Milk is subject to the same conditions as Certified Milk as regards the testing and examination of cattle. The milk must be bottled before distribution and must not contain more than 200,000 organisms per c.c., or any coliform organisms in 0.01 c.c. "Grade A" Milk must satisfy the same conditions as "Grade A (Tuberculin tested)" milk, with the exception that the tuberculin test is not required, and that veterinary examinations of the cows in the herd are made at intervals of 3 months instead of 6 months. "Pasteurised" Mill; is milk which has been pasteurised by the holder process as defined in the Order, i.e., it must be held at a temperature of 145 deg. to 150 deg. F. for at least half-an-hour, and then cooled to 55 deg. F. It must not be heated more than once and it must not contain more than 100,000 organisms per c.c. If the milk so treated is Grade A milk, the number of organisms must not exceed 30,000 per c.c., and there must be no coliform organisms in 0.1 c.c. Pasteurisation or heating of Certified or of Grade A (Tuberculin tested) Milk is not allowed. 58 The introduction of this system of licensing the sale of milk of various grades of purity, and containing limited amounts of bacteria, has at least demonstrated the fact that it is possible for the milk supply to be so organised that it shall be pure and reasonably free from bacteria. Under present conditions, however, the cost of such milk places it beyond the reach of the vast majority of the people. 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. 506 samples were taken for analysis during the year. The number certified to be adulterated was 25, or 4.9 per cent. of the total number, as against 3.9 in 1923. 472 samples (22 of which were adulterated) were purchased from Hampstead tradesmen, and 34 (3 of which were adulterated) from tradesmen coming from other districts. 59 The following table shows the articles of which samples were taken during the year:— Article. Number taken Adulterated, etc. Baking Powder 2 – Beef Suet 1 — Brandy 2 — Bread 12 — Butter 44 — Cheese 11 — Cocoa 22 — Coffee 11 — Cream 31 — Custard Powder 2 — Damson Jelly 1 – Dripping 4 – Drugs 2 –— Fish-paste 6 – Flour 4 — Gin 4 l Honey 2 — Jam 1 — Lard 19 — Lemon Squash 1 — Margarine 15 l Meat-paste 2 — Milk 240 5 Milk, Condensed 6 — Milk, Dried 1 — Pepper 6 — Rice 1 — Rum 16 6 Sausages 4 2 Tapioca 2 — Vinegar 6 — Whiskey 25 10 Totals 506 25 60 The following table shows the articles adulterated, &c., nature of adulteration, and the results of proceedings taken: — No. of Sample. Article. How adulterated, &e. Result of proceedings. 8 Whiskey 4½ per cent. water over and above that present in whiskey of the strength 35 under proof Fine £1, costs £2 2s. 20 ,, 5 2/3 ,, ,, ,, ,, 28 ,, 1 9/10 ,, ,, „ costs £5 5s. 31 ,, 21 1/3 ,, ,, „ costs £2 2s. 45 ,, 4 3/4 ,, ,, ,, ,, 53 ,, 2½ ,, ,, ,, ,, 60 ,, 3 ,, ,, ,, ,, 66 ,, 1¾ ,, ,, „ costs £5 5s. 67 ,, 1 5/4 ,, ,, ,, ,, 52 ,, 2½ ,, ,, No action. Receptacle labelled "Not below 43 U.P." 9 Rum 4 9/10 per cent. water over and above that present in rum of the strength 35 under proof Fine £1, costs £2 2s. 14 ,, 1 65/100 ,, ,, ,, ,, 27 ,, 3¼ ,, ,, „ cost £5 5s. Vendor appealed to High Court. Appeal dismissed, with costs. 46 ,, 2½ ,, ,, Fined £1, costs, £2 2s. 54 ,, 2½ ,, ,, ,, ,, 62 ,, 3 ,, ,, ,, ,, 19 Gin 4½ per cent. water over and above that present in gin of the strength 35 under proof ,, ,, 61 No. of Sample. Article. How adulterated, &c. Result of proceedings. 86 Milk 5 per cent. deficient in fat Dismissed. Warranty proved. 165 ,, .. 7 ,, ,, Fine £2, including costs. 166 ,, .. 15 ,, ,, ,, ,, 413 ,, .. 44 ,, ,, Cautioned by Borough Council. Informal sample. 391 ,, .. Trace of annatto Fine 5s., costs £1. 110 Beef Sausages 10½ grains boric acid per lb. No action. 474 ,, 13 1/3 ,, In addition to the above, five samples of milk were reported to be of poor quality. Also one sample of margarine was sold in a wrapper which was not marked in accordance with the Margarine Acts. The Council instituted proceedings against the Vendor, who, in turn, summoned his Assistant, who was held to be responsible. The summons against the Vendor was dismissed. The Assistant was fined ten shillings. 'Warranty" Defence. During 1924, one dairyman was prosecuted by the Council for selling milk 5 per cent. deficient in fat, also one for selling margarine containing 18 per cent. water, being 2 per cent. above the legal limit of 16 per cent. The "Warranty" defence was successfully proved in each case and the summonses were dismissed. Preservatives, Of the samples analysed during 1924, preservatives were found to be present in two samples of beef sausages. The amounts of boric acid found were 10½ and and 13 1/3 grains to the lb. respectively. It was not considered desirable, in view of the absence of any definite standard on the subject of the amount of preservative permissible in sausage-meat, to institute proceedings in these cases. The Departmental Committee which has been investigating the subject of the addition of preservatives to food have now made their Report to the Ministry of Health, and it is to be hoped that in the near future their recommendations will become law. 62 Analysis of Spirits. Early in the year, samples were taken at all the fully-licensed public-houses in the Borough, in order to ascertain what standard of spirits was being sold to the public. The analysis revealed that of the 46 samples, purchased at 46 premises, no less than 17 were found to be below the legal standard, i.e., 35 under proof. The facts were reported to the Council, and on the recommendation of the Public Health Committee it was resolved that 16 vendors be prosecuted. Summonses were, therefore, applied for in respect of: — Sample No. 8—Whiskey, found to be 44 under proof. 4½ per cent. of added water. 9 —Rum ,, 45 ,, 4 9/10 ,, ,, 14—Rum „ 38 „ 1 65/100 ,, ,, 19—Gin ,, 44 ,, 4½ ,, ,, 20—Whiskey ,, 46½ ,, 5 2/3 ,, ,, 27—Rum ,, 41½ 3¼ ,, ,, 28—Whiskey ,, 38.8 ,, 1 9/10 ,, ,, 31—Do. ,, 39½ ,, 2 1/3 ,, ,, 45—Do. ,, 44.7 ,, 4¾ ,, ,, 46—Rum ,, 40.3 ,, 2½ ,, ,, 53—Whiskey ,, 40 ,, 2½ ,, ,, 54—Rum ,, 40 ,, 2½ ,, ,, 60—Whiskey ,, 41 ,, 3 ,, ,, 62—Rum ,, 41 ,, 3 ,, ,, 66—Whiskey ,, 38½ ,, 1¾ ,, ,, 67—Do. ,, 38½ ,, 1¾ ,, ,, (The above samples should have contained 30.8 per cent. of alcohol— 35 under proof.) In the case of Sample No. 58, whiskey 40 under proof, 2½ per cent. of added water, the vendor was not prosecuted, in view of the fact that there was a notice on the receptacle stating that the whiskey was not below 43 under proof. The summonses against the vendors of Samples Nos. 27 and 28 were heard by the Justices at the Hampstead Police Court on 5th March, 1924. In the case of Sample No. 27, the strength of the rum was not disputed by the defence, who relied on a notice which the prosecution 63 admitted was fixed in the bar where the purchases were made. This notice, which was seen and read by the Inspector and his agent, was in the following terms:— "All spirits sold at this establishment are of the same superior quality as heretofore, but to meet the requirements of the Food and Drugs Acts, they are now sold as diluted spirits; no alcoholic strength guaranteed." On 12th March, the Chairman, in giving the considered decision of the Bench, said they were of opinion that in this case the notice exhibited was ambiguous and misleading, and did not convey to the mind of the purchaser the fact that when he asked for rum he was being supplied with spirit which was more than 35 degrees under proof. The Bench found that the sale was to the prejudice of the purchaser, and it therefore followed that there must be a conviction. The due and regular administration of the laws relating to the sale of food and drugs was of supreme importance, and, if this had been at all a bad case, a heavy penalty would have been inflicted. Under all the circumstances, the defendant would be fined £1 and 5 guineas costs. The Bench agreed to state a cose. The second case was heard; but was adjourned in view of the notice of appeal that was given in the case of Sample No. 27. The summonses against the other vendors were adjourned, pending the result of the prosecution in the case of Sample No. 27. The appeal against the decision of the Hampstead Justices was heard in the King's Bench Division on October 22nd, before the Lord Chief Justice, Mr. Justice Avory, and Mr. Justice Salter. Mr. Cecil Whiteley, K.C., and Mr. Roland Burrows appeared for the appellant; and Mr. Singleton, K.C., and Mr. S. G. Turner for the respondent. Held, in a considered judgment reviewing all the authorities, that the two questions involved were:—(i) What was the substance of the information which must be given to the purchaser? —which was a question of law. The purchaser must be told in substance that the thing which he was getting was not the thing he asked for. (ii) Were the steps taken sufficient, in all the circumstances, to convey this information to an average purchaser?-which was a question of fact for the Justices. The saying that "everyone is supposed to know the law" is too general. The maxim is: Ignorantia legis neminem excusat. It cannot be accepted as a defence against a charge of breach of the law. But, in considering this notice, the Justices would properly 64 remember that the average customer probably knows nothing of the Food and Drugs Acts. It would be unfortunate if a form of notice could be hall-marked by the Courts, so that any seller could evade the Act by hanging the notice up. To repeat a phrase used in the argument in the present case, it is not possible for the Court to "pass" a form of notice, because the sufficiency of the notice in the circumstances of the case is for the Justices in each case. The appeal was dismissed with costs. The results of the prosecutions are set out on page 56. The case is reported in 41, "Times" Law Reports, 132, and in Knight's Local Government Reports, Vol. 23, page 22. 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. 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, 1924. 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 Cream 240 27 Nil. Nil. Nature of preservative in each case in column (b) and action taken under the Regulations in regard to it. Nil. 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, 4. 1. Correct statements made, 4. 2. Statements incorrect, nil. 3. Percentage of preservative found in each sample— 0.40, 0.38, 0.37, 0.27 per cent., by weight. Percentage stated on Statutory label— 0.40 per cent., by weight. 65 (b) Determinations made of milk fat in cream sold as preserved cream:—1. Above 35 per cent., 4. 2. Below 35 per cent., nil. (c) Instances where (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V (1) and the proviso in Article V (2) of the Regulations have not been observed:—nil. (d) Particulars of each case in which the regulations have not been complied with, and action taken:—nil. 3.—Thickening substances. (а) Any evidence of their addition to cream or to preserved cream, nil. (b) Action taken where found, nil. 4.—Other observations (if any), nil. Condensed and Dried Milk Regulations. The sale of this milk is controlled by the Public Health (Condensed Milk) Regulations, 1923, which came into operation on 1st November, 1923, and the Public Health (Dried Milk) Regulations, 1923, which came into operation on 1st May, 1924. During the year, 6 samples of condensed milk and 1 of dried milk were submitted to the Public Analyst. All were found to comply with the labels on the tins. Action taken with a view to Smoke Abatement. During the year, observations were made in 2 instances, in consequence of a complaint; but it was not found necessary to serve a notice. 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. The Cleansing Station is situate 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. 66 During 1924, 2009 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. Four cleansings of adults and 910 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. In my Annual Report for 1923, a reference was made on page 45 to a special effort which was made by the Department to render more effective the work of cleansing, undertaken at the Borough Council's Cleansing Station. The effort then made did not meet with much immediate success; no less than 21, of the 45 families who were approached definitely, refused to attend for cleansing, in some instances a denial being made of the conditions complained of. During 1924, another effort was made in the direction of encouraging persons who desired to rid themselves of vermin to attend at the Cleansing Station. It was thought that possibly some parents of verminous children might not bo aware of the free facilities available; and, accordingly, in the case of every family where scholars were reported for the first time to be verminous, a special invitation was sent, drawing attention to the help which we were willing to afford. The invitation was in the following terms:— " Dear Madam, Private and Confidential. It has been reported to me that has attended at the Borough Council's Bathing Station for Cleansing. I am writing to inform you that the Bathing Station will be available for any other members of your family (including children under school age), should you desire them to attend there, and if the need unfortunately exists. If you wish to use the Bathing Station, which is available on any Tuesday or Thursday, and will let me know which of the days is most convenient to you, and whether you will attend in the morning or the afternoon, I will arrange for the Bathing Station to be put at your disposal. No charge will be made for these services. The Bathing Station is entered from the Railway Passage, leading from Finchley Road (North London Railway Station) to West End Lane. 67 This suggestion is made in your interest, should you care to avail yourself of it now, or at any future time." Effective hair combs were also offered at cost price to the parents. In 1924, 79 special invitations were issued to such "new" families; but it is regrettable that only 2 families (comprising 4 persons) availed themselves of the cleansing facilities; and only five hair combs were purchased. Since it is not considered advisable to deal sternly with the parents, it would appear that one of our chief hopes of raising the standard of personal cleanliness lies in the education of the young. But undoubtedly the pressure on housing accommodation is responsible in some measure for the failure to maintain a good standard of cleanliness. During the year, as a result of the action of the Sanitary Inspectors, 37 verminous rooms in 16 houses were cleansed and freed from vermin. Public Mortuary. During the year, the bodies of 47 persons were brought to the mortuary—22 by order of the Coroner, 15 by the Police, and 10 at the request of friends of deceased persons. In 38 instances inquests were held, and in 33 instances postmortem examinations were made and inquests followed. The following table indicates the causes of death of the persons whose bodies were received into the Mortuary. Cause of Death or Verdict, Number of Bodies received. Deaths from natural causes 29 Accidental deaths 5 Misadventure 1 Neglect at Birth 3 Suicide—Fall under train 1 Gas poisoning 5 Drowning 1 Cut throat 1 Hanging 1 Total 47 In addition to the above, the bodies of 3 still-born infants were brought to the mortuary by the Police. 68 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. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 120 7 — Workshops (Including Workshop Laundries) 722 20 — Workplaces (Other than Outworkers' premises 575 24 — Total 1417 51 — 69 2.—Defects found in Factories, Workshops, and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health (London) Act, 1891*:— Want of cleanliness 39 39 – – Want of ventilation 3 3 3 Overcrowding 6 6 – Want of drainage of floors – – – Other nuisances 67 67 — Sanitary accommodation insufficient 1 1 — unsuitable or defective 4 4 – –. not separate for sexes 1 1 – Offences under the Factory and Workshop Act, 1901: — †Illegal occupation of underground bakehouse (s. 101) 1 — – Other offences – – – – (Excluding offences relating to outwork, and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops, Transfer of Powers) Order, 1921) Total 122 121 3 - *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health (London) Act, 1891. † Illegal occupation discovered at close of year; notice of offence has been served, and occupier arranging to vacate premises. 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. and those home workers resident in the Borough are kept under supervision by Special Inspectors concerned. 70 *NATURE OF WORK. Outworkers' Lists, Section 107. Lists received from Employers. Sending Twice in the year.† Sending Once in the year. Outworkers Outworkers Lists Contractors. Workmen. Lists Contractors. Workmen. 1 2 3 4 5 6 7 (1) Wearing Apparel— (a) making, &c 29 23 60 10 13 12 (6) cleaning and washing 5 10 1 — — — (2) Making-up, ornamenting, finishing and repairing of table linen, bed linen, or other household linen (including in the term linen articles of cotton or cotton and linen mixtures), and any process incidental thereto 4 7 5 - - -- (3) Making, ornamenting, mending, and finishing of lace and of lace curtains and nets 3 - - - (4) Making of curtains and furniture hangings, and any process incidental thereto 2 6 4 1 1 (5) Cabinet and furniture making and upholstery work 1 8 3 - - - (6) Making of Electro-plate — — 1 — — (7) Making of files — — — — — (8) Manufacture of brass and of any articles or parts of articles of brass (including in the term brass any alloy or compound of copper with zinc or tin) - 1 3 - - - (9) Fur-pulling — 1 — — — (10) Making of iron and steel cables and chains — — — — — (ID 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 — 1 1 — — (14) Making or repairing of umbrellas, sunshades, parasols, or parts thereof - 6 2 - - - (15) Making of artificial flowers - - - - - - (16) Making of nets other than wire nets — 1 — — — (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 reccptacles or parts thereof made wholly or partially of paper, cardboard, chip, or similar material 1 2 3 - - - (22) Making of brushes - - - - - - (23) Pea picking - - - - - - (24) Feather sorting - - - - - - (25) Carding, boxing, or packeting of buttons, hooks and eyes, pins, and hair pins - - - - - - (26) Making of stuffed toys - - - - - - (27) Making of baskets - - - - - - (28) Manufacture of chocolate or sweetmeats — — — — — .29) The making or filling of cosaques, Christmas crackers, Christmas stockings, or similar articles or parts thereof - - - - - - (30) The weaving of any textile fabric — — — — — — Total 42 68 86 11 13 13 Notices served on occupiers as to keeping or sending lists of Outworkers, Nil; Prosecutions in relation to Outworkers' Lists, Nil. Outwork in unwholesome premises, Sec. 108, Nil; Outwork in infected premises, Sees. 109110, Nil. * In the case of those occupiers who gave out work of more than one of the classes specified in column 1, and subdivided their lists in such a way as to show the number of workers in each class of work, the list has been included among those in column 2 (or 5 as the case maybe) against the principal class only; but the outworkers have been assigned in columns 3 and 4 (or 6 and 7) into their respective classes. † The figures in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year, and of the entries of names of outworkers in those lists. 42 lists were received twice in the year. The names of Outworkers that were repeated in the duplicated Returns have not been counted twice. 71 4.—Registered Workshops (including Domestic Workshops). Workshops on the Register (s. 131) at the end of the year. Number. 0) (2) Bakers 14 Bootmakers 48 Dressmakers and ladies' tailors 53 Milliners 23 Tailors 45 Upholsterers 22 Other trades 160 Total number of workshops on Register 365 5.—Other Matters. Class. Number. (1) (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133 Act of 1901) 16 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 3 Reports (of action taken) sent to H.M. Inspector 3 Other — Underground Bakehouses (s. 101 Act of 1901) in use at the end of the year 20 Workshops. At the end of 1924 there were 365 workshops on the Register,, including 53 domestic workshops. Excluding these latter, there were 568 males and 552 females employed in the workshops. During the year, 722 inspections were made and 20 notices served. 72 Workshops other than Domestic Workshops. Trade or Business. Number of Workshops, Number of Workrooms. Number of Employees. Domestic Workshops. Total Dumber of Workshops. Males. Females. Bakers 14 16 16 23 - 14 Basketmakers 2 4 40 - 2 Blindmakers 3 3 7 2 - 3 Bootmakers 10 41 93 2 8 48 Builders and carpenters 21 25 45 — - 21 Carriage builders 2 3 4 — — 2 Confectioners 3 10 4 42 - 3 Corset makers 3 4 9 1 4 Dressmakers 40 45 155 13 53 Harness and trunk makers 5 (J 17 — 5 Ironmongers 6 0 15 — - 6 Laundresses 3 11 4 16 — 3 Knitters 3 3 27 5 8 Milliners 19 19 1 55 1 23 Monumental masons 2 2 16 — - 2 Motor makers and repairers 14 21 47 — — 14 Outfitters 4 18 3 68 — 4 Pianoforte makers 2 6 54 - 2 Picture frame makers 10 12 16 - 2 12 Photographers 8 12 5 20 — 8 Smiths and metal workers 7 7 19 — — 7 Tailors 33 37 56 36 12 45 Upholsterers & cabinetmakers Watchmakers and jewellers 20 25 45 21 2 22 13 18 22 — 1 14 Wigmakers 10 11 32 2 12 Miscellaneous 25 30 33 44 3 28 Totals 312 390 568 552 53 365 No. of Workrooms measured, 14. Legal Proceedings. Legal proceedings were taken on certain occasions in 1924 by the Council, in connection with the work of the Public Health Department, under the various. rVcts of Parliament and By-laws and Regulations made thereunder which are administered by them. The fines and costs imposed were as follows :— Statute or By-law. Fines. Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and Bye-laws made thereunder 25 9 0 29 11 0 Metropolis Management Acts, and Byelaws made thereunder 31 14 0 21 4 0 Sale of Food and Drugs Acts 23 5 0 50 8 0 Margarine Act 0 10 0 — Total 80 18 0 101 3 0 73 Flooding in Kilburn. The question of flooding in Kilburn has from time to time received careful consideration, and in 1921, on a recurrence of the nuisance, the Public Health Committee resolved to support a representation by the Works Committee to the London County Council on the subject. During 1924, several complaints were received by the Works Committee from residents in the Kilburn district of floodings which had occurred in their premises during rain; and that Committee then gave instructions for the attention of the County Council to be called to the matter, and for that authority to be urged to put in hand at the earliest possible moment the work of reconstructing their sewer in High Road, Kilburn. I am glad to note that the County Council now has in hand the matter of the construction of a north-western storm relief sewer. The estimated cost of the work amounts to £527,000 ; altogether, the construction of about five-and-a-quarter miles of sewer is involved; and its construction will occupy about two-and-a-half years. The proposed new sewer should relieve the floodings of which this Council and the Willesden Urban District Council have complained, and it will also improve conditions in other districts draining into the Ranelagh sewer and, what is of great importance, cut off part of the storm water from the low level areas. Public Conveniences. The question of the erection of a convenience for women on a site abutting upon "Grangeway just off the High Road, Kilburn, is still the subject of discussion with the London County Council. The scheme has been agreed upon by the Borough Council in conjunction with the Willesden Urban District Council, and it is to be hoped that the matter will be satisfactorily settled in the current year. The new convenience for men and women at West End Green was opened on December 5th, 1924, while that for men only, at Fortune Green, was in course of erection at the close of the year. No further progress has been made with the provision of a convenience for women near the Finchley Road Metropolitan Railway Station, or one for both sexes at Chalk Farm, 74 The Exhumation of Human Remains. By a decision of the Secretary of State, arrived at on the recommendation of the Ministry of Health, it has been resolved that whenever an exhumation licence is issued by the Home Office under Section 25 of the Burial Act, 1857, the Medical Officer of Health for the district concerned shall be notified, in order that he may be in a position to take (under his general power) any action that may appear to him to be necessary in the interests of the Public Health. In all the cases where a licence is granted for the removal of human remains from the Hampstead Cemetery, the Sanitary Staff acted in co-operation with the officials of the Cemetery in order that the Public Health might be duly safeguarded. Proposed new Public Health Station. The Public Health Committee having decided that it was desirable for the Disinfecting and Cleansing Stations and Public Mortuary to be permanently established in a central position in the Borough, together with the addition of a Coroner's Court, advantage was taken of the opportunity that presented itself for acquiring a site in the Electricity Yard. On the motion of the Chairman of the Public Health Committee—Mr. Councillor Herbert Marnham—the Borough Council on June 26th resolved " that a Special Committee of the Council be appointed to consider and report on the best way to utilise the vacant land at the Electricity Yard, not now required for electric lighting purposes." On 3rd November the Special Committee reported that, in their opinion, the requirements of the Public Health Department should be provided for on a portion of the Yard on the north side of the entrance from Lithos Road, and with this opinion the Public Health Committee agreed. On 18th December the Council authorised the Public Health Committee to engage the services of an Architect to draw up plans for the proposed new Station. 75 Section 8. Public Health Staft, 1924. (Arranged according to the Ministry of Health's instructions, 18th December, 1924.) Senior Sanitary Inspector: *W. G. Kershaw—Cert. Sanitary Inspectors' Examination Board. Diploma of Sanitary Inspectors' Association Examination Board, District Sanitary Inspectors : Wards 1 and 2 *R. Geary—Cert. Sanitary Inspectors' Examination Board. Wards 4 and 5 *J. Grimsley—Cert. Sanitary Inspectors' Examination Board : Royal Sanitary Institute, Meat and other Foods. Wards 3 and 7 *W. F. Horniblow— Ditto Ward 6 *A. C. Townsend— Ditto Special Sanitary Inspectors: 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—M.A. Trinity College, Dublin. Cert. Sanitary Inspectors' Examination Board. Housing *A. Peverett—Cert. Sanitary Inspectors' Examination Board: and Royal Sanitary Institute. Meat and other Foods. *A. C. Townsend. Ditto. (Also District Inspector for Ward 6.) 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 Disvensam : Tuberculosis Medical Officer and Assistant Medical Officer of Health for Tuberculosis Work Nurse— *A. J. Scott Pinchin, ir.n. (Lond.), m.r.c.p. (Lond.). *Miss M. Lowen, Cert, for Medical and Surgical Nursing. 76 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.) Staffed by The British Dental Hospital, 31, Camden Road, N.W. 1. Health Visitors: *Mrs. K. Roche—Cert. Sanitary Inspectors' Examination Board. *Mrs. I. G. Steward—C.M.B. *Miss A. Kennedy—Health Visitor's Certificate. Public Analyst: A. W, Stokes, p.c.s., p.i.e. Clerics : R. E. Forrest, C. W. Francis, *Miss E. Blakeman, R. H. Box, W. Sell. (Thief Clerk—F. S. Hill. 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.). * 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 g. Housing. During the year under review, continuous effort has been made to improve and maintain the sanitary conditions of the houses coming within the purview of the Housing Committee. The principle of " negotiations " witli owners has been pursued with satisfactory results. It is, however, becoming obvious that there is a certain number of house owners or managers who are not amenable to this form of treatment, so that it becomes nt cessary to adopt some action which has force of law behind it, and such question is under consideration by the Housing Committee. The most pressing need still is for more housing accommodation ; but I am as firmly convinced as ever that, before the problem is 77 overcome, it must be dealt with from the point of view of transferring some of the population, together with their industries, from the large towns into rural districts, in addition to the provision of additional houses in new suburbs of existing town?. Also, considerable relief would be given to a congested neighbourhood if all large residential institutions—schools or otherwise—could be induced to remove into the country or less populous districts. There are in Hampstead marke 1 examples of this kind, and I am of opinion that, if these institutions were removed into rural districts, it would be a benefit to all concerned. Just as strongly as we believe in the value of good heredity and environment, so strongly must we realise the inevitable calamitous results of slums and overcrowding, which tend to the production of a physically defective and morally debased population. 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 District Sanitary Inspectors, much of which has a direct bearing upon the better housing of the population. Work accomplished hj the Housing Inspectors during 1924. Underground rooms illegally occupied, discontinued or made to conform 4 New sculleries and washhouses built 1 Additional ventilation to bedrooms and scullcries 121 Rooms, staircases and w.c. apartments cleansed and repaired 1044 Verminous rooms cleansed 21 Dampness in rooms abated and floors ventilated and repaired 172 Windows and doors repaired 320 Handrails and balusters repaired 64 Coppers repaired and renewed 70 Larders provided 154 Coal sheds and receptacles provided or repaired 30 Fireplaces and ranges repaired or renewed 119 New or repaired sinks and lavatory basins or baths 45 Drains, soil pipes and ventilating pipes repaired or renewed 57 Drains cleansed and unstopped 7 Roofs, gutters and rainwater pipes repaired or renewed 291 Gully traps removed from improper positions 11 Waste pipes of sinks trapped, repaired or unstopped 55 78 Water and sinks provided to upper floors of tenement houses Water cisterns cleansed, repaired or removed from improper 51 positions, or water taken off main supply 69 W.C. apparatus repaired, renewed or unstopped 86 W.C. removed from improper positions or provided with external ventilation 44 Paving of yards and forecourts repaired or renewed and drained 78 Dnst bins provided 64 Accumulations of refuse and fixed ashpits removed 6 External repairs: pointing walls, repairing window sills, steps, &c. 92 Internal and external woodwork painted 91 Manholes repaired or renewed 41 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, 72. (ib) With State assistance under the Housing Acts, 1919, 1923 or 1924— (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) Regulations, 1910, etc. SURVEYS, Survey of 1919. In connection with the Survey made in pursuance of Section I. of the Housing Act, 1919, a Return was made to the Ministry of Health of two lists of properties,—one a list of areas which were, or might have to be, dealt with as unhealthy under Part I. or Part II. of the Act of 1890, and the other a list of insanitary houses (other than houses in unhealthy areas) which were seriously defective, but which could be made habitable. The first list contained addresses of 259 dwellings, and the other 643 dwellings. Since the original survey was 79 made, some of the premises have ceased to be used as dwellings, several have been pulled down, and others, for various reasons, have been removed from the lists. The final corrected numbers should be 234 and 597 respectively. The following tabular statement shows the progress that has been made with these two lists of properties. Premises in areas which are being or may have to be dealt with as unhealthy, under Parts I or 11 of the Housing Act, 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 Survev of 1919 234 597 831 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 No. restored to a sanitary condition in 1924 111 £3379 103 £5047 214 Remaining at 1st Jan., 1925 33 — 87 — 120 On the 1st January, 1925, there were, therefore, 120 premises out of the original 831, in respect of which schedules had been served, but the work had not been completed. As will be seen by the table, of the 214 premises completed during the year, 103 were in the list of 597 houses that were reported to the 8 Housing Committee as being below the standard compatible with health, but which could be made reasonably nt for human habitation; and 111 were in the list of unhealthy areas, containing 234 premises. Suryey of 1924. During the year under review, a further Survey was undertaken,in view of the fact that the majority of the premises included in the previous Survey had been dealt with. The following premises deemed to be in an insanitary state were transferred to the Housing Committee to be dealt with by them 011 the lines indicated in my previous Annual Reports:— Total number of houses in Street transferred to Housing Committee. Linstead Street 10 Lowfield Road 47 Hemstal Road 5 Loveridge Road 75 Ariel Road 6 Kingsgate Road 4 Oppidans Mews 15 New End 26 Golden Square 3 Manor Buildings, Silver Street 6 Southampton Road 2 New End Square 7 Total 206 The following tabular statement shows the progress that has been made with this latter list of insanitary premises:— No. of insanitary houses. Total No. of premises included in Report on Survey of 1924 206 No. restored to a sanitary condition in 1924 41 Remaining at 1st January, 1925 165 81 In respect of 133 premises, out of the 165 remaining to be dealt with, schedules have been served during 1924, but the work had not been completed at the end of the year. On the 1st January, 1925, there were, therefore, 32 premises out of the original 206 in respect of which schedules had not been served. Taking the totals of the two survey's together, on 1st January, 1925, there were 285 premises out of the total of 1037 still remaining to be put into a sanitary condition; but in respect of 253 of these, schedules had been served, but the necessary works had not been complied with on that date. 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) 1,192 (2) Number of dwelling-houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 287 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (4) Number of dwelliug-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation 822 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 255 82 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 No Statutory Notices served ; unofficial Notices only. (2) Number of dwelling-houses which were rendered fit after service of formal notices— (a) by owners (b) by Local Authority in default of owners . . (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close . . . . / B. Proceedings under Public Health Acts. (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 925 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) by owners 925 (b) by Local Authority in default of owners — 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. . 2 (2) Number of dwelling-houses in respect of which Closing Orders were made 2 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit 5 83 (4) Number of dwelling-houses in respect of which Demolition Orders were made 6 (5) Number of dwelling-houses demolished in pursuance of Demolition Orders 4 (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 1924. 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, in 1923 the Housing Committee authorised survey and examination to be made of the premises under Sec. 36 (e), Housing Act, 1909. The 4 Cottages were "represented" by the Medical Officer of Health on 9th April, 1923, as being in a state so dangerous or injurious to health as to be unfit for human habitation. The Council made a Closing Order on each of the premises on 26th April, 1923, and, under the authority of the Council, the Housing Committee on 12th May, 1924, made a Demolition Order in respect of each house. Difficulty was experienced, however, in removing the occupants of one of the cottages, No. 2; but the Justices having made an Order on the occupier to vacate the premises, he removed in November. Sherriff Road Site. At the close of the year, negotiations were in progress for the erection of a block of 16 flats on land at the corner of Lowfield Road. 84 Statement showing steps taken in 192k, in connection with premises " represented, in 192//. or previous years" by the Medical Officer of Health under the Housing Acts. Premises. Representee under Sec. lr of the Housing Act, 1009, as unfit for habitation. Closing Order. Demolition Order. Date of Committee. Made. Served. j Operative. Determinec To be considered Made. Served. | Operative Determinec Remarks. 5, Agamemnon Road 3-12-23 >20-12-23 3-1-24 18-1-1924 13-10-1924 13-10-1924 3-12-1924 27-12-1924 Notice served on occupier 4th March to vacate within 28 days. Tenant ordered, at Hiimpstead Police Court on 18-6-24. to vacate within 3 weeks. Committee postponed operation of Demolition Order for two months 89, Broomsleigh Street - - - - - - - - - - Premises changed ownership in December, and necessary works now in pr gress. Towards end of year property, which was "represented" in 1920. and in respect of which Closing and Demolition Orders were made in that year, was put up for sale. After premised became unoccupied in December, orders given for neccessary 47 & 49, Adelaide 5-3-23 22-3-23 23-3-23 — 31-1-1924 — — — — - - Road 1, 2, 3 & 4, Cornick Cottages, Cornick's Yard 9-4-23 26-4-23 8-5-23 23-5-23 - 12-5-1924 12-5-1924 5-6-1924 26-6-1924 - All premises have now been demolished. 16, Fairfax Road 97-23 26-7-23 30-7-23 28-12-23 30-10-1924 — — — — _ — 4, Harley Road (2 underground rooms) 10-3-1921 '27-3-24 1-4-24 15-4-1924 18-12-1921 - - - - - Closing Orders were appealed against, but were subsequently withdrawn. The two underground rooms have now been made to comply with Statutory requirements 68, Haverstock Hill 12-11-23 29-11-23 19-12-23 19-12-23 - 12-5-1924 12-5-1921 13-6-1924 4-7-1924 - Committee postponed operation of Demolition Order for one month. Premises demolished in 1925. 10, New End - - - - - - - - - 31-1-1924 This house was "represented" in 1920, and a Closing Order was made in that year. In 1921 a Demolition Order followed. Subsequently the premises were acquired by the Guardians and put in order. 85 Tenement House By-laws. Provisionally approved draft by-laws made by the London County Council, under Section 26 of the Housing, Town Planning, etc., Act, 1919, as amended by Section 14 of the Housing, etc., Act, 1923, were considered by the Housing Committee in October. The Committee gave instructions for certain amendments to be suggested to the County Council relating to the proposed method of registration of tenement houses. 86 Section 10. VITAL STATISTICS OP THE BOROUGH. The Borough. Tear. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tnbereulosis. Number. Rate per 100U Births. 1902 1,516 904 133 88 73 1903 1,453 837 126 87 66 1904 1,445 892 161 111 73 1905 1,421 823 133 94 73 1906 1,437 850 111 77 57 1907 1,359 817 98 73 61 1908 1,4' 0 803 97 69 74 1909 1,328 839 99 74 53 1910 1,340 829 81 60 58 1911 1,276 847 105 82 56 1912 1.281 861 79 62 64 1913 1,325 951 91 69 49 1914 1,273 913 91 71 57 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 77 75 1919 1,156 1,036 96 83 56 1920 1,566 860 75 48 41 1921 1,342 973 88 65 63 1922 1,290 970 72 56 50 1923 1,238 947 54 44 51 1924 1,186 1,029 66 56 58 No. 1 (Town) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 1902 192 163 20 104 17 1903 194 127 14 72 11 1904 195 125 20 102 13 1905 194 127 24 124 9 1906 205 131 21 102 5 1907 185 152 15 81 13 1908 225 10S 11 49 7 1909 196 140 15 76 6 1910 199 118 15 75 6 1911 207 133 19 92 7 1912 1816 135 12 65 5 1913 201 161 11 55 11 1914 152 130 14 92 5 1915 157 147 17 108 5 1916 132 140 7 53 13 1917 143 143 12 84 14 1918 115 157 13 113 11 1919 149 170 13 87 10 1920 208 112 7 34 4 1921 178 147 17 95 11 1922 161 130 11 68 13 1923 164 139 6 36 10 1924 149 138 4 27 7 87 No. 2 (Belsize) Ward. Tear. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 1902 239 135 13 75 15 1903 211 121 13 62 13 1904 217 141 23 106 12 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 188 127 8 42 7 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 185 132 13 70 11 1918 149 155 7 47 9 1919 196 159 20 102 9 1920 213 132 9 42 7 1921 197 143 12 61 7 1922 202 151 10 49 7 1923 156 147 6 38 10 1924 145 164 9 62 10 No. 3 'Adelaide) Ward Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 1902 103 95 3 29 7 1903 95 101 9 95 1 1904 100 99 13 130 8 1905 96 92 4 42 4 1906 97 92 10 103 5 1907 75 86 8 107 2 1908 93 78 6 65 4 1909 83 88 4 48 3 1910 96 78 2 21 5 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 1 1916 104 95 12 115 6 1917 114 109 7 61 6 1918 97 119 6 62 11 1919 97 130 10 104 6 1920 161 109 6 37 3 1921 133 119 10 75 8 1922 149 121 6 40 5 1923 141 128 6 42 6 1924 149 121 10 67 7 88 No. 4 (Central) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Kate per 1000 Births. 1902 110 71 11 100 5 1903 99 60 8 81 4 1904 90 62 11 122 1 1905 113 60 5 44 6 1906 95 83 3 32 2 1907 108 68 9 83 5 1908 104 82 6 58 7 1909 116 63 3 26 3 1910 105 82 8 76 3 1911 92 76 8 87 3 1912 97 76 4 41 6 1913 91 84 6 66 ... 1914 84 76 4 48 6 1915 91 92 4 42 6 1916 93 97 4 43 3 1917 69 76 2 29 ... 1918 69 99 5 72 7 1919 101 117 5 49 4 1920 131 91 7 53 2 1921 112 102 8 71 3 1922 86 113 9 106 3 1923 90 98 3 33 5 1924 91 133 4 44 8 No. 5 (West End) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number. Rate per 1000 Births. 1902 275 107 20 72 6 1903 243 111 21 86 12 1904 283 120 22 78 8 1905 250 131 23 92 11 1906 259 115 14 54 8 1907 250 114 16 64 9 1908 254 121 26 102 9 1909 239 118 13 54 fi 1910 216 121 17 79 11 1911 216 102 15 69 10 1912 226 126 13 57 12 1913 240 145 11 46 7 1914 256 140 18 70 14 1915 218 151 13 60 11 1916 211 117 10 47 5 1917 221 137 13 59 13 1918 124 162 10 81 12 1919 175 139 12 68 12 1920 268 119 16 60 6 1921 211 146 12 57 9 1922 223 138 6 27 8 1923 215 149 6 28 8 1924 179 126 8 4 r, 7 89 No. 6 (Kilburn) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis Number. Rate per 1000 Births. 1902 435 219 45 103 16 1903 417 184 39 93 18 1904 408 206 54 132 22 1905 126 171 50 117 26 1906 444 197 41 92 15 1907 391 179 28 71 16 1908 393 186 30 76 21 1909 341 182 37 108 17 1910 379 192 24 63 16 1911 347 179 31 89 16 1912 353 188 26 74 14 1913 354 213 25 71 18 1914 385 212 25 65 13 1915 329 230 40 121 11 1916 309 180 28 91 20 1917 280 208 37 132 17 1918 241 225 21 87 18 1919 296 201 24 81 11 1920 408 172 19 48 14 1921 364 204 21 58 11 1922 303 202 16 53 11 1923 333 180 16 48 7 1924 316 206 23 73 15 No. 7 (Priory) Ward. Year. Number of Births. Number of Deaths. Infantile Deaths. Number of Deaths from Pulmonary Tuberculosis. Number, Rate per 1C00 Births. 1902 162 110 16 99 7 1903 194 116 21 108 5 1904 152 121 13 85 9 1905 133 103 14 105 7 1906 150 93 9 60 8 1907 127 94 7 55 6 1908 126 93 10 79 7 1909 149 111 11 74 8 1910 138 111 6 43 8 1911 143 115 9 63 5 1912 117 115 7 60 10 1913 128 117 12 94 3 1914 113 110 16 142 5 1915 138 126 10 72 7 1916 126 106 5 40 3 1917 111 117 6 54 8 1918 100 110 7 70 7 1919 142 120 12 84 5 1920 177 95 11 62 5 1921 147 112 8 54 14 1922 167 115 14 84 3 1923 139 106 11 79 5 1924 157 141 8 51 4 APPENDIX I RE PORT i Fop the year 1924 OF THE Tuberculosis Medical Officer and Assistant Medical Officer of Health for Tuberculosis Work. A. J. SCOTT-PIN CHIN, M.D. (Lond.), M.R.C.P. (Lond). Municipal Tuberculosis Dispensary, 73, Dynham Road, N.W.6. 31s£ January, 1924. 92 APPENDIX I. Tuberculosis Dispensary, 73, Dynham Road, Kilburn, N.W.6- 31st January, 1925. I have the honour to submit a report on the working of the Borough Tuberculosis Dispensary for the year 1924. 557 patients attended the Dispensary during the year, and the total number of attendances was 1601, at which 963 systematic physical examinations were made. The attendances being slightly more than last year. ■ New applicants attending numbered 365, and these have been classified as shown in the following report:— 93 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. Nonpulmonary. (a) All persons (including " Contacts.") Adults Children under 15 Total M. 2 75 77 26 3 44 2 2 F. 5 127 132 29 7 91 3 2 M. 2 77 79 6 70 2 1 F 5 86 91 1 9 74 4 3 ... 14 365 379 56 25 279 11 8 (b) "Contacts" (included in (a) ) Adults Children under 15 M. 2 22 24 3 19 1 1 F. 1 53 54 5 2 46 1 — M. 2 39 41 — 1 37 1 2 F. 1 37 38 — 1 33 4 — (c) Insured persons (included in (a)). M. 1 60 61 21 3 34 2 1 F. - 45 45 19 1 21 3 1 1.—Number of patients under treatment or supervision (excluding persons under observation or domiciliary treatment) on the 31st L December* 95 6.—Number of reports received from Insurance Practitioners in respect of insured patients under domiciliary treatment during the year 128 2,—Total number of attendances of patients at the Dispensary during the year Insured 471 7.—Number of persons referred to hospital for consultation 10 Uninsured 1130 8.—Number of consultations with medical practitioners at the homes of patients Insured 7 3.—Number of the above attendances at which systematical physical examinations and records were made 963 Uninsured 5 9.'—Number of other visits paid by Tuberculosis Officer to the homes of patients 56 4,—Number of persons placed during the year under observation at the Dispensary for the purpose of diagnosis 115 10,—Numer of visits paid by Nurses or Health Visitors to the homes of patients for dispensary purposes 2230 5.—Number of cases in which the period of observation at the Dispensary exceeded two months 40 11.—Number of specimens of sputum examined in connection with the work of the Dispensary 222 ♦ Insured persons under domiciliary treatment by Insurance practitioners are excluded, even though they may attend the. dispensary at intervals for examination or consultation. 94 Potential contacts accruing during the year number 131, of which 75 have been examined. There have been 12 consultations with doctors at the homes of patients. 91 letters have been sent to 44 doctors concerning cases referred for opinion. 1 have made visits to the homes of patients in respect of 56 cases, and 20 visits to New End Hospital. Of the cases under treatment: — 47 have been referred to the London County Council for Sanatoria. 4 were admitted to Victoria Park Hospital. 5 do. Hempstead beds at North wood. 7 do. Hempstead General Hospital. 9 were referred to the Hempstead General Out-patients' Department. 48 do for X-ray Examination. 7 cases were referred to the London County Council for diagnostic observation, of which four were judged positive, two negative, and one doubtful. There has been an increase in the death-rate. There were 70 deaths, as against 58 last year. The bad weather during the whole of the year doubtless had some influence; but it is to be noted that the whole increase can be accounted for by the number of ex-service men who have died—14 this year, compared with 4 last year. The number of notifications—125—remains the same as last year; but four of the cases notified have been judged to be non-tuberculous, making the number just under last year's figures. In considering the notifications for 1924, it is of interest to note the increase amongst the better class population. Whether this is due to a real increase, or to the efforts which ha ve been made to secure more complete notification returns, is difficult to say. 24 of the patients notified were of sufficient standing not to require Dispensary help. 5 cases were notified from Mental Asylums, some of whom had not been resident in Hampstead for many years. 4 cases were notified from New End Hospital. 95 35 cases were notified from Hospitals and Sanatoria, and many of these did not return to the district on discharge from Sanatoria. Some have attended on their discharge, and others are attending their hospital of origin. 28 of the cases notified in 1924 died during the course of the year. 12 cases occurred in domestic servants. 64 of the notified cases have come within the orbit of the Dispensary scheme, either by attending themselves or the contacts attending for examination. 13 of the cases accepted by the London County Council have been sent to Colindale or other homes for advanced cases. During the year 48 X-ray examinations have been made, and I would like to express my appreciation to the Radiologist and the Hampstead General Hospital for the excellent films we are now receiving. We have profited much by the Hampstead beds at Northwood. The results from this Institution are excellent, and the patients are always high in their praise of the manner in which they are treated. The average stay in this Sanatorium, as far as our patients are concerned, is higher than elsewhere, and this gives the patients a very much better chance on their discharge. Perhaps it would be well to indicate the type of case one endeavours to select for this Institution. First, one has a preference for a quite early case, as the prolonged treatment given makes the chance of a cure more hopeful. Secondly the amenities of North wood are of rather a higher standard than at most other sanatoria available. Consequently, one endeavours to choose patients of the rather better class from those who come to us, and this for two reasons, one being that a poor and indigent patient is not happy at a place in which most of the other patients are better off than themselves, the other being the desire not to lower the general standard by our cases. The poorest type of patient is provided for under the London County Council Scheme. They are likely to be happier, and the assessment as to how much the patient shall pay, or whether they shall make any payment, is in the hands of the appropriate Committee. I consider that there is a weak point in the working of the 96 London County Council Scheme, inasmuch as patients attending Hospitals as out-patients are accepted for Sanatorium benefit without reference to the Tuberculosis Dispensary. I think these cases should be notified and sent to the Tuberculosis Dispensary for their Form "A" to be filled in. The present system makes it very difficult to keep in touch with the patient, or even get them to attend at all. When the patient is an in-patient at the Hospital, the state of affairs is quite different, and in this case I see no objection to a Form "A" being submitted direct from the Hospital. In my own Hospital Clinics I always make a point of referring all tuberculous patients to their appropriate Dispensary. The insured patient often prefers to attend a Hospital, for at the Dispensary we are not able to treat insured patients, whilst at the Hospital they obtain both treatment and observation. Housing continues to present a serious problem. A family has recently come under my notice living in very poor conditions, of whom four members were infected with tubercle. I have visited New End Hospital on frequent occasions during the year to keep in touch with any patients who are admitted there, and have to thank Dr. Reade for his courtesy and help in keeping me in touch with these cases. Owing to the satisfactory manner in which cases have been got away by the London County Council, we have not used the beds at New End Hospital as much as usual. We seem to have arrived at a more or less stationary condition in the treatment of tuberculosis, and on these lines I think the Dispensary has been working with smoothness and efficiency; but one feels that it is time further efforts were made, especially with regard to advanced cases, and the children of tuberculous parents, living as they do in a constant state of subjection to heavy infection of the tubercle bacillus, and lastly, the housing problem, which one hopes to see make some advance during the present year. The general health of the community depends in the first instance on the medical practitioners in the Borough. I have found the doctors in Hampstead always most willing to co-operate, and have had many doubtful cases sent to the Dispensary for investigation and observation. I am very grateful for their cooperation and help in many cases. 97 We are always glad to investigate and watch any cases of which the doctor is at all doubtful, as we are in the position in which time allows of making frequent examinations of the patient, and moreover have the advantage of being able to have X-ray and frequent sputum examinations, and the service of visitors to keep them up to attending regularly during the period of observation. Home visiting of Ex-Service tuberculous men.—The following information for the year 1924, required by the Ministry of Health, is submitted:— 1. Number of discharged men visited 72 2. Total number of visits of this kind 391 3. Proportion of number of visits to such cases to total number of visits to tuberculous cases 15.4 per cent. 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 1915 308 146 158 899 1916 230 165 100 1519 1917 383 183 113 1682 1918 371 105 124 1821 1919 296 85 57 1543 1920 384 221 112 2625 1921 479 127 192 2327 1922 445 113 223 1738 1923 422 120 199 1534 1924 365 111 151 1601 I have to thank the Dispensary Staff for their efficient and keen work, and Dr. Scrase for his helpful consideration. A. J. SCOTT-PIN CHIN, M.D. (Lond.), M.R.C.P. (Lond.). APPENDIX II. REPORT For the year 1924 of the Medical Officer in Charge Pre-Maternity Clinics. MARY KIDD, M.B. (Lond.). 27, Pond Street, N.W.3, and 73, Dynham Road, N.W.6. 6th April, 1925. 100 APPENDIX II. Report of Medical Officer in Charge of Pre-Maternity Clinics Western Clinic. Eastern Clinic. Number of new cases 207 105 Number of attendances of old cases 659 316 Number of sessions held 100 51 Average attendance per session 8 to 9 8 Number of cases sent referred to Dental Clinic 81 29 Number of patients sent to Convalescent Home 9 - Number of patients referred to the Tuberculosis Medical Officer 7 6 Of the 312 new applicants, 26 were normal cases; 145 were slightly abnormal; 54 seriously abnormal; 7 were connected with venereal disease; 44 attended for the first time after confinement; 18 were definitely not eligible cases, and in 18 it was doubtful if they were so. Analysis of Ante-Natal Cases. (Slightly and Seriously Abnormal.) Morning Sickness 29 Lupus Vulgaris 1 Dyspepsia 15 Varicose Veins 20 Constipation 43 Lax Abdominal Wall (needing bandage) 7 Colitis 1 Appendicitis 1 Discharging Umbilicus 1 Piles 2 Marked Endocervicitis 2 Anaemia 22 Retroverted gravid uterus 2 Valvular Disease of the Heart 7 Threatened Miscarriage 9 Bronchitis 2 Miscarriage (not averted) 3 Pleurisy 1 Ante-partum Haemorrhage 1 Pleurodynia 1 Premature Rupture of Membranes 1 Mastitis 2 Toxaemia of Pregnancy 3 Contracted Pelvis (minor degree of) 20 Albuminuria 7 Chronic Nephritis 1 Contracted Outlet 1 Nocturnal Epilepsy 1 Neuritis 1 199 Neuralgia 1 101 The number of new patients attending at the Kilburn Clinic remains about the same as last year, whereas the number of those at the Pond Street Clinic has increased somewhat. The total number of new patients has increased from 285 in 1923 to 312 in 1924. As the net number of births in the Borough last year was 1186, over a quarter of the expectant mothers in Hampstead have attended the Clinics. The number of infantile deaths occurring in the first month of life has been 33 in 1924. These deaths are more or less attributable to ante-natal causes. It is pleasing to record that in only three of these cases had the mothers attended the ante-natal clinic beforehand. In one of the cases the mother had whooping cough when the child was born, and the child contracted it and died at 19 days of age. In another case the child died of influenza and enteritis at three weeks, and in another case it died of bronchitis and pneumonia. In one of the other cases of death in the first month of life, where the mother had not been for ante-natal treatment, I find that she had attended during a previous pregnancy terminated by miscarriage. We had found, subsequently, that certain treatment was indicated, after doing a blood test, and we sent for her to come up to the Clinic; but she did not come. In the case of one of the children who died at three months of age, where the mother had attended the ante-natal clinic, I think that ' possibly something might have been done to prevent it: but, by an unfortunate oversight, a blood test had not been done, after a previous pregnancy, where it was possibly indicated. The cases of valvular heart disease have all been seen as often as possible beforehand, and rest had been enjoined and treatment given. They have all done well, up to date, as far as reports have been received, with the exception of one case, in which auricular fibrillation supervened. Before this, she had been resting at home as much as possible by my orders, and the two children had been put into a hostel so that she might not have too much to do; but, unfortunately, she had much domestic worry, and one day at the Clinic she had an attack of what seemed to be auricular fibrillation. It was arranged for her to go into University College Hospital, where she was kept in bed for some weeks before the child was born. Both mother and child are doing well, up to date. With regard to the seven cases of albuminuria, the amount of 102 men present was slight; but all the patients were carefully dieted and rest enjoined. The mother did well and a healthy baby was born, in spite of there having been marked toæxmia in one case. In a case in which toxaemia symptoms occurred, we sent her to New End Hospital for rest and treatment three weeks before the baby came. She had one eclamptic fit and the child was stillborn. The mother is quite well. In two other cases I have not had any report on the subsequent progress. In the case of chronic nephritis the child was stillborn, in spite of careful dieting and rest beforehand. We had sent her into New End Hospital three months before the child was expected, so as to give her every chance, as she had never been able to have a living child and was very anxious to have one. All the three cases were thoroughly investigated afterwards. One had been probably caused by retroversion of the gravid uterus, persisting in spite of treatment. The Wasserman reaction afterwards was negative. The second case was certainly due to specific disease of long standing, with cerebellar involvement, and had only been to the clinic a fortnight before the miscarriage occurred. A third case was found afterwards to have a slightly positive Wasserman reaction; but refused treatment for this. In the case of ante-partum haemorrhage, the patient refused to go into Hospital for investigation and treatment beforehand, as I advised. I persuaded her, finally, to have a doctor as well as a midwife. No further haemorrhage occurred or toxaemia symptons arose. The mother and child did well. The case of central placenta prævia was one who had first attended the Clinic in the autumn of 1923. She had wished to have the baby at home; but after the first symptons occurred I sent her to the Royal Free Hospital and she was admitted there for investigation and treatment. She was allowed to come home for a time before the confinement, as she had done so well in Hospital. We made arrangements for her to be taken back to Hospital in an ambulance as soon as any hæmorrhage occurred. She was safely delivered there, finally, in spite of the seriousness of the case. The child was stillborn. The patient in whom premature rupture of membranes had occurred was persuaded to go into New End Hospital at once. She was kept in bed there under observation and treatment. Shortly afterwards, 103 at midnight, a severe internal concealed haemorrhage took place. A consultant was hastily summoned by the Medical Superintendent and the patient's life was just saved, the child being stillborn. I think that in both these last two cases, two maternal deaths were prevented by institutional treatment having being arranged for. In a case of a primipara, where podalic version was indicated, I sent her to the Consulting Ante-Natal Clinic at the Royal Free Hospital. Version was found there to be impossible, even under an anaesthetic. The cause of this was found on an X-ray examination to be due to hyper-extension of the whole foetal axis. The patient was taken in for her confinement for fear of a still-birth occurring. A healthy baby was born alive, and both it and the mother did well. A number of cases of contracted pelvis were of minor degree only. Some were sent to New End for their confinements; others who wished to be confined at home were advised to be attended by their own doctors. Of the seven cases connected with venereal disease, three refused to go to hospital for treatment or further investigation, in spite of much persuasion. A fourth case went for a time and then refused to go. Another very old standing case was referred back to her own hospital, where she had been under treatment before. Two others went through the course of treatment advised with splendid results, both mothers and children doing extremely well. (Signed) MARY KIDD, m.b. (Lond.). 6th April, 1925. APPENDIX III. REPORT For the year 1924 of the Public Analyst. ALF. W. STOKES, F.C.S., F.I.C. Analytical Laboratory, Town Hall, Paddington, W. 14th January, 1925. 106 APPENDIX III. Analytical Laboratory, Town Hall, Paddington, W. 14th January, 1925. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies, and Gentlemen, A short abstract of the Analytical work of the year 1924 may be of interest. A total of 506 samples was analysed. The principle articles were:—Milk, 247 samples; butter, 44 samples; and spirits, 47. There were found to be adulterated: 17 samples of spirits, 5 of milk, 2 of sausages, and 1 of margarine. This shows a percentage of adulterated samples 4.9 as against 4.3 for the previous year. Prosecutions were undertaken against those selling spirits below 35 under proof. In spite of appeal to the High Court, the decisions were upheld, and fines amounting to £16, with costs of £46 4s. 0d. also, were imposed. I have the honour to remain, Yours obediently, ALF. W. STOKES, Public Analyst. 107 INDEX. PAGE. Ambulance Facilities 36 Analytical Work, Report on 106 Ante-Natal Clinics (see Pre-Maternity Clinics) — Anti-toxin (Diphtheria) 46 Area of Borough 5 Bacteriological Examinations 46 Bakehouses 54 Births 7, 8 Cancer 16-22 Care Committee (see Tuberculosis) — Census Statistics 5 Cleansing Station 49, 65-67 Clinics 33 Complaints Received 46 Condensed Milk 65 Consumption (see Tuberculosis) — Conveniences 73 Customs and Inland Revenue Acts 50 Dairies 55 Day Nurseries 33 Deaths 8.10 Dental Clinics 34 Diarrhoea and Enteritis 16 Diphtheria 24 Disinfection 65 Drainage By-laws 50-53 Dried Milk 65 Encephalitis Lethargica, Acuta 24 Enteric Fever 24 Epidemic Diarrhoea 16 Epidemic Diseases. Principal Deaths 16 Erysipelas 24 Exhumations 74 Factory and Workshop Acts 68-72 Flooding in Kilburn 73 Food and Food Premises 54-55 Fried Fish Shops 54-55 Health Visitors, Work of 36 108 PAGE. Home Office Tables (Factory and Workshop Act, 1901) 68-71 Home workers 69,70 Hospitals 34 Housing 76-85 Housing Committee 3 Ice Cream 54 Infant Welfare Centres 33 Infantile Mortality 11-14 Infectious Diseases 23-31 Institutions for Unmarried Mothers and Infants 36 Laboratory Work 45 Legal Proceedings 72 Malaria - Margarine, Wholesale Dealers 54 Marriages 6 Maternal Deaths 11,38 Maternity and Child Welfare 32-45 Measles 15 Midwives 33 Milk and Cream Regulations 64 Milk. Graded 56 Milk and Food for Mothers and Infants 37 Milk and Milkshops 54 Mortuary, Public 67 Notification of Births Act, 1907 8 Nursing Facilities 32 Offensive Trades 55 Ophthalmia Neonatorum 25 Outworkers (see Home workers) — Pneumonia, Acute primary 24 Polio Myelitis, Acute 24 Population 6 Population, Natural Increase of 7 Preservatives 61 Pre-Maternity Clinics 33,44 Report of Medical Officer in Charge 100-103 Principal Epidemic Diseases 16 Public Conveniences (see Conveniences) — Public Health Committee 3 Public Health Station 74 Puerperal Fever 24 Rags and Bones Dealers 55 Railway Companies and Sanitary Control 50-53 Rats and Mice (Destruction) Act, 1919 53 Rent Restrictions Acts 50 Restaurant Kitchens 54 109 PAGE. Sale of Food and Drugs Acts 58-61 Sanitary Inspection, &c. 46 Scarlet Fever — School Clinics 33 Sanitary Inspectors, Work of 46 Slaughterhouses 54,55 Small-pox 25 Smoke Nuisances 46, 65 Spirits, Adulteration of 62 Staff of the Public Health Department 75 Still-Births 8,41 Suicide 22 Summary of Vital Statistics 5 Tenement House Bye-laws 85 Treatment Centres 33 Tuberculosis 25-31 Tuberculosis Care Committee 31 Tuberculosis Dispensary 31, 92-97 Tuberculosis Medical Officer, Report of 92-97 Underground Rooms 47,53 Vaccination 25 Venereal Diseases 22,34 Verminous Persons and Premises 65-67 Vital Statistics 5,86-89 Violent Deaths 22 Warranty Defence 61 Water Supply, Certificates as to 47 Water Supply of Tenement Houses 47 Welfare Centres 33 Whooping Cough 15 Workshops (see Factory and Workshops Acts) — Young Children, Mortality among 14