HAMP 67 THE Metropolitan Borough of Hampstead. REPORT FOR THE YEAR 1912 OF THE Medical Officer of health. FRANK E. SCRASE, F.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Lond.) CONTENTS. pages Vital Statistics 11-25 Infantile Mortality 29-33 Infectious Diseases 37-52 Tuberculosis 55-66 Disinfection 69-70 General Sanitary Administration 73-104 Factory and Workshop Act, 1901 107-116 Report on Analytical Work 118 Legal Proceedings 121-126 Appendix—Tables 129-140 Index 141-143 5 PUBLIC HEALTH COMMITTEE, NOVEMBER 1911-12. Ex- Officio. His Worship The Mayor. (Mr. Councillor Gr. W. Holtzapffel, J.P.) Chairman. Mr. Councillor C. J. Higginson. Mr. Alderman W. Woodward. Miss Councillor M. E. Balkwill. Mr. Councillor V. H. le B. Blessley. ,, G. Buckle. „ C. W. Cunnington, M.R.C.S., D.P.H. „ J. I. Fraser. „ J. H. North. ,, T. H. Nunn. „ E. A. O'Bryen. ,, E. S. Payne. „ A. B. Weaver. 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT, MAY, 1913. Sanitary Inspectors. Senior Inspector. W. G. Kershaw. Divisional Inspectors. II. Geary, No. 1 District (Wards 1 and 2). C. H. Taylor, No. 2 District (Wards 3 and 7). A. Peverett, No. 3 District (Wards 4 and 5). J. Grimsley, No. 4 District (Ward 6). Special Inspectors. F. H. Hudson. A. C. Townsend. Mrs. T. Fisher, M.A. Mrs. K. Roche. Assistants to Inspectors. W. Larken. E. Stratton. A. Edwards. Public Mortuary. Keeper. W. Larken, 63, Flask Walk. Disinfecting Station. Disinfectors. T. Rider. G. Allaway. R. Bell. Cleansing Station. Mrs. Rider, Attendant. 7 Tuberculosis Dispensary. Tuberculosis Medical Officer. J. King Patrick, M.B., B.Sc., D.P.H. Nurse. M iss G. Goodchild. Clerical Staff. 4 Clerks and 1 Clerk-Draughtsman. Public Analyst. A. W. Stokes, F.C.S., F.I.C. Medical Officer of Health. Frank E. Scrase, F.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Lond.). 8 Public Health Department, Town Hall, Haverstock Hill, Hampstead, n.w. 6th May, 1913. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Madam, and Gentlemen, I have the honour to place before you the Medical Officer of Health's Report for the year 1912. In the compilation I have adhered to the headings and general outline of previous Reports, and as my term of office only commenced in June, 1912, the following Report must necessarily be restricted to a statement of bare facts and figures. In this respect, however, it deals with the whole of the year 1912. Pursuant to instructions sent me by the Local Government Board, I have utilized the notes and records left by the late Medical Officer of Health, and from such notes I have freely drawn in the reports and statistics concerning Tuberculosis. This subject, I may add, overshadowed all others in the work of the Department during the past year I desire to take the opportunity of expressing my thanks to the Council, especially to the Chairman and Members of the Public Health Committee, for the support and sympathetic consideration they have afforded me during my first term of office as Medical Officer of Health. I am also deeply indebted to the Members of the Staff of the Department who have carried out their work in a satisfactory and efficient manner, and at all times have accorded me their most loyal and unselfish co-operation. I have the honour to be, Mr. Mayor, Madam, and Gentlemen, Your obedient Servant, FRANK E. SCRASE, Medical Officer of Health. Vital Statistics. 11 Summary of Vital Statistics for 1912. Population estimated to middle of 1912 85,966 Density „ „ „ 37.9 persons per acre Births 1281 Birth-Rate 14.9 Marriages 647 Marriage-Rate 15.0 Deaths 861 Death-Rate 10.0 Infantile Mortality 62 per 1000 births Notifiable Infectious Diseases Attack-Rate (excluding Pulmonary Tuberculosis) 3.7 Notifiable Infectious Diseases Death-Rate „ 0.29 Death-Rate from the Seven Principal Epidemic Diseases 0.42 Death-Rate from Pulmonary Tuberculosis 0.73 Death-Rate from All Forms of Tuberculosis 0.88 Population at Census 1911 85,495 Inhabited Houses 11,294 Area of Borough 2265 acres „ „ (excluding area covered by water) 2253 acres 13 POPULATION. The population of Hampstead at the middle of 1912 was estimated by the Registrar-General to be 85,966, and this estimate has been adopted in this Report, and it forms the basis upon which the various rates have been calculated. The following is an approximate estimate of the population of each Ward at the middle of 1912:— Ward 1 (Town) 14040 ,, 2 (Belsize) 13830 „ 3 (Adelaide) 9930 „ 4 (Central) 9876 ,, 5 (West End) 12890 ,, 6 (Kilburn) 15000 „ 7 (Priory) 10400 The Borough 85966 The population of the Borough of Hampstead, as ascertained by the Census taken on April 3rd, 1911, is now stated by the Secretary of the Census Office to be 85,495. This figure is slightly lower than that which was first stated, i.e., 85,510. By the courtesy of the Secretary of the Census Office I am able to give the population and sex distribution for each Ward of the Borough at the Census. Ward Number. Persons. Males. Females. No. 1 (Town) 13795 5234 8561 No. 2 (Belsize) 13755 5418 8337 No. 3 (Adelaide) 9954 3332 6622 No. 4 (Central) 9828 3069 6759 No. 5 (West End) 12822 5331 7491 No. 6 (Kilburn) 14912 6687 8225 No. 7 (Priory) 10429 3736 6693 Total 85495 32807 52688 14 The area of the Borough (including the area, twelve acres in extent, covered by water) is 2,265 acres, and the estimated number of persons to the acre is 37.9. The proportion of persons to the acre at the census of 1911 was 37.7. At the census of 1881 the number of persons per acre was 23, in 1891 it was 30, and in 1901 it was 36. MARRIAGES. According to a return kindly furnished to me by the Superintendent Registrar of Hampstead, it appears that 647 marriages were registered in the Borough during 1912. The total number of persons married in Hampstead during 1912 was 1294, which is equivalent to a rate of 15.0 per 1000 of the population, and is a decrease on that for the year 1911, when the marriages of 1392 persons were registered, equivalent to a rate of 16.3 per 1000 of the population. The following Table gives the marriage rates for the years 1902-1912, and the average rate for the decade, 1902-1911:— Year. No. of persons married per 1000 of the population. 1902 15.3 1903 14.4 1904 15.0 1905 14.4 1906 13.8 1907 15.3 1908 14.7 1909 16.0 1910 14.8 1911 16.3 Average for the decade 15.0 1912 15.0 BIRTHS. During the year 1224 births were registered in Hampstead (excluding one birth which occurred in a previous year, and which was re-registered for legal purposes only), an increase of 25 as compared with the number—1199—registered in the previous year. Of the total births 641 were of male and 580 of female children. In addition, 63 15 births of children whose mothers were Hampstead residents occurred in the principal lying-in institutions, etc., in other metropolitan boroughs, and six of the births registered in Hampstead belonged to other districts, and should be deducted from the total. This information is supplied to me by the Registrar-General. After these corrections have been made, the total number of births belonging to Hampstead is found to be 1281, and, in accordance with the practice of the RegistrarGeneral, I have taken this number as a basis for the various rates that depend on the number of births occurring during the year. Illegitimate Births.—Out of the total of 1,281 births 76, or 59 per 1000, were those of illegitimate children. These figures are noteworthy, showing as they do a most remarkable increase in the number of illegitimate births. For purposes of comparison, I append a table of the illegitimate births occurring in the Borough for the past ten years, by which it will be seen that the illegitimate births in 1912 are approximately double those in any preceding year yet recorded. Year Number of illegitimate births. Illegitimate birth-rate per 1000 births registered. 1902 39 25.7 1903 42 28.9 1904 42 29.1 1905 35 24.6 1906 34 24.0 1907 43 32.0 1908 29 21.0 1909 43 33.0 1910 36 28.0 1911 37 29.0 1912 76 59.3 Birth-Rate. The birth-rate calculated on the number of births registered in the Borough was 14.2 per 1000 of the population, as compared with the rate of 14.0 per 1000 in 1911, and 15.8, the average for the years 1907—1911. But when the birth-rate is calculated on the total number of births belonging to Hampstead, including those that took place without as well as within the Borough, and excluding those taking place in the Borough but belonging to other districts, the rate is found to be 14.9. Thus the years 1911 and 1912 record an exactly similar 16 birth-rate, and share between them the distinction of having the lowest birth-rate ever recorded in Hampstead, but it is a point that should be noted that 1912 only maintained a birth-rate equal to its predecessor by the very large increase in the number of its illegitimate births, which, as shown by the figures given above, was double that of 1911. The highest birth-rate recorded in Hampstead was in the year 1878, when the rate was 24.5. Since then the rate has steadily declined. In England and Wales there has also been a marked reduction in the birth-rate, but the Hampstead figures show a greater proportionate decline. The following table shows the Ward and sex-distribution of the births, and the birth-rate for each Ward:— Ward. Births. Birth-rate per 1000 of the population. Males. Females, Total. No. 1 (Town) 92 91 183 13.0 No. 2 (Belsize) 106 82 188 13.6 No. 3 (Adelaide) 64 53 117 11.8 No. 4 (Central) 60 37 97 9.8 No. 5 (West End) 121 105 226 17.5 No. 6 (Kilburn) 175 178 353 23.5 No. 7 (Priory) 58 59 117 11.1 The Borough 676 605 1281 14.9 It will be seen, by comparing these figures with the death-rates in each Ward as shown below, that in none of the Wards in 1912 is the birth-rate actually lower than the death-rate. The birth-rate approaches nearest the death-rate in 1912 in the Priory Ward, the difference in this Ward being very slight. In 1911 in the Adelaide Ward the birth-rate was actually lower than the death-rate. The Natural Increase of the population—i.e., the excess of births over deaths—was 420 in 1912. 17 DEATHS. The total deaths occurring in Hampstead during the year amounted to 1,106. Of these, however, no less than 387 were of persons not belonging to the Borough, while 142 residents of Hampstead died in outlying districts. The total number of deaths, therefore, amongst persons belonging to Hampstead amounted to 861. Death-rate. The death-rate, calculated upon the total number of deaths (whether of resident or non-resident persons) occurring in the Borough during the year, was 12.9 per 1000 of the population; but after subtracting from the total deaths registered the deaths of non-resident persons dying in Hampstead, and adding the deaths of Hampstead residents who died outside the district, the recorded death-rate is found to be 10.0 per 1000 of the population, as compared with the rate of 9.9 per 1000 of the population in 1911. The average recorded death-rate for the five years 1907-1911 was 9.7. The following are the death-rates for each of the Wards:— WARD. Death-rate per 1,000 of the population. No. 1 (Town) 9.6 No. 2 (Belsize) 9.2 No. 3 (Adelaide) 7.7 No. 4 (Central) 7.7 No. 5 (West End) 9.8 No. 6 (Kilburn) 12.5 No. 7 (Priory) 10.9 In the table on page 140 the death-rates of Hampstead may be compared with those of England and Wales since 1875. The following table, which is issued by the Registrar-General, shows the death-rate of Hampstead as compared with the rates of the County of London, and the Metropolitan Cities and Boroughs:— 18 Table showing the Death-Rates from All Causes in the County of London, the City of London, and the Metropolitan Boroughs during the 52 weeks of 1912, as calculated by the Registrar-General. DISTRICT. Death-rate from all causes. Hampstead 9.8 Wandsworth 10.2 Lewisham 10.4 Woolwich 11.6 Hackney . 12.1 Stoke Newington 12.1 Battersea 12.2 Paddington 12.3 City of Westminster 12.4 Fulham 12.8 Camberwell 12.9 Kensington 13.0 Deptford 13.1 Greenwich 13.1 Hammersmith 13.1 Lambeth 13.3 City of London 13.5 St. Marylebone 13.8 Islington 14.3 Chelsea 14.6 St. Pancras 14.6 Stepney . 15.2 Bethnal Green 15.3 Holborn 15.3 Poplar 16.4 Southwark 16.7 Bermondsey 16.8 Shoreditch 18.1 Finsbury 18.8 County of London 13.6 Note.—The rate stated by the Registrar General differs from that as calculated by me. This is accounted for by the fact that the Registrar General's figures for all the Boroughs have not yet b6en completely corrected for transferable deaths. 19 Deaths of Non-Residents and Outlying Deaths. Of the 1106 deaths that occurred in Hampstead, 387 were of persons belonging to other districts. On the other hand 142 Hampstead residents died outside Hampstead. Information of the outlying deaths is received from the Registrar-General, who issues to medical officers of health a quarterly return of deaths that occur outside the district. The number of deaths of Hampstead residents that occurred in public institutions was 290, or 33.7 per cent. of the total deaths, and the number of deaths occurring in workhouses or workhouse infirmaries was 133, or 15.4 per cent. of the total deaths. A list of the institutions in which the deaths occurred is given on pages 19 and 20. Deaths at Various Ages. The following table shows the number of deaths at the various age periods, the causes of such deaths being shown in Tables III. and IV., pages 131 and 132. Age Periods. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. All Ages. Deaths 79 21 31 24 35 94 227 350 861 Uncertified Deaths. No Hampstead resident's death in 1912 was "uncertified." According to the instructions of the Registrar-General, all deaths certified by registered medical practitioners and all inquest cases are classed as "certified," and any other deaths are regarded as "uncertified." 20 Deaths of Hampstead Residents in Institutions. Institution. Totals Group Totals. Infirmaries and Workhouses— Edmonton Infirmary 1 133 Hackney Infirmary 1 Hampstead Workhouse 121 Kensington Infirmary 1 St. George's Infirmary 1 St. Pancras Infirmary 5 St. Pancras Workhouse 2 Shoreditch Infirmary 1 Hospitals, Nursing Homes, etc.— . 218, Adelaide Road 1 119- Battersea Hospital 1 54, Beaumont Street 1 73, Belsize Park Gardens 1 33, Belsize Square 2 Cancer Hospital 2 Charing Cross Hospital 1 Children's Hospital, Paddington Green . 4 Consumption Hospital, Kensington 1 Cottage Hospital, Harlesden 1 Crooksbury Sanatorium, Scale 1 6. Denningtou Park Road 2 Evelina Hospital 1 Fairliglit Sanatorium, Hastings 1 French Hospital 1 Friedenheim Hospital, Avenue Road 6 Great Northern Hospital 1 Hampstead General Hospital 28 "Ravenswood, Highgate Road 1 Home Hospital, 16, Fitzroy Square 1 Homoeopathic Hospital 2 Hospital for Epilepsy and Paralysis 1 Hospital for Incurable Children, College Crescent 1 Hospital of St. John and St. Elizabeth 4 Hostel of God, Clapham 1 Huntington Nursing Home, Bournemouth 1 King's College Hospital 1 Lock Hospital 1 London Hospital 2 London Temperance Hospital 1 Metropolitan Hospital 1 Middlesex Hospital 11 Mount Vernon Hospital 1 2. Nottingham Place, W. 1 32, Parkhill Road 1 Queen Charlotte's Hospital 1 Queen Mary's Hospital 1 20, Quex Road 2 21 Deaths of Hampstead Residents in Institutions—c. n. Institution. Totals. Group Totals. Hospitals, Nursing Homes, etc.—con. Royal Surrey County Hospital, Guilford 1 St- Anthony's Hospital, Cheam 1 St. Bartholomew's Hospital 2 St. George's Hospital 2 St. Luke's House. Kensington 2 St. Mary's Hospital 7 St. Monica's Home 1 St. Thomas's Hospital 2 Sanatorium Free Hospital 1 97 & 99, South Hill Park 3 University College Hospital 1 Victoria Home for Invalid Children 1 West End Hospice 1 Westminster Hospital 1 50, Weymouth Street, W. 1 Metropolitan Asylums Board's Hospitals— North Western Hospital. 14 Park Hospital 2 16 Asylums— Bethlem Royal Hospital 1 22 C'amberwell House Asylum 2 Claybury Asylum 1 Colney Hatch Asylum 5 Hanwell Asylum 2 Hospital for Insane, Barnwood 3 Leavesden Asylum 5 Long Grove 1 Manor Asylum 1 Tooting Bee Asylum 1 290 The names of the Institutions that are situated in Hampstead are printed in heavy type. Senile Mortality. The deaths of persons of 65 years of age and upwards numbered 350, as compared with 314 in 1911. CAUSES OF DEATH. The Births and Deaths Registration Act, 1874, made it obligatory on the part of the medical attendant to certify the cause of death, and although between then and now improvements have been instituted, the Medical Officer of Health, to whom it falls to compile statistics of causes of death, has constantly been reminded of the unsatisfactory nature of 22 much of the information supplied, and the vague and general indefinite character of the language in which some of the certificates are couched. This seems to be unavoidable under the present system, and the occurrence of such a condition of things has been a subject of much discussion. The causes are :— (a) The delivery of the certificate to the immediate relatives or friends of the deceased. (b) The registration of death by laymen. The delivery of the certificate to the relatives of the deceased must in itself create a difficulty which the medical attendant naturally desires to avoid, and one can hardly blame him if he endeavours to avoid putting into writing the fact that the deceased died of alcoholism or syphilis and then handing the certificate to the deceased's friends, well knowing that it would doubtless cause them great pain and not unlikely arouse considerable resentment to himself personally as casting a slur upon the deceased. The certification of other diseases, such as cancer or consumption, is sometimes not free from great difficulty for the same reason. The Registrar of Deaths is not infrequently a layman, and although it must be admitted that the General Register Office have drawn up clear rules to guide them, it stands to reason that by want of medical training such an officer is not always in a position to decide whether the cause of death is as clearly set out as the officer responsible for the compilation of statistics would desire. The remedy for this could be found by extending the system of notification to causes of death. It seems to me to be a perfectly logical corollary to our present system by which births, infectious diseases— including tuberculosis— are notified. The latter notification takes the form of confidential certificates to the Medical Officer of Health, and there seems to be no reason why similar confidential communications to the Medical Officer of Health should not be enacted and paid for as any other notification certificate is paid for, and that the Medical Officer of Health should be empowered to require indefinite certificates to be so amended as clearly to establish the cause of death. Such a scheme should cause no dislocation to the present system ; the registration of the fact of death would still be left with the Registrar, who would register the death only 011 an order from the Medical Officer of Health or Coroner. 23 The confidential notification of death could be transmitted by the Medical Officer of Health to the Registrar-General, and should not be available for any purpose of payment of insurance. Were such a system in vogue there could be little doubt that the numbers of deaths by alcoholism and syphilis would show a considerable increase. The causes of death are given in Table III. of the Local Government Board's series of tables, see page 131, and are set out in more detail in the extended table facing page 131. The mortality from the various communicable diseases is given in the section of the Report devoted to those diseases. As regards the other causes of death, the following require special mention : — Cancer. The following table gives the number of deaths from cancer, and the death-rate per 1000 population in each of the ten years 1903-12 : — Year. No. of Deaths from Cancer. Death-rate per 1000 of the population. 1903 105 1.27 1904 85 1.02 1905 73 0.87 1906 93 1.11 1907 69 0.82 1908 84 0.99 1909 85 1.00 1910 90 1.06 1911 86 1.00 1912 102 1.19 Of the 102 deaths from cancer 70 were of females and 32 of males, but on this point it must be borne in mind that the population of the Borough was found at the census to consist of 52,688 females and 32,807 males. It will thus be seen that the deaths from cancer are higher among females, the exact rate being 1.33 in females and 0.97 in males. In 48 cases the patients were over 65 years of age. 24 The next table gives the anatomical distribution of the disease in each sex. Situation. Males. Females. Total. Buccal cavity 3 l 4 Stomach, Liver, &c. 10 9 19 Peritoneum, Intestines and Rectum 6 16 22 Genital Organs 3 22 25 Breast — 6 6 Skin 2 1 3 Other, or unspecified organs 8 15 23 Totals 32 70 102 Alcoholism. In 2 cases death was certified to be due to alcoholism, and 6 persons died from cirrhosis of the liver, a disease usually attributed to the consumption of alcohol. The total number of deaths recorded as due to alcohol was, therefore, 8, as compared with 15 in 1911, but this is certainly an under-statement of the total mortality that may be directly attributed to this drug. Diseases of the Circulatory System. These accounted for 134 deaths, as compared with 119 in 1911. Diseases of the Respiratory System. The total mortality from these diseases was 135, as compared with 106 in 1911. Twenty-five deaths occurred in children under five years of age, and 68 in persons aged from 65 and upwards. Of the total deaths 64 were due to bronchitis, 56 to pneumonia, and 15 to other diseases of the respiratory organs. 25 Violent Deaths (excluding Suicide). Twenty-one deaths were classified under this heading, 1 was due to poisoning, 2 to burns, 2 to absorption of deleterious gases, 1 to accidental drowning, 1 to injury by revolver, 5 to falls, 4 to injuries by being run oyer by motor vehicles, 1 to carriage accident, and 1 to railway accident, 3 were due to homicide, 1 by bullet wound in head, and 2 newly born infants who were killed. Suicide. Sixteen persons committed suicide, as against 15 in 1911. In 4 cases the cause of death was poisoning, 5 deaths were due to hanging or strangulation, 2 to asphyxia, 1 to drowning, 3 to bullet wounds from revolvers, and 1 to cut throat. Infantile Mortality. 29 INFANTILE MORTALITY. The number of deaths of Hampstead children under 1 year was 79, a decrease of 26 as compared with the previous year. In the following table these infantile deaths are distributed in Wards under their respective causes:— CAUSE OF DEATH. WARDS. Non-distributable. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). 1 Small-pox .. .. .. .. .. .. .. .. .. 2 Chicken-pox .. .. .. .. .. .. .. .. .. 3 Measles .. 1 .. .. .. .. .. .. 1 4 Scarlet Fever .. .. .. .. .. .. .. .. .. 5 Whooping Cough .. .. .. 1 .. .. .. .. 1 6 Diphtheria and Croup .. .. .. .. .. .. .. .. .. 7 Erysipelas 1 .. .. .. .. .. .. .. 1 8 Tuberculous Meningitis .. .. .. .. .. 1 .. .. 1 9 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. 10 Other Tuberculous Diseases .. .. .. .. 1 .. .. .. 1 11 Meningitis (not Tuberculous) .. 2 .. .. .. 1 .. .. 3 12 Convulsions 2 .. 1 .. 1 3 1 .. 8 13 Laryngitis .. .. .. .. .. .. .. .. 14 Bronchitis .. .. .. .. .. 2 1 .. 3 15 Pneumonia (all forms) .. 2 .. .. 1 6 1 .. 10 16 Diarrhœa .. .. 1 1 .. .. .. .. 2 17 Enteritis .. .. .. .. .. .. .. .. .. 18 Gastritis .. .. .. .. .. .. .. .. .. 19 Syphilis .. .. .. .. .. 1 .. .. 1 20 Rickets .. .. .. .. .. .. .. .. .. 21 Suffocation, overlying .. .. .. .. .. 1 .. .. 1 22 Injury at Birth .. .. l .. 2 .. .. 1 4 23 Atelectasis .. 1 .. .. .. .. .. .. 1 24 Congenital Malformations .. .. .. 1 .. 3 i .. 5 25 Premature Birth 5 2 3 1 4 2 2 .. 19 26 Atrophy, Debility, and Marasmus 2 .. .. .. 3 5 1 .. 11 27 Other Causes 2 .. .. .. 1 1 .. 2 6 Totals 12 8 6 4 13 26 7 3 79 The "Infantile Mortality"—i.e., the number of deaths under one year per 1000 births—was 62, as compared with the rate of 82 per 1000 births in 1911, this figure being calculated on the total number of births belonging to Hampstead, including those that occurred in lying-in institutions outside Hampstead. The average rate for the years 19071911 was 72. The infantile death-rate for the year 1912, 61.7, was very low, and only in one previous year has a lower rate been reached, viz., in 1910 when the rate was 60. 30 The following table shows the infantile mortality of Hampstead in each year since 1880. 1880 140 1897 127 1881 136 1898 125 1882 99 1899 129 1883 98 1900 100 1884 143 1901 102 1885 110 1902 88 1886 131 1903 87 1887 107 1904 111 1888 110 1905 94 1889 122 1906 77 1890 122 1907 69 1891 104 1908 69 1892 122 1909 74 1893 102 1910 60 1894 113 1911 82 1895 135 1912 62 1896 123 The following are the infantile mortality rates for each of the Wards:— WARD. Deaths of Infants under 1 year per 1000 births. No. 1 (Town) 65.5 No. 2 (Belsize) 42.5 No. 3 (Adelaide) 51.3 No. 4 (Central) 41.2 No. 5 (West End) 57.5 No. 6 (Kilburn) 73.6 No. 7 (Priory) 59.8 The following table, which is issued by the Registrar-General, shows the infantile mortality in each of the Metropolitan Cities and Boroughs and in the County of London as calculated by the RegistrarGeneral. It will be noted that Hampstead occupies a very favourable position when compared with other districts or with the whole of London:— 31 Table showing the Infantile Death Rates of the County of London, the City of London, and the Metropolitan Boroughs during the 52 Weeks of 1912, as calculated by the RegistrarGeneral. DISTRICT. Deaths under 1 year to 1000 Births. Hampstead 62 Chelsea 68 Lewisham 70 Stoke Newington 72 Woolwich 73 Wandsworth 76 Hackney 80 Holborn 80 City of London 81 Camberwell 83 Battersea 84 Greenwich 84 City of Westminster 84 Lambeth 86 Islington 87 St. Pancras 88 Deptford 89 Hammersmith 90 Kensington 91 St. Marylebone 93 Fulham 94 Bethnal Green 96 Paddington 98 Southwark 105 Stepney 105 Poplar 107 Bermondsey 111 Finsbury 114 Shoreditch 123 County of London 91 32 The preventive measures that are more concerned with personal hygiene than the hygiene of environment have been continued during the past year. The most important work of this kind is a comprehensive system of health visiting, working on the information furnished by the Notification of Births Acts, 1907, by which Act all births are required to be notified to the Medical Officer of Health within 36 hours of their occurence. The obligation to notify imposed by the Act is in addition to, and not in substitution for, the obligation to register a birth which is imposed by the Registration Act. The Notification of Births Act came into operation in Hampstead in March, 1908, and the year 1912 is the fourth for which we possess a complete annual record of the working of the Act. The number of births notified in 1912 was 1199, including 28 still-births, the number of livebirths notified being 1171. The total number of live-births occurring in Hampstead in 1912 was 1230, so that the number of live-births notified formed 95.2 per cent. of the number that actually occurred. 274 births were notified by medical practitioners, 157 by midwives, 701 by parents and 63 from other sources. The proportion of births notified in Hampstead is high—considerably higher than in most other districts. Of the births notified to the Medical Officer of Health a certain number were selected, upwards of 800 (about 70 per cent.) to visit. The first visit is paid by the Inspector, who, while chatting to and advising the mother, is able to judge of the general homo conditions of the family. Informal inspection of the house generally follows, and obvious sanitary defects are reported to the Medical Officer of Health. The mother is invited to bring her baby to one or other of the weighing rooms where the Inspector attends weekly, assisted by one or more voluntary visitors. The Inspector attends Infant Committees (East and West) of the Health Society, and gives the names and particulars of these infants which she considers need befriending and visiting by the voluntary visitors. At these Committee meetings the voluntary visitors report any conditions inimical to the welfare of those cases which they visit. 33 Milk or oatmeal may be allowed to child or mother on the advice of the visitor or Inspector, and relying on these reports the Inspector revisits indefinitely any eases requiring official watchfulness or trained experience. In this connection approximately 250 revisits were made. At the end of the first year of the infant's life those agencies cease their activities. One of the chief objects of the health visitors is to encourage breast-feeding, but in the poorer parts of Hampstead instances have been found whore the mother, although anxious to continue nursing her baby, is unable to do so, owing to the fact that through poverty she herself is insufficiently nourished. To moot cases of this kind the West Hampstead Infants' Committee of the Hampstead Health Society have formed a fund to supply nursing mothers with milk and other food. This assistance, which is only given on certain conditions, one being that the baby must be brought regularly to he weighed, has been found of great value in our work in Hampstead for the prevention of infantile mortality. The effect on the baby, as ascertained by periodical weighing, of the improved nutrition of the mother, has in many cases been marked. Maternal nutrition is an important factor in infant welfare, and it is through improving the nutrition and general health of the mothers in the poorer districts that we may most confidently hope to effect further reductions in the amount of ill-health and mortality among infants. Infant weighing lakes place at (1) The Creche, 36, Hemstal Road, on Tuesday, 2.30 to 4.30., and (2) St. Stephen's Room, Pond Street, on Thursdays, 2.30 to 4 o'clock. Infectious Diseases. 37 NOTIFIABLE INFECTIOUS DISEASES. Information concerning Consumption will be found in the Tuberculosis Section (see pages 55-56). The list of infectious diseases notifiable in London under Section 55 of the Public Health (London) Act, 1891, during 1912 was as follows:— Small-pox Typhus Fever Cholera Relapsing Fever Diphtheria Continued Fever Membranous Croup Puerperal Fever Erysipelas Anthrax occuring in Man Scarlet Fever Hydrophobia Epidemic Cerebro-spinal Glanders Meningitis Ophthalmia Neonatorum Plague Polio-Myelitis Tvphoid Fever The total cases of infectious disease notified numbered 320. This is equivalent to an attack rate of 3.7 per 1000 of the population. The following shows the number of cases of each disease notified:— Scarlet Fever 101 Enteric Fever 9 Diphtheria and Membranous Croup 155 Puerperal Fever 3 Erysipelas 44 Ophthalmia Neonatorum 6 Polio-Myelitis 1 Epidemic Cerebro-Spinal Meningitis 1 38 The number of fatal cases was 25, equal to 7.8 per cent. of the cases notified. The deaths were distributed as follows:— DISEASE. WARDS Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). Enteric Fever 1 . . .. .. .. • • .. 1 Diphtheria and Membranous Croup .. 1 l 1 7 6 l 17 Erysipelas 1 .. .. .. .. .. .. 1 Puerperal Fever .. 2 .. .. 2 .. .. 4 Epidemic Cerebro-Spinal Meningitis .. 1 .. .. .. .. .. 1 Polio-Myelitis .. .. .. .. 1 .. .. 1 Totals 2 4 l 1 10 6 l 25 The death-rate from the notifiable infectious diseases was 0.29 per 1000 of the population. 39 Cases of Infectious Disease occurring in each Month during 1912. Disease. MONTHS. Totals. January. February. March. April. May. June. July. August. September. October. November. December. Scarlet Fever 10 13 6 4 4 4 6 4 4 22 14 10 101 Enteric Fever 1 2 1 .. 1 .. .. 1 .. 1 1 1 9 Diphtheria and Membranous Croup 27 18 14 11 9 17 11 5 7 13 10 13 155 Puerperal Fever .. 1 .. .. .. .. .. .. .. 1 1 .. 3 Erysipelas 2 6 3 5 4 2 3 6 1 3 5 4 44 Polio-Myelitis .. .. .. .. .. .. .. .. 1 .. .. .. 1 Ophthalmia Neonatorum 1 1 .. .. .. .. .. .. .. .. 3 1 6 Epidemic Cerebro-Spinal Meningitis .. .. .. 1 .. .. .. .. .. .. .. .. 1 Totals 41 41 24 21 18 23 20 16 13 40 34 29 320 40 Cases of Infectious Disease occurring in each Ward during 1912. Disease. WARDS. Totals. No. 1 (Town) No. 2 (Belsize) No. 3 (Adelaide) No. 4 (Central) No. 5 (West End) No. 6 (Kilburn) No. 7 (Priory) Scarlet Fever 10 16 14 9 18 23 11 101 Enteric Fever 2 2 .. .. 3 1 1 9 Diphtheria and Membranous Croup 22 35 6 15 37 34 6 155 Puerperal Fever .. 2 .. .. 1 .. .. 3 Erysipelas 12 6 4 4 6 7 5 44 Polio-Myelitis .. .. .. 1 .. .. .. 1 Ophthalmia Neonatorum 1 .. .. .. .. 5 .. 6 Epidemic Cerebro-Spinal Meningitis .. 1 .. .. .. .. .. 1 Totals 47 62 24 29 65 70 23 320 41 Small-pox. No case of small-pox occurred in Hampstead during the year. Vaccination. The table below gives some idea of the working of the Vaccination Act in Hampstead since 1900. I am indebted to the Vaccination Officer for the statistics in this table. Vaccination Statistics. Year. Birihs. Successfully Vaccinated. Insusceptible of Vaccination. Had Small-pox. Number in respect of whom Certificates of "Conscientious Objection" have been received. Died Unvaccinated. Vaccination Postponed. Remaining. Percentage of Births Registered. Successfully Vaccinated. Exempted by "Conscientious Objection" Certificates. Not finally accounted for (including cases postponed). Unvaccinated. 1 2 3 4 5 6 7 8 9 10 11 12 13 1901 1508 1232 15 .. 39 111 7 104 (Col. 3) 81.7 (Col. 6) 2.6 (Cols. 8 & 9) 7.4 (Cols. 6,8,& 9) 10.0 1902 1517 1255 18 .. 27 104 11 102 82.7 1.8 7.4 9.2 1903 1452 1190 19 .. 30 106 11 96 82.0 2.1 7.4 9.5 1904 1446 1197 16 .. 35 100 8 90 82.8 2.4 6.8 9.2 1905 1421 1181 18 .. 40 91 14 77 83.1 2.8 6.4 9.2 1906 1438 1183 12 .. 35 93 18 97 82.3 2.4 8.0 10.4 1907 1341 1090 7 .. 60 80 5 99 81.3 4.5 7.8 12.3 1908 1321 1028 16 .. 127 78 6 66 77.8 9.6 5.7 15.1 1909 1295 996 19 .. 151 61 5 63 76.9 11.7 5.3 17.0 1910 1269 911 14 .. 217 58 3 66 71.8 17.1 5.4 22.5 1911 1199 830 9 .. 229 58 6 67 69.2 19.1 6.1 25.2 1912 1232 760 10 .. 248 43 30 141* — — — — Note.—The number of births given as occurring in each year differs slightly from those stated elsewhere in this Report, but for all practical purposes the difference is negligible. *In this figure are included 68 births in respect of which no legal action as to vaccination has yet been taken; the rates for Columns 10-13 have therefore not been calculated. 42 It will thus be seen from this table that- a smaller percentage of children are vaccinated each year, and the rate for 1912 is probably about 60 per cent. of the births registered. The number of unvaccinated persons must be therefore rapidly increasing, and during the past five years have added a no inconsiderable number to the population. The existence of a large unvaccinated population is a factor of which public health administrators must never lose sight. Scarlet Fever. The number of cases of scarlet fever notified in each of the last 12 years is set out below. Year. No, of Cases Notified. 1901 214 1902 251 1903 165 1904 159 1905 170 1906 385 1907 314 1908 265 1909 241 1910 135 1911 125 1912 101 It will be noticed from the above table that there was a considerable decrease in the number of cases notified as against the previous year. The number of cases per 1000 of the population was 1.17. The corresponding figure in 1911 was 1.46. Of the cases notified, 77, or 76 per cent., were removed to hospital. The corresponding percentage in 1911 was 74. The total number of houses attacked was 85. Five houses had 2 cases each, three houses had 3 cases, and one of these houses had had 6 cases at the close of the preceding year, making a total of 9 cases occurring in 1 house. In all these instances the subsequent cases took the infection directly or indirectly from the primary case. Throughout the year the type of scarlet fever in Hampstead was again very mild, as is shown by the fact that no death occurred out of a total of 101 cases. 43 Careful inquiries were made in each case, with a view to ascertaining the source of infection. Five of the cases occurred among the staff of the North-Western Fever Hospital. The following table shows the number of cases occuring in the various wards. Month. WARDS. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No 5 (West End). No 6 (Kilburn). No. 7 (Priory). Totals. January — 5 1 1 2 1 — 10 February 3 2 2 — 6 — — 13 March — — 1 1 — 2 2 6 April — 1 — 2 — 1 — 4 May — — — — 1 1 2 4 June — 1 — 1 — — 2 4 July — — — — — 4 2 6 August 2 — 1 — — 1 — 4 September 1 — 1 — — 2 — 4 October 3 5 3 3 4 4 — 22 November — 1 3 — 4 4 2 14 December 1 1 2 1 1 3 1 10 Totals 10 16 14 9 18 23 11 101 Diphtheria and Membranous Croup. The number of cases notified in 1912 was 155, as compared with 141 in 1911, the attack rate, or number of cases notified per 1000 population, being 1.80. The number of fatal cases was 17, or 11.0 per cent. of the cases notified. The death-rate per 1000 population was 0.20; 123 patients, or 79 per cent. of the total cases notified, were removed to hospital. 44 The following table shows the number of cases occurring in the various Wards:— Months. WARDS. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). Totals. January 8 9 3 — 2 4 1 27 February 4 — — 2 7 5 — 18 March 2 3 — 3 5 1 — 14 April — — 1 — 6 3 — 11 May — 2 — 1 3 1 2 9 June 1 1 1 2 6 5 1 17 July 1 3 — 2 — 5 — 11 August — 1 1 — 1 2 — 5 September — 4 — — — 3 — 7 October — 8 — 1 2 2 — 13 November 4 1 — 2 1 2 — 10 December 1 3 — 2 4 1 2 13 Totals 22 35 6 15 37 34 6 155 Diphtheria was unusually prevalent during 1912, as it was in the preceding year. In the year under review, however, the number of cases notified was higher than any annual number since the year 1896. The chief prevalence occurred in the Kilburn, Belsize, and West End Wards. The disease showed an exceptionally high degree of infectivity, secondary cases being common, there being no less than 17 of such, while in seven houses no less than three cases occurred, this accounts in some measure for the increase in the number of notified cases. In a considerable number of the cases it was possible to trace the source of infection to contact with a previous case. 45 The beginning of the year, namely, January and February, were the months that the greatest number of Notifications were received. In January 27 were received, and in February 18. Of the 27 in January, 9 occurred in the Fleet Road district, but of these, three were the inmates of a family of one house. Eight occurred in the Town Ward district, but were not confined to any area. Three of the cases were also the inmates of a family in one house. It appears that the cases notified in January from the Fleet Road district must have had a sudden termination, as in the month of February not a single case was notified from the Ward. In October another slight outbreak occurred in this district, and 8 cases were notified, all of which were scholars or in the family of scholars of the Fleet Road Schools. My pointing out the prevalence of Diphtheria to the London County Council caused that body to have all the throats of children in the infected class rooms swabbed and bacteriologically examined; several cases were thus brought to light. All class rooms in which the cases occurred were thoroughly disinfected by this Department, and the disease promptly subsided. In November I gave instructions for a sanitary inspection to be made at the Schools, and the drains were tested and found defective, the disease, however, abated in November, there being only one case notified from the district during that month, and this was a contact case. Ward 5 (West End) was the Ward in which the disease was most prevalent during the year, there being 37 cases notified against 35 in Ward 2 (Belsize Ward), and 34 in Ward 6 (Kilburn Ward). The disease was, however, well distributed over Ward 5, and there was nothing in the nature of a serious outbreak occurring, as the largest number of cases notified in any month was 7 in February. In accordance with the Diphtheria Anti-toxin (London) Order, 1910, the Borough Council supply Anti-toxin free to medical practitioners for use for the poorer inhabitants of the Borough. Ten applications for Anti-toxin were received during the year, and 38,000 units were supplied. The total number of specimens examined during the year was 247, of which 68 gave a positive, and 179 a negative result. 46 Enteric Fever. The number of cases notified was 9, as compared with 13 in 1911, and 16 in 1910. The attack rate per 1000 population was 0.10. The number of fatal cases was 1, or 11.1 per cent. of the cases notified. The death rate per 1000 population was 0.01; 5 patients, or 55 per cent. of the total cases notified, were removed to hospital. Seven specimens of blood from patients suspected to be suffering from enteric fever were submitted by the doctors in attendance for bacteriological examination, three specimens proving positive and four negative. The following table shows the number of eases occuring in the various wards:— Month. WARDS. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). January — — — — l — — 1 February 1 — — — — l — 2 March — — — — 1 — — 1 April — — — — — — — — May — — — — — — l 1 June — — — — — — — — July — — — — — — — — August — 1 — — — — — 1 September — — — — — — — — October — l — — — — — 1 November 1 — — — — — — 1 December — — — — l — — 1 Totals 2 2 — — 3 l l 9 47 As regards the source of infection, in three instances it was found that the patient had clearly been infected abroad, and in another case the infection occurred out of the Borough. In one case the patient was a member of the staff of the North-Western Fever Hospital, and was presumably infected in hospital. Shell fish was presumably the cause of infection in two cases, both patients having partaken of oysters just previous to illness. In the remaining two instances the source of infection could not be traced. Puerperal Fever. Three cases were notified, all of which proved fatal, as compared with 6 cases and 3 deaths in 1911. The cases occurred in the following Wards, two in No. 2 (Belsize) Ward, and one in No. 5 (West End) Ward. The hospitals of the Metropolitan Asylums Board are now available for the reception of a limited number of Puerperal Fever cases, which, however, must be recommended for admission by the Medical Officer of Health. This arrangement was sanctioned by the Local Government Board on 20th August, 1912. In none of the three cases was it found necessary to take advantage of these facilities. Two patients were removed to institutions and one was nursed at home. Erysipelas. Forty-four cases were notified, and 1 death occurred, as compared with 49 cases and 2 deaths in 1911. The attack-rate per 1000 of the population was 0.51. Of the cases notified, 13, or 29 per cent., were removed to the Hampstead Workhouse Infirmary. The Metropolitan Asylums Board do not provide hospital accommodation for cases of erysipelas, and patients suffering from this disease are unable to obtain hospital treatment except in Poor Law Infirmaries. Polio-Myelitis. This disease, which is popularly known as "Infantile Paralysis," was, by an order of the London County Council, made permanently notifiable in the County of London from March 13th, 1912. There is 48 considerable evidence to show that the disease is communicable, but it is by no means clear how the infection is communicated. One case was notified during the year in the person of a boy aged 7 years, which did not prove fatal. The death recorded from this disease was that of a child aged 3 years who had been notified at the end of 1911. Disinfection was carried out in each case. Epidemic Cerebro-Spinal Meningitis. This disease, popularly known as "Spotted Fever," is now one of the notifiable diseases. One case occurred in the person of a child under one year of age, who died from the disease. No case occurred in 1911. Ophthalmia Neonatorum. (Inflammation of the Eyes of the newly-born.) The London County Council made an Order, which came into operation on March 13th, 1911, requiring the notification of Ophthalmia Neonatorum. This disease is one of the frequent causes of blindness, and therefore inflicts considerable loss on the community. Six cases were notified in Hampstead during the year, one of which occurred in the Town Ward and five in the Kilburn Ward. In order to prevent the disease resulting in loss of eyesight it is necessary that the patient should be properly nursed, and the chief object of notification is to facilitate the provision of skilled nursing. Of the six cases notified, four were already being nursed by a trained nurse. 49 SEVEN PRINCIPAL EPIDEMIC DISEASES. The total number of deaths from these diseases amounted to 36, and the deaths were distributed as follows:— DISEASE. WARDS. Totals. No. 1 (Town) No. 2 (Belsize) No. 3 (Adelaide) No. 4 (Central) No. 5 (West End) No. 6 (Kilburn) No. 7 (Priory) Small-pox — — — — — — — — Measles 2 3 — — 2 4 — 11 Scarlet Fever — — — — — — — — Diphtheria and Membranous Croup — 1 1 l 7 6 1 17 Whooping Cough 1 — — l 1 1 — 4 Fever 1 — — — — — — 1 Diarrhœa — 1 — — — 1 l 3 Totals 4 5 l 2 10 12 2 36 The death-rate from the seven principal epidemic diseases was therefore 0.42 per 1000 of the population. Year. 1902. 1903. 1904. 1905. 1906. 1907. 1908. 1909. 1910. 1911. 1912. Deathrate per 1000 of the population from the seven principal epidemic diseases. 0.70 0.51 0.58 0.45 0.58 0.49 0.45 0.58 0.54 0.59 0.42 Detailed information concerning small-pox, scarlet fever, diphtheria and fever will be found under the heading of Notifiable Infectious Diseases, on pages 42-48, but particulars concerning measles, whooping cough, and diarrhœa, to which notification does not apply, are given below:— 50 Measles. Eleven deaths were recorded from this disease, as compared with 14 in 1911. The mortality was 0.13 per 1000 population, the mortality in 1911 being 0.16. Measles is now included among the dangerous infectious diseases, to which Sections 60-65, 68-70, and 72-74 of the Public Health (London) Act, 1891, apply. These sections extend the provisionsrelating to isolation and disinfection to measles, but they do not make the disease compulsorily notifiable. But although measles is not a notifiable disease, many cases are reported by school teachers, parents and others. During the year 1912 429 cases were reported, as compared with 415 in 1911. The Local Government Board, in 1911, authorised the Metropolitan Asylums Board to receive cases of measles other than Poor Law cases, on the recommendation of the Medical Officer of Health. Previous to 1911, the only hospitals open to patients suffering from measles were the workhouse infirmaries, but in February, 1911, Poor Law patients were admitted to the Asylums Board hospitals, which later became available for other patients. Hospital treatment for measles on any practicable scale cannot be expected to exercise much effect in checking the spread of the disease, but it may do much to lessen the mortality by saving the lives of those patients for whose recovery skilled nursing, plenty of good food and healthy surrounding, are necessary, and who are unable to obtain these necessities in their own homes. The number of Hampstead patients removed to the Board's hospitals during the year was 55. Most of the cases of Measles are reported to the Medical Officer of Health, principally by School teachers, and the following is a list of the sources of information:— 51 Cases notified by medical practitioners 5 ,, parents or guardians 89 „ school teachers 298 „ employers and others 12 „ Metropolitan Asylums Board (on moval of a patient) 22 From Death Returns 3 429 The 429 cases occurred in 271 houses. - In 166 houses there was 1 case in the house. In 65 „ there were 2 cases „ In 30 „ „ 3 „ „ In 7 „ 4 „ In 3 ,, ,, 5 ,, ,, The following table shows the number of reported cases of Measles occurring each month in the various Wards:— Month. Ward 1 (Town.) Ward 2 (Belsize.) Ward 3 (Adelaide.) Ward 4 (Central.) Ward 5 (West End.) Ward 6 (Kilburn.) Ward 7 (Priory.) Total January - - - - - - - - February - - - - - l — 1 March — l — 2 7 12 - 22 April 2 1 — 2 — 3 — 8 May 6 4 — 1 — 7 — 18 June 21 41 6 1 1 9 1 80 July 2 4 2 — 1 6 3 18 August 6 — — — 3 13 1 23 September — 1 1 — 2 12 — 16 October — — — — 68 35 1 104 November 2 1 — — 14 72 — 89 December — — — 1 4 37 8 50 Totals 39 53 9 7 100 207 14 429 In 96 cases, or 22 per cent. of the reported cases, no doctor was in attendance. The total number of visits paid to Measles cases during 1912 by the two lady inspectors was 509. 52 Whooping Cough. Four deaths occurred from Whooping Cough as against 3 in 1911, 11 in 1910, and 18 in 1909. The mortality per 1000 population was 0.05. Like measles, whooping cough tends to become complicated by pneumonia, and the patients require to be carefully looked after, but unfortunately it is popularly regarded as a disease of slight importance. Hospital treatment for cases of whooping cough, recommended by the Medical Officer of Health, is now provided by the Metropolitan Asylums Board in addition to Poor Law cases under an Order of the Local Government Board, dated 9th August, 1912, and the number of llampstead patients removed to the Board's Hospitals during the year amounted to 10. Diarrhœa. The number of deaths from this cause was 3, as compared with 15 in 1911, the death-rate per 1000 of the population being 0"03. None of these deaths occurred among children under one year of age. Tuberculosis. 55 TUBERCULOSIS. Deaths. The number of deaths from tuberculosis in 1912 was 77. Of these, 64 deaths were due to pulmonary tuberculosis or consumption, 8 to tubercular meningitis, and 5 to other forms of tuberculosis. The following table shows the number of deaths and the deathrates from tuberculosis and from consumption respectively since 1899:— Year. Total deaths from Tuberculosis. Deathrate per 1000 population. Deaths from Consumption. Deathrate per 1000 population. Cases of Consumption notified. 1899 98 1.21 81 0.98 - 1900 92 1.13 69 0.85 — 1901 118 1.44 73 0.89 — 1902 97 1.18 73 0.89 51 1903 90 1.09 66 0.80 34 1904 102 1.23 73 0.88 39 1905 95 1.14 73 0.87 27 1906 79 0.94 57 0.68 35 1907 92 1.09 61 0.72 55 1908 84 0.99 74 0.87 30 1909 75 0.88 53 0.62 67 1910 80 0.94 58 0.68 77 1911 70 0.82 56 0.65 113 1912 77 0.88 64 0.73 183 The deaths from consumption during 1912 were distributed among the Wards as follows:— Ward. Area (Acres). Estimated Population middle of 1012. Consumption Deaths. Consumption Death-raie per 1000 of the Population. No. 1 (Town) 686 13870 5 0.36 ,, 2 (Belsize) 271 13830 7 0.51 ,, 3 (Adelaide) 325 10000 9 0.90 ,, 4 (Central) 312 9876 6 0.61 „ 5 (West End) 247 12890 12 0.93 ,, 6 (Kilburn) 195 15000 14 0.87 „ 7 (Priory) 229 10500 10 0.95 The Borough 2265 85966 64* 0.73 * 1 death from Consumption was non-distributable. 56 The following table shows the age distribution of the patients dying from consumption in Hampstead in the ten years 1903-1911:— Year. Age Period. 0—5 5—15 15—25 25—65 65— All Ages. 1903 - 1 14 46 5 66 1904 1 1 15 53 3 73 1905 1 — 12 57 3 73 1906 1 — 8 45 3 57 1907 1 2 10 45 3 61 1908 — 2 14 55 a 74 1909 1 1 12 37 2 53 1910 1 1 12 37 7 58 1911 1 1 5 44 5 56 1912 2 2 13 45 2 64 Totals. . 9 11 115 464 36 635 Notification. In 1902 a system of voluntary notification of consumption was adopted in Hampstead ; on January 1st, 1909, the Public Health (Tuberculosis) Regulations of the Local Government Board, which provided for the compulsary notification of cases of consumption occurring in Poor Law patients, came into operation ; on May 1st, 1911, compulsory notification was extended by the Public Health (Tuberculosis in Hospitals) Regulations, 1911, to all cases of consumption occurring in hospital patients ; and notification was extended, generally, by the Public Health (Tuberculosis) Regulation, 1911, which came into operation on January 1st, 1912. In view of the scope of these latter Regulations the Voluntary System which had been in operation since 1902, lapsed. The increase in the number of patients notified in recent years is due to the operation of the instalments of compulsory notification referred to. The following table gives the number of patients newly notified in each year since 1902:— 57 Year. No. of patients notified. 1902 51 1903 34 1904 39 1905 27 1906 35 1907 55 1908 30 1909 67 1910 77 1911 113 1912 183 The total number of persons notified during 1912 who were, properly speaking, " Hampstead " patients was 222, but 30 of these had been previously notified, 2 in 1907, 2 in 1908, 8 in 1909, 4 in 1910, and 20 in 1911 ; the number of new " Hampstead " patients notified was 186, and of these 86 were males and 100 females. The total number of notification certificates (including duplicates) received during 1912 relating to Hampstead patients was 318, and of these 83 were made under the Regulations of 1908, 123 under the Hospital Regulations, and 112 under the Regulations of 1911 which extended notification generally. Reference must here be made to the latest Regulations, the Publ'c Health (Tuberculosis) Regulations, dated 19th December, 1912. These Regulations revoked the previous Regulations and all Orders made by the Local Government Board thereunder, and they apply to tionpulmonan/ as well as to pulmonary tuberculosis. Article V. requires that every medical practitioner (unless acting as a School Medical Inspector) attending on or called in to visit any person (whether at an Institution or otherwise\ shall, within forty-eight hours after first becoming aware that such person is suffering from Tuberculosis, notify the case to the Medical Officer of Health of the District; unless he has grounds for believing that the case has already been notified. In the case of patients at Institutions, the notification must be sent to the Medical Officer of Health for the District in which the place of residence of the person is situated. By Article IX. it is required that notifications must be enclosed in sealed envelopes addressed to the Medical Officer of Health. Article VIII. provides that, for the 58 purposes of the Regulations, a Medical Practitioner shall be deemed to have become aware that a person is suffering from Tuberculosis when he has arrived at this conclusion from evidence other than that derived solely from tuberculin tests applied to that person. School Medical Inspectors are called upon to send weekly notifications to Medical Officers of Health, as a'so are Medical Officers of Poor Law Institutions and Sanatoria. The Board in their circular letter of the 20th December, 1912, pointed out that more than half the deaths from non-pulmonary tuberculosis arc of children under five years of age, and stated that it is probable that a much higher percentage of the total number of persons suffering from non-pulmonary tuberculosis are children of this age, and they expressed the hope that notification of these cases would facilitate the investigation of sources of infection and assist in securing improvement in the conditions under which the children live. By Article XI. the Medical Officer of Health is required:— (1) to send to the appropriate District all notifications erroneously addressed to him and to inform the notifying practitioner that he has done so ; (2) to keep a register containing the full particulars set out in each notification received by him ; and (3) to send to the .Medical Officer of Health for the County after the end of each week a statement of all notifications received during the week ; and Article XII. deals with the action to be taken by the Medical Officer of Health upon the receipt of a notification. Either he himself or an Officer acting under his instructions is required to make such inquiries and take such steps as may be necessary or desirable for investigating the source of infection, for preventing the spread of infection, and for removing conditions favourable to infection. The Board contemplate that for the purpose of carrying out the requirements of this Article a visit to the home of the patient will generally be necessary, and that the Medical Officer of Health will doubtless avail himself of the co-operation of the notifying practitioner. W hen a case is notified it is suggested that inquiry should be made to ascertain the state of health of all other members of the household. 59 A rcoord is to be kept of the enquiries or investigations made in each case into the causes and antecedents of the disease, and of the conclusions reached by the Medical Officer of Health as to the factors which combined to produce it. The Local Government Board's circular further states :— "In the Board's circular letter of the 1 6th of November, 1911, attention was drawn to the difference between pulmonary tuberculosis and infectious diseases which are made notifiable under the Infectious Disease (Notification) Act, 1899, and the Public Health (London) Act, 1891. This difference is affirmed by Article XVI. and is the basis of the administrative policy of the Board in relation to tuberculosis. Administrative action will be less needed in cases of non-pulmonary than of pulmonary disease; but investigation into sources of infection will form an important part of the work to be done in regard to all forms of tuberculosis. Inquiries under these Regulatiens need not and must not be conducted in such a way as to cause annoyance t,o patients or their friends. In visiting a workshop for instance the Medical Officer of Health must carefully avoid any suggestion that the visit is made in connection with a notified case of tuberculosis." The new Regulations came into operation on 1st February, 1913, and the operation of these Regulations can only be dealt with in future Annual Reports. It will be noted that the nnmber of new cases of consumption occurring among " Hampstead" residents notified during the year 1912 differs from the number referred to elsewhere in the Report. This is accounted for by the fact that in accordance with the terms of the Poor Law Regulations, 1908, some cases were notified to me who may not have been " Hampstead" residents, but the certificates in respect of whom I was bound to accept. Such for instance were :— 1. Persons whose place of residence prior to admission to Poor Law Infirmaries was stated to be a Hospital in Hampstead. '2. Persons leaving Poor Law Infirmaries outside Hampstead' whose intended address at place of destination was stated to be a Hospital in Hampstead. 60 3. Casuals of "No home" admitted to the Hampstead "Workhouse Infirmary. [ also occasionally receive certificates under the Hospital Regulations, 1911, of persons not properly Hampstead residents, who were inmates of the Mount Vernon Hospital at Northwood, because the place of residence prior to attendance at or admission to the Hospital was given as Mount Vernon Hospital, Hampstead. The notifications were received from the following sources:— Private Practitioners 98 School Doctors 14 Hospitals and Dispensaries 123 Hampstead District Poor Law Medical Officers 32 Medical Officer, Hampstead Workhouse 34 Medical Officers of outlying Poor Law Institutions on admission of Hampstead patients 2 Master of Hampstead Workhonse on discharge of patients 10 Masters of outlying Poor Law Institutions on the discharge of patients to Hampstead addresses 5 318 Preventive and Curative Measures. (The Municipal Tuberculosis Dispensary.) A Tuberculosis Dispensary was recommended for Hampstead by Dr. McCleary, my predecessor, in his Annual Report for the year 1910, as an appropriate or useful memorial to His late Majesty King Edward the Seventh ; and in his Report for 1911 mention was made that "the best method of securing the early recognition of the disease is the establishment of the institution known as the Tuberculosis Dispensary.' On 18th May, 1911, on a report from the General Purposes Committee, to whom the question of celebrating the Coronation of His Majesty George V. had been referred, the Council resolved " That the Mayor be asked to open a public subscription list for the purpose of celebrating the Coronation of His Majesty King George V.. and of providing a memorial to His late Majesty King Edward VII. Accordingly, on the 13th July, 1911, the then Mayor, Mr. Alderman Woodward issued a Memorandum giving a few details of the proposed 61 Health Institute which was to be Hampstead's Memorial to King Edward VII., and which would aid the preventive work being carried on by the Public Health Department. On May 31st, 1912, Dr. McCleary submitted a report on the subject of the proposed Tuberculosis Medical Officer and the establishment of the Municipal Tuberculosis Dispensary. A Joint Meeting of the Tuberculosis Sub-Committee of the Public Health Committee and the Commemoration Committee having been held, and their recommendations having been approved by the Public Health Committee, the Council on the 11th July at their meeting sanctioned an annual expenditure of £750 for the maintenance of the Dispensary (including the salary of the Tuberculosis Medical Officer), and instructed the Public Health Committee to confer with the Commemoration Committee as to the housing and equipment of the Tuberculosis Dispensary in the projected Health Institute. At the Council meeting on 31st October, the Public Health Committee submitted a report in which they stated that they had had under consideration the question of the appointment of a Tuberculosis Officer and his duties and salary, &c., and had had a report from the Tuberculosis Sub-Committee on the matter ; and recommended (i) That an advertisement be issued for a Tuberculosis Officer at a commencing salary of £400 per annum. (ii) That, his duties with regard to the two classes of persons referred to below be as follows:— A. As to Insured Persons :— Cases to be in the hands of local Medical Practitioners who shall look to the Sanatorium Committee for their remuneration. The Tuberculosis Officer to confine himself as far as practicable to diagnostic and consultative work. B. As to Non-Insured Persons : — (i) When attended by local Medical Practitioners, at fees arranged between such Practitioners and their patients, the Tuberculosis Officer shall as far as possible confine himself to diagnostic and consultive work. 62 (ii In the case of a person non-insured and not medically attended, it shall be in the discretion of the Public Health Committee as to whether such a case shall be treated by the Tuberculosis Officer. These recommendations were approved at that meeting by the Council who received and adopted the following further report of the Public Health Committee : — (а) That they had received a report from the Commemoration Committee to the effect that the subscriptions and donations received, promised, and in prospect warranted the purchase in the immediate future of a building in which to house the various departments of work contemplated, namely : — The Tuberculosis Dispensary of the Borough Council. The Children's Clinic of the Council of Social Welfare. The Mothers' Club and Girls' Classes of the Health Society. and other tenants desiring rooms for Committee and other Meetings. (б) That the Commemoration Committee had decided that a freehold property must be acquired for the purpose, and placed in the hands of Trustees. (c) That Mr. Henry Clark, D.L., J.P., and Mr. Frank Debenham, J.P., had consented to act as Trustees.* (id) That suitable premises had been viewed and approved by members of the Committee most interested, and that the Committee had resolved to make an offer for the same, subject to the approval of the Local Government Board and their own legal and sanitary advisers. (e) That the Committee had been in communication with the Local Government Board and the County Insurance Committee, and had ascertained that a grant might be available from the Local Government Board, provided they approved of the scheme in so far as it referred to the provision of the Tuberculosis *Mr. Herbert Marnham afterwards appointed as third Trustee. 63 Dispensary, and that such application ought to be made through the Local Sanitary Authority : and therefore Recommending :— (/) That, in accordance with the financial recommendations of the Departmental Committee on Tuberculosis, 1912, this Council do apply to the Local Government Board for a Capital Grant towards the early provision of a portion of the Health Institute by the Commemoration Committee as a Tuberculosis Dispensary under the control of the Public Health Committee of the Council. (<j) That the recommendation of the Chief Medical Officer of the Local Government Board be adopted, viz. :—That in the event of the failure of the voluntary side of the undertaking, the freehold property revert to the Hampstead Borough Council. A scheme for the establishment and maintenance of the Dispensary was framed, and admirable temporary premises were secured in a block of buildings belonging to the Hampstead General Hospital at Haverstock Hill. These buildings are entirely separated from the Hospital, they were formerly erected as a small out-patient department, but were found unnecessary and had never been used, Ihey constitute an ideal arrangement for a Dispensary. The accommodation at our disposal consisted of (1) a small office for the nurse at the entrance door; (2) a large waiting room; (3) a large well-equipped consulting room for the Tuberculosis Medical Officer; (4) a small private room for his office, and (5) the necessary W.C.'s and lavatories. The composition of the Dispensary consists of the following:— The Medical Officer of Health of the Borough, who is the Chief Administrative Tuberculosis Officer, receives all notification and reports, statutory and otherwise, and who is responsible for all administrative and preventative measures requisite for the treatment and prevention of the disease. The Tuberculosis Medical Officer.—An Officer who has had special experience and training in the treatment of Tuberculosis, and who is responsible, clinically, for all cases of Tuberculosis referred to him. He is, subject to the administrative control of the Medical Officer of Health, 64 in charge of the Dispensary, and in addition, his duties comprise:— To attend at the Dispensary at specified hours, and examine and treat cases. To visit selected cases, unable to attend the Dispensary, in their own homes. To examine contacts sent to the Dispensary, where possible; or to examine them at home by arrangement. To make bacteriological examinations of sputum. To keep records and details of examinations and treatment. To prepare and forward to the Medical Officer of Health for the information of the Council reports, either fortnightly or at such other intervals as shall be decided. To perform any other duties which may be so decided by the Medical Officer of Health or the Council. The Nurse, whose duties comprise : — To attend daily at the Public Health Department and see the Medical Officer of Health and receive instructions in respect to notified cases. To attend daily at the Dispensary to render assistance to the Doctor. To visit such cases as are necessary, to fill in report sheets, to distribute the literature issued by the Council, and to give instructions to the patients or their relatives. To prepare and forward fortnightlv, or at such other intervals as shall be decided, reports 011 prescribed forms for the information of the Council. To note and report on any insanitary conditions in houses visited, and generally to supervise the home life of the patients suffering from tuberculosis. The Council appointed as Tuberculosis Medical Officer Dr. J. King Patrick, late Senior Medical Officer, Leicester Tuberculosis Dispensary. 65 The Dispensary was opened on 1st February, 1913, and the medical practitioners in the Borough were communicated with and their attention called to the Dispensary. The scheme, therefore, by which tuberculosis patients are dealt with in the Borough is as follows:— The Medical Officer of Health receives the notification in the ordinary way. A lady Sanitary Inspector, specially trained in the work, visits the home and reports fully on each case, and these reports are duly filed. On receiving these reports the Medical Officer of Health decides what cases are suitable for treatment, visiting, etc., by the Tuberculosis Medical Officer and the Dispensary Staff; and when a patient has been referred to, or has once applied to the Dispensary, the subsequent treatment and home visiting is left to the Staff of the Dispensary, otherwise a case is kept under the immediate control of the Medical Officer of Health. In both cases the necessary instructions in the precautions that a patient should observe is given. During 1912, while pulmonary tuberculosis only was notifiable and the work of visitation, etc., was in Inspector Mrs. Fisher's hands, 704 visits were made. Pending further developments in connection with the Tuberculosis Dispensary, arrangements have been made with local chemists to dispense all prescriptions of the Medical Officer of Health or the Tuberculosis Medical Officer at the same rates as have been agreed upon in connection with the Medical Insurance Act, and these arrangements seem to bid fair to work well. Disinfection is carried out during the lifetime of patients, and also after death. The total number of premises so disinfected during 1912 was 194. The Council arrange for the free bacteriological examination of specimens from suspected cases of consumption. In 1912 the total number of specimens examined was 67, of which 13 were positive and 54 negative. Now that the Tuberculosis Dispensary has been opened, this work will be undertaken by the Tuberculosis Medical Officer. 66 The Council provide consumptives with disinfectants and sputum flasks in suitable cases, and each consumptive patient receives a card containing printed instructions on the precautions to be observed by consumptives. The expenditure of the Borough Council in connection with the Dispensary will not fall entirely upon the local rates, grants being made by the Government in aid of its equipment and maintenance. The Borough Council has made application for a grant towards the initial expenses of equipment. Sanatorium Benefit under the National Insurance Act. Upon the formation of the Insurance Committee for the County of London, local sub-committees were elected for each Borough, temporarily, to administer, subject to direction on all matters of principle by the Committee, and pending the approval of a scheme for the appointment of district insurance committees for each Borough, the provision of sanatorium benefit to insured persons. The Chairman of the Public Health Committee, Mr. Councillor Higginson, was appointed by the Borough Council as its representative, and your Medical Officer of Health was appointed in a consultative capacity. Mr. Higginson wasappointed as the chairman of the local sub-committee for Hampstead. At the request of this sub-committee I prepared a scheme for dispensary and domicilary treatment of cases of pulmonary tuberculosis in Hampstead, this scheme includes a list of fees respecting domiciliary treatment which I arranged after consultation with the local medical practitioners, and fees to chemists which I also agreed upon with them. A considerable amount of time of the clerical staff, as well as of myself, was required to perform the work which we were asked to undertake by the Insurance County Committee and Sub-Committee, and the Public Health Committee, after considering the request of the local sub-committee, agreed to the Medical Officer of Health and his clerical staff assisting in the work, provided that the ordinary work of the Department was not mterferred with. It will be readily understood that the arranging for domicilary treatment, out-hospital treatment, etc., involved a considerable amount of time and labour. Disinfection. 69 DISINFECTION. Number of articles disinfected:— Beds 282 Mattresses 692 Palliasses 28 Bolsters 449 Pillows 1373 Blankets 1684 Sheets. . 902 Counterpanes 659 Articles of Clothing 4947 Carpets 89 Linen Articles 3473 Books 349 Miscellaneous 1573 Total 16500 Number of premises disinfected 911 „ rooms, etc., disinfected 1240 Tn addition to the foregoing, the following were destroyed upon request of the owners:— Beds 3 Mattresses 11 Bolsters 3 Pillows 17 Blankets 10 Sheets. . 5 Articles of Clothing 40 Carpets 1 Miscellaneous 11 Linen Articles 24 Total 125 During 1911, 858 premises, 1167 rooms, etc., and 12048 article: were disinfected, while 63 articles were destroyed. 70 The amount of disinfection carried out by the Council lias increased considerably in late years, and this is in no small measure due to the practice of the Council to disinfect upon request in cases of non-infectious illness, after all cases of measles coming to the notice of the Sanitary Authority, and the clothes, etc., of verminous school children and others undergoing cleansing at the cleansing station. A small charge is made for disinfection in the first of these instances referred to, and the number of cases where such disinfection was carried out was 1 62, the amount received in fees for this work being £45 10s. Od. With regard to measles, the London County Council in the early part of 1903 obtained the approval of the Local Government Hoard for the inclusion of measles amongst the dangerous and infectious diseases in so far as 60-65, 68-70, and 72-74, Public Health (London) Act, 1891, apply. These sections while they do not make the disease compulsorily notifiable, extend to it the provisions relating to isolation and disinfection. During the year I have received information respecting 429 cases of Measles, and in all of these cases disinfection was carried out. During the year 157 school children and 20 other persons were cleansed at the cleansing station, and while this was in progress their clothing was thoroughly disinfected by being passed through the steam chambers. In seven cases also where verminous homes were being dealt with, the bedding, etc., was removed and disinfected. General Sanitary Administration. 73 Sanitary Works carried out The following is a tabulated statement of the sanitary work, etc., carried out during the year, so far as that work admits of tabulation: — General Conditions— Houses, or parts of houses, cleansed 211 Dampness in houses, or parts of houses, abated 97 Dilapidated houses, or parts of houses, repaired 52 Overcrowding— Cases of, abated (rooms) after service of notice 2 „ ,, ,, without serving of notice 2 Underground rooms — Entirely ceased to be occupied as dwellings 12 Illegal occupation discontinued 27 Structural works carried out 91 Below floors— Spaces below floors in the basement or ground floors ventilated 105 Roofs— Repaired 127 Gutterings— Repaired or renewed. . 105 Rainwater pipes— Repaired or renewed 120 Disconnected from drains 22 „ soil pipes 6 Waste pipes — Waste pipes of sinks disconnected from drains 5 „ trapped 421 ,, ,, ,, repaired or renewed 366 „ „ „ unstopped 7 ,, ,, of lavatories disconnected from drains 4 „ trapped 152 ,, „ „ repaired or renewed 214 ,, „ of baths disconnected from drains 6 „ trapped 131 „ ,, „ repaired or renewed 205 Water supply— Reinstated 18 Water and sinks provided to upper floors of tenement houses 152 74 Water cisterns— Repaired or renewed 9 Removed from improper positions 10 Cleansed 79 Fitted with close-fitting covers 35 Water-closets— Accommodation provided 50 Additional accommodation provided 26 Separate and sufficient accommodation provided for persons of each sex 3 Removed from improper positions 11 Provided with proper and sufficient external ventilation 11 Improperly constructed apparatus removed and new provided 7 Apparatus repaired or renewed 722 „ unstopped 10 ,, cleansed 28 ,, provided with proper water supply 9 Flushing cisterns repaired or renewed 203 Manholes—- Repaired or renewed 418 Drains — Repaired or renewed 774 Cleansed 63 Unstopped 42 Ventilated 79 Ventilating pipe of drains — Carried to a sufficient height above windows 21 Repaired or renewed 98 Fresh-air inlets repaired or renewed 129 Soil pipes— Repaired or renewed 376 Ventilated 10 Gullies and surface drains— Gully traps removed from improper positions 10 ,, „ cleansed 11 Inlets or surface drains trapped 3 Paving and draining Washhouses, Areas, Yards, &c.— Washhouse or scullery paving repaired or renewed 29 Areas cleansed 1 75 Paving and draining Washhouses, Areas, Yards &c.—von. Area paving repaired or renewed 110 Areas drained 13 Yards or other open spaces paved 159 Paving of yards or other open spaces repaired or renewed 179 Yards or other open spaces drained 35 Floors of buildings in which horses, &c., are kept, paved or repaired 8 Refuse and Receptacles — Dustbins provided 300 ,, cleansed 1 Fixed ashpits removed 52 Accumulation or deposits of refuse removed 129 Manure receptacles provided 1 ,, „ amended 3 Animals— Nuisances from the improper keeping of animals abated 2 Number of Inspections, &c., Made; Notices Served; and Letters, &c.. Issued. 1911. 1912. Number of Inspections 9572 9986 „ Re-inspections 14598 13920 ,, Intimation Notices issued 993 1105 ,, Statutory Notices Issued 812 874 „ Letters issued 6310 6521 ,, Notifications sent to " Head Teachers " of Schools respecting notified cases of infectious disease 426 353 ,, Notifications sent to Medical Officers of Health of other Boroughs respecting Hampstead children attending schools in their districts 74 58 „ Notifications sent to " Head Teachers " of Schools respecting cases of measles 173 273 76 Certificates as to Water Supply. The number of certificates issued during the year was 45, as compared with 22 in 1911. Drainage Work. The by-laws of the London County Council that require that plans and written particulars of drainage construction and alteration shall be deposited with the Sanitary Authority came into operation in August, 1903, and from that date till the end of 1912 the Council have approved of 500 plans for the drainage of new buildings, and 6099 plans for alterations, &c., to drains of existing premises. During the year 1912, 862 notices of drainage reconstruction or alteration were received, and in 774 cases the work necessitated the deposit of plans and written particulars. In 418 of these latter cases the work could not be delayed until the Council's approval of the plans had been received; in each of these cases the prescribed "urgency" notice was therefore submitted by the builders, the work put in hand forthwith and the plans, etc., deposited at a later date. Of 774 notices of drainage alterations, etc., requiring the deposit of plans, 397 related to work that involved the entire reconstruction of the drainage system. In 426 cases the work was carried out voluntarily, the number of instances in which voluntary complete reconstruction was carried out being 129. This class of work was chiefly in connection with the larger houses in the Borough, and in many cases the voluntary drainage reconstructions were of a very extensive character. In the 272 cases the drains were laid in the iron pipes, iron being found the most durable material. It is the practice of the Council to insist on the use of iron pipes in the case of all drains that run under a building. This requirement is enforced, if necessary, by an order made under the Metropolis Management Acts. There were two Appeals lodged with the County Council during the year against Orders made by the Borough Council in regard to drainage matters, in both of which the Appeal was dismissed as regards one item of the Order and allowed in respect to the other. On 71 occasions the power given to local authorities by Section 82 of the Metropolis Monagement Act, 1855, to examine drains has been 77 exercised. It is sometimes contended that in exercising this authority resort is being had to an old Act which is obsolete and arbitrary, but in relation to this I would point out that it is often the only fair way of treating a drain. Many cases arise where it is necessary to ascertain whether a drain is defective or not, in which no inspection chamber exists, therefore the water test cannot be applied and the smoke test may be utterly unreliable to demonstrate many of the serious defects which exist. In addition to this the examination under this Section is an essential preliminary to subsequent action under this Act, and does not necessarily involve opening the ground. In relation to the water test I would point out that there are cases where the application of such a severe test is undesirable and unfair to the drain, and where the actual condition of the drain can only be safely ascertained by a direct inspection of the pipes. Drain and Sewer. If the whole of the records of Law and Equity were searched, it is doubtful if any more flagrant instance could be discovered, where the one conflicts with the other to a greater extent, than is the case of the liabilities involved in the question of "drain and sewer." The defective statutory definitions of words which have occupied a place in the English language, as far back as, if not prior to, the Great Fire of London, has resulted in a financial burden being placed upon the shoulders of the unfortunate ratepayer, which ought to have been borne by owners of private property. In London alone it is safe to say that a sum amounting to more than £500,000 has been involved; and, taking the country as a whole, if the figures were available, they would be found to be approximately four times that amount. The words "drain" and "sewer" were terms that had distinctive meanings, which were well understood, and if the Legislature in framing Drainage and Sanitary Acts had refrained from incorporating definition clauses no difficulty would have arisen. The intention of Parliament seems to have been perfectly clear, and was, that the sewers which run under the middle of the road should be vested in and maintained by the local authority out of the rates, and that the drains from private property which discharge into them should be kept in order by the owners of the property to whom they belong. 78 This equitable arrangement was accepted by all parties as the basis of their respective liabilities, and so satisfied was everybody with it, that we find practically identical definitions incorporated in successive statutes extending over a long period of years. All appears to have gone well until 1890, when it seems to have occurred to certain owners of property, or their legal advisers, that these statutory definitions were capable of being interpreted in such a way as to make it possible for them to cast upon the local authority the burden of maintaining those drains which took the drainage of more than one premises, with the few exceptions which the statute reserves, unless the local authority could show that the combination was made with the sanction and approval of themselves or their predecessors. The result has been that in cases where a builder did what he was by law required to do, viz.,—to give notice, obtain proper sanction before he started the work, and then to carry the work out in accordance with the approved plan; the owner remains responsible for the maintenance of the pipes as a combined drain; but if, as more frequently happened, the builder gave no notice at all and coupled up the drainage of more than one house surreptitously, or added to a combined scheme without further sanction, his assignees are rewarded for his misdeeds by their ability to require the ratepayers at large to bear the cost of putting right and keeping such drains in order. In 1895, in one of the first cases decided upon the point, the late Mr. Justice Wright said that "the claim is one of grievous injustice to the local authority." There appeared to be no escape for the local authority, and in the case of St. Leonard Shoreditch v. Phelan (1890), one of the Judges in his judgment gave expression to the dictum "once a sewer always a sewer," which seemed to make it absolutely impossible for any local authority to do other than accept the liability. But this course has not commended itself to the Hampstead Council, and the policy of resisting such claims, where any grounds could be found for so doing, has been followed with the most satisfactory financial results; and, moreover, it has been found that until Parliament finds the time and opportunity to lift this burden from the rates by legislation, there are remedies which can be, and ought to be, followed. In the year under review, it is a matter for congratulation that every claim that has been made in Hampstead has been successfully resisted, although I must point out that this has only been done by the expenditure of a very considerable amount of additional and difficult work on the part of the staffs of the Legal and Public Health Departments. 79 Of the total claims made six were pressed (which in the aggregate would have involved an expenditure between £400 and £500),— all were resisted, but two claimants persisted with their claims, and legal proceedings had to be taken. In the first of these the magistrate decided in the Council's favour, but in the other case the decision went against the Council in the Police Court, but it is satisfactory to record that the Divisional Court has since held the Council's contention was right, and the appeal which was lodged against that decision has been allowed. This case is one of very grave importance, not only to Hampstead but to all Metropolitan Borough Councils, because it establishes the fact that where the wrongdoer can be found he can be made liable for his wrongful act, irrespective of the lapse of time, and it also to a larger extent gets over the principles of law which have hitherto been accepted doctrines, viz.:— 1. That a purchaser of property for value stands in an unassailable position in claiming against a local authority. 2. That, while a drain could be converted into a "sewer" by a wrongful act, a local authority could not by any means divest itself of a "sewer" and restore it to the category of a "drain." The following details taken from the case stated by the magistrate will explain the circumstances, and at the same time probably be of interest:— "The premises known as No. 178, High Road, Kilburn, are drained by a line of pipes, which takes also the drainage of certain adjoining premises as hereinafter stated, and passes under No. 178, High Road and thence to the public sewer in High Road, with which it is connected. The line of pipes referred to as a combined drain is that part of the said line of pipes which passes under No. 178, High Road. On the 13th August, 1884, an application in writing, accompanied by a plan, was made to the Vestry of the Parish of St. John, Hampstead (which was at that time the proper authority under Section 76 of the Metropolis Management Act, 1855), for permission to drain twelve houses and shops situate in High Road, Kilburn, by a combined operation. The said houses are now numbered 178 to 200 (even numbers only). The said application, which is signed by Mr. A. Hackworth (the builder and then owner of No. 178, High Road, Kilburn, and eleven other houses and shops), was approved by the Vestry of the Parish of St. John, Hampstead, at a meeting held on the 25th September, 1884, and on that date an order was made by the said Vestry for the drainage 80 of the said twelve houses and shops by a combined operation in the manner and according to the falls shown upon the approved plan. A copy of the said plan, marked 'A,' in which the scheme of the proposed drainage is shown by red lines is annexed in this case. The following is a copy of the application:— Date of meeting, Metropolis Management Acts. Parish of St. John, Hampstead, Date, August 13th, 1884. To the Vestry of the Parish of St. John, Hampstead. Alfred Hackworth, 41, Loundoun Road, St. John's Wood, N.W., do hereby make application for leave to lay, in accordance with the regulations set forth on the next page, glazed stoneware pipe main and collateral drains, as shown on the plan drawn hereon, from twelve houses and shops situate on the east side of High Road, Kilburn, and being the 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 and 12th premises south from Eresby Road, seven into the brick sewer in Eresby Road and five into sewer in High Road, belonging to Vestry and Metropolitan Board of Works respectively. Signature of Applicant, (Sd.) A. Hackworth. The said house, No. 178, High Road, Kilburn, was, on or about the 14th day of February, 1887, purchased by one Alfred John Smith from the said A. Hackworth for valuable consideration, without notice that the drainage system was in contravention of the approved plan, and subsequently was assigned by the said Alfred John Smith to the Respondents for value, without notice that the drainage system was in contravention of the approved plan. In the month of February, 1912, the Senior Sanitary Inspector, in pursuance of his powers under Section 82 of the Metropolitan Management Act, 1855, inspected the said line of pipes passing under No. 178, High Road, and stated that he found it to be in bad order and condition. On the 7th March, 1912, the Senior Sanitary Inspector, in pursuance of his said powers under Section 82 of the Metropolis Management Act, 1855, inspected the drains of each of the premises Nos. 180 to 200, High Road (even numbers only). Such inspection showed that the said drains had not been made in accordance with the directions and regulations of the Vestry nor in accordance with the plan 'A' approved on the 25th September, 1884, but, on the contrary, this examination revealed serious deviations from the said plan 'A,' inasmuch as (i) in the copy of the plan marked 'A,' as approved by the late Vestry on the 25th day of September, 1884, the twelve houses, Nos. 178 to 200, High Road (even numbers only), were divided for drainage purposes into two groups. The first group consisted of five houses (Nos. 178, 180, 182, 184 and 186) to be drained into the public sewer in High Road, Kilburn, 81 then belonging to the Metropolitan Board of Works, and the second group consisting of seven houses (Nos. 188, 190, 192, 194, 196, 198 and 200) to be drained into the public sewer in Eresby Road, then belonging to the Vestry. Whereas, as carried out and as found existing the seven houses, Nos. 178, 180, 182, 184, 186, 188 and 190, were grouped together and were drained together by means of the line of pipes passing under No. 178 which is connected with the said public sewer in High Road; (ii) a drain from a workshop in the occupation of one Harris, at the rear of No. 178, High Road (and divided from the said premises, No. 178, High Road, by a passage leading from the High Road to Eresby Road, which passage is lighted by the Council, and provides a secondary means of access to the said houses from both the High Road and Eresby Road, such lighting having been originally undertaken by the Council in 1884 at the request of the said A. Hackworth), had been connected to the said drains as shown on plan 'B'; (iii) four gullies in the said passage had been connected to the said drains as shown on plan 'B'; and (iv) certain other minor deviations had been made. The scheme of drainage as it was in fact carried out is shown upon the plan attached to this case and marked ' B,' and is thereon coloured yellow. The drainage of No. 180, High Road, Kilburn, was not originally laid as shown on the approved plan, and in the month of February, 1909, the Council became aware of this fact when the drainage of the house was relaid by the owner of those premises, the work being done under the supervision of the Council, and the course of the drain of the said premises was then altered. On the 8th March, 1912, a notice under Section 83 of the Metropolis Management Act, 1855, was served upon Mr. A. Hackworth, the original owner and builder of Nos. 178 to 190, High Road, who signed the application dated 13th August, 1884, for permission to drain the said premises, requiring him within 14 days to cause the drains of the said premises to be altered in conformity with the directions of the Vestry, and so as to be in accordance with the approved plan. Such notice was not served upon or brought to the notice of either the said Harris, the occupier of the said workshop, nor the Respondents, the owners and occupiers of No. 178, High Road. Mr. A. Hackworth did not comply with the said notice, and the Council, in alleged pursuance of their powers under Section 83 of the Metropolis Management Act, 1855, themselves caused the work to be done without any notice to either the said Mr. Harris, the occupier of the workshop, or the Respondents, the owners and occupiers of No. 178, High Road, and the Council entered upon the said workshop and removed the W.C. and lavatory erected therein, and pulled up the pipes. The said work was completed on the 4th April, 1912, and the account of the expenses thereof was sent by the Council to Mr. Hackworth. The scheme of drainage as at present existing after the execution of the said works by 82 the Council as hereinbefore stated in April, 1912, shows that the drainage of Nos. 188 and 190, High Road, have been disconnected from the line of pipes passing under No. 178, High Road, and have been added to the line of pipes passing into Eresby Road, that the four gulleys have been removed and that the whole of the drainage system to the workshop has also been removed and that the drainage of the said premises Nos. 178 to 200, High Road, is now in accordance with the plan approved by the Vestry on 25th September, 1884. On the 10th April, 1912, a notice under Section 85 of the said Act was served on the Respondents requiring them within 14 days 'to take up the 'combined drain from the sewer to the manhole in the passage at the 'rear, remove all foul and polluted earth from under and around the 'same and reinstate it in iron pipes of internal diameter of not less ' than 5 ins.' The steps taken in alleged exercise of the powers given by Sections 82, 83 and 85 of the Metropolis Management Act, 1855, were all duly authorised by the Council, and the Notices prescribed by the said Sections were duly served upon the parties as hereinbefore stated. The Appellant contended before me that the order of the Vestry was an order for the drainage of the group or block of twelve houses and shops by a combined operation, and that inasmuch as the Council after the discovery by the Appellant as aforesaid that the drains had not been made according to the directions and regulations of the Vestry, took the steps prescribed by Section 83 of the Metropolis Management Act, 1855, to cause such drains to be altered in conformity with the said directions and regulations the said line of pipes constituted a drain repairable by the Respondents." House Drainage, The issue of the Report of the Departmental Committee appointed by the Local Government Board to enquire into the use of intercepting traps in house drains is by far the most important contribution upon the question of the arrangement and construction of drains which has been made for many years. The inquiry was instituted as the result of an application by the Willesden Council to the Local Government Board for sanction to adopt a series of By-laws with regard to drains, in which the requirement to provide an intercepting trap was omitted. The Board refused their sanction, but appointed a Committee consisting of three gentlemen representing the Architectural, Medical and Engineering professions, to investigate and report upon the subject, and the fact that the Report was not issued until three years after the appointment of the Committee 83 is ample evidence that the matter received careful and prolonged consideration before the conclusions in the Report were arrived at. The conclusions briefly are:— (1) That the systematic ventilation of sewers is of secondary importance. (2) That sewer gas is offensive in smell, but is not injurious upon bacteriological or epidemiological grounds. (3) That in some circumstances the intercepting trap might with advantage be omitted from the drain. (4) That where a permanently sound drain is required iron pipes should be used. With the last of these conclusions I am in entire accord, and it is gratifying to know that the policy which has been pursued in Hampstead for the last ten years of insisting upon all drains which pass under buildings being constructed of iron has been amply justified by the enquiries of the Committee. It is one of the powers and duties of the Council to decide of what material a drain shall be constructed, and the question must be seriously considered as to whether, now that the reliability of iron pipes has been so thoroughly established, they should not be insisted upon throughout. All drains have to stand the same tests, and it is therefore equally important that the drain once laid down should be uniformly capable of resisting those accidents and influences which cause drains to become defective. The chief difficulties with regard to the use of iron pipes, viz.—of obtaining at short notice any parts or appliances which might be required during the progress of the work, has been overcome by the large and varied stocks which all the Builders' Merchants now keep. I am also assured that when all things are taken into consideration the actual cost of iron over earthenware does not exceed fifteen per cent., an additional expenditure which is more than justified by the results obtained. The third conclusion is somewhat difficult to reconcile with the principles of hygiene which sanitarians have been advocating for the last half century. In regard to Hampstead and large towns and cities generally, the suggestion that the intercepting traps can be omitted from drains is 84 somewhat belated, as probably ninety per cent. of the houses have already an intercepting trap of some form or other in the house drain' and in regard to the future it is doubtful whether any authority would go further than to make the use of the trap optional, in which case I think that the majority of residents would prefer that their drains were aerially disconnected with the sewer. Until the rodent is extinct the intercepting trap will be able to claim one distinct advantage, viz.—that it keeps rats out of the house, for it seems to be established that unless driven by fear, a rat will not dive through water unless it can see day light on the other side. Without exception the appearance of rats in a dwelling house is regarded with horror, and, further, the part played by the rat in the transmission of disease is such as to justify every possible means of excluding it from the house. During 1912 all complaints of rats which have been received in Hampstead have been traced to untrapped sewer connections, and whenever such a complaint is received the line of enquiry adopted is always in that direction. The great objection to the intercepting trap is without doubt its liability to become choked, but the risk of trouble in that direction can be obviated by the adoption of some form of stopper for the raking arm, which cannot be shaken out by the vibration of passing traffic, by special attention being adopted to ascertain that no cement or obstruction of a like character is left behind in the trap by the builder who lays the drain, and a careful enquiry into the possible existence of a running syphon trap in the drain outlet under the road before an intercepting trap is fixed within the curtilage of the premises. Any double trapping of that kind without the ventilation of the intervening drain is bound to result in obstruction and difficulty in working. Another noteworthy conclusion of the Departmental Committee is that the fresh air inlet is of small importance in a drainage system, and that it might be omitted without disadvantage. The conclusions arrived at in regard to the ventilation of sewers, and the injurious effect of drain and sewer air, are especially interesting in view of the investigation carried out in Hampstead in 1905, the 85 report on which is quoted in the Departmental Committee's Report. In fact the report deals in parts with an identical subject, namely, the danger to health from sewer and drain air. Sanitation of Railway Stations. The alterations consequent upon the widening of the Metropolitan Railway have involved the demolition of the sanitary conveniences on the down platform at Finchley Road Station. These conveniences were constructed in 1903 and were at the time the subject of legal proceedings, which the Council instituted for the purpose of vindicating the right of the Local Sanitary Authority to require that the sanitary conveniences and appliances on railway premises should be constructed in accordance with the Public Health Act and the Drainage Bye-laws. The Railway Company contended that being set up by statutory authority, local and general Acts and By-laws did not apply to them. This case was the first one ever taken to test the question. The matter was argued at great length by eminent Counsel. The learned Magistrate decided in the Council's favor upon all points and the Railway Company, after giving notice of appeal, decided to accept the Magistrate's decision. The result of these proceedings has been a very great improvement in the standard of sanitation at the railway stations in the Borough. These are now regularly inspected. The Cleansing of School Children. During the year the Council has continued the cleansing of school children infested with vermin by arrangement with the County Council. The upper part of the building, now used by the Distress Committee, is used as a Cleansing Station, and was brought into use in the early part of 1912. During the year 157 school children were cleansed. These cleansings have usually been followed by a request from the County Medical Officer of Health to deal with the bedding and clothing, and, if necessary, the homes under the London County Council (General Powers) Act, 1904, Part IV. In most cases this involves having the rooms thoroughly fumigated, sprayed, stripped, and the architraves and woodwork of a similar 86 character taken down and cleansed, the bedding, clothing, carpets, mats and rugs removed for treatment in the disinfecting apparatus, and the bedstead and other articles of furniture which may be infested with vermin thoroughly cleansed, and, if necessary, treated with a blow lamp. Arrangements also have to be made for the whole of the family to attend at the Cleansing Station while this is in progress. This complete cleansing of the home and the occupants is the only means by which any substantial good can be achieved in the direction of effectually eradicating verminous conditions. Amongst many families of the poorer classes it is quite impossible for them to attain the required standard of cleanliness and freedom from vermin unless the local authority is prepared to give them the opportunity of starting in a cleanly state, and I have been assured by the School Authorities that the cases where it has been possible to deal with the homes and families in this way have been followed by the most satisfactory results, besides which the moral effect in the neighbourhood has been good; but the present facilities at my disposal have not enabled me to deal with more than a small percentage of the total number of cases referred to me. The policy of dealing with the matter in this thorough way has also had the satisfactory result of causing certain undesirable families to leave the Borough rather than submit to the cleansing. Cleansing of Persons Act. 1897. Under the provisions of this Statute 20 persons, apart from School Children, attended at the Cleansing Station and were cleansed. At the same time their clothes were freed from vermin by being passed through the Disinfecting Apparatus. Customs and Inland Revenue Acts. These Acts provide that the owners of premises that are let in dwellings of a certain class may claim exemption or abatement from inhabited house duty on producing a certificate from the Medical Officer of Health that the dwellings afford proper sanitary accommodation for the occupants. During the year applications for certificates under these Acts were received in respect of 57 dwellings, this number being 45 more than the number for which applications were made in 1911. Three dwellings were certified during the year, the owners having carried out the works necessary to obtain the certificate. 87 PREMISES. No. of Dwellings. 101a, Abbey Road 1 89a, King Henry's Road 1 9, Parkhill Road 1 Upon receipt of application for a certificate under the above Acts an extensive and exhaustive examination is made of the premises, and a schedule of requirements is served upon the person making the application. Both the inspection and the clerical work appertaining involves a large amount of work upon the Public Health Staff, and the above figures afford an example of how even a Finance Act may cause a large amount of additional work to fall upon the Public Health Department, and it is a matter of regret that more owners did not see fit to carry out the suggestions necessary for the granting of the certificate. Houses Let in Lodgings. The number of houses registered as houses let in lodgings at the end of 1912 was 425. The registered houses are situated chiefly in the following streets:— Bolton Road. Broomsleigh Street. Canfield Place. Dunboyne Street. Fairfax Mews. Fleet Road. Iverson Road. Kelson Street. King's College Mews East. Kingsford Street. Kingsgate Road. Linstead Street. Lower Cross Road. Lowfield Road. Netherwood Street. Palmerston Road. The question of the revision of the bye-laws for houses let in lodgings has occupied the attention of the Public Health Committee during 1912. The matter was raised by a letter from the London County Council enquiring if this Council proposed amending its byelaws in view of section l6 of the Housing, Town Planning, etc., Act, 1909. This section provides that the power of making and enforcing bye-laws made under section 94 of the Public Health (London) Act, 88 1891, with respect to houses or parts of houses which are let in lodgings or occupied by members of more than one family shall, in the case of houses intended for the working classes, extend to the making and enforcing of bye-laws imposing any duty (being a duty which may be imposed by the bye-laws and which involves the execution of work) upon the owner within the meaning of the Act, in addition to or in substitution for any other person having an interest in the premises' and prescribing the circumstances and conditions under and subject to which any such duty is to be discharged. Sub-section 2 of this section empowered the owner or other person to enter upon any part of the premises at all reasonable times for the purpose of discharging any duty so imposed. The Sanitary Authority is empowered, in sub-section 3, upon the default of the owner or other person to execute any work he has been required to execute under the bye-laws, to themselves execute the works and recover the costs and expenses. The Local Government Board forwarded a copy of their model series of bye-laws, showing the alterations which the Board suggested in cases where a Metropolitan Borough Council proposed to take advantage of the provisions of the Act of 1909, and these amended model bye-laws have been followed in framing our new bye-laws. The definition terms contained in the draft bye-laws are those contained in the Board's model bye-laws, and under these draft bye-laws the owner of the premises within the meaning of the Public Health (London) Act, 1891, is defined as the "landlord " of a lodging house. The person who, under our old bye-laws, was regarded as the "landlord" is now deemed to be the "owner," and by this re-arrangement tenants, who under the old bye-laws were treated as landlords, will no longer be called upon to execute works which the owner ought reasonably to be called upon to do. The draft bye-laws have been informally submitted to the Local Govenment Board for their consideration. 89 Housing in Hampstead. During the year 1912 twenty-seven houses have been maisonetted, and 60 new houses have been built. The process of maisonetting consists of the structural alteration of houses originally erected for the occupation of one family; such alterations provide separate accommodation for two or more families. Sanitary fittings and offices are multiplied, and the existing fittings and offices modernized and brought up-to-date in every way. These arrangements enable tenants to enjoy many of the economical advantages of a small house, coupled with some of the more desirable features of bigger houses, namely,—large, lofty, well-arranged rooms, with wide and well-lit and properly ventilated staircases and passages. The demand for these maisonettes is remarkable, and most of them are let before the necessary alterations are completed. Many fine old houses in Hampstead, designed and erected to meet the requirements of a previous generation, which it has been found practically impossible to let under their existing conditions and have been standing empty for a considerable time, have, by the process of maisonetting, been brought again into occupation and, consequently, rating. The demand for the new houses has also been very brisk, and those which have been erected during the year have become occupied as soon as they are completed. The number of unoccupied houses also shows a marked decrease during the year. This points to the fact that Hampstead, in spite of the many counter attractions offered by newer districts a little further out, still continues to attract new residents. Very few of the Metropolitan Boroughs continue to do this. I estimate the increase in the population of Hampstead during 1912 to be 367. Railway Extension. The London and North-Western Railway Company, in connection with their London to Watford Electric Railway, have scheduled 76 houses in Hampstead for demolition. This scheme of demolition involves the displacement of certain families belonging to the working classes, and consequently, a re-housing scheme had to be provided by the Company. New dwellings in Malvern Road, Willesden, have been erected for the purpose. Housing, Town Planning, &c., Act, 1909. Inspector Townsend, who was appointed for the purposes of the Housing, Town Planning, &c., Act, 1909, has during the year carried 90 out 579 inspections and 2,337 re-inspections. The work accomplished under the provisions of this Act has been of a most important character. The Water Supply of Tenement Houses. The action taken in Hampstead during 1912 to improve the water supply of tenement houses under the powers conferred upon London sanitary authorities by Section 78 of the London County Council (General Powers) Act, 1907, which empowers the sanitary authority to require a proper and sufficient supply of water in each storey of a tenement house that is separately occupied has resulted in the provision of water taps and glazed earthenware sinks in 152 houses. Prior to the passing of the London County Council (General Powers) Act of 1907 London sanitary authorities had no power to insist on the provision of adequate water supply in tenement houses. This Act, however, has been the means by which this great improvement has been effected. The number of houses dealt with in Hampstead during the last four years is as follows:— 1908 24 1909 85 1910 99 1911 105 1912 152 465 Underground Rooms. Considerable progress has been made during the year with underground rooms used as dwellings. It is satisfactory to report that we are rapidly nearing the stage when every underground room in the Borough, which is occupied as a sleeping room, will have been put into conformity with the requirements of the Public Health (London) Act, or the Housing, Town Planning, &c., Act, 1909. In only one case during the year has it been necessary to make a Closing Order, and that was in regard to a room which had been newly constructed in a large house for the purpose of forming a bedroom for a man-servant. The attention of the owner and his Architects was called to the requirements of the Regulations under the Housing, Town Planning, &c., Act; but, in spite of this, the room was allowed to be occupied and, consequently, a Closing Order had to be made, following which the use of the room for sleeping urposes was discontinued. 91 Dwellings Unfit for Habitation. Referring to the Closing Order made by the Council in January, 1911, in regard to No. 83, Palmerston Road, which had been confirmed by the Local Government Board, the Council were asked by the owner to rescind the Order, but upon an inspection of the premises being made it was found that no further works had been carried out, and the Council consequently refused to determine the Order. Against this refusal the owner appealed to the Local Government Board, and, again, the Board, after holding a public enquiry upheld the decision of the Council. The owner thereupon obtained a Rule Nisi calling on the Local Government Board to show cause why a Writ of Certoriari should not issue to remove into the High Court Orders of the Local Government Board in regard to the Closing Order and the appeals of Mr. Arlidge. The matter came before the Divisional Court on the 17th and 18th December The Local Government Board were represented by the Solicitor General, Sir John Simon, K.C., and Mr. Branson; whilst Mr. S. G. Turner showed cause on behalf of the Hampstead Borough Council. Mr. Arlidge was represented by Mr. MacMorran, K.C., and Mr. Brooke Little. The Appellant's contention was that the Board was not competent to determine the appeal without he and his witnesses having had the opportunity of being heard personally by whoever actually determined the appeal. After listening to the arguments, the Court discharged the Rule. Mr. Arlidge, however, not being satisfied with this decision, has taken the matter to the Court of Appeal, where it is now awaiting hearing. Rag Flock. The Rag Flock Act came into operation on the 1st July, 1912. It imposes upon all Sanitary Authorities the need of enforcing its provisions within their district, and for that purpose the Council is empowered to appoint their Medical Officer of Health and Sanitary Inspectors for the purpose of inspecting premises and taking samples of Rag Flock for analysis, and unless the flock is found to conform to such standard of cleanliness as the Local Government Board prescribes by regulation, the person who sells or uses or has in his possession flock in contravention of the Act is liable to a fine of £10 for the first offence, and of £50 for the second and subsequent offences. The Local Government Board, in pursuance of the Act, lost no time in making the regulations which came into operation upon the same 92 day as the Act itself. These regulations prescribe that when the amount of soluble Chlorine in the form of Chlorides removed by washing by distilled water at a temperature not exceeding 25 per cent. Centigrade from not less than 40 grammes of a well mixed sample of flock exceeds 30 parts of Chloride in 100,000 parts of flock, such flock shall be deemed not to conform to the standard of cleanliness for the purposes of the Act. The Council have appointed myself and the Sanitary Inspectors officers for the purposes of the Act, and as a preliminary measure have authorised twenty samples to be taken. It has not, however, been possible to obtain any of these samples this year. So long as people sleep upon beds and use upholstered furniture, it seems probable that rag flock will find its way into almost every home. Its use in one or another of its forms has become so universal that it now enters into the composition of mattresses, bolsters, pillows, cushions, hassocks, and the stuffing of chairs, sofas and settees of all kinds. In the interests of public health, the importance of ensuring the cleanliness and purity of such an article cannot be over estimated. Flock was originally made from the residue of the manufacturing processes of cotton and wool, and was a clean and exceedingly useful article, but, as with so many other things, it was not long before the financial possibilities occurred to certain manufacturers of substituting something which could be sold at a slightly cheaper rate and at a much larger profit, and flock manufactured from filthy rags of various kinds was put upon the market by manufacturers who were quite unscrupulous in their descriptions of their goods and untruthful in their statements of purification. Anything seems good enough for the manufacture of rag flock. Old filthy, verminous and contaminated clothes, blankets, sheets rugs, carpets, rags picked from refuse heaps, and even stained bandages found a ready market with these manufacturers to be made into rag flock without any preliminary sorting, cleansing, or disinfection. When it is understood that the process of washing and disinfecting these rags involves an expenditure of from £2 to £3 per ton, and the loss of from 25 per cent. to 33⅓ per cent. of their bulk, it is obvious that manufacturers with an output of from 20 to 30 tons per week (sold by weight) are able to undersell those traders who will have nothing to do with the unwashed article and at the same time to make 93 profits quite beyond the range of their competitors who put only washed flock on the market. Many traders who admit the dangerous, offensive and repulsive character of dirty Rag Flock have been compelled to use it or face the alternative of the Bankruptcy Court. Fortunately this particular business is now likely to be so restricted as to make it unprofitable to carry it on in the future, but to those who are about to furnish, and to those who are furnishing, I would give the advice to see to it that no flock of any kind which is not guaranteed to be of the prescribed standard of cleanliness finds its way into their home, and to those who have furnished, I would say if you have any article which contains flock the purity of which is questionable, have it destroyed without delay. There is no Rag Flock actually manufactured within the Borough of Hampstead, but certain upholsterers possess machines for re-carding old Flock. Cinematograph Theatres. There are now six cinematograph theatres in the Borough. During 1912 one of these has been remodelled and proper sanitary conveniences provided for use of the staff and patrons. A new theatre has been built in Maida Vale and is of a very elaborate character, having seating accommodation for about 1,450 people. Arrangements are made in these theatres to protect the audience against fire, for the proper ventilation of the building, and proper sanitary conveniences are provided, but it is regrettable that no provision exists which compels these places to be so constructed as to admit sunlight during the hours when the performance is not in progress. These theatres differ from ordinary places of amusement in that they possess little or no provision for the admission of daylight, that the performances are continuous, and that the audiences—consisting largely of juveniles—is continually changing. Such conditions must make for bad hygiene, and, speaking from a public health point of view, I consider it most essential that these picture houses should be, during some part of each day, subjected to the sterilizing effect of sunlight. Of the beneficial effect of this latter there can be no doubt, and the composition of the audiences at these cinematograph theatres is such as 94 to render it more than usually desirable that these places of amusement should be at least once a day flooded with fresh air and sunlight. During the year we have made enquiries in every case of infectious disease as to the probable or possible source of infection, and in a number of cases the data obtained corresponded to a visit to a picture palace. Up to the present it does not seem more than what might be expected from any large mixed gathering of children, but the picture palace as a focus of infection is one that in my opinion needs closely watching. Public Mortuary. During the year the bodies of 107 persons were brought to the Mortuary, as against 84 last year—71 by order of the Coroner, 20 by the Police, and 16 at the request of friends of the deceased persons. In 90 instances, or 84.1 per cent. of the bodies admitted, inquests were held, and in 58 instances, or 54.1 per cent., post-mortem examinations were made. 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 53 Accidental deaths 21 Suicide 20 Neglect at birth 2 Misadventure 6 Found dead 2 Murder 3 Total 107 95 MORTUARY RECORD FOR THE YEAR, 1912. Bodies Admitted. No. of Post-Mortems. No of Inquests. No. of Funerals from Mortuary. Month. Males. Females. Totals. Males. Females. Totals. January 5 4 9 4 3 7 8 9 February 3 5 8 2 5 7 7 8 March 1 7 8 1 3 4 7 8 April 2 4 6 2 3 5 6 6 May 6 1 7 1 — 1 5 7 June 4 2 6 2 1 3 5 6 July 6 4 10 2 3 5 8 9 August 2 5 7 2 1 3 5 7 September 8 2 10 4 2 6 9 10 October 4 10 14 2 4 6 13 14 November 7 3 10 4 1 5 7 10 December 7 5 12 2 4 6 10 12 Totals 55 52 107 28 30 58 90 106 90 Food Inspection. The following articles of unsound or diseased food were seized or voluntarily surrendered to the Inspectors during the year. Date. Premises. Food seized or surrendered. Jan. 9th High Road 2½ lbs. tripe. April 8th Hampstead Heath 1 gallon milk. July 17th Heath Street 84 lbs. cherries. July 30th Netherwood Street 3 lbs. gooseberries During the year, upon Bank Holidays or upon other special occasions, the sanitary inspectors have been on duty on the Heath inspecting food and taking samples where they thought necessary. It has been found, as in previous years, that the food exposed for sale on these festival days is, generally speaking, of a wholesome character, the only cases of complaint being against the itinerant or casual vendor of food. Slaughterhouses. There are four slaughterhouses in the Borough, situated as follows:—40, England's Lane; 17, High Street; 69, High Street; 6, Fairfax Mews. The slaughterhouses were regularly inspected during the year, the number of inspections being 74. The quarterly lime-washing has been carried out, and in three instances, dilapidated walls and ceilings have been repaired. Food Premises. Section 8 of the London County Council (General Powers) Act, 1908, contains provisions that considerably increase the power of sanitary authorities to regulate the sanitary condition of places where food is 97 prepared or sold. This section, which has been set out in full in previous Annual Reports, provides, among other things, that there shall be no drain inlet in any room where food is prepared or sold, that no sanitary convenience shall be within such a room or in direct communication with it, and that such a room shall be kept clean and not used as a sleeping place. These places are inspected from time to time, and in a considerable number of cases conditions in contravention of the Act have been found. In 1910 and 1911 the total number of premises altered in order to comply with the Act was 52 and 60 respectively, as set out in the Reports for those years. In 1912 the number of premises dealt with was 37. Of these places 22 were found to have drain inlets in rooms where food was prepared or sold, in 34 premises the drains were defective, in three structural defects other than drainage defects of various kinds were present, and 32 premises needed cleansing. The places were dealt with as follows:—in 25 instances the drains were entirely, and 9 instances partially, reconstructed; in 22 instances improperly placed drain inlets were removed, with or without redrainage; in 3 instances more or less extensive structural alterations, other than drainage alterations, were carried out; and 33 premises were thoroughly cleansed under notice. The trades carried on and the alterations made on the premises dealt with in 1912 were as follows:– Trades. No. of Premises DRAINAGE. PREMISES. Entire reconstruction Partial reconstruction Drain openings removed. Cleansed Structurally altered. Butcher 4 2 2 4 4 1 Confectioner 2 2 — 1 2 — Dairy 4 2 1 2 3 1 Fishmonger 4 3 1 3 4 1 Greengrocer 6 3 1 4 4 — Grocer & Provision Merchant 7 5 2 2 6 – Restaurants 4 3 1 2 4 — Other Trades 6 5 1 4 5 – Totals 37 25 9 22 32 3 98 The food premises inspected during the year, together with the nature of the business carried on, were as follows:— Butcher and Pork Butcher 65 Confectioner 94 Grocer 70 Provision and Cheesemonger 42 Greengrocer and Fruiterer 72 Fishmonger 31 Fried Fish Shops 10 General Shops 23 407 953 inspections were made of these premises during the year and 89 notices were served. This list does not include bakehouses, milk shops, restaurants, and slaugterhouses, to which reference is made elsewhere. Milk Supply. The number of persons registered as purveyors of milk at the end of 1912 was 76, and the number of premises on which milk is sold was 100. The difference in the two numbers was accounted for by the fact that some of the milksellers occupy more than one shop. The premises on which milk is sold are as follows:— Dairies 51 Bakehouses and Confectioners 21 Restaurants and Coffee Shops 12 General Shops 16 Three of the registered milksellers do not occupy shops, two being registered in reference to refreshment tents on Hampstead Heath on Bank Holidays, and one has a milk round outside the Borough but keeps his barrow and utensils in the Borough. During the year 453 inspections were made of premises where milk is sold, 26 notices were served, and the following works were carried out:— Premises or parts of premises repaired, cleansed, and limewashed 31 Water cisterns cleansed 4 Drains repaired or reconstructed 8 Drain inlets inside premises abolished 4 Soil pipes reconstructed 2 Water-closets repaired or renewed 6 Water-closets cleansed 4 99 Roofs repaired 2 New sinks fixed 3 Waste pipes to sinks trapped or renewed 7 Yard paving repaired or renewed 11 Dustbins provided 6 Gullies cleansed 3 Other defects remedied 7 Section 5 of the London County Council (General Powers) Act, 1908, empowers sanitary authorities in London to remove from the register of milksellers any cowkeeper, dairyman, or purveyor of milk, who is carrying on his trade on premises unsuitable for the sale of milk, and to refuse to enter any such person upon the register. The number of general shops selling milk has been reduced from 26 in 1909 to 16 in 1912. Ice Cream. The sale of ice cream in London is controlled by Sections 42 and 43 of the London County Council (General Powers) Act, 1902. There are 80 shops in the Borough in which ice cream is sold, and 171 inspections of these premises were made during the year. In addition to these, the barrows which stand in the streets, and on Hampstead Heath on Bank Holidays, have been inspected. Table of sanitary work carried out at premises where ice cream is sold:— Premises or parts of premises repaired, cleansed and limewashed 14 Drains repaired or reconstructed 4 Soil pipes reconstructed 1 Water-closets renewed 4 „ cleansed 6 Flushing cisterns to water-closets renewed 2 Waste pipes of sinks trapped, repaired, or renewed 2 Water cisterns cleansed 3 Yard paving renewed 3 Dustbins provided 3 Other defects remedied 2 Sale of Food and Drugs Acts. The number of samples taken for analysis under the Sale of Food and Drugs Acts during the year was 506, and the number certified by the Public Analyst to be adulterated was 12, or 2.3 per cent. of the total 100 number. The corresponding percentage in 1911 was 2.9; in 1910 2.3. In addition, 21 samples were certified to be of low quality. 411 samples were purchased from Hampstead tradesmen, and 95 from persons residing without, but trading within, the Borough. The percentages of adulterated samples in these two classes were 1.2 and 7.3 respectively. Five samples were taken on Hampstead Heath on Bank Holidays, and of these 2, or 40.0 per cent., were adulterated. Forty-one samples were taken on Sundays; and of these 4, or 9.7 per cent., were adulterated, and 3 were of poor quality. All the samples were taken with the formalities prescribed by the Acts. In Hampstead one sample was analysed for every 170 persons. The figures for 1912 for London and the provinces are not yet ready. In 1911 there was in London one sample for every 181 persons, and in the provinces one sample for every 403 persons, or one to every 349 of the population over the whole country. The following table shows the articles of which samples were taken during the year, and the number found to be adulterated or of low quality:— Articles. Number taken. Adulterated. Low Quality Bismuth 2 – – Borax 4 — — Butter 109 – — Cheese 20 – — Cocoa 17 – – Coffee 24 – — Dripping 1 – — Flour 4 — — Lard 34 — — Margarine 5 – — Milk 280 12 21 Tripe 2 — — Vinegar 4 – – Totals 506 12 21 101 The following table shows the number of samples analysed during each year from 1906 to 1912, the number and percentage of the adulterated samples, and the fines and costs recovered in lega proceedings:— Year. Samples Analysed. Number adulterated. Percentage adulterated. Fines and Costs. £ s. d. 1906 413 20 4.8 50 8 6 1907 407 36 8.8 49 18 6 1908 508 18 3.5 12 1 0 1909 506 20 3.9 29 4 6 1910 506 12 2.3 25 6 0 1911 512 15 2.9 26 16 0 1912 506 12 2.3 16 15 0 The following table shows a comparison of the Wards in the Borough in respect of the samples purchased from Hampstead tradesmen:— Ward. Samples analysed. N umber adulterated. Percentage adulterated. No. 1 (Town) 63 - - No. 2 (Belsize) 70 l 1.4 No. 3 (Adelaide) 18 — — No 4 (Central) 22 — - No. 5 (West End) 68 l 1.4 No. 6 (Kilburn) 109 l 0.9 No. 7 (Priory) 61 2 3.2 Totals 411 5 1.2 The following table shows the articles adulterated, nature of adulteration, and the result of proceedings taken:— 102 No. of Sample. Article. How adulterated. Result of proceedings. 53 Milk 15 per cent, deficient in butter-fat Dismissed. Vendor proving warranty. 102 Milk 4! per cent, added water Dismissed. Vendor proving warranty. 140 Milk 86 per cent, deficient in butter-fat Vendor absconded. Summons not served. 158 Milk 16 per cent, deficient in butter-fat Dismissed. Vendor proving warranty. 180 Milk 15 per cent, deficient in butter-fat Dismissed Vendor proving warranty. £ s. d. s. d. 207 Milk 9 per cent, deficient in butter-fat Fine 2. 0. 0 Costs 17. 0 245 Milk 11 per cent, deficient in butter-fat Dismissed. Vendor proving warranty. £ s. d. £ s. d. 268 Milk 9 per cent, deficient in butter-fat Fine 10 .0 .0 Cos's 2 .15 .6 269 Milk 16 per cent, deficient in butter-fat Dismissed. Vendor proving warranty. 285 Milk 9 per cent, deficient in butter-fat Dismissed. Vendor proving warranty. 286 Milk 16 per cent, deficient in butter fat. Dismissed. Vendor proving warranty. s. d. s. d. 364 Milk 36 per cent, added water Fine 10. 0 Costs 12. 6 In addition to the above, one vendor was fined ten shillings for selling milk on the public highway without having his name and address 011 liis vehicle or receptacle. Warranty Defence. From the preceding table it will be seen that in regard to twelve samples of milk taken, and which were found to be adulterated, in no less than eight, or 66 per cent, of the cases, the summonses were dismissed, the vendor in each having proved a warranty- In one of the remaining cases the vendor pleaded a warranty which was only upset upon technical grounds, otherwise this case would have been added to the above total. In another case the vendor absconded, and the summons has consequently not been served. Tt is a matter for congratulation that in the draft of the Milk and Dairies Hill there is a proposal that the warranty defence shall not be available as a defence to proceedings under the Sale of Food and Drugs .Vets, and it is to be sincerely hoped that this provision will become law in the near future. In the existing 103 state of things, taking samples of milk under the Sale of Food and Drugs Acts lias become a perfect farce, and the money and energy expended is simply wasted. The object of the "warranty defence" was to afford a protection for the dairyman who might be the innocent victim of the farmer or other person from whom he purchased his wholesale supplies, but it has, in fact, worked out in providing a dangerous weapon in the hands of the unscrupulous, and results in the unfortunate consumer being deprived of that protection to which he is entitled. Other Statutes contain machinery for the protection of an innocent retailer, but they take the form of enabling him to bring before the Court the person whom he alleges to be the real offender, when the Magistrate is at liberty to adjudicate and to inflict the penalty upon whoever he decides to be the wrongdoer. T would also point out that every trader whose reputation may suffer as the result of a conviction through the article supplied to him by the wholesale dealer, not being of the nature and substance contracted for, has a remedy for damages at common law ; and in one case in Hanipstead where the proprietor of a small general shop was convicted for selling milk containing preservatives which he had purchased from a large firm of dairymen, he subsequently recovered £100 damages. The provision which the Food and Drugs Acts contain for taking proceedings against those who give false warranties is of 110 avail, as in a very large number of cases they turn out to be intermediary firms, who, if proceeded against, in turn, plead the warranty which they receive from the farmer. Another matter for comment is the fact that it has been found in many cases that after the milk supplied to them under a warranty has been proved to be adulterated and has come to the knowledge of the retailers they have stdl continued dealing with the same firm, and when proceedings have been taken against them in regard to subsequent offences, have again successfully pleaded the warranty as a defence. Staff of The Department. The only change in the personnel of the Department was that occasioned by the appointment of the Medical Officer of Health, Dr. (jr. F. McCleary, to the position of Principal Medical Officer to the National Health Insurance Commission (England). Dr. McCleary relinquished his office on 30th June, and I was appointed as Acting Medical Officer of Health pending the appointment of a permanent officer. The Council appointed me as their Medical Officer of Health at their meeting on 2-lth July. 104 Offices of the Department. The extension to the Town Hall having been completed, the Department at the end of June removed there from the temporary address at 7, Belsize Park Gardens, and the accommodation now provided is greatly superior to any the Department has hitherto possessed; the supervision and the work done has certainly benefitted considerably as a result. Complaints. During 1912, 705 complaints were made of the existence of insanitary conditions. A list of the matters of which complaint was made is given below:— Accumulations, offensive 3 „ of garden and other refuse 8 Animals improperly kept11 „ dead 2 Dampness in premises 36 Dirty and dilapidated premises 14 Drain, bad condition of 23 „ defective 23 „ stopped 31 Dust, non-removal 33 Dust receptacles, foul or dilapidated 76 „ absence of, or insufficient 21 Insanitary condition of premises 36 Illness attributable to insanitary conditions 8 Manure not removed 4 Overcrowding and improper mixing of the sexes 28 Rats, nuisance from 5 Roadways, bad condition of 2 Roofs and gutters, defective and leaky 7 Rubbish, nuisance from burning 3 Smells 33 „ on premises 13 „ from road gullies 4 „ „ sewer ventilators 15 „ „ stables 6 „ „ drains, &c. 26 „ „ water-closets 6 „ „ manure 2 Smoke nuisances 6 Underground rooms illegally occupied 2 Unsound food 1 Vacant land, insanitary state of 8 Verminous condition of premises 9 Water, absence of 132 „ leakage of 7 Water cisterns, dirty, &c. 6 Water-closets, accommodation insufficient or absence of 5 „ defective or insanitary 18 „ stopped 5 „ without water 2 „ „ proper flush 4 Yards unpaved and existing paving defective 6 Miscellaneous 40 730 Factory and Workshop Act, 1901. 107 Factory and Workshop Act, 1901. This part of the Report is made pursuant to Section 132 of the Factory and Workshop Act, 1901, which provides that— "The Medical Officer of Health of every District Council shall in his Annual Report to them, report specifically on the administration of this Act in workshops and workplaces, and he shall send a copy of his Annual Report, or so much of it as deals with this subject, to the Secretary of State." At the end of 1912 there were 450 workshops on the register, of which 33 wore domestic workshops. Excluding the latter, there were employed in the workshops 833 males and 1,023 females. Dressmaking is the trade chietly carried on in the llampstcad workshops, and next in order of frequency come bootmaking, tailoring, baking and millinery. The following table shows the number of each class of workshops, the number of workrooms, and the number of persons of each sex employed. Workshops, and Domestic Workshops. Trade or Business. Workshops other than Domestic Workshops. Domestic Workshops. Total number of Workshops. Number of Workshops. Number of Workrooms. Number of Employees. Males. Females. Bakers 34 40 127 — — 34 Blindmakers 4 7 8 7 — 4 Bootmakers 44 48 87 1 — 44 Builders and carpenters 20 26 32 — — 20 Cabinetmakers and polishers 2 11 160 1 1 3 Carriage builders 6 10 24 — — 6 Cycle makers and repairers 6 9 15 — — 6 Dressmakers and ladies' tailors 106 124 9 521 14 120 Engineers 2 2 2 — — 2 Florists 3 4 10 7 — 3 Harness makers 5 6 12 — — 5 Ironmongers 13 13 29 — — 13 Laundresses 6 18 3 45 — 6 Milliners 26 26 — 92 1 27 Monumental masons 2 2 15 — — 2 Motor makers 4 5 14 — — 4 Outfitters 8 30 7 200 — 8 Pianoforte makers 2 4 26 — — 2 Picture frame makers 9 11 15 — 9 Sign writers 2 3 8 — — 2 Smiths 11 11 26 — — 11 Tailors 38 17 80 46 10 48 Trunk makers 1 1 4 — — 1 Upholsterers 14 20 40 4 3 17 Watchmakers and jewellers 13 14 22 — — 13 Wigniakers 13 20 10 35 — 13 Miscellaneous 28 40 30 64 4 32 Totals 422 552 833 1023 33 455 108 Workshop Inspection. The following particulars relate to tlio workshop inspections made during 1912, bakehouse inspections being omitted. The total number of inspections made during the year was 561, as against 740 in the previous year. Cleanliness. Nine workrooms were found on inspection to require cleansing; 8 of these were cleansed on the request of the Inspector, and in 1 case it was necessary to serve a notice before the work was carried out. Ventilation and Warming. In one workshop the means of ventilation were found to be inadequate, and proper means were provided. One workshop was found to be warmed by a gas stove unprovided with a flue to carry off the products of combustion. This is a contravention of Section 6 of the Factory Act, in which it is laid down that the measures which in every factory and workshop "must be taken for securing and maintaining a reasonable temperature in each room in which any person is employed,.... must not interfere with the purity of the air of any room in which any person is employed." A proper flue was fixed to the gas stove. Overcrowding. All the workrooms in the workshops are measured by the Inspectors, and the cubic space in each room is ascertained. The maximum number of workers that can legally occupy the room is then calculated, and this information stt out on a card supplied bv the Council, which is hung up in each room. The number of legal occupants varies according as ovt rtime is worked, or whelher the room is used as a sleeping room as well as a workroom. During 1912, 27 new workrooms were measured. Overcrowding was found in 2 instances, but was abated on the service of notices. Abstract of the Act. Section 128 of the Factory Act provides that an abstract of the Act "shall be affixed at the entrance of every factory and workshop, and in such other parts thereof" as the Factory Inspector may direct; and Section 133 of the Act provides that "when any woman, young person, or child is employed in a workshop in which no abstract of this Act is affixed as by this Act required, and the Medical Officer of Health of the 109 District Council becomes aware thereof, he shall forthwith give written notice thereof to the Inspector for the district "The object of this section is to secure that all new workshops in which protected persons are employed, discovered by the officers of the local authority shall be brought to the notice of the Factory Inspector, who supplies the occupiers of workshops with the abstracts of the Act. The occupier of a workshop is under legal obligation to give notice of his occupation of the workshop to the Factory Inspector within a month after it has begun, but owing to ignorance of the law, and for other reasons this obligation is frequently left unfulfilled, and the Inspector is informed of the occupation by the local Medical Officer of Health. Pursuant to this section 10 workshops were notified to H.M. Inspector of Factories as being without the abstract as required. Bakehouses. At the end of 1912 there were 37 occupied bakehouses on the register, 21 being underground, and 10 above ground. Three of the bakehouses situated above ground use power and are therefore factories. Eight inspections were made in respect of the factory bakehouses, 114 inspections in respect of the workshop bakehouses, and 20 notices were served. The occupation of the underground room which was found towards the end of 1911 to have been recently used as a bakehouse, and had not been so used at the passing of the Factory Act of 1901, was discontinued in the early part of 1912. 110 The following is a list of the occupied Bakehouses on the Register at the end of the year:— Bakehouses in Wards. No. 1 (Town) Ward— 57, Heath Street. 3, High Street. 67, do. 26 (late 19) New End. (4) No. 2 (Belsize) Ward— 6, Fleet Road. *65, do. 45, South End Road (-3) No. 3 (Adelaide) Ward — *44, England's Lane. *90, Ilaverstock Hill. *2, King's College Road. (3) No. 4 (Central) Ward— *64, Belsize Lane. *225, Finchley Road. *289, do. †307, do. *98, West End Lane. †2, Broadhurst Gardens. (6) No. 5 (West End) Ward— †60, Cricklewood Broadway. 110, Cricklewood Broadway. 553, Finchley Road. Field Lane School, Hillfield Road. *43, Mill Lane. 44, do. 4, Munro Terrace, Fortune Green. 251, West End Lane. *279, do. (9) No. 6 (Kilburn) Ward— *63, Hemstal Road. *94, High Road, Kilburn. *354, do. 4, Kelson Street. 67, Kingsgate Road. *99, Palinerston Road. (6) No. 7 (Priory) Ward— '202, Belsize Road. *228, do. *98, Boundary Road. *93, Fairfax Road. *7, Fairhazel Gardens. *137, Finchley Road. (6) Those marked * are underground bakehouses. Those marked † are factory bakehouses. Bakehouses—Underground 21 „ Above ground 16 Total . . 37 1ll Workplaces. This term is not defined in the Factory Act. nor in the Public Health Act, and it is sometimes exceedingly difficult to decide whether certain places are or are not "workplaces." During the year 1,6913 inspections were made of all the "workplaces" in the l?orough, and 136 notices were served. Among the more important workplaces are the kitchens of restaurants, coffee-houses, &c., and the number of these places in llampstead in 1911 was 74. During 1912, I restaurant kitchen was added to the registei" and 3 removed, making a total of 72 on the register at the end of tluu year. These premises are kept under regular supervision, the number of inspections being 171 and the number of notices served 21. The following is a list of the restaurant kitchens in the various wards of the Borough. Restaurant Kitchens in Wards No. 1 (Town Ward— Jack Straw's Castle, Hampstead Heath. 37, Heath Street. 57, do. 63 & 65, do. 70, do. 100, do. 102, do. 108, do. 109, do. 3, High Street 42, do. 67, do. Bull & Bush, North End (13) No. 2 (Belsize) Ward— 2, Elm Terrace, Constant ine Road. 25, Fleet Road. 98, do. 210, Haverstock Ilill 11, South End Road. 17, do. 45, do. 65, do. 19, Southampton Road 74, Upper Patk Road. Railway Tavern, South End Green (11) No. 3 (Adelaide) Ward— I, Adelaide Road. 143, do. 97, Haverstock Hill. II, King's College Road. CosyNook, Regent's Park Road. Winchester Hotel, Winchester Road. 25, Winchester Road (7) No. 4 (Central) Ward— 72, Belsize Lane. 90, do. 159, Broadhurst Gardens. 1a, Canfield Place. 104, Finchley Road. 225, do. 289, do. 52, Lymington Road. 100, West End Lane. 272, do. 280, do. (11) 112 Restaurant Kitchens in Wards.—continued. No. 5 (West End) Ward— 92, Fortune Green Road. 106, Mill Lane. 251, West End Lane. 291, do. 295, do. 351, do. (7) No. 6 (Kilburn) Ward— 132, High Road. Kilburn. 188, do. do. 272, do. do. 308, do. do. 354, do. do. 145, Iverson Road. Towers' Coffee Rooms, ridge Road. 18, Netherwood Street. 96, Palmerston Road. (9) No. 7 (Priory) Ward — 121, Abbey Road. 21, Alexandra Road. 203, Belsize Road. 264, do. 274, do. 36, Boundary Road. 114, do. 65, Fairfax Road. 98, Finchlev Road. 115, do. 133 A, do. 34, High Road, Kilburn. 48, do. do. Steer's Restaurant, Upper Avenue Road. (14) Total 72 Home Work. The Factor}' Act provides that in certain traces, to be specified by the Home Secretary, the employers shall send to the sanitary authority twice a year lists giving the names and addresses of the out-workers employed by them. The Home Secretary has from time to time .specified certain trades to which these provisions apply. The number of lists received from employers was 116 and the number of addresses contained in the lists was 329. In those instances where it was found that the addresses were outside Hampstead, in accordance with the Act they were sent to the Medical Officers of Health of their respective districts. The total number of outworkers' premises in Ilampstead is 90. Of these 6 are factories, 47 are workshops (17 of these being domestic workshops), 1 is a workplace, and in 36 cases only a single worker is employed on the premises. 113 Factories, The sanitation of factories is largely controlled by the Factory Inspectors, but duties of considerable importance relating to general sanitation devolve upon the Borough Council, who are responsible, among other duties, for the administration of Section 38 of the Public Health (London) Act, 1891. The section imposes upon the Council the duty of securing "suitable and sufficient accommodation in the way of sanitary conveniences" for the persons of both s-exes employed in the Hampstead factories, workshops, and workplaces. The following is a list of the different classes ot lactones m Hampstead:— Art Metal Workers 2 Bakehouses 3 Bootmakers 11 Builders 4 Butchers 7 Carpet Beaters 2 Coffee Roasters 5 Dairyman 2 Laundries 6 Motor Works 7 Printers 10 Other trades 16 75 The five tables that follow have been framed by the Home Secretary "for the guidance and convenience of Medical Officers of Health in preparing that part of their Annual Report which relates to factories, workshops, workplaces, and homework." FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK. 1. Inspection of Factories, Workshops, and Workplaces. Including Inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Prosecutions. (4) Factories (Including Factory Laundries) 92 l — Workshops (Including Workshop Laundries) 675 21 — Workplaces (Other than Outworkers' premises included in Part 3 of this Report) 1693 136 — Total 2460 158 — 114 2.—Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. (1) (2) (31 (4) (5) Nuisances wider the Public Health Acts:— Want of cleanliness 79 79 — — Want of ventilation 2 2 — — Overcrowding 2 2 — — Want of drainage of floors — — — Other nuisances 43 43 — — Sanitary accommodation insufficient 2 2 — — unsuitable or defective 3 3 — — not separate for sexes — — — — Offence# under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) — 1 — — Breach of special sanitary requirements for bakehouses (ss. 97 to 100) — — — — Other offences (Excluding offences relating to outwork which are included in Part 3 of this Report.) — — — — Total 131 132 — — Column (2) in the above table gives the number of defects found, and column (3) the number remedied during the year. The corresponding figures in the two columns are not identical, because in the case of some of the defects discovered near the end of the year, the work necessary to remedy the defects had not been completed and column (3) includes some defects which were found at the end of 1911 and remedied in the following year. 115 3.—Home Work. NATURE OF WORK. Outworkers' Lists, Section 107. Outwork in unwholesome premises, Sec, 108. Outwork in infected premises, Sections 109, 110. Lists received from Employers. Notices served on Occu¬| piers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions. Instances. Orders made (S. 110). Prosecutions (Sections 109, 110). Sending Twice in the year. Sending Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Outworkers. Outworkers. Lists. Contractors. Workmen. Lists. Contractors. Workmen. 1 2 3 4 5 (5 7 8 9 10 11 12 13 14 15 16 Wearing Apparel— (1.) making, etc 78 28 153 7 4 5 — — — — — — — — — (2) cleaning and washing 12 42 1 1 2 — — — — — — — — — — Household linen — 1 8 — — — — — — — — — — — — Lace, lace curtains and nets — 1 — — — — — — — — — — — — — Curtains and furniture hangings 4 1 7 — — — — — — — — — — — — Furniture and upholstery 12 10 24 — — — — — — — — — — — — Electro-plate — 2 2 — — — — — — — — — — — File making — — — — — — — — — — — — — — — Brass and brass articles — — — — — — — — — — — — — — — Fur pulling — — — — — — — — — — — — — — — Cables and chains — — — — — — — — — — — — — — — Anchors and grapnels — — — — — — — — — — — — — — — Cart gear — — — — — — — — — — — — — — — Locks, latches and keys — — 2 — — — — — — — — — — — — Umbrellas, etc. — 6 2 — — — — — — — — — — — — Artificial flowers — Nets, other than wire nets — — — — — — — — — — — — — Tents — — — — — — — — — — — — — — — Sacks — — — — — — — — — — — — — — — Racquet and tennis balls — — — — — — — — — — — — — — — Paper, &c., boxes, paper bags 2 27 Brush making — — — — — — — — — — — — — — — Pea picking — — — — — — — — — — — — — — — Feather sorting — — — — — — — — — — — — — — — Carding, etc., of buttons, etc. — — — — — — — — — — — — — — — Stuffed toys — — — — — — — — — — — — — — — Basket making — 1 — — — — — — — — — — — — — Chocolates and sweetmeats — — — — — — — — — — — — — — — Total 108 92 226 8 6 5 — — — — — — — — — In the case of those occupiers who gave out work of more than one of the classes specified in Column 1, and subdivided their lists in such a way as to show the number of workers in each class of work, the list has been included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers have been assigned in columns 3 and 4 (or 6 and 7) into their respective classes. 116 4.— Registered Workshops. Workshops on the Register (s. 131) at the end of the year. (1) Number (2) Bakehouses 34 Bootmakers 44 Dressmakers and ladies' tailors 120 Laundries 6 Milliners 27 Tailors 48 Watchmakers and jewellers 13 Wigmakers 13 Other 150 Total number of workshops on Register 455 5. Other Matters. Class (1) Number (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 10 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspector — Reports (of action taken) sent to H.M. Inspector - Other — Underground bakehouses (s. 101):— - Certificates granted during the year — In use at the end of the year 21 Report on the Analytical Work of the Year 1912. BY ALFRED W. STOKES, F.C S., F.I.C., Public Analyst. 118 Analytical Laboratory, Town Hall, Paddinuton, W. 6th January, 1913. A short review of the Analytical Work of the year 1912 may be of interest. A total of 506 articles have been analysed, comprising of Milk 280, Butter 109, Lard 34, Cheese 20, Margarine 5, Coffee 24, Cocoa 17, Drugs 6, Flour 4, Vinegar 4, Tripe 2, and Dripping 1. It is a singular thing that throughout the whole year only one article, milk, was found to be adulterated. Of this 12 samples jiroved to be either watered or skimmed. Some of these samples were taken from vendors not belonging to the Borough, who were selling milk on the Heath on Bank Holidays. Not one of the Butter samples was adulterated. To comply with the taste for unsalted butter, almost all of the samples were preserved by Boric Acid; though in no case was the amount above the legal limit of half per cent. Only 5 samples were preserved solely by common salt. All of the articles of every kind were purchased under the strict regulations of the Foods and Drugs Acts, none were taken informally. A total of £12 10s. for fines and £4 5s. for costs was imposed. The percentage of all articles adulterated in Hampstead was only 2j, while for London it is about 8 per cent. The figures for the other Boroughs are not out yet, but I think it will be found that Hampstead stands unrivalled for the purity of its food supply. There is even an improvement this year with only 2⅓ per cent, of adulterated samples over the previous year with its 3 per cent, of samples not genuine. ALF. W. STOKES, F.C.S., F.I.C. Public Analyst. Legal Proceedings. 121 Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department in 43 cases during the year. The chief facts relating to these proceedings are set out on pages 122-126, and are summarised below. The facts relate only to the cases that were heard and decided in 1912. Statute or By-law. Number of Prosecutions. Fines Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and By-laws made thereunder 17 6180 6106 Metropolis Management Acts, and By-laws made thereunder 12 3 0 0 20 7 6 Sale of Food and Drugs Acts 11 13 0 0 4 5 6 London County Council (General Powers) Act, 19042 -0 10 6 London County Council . (General Powers) Act, 1908 1 — 0 10 6 Totals 43 22 18 0 32 4 6 122 Public Health (London) Act, 1891, and By-lam made thereunder. Ward No. Date when i proceed- ! illgK ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 6 1911. 18th July 1912. 12th Jan. Marylebone Police Court: Mr. A. C. Plowden J. H., Hampstead Nuisance Work done. 10s 6d. costs paid, and summons withdrawn. 5 19th Oct. do. do. R. E., Hendon Failure to supply return to register a Lodging House Return made. 5s. costs paid, and summons withdrawn. 5 do. do. do. do. Failure to supply return to register a Lodging House do. 5 do. do. do. do. Failure to supply return to register a Lodging House do. 5 do. do. do. do. Failure to supply return to register a Lodging House do. 6 16tli Nov, do. do. W. H., Hampstead Nuisance Work done and summons withdrawn, 6 19th Oct. do. do. B. A , Willesden Failure to supply return to register a Lodging House Return made by owner and summons withdrawn. 7 19th Dec. do. do. A. P., Hampstead Nuisance Work done, 5s. costs paid, and summons withdrawn. 6 1912. 2nd May 1912. 17th May Marylebone Police Court: Mr. Paul Taylor B.C.&E.D. Hampstead Nuisance Nuisance abated, £l1s. costs paid, and summons withdrawn. 5 1911. 14th Dec 1912. 14th June Marylebone Police Court: Mr. Den man E. O., Hampstead Nuisance Work done. 10s. td. costs paid, and summons withdrawn. 5 1912. 16th May 1912. 21st June Marylebone Police Court: Mr- Paul Taylor M. & V. H., Holborn (i) Nuisance (i) Order made to abate within 14 days and pay 10s. 6d- costs, and (ii) Non compliance with Council's notice as to yard paving (ii) Fined £2 s. and 10s. 6d. costs. 123 Public Health (Loudon) Act, 1891, and By-laws made thereunder—con. Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Kesult of Hearing. 1912. 8th Feb. 1912. 3rd July Hampstead Police Court: Justices E. O., Hampstead | (i) Nuisance (ii) Non-compliance with Notice of Council as to paving of yard Work done, 10s. 6d. costs paid and summonses withdrawn. 16th July do. do. W. P. & Co., Ltd.. Bermondsey Removing offensive matter during prohibited hours Fined £2 and 5s 6d. costs. 21st May 26th July Marylebone Police Court: Mr. Denman R. E. Hendon Nuisance Order made to abate within six weeks and 10s. 6d. costs paid. do. do. do. R. E. Hendon Nuisance Order made to abate within six weeks and 10s. 6d. costs paid. 30tli July 18th Sept Hampstead Police Court: Justices W. P. & Co., Ltd., Bermondsey Removing offensive matter during prohibited hours Fined £2 10s. and 5s. 6d. costs. 31st May 13th Dec. Marylebone Police Court: Mr. A. C. Plowden G. F. T-, Paddington Nuisance Work done and summons withdrawn. Metropolis Management Acts, and By-laws made thereunder. 7 1911. 18th Oct. 1912. 12th Jan. Marylebone Police Court: Mr. A. C. Plowden E. E. Hendon Non compliance with Council's Order made under the Act of 1855 Work done, 10s. 6d. costs paid, and summons withdrawn. 8 1912. 18th April 3rd May Marylebone Police Court: Mr. A. C. Plowden L. & N. C., St. Pancras Non-compliance with Council's Order Undertaking given to do work. £5 5s. costs paid, and summons withdrawn. 6 do. do. do. A J. & C., Hammersmith Non-compliance with Council's Order. Summons dismissed with £5 5s. costs. 2 21st Mar. 17th May Marylebone Police Court: Mr. Paul Taylor R. T., Hampstead Failing to deposit plans, &c. at 3 premises Plans deposited, 10s. 6d. costs paid, and summons withdrawn in each case. * This decision has since been reversed by the Divisional Court. 124 Metropolis Management Actx, am/ By-taws made thereunder — continued. Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 1912. 18th Apr. 14th June Marylebone Police Court: Mr. Denman H.R. C., Hampstead Failing to deposit plan, &c. (two premises Plans deposited, 10s. 6d. costs paid, and summonses withdrawn in each case. 3 do. do. do. C. G. N.. Hampstead Non-compliance with Council's Order Work done, £11s. costs paid, and summons withdrawn. 3 2nd May 21st June Marylebone Police Court; Mr. Paul Taylor J. B. W., Westminster Non-compliance with Council's Order Order complied with, £3 3s. costs paid, and summons withdrawn. 27th June 3rd July Hampstead Police Court: Justices H. B., Hampstead Non-compliance wi^h Order of Council Fined £2 and 6s. 6d. costs. 2nd May 26th July Marylebone Police Court: Mr. Denman J. P.,. Paddington Failing to deposit plans, &c. Fined £1 and 2s. costs. 18th April do. do. B. P. A., Hampstead Non-compliance with Council's Order Work done. £1 Is. cofts paid and summons withdrawn. 22nd Feb. 1912. 11th Oct. Marylebone Police Court: Mr. A. C. Plowden P., Hampstead Non-compliance with Council's Order served under the Metropolis Management Act, 1855, in respect of passageway Summons dismissed with £3 3s. costs. 17th Oct. 25th Oct. do. G. S., Hampstead Obstruction of Senior Sanitary Inspector in execution of his duties under M etropolis Management Act, 1855 Withdrawn on payment of £2 2s. costs. 125 Sale of Food /an! Drugs Act.s Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 3 1912. 22nd Feb. 1912. 15th Mar. Marylebone Police Court: Mr. A. C. Plowden J. B., Hampstead Selling milk containing 15 per cent, less than the proper amount of butter-fat Warranty proved. Summons dismissed. 6 18th April 19 th April Marylebone Police Court: Mr. Plowden D. M., Hampstead Selling milk containing 4½ per cent, added water Warranty proved and summons dismissed. No costs. 6 2nd May 17th May Marylebone Police Court: Mr. Paul Taylor E. D. C., Holborn Selling milk containing 16 per cent, less than the proper amount of butter-fat Warranty proved, and summons dismissed. No costs. 6 do. 21st June do. J. H . Willesden Selling milk containing 15 per cent, less than the proper amount of butter fat. Warranty proved, and summons dismissed. 13th June 3rrd July Hampstead Police Court: J ustices H. B., Islington Selling milk containing 9 per cent, less than the proper amount of butter-fat Fined £2 and 17s. 6d. costs. 25th July 18th Sept. Hampstead Police Court: J ustices L. C. G., Hampstead Selling milk containing 16 per cent, less than the proper amount of butter-fat Warranty proved and summons dismissed. do. do. do. D. S.. Ltd. (1910). Islington (i) Selling milk containing 9 per cent, less than the proper amount of butter-fat Fined £10 and £2 15s. 6d. costs. (ii) No name, &c., on can Fined 10s. 11th July 20th Sept. Marylebone Police Court: Mr. Paul Taylor T. J. D., Willesden Selling milk containing 11 per cent, less than the proper amount of butter-fat Warranty proved and summons dismissed. 30th July do. do. J. M. & Sons, Willesden Selling milk containing 9 per cent, less than the proper amount of butter-fat Warranty proved and summons dismissed. 126 Sale of Food and Drugs Acts —continued. Ward No. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 1912. 30th July 1912. 20th Sept. Marylebone Police Court: Mr. Paul Taylor W, G. T., Hampstead Selling milk containing 16 per cent. less than the proper amount of butter-fat Warranty proved and summons dismissed. 17th Oct. 8 th Nov. Marylebone Police Court: Mr. AC. Plowden E. T., Hampstead Selling milk containing 36 per cent. of added water Fined 10s. and 12s. 6d. costs. London Country Council (GeneraI Powers) Act, 1904. 1912. 21st May 1912. 26th July Marylebone Police Court: Mr. Denman R. E.. Hendon Non -com pliance with Notice of Council under Sec. 20 Undertaking given to do work within six weeks, 10s. 6d. costs paid and summons withdrawn. 31st May 13th Dec. Marylebone Police Court; Mr. A. C. Plowden G. E- T.,' Paddmgton Non-compliance with notice Work done and summons withdrawn. London County Council (General Powers) Act, 1908. 7 1911. 16th Dec. 31st May Marylebone Police Court: Mr. Denman A. C., Hampstead Contravention of Section 8 in respect of slaughter-house Undertaking given to do the work. 10s. 6d. costs paid and summons withdrawn. Appendix. Tables. 129 TABLE I. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Vital Statistics of Whole Borough during 1912 and Previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the Borough. Transferable Deaths. † Nett Deaths belonging to the Borough. Uncorrected Number. Nett. of Non-residents registered in the Borough. of Residents not registered in the Borough. Under 1 Year of age. At all Ages. Number. Rate. Number. Rate. Number. Rate per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 1907 84130 1341 1359 16.1 1050 12.5 330 91 98 73.1 817 9.7 1908 84480 1355 1400 16.6 995 11.8 311 119 97 69.3 803 9.5 1909 84830 1282 1328 15.6 1057 12.5 334 116 99 74.5 839 9.9 1910 85210 1270 1340 15.7 1071 12.6 350 108 81 60.4 829 9.7 1911 85599 1199 1276 14.9 1132 13.2 415 130 105 82.3 847 9.9 1912 85966 1224 1281 14.9 1106 12.9 387 142 79 61.7 861 10.0 † "Transferable Deaths" are deaths of persons who, having a fixed or usual residence in England or Wales, die in a district other than that in which they resided. Area of Borough in acres (exclusive of area covered by water), 2253. Total population at all ages, 85,495. | At Census Number of inhabited houses, 11,294. Average number of persons per house, 7.6. of 1911. 130 TABLE II. (Required by the Local Government Hoard to be used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Disease Notified during the Year 1911. notifiable disease. Number of cases notified. Total Cases Notified in each Ward. Total Cases removed to Hospital. At all Ages. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 155 .. 59 76 14 5 1 .. 22 35 6 15 37 34 6 123 Ervsipelas 44 1 .. 2 10 16 11 4 12 6 4 4 6 7 5 13 Scarlet Fever 101 .. 20 52 22 7 .. .. 10 16 14 9 18 23 11 77 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 9 .. .. .. 4 4 1 .. 2 2 .. .. 3 1 1 5 Relapsing Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 3 .. .. .. 1 2 .. .. .. 2 .. .. 1 .. .. 2 Cerebro-spinal Meningitis 1 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. Polio-Myelitis 1 .. .. 1 .. .. .. .. .. .. .. 1 .. .. .. 1 Pulmonary Tuberculosis 183 .. 3 24 41 89 21 5 43 25 21† 5 33 37 191 108 Ophthalmia Neonatorum 6 6 .. .. .. .. .. .. 1 .. .. .. .. 5 .. 1 Totals 503 8 82 155 92 123 24 9 90 87 45 34 98 107 42 330 Isolation Hospitals are provided by the Metropolitan Asylums Board, and residents of Hampstead suffering from infectious disease are usually sent to the North-Western Hospital which is within the Borough, and is situate at Lawn Road, in No. 2 (Belsize) Ward. A number of Consumptives were removed to the Hampstead Workhouse Infirmary, others to the Mount Vernon Hospital; the remainder being sent to Sanatoria in various parts of the country. * 12 in Institutions. † 1 in Institution. ‡ 2 in Institutions. EXTENDED TABLE III. Causes of, and Ages at Death during the Year 1912. No. Causes of Death. All Ages. Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the horough. Total Deaths whether of "Residents" or "Nonresidents" in Institutions in the Borough. Under l year. 1 and under 2 years, 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified 861 79 21 31 24 85 94 227 850 558 Uncertified ... ... ... ... ... ... ... ... ... ... 1 Enteric Fever 1 ... ... ... ... ... 1 ... ... 7 2 Typhus Fever ... ... ... ... ... ... ... ... ... 1 6 Measles 11 1 2 7 1 ... ... ... ... 59 7 Scarlet Fever ... ... ... ... ... ... ... ... ... 18 8 Whooping Cough 4 1 1 1 1 ... ... ... ... 8 9 Diphtheria, Croup 17 ... ... 7 8 1 ... 1 ... 48 10 Influenza 11 1 ... ... ... ... 2 2 6 ... 14 Dysentery 1 ... ... ... ... ... 1 ... ... ... 15 Plague ... ... ... ... ... ... ... ... ... ... 18 Erysipelas 1 1 ... ... ... ... ... ... ... 2 20 Pyaemia, Septieœmia l ... 1 ... ... ... ... ... ... ... 25 Mycoses l ... ... ... ... ... ... ... ... 1 28 Pulmonary Tuberculosis (not acute) 59 l ... 1 2 11 26 16 2 88 29 Acute Phthisis, Acute Miliary Tuberculosis 5 ... ... ... ... 2 3 ... ... 1 30 Tuberculous Meningitis 8 1 2 2 1 1 ... 1 ... 7 31 Tuberculosis of Peritoneum and Intestines 2 ... 1 ... ... 1 ... ... ... 1 32 Tuberculosis of Spinal Column 1 ... ... ... ... ... ... 1 ... 4 33 Tuberculosis of Joints ... ... ... ... ... ... ... ... ... 1 34 Tuberculosis of other Organs 1 ... ... 1 ... ... ... ... ... 2 35 Disseminated Tuberculosis 1 ... ... 1 ... ... ... ... ... 6 36 Rickets, Softening of Bones ... ... ... ... ... ... ... ... ... 1 37 Syphilis 1 ... 1 ... ... ... ... ... ... 1 39 Cancer of the Buccal Cavity 4 ... ... ... ... ... 1 2 1 4 40 Cancer of the Stomach, Liver, &c. 19 ... ... ... ... ... ... 12 7 14 41 Cancer of the Peritoneum, Intestines, and Rectum 22 ... ... ... ... ... 2 6 14 15 42 Cancer of the Female Genital Organs 22 ... ... ... ... ... 2 15 5 16 48 Cancer of the Breast 6 ... ... ... ... ... ... 4 2 5 44 Cancer of the Skin 3 ... ... ... ... ... ... ... 3 1 45 Cancer of other or unspecified organs 26 ... ... ... ... ... 1 9 16 10 46 Other tumours (situation undefined) 2 ... ... ... ... ... ... ... 2 ... 47 Rheumatic Fever 4 ... ... ... 2 1 l ... ... 2 48 Chronic Rheumatism, Osteo-Arthritis, Gout 3 ... ... ... ... ... ... ... 3 ... 49 Seurvy 1 ... ... ... ... ... ... 1 ... ... 50 Diabetes 6 ... ... ... ... ... l 1 4 4 51 Exophthalmic Goitre 3 ... ... ... ... 1 l 1 ... 2 53 Leucocythmæa, Lymphadenoma 2 ... ... ... ... ... ... 2 ... 4 54 Anæmia, Chlorosis 3 ... ... ... ... ... 1 2 ... 1 56 Alcoholism (acute or clironic) 2 ... ... ... ... ... ... 2 ... 1 60 Encephalitis 1 ... ... 1 ... ... ... ... ... ... 61a Cerebro-Spinal Fever 1 ... ... ... ... ... ... ... 1 ... 61b Posteria Basal Meningitis 1 1 ... ... ... ... ... ... ... 1 61c Meningitis (other forms) 3 2 1 ... ... ... ... ... ... 1 63 Other diseases of the Spinal Cord 9 ... ... 1 ... ... 1 2 5 2 64 Softerning Hæmorrhage, Apoplexy 50 ... ... ... ... ... ... 19 31 9 65 Softening of the Brain 1 ... ... ... ... ... ... ... 1 ... 66 Paralysis 3 ... ... ... ... ... ... 1 2 2 67 General Paralysis of the Insane 6 ... ... ... ... ... 5 ... 1 ... 68 Other forms of Mental Alienation 3 ... ... ... ... ... ... 3 ... ... 69 Epilepsy 2 ... ... ... ... ... 1 ... 1 ... 71 Infantile Convulsions 9 8 1 ... ... ... ... ... ... 2 74 Other diseases of the Nervous System 4 ... ... ... ... ... ... 4 ... 3 76A Mastoid Disease 1 ... ... ... ... 1 ... ... ... 4 76B Other Diseases of the Ears 2 ... 1 1 ... ... ... ... ... ... 77 Pericarditis 1 ... ... ... ... 1 ... ... ... 1 78 Acute Endocarditis 1 ... ... ... ... ... ... 1 ... 2 79a Valvular Disease of the Heart 60 ... ... ... 3 2 9 15 31 17 79b Fatty Degeneration of the Heart 9 ... ... ... ... ... ... 5 4 2 79c Other Organic Disease of the Heart 31 ... ... 1 ... 1 3 13 13 12 80 Angina Pectoris 5 ... ... ... ... ... ... 2 3 1 81 Diseases of the Arteries 10 ... ... ... ... ... 3 3 4 5 82 Embolism and Thrombosis 14 ... ... ... ... ... ... 1 13 4 83 Diseases of the Veins 2 ... ... ... ... ... ... 1 1 ... 84 Diseases of the Lymphatic System 1 ... ... 1 ... ... ... ... ... 1 89 Bronchitis 64 3 1 3 ... 2 ... 11 44 13 90 91 Broncho-Pneumonia 25 8 6 ... 1 ... 1 1 8 11 92 Pneumonia 31 2 1 1 1 ... 3 14 9 10 93 Pleurisy 2 ... ... ... ... ... ... 1 1 2 94 Pulmonary Congestion 6 ... ... ... ... ... ... 1 5 ... 95 Gangrene of the Lung ... ... ... ... ... ... ... ... ... 1 96 Asthma 5 ... ... ... ... ... 1 3 1 ... 98 Other Diseases of the Respiratory System 2 ... ... ... ... ... 1 1 ... ... 102 Perforating Ulcer of the Stomach 3 ... ... ... ... ... 1 2 ... 2 103 Other Diseases of the Stomach 1 ... ... ... ... ... ... ... 1 ... 104 Diarrhœa and Enteritis (under two years of age) 15 2 ... ... ... ... 2 4 7 8 105 Diarrhœa and Enteritis (two years of age and over) 108 Appendicitis 4 ... ... ... ... ... 1 1 2 6 109 Hernia, Intestinal Obstruction 8 1 ... ... ... ... ... 3 4 5 110 Other Diseases of the Intestines 1 ... ... ... ... ... ... 1 ... ... 113 Cirrhosis of the Liver 6 ... ... ... ... ... ... 5 1 4 114 Biliary Calculi 4 ... ... ... ... ... ... 2 2 ... 117 Peritonitis 2 ... ... ... ... 1 ... 1 ... 3 118 Other Diseases of the Digestive System 1 ... ... ... ... ... ... ... 1 1 119 Acute Nephritis 3 ... ... ... ... ... ... 1 2 2 120 Briglit's Disease 24 ... ... ... ... 2 1 11 10 6 121 Chyluria 1 ... ... ... ... ... 1 ... ... 1 122 Other Diseases of the Kidney and Annexa 1 ... ... ... ... ... 1 ... ... 1 123 Calculi of the Urinary Passages 2 ... ... ... ... ... ... 1 1 ... 124 Diseases of the Bladder 2 ... ... ... ... ... ... ... 2 2 126 Diseases of the Prostate 5 ... ... ... ... ... ... ... 5 4 129 Uterine Tumour (Non-Cancerous) 2 ... ... ... ... ... 1 1 ... 1 130 Other Diseases of the Uterus 1 ... ... ... ... 1 ... ... ... ... 131 Ovarian Cyst, Tumor (non-cancerous) 1 ... ... ... ... ... 1 ... ... 1 132 Other Diseases of the Female Genital Organs 1 ... ... ... ... 1 ... ... ... 1 134 Accidents of Pregnancy 1 ... ... ... ... ... 1 ... ... ... 135 Puerporal Hæmorrhage 1 1 ... ... ... ... ... ... ... ... 137 Puerperal Fever 3 ... ... ... ... 1 2 ... ... 3 139 Puerperal Phlegmasia, Alba Dolens, Embolism, and Sudden Death 2 ... ... ... ... 1 1 ... ... 2 142 Gangrene 2 ... ... ... ... ... ... ... 2 1 143 Carbuncle, Boil 1 ... ... ... ... 1 ... ... ... 1 145 Diseases of the Integumentary System 2 1 ... ... ... ... ... ... 1 2 146 Diseases of the Bones l ... ... ... 1 ... ... ... ... ... 150 Congenital Malformations 6 5 ... 1 ... ... ... ... ... 2 151A Premature Birth 21 21 ... ... ... ... ... ... ... 9 151b Infantile Atrophy, Debility, and Marasmus 10 9 ... ... 1 ... ... ... ... 5 152 Other Diseases peculiar to early infancy 5 5 ... ... ... ... ... ... ... ... 154 Old Age 54 ... ... ... ... ... ... ... 54 20 155 Suicide by Poison 4 ... ... ... ... ... 3 1 ... 2 156 Suicide by Asphyxia 2 ... ... ... ... ... ... 1 1 ... 157 Suicide by Hanging or Strangulation 5 ... ... ... ... ... 1 3 1 ... 158 Suicide by Drowning***** 1 ... ... ... ... ... 1 ... ... ... 159 Suicide by Firearms 3 ... ... ... ... ... ... 3 ... ... 160 Suicide by Cutting or Piercing Instruments 1 ... ... ... ... ... 1 ... ... 1 161 Suicide by Jumping from High Place ... ... ... ... ... ... ... ... ... 1 165 Other Acute Poisonings 1 ... ... ... ... ... ... ... 1 ... 167 Burns (Conflagration excepted) 2 ... ... ... ... ... ... ... 1 5 168 Absorption of Deleterious Gases (Conflagration expected) 2 1 ... 1 ... 1 ... ... ... ... 169 Accidental Drowning 1 ... ... ... ... ... ... ... 1 ... 170 Injury by Firearms 1 ... ... ... ... ... ... ... ... ... 172 Injury by Fall 5 ... 1 ... 1 ... 1 2 1 7 175 Injury by other crushing (Vehicles, Railways, Landslides, &c.) 6 ... ... ... ... ... 2 1 2 4 181 Electricity (Liehtninw excepted) ... ... ... ... ... ... ... ... ... 1 182 Homicide by Firearms 1 ... ... ... ... ... 1 ... ... ... 184 Homicide by ether means 2 2 ... ... ... ... ... ... ... ... 186 Other Violence ... ... ... ... ... ... ... ... ... 1 187 Dropsy 1 1 ... ... ... ... ... ... ... ... 188 Syncope, Sudden Death 3 ... ... ... ... 1 ... 1 1 1 189 Ill-defined causes 4 ... 1 ... ... ... ... 2 1 ... Totals 861 79 21 31 24 35 94 227 350 558 Note.—Tlie omission of a number from tlie first column denotes that no death was registered from the cause of death to which the number relates. 131 TABLE III. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Causes of, and Ages at, Death during the Year 1912. CAUSES OF DEATH. Nett deaths at the subjoined ages of " Residents," whether occurring within or without the Borough. Total Deaths, whether of ' Residents " or " Non-resients" in Institutions in the Borough. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified 861 79 21 31 24 35 94 227 350 558 Uncertified ... ... ... ... ... ... ... ... ... ... 1. Enyeric Fever 1 ... ... ... ... ... 1 ... ... 7 2. Small-pox ... ... ... ... ... ... ... ... ... ... 3. Measles 11 1 2 7 1 ... ... ... ... 59 4. Scarlet Fever ... ... ... ... ... ... ... ... ... 18 5. Whoolping Cough 4 1 1 1 1 ... ... ... ... 8 6. Diphtheria and Croup 17 ... ... 7 8 1 ... 1 ... 48 7. Influenzea 11 1 ... ... ... ... 2 2 6 ... 8. Erysipelas 1 1 ... ... ... ... ... ... ... 2 9.Phthisis (Pulmonary Tuberculosis) 64 1 ... 1 2 13 29 16 2 89 10. Tuberculous Meningitis 8 1 2 2 1 1 ... 1 ... 7 11. Other Tuberculous diseases 5 ... 1 2 ... 1 ... 1 ... 14 12. Cancer, malignant diseases 102 ... ... ... ... ... 6 48 48 65 13. Rheumatic Fever 4 ... ... ... 2 1 1 ... ... 2 14. Meningitis* 5 3 1 ... ... ... ... ... 1 2 15. Organic Heart Disesase 100 ... ... 1 3 3 12 33 48 31 16. Bronchitis 64 3 1 3 3 2 ... 11 44 13 17. Pneumnnia (all froms) 56 10 7 1 ... ... 4 15 17 21 18. Other Diseases of Respiratory Orgens 15 . ... ... 2 ... 2 6 7 3 19. Diarrhœa and Enteritis 15 2 ... ... ... ... 2 4 7 8 20. Appendicitis and Typhlitis 4 ... ... ... ... ... 1 1 2 6 21. Cirrhosis of Liver 6 ... ... ... ... ... ... 5 1 4 21A. Alcoholiam 2 ... ... ... ... ... ... 2 ... 1 22.Nephrtis and Bright's Diseases 27 ... ... ... ... 2 1 12 12 8 23. Puerperal Fever 3 ... ... ... ... 1 2 ... ... 3 24. Other accedients and diseases of Pregnancy and Parturition 4 1 ... ... ... 1 2 ... ... 2 25. Congenital Debility and Malformation, including Premature Birth 37 35 ... 1 1 ... ... ... ... 16 26 Violent Deaths, excluding Suicide 21 3 1 1 2 1 4 3 6 18 27. Suicide 16 ... ... ... ... ... 6 8 2 4 28. Other Defined diseases 250 15 4 4 1 7 19 55 145 98 29. Diseases ill-defined or unknown 8 1 1 ... ... 1 ... 3 2 1 861 79 21 31 24 35 94 227 350 558 SubEntries Included in above figures. 14 (a) Cerebro-spinal Meningtis 1 1 ... ... ... ... ... ... ... ... 28 (a) Poliranyelitis 1 ... ... 1 ... ... ... ... ... ... *Exclusive of " Tuberculous Meningitis (10), but inclusive of Cerebro-Spinal Meningitis. 132 TABLE IV. (Required by the Local Government Board to be u*ed in the Annual Report of the Medical Officer of Health.) Infant Mortality, 1912. Nett Deaths from stated Causes at various Ages under One Year of Age. CAUSE OF DEATH. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 W:eeks. 4 Weeks aud under 3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under 1 Year. All Causes Certified 25 4 2 ... 31 18 11 8 11 79 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ......... ... Measles ... ... ... ... ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... 1 1 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... 1 ... ... ... 1 Tuberculous Meningitis. ... ... ... ... ... ... 1 ... ... 1 Abdominal Tuberculosis* ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... 1 ... 1 Meningitis i not Tuberculous) ... ... ... ... ... ... 1 ... 2 3 Convulsions 1 ... ... ... 1 1 1 2 3 8 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 1 ... 1 3 Pneumonia (all forms) ... ... 1 ... 1 2 2 2 3 10 Diarrhœa ... ... ... ... ... 1 1 ... ... 2 Enteritis ... ... ... ... ... ... ... ... ... ... Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 1 ... ... ... 1 ... ... ... ... 1 Injury at Birth 3 ... ... ... 3 1 ... ... ... 4 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations 2 1 ... ... 3 1 ... ... 1 5 Premature Birth 10 2 1 ... 13 4 2 ... ... 19 Atrophy, Debility and Marasmus† 4 1 ... ... 5 5 ... 1 ... 11 Other causes 3 ... ... ... 3 ... 2 1 ... 6 25 4 2 ... 31 18 11 8 11 79 Nett Births in c legitimate, 1,207 the year illegitimate, 74 Nett Deaths in legitimate infants, 68. the year of illegitimate infants, 11. *Including deaths Irom Tuberculous Peritonitis and Enteritis, and from Tabes Mesenterica. † Including want of Breast Milk. 133 The following table was suggested by the Medical Officer of Health to the County of London in order to secure uniformity of tabulation in the Annual Reports of the Medical Officers of Health of the Metropolitan Boroughs:- TABLE V. PREMISES. NUMBER OF PLACES. Number of inspections, 1912. Number of notices, 1912. Number of prosecutions, 1912. On register at end of 1911. Added in 1912. Removed in 1912. On register at end of 1912. Milk premises 103 1 4 100 453 26 - Cowsheds - - - - - - - Slaughterhouses 4 — — 4 74 — — Other offensive trade premises - - - - - - - Ice cream premises 82 2 4 80 171 14 - Registered houses let in lodgings 425 — — 425 201 92 5 Total number of Intimation Notices served for all purposes 1105. Overcrowding— Number of dwelling rooms overcrowded 4 Number remedied 4 Number of notices issued 2 Number of prosecutions — Underground rooms — Number closed during year 12 Illegal occupation dealt with during year 130 Insanitary houses— Number closed under the Public Health (London) Act, 1891 — ,, ,, Housing of the Working Classes Act — Shelters provided under Sec. 60 (4) of the Public Health (London) Act, 1891- Number of persons accommodated during the year — 134 TABLE Y.—continued. Customs aud Inland Revenue Acts— Number of houses for which applications were received 14 Number of dwellings comprised therein 57 Number of Certificates granted (houses) *3 „ „ refused ( „ ) — „ „ deferred ( „ ) +11 Number of prosecutions under By-laics under Public Health (London) Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, &c. - (b) For prevention of nuisance arising from offensive matter running out of any manufactory - (c) For the prevention of keeping of animals in such a manner as to be injunious to health - (a) As to paving of yards, &c., of dwelling houses 3 (e) In connection with the removal of offensive matter, Ac. 2 (f) As to cesspools and privies, removal and disposal of refuse, &c. - (g) For securing the cleanliness of tanks, cisterns, &c. — (h) With respect to water-closets, earth-closets, &c. 1 (i) With respect to sufficiency of water supply to waterclosets - (j) Relating to houses let in lodgings 5 Number of prosecutions under Dairies, Cowsheds and Milkshops Orders— Dirty milk utensils — Number of prosecutions under By-laics under Metropolis Managements Acts— (a) With respect to drainage, &c. — (b) With respect to deposit of plans as to drainage, &c. 6 London County Council (General Powers) Act, 1903, Part VIII.— Number of prosecutions for breach of by-laws as to conveyance of dead horses through street - * These 3 houses comprised 3 " dwellings." † These 11 houses comprised 54 "dwellings." 135 TABLE Y.— continued. London Count;/ Council (General Powers) Act, 1904, Part IV.— Number of filthy articles purified (Sec. 19) 1240 „ „ „ destroyed (Sec. 19) — „ verminous rooms cleansed (Sec. 20) 87 „ „ houses „ (Sec. 20) 50 ,, sanitary conveniences altered (Sec. 22) — „ ,, „ removed (Sec. 22) — ,, fixed ashpits removed (Sec. 23) 52 Mortuaries— Total number of bodies removed 107 Total number of infectious bodies removed — London Count// Council (General Powers) Act, 1907, Part XII., and Sec. 48 Public Health (London) Act, 1891— Number of tenement houses in which additional water taps and sinks have been provided (Sec. 78) 152 136 TABLE VI. Vital Statistics of the Borough. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population. Deaths occurring. Death rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 82380 1516 18.4 904 11.0 133 87.7 460 5.6 33 0.40 58 0.70 1903 82730 1453 17.6 837 10.1 126 86.7 311 3.7 16 0.19 42 0.51 1904 83080 1445 17.4 892 10.7 161 111.4 301 3.6 20 0.24 48 0.58 1905 83430 1421 17.0 823 9.9 133 936 295 3.5 14 0.17 38 0.45 1906 83780 1437 17.1 850 10.1 111 772 557 6.6 22 0.26 49 0.58 1907 34130 1359 16.1 817 9.7 98 731 498 5.9 15 0.18 41 0.49 1908 84480 1400 16.6 803 9.5 97 69.3 383 4.5 20 0.24 38 0.45 1909 84830 1328 15.6 839 9.9 99 74.5 325 3.8 21 0.25 49 0.58 1910 85210 1340 15.7 829 9.7 81 60.14 233 2.8 13 0.16 45 0.54 1911 85599 1276 14.9 847 9.9 105 82.3 345 4.0 25 0.29 51 0.59 1912 85966 1281 14.9 861 10.0 79 61.7 320 3.7 25 0.29 48 0.42 TABLE VI. (1). Vital Statistics of No. 1 (Town) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). At tack-rate per iooo of the Population. Deaths occurring. Death-rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 12120 192 15.8 163 13.4 20 104.1 64 5.3 4 0.33 8 0.66 1903 12310 194 15.7 127 10.3 14 72.1 38 3.1 1 0.08 10 0.81 1904 12500 195 15.6 125 10.0 20 102.5 65 5.2 4 0.32 2 0.16 1905 12690 194 15.3 127 10.0 24 123.7 72 5.7 3 0.24 6 0.47 1906 12870 205 15.9 131 10.2 21 102.4 107 8.3 6 0.47 11 0.85 1907 13079 185 14.1 152 11.6 15 81.1 105 8.0 2 0.15 3 0.23 1908 13250 225 17.0 108 8.1 11 48.8 65 4.9 1 0.07 5 0.37 1909 13430 196 14.6 140 10.4 15 76.5 53 3.9 4 0.30 8 0.59 1910 13610 199 14.6 118 8.7 15 75.4 25 1.8 1 0.07 1 0.07 1911 13820 207 15.0 133 9.6 19 91.8 71 5.1 7 0.51 14 1.01 1912 14040 183 13.0 135 9.6 12 65.5 47 3.3 2 0.14 4 0.28 137 TABLE VI. (2). Vital Statistics of No. 2 (Belsize) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. 7. Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox) Attack rate per 1000 of the ropulation. Deaths occurring. Death rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 13030 239 18.3 135 10.4 18 75.3 94 7.2 9 0.69 12 0.92 1903 13110 211 16.1 121 9.2 13 61.6 60 4.6 2 0.14 3 0.23 1904 13200 217 16.4 141 10.7 23 105.9 47 3.6 3 0.23 8 0.61 1905 13280 209 15.7 131 9.9 13 62.2 42 3.2 2 0.15 5 0.38 1906 13370 187 14.0 127 9.5 8 42.8 60 4.5 4 0.30 7 0.52 1907 13150 205 15.2 114 8.5 13 63.4 63 4.7 3 0.22 11 0.82 1908 13530 205 15.1 126 9.3 8 39.0 81 6.0 1 0.07 4 0.29 1909 13610 204 15.0 130 9.5 16 78.4 88 6.5 5 0.37 8 0.59 1910 13710 207 15.1 119 8.7 9 43.5 49 3.6 2 0.14 8 0.58 1911 13780 189 13.7 135 9.7 17 90.0 78 5.7 2 0.14 5 0.36 1912 13830 188 13.6 127 9.2 8 42.5 62 4.5 4 0.29 5 0.36 TABLE VI. (3). Vital Statistics of No. 3 (Adelaide) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number, Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack rate per 1000 of the Population, Deaths occurring. Death-rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 10350 103 9.9 95 9.6 3 29.1 40 3.9 2 0.19 2 0.19 1903 10310 95 9.2 101 9.8 9 94.7 22 2.1 1 0.10 1 0.10 1901 10260 100 9.7 99 9.6 13 130.0 36 3.5 2 0.19 2 0.19 1905 10220 96 9.4 92 9.0 4 41.7 27 26 1 0.10 1 0.10 1906 10170 97 9.5 92 9.0 10 103.1 29 2.8 .. .. 1 0.10 1907 10120 75 7.4 86 8.5 8 106.7 29 5.9 1 0.10 1 0.10 1908 10070 93 9.2 78 7.7 6 64.6 30 3.0 2 0.20 4 0.40 1909 10040 83 8.3 88 8.8 4 48.2 16 1.6 2 0.20 4 0.40 1910 10000 96 9.6 78 7.8 2 20.8 22 2.2 1 0.10 2 0.20 1911 9950 82 8.2 99 9.9 6 73.2 19 1.9 3 0.30 4 0.40 1912 9930 117 11.8 77 7.7 6 51.3 24 2.4 1 0.10 1 0.10 138 TABLE VI. (4). Vital Statistics of No. 4 (Central) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Hate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack-rate per 1000 of the Population. Deaths occurring. Death-rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 9190 110 12.0 71 7.7 11 100.0 40 4.3 ... ... ... ... 1903 9260 99 10.7 60 6.5 8 80.8 34 3.7 4 0.43 4 0.43 1904 9330 90 9.6 62 6.6 11 122.2 17 1.8 ... ... 2 0.21 1905 9400 113 12.0 60 6.4 5 44.2 24 2.5 1 0.11 1 0.11 1906 9470 95 10.0 83 8.8 3 31.6 34 3.6 ... ... 1 0.10 1907 9540 108 11.3 68 7.1 9 83.3 33 3.4 2 0.21 2 0.21 1908 9610 104 10.8 82 8.5 6 57.7 33 3.4 1 0.10 2 0.20 1909 9680 116 12.0 63 6.5 3 25.9 29 3.0 2 0.21 5 0.52 1910 9770 105 10.7 82 8.4 8 76.2 23 2.9 2 0.20 2 0.20 1911 9859 92 9.3 75 7.6 8 87.0 25 2.5 1 0.10 2 0.20 1912 9876 97 9.8 76 7.7 4 41.2 29 29 1 0.10 2 0.20 table vi. (5). Vital Statistics of No. S (West End) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack-rate per 1000 of the Population. Deaths occurring. Death-rate par 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 12250 275 22. 4 107 8.7 20 72.1 102 8.3 6 0.49 10 0.82 1903 12320 213 19.7 111 9.0 21 86.4 55 4.5 2 0.16 2 0.16 1904 12380 283 22.8 120 9.7 22 77.7 70 5.6 3 0.24 8 0.65 1905 12450 250 20.1 131 10.5 23 92.0 29 2.3 2 0.16 11 0.83 1906 12510 259 20.7 115 9.2 14 54.1 168 13.4 5 0.40 9 0.72 1907 12580 250 19.9 114 9.1 16 64.0 153 12.2 4 0.32 9 0.71 1908 12640 254 201 121 9.6 26 102.4 68 5.4 10 0.79 12 0.95 1909 12700 239 18.8 118 9.3 13 54.1 51 4.0 2 0.16 7 0.55 1910 12770 216 16.9 121 9.5 17 78.7 41 3.4 4 0.31 13 1.02 1911 12850 216 16.8 102 7.9 15 69.4 44 3.4 5 0.39 5 0.39 1912 12890 226 17.5 126 9.8 13 57.5 65 50 10 0.77 10 0.78 139 TABLE VI. (6). Vital Statistics of No. 6 (Kilburn) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. 7 Principal Epidemic Diseases. Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack-rate per kxx) of the Population. Deaths occurring. Death-rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 11790 435 29.4 219 14.8 45 103.4 76 5.1 11 0.74 23 1.55 1903 14800 417 28.2 184 12.4 39 93.5 59 4.0 3 0.20 15 1.01 1904 11810 408 27.5 206 13.9 54 132.3 43 2.9 8 0.54 25 1.69 1905 14820 426 28.7 171 11.5 50 117.4 57 3.8 2 0.13 9 0.61 1906 14840 441 29.9 197 13.3 41 92.0 128 8.6 5 0. 34 16 1.08 1907 14850 391 26.3 179 12.0 28 71.6 86 5.8 3 0.20 13 0.87 1908 14880 393 26.4 186 12.5 30 76.3 72 4.8 4 0.27 9 0.60 1909 14890 341 22.9 182 12.2 37 108.5 67 4.5 6 0.40 10 0.67 1910 14900 379 25.4 192 12.9 24 63.3 52 3.5 3 0.20 17 1.14 1911 14920 347 23.2 179 12.0 31 89.3 82 5.5 6 0.40 17 1.14 1912 15000 353 23.5 188 12.5 26 73.6 70 4.7 6 0.40 12 0.80 TABLE VI. (7). Vital Statistics of No. 7 (Priory) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infections Diseases. 7 Principal Epidemic Diseases Deaths. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack-rate per 1000 of the Population. Deaths occurring. Death-rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. 1902 10650 162 15.2 110 10.3 16 98.7 44 4.1 1 0.94 3 0.28 1903 10620 194 18.3 116 10.9 21 108.2 43 4.0 3 0.28 7 0.66 1901 10600 152 14.3 121 11.4 13 85.5 23 2.2 .. .. .. .. 1905 10570 133 12.6 103 9.7 14 105.3 44 4.2 3 0.28 5 0.47 1906 10550 150 14.2 93 8.8 9 60.0 31 2.9 2 0.19 4 0.38 1907 10520 127 12.1 94 8.9 7 55.1 29 2.7 .. .. 2 0.19 1908 10500 126 12.0 93 8.8 10 79.3 34 3.2 1 0.09 2 0.19 1909 10480 149 14.2 111 10.6 11 73.8 21 2.0 .. .. 7 0.67 1910 10450 138 13.2 111 10.6 6 43.5 13 1.2 .. .. 2 0.19 1911 10420 143 13.7 115 11.0 9 63.0 26 2.5 1 0.09 4 0.38 1912 10400 117 11.1 115 10.9 7 59.8 23 2.2 1 0.09 2 0.19 140 Table VII. Vital Statistics of Hampstead, compared with England and Wales. Year. Birth rate per 1000. Natural increase Hampstead. Seven Principal Epidemic Diseases deathrate per 1000. Notifiable Infectious disease rate per 1000 Hampstead. General death-iate per 1000. Hampstead. England and Wales. Hampstead. England and Wales. Hampstead. England and Wales. 1875 22.6 35.4 394 - 3.4 - 12.5 22.7 1876 24.4 36.3 367 — 3.1 - 15.2 20.9 1877 24.0 35.0 413 — 2.7 — 13.7 20.3 1873 24.5 35.6 409 — 3.4 — 14.8 21.6 1879 22.8 34.7 365 - 1.9 — 13.2 20.7 1880 24.1 34.2 521 1.2 3.3 — 12.6 20.5 1881 23.8 33.9 502 2.0 2.3 — 12.7 18.9 1882 23.6 33.8 546 2.2 2.7 — 13.0 19.6 1883 23.8 33.5 685 1.8 2.3 — 11.2 19.5 1884 22.0 33.6 554 1.9 2.8 — 12.5 19.5 1885 21.2 32.9 593 1.4 2.2 - 11.5 19.0 1886 21.0 32.8 554 1.2 2.4 — 12.2 19.3 1887 21.9 31.9 628 1.1 2.4 — 11.0 18.8 1888 20.5 31.2 616 1.0 1.8 - 10.6 17.8 1889 21.0 31.1 728 0.95 2.2 — 10.7 17.9 1890 21.9 30.2 613 1.5 2.1 — 13.1 19.1 1891 21.5 31.4 670 1.0 1.9 4.5 12.2 22.5 1892 20.4 30.5 591 1.7 1.8 8.0 12.4 19.0 1893 20.5 30.8 547 1.3 2.47 11.1 12.9 19.2 1894 19.6 29.6 674 1.4 1.76 6.2 10.8 16.6 1895 19.8 30.2 452 1.0 2.14 7.3 13.4 18.7 1896 19.1 29.7 546 1.8 2.18 7.8 12.0 17.1 1897 20.2 29.7 568 1.1 2.15 5.1 11.6 17.4 1898 18.1 29.4 599 1.4 2.22 5.7 11.4 17.6 1899 19.7 29.3 650 1.1 2.21 6.0 11.4 18.3 1900 20.0 28.7 699 1.0 2.00 5.8 11.3 18.3 1901 18.3 28.5 633 0.78 2.05 5.6 10.6 16.9 1902 18.4 28.6 612 0.70 1.64 *5.6 11.0 16.2 1903 17.6 28.4 616 0.51 1.46 *3.8 10.1 15.4 1904 17.4 27.9 553 0.58 1.94 *3.6 10.7 16.2 1905 17.0 27.2 598 0.45 1.52 3.5 9.9 15.2 1906 17.1 27.0 587 0.58 1.73 6.6 10.1 15.4 1907 161 26.3 524 0.49 1.26 5.9 9.7 15.0 1908 16.6 26.5 597 0.45 1.29 4.5 9.5 14.7 1909 15.6 25.6 489 0.58 1.12 3.8 9.9 14.5 1910 15.7 24.8 511 0.54 0.99 2.7 9.7 13.4 1911 14.9 24.4 429 0.59 1.90 *4.0 9.9 14.6 1912 14.9 23.8 420 0.42 — 3.7 10.0 13.3 * Excluding Chicken-pox, which was notifiable during certain periods of these years. INDEX. PAGE Adulteration 99-102 Alcoholism 24 Analyses, Results of 99-102 Analytical Work, Report on 118 Anti-toxin 45 Area of Borough 11 Bacteriological Examinations 65 Bakehouses 109, 110 Birth-Rate 15, 16 Births, Illegitimate 15 „ Number of 14, 15 „ ,. in Wards 16 Cancer 23, 24 Census Statistics 13 Cinematograph Theatres 93, 94 Circulatory System, Diseases of 24 Cleansing of Persons Act, 1897 86 Cleansing Station 70, 85, 86 Combined Drainage 77-82 Complaints Received 104 Consumption 55-66 Customs and Inland Revenue Acts 86,87 Dairies 98 Death-Rate General 17 „ Infantile 29 Death Returns 19, 21-23 Deaths at various ages 19 „ Causes of 21-25 „ in Public Institutions 20,21 „ Non-resident 19 „ Number of 17 „ Outlying 19 „ Uncertified 19 Diarrhœa 52 Diphtheria 43-45 Disinfection 69, 70 Drain and Sewer 77-82 Drainage Work 76, 77 Enteric Fever 46, 47 142 PAGBS Epidemic Cerebro-Spinal Meningitis 48 Epidemic Diseases, Principal Deaths, and Death-Rate 49 Erysipelas 47 Factories 113, 114 Factory and Workshops Act, 1901 107-116 Food Inspection 96 FoodPremises 96,97,98 Health Visiting 32, 33 Home Office Tables 113-116 Homework 112, 115 Houses Let in Lodgings 87, 88 Housing Acts 89,90,91 Ice Cream 99 Infantile Mortality 29-33 Infections Diseases 37-52 „ „ Notifiable 32-48 „ „ „ Attack-Rate 37 „ „ „ Deaths and Death-Rate 38 Inspections and Re-inspections of Premises 75 Intercepting Traps 82-85 Legal Proceedings 121-126 Local Government Board Tables 129-132 Marriages, Number of 1912, and rates 1902-12 14 Measles 50, 51 Milksliops and Milk Supply 98,99 Mortuary, Public 94, 95 National Insurance Act, 1911 66 Natural Increase of population 16 Non-resident Deaths 19 Notifiable Infectious Diseases 37-48 Notification of Births Act, 1907 32 Nuisances, Inspection of 75 Ophthalmia Neonatorum 48 Outlying Deaths 19 Outworkers 112, 115 Polio-myelitis 47, 48 Population. Density of 14 „ Estimated to middle of 1912 13 In Wards 13 „ Natural Increase of 16 Principal Epidemic Diseases 49-52 „ „ Deaths and Death-Rate 49 Public Health Committee 5 Puerperal Fever 47 143 PAGES Rag Flock Act 91-93 Railway Stations Sanitation 85 Respiratory System, Diseases of 24 Restaurant Kitchens 111,112 Sale of Food and Drugs Acts 99-102 Sanatorium Benefit 66 Sanitary Administration, General 73-104 Scarlet Fever 42, 43 Senile Mortality 21 Slaughterhouses 96 Small-pox 41 Staff of the Public Health Department 6, 103 Suicide 25 Summary of Vital Statistics 11 Tenement Houses, Water Supply of 90 „ ,, Registration of 87, 88 Tuberculosis 55-66 Tuberculosis Dispensary 60 Uncertified Deaths 19 Underground Rooms 90 Vaccination 41,42 Verminous Persons 70,85, 86 Verminous Premises 70,85,86 Vital Statistics 11-25 Violent Deaths 25 Water Supply, Certificates as to 76 „ „ of Tenement Houses 90 Whooping Cough 52 Workshops 107,113,114,116 Workplaces 111-114 .