HAMP 69 THE Metropolitan Borough of Hampstead. REPORT FOR THE YEAR 1913. OF THE Medical Officer of Health. FRANK E. SCRASE, E.R.C.S. (Eng.), L.R.C.P. (Lond. , D.P.H. (Lond.) CONTENTS. pages Vital Statistics 11-29 Infantile Mortality 30-38 Infectious Diseases 39-66 Tuberculosis 67-89 Disinfection 90-94 General Sanitary Administration 95-131 Factory and Workshop Act, 1901 132-144 Report on Analytical Work 145-146 Legal Proceedings 147-153 Appendix I.—Tables 154=168 Appendix II.—Report on the Municipal Tuberculosis Dispensary 169-178 Index 179-181 5 PUBLIC HEALTH COMMITTEE, NOVEMBER 1912-13. Ex-Officio. His Worship The Mayor. (Mr. Councillor (jr. W. Holtzapifel, J.P.) Chairman. Mr. Councillor C. J. Iligginson. Miss Councillor M. E. Balkwill. Mr. Councillor V. H. le B. Blesslcy (until June). „ G. Buckle. „ F. C. Channing (from June). „ 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. R. J. J. Willis. 6 STAFF OF THE PUBLIC HEALTH DEPARTMENT, MARCH, 1914. Sanitary Inspectors. W. G. Kershaw, Senior Inspector. R. Geary, No. 1 District (Wards I and 2), W. F. Horniblow, No. 2 District (Wards 3 and 7), A. Pcverctt, No. 3 District (Wards 4 and 5), J. Grimsley, No. 4 District (Ward 6), Dicisional Inspector. F. H. Hudson, Sale of Food and Drugs Acts, and Factory and Workshop Act. A. C. Townsend, Housing of the Working Classes, and Housing, Town Planning, etc., Act. Mrs. T. Fisher, M.A , Factor;/ and Workshop Act, and Infectious Disease and Tubt rculosis Regulations. Mrs. K. Rugbe, Notification of Births Act, and Infectious Disease. 3 AssistanWnspectors. Public Mortuary. W. Larkcn, 63, Flask Walk, Keeper. Disinfecting Station. T. Rider, G. Allawav, and 11. Bell, Disin/ectors. Mrs. Rider, Attendant at Cleansing liooin. Tuberculosis Dispensary. J. King Patrick, M.D., 15.Sc., D.1ML, Tuberculosis Medical Officer, and Deputy Medical Officer of Health. Miss G. Goodchild, Nunc. Clerical Staff. 1 Clerks and 1 Clerk-Draughtsman. Public Analyst. A. W. Stokes, F.C.S., F.I.C. Medical Officer of Health. Frank F. ScrasC, F.H.C.S. (,Ejig.J), L.R.C.1'. (Lond.l, D.P.1I. (Loud.) 7 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W. 24th March, 1914. 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 1913. All the Returns required by the Local Government Board and by the Home Office in relation to the Factory and Workshop Act, have been incorporated therein. A report of the Tuberculosis Medical Officer on the working of the Municipal Tuberculosis Dispensary from February 1st to December 31st, 1913, will be found in Appendix II., page 109. The year under review lias been an unusually busy one in the Public Health Department. A considerable amount of new work has been thrown on the Department both by recent legislation and by local activity. Among other things may be mentioned the Sanatorium Benefit of the National Insurance Act; the Public Health (Tuberculosis) Regulations, 1912, which came into operation on February 1st, 1913, the establishment of the Municipal Tuberculosis Dispensary; and the opening of the Health Institute. These additions necessitated the appointment of three additional officers in the Public Health Department, viz.: Tuberculosis Medical Officer, Tuberculosis Nurse, and an additional Clerk. In respect to the statistics of the Borough, it will be noted that Hampstead's death-rate for the first time for many years is not the lowest in London, being slightly higher than Lewisham and Wandsworth. That the death-rate of Hampstead should rise is only to be expected, for, as will be seen by the tables on pages II and 15, the average age of the population of the Borough is steadily rising. Hampstead still holds the premier position as regards infantile mortality, the infantile death-rate being the lowest of all the Metropolitan Boroughs. 8 In presenting this review of the work of the Public Health Department for 1913. I wish to thank the Council and the Chairman and Members of the Public Health Committee for the kindly support and encouragement they have ever given me. I desire also to express my appreciation of the earnest efforts of the members of the staff of the Department whilst according me their assistance and able 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 1913. Population estimated to middle of 1913 86,346 Density „ „ „ 38.1 persons per acre Births 1325 Birth-Rate 15-0 Marriages 643 Marriage Rate 14-9 Deaths 951 Death-Rate 10.8 Infantile Mortality 69 per 1000 births Notifiable Infectious Diseases Attack-Rate (excluding Tuberculosis) 4.3 Notifiable Infectious Diseases Death Rate „ 0.15 Death-Rate from the Principal Epidemic Diseases 0.44 Death-Rate from Pulmonary Tuberculosis 0.56 Death-Rate from All Forms of Tuberculosis 0.81 Census, 1911. Population 85,495 Buildings used as Dwellings 11,976 Ordinary Dwelling Houses 10,062 Area of Borough 2265 acres „ „ (excluding area covered by water) 2253 acres 13 POPULATION. The population of Hampstead at the middle of 1913 was estimated by the Registrar-General to be 86,346. The Registrar-General's estimate has been adopted in this Report, and it forms the basis upon which the various rates have been calculated. A method of calculation, however, applicable to many localities cannot take cognisance of special factors such as the railway widening that has been in progress for many months past in the Adelaide and Priory Wards. In the former Ward over 20 houses, and in the latter over 50 houses were pulled down. The last census showed that in these two Wards the population was decreasing, and the demolitions referred to have assisted further in their depopulation. It is inevitable that there should be some degree of error in any estimate of a population, especially towards the end of a decade. The following is an approximate estimate of the population of each Ward at the middle of 1913:— Ward 1 (Town) 14250 „ 2 (Belsize) 14000 „ 3 (Adelaide) 9780 „ 4 (Central) 9996 „ 5 (West End) 13050 „ 6 (Kilburn) 15200 „ 7 (Priory) 10070 The Borough 86346 The following statistics relating to the condition of the population of Hampstead with regard to Marriage, Age and Sex arc extracted from the Census returns published in 1913:— 14 AGES. Males. Females AGES. — Unmarried Married Widowed. All Ages 32,807 52,688 All Ages Persons 53,513 26,964 5,018 Males 18,642 13,155 1,010 Females 34,871 13,809 4,008 Under 1 year 579 572 Under 15 years Males 8,113 - - 1 565 579 Females 8,793 — — 2 591 602 15 Males 472 — — 3 539 556 Females 705 — —- 4 554 634 16 Males 476 — — Females 785 — — 5 578 532 17 Males 524 — — 6 550 594 Females 958 2 — 7 547 565 18 Males 624 — - 8 514 596 Females 1,093 4 - 9 576 579 19 Males 619 4 — Females 1,142 9 - 10 557 554 20 Males 625 9 — 11 493 654 Females 1,272 25 — 12 513 573 13 469 596 15 and under 20 Males 2,715 4 — 14 488 607 Females 4,683 15 — 15 472 705 20 „ 25 Males 2,974 285 1 Females 6,405 601 8 16 476 785 25 „ 30 Males 1,893 1,135 12 17 524 960 Females 4,859 1,654 25 18 624 1,097 30 „ 35 Males 1,034 1,724 20 19 623 1,151 Females 2,911 2,106 117 20 634 1,297 35 „ 40 Males 688 1,905 27 Females 2,122 2,237 198 40 „ 45 Males 409 1,883 51 Females 1,591 1,938 266 Under 5 years 2,828 2,943 45 „ 50 Males 262 1,752 61 5 and under 10 2,765 2,866 Females 1,114 1,746 393 10 „ 15 2,520 2,984 50 „ 55 Males 200 1,524 83 15 „ 20 2,719 4,698 Females 828 1,333 433 20 „ 25 3,260 7,014 55 „ 60 Males 128 1,080 91 Females 532 861 490 25 „ 30 3,040 6,538 60 „ 65 Males 94 795 153 30 „ 35 2,778 5,134 Females 359 610 509 35 „ 40 2,620 4,557 40 „ 45 2,343 3,795 65 „ 70 Males 66 535 148 45 „ 50 2,075 3,253 Females 269 377 511 50 „ 55 1,807 2,594 70 „ 75 Males 38 821 154 Females 194 208 488 55 „ 60 1,299 1,903 75 „ 80 Males 18 143 112 60 „ 65 1,042 1,478 Females 118 75 308 65 „ 70 749 1,157 80 „ 85 Males 6 53 61 70 „ 75 513 890 Females 68 18 169 75 „ 80 273 501 85 „ 90 Males 3 13 29 Females 20 7 71 80 „ 85 120 255 85 „ 90 45 98 90 „ 95 Males 1 3 6 90 „ 95 10 20 Females 3 3 14 95 „ 100 1 9 95 „ 100 Males — — 1 Females 2 — 7 100 years and upwards — 1 100 years and upwards Males — — — Females - - 1 Unmarried 22,571 Females aged 15—45 Married 8,551 Widowed 614 15 The following table shows the percentage of the population at all ages, unmarried, married, and widowed at the Census of 1891, 1901 and 1911:— Year. Unmarried. Married. Widowed. 1891 66.5 28.1 5.4 1901 64.6 30.0 5.4 1911 62.6 31.5 5.9 The population of Hampstead is here shown arranged in percentages at various age periods, and the fact of the increasing age of the population is clearly demonstrated:— Census Year. Percentage of Population at age Periods Under 1 1—5 5-15 15—25 25—65 65— 1891 2.0 7.4 17.5 24.1 45.0 4.0 1901 1.7 6.2 14.8 23.0 49.8 4.5 1911 1.4 5.4 13.0 20.7 54.1 5.4 The following particulars relating to the distribution of the population of Hampstead in ordinary dwelling houses, flats, etc., are of interest. It will be noticed that nearly 10 per cent. of the inhabitants of the Borough live in flats, which, for the purposes of the Census, are defined as structurally distinct dwellings within the same building:— Ordinary Dwelling Houses. Separate Flats. Population Persons in Population Persons in Number. therein. each. Number. therein each. 10062 67148 6.7 2220 7606 3.4 At the Census, 526 dwelling houses, and 26M separate flats were uninhabited, while 13 ordinary dwelling houses were being built. The balance of the population—10,741—were returned as having been enumerated in other buildings used as dwellings, e.g., Institutions, Shops, Public Houses, etc. 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 16 to the acre is 38.1. 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 643 marriages were registered in the Borough during 1913. The total number of persons married in Hampstead during 1913 was 1286, which is equivalent to a rate of 14.9 per 1000 of the population, and is a decrease on that for the year 1912, when the marriages of 1294 persons were registered, equivalent to a rate of 15.0 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. 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 1912 15.0 Average for the decade 15.0 1913 14.9 BIRTHS. During the year, 1258 births were registered in Hampstead (one birth was re-registered during the year for legal purposes), an increase of 34 as compared with the number—1224—registered in the previous year. Of the total births 654 were of male and 604 of female children. Tn addition, 71 births of children whose mothers were Hampstead residents occurred in the principal lying-in institutions, etc., in other 17 metropolitan boroughs, and four of the births registered in Hampstead belonged toother 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 1325, and, in accordance with the practice of the Registrar-General, I have taken this number as a basis for the various rates that depend on the number of births occurring during the year, Still-Births:—Still-births are required to be notified to Medical Officers of Health under the provisions of the Notification of Births Act, 1907, This Act applies to any child born after the expiration of the twenty-eighth week of pregnancy, whether alive or dead. Calculated on the total number of births notified, the still-births for the years 1909—1913, represent a percentage of 2'1. The actual numbers of still-births notified in each year since 1909 are as follows :— 1909,28; 1910,21; 1911,25; 1912, 28; 1913,23. At present, still-births are not required by law to be registered, as is the case with the births of children born alive. On more than one occasion attention has been prominently drawn to the question of the registration of still-births, and important bodies for instance the Inter-Departmental Committee on Physical Deterioration, have expressed emphatic opinion in favour of such registration. The registration of still-born children would be an advantage by the knowledge it would give of the frequency of the occurrence, and such knowledge would be of great value in elucidating the causes of infantile mortality by giving information of ante-natal conditions prejudicial to survival, It might also be made a check upon mal-practice. Birth-Rate. The birth-rate, calculated on the number of births registered in the Borough, was 14.3 per 1000 of the population, as compare 1 with the rate of 14.2 per 1000 in 1912. 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 15.0, as compared with the rate of 14.9 in 1912, and 15.5, the average for the years 1908-1912. 18 The rate of 15.0 is, however, only a very slight increase over the rate for the years 1911 and 1912, which was 14.9—the lowest birth-rate ever recorded in Hampstead. 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, notwithstanding the fact that the marriage rate has not declined, but has remained constant at about 15 per 1000 for the past six years. Though the birth-rate shows a trifling increase this year, this would not have occurred but for the noteworthy increase in illegitimate births belonging to Hampstead. The low and declining birth-rate is common to the whole country, and there can be little doubt that it must be due to deliberate restriction in child-bearing. It is a significant fact that at the last Census period 1900-2, the fertility of English wives was lower than that recorded in any European country except France. The following extract from the Census returns relating to Married Women of conceptive ages in Hampstead elearly indicates the great change that is taking place in this direction:— Census. No. of Married Women. Total Aged 15—45. Aged 15—20. Aged 20—25. Aged 25—35. Aged 35—45. 1901 41 743 4001 3678 8463 1911 15 601 3760 4175 8551 So far as Hampstead is concerned, it is obvious from the Census returns that the possible favourable effect on the birth-rate that might have been expected from the higher percentage of population at all ages married,—which has increased from 28.1 per cent. in 1891 to 31.5 in 1911,—is counter-balanced by the increased age-status of the population. 19 The following table shows the Ward and sex-distribution of the live-births, and the birth-rate for each Ward:— Ward. Births. Birth-rate per 1000 of the population. Males. Females, Total. No, 1 (Town) 113 88 201 13.8 No. 2 (Belsize) 104 110 214 15.0 No. 3 (Adelaide) 59 38 97 9.7 No. 4 (Central) 47 44 91 8.9 No. 5 (West End) 126 114 240 18.0 No, 6 (Kilburn) 170 184 354 22.8 No, 7 (Priory) 70 58 128 12.5 The Borough 689 636 1325 15.0 It will be seen, by comparing these figures with the death-rates in each Ward, as shown on page 21, that in the Adelaide Ward the birthrate was actually lower than the death-rate. This was also the case in the Adelaide Ward in 1911. The Natural Increase of the population—i.e., the excess of births over deaths—was 374 in 1913. Reference to Table VII., page 1GS shows the decline in the Natural Increase in our population that has occurred in recent years. Illegitimate Births.—Out of the total of 1,325 births 73, or 55 per 1000, were those of illegitimate children ; 29 of these were born outside the Borough, chiefly in lying-in institutions. These figures are noteworthy, showing as they do a most remarkable increase in the number of illegitimate births within the last two years. For purposes of comparison, I append a table of the illegitimate births occurring in the Borough for the past twelve years, by which it will be 20 seen that the illegitimate births in 1913 are, as in 1912, 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 4.3 32.0 1908 29 21.0 1909 43 33.0 1910 36 28.0 1911 37 29.0 1912 76 59.3 1913 73 55.1 The reason for this increase in not clear, but it is probably due to more than one cause. In 1012, for the first time, the Registrar-General informed us how many of the births, occurring outside the Borough, and allocated to Hampstead were illegitimate. These births took place chiefly in lying-in institutions, and in respect of these, the presence of a very large number of domestic servants in Hampstead must be borne in mind. I am also of opinion that the National Insurance Act has indirectly added the knowledge of not a few cases to our illegitimate birth list. These are cases that, previous to the National Insurance Act, there was no inducement to reveal; but many, probably all, these mothers are insured people, and as such are entitled to a doctor and 30/- maternity benefit upon confinement. Where, formerly, illegitimate births were not registered at all, or, if they were, were registered as legitimate, the}' now are revealed first by notification, and secondly by the mother for the sake of the maternity benefit. DEATHS. The total deaths occurring in Hampstead during the year amounted to 1,273. Of these, however, no less than 474 were of persons not belonging to the Borough, while 152 residents of Hampstead died ill outlying districts. 21 The total number of deaths, therefore, amongst persons belonging to Hampstead amounted to 951. 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 14.5 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 10.8 per 1000 of the population, as compared with the rate of 10.0 per 1000 of the population in 1912. The average recorded death-rate for the five years 1908-1912 was 9.8. The following are the death-rates for each of the Wards:— WARD. Death-rate per 1,000 of the population. No. 1 (Town) 11.1 No. 2 (Belsize) 8.8 No. 3 (Adelaide) 9.9 No. 4 (Central) 8.2 No. 5 (West End) 10.9 No. 6 (Kilburn) 13.7 No. 7 (Priory) 11.4 In the table on page 108 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:— 22 Table showing the Death-Rates from All Causes in the County of London, the City of London, and tub Metropolitan Boroughs during 1913, as calculated by the Registrar-General. DISTRICT. Death-rate from all causes. Lewisham 10.6 Wandsworth 10.6 Hampstead 10.7 Fulham 12.5 Woolwich 12.6 City of Westminster 12.7 Hackney 13.4 Paddington 13.4 Stoke Newington 13.6 Camberwell 13.7 Kensington 13.7 Battersea 13.9 Chelsea 13.9 Hammersmith 13.9 St. Marylebone 14.0 Greenwich 14.2 Lambeth 14. 3 Holborn 14.6 Stepney 14.9 Islington 15.1 City of London 15.2 St. Pancras 15.2 Deptford 15.3 Bethnal Green 15.4 Poplar 16.3 Southwark 17.4 Bermondsey 17.9 Finsbury 18.3 Shoreditch 18.6 County of London 14.2 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-Generals figures for all the Boroughs have not yet been completely corrected for transferable deaths. 23 Deaths of Non-Residents, Residents, and Outlying Deaths. The Registrar of Births and Deaths for Hampstead furnishes me weekly with a Return of all the births and deaths that are registered in Hampstead. From these Returns it appears that 1273 deaths were registered in Hampstead during the year, and of these 471 were of persons belonging to other districts. On the other hand 152 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, 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 159 and 160. 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 91 35 23 23 37 118 265 359 951 Uncertified Deaths. No Hampstead resident's death in 1913 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 arc regarded as " uncertified." Deaths in Institutions. The number of deaths of Hampstead residents that occurred in institutions was 297 or 31.2 per cent. of the total deaths of residents. 102 deaths took place in workhouses or workhouse infirmaries, equivalent to 34 per cent. of the deaths in institutions or 10 7 per cent. of the total deaths of Hampstead residents. The following is a list of the institutions, and the number of deaths which occurred in each:— 24 Deaths of Hampstead Residents in Institutions. Institution. Totals. Group Totals. Infirmaries and Workhouses— Barnet Workhouse Infirmary 2 102 Hampstead Workhouse 96 Roly Infirmary, South Manchester 1 St. Pancras Infirmary 3 Hospitals, Nursing Homes, etc.— 148 148, Abbey Road l 218, Adelaide Road 3 12, Beaumont Street 1 26, Belsize Avenue 2 33, Belsize Square 5 34, Belsize Square 2 Buxton Sanatorium 1 Cancer Hospital 1 Charing Cross Hospital 2 Children's Hospital, Great Ormonde Street 1 Children's Hospital, Paddington Green 2 Chiswick House, Chiswick 1 Cottage Hospital, Harrow 1 Croydon General Hospital 1 Friedenheim, Avenue Road 10 80, Fordwych Road 2 German Hospital, Dalston 1 Great Northern Hospital 1 Guy's Hospital 1 Hampstead General Hospital 30 Heart Hospital, Soho 1 12, Hinde Street, St. Marylebone 1 Homoeopathic Hospital 1 Home Hospita1, 16, Fitzroy Square 2 Hospital for Epilepsy and Paralysis 1 Hospital for Incurable Children, College Crescent 1 Hospital of St. John and St. Elizabeth 1 Infants' Hospital, Vincent Square 1 Kendrick House, Newbury 1 King's College Hospital 2 57, King Henry's Road 2 London Temperance Hospital 4 London Hospital 2 Middlesex Hospital 9 Marting's Farm Sanatorium, Nayland 1 Mount Vernon Hospital 1 National Hospital, Queen's Square 1 National Hospital, East Finchley 1 Neville Crescent, The Hydro 1 New Hospital for Women 1 Peckham House 1 25 Deaths of Hampstead Residents in Institutions—cont. Institution. Totals. Group Totals. Hospitals, Nursing Homes, etc.—cont. 31, Porchester Square 1 Queen Charlotte's Hospital 2 "Rossinieres," Sutton l 10, Rosslyn Hill 2 St. Bartholomew's Hospital 2 St. Andrew's Hospital, Dollis Hill 1 St. Catherine's Hospital, Ramsgate 1 St. George's Hospital 1 St. Luke's Hospital 1 St. Luke's Hostel, 14, Fitzroy Square 1 St. Luke's House, 14, Pembridge Square 1 St. Mary's Hospital 12 St. Peter's Home 2 St. Thomas's Hospital 2 Seamen's Hospital. West Ham 1 97 & 99, South Hill Park 2 18, Southwold Road, Upper Clapton 1 116, Sutherland Avenue 1 Throat Hospital, Golden Square, W.C. 1 7, The Terrace, St. Pancras 1 University College Hospital 5 14a, Upper Wimpole Street 1 Metropolitan Asylums Board's Hospitals— Brook Hospital 1 14 Darenth Industrial Colony 2 North Western Hospital 10 South Eastern Hospital l Asylums— Banstead 1 33 Bethlem Royal Hospital 1 Camberwell House 2 Claybury 2 Colney Hatch 9 Epileptic Colony, Lingfield 1 Fountain Temporary Asylum, Tooting Grove 1 Hanwell 6 Leavesden 5 Long Grove 1 Park Hospital 3 Tooting Bec 1 297 The names of the Institutions that are situated in Hampstead are printed in heavy type. Mortality Among Young Children, In order to ascertain how far the steps taken to preserve infant life in Hampstead have had a beneficial effect upon young children, I 26 have had the following table prepared. In this table is shewn the infantile mortality rate, and the death-rate among children under five years of age. The former rate has been calculated on the usual basis, while the latter rate has been obtained by calculations based upon the number of deaths of children under five years of age, and the number of children born in the year mentioned and in the four preceding years. It will be observed from these figures the decrease that is, on the whole, taking place in the mortality amongst Hampstead children during the first quinquennium of life. In the recently published report of the Local Government Board on Infant and Child Mortality, the death-rate in Hampstead of children aged between one and five years for the period 1907.10 is stated to be the lowest of any of the sanitary districts in the County. Year Deaths of Infants under Deaths of Children under 1 year of age. 5 years of age. No. Rate per No. Rate per 1000 children 1000 births born in the year and in preceding four years. 1901 155 102 233 30. 2 1902 133 88 195 25.2 1903 126 87 177 23.1 1904 161 111 226 30.0 1905 133 94 189 25.7 1906 111 77 171 23.5 1907 98 69 154 21.7 1908 97 69 122 17.3 1909 99 74 148 21.3 1910 81 60 132 19.2 1911 105 82 152 22.7 1912 79 62 131 19.8 1913 91 69 149 22.7 It is thus seen that the death-rate of children under five years of age has not fallen nearly to the extent of the rate for babies under one year. The period from one to five years is at present the most unsupervised of all ages, but a movement has been begun in Hampstead to remedy this. The Council of Social Welfare has, in co-operation with the Provident Dispensaries, initiated a scheme whereby all children prior to school age arc to be medically examined by one of the staff of the Provident Dispensaries, and a full report of the child's physical 27 condition submitted to a competent committee for consideration. This has been a much needed arrangement, and I look upon it as one from which great and lasting benefit may accrue. Senile Mortality. The deaths of persons of 65 years of age and upwards numbered 359, as compared with 300 in 1912. CAUSES OF DEATH. The causes of death are given in Table III. of the Local Government Board's series of tables, see page 159. The mortality from the various communicable diseases is given in the section of the Report devoted to those diseases, see pages 42 and 57. 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 1913 100 1.14 Of the 100 deaths from cancer, 56 were of females and 44 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, and thus for this year Cancer was more frequent in males than in females. In 43 cases the patients were over 65 years of age. 28 The next table gives the anatomical distribution of the disease in each sex. Situation. Males. Females. Total. Buccal cavity 3 - 3 Stomach, Liver, &c. 7 7 14 Peritoneum, Intestines and Rectum 15 16 31 Genital Organs 1 12 13 Breast - 9 9 Other, or unspecified, organs 18 12 30 Totals 44 56 100 Alcoholism. In 3 cases death was certified to be due to alcoholism, and 15 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, 18, as compared with 8 in 1912, but this is certainly an under-statement of the total mortality that may be directly attributed to this drug. A true return of the mortality from Alcoholism and Venereal disease will not be forthcoming until some radical alteration takes place in the method of death certification. I feel sure that if the system of notification of births was extended to the notification of deaths, and the medical attendant was required to notify deaths and their causes to the Medical Officer of Health, we should have a much more reliable guide to the death-rate from causes such as Alcoholism and Venereal disease. Diseases from Organic Heart Disease. These accounted for 104 deaths, as compared with 100 in 1912. Diseases of the Respiratory System. The total mortality from these diseases was 145, as compared with 135 in 1912. Twenty-one deaths occurred in children under five years of age, and 63 in persons aged from 65 and upwards. Of the total deaths, 58 were due to bronchitis, 73 to pneumonia, and 14 to other diseases of the respiratory organs. 29 Violent Deaths (excluding Suicide). Twenty-one deaths were classified under this heading, being the same number as in 1912. Three were due to poisoning, 1 to burns, 1 to absorption of deleterious gases, 1 to drowning, 1 to injury by revolver, 7 to falls, 3 to injuries by being run over or crushed by motor vehicles, 1 to carriage accident, 1 to lift accident, and 2 to suffocation (one of these being a child aged one day, in bed with its parents). Suicide. Twelve persons committed suicide, as against 16 in 1912. In 3 cases the cause of death was poisoning, 3 deaths were due to hanging or strangulation, 5 to bullet wounds from rifles or revolvers, and 1 to a fall from window. Infantile Mortality. 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 2 1 1 1 5 6 Diphtheria and Croup .. .. .. .. .. .. .. .. .. 7 Erysipelas .. .. .. .. .. .. .. .. .. 8 Tuberculous Meningitis .. .. .. .. .. .. 1 .. 1 9 Abdominal Tuberculosis .. .. .. .. .. .. .. .. .. 10 Other Tuberculous Diseases .. .. .. .. .. .. .. .. .. 11 Meningitis (not Tuberculous) 1 .. .. .. .. .. .. .. 1 12 Convulsions .. 1 .. .. .. 1 .. 1 3 13 Laryngitis .. .. .. .. .. .. .. .. .. 14 Bronchitis .. 1 .. 1 1 .. .. 3 15 Pneumonia (all forms) .. .. 1 .. .. 2 .. .. 3 l6 Diarrhoea .. 1 1 .. 1 1 1 .. 5 17 Enteritis 1 2 .. 1 3 1 .. 8 18 Gastritis .. .. .. .. .. 1 1 .. 2 19 Syphilis .. .. 1 .. .. .. 1 .. 2 20 Rickets .. 1 .. .. .. .. .. .. 1 21 Suffocation, overlying .. .. .. 1 .. 1 .. .. 2 22 Injury at Birth 1 1 .. 1 .. .. .. .. 3 23 Atelectasis .. .. .. .. .. .. .. .. .. 24 Congenital Malformations 1 2 .. 1 .. 1 .. .. 5 25 Premature Birth 2 3 3 1 5 6 2 .. 22 26 Atrophy, Debility, and Marasmus 1 3 2 7 2 .. 15 27 Other Causes 2 .. 2 1 1 1 2 .. 9 Totals 11 16 9 6 11 25 12 1 91 33 INFANTILE MORTALITY. The number of deaths of Hampstead children under 1 year was 91, an increase of 12 as compared with the previous year The "Infantile Mortality"—ie, the number of deaths under one year per 1000 births-was 68.7, as compared with the rate of 62 per 1000 births in 1912, 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 19081912 was 69-6. The infantile death-rate for the year 1913, 68.7, was very low, and only in two previous years has a lower rate been reached, viz, in 1910, when the rate was 60, and in 1912, when the rate was 62 34 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 1913 69 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:— 35 Table showing the Infantile Death Rates of the County of London, the City of London, and the Metropolitan Boroughs during 1913, as calculated by the Registrar-General. DISTRICT, Deaths under 1 year to 1000 Births. Hampstead 73 Lewisham 78 Woolwich 79 Stoke Newington 82 Wandsworth 88 Chelsea 90 St. Marylebone 91 St. Paneras 92 Fulham 96 City of London 96 City of Westminster 96 Hackney 99 Paddington 100 Lambeth 102 Greenwich 103 Hammersmith 103 Holborn 104 Camberwell 106 Islington 107 Battersea 111 Deptford 112 Kensington 112 Poplar 112 Stepney 112 Southwark 115 Bethnal Green 118 Bermondsey 132 Finsbury 138 Shoreditch 155 County of London 105 Note:—It will be seen that, as in the case of deaths at all ages from all causes, the rate as calculated by the Registrar-General differs from that which I have stated. 36 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 Act, 1907, by which Act all births are required to be notified to the Medical Officer of Health within 36 hours of their occurrence. 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 1913 is the fifth for which we possess a complete annual record of the working of the Act . The number of births notified in 1913 was 1210, including 23 still-births, the number of live-births notified being 1187. The total number of live-births occurring in Hampstead in 1913 was 1245, so that the number of live-births notified formed 95.3 per cent. of the number that actually occurred, this being a very satisfactory percentage. 316 births were notified by medical practitioners, 171 by midwives, 672 by parents and 51 from other sources. Of the births notified to the Medical Officer of Health upwards of 800 (about 68 per cent.) were selected for visitation, and 1,116 visits and re-visits were paid. During the past year the widespread efforts to teach personal hygiene have been continued. The visit of the lady inspector, which is made soon after the birth of an infant, enables her to observe obvious sanitary defects in the home or its arrangements, to advise in matters of health, and often to advocate the seeking of medical advice when such is necessary. Chief among our efforts to check wastage of infant life should be placed the co-called Mothers' Welcome at the Health Institute. To this, as soon as the mother is able to get about, she is invited to bring her baby for the purpose of obtaining advice as regards the rearing of children, and to have her child weighed so that its general condition may be watched. Mrs. Roche, one of the Council's Health Visitors, attends the meetings of the Infants' Committees (East and West) of the Hampstead Health Society, and there informs the Committees of those mothers who, in her opinion, need befriending and helping. A visit to 37 the Health Institute on any baby-weighing day will convince one of the great popularity of the movement, and the ready means it affords for watching over the health of the babies, and for checking any unwise feeding, etc., by the mother. The weighing of babies takes place as follows:— On Wednesdays, between 2.30 and 4.30, at the Health Institute, Kingsgate Road. On Thursdays, between 2.30 and 4.0, at St. Stephen's Rooms, Pond Street. Where conditions of ill-health are partly due to poverty and ignorance, some improvement is frequently brought about by the efficient help of the various charitable agencies which work in close co-operation with the Public Health Department. The Infants' Visitors' Committees of the Hampstead Health Society, besides their invaluable work of visiting and befriending mothers during the first year of the life of their infants, provide milk and oatmeal where the father is, unfortunately, out of work. The Hampstead Creche supplies good hot dinners to nursing or expectant mothers at the low rate of 2d. per meal. The Invalid Children's Aid Association, of whose executive committee the lady inspector is a member, gives most efficient and kindly aid in getting suitable cases removed to the country or seaside, and in providing extra nourishment and clothing for delicate and ailing children. The devitalising effects of poverty, of which the inspector in her work sees so much, are thus to a great exteat counteracted. Hampstead has reason to be proud of its low infantile mortality rate, which is the lowest in London, and which has reached a point lower than some authorities have deemed it possible to attain. To further lessen this figure it will be necessary to search for, and endeavour to combat, ante-natal causes; and among the best aids to this purpose would be, as stated on page 17, the compulsory registration of still-births of whatever period of development, and the extension of the system of notification of births to the notification of deaths. One of the most powerful aids in the direction of ascertaining ante-natal causes would be a transference of the maternity benefit under the National Insurance Act to the local authority could such a transference be accomplished. I believe, by its means, expectant mothers could be got to notify their condition to the Medical Officer of Health, especially if the benefit was 38 conditional upon such notification. There would then be a chance of ascertaining and combating ante-natal causes of infantile mortality, of which at present we have no knowledge, and against which we have no weapon. Bearing 011 the subject of infantile mortality there is what appears to me a singular and unjust arrangement concerning the Maternity Benefit under the National Insurance Act, and that is that a married woman, wife of an insured man. cannot claim sickness benefit during pregnancy, but an insured woman can claim such sickness benefit even if she is not married at all. This seems to me to be at least anomalous if not unjust to the married woman. Deaths among Legitimate and Illegitimate Infants. I have prepared the following figures to show the great difference that exists in the infantile death-rates of legitimate and illegitimate children under one year of age. Year. Legitimate Infants. Infantile death rate per 1000 births. Illegitimate Infants. Infantile death-rate per 1000 births[/##] Births. Deaths. Births. Deaths. 1906 1403 106 75 34 5 147 1907 1298 85 65 43 13 302 1908 1326 87 66 29 10 345 1909 1239 88 71 43 11 256 1910 1233 71 57 36 10 278 1911 1239 94 76 37 11 297 1912 1207 68 56 74 11 149 1913 1252 73 58 73 18 246 Calculated upon the totals of the above figures the average deathrates of legitimate and illegitimate children under one year for the period 1906-1913 arefound to be 66and 241 per 1000 respectively. It is obvious that there is an excessive death-rate among illegitimate children, and the matter is one of great difficulty. There seems to be little that will serve as a substitute for true maternal care, but special attention is now being given to all illegitimate births that come under our notice as occurring among Hampstead women; and I am not without hope that the very high death-rate that obtains among illegitimate children of this Borough will be reduced in future years. Infectious Diseases. 41 NOTIFIABLE INFECTIOUS DISEASES. (EXCLUDING TUBERCULOSIS). Information concerning Tuberculosis will be found in the Tuberculosis Section (See pages 68-69). The list of infectious diseases notifiable in London under Section 55 of the Public Health (London) Act, 1891, during 1913 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 Typhoid Fever The total cases of infectious diseases notified numbered 374. This is equivalent to an attack rate of 4.3 per 1000 of the population. The following shows the number of cases of each disease notified: — Diphtheria and Membranous Croup 116 Erysipelas 32 Scarlet Fever 198 Enteric Fever 14 Puerperal Fever 1 Polio-Myelitis 4 Ophthalmia Neonatorum 9 The number of fatal cases was 13, equal to 3.4 per cent, of the eases not1f1ed. The deaths were d1str1buted as follows: — D1SEASE. WARDS Totals. No. 1 (Town). No. 2 (Bels1ze). No. 8 (Adela1de). No. 4 (Central). No. 5 (West End). "No. 6 (K1lburn), No. 7 (Pr1ory). D1phther1a and Membranous Croup 1 . . . . . . . . 1 1 3 Erys1pelas . . l . . . . 1 . . . . 2 Scarlet Fever 1 2 . . . . . . 1 . . 4 Enter1c Fever 1 . . . . . . . . . . 1 Puerperal Fever . , 1 l . . 2 Pol1o-Myel1t1s . . 1 . . . . . . . . . . 1 Totals 3 5 . . . . l 3 1 13 The death-rate from the notifiable 1nfect1ous diseases was 0.15 per 1000 of the populat1on. 42 43 Cases of Infectious Disease occurring In each Month during 1913. Disease. MONTHS. Totals. January February. March. Apr1l. May. June. July. August. September. October. November. December. D1phther1a and Membranous Croup u 12 7 n 10 8 5 4 4 17 14 13 116 Erys1pelas 2 4 2 3 1 3 1 2 2 4 3 5 32 Scarlet Fever 19 10 11 11 13 9 17 8 23 26 25 26 198 Enter1c Fever 3 . . . . 3 1 . . . . 2 2 3 . . . . 14 Puerperal Fever . . . . 1 . . . . . . . . . . . . . . . . . . 1 Pol1o-Myel1t1s . . 1 . . . . . . . . . . 2 . . 1 . . . . 4 Ophthalm1a Neonatorum 1 . . . . 1 2 1 . . 1 1 . . 1 1 9 Totals 36 27 21 29 27 21 23 19 32 51 43 45 374 Cases of Infectious Disease occurring in each Ward during 1913. 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) Diphtheria and Membranous Croup 36 23 2 11 15 19 10 116 Erysipelas 2 9 2 5 6 5 3 32 Scarlet Fever 19 17 22 18 33 78 11 198 Enteric Fever 3 .. .. 4 3 2 2 14 Puerperal Fever .. 1 .. .. .. .. .. 1 Polio-Myelitis 1 1 .. .. 1 1 .. 4 Ophthalmia Neonatorum .. 1 1 .. 1 5 1 9 Totals 61 52 27 38 59 110 27 374 45 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. Births. 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 fcr (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) (Col. 6) (Cols. 8 & 9) (Cols.6,8,&9). 81.7 2.6 7.4 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 826 10 249 46 7 94 67.0 20.2 8.2 28.4 1913 1237 686 5 281 55 28 182* - — — — 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 65 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. 46 It will thus bo seen from this table that for the period 1905 to 1912 the percentage of children vaccinated has declined from 83.1 to 67.0, this being equivalent to a decrease of 19 per cent. The number of unvaccinated persons must be therefore rapidly increasing, and during the past few years have added a not inconsiderable number to the unvaccinated population, the presence of whom is a factor of which public health administrators must never lose sight, Diphtheria and Membranous Croup. The number of cases notified in 1913 was 116, as compared with 155 in 1912, the attack-rate, or number of cases notified per 1000 population being 1.34, as compared with the rate of l.80 in the previous year. The number of fatal cases was 3, or 2.6 per cent, of the cases notified, as against 11.0 per cent. in 1912. The death-rate per 1000 population was 0.03; 98 patients, or 84 per cent, of the total cases notified, were removed to hospital. The following figures show the prevalence of diphtheria in Hampstead since 1890, the year in which the disease first became notifiable. It will be seen that the satisfactory figures of 1908, 1909 and 1910 have not been maintained in the succeeding years. Year. No. of Cases occurring. Year. No. of Cases occurring. 1913 116 1901 142 1912 155 1900 153 1911 141 1899 106 1910 48 1898 131 1909 33 1897 100 1908 55 1896 189 1907 103 1895 112 1906 97 1894 96 1905 63 1893 158 1904 55 1892 136 1903 79 1891 88 1902 85 1890 96 47 The type of diphtheria that has been prevalent during 1913 has been singularly mild in character, there being but three deaths in 116 cases. The mortality figure from this disease in 1913 is the lowest ever recorded in Hampstead. The mortality from this disease from 1901.1913 is set out in the following table:— Year. No. of Cases Notified. Deaths. No. Percentage of cases occurring. Per 1000 population. 1901 18 12.6 0.21 1902 10 11.7 Oil 1903 10 12.6 0.12 1904 5 9.0 0.06 1905 3 4.7 0.03 1906 10 10.3 0.12 1907 6 5.8 0.07 1908 5 9.1 0.05 1909 5 15.1 0.05 1910 6 12.5 0.06 1911 17 12.0 0.20 1912 17 11.0 0.20 1913 3 2.6 0.03 48 The following table shows the number of eases occurring in the various Wards:— Months. WARDS. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilbum). No. 7 (Priory). January 1 4 — 2 l 2 1 11 February l 3 — 3 2 1 2 12 March 1 3 — — 1 2 — 7 April 4 2 — — 4 1 — 11 May 2 — 1 2 2 3 10 June 1 1 l 1 1 1 2 8 July - 2 — 2 1 — 5 August . 2 — - __ - 2 — 4 September - — — — — 2 2 4 October 8 4 l — 1 3 — 17 November 11 1 — — — 2 — 14 December 5 3 — 4 1 — — 13 Totals 36 23 2 11 15 19 10 116 Though prevalent in 1913, the number of cases notified was lower than in the two preceding years. The chief prevalence occurred in the Town and Belsize Wards. It was more especially associated with scholars of one school, and only by very close watching and following up of each case, and by the swabbing of each suspected throat was the disease checked. In all buildings and areas where outbreaks have threatened, prompt isolation and disinfection have controlled the malady. In one Institution, however, in which six cases occurred, the disease still clings and will need more drastic measures than usual to eliminate it. 49 In 6 houses 3 cases occurred; in 2 houses 4 cases occurred, and in one of these houses 2 cases occurred towards the end of 1912, making 6 cases in all; in 1 house there were 5 cases; and in 1 house no less than 7 cases occurred, and 1 case was also notified in 1912, thus making 8 cases in the home. At the North-Western Hospital 4 cases of this disease occurred among the members of the staff. 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. Six applications for anti-toxin were received during the year, and 20,000 units were supplied. The total number of specimens examined during the year was 186, of which 79 gave a positive, and 117 a negative result. Erysipelas. Thirty-two cases were notified, and 2 deaths occurred, as compared with 44 cases and 1 death in 1912. The attack-rate per 1000 of the population was 0.37. Of the cases notified, 10, or 31 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. Scarlet Fever. The number of cases of scarlet fever notified in each of the last 13 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 1913 198 It will be noticed from the above table that there was a considerable increase in the number of cases notified as against the three previous years. The number of cases per 1000 of the population was 2.29. The corresponding figure in 1912 was 1.17. 4 cases, or 2.0 per cent, of those notified, proved fatal; the death-rate per 1000 population was 0.04. In the preceding year no death occurred from this disease. Of the cases notified, 159, or 80 per cent., were removed to hospital. The corresponding percentage in 1912 was 76. The total number of houses attacked was 146; five houses had 3 cases, one house had 4 cases, and 2 houses had 5 cases in each. Careful inquiries were made in each case, with a view to ascertaining the source of infection. Eight of the cases occurred among the staff of the North-Western Fever Hospital, as compared with. 5 in 1912. The prevalence of Scarlet Fever was not limited to Hampstead: it was common to the whole of the Metropolis during the year. 50 51 The following table shows the number of cases 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 2 l 5 2 2 7 - 19 February 1 l 4 — — 3 1 10 March 2 — — 2 3 4 — 11 April 2 2 2 — 4 1 — 11 May — - 3 5 3 2 — 13 June 1 2 — 1 — 5 — 9 July 1 - 1 — 4 10 — 17 August 2 1 1 — 1 3 — 8 September 2 1 3 3 5 9 — 23 October - 2 — 2 6 16 — 26 November 6 2 2 — 2 11 2 25 December 2 3 - 3 3 7 8 26 Totals 20 17 21 18 33 78 11 198 Enteric Fever The number of cases notified was 14 as compared with 9 in 1912, and 13 in 1911. The attack-rate per 1000 population was 0.16. The number of fatal cases was 1, or 7.1 per cent of the cases notified. The death-rate per 1000 population was 0*01 : 6 patients, or 43 per cent, of the total cases notified, were removed to hospital. 52 Twelve specimens of blood from patients suspected to be suffering from enteric fever were submitted by the doctors in attendance, for bacteriological examination, five specimens proving positive and seven negative. The following table shows the number of cases occurring 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 1 — — 1 — 1 - 3 February - - - - - - - - March - - - - - - - - April 1 1 — 1 - — - 3 May — 1 - - - - - 1 June - - - - - - - - July - - - - - - - - August — — — 1 1 — — 2 September 1 — — — — — 1 2 October — — — 1 — 1 1 3 November - - - - - - - - December - - - - - - - - Totals 3 2 — 4 1 2 2 14 As regards the source of infection, in two cases it was found that the patients had partaken of oysters, one patient, a female aged 13, had drunk dirty water from a ditch in Devonshire, in three cases the patients appeared to have contracted the disease on the Continent, one at a seaside resort whilst on holiday, and another whilst living in an 53 adjoining Borough. One of the patients was a member of the staff of the North-Western Hospital, and presumably was infected in hospital. A mild ease occurred in the person of a bricklayer who worked in the Borough Council's sewers. In four cases no history of infection could be ascertained. Puerperal Fever. One case was notified, which proved fatal, as compared with 3 cases in 1912, all of which proved fatal. The case occurred in the Bclsize Ward and was removed to hospital. It will be observed that only one case was recorded in 1913, and that two deaths were registered ; this is accounted for by the fact that a case notified in 1914 died in hospital at the close of 1913, and the precise causc of death was not ascertained until the post-mortem examination. The hospitals of the Metropolitan Asylums Board are now available for the reception of a limited number of puerperal fever case, which, however, must be recommended for admission by the Medical Officer of Health. This arrangement was sanctioned by the Local Goverment Board on 20th August, 1912. Epidemic Cerebro Spinal Meningitis. This disease, popularly known as "Spotted Fever," is now one of the notifiable diseases. No case was notified during the year. One case occurred in 1912. Acute Polio-Myelitis or Acute Polio-Encephalitis. 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 considerable evidence to show that the disease is communicable, but it is by no means clear how the infection is communicated. Four cases were notified during the year, one of which proved fatal. The cases were as follows:— Male, aged 20 years, who died in February, ou the second day after notification; Female, aged 10 months, notified in August. At first the left arm was paralysed, and later both legs. The patient was 54 removed to the Great Ormond Street Children's Hospital, and 1 ad partially recovered when she returned home in November, the legs only being then partially paralysed; Female, aged 2 years and 5 months, notified in August. The patient, whose right leg was paralysed, was removed to St. George's Hospital. The child's parents, who were temporarily caretaking in Hampstead, removed to South London, and nothing further has been heard of the case; Female, aged 7 months, notified in October. The child's right leg was paralysed at time of notification, but she has since recovered. Ophthalmia Neonatorum. (Inflammation of the Eyes of the newly born.) The London County Council made an Order, which came into operation oil 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. Nine cases were notified in Hampstead during the year. 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 nine cases notified, three were already being nursed by a trained nurse, two were admitted to the Infirmary, and in three other cases the patients were either attending at or inmates of hospitals. One child was receiving special treatment by the certifying medical practitioner. Principal Epidemic Diseases and Diarrhoea and Enteritis. PRINCIPAL EPIDEMIC DISEASES. The principal epidemic diseases to which reference is here made are Enteric Fever, Small-Pox, Measles, Scarlet Fever, Whooping Cough, and Diphtheria. All of these, with the exception of Measles and Whooping Cough, are notifiable diseases, and detailed information concerning them will be found under (he heading of Notifiable Infectious Diseases, on pages 41-54, but particulars concerning Measles and Whooping Cough are given in the following pages:— The total number of deaths from these diseases amounted to 39, and the death-rate was 0.44 per 1000 of the population. The deaths were distributed as follows:— DISEASE. WARDS. Totals. No. 1 (Town) No. 2 (Belsize) No. 3 (Adelaide) No. 1 (Central) No. 5 (West End) No. (> (Kilburn) No. 7 (Priory) Enteric Fever l - - - - - - 1 Small-pox --- - - - - - Measles 2 - l 3 5 7 3 21 Scarlet Fever 1 2 — — — 1 — 4 Whooping Cough 3 2 2 l — — 2 10 Diphtheria and Membranous Croup 1 — — — — 1 1 10 Totals 8 4 3 4 5 9 6 39 Measles. Twenty-one deaths were recorded from this disease, as compared with 11 in 1912. The mortality was 0.24 per 1000 population, the mortality in 1012 being 0.13. 58 Since 1903, measles has been 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 provisions relating 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 l913, 276 cases were reported, as compared with 429 in 1912 The Metropolitan Asylums Board now receive into their hospitals cases of measles on the recommendation of the Medical Officer of Health. who is required to furnish the Hoard with certain, particulars regarding the case. 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 surroundings, arc necessary, and who arc unable to obtain these necessities in their own homes. The total number of Humpstead patients removed to the Board's hospitals during the year was 24. 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:— Cases notified by medical practitioners 9 parents or guardians 30 „ school teachers 187 „ employers and others 24 „ Metropolitan Asylums Board (on removal of a patient) 13 From death returns 13 276 The 276 cases occurred in 189 houses. In 134 houses there was 1 case in the house. „ 28 „ there were 2 cases „ „ 24 „ „ 3 „ „ „ 1 house „ 4 „ „ „ 2 houses „ 5 „ „ 59 The following table shows the number of reported cases of measles occurring each month in the various Wards:— Month. No. 1 (Town.) No. 2 (Belsize.) No. 3 (Adelaide.) No. 4 (Central.) No. 5 (West End.) No. 6 (Kilburn.) No. 7 (Priory.) Totals. January 24 3 4 12 15 47 10 115 February 28 1 7 26 9 18 9 98 March — 2 — 2 4 4 1 13 April — 5 1 — 3 3 2 14 May — — — — 1 16 4 21 June - - - - - 12 1 13 July - - - - - - - - August - - - - - - - -— September — — — — — — — — October — — — 2 — — 2 November — — — — — — — — December — — — — — — — - Totals 52 11 12 42 32 100 27 276 In 59 cases, or 21 per cent. of the reported cases, no doctor was in attendance. The total number of visits paid to measles cases during 1913 by the two lady inspectors was 312. 60 In the following table the deaths at all ages from measles are set out in Wards in each year since 1901:— year. wards. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No 5 (West End). No. 6 (Kilbnrn). No. 7 (Friory). 1901 — l — — — — 1 1902 — 2 — — 4 8 1 15 1903 6 — — — — 1 1 8 1904 — 3 — l 3 8 — 15 1905 1 2 — — 4 — 1 8 1906 2 — l — — 5 2 10 1907 2 4 1 — 1 2 1 11 1908 — 1 — 1 2 — — 4 1909 4 3 — — 1 2 1 11 1910 — 4 — - 3 7 — 14 1911 4 2 l — 1 3 3 14 1912 1 4 — 2 4 — 11 1913 2 — 1 3 5 7 3 21 Totals 22 26 4 5 26 47 13 143 The question as to what steps might be taken to curtail the spread of infection and limit the fatality attending cases of measles has engaged my attention for some time past. Nearly all the deaths from measles occur among children under five years of age. In addition to the mortality, it must he remembered that the health of many children who do not succumb is considerably injured. (61) If parents and others having the care of children would only realise the serious consequences that may ensue if these complaints are too lightly regarded, a great saving of child life would be effected. Of the cases that come to my knowledge and are visited by the Council's lady inspectors, about 20 per cent. are found not being medically attended. Upon my suggestion, the Public Health Committee recommended the Council to issue leaflets, some of the chief objects of which are to bring home to people the necessity for not regarding these diseases merely as trivial ailments, and for taking due precautions for the prevention of the spread of the disease. The following is a copy of the leaflet that has been approved, and is now in circulation:— BOROUGH OF HAMPSTEAD. Public Health Department. MEASLES. Measles among young children is a dangerous infectious disease and must NOT be treated lightly. It is wrong for parents to regard measles as of trifling importance, and as a disease of childhood "to be got over, and the sooner, the better," as many a child has lost its life in consequence of such foolish reasoning. In Hampstead every year more than four times the number of children under five years of age die from measles than from scarlet fever. Symptoms. The disease generally begins like a severe cold in the head, with marked heat of the body, and coated tongue, followed by swelling of the eyelids and a watery appearance of the eyes. On the fourth day after the onset a rash appears on the forehead and face of the patient, quickly extending to the rest of the body, in the form of slightly raised spots of a dull red colour. Prevention of Spread of Infection. The only safe plan is at once to get medical advice in every case; it is wrong to wait until the child is really in danger before doing this The greatest care must be taken to avoid exposure to cold, or the consequences may be fatal. All discharges from the eyes, mouth, and nose are infectious from the first. 62 Directly a child is found to be suffering from measles he (or she) should be put to bed—it is the only safe place—and for at least a fortnight should be nursed in a warm, well-aired room, from which everybody else except the person actually engaged in nursing must be excluded Send to the Medical Officer of Health at the Town Hall, Haverstock Hill, and inform him of the illness. If you do this he will help you by having your rooms, etc, disinfected free of charge; and will assist you, if necessary, to get your child removed to hospital. By these means you may prevent other children from catching the complaint. Measles is sometimes followed by other complaints; therefore, after your child has quite recovered from the measles, have it examined either by your own doctor or at the Tuberculosis Dispensary, Dynham Road, Kilburn. By doing this you will know if any other disease threatens. Exclusion from School. The following are the regulations of the London County Council in regard to school attendance:— Disease. (1) Period of exclusion of children suffering from the disease. (2) Period of exclusion of children living in houses where the disease exists. (3) Measles At least four weeks Infants—All infants to be excluded until Monday following 14 days from the commencement of the illness of last case in the house. Seniors—If child has had the disease, may attend school. If child has not had the disease, exclude until Monday following 14 days from the commencement of the illness of the last case in the house. No child should be sent to Sunday School, or to any Play Centre, Club, Class, or Picture Palace, until permitted to return to week-day School. Frank E. Scrase, F.R.C.S., D.P.H., Medical Officer of Health. Public Health Department, Town Hall, Haverstock Hill, N,W. 63 Whooping Cough. Ten deaths occurred from whooping cough as against 4 in 1912, 3 in 1911, and 11 in 1910. The mortality per 1000 population was 0.11. 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. The Metropolitan Asylums Board now provide hospital treatment for suitable cases of whooping cough that are recommended by the Medical Officer of Health. The number of Hampstead patients removed to the Board's Hospitals during the year amounted to 3. The deaths at all ages from whooping cough since 1901 are arranged in the following table in Wards:— year. WARDS. Totals. No. 1 (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn). No. 7 (Priory). 1901 3 1 2 1 8 8 1 24 1902 4 2 - — — 2 2 10 1903 3 1 — — 9 2 15 1904 1 — 1 2 3 — 8* 1905 2 1 1 - 6 6 1 17 1906 — 1 - — — 1 - 2 1907 — 2 — — 4 5 1 12 1908 2 1 1 - 1 — — 5 1909 1 1 2 1 1 6 6 18 1910 — 2 — — 3 5 1 11 1911 1 — — — 1 1 - 3 1912 1 — — 1 1 1 — 4 1913 3 2 2 1 - — 2 10 Totals 20 15 8 5 27 47 16 139 * One death was non-distributable, 64 In view of the number of cases that are reported to me by school teachers and others, and the fact that the number of deaths that have occurred since 1901 exceed those that were due to measles, I suggested to the Public Health Committee the desirability of issuing leaflets as in the case of measles, drawing attention to the precautions that should be observed, and urging on parents and others the necessity of taking proper care of patients. The Council agreed to the recommendation of the Public Health Committee, and I accordingly drew up the following leaflet: — BOROUGH OF HAMPSTEAD. Public Health Department. WHOOPING COUGH. Whooping cough is a very infectious and if neglected very fatal disease. In Hampstead every year more than four times the number of children under 5 years of age die from whooping cough than from scarlet fever. From this its dangerous character is obvious, and it must not be treated lightly. Symptoms. In whooping cough a hard sharp cough gradually becomes more noisy, and occurs in sudden attacks ; accompanied by a peculiar whoop or crowing noise when the child draws in its breath ; the child is very often sick with the cough. When whooping cough is about, every child with a cough should be regarded as a pos-ible sufferer. Prevention of Spread of Infection. The only safe plan is at once to get medical advice in every case; it is wrong to wait until the child is really in danger before doing this. When a child is attacked, it should at once be put by itself in a warm, well-aired room, and should not he allowed tojattend school, &c., or to associate with other children. All discharges from the eyes, mouth and nose are infectious from the first. The matter COUGHED OR SPAT UP by the patient should be received into a piece of CLEAN PAPER OR RAG, and should at 65 once be burned. All discharges from the nostrils should be treated in the same way. Send to the Medical Officer of Health at the Town Hall, Haver stock Hill, and inform him of the illness. If you do this, he will advise you how to proceed; and will assist you if advisable to get your child removed to hospital. At the end of the illness thoroughly wash with disinfectant soap all the patient's bedding and clothing, boiling the bed-cover, the sheets and linen articles. By these means you may prevent other children from catching the complaint. Exclusion from School. The following are the regulations of the London County Council in regard to school attendance:— Disease. (1) Period of exclusion of children suffering from the disease. (2) Period of exclusion of children living in houses where the disease exists. (3) Whooping Cough As long as cough continues, but not to be readmitted until at least live weeks from the commencement of the illness. Infants—Three weeks exclusion from the commencement of the illness of last case in house. Seniors—If child has had the disease, may attend school. If child has not had the disease, three weeks exclusion from the commencement of the illness of last case ill house. No child should be sent to Sunday School, or to any Play Centre, Club, Class, or Picture Palace, until permitted to return to week-day School. Frank E. Scrase, F.R.C.S., D.P.H., Medical Officer of Health. Public Health Department, Town Hall, Haverstock Hill, N.W. Diarrhœa and Enteritis. The deaths at all ages from diarrhœa and enteritis in Hampstead during 1913 numbered 18. Of these, 13 occurred during the first year of life, and 1 in the second year. The deaths in the 1st, 2nd, 3rd and 66 4th quarters of the year were as follows:—1, 3, 9, 5 The deaths from these diseases at various age-periods in the last three years is as follows:— Year 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 All ages 1911 22 2 — — — 2 2 7 35 1912 2 — — — — 2 4 7 15 1913 13 1 2 — — 1 1 — 18 Totals 37 3 2 — — 5 7 14 68 The Borough Council has already done much towards combating this disease, by the appointment of a lady sanitary inspector who visits babies whose births are now promptly notified to me under the provisions of the Notification of Births Act, 1907. '1 his officer leaves a card of instructions, which she supplements with oral instructions, on the feeding and rearing of infants Many babies too are brought to the two weighing centres that are open in different parts of the Borough, and are thus kept under close surveillance The food-supply of the district is, on the whole, very good, and is, generally, under the inspection of the Medical Officer of Health and all the sanitary inspectors, as well as, in particular, under the supervision of the inspector to whom is delegated the duty of carrying out the provisions of the Food and Drugs Acts. Other matters which are so obvious as hardly to need mention—such as the paving of yards and open spaces—are factors that bear directly or indirectly upon this subject, and it is satisfactory to see that the efforts which have been put forth in the past, and which are being continued, are proving successful Upon my suggestion the issue of leaflets respecting summer diarrhoea has been undertaken, and these will be distributed in the current year. Tuberculosis. 69 TUBERCULOSIS. Deaths. The number of deaths from tuberculosis in 1913 was 71. Of these, 49 deaths were due to pulmonary tuberculosis or consumption, 6 to tuberculous meningitis, and 6 to other forms of tuberculosis. The following table shows the number of deaths and the deathrates from all forms of 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 60 0.80 34 1904 102 1.23 73 0.88 39 1905 95 1.14 73 0.87 27 190G 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 0.74 183 1913 71 0.81 49 0.56 300 The deaths from consumption and from all forms of tuberculosis during 1913 were distributed among the wards as follows:— Ward. Area (Acres). Estimated Population middle of 1913. Consumption. Tuberculosis (All Formss.) Deaths. Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Population. No. 1 (Town) 686 14250 11 0.76 13 0.89 ,, 2 (Belsize) 271 14000 5 0.35 6 0.42 ,, 3 (Adelaide) 325 9780 4 0.40 5 0.50 ,, 4 (Central) 312 9996 — - „ 5 (West End) 247 13050 7 0.53 10 0.75 ,, 6 (Kilburn) 195 15200 18 110 20 1.48 „ 7 (Priory) 229 10070 3 0.29 6 0.58 The Borough 2265 86346 49* 0.56 71* 0.81 * 1 death from consumption was, non-distributable, 70 It is satisfactory to note that the death-rate in Hampstead from pulmonary tuberculosis is decreasing, and it is to be hoped that the campaign that is now in operation will help materially in reducing the rate in the future. The death-rate from pulmonary tuberculosis in the Borough and in each Ward per 10,000 population since 1902, is as follows:— Year. DEATHS PER 10,000 POPULATION. Borough. 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 Ward. 1902 8.9 14.0 11.5 6.8 5.4 4.9 10.8 6.6 1903 8.0 8.9 9.9 1.0 4.3 9.7 12.2 4.7 1904 8.8 10.4 9.1 7.8 1.1 6.5 14.8 8.5 1905 8.7 7.9 7.5 3.9 64 8.8 17.5 6.6 1906 6.8 3.9 9.7 4.9 2.1 6.4 10.1 7.6 1907 7.2 9.9 7.4 2.0 5.2 7.1 10.8 5.7 1908 8.7 5.3 11.8 4.0 7.3 7.1 14.1 6. 7 1909 6.2 4.5 5.9 3.0 3.1 4.7 11.4 7.6 1910 5.8 4.4 5.8 5.0 3.1 8.6 10.7 7.6 1911 6.5 5.1 7.2 3.0 3.0 7.8 10.7 4.8 1912 7.4 3.0 5.1 9.1 6.1 9.3 9.3 9.6 1913 5.6 7.6 3.5 4.0 — 5.3 11.6 2. 9 It will be seen that the rates for the Kilburn Ward are higher than those of other wards, but, in considering these, it should be remembered that most of the poorer inhabitants of the Borough live in this district. Families whose incomes are lessened by the ill-health of the breadwinner naturally migrate to those streets where less expensive lodgings may be obtained. 71 The number of new cases of tuberculosis in this ward that have been notified to me during 1913 is much in excess of those in other districts of the Borough, but the factors above referred to should be borne in mind in this connection, as in the case of the death-rates from pulmonary tuberculosis. The Kilburn Ward, and especially that portion of it usually known as the Netherwood Street area, is one of the poorest and most crowded in the Borough. The streets comprising this area are as follows:— Netherwood Street, Palmerston Road, Kelson Street, Linstead Street, Lowfield Road. I have extracted the following; figures, which have a bearing on the consumption death-rate for the years 1898-1913. The population of this area was ascertained to be 3,049 persons at a special census taken in 1901, and this figure and those for each street have been assumed to represent the average annual population for the purpose of calculating the rates. I have adopted this method in view of the fact that in the case of the three first-named streets it was found that in 1901 there had been a very slight reduction in the population as compared with the number ascertained in 1898. The Borough population is that ascertained at the census at 1911. Name of Street. Estimated yearly population. No. of ordinary dwelling houses. Average No. of persons per house. Total deaths from consumption. Death-rate from consumption per 10,000 population. Netherwood Street. 1160 80 14.5 35 18.8 Palmerston Road 792 62 12.8 25 19.7 Kelson Street 207 22 12.1 10 23.4 Linstead Street 172 17 10.1 3 10.9 Lowfield Road 658 47 14.0 16 15.2 ( The Area 3049 228 13.4 89 18.2 The Borough 85495 Census 1911 10062 6.7 1034 7.7 72 The following table shows the age distribution of the patients dying from consumption in Hampstead in the eleven years 1903-1913:— Year. Age Period. All Ages. 0—5 5—15 15—25 25—65 65— 1903 - 1 14 46 5 66 1904 1 1 15 53 3 73 1905 1 — 12 57 3 73 1900 1 — 8 45 3 57 1907 1 2 10 45 3 61 1908 — 2 14 55 3 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 1913 - 1 4 39 5 49 Totals 9 12 119 503 41 684 It is clear from the foregoing that the majority of the deaths from pulmonary tuberculosis occur fat the principal wage-earning periods of life. The following table shows the deaths during the past eleven years arranged in percentages at the various age-periods:— Percentage to total Age-period. pulmonary tuberculosis deaths 0-5 1.3 5—15 1.8 15—25 17.4 25—65 73.5 65— 6.0 The enormous loss of life caused by tuberculosis has frequently been remarked upon and needs no further comment from me. I would, however, point out that since the Borough of Hampstead was formed, i.e., during the years 1901—1913 about 8 deaths out of every 100 have been attributed to this disease, or in round numbers no less than 1,130. 73 The deaths from all forms of non-pulmonary tuberculosis in the same period arc distributed in age-periods as follows:— Year. Age Periods. All Ages. 0—5 5—15 15-25 25-65 65— 1903 12 4 2 5 1 24 1904 18 3 3 5 29 1905 11 2 3 5 1 22 1906 11 5 2 4 — 22 1907 20 3 6 2 31 1908 4 4 2 — 10 1909 12 1 2 7 — 22 1910 7 5 2 4 4 22 1911 9 1 2 2 — 14 1912 8 1 2 2 — 13 1913 4 4 1 3 — 12 Totals 116 33 19 45 8 221 It will be observed that, of the deaths from non-pulmonary tuberculosis, a large proportion occur among children under the age of five years. Of the various forms of tuberculosis classified under the heading of non-pulmonary tuberculosis, tuberculous meningitis claims a considerable proportion. Since 1911, records of deaths from this localisation of the disease have been kept, and the number of deaths under this heading are here shown:— Deaths from all forms of Deaths from Tuberculous year. Non-Plulmonary Meningitis. 1urberculosis. 1911 14 7 1912 13 8 1913 12 6 74 Notification. In 1902 a system of voluntary notification of consumption was adopted in Hampstead; on 1st January, 1909, the Public Health (Tuberculosis) Regulations, which provided for the compulsory notification of cases of consumption occurring in Poor Law patients, came into operation; on 1st May, 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) Regulations, 1911, which came into operation on 1st January, 1912. In view of the scope of these latter regulations, the voluntary system, which had been in operation since 1902, lapsed. These regulations were replaced in 1913 by those which came into force on 1st February, and which apply to all forms of tuberculosis. 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:- Persons Newly Notified. Non-Pulmonary Tuberculosis. Pulmonary Tuberculosis (Notifiable from 1st February, 1913.) 1902 51 — 51 1903 34 — 34 1904 39 — 39 1905 27 — 27 1906 35 — 35 1907 55 — 55 1908 30 — 30 1909 67 - 07 1910 77 — 77 1911 113 — 113 1912 183 — 183 1913 244 56 300 The total number of persons notified in 1913 as suffering from tuberculosis was 338, but 38 of these had been notified prior to 1913. Of the 338 cases, 282 were pulmonary and 56 non-pulmonary. 75 Pulmonary Tuberculosis.—Of the 282 cases, 38 had been previously notified, 1 in 1903, 1 in 1907, 1 in 1909, 1 in 1910, 10 in 1911, and 24 in 1912, and of the remaining 244, 13 were not, properly speaking, "Hampstead" residents. The total number of residents notified or re-notified as suffering from pulmonary tuberculosis was 269. The number of new "Hampstead" patients notified in 1913 was, therefore, 231, and of these, 98 were males and 133 females. Non-pulmonary Tuberculosis.—The total number of persons notified in 1913 as suffering from non-pulmonary tuberculosis was 56, and of these, 25 were males and 31 females. All were, properly speaking, "Hampstead" residents. It will be noted that the number of new cases occurring among "Hampstead" residents notified during the year 1913 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 Public Health (Tuberculosis) Regulations, 1912, some cases were notified to me who were not, properly speaking, "Hampstead" residents, but the certificates in respect of whom I was bound to accept. Such for instance were:— Persons discharged from outlying institutions to institutions in the Borough. Persons admitted to the Hampstead Workhouse Infirmary from institutions. Casuals of no home, admitted to Hampstead Workhouse Infirmary. The total number of notification certificates (including duplicates) received during 1913 relating to Hampstead patients suffering from various forms of tuberculosis was 383 pulmonary and 62 non-pulmonary. 76 Housing Condition of Cases. In the course of investigating the 244 new cases of pulmonary tuberculosis, and the 56 new cases of non-pulmonary tuberculosis, the were found to be living under the following conditions :— Number of persons in family. Pulmonary Cases. Non-Pulmonary Cases. Occupying 1 room. Occupying 2 rooms. Occupying 3 rooms. Occupying 4 rooms. Occupying more than 4 rooms. Occupying 2 rooms. Occupying 3 rooms. Occupying 4 rooms. Occupying more than 4 rooms. 1 13 1 - - - - - - - 2 2 8 7 2 l 1 — — — 3 4 11 9 3 3 5 2 1 2 4 1 7 7 7 5 2 1 3 — 5 — 4 11 2 4 — 1 — 1 6 3 14 3 1 2 2 1 — 1 7 — — 7 6 1 1 2 — — 8 — 2 1 3 — — 4 — 1 9 — 2 2 4 2 — 2 — - 10 — — 3 — — — — — — 11 - - - - - - - - - 12 - - - - - - - - 13 — — — - 4 — - - - 23 49 50 28 22 11 13 4 5 172 33 In addition to above — Boarding-house inmates 9 1 Shop assistants living in 2 — Nursing Home inmate 1 — Guests or Dependants in other families 5 - Domestic Servants 13 6 Members of families in good houses 14 5 Inmates of Institutions 26 8 No information 2 3 244 56 77 The unsatisfactory home conditions found upon investigating the new cases of pulmonary tuberculosis notified in 1913 were as follows:— Unsatisfactory Home Conditions. Pulmonary Cases. Non-Pulmonary Cases. Overcrowding 2 ... Inadequate Ventilation 14 7 Inadequate Lighting 9 5 Dampness 9 3 Unhealthy Underground Rooms 8 2 Other Insanitary Conditions 15 4 As regards the sleeping arrangements of the new cases notified the following particulars were elicited:— Number of persons, one of whom was suffering from Tuberculosis, sleeping in one room. Pulmonary Cases. Non-Pulmonary Cases. 1 79 9 2 61 15 3 29 14 4 23 5 5 16 — 6 8 1 Totals 216 44 Sleeping in Shelter — 1 Inmates of Institutions 26 8 No information 2 3 244 56 Occupations. The following is an analysis of the occupations of the cases notified as tuberculous:— Occupation. Pulmonary Cases. Non-pulmonary Cases. Army Officer (retired) l — Artist l — Attendant on mental case 2 — Authoress - 1 78 Occupations—continued. Occupation Pulmonary Cases Non-pulmonary Cases Baker 1 — Barman — 1 Basket-maker 1 — Builder 1 — Carman 2 — Carpenter 1 — Cashier 1 - Charwoman 9 - Chauffeur 1 Clerk 12 - Club manager 1 — Coachman 1 - Collector 1 - Dentist 1 - Diamond Sorter 1 - Dressmaker 5 1 Errand boy 4 1 Farmer 1 - Factory hand 1 - Fitter's mate 1 - Flower seller 1 - French polisher 1 - Furniture remover 2 - Furrier 1 - Gas fitter 1 - House painter 4 - Housewife 27 2 Insurance Agent 1 — Journalist 2 — Labourer 6 — Landlady 1 — Laundress 1 — Merchant 2 — Milk carrier 1 — Milliner — 1 Needlewoman 4 1 79 Occupations— continued. Occupation. Pulmonary Cages. Non-pulmonary Cases. Nurse 2 — Odd Jobber 4 l Pianist at Cinema 1 — Plasterer 1 — Police Constable 1 — Police Officer (Colonial) 1 — Postman 1 — Printer's labourer 1 — Retouching photographs 1 — Scholar—middle class — 2 „ —labouring class 42 16 Shop Assistant 7 — Servant, domestic 24 8 Stock Exchange 3 — Stoker 1 — Student 2 — Sweep 1 — Tailor 2 — Teacher 2 — Warehouseman 2 — Watchmaker 1 — Wood Carver — 1 No occupation 12 3 Children below school age — 6 No information and Institution Cases 27 11 244 56 Reference was made in my Report for last year to the Public Health (Tuberculosis) Regulations, dated 19th December, 1912. These Regulations came into operation on 1st February, and they revoked the previous Regulations and all Orders made by the Local Goverment Board thereunder, and they applied to non-pulmonary as well as to pulmonary tuberculosis. Medical Practitioners (unless acting as school medical inspectors) attending on or called in to visit any person 80 (whether at an institution or otherwise) are required, within forty-eight hours after first becoming aware that such person is suffering from tuberculosis to notify the case to the Medical Officer of Health of the district, unless he has grounds for believing that the ease 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. School Medical Inspectors are required to furnish weekly notifications of all cases of tuberculosis of which they first become aware in the course of their inspections of children attending public ele.nentary schools, to the Medical Officer of Health for the district in which the place of residence of the children is situated. Medical Officers of poor law institutions and of sanatoria are required, as soon as practicable after the end of each week, to notify all cases of tuberculosis admitted during the week, and not being cases which are required to be notified under Article V. of the regulations, to the Medical Officer of Health for the district within which the places of residence of the persons notified are situate; and also to notify all cases of tuberculosis discharged during the week, other than cases transferred to a poor law institution or a sanatorium, to the Medical Officer of Health for the district within which the places of destination of the persons notified are situated. The expression "Sanatorium" is defined in the regulations as meaning a residential institution, approved by the Local Government Board under the National Insurance Act, 1911, for the treatment of tuberculosis; and the expression "Poor Law Institution" as meaning a Workhouse, a Workhouse Infirmary, or other building subject to the government of a Board of Guardians of a Poor Law Union, or of a Joint Committee, or an Asylum (not being a lunatic asylum) or School subject to the government of a Board of Managers. It is a matter for regret that these requirements were not made applicable to all residential institutions that undertake the treatment of tuberculous persons, as the partial information that I already receive, which relates only to patients admitted to or discharged from sanatoria and poor law institutions, is found to be of considerable assistance in keeping touch with the movements of tuberculous persons 81 and in disinfecting on their removal. T hope that this system of notification will be extended to all residential institutions receiving tuberculous patients, in any additions or amendments that may be made to the regulations in the future; and also that the time during which notifications arc to be made may be limited to forty-eight hours after the admission of patients. Under the present arrangement very considerable delay often occurs between the removal of a patient to a sanatorium or poor law institution and the receipt by me of the notification of his admission. Such delay often entails delay in disinfection and the continued use of infectious rooms and bedding by the patient's family or other persons. In accordance with the terms of the regulations, I keep a register containing the full particulars set out in each notification received by me; and also at the end of each week a statement of all notifications received during the week is sent to the Medical Officer of Health for the county. The notes of the investigations made in each case are carefully indexed and filed, and a most valuable record of tuberculosis in the Borough is thus being compiled, which is found to be of assistance in the steps which are taken to control the disease. The notifications were received from the following sources:— Pulmonary cases. Private Practitioners 101 School Doctors 1 Hospitals and Dispensaries 115 Medical Officers of Sanatoria— On admission of patients 43 On discharge of patients 29 Poor Law District Medical Officers 29 Medical Officer of Hampstead Workhouse Infirmary— On admission of patients 35 On discharge of patients 13 Medical Officers of outlying Poor Law Institutions— On admission of patients 5 On discharge of patients 5 Medical Officers of Asylums 7 383 82 Non-Pulmonary cases. Private Practitioners15 School Doctors 1 Hospitals and Dispensaries 24 Medical Officers of Homes, Sanatoria and Hospitals— On admission of patients 17 Poor Law District Medical Officers 2 Medical Officer of Hampstead Workhouse Infirmary— On admission of cases1 62 The following table gives an analysis of the total number of new cases of tuberculosis that were notified to me under the present regulations which came into operation on February 1st, 1912,—the period covered thus being eleven months. These regulations mark such an important step forward in connection with the campaign against tuberculosis that I have thought it well on this occasion to insert the table in the Report. To the total number of cases here stated —288—must be added 12, the number notified in January under the old regulations, in order to obtain 300, the gross total of new cases mentioned on page 74. 83 Analysis of NEW Cases of Tuberculosis brought to my knowledge by notifications made in pursuance of the Public Health (Tuberculosis) Regulations, 1912, on Forms A. B. C. and D. FORM "A." FORM "B." (School Children.) FORM "C." Admissions or Discharges to "Poor-Law Institutions" or "Sanatoria." FORM "D." Admissions or Discharges to "Poor-Law Institutions "or "Sanatoria" Total number of cases first brought to my knowledge in 1913, on Forms A, B, C, D. AGES. Under 1. 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards Total. Under 5. 5 to 10 10 to 15 Total. Under 1. 1 to 5 5 to 10 10 to 15 15 to 20 20 to 35 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Under 1 1 to 5 5 to 10 10 to 15 15 to 20 20 to 25 25 to 35 35 to 45 45 to 55 55 to 65 65 and upwards. Total. Pulmonary— Males ... ... 8 7 6 13 16 16 11 8 2 87 ... ... ... ... ... ... ... ... ... 1 2 2 ... ... ... 5 ... ... ... 1 1 ... 1 1 ... ... ... 4 96 Females ... 1 12 20 9 18 20 26 11 5 1 123 ... ... ... ... ... ... 1 1 1 1 1 1 ... ... ... 6 ... ... ... ... ... 3 3 ... ... 1 ... 7 136 Total ... 1 20 27 15 31 36 42 22 13 3 210 ... ... ... ... ... ... 1 1 1 2 3 3 ... ... ... 11 ... ... ... 1 1 3 4 1 ... 1 ... 11 232 Non- Pulmonary— Males 1 4 8 2 2 1 3 1 ... 1 ... 23 ... l ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 25 Females 1 5 7 3 ... 3 7 3 1 1 ... 31 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 31 Total 2 9 15 5 2 4 10 4 1 2 ... 54 ... 1 ... 1 ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 56 totals 2 10 35 32 17 35 46 46 23 15 3 264 ... l ... 1 ... ... 1 2 1 2 3 3 ... ... ... 12 ... ... ... 1 1 3 4 1 ... 1 ... 11 288 Note.—In the above Return, cases notified as suffering from Tuberculosis in various localizations in addition to the lungs have been counted as "Pulmonary " cases. 84 Preventive and Curative Measures. The action taken by the Public Health Department during the year has followed the lines indicated in my Annual Report for 1912. Upon my receiving a notification, Mrs. Fisher, one of the Council's lady sanitary inspectors, who has had special experience in this work, visits the patient and reports fully to myself upon the case and the home conditions. Each report is carefully considered, and the Medical Officer of Health decides if the ease is a suitable one for treatment and visiting by the Tuberculosis Medical Officer and dispensary staff. When a patient applies 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 either case the necessary instructions are given in the precautions that a patient should observe. 702 visits to pulmonary cases and 105 to non-pulmonary cases, were paid during the year by the lady sanitary inspector. All prescriptions of the Medical Officer of Health or the Tuberculosis Medical Officer are dispensed locally at the same rates as have been agreed upon in connection with the National Insurance Act. Disinfection is carried out during the lifetime of patients, and also after death. The total number of premises so disinfected during 1913 was 189. The Council arrange for the free bacteriological examination of specimens sent by medical practitioners from suspected cases of consumption. In 1913, the total number of specimens examined was 120, of which 30 were positive, and 90 negative. Now that the Tuberculosis Dispensary is open this work is undertaken by the Tuberculosis Medical Officer. The Council provide suitable consumptives with disinfectants and sputum flasks and each consumptive patient receives a card containing printed instructions on the precautions to be observed. The report of the Tuberculosis Medical Officer upon the work of the Dispensary from the period 1st February to 31st December will be found in Appendix IT to the Report (see pages 169-178). The Municipal Tuberculosis Dispensary. A scheme for the establishment and maintenance of the dispensary having been framed, suitable temporary premises were secured in a block of buildings belonging to the Hampstead General Hospital at 85 iraver,stock Ilill. 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, and they constitute an ideal arrangement. The dispensary was opened on February 1st, l'J13, a date which synchronized with the commencement of the new tuberculosis regulations. On 6th December, the premises at the Health Institute being ready for use, the Dispensary was removed there from its temporary quarters. Reference was made in my last Report to the steps that were taken in securing the establishment of the Health Institute, which is now managed by a Governing Body who arc the successors of the Coronation and Commemoration Committee. That Committee made application, through the Borough Council, to the Government for a grant towards the Building Fund or Capital Expenses, and towards the equipment of the Tuberculous Dispensary, and the Local Government Board, on 24th April, wrote to the Borough Council stating that the Treasury had consented to the proposed capital grant of £30U in aid of the provision of a Tuberculosis Dispensary at Grcville House, which has been re-arranged for the purposes of the Health Institute and the Tuberculosis Dispensary. The following are the terms of the Council's tenancy of that part of the Institute reserved for the Dispensary :— That the Tuberculosis Dispensary and its premises (tinted pink on the plan) shall be under the sole management and control of the Borough Council. That the Borough Council shall pay a rent of £45 per annum on a live years' agreement, giving the Borough Council an option for a further term of five years under the following conditions: — (i) The Health Institute shall put the dispensary premises in a condition of full, substantial and decorative repair, and in a condition suitable for use as a Tuberculosis Dispensary; and shall instal electric light and adequate means of heating. (ii) The Health Institute shall be responsible for all structural repairs and for all external repairs aud decorations. 86 (iii) In the event of a separate assessment of the dispensary premises not being allowed, the Governing Body of the Institute shall pay all rates and taxes and after deducting Property Tax and, if any, Inhabited House Duty, shall charge the Dispensary with twofifths of the rates and taxes levied on the whole premises. (iv) All internal repairs and decorations shall be taken by the Borough Council. (v) The Borough Council shall insure against fire only its own furniture in the Dispensary premises. (vi) The Health Institute shall bear the cost of any central system of heating that may be adopted, and after deducting the cost of keeping it in repair, shall charge the Dispensary with two-fifths of the annual cost. The management of the Health Institute is vested in a Governing Body—the successors of the Coronation and Commemoration Committee. This body consists of 30 members, appointed as follows:— 3 Trustees of the Institute. 11 Appointed by the Hampstead Borough Council. 3 Appointed by the Board of Guardians. 2 Members of the Hampstead Health Society. 11 Appointed by the Hampstead Council of Social Welfare. The Trustees hold the Institute in trust for the following objects:— 1. The prevention and treatment of tuberculosis. 2. Training and teaching in hygiene, nursing, the treatment of minor ailments and domestic economy and subject to the fulfilment of these conditions of the trust:— 3. The medical supervision and treatment of children. 4. Lectures, classes and gatherings supplementary to elementary education. 5. The provision of a meeting lace for purposes of mutual provident aid, or otherwise for the social well-being of the inhabitants of the Borough. 87 If, in the opinion of the Trustees, the Governing Body fails to secure the fulfilment of the Trust as a voluntary undertaking, the freehold premises of the Trust revert to the Hampstead Borough Council. The Borough Council has voted the annual sum of £750 for the maintenance of the Dispensary ; but the greater part of this amount will be refunded by the Government, the London County Insurance Committee, and the London County Council. Negotiations have been in progress for some time with the Insurance Committee respecting the amount of their contribution for the use of the dispensary, and the services of the Medical Officer of Health and Tuberculosis Medical Officer in regard to insured persons. The Council at its meeting on 11th July decided, in communicating on this subject with the County Insurance Committee, to advert to the suggestion of the temporary local sub-committee of the Insurance Committee, viz., that the Borough Council should be offered the sum of £150 per annum by the County Committee in respect of the before-mentioned services and facilities (which amount the Public Health Committee recommend should be accepted as a temporary measure for say one year), but the County Insurance Committee after consideration decided that they could not sec their way to offer more than the sum of £100—this amount to apply only for the twelve months from July, 1913. An application has also been made to the Government for a grant in respect of the maintenance of the dispensary, but the amount expected to be received from this source, and that to be granted by the London County Council had not been settled at the close of 1913. The Borough Council will, therefore, be refunded for the major part of its expenditure on the Tuberculosis Dispensary in the following manner: — 1. The cost of treating "insured" persons will be refunded by the London County Insurance Committee. 2. After the amount received under No. 1 has been deducted, 50 per cent. of the remainder will be refunded by the Local Government Board. 3. After deducting the amounts received under No. 1 and No. 2, the London County Council will pay not more than 50 per cent. of the balance remaining, i.e., 25 per cent. of the whole cost (excluding the refund for "insured" persons). 88 The constitution of the dispensary consists of the following: — The Medical Officer of Health of the Borough, who is the Chief Administrative Tuberculosis Officer, receives all notifications and reports, statutory and otherwise, and who is responsible for all administrative and preventive 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, 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, cither 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. Hampstead Tuberculosis Dispensary 89 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 fortnightly, or at such other intervals as shall be decided, reports on 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 accommodation provided at the permanent building consists of (1) waiting room, opening into (2) two dressing-rooms, opening into (3) consulting-room; (4) office for the Tuberculosis Medical Officer; (5) laboratory; (6) separate lavatory accommodation for staff and patients. The Council appointed as Tuberculosis Medical Officer, Dr. J. King Patrick, late Senior Medical Officer, Leicester Tuberculosis Dispensary; and Miss G. M. Goodchild as Tuberculosis Nurse. Disinfection. 93 DISINFECTION. Number of articles disinfected:— Beds 233 Mattresses 627 Palliasses 14 Bolsters 480 Pillows 1518 Blankets 1715 Sheets 1073 Counterpanes 686 Articles of Clothing 4779 Carpets 61 Linen Articles 2935 Books 201 Miscellaneous 987 Total 15309 Number of premises disinfected 904 „ rooms, etc., disinfected 1278 In addition to the foregoing, the following were destroyed upon request of the owners:— Beds 2 Mattresses 10 Bolsters 3 Pillows 8 Sheets 6 Counterpanes 3 Articles of Clothing 27 Carpets 1 Miscellaneous 26 Linen Articles 23 Total 109 During 1912,911 premises, 1240 rooms, etc., and 16500 articles were disinfected, while 125 articles were destroyed. 94 The amount of disinfection carried out by the Council has 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 220, the amount received in fees for this work being £63 3s. 6d. With regard to measles, the London County Council in the early part of 1003 obtained the approval of the Local Government Board for the inclusion of measles amongst the dangerous infectious diseases in so far as Sections 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 276 cases of measles, and in all of these cases disinfection was carried out. General Sanitary Administration. 97 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 334 Dampness in houses, or parts of houses, abated 160 Dilapidated houses, or parts of houses, repaired 95 Overcrowding— Cases of, abated (rooms) after service of notice 7 ,, „ „ without service of notice 3 Underground rooms— Illegal occupation discontinued 27 Structural works carried out 74 Below floors— Spaces below floors in the basement or ground floors ventilated 205 Roofs— Repaired 166 Gutterings— Repaired or renewed 130 Rainwater pipes— Repaired or renewed 170 Disconnected from drains 24 „ „ soil pipes . — Waste pipes— Waste pipes of sinks disconnected from drains 8 „ „ trapped 502 ,, „ ,, repaired or renewed 335 ,, ,, ,, unstopped 2 „ ,, of lavatories disconnected from drains 13 „ trapped 210 „ „ „ repaired or renewed 253 „ unstopped 1 „ „ of baths disconnected from drains 19 ,, „ „ trapped 184 „ „ „ repaired or renewed 175 ,, „ ,, unstopped 3 Water supply— Reinstated 10 Water and sinks provided to upper floors of tenement houses 115 98 Water cisterns— Repaired or renewed 10 Removed from improper positions 36 Cleansed 49 Fitted with close-fitting covers 33 Water-closets— Accommodation provided 5 Additional accommodation provided 35 Separate and sufficient accommodation provided for persons of each sex 7 Removed from improper positions 9 Provided with proper and sufficient external ventilation 26 Improperly constructed apparatus removed and new provided 28 Apparatus repaired or renewed 560 „ unstopped 2 ,, cleansed 20 „ provided with proper water supply 3 Flushing cisterns repaired or renewed 240 Manholes— Repaired or renewed 654 Drains— Repaired or renewed 741 Cleansed 65 Unstopped 48 Ventilated 121 Ventilating pipe of drains— Carried to a sufficient height above windows 17 Repaired or renewed 86 Fresh-air inlets repaired or renewed 168 Soil pipes— Repaired or renewed 347 Ventilated 18 Gullies and surface drains— Gully traps removed from improper positions 46 „ „ cleansed 6 Inlets or surface drains trapped 16 Paving and draining Washhouses, Areas, Yards, &c.— Washhouse or scullery paving repaired or renewed 62 Areas cleansed 4 99 Paving and draining Washhouses, Areas, Yards, &c.—con. Area paving repaired or renewed 143 Areas drained 24 Yards or other open spaces paved 231 Paving of yards or other open spaces repaired or renewed 206 Yards or other open spaces drained 98 Floors of buildings in which horses, &c., are kept, paved or repaired 19 Refuse and Receptacles— Dustbins provided 476 ,, repaired 18 ,, cleansed 2 Fixed ashpits removed 63 Accumulation or deposits of refuse removed 149 Manure receptacles provided 6 „ „ amended 1 Nuisances from the improper deposit of trade refuse abated 3 Animals— Nuisances from the improper keeping of animals abated 2 Number of Inspections, &c., Made ; Notices Served ; and Letters. &c., Issued. 1912. 1913 Number of Inspections 9986 9786 ,, Re-inspections 13920 15619 ,, Intimation Notices issued 1105 1258 ,, Statutory Notices Issued 874 938 „ Letters issued 6521 8347 „ Notifications sent to "Head Teachers" of Schools respecting notified cases of infectious disease 353 540 ,, Notifications sent to Medical Officers of Health of other Boroughs respecting Hampstead children attending schools in their districts 58 32 „ Notifications sent to "Head Teachers "of Schools respecting cases of measles 273 188 100 Certificates as to Water Supply. The number of certificates issued during the year was 18, as compared with 45 in 1912. Drainage Work. The by-laws of the London County Council which 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 1913 the Council have approved 540 plans for the drainage of new buildings, and 6992 plans for alterations, etc., to drains of existing premises. During the year 1913, 995 notices of drainage reconstruction or alteration were received, and in 893 cases the work necessitated the deposit of plans and written particulars. In 298 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 893 notices of drainage alterations, etc., requiring the deposit of plans, 347 related to work that involved the entire reconstruction of the drainage system. In 495 cases the work was carried out voluntarily, the number of instances in which voluntary complete reconstruction was carried out being 140. 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 317 cases the drains were laid in 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. Drain and Sewer. The claims which the Council had to meet under the existing unsatisfactory state of the law relating to the respective liabilities of the local authority and the owner of private property, in regard to private drains which are "technically sewers," have again been few, a result which is almost entirely due to the policy of resisting any claims that may be made if any means can be found to justify such action, 101 During the year two very important cases in which the Borough Council were concerned have been decided by the Divisional Court in regard to this question. In the first of these (Hampstead Borough Council (Kershaw) r. A. J. Smith & Co., Limited) the Council was successful, and established the principle that where a drain had been converted into a sewer by the wrongful act of a builder he can be made liable to rectify his wrongful act irrespective of the time which may have elapsed since he committed the act, provided always that proceedings are taken within six months of its discovery. The full details of the case as stated by the magistrate were set out in my last Annual Report. In the second case, that of the Hampstead Borough Council (Kershaw) r. Paine, the Court felt themselves bound by the judgment in the case of Silles r. Fulham Borough Council, 1903, to decidc against the Council, although they did so with considerable regret, and the presiding judge expressed the hope that the Court of Appeal would one day adopt one or both of the dictums to which he gave expression in the case of Heaver v. Fulham Borough Council. The following particulars taken from the case stated by the Magistrate explain the details and circumstances, and I have no doubt will be of great interest:— CASE Stated by Mr. Plowden, one of the Magistrates of the Police Court of the Metropolis, sitting at the Marylebone Police Court:— 1. The Respondent was summoned before me to answer a complaint preferred by the Appellant that at No. Sumatra Road, in the district of the Mayor, Aldermen and Councillors of the Metropolitan Borough of llainpstead there existed a nuisance, namely, defective drains, and that the said nuisance was caused by the act, default or sufferance of the said Respondent. 2. I, after hearing the case on the 30th day of May, 1913, and the 10th day of June, 1913, dismissed the said complaint. The Appellant being dissatisfied with my determination as being erroneous in point of law, has applied to me to state a special case, and has duly entered into a recognisance. I accordingly state this case for the opinion of the King's Bench Division of the High Court of Justicc. 3. At, the hearing of the said complaint the following facts were proved in evidence or admitted before me:— (a) The Appellant is the Senior Sanitary Inspector of llainpstead Metropolitan Borough Council (hereinafter referred to as "The Council"), which is the sanitary authority for the district comprising the Metropolitan Borough of llainpstead. The Respondent, who carries on business as an estate agent 102 and surveyor under the style of Messrs. Jordain & Paine, is the owner of No. 155, Sumatra Road, within the said Borough. (b) The premises known as No. 155, Sumatra Road, form part of a terrace of houses, and are drained by a line of pipes into which also ultimately passes (in the manner hereafter stated) the rainwater which falls upon part of the roof of the contiguous house on each side thereof. The said line of pipes passes under No. 155, Sumatra Road, and thence to the public sewer in Sumatra Road, with which it is connected. The said line of pipes, together with the line of pipes from the gully mentioned in paragraph 3 (c) hereof, constitutes the alleged drain complained of, and referred to in paragraph 1 hereof. (c) (i) The rainwater which falls upon part of the back roof of No. 157, Sumatra Road, passes into a stack-pipe, by means of which it is led down the outside of the party-wall between No. 157 and No. 155. The said stack-pipe discharges into the open air over a gully in the paved yard belonging to No. 155, which gully is connected to the drainage system of No. 155, so that the water from the said gully passes into the alleged drain. (ii) The rainwater which falls upon the roof over the front porch of No. 157, Sumatra Road, passes into a stack-pipe, by means of which it is led down the front wall of No. 155. The said stack-pipe discharges into the open air over a gully in the forecourt of No.] 55, which gully is connected to the drainage system of No. 155, so that the water from the said gully passes into the alleged drain. (iii) The rainwater which falls upon part of the back roof of No. 153, Sumatra Road, passes along the eaves-gutter of that house into the eaves-gutter of No. 155, and thence into a stack-pipe, by means of which it is led down the back wall of No. 155. The said stack-pipe discharges into the open air over a gully in the paved yard belonging to No. 155, which gully is connected to the drainage system of No. 155, so that the water from the said gully passes into the alleged drain. (iv) The rainwater which falls upon the front roof of No. 153, Sumatra Road, passes along the eaves-gutter of that house into the eaves-gutter of No. 155, and thence into a stackpipe, by means of which it is led down the front wall of No. 155. The said stack-pipe discharges into the open air over a gully in the forecourt of No. 155, which gully is connected to the drainage system of No. 155, so that the water from the said gully passes into the alleged drain. The drainage of the said premises as it in fact exists is shewn upon the plan attached to this case and marked "A". (d) There is no record of any application having been made to the Hampstead Vestry (the predecessors of the Hampstead Boroug Council) for their sanction to the drainage of the said premises, lo3 No. 155, Sumatra Road, and the Council have no record of any order made either by themselves or their predecessors for the drainage of the said premises, No. 155, Sumatra Road, with any other premises by a combined operation. (r) The notices prescribed by the Public Health (London) Act, 1891, were duly authorised by the Council and served on the Respondent. ( /) The nuisance alleged in the said complaint existed at the time when the said complaint was preferred, and had not been abated at the date of my said determination. (</) By an Indenture, dated 24th December, 1884, the Respondent, who was the freeholder of the land upon which the said houses have since been built, agreed with William Brittain to grant a lease of a piece of land on the south side of Sumatra Road aforesaid, together with the messuage and buildings intended to be erected thereon for the term of 99 years from the 2oth December, 1882, at the relit of a peppercorn up to the 25th December, 1885, and thenceforth at the yearly rent of £110. Under the said Indenture the said William Brittain covenanted to build and finish fit for habitation before 25th December, 1885, sixteen messuages. Under the said Indenture it was provided that the said William Brittain should have possession of the said land immediately upon the execution of the said Indenture, and that on completion of the said messuages the Respondent would grant a lease of the same to the said William Brittain or his nominee in a form signed by the Respondent and the said William Brittain at the lime of the execution of the said Indenture, by paragraph 8 of the said Indenture of the 24th December, 1884, it was provided as follows:—"All the said messuages and all buildings to be erected on the said land shall be built and constructed with good, new, sound, durable and proper bricks, timber and materials, and in a substantial and workmanlike manner, and in all things according to plans, elevations and specifications to be prepared by the landlord's surveyor, and no alteration or deviation shall be made in such plans, elevations or specifications without the previous consent in writing of such surveyor." In the year 1888 the Respondent on the failure of of the said William Brittain to repay monies advanced to him by the Respondent on a mortgage of the said land and messuages foreclosed the mortgage and took possession of the said land, messuages an I buildings, and on the 1st day of November, 1888, granted a lease of the said premises, No. 155, Sumatra Road, for a teiin of 99 years from the 25th December, 1882, at a rent of £8 10s. Od. per annum to a Mrs. Elizabeth Nowell Jordain. It is stated in the said lease that it is granted " in consideration of the expense which has bean incurred in erecting the messuage and buildings hereinafter demised, and of the rent, covenants and agreements hereinafter reserved and 104 contained.' The said lease contains the following covenant (inter alia) on the part of the said Elizabeth Nowell Jordain:— "And also that the tenant will at her own expense within six months from the date hereof complete and finish the demised messuage and buildings fit for habitation . . . . . . . with proper and sufficient garden walls, sewers, drains, flagging and paving, and other things necessary to the premises to the satisfaction of the landlord's surveyor." The drainage system was constructed as shewn on the plan annexedhereto and marked "A" at the time when the said premises were originally built. (h) On the 15th November, 1888, the Respondent sold his reversionary interest in the said premises to the Prudential Assurance Company, and since that date the rent due under the said lease has been paid by the Respondent, who has also received the rack rent from the occupying tenant of the said premises. 4. On behalf of the Appellant it was contended before me:— (a) That the line of pipes referred to in paragraph 3 (b) hereof constituted a "drain" within the meaning of the definition of that term in section 250 of the Metropolis Management Act, 1855. In support of this contention the case of Heaver v. The Fulham 13orough Council (1904) 2. K. B. 383 was referred to. (b) That having regard to the history of the said premises and the terms of the said lease, the Respondent was estopped from alleging that the said line of pipes constituted a "sewer" repairable by the llainpstead Borough Council. In support of this contention the following cases were referred to:— Heaver & Others v. The Fulham Borough Council (1904) 2. K. B. 383. Wilson's Music & General Printing Company v. The Finsbury Borough Council (1908) 1. K. 13. 563. Kershaw v.Smith (1913) 11. L. G. R. 519. 5. On behalf of the Respondent it was contended before me:— (a) That the said line of pipes was a sewer because it carried off the rainwater from the roofs of Nos. 153 & 157, Sumatra Road, as well as the sewage of No 155, and no order had been made by the predecessors of the Council for the drainage of No. 155 with any other premises by a combined operation. (b) That the Respondent was not responsible for carrying out, and had not carried out, the drainage of No. 155, Sumatra Road, and had no notice that the said William Brittain had committed a wrongful act in relation thereto. (c) That it was owing to the default and negligence of the predecessors of the Council that the rainwater from the roofs of Nos. 153 and 157, Sumatra Road, had been allowed to be carried off by the said line of pipes, and that the Council was estopped from saying the same was not a sewer. 105 (d) That there was no ground for saying that the Respondent was estopped from denying that the said line of pipes was a drain. In support of these contentions the following eases were referred to:— Kershaw v. Taylor (1895) 2. Q. B. 471. Holland v. Lazarus 61. J. P. 262. Heaver v. Fulham Borough Council (1904) 2. K. B. 383. Silles v. Fulham Borough Council (1903) 1. K. B. 829. Harvey v. Jaye 71. J. P. 473. 6. I was of opinion that both the said contentions on behalf of the Appellant failed, and I found that the said line of pipes was in law a sewer repairable by the Hampstead Borough Council. I accordingly dismissed the said complaint and awarded to the Respondent five guineas costs. The question for the opinion of this Honourable Court is whether my said determination was correct in point of law. It is a matter for serious regret that the Bill introduced by the Association of Municipal Corporations, and the Urban District Councils, Association did not meet with more success than had fallen to its lot in previous years. Although the provisions of this Bill did not apply to the Metropolis, it seems only reasonable to assume that if the ratepayers outside London were relieved from one of the most iniquitious burdens that have been placed upon their shoulders, it would not have been long before those within the County would have received the same consideration. In another case, the freeholders of the estate concerned were interviewed, and, realising that their reversion would be prejudiced by the fact that a public sewer would run across the property, at once called upon the leaseholder to withdraw his claim against the Council, which he promptly did. Sanitation of Railway Stations. The sanitary conveniences at the various railway stations in the Borough have been regularly inspected during the year. It is satisfactory to report that there is a very considerable improvement in the standard of cleanliness maintained. The extent to which these conveniences are used by all sections of the community render it most essential that they shall always be kept in proper order. The Metropolitan Railway Company during the year rebuilt their station at Finchley Road, and provided an excellent system of sanitation and drainage, which is highly satisfactory in every detail. These results 106 arc largely due to the action taken by the Council in 1003, when the vindicated their right to direct and supervise the drainage of railway property in the Borough. Cleansing Station. During the year, 168 school children, 10 children under school age, and 7 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. The position of things as regards the cleansing of school children and others is not, in my opinion, very satisfactory. Every time a child is sent to the cleansing station to be cleansed we receive a formal demand from the Loudon County Council to be informed as to what we have done to the home. In many cases wc attempt to cleanse the home, and only with the greatest difficulty can we get any parents or others to be cleansed; but in this respect it is interesting to note that the County Council are endeavouring to obtain additional powers to secure the cleansing of persons who may be the source of the re-infection of the cleansed children. I am of opinion too that the accommodation at the cleansing station is inadequate. The endeavour to hot water bathe children of quite tender years, and cut off a great deal of their hair, requires to be done with certain precautions against their catching cold or getting otherwise chilled. The cleansing station, as at present constituted, consists of one room with a screen. There is practically no accommodation for waiting, or for children to sit and dry their hair after being bathed. Should the number of people to be cleansed at the station be in any way greater, in future, than it has been, I am certain some additional accommodation must be provided for them. A case of very considerable interest occurred last year in regard to the question of the verminous condition of school children. The children of parents residing in this Borough were repeatedly found to be attending school in a verminous condition, although they had been cleansed systematically at the cleansing station. In addition to this the Council placed the cleansing station at the disposal of those members of the family who were not of school age, and, whilst the father availed himself of the offer, the mother and a daughter steadfastly refused to attend the cleansing station. The condition of the children, therefore, seemed to me to bring the parents within the provisions of 107 Section 12 of the Children Act, 1908, m that it constituted "neglect." Consequently I brought the matter to the notice of the Public Health Committee, who referred it to the Royal Society for the Prevention of Cruelty to Children. Proceedings were instituted by them against both parents, and evidence was given by the officials of the London County Council and myself, with the result that the father and mother were each sentenced to a term of six weeks' imprisonment with hard labour. The effect has been most salutary, and I think this course should be adopted in all cases where the parents subject their children to the unnecessary suffering which these verminous conditions entail. In connection with the cleansing of verminous children, another somewhat unusual incident occurred. In pursuance of the request made by the London County Council to deal with the bedding and clothing of verminous children, the sanitary inspector visited a house in Rroomsleigh Street to make an inspection of the home of a child who had been reported as attending school while in a verminous condition. The mother was at home when the inspector called, and he was admitted to the passage, but when he attempted to enter the rooms he was obstructed by the mother to such an extent as to make it inadvisable to proceed with the inspection. The matter was reported to the Public Health Committee, and by their direction the mother was summoned for obstruction, and was tined five shillings and two shillings costs. Following this, another attempt was made to carry out the inspection, but the inspector was met with the same obstruction on the occasion of his second visit. Consequently, a further summons for obstruction was issued, and this time the Magistrate inflicted a penalty of £1 and two shillings costs, and gave the woman some wholesome advice, with the result that on the third occasion when the inspector called he was admitted. Customs and Inland Revenue Acts. These Acts provide that the owners of premises that arc 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 22 dwellings, this number being less than the number for which applications were made in 1012. 108 Thirty-three dwellings were certified during the year, the owners having carried out the works necessary to obtain the certificate. In some of these cases the applications were made in 1911 and 1912, but the works required were not completed until 1913. PREMISES. 154, Alexandra Road 1 166, do. 2 5, Canfield Gardens 2 9, do. 2 46, Bennington Park Road 2 118, Finchley Road 2 Yale Court, Honeybourne Road 22 No. of Dwellings. 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. Houses Let in Lodgings. The number of houses registered as houses let in lodgings at the end of 1913 was 369. The registered houses are situated chiefly in the following streets :— Bolton Road. King's College Mews Fast Broomsleigh Street. Kingsford Street. Canfield Place. Kingsgate Road. Dunboyne Street. Linstead Street. Fairfax Mews. Lower Cross Road. Fleet Road. Lowfield Road. Iverson Road. Net her wood Street. Kelson Street. Palmerston Road. 100 The decrease in the number of houses on the register is accounted for by the fact that under the by-laws a change of landlord of a registered house removes the house from the register. During the year several premises were found to have thus ceased to be registered. The revision of the by-laws relating to these houses, which has been undertaken in view of Section 16 of the Housing, Town Planning, etc., Act, 1009, has been in progress during the year; but the amended bylaws had not been approved by the Council at the close of the year. Housing of the Working Classes Acts, 1890 to 1909. Dwellings Unfit for Habitation. The Closing Order made by the Council under Section 17 of the Housing, Town Planning, &c., Act, 1909, in February, 1911, in regard to No. 83, Palmerston Road, which was confirmed by the Local Government Board, is still the subject of litigation. The owner having unsuccessfully asked the Council to determine the Closing Order, he at once appealed to the Local Government Board in regard to the matter, and upon the Board dismissing the appeal obtained a writ of certiorari from the High Court. The case came before the Divisional Court in December of last year, when the Rule was discharged. Mr. Arlidge (the owner) carried the matter to the Court of Appeal, and after a lengthy hearing the Court came to the conclusion (Lord Justice Hamilton dissenting) that on an appeal by the owner of a house to the Local Government Board against the refusal of the local authority to determine a Closing Order, the Appellant has a right to submit his case to, but not to appear before the person who decides the issue; and that he is entitled to see the report which the Inspector holding the Public Local Inquiry makes to the Board (Rex v. Local Government Board ex-parte Arlidge, 1913, Court of Appeal). This question of procedure is one of considerable importance to the Local Government Board as, so long as this judgment of the Court of Appeal stands, it will effect all Inquiries held by the Board under the Act, and probably a large number of Inquiries held under other Acts as well. Consequently it is not to be anticipated that the question can be regarded as finally settled until it has been submitted to the judgment of the House of Lords, The case 110 is now awaiting hearing by that tribunal, and is, therefore, still sub judice. Peebles Mews, Palmerston Road, is a mews consisting of seven houses and two workshops, and is situated between and closely hemmed in by two rows of houses which are considerably higher than those in the mews itself. The mews is approached under an archway, and is lower than the adjoining street level. The houses are not very old, having been erected by the late Mr. Cairns, builder, about the year 1878. The mews was, however, not only badly situated, but suffering from those defects of closeness, narrowness and bad arrangement, the want of proper light, air and ventilation which render dwellings unfit for human habitation. The mews has been unfavourably reported upon by my two predecessors in office, and consequently, after making a careful survey and examination, I represented the premises, Nos. 1, 2, 3, 4, 5, 6, 7, Peebles Mews, on 17th June, under Section 17 of the Act of 1909, to The Council with the result that Closing Orders were made on all the premises in July. The owners availed themselves of the right of appeal to the Local Government Board, who on 8th October held a Public Local Inquiry into the matter, and the Board have intimated to the Council that they have decided to confirm the Closing Orders. Table required by Article Y. of the Housing (Inspection of District) Regulations, 1910, made by the Local Government Board, under the Housing, Town Planning, &c.. Act, 1909. (Excluding Underground Rooms.) Number of dwelling-houses inspected under and for the purposes of Section 17 of the Act of 1909 7 „ of dwelling-houses which on inspection were considered to be in a state so dangerous or injurious to health as to be unfit for human habitation 7 ,, of representations made to the Borough Council with a view to the making of closing orders 7 ,, of closing orders made 7 ,, of dwelling-houses, the defects in which were remedied without the making of closing orders — „ of dwelling-houses which, after the making of closing orders, were put into a fit state for human habitation — 111 General character of the defects found to exist. Arrangements for preventing the contamination of water supply 4 Closet accommodation 7 Drainage 7 Conditions of dwelling-houses in regard to: — Light 7 Free circulation of air 7 Dampness — Cleanliness 5 Conditions of yards or out-houses in regard to:— Paving 7 Drainage 7 Sanitary condition 7 Arrangements for the deposit of refuse and ashes 7 Any defects in other matters which may tend to render the dwelling-houses dangerous or injurious to the health of the inhabitants 7 Underground Rooms. The following statement sets forth the action taken during 1913 in regard to underground rooms that were found to be illegally occupied. No. of Houses. No. of rooms found to be occupied in contravention of See. 17 of Housing, Town Planning, &c., Act, 1909. No. of these rooms that were also occupied contrary to the provisions of the Public Health (London) Act, 1891. Illegal occupations discontinued Structural works necessary to make rooms comply either completed or well in hand before the end of the year. No. of Rooms. Represented by Medical Officer of Health under Sec. 17. Closing Orders made by Council, under Sec. 17. 74 101 77 27 74 2 2 The structural defects, and the number of rooms in which the defects were found, were as follows : — Want of Proper Area. Want of proper Damp-proof Courses. Space beneath floor insufficiently ventilated. Site not Concreted. Defective Drains. 62 79 92 8.3 61 112 The Water Supply of Tenement Houses. The action taken in Hampstead during 1913 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 115 houses. Prior to the passing of the London County Council (General Powers) Act, 1907, London Sanitary Authorities had no power to insist on the provision o 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 1913 115 580 Rag Flock Act, 1911. Under the provisions of the above Act, 11 samples were taken during the year, and of these, 9 were found not to conform to the standard of cleanliness laid down by the Local Government Board in the Regulations issued by them on 8th June, 1912. The administration of this Act appears to be beset with difficulties. In the first place its provisions should be made to apply to flock of every description, but its scope has unfortunately been very much narrowed by a judgment in the Divisional Court in the case of Gamble v. Jordan, 1913, when it was held that the re-making or re-stuffing of furniture or upholstery with rag flock was not prohibited so long as the Hock comprised only that which had been taken out of the article in question. This practically renders the Act inoperative in regard to jobbing upholsterers, a large proportion of whose business consists of re-making, and of course it is 113 impossible for an inspector to prove that the flock used in re-upholstering and re-stuffing was not being re-used. The judgment given in a subsequent case, Cooper v. Swift, 1913, has removed another administrative difficulty which was of a very serious character. It was contended by the trade that rag flock did not come within the Act unless it was made from rags which had been worn to a state of raggedness on the human person. The Court decided that any flock made from woven material constituted rag flock, irrespective of the way in which the material had been reduced to its state of raggedness. Public Mortuary. During the year, the bodies of 107 persons were brought to the mortuary, this being the same number as in 1912,-67 by order of the Coroner, 17 by the Police, and 23 at the request of friends of the deceased persons. In 82 instances (or 77 per cent. of the bodies admitted) inquests were held, and in 57 instances (or 53 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 59 Accidental deaths 16 Suicide (including 1 felo de se) 12 Neglect at birth 3 Misadventure 13 Starvation 1 Open Verdict 3 Total 107 114 MORTUARY RECORD FOR THE YEAR 1913. Bodies Admitted. No. of Post-Mortems. No of Inquests. No. of Funerals from Mortuary. Month. Male. Female. Total. Male. Female. Total. January 5 7 12 3 6 9 12 12 February 5 3 8 2 2 4 5 8 March 5 4 9 2 3 5 5 5 April 8 3 11 4 3 7 9 11 May 9 3 12 6 2 8 11 12 June 5 2 7 1 — 1 4 7 July 6 — 6 5 — 5 5 6 August 4 2 6 1 1 2 3 6 September 8 5 13 2 3 5 10 13 October 2 1 3 1 — 1 1 3 November 7 1 8 5 1 6 8 8 December 7 5 12 1 3 4 9 12 Totals 71 36 107 33 24 57 82 103 115 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. Dec. 24th Mill Lane 12 geese. Dec. 27th High Road 58 geese and 1 turkey Dec. 31st High Road 7 lbs. apples During the year, on Bank Holidays or upon other special occasions, the sanitary inspectors have been on duty on the Heath inspecting food and taking samples for analysis. 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 milk. 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 36. The quarterly lime-washing has been carried out, and in one instance, one cautionary notice was served in regard to an accumulation of rubbish in the slaughterhouse. 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 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 116 siderable number of cases conditions in contravention of the Act have been found. In 1911 and 1912 the total number of premises altered in order to comply with the Act was 60 and 37 respectively, as set out in the Reports for those years. In 1913 the number of premises dealt with was 71. Of these places, 19 were found to have drain inlets in rooms where food was prepared or sold; in 34 premises the drains were defective; in 4, structural defects, other than drainage defects of various kinds, were present; and 52 premises needed cleansing. The places were dealt with as follows:—in 30 instances the drains were entirely, and in 4 instances partially, reconstructed; in. 19 instances improperly placed drain inlets were removed, with or without redrainage; in 4 instances more or less extensive structural alterations, other than drainage alterations, were carried out; and 52 premises were thoroughly cleansed under notice. Trades. No. of Premises DRAINAGE. PREMISES. Entire reconstruction Partial reconstruction Drain openings removed. Cleansed Structurally altered. Butcher 10 4 l 3 9 l Confectioner 7 1 2 — 2 — Dairy 4 3 — 3 3 2 Fishmonger 5 3 — 1 5 — Greengrocer 5 1 1 2 5 — Grocer & Provision Merchant 21 8 7 12 1 Restaurants 10 4 - 2 9 — Other Trades 9 6 - 1 7 - Totals 71 30 4 19 52 4 The action taken by the Council in regard to the inspection of food premises, called attention to the unsatisfactory conditions existing at two places in which a large eating-house business was being carried on. These places had their origin as coffee stalls or shelters, but, instead of being removed daily, a settled pitch was taken up by them, with the result that permanent buildings were set up without either water 117 supply or sanitary accommodation, and the general conditions appertaining were such as to render their use most undesirable for such a purpose as the storage and sale of food. The action of the Council resulted in these premises being permanently closed, and as there is no part of the Borough now in which there does not exist ample opportunity for the working-classes to obtain food, I cannot regard the closing of these places as anything but a distinct improvement. The food premises inspected during the year, together with the nature of the business carried on, were as follows:— Butchers and Fork Butchers 64 Confectioners 91 Grocers 68 Provision and Cheesemongers 40 Greengrocers and Fruiterers 69 Fishmongers 30 Fried Fish Shops 9 General Shops 23 394 615 inspections were made of these premises during the year, and 84 notices were served. This list does not include bake-houses, milk shops, restaurants, and slaugterhouses, to which reference is made elsewhere. Tuberculous Milk. In the campaign against consumption the question of our milk supply is one upon which a considerable amount of public interest has been concentrated. This interest has been stimulated from time to time by the publication of the results of investigations which have been carried out in regard to the matter. The second interim report of the Royal Commission on Tuberculosis stated definitely that a very considerable amount of disease and loss of life, especially among the young, must be attributed to the consumption of cows' milk containing tubercle bacilli. This is a conclusion with which I am in complete agreement, and I was anxious to ascertain what had been the effect of the provisions of the London County Council (General Powers) Act, 1904, and the Board of 118 Agriculture's Order made under the Contagious Diseases (Animals) Act, which came into operation on 1st May, 1913, in securing a healthy milk supply for this Borough. Consequently I suggested the desirability of taking further samples of milk for examination, bactcriologieally, as to the presence of tubercle bacilli. The result is embodied in the following report:— To the Chairman and Members of the Public Health Committee. Mr. Chairman, Madam, and Gentlemen, Milk and Tuberculosis. On this subject I would remind the Committee that on July 15th, 1913, they authorised the taking of 25 samples of milk for examination, bacteriologically, as to the presence of the tubercle bacillus. These samples were taken during August and October of that year. In dealing with these samples due consideration was given to the report that was submitted to this Committee and to the Local Government Board on the analysis of milk samples undertaken in the years 1907-8 by the Council. During those years 76 samples were taken for the purpose of examination as to the presence of the tubercle bacillus' Of these samples, 21 were taken at railway stations, 14 at hospitals, 33 at shops, and 8 on rounds. Of this number, 17, or 22.4 per cent., were found to contain virulent tubercle bacilli, and the Council at its meeting on November 5th, 1908, decided that the attention of the Local Government Board should be drawn to the fact, with a request that general legislation should be introduced to deal with the question of tuberculous milk, which the Council considered was one of grave public concern. Of the samples then taken a very complete record was kept as to times, dates, and the actual origin of the milk as far as could be ascertained. The addresses of the farms from which the tuberculous milk came were carefully recorded, and the London County Council had these arms visited at that time. In taking the 25 samples which the Committee authorised, I beg to report that attention was given to the sources from which the samples came that were found to be tuberculous on the former occasion, and each tuberculous source was again sampled, and these samples submitted to the Lister Institute. The report of the Lister Institute was to the effect 119 that neither in those samples taken from sources found in 1907-8 to he tuberculous, nor in those taken from sources which had hitherto been non-tuberculous, had the tubercle bacillus been found. This is highly satisfactory and most striking, and I have given careful consideration to the causes at work which have resulted in such a remarkable diminution in tuberculous milk coming into the Borough. As this milk comes from more than one herd or farm, and is often a mixture of milk, though having only one consignee, it is sometimes most difficult to determine its sources. In some cases, however, the consignees to-day are the same as formerly, and though tuberculous then the milk is not tuberculous now. The disappearance of tuberculous milk can only result from two causes, (1) that all the milk sent into the Borough is pasteurised, or 2) that the production of tuberculous milk has been stopped at its source. In pursuing enquiries in regard to the largest of these supplies (coming from Buckinghamshire) I have visited sundry milk shops and factors, and have inspected the farm and herd. The farm has fortunately undergone no change of proprietorship nor destination of its milk since the former samples were taken. The Lister Institute reported that none of the samples of milk sent up were pasteurised, but as the detection of pasteurising is by no means easy I made this a special point of enquiry on visiting the farms. In respect to samples Nos. 1, 2, 3, and 4, which came from this farm, there was a herd of GO cows, and they were healthy cows, well kept. In 1907-8 the farmer had been informed of the result of our analyses, and that the milk he then supplied contained tubercle bacilli. He was an intelligent man, and realised the gravity of tuberculous milk. I convinced myself that no pasteurisation was taking place at this farm; the farmer did not know how to pasteurise properly, so as to escape detection, and, beyond straining and cooling, the milk was delivered untreated. In response to questions, the farmer stated that he had only had one animal slaughtered since the coming into force of the Board of Agriculture's Order respecting tuberculous cattle, that one being a cow that fell sick and was slaughtered, and the subsequent autopsy revealed tuberculosis. He said he had had no further cattle slaughtered for illness, that the condition of the herd had been, and is, healthy, and they were now all young animals, and that he had recently been more particular in the selection of his animals. A weeding-out 120 process having taken place during the past few years his animals are now younger than formerly, and cows beyond a certain age, or that had ceased to yield a good supply of milk, arc at once sold for butchers' meat, This, as far as I can discern is probably the reason for the cessation of tuberculous milk. The publicity given to the tuberculosis campaign, and the rigorous enforcement of the Board of Agriculture's Order would seem to have caused farmers to be more particular with their animals, and it would appear to me that animals formerly yielding tuberculous milk have passed into the hands of butchers. The merely nominal sum allowed as compensation, under the Board of Agriculture's Order, for tuberculous animals would seem to be very unpopular—there is a great disinclination on the part of the farmers to have animals slaughtered for the good of the community largely at their own expense. Nevertheless, be the causes at work what they may, I have great pleasure in reporting that the entrance of tuberculous milk into the Borough has ceased, and this has undoubtedly occurred without pasteurisation, or the milk having been tampered with in any way. I am, Mr. Chairman, Madam, and Gentlemen, Your obedient Servant, FRANK E. SCRASE, Medical Officer of Health. Milk Supply. The number of persons registered as purveyors of milk at the end of 1913 was 77, and the number of premises on which milk is sold was 102. The difference in the two numbers was accounted for by the fact that some of the milk-sellers occupy more than one shop. The premises on which milk is sold are as follows:— Dairies 52 Bakehouses and Confectioners 20 Restaurants and Coffee Shops 13 General Shops 17 Three of the registered milk-sellers 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, 121 During the year, 301 inspections were made of premises where milk is sold, 17 notices were served, and the following works were carried out:— Premises or parts of premises repaired, cleansed, and limewashed 28 Drains repaired or reconstucted 9 Drains unstopped 5 Soil pipes reconstructed 4 Water-closets repaired or renewed 13 Water-closets cleansed 4 New sinks fixed 10 Waste pipes to sinks trapped and renewed 12 Yard paving repaired or renewed 11 Dustbins provided 4 Other defects remedied 6 Section 5 of the London County Council (General Powers) Act, 1008, empowers Sanitary Authorities in London to remove from the register of milk-sellers, 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 on the register is now 17. 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 81 shops in the Borough in which ice cream is sold, and 126 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 military work carried out at premises where ice cream is sold. Premises or parts of premises repaired, cleansed and limewashed 13 Drains repaired or reconstructed 4 Soil pipes reconstructed 1 Water-closets repaired or renewed 4 „ cleansed 3 Waste pipes of sinks trapped, repaired, or renewed 5 122 Yard paving renewed 3 Dustbins provided 4 Other defects remedied 5 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 19, or 3.7 per cent. of the total number. The corresponding percentage in 1912 was 2.3; in 1911, 2.9. In addition, 13 samples were certified to be of low quality. 422 samples were purchased from Hampstead tradesmen, and 84 from persons residing without, but trading within, the Borough. The percentage of adulterated samples in these two classes were 2.1 and 11.9 respectively. Five samples were taken on Hampstead Heath on Bank Holidays, and of these, 2, or 40.0 per cent., were adulterated. 37 samples were taken on Sundays, none of these were adulterated but 2 were of poor quality 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 Butter 126 3 i Cheese 14 - - Cocoa 23 - — Coffee 23 - — Cream 11 3 — Jam, Raspberry 3 — — Lard 29 — — Margarine 5 — - Milk 256 13 13 Mince meat 3 — - Rice 2 — - Salmon & Shrimp paste 3 — - Spinach (tinned) 1 — - Tea 2 - - Vinegar 5 — - Totals 506 19 13 123 The following table shows the number of samples analysed during each year from 1907 to 1913, the number and percentage of the adulterated samples, and the fines and costs recovered in legal proceedings:— Year. Samples Analysed. Number adulterated. Percentage adulterated. Fines and Costs. £ s. d. 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 1913 506 19 3.7 38 16 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. Number adulterated. Percentage adulterated. No. 1 (Town) 78 2 2.5 No. 2 (Belsize) 66 4 6.0 No. 3 (Adelaide) 19 — — No. 4 (Central) 21 — — No. 5 (West End) 66 2 3.0 No. 6 (Kilburn) 104 1 0.9 No. 7 (Priory) 68 - - Totals 422 9 2.1 The following table shows the articles adulterated, nature of adulteration, and the results of proceedings taken:— 124 No. of Sample. Article. How adulterated. Result of proceedings. 67 Milk 4 per cent. deficient in butter-fat Cautioned. 79 Cream 0.23 per cent. of boric acid Vendor written to. 96 Milk 4 per cent. deficient in butter-fat Fine £2. Costs 12s. 6d. 106 Milk 31 per cent. added water „ £2. „ 12s. 6d. 132 Milk 5 per cent. added water „ £2. „ 19s. 0d. 135 Milk 10 per cent. deficient in butter-fat Dismissed. Vendor proving warranty. 140 Milk 3 per added water and 25 per cent. deficient in butter-fat Do. do. 141 Milk 17 per cent. deficient in butter-fat Summons not served. Vendor left neighbourhood 174 Milk 6 per cent. deficient in butter-fat Dismissed. Vendor proving warranty. 184 Milk 4 per cent. added water Do. do. 235 Milk 11 per cent. deficient in butter-fat Do. do. 290 Cream (preserved) 0.5 per cent. boric acid Six-tenths of one per cent. of boric acid. Vendor written to. 304 Milk 11 per cent. deficient in butter-fat Fine £1. Costs 16s. 6d. 306 Milk 31 per cent. added water ,, £5. „ 17s. 0d. 365 Milk 9 per cent. added water Dismissed. Vendor proving warranty. *482 Butter (Informal sample) 88 per cent. foreign fat No action. 188 Butter 7 per cent. of water over and above legal limit Fine £5. Costs £1 8s. 502 Cream Two-tenths of one per cent. of boric acid „ £5. „ 16s. 0d. *506 Butter 88 per cent. foreign fat „ £10. „ 14s. 6d. *Purchased from same vendor. 125 Informal Sample. A complaint was received that the proprietor of a provision shop was systematically supplying margarine instead of butter ; consequently the inspector directed his agent to purchase some butter (sample No. 482) at the shop without disclosing the purpose for which it was required. Upon analysis this was found to contain 88 per cent. of foreign fat and to be margarine. As the formalities required by the Sale of Food and Drugs Act had not been observed, no proceedings could follow. A second sample (No. 506) was, therefore, purchased, and this time the necessary declaration was made. This sample was found to be identical with the previous one; and the vendor was summoned and fined £10, with 14s. 6d. costs. Warranty Defence. Proceedings necessitated in regard to the adulteration of milk were dismissed in 6 instances, owing to the vendor successfully proving a warranty. It is a matter for sincere regret that Parliament has been unable to find the time necessary to deal with this very important question. A provision in the Act, enabling the vendor to summon before the Court at the time of hearing any person whom he alleges to be the person responsible for the adulteration would provide ample protection for the innocent trader; but under the existing state of affairs everybody's interests are studied except those of the consumer, who has been served with an adulterated article, for which a proper price has been paid ; and he apparently has no redress. Samples of Food taken in Course of Delivery. The Sale of Food and Drugs Act contains a very important provision in regard to the taking of samples in course of delivery. It is frequently alleged that some tradesmen who sell only genuine articles in their shops, make a practice of delivering to order goods which are not of the nature, substance and quality demanded by the purchaser. A suggestion was made in a newspaper that there was need for the formation of a Society to enable any persons who suspected the quality of food supplied by their tradesmen to have it analysed; but I would point out that there is no need for such an organisation, as any person who chooses to request the Inspector to sample any of the food delivered by his tradesmen is entitled to have this done, without any cost to himself, and I should be pleased to hear at any time from residents in the Borough who suspect the quality of food supplied to them. 136 Public Health (Regulations as to Food) Act, 1907. By the Public Health (Milk and Cream) Regulations, 1912, made in pursuance of this Act, a definite restriction has been placed on the use of preservatives by producers, retailers and others concerned in the milk and cream trade; no preservative is to be added to milk in any case, and no preservative is to be added to cream which is sold as cream. The regulations, however, do not prohibit the sale of cream containing boric acid, borax, or a mixture of these preservative substances, or hydrogen peroxide, provided:— (1) That it is sold, not as cream, but as "preserved cream," and (2) That the vessel in which it is sold bears a declaration, in the prescribed form, showing the amount and nature of the particular preservative added. The addition to cream of any other preservative substances than those mentioned is prohibited. The object of the regulations in regard to cream is to secure that preserved cream sold in compliance with the regulations shall be distinguished at all stages of sale from cream to which no preservative has been added; this distinction is important in the interests of the public generally, and particularly in the interests of infants and invalids. In order to secure completeness and uniformity in the statement required to be included in the Annual Report of the Medical Officer of Health, the Local Government Board suggest that the statement should be drawn up under the headings shown below. For administrative convenience the local authorities specified are those which also administer the Sale of Food and Drugs Acts, and the provisions of the Sale of Food and Drugs Act, 1875, relating to the taking of samples, have been applied to samples taken for the purpose of the regulations. But the action taken under the regulations is in other respects independent of the Sale of Food and Drugs Acts and does not affect the action which may be taken under those Acts. The attention of the milk-sellers in the Borough was called to the provisions of these Regulations by a circular letter. 127 Report for the year ended 31st December, 1913, of Administration in connection with the Public Health (Milk and Cream) Regulations, 1912. 1.—Milk; and Cream not sold as Preserved Cream. (a) (b) Number of samples examined for the presence of a preservative. Number in which a preservative was reported to be present. Milk 256 - Cream 7 2 Nature of preservative in each case in column (b) and action taken under the regulations in regard to it — Both samples were purchased from the same vendor, and were not sold as preserved cream; but were found, upon analysis, to contain 0.23 per cent. of Boracie Acid and 0.20 per cent. of Boracie Acid respectively. In the first instance, the firm was written to, and an explanation was received from them. No further action was taken. In the second instance, the firm was again written for an explanation, which was submitted by them. The Public Health Committee, after considering the matter, authorised legal proceedings to be taken against the vendor, who was fined £5 and 16s. costs. 2.—Cream sold as Preserved Cream. (a) Instances in which samples have been submitted for analysis to ascertain if the statements on the labels as to preservatives were correct: — (i) Correct statements made 3 (ii) Statements incorrect 1 Total 4 (b) Determinations made of milk fat in cream sold as preserved cream:— (i) Above 35 per cent. 4 (ii) Below 35 per cent. — Total 4 128 (c) Instances whore (apart from analysis) the requirements as to labelling or declaration of preserved cream in Article V (1) and the proviso in Article V (2) of the regulations have not been observed:— One sample of cream labelled "Preserved cream containing 0.5 per cent. Boracie Acid" was found, on analysis, to contain six-tenths of one cent. of Boracie Acid, or 42 grains per pound. (d) Particulars of each case in which the regulations have not been complied with, and action taken:— In the case above quoted the vendor was written to (Article VII of Milk and Cream Regulations), and his explanation was received. No further action was taken. 3.— Thickening substances. (a) Any evidence of their addition to cream or to preserved cream Nil. (b) Action taken where found Nil. 4. —Other observations, if any— All milk-sellers and vendors of cream have been circularised. There is no doubt that from a public health point of view it is desirable that food of all kinds should be free from preservatives, and some dairymen have decided to sell only cream which is free from preservatives. I think that all who use cream would be well-advised to stipulate that only fresh cream should be supplied; but, in regard to this, it must be remembered that cream without preservatives will not keep sweet for any longer period than ordinary milk, and care must, therefore, be exercised to obtain each day only a sufficient quantity for that day's requirements. Cream without preservatives cannot be kept for the prolonged periods which it has been customary in the past for some people to regard as a reasonable time for cream to keep good. 129 Schools. During the year surveys of the sanitary condition of three schools within the Borough were carried out. In each case the drains were found to be defective, and the matter received the attention of the responsible authorities, with the result that in two cases the drains have been reconstructed, and in the third the work is now in progress. Dust Receptacles. By arrangement with the Borough Engineer, the Dusting Superintendent now reports to the Public Health Department regularly the existence of fixed brick dust receptacles, and also where moveable receptacles of improper character are in use. with the result that the sanitary inspectors are able promptly to deal with the cases. Fixed dust receptacles are most insanitary, and afford a breeding place for flies and pests of a similar nature. I think it is a matter of the utmost importance, especially in view of the large increase in the use of gas stoves and the corresponding increase in the amount of offensive matter which is placed in the dustbins, that every house should be provided with proper and suitable moveable metal dust receptacles. Public Telephone Call Offices. In July a letter was received calling attention to the state of the mouth-piece of an instrument in a public telephone call office. The complainant alleged that he found it both wet and dirty, and suggested that some sanitary or disinfectanr covering should be provided to the mouth-piece. The matter is certainly one of public interest and public health, but I am unaware of any statute that would enable a sanitary authority to take action, probably for the reason that such things were not in vogue when the Public Health Acts were drafted. I sent a copy of the complaint to the Controller of the London Telephone Service, and was informed by him that each cabinet and instrument is thoroughly disinfected every nine days, and that the collectors have instructions to wipe the mouth-pieces of the instruments on each visit made by them to the boxes. The following announcement appears in the Telephone Directory:— "Attachment to Telephones—Attention is called to the fact that Subscribers are being induced to purchase appliances 130 for attachment to Telephones on the ground that they improve the Service or have some hygienic advantage. As in nearly all cases these attachments have the effect of either damaging the Apparatus or impairing its efficiency— in many cases both—Subscribers are reminded that under the conditions of their Telephone Service the use of such Appliances or Attachments is, in general, prohibited. The sale to the public of certain Appliances which have no such prejudicial effect has been sanctioned by the Post Office, and Subscribers should, before purchasing any Telephone Attachments, satisfy themselves that their use has received official sanction. It is the duty of the Post Office Engineers to remove any Attachments which have not been officially approved." Most users of the telephone will agree that any appliance which has the effect indicated is not likely to be very enthusiastically received by the public at large, and in any case I have little faith in the effieacy of these caps or coverings from a sanitary point of view. Some persons in using a telephone place their mouths so close to the mouth-piece as to be actually in contact, and in this practice the danger lies. If care is taken, when holding a conversation, to keep the face at a reasonable distance from the instrument no one runs any great risk; but, if only on aesthetic grounds, I think it should be possible for all users of a public telephone, before holding a conversation, to cleanse the mouth-piece for themselves if they so desire. This suggestion could be easily carried out if each call office were provided with a box (similar to those now in use in all Post Offices for distributing telegraph forms) filled with suitable sanitary paper. A sheet could be abstracted and the mouth-piece cleansed. Paper of this description is so cheap that the present charge of 2d. per call should not be increased in consequence of the adoption of this arrangement. Smoke Nuisances. During the year, observations in this connection were kept in 24 instances by the sanitary inspectors. In 3 cases intimation notices were sent, and in 1 instance it was found necessary to serve a statutory notice. 131 Complaints. During 1913, 711 complaints were made of the existence of insanitary conditions, A list of the matters of which complaint was made is given below:— Accumulations, offensive 6 „ of garden and other refuse 17 Animals improperly kept 10 „ dead 2 Dampness in premises 29 Dirty and dilapidated premises 25 Drains, bad condition of 16 „ defective 37 „ stopped 21 Dust, non-removal 53 Dust receptacles, foul or dilapidated 77 „ absence of, or insufficient 38 Insanitary condition of premises 52 Illness attributable to insanitary conditions 13 Manure not removed 10 Overcrowding and improper mixing of the sexes 30 Rats, nuisance from 11 Roadways, bad condition of 3 Roofs and gutters, defective and leaky 5 Rubbish, nuisance from burning 13 Smells 39 „ on premises 10 „ from road gullies 7 „ „ sewer ventilators 37 „ „ stables 2 „ „ drains, etc. 24 „ „ water-closets 4 „ „ manure 4 Smoke nuisances 15 Underground rooms illegally occupied 2 Unsound food 1 Vacant land, insanitary state of 4 Verminous condition of premises or persons 6 Water, absence of 73 „ leakage of 4 Water cisterns, dirty, etc. 3 Water-closets, accommodation insufficient or absence of 7 „ defective or insanitary 18 „ stopped 6 ,, without water 3 „ „ proper flush 4 Yards, unpaved and existing paving defective 1 Miscellaneous 38 780 Factory and Workshop Act, 1901. 136 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 1913 there were 506 workshops on the register, of which 35 were domestic workshops. Excluding the latter, there were employed in the workshops 848 males and 1009 females. Dressmaking is the trade chiefly carried on in the Hampstead workshops, and next in order of frequency come tailoring, bootmaking, 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 32 37 117 2 - 32 Blindmakers 4 7 9 10 — 4 Bootmakers 40 44 89 — 1 81 Builders and carpenters 19 23 28 — — 19 Cabinetmakers and polishers 2 8 162 1 1 3 Carriage builders 7 16 28 — — 7 Corset makers 5 5 14 - — Cycle makers and repaireis 6 9 14 — — 6 Dressmakers and ladies' tailors 113 134 5 521 15 128 Engineers 3 3 4 — — 3 Florists 3 4 13 7 — 3 Harness makers 5 8 12 — — 5 Ironmongers 14 14 31 — — 11 Laundresses 7 19 4 40 — 7 Milliners 25 25 — 77 1 26 Monumental masons 2 2 17 — — 2 Motor makers 8 4 12 — — 3 Outfitters 9 32 5 227 1 10 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 42 51 88 38 0 51 Upholsterers 19 26 50 8 2 21 Watchmakers and jewellers 13 14 24 — — 13 Wigmakers 13 19 19 24 — 13 Miscellaneous 26 37 51 31 5 31 Totals 436 570 818 1009 35 506 136 Workshop Inspection. The following particulars relate to (he workshop inspections made during 1913, bakehouse inspections being omitted. The total number of inspections made during the year was 508, as against 561 in the previous year. Cleanliness. Ten workrooms were found on inspection to require cleansing, and these were cleansed on the request of the inspector. Ventilation and Warming. In five workshops the ventilation was found to be unsatisfactory. In four cases, this was caused by gas stoves used for the heating of irons being unprovided with a flue to carry off the products of combustion. Proper hoods and Hues were fixed in three instances, and in one case the gas stove was moved to another room. In order to secure these alterations it was found necessary to serve three notices. In seven cases, the means of warming were found to be unsatisfactory. Three of these were improved on request, and four were reported to H.M. Inspector of Factories. Overcrowding All the workrooms in the workshops arc 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 is set out on a card supplied by the Council, which is hung up in each room. The legal number of occupants varies according as overtime is worked, or whether the room is used as a sleeping room as well as a workroom. During 1913, 37 new workrooms were measured. Overcrowding was found in 4 instances: one was abated on request, but notices had to be served in the other three cases before the overcrowding was abated. 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 137 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, 36 workshops were notified to H.M. Inspector of Factories us being without the abstract required. Bakehouses. At the end of 1913, there were 36 occupied bakehouses on the register, 20 being underground, and 16 aboveground. Three of the bakehouses situated above ground and one underground use power, and are therefore factories. Seven inspections were made in respect of the factory bakehouses, 89 inspections in respect of the workshop bakehouses, and 6 notices were served. 138 The following is a list of the occupied Bakehouses on the Register lit the end of the year:— Bakehouses in Wards. No. 1 (Town) Ward— 57, Heath Street. 3, High Street. 67, do. 20, 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, Haverstock Hill. *2, King's College Road. (3) No. 4 (Central) Ward— *64, Belsize Lane. *225, Finchley Road. †307, do. *98, West End Lane. †2, Broadhurst Gardens. (5) No. 5 (West End) Ward†60, Cricklewood Broadway. 110, do. 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, Palmerston 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 20 ,, Above ground 16 Total 30 139 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, 1,528 inspections were made of all the "workplaces" in the Borough, and 85 notices were served. Among the more important workplaces are the kitchensof restaurants, coffee-houses, etc., and the number of these places in Hampstead at the close of 1912 was 72. During 1913, 2 restaurant kitchens were added to the register and 3 removed, making a total of 71 on the register at the end of the year. These premises are kept under regular supervision, the number of inspections being 134 and the number of notices served, 10 Restaurant Kitchens in Wards. The following is a list of the restaurant kitchens in the various wards of the Borough. 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, Constantine Road. 25, Fleet Road. 98, do. 210, Haverstock Hill. 11, South End Road. 45, do. 65, do. 19, Southampton Road. Railway Tavern, South End Green. (9) No. 3 (Adelaide) Ward— 1, Adelaide Road. 143, do. 97, Haverstoek Hill. 11, King's College Road. Cosy Nook, Regent's Park Road. Winchester Hotel, Winchester Road. 25, Winchester Road. (7) No. 4 (Central) Ward— 72, Be'size Lane. 90, do. 159, Broadhurst Gardens. 1a, Canfield Place. 104, Finchley Road. 109a, do. 225, do. 52, Lymington Road. 12, Swiss Terrace. 100, West End Lane. 272, do. 280, do. (13) 140 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. 327, 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, Love- ridge Road. 18, Nether wood 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, Finchley Road. 115, do. 133a, do. 34, High Road, Kilburn. 48, do. do. Steer's Restaurant, Upper Avenue Read. (14) Total 71 Home Work. The Factory Act provides that in certain trades, 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 118, and the number of addresses contained in the lists was 323. 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 out-workers' premises in Hampstead is 79. Of these, 4 are factories, 40 are workshops (18 of these being domestic workshops), 1 is a workplace, and in 28 cases only a single worker is employed on the premises. 141 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 sexes employed in the Hampstead factories, workshops, and workplaces. The following is a list of the different classes of factories in Hampstead:— Art Metal Workers 2 Bakers 4 Bootmakers 10 Builders 4 Butchers 7 Carpet Beaters 2 Coffee Roasters 5 Dairymen 2 Laundries 5 Motor Works 6 Printers 10 Other trades 15 70 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. Number of Inspections. Written Notices. Prosecutions. (1) (2) (3) (4) Factories (Including Factory Laundries) 98 9 — Workshops 561 30 — Workplaces (Other than Outworkers premises included in Part 3 of this Report) 1528 85 - Total 2187 124 - 140 2. Defects found in Factories, Workshops and Workplaces. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Ret erred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acta:— Want of cleanliness 51 48 — — Want of ventilation 5 5 — — Overcrowding 5 5 — — Want of drainage of floors 1 1 — — Other nuisances 50 45 — — Sanitary accommodation insufficient 5 5 — — unsuitable or defective 5 5 — — i not separate for sexes 1 1 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (s. 101) - - - - Breach of special sanitary requirements for bakehouses (ss. 97 to 100) - - — - Other offences 9 3 6 — (Excluding offences relating to outwork, which arc included in Part 3 of this Report) Total 132 l18 6 — 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. 148 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 Occupiers 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. Lists† Outworkers† Lists Outworkers. Contractors. Workmen. Contractors Workmen. 1 2 3 4 5 6 7 8 9 10 11 12 13 11 15 16 Wearing Apparel— (1) making, etc. 74 51 139 6 - 10 - - - - - - - - - (2) cleaning and washing 14 29 - - - - - - - - - - - - - Household linen 8 - 20 - - - - - - - - - - - - Lace, lace curtains and nets - 2 6 - - - - - - - - - - - - Curtains and furniture hangings - - 10 - - - - - - - - - - - - Furniture and upholstery 11 13 5 - - - - - - - - - - - - Electro-plate - - 2 - - - - - - - - - - - - File making - - - - - - - - - - - - - - - Brass and brass articles - - 4 - - - - - - - - - - - - Fur pulling - - - - - - - - - - - - - - - Cables and chains - - - - - - - - - - - - - - - Anchors and grapnels - - - - - - - - - - - - - - - Cart gear - - - - - - - - - - - - - - - Locks, latches and keys - - 2 - - - - - - - - - - - - Umbrellas, etc. - 7 1 - - - - - - - - - - - - Artificial flowers - - - - - - - - - - - - - — - Nets, other than wire nets - - - - - - - - - - - - - - - Tents - - - - - - - - - - - - - - - Sacks - - - - - - - - - - - - - - - Racquets and tennis balls - - - - - - - - - - - - - - - Paper, etc., boxes, paper bags 2 - 22 - - - - - - - - - - - - Brush making - - - - - - - - - - - - - - - Pea picking - - - - - - - - - - - - - - - Feather sorting - - - - - - - - - - - - - - - Carding, etc., of buttons, etc. - - - - - - - - - - - - - - - Stuffed toys - - - - - - - - - - - - - - - Basket making - - - - - - - - - - - - - - - Chocolates and sweetmeats - - - - - - - - - - - - - - - Cosaques, Christmas Crackers, Christmas Stockings, &c. - - - - - - - - - - - - - - - Textile weaving - — - - — - — - — — — - - — — Total 112 102 211 6 - 10 - - - - - - - - - * In the case of those occupiers who gave out work of more than one of the classes specified in Column 1, and subdivided their lists in such a way as to show the number of workers in each class of work, the list has been included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers have been assigned in columns 3 and 4 (or 6 and 7) into their respective classes. † The figures in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year, and of the entries of names of outworkers in those lists. 144 4.—Registered Workshops. Workshops on the Register (s. 131) at the end of the year. Number. (1) (2) Bakehouses 32 Bootmakers 81 Dressmakers and ladies' tailors 128 Laundries 7 Milliners 26 Tailors 51 Watchmakers and jewellers 13 Wigmakers 13 Other 155 Total number of workshops on Register 506 5. —Other Matters. Class. (1) Number. (2) Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory and Workshop Acts (s. 133.1901) 36 Action taken in matters referred by H.M. Inspector as remediable under the Public Health Arts, but not under the Factory and Workshop Acts (s. 5 1901) Notified by H.M. Inspector 3 Reports (of action taken) sent to H.M. Inspector 3 Other 6 Underground Bakehouses (s. 101):— Certificates granted during the year — In use at the end of the year 20 Report on the Analytical Work of the Year 1913. BY ALFRED W. STOKES, F.C.S., F.I.C., PUBLIC ANALYST. 146 Analytical Laboratory, Town Hall , Paddington, W. 5th February, 1914. A short abstract of the analytical work of the year 1913 may be of interest. A total of 506 samples were analysed, comprising:— Milk 256 samples. Butter 126 ,, General Groceries 64 ,, Lard 29 ,, Cheese 14 „ Cream 11 ., Margarine 5 „ Spinach 1 ,, The only adulterated samples were dairy articles, viz.:— Milk 13 samples. Butter 3 ., Cream 3 ,, This year the total adulteration reaches 3¼ per cent.; the previous year it was 2⅓ per cent. Milk this year shows 5 per cent. of adulterated samples ag tinst 4¼ per cent. in 1912. These figures are far below those for the rest of London and demonstrate that Hampstead is especially fortunate in the purity of its food supply. ALF. W. STOKES, F.C.S., F.I.C., Public Analyst. Legal Proceedings. 149 Legal Proceedings. Legal proceedings were taken by the Council in connection with the work of the Health Department in 42 cases during the year. The chief facts relating to these proceedings are set out on pages 150-153, and arc summarised below. The facts relate only to the cases that were heard and decided in 1913. Number Statute or By-law. cutions. Fines Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and By-laws made thereunder 10 2 0 0 6 4 0 Metropolis Management Acts, and By-laws made thereunder 9 14 10 0 10 4 0 Sale of Food and Drugs Acts 11 12 0 0 3 18 0 Rag Flock Act, 1911 5 4 7 6 17 6 London County Council (General Powers) Act, 1904 2 1 5 0 0 4 9 London County Council (General Powers) Act, 1908 2 2 0 0 0 15 0 Totals 39 36 2 6 23 2 6 150 Public Health (Loudon) Art, 1891, and By-laws made thereunder. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 1912 17th Oct. 1913 29th Jan. Marylebone Police Court. Mr. Plowden E. O., Hampstead Nuisance Work done; 10s. 6d. costs, and summons withdrawn 27th Nov. 18th J uly Marylebone Police Court. Mr. Denman Owner (i) Nuisance (ii) Non-paving of yard Work done; 1s. (3d. costs allowed, and summonses withdrawn. 1913 9th Jan. do. do. Owner (i) Nuisance (ii) Non-paving of yard Work done; 10s. 6d. costs allowed and summonses with drawn. 23rd Jan. 10th June Marylebone Police Court. Mr. Plowden C. C. P., Stoke Newington Nuisance Dismissed with £5 5s. costs. 6th Feb. 18th July Marylebone Police Court. Mr. Dennian H. B Hampstead Nuisance Order made to a bate within one month, and £1 1s. 0d. costs allowed. 29th May 11th June Hampstead Petty Sessional Court. Justices M. B. T., Hampstead Contravention of Section 41 Fined £2, and costs. 15th May 13th June Marylebone Police Court. Mr. Plowden R. E., Hendon Nuisance Work done: 10s. 6d. costs paid and summons withdrawn. 4th Nov. 12th Dec. Marylebone Police Court. Mr. Paul Taylor A. C., Hampstead Non-payment of 3s. cost of removal of vegetable matter Older made to pay debt and 10s. 6d. costs. 30th Oct. do. do. W. H., Westminster Non-compliance with Council's notice to pave yard Work done; 10s. 6d. costs paid, and summons with, drawn. 16th Oct. do. do. D. D., Willesden Nuisance at two premises Work done; 10s. 6d. costs paid on each summons, and summonses withdrawn. 151 Metropolis Management Acta, and By-lavs made thereunder. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 1913 20th Feb, 1918 14th May Hampstead Petty Sessional Court. Justices E. O., Hampstead Non - compliance with Council's Orders Work done; £1s. 0d. costs allowed, and summonses withdrawn. 5th Mar. 19th Mar. do. W. H., Willesden Doing sanitary work without having given notice Fined 10s. and 5s. (id. costs. 17 th April 18th July Marylebone Police Court. Mr. Denman E. S., Hampstead Failing to deposit plans, etc. Plans deposited, etc. £1 1s. 0d costs paid and summons withdrawn. 3rd April do. do. G. M., Willesden Failing to deposit plans, etc. Plans, etc., deposited £1 1s. costs, and summons withdrawn 20th May 11th June Hampstead Petty Sessional Court. Justices M. B. T., Hampstead (i) Contravention of drainage byelaw 10 (ii) Failing to deposit plans, etc. Fined £10 on (i), £2 on (ii) and costs. 15th May I3th June Marylebone Police Court. Mr. Plowden T. K., Hampstead Non-compliance with Council's Order Work done; £1 1s. costs paid and summons withdrawn 10th July 30th July Hampstead Police Court. Justices R. T., Hampstead (i) Failing to deposit plans, etc. (ii) Contravention of drainage byelaw (iii) Contravention of drainage byelaw 10. Fined £1 and 16s. 6d. costs. 30th Oct. 3rd Dec. do. S. H. P., Hampstead Failing to deposit plans, etc. Fined £1 and £2 2s. costs Sale of Food and Drugs Acts. 1913 17th April 1913 9th May Marylebone Police Court. Mr. Francis E. T., Hampstead Selling milk containing 31 per cent. of added Water Fined £2 and 12s. 6d, costs do. do. do. W. S., St. Pancras Selling milk containing 4 percent. deficiency of butter fat. Fined £2 and 12s. 6d. costs 152 Sale of Food and Drugs Acts—continued. Date when proceedings ordered. Date of Hearing. Court, and Name of Magistrate. Initials and District of Defendant. Offence. Result of Hearing. 1913 17th April 1913 14th May Hampstead Petty Sessional Court. Justices S. & R., Ltd., Hendon Selling milk containing 5 per cent. of added water Fined £2 and 19s. costs. 1st May 23rd May Marylebone Police Court. Mr Paul Taylor T. J. D. Willesden Selling milk containing 10 per cent. less than the proper amount of butter fat Warranty proved and summons dismissed do. do. do. A. J. W., St. Pancras Selling milk containing 3 per cent. of added water and 25 per cent. less than the proper amount of butter-fat. Warranty proved and summons dismissed. 29th May 20th June Marylebone Police Court. Mr. Plowden J. P. B., Willesden Selling milk containing 4 per cent. added water Warranty proved and summons dismissed. do. do. do J. H., Willesden Selling milk containing 6 per cent. less than the proper amount of butter fat Warranty proved and summons dismissed. 10th July 30th July Hampstead Police Court. J ustices W. S., St. Pancras Selling milk containing 11 per cent. less than the proper amount of butterfat Warranty proved and summons dismissed 23rd Sept. 24th Sept. do. G. D., St. Pancras Selling milk with 11 per cent. less than the proper amount of butter fat Fined £1 and 17s. costs. do. 25th Sept. do. R. L., Islington Ditto with 31 per cent. of added water Fined £5 and 17s. costs., or 1 month's imprisonment 13th Nov. 12th Dec. Marylebone Police Court. Mr. Paul Taylor R. P., Paddington Selling milk containing 9 per cent. of added water Warranty proved and summons dismissed 153 Rag Flock Act, 1911. Date w hen proceedings ordered. Date of Hearing. Court and Name of Magistrate. Initials and District of Defendant, Offence, Result of Hearing. 1913 6th Feb. 1913 14th Feb. Marylebone Police Court. Mr. Plowden T. W., St. Paneras Contravention of Act Fined 12s. 6d. and 3s. costs. do. 19th Feb. Hampstead Petty Sessional Court. Justices F. H. C., Hampstead Do. Fined £2 and 7s. 6d. costs, 20th Feb. 28th Feb. Marylebone Police Court. Mr, Plowden P. Le-B., St. Pancras Do. Fined 10s. and 12s. 6d. costs. do. do. do. E. E. J. & J. B., St. Pancras Do. Fined £1 and 12s. 6d, costs, 3rd April 18th April do. J. G., Hampstead Do. Fined 5s. and 2s. costs. London County Council (General Powers) .Act, 1904. 1913 11th Mar. 1913 18th April Marylebone Police Court. Mr. Plowden K. S., Hampstead Obstructing Inspector in execution of duties under the Act Fined 5s, and 2s, costs. 15 th May 13th June do. K. S., Hampstead Obstruction of Inspector at 81, Broomsleigh Street, in carrying out duties under the Act Fined £1 and 2s. costs. London County Council (General Powers) Act, 1908. 1913 5th Mar. 1913 19th Mar. Hampstead Petty Sessional Court. Justices J. W., Hampstead Contravention of Section 8 as to maintaining cleanliness Fined £1 and 7s. 6d. costs. 20th Feb. do. do. A. C, Hampstead Contravention of Section 8 as to maintaining cleanliness Fined £1 and 7s. 6d, costs. APPENDIX 1. Tables. 157 TABLE I. (Required by the Local Government Hoard to be used in the Annual Report of the Medical Officer of Health.) Vital Statistics of Whole Borough during 1913 and Previous Years. Year. Population estimated to Middle of each Year. Birhs. Total Deaths Registered in the Borough. Transferable Deaths. † Nett Deaths belonging to the Borough. Uncollected 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 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 1913 86346 1258 1325 150 1273 14.5 474 153 91 68.7 951 10.8 † “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 Total number of buildings used as dwellings, 11,976. Average number of persons per house, 7.1. of 1911. Number of ordinary dwelling houses, 10,062. Average number of persons per house, 6.7. 158 TABLE II. (Required by the Local Government Board to he used in the Annual Report of the Medical Officer of Health.) Cases of Infectious Disease Notified during the Year 1913. NOTIFIABLE DISEASE. Number of cases notified. Total Cases Notified in each Ward. Total Cases removed to Hospital. At all Ages. At Ages—Years. 1 2 3 4 5 6 7 Under 1. 1 and under 5. 5 and under 15. 15 and under 25. 25 and under 45. 45 and under 65. 65 and upwards. Ward No. (Town). Ward No. (Belsize). Ward No (Adelaide). Ward No. (Central). Ward No. (West Enc Ward No. (Kilburn). Ward No. (Priory). Small-pox .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Cholera Plague .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria (including Membranous Croup) 116 1 35 49 17 13 1 .. 36 23 2 11 15 19 10 98 Erysipelas 32 .. 2 3 8 7 7 5 2 9 2 5 6 5 3 10 Scarlet Fever 198 1 51 109 22 14 1 .. 19 17 22 18 33 78 11 159 Typhus Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever 14 .. 1 1 6 5 1 .. 3 .. .. 4 3 2 2 6 Relapsing Fever Continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 1 .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. Cerebro-spinal Meningitis .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Polio-Myelitis 4 1 2 .. 1 .. .. .. 1 1 .. .. 1 1 .. 2 Pulmonary Tuberculosis 244* .. 2 51 53 97 37 4 41 31 20 11 31 84 26 95* Other forms of Tuberculosis 56* 2 9 22 6 11 3 .. 6 9 6 8 9 13 5 22* Ophthalmia Neonatorum 9 9 .. .. .. .. .. .. .. 1 1 .. 1 5 1 3 Totals 674 14 102 235 114 150 50 9 108 92 53 57 99 207 58 395 Isolation Hospitals are provided by the Metropolitan Asylums Board, and residents of Hampstead suffering from infectious disease were chiefly removed to the North-Western Fever Hospital, which is within the Borough, and is situate at Lawn Road, in No. 2 (Belsize) Ward. Persons suffering from Pulmonary Tuberculosis were removed to institutions in various parts of the country, the largest numbers going into Mount Vernon Hospital and Northwood, Northern Hospital, Winchmore Hill, Brompton Hospital andFrimley, Royal Sea Bathing Hospital, Margate, Carshalton and Hampstead Workhouse Infirmary. * These figures relate only to cases notified for the first time in 1913. The cases of Pulmonary Tuberculosis notified in Institutions were as follows: 9 in Ward 1, 1 in Ward 2, 2 in Ward 3, and 3 in Ward 7. 159 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 1913. Nett deaths at the subjoined ages of "Residents," whether occurring within or without the Borough. Total Deaths, whether of .. Residents or " Non-residents" in Institutions in the Borough. CAUSES OF DEATH. 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. All causes 1 2 3 4 5 6 7 8 9 10 11 Certified (1) 951 91 35 23 23 37 118 265 359 644 Uncertified ... ... ... ... ... ... ... ... ... ... 1. Enteric Fever 1 ... ... 1 ... ... ... ... ... 11 2. Small pox ... ... ... ... ... ... ... ... ... ... 8. Measles 21 1 11 6 2 ... ... 1 ... 63 4. Scarlet Fever 4 ... ... 2 ... 2 ... ... ... 18 5. Whooping Cough 10 5 4 1 ... ... ... ... ... 35 6. Diphtheria and Croup 3 ... ... 3 ... ... ... ... ... 45 7. Influenza 16 ... 1 ... ... 1 2 7 5 ... 8. Erysipelas 2 ... ... ... 1 ... ... 1 ... 1 9. Phthisis (Pulmonary Tuberculosis) 49 1 4 25 14 5 116 10. Tuberculous Meningitis 6 1 2 ... 3 ... ... ... ... 4 11. Other Tuberculous Diseases 6 ... 1 ... 1 1 1 2 ... 9 12. Cancer, malignant disease 100 ... ... 1 ... 2 8 46 43 72 13. Rheumatic Fever 4 ... ... 1 ... 2 1 ... ... ... 14. Meningitis (2) 6 1 ... ... 2 2 ... 1 ... 6 15. Organic Heart Disease 104 ... 1 ... 3 3 11 26 60 32 16. Bronchitis 58 3 2 ... 1 1 1 15 35 13 17. Pneumonia (all forms) 73 3 7 4 1 4 8 20 26 22 18. Other Diseases of Respiratory Organs 14 2 ... ... ... 3 7 2 4 19. Diarrhœa and Enteritis(3) 18 13 1 2 ... ... 1 1 ... 13 20. Appendicitis and Typhlitis 11 ... ... ... 1 3 2 2 3 7 21. Cirrhosis of Liver 15 ... ... ... 1 ... 1 7 6 2 21a. Aleoholism 3 ... ... ... ... ... ... 3 ... 1 22. Nephritis and Bright's Disease 45 ... ... ... ... 2 8 20 15 11 23. Puerperal Fever 2 ... ... ... ... ... 2 ... ... 1 24. Other accidents and diseases of Pregnancy and Parturition 2 ... ... ... ... ... ... ... ... 2 25. Congenital Debility and Malformation, including Premature Birth 43 42 1 ... ... ... ... ... ... 10 26. Violent Deaths, excluding Suicide 21 1 ... ... 1 3 5 7 4 24 27 Suicide 12 ... ... ... ... ... 5 6 1 5 28. Other Defined Diseases 298 20 2 2 5 7 32 76 154 112 29. Diseases ill-defined or unknown 4 1 ... ... ... ... ... 3 ... 1 Totals 951 91 35 23 23 37 118 265 359 644 Sub Entries. 14 (a) Cerebro-spinal Meningitis ... ... ... ... ... ... ... ... ... 1 Included in above figures. 28 (a) Poliomyelitis 1 ... ... ... ... 1 ... ... ... ... All "Transferable Deaths" of residents, i.e , of persons resident in the Borough who died outside it, have been included with the other deaths in columns 2-10. Transferable deaths of nonresidents, i.e., of persons resident elsewhere in England and Wales who died in tne Borough have in like manner been excluded from these columns. (1) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as "Certified"; all other deaths are regarded as "Uncertified." (2) Exclusive of "Tuberculous Meningitis" (see Title 10), but inclusive of Cerebro-spinal Meningitis. (3) Title 19 is used for deaths from Diarrhœa and Enteritis at all ages. 160 TABLE IV. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) Infant Mortality, 1913. Nett Deaths from stated Causes at various Ages under One Year of Age. causes of death. Under 1 Week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 4 Weeks and under 3 Months. 3 and under 6 Months. 6 and under 9 Months. 9 and under 12 Months. Total Deaths under 1 Year. All Causes Certified 28 6 4 2 40 19 18 9 5 91 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... ... 1 1 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... 1 1 ... 2 2 ... 5 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous gitis ... ... ... ... ... ... ... 1 ... 1 Abdominal Tuberculosis (a) ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... 1 ... ... 1 Convulsions 2 ... ... ... 2 ... 1 ... ... 3 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... ... 2 1 ... 3 Pneumonia (all forms) ... ... ... ... ... 1 1 1 ... 3 Diarrhœa ... ... ... ... ... 1 2 2 ... 5 Enteritis 1 ... ... ... 1 2 2 ... 3 8 Gastritis ... ... ... ... ... 1 ... 1 ... 2 Syphilis ... ... ... ... ... 2 ... ... ... 2 Rickets ... ... ... ... ... ... 1 ... ... 1 Suffocation, overlying 1 ... ... ... 1 ... ... 1 ... 2 Injury at Birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis ... ... ... ... ... ... ... ... ... ... Congenital Malformations (b) 1 ... ... ... 1 2 2 ... ... 5 Premature Birth 18 8 2 ... 18 3 1 ... ... 22 Atrophy, Debility and Marasmus 1 1 2 1 5 7 3 ... ... 15 Other causes 6 2 ... ... 8 ... ... ... 1 9 Totals 28 6 4 2 40 19 18 9 5 91 Nett Births in Clegitimate, 1,252 Nett Deaths in legitimate infants, 73. the year illegitimate, 73 the year of illegitimate infants, 18. (a) Under Abdominal Tuberculosis have been included deaths from Tuberculous Peritonitis and Enteritis and from Tabes Mesenterica. (b) The total deaths from Congenital Malformations, Premature Birth, Atrophy, Debility and Marasmus, equal the total in Table III, under the heading Congenital Debility, and Malformation including Premature Birth. Want of Breast Milk has been included under Atrophy and Debility. 161 TABLE V. (This 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.) PREMISES. NUMBER OF PLACES. Number of inspections, 1913. Number of notices, 1913. Number of prosecutions, 1913. On register at end of 1912. Added in 1913. Removed in 1913. On register at end of 1913. Milk premises 100 4 2 102 301 17 — Cowsheds — — — — — — — Slaughterhouses 4 — — 4 36 — — Other offensive trade premises — — — — — — — Ice cream premises 80 4 3 81 126 13 — Registered houses let in lodgings 425 17 73 369 371 183 — Total number of Intimation Notices served for all purposes 1258 Overcrowding— Number of dwelling rooms overcrowded 10 Number remedied 10 Number of notices issued 7 Number of prosecutions — Underground rooms — Number closed during year 27 Illegal occupation dealt with during year 101 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 (Loudon) Act, 1891 — Number of persons accommodated during the year — 162 TABLE V.—continued. Customs and Inland Revenue Arts— Number of houses for which applications wore received 9 Number of dwellings comprised therein 22 Number of Certiticates granted (houses) * 7 „ „ refused ( „ ) — „ „ deferred ( „ ) † 8 Legal Prosecutions. By-laws under Public Health (London) Act, 1891— (a) For prevention of nuisance arising from snow, ice, salt, filth, etc. — (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 injurious to health — (d) As to paving of yards, etc., of dwelling houses 4 (e) In connection with the removal of offensive matter, etc. — (f) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. — (A) With respect to water-closets, earth-closets, etc. 2 (i) With respect to sufficiency of water supply to waterclosets — (j) Relating to houses let in lodgings — Dairies, Cowsheds and Milkshops Orders— Dirty milk utensils — By-laws under Metropolis Management Acts— (a) With respect to drainage, etc. 3 (b) With respect to deposit of plans as to drainage, etc. 4 By-Laws under London County Council (General Powers) Act, 1903, Part VIII.— Conveyance of dead horses through street — * These 7 houses comprised 33 "dwellings." † These 8 houses comprised 20 "dwellings." 163 TABLE V. — continued. Action taken under: London County Council (General Powers) Act, 1904, Part IV.— Number of fifthy articles purified (Sec. 19) 2517 „ „ „ destroyed (Sec. 19) — „ verminous rooms cleansed (Sec. 20) 67 „ „ houses „ (Sec. 20) 42 ,, sanitary conveniences altered (Sec. 22) 2 „ „ „ removed (Sec. 22) — ,, fixed ashpits removed (Sec. 23) 63 London County 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) 115 Mortuary. Total number of bodies removed. 107 Total number of infectious bodies removed —. 164 TABLE VI. Vital Statistics of the Borough. Number of ordinary dwelling houses 10,062 Population 67,146 At Census 1911. Average number of persons per house 6.7 Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infections Diseases. Pulmonary Tuberculosis. 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). Attaek-rate per 1000 of the Population. Deaths occurring . Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Population. 1902 82380 1516 18.4 904 110 133 87.7 460 5.6 33 0.40 73 0.89 1903 82730 1453 176 837 101 126 86.7 311 3.7 16 0.19 66 0.80 1901 83080 1445 17.4 892 10.7 161 111.4 301 3.6 20 0.24 73 0.89 1905 83430 1421 17.0 823 9.9 133 93.6 295 3.5 14 0.17 73 0.87 1906 83780 1437 17.1 850 10.1 111 77.2 557 6.6 22 0.26 57 0.68 1907 84130 1359 16.1 817 9.7 98 73.1 498 5.9 15 0.18 61 0.72 1908 84480 1400 16.6 803 9.5 97 69.3 383 4.5 20 0.24 74 0.88 1909 81830 1328 15.6 839 9.9 99 74.5 325 3.8 21 0.25 53 0.62 1910 85210 1340 15.7 829 9.7 81 60.4 233 2.8 13 0.16 58 0.68 1911 85599 1276 14.9 847 9.9 105 82.3 345 40 25 0.29 56 0.65 1912 85966 1281 14.9 861 10.0 79 61.7 320 3.7 25 0.29 64 0.74 1913 86346 1325 15.0 951 10.8 91 68.7 374 4.3 13 0.15 49 0.56 TABLE VI. (1). Vital Statistics of No. 1 (Town) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. Pulmonary Tuberculosis. 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. Deaths. Death-rate per 1000 of the Population. 1902 12120 192 15.8 163 13.4 20 104.1 64 5.3 4 0.33 17 1.40 1903 12310 194 15.7 127 10.3 14 72.1 38 3.1 1 0.08 11 0.89 1904 12500 195 15.6 125 10.0 20 102.5 65 5.2 4 0.32 13 1.04 1905 12690 194 15.3 127 10.0 24 123.7 72 5.7 3 024 9 079 1906 12870 205 15.9 131 102 21 102.4 107 8.3 6 0.47 5 0.39 1907 13070 185 14.1 152 11.6 15 81.1 105 8.0 2 0.15 13 0.99 1908 13250 225 17.0 103 8.1 11 48.8 65 4.9 1 0.07 7 0.53 1909 13430 196 14.6 140 10.4 15 76.5 53 3.9 4 0.30 6 0.45 1910 13610 199 14.6 118 8.7 15 75.4 25 1.8 1 0.07 6 0.44 1911 13820 207 15.0 133 9.6 19 91.8 71 5.1 7 0.51 7 0.51 1912 14040 183 13.0 135 9.6 12 65.5 47 3.3 2 0.14 5 0.36 1913 14250 201 13.8 161 11.1 11 54.7 61 4.3 3 0.21 11 0.76 165 TABLE VI. (2), Vital Statistics of No. 2 (Belsize) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. Pulmonary Tuberculosis. 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. Deaths. Death-:a e per 100J of the Population. 1902 13030 239 18.3 135 10.4 18 75.3 94 7.2 9 0.69 15 1.15 1903 13110 211 161 121 9.2 13 61.6 60 46 2 0.14 13 0.99 1904 13200 217 16.4 141 10.7 23 105.9 47 3.6 3 0.23 12 0.91 1905 13280 209 15.7 131 9.9 13 62.2 42 3.2 2 0.15 10 0.75 1906 13370 187 14.0 127 9.5 8 42.8 60 4.5 4 0.30 13 0.97 1907 13450 205 15.2 114 8.5 13 63.4 63 4.7 3 0.22 10 0.74 1908 13530 205 15.1 126 9.3 8 39.0 81 6.0 1 0.07 16 1.18 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 10 0.72 1912 13830 188 13.6 127 9.2 8 42.5 62 4.5 4 0.29 7 0.51 1913 14000 214 150 126 88 16 74.7 52 3.7 5 0.35 5 0.35 TABLE VI. (3). Vital Statistics of No. 3 (Adelaide) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infections Diseases. Pulmonary Tuberculosis. Number. Estimated rate per1000 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. Deaths. Death-rate per 1000 of the Population. 1902 10350 103 9.9 95 9.6 3 29.1 40 3.9 2 0.19 7 0.68 1903 10310 95 9.2 101 9.8 9 94.7 22 2.1 1 0.10 1 0.10 1904 10260 100 9.7 99 9.6 13 130.0 36 3.5 2 0.19 8 0.78 1905 10220 96 9.4 92 9.0 4 41.7 27 2.6 1 0.10 4 0.39 1906 10170 97 9.5 92 9.0 10 103.1 29 2.8 .. .. 5 0.49 1907 10120 75 7.4 86 8.5 8 106.7 29 2.9 1 0.10 2 0.20 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 3 0.30 1910 10000 96 9.6 78 7.8 2 20.8 22 2.2 1 0.10 5 0.50 1911 9950 82 8.2 99 9.9 6 73.2 19 1.9 3 0.30 3 0.30 1912 9930 117 11.8 77 7.7 6 51.3 24 2.4 1 0.10 9 0.91 1913 9780 97 9.7 99 9.9 9 92.8 27 28 ... ... 4 0.40 166 TABLE VI. (4). Vital Statistics of No. 4 (Central) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Kate per 1000 Births. Cases occurring (excluding Chicken-pox). Attack-rate per 1000 of the Population. Deaths occurring. Death-rate per 1000 of the Population. Deaths. Death-rate per 1000 of the Population. 1902 9190 110 12.0 71 7.7 11 100.0 40 4.3 ... ... 5 0.54 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 ... ... 1 0.11 1905 9400 113 12.0 60 6.4 5 44.2 24 2.5 1 0.11 6 0.64 1906 9470 95 10.0 83 8.8 3 31.6 34 36 ... ... 2 0.21 1907 9540 108 11.3 68 7.1 9 83.3 33 3.4 2 0.21 5 0.52 1908 9610 104 10.8 82 8.5 6 57.7 33 3.4 1 0.10 7 0.73 1909 9680 116 12.0 63 6.5 3 25.9 29 3.0 2 0.21 3 0.31 1910 9770 105 10.7 82 8.4 8 76 2 28 29 2 0.20 3 0.31 1911 9859 92 9 3 75 7.6 8 87.0 25 2.5 1 0.10 3 0.30 1912 9876 97 9.8 76 7.7 4 41.2 29 2.9 1 0.10 6 0.61 1913 9996 91 8.9 84 8.2 6 65.9 38 3.8 ... ... ... ... TABLE VI. (5). Vital Statistics of No. 5 (West End) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. Pulmonary Tuberculosis. 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. Deaths. Death-rate per 1000 of the Population. 1902 12250 275 22.4 107 8.7 20 72.1 102 8.3 6 0.49 6 0.49 1903 12320 243 19.7 111 9.0 21 86.4 55 4.5 2 0.16 12 0.97 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 0.88 1906 12510 259 20.7 115 92 14 54.1 168 13.4 5 0.40 8 0.64 1907 12580 250 19.9 114 9.1 16 64.0 153 12.2 4 0.32 9 0.71 1908 12640 254 20.1 121 9.6 26 102.4 68 5.4 10 0.79 9 0.71 1909 12700 239 18.8 118 9.3 13 54.1 51 4.0 2 0.16 6 0.17 1910 12770 216 16.9 121 9.5 17 78.7 44 3.4 4 0.3l 11 0.86 1911 12850 216 16.8 102 7.9 15 69.4 44 3.4 5 0.39 10 0.78 1912 12890 226 17.5 126 9.8 13 57.5 65 5.0 10 0.77 12 0.93 1913 13050 240 18.0 145 10.9 11 45.8 59 4.5 1 0.07 7 0.53 167 TABLE VI. (6). Vital Statistics of No. 6 (Kilburn) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. Pulmonary Tuberculosis. 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. Deaths. Death-rate per 1000 of the Population. 1902 14790 435 29.4 219 14.8 45 103.4 76 5.1 11 0.74 16 1.08 1003 14800 417 28.2 184 12.4 39 93.5 59 4.0 3 0.20 18 1.22 1904 14810 408 27.5 206 13.9 54 132.3 43 2.9 8 0.54 22 1.48 1905 14820 426 28.7 171 11.5 50 117.4 57 3.8 2 0.13 26 1.75 1906 11840 444 29.9 197 13.3 41 92.0 128 8.6 5 0-34 15 1.01 1907 14850 391 26.3 179 12.0 28 71.6 86 5.8 3 0.20 16 1.08 1908 14880 393 264 186 12.5 30 76.3 72 4.8 4 0.27 21 1.41 1909 14890 341 22.9 182 12.2 37 108.5 67 4.5 6 0.40 17 1.14 1910 14900 379 25.4 192 12.9 24 63.3 52 3.5 3 0.20 16 1.07 1911 14920 347 23.2 179 12.0 31 89.3 82 5.5 6 0.40 16 1.07 1912 15000 353 23.5 188 12.5 26 73.6 70 4.7 6 0.40 14 0.93 1913 15200 354 22.8 213 13.7 25 70.6 110 7.2 3 0.19 18 1.16 TABLE VI. (7). Vital Statistics of No. 7 (Priory) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases. Pulmonary Tuberculosis. 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. Deaths. Death-rate per 1000 of the Population. 1902 10650 162 15.2 110 10.3 16 98.7 44 4.1 1 0.94 7 0.66 1903 10620 194 18.3 116 10.9 21 108.2 43 4.0 3 0.28 5 0.47 1904 10600 152 14.3 121 11.4 13 85.5 23 2.2 .. .. 9 0.85 1905 10570 133 12.6 103 9.7 14 105.3 44 4.2 3 0.28 7 0.66 1906 10550 150 14.2 93 8.8 9 60.0 31 2.9 2 0.19 8 0.76 1907 10520 127 12.1 94 8.9 7 55.1 29 2.7 .. .. 6 0.57 1908 10500 126 12.0 93 8.8 10 79.3 34 3.2 1 0.09 7 0.67 1909 10480 149 14.2 111 10.6 11 73.8 21 2.0 .. .. 8 0.76 1910 10450 138 13.2 111 10.6 6 43.5 13 1.2 .. .. 8 0.76 1911 10420 143 13.7 115 11.0 9 63.0 26 2.5 1 0.09 5 0.48 1912 10100 117 11.1 115 10.9 7 59.8 23 2.2 1 0.09 10 0.96 1913 10070 128 12.5 117 11.4 12 93.7 27 2.7 1 0.10 3 0.29 168 TABLE VII. Vital Statistics of Hampstead, compared with England and Wales. Year. Birth rate per 1000. General death-late per 1000. Natural increase Hampstead. Notifiable Infee tiousdisease rate per 1000 Hampstead. Hampstead. England and Wales. Hampstead. England and Wales. 1875 22.6 3.4 12.5 22.7 394 — 1876 24.4 36.3 15.2 20.9 367 — 1877 24.0 35.0 13.7 20.3 413 — 1878 24.5 35.6 14.8 21.6 409 — 1879 22.8 34.7 13.2 20.7 365 — 1880 24.1 34.2 12.6 20.5 521 — 1881 23.8 33.9 12.7 18.9 502 — 1882 23.6 33.8 13.0 19.6 546 — 1883 23.8 33.5 11.2 19.5 685 — 1884 22.0 33.6 12.5 19.5 554 — 1885 21.2 32.9 11.5 19.0 593 — 1886 21.0 32.8 12.2 19.3 554 — 1887 21.9 31.9 11.0 18.8 628 — 1888 20.5 31.2 10.6 17.8 616 — 1889 21.0 31.1 10.7 17.9 728 — 1890 21.9 30.2 13.1 19.1 613 — 1891 21.5 31.4 12.2 22.5 670 4.5 1892 20.4 30.5 12.4 19.0 591 8.0 1893 20.5 30.8 12.9 19.2 547 11.1 1894 19.6 29.6 10.8 16.6 674 6.2 1895 19.8 30.2 13.4 18.7 452 7.3 1896 191 29.7 12.0 171 546 7.8 1897 20.2 29.7 11.6 17.4 568 5.1 1898 18.1 29.4 11.4 17.6 599 5.7 1899 19.7 293 11.4 18.3 650 6.0 1900 20.0 28.7 11.3 18.3 699 5.8 1901 18.3 28.5 10.6 16.9 633 5.6 1902 18.4 28.6 11.0 16.2 612 *5.6 1903 17.6 28.4 10.1 15.4 616 *3.8 1904 17.4 27.9 10.7 16.2 553 *3.6 1905 17.0 27.2 9.9 15.2 598 3.5 1906 17.1 27.0 10.1 15.4 587 6.6 1907 16.1 26.3 9.7 15.0 524 5.9 1908 16.6 26.5 9.5 14.7 597 4.5 1909 15.6 25.6 9.9 14.5 489 3.8 1910 15.7 24.8 9.7 13.4 511 2.7 1911 14.9 24.4 9.9 14.6 429 *4.0 1912 14.9 23.8 10.0 13.3 420 3.7 1913 150 23.9 10.8 13.7 374 4.3 * Excluding Chicken-pox, which was notifiable during certain periods of these years, Also excluding notifications of Pulmonary, and other forms of, Tuberculosis. APPENDIX II. Report of the Tuberculosis Medical Officer on the work of the Hampstead Municipal Tuberculosis Dispensary from 1st February to 31st December, 1913. 171 Report on the work of the Hampstead Municipal Tuberculosis Dispensary from 1st February to 31st December, 1913. Since the opening of the Dispensary, 455 persons have applied for treatment, and of these 191 were found to be tuberculous and were dealt with at the dispensary as their circumstances demanded. Table I. shows the number of applications for each individual month and indicates the proportion of insured persons under the National Insurance Act who applied for treatment, and the number of these who were found to be tuberculous:— TABLE I. Total Number of Applications made during year 1913. Month. Tuberculous. Non-Tuberculous. Totals. Insured. Non. Insured. Total. Insured. Non. Insured. Total. Insured. Non. Insured. Total. February 12 8 20 4 8 12 16 16 32 March 12 31 43 4 23 27 16 54 70 April 6 18 24 3 20 23 9 38 47 May 3 17 20 3 28 31 6 45 51 June 7 13 20 3 31 34 10 44 54 July 7 8 15 5 14 19 12 22 34 August 7 2 9 4 23 27 11 25 36 September 1 1 2 4 8 12 5 9 14 October 6 12 18 6 26 32 12 38 50 November 6 3 9 6 20 26 12 23 35 December 3 8 11 3 18 21 6 26 32 Totals 70 121 191 45 219 264 115 340 455 172 Sex and Age distribution of the 455 applicants. Table II shows the age and sex distribution of the applicants for treatment, and also exhibits the incidence of tuberculosis at each age group. It is interesting as showing the large proportion of children under 10 who were examined (187, or 41 per cent.). It is obviously of the greatest importance in the attempt to eradicate tuberculosis to bring under review for examination purposes as many children and adolescents as possible, as in the detection of early cases among this class of the community lies one of our most useful preventive measures. A considerable proportion of the children included in this number were actually living in the same house with infective cases of the disease, and so under conditions where infection was liable to occur. It will also be noticed that the incidence of pulmonary tuberculosis increases markedly from infancy into childhood and adolescence, and decreases after the age of 40. 178 TABLE II. Table showing Sex and Age Distribution of 455 Applicants, and the incidence of Pulmonary and non-Pulmonary tuberculosis at each age group. Age. 0—1 1-5 6—10 11-20 21—30 31—40 41—50 51—60 Over 60 All Ages. Sex. M. F. Both M. F. Both M. F. Both m. F. Both M. F. Both M. F. Both M. F. Both M. F. Both M. F. Both m. F. Both Total Examined 2 3 5 35 28 63 53 66 119 45 50 95 22 33 55 23 41 64 15 26 41 4 5 11 1 3 1 200 255 455 Pulmonary Tuberculosis — — — — 4 4 16 18 34 17 27 44 12 25 37 11 23 34 6 10 16 1 2 3 1 1 2 64 110 174 Non-Pulmonary Tuberculosis — — — — 2 2 4 — 4 2 1 3 — 2 2 1 3 4 2 — 2 — — — — — — 9 8 17 Non-Tuberculous 2 3 5 35 22 57 33 48 81 26 22 18 10 6 16 11 15 26 7 16 23 3 3 6 — 2 2 127 137 264 Percentage of Pulmonary Tuberculosis — — — — 14 6 30 27 28 38 54 46 54 76 67 48 56 53 40 38 39 25 40 33 100 33 50 32 43 38 174 Number of Persons Treated. Since the opening of the Dispensary the following patients have been treated:— Linired: — Pulmonary 515 Non-pulmonary 5 — 58 Non-1 uxured:— Pulmonary 99 Non-pulmonary 8 — 107 165 Table III shows the proportion of males, females, and children under 14, treated, taking insured and non-insured patients together. It will be seen that whereas 191 persons examined at the dispensary were found to be tuberculous, 165 of these were actually treated. The remaining 26 were either sent for consultative purposes only and were referred back to the practitioner at his request, or were sent direct to sanatoria, or otherwise, and did not come under the dispensary for treatment. TABLE III. Males. Females. Children under 11. Total. Pulmonary 36 67 49 152 Non-pulmonary 4 4 5 13 Totals 40 71 54 165 Attendances:— The attendances made by these patients for treatment during the eleven months were :— Insured 080 Non-Insured 1828 2 808 175 Stage of Disease:— Table IV shows the stage of the disease as it affected the 132 pulmonary cases treated, in terms of Turban's Stadia. Males. Females. Children under 14. Totals. Stage I. 15 31 49 95 „ II. 8 28 — 36 „ III. 13 8 — 21 Totals 36 67 49 152 Stage I. of Turban's classification implies slight disease affecting one lobe of the lung or half of two lobes. Stage II. implies definite infitration of one lobe or disease of moderate severity affecting only half of two lobes. Stage III. implies any condition of greater extent and severity than Stage II., or any cavity formation in the lungs. This classification has the disadvantage that it is based purely on anatomical data and takes no cognisance of systemic disturbance. It however exhibits sufficiently clearly the preponderence of earlier cases dealt with at the dispensary. It is obvious that the earlier cases of phthisis are induced to come to the dispensary the more hopeful the outlook for the individual patient, and the less the chance of contagion as regards those who come into contact with him. R"-o.raminationi.—During the eleven months, 100 re-examinations of patients under treatment took place. Contactx.—During the period under review, 201 contacts wore examined, and 48 of these (23 per cent.) were found to be suffering from pulmonary tuberculosis, and were treated at the dispensary. One of the tragic facts about pulmonary tuberculosis is that infected persons do not, as a rule, seek medical advice until the disease is in the more advanced stages and, in consequence, the difficulty of arresting the disease in the individual is much increased. Every effort has been made to induce those in close relationship with existing cases to undergo examination at the dispensary, and in this way many hitherto unsuspected cases of the disease have been "unearthed" and treated, 176 Where it is nor possible for the contacts to attend the dispensary for examination the Medical Officer examines them in their own home, but this is not a course to be recommended unless as a last resource. This work is beset with many difficulties, but must be regarded as a very useful measure on the preventive side of the work of a tuberculosis dispensary. Home Visits.— Visits to the homes of the patients are undertaken by the Medical Officer and the Nurse, and have for tlieir object (a) the supervision and education of the consumptive patients; and (b) treatment of such cases as are unable, on account of the severity of their case, or for other reasons, to attend at the dispensary. Since the opening of the dispensary the following domiciliary visits have been made:— Medical Officer 317 Nurse 696 1013 In addition, every notified case is visited by a Borough Council health visitor who reports on housing conditions, and a great number of visits are undertaken by the voluntary visitors of the Council of Social Welfare. No figures are available with respect to the last-mentioned visitors in view of the fact that their work is done quite independently of the dispensary staff, and so no official relationship exists between the voluntary workers and the Borough Council staff. At the same time every effort is made to insure unoffical co-ordination, by frequent and periodical consultations between the Tuberculosis Medical Officer and the voluntary agency, and this co operation is further insured bv the fact that the Medical Officer of Health, the Dispensary Medical Officer, and the Borough Council health visitor are all members of the JointTuberculosis Committee of the Council of Social Welfare and the Hampstead Health Society. The work done by the voluntary agencies mentioned and the co-operation with the Borough Council officials indicated are important factors in the work of the dispensarv, and the Tuberculosis Medical Officer takes this opportunity of acknowledging the valuable assistance afforded by the voluntary workers. In view of the importance of housing conditions as a factor in the incidence and spread of pulmonary tuberculosis, domicilary visitation and supervision plays an important part in the work of the dispensary. 177 Tuberculin.—Many of the patients treated have received full courses of tuberculin treatment with, in the majority of cases, most excellent results. The tuberculins used have been P.T.O., P.T., Old Tuberculin, Rosenbach's Tuberculin, B.E. and Albumose Free Tuberculin (T.A.F.). The haphazard use of tuberculin has nothing to commend it, but in carefully selected cases there would appear to be a distinct field of usefulness for the remedy when carefully combined with a judicious ordering of the patient's whole manner of living. Tuberculin must be regarded merely as an item in the remedial scheme, and its use must not be allowed to overshadow the other factors calculated to improve his hygienic environment. Patuiits discharged.—During the eleven months undericonsideration, 23 patients were discharged. Their condition on discharge was as follows: — Much improved 13 Improved 6 I a statu qua 4 23 In addition, the following patients were dealt with as indicated:— Kent to Sanatoria, Hospitals, Convalescent Homes (other than Poor Law), etc 23 Sent to Workhouse Infirmary (including 11 children sent to Guardians' Homes through Infirmary) 14 Left District 5 Ceased attending 13 Bacteriological Examination of Sputa.—The following specimens were examined in the laboratory, including specimens sent by medical practitioners practising in the Borough : — Positive 40 Negative 101 141 178 Total Attendance*.—Table V shows the total attendances of patients at the dispensary for all purposes during the period— February 39 March 394 April 447 May 561 June 552 July 348 August 387 September 146 October 317 November 444 December 356 Total 3988 J. KING PATRICK, m.d., ch.b., b.sc., o.p.h., Tuberculosis Medical Officer and Deputy Medical Officer of Health. INDEX. page Acute Polio-myelitis or Polio-encephalitis 53 Adulteration 122-124 Alcoholism 28 Analyses, Results of 122-128 Analytical Work, Report on 146 Anti-toxin 49 Area of Borough 15 Bacteriological Examinations 49 Bakehouses 137, 138,144 Birth-Rate 1719 Births, Illegitimate 19-20 „ Number of 16 „ „ in Wards 19 Cancer 27, 28 Census Statistics 14, 15 Cerebro-Spinal Fever 53 Circulatory System, Diseases of 28 Cleansing Station 106 Combined Drainage 100-105 Complaints. Received 131 Consumption (see Tuberculosis) Customs and Inland Revenue Acts 107,108 Dairies 120, 121 Death-Rate, General 21 „ Infantile 33 Death Returns 23, 28 Deaths at various ages 23, 25-27 ,. among Legitimate arid Illegitimate Infants 38 „ Causes of 27-29, 159, 160 ,, in Public Institutions 24, 25 ,, Non-resident 20, 23 „ Number of 20,21, 23 „ Outlying 20, 23 „ Uncertified 23 Diarrhoea and Enteritis 65, 66 Diphtheria 46 Disinfection 93 Drainage Work, Drain and Sewer 100-105 Dust Receptacles 129 Enteric Fever 51-53 180 PAGE Epidemic Cerebro-Spinal Meningitis 53 Epidemic Diarrhoea 65, 66 Epidemic Diseases, Principal, Deaths and Death-Rate 57 Erysipelas 49 Factories 141, 142 Factory and Workshop Act, 1901 132-144 Flats, population in 15 Food Inspection 115 Food Premises 115-117 Health Visiting 36, 37 Home Office Tables (Factory and Workshop Act, 1901) 141-144 Homework 140-143 Houses Let in Lodgings (see Tenement Houses) Housing of the Working Classes Act, 1890—1909 109-112 Housing (Inspection of District) Regulations 1910 110 Housing, Town Planning, etc., Act, 1909 109 Ice Cream 121, 122 Infantile Mortality 30-38 Infectious Diseases 39-66 „ „ Notifiable 41 „ ,, „ Attack-Rate 41 ,, ,, „ Deaths and Death-Rate 42 Informal Samples 125 Inspections and Re-inspections of Premises 99 Legal Proceedings 149-153 Local Government Board Tables 157-160 Marriages, Number of, 1913, and rates 1903-13 16 Measles 57-62 Maternity Benefit 20, 37, 38 Milkshops and Milk Supply 117-121 Mortuary, Public 113, 114 National Insurance Act, 1911 20, 37, 38 Natural increase of population 19 Netlierwood Street Area 71 Non-residents, Deaths of 20, 23 Notifiable Infectious Diseases 41-54 Notification of Births Act, 1907 36 Nuisances, Inspection of 99 Ophthalmia Neonatorum 54 " Outlying" Deaths 23,28 Outworkers 140, 143 Polio-myelitis 53-54 Population, Density of 16 „ Estimated to middle of 1913 13 In Flats 15 „ In Wards 13 „ Natural Increase of 19 Preservatives in Milk and Cream 126-128 181 PAGE Principal Epidemic Diseases 57-65 „ „ „ Deaths and Death-Rate 59 Public Health Committee 5 Public Health (Milk and Cream) Regulations, 1912 127, 128 Public Health (Regulations as to Food) Act. 1907 126-128 Puerperal Fever 53- Rag Flock Act, 1911 112, 113 Railway Stations, Sanitation at 105 Respiratory System, Diseases of 28 Restaurant Kitchens 139,140 Sale of Food and Drugs Acts 122-126- Sanatorium Benefit 87 Sanitary Administration, General 95131 Scarlet Fever 50, 51 Schools 129 Senile Mortality 27 Slaughterhouses lift Small-pox 45 Smoke Nuisances 130 Staff of the Public Health Department 6 Still-births 17 Suicide 29 Summary of Vital Statistics 11 Telephone Call Offices 129, 130 Tenement Houses, By-laws 109 „ „ Registration of 108 „ „ Water Supply of 112 Tuberculosis .. 67 89 Tuberculosis Dispensary 84 „ ,, Report, Feb. 1st to Dec. 31st 171-178 Tuberculous Milk 117-120 Uncertified Deaths 23 Underground Rooms 111 Vaccination 45 Venereal Disease 28 Verminous Persons106, 107 Verminous Premises 106,107 Vital Statistics 11-29 Violent Deaths 29 Warranty Defence 125 Water Supply, Certificates as to 100 „ „ of Tenement Houses 112 Whooping Cough 63-65 Workshops 131-138, 141, 142, 144 Workplaces 139, 140, 141, 142 Young Children, Mortality among 25-27