HAMP66 THE Metropolitan Borough of Hampstead. REPORT for the year 1917, of the Medical Officer of Health, FRANK E. SCRASE, F.R.C S. (Eng.), L.R.C.P. (Lond.), D.P.H, (Lond.) CONTENTS. pages SECTION A.—Natural and Social Conditions of the Borough (including a review of the Vital Statistics, etc.) 5—11 „ B.—Sanitary Administration and Circumstances of the Borough 11—23 „ C.—Prevalence of and Control over Acute Infectious Diseases 23—28 „ D.—Prevalence of and Control over Tuberculosis 28—33 E.—Means for preventing Mortality in Children 33—35 „ F.—Vital Statistics of the Borough, etc. 36—45 „ G.—Legal proceedings 46 APPENDIX.—Report of the Public Analyst on the Analytical Work of the Year 47 2 PUBLIC HEALTH COMMITTEE. NOVEMBER, 1916-17 Ex- officio: HIS WORSHIP THE MAYOR. (Mr. Alderman E. A. O'Bryen, J.P.). Chairman: Mr. Councillor R. J. J. Willis. Miss Councillor M. E. Balkwill. Mr Councillor G. Buckle Mr. ,, R. H. H. Cust. „ „ C. W. Cunnington. M.R.C.S., d.p.h. ,, ,,J. F. Fraser „ ,, A. W. George, m.r.c.s., l.r.c. p. ,, ,, C. J R. MacFadden, m.d , c.m. ,, ,, T.H. NUNN. ,, ,, E. S. Payne. „ ,, H. R. Smith. ,, ,, C. Stuttaford Staff of the Public Health Department: Sanitary Inspectors : W. G Kershaw, Senior Inspector. R. Geary (Wards 1 & 2), *W F. Horniblow (Wards 3 & 7). Divisional A. Peverett (Wards 4 & 5). *J. Grimsley (Ward 6) Inspectors. F. H. Hudson, Sale of Food and Drugs Acts and Factory and Workshop Acts. *A. C. Townsend, Housing of the Working Classes, and Housing. Town Planning. &c.. Acts. Mrs. T Fisher, M.A . Factory and Workshop Acts & Tuberculosis Regulations. Miss F. Hall. Infectious Diseases. Health Visitor : Mrs. K. Roche, Notification of Births Act. Assistants to Inspectors : *Edwards. **Deverell. Public Mortuary: *W. Larken, 63. Flask Walk, Keeper. E. Stratton. Deputy Keeper. Disinfecting and Cleansing Stations. *T. Rider, G Allaway, and R. Bell, Disinfectors. Mrs. Rider, Attendant at Cleansing Room. A. L. Gibbons. Temporary Disinfector. Tuberculosis Dispensary: J. F. Halls Dally. m.d., m.r.c.p. (London) m.r.c.s., l.r.C.p.(Lond.), Tuberculosis Medical Officer. *Miss G. Goodchild, Nurse. Clerical Staff: *W. Sell, Clerk. *F. Hill, Clerk. *R. Pollock, Clerk-Draughtsman. Temporary Clerks: Miss E. Blakeman, Miss K. Geary. Miss F. Ingram. Public Analyst: A. W. Stokes. F.C.S.. F.I.C. Medical Officer of Health: Frank E. Scrase, f.r.c.s. (Eng.), l.r.c.p. (Lond.), d.p.h. (Lond.). *These members of the Staff are on Service with His Majesty's Forces. * * Killed on Active Service. 3 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W. 3. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Madam and Gentlemen, I have the honour to submit to you the Annual Report for the year 1917. I desire to thank the Council and Chairman and Members of the Public Health Committee for the support and encouragement they have always accorded me and also to express my appreciation of the earnest efforts of the Public Health staff (permanent and temporary) for their able assistance and co-operation. I have the honour to be, Mr. Mayor, Madam and Gentlemen, Your obedient Servant, FRANK E. SCRASE, Medical Officer of Health. 4 INDEX. page Acute Polio-myelitis or Polioencephalitis 25 Analytical Work, Report on 47 Anti-toxin 24 Area of Borough 5 Bacteriological Work 24 Bakehouses 15, 16 Births 5, 6, 7 Cancer 9 Cerebro-Spinal Meningitis 25 Cleansing Station 13, 40 Complaints 13 Customs and Inland Revenue Acts 13, 40 Dairies 14 Deaths 5, 7, 8, 9, 10, 11 Diarrhoea and Enteritis 28 Diphtheria 24 Disinfection 27, 40 Drainage Work 12 Enteric Fever 25 Erysipelas 25 Factories 20 Food Premises and Food Inspection 14, 16, 40 Fried Fish Vendors 15 Health Visiting 33, 34, 35 Housing 19, 20, 40 Ice Cream 15, 40 Infantile Mortality 5, 33, 35 Infant Welfare 33. 34 Infectious Diseases 5, 23 page Legal Proceedings 46 Marriages 5, 6 Measles 5, 26, 27 Milk Supply and Milkshops 14, 18, 40 Mortuary, Public 13, 40 Opthalmia Neonatorum 25 Outworkers 22 Population 5, 6 Public Health Committee 2 Puerperal Fever 25 Respiratory System, Diseases of 38 Restaurant Kitchens, etc. 16 Sale of Food and Drugs Act 16, 17 Sanitary Inspections, etc. 11, 12 Scarlet Fever 25 Slaughterhouses 16, 40 Small-pox 24 Smoke Nuisances 13, 40 Staff of Public Health Department 2 Tenement Houses 14, 20, 40 Tuberculosis 5, 28, 29, 30, 31, 32 Tuberculosis Dispensary 32, 33 Underground Rooms 40 Vaccination 24 Verminous Premises & Persons 13, 40 Vital Statistics 5, 36, 37, 38, 39, 41, 42, 43, 44, 45 Water Supply 20 Whooping Cough 28 Workshops & Workplaces 20, 21, 22, 23 Young Children. Mortality among 33, 34, 35, 39 Section A. NATURAL AND SOCIAL CONDITIONS OF THE BOROUGH. SUMMARY OF VITAL STATISTICS FOR 1917. Population estimated to middle of 1917 75,649 Density 33.5 persons per acre Births 1,123 *Birth- Rate 13.3 Marriages 708 Marriage-rate 9.3 Deaths 922 Death- Rate 10.8 Infantile Mortality 80.1 Notifiable Infectious Diseases Attack-Rate (excluding Measles and Tuberculosis) 3.1 do do. do. do. (including Measles and Tuberculosis) 36.3 Notifiable Infectious Diseases Death- Rate (excluding Measles and Tuberculosis) .09 do. do, do. do. (Including Measles and Tuberculosis) 1.33 Death- Rate from the Principal Epidemic Diseases .22 Death- Rate from Pulmonary Tuberculosis .91 Death- Rate from All Forms of Tuberculosis 1.12 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 * By direction of the Registrar-General this rate has been calculated upon a population of 84,327. 6 POPULATION. The Registrar-General's provisional estimate of the population of Hampstead at the middle of 1917 is 75,649. This estimate has been adopted in this Report and, with the exception of the birth rates, it forms the basis upon which the various rates have been calculated. By the direction of the Registrar General the birth rates have been calculated upon the estimated population of 84,327. MARRIAGES. According to the return kindly furnished to me by the Superintendent Registrar of Hampstead, it appeals that 708 marriages were registered in the Borough during 1917. The following Table gives the marriage rates for the years 1907-1917:— Year. Rate. Year. Rate. 1907 15.3 1912 15.0 1908 14.7 1913 14.9 1909 16.0 1914 19.0 1910 14.8 1915 23.2 1911 16.3 1916 17.8 1917 9.3 BIRTHS. During the year 998 births were registered in Hampstead, a decrease of 53, as compared with 1,051 registered in the previous year. In addition 125 births of children, whose mothers were Hampstead residents, occurred outside the Borough in Lying-in Institutions, etc. The net number of births belonging to Hampstead was 1,123, as compared with 1,164 in 1916, a decrease of 41. The following table shows the Ward and sex-distribution of the live-births, and the birth-rate for each Ward. Ward. Births. Birth-rate per1000 of the population. Males Female Total No. 1 (Town) 69 74 143 10.3 No. 2 (Bel size) 105 80 185 13.6 No. 3 (Adelaide) 55 59 114 11.9 No. 4 (Central) 36 33 69 6.9 No. 5 (West End) 116 105 221 17.3 No. 6 (Kilburn) 153 127 280 18.9 No. 7 (Priory) 60 51 111 11.2 The Borough 594 529 1123 13.3 7 Illegitimate Births. Of the total 1123 births, 71 or 63.2 per 1,000 were those of illegitimate children. 41 of these were born outside the Borough, chiefly in Lying-in Institutions. The following Table shows the illegitimate births which have occurred in the Borough during the years 1907-1917:— Year. Number of illegitimate births. Illegitimate birth rate per 1000 births registered. 1907 43 32.0 1908 29 21.0 1909 43 33.0 1910 36 28.0 1911 37 29.0 1912 76 59.3 1918 73 55.1 1914 55 43.2 1915 81 61.0 1916 76 65.2 1917 71 63.2 DEATHS. The death rate, calculated upon the total number of deaths (whether resident or non-resident persons) registered in the Borough during the year, was 14.5 per 1,000 of the population, but after subtracting those of non-resident persons dying in the Borough and adding the deaths of Hampstead residents who died outside the District the recorded death-rate is found to be 10.8 per 1,000 of the population. The following are the death-rates for each of the Wards:— Ward. Death-rate per 1,000 of the population. No. 1 (Town 11.2 No. 2 (Bel size) 10.6 No. 3 (Adelaide) 13.1 No. 4 (Central) 8.8 No. 5 (West End) 11.0 No. 6 (Kilburn) 15.2 No. 7 (Priory) 13.6 The Borough 10.8 In the table on page 45 the death-rates of Hampstead may be compared with those of England and Wales since 1875. The following table shows the death-rate of Hampstead as compared with the rates of the County of London, and the Metropolitan Cities and Boroughs:— 8 Table showing the Death-rates from all Causes in the County of London, the City of London, and the Metropolitan Boroughs during 1917. District. Death-rate from all causes. Woolwich 10.6 Hampstead 10.8 Wandsworth 12.6 Stepney 12.5 Lewisham 13.2 Fulham 13.6 Hammersmith 13.8 Stoke Newington 14.1 Chelsea 14.2 Hackney 14.4 Greenwich 14.6 County of London 15.0 Battersea 15.2 Camberwell 15.3 Lambeth 15.3 Islington 15.4 City of Westminster 15.5 Bethnal Green 15.6 City of London 15.6 Deptford 15.7 Paddington 16.7 Kensington 16.3 St. Pancras 16.8 Poplar 16.8 St. Marylebone 16.9 Southwark 17.4 Bermondsey 18.8 Holborn 19.5 Finsbury 20.6 Shoreditch 22.5 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. & IV. 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 90 20 12 20 41 104 246 389 922 9 Deaths at Ages. Year. Under 25 25 and upwards. Totals. 1913 209 742 951 1914 187 726 913 1915 207 787 994 1916 136 726 862 1917 183 739 922 Deaths in Institutions. The number of deaths of Hampstead Residents which occurred in Institutions was 280 or 30.3 per cent. of the total deaths of residents. 76 deaths took place in Workhouses or Workhouse Infirmaries, equivalent to 36.8 per cent. of the deaths in Institutions. Causes of Death. The causes of death are given in Table 3 at the end of the Report. The deaths from Cancer call for special consideration. The following Table gives the number of deaths from Cancer and the death-rate per 1,000 of the population in each of the years 1907-1917. Year No. of Deaths from Cancer. Death-rate per 1,000 of the Population Year. No. of Deaths from Cancer. Death-rate per 1,000 of the population. 1907 69 0.82 1913 100 1.14 1908 84 0.99 1914 114 1.31 1909 85 1.00 1915 118 1.44 1910 90 1.06 1916 113 1.38 1911 86 1.00 1917 107 1.41 1912 102 1.19 Of the 107 deaths from Cancer, 70 were females and 37 males. 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. In 40 cases the patients were over 65 years of age. The next Table gives the anatomical distribution of the disease in each sex. Situation. Males. Females. Total. Buccal cavity 9 2 11 Stomach, Liver, &c. 10 12 22 Peritoneum, Intestines and Rectum 7 13 20 Genital Organs - 20 20 Breast 1 10 11 Other, or unspecified organs 10 13 23 Totals 37 70 107 10 The following is a list of the Institutions and the number of deaths which occurred in each:— Deaths of Hampstead Residents in Institutions. Institution. Total. Infirmaries and Workhouses. Hendon Workhouse 1 Holborn Infirmary 1 Paddington Workhouse 5 St. Marylebone Workhouse 5 St. Marylebone Infirmary 62 St. Pancras Workhouse 1 Union Workhouse Infirmary. Linton 1 Hospitals, Sanatoria Nursing Homes. 35 Adamson Road 1 Aston Grange Nursing Home, Knole Road, Bournemouth 1 49 Beaumont Street 1 32 Belsize Lane 1 33 Belsize Square 3 Bethlehem Hospital 1 Brompton Hospital, Chelsea 3 Carr Burton Memorial Hospital, Sackville Road, Hove 1 Caterham 1 Children's Hospital Paddington 1 Charing Cross Hospital 1 Children's Hospital, Great Ormonde Street 3 Consumption Hospital, Kensington 1 Convalescent Home, Ruswarp 1 Cottage Hospital, Harlesden 1 Downs Sanatorium 3 6 Dennington Park Road 3 Darenth, Industrial Colony 1 Ewell Epileptic Colony 1 East Anglican Sanatorium 1 25 Ferncroft Avenue 2 27 Ferncroft Avenue 1 80 Fordwych Road 2 Hackney Institution 1 Hartington Nursing Home, Poole Road, Bournemouth 1 1 Highbury Terrace 1 Home Hospital. Fitzroy Square 1 Home of Compassion, Thames Ditton 1 Hospital for Epileptic and Paralytic 1 Hospital for Women, Soho 1 Hospital of St. John and Elizabeth 7 Homœpathic Hospital 1 Hampstead General Hospital 15 Infants Hospital 4 King's College Hospital 1 1st London General Hospital, Brixton 1 London Hospital 1 London Temperance House 1 17 Manchester Street 1 Maternity Hospital, Bury St. Edmunds 1 Institution. Total. Hospitals, &c., continued. Middlesex Hospital 8 Mental Nursing Home, Clapton 1 3 Merton Road 1 Northern Hospital 1 31 Nottingham Place 1 32 Parkhill Road 2 216 Portsdown Road, Paddington 1 Prince of Wales General Hospital, Tottenham 1 216 Portsdown Road 1 Queen Mary's Hospital 1 Royal Earlswood Institute 1 Royal Free Hospital 1 Royal Hospitable for Incurables 1 10 Rosslyn Hill 1 St. Bartholomew's Hospital 2 St. Columba's Hospital 4 St. George's Hospital 1 St. George's Home, Chelsea 1 St. Mary's Hospital 5 St. Peter's Home 1 St. Luke's House, Kensington 1 St. Joseph's Hospital, Hackney 1 97 South Hill Park 5 St. Mary's Nursery College 1 St. John's Home, Merton 1 St. Monica's Home 1 St. Thomas's Hospital 1 The Haven. Falmouth Nursing Home 1 The Meath Home, Westbrook, Godalming 1 The Nook, Holford Road 1 7 The Terrace, St. Pancras 1 3 Upper Montague Street 1 University College Hospital 3 West London Hospital 1 Warrington Lodge, Paddington 1 69 Warrington crescent 2 M.A.B. North Western Hospital 7 Asylums. Banstead Asylum 5 Broadmoor Asylum, Crawthorne 1 City of London Asylum 1 Colney Hatch 14 Cane Hill 2 Claybury 4 Hanwell 14 Levesden 5 Leveralls Asylum 1 Long Grove 3 Nethune 1 Tooting Bee 11 University College Asylum 1 11 TOTALS. Infirmaries and Workhouses 76 Hospitals, Sanatoria, Nursing Homes, etc. 134 M.A.B. Hospitals 7 Asylums 63 280 Violent Deaths (excluding Suicide). 24 deaths were classified under this heading as compared with 32 in 1916. Of these 2 were due to burns; 8 to falls; 5 to injuries caused by being knocked clown by vehicles; 3 to drowning; 2 to suffocation; 1 to poisoning; 2 accidents to bicycles and 1 under an anesthetic. Suicide. 7 persons committed suicide as compared with 4 in 1916. In 1 case death was due to cutting of the throat, 1 to bullet wounds from a pistol, 1 from hanging. 3 from drowning and 1 from fall from window. Section B. SANITARY ADMINISTRATION AND CIRCUMSTANCES OF THE BOROUGH. SANITARY INSPECTIONS, &c. 1917 Number of Inspections 4441 „ Re-inspections 5491 „ Intimation Notices issued 251 „ Statutory Notices issued 319 ,, Notifications sent to "Head Teachers" of Schools respecting notified cases of infectious disease 186 „ Notifications sent to Medical Officers of Health of other Boroughs respecting Hampstead children attending schools in their districts 22 „ Notifications sent to "Head Teachers" of Schools respecting cases of Measles 1865 12 The following is a tabulated statement of the sanitary work, &c., carried out during the year, so far as that work admits of tabulation :— General Conditions— Improperly constructed apparatus removed and new provided 6 Houses, or parts, cleansed 109 Dampness in houses, or parts abated 75 Apparatus repaired or renewed 136 Dilapidated houses, or parts of houses, repaired 53 Apparatus unstopped 16 Apparatus cleansed 34 Overcrowdi ng— Apparatus provided with proper water supply 4 Cases of, abated (rooms) after service of notice - Flushing cisterns repaired or renewed 201 Cases of, abated (rooms) without service of notice 4 Manholes repaired or renewed 167 Drains repaired or renewed 135 Under ground Rooms— Drains cleansed 47 Drains unstopped 53 Illegal occupation discontinued 10 Drains ventilated 33 Structural work carried out 8 Ventilating pipes of drains— Below floors— Carried to a sufficient height above windows 1 Spaces below floors in basement or ground floors ventilated 99 Repaired or renewed 10 Roofs repaired 1 12 Fresh-air inlets repaired or renewed 37 Gutterings repaired or renewed 135 Soil pipes repaired or renewed 117 Rainwater pipes— Gullies and surface drains Repaired or renewed 113 Gully traps removed from improper positions 17 Disconnected from drains — Disconnected from soil pipes 2 Gully traps cleansed 48 Sinks disconnected from drains 1 Inlets or surface drains trapped 34 Sinks trapped 163 Paving and draining wash houses, areas, yards, &c.— Sinks repaired or renewed 112 Sinks unstopped 4 Lavatories disconnected from drains Lavatories trapped 109 Wash house or scullery paving repaired or renewed 11 Lavatories repaired or renewed 81 Areas cleansed 9 Baths disconnected from drains Area paving repaired or renewed 111 Baths trapped 101 Areas drained 3 Baths repaired or renewed 60 Yards or other open spaces paved 16 Water supply re-instated 7 Paving of yards or other open spaces repaired or renewed 75 Water and sinks supplied to upper floor of tenement houses 47 Yards or other open spaces drained 10 Water cisterns repaired or renewed 3 Floors of buildings in which horses, &c., are kept, paved or repaired 2 Removed from improper positions 5 Cleansed 90 Refuse and receptacles— Fitted with close- fitting covers 30 Water-closet accommodation provided 11 Dustbins provided 187 Fixed Ashpits removed 19 Additional accommodation provided 19 Accumulation or deposits of refuse removed 153 Separate accommodation for persons of each sex 5 General— Removed from improper positions 11 Nuisances from the improper keeping of animals abated 3 Provided with proper and sufficient external ventilation 4 Drainage Work. Since the Bye-laws of the London Comity Council which require the deposit of plans and particulars came into operation in August 1903, 605 plans for the drainage of new buildings and 8855 plans for the alteration and reconstruction of drains in existing premises have been received. During 1917, 252 Notices of drainage work were received. 224 of these necessitated the deposit of plans and particulars. 49 related to the entire reconstruction of the drainage system. 13 Cleansing Station. During 1917 444 children and 7 adults were cleansed at the Cleansing Station by the Council's Attendant, and while this was in progress their clothes were thoroughly disinfected. Customs and Inland Revenue Acts. During the year applications for certificates under these Acts were received in respect of 43 dwellings, this number being 10 more than the number for which applications were made in 1916. Smoke Nuisances. During the year observations were made in 38 instances by the Sanitary Inspectors. Four intimation notices were sent. Public Mortuary. During the year the bodies of 52 persons were brought to the mortuary—34 by order of the Coroner, 10 by the Police, and 8 at the request of friends of deceased persons. In 16 instances inquests only were held, and in 26 instances post mortem examinations were made and inquests followed. The following table indicates the causes of death of the persons whose bodies were received into the Mortuary:— Cause of Death or Verdict Number of Bodies Received. Deaths from natural causes 34 Accidental Deaths 8 Suicide 5 Wilful Murder 1 Open Verdict 1 Verdict of Felo de se 1 Death from enemy aircraft bomb 1 One body taken to St. Pancras for enquiry 1 Total 52 Complaints. During 1917, 604 complaints were made of the existence of insanitary conditions, relating to 629 nuisances as follows :— Accumulations 13 Animals improperly kept 10 Animals dead 4 Dampness in premises 37 Dirty and dilapidated premises 35 Drains defective 46 „ stopped 31 Dust, non-removal 77 Dust receptacles, foul or dilapidated 16 ,, absence of, or insufficient 7 Insanitary condition of premises 26 Overcrowding 8 Rats, nuisance from 4 Roofs and gutters, defective and leaky 34 Rubbish Nuisance from burning 1 Carried forward 340 Brought forward 349 Smells on premises 20 Smells from Sewer Ventilators 8 Smells from drains, etc. 4 Smells from manure 2 Smoke nuisances 11 Verminous conditions 5 Water, absence of 112 Water, leakage of 16 Water-closets, insufficient or absence of 12 Water-closets, defective 27 Water-closets, stopped 14 Yards, unpaved and existing paving defective 1 Miscellaneous 45 Food, unsound 13 Total 639 14 Houses Let in Lodgings. The number of houses let in lodgings on the Register at the end of 1917 was 405. The alterations in the Bye-laws governing these premises, rendered necessary in view of Section 16 of the Housing, Town Planning, &c., Act, 1909, are still the subject of negotiation between the Borough Council and the Local Government Board. 970 Inspections and re-inspections have been made during the year of the houses on the Register. Milk Supply. 66 persons occupying 94 premises have been registered as purveyors of milk, comprising 49 dairies. 18 bakehouses and confectioners, 12 restaurants and coffee shops and 15 general shops. During the year 205 inspections were made, 11 Notices were served and the following works were carried out :— Drains unstopped l Premises repaired, cleansed and lime washed 12 Roofs and Rainwater pipes repaired l Water closets repaired or renewed 3 Water closets cleansed 5 Yard paving repaired or renewed 3 Dustbins provided 9 Other Foods. The following food was seized or voluntarily surrendered to the inspectors during the year:— Date. Premises. Cwts. qrs. lbs. Food Seized or Surrendered. 1st June West End Lane 7 Beef 18 June High Road 1 3 17 Ground Rice 3 2 0 Coffee Beans 5 2 14 Tea 6 2 24 Tapioca 1 0 28 Pearl Barley 1 0 17 Sago 0 0 24¾ Vermicelli 0 1 21½ Flaked Rice 0 3 26 Salt* 0 1 17 Arrowroot 1 1 17 Almonds 1 3 15 Borax 1 3 14 Desiccated Cocoanut. 27 1 11¼ 8 Packets Desiccated Soup 13 July High Road One Pork Pie 14 July High Road 6 punnets raspberries 29 September Netherwood Street 173 lbs. Cheese 3 October High Road 1 Picnic Ham Food Premises. Section 8 of the London County Council General Powers Act, 1908, considerably increases the power of sanitary authorities to improve the conditions of places where food is prepared or sold. During 1917 the food premises have been under constant supervision and in live instances notices were served to abate insanitary conditions. These included reconstruction of drains removing of gullies from inside premises, cleansing and repairs of a minor character. 15 Fried Fish Shops. The following is a list of the Fried Fish Shops in the Borough. These are now kept under systematic inspection. Belsize Ward 106 Fleet Road. West End Ward 86 Mill Lane and 1 Munro Terrace. Kilburn Ward 132 High Road; 89 Kings gate Road and 95 Palmerston Road. Ice Cream. There are 72 shops in the Borough in which Ice Cream is sold. In regard to these, 109 inspections and 6 notices were served during the year. In addition, the barrows standing in the street and on Hampstead Heath on Bank Holidays, have been inspected. The following Sanitary work has been carried out during the year:— Premises repaired, cleansed or limewashed 15 Drains reconstructed 1 Soil pipes ditto 1 Water closets repaired or renewed 2 ,, cleansed 3 Waste pipes of sinks trapped, repaired or renewed 3 Yard paving repaired 2 Dustbins provided 8 Refuse removed 2 Bakehouses. At the end of 1917 there were 38 occupied bakehouses on the register, 21 being underground and 17 above ground. Six of the bakehouses situated above ground and four underground use power, and are therefore factories. Twenty inspections were made in respect of the factory bakehouses, 88 inspections in respect of the workshop bakehouses and 11 notices were served. The following is a list of the occupied bakehouses on the Register at the end of the year:— Town Ward 3 & 67 High Street and 26 New End. Belsize Ward 6 & *65 Fleet Road and 45 South End Road. Adelaide Ward *†44 England's Lane, *90 Haverstock Hill and *2 King's College Road. Central Ward *64 Belsize Lane, *225, *289 and †307 Finchley Road, *98 and 250 West End Lane and †2 Broadhurst Gardens. 16 West End Ward †60 and 110 Cricklewood Broadway, †553 Finchley Road, Field Lane School, Hillfield Road, *43 & 44 Mill Lane, †4 Munro Terrace, Fortune Green, and 251 & *279 West End Lane. Kilburn Ward *63 Hemstal Road, *94, †218 & *354 High Road, Kilburn, *4 Kelson Street. 67 Kingsgate Road and * †99 Palmerston Road. Priory Ward *202 & *228 Belsize Road, * †98 Boundary Road, * †.93 Fairfax Road, *7 Fairhazel Gardens and *137 Finchley Road. Those marked * are underground bakehouses. Those marked † are factory bakehouses. Bakehouses—Underground 21 „ Above ground 17 Total 38 Restaurant Kitchens, etc. The total number of these premises on the register at the end of 1917 was 66. They are kept under regular supervision, 94 inspections have been made and 6 notices served during the year. Meat Supply. The Meat Supply of the Borough is good and in only two cases has any unsound or diseased meat been found by the Sanitary Inspectors during the year. Slaughter Houses. There are 4 Licensed Slaughter Houses in the Borough, situated at 40 England's Lane, and 17 and 69 High Street and 6 Fairfax Mews. These have been regularly inspected during the year; 37 inspections having been made. The quarterly lime washing has been duly carried out. Sale of Food and Drugs Act. 508 samples were taken for analysis during the year. The number certified to be adulterated was 7 or 1.3 per cent. of the total number, as against 2.1 in 1916 and 7.7 in 1915. 5 samples were certified to be of low quality. 479 samples were purchased from Hampstead tradesmen and 29 from tradesmen coming from other districts. The percentage of adulterated samples in the two classes was 1.2 and 3.4 respectively. 23 samples were taken on Sundays. One of these were adulterated and four were of low quality. 17 The following table shows the articles of which samples were taken during the year:— Articles. No. taken. Adulterated. Low Quality. Butter 72 - - Cheese 35 - - Cocoa 46 - - Coffee 51 - - Cream 10 - - Dripping 1 - - Egg powder 1 - - Flour 7 - - Lard 56 4 - Margarine 34 - - Milk 183 3 5 Mustard 1 - - Pepper 2 - - Semolina 2 - - Soup powder 2 - - Sugar 1 - - Tinned Fish 1 - - Vinegar 3 - - Totals 508 7 5 The following table shows the articles adulterated, nature of adulteration, and the results of proceedings taken:— No. of Sample. Article. How adulterated. Result of proceedings. 166 Milk added water Informal sample 222 Lard 100% foreign fat Informal sample 236 Milk 22% added water Costs £3 3s. 243 Lard 40% cocoanut fat Informal sample 245 Lard 4096 cocoanut fat Fine £4. Costs £1 1s. 256 Lard 50% cocoanut fat and 17¾% added water Fine £5. No costs. 370 Milk 20% deficient in fat Fine £5. Costs 10/6. The sample of milk No. 236 was watered to the extent of 22% by the woman milk carrier on the round. She was observed to draw water from a tap in the rear basement of a large block of flats, this water being added to milk in hand can. For this offence she was sent to prison for one month. 18 Milk and Cream Regulations, 1912. The object of these regulations is to secure that cream containing preservative shall be distinguished at all stages of sale from cream to which no preservative has been added. The following samples of milk and Cream not sold as preserved cream, were taken during the year:— 1.—Milk; and Cream not sold as preserved Cream. (a)—Number of samples examined for the presence of a preservative. (6)—Number in which a preservative was reported to be present. Milk 183 - Cream 8 - 2.—Cream sold as Preserved Cream. (a) Samples submitted for analysis to ascertain if the statements on the labels as to preservatives were correct:—1. Correct statements made 2; 2. Statements incorrect, nil. (b) Determinations made of milk fat in cream sold as preserved cream:—1. Above 35 per cent., 2; 2. Below 35 per cent., nil. (c) Instances where (apart from analysis) the requirements as to labelling of preserved cream in Article V (1) and the proviso in Article V (2) of the Regulations have not been observed:—nil. (d) Particulars of each case in which the regulations have not been complied with, and action taken :—nil. 3.—Thickening substances. (a) Addition to cream or to preserved cream, nil; (b) Action taken where found, nil. 4.—Other observations (if any), nil. Percentage of Preservative found in each sample where this has been determined, and also the percentage indicated on the Statutory label :— Official No. Sample Analyst's Report. Percentage on Statutory label. 202 Preserved Cream Genuine Not exceeding 0.5% Boric Acid 207 Preserved Cream Genuine Not exceeding 0.5% Boric Acid 19 HOUSING. Dwellings unfit for Habitation. 83, Palmerston Road. This house was represented as being unfit for human habitation by my predecessor (Dr. McCleary) on the 20th December, 1910, and the Closing Order was made by the Council on the 12th January, 1911, since when it has been the subject of continuous litigation. It has been referred to year by year in my previous reports. The following shows the further proceedings which have taken place during the year under review :— 1917. Jan. 1st. The Closing Order was determined and the Demolition Order quashed, the basement rooms having been structurally closed in accordance with the Order of the Local Government Board. Jan. 15th. The rule nisi obtained by Mr. Alderman Woodward to show cause why the Council should not grant him inspection of documents was argued in the Divisional Court and discharged with costs. The Chancery action commenced in 1916 is still pending. 84 & 85, Palmerston Road. These houses belong to the same owner as No. 83, and the Council have authorised me to make a survey and examination for the purpose of determining whether any powers under the Housing Act should be exercised in regard to these premises. Up to the present I have not been able to effect an entry. 1 TO 7, Peebles Mews. The Local Government Board have made an Order in regard to the above premises intimating their willingness to quash the Demolition Orders provided certain essential works are carried out and the premises used for some purpose other than for human habitation, but so far alterations have not been made and the premises remain closed. No action has been taken during the year in regard to the following houses, all of which remain closed:— Represented. Closing Order made. Woodbine Cottage 1.12.14 10.12.14 Grove Cottage 1.12.14 10.12.14 Hope Cottage 1.12.14 10.12.14 8 Woodchurch Road 20.10.14 29.10.14 20 The following houses were represented as unfit for human habitation during 1917:— Represented. Closing Order made. 7 Abbey Lane 23.1.17 1.2.17 8 Abbey Lane 23.1.17 1.2.17 South End House South End Road 20.3.17 29.3.17 32 Netherwood Street 16.10.17 25.10.17 South End House has been demolished. The other premises have been boarded up and still remain closed. Town Ward Scheme. On the 3rd April, 1917, I submitted a report to the Public Health Committee calling their attention to the fact that a number of houses in the Town Ward were, in my opinion, unfit for human habitation, and that the prevailing conditions were such as could only be dealt with by a re-construction scheme, as the result of which the Council directed a survey and examination to be made and when this had been carried out, on the 20th December, 1917 1 represented the properties referred to, comprising 75 premises, to the London County Council under part 1 of the Housing of the Working Classes Act, 1890. The Water Supply of Tenement Houses. During 1917, the powers conferred by Section 78 of the L.C.C. General Powers Act, 1907, have been exercised in regard to 30 houses, making a total of 863 houses which have been dealt with in Hampstead since the Act came into force. Factories and Workshops Act. Whilst maintaining careful supervision of the sanitary conditions of the workshops and workplaces, due regard has been paid to the altered conditions now pertaining. In many establishments women have taken the place of men, so that establishments are now employing both sexes when they formerly employed one. The Local Government Board in a letter upon this subject dated 14th June, 1915, suggested that endeavours should be made to re-arrange things as to obviate the expense of providing double sanitary accommodation. These arrangements would be only temporary during the War. This suggestion was adopted and adhered to. 21 At the end of 1917 there were 355 workshops on the Register, of which 31 were domestic workshops. Excluding these, there were 502 males and 500 females employed therein. During the year 391 inspections were made and 7 notices served. TRADE OR BUSINESS. No. of Workshops. Workshops other than Domestic Workshops. Domestic Workshops. Total No. of Workshops. No. of Workrooms. No. of Employees. Males. Females. Bakers 26 28 75 4 - 26 Blindmakers 3 5 5 4 - 3 Bootmakers 31 34 55 - - 31 Builders and Carpenters 18 20 24 - - 18 Cabinet Makers and Polishers 2 6 22 1 1 3 Carriage Builders 4 9 11 - - 4 Corset Makers 2 2 - 4 - 2 Cycle Makers and Repairers 4 8 9 - - 4 Dressmakers & Ladies Tailors. 59 66 - 195 11 70 Harness Makers 4 8 16 2 - 4 Ironmongers 13 13 24 - - 13 Laundresses 4 11 2 28 - 4 Milliners 16 16 - 29 1 17 Monumental Masons 2 2 13 - - 2 Motor Makers 10 13 28 - - 10 Outfitters 8 26 4 81 - 8 Pianoforte Makers 2 4 27 - - 2 Picture Frame Makers 10 12 12 - - 10 Sign Writers 2 5 8 4 - 2 Smiths 10 10 19 - - 10 Tailors 23 26 47 43 13 36 Upholsterers 18 23 26 15 1 19 Watchmakers and Jewellers 12 12 17 - - 12 Wig makers 9 10 3 16 - 9 Miscellaneous 32 41 55 74 4 36 Totals 324 410 502 500 31 355 Inspections: (excluding bakehouses) 302 Cleanliness : Workrooms cleansed 6 Warming and Ventilation: Workshops inadequately ventilated 3 Overcrowding : Workrooms overcrowded 0 Abstract and Factory Act not exhibited: Workshop 9 22 Workplaces. 875 inspections of workplaces were made during the year and 16 notices were served. Homework. 73 lists of outworkers were received from employers. These contained 186 entries. There are 80 outworkers' premises in Hampstead, 5 being Factories, 23 Workshops, 11 Domestic Workshops and 41 single workers. *Nature of Work. Outworkers' Lists, Section 107. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions Sending Twice in the year. Sending Once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Lists. Outworkers.† Outworkers Contrac tors. Workmen. Lists. Contrac tors. Workmen. 1 2 3 4 5 6 7 8 9 10 Wearing Apparel— (1) making, &c. 42 34 47 3 1 5 - - - (2) cleaning & washing 14 23 2 - - - - - - Household linen 4 4 11 - - - - - - Lace, lace curtains & nets - - 2 - - - - - - Curtains & furniture hngs 4 9 10 - - - - - - Furniture and upholstery 4 8 4 - - - - - - Electro-plate - - 2 - - - - - - File making - - - - - - - - - Brass and brass articles - - 2 - - - - - - Fur Pulling - - - - - - - - - Cables and Chains - - - - - - - - - Anchors and Grapnels - - - - - - - - - Cart Gear - - - - - - - - - Locks, latches and keys - - 4 - - - - - - Umbrellas. &c. - 4 - - - - - - - Artificial flowers - - - - - - - - - Nets, other than wire nets - - - - - - - - - Tents - - - - - - - - - Sacks - - - - - - - - - Racquet and tennis balls - - - - - - - - - Paper. etc., boxes, paper bags 2 - 14 - - - - - - Brush making - - - - - - - - - Pea picking - - - - - - - - - Feather sorting - - - - - - - - - Carding &c.,of buttons &c. - - - - - - - - - Stuffed toys - - - - - - - - - Basket making - - - - - - - - - Chocolates and sweetmts - - - - - - - - - Cosaques, Christmas Crackers, Christmas Stockings, etc. - - - - - - - - - Textile weaving - - - - - - - - - Total 70 82 98 3 1 5 - - - Outwork in unwholesome premises, Sec. 108. Nil; Outwork in infected premises, Sees. 109— 110. Nil. * In the case of those occupiers who gave out work of more than one of the classes specified in Column 1, and subdivided their lists in such a way as to show the number of workers in each class of work, the list has been included among those in column 2 (or 5 as the case may be) against the principal class only, but the outworkers have been assigned in columns 3 and 4 (or 6 and 7) into their respective classes. † The figures in columns 2, 3 and 4 are the total number of the lists received from those employers who comply strictly with the statutory duty of sending two lists each year, and of the entries of names of outworkers in those lists. 23 Registered Workshops. Workshops on the Register (s. 131) at the end of year. No. Bakehouses 26 Bootmakers 31 Dressmakers and ladies' tailors 70 Laundries 4 Milliners 17 Tailors 36 Watchmakers and jewellers 12 Wigmakers 9 Other 150 Total number of workshops on Register 355 Other Matters. Class (1) No. (2) Matters notified to H.M. Inspector of Factories :— Failure to affix Abstract of the Factory and Workshop Acts (s. 133, 1901) 9 Action taken in matters referred by H.M. Inspector as remediable under the public Health Acts, but not under the Factory and Workshop Acts (s. 5, 1901):— Notified by H. M. Inspector — "Reports (of action taken) sent to H.M. Inspector — Other — Underground Bakehouses (s. 101) in use at the end of the year 21 Section C. PREVALENCE OF & CONTROL OVER ACUTE INFECTIOUS DISEASES. NOTIFIABLE INFECTIOUS DISEASES (EXCLUDING TUBERCULOSIS). The list of Infectious Diseases notifiable in London during 1917, was as follows:— Small-pox. Typhoid or Enteric Fever. Cholera. Typhus Fever. Diphtheria. Relapsing Fever Membranous Croup. Continued Fever. Erysipelas. Puerperal Fever. Scarlet Fever. Anthrax Occuring in Man. Epidemic Cerebro Hydrophobia Spinal Meningitis. Glanders Plague. Ophthalmia Neonatorum. Polio-Myelitis. Measles. German Measles. 24 Bacteriological Work. The following is a Summary of the Bacteriological Work performed by the Lister Institute :— Positive. Negative Total. Diphtheria 72 293 365 Enteric Fever 4 — 4 Cases of Infectious Disease occurring in each month during 1917. disease. MONTHS. January. February. March. April. May. June. July. August. September. October. November. December. j Totals. Diphtheria & Membranous Croup 7 7 14 12 11 8 7 15 5 12 12 21 131 Erysipelas 1 4 3 1 - 4 3 1 2 2 2 4 27 Scarlet Fever 4 10 2 6 1 3 6 - 4 7 11 6 60 Enteric Fever - 1 - - - 2 - - 2 - 2 5 12 Puerperal Fever - - - - - - - - - - - - - Polio-Myelitis - - - - - - - - - - - - - Ophthalmia Neonatorum - - 1 - - - - 2 1 - 1 1 6 Epidemic Cerebrospinal Meningitis 1 1 2 - 1 - - - - - - 1 6 Measles 60 193 210 170 239 214 120 25 3 13 4 6 1257 German Measles 50 102 255 240 174 71 29 12 4 3 5 1 946 Totals 123 318 487 429 426 302 165 55 21 37 37 45 2445 Small-Pox. No cases of small-pox occurred in Hampstead during the year. Vaccination. Of the births recorded 636 were successfully vaccinated. In 11 cases the children were insusceptible of vaccination. In regard to 202 Certificates of Conscientious Objection were obtained; 61 died before vaccination was performed; 15 cases of vaccination were postponed and 74 remained to be dealt with. I am indebted to the Vaccination Officer for these statistics. Diphtheria and Membranous Croup. The number of cases notified in 1917 was 131, as compared with 98 in 1916. The attack rate, or number of cases notified per 1,000 of the population was 1.73 compared with the rate of 1.02 in the previous year. The number of cases notified proving fatal was 3, or 2.29 per cent. of the cases notified, as against 2 per cent. in 1916. The deathrate per 1,000 of the population, calculated on the total deaths was 0.03. 118 patients, or 90.7 per cent. of the cases notified were removed to hospital. 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. 2 5 Erysipelas. 27 cases were notified, but no deaths occurred, as compared with 40 cases in 1916. The attack rate, per 1,000 of the population was 35. Of the cases notified, 6 or 222 per cent. were removed to the Hampstead Workhouse Infirmary or Nursing Homes. Scarlet Fever. 60 cases of scarlet fever were notified during the year. The number of cases per 1,000 of the population was .79; the corresponding figure in 1916 being 1.61. Of the cases notified 52 or 86 per cent. were removed to hospital. Enteric Fever. The number of cases notified was 12. The attack rate per 1,000 of the population was .15. 3 of the cases notified proved fatal. Puerperal Fever. No case of this disease occurred during the year. Epidemic Cerebro-Spinal Meningitis. This disease popularly known as "spotted fever," was made notifiable on the 15th August, 1912. During 1917 6 cases were notified, 1 of whom died. The mode of infection in this disease is not clear, although the disease is epidemic in character. The war would seem to have made the disease more prevalent and special care was taken of all the cases which occurred in the Borough. Acute Polio-Myelitis. No case of this disease occurred during the year. Ophthalmia Neonatorum. 6 cases were notified during the year and investigated by the Health Visitor. In no case was there any evidence of really bad nursing nor was any permanent injury left. With proper nursing arrangements the complaint would rarely ever occur. Principal Epidemic Diseases. Enteric Fever. Scarlet Fever. Small-pox. Whooping Cough. Measles. Diphtheria. All of these, with the exception of whooping cough, are notifiable diseases. The total number of deaths from the principal epidemic diseases amounted to 17 and the death-rate was .22 per 1,000 of the population. 26 Measles and German Measles. On the 1st January, 1916, the Notification of Measles and German Measles Order, 1915, came into operation. Parents or guardians are now required to notify to the Medical Officer of Health the occurrence of all cases of these diseases unless already notified by a doctor in attendance. Notice of this obligation has been publicly posted throughout the Borough. During 1917, 1257 cases of Measles and 946 cases of German Measles were notified. Arrangements have been made by the Council for the provision of nursing and medical assistance in necessitous cases. It is hoped that the effect of this will be to ultimately reduce the attack and death rates and to prevent many of the complications which up till now have unquestionably been responsible for some of the diseases from which people have suffered and died in after years. Ten deaths were recorded from measles as compared with one in 1916. The mortality was 0.13 per 1,000 of the population, the mortality in 1916 being 0.01. The following tables show the number of notified cases of Measles and German Measles occurring each month in the various Wards:- Measles. Month. No. I (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kliburn). No. 7 (Priory). Totals. January 3 12 22 12 6 2 3 60 February 40 24 55 21 25 4 24 193 March 28 26 44 41 33 15 23 210 April 13 25 18 16 25 54 19 170 May 11 16 15 13 20 138 26 239 June 3 5 3 6 42 145 10 214 July 2 1 2 1 34 74 2 120 August 1 3 1 12 8 - - 25 September - 3 - - - - - 3 October - - 1 3 2 5 2 13 November 2 1 - 1 - - - 4 December 2 1 1 1 - - 1 6 Totals 105 117 161 131 196 437 110 1257 27 German Measles. Month. No. I (Town). No. 2 (Belsize). No. 3 (Adelaide). No. 4 (Central). No. 5 (West End). No. 6 (Kilburn.) No. 7 (Priory). Totals. January 11 9 17 1 7 - 5 50 February 19 21 22 11 11 5 13 102 March 53 31 26 53 47 16 29 255 April 33 32 28 38 55 23 31 240 May 31 21 12 23 32 17 38 174 June 7 3 8 9 23 17 4 71 July 4 2 1 2 14 1 5 29 August 3 - - 1 7 - 1 12 September - 1 - - 1 - 2 4 October - - 1 - 1 - 1 3 November 2 1 1 - 1 - - 5 December - - - - - - 1 1 Totals 163 121 116 138 199 79 130 946 Disinfection. No. of Articles Disinfected. No. of Articles Destroyed. Beds 205 Beds 5 Mattresses 835 Mattresses 14 Palliasses 19 Blankets 5 Bolsters 488 Miscellaneous 3 Pillows 975 Palliasses 2 Blankets 1838 Bolsters 9 Sheets 873 Pillows 17 Counterpanes 535 Sheets 5 Articles of Clothing 6961 Counterpanes 1 Carpets 31 Articles of Clothing 10 Linen Articles 2197 Linen Articles 1 Books 349 Miscellaneous 256 Total 15562 Total 72 Number of premises disinfected 2743 „ rooms, etc., „ 2175 28 Whooping Cough. 1 death occurred from Whooping Cough as against 7 in 1916. The mortality rate per 1000 of the population was .01. Diarrhœa and Enteritis. The deaths at all ages from diarrhœa and enteritis in Hampstead during 1917 numbered 12. Of these 9 occurred during the first year of life. The deaths in the 1st, 2nd, 3rd, and 4th quarters of the year were as follows:-3,2,1,3. The deaths from these diseases at various age periods in the last six years is as follows:- Year. Under 1 year. i and under 2 Years 2 and under 5 years. 5 and under 1 5 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. All ages. 1912 2 - - - - 2 4 7 15 1913 13 1 2 - - 1 1 - 18 1914 7 2 1 1 - 1 2 2 16 1915 14 - 1 - - 2 - 1 18 1916 6 - - - - - - 2 8 1917 9 - - - - 1 2 12 Totals 51 3 4 1 - 6 8 14 87 The following are the deaths from diarrhœa and enteritis in recent years:- 1906 30 1912 15 1907 14 1913 18 1908 22 1914 16 1909 11 1915 18 1910 15 1916 8 1911 35 1917 12 Section D. PREVALENCE OF AND CONTROL OVER TUBERCULOSIS. During 1917, 308 cases were notified, the character of which and the age periods in which the disease occurred is shown in the table on page 37. The number of cases notified during the last two years has increased. This is chiefly due to the large examination of men for military purposes. It is customary for the Medical Examination Board to refer the cases of men rejected for Tuberculosis to the Municipal Dispensary for treatment. The number of deaths from tuberculosis in 1917 was 85. Of these 69 deaths were due to pulmonary tuberculosis, 8 to tuberculous meningitis and 8 to other forms of tuberculosis. 29 The following table shows the number of deaths and the deathrates from all forms of tuberculosis and from pulmonary tuberculosis respectively since 1899:- Year. Total deaths from Tuberculosis. Death-rate per 1,000 population Deaths from Pulmonary Tuberculosis. Death-rate per 1,000 population. Cases of Tuberculosis notified. 1899 98 1.21 81 0.98 - 1900 92 1.13 69 0.85 - 1901 118 1.44 73 0.89 - 1902 97 1.18 73 0.89 51 1903 90 1.09 66 0.80 34 1904 102 1.23 73 0.88 39 1905 95 1.14 73 0.87 27 1906 79 0.94 57 0.68 35 1907 92 1.09 61 0.72 55 1908 84 0.99 74 0.87 30 1909 75 0.88 53 0.62 67 1910 80 0.94 58 0.68 77 1911 70 0.82 56 0.65 113 1912 77 0.88 64 0.74 183 1913 61 0.81 49 0.56 300 1914 71 0.82 57 0.66 172 1915 71 0.86 48 0.58 220 1916 80 0.98 55 0.67 244 1917 85 1.12 69 0.91 308 The deaths from pulmonary tuberculosis and from all forms of tuberculosis during 1917 were distributed among the wards as follows:- Ward. Area (Acres). Estimated Population middle of 1917. Pulmonary Tuberculosis. Tuberculosis (All Forms). Deaths. Death-rate per 1000 of the population. Deaths. Death-rate per 1000 of the population. No. 1 (Town) 686 12593 14 1.11 14 1.11 ,, 2 (Belsize) 271 12283 11 .89 13 1.05 ,, 3 (Adelaide) 325 8383 6 .71 8 .95 ,, 4 (Central) 312 8733 - - 2 .24 ,, 5 (West, End) 247 11473 13 1.13 17 1.48 ,, 6 (Kilburn) 195 13472 17 1.26 22 1.63 ,, 7 (Priory) 229 8712 8 .91 9 1.03 The Borough 2265 75649 69 .91 85 1.12 30 The following table shows the age distribution of patients dying from Pulmonary Tuberculosis in Hampstead in the fifteen years 1903-1917. 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 13 1906 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 19J2 2 2 13 45 2 64 1913 - 1 4 39 5 49 1914 - 2 10 42 3 57 1915 - 1 7 37 3 48 1916 - 4 11 37 3 55 1917 - - 21 47 1 69 Totals 9 19 168 666 51 913 The deaths from all forms of Non-Pulmonary Tuberculosis was 16 in 1917, distributed in age periods as follows:-0.5 4; 5.15 4; 15.25 3; 25.65 5. The total number of notification certificates (including duplicates) received during 1917, relating to Hampstead patients was 455, i.e.;-396 Pulmonary and 59 Non-Pulmonary cases. In accordance with the terms of the Regulations, a Register is kept in which the full particulars of each notification are set out. A weekly statement of these is sent to the County Medical Officer. The notes of investigations are indexed and filed and comprise a full record of Tuberculosis in the Borough. This is of great assistance in the efforts which are being taken to control the disease. The unsatisfactory home conditions found upon investigating the new cases of Pulmonary Tuberculosis notified in 1917 were as follows:- Unsatisfactory Home Conditions Pulmonary Cases. Non-Pulmonary Cases. Overcrowding 2 - Inadequate Ventilation 12 2 Inadequate Lighting 2 1 Dampness 8 1 Other Insanitary Conditions 5 7 31 Occupations. The following is an analysis of the occupation of the cases notified as tuberculous during 1917:- Occupation. Pulmonary. NonPulmonary. Occupation. Pulmonary. NonPulmonary. Antique Dealer 1 - Insurance Agent 1 - Architect and Surveyor 3 - Jeweller 1 - Army Officer 1 - Labourer 2 - Belgian Refugee 1 - Landowner 1 - Bookkeeper 1 - Laundress 1 - Bootmaker 3 - Lavatory Attendant 1 - Builder's Foreman 1 - Letter Carrier 3 - Butcher's Roundsman 1 - Machinist 1 - Buyer 1 - Manager 6 - Caretaker 2 1 Manufacturer 2 - Carman 1 - Merchant 1 - Carpenter 1 - Messenger 1 - Chartered Accountant 2 - Milk Carrier 1 - Charwomen 5 - Mortuary Keeper 1 - Chauffeur 8 - Motorbus Driver 1 - Chemist 1 - Munition Worker 3 - Civil Servant 2 - Omnibus Conductor 1 - Clerk 31 1 Police Constable 1 - Collector 1 1 Porter 2 1 Commercial Traveller 1 - Photographer 1 - Companion 1 - Retired Banker 1 - Crane Driver 1 - Retired Naval Officer 1 - Dancer 1 - Scholar 9 19 Dental Mechanic 1 - Schoolmaster 1 - Domestic Servant 17 2 Sculptor 1 - Dressmaker 1 - Shop Assistant 10 1 Dustman 1 - Sick Nurse 1 - Electrician 2 - Solicitor 2 - Engineer 2 - Tailoress 1 - Errand Boy 1 - Tuberculosis Health Visitor 1 - Ex-Soldier 22 - Ex-Naval Airman 1 - Underground Railway Employee 1 - Furrier 1 - Gardener 3 - Undertaker's Assistant 1 - Gasfitter 1 - Upholsterer 2 - Governess 1 - Veterinary Surgeon 1 - House Painter 2 - No occupation 19 22 Housewive 25 3 No information 20 1 Total number of Pulmonary Cases 256 Total number of Non-Pulmonarv Cases 52 Removal of Cases. Of the cases of Pulmonary Tuberculosis newly notified in 1917, 84 were removed: 57 to Sanatoria (of these 41 were insured and 6 non-insured persons). 2 to Hospitals, 15 to Infirmaries and 10 to nursing or other Homes. 17 of the newly notified cases of nonpulmonary tuberculosis were removed: 15 to Hospitals or Sanatoria and 2 to the Infirmary. Of the pulmonary cases notified prior to 1917, 18 were removed: 8 to Sanatoria, 3 to Hospital, 6 to the Infirmary and 1 to a Home. 4 cases of non-pulmonary Tuberculosis notified prior to 1917 were removed: 1 to a Sanatorium: 2 to Hospitals and 1 to a Home. Of the pulmonary cases notified in 1917, 18 were of persons already dead or dying and in 1 7 other cases the patients did not survive the year under review. 32 Pulmonary Cases. Of the 256 cases notified, 58 were beyond the scope of the Department (25 cases being in institutions, 15 leaving Hampstead within a short time and 18 being dead or dying), 6 were out-patients of Hospitals, 13 in-patients at Homes, Sanatoria or the Infirmary. 44 were being treated by private doctors only, 134 attended the Dispensary, and 1 was in the charge of the District Poor Law Medical Officer. Non-Pulmonary Cases. Of the 52 cases, 17 were beyond the scope of the Department, 10 being dead or dying, 1 having left Hampstead and 6 being Institution cases, 1 was an out-patient at a Hospital, 5 in-patients at Hospitals or the Infirmary, 6 were treated by private doctors, 23 attended the Dispensary. The Municipal Tuberculosis Dispensary The work of the Tuberculosis Dispensary has increased very largely for the reason stated on page 28 namely : that a large number of men were discovered to have the early stages of Phthisis by the Military Medical Examination Boards and these Boards referred them to the Public Health Department for advice, which led to them being added to the clientele of the Dispensary. A summary of the work of the Dispensary is included in the following Table :— Insured. Non-insured. M. F. Children under 16 Adults.. M. F. I. (a) Number of persons examined for the first time during the above period at or in connection with the Dispensary 74 36 153 60 60 (b) Number included under r (a) who were found to be suffering from Pulmonary Tuberculosis 53 24 9 37 30 (c) Number included under 1 (a) who were found to be suffering from Non- Pulmonary Tuberculosis 2 5 18 44 (d) Number included under I (a) who were found to be non-tuberculous 7 114 11 22 (e) Number included under I (a) in whom the diagnosis was found to be doubtful 5 - 12 8 4 Insured. Non-insured. 2. (a) Total attendances at the Dispensary (including attendances at the Dispensary of persons included under I (a) 348 1334 (b) Number of the above attendances at which systematic physical examinations and records were made 180 536 33 Section E. MEANS FOR PREVENTING MORTALITY IN CHILDREN AND IN INFANCY. Notification of Births. By the Notification of Births Act 1907 all births are required to he notified to the Medical Officer of Health within 36 hours of their occurrence. This is in addition to the usual registration with the Registrar of Births. In 1917, 964 births were notified, including 21 still births. 300 were notified by medical practitioners, 164 by midwives, 2 77 by parents and 202 from other sources. In 750 cases the parents were visited, and 537 re-visits were made. When the mother is able to get about she is visited by a Health Visitor employed by the Borough Council and invited to bring her baby to one of the four Weighing Centres which are at work in the Borough. In June 1917 an Infant Welfare Centre was opened at the Friends' Meeting House, Heath Street, under the auspices of the Hampstead Council of Social Welfare. This fulfils a much needed want in the Town Ward. A record of the work done there during 1917 is included in the table on this page. It must be borne in mind that the figures given in relation to the Heath Street Centre only apply to the period from June to December. The following Table gives briefly the work done at each Centre:- Health Institute. Emmanuel Hall. Lyndhurst Hall. Friends' Meeting House. Total. No. Weighed 410 78 165 57 710 Total Attendances 2699 598 1153 351 4801 Average attendance 27 12 20 13 79 Thus it will be seen that of the 964 births notified during 1917 710 attended the Weighings, which is undoubtedly a high percentage of the births of the Borough, considering that such a large number of our babies are born in well-to-do families. In April 1917 the Council decided to inaugurate and staff an AnteNatal Clinic for the purpose of advising and examining expectant mothers The main object of such Clinic is to ascertain if any condition exists prejudicial to either mother or child prior to parturition and to combat it at the time or anticipate it at the birth. Considerable difficulty was experienced in staffing the Clinic satisfactorily. The Maternity Hospitals were unable to help on account of shortage of staff. In June the Council appointed Dr. A. W. Kirkpatrick Picard as Medical Officer in charge, with consulting rooms at the Municipal Dispensary and at the Provident Dispensary, New End. 34 At first the innovation was received with great diffidence by the expectant mothers, but the attendance gradually increased. Unfortunately, in November, Dr. Picard was compelled to resign on account of ill-health. Mortality among Young Children. The following table shows the Infantile Mortality rate and the Death rate among children under five years of age. The latter rate is calculated upon a period of five years. Year. Deaths of Infants under 1 year of age. Deaths of children under 5 years of age. No. Rate per 1000 Births. No. Rate per 1000 Children born in the year and in preceding 4 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 1914 91 72 129 20.0 1915 101 76 144 22.2 1916 73 62 94 14.7 1917 90 80 122 19.6 Deaths among Legitimate and Illegitimate Infants. The death rate among illegitimate children is a matter of great difficulty to deal with. Illegitimate children seldom receive the same maternal care that is bestowed upon legitimate children, and that they should be looked after as well as circumstances will permit is important. Special attention is now being given to all illegitimate births which come under our notice. 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. 35 Year. Legitimate Infants. Illegitimate Infants. Births. Deaths. death-rate per 1000 births. Births. Deaths. death-rate per 1000 births. 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 11 356 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 1914 1218 77 63 55 14 254 1915 1246 82 65 81 19 234 1916 1088 65 59 76 8 105 1917 1052 74 70 71 16 225 The following table shows the infantile mortality of Hampstead in each year since 1880. 1880 140 1893 102 1906 77 1881 136 1894 113 1907 69 1882 99 1895 135 1908 69 1883 98 1896 123 1909 74 1884 143 1897 127 1910 60 1885 110 1898 125 1911 82 1886 131 1899 129 1912 62 1887 107 1900 100 1913 69 1888 110 1901 102 1914 72 1889 122 1902 88 1915 76 1890 122 1903 87 1916 62 1891 104 1904 111 1917 80 1892 122 1905 94 36 Section F. V1TAL STATISTICS OF THE BOROUGH, ETC. TABLE I. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health). Vital Statistics of Whole Borough during 1917 and the Six Previous Years. Year. Population estimated to middle of each year. Uncorrected Number. Births. Total Deaths Registered in the Borough. Transferable DEATHS† Nett Deaths Belonging to the Borough. Nett. Number. Rate. 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 per 1,000 Nett Births. Number. Rate. 1 2 3 4 5 6 7 8 9 10 11 12 13 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 15.0 1273 14.5 474 153 91 68.7 951 10.8 1914 86731 1213 1273 14.7 1145 13.2 420 188 91 71.5 913 10.5 1915 81760 1222 1327 16.2 1228 14.5 442 245 101 76.1 994 121 1916 81470 1051 1164 13.1 1027 12.6 381 254 73 62.7 862 10.5 1917 75649 998 1123 13.3 1096 14.4 429 246 90 80.1 922 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 tl at in which they resided. Area of Borough in acres (exclusive of area covered by water), 2253. Total population at all ages, 85,495. Total number of buildings used as dwellings, 1 1,976. Average number of persons per house, 71. At Census of 1911 Number of ordinary dwelling houses, 10,062. Average number of persons per house, 6 7. 37 TABLE II. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health). Cases of Infectious Disease Notified during the Year 1917. Number of Cases Notified. Total Cases Notified in each Ward. Total Cases removed to Hospital. Notifiable Disease. At all Ages. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No. 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No 6 (Kilburn). Ward No. 7 (Priory). Under 1. 1 & under 5. 5 & under 15 15 & under 25 25 & under 45 45 & under 65 65 and upwards. Small Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera, Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous Croup) 131 1 18 72 26 14 ... ... 16 50 16 6 11 21 11 118 Erysipelas 27 1 ... 2 3 2 15 4 4 6 1 2 1 11 2 6 Scarlet Fever 60 ... 8 34 10 8 ... ... 7 22 7 1 3 16 4 52 Typhus Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric Fever 12 ... ... ... 5 5 2 ... 2 2 2 2 1 2 1 7 Relapsing Fever (Continued Fever) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Meningitis 6 ... 1 2 3 ... ... ... ... 1 ... 3 ... 1 1 4 Polio-Myelitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neonatorum 6 6 ... ... ... ... ... ... 1 ... 1 ... 1 2 1 ... Pulmonary Tuberculosis (1) 256 ... 4 9 53 140 41 9 45 20 41 16 35 68 31 84* Other forms of Tuberculosis (2) 52 ... 13 24 6 6 3 ... 6 3 5 1 9 22 6 17 * Measles 125 7 41 411 615 102 84 4 ... 105 117 161 131 196 437 110 49 German Measles 946 5 94 286 263 258 39 1 163 121 116 138 199 79 130 20 Totals 2753 54 549 1044 471 517 104 14 349 342 350 300 456 659 297 357 Isolation Hospitals are provided by the Metropolitan Asylums Board, and residents of Hampstead suffering from infectious disease (excluding Tuberculosis) 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 j:arts of the country. * These figures relate only to cases notified for the first time in 1917 (1) Of these 256 cases, 215 were notified on Form A, 1 on Form B, 23 on Form C. and 17 on Form D. (2) Of these 52 cases, 49 were notified on Form A, 1 on Form B, 2 on Form C 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 year 1917. Causes of Death. Nett Deaths at the subjoined ages of " Residents," whether occuring within or without the Borough. Total Deaths,whether of " Residents " or '' Non-residents " in Institutions in the Borough. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under | 15 years. 15 and under 25 years. 25 and under 4 5 years. 45 and under 65 years. 65 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 All causes Certified (a) 922 90 20 12 20 41 104 246 389 Uncertified ... ... ... ... ... ... ... ... ... ... 1 Enteric Fever 3 ... ... ... ... ... 2 1 ... 5 2 Small-pox ... ... ... ... ... ... ... ... ... ... 3 Measles 10 2 5 3 ... ... ... ... ... 55 4 Scarlet Fever ... ... ... ... ... ... ... ... ... 10 5 Whooping-cough 1 ... ... 1 ... ... ... ... ... 15 6 Diphtheria and Croup 3 1 ... ... 2 ... ... ... ... 50 7 Influenza 15 ... ... ... ... ... 1 4 10 ... 8 Erysipelas ... ... ... ... ... ... ... ... ... ... 9 Phthisis (Pulmonary Tuberculosis) 69 ... ... ... ... 21 29 18 1 93 10 Tuberculous Meningitis 8 1 2 ... 1 2 1 1 ... 3 11 Other Tuberculous Diseases 8 ... ... 1 3 1 2 1 ... 14 12 Cancer, malignant disease 107 ... 1 ... ... ... 8 58 40 49 13 Rheumatic Fever 3 ... ... ... 2 ... ... 1 ... 1 14 Meningitis (b) 7 2 1 2 ... 1 1 ... ... 2 15 Organic Heart Disease 97 ... ... ... ... 3 9 27 58 8 16 Bronchitis 73 3 1 ... 1 ... 4 6 58 6 17 Pneumonia (all forms) 81 12 10 1 4 2 8 16 28 19 18 Other Diseases of Respiratory Organs 16 1 ... ... 1 1 3 7 3 6 19 Diarrhœa and Enteritis (c) 12 9 ... ... ... ... ... 1 2 3 20 Appendicitis and Typhlitis 4 ... ... ... ... 1 ... 3 ... 2 21 Cirrhosis of Liver 3 ... ... ... ... ... ... 1 2 1 21a Alcoholism 3 ... ... ... ... ... ... 1 2 ... 22 Nephritis and Bright's Disease 33 1 ... ... ... ... 3 20 9 9 23 Puerperal Fever ... ... ... ... ... 8 ... ... ... 2 24 Other accidents and diseases of Pregnancy and Parturition 1 ... ... ... ... ... 1 ... ... 5 25 Congenital Debility and Malformation, including Premature birth 43 41 ... 1 1 ... ... ... ... 3 26 Violent Deaths, excluding Suicide 24 3 ... 2 1 1 5 9 3 13 27 Suicides 7 ... ... ... ... ... 3 3 1 2 28 Other Defined Diseases 291 14 ... 1 4 8 24 68 172 50 29 Diseases ill-defined or unknown ... ... ... ... ... ... ... ... ... ... Sub-Entries, included in above figures. 922 90 20 12 20 41 104 246 389 14 (a). Cerebro-spinal Meningitis 1 ... ... ... ... 1 ... ... ... 10 28 (a). Polio-Myelitis ... ... ... ... ... ... ... ... ... ... 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 non-residents, i.e.. of persons resident elsewhere in England and "Wales who died in the Borough have in like manner been excluded from these columns. (a) All deaths certified by registered Medical Practitioners and all Inquest cases are classed as "Certified ": all other deaths are regarded as " Uncertified." (b) Exclusive of "Tuberculous Meningitis" (see title 10), but inclusive of Cerebro-spinal Meningitis. (c) Title 1 9 is used for deaths from Diarrhoea and Enteritis at all ages 38 39 TABLE IV. (Required by the Local Government Board to be used in the Annual Report of the Medical Officer of Health.) INFANT MORTALITY, 1917. 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 months and under 6 months 6 months and under 9 months 9 months and under 12 months. Total Deaths under 1 year. All Causes Certified 28 5 5 4 42 19 18 4 7 90 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... 1 ... 1 ... 2 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping Cough ... ... ... ... ... ... ... ... ... ... Diphtheria & Croup ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 1 ... ... 1 Abdominal Tuberculosis (a) ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... 1 1 ... ... 2 Convulsions ... 1 ... ... 1 1 3 ... 1 6 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 1 2 1 ... 4 Pneumonia (all forms) ... ... 1 ... 1 3 3 1 ... 12 Diarrhœa ... ... ... 1 1 2 ... 1 ... 4 Enteritis ... ... ... ... ... 4 1 ... ... 5 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... ... 1 ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlying 1 1 ... ... 2 ... ... ... ... 2 Injury at Birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis 1 ... ... ... 1 ... ... ... ... 1 Congenital Malformations (b) 3 1 ... 1 5 ... 1 ... ... 6 Premature Birth 16 1 2 ... 1 9 2 ... ... ... 21 Atrophy, Debility, Marasmus 4 1 2 1 8 2 4 ... ... 14 Other causes ... ... ... l 1 2 1 ... 1 5 Totals 28 5 5 4 42 19 18 4 7 90 Nett Births in the year: legitimate, 1052; illegitimate 71. Nett Deaths in the year of: legitimate infants, 74; illegitimate infants, 16 (a) Under Abdominal Tuberculosis have been included deaths from Tuberculosis 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. 40 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 on register at end of 1916 Number added in 1917. Number removed in 1917. On register at end of 1917. Number of inspections 1917. Number of prosecutions, 1917. Cowsheds - - - - - - Milkshops 95 1 2 94 205 - Houses let in lodgings 405 — — 405 970 - Ice cream premises 72 — - 72 109 - Slaughter-houses.—Number of inspections, 37; notices, 1. Offensive Trades.—Number of inspections, 8; notices, nil. Smoke Nuisances.—Number of observations, 38; nuisances and complaints, 2; notices, 4; summonses, nil. Housing of the Working (Masses.—Number of houses inspected, 73; dealt with under section la of the Housing, Town Planning, etc., Act. 1909, nil; representations 4 closing orders, 4 houses remedied without closing orders, nil: remedied after closing orders, nil; houses demolised, 1. Underground Booms.—Number illegally occupied, 10; closed or illegal occupation discontinued, 10. Overcrowding.—Number of rooms overcrowded, 4; remedied,4; prosecutions, nil. Cleansing.—Number of adults cleansed, 7; children cleansed, 444; rooms or premises cleansed, 41. Water Supply to Tenement Houses.—Number of premises supplied, 30; prosecutions, nil. Inland Revenue Act (applications tor certificates).—number of houses, 16; tenements included therein, 43; applications granted, 1—house comprising 3 dwellings; refused, 15. Sale of Food.—Number of premises used, other than ice-cream premises, milkshops and cowsheds, 465; inspections, 1443. Disinfection Shelter.—Number of persons accommodated, nil. Mortuary.—Number of bodies recthed, 52; infectious bodies, nil. 41 TABLE VI. Vital Statistics of the Borough. Number of ordinary dwelling houses 10,062 Population 85,495 At Census 1911. Average number of persons per house 84 In these Tables the Birth-rate is calculated upon a Population of 84,327. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases (excluding Tuberculosis and Measles). Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases notified. 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 82,380 1,516 18.4 904 11.0 133 87.7 460 5.6 33 0.40 73 0.89 1903 82,730 1,453 17.6 837 10.1 126 86.7 311 3.7 16 0.19 66 0.80 1904 83,080 1,445 17.4 892 10.7 161 111.4 301 3.6 20 0.24 73 0.89 1905 83,430 1,421 17.0 823 9.9 133 93.6 295 3.5 14 0.17 73 0.87 1906 83,780 1,437 17.1 850 10.1 111 77.2 557 6.6 22 0.26 57 0.68 1907 84,130 1,359 16.1 817 9.7 98 73.1 498 5.9 15 0.18 61 0.72 1908 84,480 1,400 16.6 803 9.5 97 69.3 383 4.5 20 0.24 74 0.88 1909 84,830 1,328 15.6 839 9.9 99 74.5 325 3.8 21 0.25 53 0.62 1910 85,210 1,340 15.7 829 9.7 81 60.4 233 2.8 13 0.16 58 0.68 1911 85,099 1,276 14.9 847 9.9 105 82.3 345 4.0 25 0.29 56 0.65 1912 85,966 1,281 14.9 861 10.0 79 61.7 320 3.7 25 0.29 64 0.74 1913 86,346 1,325 15.0 951 10.8 91 68.7 374 4.3 13 0.15 49 0.56 1914 86,.731 1,273 14.7 913 10.5 91 71.5 583 6.7 23 0.26 57 0.66 1915 81,60 1,327 15.3 994 12.1 101 76.1 425 5.1 17 0.20 48 0.58 1916 81,470 1,164 13.1 862 10.5 73 62.7 290 3.5 7 0.08 55 0.67 1917 75,69 1,123 13.3 922 10.8 90 80.1 242 3.1 7 0.09 69 0.91 TABLE VI (1). Vital Statistics of No. 1 (Town Ward). Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases (excluding Tuberculosis and Measles). Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases notified. 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 12,120 192 15.8 163 13.4 20 104.1 64 5.3 4 0.33 17 1.40 1903 12,310 194 15.7 127 10.3 14 72.1 38 3.1 1 0.08 11 0.89 1904 12,500 195 15.6 125 10.0 20 102.5 65 5.2 4 0.32 13 1.04 1905 12,690 194 15.3 127 10.0 24 123.7 72 5.7 3 0.24 9 0.79 1906 12,870 205 15.9 131 10.2 21 102.4 107 8.3 6 0.47 5 0.39 1907 13,070 185 14.1 152 11.6 15 81.1 105 8.0 2 0.15 13 0.99 1908 13,250 225 17.0 108 8.1 11 48.8 65 4.9 1 0.07 7 0.53 1909 13,430 196 14.6 140 10.4 15 76.5 53 3.9 4 0.30 6 0.45 1910 13,610 199 14.6 118 8.7 15 75.4 25 1.8 1 0.07 6 0.44 1911 13,820 207 15.0 133 9.6 19 91.8 71 5.l 7 0.51 7 0.51 1912 14,040 183 13.0 135 9.6 12 65.5 47 3.3 2 0.14 5 0.36 1913 14,250 201 13.8 161 11.1 11 54.7 61 4.3 3 0.21 11 0.76 1914 14,400 152 10.5 130 9.1 14 92.1 131 9.1 6 0.42 5 0.35 1915 13,550 157 10.9 147 10.8 17 108.2 86 6.3 1 0.0 7 5 0.36 1916 13,510 132 9.7 140 10.3 7 53.0 44 3.2 1 0.07 13 0.96 1917 12,593 143 10.3 143 11.2 12 83.9 30 2.3 1 0.07 14 1.11 42 TABLE VI. (2). Vital Statistics of No. 2 (Belsize) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases (excluding Tuberculosis and Measles.) Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 births. Cases notified. 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 13,030 239 18.3 135 10.4 18 75.3 94 7.2 9 0.69 15 1.15 1903 13,110 211 16.1 121 9.2 13 61.6 60 4.6 2 0.14 13 0.99 1904 13,200 217 16.4 141 10.7 23 105.9 47 3.6 3 0.23 12 0.91 1905 13,280 209 15.7 131 9.9 13 62.2 42 3.2 2 0.15 10 0.75 1906 13,370 187 14.0 127 9.5 8 42.8 60 4.5 4 0.30 13 0.97 1907 13,450 205 15.2 114 8.5 13 63.4 63 4.7 3 0.22 10 0.74 1908 13,530 205 15.1 126 9.3 8 39.0 81 6.0 1 0.07 16 1.18 1909 13,610 204 15.0 130 9.5 16 78.4 88 6.5 5 0.37 8 0.59 1010 13,710 207 15.1 119 8.7 9 43.5 49 3.6 2 0.14 8 0.58 1911 13,780 189 13.7 135 9.7 17 90.0 78 5.7 2 0.14 10 0.72 1912 13,830 188 13.6 127 9.2 8 42.5 62 4.5 4 0.29 7 0.51 1913 14,000 214 15.0 126 8.8 16 74.7 52 3.7 5 0.35 5 0.35 1914 14,100 195 13.8 141 10.0 9 46.1 89 6.3 6 0.42 11 0.78 1915 13,250 317 22.4 144 10.8 12 37.8 65 4.9 4 0.30 6 0.45 1916 13,200 189 14.3 127 9.6 7 37.0 63 4.7 2 0.15 6 0.45 1917 12,283 185 13.6 132 10.6 13 70.2 81 6.5 - - 11 0.89 TABLE VI. (3). Vital Statistics of No. 3 (Adelaide) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases (excluding Tuberculosis and Measles). Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases notified. 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 10,350 103 9.9 95 9.6 3 29.1 40 3.9 2 0.19 7 0.68 1903 10,310 95 9.2 101 9.8 9 94.7 22 2.1 1 0.10 1 0.10 1904 10,260 100 9.7 99 9.6 13 130.0 36 3.5 2 0.19 8 0.78 1905 10,220 96 9.4 92 9.0 4 41.7 27 2.6 1 0.10 4 0.39 1906 10,170 97 9.5 92 9.0 10 103.1 29 2.8 ... ... 5 0.49 1907 10,120 75 7.4 86 8.5 8 106.7 29 2.9 1 0.10 2 0.20 1908 10,070 93 9.2 78 7.7 6 64.6 30 3.0 2 0.20 4 0.40 1909 10,040 83 8.3 88 8.8 4 48.2 16 1.6 2 0.20 3 0.30 1910 10,000 96 9.6 78 7.8 2 20.8 22 2.2 1 0.10 5 0.50 1911 9.950 82 8.2 99 9.9 6 73.2 19 1.9 3 0.30 3 0.30 1912 9.930 117 11.8 77 7.7 6 51.3 24 2.4 1 0.10 9 0.91 1913 9.780 97 9.7 99 9.9 9 92.8 27 2.8 ... ... 4 0.40 1914 9.730 88 9.0 99 10.2 5 56.8 28 2.9 ... ... 2 0.20 1915 9,150 77 7.9 104 11.3 5 64.9 30 3.2 2 0.21 2 0.21 1916 9,100 104 11.4 95 10.4 12 11.3 30 3.3 1 0.11 5 0.54 1917 8.383 114 11.9 109 13.1 7 61.4 27 3.2 . - 6 0.71 43 TABLE VI. (4). Vital Statistics of No. 4 (Central) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notlfiable Infectious Diseases (excluding Tuberculosis and Measles). Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 Births. Cases Notified. 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 9,190 110 12.0 71 7.7 11 100.0 40 4.3 ... ... 5 0.54 1903 9,260 99 10.7 60 6.5 8 80.8 34 3.7 4 0.43 4 0.43 1904 9,330 90 9.6 62 6.6 11 122.2 17 1.8 ... ... 1 0.11 1905 9,400 113 12.0 60 6.4 5 44.2 24 2.5 1 0.11 6 0.64 1906 9,470 95 10.0 83 8.8 3 31.6 34 3.6 ... ... 2 0.21 1907 9,540 108 11.3 68 7.1 9 83.3 33 3.4 2 0.21 5 0.52 1908 9,610 104 10.8 82 8.5 6 57.7 33 3.4 1 0.10 7 0.73 1909 9,680 116 12.0 63 6.5 3 25.9 29 3.0 2 0.21 3 0.31 1910 9,770 105 10.7 82 8.4 8 76.2 28 2.9 2 0.20 3 0.31 1911 9,859 92 9.3 75 7.6 8 87.0 25 2.5 1 0.10 3 0.30 1912 9,876 97 9.8 76 7.7 4 41.2 29 2.9 1 0.10 6 06.1 1913 9,996 91 8.9 84 8.2 6 65.9 38 3.8 ... ... ... ... 1914 10,061 84 8.3 76 7.5 4 47.6 26 2.6 2 0.20 6 0.60 1915 9,500 91 9.0 92 9.7 4 42.5 34 3.5 2 0.21 6 0.62 1916 9,450 93 9.8 97 10.2 4 43.0 14 l.4 ... ... 3 0.31 1917 8,733 69 6.9 76 8.8 2 28.9 14 1.0 ... ... ... ... 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 (excluding Tuberculosis and Measles.) Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the | Population. Number. Rate per 1000 Births. Cases notified. 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 12,250 275 22.4 107 8.7 20 72.1 102 8.3 6 0.49 6 0.49 1903 12,320 243 19.7 111 9.0 21 86.4 55 4.5 2 0.16 12 0.07 1904 12,380 283 22.8 120 9.7 22 77.7 70 5.6 3 0.24 8 0.65 1905 12,450 250 20.1 131 10.5 23 92.0 29 2.3 2 0.16 11 0.88 1906 12,510 259 20.7 115 9.2 14 54.1 168 13.4 5 0.40 8 0.64 1907 12,580 250 19.9 114 9.1 16 64.0 153 12.2 4 0.32 9 0.71 1908 12,640 254 20.1 121 9.6 26 102.4 68 5.4 10 0.79 9 0.71 1909 12,700 239 18.8 118 9.3 13 54.1 51 4.0 2 0.16 6 0.47 1910 12,770 216 16.9 121 9.5 17 78.7 44 3.4 4 0.31 11 0.86 1911 12,850 216 16.8 102 7.9 15 69.4 44 3.4 5 0.39 10 0.78 1912 12,890 226 17.5 126 9.8 13 57.5 65 5.0 10 0.77 12 0.93 1913 13,050 240 18.0 145 10.9 11 45.8 59 4.5 1 0.07 7 0.53 1914 13,100 256 19.5 140 10.7 18 70.3 68 5.2 1 0.08 14 0.88 1915 12,390 218 16.6 151 12.1 13 59.6 72 5.8 3 0.24 11 0.40 1916 12,340 211 17.0 117 9.4 10 47.4 35 2.8 1 0.08 5 1.13 1917 11,473 221 17.3 137 11.0 13 58.8 17 1.4 2 0.17 13 44 TABLE VI. (6). Vital Statistics of No. 6 (Kilburn Ward). Year. Population estimated to middle of Year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases (excluding Tuberculosis and Measles). Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the Population. Number. Rate per 1000 births. Cases notified. 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 14,790 435 29.4 219 14.8 45 103.4 76 5.1 11 0.74 l6 1.08 1903 14,800 417 28.2 184 12.4 39 93.5 59 4.0 3 0.20 18 1.22 1904 14,810 408 27.5 206 13.9 54 132.3 43 2.9 8 0.54 22 1.48 1905 14,820 426 28.7 171 11.5 50 117.4 57 3.8 2 0.13 26 1.75 1906 14,840 444 29.9 197 13.3 41 92.0 128 8.6 5 0.34 15 1.01 1907 14,850 391 26.3 179 12.5 28 71.6 86 5.8 3 0.20 16 1.08 1908 14,880 393 26.4 186 12.5 30 76.3 72 4.8 4 0.27 21 1.41 1909 14,890 341 22.9 182 12.2 37 108.5 67 4.5 6 0.40 17 1.14 1910 14,900 379 25.4 192 12.9 24 63.3 52 3.5 3 0.20 16 1.07 1911 14,920 347 23.2 179 12.0 31 89.3 82 5.5 6 0.40 16 1.07 1912 15,000 353 23.5 188 12.5 26 73.6 70 4.7 6 0.40 14 0.93 1913 15,200 354 22.8 213 13.7 25 70.6 110 7.2 3 0.19 18 1.10 1914 15,300 385 25.2 212 13.8 25 64.9 186 12.1 6 0.40 13 0.85 1915 14,440 329 21.5 230 15.8 40 121.5 98 6.7 3 0.20 11 0.76 1916 14,440 309 21.3 180 12.4 28 90.6 84 5.8 ... ... 20 1.38 1917 13,472 280 18.9 208 15.2 37 132.1 53 3.9 3 0.22 17 1.26 TABLE VI. (7). Vital Statistics of No- 7 (Priory) Ward. Year. Population estimated to middle of year. Births. Deaths. Infantile Deaths. Notifiable Infectious Diseases (excluding Tuberculosis and Measles). Pulmonary Tuberculosis. Number. Estimated rate per 1000 of the Population. Number. Estimated rate per 1000 of the | Population. Number. Rate per 1000 births. Cases notified. 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 10,650 162 15.2 110 10.3 16 98.7 44 4.1 1 0.94 7 0.66 1903 10,620 194 18.3 116 10.9 21 108.2 43 4.0 3 0.28 5 0.47 1904 10,600 152 14.3 121 11.4 13 85.5 23 2.2 ... ... 9 0.85 1905 10,570 133 12.6 103 9.7 14 105.3 44 4.2 3 0.28 7 0.66 19o6 10,550 150 14.2 93 8.8 9 60.0 31 2.9 2 0.19 8 0.76 1907 10,520 127 12.1 94 8.9 7 55.1 29 2.7 ... ... 6 0.57 1908 10,500 126 12.0 93 8.8 10 79.3 34 3.2 1 0.09 7 0.67 1909 10,480 149 14.2 111 10.6 11 7.38 21 2.0 ... ... 8 0.76 1910 10,450 138 13.2 111 10.6 6 43.5 13 1.2 ... ... 8 0.76 1911 10,420 143 13.7 115 11.0 9 63.0 26 2.5 1 0.09 5 0.48 1912 10,400 117 11.1 115 10.9 7 59.8 28 2.2 1 0.09 10 0.96 1913 10,070 128 12.5 117 11.4 12 93 .7 27 2.7 1 0.10 3 0.29 1914 10,040 113 11.2 110 10.9 16 141.6 55 5.5 2 0.20 5 0.50 1915 9,480 138 13.7 126 13.2 10 72.4 40 4.2 2 0.21 7 0.73 1916 9,430 126 13.3 106 11.2 5 39.6 20 2.1 2 0.21 3 0.31 1917 8,712 111 11.2 117 13.6 6 54. 0 20 2.2 1 0.11 8 0.91 45 TABLE VII. Vital Statistics of Hampstead, compared with England and Wales. Year. Birth-rate per 1000. General death-rate per 1000. Natural increase Hampstead. Notifiable Infectious disease rate per 1000. Hampstead Hampstead. England and Wales. Hampstead. England and Wales. 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 19.2 517 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 19.1 29.7 12.0 17.1 546 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 29.3 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 l5.7 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 15. 23.9 10.8 13.7 374 4.3 1914 14.7 23.8 10.5 14.0 360 6.7 1915 15.3 21.8 12.1 14.8 333 *5.1 1916 13.1 21.6 10.5 14.0 302 **14.2 1917 133 17.8 10.8 14.4 201 **32.3 * Excluding Chicken-pox, which was notifiable during certain periods of these years. † Excluding notifications of Pulmonary Tuberculosis 1902-1913, and all forms of Tuberculosis since 1913. Measles and German Measles became notifiable on 1st January, 1916, and is included in the rate in the last column. This rate cannot be compared with years previous to 1916. Excluding Measles and German Measles the rate is 31. 46 Section G. LEGAL PROCEEDINGS. Legal proceedings were taken by the Council in connection with the work of the Health Department in 21 cases during the year. The chief facts relating to these proceedings are summarised below. The facts relate only to the cases that were heard and decided in 1917. Statute or Bye-Law. No. of Prosecutions. Fines. Costs. £ s. d. £ s. d. Public Health (London) Act, 1891, and Rye-laws made thereunder 13 10 0 0 18 1 6 Metropolis Management Acts, and Bye-laws made thereunder - - Sale of Food and Drugs Act 4 14 0 0 4 14 6 Housing, Town Planning, etc., Act, 1909 — — — — — — — Factory and Workshop Act — — — — — — — L.C.C. General Powers Act, 1908 — — — — — — — Milk and Cream Regulations — — — — — — — Total 17 24 0 0 23 2 0 47 Appendix. REPORT OF THE PUBLIC ANALYST ON THE ANALYTICAL WORK OF THE YEAR. Analytical Laboratory, Town Hall, Paddington, W. January, 1918. The total number of samples taken during the year was 508. These comprised ; Milk 183, Cheese 35, Cream 10, Flour 7. Only 3 samples of Milk, 4 of Lard and 4 of Margarine were found to be defective. Only 2.1 per cent. of the samples taken were adulterated. I do not think that any other London Borough taking so many samples can shew as pure a food supply from year to year. I have the honour to remain, Yours obediently, ALF. W. STOKES, Public Analyst.