HAMP 33 Cheo's And Rep / THE Metropolitan Borough Hampstead. REPORT for the year 1932 OF THIS Medical Officer of Health. H. LESLIE OLDERSHAW, M.D. State Medicine (Lond.), B.S., D.P.H. Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. Together with the Reports of the Tuberculosis Medical Officer, the Medical Officer-in-Charge of the Ante-natal Clinics, and the Public Analyst. F. P. Lewingdon, 26 & 27, Evcrsholt Street, London, N.W.I. THE Metropolitan Borough of Hampstead. REPORT for the year 1932 OF THE Medical Officer of Health. H. LESLIE OLDERSHAW, M.D. State Medicine (Lond.), B.S., D.P.H. Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. Together with the Reports of the Tuberculosis Medical Officer, the Medical Officer-in-Charge of the Ante-natal Clinics, and the Public Analyst. 2 CONTENTS. pages Lists of Committees concerned with the work of the Department 3 Staff of the Public Health Department 4 Introduction 6 SECTION 1.—Natural and Social Conditions and Statistics of the Borough 11 „ 2.—General Provision of Health Services in the Borough 27 ,, 3.—Maternity and Child Welfare (including the Report of the Medical Officer-in-Charge of the Antenatal Clinics) 35 „ 4.—Sanitary Circumstances of the Borough 71 „ 5.—Housing 85 ,, 6.—Inspection and Supervision of Food (including the Report of the Public Analyst) 101 ,, 7—Prevalence of, and Control over, Infectious and other Diseases (including Tuberculosis and the Report of the Tuberculosis Medical Officer) 125 INDEX 151 3 List of Committees concerned with the work of the Department. His Worship the Mayor (Mr. Councillor H. Baily, m.b.e., j.p.), ex-officio member of Committees. PUBLIC HEALTH COMMITTEE. Chairman : Mr. Councillor S. M. Copeman, m.a., m.d., F.r.c.p., F.r.s. Mr. Alderman W. J. Spriggs. Councillor Mrs. M. Evans, r.r.C. „ Councillor J. A. A. Atkin, Mr. Councillor L. G. Glover, m.p.s., m.i.c.o. m.a., m.d. ,, ,, S. A. Boyd, m.s., m.b., Councillor Miss A. M. Glover. F.r.c.s. Mr. Councillor T. H. Nunn, m.a. ,, ,,R H. H. Cust, m.a., j.p. „ „ E. H. Parkes, F.r.i.b.a. Councillor Mrs. M. F. Dow, m.a. Councillor Miss C. M. Richards. Sub-Committees:—Drainage Plans, Tuberculosis, and Medical. MATERNITY AND CHILD WELFARE COMMITTEE. (Members of the Council.) Chairman: Councillor Mrs. R. S. G. Carnegie. Councillor Mrs. A. J. Arnholz. Councillor Miss A. M. Glover. Mr. Councillor S. A. Boyd, m.s., m.b., Mr. Councillor T. H. Nunn, m.a. f.r.c.s. Councillor Miss C. M. Richards. „ „ S. M. Copeman, m.a., Mr. Councillor B. S. Townroe, m.a. m.d., f.r.c.p., f.r.s. Councillor Mrs. M. Townroe. Councillor Mrs. M. Evans, r.r.c. (Persons not Members of the Council.) (Appointed in pursuance of Section 2 (2) of the Maternity and Child Welfare Act, 1918.) The Mayoress, Mrs. J. M. W. Baily, d.sc. Mrs. E. S. Grundy (resigned in April, 1932). Miss G. M. MacDonald (appointed on resignation of Mrs. Grundy). Miss F. Heath Johnson, m.a., m.r.c.s., l.r.c.p. Mrs. P. Ruff. Lady H. K. Thompson. Sub-Committees:—(a) Applications for Assistance, and (6) Child Mortality and Maternal Diseases. HOUSING COMMITTEE. Chairman: Mr. Alderman F. G. Howard, j.p., l.c.c. Councillor Mrs. Arnholz. Mr. Councillor L. G. Glover, Mr. Councillor G. Buckle. m.a., m.d. „ „ C. W. Crutchley. Councillor Mrs. M. I. Gruner. „ „ R. H. H. Cust, m.a., j.p. Mr. Councillor G. C. Hutchinson, m.a. Councillor Mrs. M. F. Dow, m.a. Councillor Mrs. A. Moody, j.p. Mr. Councillor B. L. Drage. Mr. Councillor E. H. Parkes, F.r.i.b.a. Councillor Mrs. M. Evans, r.r.c. „ „ S. Simpson. ,, „ K. I. Fisher, ,, ,, J. M. Symmons, m.a. l.r.a.m., a.r.c.m. At its meeting on the 24th November, 1932, the Council decided that Standing Order No. 77 should be suspended for one year so far as it relates to the Public Health Committee and to the Maternity and Child Welfare Committee, in order to enable the Chairman of each Committee to be added to the other Committee. 4 Staff of the Public Health Department. Medical Officer of Health—H. Leslie Oldershaw, m.d. State Medicine (Lond.), b.s., m.r.c.s. (Eng.), l.r.c.p. (Lond.), d.p.h. *Tuberculosis Officer and Assistant Medical Officer of Health for Tuberculosis Work—a. j. Scott Pinchin, m.d. (Lond.), f.r.c.p. (Lond.). *Mcdical Officer in Charge of Ante-Natal Clinics—Miss Mary Kidd, m.b.j b.s. (Lond.). Clerical Staff—Frank S. Hill, F.s.s. (Assistant Administrative Officer). W. Sell. R. H. Box, Cert. Soc. of Apoths. (Also Vaccination Officer). A. Slade. S. C. Smith. A. J. Anscomb. Miss E. M. Blakeman. Miss E. Selwood. Health Visitors—Mrs. I. G. Steward (c) (Senior Visitor) )} Miss A. Kennedy (a)} For Maternity and Miss C. Lambe (a), (b), (c), (d)} Child Welfare. Miss M. Lowen (b) (Tuberculosis Visitor and Dispensary Nurse) Miss P. Reymond (a), (c), (d) (Infectious Diseases) Sanitary Inspectors—F. H. Hudson (d), (e) (Senior of the Inspectors) J. Grimsley (d), (e) A. Peverett (d), (e) A. C. Townsend (d), (e) W. F. Horniblow (d), (e) J. F. Armstrong (d), (e) Miss P. Reymond (a), (c), (d) (Factories and Workshops) E. Stratton (Assistant to Inspectors) R. Martin (Assistant to Inspectors and Mortuary Keeper) J. Cuskin (Assistant to Inspectors) Public Health Station Staff—W. Bell (Senior Disinfector and Resident Caretaker) W. Day (Disinfector) C. Gross (Disinfector) *Mrs. Blanden (Bathing Station Attendant) *Public Analyst—H. E. Cox, m.sc., ph.d. (Lond.), f.i.c., 11, Billiter Square, E.C.3. *Public Vaccinators—E. A. Seymour, m.b., b.s. (Lond.), 12, Thurlow Road, N.W.3. H. D. Wyse, m.b., b.s. (Lond.), 23, Hilgrove Road, N.W.6. W. Butement, m.b., b.s. (N.Z.), 1, Lyncroft Gardens, N.W.6. * Part-time Officers. (a) Health Visitor's Certificate. (b) State Registered Nurse. (c) Certificate of Central Midwives Board. (d) Sanitary Inspector's Certificate. (e) Food Inspector's Certificate. 5 Office Hours, etc. The Offices of the Public Health Department, which are situated at the Town Hall, Haverstock Hill, N.W.3. are open daily from 9 a.m. to 5 p.m. (Saturdays, 9 a.m. to 12.30 p.m.). Telephone : Primrose 1101. The Sanitary Inspectors and Health Visitors attend daily from 9 a.m. to 10.30 a.m., and Saturdays, 9 a.m. to 12.30 p.m. The time-table of the Maternity and Child Welfare Clinics and Centres will be found on page 30. The Tuberculosis Dispensary is open at the following times:—Tuesdays, 2 p.m.; Wednesdays, 5 p.m.; Fridays, 4.30 p.m. and 8 p.m. Each session lasts for a minimum of 2 hours. Telephone : Maida Vale 1692. The Bathing Station is available every day, and it is used by the London County Council for the cleansing of verminous school children on Mondays, Wednesdays and Fridays. 6 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. 25th May, 1933. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my first annual report upon the state of the public health in the Metropolitan Borough of Hampstead, which is for the year 1932, and is the thirty-second of the series. My predecessor, F. E. Scrase, Esq., F.R.C.S. (Eng.), D.P.H., retired on the 15th September, 1932, after completing more than 20 years in your service. The efficiency with which he performed the important duties of Medical Officer of Health has already been manifested in the tokens of esteem witnessed in the Council Chamber, and particularly also in the high regard and affection in which he is held by his medical colleagues practising in the Borough. The Annual Report for the year 1925 was a Survey Report and the next Survey Report should normally have been made in respect of the year 1930. The Minister of Health, however, considers " the time is not ripe to require Medical Officers of Health to prepare a record of progress covering a period of years." Accordingly, therefore, he has instructed that the Annual Report for 1932 shall be in the nature of an Ordinary Report. The Death Rate in Hampstead for 1932 was 11.6 per 1000 population as compared with 12.0 for England and Wales. The Birth Rate of 10.9 per 1000 population is lower than that for any year since 1926, and compares with a rate of 15.3 for England and Wales. The low birth rate is a matter of national concern, but it is to a great extent compensated by the decreased Infantile Mortality Rate which figure in Hampstead in 1932 was 54 per 1000 births as against 65 for England and Wales. The incidence of Infectious disease during 1932 was again low and occasioned no concern apart from a mild outbreak of Measles (which is compulsorily notifiable in Hampstead) in April, May and 7 June, during which months there were 427 cases. Diphtheria and Scarlet Fever were both mild in type and the Borough continues to escape the ravages of Smallpox experienced in certain other Metropolitan Boroughs. The work of the Maternity and Child Welfare Service proceeded normally during the year. The Infant Mortality rate was 54 and Hampstead now occupies fourth place amongst Metropolitan Boroughs For yet further progress in this, the most essential of all Social Services, discussions between the Borough Council and the Voluntary Bodies were taking place toward the close of the year. At the end of the year arrangements had been completed for the commencement of a detailed investigation and report on certain Clearance Areas under the Housing Act, 1930. The number of tenement houses on the Register in December, 1932, was 1,578. Invaluable work continues to be done by my Inspectors in the enforcement of the Tenement House Bye-laws of the London County Council, but unfortunately this work is curtailed owing to the reduction in staff since 1932, and the large amount of voluntary work undertaken by property owners which has to be supervised by the Sanitary Inspectors. A new feature of the Annual Report for this year is the inclusion of a brief Meteorological Survey of the Borough during the past year. For this I am indebted to the kindness of Mr. E. L. Hawke, M.A., F.R.M.S. The information recorded therein has, of course, a direct bearing on the health of the Borough and proves a definite addition to the value of this Report. In conclusion I wish to tender my thanks to the Chief Officials for their ready and invaluable co-operation, also to the members of the Committees on which I serve for their unfailing support. In particular, my best thanks are due to the whole staff of the Public Health Department for their loyal work during the very difficult period of taking up a new appointment. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. LESLIE OLDERSHAW, Medical Officer of Health. Section I. Natural and Social Conditions and Statistics of the Borough. 11 Natural and Social Conditions and Statistics of the Borough. Area of Borough 2265 acres (including 12 acres covered by water). Registrar General's estimate of resident population, 1932 90,130 Gross estimated population density per acre, 1932 39 Area of parks and open spaces maintained by Government, County Council and Borough Council = 335 acres, i.e., 14-8 per cent, of total area—as compared with 9.3 per cent, for the whole of London (metropolitan area). Population at Census, 1931 88,947 Number of inhabited houses (end of 1932) 14,935 Number of houses occupied by the Working Classes, Approximately one-half Number of families, Census 1931 23,709 Rateable Value, 6th April, 1932 £1,476,980 Sum represented by a penny rate in the £ (year 1931-1932) £5,872 12s. 9d. Summary of Vital Statistics for 1932. Marriages 822 Marriage Rate per 1,000 of the estimated resident population 18.2 Live Births M. F. Totals. 981 {Legitimate 490 400 890} {Illegitimate 40 51 91} Live Birth Rate per 1,000 of the estimated resident population 109 M. F. Totals. Still Births {Legitimate 9 11 20 {Illegitimate 3 3 6 26 Still Birth Rate per 1,000 total (live and still births) births 26 Deaths 1,043 Death Rate per 1,000 of the estimated resident population 11.6 Deaths from puerperal causes :— Deaths. Rate per 1000 total (live and still) births. Puerperal sepsis 1 1 Other puerperal causes 1 1 Total 2 2 - - 12 Deaths of Infants under 1 year of age :— M. F. Totals. Legitimate 18 20 38 53 Illegitimate 7 8 15 Death Rate of Infants under 1 year of age:— All infants per 1,000 live births 54 Legitimate infants per 1,000 legitimate live births 43 Illegitimate infants per 1,000 illegitimate live births 165 Deaths from Measles (all ages) 3 „ Whooping Cough (all ages) — „ Diarrhoea (under 2 years of age) 8 Deaths from Tuberculosis of the Respiratory System 32 Death Rate 0.35 Deaths from All Forms of Tuberculosis 40 Death Rate 0.44 Deaths from Cancer 174 Death Rate 1.93 Census 26th-27th April, 1931. In accordance with the practice of my predecessors, I submit certain statistical information obtained at the Census relating to the population of the Borough. The population of the Borough at the last Census as compared with that of 1921 was as follows :— 1921. 1931. Males 33,253 34,926 Females 52,900 54,021 Total 86,153 88,947 It will be noted that the population of Hampstead was, according to the corrected Census figures, 88,947, representing an inter censal increase of 2,794 or 3.2 per cent. as compared with the inter censal increase (1911-1921) of 0.8 per cent. The Census Returns showed that 3,215 persons were enumerated in Hampstead but were resident elsewhere in England and Wales, and 4,798 Hampstead residents were enumerated elsewhere. 13 680 persons or 0 8 per cent. of the total population were residents in Schools, Orphanages and other Educational Institutions, and 1,992 or 22 per cent. of the total population were enumerated as being resident in Hospitals, Nursing Homes, etc. Of the total enumerated population of the Borough, 78,763 or 88 5 per cent. were resident in dwellings occupied by private families. The Census Returns show that in only seven other Metropolitan Boroughs has there been any increase in population. Acreage (Land and Inland Water) TOTAL POPULATION. Private Families and Dwellings, 1931. [See definitions at foot of table.) 1921. 1931. Persons. J Persons. Males, i Females. Persons per Acre. Struc- Popula- turally Per- Private tion in Separate Rooms sons Families. Private Dwell- occupied. per Families. ings Room, occupied. The Bobouoh 2,265 86,153 88,947 34,926 54,021 393 23,709 78,763 14,758 ' 112,014 0 70 Wards: No. 1. Town693 I 12,852 12,481 4,473 8,008 18 0 3,051 11 138 2,381 17,494 0'64 No. 2. Belsize270 1 13,562 14,334 5,783 8,551 53.1 3,658 11,772 2,189 16,511 071 No. 3. Adelaide 318 10,393 11,137 4.046 7,091 35 0 3,024 9 347 1,947 15,777 059 No. 4. Central 314 9,502 10,580 3.578 7,002 33 7 2,397 8,731 1,862 14,810 0 59 No. 5. West End 248 13,558 14,167 5,920 8,247 57 1 3,991 13,540 2,744 ! 19,162 0-71 No. 6. Kilburn 187, 15,669 15,124 6,885 8,239 80 9 4,524 14,333 1.925' 14,293 1 00 No. 7. Priory235 10,617 11,124 4.241 6,883 47 3 3,064, 9,899 i 1 710 13,967 0 71 Private Family—Any person or group of persons in separate occupation of any premises or part of premises is treated as a separate family for Census purposes. Private families comprise all such families, with the exception of those enumerated in (i) Institutions or (ii) business establishments or boarding-houses. Structurally separate Dwellings are defined as any room or sets of rooms, intended or used for habitation, having separate access either to the street or to a common landing or staircase. Thus each fiat in a block of flats is a separate unit; a private house which has not been structurally subdivided is similarly a single unit, whether occupied by one family or several families. But where a private house has been subdivided into maisonettes or portions, each having its front door opening on to the street or on to a common landing or staircase to which visitors have access, then each such portion is treated as a separate unit. Rooms—For the purpose of the Census the rooms enumerated are the usual living rooms, including bedrooms and kitchens, bnt excluding sculleries, landings, lobbies, closets, bathrooms, or any warehouse, office, or shop rooms. 15 Age last Birthday. Persons. Males. Total. Single. Married. Widowed. Divorced. Females. Total. Single. Married. Widowed. Divorced. All Ages 88,947 34,926 17,122 16,550 1,137 117 54,021 31,165 17,262 5,345 249 0— 4 4,029 2,105 2,105 — — — 1,924 1,924 — — 5— 9 4,175 2,095 2,095 — — — 2,080 2,080 — — — 10—14 4,423 2,148 2,148 — — — 2,275 2,275 — — — 15—19 6,807 2,776 2,765 11 — — 4,031 3,995 36 — — 20—24 9,426 3,530 3,104 426 — — 5,896 5,006 883 5 2 25—29 9,227 3,507 1,908 1,581 11 7 5,720 3,605 2,057 37 21 30—34 7,469 2,724 847 1,850 15 12 4,745 2,349 2,279 78 39 35—39 7,009 2,578 527 2,004 26 21 4,431 1,943 2,236 208 41 40—44 6.699 2,463 383 2,007 47 26 4,236 1,717 2,175 304 40 45—49 6,512 2,402 325 1,999 64 14 4,110 1,542 2,124 405 39 50—54 6,023 2,298 267 1,944 76 11 3,725 1,297 1,810 586 32 54—59 5,185 1,099 223 1,633 130 13 3,186 1,109 1,398 660 19 60—64 4,267 1,643 168 1,318 150 7 2,624 868 1,060 686 10 65—69 3,169 1,144 112 859 171 2 2,025 633 659 730 3 70—74 2,297 799 84 527 186 2 1,498 427 356 715 — 75—79 1,324 443 46 266 129 2 881 235 138 508 — 80—84 601 187 12 93 82 — 414 108 32 274 — 86—89 252 72 3 29 40 — 180 44 17 119 — 90—94 45 11 — 3 8 — 34 8 1 25 — 95 & over 8 2 — — 2 — 6 — 1 5 — The age distribution of the population per cent. of each sex was as follows:— Age group. Males Females 0— 4 6.0 3.6 5—19 20.1 15.5 20—39 35.3 38.5 40— 38.6 42.4 The marital condition distribution per cent. of each sex was as follows:— Males. Females. Single 49.0 57.6 Married 47.4 32.0 Widowed and Divorced 3.6 10.4 16 Meteorology. Through the kindness of E. L. Hawke, Esq., M.A., F.R.A.S., F.R.Met.S., the Hon. Meteorologist to the Hampstead Scientific Society, I am able to submit his abstract of the meteorological records kept at that Society's Observatory on the top of Hampstead Heath adjoining the White Stone Pond:— "The outstanding feature of 1932 in Hampstead, as in most other parts of England, was its excessive dulness. Sunshine amounted to only 1,262.0 hours, compared with the normal of 1,490.0 hours. No other year since records were begun in 1910 has yielded so few sunny hours, the nearest approaches having been 1,274.1 hours in 1931, and 1,299.7 hours in 1912. In spite of this marked deficiency of sunshine, 1932 proved the driest year since 1921 at Hampstead. The total rainfall of 24.71 ins. was short of the twenty-years average by 3.88 ins., though the number of days with a measurable fall (0.01 in. or more) was rather greater than usual. Eight months were dry, and four wet; October, with 5.39 ins. (more than twice the normal) was by far the wettest, and February, with 0.23 ins. (one-ninth of the normal) was the driest. The largest daily measurement was 1.10 ins.—the result of a thunderstorm —on August 1st. The mean temperature of the year, 48.7 deg., was 0.3 deg. below the average for the twenty years 1910-1929, but slightly above what is computed to be the true average for the district. February was the coldest month, with a mean temperature of 35.3 deg. (4.4 deg. below normal), and August the warmest, with a mean of 65.3 deg. (4.7 deg. above normal, and the highest for any month since July, 1923). The absolute extremes for the year were:— (a) By the screened thermometers Maximum, 93.6 deg., on August 19th. Minimum, 21.0 deg., on March 12th. (b) By the exposed thermometers Maximum, 142.2 deg., on June 16th. Minimum, 11.0 deg., on February 7th. The "shade" maximum of 93.6 deg. on August 19th has only once been equalled or exceeded since records were begun. The occasion was August 9th, 1911, when 94.1 deg. was attained. 17 Snow fell on 17 days during the year, covering the ground at 9 a.m. on four days. Days with thunderstorms (or thunder alone) numbered 14; days with hail, eight; days with at least three minutes of measured sunshine, 292; nights with ground-frost (temperature on grass 30.4 deg. or lower), 121. The most brilliant day of the year was June 18th, when 14.7 hours of sunshine were registered. May was both the wettest and the dullest month of that name in the series of observations extending back to 1910; the rainfall of 4.08 ins., was more than double the normal, and the total duration of sunshine, 111.7 hours, only 52 per cent. of the normal." VITAL STATISTICS. Population. For the purpose of this Report the Registrar General's estimate of the population at the middle of 1932, which was calculated to have been 90,130, has been adopted. The following are estimates of the population of each Ward at the middle of the year under review:— Ward. Estimated Population. No. 1 (Town) 12,650 No. 2 (Belsize) 14,500 No. 3 (Adelaide) 11,300 No. 4 (Central) 10,700 No. 5 (West End) 14,350 No. 6 (Kilburn) 15,330 No. 7 (Priory) 11,300 The Borough 90,130 Marriages. The Superintendent Registrar informs me that 822 marriages were registered in the Borough during 1932, as compared with 763 in the preceding year. The marriage rate per 1,000 of the population for the year 1932 was 18.2. 18 Live Births. During 1932, 981 live births were registered with the Registrar. In the following tables, the live births have been distributed according to sex, wards, etc.:— LIVE BIRTHS. MALES. FEMALES. TOTALS. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Registered in the Borough 690 73 763 635 83 718 1325 156 1481 Add number occurring outside the Borough whose mothers were Hampstead residents 129 13 142 89 16 105 218 29 247 819 86 905 724 99 823 1543 185 1728 Deduct number who could not be deemed to belong to Hampstead 329 46 375 324 48 372 653 94 747 Nett number belonging to Hampstead, 1932 490 40 530 400 51 451 890 91 981 Nett Iiirthi, 1931 488 46 534 410 40 450 898 86 984 The 981 nett births were distributed among the various Wards as follows:—No. 1 (Town) 113, No. 2 (Belsize) 130, No. 3 (Adelaide) 98, No. 4 (Central) 68, No. 5 (West End) 188, No. 6 (Kilburn) 247, and No. 7 (Priory) 137. The following are the birth rates per 1,000 of the population for each of the Wards, the Borough, London, and England and Wales:— No. 1 (Town) Ward 8.1 No. 2 (Belsize) „ 9.0 No. 3 (Adelaide) „ 8.7 No. 4 (Central) „ 6.3 No. 5 (West End) „ 13.1 No. 6 (Kilburn) „ 16.1 No. 7. (Priory) „ 12.1 The Borough 10.9 London 14.2 England and Wales 15.3 There was no Natural Increase in population, i.e., excess of births over deaths. CHART SHEWING THE BIRTH RATE AND THE DEATH RATE PER 1000 POPULATION IN HAMPSTEAD 19 Legitimate and Illegitimate Births. Of the total 981 nett live births belonging to Hampstead, 890 were those of legitimate and 91 of illegitimate children, the latter being at the rate of 93 per 1,000 births. 29 of the Hampstead illegitimate infants were born outside the Borough, chiefly in Lying-in Institutions. Still Births. During 1932, the nett number of registered still births for Hampstead was 26. In the following Table the still births for 1932 have been distributed according to sex, etc.:— STILL BIRTHS. MALES. FEMALES. TOTALS. mate. Illegitimate. Total. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Registered in the Borough 17 3 20 18 2 20 35 5 40 Add number occurring outside the Borough whose mothers were Hampstead residents 3 1 4 2 1 3 5 2 7 20 4 24 20 3 23 40 7 47 Deduct number who could not be deemed to belong to Hampstead 11 1 12 9 - 9 20 1 21 Nett number belonging to Hampstead, 1932 9 3 12 11 3 14 20 6 26 Nett Still Births, 1931 23 1 24 11 2 13 34 3 37 Deaths. The total nett deaths during 1932 numbered 1,043, as compared with 1,025 in the preceding year. These 1,043 nett deaths represent a "recorded" death rate of 11.6 per 1,000 of the population. This "recorded" death rate is the rate obtained by deducting from the total deaths registered in Hampstead the number who were non-resident persons, and, after subtracting these, adding the number of deaths of Hampstead residents who died outside the Borough. The nett deaths were distributed among the various Wards as follows:- No. 1 (Town) 137, No. 2 (Belsize) 181, No. 3 (Adelaide) 150, No. 4 (Central) 119, No. 5 (West End) 143, No. 6 (Kilburn) 160, and No. 7 (Priory) 153. 20 The following are the death rates per 1,000 of the population for each of the Wards, the Borough, London, and England and Wales:— No. 1 (Town) Ward 10.8 No. 2 (Belsize) „ 12.5 No. 3 (Adelaide) „ 13.3 No. 4 (Central) „ 11.1 No. 5 (West End) „ 10.0 No. 6 (Kilburn) „ 10.4 No. 7 (Priory) „ 13.5 The Borough 11.6 London 12.3 England and Wales 12.0 Proportions of deaths from principal causes 1932 21 Age and Sex Allocation of Deaths of Hampstead Residents during the Year 1932. CAUSES OF death. Nett deaths at the subjoined ages of "Residents," whether occurring within or without the Borough. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. i 2 3 4 5 6 7 8 9 10 11 12 13 14 1. Typhoid and Paratyphoid Fevers M ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... 1 ... ... ... 2. Measles M 2 ... 2 ... ... ... ... ... ... ... ... ... F 1 ... ... 1 ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... 1 ... 1 ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... 5. Diphtheria M 2 ... 1 ... 1 ... ... ... ... ... ... ... F 2 ... ... 1 ... ... ... ... ... 1 ... ... 6. Influenza m 16 ... ... ... ... 1 1 ... 2 2 5 5 F 20 ... ... ... ... 1 1 ... ... 6 4 8 7. Encephalitis Lethargica M ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... 1 ... ... ... 8. Cerebro-spinal Fever M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 9, Tuberculosis of respiratory system M 14 ... ... ... ... 3 2 1 4 3 1 ... F 18 ... ... ... ... 8 3 2 3 1 1 ... 10. Other Tuberculous Diseases M 4 ... ... ... 1 ... ... 1 ... 2 ... ... F 4 ... ... ... 2 ... ... ... 2 ... ... ... 11. Syphilis M ... ... ... ... ... ... ... ... ... ... ... ... F 2 1 ... ... ... ... ... ... 1 ... ... ... 12. General paralysis of the insane, tabes dorsalis M 2 ... ... ... ... ... ... ... ... 1 1 ... F ... ... ... ... ... ... ... ... ... ... ... ... 13. Cancer, malignant disease M 70 ... ... ... ... ... ... 1 10 23 15 21 F 104 ... ... ... ... ... 1 6 17 23 35 22 14. Diabetes M 7 ... ... ... ... ... ... ... ... 4 ... 3 F 9 ... ... ... ... ... ... ... ... 4 5 ... 15. Cerebral hæmorrhage, &c. M 16 ... ... ... ... ... ... 1 2 5 3 5 F 27 ... ... ... ... ... ... ... 3 5 8 11 16. Heart Disease m 104 ... ... ... ... 1 2 5 10 18 36 32 F 136 ... ... ... ... ... 3 5 13 11 43 61 17. Aneurysm m ... ... ... ... ... ... ... ... ... ... ... ... F 5 ... ... ... ... ... ... ... ... 2 2 1 18. Other circulatory diseases M 21 ... ... ... ... ... ... ... 1 4 10 6 F 39 ... ... ... ... ... ... ... 1 5 15 18 19. Bronchitis M 6 ... ... ... ... ... ... ... ... ... ... 6 F 17 ... ... ... ... ... ... ... ... ... 8 9 20. Pneumonia (all forms) M 20 4 1 ... 1 1 1 1 4 2 3 2 F 32 1 ... ... ... ... 1 3 2 8 9 8 21. Other Respiratory Diseases m 7 ... ... ... ... ... 1 1 2 1 1 1 F 12 ... ...... ... ... 1 2 1 ... ... 3 5 22. Peptic Ulcer m 10 ... ... ... ... 1 1 1 1 3 1 2 F 5 ... ... ... ... ... ... ... 1 2 2 ... 23. Diarrhœa, &c. M 3 3 ... ... ... ... ...... ... ... ... ... ... F 7 4 1 ... ... ... ... ... ... 1 ... 1 24. Appendicitis M 2 ... ... ... ... ... ... ... 2 ... ... F 4 ... ... ... ... ... ... ... 1 ... 2 ... 25. Cirrhosis of Liver M 5 ... ... ... ... ... ... ... 2 1 2 ... F 3 ... ... ... ... ... 1 ... ... ... 2 ... 26 Other diseases of liver, &c. M 2 ... ... ... ... ... ... 1 ... ... ... 1 F 7 ... ... ... ... ... ... 1 1 3 1 1 27. Other digestive diseases m 5 1 ... ... ... ... ... ... ... 1 2 1 F 19 ... ... ... ... 2 2 2 6 1 4 2 28. Acute and Chronic Nephritis M 21 ... ... ... ... ... ... 2 2 7 6 4 F 15 ... ... ... ... 1 ... 1 1 1 2 9 29. Puerperal Sepsis F 1 ... ... ... ... ... 1 ... ... ... ... ... 30. Other puerperal causes F 1 ... ... ... ... 1 ... ... ... ... ... ... 31. Congenital Debility, premature birth, malformations, &c. W 15 14 ... ... 1 ... ... ... ... ... ... ... F 15 15 ... ... ... ... ... ... ... ... ... ... 32. Senility M 2 ... ... ... ... ... ... ... ... ... ... 2 F 13 ... ... ... ... ... ... ... ... ... 1 12 33. Suicide m 16 ... ... ... ... ... 5 4 3 3 ... 1 F 10 ... ... ... ... ... 2 3 1 3 1 ... 34. Other violence M 16 ... 1 ... 2 5 2 ... 1 1 3 1 F 20 4 2 ... ... ... 2 ... 2 3 7 35 Other Defined Diseases M 55 3 1 ... 1 1 3 4 6 10 16 10 F 48 3 ... 2 3 1 3 6 8 10 12 36. Causes ill-defined or unknown m ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... All { causes { M 445 25 7 ... 8 13 18 23 50 93 105 103 F 598 28 3 3 4 17 20 27 61 87 161 187 Totals 1043 53 10 3 12 30 38 50 111 180 266 290 All "Transferable Deaths" of residents, i.e., of persons resident in the Borough who died outside it, have been included. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who died in the Borough have in like manner been excluded. 22 Table showing the Birth, Death and Infantile Mortality rates during 1932 in the Metropolitan Cities and Boroughs:— Birth Rate. Death Rate. Infantile Mortality Rate. City of London 6.5 Lewisham 10.2 City of London 46 Westminster 9.1 Woolwich 11.1 Chelsea 52 Holborn 9.6 Hackney 11.5 Stoke Newington 53 Hampstead 10.9 Hampstead 11.6 Hackney 54 St Marylebone 11.0 Wandsworth 11.6 Hampstead 54 Chelsea 11.9 Greenwich 11.8 Lewisham 54 Wandsworth 11.9 Bermondsey 12.0 Bermondsey 56 Lewisham 12.7 Bethnal Green 12.0 Lambeth 56 Kensington 12.9 Camberwell 12.0 Battersea 58 Paddington 13..8 Battersea 12.1 Fulham 58 St. Pancras 13.8 Poplar 12.1 Woolwich 60 Woolwich 14.0 Deptford 12.2 Stepney 62 Fulham 14.3 Fulham 12.3 Wandsworth 62 Hackney 14.5 Shoreditch 12.3 Poplar 63 Hammersmith 14.5 Stepney 12.3 Camberwell 65 Greenwich 14.7 Westminster 12.3 Deptford 65 Lambeth 14.7 Islington 12.4 Hammersmith 66 Battersea 14.8 St. Marylebone 12.4 Westminster 66 Camberwell 14.8 Lambeth 12.5 Islington 68 Stoke Newington 15.0 City of London 12.8 Bethnal Green 69 Islington 15.2 Hammersmith 12.8 St. Pancras 69 Bethnal Green 15.4 Chelsea 12.9 Holborn 72 Deptford 15.9 Stoke Newington 12.9 Southwark 72 Finsbury 16.0 St. Pancras 13.1 Greenwich 80 Southwark 16.2 Southwark 13.1 Shoreditch 80 Bermondsey 16.6 Paddington 13.3 Finsbury 81 Stepney 16.7 Finsbury 13.4 St. Marylebone 87 Poplar 17.2 Kensington 13.6 Kensington 98 Shoreditch 17.5 Holborn 14.2 Paddington 107 County of London 14.2 County of London 12.3 County of London 66 23 Infantile Mortality. During 1932, 53 infants under one year of age died, the infantile death rate was 54 per 1,000 live births as compared with the rate of 61 in 1931. The following table shows the deaths and death rates of legitimate and illegitimate infants:— Legitimate Infants Males. Females Total. No. of births 490 400 890 „ deaths 18 20 38 Death rate per 1000 legitimate live births 43 Illegitimate Infants. No. of births Males. Females Total. 40 51 91 „ deaths 7 8 15 Death rate per 1000 illegitimate live births 165 Total. No. of births Males. Females Total. 530 451 981 „ deaths 25 28 53 Death rate per 1000 live births 54 This subject is dealt with further in the Section relating to Maternity and Child Welfare. Deaths of Young Children. During 1932, 66 deaths occurred of children under 5 years of age. This is equivalent to a rate of 13.3 per 1,000 live children born in that and the four preceding years. Maternal Deaths. During the year 1932, the number ot women dying in, or in consequence of, child-birth was as follows:— 1. Puerperal Causes (a) Puerperal Sepsis at home in insitution 1 3 (b) Other Puerperal causes at home in institution 1 2. Non-puerperal causes at home in institution 1 Total Maternal Deaths 3. The subject of maternal mortality is dealt with in the Section of this Report relating to Maternity and Child Welfare. Section 2. General Provisions of Health Services in the Borough. 27 General Provision of Health Services in the Borough. (i) Staff. A list of the Staff of the Public Health Department will be found on page 4 of this report. The principal alteration in the personnel of the Staff in 1932 was the retirement of Dr. F. E. Scrase, on reaching the age-limit, after 21 years service as Medical Officer of Health. The steady increase in the work of the clerical staff, which has from time to time necessitated the appointment of temporary assistance, was considered by the Public Health Committee during the year, and in July it was decided to place Mr. A. J. Anscomb on the permanent staff. Mr. R. H. Box, a clerk in the Public Health Department, is continuing to act as temporary Vaccination Officer. (ii) Professional Nursing in the Home. (a) General. The Hampstead District Nursing Association, 3, Pond Street, and the Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, provide skilled nurses for the sick poor. (b) For Infectious Diseases. The Borough Council contributes towards the expenses of the Nursing Associations, whose nurses are available for cases of Measles, Whooping Cough, Epidemic Diarrhoea, Ophthalmia Neonatorum, Acute Primary or Acute Influenzal Pneumonia, Influenza, Malaria, Dysentery or Trench Fever. During 1932, 65 cases were nursed under this arrangement by the Kilburn and West Hampstead District Nursing Association, and 21 by the Hampstead District Nursing Association. (c) For Maternity Cases. Both Associations employ fully trained nurses to attend maternity cases. The work carried out in this connection is referred to in Section 3 of this Report. (iii) Midwives. These are controlled by the London County Council, the local supervising authority under the Midwives Acts, 1902 to 1926. 28 The Borough Council has arranged with both Nursing Associations for the provision of registered midwives. Details of the work of these midwives will be found in Section 3 of this Report. (iv) Laboratory Facilities. Dr. H. E. Cox is the Public Analyst appointed under the Food and Drugs (Adulteration) Act, 1928, by the Borough Council, and his Laboratories are situated at 11, Billiter Square, E.C.3; his report will be found in Section 6. A report on the samples taken for analysis during the year will be found on pages 119 to 121. The examination of clinical material (sputum, swabs, etc.) is undertaken by the Hampstead General Hospital at their Laboratory at the Hospital at Haverstock Hill. Information relating to the work carried out in this connection will be found in those parts of this Report relating to infectious disease. (v) Legislation in Force. List of Local Acts, Special Local Orders, General Adoptive Acts, and Bye-laws, relating to the Public Health, in force in the Borough. Prevention of nuisance arising Public Health from snow, rubbish, offal, filth, (London) Act, June, 1893. etc., in any street1891, Sec. 16 (1). Prevention of nuisance arising from offensive matters running out of any manufactory, slaughter house, butcher's or fishmonger's shop, etc. ditto ditto Prevention of keeping animals on any premises in such manner as to be a nuisance, etc. ditto ditto Paving of yards or open spaces in connection with dwelling houses ditto Oct., 1907. Removal of manure, etc. ditto, Sec. 36 (2) May, 1912. Keeping of w.c.'s supplied with a sufficient supply of water ditto, Sec. 39 (2) June, 1893. Cleansing of cisterns ditto, Sec. 50 ditto Regulations (Underground Rooms) under Section 17 (7) Housing (Town Planning, etc.) Act, 1909. 29 In addition to the foregoing bye-laws made by the Borough Council or the late Vestry, there are in force, among others in the Borough, Bye-laws made by the London County Council, relating to drainage work, sanitary fittings, etc.; and to houses divided into separate tenements, etc. (vi) Hospitals. Arrangements have been made with two Hospitals in the Borough, i.e., The New End (London County Council) Hospital and The Children's Hospital, College Crescent, in connection with the Council's maternity and child welfare work. Details of the use that was made of these facilities will be found in the Section of this Report relating to Maternity and Child Welfare. The Borough possesses two endowed beds at the Hampstead General Hospital, Haverstock Hill, Hampstead. Letters of admission are granted at the discretion of His Worship the Mayor. Residential Institutional Treatment for tuberculous patients is provided by the London County Council. Hampstead possesses two endowed beds at Mount Vernon Hospital, Northwood. This hospital was formerly situated in Hampstead and was originally used for tuberculous patients, but is now a Cancer Hospital. Letters of admission to these beds are issued by His Worship the Mayor. The Council contributes towards the cost of beds in Queen Charlotte's Hospital, which are available for Hampstead residents. This Hospital is not in Hampstead but in the adjoining Borough of St. Marylebone. (vii) Ambulance Facilities. (a) For infectious cases Provided, free of charge, by the London County Council. The Ambulances of the County Council are available for hire for non-infectious cases. (b) For non-infectious The Ambulances of the London County and accident cases Council are available, free of charge, for accident cases. The Ambulances of the St. John Ambulance Association are also available for accident cases. 30 Ambulances are provided by the don County Council, free of charg, for the conveyance of parturient women at any hour of the day or night, to hospitals or private residences, if the case is one of urgency, whether from the home, place of business or elsewhere, on the application of a qualified medical practitioner or certified midwife, provided that either a doctor or midwife accompanies the case. If such (c) For maternity a case not being one of urgency occurs patients between the hours of 11 p.m. and 8 a.m. free ambulances are also available for their removal to maternity hospitals with which they have already made arrangements, if a letter of admission to such hospital is produced; ambulance cards for these latter cases are issued to patients when they make their arrangements at the Hospital and in these cases it is sufficient for a female friend to accompany the patient. (viii) Clinics and Treatment Centres. Description. Where held, etc. By whom provided. Times when held. Ante-natal Clinics 75, Dynham Road (in Municipal Tuberculosis Dispensary) 27, Pond Street (rooms rented in the rebuilt premises of the Day Nursery) Borough Council Monday, 2 p.m. Thursday,9.15 a.m. Tuesday, 2.30 p.m. Infant Welfare Centres Heath Street Baptist Chapel Hall Wesleyan Church Hall, Lisburne Road New College Chapel Hall, Avenue Road Health Institute, 107, Kingsgate Road St. James' Mission Hall, Netherwood Street Mission Hall, Broomsleigh Street Hampstead Council of Social Welfare Wednesday, 2.30 p.m. Thursday, 2 p.m. Monday, 2 p.m. Tuesday, 2 p.m. Wednesday, 2 p.m. Tuesday, 2 p.m. Friday, 2 p.m. 31 Description. where held, etc. By whom provided. Times when held. Toddler's Clinic Health Institute, 107, Kingsgate Road Hampstead Council of Social Welfare Every two months. Dental Clinics for 27, Pond Street Health Institute, 107, Kingsgate Road Borough Council Hampstead Council of Social Welfare Wednesday,10 a.m. Tuesday, 2.30 p.m. Expectant and Nursing Mothers and Children under 5 years of age } Dental Clinic for Tuberculosis Dispensary patients British Dental Hospital, 31, Camden Road Borough Council Wednesday,! 1 a.m • Tuberculosis Dispensary 75, Dynham Road (forms part of The Health Institute) Borough Council Tuesday, 2 p.m. Wednesday, 5 p.m. Friday, 4.30 p.m. and 8 p.m. Cleansing Station Electricity Station Yard, Lithos Road Borough Council For L.C.C. Scholars, Mondays, Wednesdays and Fridays For other cases, Tuesdays and Thursdays. Venereal Diseases No Clinic in the Borough — — Clinics and Treatment Centres arranged in Chronological Order. Monday. All day Cleansing Station for L,.C.C. Scholars. 2.0 p.m. Ante-natal Clinic, 75, Dynham Road. 2.0 p.m. Infant Welfare Centre, New College Chapel Hall, Swiss Cottage. T uesday. All day Cleansing Station for Borough Council cases. 2.0 p.m. Tuberculosis Dispensary, 75, Dynham Road. 2.0 p.m. Infant Welfare Centre, 107, Kingsgate Road. 2.0 p.m. Infant Welfare Centre, St. James's Mission Hall, Netherwood Street. 2.30 p.m. Dental Clinic, 107, Kingsgate Road. 2.30 p.m. Ante-natal Clinic, 27, Pond Street. Wednesday. All day Cleansing Station for L.C.C. Scholars. 10 a.m. Dental Clinic, 27, Pond Street. 11 a.m. Dental Clinic, Tuberculosis Dispensary patients, British Dental Hospital, 31, Camden Road. 32 2.0 p.m. Infant Welfare Centre, 107, Kingsgate Road. 2.30 p.m. Infant Welfare Centre, Heath Street, Baptist Chapel Hall. 5 p.m. Tuberculosis Dispensary, 75, Dynham Road. Thursday. All day Cleansing Station for Borough Council cases. 9.15 a.m. Ante-natal Clinic, 75, Dynham Road. 2.0 p.m. Infant Welfare Centre, Wesleyan Church Hall, Lisburne Road. Friday. All day Cleansing Station for L.C.C. Scholars. 2.0 p.m. Infant Welfare Centre, Mission Hall, Broomsleigh Street. 4.30 p.m. Tuberculosis Dispensary, 75, Dynham Road. 8 p.m. Tuberculosis Dispensary, 75, Dynham Road. List of Hospitals at which persons suffering from Venereal Disease can receive free treatment under conditions of strict secrecy in pursuance of the Scheme prepared by the London County Council. Name and address of Hospital. Department. Albert Dock, Royal Albert Docks, E.16. Men and Women. Guy's, St. Thomas Street, E.C.I. Men, women and children. Hospital for Sick Children, Great Ormond Street, Children. W.C.I. King's College, Denmark Hill, S.E.5. Men and women. Metropolitan, Kingsland Road, E.8. Ditto. Middlesex, Berners Street, W.l. Ditto. Miller General, Greenwich, S.E.10, Ditto. Royal Free, Gray's Inn Road, W.C.I. Women and children. Royal Northern, Holloway Road, N.7. Men, women and children. St. George's, Hyde Park Corner, S.W.I. Men and women. St. John's (Lewisham), Morden Hill, Lewisham, Men, women and children. S.E.13. St. Mary's, Cambridge Place, Paddington, W.2. Men and women. St. Paul's, Endell Street, W.C.2. Men, women and children. St. Thomas's, Westminster Bridge Road, S.E.I. Ditto. Seamen's, Greenwich, S.E.10. Men. South London for Women, South Side, Clapham Women and children. Common, S.W.4. University College, Gower Street, W.C.I. Men and women. West London, Hammersmith Road, W.6. Ditto. Westminster, Broad Sanctuary, S.W.I. Ditto. Whitechapel (L.C.C.) Clinic, Turner Street, Mile Men, women and children. End, E.l. Further reference to these diseases will be found in Section 7. Section 3. Maternity and Child Welfare. 35 Maternity and Child Welfare. Maternity and Child Welfare work is the rock upon which all other public health activities may be built; it is, therefore, the most fundamental of public health activities. Throughout the country generally, and in Hampstead in particular, invaluable work has been done in the past, and is being carried on to-day by voluntary associations. These Bodies have done much excellent service, especially in the direction of pioneer work and in experimental activities associated with various forms of social service. Acting on the instructions of my Committee, in October last I prepared a report in which I suggested various modifications which, in my opinion, were calculated to bring the work of the Council of Social Welfare more closely associated with the duties already being performed by the Committee and officers of the Borough. A special sub-committee was appointed to enquire into this report and at the close of the year negotiations were still in progress. The following services are undertaken with the approval of the Ministry of Health for supervising the health of expectant or nursing mothers and children under five years of age. Home visiting by health visitors of expectant or nursing mothers, and of children up to five years of age. Infant Welfare Centres. Toddlers' Clinic. Distribution of pamphlets and booklets giving advice on various matters concerning the welfare of mothers and children. Midwives and home nursing of children and women. These services are secured by subsidising the two local District Nursing Associations. Ante-natal Clinics for medical supervision and for giving advice to expectant mothers. Dental Clinics for expectant or nursing mothers, and children up to five years of age. Maternity Hospitals. Home for care of children whose mothers are in hospitals for confinement, etc. Convalescent Homes for ailing children, and for mothers with their babies after confinement. Homes for unmarried mothers. 36 Creches (Day Nurseries). Foster Home. Hospital treatment for sick and ailing children and for the performance of minor operations. Consulting Obstetricians, whose help is available in cases of difficulty or abnormality. Milk and food for expectant or nursing mothers and for children. In pursuance of the Local Government Act, 1929, the Minister of Health prepared a scheme determining, in relation to Voluntary Associations providing Maternity and Child Welfare services, which are to be treated as services in respect of which the County Council is to contribute, and which are services in respect of which the Borough Council is to contribute. Details of this scheme were published in the Annual Report for 1930. The following Institutions received financial aid from the Borough Council:— Name and Address of Institution, etc. Nature of Maternity and Child Welfare Services rendered. Amount of Council's Contribution. New End Hospital, New End, N.W.3. Maternity Ward of 5 beds. 9s. per day per bed occupied. Patients assessed to pay according to their means. Queen Charlotte's Hospital, Marylebone Road, N.W.I. Beds for Confinement cases. £1 per Hampstead mother admitted. Beauchamp Lodge Emergency Home for Children, Warwick Crescent, Paddington, W. Boardine-out of children under five years of age whose mothers are in hospitals for confinement, illness, etc. 12s. 6d. per week per bed occupied. Parents assessed to pay according to their means. Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, N.W.6. Provision of Mid- wives. Nursing of cases of Measles, Ophthalmia Neonatorum, etc. Note.—Cases of Pneumonia, Influenza, etc., are also nursed, similar fees being paid therefor. £200 per annum. 2s. 6d. per visit for first case in a family and 1s. 3d. per visit for second and subsequent cases, if visited at the same time. Hampstead District Nursing Association, 3, Pond Street, N.W.3. Provision of Mid- wives. Nursing of cases of Measles, Ophthalmia Neonatorum, etc. Note.—Cases of Pneumonia, Influenza, etc., are also nursed, similar fees being paid therefor. £3 3s. 0d. per case. 2s. 6d. per visit for first case in a family and 1s. 3d. per visit for second and subsequent cases, if visited at the same time. 37 Name and Address of Institution, etc. Nature of Maternity and Child Welfare Services rendered. Amount of Council's Contribution. St. Mary's Convalescent Home, Birchington-on-Sea. Convalescent Home for mothers and babies. (Mothers convalescent after childbirth.) £40 per annum retaining fee for 1 bed and 14s. per week for mother and baby (up to 6 months), and 7s. per week for mother alone. Patients assessed to pay according to their means. This facility was terminated on September 30th, and the Council authorised the Maternity and Child Welfare Committee to arrange, as and when required, for accommodation in suitable Homes and upon the most convenient terms, for convalescent patients. The Children's Hospital, College Crescent, N.W.3. Beds for sick and ailing children under five years of age, and for minor operations. 17s. 6d. per week per bed occupied. Parents assessed to pay according to their means. Hampstead Foster Home, 99, Haverstock Hill, N.W.3. Hampstead Council of Social Welfare, 27, Heath Street, N.W.3. Home for the first babies of unmarried mothers. Six Infant Welfare Centres. £200 per annum. (£652 per annum also paid by London County Council.) *£725 per annum. Brondesbury and Kilburn Day Nursery, 36, Hemstal Road, N.W.6. Day Nursery. *£431 per annum. Hampstead and North St. Pancras Day Nursery, 27 & 29, Pond Street, N.W.3. Day Nursery. *£543 per annum. * Payable by the Council under the Scheme of the Minister of Health under Section 101 (6), Local Government Act, 1929. National Council for the Unmarried Mother and her Child, 117, Piccadilly, W. Welfare work. £3 3s. Od. Note.—A Dental Clinic for expectant or nursing mothers and children up to five years of age, has been established by the Borough Council at 27, Pond Street. This is staffed and equipped by the British Dental Hospital for the sum of £110 per annum. Information relating to the work carried out during 1932 will be found on page 48. A similar Clinic has been established by the Hampstead Council of social Welfare at the Health Institute, Kingsgate Road, Kilburn. The Council has nominated the following members of the Maternity and Child Welfare Committee to serve on the Committees of certain of the above-mentioned Institutions to which the Council contributes:— Kilburn and West Hampstead District Nursing Association, Councillor Mrs. Arnholz. Hampstead District Nursing Association, Mr. Councillor Monckton Copeman. 38 Hampstead Foster Home, Councillor Miss Richards. Hampstead Council of Social Welfare, Councillor Mrs. Carnegie. Brondesbury and Kilburn Day Nursery, Councillor Mrs. Evans. Hampstead and North St. Pancras Day Nursery, Councillor Miss Glover. Infant Welfare Centres. The following are the Infant Welfare Centres in the Borough:— Centre. Day and Time held. Doctor in attendance. Health Visitor. Average attendance per session. 1. Belsize Monday, 2—4 p.m. Dr. M. A. Blandy Miss Lambe 37 2. Branch Tuesday, 2—4p.m. Dr. I. M. Finlayson 44 3. Kilburn Tuesday, 2—4 p.m. Wednesday, 2-4 p.m. Dr. A. S. Hall- Craggs Mrs. Steward Mrs. Steward 50 4. New End Wednesday, 2.30— 4 p.m. Dr. S. M. Pratt Miss Kennedy 23 5. Liaburne Road Thursday, 2—4 Dr. M. A. Blandy . Miss Lambe 42 6. Mill Lane Friday, 2—4 p.m. Dr. H. M. Gregory Foster Miss Kennedy 39 A Toddlers' Clinic was started by the Council of Social Welfare on the 1st June, 1931, and is held once every two months at the Health Institute. It is greatly to be regretted that, owing to lack of finance, this invaluable clinic cannot be held more frequently. An excellent recent innovation has been the formation of a Toddlers' Play Centre, also under the auspices of the Council of Social Welfare. At this Centre children who appear to be somewhat neglected on the arrival of the next baby are given some opportunity for the development of their minds, bodies and morals, by means of play and the discipline that play involves. It is held at the Health Institute every Monday and Friday morning, but unfortunately, owing to the limited staff, it is impossible to arrange for the attendance of a Health Visitor. Ante-Natal Clinics. The two ante-natal clinics in the Borough are provided and maintained by the Borough Council, namely:— Western Clinic: Two sessions weekly (viz., Monday at 2 p.m. and Thursday at 9.15 a.m.) at 75, Dynham Road. Held in the premises rented by the Borough Council from the Health Institute for the purpose of a Tuberculosis Dispensary. Eastern Clinic: One session weekly (viz.,Tuesday at 2.30 p.m.) at 27, Pond Street. Held in the premises of the Day Nursery, for which the Borough Council pays a rent of £100 per annum. 39 The Medical Officer in charge (Dr. Kidd) is a part time officer appointed by the Borough Council whilst a Health Visitor is in attendance at each session. In October I reported to the Maternity and Child Welfare Committee on the subject of the importance of securing the proper antenatal examination or treatment for expectant mothers who engage a midwife from either of the Nursing Associations for their confinement; and as a result an arrangement was arrived at with the Associations whereby their mid wives referred all such expectant mothers (other than those who elected to be seen by a private doctor) to the Medical Officer-in-Charge of the Council's ante-natal clinics. The Medical Officer of the ante-natal clinic reports direct to the Superintendents concerned the results of her findings and other appropriate observations. The Superintendents of the Nursing Associations submit to me a weekly report on the expectant mothers applying for the services of a midwife, and on this form is indicated whether such women have been examined by the Council's Medical Officer or by their private doctor. Expectant mothers who are found to be normal in all respects are continued under the observation of the midwife of the District Nursing Association, whilst, if the expectant mother is found to be abnormal in any respect, the Medical Officer of the ante-natal clinic arranges to keep her under her supervision and arranges for any treatment which may be necessary. So far as is possible, Dr. Kidd arranges to make at least one post-natal examination of the mother. The following is the report for the year 1932 of the Medical Officer, Miss Mary Kidd, M.B., B.S. (Lond.):— To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I beg to submit the following report on the working of the Borough Council's Ante-Natal Clinics during the year 1932:— Pond Street Clinic. Kilburn Clinic. 1931. 1932. 1931. 1932. New patients 127 113 297 282 Attendances of old patients 473 493 922 1193 Number of sessions held 52 51 101 100 40  Pond 1931, Street Clinic. 1932. between Kilburn 1931. Clinic. 1932. between Average attendance per session l1 11 & 12 12 14 & 15 Number of patients referred to dental clinic 53 55 117 123 Number of patients sent to 4 1 6 8 Convalescent Home Of the 395 new patients, 53 were normal. 140 were slightly abnormal. 133 were seriously abnormal. 4 were connected with venereal disease. 43 were post-natal. 10 were not eligible. 12 were doubtfully eligible. Analysis of 273 Abnormal Cases. Morning sickness 21 Bacilluria with cystitis 3 Dyspepsia 16 Threatened miscarriage 8 Constipation 43 Ante-partum haemorrhage 3 Anaemia and debility 20 Slight pelvic contraction. 8 Sleeplessness 3 Breech presentation 11 Lax abdominal wall (needing support) 13 Transverse presentation 3 Marked vaginal prolapse 3 Varicose veins 13 Endocervicitis 26 Valvular disease of heart 6 Other causes 22 Bronchitis 3 Albuminuria 20 Total 273 Toxaemia of pregnancy 28 The number of expectant mothers attending the Clinics for the first time in 1932 remains about the same as in 1931, but the attendances of old cases shows a decided increase. The number of births in Hampstead last year was 981, practically the same as the year before when the number was 984. Of the expectant mothers in the Borough, close upon a third attended our Clinics before the birth of their babies. In addition, 43 mothers came to see us for the first time after their confinements, to receive postnatal care. Of the 981 Hampstead babies born in 1932, 30 died in the first 41 month of life. Such deaths are mostly due to the physical condition of the mothers during pregnancy and are therefore largely preventable by ante-natal care. I am glad to be able to record that only 8 Hampstead babies whose mothers had attended our Clinics died below the age of 1 month. The neo-natal death rate (which term is used to describe the number of infant deaths occurring in the first four weeks of life) was only 26 per 1000 amongst the babies of our patients. I do not think that one could have done any more to prevent these deaths, than was done. For example, two children died at 4 days old; children of an unmarried mother who only came to the Clinic once and did not return. A third infant died at 4 weeks of age from toxaemia due to an infected cephalhematoma after a normal confinement. A fourth child, healthy at birth, died of pneumonia at ten days old. A fifth child died at 3 days of cerebral haemorrhage due to rapid moulding of the head and delivery. No disproportion or pelvic contraction had been noted beforehand. A sixth child also died of cerebral haemorrhage in the second week of life. In this case forceps had had to be used owing to bleeding before delivery. The seventh and eighth infants died owing to prematurity. In one of these, I had only seen the mother for the first time the day before her confinement and had sent her into New End Hospital promptly, as the membranes had ruptured two or three weeks previously. In the other one, I had suspected the presence of syphilis in the mother before her child's birth owing to her history, but a blood test taken some time previously had been negative as regards the Wasserman reaction and all my efforts to induce her to go to the Royal Free Hospital and have another blood test (after a provocative injection of novarsenobillon) had proved fruitless. I am glad to say that there were no maternal deaths amongst the Hampstead mothers who attended the Clinics. Abnormal Cases. Six expectant mothers were found to be suffering from valvular disease of the heart, due to rheumatism in childhood or youth. The mitral valve was affected in all cases and the aortic as well, in one. The latter patient decided to go into St. Mary's Hospital, Paddington, for her confinement and I sent her to the ante-natal clinic there with a note to the doctor in charge, who kept her under observation during pregnancy. A Caesarian section was performed and both mother and 42 baby did well subsequently and were sent from the Hospital to a Convalescent Home. Yet another case went to Queen Charlotte's Hospital for her confinement and had a normal delivery and convalescence. I sent the third patient to book up at the Royal Free Hospital for her confinement and she was seen there by the Cardiologist every month and was confined in the maternity ward after induction of premature labour had been carried out. She is now doing well after a slow and tedious convalescence A fourth patient decided to go to New End Hospital for her confinement and I sent her to one of the Out Patient Physicians at the Hampstead General Hospital for his opinion on her case. He kindly kept her under his observation and treatment during pregnancy, and she did very well subsequently, after a normal labour at New End Hospital. The last two cases did not return to the clinic after their first visits, although we endeavoured to induce them to do so. Two cases of suspected phthisis and one where the disease was quiescent were referred to the Tuberculosis Medical Officer. Another case of arrested phthisis was already under his care when she first came to see me. I sent one of the patients suffering from bronchitis and asthma to the Asthma Clinic at St. Mary's Hospital, Paddington, whilst I sent the other to book up for her confinement at the Royal Free Hospital, where I knew there would be ample possibilities for the treatment of her complaint. The presence of albuminuria was detected in 20 cases. Urine tests were carried out frequently and their blood pressures were estimated as frequently as possible. A non-meat diet was enjoined on all. Reports received on 17 of these cases, up-to-date, indicate that no eclamptic symptoms supervened in any one and that healthy babies were born. Toxaemia of pregnancy was present in a greater or less degree in 28 cases. Blood pressure estimations and urine tests were carried out as far as possible in each one, and the diet was carefully regulated so as to exclude meat. Reports have been obtained on the subsequent progress of 24 of these women. No eclamptic symptoms made their appearance in any case and the confinements were happily uneventful in this respect. I arranged with the Medical Superintendent at New End Hospital to admit three of the above patients for observation and 43 treatment; and in one case a fortnight beforehand and in two other cases several weeks beforehand; as in all, the blood pressure was decidedly high. The two latter were unmarried girls in domestic service, and the condition was undoubtedly aggravated by the anxiety consequent on their condition and also by hard work. It was of interest to note in some of the milder cases of toxaemia the way in which the blood pressure would fall to a normal level again after a few weeks of careful dieting and especially of avoidance of meat. There were three cases of ante-partum haemorrhage. I sent one of them to the Consulting Ante-Natal Clinic at the Royal Free Hospital for an opinion on her condition and she was treated with a course of corpus luteum tabloids and carefully dieted, so as to exclude meat as an article of diet. She did very well and was confined at home by a midwife without any further haemorrhage, a doctor being only summoned at the time of the confinement, because of the fear of possible haemorrhage. I referred a second case also to the Consulting Ante-Natal Clinic, as she had had a good deal of bleeding on and off when I first saw her, and her condition was further complicated by the presence of endocervicitis. She was transferred from the said Clinic to the Special Department at the Royal Free Hospital for treatment of the latter condition and she was admitted for ten days intensive treatment, which was continued afterwards as an outpatient. I am glad to say that she did well in spite of occasional recurrences of bleeding and I kept her under observation and dieted her carefully and made all arrangements for her confinement in the Borough Council Ward at New End Hospital in good time. She had a perfectly normal labour, but the child had a sharp attack of ophthalmia neonatorum afterwards, in spite of all the most efficient treatment she had received at the Special Department at the Royal Free Hospital which had been designed to prevent this. I think there is no doubt that if she had come to us earlier in pregnancy she could have had a longer course of treatment. Fortunately, after a stay at St. Margaret's Hospital with its mother, the little one's eyes recovered completely. The third case is still under observation and is doing well. A breech presentation in the last few weeks of pregnancy, was present in 11 cases. It is important to diagnose these in good time and to turn them into vertex presentations, as in the case of a first child, especially, injury from pressure on the unmoulded head is apt to 44 occur and may even lead to a still-birth. Unfortunately, this happened in one case. In nine other cases the confinements passed off well and live babies were born as version (or, in other words, "turning") had been performed on seven mothers; two at our Clinics, three at the Consulting Ante-Natal Clinic at the Royal Free Hospital, at my request, and two at New End Hospital. In two cases, the breech presentation turned naturally into a vertex in the last few weeks of pregnancy, as it sometimes is apt to do. We can get no further report on the eleventh case. There were 3 cases of transverse presentation. In such a condition, the child is lying right across the mother's abdomen and great difficulty is apt to arise during labour. In one case I converted the malpresentation into a normal vertex presentation at the Clinic, whilst I sent another to New End Hospital for the same purpose, as she was going to be confined there. In the third case the malpresentation rectified itself naturally as it occasionally does. All three confinements were normal and mothers and babies did well. The case of disproportion between the fcetal head and a pelvis that showed slight general contraction, did extremely well, I am glad to say, as it is such a type of case that is apt to lead to a maternal death. The disproportion became manifest about a month before the confinement was due, and with the consent of the midwife who had been booked to attend her I sent the patient to the Consulting AnteNatal Clinic. Professor Mcllroy arranged to admit her to the Royal Free Hospital for her confinement and, as drug induction of premature labour had failed, she decided to let her go to full time and do Caesarian section if necessary, after labour had commenced. Fortunately, however, the child was not a big one and was finally able to be born naturally, as occasionally happens in such cases where great difficulty has been anticipated. There were 8 cases in which a minor degree of contracted pelvis was found to be present and these were watched as carefully as possible so as to detect any possible disproportion between the fcetal head and pelvis that might subsequently arise. Reports are to hand of the confinements of 6 of these patients. In 5 of them, the babies were small and weighed less than 7 lbs. at birth (indeed 3 were premature) so that no disproportion was manifested and labours were 45 all normal, 2 taking place in Hospital. In a sixth case, we advised the midwife who had been booked for the confinement to engage a doctor also. Forceps had to be applied as the baby was a full-time one of average size and weight. Both mother and child did well. I am glad to record that venereal disease was only found in 4 cases last year. Two of these were old-standing cases of specific disease. One had been under treatment at the V.D. Clinic at the Royal Free Hospital before she came to see me and is still attending there, but has not yet been confined. The other was an old patient of mine whom I had sent to the same V.D. Clinic during a previous pregnancy. She had a course of treatment during this last pregnancy and has been recently confined in a special isolation ward in the V.D. department of the Royal Free Hospital. Her baby is a healthy and beautiful one and presents no trace of any congenital taint, thanks to the treatment its mother received before its birth. Gonorrhæa was present in the two other cases,—both unmarried women. I sent one of them to the V.D. department just referred to, and she was admitted into the Hostel that is connected with it, for the remainder of her pregnancy and is to be confined in the special isolation ward at the Hospital, shortly. I sent the other case straight away into another Hospital for treatment. Whilst on this subject I should add blood tests were carried out in 21 cases last year at our Clinics, and the Wasserman reaction was found to be negative in all, by the Pathologist at the Royal Free Hospital who does this work for the London County Council. Marked endocervicitis was present in 26 expectant mothers. It is most important to detect and treat such cases promptly as this condition is apt to give rise to ophthalmia neonatorum (or discharging eyes) in the babies subsequently born to these mothers. It is interesting to note that in most of these cases that ubiquitous germ, the Bacillus coli communis, was found by the Pathologist at the Royal Free Hospital to be the offender. It is more and more being realized that this germ is just as responsible for severe cases of ophthalmia neonatorum as the gonococcus is. Reports have been received on the subsequent progress of 19 of these cases, up-to-date. All of them received some form of treatment, mostly at the Special Department for married mothers at the Royal Free Hospital, but a few at the Clinic in the form of lactic acid pessaries and sitz baths. It is most 46 Satisfactory to be able to record that ophthalmia neonatorum was only present in 3 out of 19 babies subsequently born. We had endeavoured to induce the mothers of two of these infants to attend the Special Department at the Royal Free Hospital for treatment of the endocervicitis present in each case, but they had been most irregular in their attendances. In the third case the Pathologist's report had not led us to anticipate the appearance of ophthalmia neonatorum and so no treatment had been given to the mothers beyond a course of baths. Fortunately in her baby's case, and in one of the others, the conditions cleared up very quickly and does not seem to have been severe enough to be notified. In one of the cases, however, where the mother was slack in her attendances for treatment at the Special Clinic, the baby's eyes discharged a good deal and it had to be taken into St. Margaret's Hospital with its mother for intensive treatment. Fortunately its eyes recovered without permanent damage. There were also 3 other cases of endocervicitis last year whom I sent for treatment to the Special Department at the Royal Free Hospital, but they have not yet had their babies. I have not been able to get any reports as to the subsequent progress of three others whom I sent there for the same purpose. Before leaving the subject of ophthalmia neonatorum I should like to say that only 6 cases of this disease were notified in our Borough last year. In 3 of these, the mothers had attended our Clinics before their babies were born. I have referred to two of these in preceding paragraphs, namely, the child of the patient with antepartum haemorrhage and endocervicitis where much treatment had been given beforehand, and the child of the patient who had been so slack in taking advantage of the treatment. Fortunately, as I said, the conditions in both cases cleared up well after intensive treatment of the eyes at St. Margaret's Hospital and no damage occurred to the eyesight. In the third notified case there had been no indication before its birth that the mother suffered from endocervicitis. Intensive treatment was given at St. Margaret's Hospital and the discharge from the eyes cleared up well, but a tiny opacity is left behind on one cornea. With regard to the 43 mothers who attended the Clinics for the first time after their confinements, it was a real pleasure to give them post-natal care. To give an idea of the importance of this work I 47 will briefly recount some of the various conditions from which these women were suffering. Four were finding great difficulty in getting the breasts to function properly; two others were suffering from overdistension of these organs, and another two had retention cysts in the breasts. As a direct result also of their confinements, four mothers showed symptoms of sub-involution of the uterus and three had vaginal prolapse, whilst one was found to be suffering from endocervicitis, one from eroded cervix, and in another case, venereal disease was suspected. Again, as an indirect result of their confinements, fifteen of these women were suffering from debility and anæmia and two from piles and bronchitis respectively. More serious conditions which came to light, were, a case of chronic nephritis, one of Graves' disease and one of cholecystitis. In conclusion, I should like gratefully to acknowledge the help I have received from Professor Mcllroy and Mrs. Rorke at the Royal Free Hospital in connection with some of the cases referred to in preceding paragraphs. I should like also to thank the members of the Consulting Staff at the Hampstead General Hospital for seeing and treating several of my cases at the Out-Patient Department at that Hospital. My thanks are due also to Mr. Winsbury White, the Urologist at St. Paul's Hospital for the long and successful courses of treatment he has given to cases of cystitis and bacilluria that I have sent to him from time to time during the last two years. I wish to thank Dr. Scrase and Dr. Oldershaw for much assistance in my work, and also the sympathetic and efficient Health Visitors and the two kind voluntary helpers, Mrs. Edney and Mrs. Summerson, who prepare the tea for the mothers at the Clinics and who give much help in other ways. MARY KIDD. M.B. (Lond.). March, 1933. Dental, Clinics. Under the present arrangement the Borough Council provides a dental clinic on the eastern side of the Borough, at 27, Pond Street, 48 for ante-natal and post-natal cases and for children up to the age of 5, whilst the Council of Social Welfare maintains a dental clinic on the western side of the Borough at the Health Institute. The following is a summary of the work carried out at the Borough Council's dental clinic at Pond Street during the year 1932. Number of Sessions held 52 Patients' Attendances 562 Number of Fillings 214 Number of Scalings 14 Extraction cases Total Number of teeth extracted 267 Gas Administrations 67 Local Administrations 16 Without Anæsthetic 1 Number of Dentures (including repairs) 40 Number of Dressings and Root treatment 100 Number for Advice 89 Number of Denture visits 128 Number of New Patients 88 Home Visiting. There are three Health Visitors engaged by the Borough Council for the purpose of supervising the welfare of children up to 5 years of age, and they are responsible for the supervision of some 4,000 children. The present arrangement for the home visiting of babies is as follows :— After the "notification" visit, three visits are paid up to six months. A fourth visit is made at, or just after, one year. After the child reaches one year of age, it is only seen again under most exceptional circumstances, and the vast majority of infants over two years of age are never visited unless there is a new baby, or for some other exceptional reason. The supervision therefore of the toddlers from two years of age to five years is not in every respect satisfactory, but is the best which can be arranged with the present limited and inadequate health visiting staff. These Health Visitors also visit in connection with ophthalmia neonatorum, puerperal fever, puerperal pyrexia and measles. 49 The following table gives a record of the work of the Health Visitors in 1932:— Number of first visits to expectant mothers 139 „ re-visits „ „ 168 „ infants under one year visited for the first time 801 „ re-visits to infants under one year 3146 „ visits to children over one year 3469 „ visits re deaths of infants under two years of age 53 „ „ still births 23 „ „ maternal deaths 3 „ „ infectious diseases 1024 „ attendances at Borough Council's Ante-Natal Clinics 140 „ „ „ „ Dental Clinic 55 „ „ Hampstead Council of Social Welfare Infant Welfare Centres 294 „ complaints investigated 6 „ applicants for assistance visited 119 „ unclassified visits 198 Of the total births 81 per cent, were visited by the Health Visitors, the other 19 per cent, being considered outside the scope of our facilities for sundry reasons, chiefly economic. Approximately 73 per cent, of the infants under one year visited for the first time, attended the Infant Welfare Centres during 1932. The booklet entitled "How to Rear a Baby" is sent by post with a suitably worded letter to those border-line cases in which it is not easy to decide whether or not a visit is desirable. Maternity Beds. (I) New End Hospital. On the 1st October, 1932, a revised agreement between the County Council and the Borough Council in respect of the reception of borough maternity patients into New End Hospital came into force embodying amendments to the following effects:— 50 (A) The condition as to minimum payment of 70 per cent. of the accommodation, whether used or not, each quarter, to be waived. (B) Borough Council cases to the number of five to be given preference for admission to the ward used for the Hampstead Borough Council's cases, provided— (a) that the County Council shall have the right to use unoccupied beds; (b) that the Borough Council's emergency cases of which less than 14 days' notice of admission is given by the Borough Council to the Medical Superintendent shall be given preference for admission to the ward only so far as is practicable, and that they may, if accommodation is not available in the ward, be accommodated elsewhere in the hospital. (C) With regard to the Borough Council's cases which may need more than four weeks' treatment in the hospital from the date of confinement, the Borough Council to have the right to give three days' notice at any time from the 25th day of treatment that it will no longer be responsible for the cost of maintenance of such patients, and, after the expiration of such notice, the patient to be regarded as one for whom the County Council and not the Borough Council is responsible. (D) The rate of payment of 9s. 0d. a day for each occupied bed to be continued. These beds are available for married women only. During the year 59 patients were admitted to this Ward. Of the 59 cases admitted in 1932, 27 were assessed to pay £1 l1s. 6d. weekly; 18 were assessed to pay £2 2s. 0d. weekly; 1 was assessed to pay £2 10s. 0d. weekly; 10 were assessed to pay £2 12s. 6d. weekly; and 3 were assessed to pay £3 3s. 0d. weekly. The patients, who are admitted without the intervention of the Relieving Officer, receive treatment from the Medical Superintendent of the Hospital, and contribute towards the cost of their accommodation according to the assessment of the Sub-Committee of the Maternity and Child Welfare Committee. 51 The following is the scale of charges for a maternity bed in New End Hospital under this Scheme approved by the Borough Council:— Amount of NET income of husband and wife (arrived at after deducting rent, insurances and 10s. 6d. for each child under 14 years of age). Charge per week to the patients. Under £2 weekly Fixed by Committee. £. s. d. £ s. d. £. s. d. Between 2 0 0 and 2 10 0 1 11 6 „ 2 10 0 „ 3 0 0 2 2 0 „ 3 0 0 „ 3 10 0 2 12 6 „ 3 10 0 „ 4 0 0 3 3 0 It was agreed that in those cases where the charge is fixed by the Committee, the minimum amount should be £1 11s. 6d. per week, except in very special cases. The above charges are based on the assumption that applicants will receive one Maternity Benefit under the National Health Insurance, but 10s. 6d. is added to the net weekly income if both husband and wife are eligible for Maternity Benefit, and 10s. 6d. is deducted from the net weekly income if neither husband nor wife is eligible for Maternity Benefit. The scheme is limited to families whose net income, calculated in accordance with the above scale, does not exceed £4 per week. (II) Queen Charlotte's Hospital. The Borough Council subscribes in respect of Hampstead mothers confined in this hospital and receives hospital letters of admission in return. During 1932 the number of Hampstead women for whom such contribution was made was 40. (III) Queen Mary's Maternity Home, Heath Street. This Home is available for the wives of ex-service men. The Council does not make a grant to the Home. During 1932, 57 Hampstead mothers were confined there. Convalescent Homes and Other Institutions. St. Mary's Convalescent Home, Birchington-on-Sea. Up to the 30th September the Borough Council retained one bed in this Home, the applicants being assessed to pay according to their means. From January to September 6 mothers and babies stayed at the Home. 52 The arrangement with this Home terminated on the 30th September and the Council authorised the Maternity and Child Welfare Committee to arrange, as and when required, for accommodation in suitable Homes and upon the most convenient terms, for mothers and babies. During the last three months of the year, 3 mothers and their babies were admitted to various Convalescent Homes. The Hampstead Hostel for Mothers and Babies, 7, Fitzjohn's Avenue, accommodates unmarried mothers with their babies after confinement. This hostel occupies a large house with an extensive garden, and is managed by a voluntary committee. During the year 1932, twenty-five mothers were admitted with their babies. No expectant mothers are admitted and no babies without their mothers. There are 16 beds for mothers in the hostel. The Borough Council does not assist the two latter institutions financially, but the London County Council makes grants under the Local Government Act, 1929. The Foster Home, "Eagle's Nest", 99, Haverstock Hill. This institution, which is organised and controlled by a Voluntary Committee, is housed in a mansion with a large garden, and is doing excellent work. During 1932, twelve babies, and a nursing mother and her baby were admitted. There are 28 beds for "first" babies of unmarried mothers, which are always occupied. On an average, about one-half of the inmates come from Hampstead. The home receives a donation of £200 per annum from the Borough Council, and also a grant from the London County Council under the Local Government Act, 1929. The Cross Roads Club, 88, Alexandra Road. This Club receives unmarried expectant mothers prior to their confinements, and also arranges for their immediate future; in some cases the mothers return to the Home after confinement. The Club is managed by a voluntary Committee and receives a grant from the London County Council under the Local Government Act, 1929. The Children's Hospital (late Northcourt Hospital), College Crescent. The Borough Council has an arrangement with this hospital whereby sick and ailing children, and children needing minor operations such as circumcision, removal of tonsils and adenoids, etc., are admitted. During 1932, four children were thus treated at the Hospital. 53 Beauchamp Lodge. The Council has an arrangement with Beauchamp Lodge Emergency Home for Children, 2, Warwick Crescent, Paddington, for the boarding-out of children under five years of age whose mothers have been admitted into hospitals for their confinements. During 1932 no child from Hampstead families was admitted under this arrangement. Notification of Births Act, 1907. All births, whether of live or still born children, are required to be notified to the Medical Officer of Health within 36 hours. The following statement shows the source of information, etc., of the births occurring in Hampstead and notified during the year:— Notified within 36 hours. Notified after 36 hours. Total Notified. Live Births. Still Births. Live Births. Still Births. Live Births. Still Births. Notified by midwives 660 9 7 1 667 10 „ parents 31 1 18 — 49 1 „ doctors 437 15 3 2 440 17 „ nurses and others 318 11 7 — 325 11 1446 36 35 3 1481 39 The total number of Hampstead live births registered during 1932 was 981, and they took place as follows:— Queen Mary's Maternity Home 57 or 6 per cent. Nursing Homes 143 „ 15 „ Hospitals 378 „ 38 „ Usual place of residence 376 „ 38 „ Other addresses 27 „ 3 „ 59 per cent, of the net live births took place in Homes and Hospitals. Information has been recorded, wherever possible, of the housing conditions of families in which a birth occurred at home. The following table shows an analysis of 266 instances where these births were visited, and where the information was obtainable:— 54 No. of persons in family. No. of families occupying the following number of rooms. 1 room. 2 rooms. 3 rooms. 4 rooms. 5 rooms. 6 rooms. 7 rooms. 8 rooms. 9 rooms. 1 1 - - - - - - - - 2 11 42 31 3 — - - - - 3 3 31 27 9 4 - - - - 4 3 20 22 10 2 - - - - 5 — 8 10 2 - - - - - 6 1 2 8 4 1 - - 1 - 7 - 2 2 1 1 - - - - 8 — 1 2 - - - - - - 9 - - - - 1 - - - - Totals 19 106 102 29 9 - - 1 - The newly-born baby has not been included in the above. Of these 266 births:— 7.0 per cent, occurred in 1-roomed tenements. 39.8 „ „ 2 „ 38.3 „ „ 3 „ The table shows the limited housing conditions in some of the tenements where babies are born at home. It demonstrates that of 266 babies, 19 were born in one-roomed tenements and 106 in tworoomed tenements. In each of 3 one-roomed tenements where 4 persons were already living a baby was born, and in 1 one-roomed tenement 6 persons were already living. With regard to two-roomed homes, in 8 instances 5 persons were already inhabiting the rooms prior to the birth of the baby; in 2 cases the baby's advent raised the number of occupants to 7, in 2 cases to 8, and in 1 instance to 9. In 2 three-roomed tenements there were 7 persons occupying the rooms before the birth and in 2 cases there were 8. Still Births. Under the Births and Deaths Registration Act of 1926, the registration of still-births became compulsory as from 1st July, 1927. During 1932 the number of Hampstead still-births registered was 26, of these 18 were registered upon a doctor's certificate, 7 upon a 55 midwife's certificate, and 1 upon a Coroner's certificate. Of these, 22 were notified under the Notification of Births Act, 1907. The number of still-births is approximately 2.6 per cent, of the total births. Of the 26 still-births, 6 of the mothers had attended at the Borough Ante-Natal Clinics. Puerperal Fever, Etc. Puerperal Fever and Puerperal Pyrexia. During the year no case of fever but 11 cases of pyrexia were notified under the Regulations of 1926 and 1928. Of these 10 were notified from institutions and received treatment there. The North Western Fever Hospital at Lawn Road has special accommodation for the treatment of these cases. No application was received during the year from any general practitioner for either specialist medical opinion or for bacteriological reports, both of which facilities are available under the Borough Scheme. Ophthalmia Neonatorum. There were 6 notifications received during 1932. Arrangements are made with the two local Nursing Associations for home treatment of this condition, whilst hospital treatment, if necessary, is available at St. Margaret's (L.C.C.) Hospital, N.W.5. Total cases notified by medical practitioners 6 Number treated in Hospital 5 „ a maternity home 1 Vision unimpaired 6 „ impaired — Total Blindness — Number of Deaths — Epidemic Diarrhæa. This disease is not notifiable in this Borough and owing to the modern sanitation is now fortunately but rarely encountered. There was no death registered as due to this disease during the year. School Entrants. In order that all information available both from your Health Visitors and the doctors at the Welfare Centres may be made available for the County School Medical Officer of Health, it is arranged 56 that all records relating to the health of these children are entered on special cards supplied by the London County Council for that purpose which are forwarded to the School Medical Officer. Through the kindness of the Medical Officer of Health and School Medical Officer of the London County Council, I am enabled to submit the following highly interesting table, showing the result of routine examination of 608 elementary school entrants in Hampstead during 1932. It will be noted that in 98.5 per cent, of the cases the "clothing and boots" of the Hampstead children were "good," as compared with 57.7 per cent, for London. The examination in relation to the state of "nutrition" revealed the fact that 23.5 per cent, of the Hampstead children were classified as "good," the corresponding figure for London being 22.0 per cent. This shows an improvement on the figure for 1931, when only 18.1 per cent, of the Hampstead children were so classified, against 21.5 per cent, for London. 73.4 per cent, of the Hampstead children were "average" and 3.1 per cent, "below normal" as against 73.5 per cent, and 4.5 per cent, for London. For "cleanliness of the head and body" the Hampstead children were 100 per cent., but with regard to "teeth" 49.4 per cent, only were all sound, as against 55.2 per cent, for the whole of London, and 45.6 per cent, were recommended for treatment as against 41.2 per cent, for London. The Chief Medical Officer of the Board of Education in his annual report for 1931 discusses the problem of high incidence of disease in the child below school age and states:— "Details are given of a special survey of 3,000 children taken as a picture of the condition of children at pre-school ages throughout the country. The basic fact is that approximately 27 per cent, had physical or mental defects, or suffered from some definite impairment of health, and even these figures do not include minor degrees of dental and visual defects. The data provided by this survey confirm the experience of every school doctor. It is the physical impairment of the pre-school child that mainly creates the problem of disease in school life." This again emphasises the necessity for further provision in Hampstead for the pre-school child by way of Toddlers' Clinics. 57 Table showing Results of Routine Medical Inspection of Entrant Children in Hampstead to Elementary Schools during the year 1932, indicating the conditions with regard to Clothing, Nutrition, Cleanliness and Teeth of the Children examined. Number who were examined. Clothing and Boots. Nutrition. Cleanliness of Head. Cleanliness of Body. Teeth. Good. Fair. Poor. Good. Average. Below normal Bad. Clean. Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than 4 decayed. 4 or more decayed. No. rec. for treat ment Entrants: Boys 306 304 2 - 61 236 9 - 306 - - 306 - - 146 104 56 142 Girls 302 295 7 - 82 210 10 - 302 - - 302 - - 154 103 45 135 Total 608 599 9 - 143 446 19 - 608 - - 608 - - 300 207 101 277 Hampstead per centages 98·5 1·5 - 23·5 73·4 3·1 - 100·0 - - 100·0 - - 49·4 34·0 16·6 45·6 London per centages 57·7 41·5 0·8 22·0 73·5 4·5 - 95·9 3·6 0·5 97·2 2·7 0·1 55·2 32·7 12·1 41·2 58 Table showing Results of Routine Medical Inspection of Entrant Children in Hampstead to Elementary Schools during the year 1932, indicating the Defects found. f = defects found. o = noted for treatment and included in defects found. Disease or Defect. Boys (306). Girls (302). Hampstead. per cent. London. per cent. Hampstead. per cent. London. per cent. Skin disease f - - 1·3 1 0·3 1·1 o — — 0·8 — — 0·6 Tonsils only f 49 16·0 16·1 68 22·5 15·9 o 21 6·9 6·1 31 10·3 6·0 Adenoids only f 1 0·3 1·3 1 0·3 0·9 o 1 0·3 0·7 — — 0·5 Tonsils and Adenoids f 4 1·8 3·4 5 1·7 2·9 o 4 1·8 2·6 5 1·7 2·2 Other Nose and Throat f 2 0·6 1·2 — — 1·2 o — — 0·4 — — 0·4 Glands of Neck f 2 0·6 2·8 1 0·3 2·3 o — — 0·4 — — 0·3 Eye disease f 11 3·6 3·4 4 1·3 3·2 o 8 2·6 2·2 3 1·0 2·1 Otorrhæa f — — 1·1 3 1·0 1·1 o — — 0·7 2 0·7 0·6 Other Ear Defects f — — 0·4 — — 0·4 o — — 0·2 — - 0·2 Hearing f 2 0·6 0·2 — — 0·2 o — — 0·1 — — 0·1 Speech f — — 0·3 — — 0·2 o — — 0·1 — — 0·0 Heart f 1 0·3 1·7 — — 1·7 o — — 0·1 — — 0·1 Anæmia f 4 1·3 1·4 2 0·7 1·0 o — — 0·5 — — 0·4 Lungs f 7 2·3 4·1 1 0·3 3·5 o — — 1·3 — — 1·1 Epilepsy f — — 0·0 — — 0·0 o — — o·0 — — 0·0 Chorea f — — 0·0 — — 0·0 o — — 0·0 — — 0·0 Paralysis f — — 0·1 — — 0·0 o — — 0·0 — — 0·0 Other Nervous Disorders f 1 0·3 0·4 — — 0·4 o — — 0·1 — — 0·1 Pulmonary T.B. f — — 0·0 — — 0·0 o — — 0·0 — — 0·0 Other T.B. f — — 0·0 — — o·o o — — 0·0 — — 0·0 Rickets f 2 0·6 0·9 — — 0·4 o — — 0·l — — 0·1 Spinal Deformities f — — 0·2 1 0·3 0·1 o — — 0·1 1 0·3 0·1 Other Deformities f 1 0·3 0·9 3 1·0 0·7 o — - 0·3 — 0·2 Other Defects f 2 0·6 2·5 2 0·7 2·5 o 1 0·3 1·3 1 0·3 1·4 59 Provision of Midwives. The Borough Council has a scheme whereby the local district Nursing Associations provide for their nurses to attend confinements. During 1932, the midwives of the Kilburn and West Hampstead District Nursing Association attended 148 cases, whilst those of the Hampstead District Nursing Association attended 49 cases. Of the 197 cases, 84 were attended in the company of a medical practitioner. Patients are charged by the Associations according to their means; in very poor cases no charge is made. Accouchement Outfits. The Council resolved on 30th April, 1931, to obtain a supply of Accouchements Outfits, and to distribute such outfits to the patients through the midwives or maternity nurses, who were asked to notify their patients when booking for confinements that application for such outfits should be made to the Medical Officer of Health at the Town Hall. During the year the Council resolved not to purchase a further supply of outfits as the whole of the first consignment had been supplied to persons referred to the Council by the District Nursing Associations, and requested the Nursing Associations to make their own arrangements for the future supply of the outfits to their patients. Infantile Mortality. The infantile mortality rate for the Borough of Hampstead for the year 1932 was 54. This compares with 61 for the previous year and 54.6 for the 10 years ended 1931. I have calculated the infantile mortality rates for the Borough and for each Ward for the ten years ended 1931, and set them out below together with the Live Birth and General Death rates. Ward. Infantile Mortality Rate. Live Birth Rate. General Death Rate. No. 1 (Town) 52·1 10·7 10·9 No. 2 (Belsize) 47·8 10·5 11·0 No. 3 (Adelaide) 45·5 11·1 10·7 No. 4 (Central) 46·1 8·3 11·4 No. 5 (West End) 50·1 13·6 11·2 No. 6 (Kilburn) 61·5 17·6 12·3 No. 7 (Priory) 68·3 13·4 11·7 The Borough 54·6 12·4 11·4 60 From the accompanying diagram the infantile mortality rate for Hampstead is shown. The neo-natal mortality (i.e., the children dying under the age of 1 month) has not, unfortunately, markedly decreased in recent years. In Britain, at any rate, the success in reducing infant mortality has been achieved by a combination of factors, chief among which are:— 1. The gradual and continued improvement of sanitary conditions as a whole, and housing in particular. 2. The increased capabilities of young mothers consequent on the introduction of compulsory free education. 3. The work done, both directly and indirectly, throughout the country by the various maternity and child welfare organisations. 4. The improvement of the food supplies (milk especially) available to the working classes owing to increased legal powers of supervision. If the causes of death in infants under 1 year be tabulated, it is found that most of them can properly be placed in one or another of the following three groups, viz. :— (a) Respiratory diseases, e.g., bronchitis and broncho-puenmonia. (b) Gastro-intestinal diseases, e.g., infantile diarrhœa and enteritis. (c) Developmental conditions. But what is of the greatest significance is that, whilst the number of deaths from both respiratory and gastro-intestinal diseases has diminished progressively year by year, those of the third group have shown but little decrease. It would appear, as is in fact the case, that those factors enumerated above, which have been so potent in causing a reduction of the infantile death rate as a whole, have made no marked impression on deaths from developmental conditions. If these infantile deaths be analysed further, it will be found that well over 90 per cent, of the deaths from developmental conditions occurred during the first month of life. In short then, the problem which is confronting us to-day, in order to reduce the infantile mortality rate still further, is to remove if possible those factors which are causing the deaths of infants in the first month of life and which CHART SHEWING THE INFANT MORTALITY PER 1000 BIRTHS IN HAMPSTEAD The Infant Death Rate per 1000 births for the Borough is represented by the chimneys, the lined portion of which shews the death rate amongst newly-born babies (i.e. under 1 month old). The Infant Death Rate for England and Wales is represented by the line. 61 are for the most part developmental conditions. This group of infantile deaths occurring in the first month of life is generally referred to as the neo-natal mortality. It follows therefore that the chief means by which a reduction may be made in the number of neo-natal deaths is by careful and expert ante-natal care, for the cause of the death of the infant in the large proportion of cases is due to a maternal defect which could, and should, have been remedied during pregnancy. Apart from certain conditions, we must look for help from the midwife, who, by careful ante-natal examination and reference of all abnormal cases for expert guidance, is able to play a vital part in reducing infant wastage. The ideal would be for every expectant mother to be under regular observation by her midwife and to be examined at least twice during the course of her pregnancy by her medical attendant. The initial inspection by her doctor should be made early in pregnancy and should be directed to her general physical condition, whilst the later examination should be essentially obstetrical. Only too often does ante-natal care consist solely of urine testing. This is strongly to be deprecated, as it is totally inadequate and is apt to give the pregnant mother a false sense of security, and moreover is likely to bring discredit on both the attendant midwife and the ante-natal service in general. Maternal Mortality and Morbidity. The number of women dying in, or in consequence of, child birth during 1932 was 3. This represents a maternal mortality rate of 2.98, as compared with 1.9 and 5.7 for the preceding two years. During the year the Departmental Committee issued their Final Report. The subject of Maternal Mortality and Morbidity is one of paramount national importance and worthy of careful study by all Maternity and Child Welfare authorities. On considering the position as it affects the Borough of Hampstead, I find that my predecessor, Dr. Scrase, reported fully on the matter in his Annual Report for 1930, that being his last Survey Report. From that Report it appears that during the 10 years 1921-1930, the rate of maternal deaths in Hampstead was 4.2 per 1,000 births, an increase compared with the rate for the 10 years 1901-1910 which was only 3.1. The maternal mortality rate in 1930 was as high as 5.7. In 1931 the rate dropped to 1.9, but for the year 1932 the rate has increased to 2.98. 62 The Conclusions and Recommendations of the Departmental Committee's Report are comprehensive and relate, of course, to the country as a whole. The conclusions fall into two categories, (1) Clinical and (II) Administrative, and important among the Recommendations are the two following statements:— "Every pregnant woman should have a routine medical examination by a doctor during the early months of pregnancy. More hospital accommodation should be provided for the treatment of cases of heart disease, tuberculosis and nephritis associated with pregnancy. Where it appears that further child-birth will endanger life, medical advice should be given as to the prevention of pregnancy. More vigorous efforts should be made to apply effectively and widely the new knowledge now available for the prevention of rickets,"and, "The Committee desire to see confidential inquiries into the circumstances of maternal deaths continued by the Public Health Authorities, but deprecate the institution of a system of inquiry by a Coroner into every maternal death as a matter of routine." It is interesting to note that the Committee state that they are "convinced that the primary essential for the reduction of a high maternal mortality is sound midwifery, before, during and after child-birth,"and that "this does not chiefly depend upon administrative arrangements or the expenditure of public money."The Report also states:— "False hopes would be raised if it were suggested that all maternal deaths are preventable. Changes in social life necessary to raise the standard of health and physical development of the women of the nation can come only with time; great advances in medical knowledge must be made before many of the risks of child-birth can be eliminated; even then the factor of human fallibility will remain. Nevertheless, we are confirmed in the opinion expressed in our Interim Report that at least half the deaths which have come under review could have been prevented had due forethought been exercised by the expectant mother and her attendant, a reasonable degree of skill been brought to bear upon the management of the case, and adequate facilities for treatment been provided and utilised." 63 Medical Investigation Sub-Committee. The work of this Committee is proving of great value. It consists of the medical members of the Council (E. Collingwood Andrews, Esq., M.A., M.D., S. Boyd, Esq., M.S., F.R.C.S., S. Monckton Copeman, Esq., M.D., F.R.S., F.R.C.S., L. G. Glover, Esq., M.A., M.D.), who investigate in detail all deaths of Infants under 2 years of age, Still Births, Puerperal Fever and Pyrexia, and Maternal Deaths. The Medical Officer of Health has previously ascertained all particulars relating to each case from the Health Visitors, General Practitioners, and Hospital Medical Officers concerned. All the information obtained is treated in a confidential manner, and as a result of the investigations either adjustments of the existing administrative procedure, or other measures are undertaken which are calculated to prevent a recurrence of the conditions ascertained to be the cause of the fatality. During the year the Committee investigated:— Deaths of Infants under 2 years 63 Still Births 26 Puerperal Fever — Puerperal Pyrexia 11 Maternal Deaths 2 Total 102 During the course of the investigation the following facts emerged, which are of interest. Of the deaths under 2 years of age, 74 per cent. occurred in institutions, and of the 30 deaths occurring during the first month, 70 per cent. of the mothers had not attended an ante-natal clinic, whilst of the 19 deaths between 2 months and one year, 53 per cent. had never attended an infant welfare centre. Of the 26 still births, 77 per cent. of the mothers had not attended the ante-natal clinics, whilst not one of the Maternal Deaths had attended the ante-natal clinics. There were 16 deaths of illegitimate children under 2 years of age, which represents a Mortality Rate of 89 per 1,000 illegitimate births as compared with 26 for legitimate children. Consulting Obstetricians. The Council has inaugurated a scheme whereby the services of obstetricians of consultant status are available to all medical practi- 64 tioners in cases of difficulty or abnormality occurring among Hampstead mothers. The following are the consultants:— *Miss Margaret Basden, M.D., F.R.C.S., 114, Harley Street, W.l, and 26, Thurlow Road, Hampstead, N.W.3. Arthur O. Gray, M.D., F.R.C.S., 18, Harley Street, W.l. *C. S. Lane-Roberts, M.S., F.R.C.S., 64, Harley Street, W.l, and 17, Sussex Place, N.W.1. L. C. Rivett, M.C., F.R.C.S., 118, Harley Street, W.l, and 3, Hanover Terrace, Regent's Park, N.W.1. *Appointed to undertake special investigations into Maternal Mortality in pursuance of Circular No. 934, dated 24th October, 1928, of the Ministry of Health. The Borough Council is responsible to the Consulting Obstetrician for a fee of £5 5s. per case. The scheme is intended to apply to those people who cannot afford a Consultant's ordinary fee, and is not to be confused with the London County Council's scheme, whereby a midwife can summon a general practitioner to her aid. The Borough Council reserves to itself the right to ask the patient to contribute a portion, or the whole, of the fee. The following is a list, approved by the Council, of contributions to be paid by patients:— Amount of net income of husband and wife, which is arrived at after deducting rent, insurances and 10s. 6d. for each child. Charge to Applicant in respect of services of Consulting Obstetricians. Under £2 weekly No charge. £ s. d. £ s. d. £ s. d. Between 2 0 0 and 2 10 0 1 1 0 2 10 0 „ 3 0 0 2 2 0 3 0 0 „ 3 10 0 3 3 0 3 10 0 „ 4 0 0 4 4 0 4 0 0 „ over 5 5 0 During the year Consultants were called in to two cases. One case was a miscarriage complicated by Influenzal Pneumonia and the patient subsequently died (found later to be a "resident"of another Borough). One case was difficult confinement; child still-born; mother subsequently died. Arrangements for the supply of Food and Milk. The number of families assisted, either with milk free, or at half cost, or with milk and food free, varies during the year from 65 90 in September to 150 in January. During the year the percentage of unemployed applicants for milk for their wives and children has varied, the lowest being 64 per cent. in August, and the highest 74 per cent. in December. The number of expectant and nursing mothers to whom milk las been supplied varied from time to time during the year, the Ijwest number being 37, and the highest 66. The number of children to whom milk has been supplied varied from 70 to 112. One expectant and two nursing mothers were supplied with food during the year. Since November, 1932, the Maternity and Child Welfare Committee have in suitable cases, and upon the special recommendation of the doctors attending the Welfare Centres, granted a free supply of Cod Liver Oil. The extra cost involved per annum is estimated as only £6, and Cod Liver Oil is recognised as one of the richest sources of Vitamins A and D, whose functions are an anti-infective and pyorrhoea-preventing action in the growth-promoting Vitamin A, and a tooth calcifying (probably caries-preventing) action in the antirachitic Vitamin D. Scale of Income (after deduction of rent). Number of persons in family. FREE. assisted (half-price) milk. Scale per head. Scale per family. Scale per head. Scale per family. l S. d. £ s. d. S. d. £ s. d. 13 0 0 13 0 15 0 0 15 0 2 10 6 1 1 0 12 6 1 5 0 3 8 6 1 5 6 10 0 1 10 0 4 7 6 1 10 0 8 6 1 14 0 5 7 0 1 15 0 8 0 2 0 0 6 6 6 1 19 0 7 6 2 5 0 7 6 6 2 5 6 7 6 2 12 6 8 6 6 2 12 0 7 6 3 0 0 9 6 6 2 18 6 7 6 3 7 6 10 6 6 3 5 0 7 6 3 15 0 11 6 6 3 11 6 7 6 4 2 6 12 6 6 3 18 0 7 6 4 10 0 66 The free assistance given is one pint of milk daily to expectant or nursing mothers, and children up to three years of age. Between three and five years of age assistance can be given on production of a special medical certificate. When special application is made, either 2 lb. quaker oats and ½ lb. cocoa weekly, or 1 tin of Ovaltine a fortnight is given to expectant or nursing mothers. When specially ordered Dried Milk is given for infants, in lieu of cow's milk. In "assisted "cases no food is given, but milk is granted at half price. There is no doubt that many of the families who apply for help are forced to do so on account of the unduly large percentage of their income which is spent in rent, due to the high rentals charged for rooms in the working class districts of the Borough. If these workers could find accommodation at reasonable cost, many cases would cease to receive assistance under this heading. Brondesbury and Kilburn Day Nursery. This creche, which is doing excellent work, is accommodated at 36, Hemstal Road, Kilburn, in a large spacious house and is controlled by a Voluntary Committee. There are 36 places in the Nursery, 26 of which are for children aged from 2-5 years, and 10 for babies under 2 years. The total number of attendances during 1932 was 5,589. Hampstead and North St. Pancras Day Nursery. This creche occupies commodious premises at 27 and 29, Pond Street. A few years ago the premises were re-built, and by an arrangement with the Voluntary Committee which manages the creche, the Borough Council rents a portion of the premises for the purpose of an ante-natal clinic and dental clinic for mothers and children. There are 50 places in the Nursery for children under 5 years of age. The total number of attendances during 1932 was 9,207. Invalid Children's Aid Association. The Hampstead Branch of this Association meets at 51, Howitt Road, and valuable help is given to boys up to 14 years of age and girls up to 16, by the way of convalescence in the country or at the 67 seaside; by the provision of surgical appliances, extra nourishment (e.g., milk or cod liver oil and malt), etc. The Local Secretary is Miss Harrison. Widows', Orphans', etc., Act, 1925. The Widows', Orphans', and Old Age Contributory Pensions Act, 1925, provides that, in certain circumstances (e.g., desertion or abandonment of a child) and in respect of an orphan's pension, the Minister of Health may direct that the money shall be paid to the Local Authority for the benefit of the child. In London the County Council is the Local Authority, but the Borough Council has agreed to carry out the powers and duties of the County Council. During 1932 no cases were referred to the Borough Council. Section 4. Sanitary Circumstances of the Borough. 71 Sanitary Circumstances of the Borough. Sanitary Inspection. The following statements contain particulars required to be submitted under Article 19 (15) of the Sanitary Officers Order, 1926, and affords some indication of the work performed by the Sanitary Inspectors. These Inspectors attend at the Offices of the Department from 9 to 10.30 a.m. for the purpose of being interviewed by builders and others, and for keeping their Official Diaries and Records, etc. Total number of Inspections of all kinds during the year, 4,035. Re-inspections, other visits and re-visits, 12,863. Total number of dwelling-houses inspected for housing defects, 1,102. Total number found not in all respects reasonably fit for human habitation, 661. The inspections were occasioned by various causes, e.g., 714 complaints received; special inspections, registration and inspection of Tenement Houses; examinations after occurrence of infectious disease; sanitary work, voluntary or otherwise, in progress. The total number of Notices served during the year was as follows:— (1) Informal {i.e., intimations), 1,039; (2) Statutory, 497. Statement showing number of premises inspected, etc., by the Sanitary Inspectors during 1932:— Nature of Duties. Totals. Summary of Visits of all kinds to all premises:— (a) Total number of inspections 4035 (b) Total number of re-inspections and other visits and re-visits 12863 Dwelling-houses, whether Registered Tenement Houses or not, inspected for housing defects under the Public Health or Housing Acts :— (a) After infectious disease 155 (b) For purposes of registration of tenement houses.. 5 (c) For purposes of annual complete inspection of registered tenement houses 701 (d) After any complaint that necessitates a complete inspection of a house 178 (c) In connection with any Special Inquiry 68 (f) Complete house inspections for Rent Restrictions Acts Certificates 5 Investigation of Complaints, Inspection of Factories, Workshops and Workplaces, etc.:— (a) No. of Factories (excluding bakehouses) inspected 150 (b) No. of Workshops (excluding bakehouses) inspected 324 (c) No. of Workplaces inspected 955 (d) No. of bakehouses, milkshops and other food premises inspected 1087 (e) No. of applications and plans re sanitary work rceeived 721 (f) No. of Complaints investigated 714 Note.—The Senior of the Inspectors is the Sampling Officer under the Food and Drugs (Adulteration) Act, 1928. 72 Work, etc., supervised or action taken by the Sanitary Inspectors, whether under notice or voluntary, at premises not registered as Tenement Houses:— Overcrowding. Totals. Number of rooms found overcrowded 2 Cases abated (rooms) after service of notice 2 Cases abated (rooms) without service of notice — Underground sleeping rooms. Illegally occupied—found, or brought to the Inspectors' notice 33 Closed, or illegal occupation discontinued 19 Made to conform 8 Verminous conditions. Rooms disinfested 20 Number of houses concerned 12 Beds and bedding disinfested — Floors of rooms cleansed 12 Animals. Nuisances from improper keeping in rooms abated 2 Nuisances from improper keeping on the premises abated 2 Smoke nuisances. CoflTplaints received 2 Observations made 5 Notices served 1 Drainage systems, &c. Drainage systems repaired or renewed, partly or wholly 428 Plumbing defects remedied (soil pipes, waste pipes, &c.) 686 Roofs, rainwater pipes and gutters repaired or renewed 260 Water supply. Water supply provided to separate lettings 272 Number of houses concerned 173 Sinks provided to separate lettings 284 Number of houses concerned 173 Water cisterns cleansed or covered 21 Water-Closets. Additional provided 156 Removed from improper position 20 Flushing cisterns repaired 66 Yards, &c., Paving, &c. Yards or open spaces newly paved and drained or repaired 167 Bathrooms. New provided 213 Dust Bins. Repaired or renewed 172 Work, etc., supervised or action taken by the Sanitary Inspectors, whether under notice or voluntary, at Registered Tenement Houses:- Overcrowding. Totals Number of rooms found overcrowded 8 Cases abated (rooms) after service of notice 6 Cases abated (rooms) without service of notice — Underground sleeping rooms. Illegally occupied—found, or brought to the Inspectors' notice 11 Closed or illegal occupation discontinued 8 Made to conform 2 Verminous conditions. Rooms disinfested 48 Number of houses concerned 25 Beds and bedding disinfested 8 Floors of rooms cleansed 35 Animals. Nuisances from improper keeping in rooms abated — Nuisances from improper keeping on the premises abated 3 73 Drainage systems, &c. Totals. Drainage systems repaired or renewed, partly or wholly 31 Plumbing defects remedied (soil pipes, waste pipes, &c.) 82 Roofs, rainwater pipes and gutters repaired or renewed 180 Water supply. Water snpply provided to tenements 71 Number of houses concerned 53 Sinks provided to tenements 77 Number of houses concerned 57 Water cisterns cleansed or covered 16 Water-Closets. Additional provided 1 Removed from improper position 4 Flushing cisterns repaired 57 Yards, &c., Paving, &c. Yards or open spaces newly paved and drained or repaired 66 Bathrooms. New provided 2 Dust Bins. Repaired or renewed 78 Miscellaneous. Window cords repaired or renewed 149 Window fittings repaired or renewed 56 Filth and refuse removed from rooms 12 Washing (of clothes) accommodation provided - Coppers repaired or renewed 7 Suitably ventilated food cupboards provided 2 Kitchen ranges repaired or renewed 36 Common staircases repaired 43 Common staircases provided with adequate means of natural light — Common staircases provided with adequate means of artificial light House-! or parts cleansed (excluding verminous rooms) 344 Number of rooms concerned 1026 Dampness in houses or parts abated 90 Dilapidated houses or parts repaired 220 Houses Let in Lodgings. Reference to action taken with regard to these premises will be found in Section 5. Businesses of Rag and Bone Dealers. There is only one place in the Borough where the business of a dealer in Rags, etc., is carried on. Increase of Rent and Mortgage Interest (Restrictions) Acts. Number of certificates applied for 7 „ „ issued 7 Factory and Workshop Act, 1901. Section 132 of the Act of 1901 requires every Medical Officer of Health in his Annual Report specially to report on the administration of the Act, and tabulated statements were framed by the Home Secretary with a view to such reports being made upon uniform lines. It is the duty of the Borough Council to keep a Register of all Workshops situated within their district. 74 Inspection of Factories, Workshops, and Workplaces, including Inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories (Including Factory laundries) 150 7 - Workshops (Including Workshop Laundries) 324 40 - Workplaces (Other than Outworkers' premises) 955 91 - Totals 1,429 138 - These premises are supervised by Mr. F. H. Hudson, the Senior of the Inspectors, and by Inspector Miss Reymond— the former inspecting premises where men are employed and the latter those where women and girls are working. In some cases, owing to the introduction of machinery, former "workshops"have become "factories."In certain instances they are automatically converted, at a very small cost, by the installation of a small electric motor. When such premises become "factories " the health conditions pass under the supervision of H.M. Inspector of Factories except so far as sanitary accommodation is concerned. 75 Defects found in Factories, Workshops, and Workplaces. Particulars. Number of Defects. Number of offences in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health (London) Act, 1891*:— Want of cleanliness 73 73 - - Want of ventilation 2 2 - - Overcrowding 3 3 - - Want of drainage of floors — — _ - Other nuisances 103 103 - - Sanitary accommodation insufficient - unsuitable or defective 53 53 not separate for sexes 18 18 — - Offences under the Factory and Workshop Act, 1901:— Illegal occupation of underground bakehouse (s.101) Other offences — — - - (Excluding offences relating to outwork, and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops, Transfer of Powers) Order, 1921.) Totals 252 252 - - * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health (London) Act, 1891. Home Work (Outworkers). Certain classes of work done at the homes of workers are controlled by the Factory and Workshop Act, 1901. The object of this supervision is to prevent work being done in insanitary dwellings, or in premises where there is dangerous infectious disease. Every occupier of a place from which home work is given out, and contractors employed by them, are required to keep lists of their home workers, and to send to the local authority on or before 1st February and 1st August in each year copies of such lists. Upon receipt of these, the names and addresses of those workers who reside in other districts are forwarded to the Medical Officers of Health concerned. 76 *NATURE OF WORK. 1 Outworkers Lists, Section 107. Lists received from Employers. Sending Twice in the year. † Sending Once in the year. Outworkers Outworkers Lists 2 Contractors Workmen. Lists 5 Contractors. Workmen. (1) Wearing apparel- fa) making, &c 40 94 38 4 5 2 (6) cleaning- and washing 8 12 2 2 2 — (2) Making- up, ornamenting, finishing and re- pairing of table linen, bed linen, or other household linen (including in the term linen articles of cotton or cotton and linen mixtures), and any process incidental thereto 1 1 — — — — (3) Making, ornamenting, mending, and finishing of lace and of lace curtains and nets — — — — — — (4) Making of curtains and furniture hangings, and any process incidental thereto 4 2 6 — — — (5) Cabinet and furniture making and upholstery work 2 3 2 — — — (6) Making of electro-plate — — — — — — (7) Making of files — — — — - — (8) Manufacture of brass and of any articles or parts of articles of brass (including in the term brass any alloy or compound of copper with zinc or tin)— — — — — — (9) Fur-pulling — — — — — — (10) Making of iron and steel cables and chains — — — — — — (11) Making of iron and steel anchors and grapnels — — — — — — (12) Making of cart gear, including swivels, rings. loops, gear-buckles, mullin bits, hooks, and attachments of all kinds — — — — — — (13) Making of locks, latches, and keys — — — — — — (14) Making or repairing of umbrellas, sunshades, parasols, or parts thereof 2 4 — — — — (15) Making of artificial flowers — — — — — — (16) Making of nets other than wire nets — — — — — — (17) Making of tents — — — — — — (18) Making or repairing of sacks — — — — — — (19) Covering of racquet or tennis balls — — — — — — (20)Making of paper bags — — — — — — (21) Making of boxes or other receptacles or parts thereof made wholly or partially of paper, cardboard, chip, or similar material 1 — 2 — — — (22) Making of brushes — — — — — — (23) Pea picking — — — — — — (24) Feather sorting — — — — — — (25) Carding, boxing, or packeting of buttons, hooks and eyes, pins, and hair pins — — — — — — (26) Making of stuffed toys — — — — — — (27) Making of baskets — — — — — — (28) Manufacture of chocolate or sweetmeats — — — — — — (29) The making or filling of cosaques, Christmas crackers, Christmas stockings, or similar articles or parts thereof — — — — — — (30) The weaving of any textile fabric — — — — — — (31) Making of lampshades other than those made wholly of metal or glass or stone — — — — — — Total 9 116 1 50 6 7 2 Notices served on occupiers as to keeping or sending lists of Outworkers, Nil; Prosecutions in relation to Outworkers' Lists, 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 th3 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. 66 lists were received twice in the year. The names of Outworkers that were repeated in the duplicated Returns have not been counted twice. 77 There are 34 outworkers' premises in Hampstead: of these— 2 are factories. 8 are workshops. 4 are workplaces. 20 are single workers. 34 Outwork in Unwholesome Premises. Section 108. In no instance during 1932 was outwork found to be carried on in unwholesome premises. Factories. The following is a list of the different classes of Factories in Hampstead:— Factories. The following is a list of the different classes of Factories Hampstead :— > in Bakers 27 Dairymen 2 Bootmakers 19 Launderers 2 Butchers 4 Motor and other engineers 33 Cabinet makers and Up- Opticians 2 holsterers 8 Printers 4 Carpet beaters 2 Other trades 24 Coffee roasters 5 132 Workshops. At the end of 1932, there were 347 workshops on the Register, including 33 domestic workshops. During the year, 324 inspections were made and 40 notices served. The chief occupations in males were bootmakers, tailors, upholsterers and cabinet makers, builders and carpenters; and for females, dressmakers, outfitters and costumiers, wigmakers and tailors. In order to prevent overcrowding, the Factory and Workshop Act requires a notice to be affixed in every factory and workshop specifying the number of persons who may be employed in each room. Special Notice Cards provided by the Council indicate the cubic capacity of the room and the number of persons who may be employed therein. The number of workrooms measured and Notice Cards provided in 1932 was 14. 78 Employment of Protected Persons in Workshops. The Medical Officer of Health is required to notify H.M. Inspector of Factories of cases in which any child, young person, or women is employed; and the Factory and Workshop Act, 1901, also provides that where any woman, young person, or child is employed in a workshop in which no Abstract of that Act is affixed, and the Medical Officer of Health of the district becomes aware thereof, he shall give notice to H.M. Inspector. This prescribed Abstract must be prominently exhibited in the workshop so as to give to the employees information concerning the protection afforded to them by the law. During the year 23 cases were reported to the Factory Inspector. Rats and Mice (Destruction) Act, 1919. During "Rat Week,"i.e., the first week in November, more general tactics are adopted by way of laying poisons in certain places, particularly the sewers. The Borough Council issues an advisory leaflet on the eradication of rats and mice, and rat poisons may be purchased from the Public Health Department. Upon request, the Council sends an employee, who lays poison baits at infested premises on three separate occasions, for a nominal fee. Dog Nuisance. The Borough Council has made a bye-law, as follows:— "No person being in charge of a dog in any street or public place, and having the dog on the lead, shall allow or permit such dog to deposit its excrement upon the public footway. Any person offending against this bye-law shall be liable to a penalty not exceeding Forty Shillings." Warning Posters are, from time to time, exhibited in the Borough. Legal Proceedings. The following is a list of the summary proceedings taken by the Department during 1932:— Date of Hearing. Nature of Offence. Result of Hearing. 15th Jan. Nuisance Order made to abate in 28 days, and pay 21s. costs. 26th Feb. Unlawfully continuing to let under- Fined £9. ground room Costs £1 1s. 0d. 26th Feb. Ditto ditto. Fined £1. 6th April Selling margarine containing 10.5 per Warranty proved. cent. water. Summons dismissed. 79 Date of Hearing. Nature of Offence. Result of Hearing. 6th April Nuisance Work done. £1 11s. 6d. paid for costs, and summons withdrawn. 18th May False warranty on sale of butter Dismissed under Probation of Offenders Act on payment of £10 10s. 0d. costs. 3rd June Selling butter containing 16.4 per cent. Warranty proved. water. Summons dismissed. 15th June Contravention of Tenement House Bye- Work done. laws. £2 2s. 0d. costs paid and summons withdrawn. 29th June Nuisance Work done. £1 1s. 0d. costs paid and summons withdrawn. 5th Aug. Ditto Work done. Order to pay 10s. 6d. costs. 28th Oct. (1) Failing to send Certificate in case Fined 10s. Od. of Diphtheria. Costs £2 2s. 0d. (2) Failing to send Certificate in case of Fined £1. Measles. Costs £1 1s. 0d. 22nd Dec. Nuisance Order to abate in 21 days, and pay 10s. 6d. costs. Public Mortuary, New End. During the year, the bodies of 47 persons were brought to the mortuary—1 by request of the Medical Officer of Health, 13 by the Police and 33 at the request of friends. In 12 instances a postmortem examination was made. The following table indicates the cause of death of 47 persons whose bodies were received into the Mortuary:— Cause of Death or Verdict. Number of Bodies received. Deaths from natural causes 34 Neglect at birth 2 Open verdict 2 Suicide by liquid poisoning 2 „ gas poisoning 1 „ drowning 2 „ throwing self under train 2 „ shooting (pistol) 1 Accidental death (motor) 1 47 80 Exhumation and Re-interment of Bodies. During the year the bodies of three persons buried at the Hampstead Municipal Cemetery, Fortune Green Road, have been exhumed and subsequently re-interred in the same Cemetery. In accordance with the terms of the licences issued by the Home Secretary in respect of these cases, the work of removal and re-interment was carried out under the supervision of the Staff of the Public Health Department. Nuisance caused by Pigeons. The London County Council (General Powers) Act, 1927, now enables a Sanitary Authority to take certain steps with a view to reducing the number of pigeons within its area. Section 52 of this Act provides that, for the purpose of abating or mitigating any nuisance, annoyance or damage caused by the congregation at any place in the Borough of house-doves or pigeons having, or believed by the Borough Council to have no owner, or of preventing or minimising any such nuisance, annoyance or damage which might, in the opinion of the Council, be so caused, the Council may seize and destroy or sell any such house-dove or pigeon in excess of such number as the Council may consider reasonable, and take such steps as they deem necessary for such purpose. It is, however, necessary for the Council to obtain consent to the measures adopted by them from the person or corporation in whom the building or land upon which the birds congregate is vested. During the year posters were exhibited in the Borough appealing to the citizens to co-operate in this matter by refraining from feeding pigeons. There is no doubt that, under certain conditions and when gathering together in large numbers, pigeons are a considerable nuisance and cause damage to property. The poster exhibited in the Borough is in the following terms:— METROPOLITAN BOROUGH OF HAMPSTEAD. Nuisance by Pigeons. Considerable inconvenience is caused in many parts of the Borough by pigeons. Many complaints of damage to property and fouling of houses, both inside and out, have been received. 81 The public are therefore earnestly requested to refrain from feeding stray pigeons as this undoubtedly leads to an increase in their numbers. H. Leslie Oldershaw, Public Health Department, M.D. (Lond.) State Medicine, D.P.H., Town Hall, Haverstock Hill, Medical Officer of Health. Hampstead, N.W.3. Rag Flock Acts, 1911 and 1928. These Acts prohibit the sale or use, for the purpose of making any article of upholstery, cushions or bedding, of unclean flock manufactured from rags. There are no premises in the Borough on which rag flock is manufactured, used or sold. Health Education. Leaflets are published by the Borough Council on the following subjects:— "Advice to Expectant Mothers." "How to rear a Baby." "Tuberculosis." "Cancer." Copies of these leaflets are available at the Offices of the Public Health Department, and at all Public Libraries in the Borough. Section 5. Housing. 85 Housing. Although it is probably safe to say that the difficulties of securing adequate housing for all families in the Borough are not greater than in former years, the pressure on available accommodation is still great, notwithstanding the number of families who have removed to houses provided by the London County Council or subsidised by the Borough Council. It is naturally those families who are most embarrassed financially whose existing environment is worst, and it is these families in particular whom the Housing Committee have in mind and for whom they are determined to provide a home at a suitable rental. The impossibility of many families securing proper accommodation will be at once apparent when it is remembered that the standard set up in the Report for 1915-16 of the Chief Medical Officer of the Ministry of Health on Child Mortality is as follows:— "No family can be regarded as housed under conditions which fulfil the needs of health unless the house or tenement provides adequate sleeping accommodation, and comes up to the following minimum standard in other respects:— 1. An adequate kitchen and living room, possibly the two combined. 2. Cool and dustless storage for food. 3. A scullery with sink and water supply within the dwelling. 4. Satisfactory storage for coal and a movable covered ashbin. 5. Separate sanitary conveniences for each family." Nevertheless progress is quietly and steadily made by your Officers, whose efforts have been persistently maintained during the year under review. In Hampstead the problem of the working class in finding accommodation at reasonable rents is more pronounced than in most London Boroughs. Many of the large houses in the Borough are now let out in rooms, but the rents charged form too high a proportion of the workers' earnings. It would appear that the unavoidable result in certain cases is that not enough money remains after the payment of 86 rent to provide sufficient food for the family, and the health of the children suffers seriously as a consequence. From some of these cases come the applications of expectant or nursing mothers and children under 5 years of age for free milk and food. The need for such assistance exists not only among the unemployed and the lower paid workers, but also among the reasonably paid workers whose wages should and would be sufficient for their needs if the rents they are called upon to pay were not unduly high. This is a serious matter, affecting as it does the larger field of general public health, for a lowered vitality of the population renders much more likely the occurrence of illness and disease with their sequelae. The table of results of routine medical inspection of entrant children in Hampstead to elementary schools which is shown in each Annual Report indicates the striking fact that, while the standard of clothing and boots and cleanliness of person of Hampstead children was better than the whole of London, the percentage of children whose condition as to nutrition was described as "good" has been below that of London for several years until 1932. Those whose condition was described as "average" which had been in past years a little better than the County was, in 1932, the same. The following are but two of many instances of families receiving assistance by way of milk under the Maternity and Child Welfare Act, in which an unduly high percentage of the family income is taken for rent. 1. Man, wife and five children. Family income averaging £3 per week, occupy 3 rooms at a rent of 25s. per week. 2. Man, wife and two children. Family income averaging 30s. per week, occupy 2 rooms at a rent of 17s. 6d. per week. The difficulties of families where there are many children are of course accentuated. In no part of Hampstead, so far as I am aware, have we dropped below the "one-roomed home" housing standard. At the censal years of 1911, 1921 and 1931, the number of private families comprising 3 or more persons occupying one-roomed homes, together with the number of persons in the family, will be seen from the following table:— 87 Families in One-roomed homes. No. of persons in family. 1911. 1921. 1931 3 103 158 133 4 45 49 32 5 12 18 6 6 5 9 3 7 1 2 1 It is some satisfaction to note the gradual diminution in the number of one-roomed homes since 1921, but it must be noted that we have not improved upon the 1911 standard in this respect. A good slogan for public health authorities, sanitary reformers and statesmen alike would be "the abolition of the one-roomed home." To the unhealthy and handicapping conditions that must be associated with such circumstances there is added the degradation and lowering of the standards of modesty and morality, which conditions, if not remedied, threaten the community with moral and physical national decay. A feature, possibly peculiar to Hampstead, is that of certain old worn-out cottages in the vicinity of Hampstead Heath, which were in the first place scheduled by the Medical Officer of Health for demolition. Before the Council can demolish them under the Housing Act they are purchased by builders who, after almost razing them to the ground, entirely remodel them, in some cases throwing two cottages into one. On completion of the extensive alterations these premises (which were previously occupied by members of the working classes) are let or sold to members of the professional classes. Statistics. The following information is required by the Ministry of Health to be set out in this Annual Report:— 1. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1102 (b) Number of inspections made for the purpose 1951 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 769 (b) Number of inspections made for the purpose 1482 88 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil. (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 661 2. Remedy of Defects during the Year without Service of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 369 3. Action under Statutory Powers during the Year:— A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930: — (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil. (i>) By local authority in default of owners Nil. B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 292 (2) Number of dwelling-houses in which defects were remedied after service of formal notices: — (a) By owners 292 (b) By local authority in default of owners Nil. C.—Proceedings under sections 19 and 21 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. D.—Proceedings under section 20 of the Housing Act, 1930: (1) Number of separate tenements or underground rooms in pect of which Closing Orders were mad 7 (2) Number of separate tenements or underground rooms in pect of which Closing Orders were determined, the tenement or room having been rendered fit 4 E.—Proceedings under section 3 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which notices became operative requiring repairs Nil. (2) Number of dwelling-house which were rendered fit after service of formal notices:— (a) By owners Nil. (b) By local authority in default of owners Nil. 89 (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil. F.—Proceedings under sections 11, 14 and 15 of the Housing Act, 1925: (1) Number of dwelling-houses in respect of which Closing Orders became operative Nil. (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit Nil. (3) Number of dwelling-houses in respect of which Demolition Orders became operative Nil. (4) Number of dwelling-houses demolished in pursuance of molition Orders Nil. Note.—Section 3 and Sections 11 to 15 of the Housing Act, 1925, have been repealed by the Housing Act, 1930, but the proviso to Section 64 of the Act of 1930 continues in force any Notices, Closing Orders and Demolition Orders made before the operation of the Act (15th August, 1930), and houses subject to those Notices and Orders must continue to be dealt with under the relative provisions of the Act of 1925. Housing Conditions at Census, 1931. Certain information was ascertained at the last Census which indicated some of the housing conditions that existed in the Borough. I have extracted the following statistics relating to dwellings with more than two persons per room, this being the accepted standard of overcrowding of the Registrar-General, and have compared them with the corresponding figures from the two preceding census returns. On this basis of the conventional standard of overcrowding, i.e., "more than two persons per room," the overcrowded element among the London Boroughs was at its lowest in Hampstead and Lewisham each with 4.1 per cent. of its population falling within the category. At the other end of the scale was Finsbury with 29.4 followed by Shoreditch with 29.1 per cent. of the population thus overcrowded. The actual number of persons in Hampstead living more than two to a room at the 1931 census was 3,253 as compared with 5,243 in 1921. It is satisfactory to find that this density is decreasing, although considerable improvement is still imperative. The average size of private families (persons) in the Borough was ascertained to be 3.32 as compared with 3.72 at the census of 1921. The average number of persons per room was 0.70 as compared with 0.71 in 1921. 90 Details of Dwellings with more than 2 persons per room (up to 5-roomed dwellings) with total number of inhabitants as ascertained at Censal years 1911, 1921, 1931:— No. of persons in family. Number of Private Families occupying the following number of rooms. 1 room. 2 rooms. 3 rooms. 4 rooms. 5 rooms. 1911 1921 1931 1911 1921 1931 1911 1921 1931 1911 1921 1931 1911 1921 1931 3 103 158 133 - - - - - - - - - - - - 4 45 49 32 - - - - - - - - - - - - 5 12 18 6 205 168 135 - - - - - - - - - 6 5 9 3 111 94 65 - - - - - - - - - 7 1 2 1 49 40 31 126 143 74 - - - - - - 8 — — — 11 17 8 75 58 29 — - — — — — 9 — — — 8 4 7 35 27 11 36 28 18 — — — 10 — — — 2 3 1 15 10 7 8 26 8 — — — 11 - - - - - 1 5 3 3 7 4 1 10 4 1 12 — — — 1 — 2 2 1 3 — — 1 3 — 13 - - - - - - - - - - - - 2 - - 14 - - - - - - - - - - - - - 1 — Tenement Houses. Houses registered as tenement-houses are those intended or used for occupation by the working-classes and let in lodgings (a) if the "tenant," that is "the person by whom or on whose behalf the house is let, or who for the time being receives or is entitled to receive the profits arising from the letting," resides therein and in addition to his family more than one other family is lodged; and (b) where the tenant does not reside on the premises and more than one family reside therein. If, therefore, the "tenant" lives in the lodging-house the premises are not registered unless three families or more occupy it; but should the "tenant" be non-resident then it is registered if two families or more occupy it. During the year 696 tenement houses were inspected and 2,900 defects were discovered. It must be borne in mind that in certain instances considerable time and trouble is expended by the inspectors and clerical staff at the Town Hall before the necessary repairs are effected, as unfortunately in the case of certain landlords it is not sufficient merely to call their attention to the presence of certain defects. Repeated visits, copious correspondence and eventually the service of statutory notices are required to enforce the requirements of the Bye-laws. 91 During the year three additional tenement houses were placed upon the Register. At the end of the year the total number of tenement houses on the Register was 1,578. In May, 1930, the Council appointed two Temporary Sanitary Inspectors and a clerk for the purpose of registering and inspecting tenement houses in the Borough. All these three officers have now obtained permanent posts with other Councils, one Inspector leaving this Council's service in June, 1931, and the other Inspector in May, 1932, whilst the clerk resigned in October, 1931. These positions were not filled and the work of inspecting tenement houses and the clerical work therewith have been transferred to the existing inspectorial and clerical staff. It is probable that in Hampstead more useful work can be done by the rigid enforcement of the Tenement House Bye-laws of the London County Council than by any other means. Unfortunately this is impossible at the present time owing to the large amount of voluntary work undertaken by owners of property, which has to be supervised by the Sanitary Inspectors. This work includes improvements in good class property, the erection of garages, etc., and in order that the requirements of the Drainage Bye-laws are observed, it is essential for the Inspectors to devote a considerable amount of their time to the supervision of this work. I regard the supervision of registered tenement houses as a matter of paramount importance. For the reasons I have stated, it has not been possible in the past for the Inspectors to give sufficient time to the supervision of tenement houses. Overcrowding. In the Annual Report for 1930, my predecessor reported that as a result of the inspection and registration of tenement houses then being carried out by the temporary sanitary inspectors a large number of cases of illegal overcrowding and improper mixing of sexes had been reported. On re-inspecting these tenement houses, further cases have been reported, and every effort has been made to abate the overcrowded conditions originally pertaining, but owing to the serious shortage in 92 Hampstead of houses at a suitable rent for the working classes it has only too often been impossible for your staff to obtain abatement of the overcrowding. Since 1930, 126 cases of illegal overcrowding and 102 cases of improper mixing of sexes have been reported to the Public Health Committee. At the end of the year 1932 a special inspection of these cases was made and it was found that 97 of the cases of illegal overcrowding had been abated—in 29 cases the families had secured accommodation elsewhere, and in 68 cases there had been rearrangement of the sleeping accommodation. The remaining 29 cases are impossible of abatement by any rearrangement, and of the 68 cases rearranged, many of these have found it necessary to make use of a combined kitchen and living room to put younger children in for sleeping purposes, an arrangement which is far from satisfactory and caused directly by the lack of suitable accommodation for the working classes. In addition to the " illegal " overcrowding there are numerous cases of serious overcrowding which it is impossible to eradicate. It must be remembered that the amount of cubic air space required by the bye-laws is as follows and it will be at once realized the extreme degree of overcrowding which can obtain before it can be defined as " illegal." Adults. Cubic feet. Children under 10. Cubic feet. Controlled Houses. Living and sleeping 400 200 Sleeping only 300 150 Decontrolled Houses. Living and sleeping or sleeping only 400 300 The following case is a typical instance of how cases of " illegal " overcrowding have been abated by re-arrangement, yet serious overcrowding still obtains. Family of 11 people occupy two rooms (one daughter is stated to be sleeping out, but only a night inspection could prove this). 93 Reported as illegally overcrowded in 1930. On re-inspection recently the inspector reported the following circumstances: Cubic capacity. Cubic feet. First floor front room used for sleeping by 3 adults and 5 children 1,801 First floor back room used for sleeping by 2 adults and as a living room by the family of 11 people 1,107 As rearranged, there is no "illegal" overcrowding existing. In addition the Bye-laws provide for the "separation of the sexes" so that, "as far as practicable, a person shall not cause or knowingly permit persons of different sexes above the age of 12 years, and not being persons living together as husband and wife, to occupy the same sleeping apartment." Of the 102 cases of illegal mixing of sexes reported, 16 have secured accommodation elsewhere, whilst 75 have been abated by rearrangement of the sleeping accommodation, leaving a residue of 11 cases where it is impossible to "rearrange." This again stresses the need for additional housing accommodation. Hampstead Housing Association. Although this Association receives no financial assistance from the Borough Council, it is of interest to record that it is in its fifth year and is carrying out excellent work by acquiring insanitary houses, reconditioning them and charging economic rents to the existing tenants. Their last Annual Report shows that they now own 10 leasehold properties in the Kilburn district. Underground Rooms Illegally Occupied. At a house in Dennington Park Road, two underground rooms were found occupied in contravention of the Housing Act and Closing Orders were made prohibiting the use of the rooms for sleeping purposes. At premises in Heath Villas, Vale of Health, the front underground room was found to be illegally occupied and a Closing Order was made. 94 At a front underground room in Gayton Road, as a result of the Council proposing to take into consideration the question of the making of a Closing Order, the works necessary to render the room fit for human habitation were carried out. At Cleve Road, Closing Orders were made in 1932 in respect of four underground rooms. Two of these were subsequently made to conform with the Regulations and the Closing Orders in respect of them were determined in 1933. Another underground room at the same house was found to be illegally occupied, and on the Housing Committee early in 1933 recommending that a Closing Order should be made, the necessary works were carried out. The method of dealing with underground rooms used for sleeping, by closure is only resorted to in those cases in which it is thought the rooms are not capable, at a reasonable expense, of being rendered fit for human habitation, or in those cases where the occupants have been housed elsewhere by the County Council and that Council has asked that Closing Orders be made in respect of the vacated underground sleeping rooms. Apart from the foregoing it is our practice to get the owners to carry out the necessary works to make the rooms conform to the requisites of the Public Health (London) Act, 1891, or to the Regulations made by the Council under the Housing Acts, in order that they may again be let. Closing Orders which were made in 1930 in respect of four underground rooms at premises in Oak Hill Way were determined on the 22nd December, 1932, the necessary works having been carried out to make the rooms conform with the Regulations made by the Council. The Borough Council's Five Years' Housing Programme. The Council, on the 23rd July, 1931, upon the recommendation of the Housing Committee, resolved that formal notice should be given in pursuance of Section 16 (5) (2) of the Housing Act, 1930, to the London County Council that the Borough Council intended to take into consideration a proposal that the following areas should be declared to be Clearance Areas, viz.:— Stamford Place: (A small confined court on the east side of Heath Street, with adjoining property fronting Heath Street, and a small cul-de-sac part of Hampstead Square.) 95 Golden Yard: (A congested area on the west side of Heath Street, with 4 houses in Holly Mount.) Kings College Mews West: (The southern half, together with a dwelling at the northern extremity.) These dwellings were considered, by my predecessor, by reason of disrepair or sanitary defect, to be unfit for human habitation, and, by reason of the narrowness or bad arrangement of the streets, to be injurious or dangerous to the health of the inhabitants, and he recommended that they should be dealt with as Clearance Areas, i.e., the buildings to be demolished and the persons so displaced to be rehoused in other accommodation to be provided by the Council. In June, 1932, the Housing Committee reported upon the question of omitting certain premises from the proposed Clearance Area of Golden Yard, and upon their recommendation the Borough Council agreed to exclude Nos. 13, 14, 15 and 16 (Alma Cottage), Holly Mount, and 4, Golden Yard, from the Golden Yard Area upon the owner giving an undertaking, inter alia, to carry out certain works approved by the Borough Engineer and the Medical Officer of Health, and agreeing not to use or permit to be used No. 4, Golden Yard for dwelling house purposes. During the year the Housing Committee has continued to give earnest consideration to the question of the provision of additional housing accommodation which would also enable them to provide homes for persons living in certain properties proposed to be dealt with under the Housing Acts, action in respect of which has been precluded on account of our inability to offer alternative accommodation. The Committee has given further consideration to the question of giving effect to the five-years' programme of proposals which were submitted by the Council to the London County Council in pursuance of Section 25 of the Housing Act, 1930, which proposals involved the erection of 298 dwelling houses. In such consideration the Committee has had regard to Circular 1238, dated the 12th January, 1932, of the Ministry of Health suggesting that local authorities should concentrate their efforts on the provision of a type of house which can be built at a low cost and can be let at a rent within the means of the more poorly paid workers. 96 The last housing operations carried out by the Borough Council were in 1921, when the present South End Close scheme of 140 flats was completed. In 1927 the Council arranged for 100 houses on the Wormholt and Watling Estates to be allocated to the Borough Council by the London County Council, and, in respect of these houses, the Borough Council is contributing £7 per annum per house for 40 years towards the loss on the same. On the 15th March, 1929, after a Public Meeting held in the previous month and a deputation to the Borough Council, 15 local government electors made a statutory complaint under Section 73 of the Housing Act, 1925, that the Council had failed to carry out their duties under the Act. After an informal Inquiry held by the Ministry of Health, the position was that the Council were to consider what steps were to be taken to provide housing accommodation for the working classes of the Borough. On the 28th November, 1930, a further statutory complaint was made by 12 local government electors, and, on the 8th December, 1930, again a complaint was made to the Minister by 4 local government electors, as a result of which a communication was sent to the Ministry to the effect that the implementing of the housing proposals (i.e., the fiveyears' programme referred to above) was receiving the earnest attention of the Council. The Committee have made exhaustive enquiries, but without success, as to possible schemes on land within the Borough which is suitable both as to cost and facilities and the possibility of low rentals. At the instigation of the Ministry of Health enquiries were therefore made in respect of land outside, but adjacent to, the Borough at Cricklewood, as such a site offered the possibility of a considerable saving in price and building cost, and the Council, on the 28th April, 1932, gave authority for application to be made to the Minister of Health for an Order to transfer such powers of the London County Council as are necessary to enable such a scheme to be carried out. The Order of the Minister was made on the 2nd November, 1932, but the Minister stated that it was made without prejudice to the consideration of any order for compulsory purchase which might be submitted at a later stage. The land in question is situated in the area of the Hendon Borough Council. It was formerly part of Westcroft Farm and is now, with minor exceptions, utilised for the purpose of the Home of 97 Rest for Horses. It has a total area of about 18½ acres. On the basis of 16 dwellings to the acre, this would provide for 296 houses and therefore satisfy the five-years' programme of 298 dwellings. Subsequent to the close of the year under review the Council decided to approve in principle of a scheme for the provision of houses on the general basis outlined above, and resolved that a Compulsory Purchase Order be made and sealed and submitted to the Ministry of Health for confirmation. Small Dwellings Acquisition Acts, 1899—1923. No advances were made during the year by the Council to assist in the purchase of houses under the provisions of these Acts. County Council Housing Estates. The following figures relate to families removed to London County Council Estates since 1927, through the action of the Borough Council:- Number of houses at the Wormholt Estate at the disposal of the Borough Council by payment to the L.C.C. of a yearly subsidy of £7 per house 77 Number of houses at the Watling Estate at the disposal of the Borough Council under similar arrangements 23 Number of houses allotted to Hampstead under special arrangement with the L,.C.C. for relief of overcrowding :— Watling 60 Tottenham 3 Downham 1 Morden 16 Total 180 The total number of families removed from Hampstead to County Council houses since 1927 is 206, involving 1,110 persons. The additional 26 families are accounted for by changes in tenancies at the subsidy houses (6 at Watling and 20 at Wormholt), the Borough Council having the right to nominate tenants for any of the 100 subsidised houses which become vacant. These are the only houses for which the Borough Council can nominate fresh tenants when they become vacant. 98 Borough Council Municipal Dwellings. At Park Dwellings, L,ower Cross Road, 42 tenements were provided in 1906, as follows: 12 two-roomed tenements; 20 threeroomed tenements; 10 four-roomed tenements. Each tenement is provided with a scullery. For these flats the following rents are now charged: two-roomed tenements, 10s. Od.; three-roomed tenements, 13s. 4d.; four-roomed tenements, 17s. Od. At South End Close, South End Green, 140 flats were provided in 1921, 20 being one-bedroom, 78 two-bedroom, and 42 three-bedroom flats. Each is provided with a scullery, bath, etc. The following inclusive rents are now charged: one-bedroom flats, 20s. per week plus light; two-bedroom flats, 25s. per week plus light; three-bedroom flats, 30s. per week plus light. (Top floor flats, 2s. 6d. per week less.) These dwellings are still under the control of the Borough Council. Representations. Statement showing steps taken in 1932 in connection with premises " represented in 1932 or previous years" by the Medical Officer of Health under the Housing Acts :— Premises. Representation. Date of Committee. Closing Order. Date of Council. Demolition Order. Date of Council. Remarks. 15, Dennington Park Road. (Front and back underground rooms). 9-5-32. 30-6-32. — 11, Heath Villas. (Front underground room). 9-5-32. 30-6-32. — 44, Gayton Road. (Front underground room). 11-7-32. — — Works required were carried out by the Owner and no further action taken. 16, Cleve Road. (Four underground rooms). 11-7-32. 24-11-32. — Oak Hill Hotel, Oak Hill Way. (Four underground rooms). 12-5-30. 29-5-30. — Works required carried out and Closing Order determined 22-12-32. Section 6. Inspection and Supervision of Food. 101 Inspection and Supervision of Food. Milk Supply. Milk and Dairies Order, 1926. Milk and Dairies (Consolidation) Act, 1915. The number of premises in respect of which persons are registered as purveyors of milk is 78, comprising 47 dairies, 5 restaurants and coffee shops, 16 general shops, and 10 grocery and provision dealers. During the year, 143 inspections were made and 8 notices were served. Milk (Special Designations) Order, 1923. Milk and Dairies (Amendment), Act, 1922. Number of licences in force for the sale of milk under special designations. Purpose of Licence. Number of Licences granted. Sale of " Certified " Milk. Licence in respect of the shop or other premises at or from which the milk is sold 7 Sale of "Grade A (Tuberculin tested)" Milk. Licence in respect of the shop or other premises at or from which the milk is sold 11 Sale of "Grade A" Milk. Licence in respect of the shop or other premises (not being the establishment at which the milk is produced or bottled) at or from which the milk is sold 2 Sale of "Pasteurised" Milk. Licence in respect of any shop or other premises at or from which the milk is sold 33 102 Name of Applicant. Designation of Licence "Certified" "Grade A (Tuberculin Tested)" " Grade A" "Pasteurised" Jenkin Jones — 122, Boundary Road — 122, Boundary Road Roberts & Sons — 54a, Netherwood Street — 54a, Netherwood Street W. E. Higgins — — 5, Quex Road — Morgan Bros. — 57, Hemstal Road — 57, Hemstal Road Evans & Son 5, Elm Terrace, Constantino Road 5, Elm Terrace, Constantine Road — — Express Dairy Co., Ltd. 42, England's Lane 569, Finchley Road 25, Heath Street 60, Mill Lane 11, New College Parade 42, England's Lane 569, Finchley Road 25, Heath Street 60, Mill Lane 11, New College Parade — 42, England's Lane 569, Finchley Road 242, Haverstock Hill 25, High Street 60, Mill Lane 11, New College Parade Wildwood Dairy, North End United Dairies (London), Ltd. Supplementary licences from 58, Acacia Road, St. Marylebone, and 462, Finchley Road, Hendon Supplementary licences from 58, Acacia Road, St. Marylebone, and 462, Finchley Road, Hendon — 56, Belsize Lane 230, Belsize Road 6, College Crescent 68, Cricklewood Broadway 41, England's Lane 91, Fairfax Road 309, Finchley Road 473, do. 7, Fleet Road 68, Fortune Green Road 83, Haverstock Hill 76, Heath Street 336, High Road, Kilburn 28, King's College Road 63, Mill Lane 57, New End 62, Rosslyn Hill 96, West End Lane 221, do. 277, do. 27, Winchester Road A. J. Baker & Co. — — Supplementary licence from 109, Boundary Road, St. Marylebone Supplementary licence from 109, Boundary Road, St, Marylebone Evans Bros. 13, South End Road 13, South End Road 13, South End Road 13, South End Road London Co-operative Society, Ltd. — Supplementary licence from Willesden — Supplementary licence from Edmonton D. E. Phillips — 81, Kingsgate Road — 81, Kingsgate Road 103 No licences for graded milk or registration of retailers were refused or revoked during the year. In eight cases supplementary licences were granted authorising the sale of graded milk within the Borough from premises outside Hampstead. Under the Order of 1923 four designations are prescribed, i.e., Certified and Grade A (Tuberculin Tested), both of which kinds of milk must be sold raw and not pasteurised; and Grade A and Ordinary milk, which are permitted to contain a higher rate of bacteria per cubic centimetre than Certified and Grade A (Tuberculin Tested), but which must be pasteurised. Street Traders. All applications by Stallholders for licences to sell foodstuffs are referred to the Public Health Department prior to the issue of a licence, and in those cases where the food is stored in the Borough the premises are inspected. In those instances in which the place of storage is situated in another district, an inquiry is addressed to the Medical Officer of Health of that area concerning the sanitary condition of the premises. Bye-laws were made by the Borough Council on 26th January, 1928, with regard to street trading; and these relate inter alia to the protection of the food from contamination, the storing of refuse arising from the business in suitable covered receptacles, etc. 104 List of Licenced Street Traders' Stalls from which Food is sold, 1932. Position or place of stall. Class of article sold. Gascony Avenue or Eresby Road Vegetables. Gascony Avenue, south side carriageway 9 yards from building line of High Road, Kilburn Coffee stall. Gayton Road Salads and Fruit. Grangeway, near electric kiosk Peanuts and Sweets. Do. rear of Picture Palace Ice cream. Greville Road, outside 12, High Road Coffee stall (night only). Kilburn Priory Coffee stall (night only). Netherwood Street Wet and dry fish. Do. Wet fish. Do. outside 318, High Road Coffee stall. Do. outside 316, High Road Fruit. Do. outside 318, High Road Groceries and household sundries. Do. outside 316, High Road Greengrocery. Do. outside No. 2a Salads. Do. carriageway outside No. 3 Fruit and vegetables. Do. Ice cream and chestnuts. Do. outside No. 5 Groceries. Do. Eggs and dead poultry. Do. Fish. Do. Wet and dry fish. Do. Wet fish. Palmerston Road Vegetables and fruit. Do. Fruit. Do. Eggs. Do. Salads and vegetables. Do. Salads and fruit. Do. Vegetables. Stanley Gardens Fruit and vegetables. South End Road, junction of East Heath Road Ice cream. Finchley Road, outside Met. Rly. Station (Canfield Gardens entrance). Night coffee stall. Glenloch Road Fruit. Spaniards Road Sweets and peanuts. Registration of Dairy Premises and Dairymen. In the case of one application for registration under the Milk and Dairies Acts and the Milk and Dairies Order, 1926, I was of the opinion that the premises were not suitable for the storage and bottling of milk. The Council accordingly resolved that a notice should be served upon the applicant under Section 2 of the Milk and Dairies (Amendment) Act, 1922, to appear before the Public Health Committee to show cause why the Council should not refuse to register 105 him. The applicant ultimately decided not to proceed further with his application for the registration of the premises in question, but applied for registration only as a dairyman, having arranged to convey milk direct from a railway station in the Borough to certain addresses in Hampstead. Ice Cream. All premises used for the manufacture, storage or sale of ice cream must be registered with the Local Authority; and the sanitary conditions that must pertain have been prescribed. Every itinerant vendor is required to exhibit the name and address of the manufacturer of the ice cream on his barrow, but no standard of purity or of content of ice cream has yet been fixed. The London County Council (General Powers) Act, 1928, provided that Ice-cream premises should be registered, but contained no power for the Authority to refuse registration in the case of unsuitable premises or to remove from the register premises subsequently found to be unsuitable. Under the Act of 1932, however, the Authority may, on giving notice of their intention to do so, either refuse to register unsuitable premises or remove such premises from the register, subject to a right of appeal by the person concerned to a court of summary jurisdication. The new statute repeals the registration clause of the Act of 1928, but it is enacted that any premises already registered shall be deemed to be registered under the new Act. 67 premises used for the manufacture, storage, or sale of ice cream are on the Register. Chemical and Bacteriological Examination of Food. The Public Analyst undertakes this work at his Laboratories at 11, Billiter Square, E.C.3. Details of the amount of work carried out during 1932 will be found in this Section of the Report. Analytical Work. The report of the Public Analyst will be found in this Section. Food and Drugs (Adulteration) Act, 1928. 504 samples were taken for analysis during the year by the Sampling Officer under the Act. The number certified to be adulterated was 13, or 2.6 per cent. of the total number, as compared with 14, or 2.5 per cent. in 1931. 106 Of the total samples taken for analysis, 294 were formal samples and 210 informal. The following table shows the articles of which samples were taken during the year :- Article. Number taken. Number Adulterated. Baking Powder 3 — Beef Mince 6 1 Bread 1 — Butter 55 2 Cereals 3 — Cheese 23 — Cocoa 13 — Coffee 10 — Cream 18 1 Dripping 8 — Drugs 19 — Flour 7 — Fruits, Dried 8 — Honey, Jam and Lemon Curd 14 — Ice Cream 3 — Jelly Crystals 1 — Lard 25 — Lemon and Orange Squash 5 — Margarine 48 4 Meat and Fish Paste 17 — Milk 131 1 Mincemeat 4 — Mustard 6 — Peas, Tinned 4 — Pepper 9 — Salt 1 — Sausages 13 3 Spices 9 — Spirits 15 — Sugar 4 — Sweets 2 — Tea 10 — Vinegar 9 1 Totals 504 13 107 The following table shows the articles adulterated, etc., nature of adulteration, and the results of proceedings taken :— No. of Sample Article. Analyst's Report. Result of proceedings. 5 Milk Added water 5.4 per cent. Informal sample. No action. 7 Cream Milk emulsified with 30 per cent. vegetable oil No action. Carton labelled 'Vitacream.' 68 Margarine Water 16.5 per cent. Dismissed. Warranty proved. The Warrantor was prosecuted for giving false warranty. Summons dismissed on payment of £10 10s. costs. 120 Butter Water 16.4 per cent. Dismissed. Warranty proved. 308 Butter Water 161 per cent. No action. 311 Malt Vinegar Artificial vinegar Vendor cautioned. 336 Margarine Minute amount of boric acid Vendor cautioned. 355 Margarine Minute amount of boric acid Vendor cautioned. 363 Margarine Minute amount of boric acid Vendor cautioned. 414 Mince Beef Sulphur dioxide 100 parts per million Informal sample. No action. 432 Sausages Sulphur dioxide 1750 parts per million These samples were obtained from the same Vendor. Fines £9. Costs £3 3s. 0d. 461 Sausages Sulphur dioxide 2160 parts per million 462 Sausages Sulphur dioxide 920 parts per million Warranty Defence. In the case of Sample No. 68, Margarine, 0.5 per cent. excess of water, the Warranty defence was successfully raised. The Warranty was contained on the invoice in the following words: "The goods included in this Invoice are guaranteed to be of the nature, substance and quality therein described and to comply with the provisions of the Sale of Food and Drugs Act and with all other statutory 108 ments or regulations relating to the sale of food." The matter was reported to the Council, who, on the recommendation of the Public Health Committee, decided to proceed against the responsible persons in respect of the false warranty. The Warrantors, who were the actual manufacturers, were accordingly prosecuted. The summons was dismissed under the Probation of Offenders Act, but the Council was awarded ten guineas cost. A summons issued against the vendor of a sample of Butter No. 120 containing 0.4 per cent. excess of water was dismissed, the warranty being proved. Bacteriological Examinations. During the year the following 25 special bacteriological examinations—apart from those in connection with diphtheria, enteric fever and tuberculosis—were carried out:— 4 samples of milk from itinerant street vendors examined for the presence of tubercle bacillus. 12 samples of pasteurised milk from Hospitals and 6 of pasteurised milk from Schools, all County Council Institutions. 1 sample of pasteurised milk from another Hospital. 2 samples of water from the Public Swimming Baths, Finchley Road. No action was found to be necessary as a result of these examinations. Artificial Cream Act, 1929. In pursuance of the Act the following premises have been registered:—110, High Road, Kilburn. Public Health (Condensed Milk) Regulations, 1923, the Public Health (Dried Milk) Regulations, 1923, and Amending Regulations of 1927. No dried milk is now sold in the Borough. In the labelling of condensed and dried skimmed milks, prominence is required to be given to the words "Unfit for Babies." No offence against the Regulations was discovered during 1932. 109 Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. The list of samples found to contain preservatives will be found on page 107. In the case of three samples of sausages found to contain preservatives in contravention of these Regulations and obtained from the same vendor, legal proceedings were instituted and fines totalling £9, and £3 3s. 0d. costs were imposed. Slaughterhouses and Meat Supply. There are now no slaughterhouses in the Borough. The meat supply in the Borough is of good quality. Wrapping of Bread and other Food. The Borough Council resolved on the 30th June to make representations to the London County Council in support of those made by another London Borough Council, for clauses to be inserted in the next County Council General Powers Bill to provide (a) for the compulsory wrapping of bread and (b) for the prohibition of the use of newspapers or waste paper of that description for the wrapping of foodstuffs such as fish, meats and sweets. Sale of Food Order, 1921. Imported meat, bacon, ham or lard is required to be labelled with the word "imported," or with a word or words disclosing the country of origin. No infringement of this Order was discovered during 1932. Unsound Food and Food Inspection. The following is a list of food seized or voluntarily surrendered during the year :- 1 tin of prawns. 7 lbs. walnuts. Sanitary condition of Bakehouses and other premises where foods are manufactured, prepared, stored, or exposed for sale. These premises must be thoroughly cleansed and limewashed, or, if painted, be thoroughly washed twice a year. 110 The following table summarises the work done in this connection during 1932 :— No. of Premises on Register. No. of Inspections. No. of Notices. No. of Prosecutions. Bakehouses:— Factories— Underground 15 56 1 — Aboveground 12 Workshops— Underground 1 23 1 — Aboveground 12 Cow Sheds — — — — Fried Fish Shops 9 38 — — Ice-cream Premises 67 117 6 — Milkshops 78 143 8 — Offensive Trades — — — — Other Food Premises 455 602 42 — Restaurants and Eatinghouses 59 108 11 — Slaughterhouses — — — — The underground bakehouses at 98, Boundary Road, 225 and 289, Finchley Road are out of use. New aboveground workshop bakehouses were opened during the year at 32, Heath Street, 87, Haverstock Hill and 29, Winchester Road. Butter Factories.—No premises in the Borough are registered as Butter Factories. Wholesale Dealers in Margarine.—Various wholesale dealers are on the Register in respect of 9 premises. Merchandise Marks Act, 1926. Under this Act certain imported goods are required to bear an indication of origin when exposed for sale. Prior to 1932, Orders have been made relating to the following foodstuffs:- Honey and Fresh Apples. Currants, Sultanas and Raisins, Eggs in shell, dried Eggs and Oat products. Raw Tomatoes. Salmon and Sea Trout. 111 The Merchandise Marks (Imported Goods) No. 1 Order, 1932. By this Order, which came into operation three months after the date of issue on 17th March, it is an offence to sell or expose for sale in the United Kimgdom any imported butter unless it bears an indication of origin. The provisions of the Order extend to all blends or mixtures of butter which consist of or contain imported butter. The indication of origin is required to be marked indelibly and in a conspicuous manner. The requirement of marking on sale does not apply to butter taken in the presence of the purchaser from butter in bulk which is marked in the prescribed manner. The obligation to enforce foodstuffs Orders is, by Section 9 of the Act, placed upon the Borough Council by virtue of it being the Food and Drugs Authority. With a view to assisting towards implementing the policy underlying this Act and the Orders made thereunder, a letter was addressed in December to all traders concerned in the Borough reminding them of the requirements as to the marking of imported produce. This communication was in the following terms:- 9th December, 1932. Dear Sir(s), Merchandise Marks Act, 1926. From time to time Orders in Council have been issued requiring the marking of imported foodstuffs with an indication of origin. A notice has been prepared, with the assistance of the Federation of Grocers' Associations, giving information as to the marking of imported foodstuffs. I enclose a copy herewith for your guidance, and trust that I may rely upon your co-operation. These Orders are enforceable in Hampstead by the Borough Council who have appointed all their Sanitary Inspectors as Officers under the Act. Yours faithfully, H. Lesie Oldershaw, Medical Officer of Health. METROPOLITAN BOROUGH OF HAMPSTEAD. Marking of Imported Foodstuffs. Notice to Traders. Imported foodstuffs of the following kinds must, by law, be marked to show where they came from:- 1. Fresh Apples. 2. Raw Tomatoes. 112 3. Eggs (hen or duck eggs in shell). 4. Dried Eggs. 5. Currants, sultanas and raisins. 6. Oat products (oatmeal, rolled oats, oat flour, and groats). 7. Honey. 8. Frozen or Chilled Salmon or Sea Trout. 9. Butter. If the goods are from foreign countries, they must be marked either with the word "Foreign" or with words which show the country from which they came, such as "Grown in France," "Dutch Produce" or "Danish." If they are imported from an overseas part of the Empire, they must be marked with the word "Empire" or with words showing the country from which they came, such as " Australian produce," " Grown in Guernsey " or " Canadian." Fresh apples, raw tomatoes, loose currants, sultanas and raisins, and loose oat products must be clearly marked with a show ticket having letters not less than half an inch high when exposed for sale in any quantity. These goods must also be marked when actually sold if they are sold in quantities of more than 14 lbs., but when sold in quantities of 14 lbs. or less, they may be handed to the purchaser in unmarked bags. Frozen or Chilled Salmon or Sea Trout must be marked by means of a label or show ticket having letters not less than half an inch high placed on or in close proximity to the fish or portions of fish when exposed for sale retail. Portions of such fish are not required to be marked when actually sold. Butter in bulk is required to be marked by a show ticket clearly visible to intending purchasers having letters not less than one half an inch high. Small quantities of butter taken in the presence of the purchaser from a bulk of butter bearing this show ticket may be handed to the purchaser in unmarked wrappers or bags. Packages of currants, sultanas and raisins made up before reaching the retailer; packages of dried eggs made up before reaching the retailer; containers of honey; and packages of oat products made up before reaching the retailer, should be marked in capital letters not less than one-twelth of an inch in height when the longest side of the package is not more than six inches, and not less than one-eighth of an inch in height when the longest side is more than six inches. Butter wrapped or packed ready for retail sale must be marked either by means of printing or stamping on the outside of each package or by means of a label securely attached to the outside of each package or visible through the wrapper in plain block letters not less than one-twelth of an inch in height. Blends or mixtures of oat products, or of honey, may be marked simply " Blended Imported." Blends or mixtures consisting of or containing imported butter may be marked simply " Including imported butter." 113 Imported eggs must be plainly stamped on the shell of each egg in letters not less than one-twelfth of an inch high. This notice is intended only to give short particulars of what is required when these goods are exposed for sale in shops or on stalls and barrows, and when they are sold by shop-keepers, stall-holders and barrowmen. Further details about the Orders made under the Merchandise Marks Act, 1926, can be obtained from the Medical Officer of Health, Town Hall, Haverstock Hill, N.W.3. Traders can be prosecuted and fined if they do not carry out these Marking Orders. Public Health Department, Town Hall, Haverstock Hill, N.W.3. December, 1932. Agricultural Produce (Grading and Marking) Act, 1928. The Minister of Agriculture and Fisheries has made Regulations which are enforced by the Borough Council's Sanitary Inspectors prescribing designations to indicate the quality of articles of agricultural produce:— In 1928 No. General. 674 984 Eggs. 350 Tomatoes and Cucumbers. In 1929 497 Apples and Pears. 753 Wheat Flour. 812 Beef. 1115 Malt Flour and Malt Extract. 1117 Potatoes. In 1930 5 Broccoli. 340 Strawberries. 368 Dressed Poultry. 370 Canned Fruits, Peas and Beans. In 1931 458 Plums Produced and Canned in England and Wales. Cherries Gooseberries Strawberries Loganberries Blackberries Raspberries Red Currants Black Currants Apples 114 In 1931 No. Beans Produced and Canned in England and Wales. 442 Beetroots Carrots Celery Peas New Potatoes Spinach Turnips In 1932 483 Honey London County Council (General Powers) Act, 1932. Section 5 of this Act requires that the owner or occupier of premises which are used or proposed to be used for the preparation or manufacture of sausages, or the potting, pressing, pickling, or preserving of meat, fish or other food intended for sale shall be registered with the Sanitary Authority. The following list has been prepared of articles of food which are deemed to come within the scope of the Act:- SAUSAGES and allies; large and small; with or without skins. 1. Sausages. 2. Saveloys. 3. Black Puddings. 4. White Puddings. 5. Haggis. 6. Rissoles. 7. Bladders of Lard. MEAT: Potted, Pressed, Pickled, Preserved. 8. Potted Meat or Head, Tongues, etc. 9. Meat Pastes. 10. Meat Extracts. 11. Faggots. 12. Cooked Meats, Sheepshead, etc., Pork. 13. Meat Pies, Pork Pies. 14. Dripping. 15. Brawn. 16. Brisket (pressed). 17. Meat and Pork (pressed). 18. Meat and Pork (pickled). 19. Trotters (pickled). 20. Hams Boiled, cooked, smoked or cured or otherwise preserved 21. Bacon 115 FISH: Potted, Pressed, Pickled, Preserved. 22. Pastes—various. 23. Cured or Dried Fish. 24. Eel Pies and Jellied Eels. 25. Pickled or Soused. 26. Canned. OTHER FOODS: Potted, Pressed, Pickled, Preserved. 27. Canned Soups containing Meat. 28. Hor d'CEuvres, if containing Meat or Fish. During 1932 the following premises have been registered by the Council under the Act:— Boundary Road, 132. Elm Terrace, Constantine Road, 1. Finchley Road, 138, 140, 163, 191, 233, 341, 471, 511, 515. Flask Walk, 2, 8. Fleet Road, 11. Fortune Green Road, 58, 110, 114. Heath Street, 45, 51, 72, 112. High Road, 96, 128, 292. High Street, 17, 44, 69. New End, 28. Midland Parade, West End Lane, 4. Rosslyn Hill, 56. Southampton Road, 39. South End Road, 55, 59. South Hill Park, 8. Upper Belsize Terrace, 9. West End Lane, 94, 120, 134, 188, 223, 257, 263, 274, 333, 341. Food Poisoning. By Section 7 of the London County Council (General Powers) Act, 1932, it is provided that medical practitioners shall notify cases of food poisoning or suspected food poisoning to the Medical Officer of Health. From the passing of this Act until the close of the year 5 cases were notified. REPORT for the year 1932 of the Public Analyst. H. E. COX, M.Sc., Ph.D. (L,ond.), F.I.C. 11, Billiter Square, E.C.3. January, 1933. 119 The Laboratory, 11, Billiter Square, London, E.C.3. January, 1933. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I beg to submit a short summary of the analytical work carried out by me as your Borough Analyst during the year 1932. Altogether 504 samples have been submitted under the Sale of Food and Drugs Act, and in addition a few of the samples have been examined bacteriologically and in other ways. The following list shows the principal items:— Milks 131 Butters 55 Margarine 48 Cheese 23 Lard 25 Tea, coffee, cocoa 33 Cream 18 Dripping 8 Spirits 15 Vinegar 9 Condiments and spices 19 Flour, bread and cereals 11 Sugar, jam and preserves 27 Meat, meat extract, sausage meat 27 Fish and fish pastes 9 Non-alcoholic beverages 5 Drugs .and pharmaceutical preparations 19 and there was a variety of others. There have been no new regulations made under the Sale of Food and Drugs Act during the year, but an event of importance was the issue of the new British Pharmacopoeia, which, amongst many improvements, provides better standards for quite a large number of drugs or other pharmaceutical products coming within the scope of the Food and Drugs Act, including quantitative standards for certain of 120 the vitamins; at present only one of these can be determined by chemical methods and for the others recourse must be had to biological methods which lie outside the scope of the Public Analyst. In general the result of the analytical investigations have been satisfactory. There have been a number of instances of small adulteration or infringement of the regulations, but gross sophistication is rarely found in the Borough. There is a tendency on the part of some few manufacturers to issue labels or descriptions which are exaggerated or ambiguous, yet often they do not make any statement which is demonstrably false. For instance, rum and coffee was found to contain very little caffeine and only 1 per cent, of alcohol. It will be appreciated that when a teaspoonful of this is diluted to a teacup there is for all practical purposes no rum and very little coffee, yet it could not be stated that there was no rum in the bottle though the maximum possible must have been about 2\ per cent, in the essence itself. Again, a Devon Cream Toffee contained only 2 per cent, of butter-fat, corresponding to about 4 per cent, of cream, and the remainder of the fat was cocoanut oil. This composition is far from what is suggested by the name " Devon Cream." Of the milk samples the average composition is good, namely:— Total milk solids ... ... 12-39 per cent. Fat ... ... ... 361 Solids not fat ... ... 8-78 „ and the individual samples were remarkably uniform; one only was adulterated, it contained 5-4 per cent, of added water. Some of the butters and margarines contained small excesses of water and three contained traces of boric acid. Other infringements of the Preservatives Regulations were three sausages and one minced beef which contained sulphur dioxide. There was also an instance of the substitution of artificial vinegar for malt vinegar; artificial vinegar is merely coloured acetic acid, and in my opinion it is unfortunate that it may be sold as vinegar without qualification, because most people do not take the trouble to specify malt vinegar and so may receive this diluted acetic acid instead of the superior brewed and fermented product. 121 A sample of lemon cheese was found to be a somewhat inferior artificial product. It contained practically no protein, very little fat and was mainly coloured sugar, starch and water. Some ice creams were examined during the summer and they exhibited the usual wide variation in fat content. The whole subject of cream and ice-cream is ripe for consideration by the Ministry of Health Committee on Foods when it resumes its labours. There have, as usual, been a few instances of contamination which may be presumed to have been accidental, such as some fish reported to have a flavour of disinfectant and some bread in which I found a dye—methyl-violet. Apart from these irregularities the foods analysed have been of good quality and in general of a high standard of purity. The total number of adulterated or unsatisfactory samples was 13, which corresponds to 26 per cent. I have the honour to remain, Your obedient servant, (Sgd.) H. E. COX, Borough Analyst. Section 7. Prevalence of, and Control over, Infectious and other Diseases. 125 Prevalence of, and Control over, Infectious and other Diseases. Notifiable Diseases during the Year 1932. The following is a list of the diseases which were compulsorily notifiable in Hampstead during 1932 :— Anthrax Membranous Croup Cerebro-Spinal Meningitis, Ophthalmia Neonatorum acute Plague Cholera Pneumonia, acute influenzal or Continued Fever acute primary Diphtheria Polio-Encephalitis, acute Dysentery Polio-Myelitis, acute Encephalitis Lethargica, acute Puerperal Fever and Pyrexia Enteric Fever Relapsing Fever Erysipelas Scarlet Fever and Scarlatina Glanders Small-pox Hydrophobia Tuberculosis, all forms Malaria (except where induced Typhoid Fever for therapeutic purposes) Typhus Fever. Measles (if not already notified, or if a notified case has not occurred in the same household within the preceding two months) No cases of the following notifiable diseases were reported during the year:— Anthrax Polio-Myelitis, acute Cholera Puerperal Fever Glanders Plague Hydrophobia Relapsing Fever Membranous Croup Typhus Fever. Polio-Encephalitis, acute 126 Notifiable Diseases during the Year 1932. notifiable diseases. *Total cases notified in age-periods. *Total cases notified in each Ward. * Cases admitted to Hospital. Total deaths in age-periods. At all Ages. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). I Ward No. 7 (Priory). At all Ages. At Ages—Years. Under 1. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45.| 45 and under 65. 65 and over. 1 Under 1. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Cerebro-spinal Fever 1 .. .. .. .. .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Continued Fever 2 .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 63 2.. 3 4 6 22 10 6 9 1 .. .. 8 9 3 4 9 22 8 59 1 .. i .. 1 .. i .. .. .. .. 1 .. Dysentery 1 .. .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Lethargica 1 .. .. .. .. .. .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. 1 1 .. .. .. .. .. .. .. .. .. .. 1 .. Enteric Fever 8 .. .. .. .. .. 2 2 1 2 l .. 2 3 1 1 .. •• 1 6 1 .. .. .. .. .. .. .. .. .. .. 1 .. Erysipelas 23 1 .. .. .. .. .. .. 2 6 4 7 3 4 6 3 3 3 1 3 15 .. .. .. .. .. .. .. .. .. .. .. .. .. Malaria 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 •• .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 6 6 .. .. .. .. .. .. .. .. .. .. .. .. .. 2 1 .. 1 2 6 .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 74 1 1 3 2 3 3 2 13 11 23 12 9 6 6 8 11 21 13 32 15 .. .. .. .. .. .. .. .. 1 3 6 5 Puerperal Pyrexia 11 .. .. .. .. .. .. .. 2 9 .. .. .. 3 .. 1 3 .. .. 4 10 .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 166 1 .. 12 8 8 62 26 12 31 6 .. .. 29 40 16 10 22 40 9 153 2 .. 1 .. .. .. 1 .. .. .. .. .. .. Small-pox 1 .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. † Measles 716 14 59 3 72 86 290 69 21 32 9 1 117 153 39 4(1 132 196 39 104 3 2 1 .. .. .. .. .. .. .. .. .. ‡ Tuberculosis 94 .. .. .. 2 1 2 14 42 14 14 5 8 23 12 10 12 15 14 73 40 .. .. .. .. .. 3 .. 11 5 4 15 2 Totals 1168 24 60 79 89 102 382 112 61 147 46 46 20 182 240 84 82 189 296 95 462 66 .. 4 1 1 5 .. 11 6 7 24 7 * Cancelled cases have not been included. † Notifiable under the Borough of Hampstead (Measles) Regulations, 1920. † Statistics relating to Tuberculosis are given in subsequent pages. 127 Cerebro-Spinal Fever. Only one case of cerebro-spinal fever occurred in the Borough last year. This was in a youth of 18 years who was admitted to the New End Hospital profoundly ill with a high temperature and delirium. Meningoccocal antiserum was administered intrathecally, intravenously and intramuscularly with the result that the patient made an uninterrupted recovery. Diphtheria. During the year 63 cases of diphtheria were notified and 4 deaths were registered from this cause. The attack rate was 0.7 per 1,000 of the population and the mortality from the disease was 0.04. Of the 63 notified cases all except four were removed to hospital. It is interesting to note that there were 69 cases notified in the Borough for the year 1931. 216,000 units of anti-toxin were issued by the Public Health Department to medical practitioners during the year. Schick testing with subsequent immunizing is not, unfortunately, carried out on a large scale in the Borough, and it has not as yet been introduced at the Welfare Centres. However, during the year 37 girl inmates of a residential institution were successfully immunized following preliminary Schick Testing. Dysentery. One case of Dysentery was reported. Bacteriological examinations shewed the infection to be due to Sonnes Baccillus. During the year only 83 cases were notified in the Metropolis. It was impossible to ascertain the source of the infection as the patient had only returned from the country a short time before the onset of the illness. Encephalitis Lethargica. Only one case of this dreaded infection occurred during 1932. This was in a female aged 50 years and had a fatal termination. Although the case was not actually notified until after death the patient had received expert hospital care and attention during her illness. Enteric Fever. Although 8 cases of Enteric Fever were notified it is pleasing to report that they were all isolated cases. In one, the infection had 128 occurred on the continent, in another the infection had probably occurred whilst on holiday in Somerset, whilst a third had eaten infected shell fish. Only one case terminated fatally. Malaria. Only one case of Malaria was notified during the year, and it was in a visitor to this country who had contracted the infection abroad. Measles. During the year there were 716 cases of Measles notified in pursuance of the Borough of Hampstead (Measles) Regulations, 1920; this represents an increase of 491 over the previous year. There were 3 deaths (at ages 1 year 4 months, 1 year 11 months and 2 years). The outbreak commenced in the first week of April and lasted until the end of July, whilst the peak was reached in May, for 117 cases were reported during the first fortnight. Hospital accommodation was provided for 104 of the total cases. All the notified cases were visited in their homes by the Health Visitors, whilst in appropriate cases home nursing was provided free of charge by the two local branches of the Nursing Association. An analysis of the cases shews that 73 occurred in children under 2 years of age, 221 occurred between the ages of 2 and 5 years, whilst 290 were children between the ages of 5 and 10 years. London County Council Scheme of Control. During 1932 the Scheme of Control drawn up with the approval of the London County Council and the Metropolitan Borough Councils was put into operation in connection with five Schools in the Borough, and the Head Teachers were supplied with advice leaflets for distribution to parents through the School organisation. Generally speaking, the Scheme aims at closer co-operation between the School Nurses, Head Teachers, and School Attendance Staffs of the County Council, and the Public Health Staffs of the Borough Councils, and its objects is the reducing of the mortality and mitigating the complications associated with measles epidemics. The measures set out in the Scheme, however, are mostly required in those areas where overcrowding and insanitary conditions prevail. The Scheme was devised primarily to assist Borough Medical Officers of Health to arrange for Health Visitors to follow up cases 129 of measles (particularly in children under 5 years of age) to provide early nursing assistance in the home where necessary, or to arrange for the removal of patients to hospital, as complication and deaths from measles are nearly always due to want of proper medical and nursing treatment during the first few days of illness. The importance of this action has been appreciated in Hampstead, and for many years Measles has been a compulsorily notifiable disease. In view of this, the operation of the Scheme in Hampstead was carefully reconsidered during the year and the opinion formed was that it would appear that the compulsory notification of measles and the prompt reporting of cases by the Head Teachers is all that is necessary in the Borough. Pneumonia. During the year 44 cases of acute primary pneumonia and 30 cases of acute influenzal pneumonia were notified. In the preceding year the corresponding figures were 50 and 35. Of the total deaths from pneumonia, 11 occurred in persons over 45 years of age, and 12 deaths took place in the first four months of the year. The age of the patient is the most important factor of mortality. As in most infectious diseases, the "carrier" plays an important role, although there is little proof of direct infection either from "carrier patients" or contacts. It is now generally accepted that there is a" wide susceptibility to the carrier state but a low susceptibility to the disease itself." Scarlet Fever. During 1932 there were 166 cases of scarlet fever, which represents a decrease of 2 in the figures given for the previous year. The large majority (viz., 92 per cent.) of these cases were removed to hospital. Fortunately the disease continues to be of a mild type; only 2 terminated fatally. There were 19 cases notified from one institution during the year. Smallpox. Only one case of Smallpox occurred in a Hampstead resident. A case of Smallpox occurred during the year in the person of a female domestic servant aged 21 years. The patient, who was unvaccinated, was removed from her Hampstead address to a private isolation 130 institution as a case of chickenpox, but was there diagnosed to be suffering from smallpox. As chickenpox is not notifiable in this Borough she had therefore not come within the purview of the Public Health Department. Another case, although not resident in the Borough, occurred in the person of a waitress, aged 16, whose home address was in Southwark, but who slept during the week at the restaurant in Hampstead where she had just secured employment. This girl began work in Hampstead on a Monday, on which day she complained of headache. On the following Friday a rash appeared, on the next day at midday she was sent home, and the same evening was removed to hospital. The customary precautions were observed in both instances and no further case arose. During the year notifications were received from various Port Medical Officers of passengers arriving by steamships from abroad on board of which cases of Small-pox had occurred during the voyage. Altogether, 29 such "contacts" arrived in the Borough and were kept under surveillance for the customary sixteen days from the date of last possible contact with the patients. It is particularly pleasing that, although there were 1,138 cases of smallpox in the Metropolis during 1932, only one was a resident of Hampstead. A certain measure of explanation may be forthcoming in that Hampstead continues to obtain a relatively high degree of immunity by means of vaccination. I append the return of the Vaccination Officer, from which it will be seen that the percentage of persons vaccinated is considerably higher in Hampstead than in England and Wales. Year. Hampstead. Per cent. England and Wales. Per cent. 1926 71 448 1927 69 449 1928 66 426 1929 66 399 1930 62 401 1931 61 Figure not yet available 131 Vaccination. The Acting Vaccination Officer, Mr. R. H. Box, has submitted the following Report:— 1. Number of Births returned in the "Birth List Sheets" as registered from 1st January to 31st December, 1931 1489 2. Number of these :— (a) Successfully vaccinated 871 (b) Insusceptible of Vaccination 16 (c) Had Smallpox - (d) Number in respect of whom Statutory Declaration of conscientious objection have been received 356 (e) Died unvaccinated 40 3. Number of these Births which on 31st January, 1932, remained unentered in the "Vaccination Register" on account of:— (a) Postponement by Medical Certificate 5 (b) Removal to Districts the Vaccination Officers of which have been duly apprised 114 (c) Removal to places unknown, or which cannot be reached; and cases not having been found 68 4. Number of these Births remaining on 31st January, 1932, neither duly entered in the "Vaccination Register" under headings numbered 2 nor temporily accounted for in the "Report Book" under headings numbered 3 19 5. Total number of Certificates of successful primary vaccination of children under 14 received during the Calendar year 1931 (including any relating to births registered in previous years) 1061 6. Number of Statutory Declarations of conscientious objection actually received, irrespective of dates of birth of the children to which they relate, during the Calendar year 1931 304 7. Number of cases of children in entries 1 and 2 (d) successfully vaccinated after the declaration of consientious objection had been made 1 132 8. Total number of Certificates for the year 1931 of successful primary vaccination of which copies have been sent to Vaccination Officers of other districts 167 Whooping Cough. This disease is not compulsorily notifiable in Hampstead, our principal source of information of the occurrence of cases is the Head Heachers of Schools. During 1932, no case proved fatal. Tuberculosis. In Hampstead, as elsewhere, the incidence of and mortality from tuberculosis have shewn a steady decline in recent years. This has been obtained as a result of a combination of circumstances, chief amongst which are the concerted efforts of the public tuberculosis services, the better housing and nutrition of the working classes and the apparent increased immunity to infection of the surviving community as a whole. Probably the greatest and gravest problem with which the Tuberculosis Service is faced to-day is the supervision and care of the highly infectious advanced case. This type of patient having failed to respond to sanatorium treatment, and for various reasons unsuitable for further detention in hospital, returns to an overcrowded home, depleted in the necessities of life, and of a necessity only too often becomes a menace to the other members of the household. The Tuberculosis Medical Officer (A. J. Scott Pinchin, M.D., F.R.C.P.) in his report points out that "we are no nearer a satisfactory solution for the care of the advanced case." The accompanying graph shews that, apart from the war years of 1915-1918, Hampstead continues to have an incidence and mortality from tuberculosis commendably lower than both the Metropolis and England and Wales as a whole. The 10 years from 1913 to 1923 shewed a marked reduction in the incidence of tuberculosis from 5.0 to 1.8 per 1,000 of the population; although the incidence has naturally not declined to the same degree there is still a steady decline to the figure of 1.0 per 1,000 of population for the year 1932. Pulmonary Tuberculosis. Notification & Mortality Rates per 1000 of Population from 1913 to 1931. 133 Notification of Tuberculosis. During the year 1932, 94 new cases of Tuberculosis were notified, 74 being cases of Pulmonary Tuberculosis, and 20 other forms of the disease. There were 10 deaths of persons certified during the year as being due to tuberculosis who had not previously been notified, the ratio of non-notified tuberculosis deaths to total tuberculosis deaths was, therefore, 1 in 4. The following statistical table, prescribed by the Ministry of Health, gives an analysis of the newly notified cases and deaths during 1932:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Inspiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0- - - - - - - - - 1- — - 1 1 - — — — 5- — 1 1 2 - - 1 2 15- 12 17 1 5 3 8 — — 25- 4 16 1 2 2 3 — - 35- 9 3 2 2 1 2 1 - 45- 3 3 - 1 4 3 - 2 55- 5 3 2 2 3 1 2 — 65 and upwards 2 3 - - 1 1 - - Totals 35 46 8 15 14 18 4 4 Occupations. The following is an analysis of the occupations of the new cases notified as tuberculosis during 1932:— Occupation. Pulmonary Cases. NonPulmonary Cases. Occupation. Pulmonary Cases. NonPulmonary Cases. Bank Manager 1 — Nurse 2 1 Cabinet Maker 1 — Pianist 1 — Chauffeur 2 — Painter . — 1 Cleaner 1 — Plumber 1 — Clerk 9 2 Policeman 1 — Company Secreta 2 — Postman 1 — Doctor 1 — Sanitary Inspect 1 — Domestics 12 2 Salesman 1 1 Doorkeeper 1 — Seaman 1 — Dressmaker 1 3 Shop Assistant 1 1 Electrician 1 — Shop Keeper 1 — Engineer 3 1 School 3 2 Factory Worker 2 — Students 2 — Gardener 1 — Waitress — 1 House Boy 1 — Wood Machinist — 1 Housewife 11 1 Lecturer 1 — Totals 74 20 Lift Attendant 1 — - - Nil 6 3 134 Removals to Sanatoria and Hospitals. Sanatorium treatment for insured and non-insured persons is undertaken by the London County Council. By Section 4 of the National Health Insurance Act, 1920, Sanatorium Benefit ceased to be included among the benefits conferred by Part I of the Insurance Act of 1911. Of the 74 cases of Pulmonary Tuberculosis newly notified in 1932:— 36 were treated at Sanatoria. 12 „ „ Hospitals. 6 „ „ L.C.C. Hospitals. Of the cases of Non-Pulmonary Tuberculosis newly notified in 1932:— 8 were treated at Sanatoria. 6 „ „ Hospitals. 5 „ „ L.C.C. Hospitals. The following cases, notified prior to 1932, were also removed:— Pulmo inary. Non-Pu lmonary. Insured. NonInsured. Insured. NonInsured. To Sanatoria 8 l l To Hospitals 2 l — To L.C.C. Hospitals 2 4 2 l Public Health (Tuberculosis) Regulations, 1930. The following table, compiled from the Register of Notifications kept in pursuance of Article 10 of the Tuberculosis Regulations, 1930, indicates the number and distribution of cases during the year. At the present time 17 discharged soldiers in receipt of a pension for tuberculosis are resident in Hampstead. The number of cases of 135 tuberculosis known to the department at the end of 1932 totalled 453 —359 pulmonary and 94 non-pulmonary. Tuberculosis Regulations, 1930. Pulmonary. N on-Pulmonary. Totals. Males. Females. Males. Females. Males. Females. Number of cases on the Register at the commencement of the year 1932 196 216 47 58 243 274 Number of cases notified under the Regulations for the first time during the year 29 43 8 14 37 57 Number of cases removed from the Register in a preceding year which have been restored to the Register during the year 2 1 1 2 3 3 Number of cases brought under notice otherwise than by notification during the year 14 17 3 1 17 18 *Number of cases removed from the Register during the year 241 277 59 75 300 352 74 85 17 23 91 108 Number of cases remaining on the Register at the end of the year 167 192 42 52 209 244 *These consist of cases which have been denotified, and those which have died or removed from the Borough. Deaths from Tuberculosis. The number of deaths from Tuberculosis in 1932 was 40, of these 32 were due to pulmonary tuberculosis and 8 to other forms. Staff engaged on Tuberculosis Work. The Borough Council staff specially engaged on work directly connected with Tuberculosis and the Dispensary consists of the following:— (1) The Medical Officer of Health, who is the Administrative Tuberculosis Medical Officer. 136 (2) Tuberculosis Medical Officer, a part-time Officer of consultant status, who acts as an Assistant to the Medical Officer of Health for tuberculosis work. (3) Tuberculosis Nurse. (4) Clerk. All newly notified cases are visited by the Nurse and informed of the Dispensary facilities and they are urged to attend, if suitable cases. Medical practitioners are invited to bring or send their cases to the Tuberculosis Medical Officer for consultation and advice, and the other members of the family are examined as "contacts." X-ray Examinations. Arrangements are in operation for patients under Dispensary supervision to be X-rayed at the Hampstead General Hospital. There were 79 such examinations made during 1932. Pathological Examinations for Sputum. Arrangements have been made with the Pathological Department of the Hampstead General Hospital whereby any medical practitioner may send specimens of sputum for examination and report. This service was utilised during 1932 on 151 occasions by local practitioners (exclusive of the 83 specimens sent for examination by the Tuberculosis Medical Officer). Artificial Pneumo-thorax. Treatment of suitable cases of pulmonary tuberculosis by means of artificial pneumo-thorax is one of the important advances of recent years in attacking this disease. This treatment has the effect of collapsing the lung in the chest by injections of air, and thus putting it completely at rest. Re-fills are required at intervals to replace the air which gradually becomes absorbed. Arrangements exist for patients to receive this treatment at Brompton, Victoria Park, Colindale and University College Hospitals. During the year 1932, there were 12 patients referred to these hospitals entailing 142 attendances. Dental Treatment. Dental treatment for tuberculous patients is given by arrangement with the British Dental Hospital. Patients in need of dental aid may obtain treatment at this Hospital, 31, Camden Road, N.W.1, on Wednesdays at 11 a.m. During the year 4 patients attended and the total attendances were 19. 137 Home Nursing. The Staff of the two local District Nursing Associations are available for the nursing of requisite cases. Supply of Beds and Shelter. The Borough Council supply a shelter to any suitable case where there is accommodation for the erection of such. It was used on one occasion in 1932. The Borough Council also supply on loan single beds and bedding in order to effect the separation of infectious cases of Tuberculosis. This facility was made use of in 4 cases during the year. Public Health (Prevention of Tuberculosis} Regulations, 1925. No person suffering from Tuberculosis of the respiratory tract, and being in an infectious state, may work in connection with a dairy which would involve milking, treatment of milk, or handling milkvessels. No case arose during the year necessitating action to be taken under these Regulations. Tuberculosis Care Committee. In the year 1923 the Borough Tuberculosis Care Committee was established, and this took the place of the voluntary Tuberculosis Care Committee which had previously existed. It is representative of the following bodies :— The Borough Council. Hampstead Council of Social Welfare. London County Council. London Insurance Committee. Invalid Children's Aid Association. Local War Pensions Committee. Ex-Service Benevolent Committee. The representatives of the Borough Council are Mrs. Councillor Dow, Mr. Councillor Baily and Mr. Councillor Parkes. It works in close co-operation with the Tuberculosis Dispensary, and every case of tuberculosis coming to the Dispensary, and others of a Dispensary class, are put in touch with the Care Committee if assistance of any kind is required. The financial circumstances of all cases recommended for sanatorium treatment under the tuberculosis scheme are investigated by 138 the Committee, and the patients are assessed to pay according to their means. The subsequent collection of these voluntary payments is the duty of the Care Committee's Secretary. The Committee, through its Secretary, Miss Talbot Kelly, keeps in touch with the patient's family while he is in sanatorium and is frequently able to render practical help. When a patient is discharged from sanatorium his condition and prospects receive the consideration of the Committee, which renders any assistance that is within its powers. During the year under review the Committee dealt with 213 cases. The Municipal Tuberculosis Dispensary. The Dispensary is housed in, and forms part of, the King Edward VII Memorial (Hampstead Health Institute), situated at the junction of Kingsgate and Dynham Roads. The Dispensary is open at the following times:— Tuesdays, 2 p.m. Wednesdays, 5 p.m. Fridays, 4.30 and 8 p.m. During the year 200 sessions were held, and 215 new cases (of which 89 were contacts) were examined. The total attendances of all kinds numbered 1,029; an average of 5.2 per session. The Borough is particularly fortunate in having the services of A. J. Scott-Pinchin, M.D.(Lond.), F.R.C.P.(Lond.), as Tuberculosis Medical Officer and Assistant Medical Officer of Health for Tuberculosis Work, and whose report for the year 1932, I append herewith. 139 Municipal Tuberculosis Dispensary, 75, Dynham Road, Kilburn, N.W.6. February, 1933. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit a report on the working of the Borough Tuberculosis Dispensary for the year 1932. 359 patients attended the Dispensary during the year, and the total number of attendances was 1,029, at which 615 systematic physical examinations were made. The attendances were 131 less than last year. New applicants attending numbered 216 (21 less than the five year average), and these have been classified as shown in Sections A and B of the following table:— 140 Tuberculosis Scheme of the Hampstead Metropolitan Borough Council. Return showing the work of the Dispensary during the year 1932. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 17 19 — — 3 3 1 2 20 22 1 2 45 (b) Doubtfully tuberculous — — — — — — 1 2 1 — 4 (c) Non-tuberculous — — — — — — 19 36 12 10 77 13.—Contacts examined during the year:— (a) Definitely tuberculous 1 2 — — — — — — 1 2 — — 3 (6) Doubtfully tuberculous — — — — — — — — 2 — — 2 (c) Non-tuberculous - - - — - — — — 14 33 20 18 85 C.—Cases written off the Dispensary Register (a) Recovered — — — — — — — — — — — — (b) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) - - - - - - - - 33 70 35 29 167 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 72 84 9 8 7 18 19 14 79 102 28 22 231 (b) Diagnosis not completed — — — — — — — — 1 4 2 — 7 Number of persons on Dispensary Register on January 1st 181 Number of visits by Tuberculosis Officer to Homes (including personal consultations) 16 Number of patients transferred from other areas and of "lost sight of " cases returned 75 Number of:— Number of patients transferred to other areas and cases "lost sight of" 51 (a) Specimens of sputum, &c., examined 83 (b) X-ray examinations made in connection with Dispensary work 79 Died during the year 16 Number of Insured Persons under Domiciliary Treatment on the 31st December 24 Number of attendances at the Dispensary (including Contacts) 1029 Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1043 Number of "Recovered" cases restored to Dispensary Register, and included—in A (a) and A (b) above - Number of consultations with medical practitioners:— Number of "T.B. plus" cases on Dispensary Register on December 31st 104 (a) Personal 6 (b) Other 82 141 There have been 6 consultations with doctors in regard to patients at their homes. 82 letters have been sent to 32 doctors concerning cases referred for an opinion. I have made visits to the homes of patients in relation to 16 cases and occasional visits to New End Hospital in connection with tuberculous patients, when there have been any at that Institution. Of the cases under treatment:— 36 were referred to the London County Council for treatment in sanatoria and hospitals. 10 were admitted to New End Hospital. 3 were admitted to Victoria Park Hospital. 4 were admitted to the Hampstead General Hospital. 3 were referred to the Out-patient Department of the Hampstead General Hospital. The number of notifications has decreased, the total being 94—74 pulmonary and 20 non-pulmonary. The primary notifications were 15 less than last year, but the relative proportion of non-pulmonary cases was higher than usual. Of the total primary notifications:— 38 attended the Dispensary during the year. 14 cases were not of Dispensary class. 52 cases were notified from Hospitals or Sanatoria; this figure shews a steady increase; many of these are still attending their hospital of origin or are still in sanatoria. 14 were domestic servants. 25 cases were transferred from other boroughs. Of these, 15 attended the Dispensary, 3 died during the year and 6 removed again, thus 36 per cent. of the total were purely transitory. 16 of the primary cases notified died during the year only 4 of which had attended the Dispensary. 10 of the deaths occurred in hospital and 6 at home. A total of 40 deaths occurred during 1932, a decrease of 8. Only 16 of these were Dispensary patients and 8 were nonpulmonary cases. 142 25 died at Institutions and 15 at home, compared with 12 last year and 8 the year before, a fact somewhat to be deplored, especially as it is associated with a decreased death rate. We are no nearer a satisfactory solution for the care of the advanced case. 79 X-ray examinations have been made, this number tending to increase yearly. I have to thank the Radiologist at the Hampstead General Hospital for the uniformly good films he supplies. I have visited New End Hospital when tuberculosis cases have been admitted and have to thank Dr. Swindells for his courtesy and help in respect of these patients. Potential contacts during the year numbered 110. 41 of these have been examined, i.e., 37.3 per cent. A total of 90 contact cases were examined altogether, an increase of 15 on the five-yearly average. Reviewing the work of the past year, there are certain points of some interest to be noted. Of the 6 cases of tuberculous meningitis notified only one was in a child. Of the 10 cases notified with tuberculous glands, only 2 were children of 3 and 9 years respectively, the others ranged from the ages of 18 to 63, the average age being 33. I believe this is a good feature from the Public Health point of view. There is also to be noted a shifting of the age to a period somewhat older in that group of young women which of recent years has shown the only increased incidence of disease. Females. Year. 15-20 years. 20-25 years. 1930 4 9 1931 7 10 1932 5 16 Males. Year. 15-20 years. 20-25 years. 1930 5 10 1931 5 6 1932 1 7 Possibly this may be explained by the economic conditions, owing to which the younger girls may find it more difficult to obtain work. 143 It is generally regarded that the cause of the increased incidence of the disease in the 15-20 year old group has been due to their going out to work, a condition which did not obtain so much before the war. There has always been much discussion and a good deal of difference of opinion on the subject of the incidence of tuberculosis on the conjugal partners of tuberculosis patients. In this matter I have always held the view that marital tuberculosis is much more common than is generally supposed, and my contact with a Dispensary for a good many years has confirmed me in this opinion. Many years ago I had a tuberculous male patient who had three successive wives who died of the disease and a woman patient who had two husbands in succession who died of this complaint. A case occurring in the Dispensary practice of a cross infection, i.e., the wife, infected by a husband who died, married again and the second husband died of tuberculosis. This suggested to me the advisability of looking through the Register to determine the number of such cases which had come under observation. For this purpose the consecutive names of married patients were taken from the register, only those cases being recorded in which both husband and wife had been examined, or in which it was reasonably certain that either husband or wife had died previously of tuberculosis. The names of 166 couples were thus extracted. In 117 the first patient attending was the husband and in 49 the first was the wife. In 36 of these cases both partners were affected, i.e., 21.7 per cent. In 9 of these couples one partner had died prior to attending the Dispensary, but in 27 cases both partners were seen at the Dispensary, giving a percentage of 16.2 per cent. Of the 27 couples seen at the Dispensary, in 20 cases the husband was the first case and in 7 the wife. Of the 9 in whom one partner had previously died, in 3 cases it was the husband and in 6 the wife. Of the rest of the 166 cases inspected, in 28 cases one partner was suspect, in 8 cases the husband and in 20 cases the wife. 144 The inclusion of these cases gives a total of 38.5 per cent. of married couples in which infection had probably been passed from one to the other. From these figures it would appear that in a majority of cases the other partner becomes infected. In a large number the infection is benign and the patient recovers with an increased resistance to the disease. This tendency to recovery is dependent on several factors; the degree of infectivity of the primary cases and the resistance of the person infected. In fulminating cases or chronic cases with many bacilli in the sputum, it is usual for the partner to become badly infected, whereas in the mild case the other partner by successive small doses of the bacillus acquires a resistance to the disease. One of our cases continues to work at one of Dr. Jane Walker's Sanatoria and is keeping well. Cases for sanatoria through the London County Council have been got away without undue waiting and we are grateful to the officers in charge of that Department for their help and consideration in this respect. Miss Harrison, Secretary to the Invalid Children's Aid Association, has as usual been of great service in getting children to the country when necessary. In the following tabular statement some idea may be gained of the work done in connection with the Dispensary since its inception;— Year. No. of New Applicants. No. of New Applicants treated. No. of Contacts examined. Attendances of all kinds. 1913 1st Feb. to 31st Dec. 455 191 204 2808 1914 455 118 195 1913 1915 308 146 158 899 1916 230 165 100 1519 1917 383 183 113 1682 1918 371 105 124 1821 1919 296 85 57 1543 1920 384 221 112 2625 1921 479 127 192 2327 145 Year. No. of New Applicants. No. of New Applicants, treated. No. of Contacts examined. Total Attendances of all kinds. 1922 445 113 223 1738 1923 422 120 199 1534 1924 365 111 151 1601 1925 299 81 128 1359 1926 262 93 112 1154 1927 223 73 75 1184 1928 220 66 77 1132 1929 209 56 55 1020 1930 197 52 48 934 1931 304 90 105 1160 1932 217 47 90 1029 I have to thank the Dispensary Staff for their efficient and keen work, and Dr. Oldershaw, our Medical Officer of Health, with whom it will be a great pleasure and help to be associated in the work. A. J. SCOTT PINCHIN, M.D. (Lond.), F.R.C.P. (Lond.). Cancer. For some years past the Borough Council has been concerned with the possibility of taking action in connection with Cancer. As long ago as 1924 Conferences were held at the Town Hall between representatives of the local division of the British Medical Association and the Public Health Committee, when various matters were discussed, including the question of disinfection, the need for diagnostic aid to local practitioners, the advisability of issuing leaflets and posters, and the question of the sufficiency of hospital beds for advanced cases. As a result of these discussions certain recommendations were made to the Council who resolved as follows:— "That the Medical Officer of Health be authorised to offer disinfection after all deaths from cancer. That propaganda work among medical men be left entirely to the local profession to arrange. That propaganda work among the public at large be commenced by the cautious distribution of a leaflet drawn up by the Medical Officer of Health." 146 It was then resolved by the Council that no action at the present time on the part of the Borough Council was needed for diagnostic aid to local medical practitioners, or for the sufficiency of hospital beds for advanced cases. During 1932, Cancer was responsible for 174 deaths in Hampstead, and nearly 30,000 deaths in England and Wales. These facts would indicate that this disease demands from the State more serious attention than it has yet received. It would be a distinct advantage to humanity if, in addition to the educative propaganda which now takes place, there were facilities for the periodic examination of those (by reason of their age, sex, etc.) most likely to be affected. Again, the general practitioner should be in a position to receive specialist advice from clinics connected with hospitals where beds are immediately available for all cases requiring treatment. The Borough Health Visitors might be made use of by "following-up" certain cases at the discretion of the Medical Officer of the clinic. Although scientific investigation into the cause and treatment of Cancer continues, it would appear that at the moment the only procedure to be adopted to obtain a reduction in the number of deaths from Cancer is to secure an early diagnosis followed by immediate treatment. Hospital Beds. The Borough possesses two endowed beds at the Mount Vernon Hospital for Cancer at Northwood, Middlesex. Letters of admission to these beds are issued by His Worship the Mayor. Radium. Radium is used at the Marie Curie Hospital, 2, Fitzjohn's Avenue, and at the Westminster Hospital Annexe, 66, Fitzjohn's Avenue. 147 Deaths from Cancer by Site, Age and Sex, 1932. Males. All ages. 0- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85- Tongue 2 ... ... ... ... ... ... ... 2 ... ... ... ... ... ... Cheek (internal) 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Pharynx 3 ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... (Esophagus 3 ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... Pylorus 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stomach 9 ... ... ... ... ... ... ... 3 1 1 2 2 ... ... Rectum 7 ... ... ... ... ... ... ... ... 2 ... 1 2 ... ... Liver 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Pancreas 3 ... ... ... ... ... ... ... ... 2 ... ... 1 ... ... Colon 6 ... ... ... ... 1 ... ... 1 ... ... ... 1 2 1 Sigmoid Flexure 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Intestines (unstated) 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... Larynx 4 ... ... ... ... ... ... 1 ... 1 1 ... ... 1 ... Lung 6 ... ... ... ... ... 1 2 ... 2 ... ... ... ... ... Mediastinum 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... Kidney 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Bladder 7 ... ... ... ... ... 1 1 ... ... 3 ... 1 1 ... Prostate 8 ... ... ... ... ... ... ... 2 ... 3 ... ... 2 1 Skin of left Ear 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... Abdominal Glands 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Spinal Column 2 ... ... ... ... ... ... 1 1 ... ... ... ... ... Total 70 ... ... ... ... 1 4 6 12 11 9 6 8 10 3 Females. All ages. 0- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85- (Esophagus 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Pylorus 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Stomach 15 ... ... ... ... ... ... 1 1 ... 4 2 3 2 2 Duodenum 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Rectum 6 ... ... ... ... ... ... 1 1 1 1 1 ... ... ... Liver 4 ... ... ... ... ... ... 1 ... ... ... ... 2 1 ... Gall Bladder 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Pancreas 3 ... ... ... ... ... 1 ... ... ... 1 1 ... ... ... Caecum 2 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... Colon 13 ... ... ... ... ... ... ... 1 ... 7 2 3 ... ... Sigmoid Flexure 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Intestines (unstated) 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Larynx 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... Lung 3 ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... Mediastinum 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Cervix Uteri 4 ... 1 ... ... ... ... ... ... ... 2 ... 1 ... ... Body of Uterus 3 ... ... ... ... ... ... ... ... 1 1 1 ... ... ... Uterus (undefined) 2 ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... Ovary 5 ... ... ... ... ... ... 1 3 ... 1 ... ... ... ... Vagina 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... Vulva 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... Left Breast 5 ... ... ... ... ... ... 1 1 I 1 I ... ... ... Right Breast 5 ... ... ... 1 ... 1 ... ... 2 1 ... ... ... ... Both Breasts 2 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... Breast (undefined) 16 ... ... ... 2 1 3 1 1 2 2 ... 1 2 1 Bladder 2 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... Right Axillary Glands 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Right Humerus 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Thyroid body 2 ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... Total 104 ... 1 ... 4 2 6 n 13 10 24 11 12 7 3 148 Influenza. There were 36 deaths due to Influenza during 1932, as compared with 38 deaths during the previous year. Only 4 of these deaths occurred under the age of 45, whilst 13 were over 75 years of age. Venereal Disease. A list of hospitals at which free treatment may be obtained will be found in Section 2 of this report. Information on this subject is given under the strictest secrecy at the Public Health Department to persons who apply personally or by letter. Disinfection of clothing, bedding, etc., is carried out free of charge by the Public Health Department. Hospital Accommodation. During the year 389 patients suffering from notifiable infectious diseases (excluding tuberculosis) were removed to hospital. The great majority of the cases of fever, diphtheria, etc., were admitted to hospitals of the London County Council, while others were treated at special Institutions. Tuberculous patients requiring institutional treatment were sent to Sanatoria and Hospitals under the London County Council Scheme. Bacteriological and X-Ray Work. All bacteriological and X-ray work of the Council in connection with infectious disease is carried out by the Hampstead General Hospital. The following is a summary of the bacteriological work carried out at the Hospital during the year 1932:— Positive. Negative. Total. Diphtheria 33 322 355 Enteric Fever 1 3 4 Specimens of Sputum 33 201 234 X-ray Examinations made — — 79 Public Health Station. The Public Health Station is situated in the Electricity Yard, Lithos Road, Finchley Road, and comprises Disinfecting Station, Bathing Station and Laundry, Garage, Public Health Stores, Furnaces for destroying bedding, etc., with quarters for the resident Senior Disinfector. 149 Disinfection. The Disinfecting Station is equipped with a Washington-Lyons apparatus, and is staffed by three men, one of whom, the Senior Disinfector, is the Resident Caretaker of the Station. The collection of infected or infested material and its subsequent return are carried out by two Motor Vans. The following is a record of the work carried out by the Disinfecting Staff during 1932:— Number of houses or parts of houses and contents disinfected 1,816 „ verminous rooms disinfested .65 „ „ articles of clothing disinfested *43 „ „ beds disinfested 4 „ persons accommodated at Shelter — * Excluding the clothing of persons dealt with at the Bathing Station. Cleansing and Disinfection of Verminous Persons and their Belongings. Cleansing of Persons Act, 1897, Children Act, 1908 (Sec. 122), London County Council (General Powers) Acts, 1922 and 1928. The following cleansings and medicinal baths were carried out at the Bathing Station, which forms part of the Public Health Station, during the year :— Verminous conditions. Adults 1 Children ... 889 Scabies. Adults 31 Children ... 89 Whilst the cleansings and baths were in progress, the persons' clothing was thoroughly disinfected by being passed through the disinfecting apparatus. During the year, the Council's disinfectors disinfested 65 verminous rooms and contents, and, in addition, as a result of the action of the Sanitary Inspectors, 68 verminous rooms in 37 houses were also cleansed and freed from vermin. 150 No action was taken under Section 26 of the London County Council (General Powers) Act, 1928, which provides for the compulsory cleansing of verminous persons, nor was it found necessary to enforce Sections 59 and 105 of the Public Health (London) Act, 1891, as extended by the London County Council (General Powers) Act of 1922, under which the cleansing or destruction of filthy, etc., or verminous articles, and the cleansing of houses infested with vermin can be insisted upon. Shelter. The Council is required to provide, free of charge, accommodation with any necessary attendants, for the members of any family in which any dangerous infectious disease has appeared, who have been compelled to leave their dwellings for the purpose of enabling such dwellings to be disinfected. The Shelter consists of a small cottage devoted entirely to this purpose in the Electricity Yard, Lithos Road. It consists of three rooms, two downstairs and one upstairs, with a lavatory on each floor. It was not found necessary to house any families in the Shelter during the year. 151 INDEX. PAGE Accouchement Outfits 59 Agricultural Produce (Grading and Marking) Act, 1928 113 Ambulance Facilities 29 Analyst, Public, Report of 119 Analytical Work 105 Ante-Natal Clinics 38, 39 Anti-toxin (Diphtheria) 127 Area of Borough 11 Artificial Cream Act, 1929 108 Artificial Pneumo-thorax 136 Bacteriological Work 108, 148 Bakehouses 109 Bathing Station 148, 149 Beauchamp Lodge Home, Paddington 53 Births 18, 53 Bread, Wrapping of 109 Butter Factories 110 Cancer 145 Care Committee (see Tuberculosis). Census Statistics 12-15 Cerebro-Spinal Meningitis 127 Chemical Work 105 Child Mortality 63 Children's Hospital 37, 52 Cleansing of verminous houses, persons, etc. 72, 149 Cleansing Station (see Bathing Station). Clearance Areas 94 Clinics 30-32 Complaints Received 71 Condensed Milk 108 Consulting Obstetricians 63 Consumption (see Tuberculosis). Continued Fever 126 County Council Housing Estates 97 Creches (see Day Nurseries). Cricklewood Housing Scheme 96 Cross Roads Club, 88, Alexandra Road 52 Dairies 104 152 PAGE. Day Nurseries 66 Deaths 11, 19-21, 147 Dental Clinics, etc. 47,136 " Diamond Jubilee" Beds 29, 146 Diarrhoea and Enteritis 21 Diphtheria and Anti-toxin 127 Disinfection 149 Dog Nuisance 78 Dried Milk 108 Dysentery 127 Encephalitis Lethargica 127 Enteric Fever 127 Epidemic Diarrhœa 21, 55 Erysipelas 126 Exhumations and Re-interments 80 Factory and Workshop Acts 73-77 Food and Drugs (Adulteration) Act, 1928 105 Food and Food Premises 104, 110 Food and Milk for Mothers and Infants 64 Food, Inspection and Supervision of 101 Food Poisoning 115 Food, Preservatives in 109 Foster Home, 99, Haverstock Hill 52 Fried Fish Shops 110 Golden Yard Area 95 Hampstead Council of Social Welfare 37, 38 Hampstead General Hospital Borough Beds 29, 146 Hampstead Hospital for Children (late Northcourt) 37, 52 Hampstead Hostel for Mothers and Babies 52 Hampstead Housing Association 93 Health Education and Propaganda 81 Health Services 27 Health Visitors, Work of 48, 49 Home Office Tables (Factory and Workshop Act, 1901) 74, 75 Home Workers 75,77 Hospitals 29 Hospital accommodation 148 Hospital Beds, Borough Jubilee Beds 29, 146 Hospitals connected with Public Health Department 29,36 Houses Let in Lodgings (see Tenement Houses, &c.). Housing Committee 3, 95 Housing Conditions where births occurred 53-54 Housing Section 85 Ice Cream 105, 110 Illegimate Children 19 Imported Foodstuffs 111 153 PAGE. Improper Mixing of Sexes 93 Infant Welfare Centres 30, 38 Infantile Mortality 23,59 Infectious Diseases 125 Influenza 148 Inspections and Re-inspections. 71 Institutions for Unmarried Mothers and for Infants 52 Invalid Children's Aid Association 66 King's College Mews West Area 95 Laboratory Work 28 Legal Proceedings 78 Margarine, Wholesale Dealers 107 Malaria 128 Marriages 17 Maternal Mortality 61 Maternity and Child Welfare 35 Maternity and Child Welfare Centres 30, 38 Maternity and Child Welfare Committee 3 Maternity, Clinics (see Ante-Natal Clinics). Maternity Homes and Hospitals 49, 51 Measles 128 Meat, Inspection, and Meat Regulations, 1924 109 Medical Investigation Sub-Committee 63 Merchandise Marks Act, 1926 110 Meteorology 16 Midwives and Midwifery Nursing 27, 59 Milk and Dairies (Amendment) Act, 1922 101 Milk and Dairies (Consolidation) Act, 1915 101 Milk and Dairies Order, 1926 101 Milk and Food for Mothers and Infants 64 Milk and Milkshops 101 Milk, Condensed or Dried 108 Milk (Special Designations) Order, 1923 101 Mortuary, Public 79 Mount Vernon Hospital Borough Beds 29, 146 Municipal Dwellings 98 National Council for the Unmarried Mother and her Child 37 New End Hospital 29, 86, 49 Notification of Births Act, 1907 53 Nursing Associations and Facilities 27, 36, 59 Offensive Trades 110 Officials, Public Health 4 Ophthalmia Neonatorum 55 Outworkers (see Home Workers). Overcrowding 91 Park Dwellings 98 154 PAGE. Pathological examinations for Sputum 136 Pigeon Nuisance 80 Pneumonia, Acute Primary and Acute Influenzal 129 Population 17 Population, Density 11 Population, Natural Increase of 12 Pre-Maternity Clinics (see Ante-Natal Clinics). Preservatives, &c., in Food Regulations, 1925 and 1926 109 Public Health Committee 3 Public Health Station 148 Public Health (Tuberculosis) Regulations, 1925, 1930 133 Public Vaccinators 4 Puerperal Fever and Pyrexia 55 Puerperal Sepsis 11, 23 Queen Charlotte's Hospital 51 Queen Mary's Maternity Home, Heath Street 51 Rag and Bone Dealers 73 Rag Flock Acts 81 Rats and Mice (Destruction) Act, 1919 78 Rent Restriction Acts 73 Restaurant Kitchens 110 St. Mary's Convalescent Home, Birchington 51 Sale of Food Order, 1921 109 Sanitary Inspectors, Work of 71, 74 Scabies 149 Scarlet Fever 129 School Entrants and School Medical Inspection 55-58 Shelter 137, 150 Slaughterhouses 109 Small Dwellings Acquisition Acts 97 Smallpox 129 Smoke Abatement 72 South End Close 98 Staff of the Public Health Department 4, 27 Stamford Place Area 94 Still Births 54 Street Traders 103, 104 Summary of Vital Statistics 11 Tenement Houses and Bye-laws 72, 90 Toddler Clinics 31, 38 Treatment Centres 30 Tuberculosis 132 Tuberculosis Care Committee 137 Tuberculosis Dental Clinic 136 Tuberculosis Dispensary 138 Tuberculosis Medical Officer, Report of 139 155 PAGE. Tuberculosis Regulations, 1925, 1930 133 Underground Rooms 93 Unmarried Mothers 52 Vaccination and Vaccination Order, 1930 130, 131 Vaccination Officer 131 Venereal Diseases, Clinics and Treatment Centres 148 Verminous Persons and Premises, etc. 72, 149 Vital Statistics 11, 17-23 " Warranty" Defence 107 Water Supply of Tenement Houses 73 Welfare Centres 30 Whooping Cough 132 Widows', Orphans', &c., Act, 1925 67 Workshops (see Factory and Workshops Acts). X-ray Work 136 Young Children, Mortality among 23, 59