AC 4351 HAMP34 the Metropolitan Borough of Hampstead. REPORT for the year 1933 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. F. P. Lewingdon, 26 & 27, Eversholt Street, London, N.W.1. 67323 the Metropolitan Borough of Hampstead. REPORT for the year 1933 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. 2 CONTENTS. PAGE Lists of Committees concerned with the work of the Department 3 Staff of the Public Health Department 4 Introduction 5 SECTION I.—Statistics and Social Conditions of the Borough 11-17 ,, 2.—General Provision of Health Services in the Borough 21-23 ,, 3.—Maternity and Child Welfare (including the Report of the Medical Officer of the Ante natal Clinics) 27-49 ,, 4.—Sanitary Circumstances of the Borough 53-62 „ 5.—Housing 65-72 „ 6.—Inspection and Supervision of Food (including the Report of the Public Analyst) 75-87 ,, 7.—Prevalence of, and Control over, Infectious and other Diseases (including Tuberculosis and the Report of the Tuberculosis Medical Officer) 91-113 INDEX 114-118 3 List of Committees concerned with the work of the Department. His Worship the Mayor (Mr. Alderman W. P. Newman, j.p., f.s.i., F.a.i.), ex-officio member of Committees. PUBLIC HEALTH COMMITTEE. Chairman : Mr. Councillor L. G. Glover, m.a., m.d. Mr. Alderman W. J. Spriggs. „ Councillor J. A. A. Atlan, m.p.s. m.i.c.o. „ „ S. A. Boyd, m.s., m.b., f.r.c.s. „ „ S. M. Copeman, m.a., m.d., f.r.c.p., f.r.s. Mr. Councillor R. H. H. Cust, m.a., j.p. Councillor Mrs. M. F. Dow, m.a. „ „ M. Evans, r.r.c. Councillor Miss A. M. Glover. Mr. Councillor T. H. Nunn, m.a. „ „ E. H. Parkes, F.r.i.b.a. Councillor Miss C. M. Richards. The Chairman of the Maternity and Child welfare Committee. Sub-Committees:—(a) Drainage Plans, and (6) Tuberculosis. MATERNITY AND CHILD WELFARE COMMITTEE. (Members of the Council.) Chairman: Councillor H. Baily, m.b.E. Councillor Mrs. A. J. Arnholz. Mr. Councillor S. A. Boyd, m.s., m.b., f.r.c.s. Councillor Mrs. R. S. G. Carnegie. Mr. Councillor S. M. Copeman m.a., m.d., f.r.c.p., f.r.s. Councillor Mrs. M. Evans, r.r.c. Councillor Miss A. M. Glover. Mr. Councillor T. H. Nunn, m.a. Councillor Miss C. M. Richards. Mr. Councillor B. S. Townroe, m.a., j.p. Councillor Mrs. M. Townroe. The Chairman of the Public Health Committee. (Persons not Members of the Council.) (Appointed in pursuance of Section 2 (2) of the Maternity and Child Welfare Act, 1918.) Mrs. J. M. W. Baily, d.sc. Mrs. E. S. Grundy. Miss G. M. MacDonald. Mrs. P. Ruff. Lady H. K. Thompson. Sub-Committees:—(a) Applications for Assistance, and (b) Child Mortality and Maternal Diseases. HOUSING COMMITTEE. Chairman : Mr. Alderman F. G. Howard, j.p., l.c.c. Councillor Mrs. Arnholz. Mr. Councillor F. R. Bailey. „ „ H. Baily, m.b.e. ,, „ J. Batchelor. „ „ R. H. H. Cust, m.a., J.P. Councillor Mrs. M. F. Dow, m.a. „ „ M. Evans, r.r.c. „ „ K. I. Fisher, l.r.a.m., a.r.c.m. Mr. Councillor L. G. Glover, m.a., m.d. R. C. Griffith. Councillor Mrs. M. I. Gruner. Mr. Councillor G. C. Hutchinson, m.a. Councillor Mrs. A. Moody, J.P. Mr. Councillor E. H. Parkes, f.r.i.b.a. „ „ J. M. Symmons, m.a. 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.). *Medical Officer, Ante-Natal Clinics—Miss Mary Kidd, m.b., b.s. (Lond.). †Medical Officers, Maternity and Child Welfare Centres and Toddlers' Clinics— Miss R. Balmer, o.b.e., m.b., b.s. (Lond.). Miss M. Blandy, m.b., m.r.c.p. (Lond.). Mrs. A. Hall-Craggs, m.r.c.s., l.r.c.p. (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 (d). A. J. Anscomb. Miss E. M. Blakeman. Miss E. Selwood. Health Visitors—Mrs. I. G. Steward (c) (Senior Visitor) Miss H. B. Evans (a), (b), (c) Miss A. Kennedy (a) Miss C. Lambe (a), (b), (c), (d) Miss M. Lowen (b) (Tuberculosis Visitor and Dispensary Nurse) Miss P. Reymond (a), (c), (d) Sanitary Inspectors—F. H. Hudson (d), (e) (Senior of the Inspectors) J. F. Armstrong (d), (e) J. Grimsley (d), (e) W. F. Horniblow (d), (e) A. Peverett (d), (e) Miss P. Reymond (a), (c), (d) (Factories and Workshops) A. C. Townsend (d), (e) J. Cuskin (Assistant to Inspectors) R. Martin (Assistant to Inspectors and Mortuary Keeper) E. Stratton (Assistant to Inspectors) Public Health Station Staff—W. Bell (Senior Disinfector and Resident Caretaker) W. Day (Disinfector) J. R. Williams (Disinfector) *Mrs. Blanden (Bathing Station Attendant) *Public Analyst—H. E. Cox, D.SC., ph.d. (Lond.), F.I.C.., 11, Billiter Square, E.C.3. *Public Vaccinators—W. Butement, m.b., b.s. (N.Z.), 1, Lyncroft Gardens, N.W.6. 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. * Part-time Officers, † Part-time Officers of Council of Social Welfare approved by the Maternity and Child Welfare Committee. (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 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. 17th April, 1934. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit my Annual Report upon the state of the public health in the Metropolitan Borough of Hampstead for the year 1933, which is the thirty-third of the series. The report contains the information required by the Ministry of Health, and is arranged in accordance with their suggestions. A complete survey of the Health Services in the Borough was carried out by officials of the Ministry of Health during the year. Dr. Jane Turnbull inspected the Maternity and Child Welfare Section in February, and Dr. N. Beattie inspected the other services in May and June. The report of their survey was, however, not to hand at the conclusion of the year, but will be referred to in my Annual Report for 1934. The death rate in Hampstead for 1933 was 11.0 per 1,000 of the population as compared with 12.3 for England and Wales. The birth rate of 9.6 per 1,000 of the population is the lowest yet recorded in Hampstead, but is compensated in part by the low infantile mortality figure (viz.: 38 per 1,000 births, c.f. 64 for England and Wales). The incidence of infectious disease during 1933 was higher than in the preceding year. There were 451 cases of Scarlet Fever, but all were fortunately of a mild type. It is most important that full advantage should be taken of the recent researches in preventive medicine for the protective immunisation of the individual against Diphtheria and Scarlet Fever. The arrangements which have been 6 made during the year in Hampstead with this end in view are contained in the body of the report. It is hoped to extend these services during the forthcoming year. The outcome of the discussions between the Borough Council and the Voluntary Bodies associated with maternity and child welfare services are referred to on pages 35-37. These negotiations have resulted in a marked increase in co-operation with the resulting improvement of the service. A weekly Central Dental Clinic is now established at the Public Health Station, Lithos Road, and also a Toddlers' Clinic is held weekly on alternative sides of the Borough. In June last the Maternity and Child Welfare Committee appointed an additional health visitor to assist in the expansion of these services. During the year the Transfer of Powers (London) Order, 1933, resulted in the transfer of the supervision of foster-children and foster-mothers from the London County Council to the Hampstead Borough Council. By the end of the year under review detailed investigations and reports had been completed by this Department on the various " Areas " for treatment under the Housing Act, 1930. Simultaneously, the Housing Committee had made marked progress in their scheme for the erection of 300 working-class dwellings, which will fructify during the forthcoming year. The important work under the Tenement House Bye-laws of the London County Council is still unfortunately curtailed, owing, in part, to the reduction in staff since 1929, and in part to the increased duties devolving on this Department due to new legislation. During the year 496 samples of food and drugs were submitted by this Department to the Borough Analyst, H. E. Cox, Esq., D.Sc., Ph.D., for analysis. The results were most gratifying in so far as only 18 were unsatisfactory. In London, at any rate, there is no doubt that the quality of milk retailed has improved considerably during the last decade. However, the time is overdue for the establishment of legal standards and definitions for very many food commodities which are in common use by the working classes, and to this end a Departmental Committee on Food Law is now sitting. 7 Mr. E. L. Hawke, M.A., F.R.M.S., has again very kindly provided me with a brief Meteorological Survey of the Borough for the past year. The information contained therein is of great interest when read in conjunction with Section VII of this report, which deals with Infectious Diseases, and particularly having regard to the observations of the Tuberculosis Officer on page 112. In conclusion, I wish to tender my thanks to the Chief Officials for their invaluable co-operation, and also to the members of the Committees on which I serve for their support. In particular, my best thanks are due to the whole staff of the Public Health Department for their loyal work. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. LESLIE OLDERSHAW, Medical Officer of Health. Section I. Statistics and Social Conditions of the Borough. 11 Statistics and Social Conditions of the Borough. Area (in acres) ... 2,265 (including 12 acres covered by water). Registrar-General's estimate of resident population, 1933 ... 90,380 Number of inhabited houses (end of 1933) according to Rate Rooks— 9,775 dwelling houses, 2,750 maisonetted and divided houses, 2,750 separate flats, 2,835 shops and offices. Rateable value £1,483,263. Sum represented by a penny rate £5,876 1s. 8d. Extent of Unemployment. I am indebted to the Chief Officer of Public Assistance of the London County Council for the following information relating to the year 1933, which was extracted from the periodical returns received by the County Council from the Statistical Branch of the Ministry of Labour :—The number of men registered as unemployed varied from 889 in August to 1,768 in January, and the unemployed women from 235 in December to 312 in February. Calculated upon the number of insured people in the Borough, the lowest number was 4.9 per cent. in December and the highest 9.1 in January. Extracts from Vital Statistics of the Year. Live Births Total. M. F. Legitimate 776 380 396 Illegitimate 88 41 47 Birth Rate per 1,000 of the estimated resident population—9.6. Stillbirths 29 14 15 Rate per 1,000 total (live and still) births—32. Deaths 994 457 537 Death Rate per 1,000 of the estimated resident population—11.0. Deaths from puerperal causes Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis Nil. Nil. Other puerperal causes Nil. Nil. Total Nil. Nil. 12 Death Rate of Infants under one year of age:— All infants per 1,000 live births 38 Legitimate infants per 1,000 legitimate live births 27 Illegitimate infants per 1,000 illegitimate live births 136 Deaths from Measles (all ages) Nil. „ Whooping Cough (all ages) 3 „ Diarrhoea (under 2 years of age) 6 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 report on meteorology in Hampstead during the year 1933, which is based on records kept at that Society's Observatory on the top of Hampstead Heath adjoining the White Stone Pond :— " The chief characteristics of the weather during 1933 were the dearth of rain, the excess of sunshine, the persistence of abnormally high temperature from spring to autumn, and the severe December. Only 1861 ins. of rain was measured during the year, the fall being 998 ins., or 35 per cent. short of the annual average for the period 1910-1929. Continuous records of this climatic element have been kept on or near the summit of Hampstead Hill since 1863—at Squire's Mount until 1909, and at the Observatory from 1910 onwards. The statistics show that four years out of the seventy-one have been drier than 1933:—1921, with 15.50 ins.; 1898, with 17.17 ins.; 1904, with 17.65 ins.; and 1893, with 18.55 ins. Rainfall last year was below normal in every month except March, May and September. The monthly measurements ranged from 2.68 ins. in September to 0.39 in. in December. There were, in all, 154 days on which at least 0.01 in. of precipitation in any form was registered, this number being 24 in defect of the average. Snow occurred on 23 days, hail on three, and thunderstorms, or thunder alone, on 15 (14 of which were in the first half of the year). September 24th was the wettest day, with 0.75 in. of rain. The duration of sunshine for the year was 1,735.5 hours, an amount which exceeds the normal by 245.5 hours. Slightly higher annual totals have been obtained on three occasions since 1910, when registration was begun, the maximum being 1,7547 hours in 1911, 13 Every month from January to April and from June to September was brighter than usual last year, while both March and August established new records. June was the sunniest month (255.7 hours), and December the dullest (34.4 hours). The number of days with measurable sunshine (three minutes or more) was 294, as compared with the normal of 290. Each of June's first eight days yielded at least 12½ sunny hours, and June 7th gave the greatest daily duration for the year—14.5 hours, or 88 per cent, of the maximum possible. The mean temperature of 1933, 49.9 deg., was 0.9 deg. above the average for the twenty years 1910-1929, and about 1.7 deg. above what is computed to be the true average for the district. A remarkable period of persistent warmth set in during the early spring and continued with little interruption until mid-autumn. Each month from March to October proved warmer than usual. The mean temperature of the meteorological summer (June to August) was 63.6 deg., 3.7 deg. above normal, and had only once been equalled or exceeded in the Observatory records. This occasion was in 1911, when the corresponding figure was 63.7 deg. The monthly values for these two memorable summers are here appended for comparison :— Mean Temperature. 1933. 1911. Normal. deg. deg. deg. June 60.2 57.8 57.7 July 65.3 66.3 61.3 August 65.4 66.9 60.6 It will be seen that in each instance August was the hottest month, by a narrow margin over July, which ordinarily gains that distinction. Both the first two and the last two months of 1933 were, on the whole, cold. December was notably severe, giving a mean temperature of 33.3 deg.—6.7 deg. below normal. Ground-frost occurred on every night (a very uncommon event), but did not attain exceptional intensity. There were only three days on which the Sheltered thermometer rose to 40 deg., and the absolute maximum, 42.7 deg. on the 22nd, was 4 deg. lower than that of any other calendar month back to 1910. In all probability this was in Hampstead. as in other parts of London, the coldest December since 1890. 14 The extreme temperatures for 1933 were :— Maximum in the screen, 90.5 deg., on August 6th. Minimum in the screen, 22.4 deg., on January 23rd. Minimum on the grass, 13.0 deg., on January 23rd. There were 146 nights with ground-frost during the year. Skating was in progress on one or more of the Hampstead ponds for some days during the second half of January, and again in December. The heaviest snowstorm of the year was that of February 24th-25th. This covered the ground to the depth of only a few inches in Hampstead, but the heights of the Chilterns, less than 25 miles to the north-west, lay under fully two feet of snow when the storm ended." Town Planning. Three Town Planning Schemes have been applied to Hampstead during 1933. These aim at protecting the existing amenities of the major portion of the Borough, and, what is of special importance, of the open spaces of Hampstead, Parliament Hill Fields and Ken Wood; and enables development and redevelopment in the vicinity to be guided and controlled so as to ensure that the character and design of the buildings will be in harmony with the neighbourhood and that the amenities of the district shall not only escape injury but also be improved. It is gratifying to find that safeguards have been secured so that the enjoyment of the existing open spaces will not be seriously interfered with by the improper development of surrounding properties, and that future alterations in the Borough will be adequately controlled. VITAL STATISTICS. Population. For the purpose of this Report the Registrar-General's estimate of the population at the middle of 1933, which was calculated to have been 90,380, has been adopted. This shows an increase of 1,433, as compared with 88,947 at Census, 1931. 15 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) 14,620 No. 3 (Adelaide) 11,300 No. 4 (Central) 10,780 No. 5 (West End) 14,350 No. 6 (Kilburn) 15,340 No. 7 (Priory) 11,340 The Borough 90,380 Deaths. The total nett deaths during 1933 numbered 994, as compared with 1,043 in the preceding year. These 994 nett deaths represent a "recorded" death rate of 11.0 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 nonresident persons, and, after subtracting these, adding the number of deaths of Hampstead residents who died outside the Borough. The following are the statistics for each of the Wards and the Borough :— No. of Deaths. Death Rate. No. 1 (Town) Ward 151 11.9 No. 2 (Belsize) „ 132 9.0 No. 3 (Adelaide) „ 131 11.6 No. 4 (Central) „ 105 9.7 No. 5 (West End) „ 158 11.0 No. 6 (Kilburn) „ 189 12 .3 No. 7 (Priory) „ 128 11.3 The Borough 994 11.0 The death rates for London and for England and Wales were 12 2 and 12 3 respectively. 16 Age and Sex Allocation of Deaths of Hampstead Residents during the Year 1933. 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. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1. Typhoid and Paratyphoid Fevers M ... ... ... ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 2. Measles M ... ... ... ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough M 2 ... 1 1 ... ... ... ... ... ... ... ... f 1 ... ... 1 ... ... ... ... ... ... ... ... 5. Diphtheria M 2 ... ... 1 1 ... ... ... ... ... ... ... F 1 ... ... ... 1 ... ... ... ... ... ... ... 6. Influenza M 26 ... ... 1 2 1 3 1 5 3 7 3 f 28 ... ... ... ... 1 1 3 2 4 2 15 7. Encephalitis Lethargica M ... ... ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 8. Cerebro-spinal Fever M 2 ... ... ... 1 ... ... 1 ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 9, Tuberculosis of respiratory system M 22 ... ... ... ... 4 3 6 3 3 2 1 f 15 ... ... ... ... 6 4 2 1 1 1 ... 10. Other Tuberculous Diseases M 2 ... ... ... 1 ... 1 ... ... ... ... ... f 1 ... ... ... ... ... 1 ... ... ... ... ... 11. Syphilis M 3 ... ... ... ... ... 1 ... ... ... 2 ... F 2 ... ... ... ... ... ... ... 1 ... 1 ... 12. General paralysis of the insane, tabes dorsalis M 5 ... ... ... ... ... ... 1 2 1 1 ... f 1 ... ... ... ... ... ... ... 1 ... ... ... 13. Cancer, malignant disease M 65 ... ... ... ... ... 1 2 9 17 16 20 f 82 ... ... ... ... ... ... 7 14 19 26 16 14. Diabetes M 5 ... ... ... ... ... ... ... ... 1 ... 4 f 16 ... ... ... 1 ... ... ... ... 4 4 7 15. Cerebral hæmorrhage, &c. M 7 ... ... ... ... ... 1 ... ... 1 3 2 f 12 ... ... ... ... ... ... ... 2 3 4 3 16. Heart Disease M 117 ... ... ... ... ... 1 5 10 19 36 46 f 138 ... ... ... ... ... 3 2 11 15 34 75 17. Aneurysm M 2 ... ... ... ... ... ... ... ... 1 ... 1 f 3 ... ... ... ... 1 ... ... ... 2 ... ... 18. Other circulatory diseases M 31 ... ... ... ... ... ... 1 1 6 13 10 f 27 ... ... ... ... ... ... ... 3 1 10 13 19. Bronchitis M 11 1 ... ... ... ... ... ... ... 2 5 3 f 16 ... ... ... ... ... ... ... ... 3 2 11 20. Pneumonia (all forms) M 23 2 ... ... 1 ... 2 1 2 9 4 2 71 f 26 3 1 2 1 1 1 2 1 1 6 7 11 21. Other Respiratory Diseases M 3 ... ... ... ... ... 1 ... ... 1 ... 1 f 10 ... ... ... 1 ... ... 1 1 1 2 4 22. Peptic Ulcer M 9 ... ... ... ... ... ... ... 4 2 2 1 f 7 ... ... ... ... ... ... ... 2 4 1 ... 23. Diarrhoea, &c M 1 1 ... ... ... ... ... ... ... ... ... ... f 7 5 ... ... ... ... ... 1 ... ... ... 1 24. Appendicitis M 5 ... ... 1 ... 2 1 ... ... ... ... ... f 8 ... 1 ... 1 ... ... ... 2 2 2 ... 25. Cirrhosis of Liver M ... ... ... ... ... ... ... ... ... ... ... ... f 3 ... ... ... ... ... ... ... 1 1 ... 1 26, Other diseases of liver, &c. M 1 ... ... ... ... ... ... ... ... 1 ... ... f 2 ... ... ... ... ... ... ... ... 1 1 ... 27. Other digestive diseases M 15 1 ... ... 1 ... 2 ... 4 1 1 1 f 14 ... ... ... 1 1 ... ... 2 7 3 ... 28. Acute and Chronic Nephritis M 16 ... ... ... ... ... 2 ... 3 5 4 1 f 20 ... ... ... ... ... ... ... 2 4 7 1 29. Puerperal Sepsis f ... ... ... ... ... ... ... ... ... ... ... ... 30. Other puerperal causes f ... ... ... ... ... ... ... ... ... ... ... ... 31. Congenital Debility, premature birth, malformations, &c. M 6 6 ... ... ... ... ... ... ... ... ... ... F 11 11 ... ... ... ... ... ... ... ... ... ... 32. Senility M ... ... ... ... ... ... ... ... ... ... ... ... F 6 ... ... ... ... ... ... ... ... ... 1 5 33. Suicide M 10 ... ... ... ... 1 1 2 2 2 1 1 F 12 ... ... ... ... 2 1 3 1 5 ... ... 34. Other violence M 18 ... ... ... ... 4 3 3 :( 1 3 1 F 21 2 1 ... ... ... 1 2 2 4 2 7 35 Other Defined Diseases M 47 ... ... 1 ... 1 3 2 2 3 13 22 F 47 1 1 1 2 ... 3 5 7 7 9 11 36. Causes ill-defined or unknown M 1 ... ... ... ... 1 ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... All causes M 457 11 1 5 7 14 26 25 51 79 113 125 F 537 22 4 4 8 12 15 28 56 89 118 181 Totals 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. Proportions of deaths from principal causes 1933 17 Table showing the Birth, Death and Infantile Mortality rates during 1933 in the Metropolitan Cities and Boroughs:— Birth Rate. Death Rate. Infantile Mortality Rate. City of London 77 Lewisham 10.2 Hampstead 38 City of Westminster 8.7 City of London 10.9 Lewisham 39 Holborn 9.4 Hampstead 11.0 Stoke Newington 46 Hampstead 9.6 Woolwich 11.2 Battersea 49 St. Marylebone 9.7 Hackney 11.5 Camberwell 49 Chelsea 10.6 Wandsworth 11.5 Finsbury 50 Wandsworth 10.9 Greenwich 11.9 Wandsworth 50 Kensington 12.0 Deptford 12.1 Hackney 51 Lewisham 12.2 St. Marylebone 12.2 Deptford 54 Stoke Newington 12.6 Camberwell 12.3 Poplar 54 Woolwich 12.6 Stoke Newington 12.3 St. Marylebone 56 Fulham 13.1 Islington 12.4 St. Pancras 58 Camberwell 13.3 Poplar 12.4 Bermondsey 61 Paddington 13.4 City of Westminster 12 4 Woolwich 62 Lambeth 13.6 Battersea 12.5 Islington 63 St.. Pancras 13.6 Bermondsey 12.5 Lambeth 63 Greenwich 13.7 Bethnal Green 12.5 Southwark 63 Hammersmith 13.9 Finsbury 12.8 City of London 65 Bermondsey . 14.0 Hammersmith 12.9 Fulham 65 Hackney 14.0 Kensington 12.9 Hammersmith 65 Southwark 14.2 Stepney 12.9 Stepney 65 Bethnal Green 14.3 Fulham 13.0 Bethnal Green 66 Islington 14.3 Shoreditch 13. 0 Greenwich 66 Battersea 14.7 Lambeth 13.1 City of Westminster 68 Deptford 14.8 Paddington 13.4 Holborn 70 Finsbury 15.1 Holborn 13.5 Kensington 72 Stepney 15.1 Chelsea 13. 6 Shoreditch 74 Poplar 15 .4 St. Pancras 13.7 Chelsea 78 Shoureditch 16.0 Southwark 13.9 Paddington 85 County of London 13. 2 County of London 12.2 County of London 59 Section 2. General Provisions of Health Services in the Borough. 21 General Provisions of Health Services in the Borough. 1.—Staff. A list of the staff of the Public Health Department will be found on page 4 of this report. Miss Hilda B. Evans was appointed as an additional health visitor and began her duties on the 14th August. Under the re-arrangement of duties referred to in the Maternity and Child Welfare Section of this report, part of the services of Miss Reymond, Woman Sanitary Inspector, have been given to the duties of health visitor. Miss Reymond has the necessary qualifications and experience. 2.—Laboratory Facilities. The examination of clinical material (sputum, swabs, etc.) is undertaken by the Hampstead General Hospital at their Laboratory at the Hospital in 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. 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 page 79. 3.—Ambulance Facilities. The London County Council provide ambulances free of cost for the conveyance of:— (a) Persons meeting with accidents or suffering from sudden illnesses. (b) Parturient women, if the cases are urgent and accompanied by the medical practitioner or certified midwife. (c) Non-urgent cases of parturition occurring between the hours of 11 p.m. and 8 a.m., if letters of admission to maternity hospitals are produced. (d) Persons suffering from infectious diseases who are to be transferred to the Council's fever hospitals. (e) For conveyance to general hospitals and institutions of non-infectious cases when application is made through the County Council's public assistance department. The London County Council Ambulances may also be hired (10s.) for places other than their hospitals, 22 4.—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, to the extent of 2s. 6d. per visit for the first case in a family, and 1s. 3d. per visit for second and subsequent cases, if visited at the same time. During 1933, 51 cases were nursed under this arrangement by the Kilburn and West Hampstead District Nursing Association, and 39 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. 5.—Clinics and Treatment Centres. (a) Infant Welfare Centres, Ante-natal Clinics, Dental Clinics, vide pages 32, 37 and 39. (b) School Clinics:—Kilburn School Treatment Centre, 107, Kingsgate Road; New End Hospital School Treatment Centre, Heath Street. (c) Tuberculosis Clinics, vide page 108. (d) Venereal Diseases. 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, including the following hospitals:—Guy's; Children's Hospital, Great Ormonde Street; Middlesex; Royal Free; Royal Northern; St. George's; St. Mary's; University College; Westminster. 6.—Hospitals. (a) Public :—New End Hospital (260 beds); North-Western Fever Hospital (410 beds). 23 (b) Voluntary :—Hampstead General and North-West London Hospital (138 beds); Children's Hospital, College Crescent (63 beds); Queen Mary's Maternity Home (17 beds); Marie Curie Hospital, Fitzjohn's Avenue (30 beds); Westminster Hospital Annexe, Fitzjohn's Avenue (22 beds); and St. Columba's Hospital, Avenue Road (50 beds). The Borough possesses two endowed beds at both the Hampstead General Hospital and the Mount Vernon Hospital, Northwood, and in addition the Council contributes towards the cost of beds in Queen Charlotte's Hospital, Marylebone, which are available for Hampstead residents. Section 3. Maternity and Child Welfare. 27 Maternity and Child Welfare. The duties imposed upon the Council by the Maternity and Child Welfare Act are among its most important functions. These duties form part of a great movement having for their ultimate object the building up of a healthy nation. A notable feature of the work, characteristic of our people, is the fact that it is being achieved without any coercion or threat of legal proceedings, the only branch in which the demands of the law are in evidence being that relating to Infant Life Protection. This being the case, it is evident that endless tact and persuasion must be exercised by the staff engaged in the work. It is not easy to estimate the amount of suffering and disability which is prevented by this work among women and children, nor to what extent the home visits of the Health Visitors ultimately result in improvements in the hygienic conditions of the homes; but that considerable good does result does not admit of argument. Maternity and Child Welfare activities have developed pari passu with the appreciation of the fact that physical health is of first and vital importance to the nation, and with the knowledge that it is false economy to refrain from dealing with these matters until public health work, instead of being preventive, becomes curative. Live Births. During 1933, 864 live births of Hampstead children were registered. In the following tables, these 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 620 78 698 608 81 689 1228 159 1387 Add number occurring outside the Borough whose mothers were Hampstead residents 110 12 122 125 21 146 235 33 268 Deduct number who could not be deemed to belong to Hampstead 730 90 820 733 102 835 1463 192 1655 350 49 399 337 55 392 687 104 791 Nett number belonging to Hampstead, 1933 380 41 421 396 47 443 776 88 864 Nett births, 1932 490 40 530 400 51 451 890 91 981 28 There was no Natural Increase in population, i.e., excess of births over deaths. The following are the statistics for each of the Wards and the Borough :— No. of Births. Birth rate. No. 1 (Town) Ward 105 8.3 No. 2 (Belsize) „ 125 8.5 No. 3 (Adelaide) „ 91 8.0 No. 4 (Central) „ 55 5.1 No. 5 (West End) „ 142 9.9 No. 6 (Kilburn) „ 249 16.2 No. 7 (Priory) „ 97 8.5 The Borough 864 9.6 The birth rate for London and for England and Wales were 13.2 and 14.4 respectively. Legitimate and Illegitimate Births. Of the total 864 nett live births belonging to Hampstead, 776 were those of legitimate and 88 of illegitimate children, the latter being at the rate of 102 per 1,000 births. 33 of the Hampstead illegitimate infants were born outside the Borough, chiefly in Lying-in Institutions. Still Births. During 1933, the nett number of registered still births for Hampstead was 29. In the following Table the still births for 1933 have been distributed according to sex, etc.:— STILL BIRTHS. MALES. FEMALES. TOTALS. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Registered in the Borough 19 8 27 22 2 24 41 10 51 Add number occurring outside the Borough whose mothers were Hampstead residents 2 1 3 2 1 3 4 2 6 Deduct number who could not be deemed to belong to Hampstead 21 9 30 24 3 27 45 12 57 14 2 16 11 1 12 25 3 28 Nett number belonging to Hampstead, 1933 17 7 14 13 2 15 20 9 29 Nett Still Births, 1932 9 3 12 11 3 14 20 6 26 29 Infantile Mortality. During 1933, 33 infants under one year of age died; the infantile death rate was 38 per 1,000 live births as compared with the rate of 54 in 1932. Deaths of Young Children. During 1933, 47 deaths occurred of children under 5 years of age. This is equivalent to a rate of 9.8 per 1,000 live children born in that and the four preceding years. Maternal Deaths. No maternal death occurred during the year 1933. 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:— Number of Births notified under the Notification of Births Act, 1907, as adjusted by any transferred notifications. Live Births 927 Still Births 26 Total 953 Notified by Midwives 371 „ „ Doctors and Parents 582 Total 953 Of the total nett births only 38 per cent. occurred at the usual place of residence of the mother. Information has been recorded, wherever possible, of the housing conditions of families in which a birth occurred at home. The follow- Information has been recorded, wherever possible, of the housing conditions of families in which a birth occurred at home. The follow- 30 ing table shows an analysis of 222 instances where these births were visited, and where the information was obtainable :— 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. l 2 — — — — — — — — 2 6 27 32 l 2 — — — — 3 3 33 25 12 — 4 — — — 4 1 16 19 3 1 — — 1 — 5 — 4 5 4 1 — — — — 6 — 3 2 4 — — — — — 7 — — 1 3 — 1 — — — 8 — — — — 1 — — — — 9 — — 2 1 — — — 1 — 10 — — — 1 — — — — — Totals 12 83 86 29 5 5 — 2 — The newly-born baby has not been included in the above. Of these 222 births:— 5.4 per cent. occurred in 1-roomed tenements. 37.4 „ „ 2 „ 38.7 „ „ 3 „ The table shows the limited housing conditions in some of the tenements where babies are born at home. It demonstrates that of 222 babies, 12 were born in one-roomed tenements and 83 in tworoomed tenements. In 1 one-roomed tenement where 4 persons were already living a baby was born. With regard to two-roomed homes, in 4 instances 5 persons were already inhabiting the rooms prior to the birth of the baby, and in 3 cases the baby's advent raised the number of occupants to 7. In 1 three-roomed tenement there were 7 persons occupying the rooms before the birth, and in 2 cases there were 9. Health Visiting Staff. On the 25th May, 1933, the Council gave consideration to the question of increasing the staff of Health Visitors. This matter had been raised by me in a Special Report that I had prepared on the 31 instruction of the Maternity and Child Welfare Committee, which dealt with several aspects of the work among women and children. The Council decided to appoint an additional Health Visitor, in view of the increased work due to the transference of the duties of the London County Council relating to infant life protection, and the increase of the original number of infant welfare centres from four to six. Miss Hilda B. Evans, Surrey County Council, was appointed on 29th June and commenced her duties on 14th August. At the same time it was agreed that Miss P. Reymond, the Council's Woman Sanitary Inspector, should in future devote part of her time (40 per cent.) to the work of health visiting, and that while she should continue to inspect factories, workshops and workplaces where women are employed, her duties relating to the investigation of cases of infectious disease should be shared by the Health Visitors. Advantage has been taken of the increase in the staff of Health Viisitors to arrange for a greater number of visits to be paid to children. The minimum number of visits which the Health Visitors are now expected to pay to each child is as follows:— Year of Life. Total. First At 1, 2, 3, 6, 9, 10 and 12 months 7 Second Once every 3 months 4 Third „ 4 „ 3 Fourth „ 6 „ 2 Fifth „ 6 „ 2 The following table gives a record of the work of the Health Visitors in 1933 :— First visits to expectant mothers 230 Re-visits to expectant mothers 234 First visits to infants under one year 811 Re-visits to infants under one year 3224 Visits to children from 1 to 2 years 1720 Visits to children from 2 to 5 years 3140 Visits to foster-mothers and foster-children 825 Visits re infectious diseases 971 Attendances at Borough Council's Ante-natal Clinics 119 32 Attendances at Borough Council's Dental Clinic 64 Attendances at Hampstead Council of Social Welfare Infant Welfare Centres and Toddlers' Clinics 314 Miscellaneous visits 567 Approximately 61 per cent. of the infants under one year of age visited for the first time attended the Infant Welfare Centres during 1933. A suitably worded letter, together with certain literature, is sent by post to those border-line cases in which it is not easy to decide whether or not a visit is desirable. 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. The Medical Officer in attendance (Dr. Kidd) is a part-time officer appointed by the Borough Council, whilst a Health Visitor is present at each session. (a) Total number of attendances by expectant mothers at the Ante-natal Clinics during the year—1,792. (b) Total number of expectant mothers who attended at the Ante-natal Clinics during the year—435. (c) Percentage of total notified births (live and still) represented by the number in (b)—46 per cent. In addition, 29 mothers attended for the first time, after their confinements, to receive post-natal care. 33 The following is the report for the year 1933 of the Medical Officer of the Council's Ante-natal Clinics, 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 1933:— Pond Street 1933. Clinic. 1932. Kilburn 1933. Clinic. 1932. New patients 114 113 290 282 Attendances of old patients 473 493 1123 1193 Number of sessions held 51 51 100 100 Average attendance per session 11•5 12 14 15 Number of patients referred to Dental Clinic 37 55 135 123 Number of patients sent to Convalescent Homes 3 1 6 8 The past year has been one of quiet routine work at the Antenatal Clinics and the attendances of the expectant mothers have been well-maintained. Looking back on the past sixteen years since the Clinics were started, one notices a marked increase in the readiness of the mothers to take advantage of the advice and health-teaching bestowed upon them, not only by myself but also by the Health Visitors. Another point of interest that emerges from such a survey is, that the expectant mother, now-a-days, tends to begin her attendances at the Clinic much earlier in pregnancy than formerly as she seems to feel (and rightly) that the sooner she seeks advice on her condition, the better. Unfortunately, there is another aspect of the picture which is less encouraging, but I felt it would be misleading if I did not speak of it. And that is, that the physical condition of those expectant mothers whose husbands are unemployed (or who have had long spells of unemployment alternating with short periods of work) is far from satisfactory. Many such women, indeed, are definitely "below par" and under-nourished when they first come under my care. This is not only a matter of clinical observation but is confirmed by further 34 evidence. In the course of the routine examination of every case at the Clinic, it is customary now-a-days to take readings of the blood pressure at regular intervals so as to detect any tendency to a rise indicative of toxæmia of pregnancy. In carrying out these routine observations, it has been noticed that the blood pressure of many of these under-nourished women is definitely below the average for their ages and below a level which is consistent with health. For instance, in the type of case I am referring to, it is not uncommon to find a systolic pressure of only 100. Fortunately, in our Borough, the Maternity and Child Welfare Committee arranges for every necessitous expectant mother to have a pint of milk free daily when she is six months pregnant, provided she has a medical certificate that she needs it. It is most encouraging to note the improvement in the physical condition of such a woman after she has had this extra nourishment for a time and especially, too, the way in which her blood pressure frequently responds by a beneficial rise. One cannot help wondering, though, what the physical condition of such expectant mothers must be in less fortunate localities than Hampstead, where the local Health Authority does not provide the extra nourishment for them as our Borough Council does. Finally, one is forced to the conclusion that if the nutrition of the school children in areas where unemployment is rife has not suffered to any serious extent (as the Education Authorities assure us is the case), it must be because the shortage of food in such households is falling upon the parents instead of the children and especially on the mothers. "I have not had a cooked dinner for six months, Doctor," said an unemployed man's wife to me not long ago. In conclusion, I wish to thank the Maternity and Child Welfare Committee and the Medical Officer of Health for their most helpful support and consideration during the last year. MARY KIDD, M.B., B.S. (Lond.). March, 1934. 35 Infant Welfare Centres. Under the Scheme approved by the Minister of Health, in pursuance of the Local Government Act, 1929, the Borough Council made a grant of £725 per annum to the Hampstead Council of Social Welfare in respect of the Maternity and Child Welfare work carried out by them. The Maternity and Child Welfare Committee, having received application for an additional annual grant from the Hampstead Council of Social Welfare for the purpose of carrying on the infant welfare work under the existing scheme, caused a thorough investigation of the position to be made by a Special Sub-Committee, which had the advantage of the advice of Dr. Turnbull of the Ministry of Health and of a comprehensive report by myself. The Sub-Committee considered whether it was desirable, having regard to certain disadvantages which existed by way of lack of co-ordination, to continue the then existing arrangement at the increased expenditure, or whether a more satisfactory and efficient means of discharging the Borough Council's liability to maintain efficiency and progress could not be obtained by an entire revision of the system and the taking over by the Borough Council of the Infant Welfare Centres. They also considered a suggestion that the Toddlers' Clinic then being held every two months at the Health Institute, Kingsgate Road, by the Council of Social Welfare should also be taken over and the number of sessions increased, and for a Clinic also to be established on the eastern side of the Borough. The suggestions provided for the retention of the invaluable services given by lady helpers to the Council of Social Welfare. As regards the Dental Clinics, the Sub-Committee's opinion was that the work at present performed by the Dental Clinic of the Council of Social Welfare at the Health Institute, Kingsgate Road, and that of the Borough Council at Pond Street, could well be performed at a total cost equal to that incurred in respect of the Borough Council's present clinic alone, at a Municipal Clinic to be held in the centre of the Borough at the Public Health Station, Lithos Road, Finchley Road, and that the Borough Council should take over the whole of these dental services. Thorough discussion on the subject and investigation of the matter took place by the Committee, who had an exchange of views 36 with the Council of Social Welfare upon the questions involved, it being desirable that their concurrence should be obtained to these proposals, as they were the recipients of a block grant paid annually and amounting to £725, which grant would be discontinued under any such transfer scheme. The Maternity and Child Welfare Committee finally came to the conclusion that, for the present, it was desirable to limit their proposals to certain revised arrangements which had been agreed with the Council of Social Welfare. The proposals were:—that the Council of Social Welfare should close down their Dental Clinic at the Health Institute, leaving the whole of this work to be carried out by a central Clinic of the Borough Council at the Public Health Station, Lithos Road. This involved no additional expenditure so far as the Borough Council was concerned, except the small cost of fitting up the new room, and it saved the Council of Social Welfare an annual expenditure which in the Standard Year amounted to £119 17s. In respect of this dental work, the Council of Social Welfare originally received under the block grant a sum of £105 2s. 9d.; on a re-adjustment of dental work on the 1st April, 1931, whereby the Borough Council relieved the Council of Social Welfare of a part of their services, the Council of Social Welfare agreed to refund, and had since refunded annually, the sum of £45 4s. 3d. to the Council. It was felt that on the transfer of the balance of the dental work, the Council of Social Welfare should refund a further amount of £59 18s. 6d. The Council of Social Welfare, however, asked that they should, as from the taking over of the dental work by the Council, be permitted to retain both these sums, i.e., a total annual amount of £105 2s. 9d. included in the grant in respect of work which they would no longer undertake. They were prepared, however, to give an undertaking that this sum should be definitely earmarked and applied for an extension of the work in connection with the Toddlers' Clinics. This £105 2s. 9d. was equivalent to an additional grant to the Council of Social Welfare, who were, in addition, saved a net amount of £59 18s. 6d. by the handing over of the work. By a letter, dated 6th July, 1933, the Council of Social Welfare withdrew all applications for further grant. In connection with disadvantageous conditions of working which previously existed in connection with the Infant Welfare Centres, the 37 following revised conditions were agreed with the Council of Social Welfare, viz.:— (1) Medical Officer of Health to have direct communication with the Centre doctors. (2) Medical Officer of Health to be consulted at all stages on appointment of doctors, whose appointments must be approved by the Maternity and Child Welfare Committee. (3) Medical Officer of Health to be notified forthwith in the event of any deputy acting in place of a Centre doctor. (4) Days, hours, or any temporary suspension of sessions to be approved by the Maternity and Child Welfare Committee. The following Infant Welfare Centres were held in the Borough during 1933:— 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 Reymond 43 2. Branch Tuesday, 2—4 p.m. Dr. I. M. Finlayson Mrs. Steward 54 3. Kilburn Tuesday, 2—4 p.m. Wednesday, 2 — 4 p.m. Dr. A. S. Hall- Craggs Miss Evans Mrs. Steward 49 4. New End Wednesday, 2.30— 4 p.m. Dr. S. M. Pratt Miss Kennedy 28 5. Lisburne Road Thursday, 2—4 p.m. Dr. M. A. Blandy Miss Lambe 38 6. Mill Lane Friday, 2—4 p.m. Dr. H. M. GregoryFoster Miss Evans 42 Total number of attendances at all Centres during the year:— (i) By children under 1 year of age—8,590. (ii) By children between the ages of 1 and 5 years— 6,503. Total number of children who attended at the Centres for the first time during the year and who, on the date of their first attendance, were :— (i) Under 1 year of age—497. (ii) Between the ages of 1 and 5 years—194. Since the close of the year, the Branch Centre held at the Mission Hall, Netherwood Street, on Tuesdays from 2 to 4 p.m. has been transferred to the Health Institute, where it is held on Wednesdays from 10 a.m. to 12 noon. The New End Centre, which was held on 38 Wednesdays from 2.30 to 4 p.m., is now held on Thursdays from 10.15 a.m. to 12 noon. On the 1st January, 1934, the Medical Staff of the Centres was reduced to two, viz.:— Dr. M. A. Blandy, who attends the Centres at Belsize, Heath Street and Lisburne Road. Dr. A. S. Hall-Craggs, who attends the Centres at The Health Institute and Mill Lane. Toddlers' Clinic. The Hampstead Council of Social Welfare up to September, 1933, were holding a Toddlers' Clinic every two months at the Health Institute. On and after the 6th October, as a result of the new arrangement with the Borough Council, weekly toddlers' sessions were held alternatively on either side of the Borough. Dr. Ruth Balmer, who has special experience in pre-school children, was appointed the Medical Officer in attendance at the Clinic. In co-operation with the Chairman and the Vice-Chairman of the Infant Welfare Committee of the Hampstead Council of Social Welfare, 1 arranged that the children attending the Toddlers' Clinic should consist of :— (1) "Special Children"—referred by the Borough Council. (2) " Other Children"—referred by Health Visitors, Voluntary Workers, Parents, Re-visits of " Special Children," etc. " Special Children." The parents of every child in the Borough attaining the age of three years receive a special invitation from this Department, to bring the child to the Toddlers' Clinic for a routine examination. It has been arranged for the health visitor to deliver the letter inviting the child for examination, when, and at the same time, she uses her influence in persuading the mother to bring the child along. The examination by the Doctor at the Clinic is on the lines of a school medical inspection. " Defective " children are referred either to their family doctor or to a hospital and are subsequently followed up by the health visitor to ensure that they are receiving the requisite treatment. These "defective" children are called up again to the 39 Clinic for subsequent examination. From October to the end of the year 234 parents have received invitations, 79 of whom have accepted, and of this number in no less than 44 cases the children were found to be suffering from various defects. It is our ambition that these defects shall be remedied before the child commences school. Ray-Therapy. Arrangements have been made with The Institute of Ray-Therapy whereby children from the Toddlers' Clinic may receive "Sunlight" treatment free of charge. Arrangements for the Supply of Milk and Food. There have been 263 families assisted with free milk or milk at half price during the year, for either expectant mothers, nursing mothers or children under the age of 3 years; and in a few "special " cases for children between 3 and 5 years. 66 children under 5 years of age have, in addition to the milk, received free cod liver oil or emulsion. Dental Clinics. Until the end of September, the Borough Council provided a dental clinic on the eastern side of the Rorough, at 27, Pond Street, for ante-natal and post-natal cases and for children under 5 years of age, whilst the Council of Social Welfare maintained a dental clinic on the western side of the Rorough, at The Health Institute, for similar cases. On the 5th October, however, the new Central Municipal Dental Clinic was opened, in lieu of the two mentioned above. The following is a summary of the work carried out at the Borough Council's Dental Clinics during the year (at Pond Street from January to September and at Lithos Road from October to December):— Number of Sessions held 53 Patients' Attendances 629 Number of Fillings 232 Number of Scalings 34 40 Extraction cases Total Number of Teeth extracted 370 Gas Administrations 104 Local Administrations 14 Without Anaesthetic 1 Number of Dentures (including repairs) 42 Number of Dressings and Root Treatment 96 Number for Advice 116 Number of Denture visits 120 Number of New Patients 160 School Entrants. In order that all information available, both from your Health Visitors and the doctors at the Infant Welfare Centres, may be made available for the County School Medical Officer of Health, 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. The information thus forwarded to the County Council relates to the early nurture and illnesses of the children and to the general home conditions. Through the kindness of the Medical Officer of Health and the School Medical Officer of the London County Council, I am enabled to submit the following highly interesting table, showing the result of routine examinations of 458 elementary school entrants in Hampstead during 1933. 41 Table showing Results of Routine Medical Inspection of Entrant Children in Hampstead to Elementary Schools during the year 1933, 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 treatment Entrants : Boys 242 234 8 — 57 178 7 - 242 — — 242 — — 130 58 54 107 Girls 216 215 1 — 68 142 6 — 216 — — 216 — — 124 55 37 87 Total 458 449 9 — 125 320 13 — 458 — — 458 — — 254 113 91 194 Hampstead per centages 98•0 2•0 — 27•3 69•9 2•8 — 100•0 — — 100•0 — — 55•5 24•7 19•9 42•4 London per centages 55•0 44•2 0•8 20•5 75•4 4•1 — 96•6 3•0 0•4 98•2 1•7 0•1 55•7 32•6 11•7 40•4 42 Table showing Results of Routine Medical Inspection of Entrant Children in Hampstead to Elementary Schools during the year 1933, indicating the Defects found. f = defects found. o = noted for treatment and included in defects found. Disease or Defect. Boys (242). Girls (216). Hampstead. per cent. London. per cent. Hampstead. per cent. London. per cent. Skin disease f 1 0•4 1•1 — — 0•9 o — — 0•8 — — 0•6 Tonsils only f 46 19•0 14•2 36 16•7 14•4 o 21 8•7 5•1 11 5•1 5•0 Adenoids only f 4 1•7 1•1 1 0•5 0•9 o 1 0•4 0•6 — — 0•5 Tonsils and Adenoids f 5 2•1 2•7 8 3•7 2•5 o 4 1•7 1•9 6 2•8 1•8 Other Nose and Throat f 3 1•2 1•2 1 0•5 1•1 o 2 0•8 0•5 — — 0•4 Glands of Neck f 2 0•8 2•4 2 0•9 2•1 o — — 0•3 — — 0•2 Eye disease f 11 4•5 3•2 5 2•3 3•0 o 5 2•1 2•0 3 1•4 2•0 Otorrhœa f 2 0•8 1•1 — — 1•0 o 2 0•8 0•8 — — 0•7 Other Ear Defects f — — 0•4 — — 0•5 o — — 0.•2 — — 0•3 Hearing f 3 1•2 0•2 4 1•9 0•2 o 1 0•4 0•1 3 1•4 0•1 Speech f 1 0•4 0•3 — — 0•2 o — — 0•0 — — 0•0 Heart f 3 1•2 1•7 — — 1•7 o — — 0•1 — — 0•1 Anæmia f 2 0•8 1•1 2 0•9 0•9 o — — 0•4 — — 0•3 Lungs f 5 2•1 3•7 2 0•9 3•4 o 1 0•4 1•1 — — 1•1 Epilepsy f — — 0•0 1 0•5 0•0 o — — 0•0 — — 0•0 Chorea f — — 0•0 — — 0•0 o — — 0•0 — — 0•0 Paralysis f — — 0•0 — — 0•0 o — — 0•0 — — 0•0 Other Nervous Disorders f — — 0•5 1 0•5 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 — — 0•0 o — — 0•0 — — 0•0 Rickets f — — 0•7 — — 0•3 o — — 0•1 — —. 0•0 Spinal Deformities f — — 0•1 — — 0•1 o — — 0•1 — — 0•1 Other Deformities f — — 0•9 1 0•5 0•7 o — — 0•2 — — 0•2 Other Defects f — — 2•5 4 1•9 2•6 o — — 1•4 — — 1•5 43 Maternity Beds. (I) New End Hospital. The Borough Council has made an arrangement with the London County Council whereby a ward containing five beds is set aside for Borough Council cases. The Borough Council contribute 9s. per day per bed occupied, and the patients are assessed by the Assistance Sub-Committee of the Borough Council to contribute according to their means. These beds are available for married women only. During the year, 46 patients were admitted to this ward. (II) Queen Charlotte's Hospital. The Borough Council subscribes £1 in respect of every Hampstead mother confined in this Hospital and receives Hospital Letters of Admission in return. During 1933, the number of Hampstead women for whom such contribution was made was 59. (III) Queen Mary's Maternity Home, Heath Street. This Home is available for the wives of ex-service men. The Borough Council does not make a grant to the Home. During 1933, 45 Hampstead mothers were confined there. The Children's 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 1933, eight children were thus treated at the Hospital. The Borough Council pays 21s. per week per bed occupied and the parents are assessed to pay according to their means. 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 two 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 44 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 1933, the Committee investigated:— Deaths of Infants under 2 years 38 Still Births 29 Puerperal Fever 2 Puerperal Pyrexia 12 Other Cases 1 Total 82 During the course of investigation the following facts emerged, which are of interest. Of the deaths under 2 years of age, 84 per cent. occurred in institutions; and of the 16 deaths occurring during the first month, 69 per cent. of the mothers had not attended an antenatal clinic, whilst of the 17 deaths between 2 months and one year, 47 per cent. had never attended an infant welfare centre. Of the 29 still births, 55 per cent. of the mothers had not attended the ante-natal clinics. There were 12 deaths of illegitimate children under 2 years of age, which represents a Mortality Rate of 67 per 1,000 illegitimate births as compared with 14 for legitimate children. Convalescent Homes and Other Institutions. Convalescent Homes. During 1933, 8 mothers and babies, and one mother alone, were sent to Convalescent Homes; the Borough Council being responsible for the payment and the applicants being assessed by the Assistance Sub-Committee to contribute according to their means. Beauchamp Lodge. The Borough Council has an arrangement with Beauchamp Lodge Emergency Home for Children, 2, Warwick Crescent, Paddington, 45 for the boarding-out of children under five years of age whose mothers have been admitted to Hospitals for their confinements. The Borough Council pays 12s. 6d. per week per bed occupied, the parents being assessed to contribute according to their means. During 1933, six children from Hampstead families were admitted under this arrangement. The Hampstead Hostel for Mothers and Babies, 7, Fitzjohn's Avenue. This hostel occupies a large house with an extensive garden, and is managed by a voluntary committee. During the year 1933, 21 unmarried mothers were admitted with their babies. No expectant mothers are admitted and no babies without their mothers. There are 15 beds for mothers in the hostel. 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 1933, 15 babies were admitted. There are 28 beds, which are always occupied, for "first" babies of unmarried mothers. On an average, 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. During 1933, 111 expectant mothers and 103 mothers and babies were admitted. The Club is managed by a Voluntary Committee and receives a grant from the London County Council under the Local Government Act, 1929. Brondesbury and Kilburn Day Nursery. This Day Nursery was accommodated at 36, Hemstal Road, Kilburn, in a large, spacious house and was controlled by a Voluntary Committee. There were 36 places in the Nursery, 26 of which were for children aged from 2 to 5 years, and 10 for babies under 2 years of age. The total number of attendances made during 1933 w as 4,006. 46 The Borough Council contributed £431 per annum. The Maternity and Child Welfare Committee agreed with the Voluntary Committee that the number of attendances did not justify the continuance of the Nursery and it was accordingly closed down at the end of December. Hampstcad and North St. Pancras Day Nursery. This Day Nursery occupies commodious premises at 27 & 29, Pond Street. There are 50 places in the Nursery for children under 5 years of age. The total number of attendances made during 1933 was 10,546. The Nursery is controlled by a Voluntary Committee and the Borough Council contributes £543 per annum. By an arrangement with this Voluntary Committee the Borough Council rents a portion of the premises for the purpose of an Ante-natal Clinic. Ophthalmia Neonatorum, Puerperal Fever and Puerperal Pyrexia, etc. Disease. Number of cases notified during the year. Number of cases visited by officers of the Council. Number of cases for whom home nursing was provided by the Council. N umber of cases removed to hospitals. Ophthalmia Neonatorum 6 (In 1 case the vision was seriously impaired) 5 3 3 Puerperal fever 2 — — 2 (Hospital cases) Puerperal pyrexia 12 — — 12 (11 do. ) Measles and german measles (in children under 5 years of age) 29 25 2 7 Whooping Cough (do.) Not notifiable 74 — 39 Epidemic diarrhœa (do.) do. — — — Poliomyelitis (do.) — — — — CHART SHEWING THE INFANT MORTALITY PER 1000 BIRTHS IN HAMPSTEAD. 47 Provision of Midwives. The Borough Council has a scheme whereby the local district Nursing Associations provide for their nurses to attend confinements. During 1933, the midwives of the Kilburn and West Hampstead District Nursing Association attended 122 cases, whilst those of the Hampstead District Nursing Association attended 28 cases. Of the 150 cases, 65 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. Infantile Mortality. The infantile mortality rate for the Borough of Hampstead for the year 1933 was 38. This compares with 54 for the previous year. From the accompanying diagram the infantile mortality rate for Hampstead is shown. Maternal Mortality and Morbidity. No women died in, or in consequence of, child birth during 1933. The maternal mortality rates in the two preceding years were 298 and 1.9 respectively. Consulting Obstetricians. The Council has inaugurated a scheme whereby the services of obstetricians of consultant status are available to all medical practitioners in cases of difficulty or abnormality occurring among Hampstead mothers. The following are the consultants :— Basden, Margaret, M.D., F.R.C.S., 114, Harley Street, W.1, and 26, Thurlow Road, N.W.3. Brown, R. Christie, M.S., F.R.C.S., 40, Harley Street, W.1, and 292, Finchley Road, N.W.3. Gray, Arthur O., M.D., F.R.C.S., 18, Harley Street, W.l. Rivett, L. C., M.C., F.R.C.S., 118, Harley Street, W.l, and 3, Hanover Terrace, Regent's Park, N.W.1. White, Norman, M.D., F.R.C.S., 19, Queen Anne Street, W.l, and 55, Fitzroy Road, N.W.1. Infant Life Protection. Under the Transfer of Powers (London) Order, 1933, the functions of the County Council relating to Infant Life Protection under 48 Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932, were transferred to the Metropolitan Borough Councils as from 1st April, 1933. Foster-mothers are required to give notice to the Borough Council when receiving for reward children up to the age of nine years, and the Health Visitors of the Borough Council, who were appointed as Infant Life Protection Visitors, make the necessary inspection of the premises where the foster-children are to be kept. The duties of the Health Visitors when acting as Infant Life Protection Visitors, include supervising the health and well-being of the children and giving advice and directions as to the care of their health, nursing, and maintenance. Special endeavours are made to secure the attendance of these children at the Infant Welfare Centres. During the year, one application for permission to take a fosterchild was refused, owing to the unsatisfactory condition of the home. The Borough Council is now also the authority for making application to a Court of Justice for an order directing the removal of an infant to a place of safety. In April, 1933, particulars were received from the London County Council of 88 ex-foster-mothers. The policy adopted has been to encourage the distribution of the foster-children in the Borough among as many foster-mothers as possible. For this reason, these 88 "lapsed" foster-mothers were written to, asking if they would care to have their names re-entered on the current register of fostermothers. Six replies were received asking for this to be done. A special effort has been made to procure co-operation between the London County Council Care Committee and the Borough Council, and, as a result, an arrangement has been made whereby particulars of all foster-children reaching the age of nine years are forwarded to the Care Committee, who keep these children under special observation. During the year, the name of one child was forwarded to this Committee. It is interesting to note that during the year three foster-mothers have legally adopted the foster-children in their care. 49 The following are the statistics relative to this work from 1st April, 1933, when the duties were transferred from the London County Council:— 1st April, 1933. 26 foster-mothers having charge of 48 foster-children. 31st December, 1933. 43 foster-mothers having charge of 49 foster-children. Number of foster-children removed (1st April to 31st Dec.) 70 „ foster-children added „ 71 „ foster-mothers removed„ „ 13 „ foster-mothers added „ „ 30 ,, visits paid by Health Visitors to foster-children from 1st April to 31st December 561 There was one death of a foster-child during the year, but no inquest was held. It was not found necessary to take any legal proceedings during the year. 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 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. Section 4. Sanitary Circumstances of the Borough. 53 Sanitary Circumstances of the Borough. Sanitary Inspection. The Council employs six male Sanitary Inspectors, and also one woman Sanitary Inspector, part of whose time is devoted to the work of a Health Visitor. 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. Statement showing the number of premises inspected, etc., by the Sanitary Inspectors during 1933 :— Total number of inspections 4,153 Total number of re-inspcctions and other visits and re-visits 11,233 Total number of dwelling-houses inspected for housing defects 2,038 Number of these found not in all respects reasonably fit for human habitation 1,135 The inspections were occasioned by various causes, e.g., complaints received; special inspections, registration and inspection of tenement houses; examination of premises after the 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), 1,092 relating to 972 premises. (2) Statutory 183 relating to 131 premises. Investigation of Complaints, Inspection of Factories, Workshops and Workplaces, etc. Number of complaints investigated 754 „ „ premises inspected after the occurrence of infectious disease 413 „ „ inspections of Factories (excluding bakehouses) 97 54 Number of inspections of Workshops (excluding bakehouses) 238 „ „ inspections of Workplaces 271 „ „ inspections of Bakehouses, Milkshops and other food premises 591 Alteration of Sanitary Inspectors' Districts. In view of the activities of the Housing Committee in connection with the Housing Act, 1930, it was found essential for one of the five District Inspectors to devote the whole of his time to making detailed investigations of certain areas in the Borough. I arranged, therefore, for the Borough to be divided into four instead of five areas, with a consequent increase in the work of each Inspector. It should be noted that, in spite of the additional public health legislation in recent years, the sanitary staff has been reduced since 1929 by one full-time inspector and one assistant to the inspectors. The two temporary inspectors and one temporary clerk who commenced duty in May, 1930, subsequently left the service of the Council, the Inspectors in June, 1931, and May, 1932, respectively, and the clerk in October, 1931. Work, etc., supervised or action taken by the Sanitary Inspectors, whether under notice or voluntary, at premises not registered as Tenement Houses:— Totals Overcrowding. Number of rooms found overcrowded 5 Cases abated (rooms) after service of notice — Cases abated (rooms) without service of notice — Underground sleeping rooms. Illegally occupied—found, or brought to the Inspectors' notice 18 Closed, or illegal occupation discontinued 4 Made to conform 14 Verminous conditions. Rooms disinfested 48 Number of houses concerned 15 Beds and bedding disinfested 9 Floors of rooms cleansed 17 Animals. Nuisances from improper keeping in rooms abated 1 Nuisances from improper keeping on the premises abated 2 Smoke nuisances. Complaints received Observations made 2 Notices served 2 Drainage systems, &c. Drainage systems repaired or renewed, partly or wholly 316 Plumbing defects remedied (soil pipes, waste pipes, &c.) 601 Roofs, rainwater pipes and gutters repaired or renewed 201 55 Water Supply. Water supply provided to separate lettings 407 Number of houses concerned 260 Sinks provided to separate lettings 420 Number of houses concerned 264 Water cisterns cleansed or covered 19 Water-Closets. 229 Additional provided Removed from improper position 14 Flushing cisterns repaired 115 Yards, &c., Paving, &c. Yards or open spaces newly paved and drained or repaired 107 Bathrooms. New provided 332 Dust Bins. 590 Repaired or renewed Work, etc., supervised or action taken by the Sanitary Inspectors, whether under notice or voluntary, at Registered tenement Houses:— Totals Overcrowding. Number of rooms found overcrowded 12 Cases abated (rooms) after service of notice — Cases abated (rooms) without service of notice 1 Underground sleeping rooms. Illegally occupied—found, or brought to the Inspectors' notice 5 Closed or illegal occupation discontinued 1 Made to conform 3 Verminous conditions. Rooms disinfested 87 Number of houses concerned 52 Beds and bedding disinfested 31 Floors of rooms cleansed 51 Animals. Nuisances from improper keeping in rooms abated 1 Nuisances from improper keeping on the premises abated 1 Drainage systems, &c. Drainage systems repaired or renewed, partly or wholly 41 Plumbing defects remedied (soil pipes, waste pipes, &c.) 93 Roofs, rainwater pipes and gutters repaired or renewed 237 Water supply. Water supply provided to tenements 46 Number of houses concerned 37 Sinks provided to tenements 48 Number of houses concerned 39 Water cisterns cleansed or covered 18 Water-Closets. Additional provided 1 Flushing cisterns repaired 71 Yards, &c., Paving, &c. Yards or open spaces newly paved and drained or repaired 63 Bathrooms. New provided 1 Dust Bins. Repaired or renewed 135 Miscellaneous. Window cords repaired or renewed 408 Window fittings repaired or renewed 226 Filth and refuse removed from rooms 26 Washing (of clothes) accommodation provided 4 56  Totals Coppers repaired or renewed 25 Kitchen ranges repaired or renewed 35 Common staircases repaired 87 Common staircases provided with adequate means of natural light 10 Common staircases provided with adequate means of artificial light 3 Houses or parts cleansed (excluding verminous rooms) 292 Number of rooms concerned 1006 Dampness in houses or parts abated 125 Dilapidated houses or parts repaired 270 Tenement Houses. During the year, two additional tenement houses were placed upon the Register. At the end of the year the total number of tenement houses on the Register was 1,548. During the year, 441 tenement houses were inspected and 3,009 defects were discovered as compared with 696 houses and 2,900 defects in 1932. It is of the utmost importance that all the tenement houses in the Borough, which house a large percentage of the working classes, should be kept in a good state of repair. Unfortunately, with the present limited staff of Sanitary Inspectors and the large amount of voluntary work which has to be supervised in a Borough such as Hampstead, it is not possible to devote to this section of the work the time which it demands. Common Lodging Houses and Seamen's Lodging Houses. None exist in the Borough. 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. Offensive Trades. No offensive trade is carried on in the Borough. Increase of Rent and Mortgage Interest (Restrictions) Acts. Number of certificates applied for 5 „ „ issued 3 Factory and Workshop Acts. Section 132 of the Act of 1901 requires every Medical Officer of Health in his Annual Report specially to report on the administration of the Act, and 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, 57 Inspection of Factories, Workshops, and Workplaces, including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Occupiers Prosecuted. (1) (2) (3) (4) Factories (Including Factory Laundries) 143 17 Nil. Workshops (Including Workshop Laundries) 271 18 Nil. Workplaces (Other than Outworkers' premises) 271 15 Nil. Totals 685 50 Nil. 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 Acts*:— Want of cleanliness 62 62 Nil. Nil. Want of ventilation 3 3 Nil. Nil. Overcrowding Nil. Nil. Nil. Nil. Want of drainage of floors 3 3 Nil. Nil. Other nuisances 54 54 1 Nil. Sanitary accommodation insufficient 5 5 Nil. Nil. unsuitable or defective 11 11 1 Nil. not separate for sexes 10 10 1 Nil. Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) Nil. Nil. Nil. Nil. Other offences 3 3 Nil. Nil. (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 151 151 3 Nil. * 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. 58 Factories. The following is a list of the different classes of Factories in Hampstead:— Bakers 28 Dairymen 2 Bootmakers 22 Launderers 2 Butchers 6 Motor and other engineers 29 Cabinet makers and Upholsterers 7 Printers 7 Other trades 39 Carpet beaters 2 151 Coffee roasters 5 Confectioners 2 Workshops. At the end of 1933, there were 315 workshops on the Register, including 53 domestic workshops. During the year, 271 inspections were made and 18 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. The number of workrooms measured and Notice Cards re overcrowding provided in 1933 was 5. Outworkers. Certain specified classes of work done at the homes of workers are controlled by the Factory and Workshop Act, 1901. There are 67 such outworkers in Hampstead known to the Public Health Department. Of these, 4 are factories, 14 are workshops, 5 are workplaces and 44 are single workers. Persons sending out home work are required to keep lists of their home workers and to send copies of the lists to the Borough Council on or before the 1st February and the 1st August in each year. In February, 49 lists were received, and 47 lists in August. These lists included the names of 140 and 136 outworkers respectively. In many instances, of course, the same outworker's name was reported by different firms twice in the year. Of the actual outworkers thus notified amounting to 142, 26 belonged to Hampstead and 116 59 elsewhere. Particulars of the latter were sent to the Local Authorities concerned, while information concerning 41 outworkers resident in Hampstead was received from other Authorities. In no instance during 1933 was outwork found to be carried on in unwholesome premises. Rats and Mice (Destruction) Act, 1919. The Borough Council issues an advisory leaflet on the eradiction of rats and mice, and rat poisons may he 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 the sum of ten shillings. The Public Health Committee gave authority on 19th September for ernploying the services of a firm of professional rat catchers to deal with any specially infested areas. Bug Infestation of Houses. The question of dealing effectually with bug infested premises has received special attention during the year. Doubtless due in large measure to the very hot summer, the Public Health Department has been appealed to in an unusually large number of cases to help landlords and tenants of premises where bugs have appeared. There were 233 requests for bug disinfestation during the year. For many years past the need for dealing with these and kindred pests has been the subject of concern to health officers. In 1904, the Fondon County Council secured the insertion of clauses relating to verminous houses in their General Powers Act of that year, but these provisions having been found to be insufficient to attain the objects aimed at, they were repealed and provisions in lieu thereof were secured by the General Powers Act of 1922, whereby a Sanitary Authority is empowered, at their own expense, to cause filthy or verminous articles to be cleansed, disinfected or destroyed. The same Act also empowers the Sanitary Authority to order the owner or occupier to carry out the cleansing of vermin infested houses. In a later General Powers Act of 1928, the Sanitary Authority was given authority to apply to a petty sessional court for an order for the compulsory removal of a verminous person to the Cleansing Station, who will not consent voluntarily to attend such Station for cleansing. 60 The practice of the Public Health Department had hitherto been as follows:—Upon receipt of information as to bug infestation, a sanitary inspector examined the structure of the premises affected whenever deemed desirable and the Council's disinfectors sprayed the rooms with Vermicine and, if necessary, removed bedding for steam disinfection. A nominal charge of 5s. was made for disinfecting a room in a good class house, whilst no charge was made to the poorest citizens. It should be noted that complaints of infestation and requests for disinfestation come from better class residences as well as from the poorer districts. It is most important, if the matter of vermin eradiction is to be dealt with successfully, to obtain the active co-operation of the tenants of the rooms affected, and with a view to securing this co-operation the following procedure has been instituted as an experiment:— 1. The Sanitary Inspector visits in order to satisfy himself as to the dilapidation or otherwise of the structure of the premises which may call for the removal of the architraves, etc., and also to decide if it is necessary for bedding, etc., to be removed and disinfected. No charge is made for such disinfection. 2. Tins of Vermicine (16 ozs.) suitably labelled, and hand sprayers have been purchased in large quantities by the Public Health Department and are retailed. to tenants for 1s. each. These charges are remitted in special cases of poverty, etc., at the discretion of the Medical Officer of Health. By this procedure it is hoped that tenants will be encouraged to persevere in the eradiction of vermin, such action on their part being complementary to the removal of bedding for disinfection by the Council's disinfectors, for which service a nominal charge is made except in cases of poverty, and to any steps taken by the landlord or owner as a result of the action of the Sanitary Inspectors. The question of improved methods of disinfestation is the subject of investigation by the Ministry of Health, 61 One-room Flatlets. During the year, the growing practice of owners in converting residences into one-room flatlets came under review, and the desirability considered of legislation being introduced to enable the appropriate local authorities to make and enforce bye-laws to control premises thus converted, somewhat on the lines of the bye-laws relating to houses let in lodgings. Questions involved in this sub-letting of premises include those of water supply, washing accommodation, heating of water and rooms. The question of refuse bins and the satisfactory storage of food also arises, as well as that of ventilation. It is possible that such arrange ments may be made in such a manner as to prove to be a serious danger to health, and further objections may arise in regard to the provision and situation of W.C. accommodation, etc. Although it is not suggested that the type of conversion referred to should be entirely prohibited, having regard to the present economic conditions and the great demand for this type of flat, there is no doubt that local authorities should exercise control over such premises. On the recommendation of the Public Health Committee the Council on the 23rd November resolved to support a proposal put forward by the Kensington Borough Council to the effect that legislation should be introduced to enable local authorities to exercise control over one-room flatlets. Legal Proceedings. The following is a list of the summary proceedings taken by the Department during 1933:— Date of Hearing. Nature of Offence. Result of Hearing. 20th Jan. Selling sausages containing 920 parts of sulphur dioxide per million and failing to declare its presence Fined £7 and £2 2s. costs. Excess of sulphur dioxide Withdrawn. Failing to label Fined £2 and £1 1s. costs. 3rd Feb. Failing to render certificate in case of Diphtheria Fined £2 and £3 3s. costs. 8th Feb. Nuisance and underground rooms illegally occupied Work done. 10s. 6d. costs paid and summons withdrawn. 5th May Nuisance Order made to abate in 7 days and pay 10s. 6d. costs. 5th May Ditto Ditto ditto. 24th May Non-deposit of plans of sanitary work carried out Plans deposited and summons withdrawn. 62 Date of Hearing. Nature of Offence. Result of Hearing. 16th June Nuisance (occupied premises without water supply) Order made to abate in 14 days. 10th Aug. Non-compliance with Order to provide water supply Order complied with and summons withdrawn. 17th Aug. Selling bread and margarine as bread and butter Dismissed under the Probation of Offenders Act on payment of £1 1s. costs. 17th Aug. Non-paving of yard Work done. 10s. 6d. costs paid and summons withdrawn. 30th Aug. Selling bread and margarine as bread and butter Fined £3 and£l 11s. 6d. costs. 19th Oct. Non-deposit of plans and contravention of drainage by-laws Work altered. Plans deposited. £1 1s. costs allowed and summons withdrawn. 15th Dec. Selling milk deficient in milk fat Dismissed under the Probation of Offenders Act on payment of £1 11s. 6d. costs. Public Mortuary, New End. During the year, 63 bodies were brought to the mortuary, 11 by the Police and 52 at the request of friends. In 8 instances postmortem examinations were made. Health Education. Booklets and leaflets are supplied by the P>orough Council on the following subjects:—"Safety in the Home," "To Mothers and Fathers," "Tuberculosis," "Cancer" and various leaflets relating to dental care, etc. Copies of these are available at the Offices of the Public Health Department. Hampstead has never relied upon any occasional demonstrations in the direction of health education, such as a " Health Week." There is no doubt that more valuable and lasting results are obtained by the quiet and consistent efforts of those engaged in the various branches of public health work. Practically all the activities of the Department are educational in nature, whether it be the work of the Sanitary Inspectors in securing environmental improvements, or the work of the Health Visitors among the individual members of the community. Section 5. Housing. Cricklewood Housing Scheme. 65 Housing. 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) 2038 (6) Number of inspections made for the purpose 3179 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 508 (b) Number of inspections made for the purpose 653 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 32 (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 1135 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 841 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. (b) 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 972 (2) Number of dwelling-houses in which defects were remedied after service of formal notices : — (a) By owners 131 (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 Demo- lition Orders Nil. 66 1).—Proceedings under section 20 of the Housing Act, 1930: (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil. (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 3 Overcrowding. Housing conditions can only be regarded as satisfactory when the standard conformed to is such that every family is in occupation of a dwelling of sufficient proportions and equipment adequately to house them. It is now five years since the Report of the Special Committee of the National Housing and Town Planning Council was published, but the following extracts from their summary of Conclusions are of interest to quote :— "Although over a million houses have been built since the War, the pressure of overcrowding in the slums has been little, if at all, relieved. There are probably in England and Wales over a million houses below a satisfactory standard, and two million houses (including many of the unfit houses) which are seriously overcrowded. To remedy these conditions, at least a million new working-class houses are immediately needed, although the absence of sufficient data prevents these figures from being more than an estimate. At least 90 per cent. of those who live in the slums could be relied on to make good tenants if they had good houses at rents which they could afford to pay. It is estimated that during the next ten years 1½ million working-class houses should be built in England and Wales, of which one million should be let at a weekly rental of about 11s. gross and half-a-million at about 7s. 6d. gross." Undoubtedly, considerable progress has been made by local authorities in regard to the provision of the required accommodation, but there is still much to be done. 67 The question of overcrowding continues to be a serious one. In my last Annual Report I stated that, as a result of a special inspection of the 126 cases of illegal overcrowding found since 1930, there were still 29 cases remaining unabated. During the year 1933 a further 17 cases were reported by the sanitary inspectors, making the total 46. No statutory action has been taken during the year in respect of these cases owing to the impossibility of offering alternative accommodation until fruition of the Cricklewood Housing Scheme. In addition to the cases of "illegal overcrowding" there are numerous cases of serious overcrowding where no improvement can take place until the supply of houses at moderate rents meets the demand. It will be realised that an extreme degree of overcrowding can exist before it can be defined as illegal, having regard to the fact that the cubic air space required by the Tenement House Bye-laws is as follows:— Children Adults. under 10. Cubic feet. Cubic feet. Controlled, Houses. Living and sleeping 400 200 Sleeping only 300 150 Decontrolled Houses. Living and sleeping or sleeping only 400 300 The usual accepted standard of overcrowding is that of "more than two persons per room," but while the application of this standard affords some indication of undesirable conditions, it is really a standard of density measurement and is not an altogether satisfactory standard of adequate housing conditions. The standard of re-housing accommodation indicated in Section 37 of the Housing Act, 1930, is as follows:— 2 bedroomed house providing accommodation for 4 persons. 3 „ „ 5 „ 4 „ „ 7 „ The number of persons in Hampstead living more than two to a room at the 1931 Census was 3,253. The average size of private families (persons) in the Borough was then ascertained to be 3.32. 68 Improper Mixing of Sexes. The tenement house 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." The total number of cases reported by the Sanitary Inspectors and remaining unabated at the commencement of the year was 6. During the year, a further 11 cases were reported, making a total of 17, of which further inspection shows that 2 have since been abated. Hampstead Housing Association. The following extracts from the Annual Report of this voluntary Association shew the excellent work which this body continues to perform. " The total amount of paid up capital is £5,003, whilst there is nearly £3,000 Share Capital available for allotment. The Association now holds 11 houses, No. 40, Palmerston Road having been purchased during the year. " The tenants continue to be grateful for their changed and improved surroundings. During the year the rents have been paid regularly and the arrears are very small. They are all caused by unemployment or illness, and whenever it is possible, a small extra payment to reduce the debt is willingly given. " The work of reconditioning houses in these streets in Hampstead is one that should be undertaken. A visit to those owned by the Association would make it quite plain that what has been done for 10 houses and 40 tenants is well worth doing for many other houses where hundreds of people are living in slum conditions, which could be altered if only friends were interested enough in the Housing problem to be willing to give their money or lend it at a small rate of interest." Underground Rooms Illegally Occupied. The required standard to which underground rooms must conform if separately occupied is prescribed in the Public Health (London) Act, 1891, Section 96, and if used separately for sleeping 69 purposes, in the Regulations made by the Borough Council under the Housing Act, 1909. During the year, 23 rooms were reported as being illegally occupied, and in five of these cases the illegal occupation has since been discontinued. The question of statutory action has been deferred pending the development of the Housing Scheme at Cricklewood, when it is hoped that alternative accommodation will be available. Closing Orders made by the Council in respect of underground rooms at 16, Cleve Road and 15, Adamson Road have been determined by the Housing Committee, the necessary works to make them conform having been carried out. 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 75 Number of houses at the Watling Estate at the disposal of the Borough Council under similar arrangements 25 Number of houses allotted to Hampstead under special arrangement with the L.C.C. for relief of overcrowding:— Watling 71 Tottenham 3 Downham 1 Morden 16 Total 191 The total number of families removed from Hampstead to County Council houses since 1927 is 228, involving 1,223 persons. The additional 37 families are accounted for by changes in tenancies at the subsidy houses (12 at Watling and 25 at Wormholt), the Borough Council having the right to nominate tenants for any of the 100 70 subsidised houses which become vacant. These are the only houses for which the Borough Council can nominate fresh tenants when they become vacant. Borough Council Municipal Dwellings. At Park Dwellings, Lower 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, 19s. per week plus light; two-bedroom flats, 23s. 6d. per week plus light; threebedroom flats, 28s. 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 1933 in connection with premises "represented in 1933 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, Adamson Road. (Back basement room) 15-6-25 2-7-25 - Closing Order determined on—works necessary to make the room conform having been carried out. 16, Cleve Road. (Four underground rooms) 11-7-32 24-11-32 - Two rear rooms on east side converted into one room and made to conform and Closing Orders determined. 71 The Borough Council's Five Years' Housing Programme. Cricklewood Housing Scheme. At its meeting on 26th January, 1933, the Council considered a report from the Housing Committee in relation to this Scheme, which represents the greatest effort made by Hampstead, both in the direction of providing alternative accommodation for persons to be displaced as a consequence of action taken in respect of Clearance Areas or Improvement Areas and of making provision for the re-housing of the poorer inhabitants living in overcrowded conditions or in uninhabitable houses. This Scheme will be carried through without any State grant or subsidy, and the accommodation will be available for the working-classes at rents which they can afford to pay. The Housing Committee had made exhaustive enquiries as to possible schemes on land within the Borough, but without success. Finally, at the instigation of the Ministry of Health, enquiries were made in respect of land outside, but adjacent to, the Borough. A suitable site comprising 18½ acres having been found at Cricklewood in the area of the Hendon Borough Council, used as a Home of Rest for Horses, application was made to the Minister for an Order to transfer such powers of the London County Council as are necessary to enable a scheme to be carried out on that site. At a meeting on 29th June, 1933, the Council appointed Mr. Douglas Wood, F.R.I.B.A., F.S.I., as the Architect for the Scheme, and also authorised the Housing Committee to take all steps necessary to obtain tenders for the proposed housing scheme, and to obtain the approval under the Hendon Town Planning Scheme, 1928, to the building and other proposals involved. The number of dwellings to be provided is 290, made up as follows, viz.:— 32 One-Bedroom Flats. 136 Two-Bedroom Flats. 112 Three-Bedroom Houses. 10 Four-Bedroom and Parlour Type Houses. Each dwelling will have a living room, a bathroom and a kitchenette, in addition to the rooms mentioned, 72 Rents. The rental basis approved in principle by the Council for the dwellings is as follows :— 1 Bedroom type 9s. Od. per week. 2 „ „ 11s. Od. „ 3 „ „ 13s. Od. „ 4 „ „ 15s. Od. „ At the same meeting the Council again gave careful consideration to the preparation of a programme for slum clearance and improvement as a result of which certain properties were scheduled. On 29th November, I reported to the Housing Committee the results of a detailed examination of each house in the following areas:—Stamford Place, Golden Yard and Holly Mount, Fairfax Place and Yard, and King's College Mews West. At the end of the year this report was under consideration by the Housing Committee with the object of my representing under the Housing Act, 1930, certain houses in these Areas, some of which it is suggested should be treated as Clearance Areas under Section 1, certain others to be dealt with by means of Closing Orders under Section 20, and other houses to be demolished under Section 19. It is intended that the Orders will become operative so as to coincide with the new dwellings which will be available on the Cricklewood Housing Estate, in order that the present occupants may be given the option of removing thereto. Section 6. Inspection and Supervision of Food. 75 Inspection and Supervision of Food. (A) Milk Supply. (i) Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies Order, 1926. The number of premises in respect of which persons are registered as purveyors of milk is 84. During the year, 153 inspections were made and 15 notices were served. During the year, two samples were taken for the presence of tubercle bacilli and both proved negative. There were 114 milk samples taken under the Food and Drugs (Adulteration) Act, and of these, 112 were reported as satisfactory. The average composition of the milk samples examined was:— Total milk solids 12.36 per cent. Fat 3.59 „ Solids not fat 8.77 „ (ii) Milk (Special Designations) Order, 1923. Number of licences in force during 1933 for the sale of milk under special designations :— Purpose of Licence. Number of Licences granted. Sale of "Certified" Milk from shop or other premises 7 Sale of "Grade A (Tuberculin tested)" Milk from shop or other premises 11 Sale of "Grade A" Milk from shop or other premises 2 Sale of "Pasteurised" Milk from shop or other premises 33 During the year, seven samples of Pasteurised milk were taken for bacteriological examination and complied with the requirements. 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. 76 (B) Meat and Other Foods. (i) Meat and Slaughterhouses. There are now no slaughterhouses in the Borough, but a general supervision of shops and premises concerned with the meat supply of the Borough is exercised by all the Sanitary Inspectors. (ii) 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 1933. (iii) Unsound Food and Food Inspection. The following is a list of food seized or voluntarily surrendered during the year :— 27 Turkeys (14 stone 10 lbs.). 18 Sacks of Potatoes. 27 lbs. of Split Peas. In certain instances during the year information was received of unsound or unwholesome food having been purchased outside the Borough, in good faith, by individuals or tradesmen. In all these cases prompt action was taken by the Department to prevent the distribution of the food concerned. (iv) Premises where foods arc manufactured, prepared, stored or exposed for sale. These premises have been kept under observation during the year by all the Sanitary Inspectors, and during 1933, 609 inspections were made. 77 The following table summarises the work done in connection with Food premises during 1933:— No. of Premises on Register. No. of Inspections. No. of Notices. Bakehouses:— Factories-— Underground 15 24 5 Aboveground 13 22 5 Workshops— Underground 1 7 3 Aboveground 11 26 3 Fried Fish Shops 6 15 — Ice Cream Premises 70 61 5 Milk Premises 84 153 15 Butter and Margarine Manufacturers and Dealers 9 18 - Restaurants and Eatinghouses 64 59 12 Other Food Premises, e.g., Butchers, Greengrocers, Grocers, Provision Dealers, etc. 455 224 28 No prosecutions were undertaken in respect of Food Premises during the year. There are no Cowsheds, Slaughterhouses or Poultry Slaughter houses in the Borough. The underground bakehouses at 98, Boundary Road, 225 and 289, Finchley Road, and the aboveground bakehouse at 124, Boundary Road are now out of use. A new aboveground factory bakehouse was opened during the year at 16, King's College Road. (v) Registration of Food Premises. (a) Ice Cream.—During the year, one sample was submitted for bacteriological examination. There are 70 premises used for the manufacture, storage or sale of ice cream on the Register as required by the London County Council (General Powers) Act, 1932. 78 In the case of one application for registration, in view of the fact that the premises were not suitable, the Public Health Committee refused the application and decided that a notice should be served upon the applicant in accordance with the provisions of the London County Council (General Powers) Act, 1932, to appear before them to show cause why the Council should not refuse to register the premises in question. The applicant carried out the necessary works and the premises were subsequently registered. In another case an application was refused on the grounds that the premises were not suitable, and a similar notice was served upon the applicant, who did not persist in his application and the premises were not registered. (b) Cooked Meat, etc.—Up to the end of the year 48 premises have been registered as required by the 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 list which was prepared of articles of food which are deemed to come within the scope of the Act was set out in my last Annual Report. (vi) 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 certain articles of agricultural produce. (vii) Merchandise Marks Act, 1926. Under this Act certain imported goods are required to bear an indication of origin when exposed for sale. The obligation to enforce foodstuffs Orders is, by Section 9 of the Act, placed upon the Borough Council by virtue of its being the Food and Drugs Authority. One vendor of tomatoes was cautioned by instruction of the Public Health Committee during the year for exposing tomatoes for sale by retail without bearing the correct indication of origin. 79 (viii) Stalls and Vehicles (including Street Traders). All applications by Stallholders for licences to sell foodstuffs arcreferred 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 the 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. (ix) 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. During the year, no cases were notified. (C) Adulteration, etc. (i) Food and Drugs (Adulteration) Act, 1928. 496 samples were taken for analysis during the year by the Sampling Officers under the Act. The number certified to be adulterated was 18, or 3 6 per cent. of the total number, as compared with 13, or 2 6 per cent. in 1932. Of the total samples taken for analysis, 281 were formal samples and 215 informal. The following table shows the articles of which samples were taken during the year:— Article. Number taken. Number Adulterated. Bread and Butter 16 5 Butter 56 1 Cereals 9 - Cheese 21 - Cocoa 15 — Carried forward 117 6 80 Article. Number taken. Number Adulterated. Brought forward 117 6 Coffee 13 — Cream 13 — Dripping 10 — Drugs 12 1 Fish Pastes 12 — Flour 4 — Fruit Preserves 11 — Ham and Chicken Roll 2 2 Jam and Honey 10 — Lard 35 — Lemonade Powders and Crystals 5 — Limejuice and Soda 2 2 Margarine 54 1 Meat, Minced 6 — Milk 114 2 Milk, Condensed 2 — Mustard 6 — Peas 4 — Pepper 8 — Sausages 18 4 Spices 3 — Spirits 7 — Sweets 2 — Tea 5 — Vinegar 5 — Various 16 — Totals 496 18 The following table shows the articles adulterated, etc., and the nature of adulteration :— No. of Sample. Article. Analyst's Report. 35 Ham and Chicken Roll Trace of boric acid, about 0•01 per cent. 44 Ham and Chicken Roll Trace of boric acid, about 0•01 per cent. 45 Sausages 20 parts of sulphur dioxide per million. 109 Butter Water, 16•1 per cent. 179 Sausages Sulphur dioxide, 100 parts per million. 81 No. of Sample. Article. Analyst's Report. 180 Sausages Sulphur dioxide, 140 parts per million. 196 Bread and Butter Bread and margarine. 269 Margarine Water, 16•2 per cent. 297 Milk, Pasteurised Number of bacteria per c.c., 750,000. 322 Grey Powder Deficient in mercury to the extent of 12 per cent. 328 Bread and Butter Bread and margarine. 329 Sausages Sulphur dioxide, 280 parts per million. 336 Bread and Butter Bread and margarine. 359 Bread and Butter Bread and margarine. 346 Lime Juice and Soda No lime juice. 362 Lime Juice and Soda No lime juice. 364 Bread and Butter Bread and margarine. 409 Milk Deficient in milk fat, 23 per cent. (ii) Artificial Cream Act, 1929. The following is the only registered premises in the Borough:— 110, High Road, Kilburn. (iii) Public Health (Condensed Milk) Regulations, 1923 and 1927. One of the samples of condensed milk submitted for analysis calls for comment. The Public Analyst reported that the contents of the tin were satisfactory as regards composition, but that he found at least 500 organisms per gram capable of growing at blood-heat, although the label stated that the contents were "absolutely free from bacteria." From its mode of preparation sweetened condensed milk is not a sterile material, and the Public Health Committee considered that it was misleading to the purchaser to affix such a description to the tin, which also bore the statement " Made in Holland." Accordingly the attention of the vendors and the Ministry of Health was called to the matter. (iv) Public Health (Dried Milk) Regulations, 1923 and 1927. No sample was taken during the year. (v) Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. Of the samples of food submitted for analysis, four were found to contain preservatives. These were all of sausages. In one case a 82 notice in accordance with the Regulations was exhibited in the premises; in another case the amount of preservatives was so small that no action was taken; while the vendors of the remaining two samples (found to contain 100 and 140 parts of sulphur dioxide per million) were cautioned. (D) Chemical and Bacteriological Examination of Food. The Public Analyst undertakes the chemical analysis of food at his Laboratories at 11, Billiter Square, E.G.3. Details of this work, together with the Annual Report of the Public Analyst, will be found in this Section of the Report. The Public Analyst also conducted certain bacteriological work during the year, including the examination of samples of drinking water, ice-cream, designated and raw milk. Bacteriological examination of raw and graded milks was also undertaken for the Borough Council during the year by the Royal Institute of Public Health, Queen Square, Bloomsbury. No cases of food poisoning were notified under the London County Council (General Powers) Act, 1932. (E) Nutrition. The routine medical inspection of entrant children in Hampstead to Elementary Schools during the year 1933, demonstrates that 23 5 per cent. were classed as "good," 73 4 per cent. were "average" and 31 per cent. were "below normal." The corresponding figures for the County of London were 220 per cent., 73 5 per cent. and 45 per cent. Reference should also be made to the report of the Ante-Natal Officer, Dr. M. Kidd, who makes important observations relative to the nutrition of expectant mothers (vide, page 33). REPORT for the year 1933 of the Public Analyst. H. E. COX, D.Sc., Ph.D. (Lond.), F.I.C. 11, Billiter Square, E.C.3. 2nd February, 1934. 85 The Laboratory, 11, Billiter Square, London, E.C.3. 2nd February, 1934. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I beg to submit a short account of the analyses carried out by me under the Sale of Food and Drugs Act during the year 1933. The total number of samples examined has been rather lower than in the previous years. It amounts to 496 in all. The following list shows the principal articles examined, in addition to which there have been a large variety of other articles of food or drink or medicine:— Milk 114 Condensed Milk 2 Butter 55 Cream 13 Margarine 54 Cheese 23 Lard 35 Dripping 10 Sausages 18 Fish and Meat Products 21 Bread and Butter 16 Jam 7 Coffee 13 Cocoa 15 Spirits 7 Lemonade Powders 5 Cereals 11 Preserved Fruits 7 Peas 4 Vinegar 5 Pepper 7 Medicines 11 It is perhaps inevitable that in making a Report of this kind, one should refer more to the adulterated or unsatisfactory samples than 86 to the larger number of those of excellent quality. So before referring to the irregularities, it should be pointed out that the general standard of foods sold in the Rorough is high, the number of cases of real adulteration is small and most of the irregularities consist in infringements of the Preservative Regulations or the failure to comply with some or other legal standard or limit. There are also cases of mis-description. No new Regulations under the Food and Drugs Act have come into force during the year, but a matter of considerable importance has been the sitting of a Departmental Committee on Food Law, which is deliberating upon the desirability or otherwise of setting up standards for certain articles of food other than milk. I have had the privilege of giving evidence before this Committee in favour of Standards for certain major articles of diet which seemed in need of such Standards. If the Committee recommends Standards, it will, I think, be found necessary to make other amendments of the Act to cover matters of description and advertisement. I have upon more than one occasion referred to the frequency of mis-descriptions or misleading labels. Certain instances have come under my notice during the year in the Borough, such as Lemonade and Lime Juice and Soda, which contained no evidence of the presence of lemon or lime products. Even the acid was tartaric and not citric. In view of the prominence now given to vitamins in dietetics, persons partaking of these beverages might reasonably suppose that they got some small modicum of vitamin in Lime Juice, whereas in fact they get none from mixtures of tartaric acid and sugar appropriately flavoured. In this connection it may be noted that a chemical method for the determination of Vitamin C in such products is now available, whereas only a short time ago recourse had to be made to elaborate feeding experiments. Of the milk samples, only two have been found to be unsatisfactory. One was deficient in fat to the extent of 23 per cent. and another, alleged to be pasteurised, showed no evidence of having been so treated. The average composition of the milks is good, the figures being very close to those of previous years, viz.:— Total milk solids 12.36 per cent. Fat 3.59 Solids not fat 8.77 „ Bacteriological tests were made of some of these samples. 87 The number of Butters or Margarines containing excessive water has much diminished. There have been only two this year, and no cases of adulteration of butter with margarine have been observed, though another form of this practice still takes place in certain eating houses, for five lots of bread and butter ordered by your Inspectors as bread and butter were found to consist of bread and margarine. There have been some few infringements of the Preservative Regulations. Four lots of Sausages contained Sulphur Dioxide without the Statutory Declaration, and two meat products contained traces of boric acid. A number of samples of Grey Powder were examined and two contained 28 and 21 per cent. of mercury respectively instead of the 33 per cent. required by the British Pharmacopoia. It is well known that there is much difficulty in mixing Grey Powder, so a fairly wide limit of error should be adopted, but when a sample contains so little as 21 instead of 33 per cent., the deficiency seems to be beyond a reasonable limit of error. Some of the meat products, sausages and meat and fish pastes contained rather large proportions of water, in some cases so much, that it is doubtful whether the purchaser obtained that proportion of meat which he might reasonably expect, but there is no legal limit at present. This matter is of some importance because in the homes of those who are less well-to-do sausages often form a major part of the meat supply for the week; they ought, therefore, to contain a full proportion of meat. The total number of samples regarded as adulterated is 18 or 36 per cent. There were also minor cases of slight infringements of Regulations. The word " adulterated " is perhaps an unfortunate one, as this term really only applies to some of the samples, the others might better be termed " unsatisfactory," but for purposes of classification under the Act must be reported as " adulterated." It is clear that there is still need of careful control of the food supplies, so that the purchaser may really get the kind and quality of food which he desires. I have the honour to remain, Your obedient Servant, H. E. COX, Borough Analyst. Section 7. Prevalence of, and Control over, Infectious and other Diseases. 91 Prevalence of, and Control over, Infectious and other Diseases. Cerebro-Spinal Fever. Three cases of Cerebro-Spinal Fever occurred in the Borough during the course of the year under review. All three patients concerned were males (ages 14, 42 and 57), two of whom died. The cases were in no wise associated with one another, and lived in different parts of the Borough, the illnesses being in the months of February, March and April. Diphtheria. During the year, 104 cases of diphtheria were notified and three deaths were registered from this cause. The morbidity rate was 11 per 1,000 of the population and the case mortality was 29 per cent. Of the 103 notified cases all except one were removed to hospital. 224,000 units of anti-toxin were issued by the Public Health Department to medical practitioners during the year. I minimisation. In June, 1933, a scheme was instituted whereby immunising material against diphtheria might be made available free of charge for the use of general practitioners in the Borough. The medical practitioners were circulated and 32 have intimated their intention of partaking in the scheme. Returns are made by them, whereby this Department is informed of the name, age, address and date on which the patient receives the injections. Although the scheme makes no arrangement for the provision to the medical practitioners of Schick testing material, it is hoped that each practitioner makes his own arrangement to effect at least a final Schick Test. It would, of course, be of untold advantage if simultaneous immunisation against both Diphtheria and Scarlet Fever were arranged, and, if necessary, the above general-practitioner scheme supplemented by immunisation at the London County Council Schools, each school in the Borough being dealt with in rotation. 92 Malaria. One case of Malaria was notified during the year, a boy aged six years, who had contracted the disease in British East Africa. Measles. During the year, there were 81 cases of Measles notified in pursuance of the Borough of Hampstead (Measles) Regulations, 1920; this represents a decrease of 635 over the previous year. There were no deaths. Enteric Fever. Four cases were notified as Enteric Fever during the year; in two the B. Typhosus was responsible and in the other two Paratyphoid B. Three of the cases made an uninterrupted recovery, but the fourth case, a male aged 26, who had contracted Typhoid Fever while on holiday in Spain, had a fatal termination in 1934. Pneumonia. During the year, 66 cases of acute primary pneumonia and 54 cases of acute influenzal pneumonia were notified. In the preceding year the corresponding figures were 44 and 30. The total deaths were 49. Of the total deaths from pneumonia, 32 occurred in persons over 45 years of age. The age of the patient is the most important factor of mortality. Scarlet Fever. During 1933, there were 451 cases of Scarlet Fever as compared with 166 in 1932 and 168 in 1931. Fortunately, the disease continues to be of a mild type, and no case had a fatal termination. From the chart attached it will be seen that the disease first became manifest in February and continued intermittently throughout the year. The peak period was in the month of July when 20 cases were notified in the week ending July 22nd. The illness was prevalent throughout the whole of the Borough and, indeed, the whole of the Metropolis. There were 135 cases reported from the Town Ward and 124 from the Kilburn Ward, Chart showing the number of cases of Scarlet Fever occurring in Hampstead DURING EACH WEEK OF 1933. 93 The distribution of the cases in age groups shewed, as expected, that the main incidence of Scarlet Fever falls on the 5-15 age-group, thus:— Under school age 86 = 190 per cent. School age 285 = 632 „ Over school age 80 = 178 „ It is interesting to note that closure of the public elementary schools for public holidays immediately resulted in a decrease in the number of cases of scarlet fever notified, which is rather at variance with the generally accepted view that, in an urban area such as Hampstead, school closure does not in any way assist in the suppression of infectious disease. Most of the cases (96 per cent.) were removed to Infectious Disease Hospitals and the Health Visiting Staff made most careful enquiries. As a consequence of these enquiries it was found that no less than 29 patients after their discharge from hospital in a non-infectious state had subsequently become infectious and given rise to "return cases." It will be noted that the "infecting case rate" is 64 per cent., which is a high figure. Before a case was regarded as responsible for a " return case " it had to fulfil all the four following criteria :— (1) To have returned recently from fever hospital after suffering from Scarlet Fever. (2) To have discharging nose or other obvious inflammation of the naso-pharynx. (3) To have been in close association with the secondary case. (4) Swabs from the naso-pharynx to reveal the presence of hemolytic streptococci. Further examination of these 29 cases showed that their average stay in hospital was 47 days; no case had been in hospital for less than 28 days, whilst 5 cases had been in hospital for more than 56 days, and 2 cases had indeed been detained in hospital for more than 100 days. Whilst certain of these cases occurred, of course, in the overcrowded tenement houses of the Borough, "return cases" were 94 also frequent among well-nourished children living under satisfactory housing conditions. Immunisation. Owing to a small outbreak of Scarlet Fever at Bartrams School in which 16 cases occurred amongst the 216 scholars, it was decided that immunisation should be offered to the school authorities. There were 48 acceptances for preliminary Dick testing, of whom 10 were over 14 years of age and 38 under. Three of the adults and 14 of the children showed positive reactions (i.e., 35 per cent.), and these were all subsequently immunised by Dr. C. R. Lane. The low percentage of positive reactors is doubtless accounted for in that many had been spontaneously immunised in the outbreak immediately preceding. Dr. Lane reported that there was no reaction of any kind in any of the patients. No further case of Scarlet Fever has occurred at the school. Burroughs Wellcome material was used; the course of immunising adopted and the results obtained were as follows : — The first course consisted of four injections at fortnightly intervals. The injections given were 500A, 1000A, 5000C and 20000C skin test doses respectively. Four weeks after the fourth injection the individuals were again Dick tested and it was found that one adult and 8 children were still positive (i.e., 50 per cent.). The positive reactors were then given a further injection of 20000C skin test doses; another Dick test performed three months after the completion of the first course showed no positive cases. It will be noted that the doses of toxin used were small as compared with what the Dicks are now recommending, but they were much the same as used by Benson in Edinburgh with excellent results some years ago. 95 Notifiable Diseases during the Year 1933. 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. Under 1. 1 and under 2. 2 and under 3. 3 and under 4. At Ages—Years. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Ward No. 1 (Town). ward No. 2 (Belsize). Ward No 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). At all Ages. Under 1. 1 and under 2. 2 and under 3. 3 and under 4. At Ages—Years. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. Cerebro spinal Fever 3 .. .. .. .. .. .. .. 1 .. 1 1 .. 2 .. .. .. .. .. 1 3 2 .. .. .. .. .. .. 1 .. .. 1 .. .. continued Fever .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Diphtheria 104 2 3 3 10 5 44 14 6 13 1 3 31 24 5 8 9 19 8 103 3 .. .. 1 .. .. 1 1 .. .. .. .. .. Dysentery .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Le- thargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Enteric Fever (including Paratyphoid) 4 .. .. .. .. .. .. .. 1 3 .. .. .. 1 1 .. .. 1 1 .. 4 .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 44 1 1 .. 1 .. 3 2 1 .. 5 14 9 10 6 4 6 5 6 7 35 3 .. 1 .. .. .. .. .. .. .. .. 1 1 Malaria 1 .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 6 6 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 3 3 .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 120 4 2 1 .. 2 7 3 9 22 14 38 18 13 25 12 8 18 32 12 59 49 5 1 1 .. 1 .. 2 1 3 3 13 19 Scarlet Fever 2 .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. 1 1 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 12 .. .. .. .. .. .. .. 1 9 2 .. .. .. 1 2 .. 3 2 4 12 .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Pyrexia 451 3 5 17 21 40 195 90 18 41 16 5 132 71 30 12 50 120 36 436 .. .. .. .. .. .. .. .. .. .. .. .. .. † Measles 81 2 6 9 7 7 19 20 6 5 .. .. .. 12 13 .. 13 14 19 3 10 .. .. .. .. .. .. .. .. .. .. .. .. .. ‡ Tuberculosis 101 .. .. .. 1 .. 2 4 6 45 19 21 3 16 18 11 7 17 20 12 81 40 .. .. .. .. .. .. 1 10 9 8 8 4 Totals 929 18 17 30 40 54 271 133 49 146 59 82 30 217 159 71 54 118 224 86 749 97 5 2 2 .. 1 1 5 11 12 12 22 24 * Cancelled cases have not been included. † Notifiable under the Borough of Hampstead (Measles) Regulations, 1920. ‡ Statistics relating to Tuberculosis are given in subsequent pages. 96 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, 1932 1483 2. Number of these :— (a) Successfully vaccinated 894 (b) Insusceptible of Vaccination 9 (Y) Had Smallpox — (d) Number in respect of whom Statutory Declaration of conscientious objection have been received 314 (e) Died unvaccinated 49 3. Number of these Births which on 31st January, 1932, remained unentered in the " Vaccination Register " on account of :— (a) Postponement by Medical Certificate 8 (b) Removal to Districts the Vaccination Officers of which have been duly apprised 126 (c) Removal to places unknown, or which cannot be reached; and cases not having been found 74 4. Number of these Births remaining on 31st January, 1933, neither duly entered in the " Vaccination Register" under headings numbered 2 nor temporily acounted for in the " Report Book " under headings numbered 3 9 5. Total number of Certificates of successful primary vaccination of children under 14 received during the Calendar year 1932 (including any relating to births registered in previous years) 966 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 1932 333 7. Number of cases of children in entries 1 and 2 (d) successfully vaccinated after the declaration of conscientious objection had been made 1 97 8. Total number of Certificates for the year 1932 of successful primary vaccination of which copies have been sent to Vaccination Officers of other districts 141 Whooping Cough. This disease is not compulsorily notifiable in Hampstead, our principal source of information of the occurrence of cases is the Head Teachers of Schools. During 1933, three cases proved fatal. Dysentery, Encephalitis Lethargica, Polio Myelitis, Small Pox. There was no case of the above diseases notified during the year. Cancer. 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. 98 Deaths from Cancer by Site, Age and Sex, 1933. Site. Sex 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85- Total. Pharynx M ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 1 ... ... ... ... 1 (Esophagus M ... ... ... ... ... ... ... ... ... 2 ... ... 2 F ... ... ... ... 1 1 ... ... ... ... ... ... 2 Pylorus M ... ... ... ... ... ... ... ... 1 ... ... ... 1 F ... ... ... ... ... 1 ... ... ... ... ... ... 1 Stomach M ... ... ... 2 ... 1 ... 1 2 4 ... ... 10 F ... ... ... 1 l 1 1 2 4 1 ... 1 12 Rectum M ... ... ... ... ... 3 4 ... ... 1 2 1 11 F ... ... ... ... 2 ... ... ... ... ... ... ... 2 Liver M ... ... ... ... ... ... 1 ... ... ... ... ... 1 F ... ... ... ... 1 1 ... ... 1 1 ... ... 4 Gall Bladder M ... ... ... ... ... ... ... ... 1 ... ... ... 1 F ... ... ... ... ... ... 1 ... ... ... ... ... 1 Pancreas M ... ... ... ... ... ... ... 1 1 1 ... ... 3 F ... ... ... ... ... ... 1 ... 1 ... ... ... 2 Caecum M ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... 1 ... ... ... 1 ... 2 Colon M ... ... ... 1 1 1 ... 1 ... 1 3 ... 8 F ... ... ... ... ... 1 ... 1 6 2 ... ... 10 Hepatic Flexure M ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 1 ... ... ... ... 1 Sigmoid Flexure M ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... 1 ... ... ... ... ... 1 Intestine (not stated) M ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... 1 1 Peritoneum M ... ... ... ... ... ... ... ... ... ... ... ... ... F ... 1 ... ... ... ... ... ... ... ... ... ... 1 Larynx M ... ... ... ... ... 1 ... 1 ... ... ... ... 2 F ... ... ... ... ... ... ... ... ... ... ... ... ... Lung M ... 1 ... 2 1 2 1 1 1 ... ... ... 9 F ... ... ... 1 ... 1 ... ... ... ... 1 ... 3 Mediastinum M ... ... ... ... ... 1 ... ... ... ... ... ... 1 F ... ... ... ... ... ... ... ... ... ... ... ... ... Cervix Uteri F ... 1 ... 1 ... ... ... ... ... ... ... ... 2 Body of Uterus F ... ... ... ... ... ... ... ... 1 ... ... ... 1 Uterus (undefined) F ... 1 ... 1 ... 1 1 ... ... ... 1 ... 5 Ovary F ... ... 1 2 ... ... ... ... ... 1 1 5 Left Breast F ... ... ... ... ... ... 1 ... 2 ... ... 3 Right Breast F ... ... ... ... ... 1 ... ... ... ... ... ... 1 Both Breasts F ... ... ... ... ... ... ... 1 ... ... ... ... 1 Breast (not stated) F ... 1 3 1 1 1 3 2 2 1 1 ... 16 Bladder M ... ... 1 1 ... ... ... 1 ... ... ... ... 3 Prostate M ... ... ... ... ... ... ... 3 1 2 ... ... 6 Testes M ... ... ... ... ... ... ... ... ... ... ... 1 1 Face M ... ... ... ... ... 1 ... ... ... ... ... ... 1 F ... ... ... ... ... ... ... ... ... ... ... ... ... Abdominal Wall M ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ...... ... ... ... ... ... ... ... 1 1 Brain M ... ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... 1 ... ... ... ... ... 1 Lymphatic glands of neck M ... ... ... ... ... ... 1 ... ... ... ... ... 1 F ... ... ... ... ... ... ... ... ... ... ... ... ... Spinal Column M ... ... ... 1 ... ... ... ... ... ... ... ... 1 F ... ... ... ... ... ... ... 1 ... ... ... ... 1 Ethmoid cells M ... ... ... ... ... ... ... ... ... 1 ... ... 1 F ... ... ... ... ... ... ... ... ... ... ... ... ... Thyroid M 1 ... ... ... ... ... ... ... ... ... ... ... 1 F ... ... ... ... ... ... ... 1 ... ... ... ... 1 Neck and throat (site not defined) M ... ... ... ... ... ... ... ... ... ... ... 1 1 F ... ... ... ... ... ... ... ... ... ... ... ... ... M 1 l 1 7 2 10 7 9 7 12 5 3 65 F ... 4 3 6 8 9 10 11 15 7 5 4 82 Total 1 5 4 13 10 19 17 20 22 19 10 7 147 99 Influenza. There were 54 deaths due to Influenza during 1933, as compared with 36 deaths during the previous year. Only 13 of these deaths occurred under the age of 45, whilst 15 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, 749 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 1933:— Positive. Negative. Total. Diphtheria 70 574 644 Enteric Fever 4 8 12 Scarlet Fever (for Haem. Strep.) 63 41 104 Specimens of Sputum 37 146 183 X-ray Examinations made — — 84 Public Health Station. The Public Health Station is situated in the Electricity Yard, Lithos Road, Finchley Road, and comprises Disinfecting Station, 100 Bathing Station and Laundry, Garage, Public Health Stores, Furnaces for destroying bedding, etc., with quarters for the resident Senior Disinfector. 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 1933 :— Number of houses or parts of houses and contents disinfected 1,840 „ verminous rooms disinfested 233 „ „ articles of clothing disinfested *190 „ „ beds disinfested 72 „ 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 4 Children 905 Scabies. Adults 5 Children 64 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 233 verminous rooms and contents, and, in addition, as a result of the action 101 of the Sanitary Inspectors, 135 verminous rooms in 67 houses and 40 sets of beds and bedding were also cleansed and freed from vermin. 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 any families 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 in the Electricity Yard, Lithos Road. Tuberculosis. Notification. During the year 1933, 104 new cases of Tuberculosis were notified, 94 being cases of Pulmonary Tuberculosis, and 10 other forms of the disease. Three certificates relating to Pulmonary cases were subsequently withdrawn. There were 8 deaths of persons certified during the year as due to tuberculosis, who had not previously been notified. The total number of deaths from tuberculosis was 40 and the ratio of nonnotified tuberculosis deaths to total tuberculosis deaths was, therefore, 1 in 5. 102 The following statistical table, prescribed by the Ministry of Health, gives an analysis of the newly notified cases and deaths during 1933:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0- - - - - - - - - 1- — — 1 — — — — — 5- 3 — 3 — — — 1 15- 10 15 2 4 6 - — 25- 11 13 — 3 4 1 1 35- 13 7 — — 6 2 — — 45- 8 7 1 1 3 1 — — 55- 2 2 1 3 1 - 65 and upwards 3 — — 1 3 1 — — Totals 50 44 5 5 22 15 2 1 Occupations. The following is an analysis of the occupations of the new cases notified as tuberculosis during 1933 :— Occupation. Pulmonary Cases. NonPulmonary Cases. Occupation. Pulmonary Cases. NonPulmonary Cases. Bacteriologist 1 — Journalist 1 — Bag Making 1 — Labourer 3 — Baker's Assistant 2 — Librarian — 1 Canvasser 1 — Manservant 1 — Caretaker 1 — Merchant 1 — Cashier 1 — Nil. 3 1 Chauffeur 1 — Nurse 5 1 Cinema Cameraman 1 — Picture Palace At tendant 1 - Clerk 6 1 Commercial Traveller 3 - Porter 1 Postman 2 Company Secretary 1 — Scholar 4 3 Cook 1 — Shop Assistant 5 — Domestic 6 1 Soldier 2 — Dyer and Cleaner 1 — Student 3 — Engineer 1 — Tailor 1 — Factory Hand 2 — Telephone Operator 1 — Fitter 2 Tennis Racket Stringer 1 - Gardener 2 — Hairdresser 2 Totalisator Operator 1 — Housekeeper 1 — Waitress 1 — Housewife 18 2 Instrument Maker 1 Totals 94 10 Insurance Broker 1 — — — 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 103 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 94 cases of Pulmonary Tuberculosis newly notified in 1933:— 55 were treated at Sanatoria. 10 „ „ Hospitals. 11 „ „ L.C.C. Hospitals. 3 notifications were withdrawn. Of the 10 cases of Non-Pulmonary Tuberculosis newly notified in 1933:— 6 were treated at Sanatoria. 4 „ „ Hospitals. The following cases, notified prior to 1933, were also removed:— Pulmonary. Non-Pulmonary. Insured. Non- Insured. NonInsured. Insured. To Sanatoria 11 1 — — To Hospitals 1 — To L.C.C. Hospitals 8 3 — — 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 16 discharged soldiers in receipt of a pension for tuberculosis are resident in Hampstead. The number of cases of tuberculosis known to the department at the end of 1933 totalled 420 —347 pulmonary and 73 non-pulmonary. Tuberculosis Regulations, 1930. Pulmonary. Non-Pulmonary. Totals. Males. Females. Males. Females. Males. Females. Number of cases on the Register at the commencement of the year 1933 167 192 42 52 209 244 Carried forward 167 192 42 52 209 244 104 Tuberculosis Regulations, 1930. Pulmonary. Non-Pulmonary. Totals. Males. Females. Males. Females. Males. Females. Brought forward 167 192 42 52 209 244 Number of cases notified under the Regulations for the first time during the year 50 44 5 5 55 49 Number of cases removed from the Register in a preceding year which have been restored to the Register during the year 2 1 1 - 3 1 Number of cases brought under notice otherwise than by notification during the year 16 13 2 3 18 16 235 250 50 60 285 310 Number of cases removed from the Register during the year 71 67 13 24 84 91 Number of cases remaining on the Register at the end of the year 164 183 37 36 201 219 *Ihese consist of cases which have been denotified, and those which have died or removed from the Borough. Deaths. The number of deaths from Tuberculosis in 1933 was 40; of these 37 were due to pulmonary tuberculosis and 3 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. (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. 105 (3) Tuberculosis Nurse. (4) Clerk. All newly notified cases are visited by the Nurse and informed of the Dispensary facilities and if they are suitable cases are urged to attend. 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 84 such examinations made during 1933. Pathological Examinations of 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 1933 on 100 occasions by local practitioners (exclusive of the 83 specimens sent for examination by the Tuberculosis Medical Officer). Artificial Pneumo-thorax. Arrangements exist for patients to receive this treatment at Brompton, Victoria Park. Colindale and University College Hospitals. During the year 1933, there were 9 patients referred to these hospitals entailing 136 attendances. Sanocrysin Injections. The Borough Council has made arrangements with Brompton Hospital under which they guarantee payment of a fee (3s. 6d. per injection) in respect of cases sent in by the Tuberculosis Medical Officer and where his concurrence has been obtained before the injections are given. 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 7. 106 Finsen-Light Treatment. During 1933, one Dispensary patient was referred by the Tuberculosis Officer to the London Hospital for Finsen-Light Treatment, the Council paying a sum of 5s. for each attendance at the hospital. From March to December the patient made 16 attendances at the hospital. 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 1933. 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 two 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 milk vessels. 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, Mrs. Councillor Moody, Mr. Councillor Baily and Mr. Councillor Parkes. 107 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 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. In February the Borough Council considered an application from the Care Committee asking for a larger contribution, and decided to increase their grant towards the administrative expenses of the Tuberculosis Care Committee in respect of the financial year 1933-1934 to £100—the annual amount previously voted having been £45. Details of the work during the year of the Hampstead Borough Tuberculosis Care Committee are tabulated below:— Number of cases reviewed 158 Number of new cases referred to the Care Committee during the year 91 Number of cases assessed during the year 82 Amount collected from patients on behalf of the London County Council £66 12s. Number of cases referred to the Hampstead Borough Council for extra nourishment or dental treatment 11 Number of cases referred to the Public Assistance Committees 18 Number of cases referred to Service Funds 13 Number of cases referred to Voluntary Associations 16 108 Number of cases referred to other Agencies 14 Number of interviews by the Care Committee Secretary with patients 822 Provision of Extra Nourishment. On the recommendation of the Public Health Committee, the Council, on 23rd November, resolved to allocate the sum of £30 for the remainder of the current financial year for the purpose of providing extra nourishment (milk, eggs and butter) to the classes of patients indicated in Circular 257 of the Ministry of Health. 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, 199 sessions were held, and 260 new cases (of which 62 were contacts) were examined. The total attendances of all kinds numbered 1,203; an average of 61 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 1933, I append herewith. 109 Municipal Tuberculosis Dispensary, 75, Dynham Road, Kilburn, N.W.6. February, 1934. 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 1933. 380 patients attended the Dispensary during the year, and the total number of attendances was 1,203, at which 678 systematic physical examinations were made. The attendances were 174 more than last year. New applicants attending numbered 260 (44 more than the previous year), and these have been classified as shown in Sections A and B of the following table:— 110 Tuberculosis Scheme of the Hampstead Metropolitan Borough Council. Return showing the work of the Dispensary during the year 1933. 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 35 32 2 — 1 4 2 — 36 36 4 — 76 (b) Doubtfully tuberculous — — — — — — — — — 3 1 — 4 (c) Non-tuberculous — — — — — — — — 23 50 17 10 100 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 — — — — — — — 1 — — — 1 (b) Doubtfully tuberculous — — — — — — — — l 1 — — 2 (c) Non-tuberculous — — — — — — — 10 18 16 15 59 C.—Cases written off the Dispensary Register as: — (a) Recovered 2 3 5 2 2 3 13 9 4 6 18 11 39 (b) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) 33 72 35 25 165 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 81 101 8 6 6 13 9 2 87 114 17 8 226 (b) Diagnosis not completed — — — — — — — — 2 4 1 — 7 Number of persons on Dispensary Register on January 1st 238 Number of patients transferred from other areas and of " lost sight of" cases returned 44 Number of patients transferred to other areas and cases " lost sight of" 07 Died during the year 20 Number of attendances at the Dispensary (including Contacts) 1203 Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1154 Number of consultations with medical practitioners:— (a) Personal 14 (b) Other 113 Number of visits by Tuberculosis Officer to Homes (including personal consultations) 21 Number of: — (a) Specimens of sputum, &c., examined 83 (b) X-ray examinations made in connection with Dispensary work 84 Number of Insured Persons under Domiciliary Treatment on the 31st December 20 Number of 44 Recovered " cases restored to Dispensary Register, and included—in A (a) and A (b) above — Number of " T.B. plus " cases on Dispensary Register on December 31st 127 111 There have been 14 consultations with doctors in regard to patients at their homes and 113 letters have been sent to 52 doctors concerning cases referred for an opinion. I have made visits to the homes of patients in relation to 21 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:— 52 were referred to the London County Council for treatment in Sanatoria and Hospitals. 15 were admitted to New End Hospital. 4 were admitted to Victoria Park Hospital. 6 were admitted to the Hampstead General Hospital. The number of notifications has increased, the total being 101, 91 pulmonary and 10 non-pulmonary. The primary notifications were 7 more than last year. Of the total primary notifications :— 43 attended the Dispensary during the year. 18 cases were not of Dispensary class. 58 cases were notified from Hospitals or Sanatoria; this figure continues to shew a steady increase; many of these are still attending their hospital of origin or are still in sanatoria. 7 were domestic servants. 25 cases were transferred from other boroughs. Of these, 18 attended the Dispensary, one removed again and one died. 13 of the primary cases notified died during the year, only two of which had attended the Dispensary. 10 of the deaths occurred in hospital and three at home. A total of 40 deaths occurred during 1933. This number of deaths is the same as in the previous year. Only 17 of these were Dispensary patients and three were nonpulmonary cases. 30 died at Institutions and 10 at home, compared with 15 last year and 12 the year before. 112 84 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 uniformity 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 151. 46 of these have been examined, i.e., 31 per cent. A total of 62 contact cases were examined altogether. The past year was unusual on account of the exceptionally fine summer and excess of sunshine. The immediate effect of this was somewhat trying to the tubercular patient and a certain number of quiescent cases became activated. Moreover, the number of cases notified in each month from May to September was increased. The general health appears to have been exceptionally good for the remainder of the year, respiratory infections of an infective nature having been few, and if this continues and there is no influenzal epidemic it is possible that the general incidence of tuberculosis will be again decreased. As a result of the climatic conditions, there was a considerable increase of work at the Dispensary during the year, new cases examined numbering 260. Consultation cases with doctors were 30 more than last year, whilst the number of individual doctors sending cases for consultation increased by 20. 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 the 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. 113 In the following tabular statement some idea may be gained of the work done in connection with the Dispensary since its inception:— Year. No. of New Applicants. No. of New Applicants treated. No. of Contacts examined. Total Attendances of all kinds. 1913 1st Feb. to 31st Dec. 455 191 204 2808 1914 455 118 195 1913 1915 308 146 158 899 1916 230 165 100 1519 1917 383 183 113 1682 1918 371 105 124 1821 1919 296 85 57 1543 1920 384 221 112 2625 1921 479 127 192 2327 1922 445 113 223 1738 1923 422 120 199 1534 1924 365 111 151 1601 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 1933 260 55 62 1203 I have to thank the Dispensary Staff for their efficient and keen work, and Dr. Oldershaw, our Medical Officer of Health, for his help and co-operation. A. J. SCOTT PINCHIN, M.D. (Lond), F.R.C.P. (Lond.). 114 INDEX. PAGE Adulteration, etc. 79 Agricultural Produce (Grading and Marking) Act, 1928 78 Ambulance Facilities 21 Analyst, Public, Report of 85 Analytical Work 79 Ante-Natal Clinics 32 Anti-toxin (Diphtheria) 91, 95 Area of Borough 11 Artificial Cream Act, 1929 81 Artificial Pneumo-thorax 105 Bacteriological Work 82, 99 Bakehouses 77 Bathing Station 100 Beauchamp Lodge, Paddington 44 Births 27, 29,30 Bug infestation of houses 59 Butter Factories 77 Cancer 97,98 Care Committee (see Tuberculosis). Cerebro-Spinal Fever 91, 95 Chemical and Bacteriological Examination of Food 82 Child Mortality 29 Children's Hospital, College Crescent 43 Cleansing of verminous houses, persons, etc. 100 Cleansing Station (see Bathing Station). Clearance Areas 71,72 Clinics and Treatment Centres 22 Closing Orders 69 Common Lodging Houses 56 Complaints Received 53 Condensed Milk 81 Consulting Obstetricians 47 Consumption (see Tuberculosis). Convalescent Homes, etc. 44 County Council Housing Estates 69 Creches (see Day Nurseries). Cricklewood Housing Scheme 71 115 PAGE Cross Roads Club, 88, Alexandra Road 45 Day Nurseries 45,46 Deaths 15 Dental Clinics, etc. 36,39,105 " Diamond Jubilee" Beds 23 Diphtheria, Anti-toxin, and Immunisation 91,95 Disinfection 100 Dried Milk 81 Dysentery 97 Encephalitis Lethargica 97 Enteric Fever 92, 95 Epidemic Diarrhœa 95 Erysipelas 95 Factory and Workshop Acts 56 Finsen Light Treatment 105 Flatlets, one-room 61 Food and Drugs (Adulteration) Act, 1928 79 Food and Food Premises 76, 77 Food and Milk for Mothers and Infants 39 Food, Inspection and Supervision of 75-87 Food Poisoning 79 Food, Preservatives in 81 Food Unsound 76 Foster Children and Foster Mothers 47-49 Foster Home, 99, Haverstock Hill 45 Fried Fish Shops 77 Hampstead Council of Social Welfare 35-39 Hampstead General Hospital Borough Beds 23 Hampstead Hospital for Children 43 Hampstead Hostel for Mothers and Babies 45 Hampstead Housing Association 68 Hampstead and North St. Pancras Day Nursery 46 Health Education and Propaganda 62 Health Services 21 Health Visitors and Work of 30, 31 Home Office Tables (Factory and Workshop Act, 1901) 57 Home Workers 58 Hospitals 22, 43 Hospital accommodation 99 Hospital Beds, Borough Jubilee Beds 23 Houses, Inhabited, number of 11 Houses Let in Lodgings (see Tenement Houses etc.). Housing Committee 3 Housing Conditions where births occurred 30 116 PAGE. Housing Section 65-72 Ice Cream 77 Illegimate Children 11 Immunisation, Diphtheria and Scarlet Fever 91, 94 Imported Foodstuffs 78 Improper Mixing of Sexes 68 Infant Life Protection 47-49 Infant Welfare Centres 35-37 Infantile Mortality 29, 47 Infectious Diseases 91-113 Influenza 99 Inspections and Re-inspections 53 Institutions for Unmarried Mothers and for Infants 45 Invalid Children's Aid Association 49 Laboratory Facilities 21 Legal Proceedings 61 Margarine, Wholesale Dealers 77 Malaria 92, 95 Maternal Mortality 29, 47 Maternity and Child Welfare 27-49 Maternity and Child Welfare Centres 32-39 Maternity and Child Welfare Committee 3 Maternity, Clinics (see Ante-Natal Clinics). Maternity Beds 43 Measles 46,92, 95 Meat and other Foods 76-79 Medical Investigation Sub-Committee 43 Merchandise Marks Act, 1926 78 Meteorology 12-14 Midwives and Midwifery Nursing 47 Milk and Dairies Acts, 1915 75 Milk and Dairies Order, 1926 75 Milk and Food for Mothers and Infants 39 Milk, Condensed or Dried 81 Milk (Special Designations) Order, 1923 75 Milk Supply 75 Mortuary, Public 62 Mount Vernon Hospital Borough Beds 23 Municipal Dwellings 70 New End Hospital 43 Notification of Births Act, 1907 29 Nursing in the Home 22, 106 Nutrition 82 Offensive Trades 56 Officials, Public Health 4 117 PAGE. One-room Flatlets 61 Ophthalmia Neonatorum 46, 95 Outworkers (see Home Workers). Overcrowding 66 Park Dwellings 70 Pathological examinations for Sputum 105 Pneumonia, Acute Primary and Acute Influenzal 92, 95 Polio Myelitis 97 Population 11, 14, 15 Population, Natural Increase of 28 Poultry Slaughterhouses 77 Pre-Maternity Clinics (see Ante-Natal Clinics). Preservatives, &c., in Food Regulations, 1925 to 1927 81 Public Health Committee 3 Public Health Station 99 Public Health (Tuberculosis) Regulations, 1925, 1930 103, 106 Public Vaccinators 4 Puerperal Fever and Pyrexia 46,95 Puerperal Sepsis 11 Queen Charlotte's Hospital 43 Queen Mary's Maternity Home, Heath Street 43 Rag and Bone Dealers 56 Rats and Mice (Destruction) Act, 1919 59 Ray-Therapy 39 Rent Restriction Acts 56 Restaurant Kitchens 77 Sale of Food Order, 1921 76 Sanitary Inspectors, Work of 53 Sanocrysin Injections 105 Scabies 100 Scarlet Fever and Immunisation 92 School Entrants and School Medical Inspection 40-42 Seamen's Lodging Houses 56 Shelter 101, 106 Slaughterhouses 76 Smoke Abatement 54 South End Close 70 Staff of the Public Health Department 4 Stalls 79 Still Births 28 Street Traders 79 Tenement Houses and Bye-laws 55, 56 Toddlers' Clinics 36, 38 Town Planning 14 Transfer of Powers (London) Order, 193347-49 118 PAGE. Treatment Centres 22 Tuberculosis 95, 101 Tuberculosis Care Committee 106 Tuberculosis Dental Clinic 105 Tuberculosis Dispensary 108, 109 Tuberculosis Medical Officer, Report of 109 Tuberculosis Patients. Extra Nourishment for 108 Tuberculosis Regulations, 1925, 1930 103, 106 Underground Rooms 54,55 Unemployment 11 Unmarried Mothers 45 Vaccination and Vaccination Order, 1930 96 Vaccination Officer 96 Venereal Diseases, Clinics and Treatment Centres 99 Verminous Persons and Premises, etc. 100 Vital Statistics 11, 14-17 Water Supply of Tenement Houses 55 Welfare Centres 35-37 Whooping Cough 46, 97 Workshops (see Factory and Workshops Acts). X-ray Work 99, 105 Young Children, Mortality among 29