AC4351 M HAMP 35 the Metropolitan Borough of hampstead. REPORT for the year 1934 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. Printed by F. P. Lewingdon, 26 & 27, Eversholt Street, N.W.1. THE Metropolitan Borongh of hampstead. REPORT for the year 1934 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 1.—Statistics and Social Conditions of the Borough 11 „ 2.—General Provision of Health Services in the Borough 21 ,, 3.—Maternity and Child Welfare (including the Report of the Medical Officer of the Ante-natal Clinics) 27 ,, 4.—Sanitary Circumstances of the Borough 59 „ 5.—Housing 71 ,, 6.—Inspection and Supervision of Food (including the Report of the Public Analyst) 87 „ 7.—Prevalence of, and Control over, Infectious and other Diseases (including Tuberculosis and the Report of the Tuberculosis Medical Officer) 105 INDEX 127 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. t. Springs. „ Councillor F. R. Bailey. „ „ 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., l.c.c (until March). „ 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. Alderman F. G. Howard, j.p. (from March). 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 (b) Tuberculosis. MATERNITY AND CHILD WELFARE COMMITTEE. (Members of the Council.) Chairman: Mr. Alderman 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., l.c.c. (until March). Councillor Mrs. M. F. Dow, m.a. (from April). 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. W. H. Samuel, m.b.e. 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. Councillor Mrs. A. J. Arnholz. Mr. Alderman H. Baily, m.b.e. Mr. Councillor J. Batchelor. „ „ R. H. H. Cust, m.a., j.p. Councillor Mrs. 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. Councillor Mrs. M. I. Gruner. 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 (e), (f) A. J. Anscomb. Miss E. M. Blakeman. Miss E. Selwood. Miss C. Montague. Health Visitors—Mrs. I. G. Steward (d) (Senior Visitor) Miss H. B. Evans (a), (c), (d) Miss A. Kennedy (a) Miss C. Lambe (a), (b), (d), (e) Miss M. Lowen (b) (Tuberculosis Visitor and Dispensary Nurse) Miss N. B. May (o), (b), (d) (from December, 1934) Miss P. Reymond (a), (d), (e) (resigned 30th November, 1934) Sanitary Inspectors—F. H. Hudson (e), (f) (Senior of the Inspectors) J. F. Armstrong (e), (f) J. Grimsley (e), (f) W. F. Horniblow (e), (f) Miss C. Lambe (a), (6) (d), (e) (Factories and Workshops) A. Peverett (e), (f) W. Robinson (e), (f) (Tenement Houses) (from July, 1934) A. C. Townsend (e), (f) 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. (until July) J. Davies, m.d. (Lond.), m.r.c.p. (Lond.), m.r.c.s., 103, Cholmley Gardens, N.W.6 (from July) 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. tPart-time Officers of Council of Social Welfare approved by the Maternity and Child Welfare Committee. (a) Health Visitor's Certificate. (d) State Certified Midwife. (b) State Registered Nurse. (e) Sanitary Inspector's Certificate. (c) General Nursing Certificate. (/) Food Inspector's Certificate. 5 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. 17th April, 1935. 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 1934, which is the thirty-fourth of the series. The report contains the information required by the Ministry of Health, and is arranged in accordance with their suggestions. In these introductory paragraphs it is my intention to refer very briefly to the various outstanding events of the year under consideration. In the body of the report the various health services are dealt with in some detail in their appropriate sections. 1. Report of Ministry of Health Inspection. A complete survey of the Health Services of the Borough was carried out by officials of the Ministry of Health during 1933, and their report came to hand on the 16th of February, 1934. This Ministry report stated, inter alia, that "a reasonable standard of efficiency and progress is being maintained by the Council in the discharge of their functions relating to Public Health, and the Minister notes with appreciation the comprehensive provision made in the Borough for maternal care, and the special arrangements for the consideration of each maternal or infant death." The attention of the Borough Council was directed by the Ministry to the augmentation of certain of the Public Health services, to which appropriate reference will be made later. 2. Statistics. The adjusted death rate in Hampstead for 1934 was 106, as compared with 118 for England and Wales. 6 The birth rate of 10.4 per 1,000 of the population shows a slight increase over the corresponding figure for last year, which was 9 6. The infantile mortality figure was 53 per 1,000 live births (c.f. 54, the average for the last 10 years). 3. Maternity and Child Welfare. Considerable progress has been made in these services during the year under review. Schemes have been brought into operation for the provision of Home Helps and Maternity Outfits, which have commanded immediate success. The Toddlers' Clinic, which was established at the end of last year, is proving a valuable adjunct. Arrangements have been made with the Institute of Ray Therapy, whereby appropriate mothers and their children attending the various Welfare Centres in the Borough may receive free treatment. The Municipal Dental Clinic, which was established at the Public Health Station in October, 1933, is more than fulfilling expectations, and during the year under review, no less than 1,268 attendances were made by expectant mothers, nursing mothers, and toddlers. Special care and attention has been given to the powers under the Children and Young Persons Acts, 1908 and 1932, which were transferred to the Metropolitan Boroughs as and from the 1st of April, 1933. There were 619 visits paid to the fosterchildren and 504 visits to the foster-mothers. We are, however, experiencing a serious lack in the Borough of an adequate number of satisfactory foster-mothers. Throughout the year we receive many applications from mothers who wish to place their infants, and it occasions us great regret that we are unable to assist them. It would appear that an additional Foster-Home in the Borough is urgently required. Dr. Kidd, in her report (page 36) records her observations at the Ante-Natal Clinics in respect of the problem of high blood pressure during pregnancy. Her findings are of great interest and importance and warrant careful note. 7 4. Sanitary Circumstances in the Borough. The Council's attention was drawn in the report of the Ministry of Health to the importance of the inspection of tenement houses in order to ensure compliance with the Bye-laws of the London County Council in regard to such houses. Acting on the advice of the Minister, the Council appointed an additional inspector for these duties, and accordingly Mr. Robinson commenced duties on the 2nd of July, 1934. As a consequence, considerable progress has been made in this work, and it has also enabled us, to a certain extent, to devote more attention to the duties imposed upon this Authority by the Housing (Consolidated) Regulations, 1925. On the last day of the year, the Shops Act, 1934, came into operation. This placed upon the Sanitary Authority the responsibility of inspecting shops and warehouses in the Borough, with a view to investigating the provision of suitable and sufficient ventilation, heating, and the provision of suitable and sufficient sanitary conveniences for use of persons employed in or about the shop. The present staff will attempt to undertake this work in addition to their present duties. In my last Annual Report I referred to the growing practice in Hampstead of owners converting residences into one-room flatlets, and the desirability of legislation to control the premises thus converted. This practice still continues apace, but unfortunately there is still no legislation to enable an Authority to exercise the necessary supervision. 5. Housing. In common with other Authorities throughout the country, every effort has been made in order to improve the housing conditions of the working classes in Hampstead. At the end of the year the Westcroft Housing Estate was well under way, and will provide 290 first-class dwellings for the working classes at a reasonable rental. Coinciding with this, attention has been directed to Clearance Areas, Closing Orders, and Individual Demolition Orders, further reference to which is made in the body of the Report. Another special feature in connection with the removal of the tenants to the Westcroft Housing Estate is 8 that the Council has undertaken the removal, and disinfestation by hydro-cyanic acid gas of the effects of all tenants. This in itself is a vastly important procedure. However, important and highly commendable as the provision of the 290 dwellings at the Westcroft Estate is, it must not be assumed that the housing problem in Hampstead is thereby solved. Unfortunately it is too prevalent for low wage earners to be called upon to pay no less than 20 to 25 shillings per week for two and three roomed accommodation. This is, of course, an undue proportion of the family income, and as a consequence it has a very serious reaction on the general health and well-being of the parents and children. Not until satisfactory housing accommodation is offered at rentals which the working classes can afford to pay can one consider that the housing difficulty has been solved. This, to my mind, is the greatest difficulty which has to be overcome in Hampstead. At the time of writing the Housing Bill is before Parliament, the object of which is to make for further and better provision for the abatement and prevention of overcrowding, etc., and to which further reference is made in the report. 6. Inspection and Supervision of Food. The usual high standard of food stuffs has been maintained in the Borough. The work carried out by the Department in this respect is contained in Section 6 of the Report. 7. Prevalence and Control of Infectious Disease. Apart from a short but severe outbreak of measles, the Borough was comparatively free from infectious disease. This epidemic of measles commenced in February and lasted until the end of May, during which time 1,311 cases were notified, resulting in 9 deaths, principally in children of pre-school age. Measles has been notifiable in Hampstead since 1920, and as a consequence we are in a position to ascertain its mortality rate and make appropriate comparison with that of Scarlet Fever and Diphtheria, reference to which is made on page 109. The Scheme for Immunisation against Diphtheria has been greatly augmented, and every endeavour is being made to make 9 it a complete success, although, of course, it is realised that unless the Schick immunes are maintained above a certain percentage (about 30 per cent.), the incidence of diphtheria in the Borough will not be reduced. The Borough has again been free from smallpox, although 146 cases occurred in the metropolis during the year. Reference is made in the body of the Report to the high incidence of vaccination in this Borough (page 113), and it is only fair to assume that this has some direct relation to our immunity from smallpox. The Tuberculosis Medical Officer (A. J. Scott Pinchin, M.D., F.R.C.P.) reports that an exceptionally fine summer and freedom from an influenza epidemic acted beneficially on his patients. The hot summer, however, resulted in an increase of 50 per cent, in the Tuberculosis death rate. Indiscriminate sun bathing had, in several cases which were quiescent, resulted in their becoming active. It is pleasing to note that during the year under review only five Dispensary cases died in their homes, and in each case the home condition was satisfactory. I am again indebted to Mr. E. L. Hawke, M.A., F.R.M.S., who has provided me with a brief meteriological survey of the Borough for 1934, which is of great interest and importance. It is again my pleasure to express my sincere appreciation for the valuable support of the members of the Committees which I serve, and also to the chief officers of the various departments of the Borough Council. The staff of the Public Health Department have, as is their custom, worked loyally and well during a strenuous year. 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. 13 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, 1934 90,000 Number of inhabited houses (end of 1934) according to Rate Books— 9,739 dwelling houses, 2,924 maisonetted and divided houses, 3,245 separate flats, 2,832 shops and offices. Rateable value £1,495,186. Sum represented by a penny rate £5,885 14s. 4d. 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 1934, 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 673 in June to 988 in November, and the unemployed women from 124 in June to 305 in January. Calculated upon the number of insured people in the Borough, the lowest number was 6.8 per cent, in June and the highest 11.0 in January and November. Extracts from Vital Statistics of the Year. Total. M. F. Legitimate 855 414 441 Live Births{ Illegitimate 85 47 38 Birth Rate per 1,000 of the estimated resident population—10.4. Stillbirths 27 9 18 Rate per 1,000 total (live and still) births—28. Deaths 1014 478 536 Crude Death Rate per 1,000 of the estimated resident population—113. Death Rate Comparability Factor (C.F.) = 0.94. Adjusted Death Rate = Crude Death Rate X C.F. = 11.3 X 0.94 = 10.6. Deaths from puerperal causes :— Rate per 1,000 total Deaths. (live and still) births. Puerperal sepsis 2 2 Other puerperal causes 2 2 Total 4 4 14 Deaths. The deaths during 1934, after deducting those registered in Hampstead who were non-resident persons and adding the deaths of Hampstead residents who died outside the Borough, were 1,014 as compared with 994 in the preceding year. This represents a Crude Death Rate of 113 per 1,000 of the population. If the population of all areas were similarly constituted as regards the proportions of their sex and age group components, their Crude Death Rates (deaths per 1,000 population) could be accepted as valid comparative measures of the mortalities experienced by the several populations. In practice, however, populations are not thus similarly constituted, and their Crude Death Rates fail as true comparative mortality indexes in that their variations are not due to mortality alone, but arise also from differences in their population constitution, the two elements being combined in indistinguishable proportions. The Registrar General has therefore prepared Comparability Factors for adjusting local death rates. When the Crude Death Rate of an Area is multiplied by the Factor appropriate to that area, an "Adjusted Death Rate" is obtained which is comparable, from a mortality point of view, with the Crude Death Rate of the country as a whole, or with the mortality of any other local area, the Crude Death Rate of which has been similarly modified. The Crude Death Rate for Hampstead is 11.3 which, when multiplied by the local Comparability Factor of 0.94 gives the Adjusted Death Rate of 10.6. The Death Rates for London and for England and Wales were 11.9 and 11.8 respectively. Death Rate of Infants under one year of age :— All infants per 1,000 live births 53 Legitimate infants per 1,000 legitimate live births 42 Illegitimate infants per 1,000 illegitimate live births 165 Deaths from Measles (all ages) 9 „ Whooping Cough (all ages) 3 „ Diarrhœa (under 2 years of age) 8 15 Meteorology. Through the kindness of E. L. Hawke, Esq., M.A., F.R.A.S., E.R.Met.S., Secretary of the Royal Meteorological Society and Hon. Meteorologist to the Hampstead Scientific Society, I am able to submit his report on meteorology in Hampstead during the year 1934, which is based on records kept at that Society's Observatory on the top of Hampstead Heath adjoining the White Stone Pond:— "The year 1934, like its predecessor, was notable chiefly for continued drought. In eight months out of the twelve there was a marked deficiency of rain, while December alone gave a fall substantially in excess of the normal. On November 30th the year's total stood at only 16.52 ins., representing not quite two-thirds of the average, and 1.70 ins. less than the measurement for the corresponding period of 1933. December, however, proved to be the wettest since 1915, adding as much as 5.54 ins., and thus raising the 1934 aggregate to 22.06 ins. Even so, the year, with 6.53 ins. less than the normal rainfall, ranked as the third driest since records were begun at the Observatory in 1910. The number of days on which at least 0.01 ins. of precipitation in any form was registered during 1934 was 162—16 fewer than usual. The duration of appreciable rainfall (excluding slight drizzle but including snow, sleet and hail) was 482.4 hours, of which December contributed 124 hours, or just over 25 per cent. For the second year in succession no day yielded as much as an inch of rain, the maximum measurement being 0.92 ins. on August 28th. Thunderstorms, or thunder alone, occurred on 18 days; the most noteworthy occasion was on the afternoon of September 15th, when two short storms of exceptional violence broke over the district, accompanied by hailstones ranging upwards to about an inch in diameter, which did extensive minor damage. Snow fell on only seven days, one of which was October 31st—an unusually early date. The total number of sunny hours in 1934 was 1,509. This exceeds the average by 29 hours, but is 226.5 hours less than was recorded in 1933. Eight months showed a deficit below the normal, and the year's excess was due in large measure to a spell of remarkably brilliant weather from June 30th to July 11th. During that period the sun left its trace on the registering instrument for 156.7 16 hours, which is equivalent to nearly 80 per cent. of the maximum possible. Entirely sunless days numbered 70—five fewer than usual. The monthly durations of sunshine ranged from 272.9 hours in July to 13.1 hours in December. This latter figure is barely more than one-third of the average, and is 3.6 hours less than the previous lowest record for any calendar month in the 25 years covered by the observations. The sunniest day of 1934 was July 1st, with 14.6 hours. The mean temperature of the year, 50.1 deg., exceeded the normal by 1.1 deg., and was the highest since 1921. February and March were both predominantly cold, while January and May were somewhat colder than usual, but weather of more than the ordinary warmth prevailed in all the remaining months. December was outstanding in this regard; with a mean temperature of 46.1 deg., 6.1 deg. above normal, it was by far the warmest winter month since records were begun in 1910, slightly warmer than an average April, and nearly 13 deg. warmer than the notably severe December of 1933. The three months, June to August, constituting the meteorological summer, together gave 79.4 hours more than the ordinary allowance of sunshine, only just over half of the average quantity of rain, and a mean temperature 2 deg. higher than usual. It was, on the whole, a fine and genial season, and though neither so bright nor so warm as the summer of 1933, it was almost as dry. July was the hottest month, with a mean temperature of 65.3 deg.—4 deg. above normal. This was equalled in the previous July, but had not been surpassed since 1923. The extreme readings of the thermometers during 1934 were:— Maximum in the screen, 84.7 deg., on June 17th. Minimum in the screen, 23.0 deg., on January 24th. Minimum on the grass, 11.3 deg., on January 24th. Ground-frost was registered on 119 nights during 1934, only 37 of these being subsequent to the end of March. Except from February 26th to March 1st, there was very little snow during the year, and at no time was the Heath covered to a depth of more than two inches. Fog was frequent in February and November; during the latter month it enveloped the district for varying periods on as many as seventeen days, and was occasionally very dense." CHART SHOWING THE BIRTH RATE AND THE DEATH RATE PER IOOO POPULATION IN HAM PSTEAD. AN D IN ENGLAN D AND WALES. Rates for Hampstead Shown in BLACK. Rates For England and Wales Shown in RED. 17 VITAL STATISTICS. Population. For the purpose of this Report the Registrar-General's estimate of the population at the middle of 1934, which was calculated to have been 90,000, has been adopted. This shows an increase of 1,053, as compared with 88,947 at Census, 1931. The following are estimates of the population of each Ward at the middle of the year under review:— Ward. Estimated Population. No. 1 (Town) 12,620 No. 2 (Belsize) 14,480 No. 3 (Adelaide) 11,290 No. 4 (Central) 10,690 No. 5 (West End) 14,330 No. 6 (Kilburn) 15,300 No. 7 (Priory) 11,290 The Borough 90,000 The following are the statistics for each of the Wards and the Borough:— No. of Deaths. Death Rate. No. 1 (Town) Ward 137 10.8 No. 2 (Belsize) „ 158 10.9 No. 3 (Adelaide) „ 125 11.0 No. 4 (Central) „ 109 10.2 No. 5 (West End) „ 153 10.6 No. 6 (Kilburn) „ 193 12.6 No. 7 (Priory) „ 139 12.3 18 Age and Sex Allocation of Deaths of Hampstead Residents during the Year 1934. 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 1 ... ... ... ... ... 1 ... ... ... ... ... F 1 ... ... ... ... ... ... 1 ... ... ... ... 2. Measles M 5 ... 4 1 ... ... ... ... ... ... ... ... f 4 ... 1 1 2 ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... ... ... ... ... ... f 1 ... ... ... ... ... 1 ... ... ... ... ... 4. Whooping Cough M 2 2 ... ... ... ... ... ... ... ... ... ... f 1 ... ... 1 ... ... ... ... ... ... ... ... 5. Diphtheria M 5 1 ... ... 3 ... ... ... 1 ... ... ... f 3 1 ... ... 2 ... ... ... ... ... ... ... 6. Influenza M 7 1 ... ... ... 1 ... ... 1 ... 4 ... f 4 ... ... ... ... ... ... ... ... 1 2 1 7. Encephalitis Lethargica M 1 ... ... ... ... ... 1 ... ... ... ... ... F 1 ... ... ... ... ... ... 1 ... ... ... ... 8. Cerebro-spinal Fever M ... ... ... ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 9. Tuberculosis of respiratory system M 26 1 ... ... ... 5 5 5 7 2 1 ... f 27 ... ... ... ... 8 8 5 3 2 ... 1 10. Other Tuberculous Diseases M ... ... ... ... ... ... ... ... ... ... ... ... f 6 ... ... 1 1 ... 1 1 ... ... 2 ... 11. Syphilis M 3 ... ... ... ... ... ... ... ... 3 ... ... f 1 ... ... ... ... ... ... ... ... 1 ... ... 12. General paralysis of the insane, tabes dorsalis m 3 ... ... ... ... ... ... ... ... 2 1 ... f 1 ... ... ... ... ... ... ... ... 1 ... ... 13. Cancer, malignant disease M 57 ... ... ... ... ... ... 2 6 18 14 17 F 89 ... ... ... ... 1 2 3 18 18 27 20 14. Diabetes M 5 ... ... ... ... ... ... ... ... 2 2 1 F 15 ... ... ... ... 1 ... 4 1 1 3 5 15. Cerebral hæmorrhage, &c. M 3 ... ... ... ... ... ... ... ... 2 ... 1 f 21 ... ... ... ... ... ... ... ... 1 9 14 16. Heart Disease m 130 ... ... ... 1 ... 2 4 13 31 34 45 F 122 ... ... ... ... 1 5 3 6 11 27 69 17. Aneurysm m 7 ... ... ... ... ... ... ... 2 1 3 1 f 3 ... ... ... ... ... ... ... ... ... 1 2 18. Other circulatory diseases m 25 ... ... ... ... ... ... ... ... 5 8 12 F 34 ... ... ... ... ... 1 ... 2 2 12 17 19. Bronchitis m 17 3 ... ... ... ... ... 1 3 ... 4 6 F 11 2 ... ... ... ... ... ... ... 1 1 7 20. Pneumonia (all forms) m 32 5 1 2 ... ... 1 1 4 8 5 5 f 26 3 1 1 ... 1 1 2 2 1 5 9 21. Other Respiratory Diseases M 4 ... ... ... ... ... ... ... ... 1 1 2 f 6 ... ... ... ... ... ... ... 2 ... ... 4 22. Peptic Ulcer M 9 ... ... ... ... ... 3 ... 1 5 ... ... f 5 ... ... ... ... ... ... ... 1 2 1 1 23. Diarrhœa, &c M 4 4 ... ... ... ... ... ... ... ... ... ... F 4 3 ... ... ... ... ... ... ... ... 1 ... 24. Appendicitis M 2 ... ... ... ... ... ... 1 ... ... 1 ... F 5 ... ... ... ... ... ... 1 1 1 2 ... 26. Cirrhosis of Liver M 1 ... ... ... ... ... ... ... ... 1 ... ... f 1 ... ... ... ... ... ... ... ... ... 1 ... 26 Other diseases of liver, &c. M ... ... ... ... ... ... ... ... ... ... ... f 7 ... ... ... ... ... ... 1 1 1 2 2 27. Other digestive diseases 11 11 1 1 ... 1 ... 1 ... 2 4 1 ... f 19 1 ... 1 ... ... 1 ... 2 3 7 4 28. Acute and Chronic Nephritis M 21 ... ... ... ... 1 ... ... 2 6 5 7 F 26 ... ... ... ... ... 1 1 1 9 6 8 29. Puerperal Sepsis f 2 ... ... ... ... 1 1 ... ... ... ... ... 30. Other puerperal causes f 2 ... ... ... ... 1 1 ... ... ... ... ... 31. Congenital Debility, premature birth, malformations, &c. m 11 11 ... ... ... ... ... ... ... ... ... ... f 8 8 ... ... ... ... ... ... ... ... ... ... 32. Senility M 2 ... ... ... ... ... ... ... ... ... ... 2 f 10 ... ... ... ... ... ... ... ... ... ... 10 33. Suicide m 17 ... ... ... ... 1 7 2 2 5 ... ... f 12 ... ... ... ... 1 3 ... 3 3 2 ... 34. Other violence m 24 1 ... ... 1 8 3 2 5 5 1 3 f 13 ... ... ... ... ... 1 1 ... 1 4 6 35. Other Defined Diseases m 43 ... ... ... 1 2 3 2 2 6 18 9 f 42 2 ... 1 2 ... 3 4 6 8 8 8 36. Causes ill-defined or unknown M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... All causes{ M 478 30 6 3 7 13 27 20 51 107 103 111 f 536 20 2 6 7 15 30 28 49 68 123 188 Totals 1014 50 8 9 14 28 57 48 100 175 226 299 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 1934. 19 Table showing the Birth, Death and Infantile Mortality rates during 1934 in the Metropolitan Cities and Boroughs:— Birth Rate. Adjusted Death Rate. Infantile Mortality Rate. City of London 6.8 Lewisham 10.1 Lewisham 43 Holborn 8.6 Wandsworth 10.4 Finsbury 51 St. Marylebone 9.0 Hampstead 10.6 Hampstead 53 Westminster 9.4 Stoke Newington 11.0 Hackney 56 Hampstead 10.4 Chelsea 11.4 Wandsworth 57 Chelsea 10.8 City of London 11.6 Fulham 59 Wandsworth 11.0 Islington 11.9 Stoke Newington 60 Lewisham 12.2 Woolwich 12.0 Battersea 60 Kensington 12.3 Westminster 12.1 St. Marylebone 61 St. Pancras 13.1 Hackney 12.2 Islington 62 Camberwell 13.2 Battersea 12.3 Poplar 62 Fulham 13.7 Camberwell 12.3 Lambeth 63 Greenwich 13.7 Paddington 12.3 Woolwich 63 Paddington 13.7 Greenwich 12.4 Bermondsey 64 Stoke Newington 13.7 Kensington 12.5 Chelsea 65 Woolwich 13.7 Lambeth 12.6 St. Pancras 65 Hammersmith 13.8 St. Marylebone 12.6 Westminster 66 Hackney 14.2 Fulham 12.7 Camberwell 67 Lambeth 14.2 Holborn 13.0 Deptford 68 Battersea 14.3 St. Pancras 13.2 Holborn 71 Bethnal Green 14.3 Bethnal Green 13.3 Bethnal Green 72 Islington 14.7 Hammersmith 13.3 Hammersmith 77 Bermondsey 14.8 Deptford 13.6 Southwark 77 Southwark 14.9 Poplar 13.7 Shoreditch 84 Finsbury 15.1 Bermondsey 14.1 Greenwich 87 Stepney 15.3 Stepney 14.3 Stepney 87 Poplar 15.5 Shoreditch 14.4 Kensington 93 Deptford 15.8 Southwark 14.4 Paddington 95 Shoreditch 16.1 Finsbury 14.6 City of London 121 Section 2 General Provisions of Health Services for the Borough. 23 General Provisions of Health Services for the Borough. 1.—Staff. A list of the staff of the Public Health Department will be found on page 4 of this report. Dr. J. Davies was appointed as a Public Vaccinator in July in place of Dr. Buteman who had resigned. Miss N. B. May was appointed as a Health Visitor on 22nd November, in consequence of the resignation of Mrs. Casewell. Mr. W. Robinson was appointed as an additional Sanitary Inspector in July to inspect Tenement Houses. Miss C. Montague was appointed as shorthand-typist in July. 2.—Laboratory Facilities. The examination of clinical material {sputum, swabs, etc.) was 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 pages 95-97. Bacteriological examinations have been conducted by the Royal Institute of Public Health. 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. 24 The London County Council Ambulances may also be hired (10s.) for places other than their hospitals. These services appear to be adequate for the needs of the Borough. 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 1934, 94 cases were nursed under this arrangement by the Kilburn and West Hampstead District Nursing Association, and 30 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) Ante-natal Clinics, Infant Welfare Centres, Dental Clinic, vide pages 35, 40 and 42 respectively. (b) School Clinics:—Kilburn School Treatment Centre, 107, Kingsgate Road; New End Hospital School Treatment Centre, Heath Street. (c) Tuberculosis Clinic, vide page 122. (d) Venereal Diseases. Persons suffering from venereal disease can receive free treatment under conditions of strict secrecy in pursuance of the scheme prepared by 25 the L,ondon County Council, including the following hospitals:—Guy's; Children's Hospital, Great Ormond 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). (b) Voluntary:—Hampstead General and North-West LondonHospital (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. « 29 Survey by Ministry of Health. In February, 1934, a communication was received from the Ministry of Health stating that the Minister had had under consideration the report made by his officers after the general survey of the public health services of the Borough Council. It was stated, inter alia, that the Minister noted with appreciation the comprehensive provision made in the Borough for maternal care and the special arrangements for the consideration of each maternal or infant death. The Ministry's letter made reference to the understanding which was reached by the Borough Council with the Hampstead Council of Social Welfare for the revision in certain respects of the arrangements for the co-ordination of the municipal and voluntary work performed for maternity and child welfare; and to the fact that an additional Health Visitor had been appointed and that a re-arrangement of health visiting work had been effected. Maternity and Child Welfare. Live Births. During 1934, 940 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 676 81 757 639 62 701 1315 143 1458 Add number occurring outside the Borough whose mothers were Hampstead residents 119 20 139 116 17 133 235 37 272 795 101 896 755 79 834 1550 180 1730 Deduct number who could not be deemed to belong to Hampstead 381 54 435 314 41 355 695 95 790 Nett number belonging to Hampstead, 1934 414 47 461 441 38 479 855 85 940 Nett ftirtht, 1933 380 41 421 396 47 443 776 88 864 30 The following are the statistics for each of the Wards and the Borough:— Births. Birth rate. Infant deaths. Infant death rate. No. 1 (Town) Ward 117 9.3 5 42.7 No. 2 (Belsize) „ 129 8.9 2 15.5 No. 3 (Adelaide) „ 80 7.1 2 25.0 No. 4 (Central) „ 65 6.1 4 61.5 No. 5 (West End) „ 184 12.8 7 38.0 No. 6 (Kilburn) „ 242 15.8 20 82.6 No. 7 (Priory) „ 123 10.9 10 81.3 The Borough 940 10.4 50 53.2 The birth rates for London and for England and Wales were 13 2 and 148 respectively. The infant death rates were 67 and 59 Legitimate and Illegitimate Births. Of the total 940 nett live births belonging to Hampstead, 855 were those of legitimate and 85 of illegitimate children, the latter being at the rate of 90 per 1,000 births. Of the Hampstead illegitimate infants, 37 were born outside the Borough, chiefly in Lying-in Institutions. In the accompanying graph showing the Legitimate and Illegitimate Birth Rates during the last 14 years, it will be seen :— 1. The Legitimate Birth Rate has fallen continuously and con- siderably. 2. The Illegitimate Birth Rate has remained stationary. It would appear, therefore, that certain factors are in operation which, whilst tending towards a reduction in the number of legitimate births, leave untouched the number of illegitimate births. It is generally acknowledged that there is an increasing application of contraceptive methods and an increasing incidence of interference resulting in abortion. It may be that these factors are more accessible to the married than the unmarried, particularly in Hampstead, where no less than 71 per cent. of the illegitimate births occur among domestic servants. Nevertheless the increased application of these factors will also have resulted in some decrease in the number of illegitimate births as compared with those of 20 years ago. The accompanying table shows that, so far as Hampstead is concerned at any rate, there has been no marked alteration in the age METROPOLITAN BOROUGH OF HAMPSTEAD LEGITIMATE & ILLEGITIMATE BIRTH-RATES. 1921 -1931. 31 of marriage, which otherwise would have had the effect of increasing the illegitimate rate at the expense of the legitimate rate. One is loath to assume that there has been any decrease in morality, which, in spite of the increase of contraceptive methods and abortions, has the nett result of keeping the illegitimate rate stationary. In any case I think this would only offer a partial and most unsatisfactory explanation. One can only be left to conclude that the increased stress and strain of modern life, both in business and in pleasure, has resulted in less fertility, which, coupled with the increased application of contraceptive methods and abortion, has resulted in a general and continuous decline of the legitimate Birth Rate. Still Births. During 1934, the nett number of registered still births for Hampstead was 27. In the following Table the still births for 1934 have been distributed according to sex, etc.:— STILL BIRTHS. MALKS. FEMALES. TOTALS. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Registered in the Borough 13 2 15 20 7 27 33 9 42 Add number occurring outside the Borough whose mothers were Hampstead residents 4 1 5 5 - 5 9 1 10 17 3 20 25 7 32 42 10 52 Deduct number who could not be deemed to beloug to Hampstead 9 2 11 11 3 14 20 5 25 Nett number belonging to Hampstead, 1934 8 1 9 14 4 18 22 5 27 Nutt Still Births, 1933 7 7 14 13 2 15 20 9 29 Infant Mortality. During 1934, 50 infants under 1 year of age died, giving an infantile death rate of 53 per 1,000 live births. This, unhappily, is a great increase on the rate of 38 for the previous year. 32 The infant deaths for 1933 and 1934 may be compared as under: 1933—(33 actual) Neo-natal 16 38 per 1,000 births. 1—12 months 17 Respiratory 5 Gastro-intestinal 7 Developmental 3 .Other causes 2 1934—(50 actual) Neo-natal 19 53 per 1,000 births. 1—12 months 31 Respiratory 14 Gastro-intestinal 8 Developmental 4 Other causes 5 From the above tables it will be seen that the Neo-natal deaths remain more or less stationary, as is the case also with the deaths from Gastro-intestinal and Developmental conditions. However, it will be noted that in 1934 there was a great increase over 1933 in the number of deaths from Respiratory causes (c.f. 14 and 5). This may be accounted for by the particularly hot and dry summer. (N.B.—The Death Rate from Tuberculosis in 1934 was the highest for 9 years.) Deaths of Young Children. During 1934, 67 deaths occurred of children under 5 years of age. This is equivalent to a rate of 14 per 1,000 live children born in that and the four preceding years. Maternal Deaths. Four maternal deaths occurred during the year 1934, which is a rate of 4 per 1,000 births. Each death was carefully investigated by the Medical Sub-Committee and a detailed report sent to the Minister of Health. 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 1039 Notified by Midwives 395 Still Births 23 „ „ Doctors and Parents 667 Total 1062 Total 1062 33 Of the total nett live births registered only 33 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 following table shows an analysis of 213 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. l l — — — — — — — 2 2 24 24 8 l — — 3 5 20 29 8 l 2 — l 4 — 25 17 3 2 1 — l 5 — 3 12 3 — — — — 6 — 2 4 2 1 — — — 7 — — 5 1 1 — — — 8 — — 1 3 — — — — Totals 8 74 92 28 6 3 — 2 The newly.born baby has not been included in the above. Of these 213 births :— 3 8 per cent, occurred in 1.roomed tenements. 34.7 „ „ 2 43.2 „ „ 3 The table shows the limited housing conditions in some of the tenements where babies are born at home. It demonstrates that of these 213 babies, 8 were born in one.roomed tenements and 74 in two. roomed tenements. In 5 one.roomed tenements where 3 persons were already living a baby was born. With regard to two.roomed homes, in 3 instances 5 persons were already inhabiting the rooms prior to the birth of the baby, and in 2 cases the baby's advent raised the number of occupants to 7. In 5 three.roomed tenements there were 7 persons occupying the rooms before the birth, and in 1 case there were 8. 34 Health Visiting Staff. In connection with maternity and child welfare work, the Council employs four Health Visitors; while 40 per cent, of the time of the Woman Sanitary Inspector is also devoted to this work. The holder of this latter appointment, Mrs. Casewell, resigned on 30th November, and Miss Lambe, one of the Council's Health Visitors, was promoted in her stead. To fill the vacancy thus occasioned among the full time Health Visiting Staff, Miss N. B. May, Health Visitor for the Pad. dington Metropolitan Borough Council, was appointed and commenced her duties on 17th December. The minimum number of visits which the Health Visitors are 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 At the close of the year the Health Visitors had under their supervision for systematic visiting 597 infants under one year of age and 1,799 children aged between one and five years. The following table gives a record of the work of the Health Visitors in 1934 :— First visits to expectant mothers 252 Re.visits to expectant mothers 405 First visits to infants under one year 833 Re.visits to infants under one year 3855 Visits to children from 1 to 2 years 2353 Visits to children from 2 to 5 years 4367 Visits to foster.mothers and foster.children 1123 Visits re infectious diseases ... 2619 Attendances at Borough Council's Ante.natal Clinics 152 Attendances at Borough Council's Dental Clinic 121 Attendances at Hampstead Council of Social Welfare Infant Welfare Centres and Toddlers' Clinics 397 Miscellaneous visits 846 35 Approximately 67 per cent, of the infants under one year of age visited for the first time attended the Infant Welfare Centres during 1934. At every first visit a letter, giving in detail the various facilities of the Council relating to Maternity and Child Welfare, together with certain literature, is given to the mothers, and this letter and 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. Student Health Visitors. During the year, three student health visitors from the College of Nursing have received instruction from time to time. These students are preparing for the examination for the Health Visitors' Certificate and they receive practical instruction in all branches of the work, including tuberculosis. They attend at the Town Hall two or three times a week for a period of six weeks : accompany the health visitors in their routine visits : attend at the Municipal Ante.natal and Dental Clinics and Tuberculosis Dispensary and visit the voluntary Infant Welfare Centres. The College of Nursing pays to the Borough Council a fee of £1 Is. Od. for each student so instructed. 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—1,959. 36 (b) Total number of expectant mothers who attended at the Ante-natal Clinics during the year—454. (c) Percentage of total notified births (live and still) represented by the number in (b)—43 per cent. In addition, 40 mothers attended for the first time, after their confinements, to receive post-natal care. The following is the report for the year 1934 of the Medical Officer of the Council's Ante-natal Clinics, Miss Mary Kidd, M.B., B.S. (L,ond.) :— To the Mayor, Aldermen and Councillors op the Metropolitan Borough op 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 1934 :— Pond Street 1934. Clinic. 1933. Kilburn 1934. Clinic. 1933. New patients 127 114 307 290 Attendances of old patients 551 473 1252 1123 Number of sessions held 51 51 101 100 Average attendance per session 13 11.5 15 14 Number of patients referred to Dental Clinic 47 37 116 135 Number of patients sent to Convalescent Homes 3 3 14 6 That many of the expectant mothers of the Borough are continuing to avail themselves of the Ante-natal Care provided by the Council is shown by the figures of the above table. It will be noticed, indeed, that the average attendance per session has risen at each of the Clinics. Considerably over a third of the Hampstead women who had children in 1934 received ante-natal care under my auspices. I am glad to record, too, that the number of those who avail themselves of the facilities for convalescence after childbirth has actually almost doubled in the last year. In preparing this Report, I have carried out a little research into a matter in which Sir George Newman is much interested. In his 37 Annual Report for 1933 he discusses the somewhat obscure problem of high blood pressure in pregnancy and he refers to an enquiry into the matter which has recently been carried out by members of the Regional Medical Staff of the Ministry of Health. It was found that of 661 expectant mothers who had manifested a systolic pressure of 140 m.m. or more, a normal confinement without any adverse symptoms had occurred in 535 cases. Another 124 of these women had, however, shown some definite signs of toxsemia of pregnancy such as headaches and albuminuria, etc. Finally, the remaining 2 women of this series suffered from definite complications (presumably eclampsia) which were due to toxaemia in all probability. These observations have interested me greatly as they confirm our findings at the Ante.natal Clinics in recent years when blood pressure estimations have been carried out as frequently and carefully as possible, namely, that a fair proportion of expectant mothers who show a systolic pressure of 140 m.m. or over, pass through their pregnancies perfectly well without any symptoms of toxsemia. I thought it would be useful, however, to enquire into the history of each of the 26 cases of this nature that I encountered last year, where a full history is now available, the confinements having already taken place. In beginning my investigation, I found that the average age of the 26 women who manifested a systolic pressure of 140 m.m. or over, was 28. I discovered next, that 11 out of the 26 cases presented no symptoms whatsoever of toxsemia of pregnancy, no albuminuria or marked headache or any extreme swelling of the lower limbs, beyond what could be accounted for by the increasing pressure on the big veins at the back of the abdomen. It was most interesting indeed to note, that several of these people remarked to us how well they felt. All of these mothers were of course carefully dieted; meat being excluded from the daily menu as far as possible and eggs only allowed in moderation, if at all. Turning to the other side of the picture, I find that definite symptoms of toxsemia of pregnancy were manifested by the remaining 15 women. The presence of albumin in the urine in each case was detected during the last few weeks of pregnancy only, as a general rule, and never in large amounts. Marked headache and definite 38 disturbances of vision were noted in 3 cases and slight headache in 6. Extreme swelling of the lower limbs was noted in 4 cases. One woman with a rising diastolic pressure, displayed symptoms of a small concealed haemorrhage of the uterus in the last three weeks before her confinement, so I sent her into New End at once for rest and treatment. I was obliged also to send 4 other women out of these 15 into New End for a rest before their confinements, for periods varying from a few days to 3 weeks. One of them had only a slight rise of blood pressure and a trace of albumin in the urine, but she was complaining of sickness and headache and " spots in front of the eyes," which are always danger signals. The remaining 3 people were sent into New End as the blood pressure in each case had risen to 170/105, 185/105, and 145/105 respectively. The latter woman subsequently developed mild eclampsia (without fits) during the second stage of labour and the first two days of the puerperium, but she made a good recovery subsequently and the baby was alive and healthy. This was a highly satisfactory denouement. I find that the remaining 25 patients out of our series of 26, passed through their confinements without any symptoms of eclampsia and healthy babies were born, with the exception of 3 cases where a still birth unfortunately occurred. An investigation showed, however, that 2 of these were almost certainly due to difficult labour and not to any toxic condition present, but the third case of stillbirth was undoubtedly caused by the toxaemia present in the mother before delivery. She had had a high blood pressure and albuminuria but had entirely refused to go into Hospital for a rest before her confinement as we had urged her to do. With regard to the case of eclampsia noted above I am glad to record that it is the first case I have come across since the year 1927. I have followed up most carefully (as far as possible) all cases of toxaemia of pregnancy met with at the Clinics and (if I except the year 1933, when I could not carry out the usual researches owing to illness) I find that, of a series of just over 1,900 Hampstead mothers attending the Clinics, I have only been able to trace this one case of eclampsia, and that a mild one without any fatal results. This little investigation therefore confirms me in my belief that the frequent observation of the expectant mother and testing of her 39 blood pressure and urine, is helping to diminish the incidence of eclampsia in our midst. Of the two tests, I consider the estimation of blood pressure is of more value in putting one on the track of the potential eclamptic, rather than the urine test. In the case referred to above, we were watching her closely and dieting her, because her diastolic pressure was high, long before any albumin appeared in the urine. I consider that the blood pressure estimations cannot be valued too highly as long as it is always borne in mind that there is a nervous element present in a certain small proportion of cases which must be taken into account, as it may help to bring about a temporary rise of systolic pressure which disappears when the patient becomes accustomed to the carrying out of the test. In such cases, the diastolic pressure is usually normal although the systolic is high. It is the woman with a persistently high diastolic pressure who must be most closely watched for possible complications. Finally, it is of interest to note that in this series of 26 cases, 16' women had one or more decayed teeth and three women had some degree of dental sepsis. The connection between an unhealthy mouth and toxaemia of pregnancy, although obscure, seems to be a real one. Undoubtedly the splendid work of our dentist is helping to diminish the incidence of toxaemia of pregnancy amongst the expectant mothers of Hampstead, as so many of them go to the Dental Clinic for treatment now. I cannot speak too highly of milk as a food when planning a diet for a patient suffering from toxaemia of pregnancy. Most experts seem to agree that butcher's meat must be cut out of her diet then (with the exception perhaps, of an occasional meal of liver), and eggs also are regarded by them with suspicion. It will be readily understood, therefore, how valuable as a source of protein is the curd in milk for such cases. Consequently, it is a great help when one encounters the first symptoms of toxaemia of pregnancy in a necessitous expectant mother, to be able to obtain a supply of free milk for her. MARY KIDD, M.B. (Lond.). 40 Infant Welfare Centres. The following Infant Welfare Centres were held in the Borough during 1934:— Name and address of Centre. Day and Time held. Doctor in attendance. Health Visitor. Average attendance per session. " Belsize Congregational Church Hall, Monday, 2—4 p.m. Dr. M. A. Blandy Mrs. Casewell 41 Avenue Road 4i Kilburn Health Insttute. Kingsgate Road Tuesday, Wednesday, 2—4 p.m. Dr. A. S. Hall. Craggs Miss Evans Mrs. Steward |44 " Branch Health Institute, Kingsgate Road Wednesday, 10—12 noon Do. Mrs. Steward 28 " New End ", Baptist Chapel Hall, Heath Street Thursday, 10—12 noon Dr. M. A. Blandy Miss Kennedy 19 "Lisbume Road", Wesley an Mission Hall, Lisbume Road Thursday, 2—4 p.m. Do. Miss Lambe 32 " Mill Lane ", Mission Hall, Hroomsleigh Street Friday, 2—4 p.m. Dr. A. S. Hall. Craggs Miss Evans 49 Total number of attendances at all Centres during the year:— (i) By children under 1 year of age—7,872. (ii) By children between the ages of 1 and 5 years— 5,757 (including Toddlers). 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—557. (ii) Between the ages of 1 and 5 years—104. Total number of children who attended at the Centres during the year, and who at the end of the year were :— (i) Under 1 year of age—459. (ii) Between the ages of 1 and 5 years—1,083 (including Toddlers). Toddlers' Clinic. Weekly toddlers' sessions are held alternatively on either side of the Borough. Dr. Ruth Balmer, who has special experience in preschool children, is the Medical Officer in attendance at the Clinic. 41 The average attendance per session during 1934 was: 27, Pond Street, 16. Health Institute, 23. The children attending the Toddlers' Clinic 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 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. The health visitor delivers the letter of invitation, while 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 Clinic for subsequent examination. During the year 597 parents have received invitations, 185 of whom have accepted, and of this number 47 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. On 21st December, 1933, the Council agreed to make an annual subscription of £2 2s. Od. to the Institute of Ray.Therapy, 152, Camden Road, N.W., on condition that free treatment was given to patients referred to the Institute from the Toddlers' Clinic. On 14th May, 1934, a letter was received from the Secretary of the Infant Welfare Committee of the Hampstead Council of Social Welfare, asking whether the Borough Council would consider subscribing £2 2s. Od. in respect of each of the five Infant Welfare Centres in the Borough, in order that children from such Centres may receive free treatment at the Institute. 42 The Institute having indicated that they were prepared to accept children from the Toddlers' Clinic and the five Infant Welfare Centres for a special inclusive fee of £6 6s. Od. per annum, the Council resolved:— That, as from 1st October, 1934, they do make an annual inclusive subscription of £6 6s. Od. to the Institute on condition that free treatment was given to children to be referred to the Institute from the Toddlers' Clinic and the five Infant Welfare Centres in the Borough. Arrangements for the Supply of Milk and Food. There have been 260 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. 133 children under 5 years of age have, in addition to the milk,, received free cod liver oil or emulsion. Municipal Dental Clinic. The Municipal Dental Clinic is held at the Public Health Station, Lithos Road; the Dentist is Mr. Roy M. Hastings, L.D.S., R.C.S. Eng. The following is a summary of the work carried out during the year:— Number of Sessions held 70 Number of New Patients 284 Total Attendances of all patients 1268 Number of Fillings 438 Number of Scalings 44 Extraction cases Total Number of Teeth extracted 873 Gas Administrations 210 19 Local Administrations Without Anaesthetic 2 Number of Dentures (including repairs) 70 Number of Dressings and Root Treatment 194 Number for Advice 309 Number of Denture visits 173 43 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 710 elementary school entrants in Hampstead during 1934. I am also supplied with the names and addresses of any school children in the Borough who are found, at the routine School Medical Inspection, to be below normal so far as their nutritional condition is concerned. Special enquiries are then made at these homes to ascertain whether or not there are any children under school age similarly below normal nutrition who may, by chance, be unknown to my Health Visitors. Table showing Results of Routine Medical Inspection of Entrant Children in Hampstead to Elementary Schools during the year 1934, 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 356 353 3 — 90 255 11 — 354 2 — 356 — — 192 104 60 150 Girls 354 350 4 — 121 223 10 — 353 1 — 354 — — 193 98 63 152 Total 710 703 7 — 211 478 21 — 707 3 — 710 — — 385 202 123 302 Hampstead per cent. ages ... 990 10 — 29 .7 67.3 30 — 996 04 — 1000 — — 54.2 28.5 173 42.5 London per cent. ages ... 1 | 53.7 45.7 06 200 75.9 41 — 96.9 2.7 0.4 98.6 13 01 54.5 | 34.3 113 41.8 45 Table showing Results of Routine Medical Inspection of Entrant Children in Hampstead to Elementary Schools during the year 1934, indicating the Defects found. f = defects found. o = noted for treatment and included in defects found. Disease or Defect, Boys (356). Girls (354). Hamp— stead. per cent. London, per cent. Hamp— stead. per cent. London, per cent. Skin disease f — — 1.1 2 0.6 0.8 Tonsils only 0 — — 0.7 1 0.3 0.6 f 41 11.5 14.7 47 13.3 14.3 0 12 3.4 5.0 14 4.0 4.7 Adenoids only f 6 1.7 11 1 0.3 0.8 0 2 0.6 0.7 — — 0.5 Tonsils and Adenoids f 11 31 3.0 11 31 2.6 0 6 1.7 2.1 9 2.5 1.8 Other Nose and Throat f 1 0.3 1.1 4 1.1 1.0 0 — — 0.5 1 0.3 0.4 Glands of Neck f 6 1.7 2.9 7 2.0 2.3 0 — — 0.3 — — 0.2 Eye disease f 10 2.8 3.3 15 4.2 3.1 0 3 0.8 2.1 4 1.1 2.0 Otorrhoea f 1 0.3 1.2 2 0.6 1.1 0 — — 0.7 2 0.6 07 Other Ear Defects f — — 0.4 — — 0.5 0 — — 0.2 — — 0.2 Hearing ... f — — 0.1 3 0.8 0.2 0 — — 0.1 1 0.3 01 Speech f 1 0.3 0.4 — — 0.2 0 — — 0.0 — — 0.0 Heart f 1 1.3 1.9 1 0.3 1.7 o — — 0.1 — — 0.1 Anaemia ... f 13 3.7 1.2 12 3.4 0.9 0 — — 0.4 — — 0.3 Lungs f 10 2.8 3.9 7 20 3.4 o 1 0.3 1.2 3 08 1.1 Epilepsy ... f — — o.o — — 0.0 0 — — 0.0 — — 0.0 Chorea f — — 00 — — 0.0 o — — 0.0 — — 00 Paralysis ... f — — 0.1 — — o.o o — — o.o — — 0.0 Other Nervous Disorders f 2 0.6 0.5 1 03 0.4 0 — — 0.l — — 0.1 Pulmonary T.B. f — — 0.0 — — o.o o — — 0.0 — — 0.0 Other T.B. f — — o.o 1 03 0.0 0 — — 0.0 — — o.o Rickets ... f 1 03 1.0 2 06 0.5 0 1 03 0.2 1 03 0.1 Spinal Deformities ... f — — 0.1 — — 0.2 o — — 0.1 — — 0.0 Other Deformities f — — 1.0 1 03 0.8 o — — 0.3 — — 0.2 Other Defects f 3 0.8 2.7 4 11 2.8 o — — 1.5 2 0.6 1.6 46 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, 36 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 1934, the number of Hampstead women for whom such contribution was made was 46. (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 1934, 52 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., arc admitted. During 1934, five 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.C.P., F.R.S., L.C.C., L. G. Glover, Esq., M.A., M.D.) who investigate in detail all deaths of infants under two years of age, Still Births, Maternal Deaths, and all notified cases of Puerperal Fever and Pyrexia. 47 The Medical Officer of Health has previously ascertained all particulars relating to each case from the Health Visitors, General Practitioners, and Hospital Medical Officers concerned. All the information obtained is treated in a confidential manner, and as a result of the investigations, either adjustments of the existing administrative procedure, or other measures are undertaken which are calculated to prevent a recurrence of the conditions ascertained to be the cause of the fatality. During the year 1934, the Committee investigated :— Deaths of Infants under 2 years 57 Still Births 27 Puerperal Fever 5 Puerperal Pyrexia 18 Maternal Deaths 4 Total 111 During the course of investigation the following facts emerged, which are of interest. Of the deaths under 2 years of age, 82 per cent, occurred in institutions; and of the 19 deaths occurring during the first month, 10.5 per cent, of the mothers had not received antenatal supervision, whilst of the 25 deaths between 2 months and one year, 32 per cent, had never attended an infant welfare centre. Of the 27 still births, 7.4 per cent, of the mothers had not received ante.natal supervision. There were 15 deaths of illegitimate children under 2 years of age, which represents a Mortality Rate of 87 per 1,000 illegitimate births as compared with 26 for legitimate children. This Committee has been doing very valuable work since its inception in 1924. In October, 1923, my predecessor, Dr. Scrase, suggested to the Maternity and Child Welfare Committee that by a systematic enquiry into the death of every child under two years of age, it might be possible to ascertain in what respects, if. any, the Borough Scheme in relation to maternity and child welfare might be improved upon, or the efficiency of its application increased. This was agreed to by the Maternity and Child Welfare Committee and the first quarterly meeting of the Infant Deaths, etc., 48 Sub.Committee was held on the 10th April, 1924. This Sub.Com. mittee consisted of three medical members, with the Chairman of the Maternity and Child Welfare Committee as ex.officio member of the Sub.Committee. All deaths of Hampstead children under two years of age were carefully investigated. In July, 1924, the Sub.Committee added to its investigations all still births and maternal deaths; and later, in June, 1926, considered notified cases of puerperal fever and puerperal pyrexia. As a result of the consideration and investigations of the Sub. Committee many valuable introductions have been made into the Council's maternity and child welfare scheme, as will be seen from the following :— (a) A panel of Consulting Obstetricians was appointed by the Council in June, 1926, as a result of the Sub.Committee's recommendation. This matter was first under discussion by the Sub.Committee in October, 1924. (b) In September, 1924, the Sub.Committee suggested that leaf— lets be printed to make more widely known the existence of our Ante.Natal Clinics, which advice was acted upon. (c) In June, 1925, the two Creches in the Borough agreed to co— operate with the Borough Council by reporting to me immedi— ately any children who appeared ill, or who were refused by the Creches because of ill.health. This was arranged as a result of a suggestion by the Sub.Committee. (d) In June, 1926, in accordance with the Sub.Committee's request, the Coroner agreed to notify me when an inquest was to be held on any case where the cause of death related to child.birth, and also of any inquest on children under two years of age. (e) Also in June, 1926, the Sub.Committee suggested that every patient at the Borough Council's Ante.natal Clinics might be given a Wasserman Test. It was finally decided, however, by the Maternity and Child Welfare Committee that such a scheme would not be advisable. (f) As a result of the Sub.Committee's recommendation, two of the Consultants on the panel were appointed, in March, 1929, 49 to undertake investigations into certain maternal deaths where it might be deemed desirable by the Medical Officer of Health. (g) In April, 1934, in compliance with a request from the Sub. Committee, the Medical Superintendent of New End Hospital very kindly agreed to forward me reports on all confinements taking place in the Hospital, for the information of the Medical Officer at the Borough Ante.natal Clinics. (h) Following the advice of the Sub.Committee, the Kilburn and West Hampstead District Nursing Association, in December, 1934, purchased a Carbon di.oxide apparatus for the use of its Midwives in cases of emergency, and the provision of a similar apparatus is under discussion by the Committee of the Hampstead District Nursing Association. (i) Consequent upon a recommendation of the Sub.Committee a scheme was inaugurated by the Council in December, 1934, whereby private midwives arc to be compensated for the loss of patients who are referred by the Borough Ante.natal Clinics to Hospitals for confinement. It will be seen, therefore, that the anticipated usefulness of this Medical Sub.Committee has been more than justified during the ten years it has been in existence. The Sub.Committee continues to function as hitherto, but at the present time it is attended not only by the Medical Members and the Medical Officer of Health, but by the Medical Officer of the Council's Ante.Natal Clinics, the Medical Officers of the Infant Welfare Centres, and the Health Visitors. Convalescent Homes and Other Institutions. Convalescent Homes. During 1934, 17 mothers and babies 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 had an arrangement during the year with Beauchamp Lodge Emergency Home for Children, 2, Warwick Crescent, Paddington, for the boarding.out of children under five years of 50 age whose mothers have been admitted to Hospitals for their confinements. The Borough Council paid 12s. 6d. per week per bed occupied, the parents being assessed to contribute according to their means. During 1934, four children from Hampstead families were admitted under this arrangement. An alternative arrangement has been agreed upon whereby such children may be boarded.out with approved "foster.mothers" at the same charge of 12s. 6d. per week, the parents being assessed to contribute towards the cost as heretofore. 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. There are beds for 15 mothers and babies in the hostel. During the year 1934, 16 unmarried mothers were admitted with their babies. No expectant mothers are admitted and no babies without their mothers. The London County Council makes a grant 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. There are 28 beds, which are always occupied, for " first " babies of unmarried mothers. During 1934, 5 babies were admitted, the remaining 23 having been admitted prior to 1934. 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 following Homes are managed by Voluntary Committees and receive grants from the London County Council under the Local Goverment 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 with their babies. It has accommodation for 16 expectant mothers, and 16 mothers and babies. During 1934, 115 expectant mothers and 98 mothers and babies were admitted. 51 Main Memorial Home, 141, West End Lane. This Home was opened in August, 1934. It receives unmarried .expectant mothers and mothers with young babies after discharge from hospital. It has accommodation for 7 expectant mothers and .7 mothers and babies. St. Agatha's House, 39, Lancaster Road. This Home receives unmarried expectant mothers for 3 months prior to their confinements, and after discharge from hospital, with their babies, until the infants are 3 months old. It has accommodation for 10 mothers and 5 babies. Hampstead 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 1934 was 8,854. 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 duriug the year. Number of caees visited by officers of the Council. Number of cases for whom home nursing was provided by the Council. Number of cases removed to hospitals. Ophthalmia Neonatorum 7 (In no case was the vision impaired) 5 3 4 Puerperal fever 5 1 — 4 Puerperal pyrexia 18 9 — 18 Measles (in children under 5 years of age) 558 503 46 127 Whooping Cough (do.) Not notifiable 106 1 16 Poliomyelitis (do.) 1 1 — 1 52 Provision of Midwives. The Borough Council has a scheme whereby the local district" Nursing Associations provide for their nurses to attend confinements. During 1934, the midwives of the Kilburn and West Hampstead District Nursing Association attended 99 cases, whilst those of the Hampstead District Nursing Association attended 32 cases. Of the 131 cases, 56 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. Compensation to Midwives. The question of compensating midwives for loss of patients referred by the ante.natal clinics to hospital for confinement was considered towards the end of the year. The Council resolved that private midwives, other than those attached to the District Nursing Association, Maternity Homes or Hospitals, should be compensated for loss of such cases at the rate of 10s. 6d. per case, which arrangement the Ministry of Health sanctioned, suggesting the adoption of the following conditions :— (a) That in each case the patient will be required to confirm the statement that she had engaged the midwife to attend her confinement and had been referred by the midwife to the clinic. (b) That the Medical Officer of the clinic will certify that she advised the patient to be confined in a Hospital or Home. (c) That no payment will be made to the midwife where the patient herself has applied to be confined in a Hospital or Home. Infantile Mortality. The infantile mortality rate for Hampstead in 1934 was 53 per 1,000 live births. Maternal Mortality and Morbidity. Four women died in, or in consequence of, child birth during 1934. This represents a maternal mortality rate of 4.14 as compared, with nil and 2.98 for the preceding two years. CHART SHEWING THE INFANT MORTALITY PER IOOO BIRTHS IN HAMPSTEAD. The Infant Death Rate per 1000 births for the Borough is represented by the chimneys, the lined portion of which shews the death rate amongst newly.born babies (i.e. under 1 month old). The Infant Death Rate for England and Wales is represented by the line. 53 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.l, and 26, Thurlow Road, N.W.3. Brown, R. Christie, M.S., F.R.C.S., 40, Harley Street, W.l, and 292, Finchley Road, N.W.3. Gray, Arthur O., M.D., F.R.C.S., 114a, 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.I. White, Norman, M.D., F.R.C.S., 19, Queen Anne Street, W.l, and 55, Fitzroy Road, N.W.I. During the year the services of the Consultants were called for under this scheme in two cases. One was a case of puerperal fever— child born alive—mother and baby were removed to Hospital and the mother subsequently died some weeks later from "Septicœmia, Infective Endocarditis." One was a case of pueperal pyrexia—child born alive—mother and baby were removed to Hospital and the patient recovered. In neither case was a charge made to the patient towards the cost of the services of the Consultant, the full fee being paid by the Borough Council. 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. Home Helps. Early in the year I reported to the Maternity and Child Welfare Committee on the question of the provision of Home Helps for 54 domestic assistance to maternity patients in the Borough during the lying-in period. The Committee agreed that such service should be provided by the Council, and the following scheme was approved in respect of this service :— Panel. A panel of Home Helps considered suitable by the Committee to be formed, including women recommended by the Superintendents of the Local District Nursing Associations,—the persons on such panel to be available to homes in cases of child-birth occurring in the Borough. Rate of Payment. Home Helps to be paid at the rate of 5s. 0d. per day when employed, with no retaining fee. In normal cases they will be on duty for 10 days; hours 8 a.m. to 1.30 p.m., 4 p.m. to 5 p.m. daily, subject to variation in certain cases. Duties. To be fixed by the Committee and to consist of general home management, including cooking, certain washing, the care of the children, etc. A doctor or midwife will be in attendance on the case and no nursing duties of any description are to be undertaken by the Home Helps. Payments by Applicants. Applicants to be assessed to pay the whole or a portion of the cost of the Home Helps, according to their means. On the 20th April the Ministry of Health sanctioned the proposed arrangements. During the year—April to December—ten mothers availed themselves of this facility, being assessed to contribute at charges varying from 5s. to 6d. a day. At the present time there are six Home Helps on the "panel," but this number can, of course, be increased should occasion arise. The scheme would appear to fulfil a need and to be working satisfactorily, both from the point of view of the mothers and the Home Helps. 55 Maternity Outfits. The question of the provision of these outfits was considered by the Maternity and Child Welfare Committee early in the year, and at their suggestion authority was given by the Council for supplies of suitable sterilised maternity outfits to be obtained for distribution to maternity patients in the Borough—the applicants to be assessed by the Assistance Sub-Committee and to contribute towards the cost of such outfits according to their means. Two types of outfits are thus issued, one containing the minimum contents and the other a somewhat fuller outfit. Under this arrangement 57 outfits were supplied during 1934. In 33 instances the full price was paid for the 5s. 6d. outfit. ,, 12 „ ,, ,, 3s. 8d. ,, „ 10 „ the applicants were assessed to contribute towards the cost of the 3s. 8d. outfit, the charges varying from 2s. 6d. to 1s. 0d. ,, 2 „ the 3s. 8d. outfit was supplied free of charge. Infant Life Protection. (Under Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932.) The following are the statistics relative to this work during the year:— On 31st December, 1934, there were in the Borough 25 fostermothers having charge of 31 foster-children. Number of foster-children removed 98 „ foster-children added 80 „ foster-mothers removed 45 ,, foster-mothers added 27 „ visits paid by Health Visitors to foster- children 619 „ visits paid by Health Visitors to foster- mothers 504 It was not found necessary to take any legal proceedings during the year, but pressure was brought to bear on one foster-mother who 56 was found to be unsatisfactory, and the two foster-children were removed from her care by the mothers. Her name was removed from the official list, and she was thereby precluded from taking further foster-children. There was one death of a foster-child during the year, but no inquest was held. During the year it was found necessary to report three fostermothers to the Maternity and Child Welfare Committee, for repeated failure to comply with the regulations regarding notification. The Town Clerk was instructed to write to these foster-mothers drawing attention to their obligations under the Children and Young Persons Act, 1932, and I am glad to report that there has since been no difficulty in obtaining notifications from them. In June, 1934, a letter was received from the Hampstead Foster Home, " Eagle's Nest," 99, Haverstock Hill, applying for a certificate of exemption from the provisions of Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932, relating to the nursing and maintenance for reward of children under 9 years of age apart from their parents. In view of the excellent manner in which the children are cared for at this Home, and also of the fact that it is inspected by Officials of the London County Council, which Authority makes a grant to the Home under the Local Government Act, 1929, the Borough Council resolved to grant the Certificate of Exemption for a period of one year. This Certificate exempts the Home from making various notifications, etc., required by the Act, and also exempts the Home from official inspections by the Officers of the Borough Council. In this connection I would add that, through the courtesy of the Matron, I am informed of the destination of babies leaving the Home, in order that I may notify the Medical Officers of Health of the Districts to which the infants proceed. A similar arrangement also applies to four other Homes in the Borough where infants are accommodated, viz.: St. Agatha's House, 39, Lancaster Road, The Cross Roads Club, 88, Alexandra Road, The Hampstead Hostel for Mothers and Babies, 7, Fitzjohn's Avenue, and the Main Memorial Home, 141, West End Lane. 57 During the year, nine boarding schools which receive children under 9 years of age were inspected by my staff. It is interesting to note that two of these schools receive children under the age of three years. The general sanitation, etc., except in isolated instances, was found to be satisfactory, but periodical inspections, etc., will be made. One of the schools, which is a charitable institution, has been exempted from the provision of the Children Acts, 1908 and 1932, subject to facilities being given for an annual inspection to be made. Section 4 Sanitary Circumstances of the Borough. 61 Sanitary Circumstances of the Borough. Sanitary Inspection. The Council employs seven 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 1934:— Total number of inspections 3,898 Total number of re-inspections and other visits and re-visits 10,826 Total number of dwelling-houses inspected for housing defects 1,671 Number of these found not in all respects reasonably fit for human habitation 1,063 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), 1,011 relating to 912 premises. (2) Statutory 281 relating to 170 premises. Investigation of Complaints, Inspection of Factories, Workshops and Workplaces, etc. Number of complaints investigated 730 „ „ premises inspected after the occurrence of infectious disease 218 „ „ inspections of Factories (excluding bakehouses) 73 62 Number of inspections of Workshops (excluding bakehouses) 203 „ „ inspections of Workplaces 424 „ „ inspections of Bakehouses, Milkshops and other food premises 910 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 7 Cases abated (rooms) after service of notice 6 Cases abated (rooms) without service of notice 2 Underground sleeping rooms. Illegally occupied—found, or brought to the Inspectors' notice 19 Closed, or illegal occupation discontinued 9 Made to conform 16 Verminous conditions. Rooms disinfested 15 Number of houses concerned 9 Beds and bedding disinfested 4 Floors of rooms cleansed 14 Animals. Nuisances from improper keeping in rooms abated 1 Nuisances from improper keeping on the premises abated — Smoke nuisances. Complaints received 3 Observations made 3 Notices served 1 Drainage systems,&c. Drainage systems repaired or renewed, partly or wholly 410 Plumbing defects remedied (soil pipes, waste pipes, &c.) 624 Roofs, rainwater pipes and gutters repaired or renewed 254 Water supply. Water supply provided to separate lettings 351 Number of houses concerned 253 Sinks provided to separate lettings 349 Number of houses concerned 246 Water cisterns cleansed or covered 14 Water-Closets. Additional provided 186 Removed from improper position 30 Flushing cisterns repaired138 Yards, &c., Paving, &c Yards or open spaces newly paved and drained or repaired 135 Bathrooms. New provided 290 Dust Bins. Repaired or renewed 184 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 15 Cases abated (rooms) after service of notice 3 Cases abated (rooms) without service of notice 2 Underground sleeping rooms. Illegally occupied—found, or brought to the Inspectors' notice 3 Closed or illegal occupation discontinued Made to conform 2 63 Totals. Verminous conditions. Rooms disinfested 121 Number of houses concerned 59 Beds and bedding disinfested 31 Floors of rooms cleansed 73 Animals. Nuisances from improper keeping in rooms abated 1 Nuisances from improper keeping on the premises abated 2 Drainage systems, &c. Drainage systems repaired or renewed, partly or wholly 61 Plumbing defects remedied (soil pipes, waste pipes, &c.) 74 Hoofs, rainwater pipes and gutters repaired or renewed 162 Water supply. Water supply provided to tenements 32 Number of houses concerned 27 Sinks provided to tenements 75 Number of houses concerned 69 Water cisterns cleansed or covered 8 Water-Closets. Additional provided 6 Flushing cisterns repaired 64 Removed from improper position 2 Yards, Paving, &c. Yards or open spaces newly paved and drained or repaired 66 Bathrooms. New provided 2 Dust Bins. Repaired or renewed 68 Miscellaneous. Window cords repaired or renewed 347 Window fittings repaired or renewed 294 Filth and refuse removed from rooms 41 Washing (of clothes) accommodation provided 5 Coppers repaired or renewed 55 Suitably ventilated food cupboards provided 6 Kitchen ranges repaired or renewed 54 Common staircases repaired 113 Common staircases provided with adequate means of natural light 9 Houses or parts cleansed (excluding verminous rooms) 270 Number of rooms concerned 1125 Dampness in houses or parts abated 117 Dilapidated houses or parts repaired 249 Tenement Houses. During the year four additional tenement houses were placed upon the Register and at the end of the year the total number of tenement houses on the Register was 1,554. During the year, 592 tenement houses were inspected and 3,263 defects were discovered. Following upon the receipt by the Minister of Health of the report made by his Officers after the general survey of the public health services of the Borough Council, a communication was received by the Borough Council in which their attention was drawn to the importance of the inspection of tenement houses in order to ensure compliance with the byelaws of the London County Council in regard to such houses. It was pointed out that the Minister had been advised that the present number of Sanitary Inspectors was insufficient for the adequate performance of this function, and that an increase of staff should be considered. 64 The Public Health Committee considered the question of the enforcement of the Tenement House Byelaws and the staffing of the Department, and upon their recommendation the Council resolved to fill the then existing vacancy in the Inspectorial Staff by the appointment of an additional Sanitary Inspector whose duties should primarily be concerned with, the inspection of tenement houses. In view of the desirability of relieving this officer of as much clerical work as possible in order that he might give more time to inspections, and also in order to relieve the pressure of work on the clerical staff, a shorthand-typist was appointed on the staff of the Department. Drainage Bye-laws. During the year the drainage bye-laws of the London County Council, which had been in operation since 4th September, 1930, came under revision, experience having indicated the desirability of certain amendments in order to bring the bye-laws into line with modern needs and practice. In addition, provision was made so as to permit of the installation of a modern system of house drainage known as the onepipe system. In the one-pipe system, the pipes conveying excretal matters from water-closets, slop sinks and urinals and waste water from baths, lavatory basins, bidets and sinks, are joined to a single pipe connected direct to the drain, in contra-distinction to the twopipe system, in which the removal of excretal matters from water closets, slop sinks and urinals is effected by a pipe connected direct to the drain, and the removal of waste water from baths, lavatory basins, bidets and sinks is effected by a second pipe separate and distinct from the other, and discharging the waste water over or into a properly trapped gully connected to the drain. The new bye-laws, with certain exceptions, were approved by the Minister of Health on 28th July, and are being enforced in the Borough. Common Lodging Houses and. Seamen's Lodging Houses. None exists 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. 65 Increase of Rent and Mortgage Interest (Restrictions) Acts. Number of certificates applied for 5 „ issued 4 Factory and Workshop Acts. The Borough Council is the Authority for inspections under the Factory and Workshop Act, 1901, to the following extent:— (i) Factories, defined as being places where mechanical power is used in connection with any trade process specified in the Act, etc. In these premises the Borough Council is responsible for enforcing the requirements as to the provision of suitable and sufficient sanitary accommodation for the employees, and also for the enforcing of the special requirements contained in Sections 97-102 of the Factory and Workshop Act, 1901, in relation to factory bakehouses. (ii) Workshops, defined as being places which are not factories but where any manual labour is carried on as a trade, etc. In these premises the Borough Council has power to enforce the following requirements:—(1) Sanitation (a) Cleanliness, (b) Air Space, (c) Ventilation, (d) Drainage of floors; (2) Sanitary Accommodation. To supervise the provision and maintenance of suitable and sufficient accommodation for persons of each sex employed, and also the special requirements relating to workshop bakehouses. (iii) Workplaces. Although not defined by statute, it has been held that this term includes any place (not being a factory or workshop) where people assemble together to do work permanently of some kind or other, and similar requirements are enforceable to those in operation for workshops. (iv) Domestic factories and workshops. These are defined as private rooms or dwellings where a trade process is carried on by the members of the families residing therein, and are supervised in regard to cleanliness and the number of persons working therein, etc. 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. 66 Inspection of Factories, Workshops, and Workplaces, including Inspections made by Sanitary Inspectors. Premises. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories (Including Factory Laundries) 73 6 Nil. Workshops (Including Workshop Laundries) 203 16 Nil. Workplaces (Other than Outworkers' premises) 424 45 Nil. Totals 700 67 Nil. Defects found in Factories, Workshops, and Workplaces. Particulars. Number of Defects. Number of offences in respect of which Prose cutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*:— Want of cleanliness 93 93 Nil. Nil. Want of ventilation 4 4 Nil. Nil. Overcrowding 2 2 Nil. Nil. Want of drainage of floors 14 14 Nil. Nil. Other nuisances 117 117 Nil. Nil. Sanitary accommodation insufficient 6 6 Nil. Nil. unsuitable or defective 29 29 Nil. Nil. not separate for sexes 2 2 Nil. Nil. Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) 1 1 Nil. Nil. Other offences (Excluding offences relating to outwork, and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops, Transfer of Powers) Order, 1921.) 5 5 Nil. Nil. Totals 273 273 Nil. 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. 67 Factories. The following is a list of the different classes of Factories in Hampstead:— Bakers 30 Dairymen 2 Bootmakers 21 Launderers 2 Butchers 7 Motor and other engineers 26 Cabinet makers and Upholsterers 7 Printers 7 Other trades 43 Carpet beaters 2 Total 152 Coffee roasters 3 Confectioners 2 Workshops. At the end of 1934, there were 399 workshops on the Register, including 96 domestic workshops. During the year, 424 inspections were made and 45 notices served. The chief occupations for males were bootmakers, tailors, upholsterers and cabinet makers, builders and carpenters; and for females, dressmakers, outfitters and costumiers, wigmakers and tailors. Outworkers. Certain specified classes of work done at the homes of workers are controlled by the Factory and Workshop Act, 1901. There are 108 such outworkers in Hampstead known to the Public Health Department. Of these, 5 are factories, 20 are workshops, 3 are workplaces and 80 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, 50 lists were received, and 51 lists in August. These lists included the names of 146 and 139 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 140, 24 belonged to Hampstead and 116 elsewhere. Particulars of the latter were sent to the Local Authorities concerned, while information concerning 84 outworkers resident in Hampstead was received from other Authorities. In no instance during 1934 was outwork found to be carried on in unwholesome premises. 68 Rats and Mice (Destruction) Act, 1919. The Borough Council issues an advisory leaflet on the eradication of rats and mice, and rat poisons may be purchased from the Public Health Department. Upon request, the Council sends an employee, who lays poison baits at infested premises on three separate occasions, for the sum of ten shillings. The services of a firm of professional rat catchers are engaged to deal with any specially infested areas. Bug Infestation of Houses. On the 9th May, 1934, Circular 1395 was issued by the Ministry of Health, together with a memorandum, and the Council were requested to take into immediate consideration the question of securing disinfestation wherever the nuisance was found to occur. The Memorandum sets out in full the life history of the bed-bug and also deals with the difficult problem of disinfestation. The Ministry state that Hydrogen Cyanide is the only certain method of killing the bed-bug. This gas will usually penetrate all ordinary hiding places and kill both bed-bugs and their eggs. Fumigation of homes and furniture by this gas, although effective, is of course fraught with danger, both to the operator and to those in adjacent dwellings. The Public Health Committee agreed that for routine cases the existing scheme in operation in the Borough should continue. Briefly, this scheme is as follows:— On receipt of information of premises being infested with bugs (a) A 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 disinfested. No charge is made for such disinfestation. (b) Tins of Insecticide, suitably labelled, and hand sprayers, purchased by the Public Health Department, are retailed to tenants. The charges are remitted in special cases of poverty, etc., at the discretion of the Medical Officer of Health. The object aimed at is to secure the co-operation of the occupiers of the infested rooms, as, without this, the task of ridding premises of bugs is unlikely to be successful. During the year 318 tins of Insecticide and 88 hand sprayers were issued. 69 The action taken by the Council in relation to bug-infestation in connection with the Westcroft Housing Estate is set out in the Housing Section of this Report. Shops Act, 1934. This Act, which came into operation on the 30th of December, places upon the Sanitary Authority the responsibility of inspecting shops and warehouses in the Borough with a view to investigating (1) the provision of suitable and sufficient ventilation, (2) the maintenance of a reasonable temperature, and (3) the provision of suitable and sufficient sanitary convenience for use of persons employed in or about the shop. Legal Proceedings. The following is a list of the summary proceedings taken by the Department during 1934:— Date of Hearing. Nature of Offence. Result of Hearing. 2nd Feb. (i) Non deposit of plans (i) Fined £2. (ii) and (iii) Contravention of drainage byelaw 10 (ii) Fined £2. (iii) Fined £2. (iv) and (v) Contravention of Public Health byelaw 2 (iv) Fined £2. (v) Fined £5. 18th May Selling pearl barley containing siliceous matter (talc) and sulphur dioxide Fined £2 and £3 3s. costs. 30th May Selling pearl barley containing siliceous matter (talc) Fined £2 and £5 5s. costs. 11th July (1) Selling adulterated milk (1) Fined £4. (2) Using dirty utensils (2) Fined £2 and £1 11s. 6d. costs. 12th July Nuisance under Public Health (London) Act, 1891 Order made to abate nuisance in 14 days and pay 2 guineas costs. 16th Aug. Nuisance under Public Health (London) Act, 1891 Order made to abate nuisance in 21 days and pay 1 guinea costs. 23rd Nov. Obstructing Sanitary Inspector in contravention of the Tenement House Byelaws Fined 10s. and 10s. 6d. costs. 28th Nov. Failing to observe due cleanliness at a Public House Two defendants each fined £1 and £2 2s. costs. 5th Dec. (i) Removing offensive matter at unlawful hour (i) Fined £2. (ii) Removing offensive matter in unsuitable vessel (ii) Fined £2. 5th Dec. Nuisance under Public Health (London) Act, 1891 Order made to abate within 28 days. Public Mortuary, New End. During the year, 75 bodies were brought to the mortuary, 18 by the Police, 55 at the request of friends, and 2 by order of the Coroner. Section 5. Housing. 73 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) 1671 (b) Number of inspections made for the purpose 2827 (2) (a) Number of dwelling-houses (included under sub-head (1) above which were inspected and recorded under the Housing Consolidated Regulations, 1925 78 (i) Number of inspections made for the purpose ... 197 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 22 (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 ... 912 ,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 ... Nil. 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. (ft) 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 864 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 864 (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 lition Orders Nil. 74 D.—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 21 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. Overcrowding. As I explained in my last Annual Report there were 46 cases of illegal overcrowding at the end of 1933, which had been reported by the sanitary inspectors and in regard to which no statutory action had been taken. During the year 1934, a further 22 cases were found by the inspectors, making a total of 68, of which number 16 have since been abated, leaving 52 to be dealt with. It must be appreciated that " illegal overcrowding " bears no reference to the number of cases of overcrowding in the generally accepted sense, i.e., families living more than two persons per room, as, in fact, an extreme degree of over— crowding 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 :— Adults. Children under 10. cub. ft. cub. ft. Controlled Houses. Living and sleeping 400 200 Sleeping only 300 150 Decontrolled Houses. Living and sleeping or sleep— ing only 400 300 It is hoped that the Westcroft Housing Estate will help to relieve some of these overcrowded families. In a few cases it is found, upon enquiry into their financial circumstances, that it is not economic circumstances which are the cause of the overcrowding, for the incomes of the wage earners should make it possible for them to acquire other and better accommodation without State assistance. The question of overcrowding has been the subject of much consideration by the Minister of Health during the past year, and a very far reaching Housing Bill dealing with this subject is now before Parliament. 75 This Bill provides that each local authority, before a date to be fixed by the Minister, shall cause an inspection of its district to be made for the purpose of ascertaining the extent of overcrowding in the district. On completion of the inspection the local authority will have to submit to the Minister a report showing (i) the result of the inspection, (ii) the number of new houses required to abate over— crowding in the district, and (iii) proposals for the provision of such houses unless satisfied that the required number of new houses will be otherwise provided. The Medical Officer of Health must also furnish annually to the Minister particulars with regard to overcrowding in his Borough. The Bill seeks to provide that a dwelling-house shall be deemed to be " overcrowded " if persons over 10 years of age of opposite sexes, and not being persons living together as husband and wife, or an excess of the " permitted number of persons ", sleep in one room. The " permitted number of persons " is the number determined in accordance with one or other of the two following tables, which— ever be the less :— (a) Where the dwelling-house consists of:— (i) One room 2 persons. (ii) Two rooms 3 „ (iii) Three rooms 5 „ (iv) Four rooms 7½ „ (v) Five rooms or more 10 persons, with an additional two persons in respect of each room in excess of five. or (b) the aggregate number obtained by reckoning for each room a number of persons as follows:— Where the floor area of a room is:— (i) 110 square feet or more 2 persons. (ii) 90 square feet or more, but less than 110 square feet „ (iii) 70 square feet or more, but less than 90 square feet 1 „ (iv) 50 square feet or more, but less than 70 square feet ½ „ (v) Under 50 square feet Nil. 76 In computing the number of rooms in a house, no regard is to be had to any room having a floor area of less than 50 square feet, or which is of a type not normally used in the locality either as a living room or as a bedroom. No account is to be taken of a child under one year old, and a child who has attained the age of one year but is under ten years of age is to be reckoned as one-half of a unit. After a date to be fixed by the Minister the occupier or landlord of a dwelling-house who causes or permits it to be overcrowded is to be liable to penalties. The standard, however, is not to operate as regards existing overcrowding or overcrowding due to increase in the number of children or their increasing age, unless the occupier is offered " suitable alternative accommodation." It will be the duty of the local authority, which alone is authorised to institute a prosecution, to enforce the standard and consequently to offer to the overcrowded family suitable alternative accommodation. 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 332. These figures would appear, therefore, to indicate that approximately a further 500 dwellings are required immediately. 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 15. During the year, a further 30 cases were reported, making a total of 45, of which further inspection shows that 3 have since been abated. Underground Rooms Illegally Occupied. The required standard to which underground rooms must con— form if separately occupied is prescribed in the Public Health (London) Act, 1891, Section 96, and if used separately for sleeping purposes, in the Regulations made by the Borough Council under the Housing Act, 1909. 77 During the year, 22 rooms were reported as being illegallyoccupied, and in 10 of these cases the illegal occupation has since been discontinued. 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 69 Number of houses at the Watling Estate at the disposal of the Borough Council under similar arrangements 31 Number of houses allotted to Hampstead under special arrangements with the L.C.C. for relief of over— crowding :— Watling 75 Tottenham 4 Downham 1 Morden 20 Total 200 The total number of families removed from Hampstead to County Council houses since 1927, through action by the Borough Council, is 241 involving 1,304 persons. The additional 41 families are accounted for by changes in tenancies at the subsidy houses (16 at Watling and 25 at Wormholt), the Borough Council having the right to nominate tenants for any of the 100 subsidised houses which become vacant. These are the only County Council houses for which the Borough Council can nominate fresh tenants when they become vacant. Borough Council Municipal Dwellings. At Park Dwellings, Garnett Road (late Lower Cross Road), 42 tenements are provided, as follows: 12 two-roomed tenements; 20 three-roomed tenements; 10 four-roomed tenements. Each 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. 78 At South End Close, South End Green, 140 flats are provided, as follows :— 20 one-bedroom, 78 two-bedroom, and 42 three-bedroom flats. Each is provided with a scullery, bath, etc. The following rents are now charged : one-bedroom flats, 19s. per week plus light; two-bedroom flats, 23s. 6d. per week plus light; three-bedroom 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. -+ Statement showing steps taken in 1934 in connection with premises " represented in 1934 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. 10, Rosslyn Hill 8-1-34 22-2-34 — Front underground room. 8, 9, 9a and 10, King's College Mews West 5-3-34 — — Represented as a Clearance Area. Enquiry by Minister of Health, 17th July. Clearance Order made. 1-6, Stamford Place 9-4-34 — — Represented as a Clearance Area. Enquiry by Minister of Health, 17th July. Clearance Order made. .5, Exeter Mews 9-4-34 24-5-34 — Closing Order made on the upper part. 6, King's College Mews East 7-5-34 — — Owner undertook not to use the upper part for human habitation after present tenants vacate. 31-55, New End 7-5-34 — — Represented as a Clearance Area. Consideration deferred. 2, 3 and 7, Golden Yard 11-6-34 — — Owners undertook that Nos. 2 & 3 would not be used for human habitation after present tenants given alternative accommodation and that the necessary repairs to No. 7 would be carried out. 1, 6 and 7, King's College Mews West 11-6-34 25-10-34 — Closing Orders on upper parts of these premises. 79 Premises. Representation. Date of Committee. Closing Order. Date of Council. Demolition Order. Date of Council. ks. 10, Holly Place 11-6-34 — — Question adjourned fox owner to submit proposals to carry oul the necessary works Undertaking subsequently accepted. 4, Prospect Place 11-6-34 — — Undertaking given that repairs and alterations required would be carried out after present tenants were given alternative accommodation. 1, 2, 3, 4, Fairfax Yard and 3, 5, 7, 13, 15, 17, 19, 31, 33, 35, 37, 39, 41, 43 and 45, Fairfax Place 8-10-34 20-12-34 — Closing Orders made or the upper parts of al these premises wit! the exception of Nos 3, 5 & 7, Fairfax Place, in regard tc which the owners undertook to submit proposals for carrying out the necessary alterations and repairs. The " Westcroft " Estate. This Scheme, details of which were given in my Annual Report for 1933, and which was earlier described as the Cricklewood Housing Scheme, has been pushed forward rapidly during the year. The Council has also taken appropriate steps from time to time in relation to various unfit premises in the Borough, so that when action is taken under the Housing Acts in connection with these scheduled properties there may be alternative accommodation available at this Housing Estate. In view of the fact that at the beginning of 1935 the Council would commence to transfer residents to the new housing estate at Cricklewood, the Public Health Committee brought to the notice of the Housing Committee the possibility of infestation of the new flats and houses by bugs. Arrangements were accordingly made whereby a specialist firm undertakes the removal and disinfestation of the effects of all families removing to the Westcroft Estate, and for other necessary work to be carried out by the Council's disinfecting staff. 80 The means adopted for the prevention of infestation of the new Estate by bugs is as follows :— Early in the morning of the day of removal, the bedding, mattresses, curtains, clothing, etc., are collected and brought to the Public Health Station, where they are subjected to super— heated steam for twenty minutes in the disinfecting chamber, and are afterwards dried. Furniture removal vans collect the furniture, household effects, carpets, etc., and on arrival at the rear of the Public Health Station, the vans are hermetically sealed after hydrogen cyanide (prussic acid gas) has been released. After the expiration of four hours the vans are re-opened and ventilated. The household effects are then transported to the new home. Upholstered furniture is beaten in the open air before being taken into the house. It was decided that this procedure should apply to all families, removing to the new Estate. A letter of advice is sent to the prospective tenants when they are notified of the day on which removal to the new Estate is to take place. This communication is in the follow— ing terms :— Before delivery to the new premises your furniture and effects will be fumigated. Drawers and boxes, etc., should not be packed tightly, nor should they/ be locked as their contents must be ventilated after fumigation. Food, plants, or wet clothes must not be packed with the furnitureMoney, valuable papers, jewellery, etc., must not be put in the varr, but conveyed by yourself to the new premises. Furniture and bedding will be delivered at your new address as early as possible in the afternoon or evening of the same day of collection. All your effects must be carefully cleansed before the day of removalDo 11 ot take unwanted articles of any kind with yon to your new houseThe rooms must be especially well ventilated on the first evening and. night of occupation. The Borough Council's Five Years' Housing Programme. King's College Mews West Area. On 22nd March, 1934, the Housing Committee reported that they had considered the steps to be taken in order to implement the Council's, programme of slum clearance and improvement of housing conditions. HOUSING ACT, 1930 Stamford Place (Entrance thereto). Kings College Mews West. Golden Yard 81 approved on the 29th June, 1933, and had given particular regard to securing that displacements of occupiers of dwellings, so far as possible, should take place as re-housing accommodation is provided under the Cricklevvood Housing Scheme. They also reported that the King's College Mews West area would be the first to be dealt with under the programme, my official Representation, dated 5th March, of Nos. 8, 9, 9a and 10, King's College Mews West, made in pursuance of Section 51 (2) of the Housing Act, 1930, having been submitted to them. With regard to the other dwelling houses in this Mews, it was recommended that procedure in accordance with the programme would be by way of Closing Order and would be the subject of a further recommendation to the Council. The Council adopted the recommendation of the Housing Committee, and resolved that Nos. 8, 9, 9a and 10 should be defined as the " King's College Mews West Clearance Area," and be declared to be a Clearance Area within the meaning of the Housing Act, 1930. On 26th April the Council further resolved that a Clearance Order, ordering the demolition of the buildings, be made and submitted to the Minister of Health for confirmation, and that authority be given to issue the necessary statutory notices and to secure the confirmation thereof and compliance therewith. On 17th July one of the Inspectors of the Minister of Health held an Inquiry at the Town Hall and subsequently on 12th September the Minister confirmed the Clearance Order. The photograph (facing this page) shows the Area, and also other dwellings where living rooms over garages will be closed for human habitation. Stamford Place Clearance Area. The question of dealing with Stamford Place, Heath Street, has engaged the attention of the Council from time to time for many years past. On 9th April, 1934, I represented the premises in Stamford Place, numbered 1-6, to the Council in pursuance of Section 51 (2) of the Housing Act, 1930. The matter was carefully considered by the Housing Committee, who reported to the Council that in their view it was desirable to take 82 steps to deal with the Area outside the programme of slum clearance submitted to the London County Council under the Housing Act, 1930, both in view of the conditions of the properties therein and of the favourable opportunities for re-housing which would be provided by the Cricklewood Housing Estate. The Council on 26th April resolved that these premises should be defined as the " Stamford Place Clearance Area," and be declared to be a Clearance Area within the meaning of the Housing Act, 1930. On 31st May the Council further resolved that a Clearance Order, ordering the demolition of the buildings, be made and submitted to the Minister of Health for confirmation, and that authority be given to issue the necessary statutory notices and to secure the confirmation thereof and compliance therewith. By Section 1 (3) of the Housing Act, 1930, a Council is required, as soon as may be after declaring the area to be a Clearance Area, to proceed to secure the clearance of the area, or by purchasing the land comprised in the area and themselves undertaking or otherwise securing the demolition of the buildings thereon. In the case of this Area it was agreed that the procedure to be adopted was for proceedings to be taken to secure the demolition of the buildings without the Council themselves purchasing the land. On 17th July one of the Inspectors of the Minister of Health held an Inquiry at the Town Hall, and on the 12th September the Minister confirmed the Clearance Order. The photograph (facing page 81) shows the narrow passagewayleading from Hampstead Square into the courtyard known as Stamford Place. The room over the archway forms part of No. 4, and the windows and doors on the left beyond the archway belong to Nos. 4 and 5. Golden Yard, Area. The premises in this congested area on the west side of Heath Street, together with houses in Holly Mount, have engaged the attention of the Council for some time past. In 1932, houses in Holly Mount, together with No. 4, Golden Yard, were excluded from the Area under consideration, upon the Owner giving an undertaking, inter alia, to carry out certain works and agreeing not to use or permit to be used No. 4, Golden Yard for dwelling house purposes. 83 In June, 1934, I reported to the Housing Committee the conditions existing at Nos. 2, 3 and 7, Golden Yard, which were such that they could not be made fit for human habitation at a reasonable cost. Accordingly, the question of taking action under the Housing Act, 1930, was considered by the Housing Committee at its meeting on 8th October. The owner furnished the Town Clerk with a written undertaking not to use or allow to be used Nos. 2 and 3 for human habitation after alternative accommodation had been offered or found for the present tenants, and upon vacation of the premises to allow them to be used only for business purposes. He further undertook to recondition No. 7 to the satisfaction of the Council. This reconditioning included the addition of a kitchenette, discontinuance of the use of a basement room, and improved light and ventilation by means of additional windows. The photograph (facing page 81) illustrates the condemned houses in Golden Yard, and also the houses in Holly Mount, which were constructed on top of the Golden Yard houses. Fairfax Place and Yard. I reported to the Housing Committee on 8th October the conditions found upon inspection to exist at 1, 2, 3 and 4, Fairfax Yard, and 3, 5, 7, 13, 15, 17, 19 and 31, 33, 35, 37, 39, 41, 43 and 45, Fairfax Place. These premises were originally constructed as stables and lofts with rooms for stablemen, and now consist of dwelling rooms over garages and workplaces. They fall far short of present day standards for working class homes. These conditions were duly considered by the Housing Committee on the 3rd of December, and upon their recommendation Closing Orders were made with respect to the upper parts of all the premises, with the exception of Nos. 3, 5 and 7, Fairfax Place. No appeal was lodged to the County Court against these Closing Orders. These latter premises, Nos. 3, 5 and 7, differed from the other properties in Fairfax Place inasmuch as they possessed adequate through ventilation, and the tenants had the use of back yards and washhouses. The Owners submitted proposals for reconditioning the premises to the satisfaction of the Council which were accepted by the Housing Committee on the 7th of January, 1935. The remaining premises in Fairfax Place are to be dealt with in 1935. 84 The photograph (facing page 81) illustrates the dwelling rooms, all of which are situated over garages and workshops. 1, 6 and 7, King's College Mews West. In addition to the premises in this Mews, which constitute the properties described as the King's College Mews West Area, there were certain other premises that called for serious attention. In June, 1934, I reported that inspection of the upper part of Nos. 1, 6 and 7 had been made and that they had been found to be in such a condition that they could not be made fit for human habitation at a reasonable cost. Accordingly the Housing Committee at their meeting on 8th October resolved that in accordance with Sections 19 and 20 of the Housing Act, 1930, a Closing Order be made with respect to the upper parts of the premises. No appeal was made by the owners. New End Area. In May I reported to the Housing Committee on the condition of the following premises in New End :— 31-55 (odd numbers), New End, and Grove Cottage, Grove House and Myrtle Cottage, Christ Church Passage. These 16 houses are situated on about half-an-acre of land onehalf of which is lying derelict. All the houses are from 150 to 200 years old and as a consequence are, for the most part, worn out. The internal arrangements are very bad; none of the houses has damp proof courses; there is lack of through ventilation in one or more rooms in each house; in several of the houses the height of the rooms is considerably below modern requirements; and there is lack of proper and sufficient washing accommodation in a suitable position. The Housing Committee decided that consideration should be given to the question of the desirability of declaring this area as a Clearance Area; they were also of opinion that consideration should be given to the question of the possibility of rebuilding and rehousing on the site if the same were cleared. Upon their recommendation the Council resolved that formal notice should be given in pursuance of Section 16 (5) (2) of the Housing Act, 1930, to the London County Council that they intended to take into consideration a proposal that the New End Area should be declared by them to be a Clearance Area. The Housing Committee was also authorised to obtain architectural 85 and valuation reports with regard to the possibility of rebuilding and rehousing on the site. Various negotiations subsequently took place with the owner and on 7th January, 1935, I represented these premises to the Council in pursuance of Section 51 (2) of the Housing Act, 1930, as constituting an Area that should be dealt with as a Clearance Area. The further progress in connection with these houses will be noted in my Annual Report for 1935. 10, Holly Place and 4, Prospect Place. The condition of these premises was specially reported to the Housing Committee, and, as a result, in each case the agent for the owner furnished an undertaking that after the tenant had vacated the premises the same would not be allowed to be re-occupied until certain specified works had been completed which would render the premises fit for human habitation. This undertaking was accepted by theCommittee, who arranged for the tenants to be rehoused at the Westcroft Estate. Hampstead Housing Association, Ltd. This Association now manages 11 houses in the Borough, five situated in Kelson Street, five in Palmerston Road and one in Netherwood Street. The Report submitted to the Sixth Ordinary General Meeting held in June, 1934, states :— " The management of the houses has gone on smoothly during the past year, but there has not been any addition to the work. The reconditioning of such defective property as can be made fit for a reasonable period by this means is one of the suggestions of the Mansion House Council and it is also the chief aim of this Association. In the immediate neighbourhood of the 11 houses already acquired, there are houses which have been visited by the Directors during the past year; but the prices asked, to which have to be added large sums for reconditioning, have prevented any action being taken." Section 6. Inspection and Supervision of Food. 89 Inspection and Supervision of Food. (A) Milk Supply. Examination of Samples for bacterial content and for tubercle bacilli. In the early part of the year, the Council received a communication from the Ministry of Health in which it was stated that the Minister had had under consideration the report of his Officers after the survey of the public health services of the Borough. With regard to the supervision of food supplies, the Ministry suggested that the number of samples of graded and of ordinary milk submitted for bacteriological examination, and to examination for the presence of tubercle bacilli, should be increased. I accordingly arranged for 10 samples of graded, and raw milk, to be submitted for examination for the presence of Tubercle Bacilli, and for 20 samples of these types of milk and one of sterilised milk to be examined for Bacterial Count—a total of 31 samples. All these samples were found to be satisfactory and it would appear, therefore, that the quality of milk retailed in Hampstead is of a satisfactory standard. Nevertheless, it must be borne in mind, that all milks sold as pasteurised may not have been subjected to sufficient pasteurisation, and consequently an occasional test for tubercle bacilli is desirable. Further, milk, whether pasteurised or not, may be kept for an undue length of time or under unsuitable conditions before it is retailed, and as a consequence bacteriological examination is necessary to ascertain whether or not the milk complies with the bacteriological standards laid down in the Milk (Special Designations) Order, 1923. In view, however, of the bacteriological results obtained, the Public Health Committee agreed that, for the future, it would suffice if about 20 samples per annum were taken, from sources where the arrangements for storage and sale were suspected to be not entirely satisfactory, and in addition that some 10 samples be taken during the course of the year for the presence of tubercle bacilli. Milk for School Children. During the year arrangements were made by the London County Council, designed to operate as from 1st October, whereby children 90 attending their schools should be supplied with milk at a reduced price to be drunk as a beverage by children in the schools. Children coming within the scheme receive one-third of a pint of milk daily. Although this new departure was undertaken by the London County Council, and relates to children of school age, its bearing upon health is of sufficient importance to merit reference in the Report of a Borough Medical Officer of Health. The Borough Medical Officers of Health co-operated with the County Medical Officer of Health in this matter, and it has been arranged that all milk supplied to Hampstead scholars under the scheme should be pasteurised and should comply with the requirements of the Milk (Special Designations) Order, 1923. So far as Hampstead is concerned, this brings the grade of milk supplied, i.e., Pasteurised, into conformity with that supplied to mothers and children under the Maternity and Child Welfare Act, 1918. (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, 196 inspections were made and 25 notices were served. There were 105 milk samples taken under the Food and Drugs (Adulteration) Act, and of these, 5 were unsatisfactory. The average composition of the milk samples examined was Total milk solids 12.28 per cent. Fat 3.51 „ Solids not fat 8.77 „ Two samples of milk were taken in course of delivery from a Buckinghamshire farmer to a certain local purveyor of milk—one from the morning milking, and one from the evening milking. One was found to contain added water to the extent of 5 per cent., and the other was 3 per cent, deficient in milk fat. On instruction of the Public Health Committee a warning letter was addressed to the vendor. The facts were also communicated to the Buckingham County Medical Officer of Health. Samples were thereupon taken from the cows by the Buckinghamshire County authority and showed deficiency in non-fatty solids. 91 At the request of the Hampstead purveyor of milk, three samples were taken, one from the morning milking and two from the evening milking. Of these, one of the evening milkings proved to be slightly deficient in non-fatty solids. A further request was made for samples to be taken, and three were accordingly taken, two from the morning milking and one from the evening milking in which the fat figure and the solids non-fat figure were below legal requirements. The Buckinghamshire authority thereupon took two samples on " appeal to cow " and these were submitted to the Hampstead Borough Analyst. Both showed a solids non-fat figure below 85 per cent.; the fat figures were 31 per cent, and 3 4 per cent. I was later informed that the matter had been referred to the County Agricultural Organiser, who was assisting the farmer to bring the milk up to the required standard by making drastic alterations in the rations given to the cows. (ii) Milk (Special DesignationsJ Order, 1923. Number of licences in force during 1934 for the sale of milk under special designations :— Number of Purpose of Licence. Licences granted. Sale of " Certified " Milk from shop or other premises 9 Sale of "Grade A (Tuberculin tested)" Milk from shop or other premises 11 Sale of " Grade A " Milk from shop or other premises 4 Sale of " Pasteurised" Milk from shop or other premises 37 No licences for graded milk or registration of retailers were refused or revoked during the year. In 15 cases supplementary licences were granted authorising the sale of graded milk within the Borough from premises outside Hampstead. Milk Act, 1934. Section 10 of this Act is in substitution of Section 3 of the Milk and Dairies (Amendment) Act, 1922, and provides, among other things, for designations of milk, and issue of licences. It prohibits 92 the use of special designation in regard to milk in any manner calculated to suggest that it refers to that milk, unless there is in force a milk licence authorising the use of that designation in connection with that milk; and also prohibits reference to milk by any such description, not being a special designation, as is calculated falsely to suggest either that the cows from which the milk is derived are free from the infection of tuberculosis or of any other disease, or that the milk is tested, approved or graded by any competent person. (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 1934. (iii) Unsound Food and Food Inspection. In November, I was informed that cases of illness had occurred which had been traced to Tinned Tomato Puree. The brand in question was described as " Tarantella " Tomato Puree. I communicated with the Importers and obtained from them the names of certain multiple shops in the Borough who had received consignments of the tinned food. These were visited, and tins were submitted for analysis to the Borough Analyst. Pending the receipt of Dr. Cox's report, calls were made at all foodshops in the Borough and a request preferred that tins of tomato puree of this brand should not be offered for sale pending further instructions. The report of Dr. Cox indicated that Copper was present in amounts as high as 20 parts per million; and Tin in amounts as high as 640 parts per million or 4 5 grains per lb. I therefore invited the shopkeepers concerned to withdraw the goods in question from sale and in every case this request was readily acquiesced with. A total of 778 tins were, in consequence, voluntarily surrendered to me with a request for their destruction and an undertaking to make no claim for compensation upon the Borough Council. 93 The following is a list of food seized or voluntarily surrendered during the year :— One Steamer Box of Whiting (4½.5 stone). Two 16 lb. tins of Ham. One 6 lb. tin of Beef. Two 1 lb. tins of Beef. 778 tins of Tomato Puree. (iv) Premises where foods are manufactured, prepared, stored or exposed for sale. These premises have been kept under observation during the year by all the Sanitary Inspectors, and during 1934, 910 inspections were made. The following table summarises the work done in connection with Food premises during 1934 :— No. of Premises on Register. No. of Inspections. No. of Notices. Bakehouses:— Factories— Underground 15 39 7 Aboveground 15 32 3 Workshops— Underground 1 6 — Aboveground 13 22 6 Fried Fish Shops 11 40 7 Ice Cream Premises 88 22 4 Milk Premises 84 196 25 Butter and Margarine Manu— facturers and Dealers 2 9 — Restaurants and Eating. houses 56 51 11 Other Food Premises, e.g., Butchers, Greengrocers, Grocers, Provision Dealers, etc. 444 502 48 One prosecution was undertaken in respect of Food Premises during the year, and fines and costs were imposed. There are no Cowsheds, Slaughterhouses or Poultry Slaughterhouses in the Borough. 94 The underground bakehouses at 98, Boundary Road, 225 and 289, Tmchley Road, are now out of use. Two aboveground factory. and two aboveground workshop. bakehouses were opened during the year at 232, High Road, Kilburn, 9, South End Road, 200, Haverstock Hill and 80, Heath Street. A bakehouse newly opened in premises unsuitable for the purpose, 4a, Downshire Hill, was closed after service of a notice by the Public Health Department. (v) Registration of Food Premises. (a) There are 88 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. (b) Cooked Meat, etc.—Up to the end of the year 42 premises had been registered as required by the London County Council (General Powers) Act, 1932. (vi) Agricultural Produce (Grading and Marking) Act, 1928. The Minister of Agriculture and Fisheries has made Regulations 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 Sanitary Inspectors supervise, generally, such of the requirements of these Acts as are enforceable by the Borough Council. Butter Factories and Wholesale Dealers in Margarine. The custom of some retail shops selling Margarine to other traders and constituting themselves wholesale dealers appears to have fallen into disuse in Hampstead, probably due to increased facilities being given by the wholesale Margarine Merchants, with the result that at the end of the year only two traders were so registered :— 304, High Road, Kilburn—Messrs. Maypole Dairy Co., Ltd. 233, Finchley Road—Messrs. Upton, Ltd. There is now no butter factory in the Borough. 95 (viii) Stalls and Vehicles (including Street Traders). 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. All applications by Stallholders for licences to sell foodstuffs are referred to the Public Health Department prior to the issue of a licence, and in those cases where the food is stored in the Borough the premises are inspected. In those instances in which the place of storage is situated in another district, an inquiry is addressed to the Medical Officer of Health of that area concerning the sanitary condition of the premises. (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, five cases were notified. (C) Adulteration, etc. (i) Food and Drugs (Adulteration) Act, 1928. 508 samples were taken for analysis during the year by the Sampling Officers under the Act. The number certified to be adulterated was 25, or 49 per cent, of the total number, as compared with 18, or 3 6 per cent, in 1933. Of the total samples taken for analysis, 163 were formal samples and 345 informal. The following table shows the articles of which samples were taken during the year :— Article. Number taken. Number Adulterated Bread and Butter 3 1 Butter 55 1 Cereals 10 — Cheese 21 — Cocoa 12 — Coffee 8 — Cream 11 — Carried forward 120 2 96 Article. Number taken. Number Adulterated Brought forward 120 2 Dripping 20 1 Drugs 6 — Fish and Meat Paste 13 1 Fish (tinned) 14 2 Food (patent) 3 — Fruits (dried) 9 Honey 9 — Jam 15 — Lard 23 Margarine 47 — Milk 105 4 Milk (condensed) 4 — Mincemeat 4 — Mustard 4 1 Pearl Barley 18 7 Peas (tinned) 6 — Pepper 11 — Sausages 23 1 Spirits 11 1 Sugar 6 — Tea 5 — Tomatoes and Tomato Puree (tinned) 7 5 Vinegar 4 — Various 19 — Wine 2 — Totals 508 25 The following table shows the articles adulterated, etc., and the nature of adulteration :— No. of Sample. Article. Analyst's Report. 314 Dripping 5 4 per cent, of water. 317 Bloater Paste Sulphur dioxide, 75 parts per million. 321 Mustard Mustard oil 30 3 per cent., Ash 3 9 per cent, and a small proportion of maize starch. 326 Beef Sausages 210 parts per million of sulphur dioxide. 97 No. of Sample. Article. Analyst's Report. 339 Pearl Barley 180 parts per million of sulphur dioxide and faced with 16 per cent, of talc. 344 Pearl Barley 200 parts per million of sulphur dioxide and faced with 0 5 per cent, of talc. 352 Pearl Barley Siliceous matter (talc.) 08 per cent. 358 Pearl Barley Siliceous matter (talc.) 12 per cent, and sulphur dioxide 190 parts per million. 367 Bread and Butter Consists of bread and margarine. 126 Milk Added water 23 parts. 384 Pearl Barley Faced with 13 per cent, of talc. 400 Pearl Barley Faced with 07 per cent, of talc. 412 Pearl Barley Faced with 0.4 per cent, of talc. 252 Butter Water 16 2 per cent. 272 Milk Added water 5 parts. 279 Rum Added water 1 per cent. 294 Tomato Puree Copper 10 parts per million. 285 Tomato Puree Copper 16 parts per million. Tin 640 parts per million. 286 Tomato Puree Copper 20 parts per million. Tin 190 parts per million. 287 Tomato Puree Copper 3 parts per million. Tin 300 parts per million. 295 Tomato Puree Copper 40 parts per million. Tin 2 3 grain per lb. 297 Milk Slightly deficient in non.fatty solids. 317 Sardines (Tinned) 30 parts per million of lead. 342 | Herring Roes (Tinned) Minute trace of boric acid. 353 Milk Deficient in fat to the extent of 15 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. Four samples were taken during the year and found to be satisfactory. (iv) Public Health (Dried Milk) Regulations, 1923 and 1927. One sample was taken during the year and found to be satisfactory. 98 (v) Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. 55 samples of articles of food specified in these Regulations were submitted for analysis. Of these, one unlabelled sample of sausages contained an excess quantity of preservatives, i.e., 210 parts per million of sulphur dioxide. The vendor was a new trader and, upon his attention being directed to the legal requirements as to labelling, immediately complied therewith. He was officially cautioned by the Council. In addition preservatives were also found to be present in samples of articles of food not specified in the Regulations. These were as follows:—Bloater Paste: one informal sample found to contain sulphur dioxide; Pearl Barley: an informal sample found to. contain 180 parts per million of sulphur dioxide. A formal sample was subsequently taken and the vendor was fined £2 0s. Od. and £3 3s. Od. costs. Another informal sample was found to contain 200 parts per million of sulphur dioxide. A formal sample was taken and the vendor was fined £2 0s. Od. and £5 5s. Od. costs. (D) Chemical and Bacteriological Examination of Food. The Public Analyst undertakes the chemical analysis of food at his Laboratories at 11, Billiter Square, E.C.3. Details of this work, together with the Annual Report of the Public Analyst, will be found in this Section of the Report. 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. (E) Nutrition. The routine medical inspection of entrant children in Hampstead to Elementary Schools during the year 1934 demonstrates that 297 per cent, were classed as " good," 67 3 per cent, were " average " and 3 0 per cent, were " below normal." The corresponding figures for the County of London were 20 0 per cent., 75 9 per cent, and 41 per cent. REPORT for the year 1934 of the Public Analyst. H. E. COX, D.Sc., Ph.D. (Lond.), F.I.C. 101 The Laboratory, 11, Billiter Square, London, E.C.3. 1st February, 1935. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, In accordance with my custom I beg to submit a short account of the analytical work carried out by me, as your Borough Analyst, under the Food and Drugs (Adulteration) Act during the year 1934. The total number of samples of various kinds which have been examined during the year is 508. The following list shows some of the principal items which have been examined. In addition to those named a wide variety of other products have been analysed :— Milk ... ... ... ... 105 Cream ... ... ... ... 11 Butter ... ... ... ... 55 Margarine ... ... ... 47 Lard ... ... ... ... 23 Cheese ... ... ... ... 21 Dripping... ... ... ... 20 Sausages... ... ... ... 23 Fish and Meat Pastes ... ... 13 Coffee ... ... ... ... 8 Cocoa ... ... ... ... 12 Spirits ... ... ... ... 11 Pearl Barley ... "... ... 18 Jam ... ... ... ... 13 Honey ... ... ... ... 9 Sardines... ... ... ... 12 Pepper ... ... ... ... 11 Tomato Products ... ... ... 7 Dried Fruits ... ... ... 9 As in what follows it is necessary to draw attention to the various irregularities which have been detected during the year, it may be well to emphasize at the outset that the average of the food stuffs sold in the Borough, as shown by analysis, is distinctly good. Cases of 102 adulteration in the stricter sense of the word are rare, though there are quite a number of instances of breach of Regulations and various sophistications which are included as adulteration under the Food and Drugs Act. There are also instances of contamination of various kinds. Of the samples of Milk examined, five were adulterated. Two definitely contained added water, two were substantially deficient in fat and one was deficient in non.fatty solids, although there was no conclusive evidence of the addition of water. Two other samples were deficient, but as subsequent " appeal to cow " samples from the farm from which the supply emanated were also found to be deficient, the original samples had to be passed as genuine. The average composition of all the Milks for the year is :— Total milk solids . 12.28 per cent. Fat 3.51 „ Solids not fat 8.77 „ which is only very slightly below the average in 1933. No bacteriological tests have been made on any of these samples. Of the Butter and Margarines, two contained small excess of water; one specimen purporting to be bread and butter was found to be bread and margarine, one dripping contained excess of water, three samples of sausages contained sulphur dioxide, seven pearl barleys were faced with talc., three of them to such an extent as to warrant legal proceedings, a sample of herring roes contained boric acid and one fish paste contained sulphur dioxide, both contrary to the Regulations, one rum showed evidence of the addition of water and one mustard had been mixed with a small amount of maize starch. Two matters connected with the contamination of food with poisonous metals have caused some difficulty during the year. The difficulty mainly centres round the deciding of what is a proper limit to adopt and what action it is appropriate to take. Contaminations such as have been met arise by inadvertance or careless methods of manufacture, and it is not always possible to trace and eliminate these at short notice, so that in the case of certain imported products too rigorous application of a limit would result in the disappearance of important commodities from the market. On the other hand, it is the primary duty of your Analyst and the Medical Officer to protect the jnterests of the consumer. It is much to be hoped that now that the 103 Departmental Committee has reported in favour of the establishment of standards and definitions for foods, action will be taken by Parliment so that difficulties of this kind can be settled by the Central' Authority after due investigation. The difficulties this year have been in relation to Sardines and to Tomatoes. Sardines were found to contain quite substantial amounts of lead, which were subsequently found to be due to lead coated grids used in the cooking process. For a time, it was almost impossible to obtain Sardines free from this rather serious form of contamination, but fortunately the difficulty has now been overcome. Some of those examined were found to contain as much as 30 parts per million of lead, and this figure was exceeded in certain other districts. In the cases of Tomatoes—mainly in the form of Tomato Puree—the contamination has been copper which has been found in amounts varying from unimportant traces up to about 70 parts per million. This arises from the evaporation or processing of the Puree in copper pans. Copper is not so dangerous a poison as is lead, and its effect is reputed to be non.cumulative, but even so, there can be no doubt that such large quantities of copper are wholly undesirable and ought not to be tolerated. It was found,, unfortunately, that the contamination was very wide.spread, but happily it is being remedied. I have had occasion during the year to investigate the composition of Fish Pastes, and have collected my results in a separate publication, of which copies will be sent shortly. It is interesting to note the frequency with which farinaceous fillers are present, and the fact that there is no limit or Regulation governing this in this country, although many other countries have thought it necessary so to protect the consumer by limiting Regulations. No doubt this subject will receive the attention of the Authorities when the Standards advocated by the Departmental Committee are considered. The total number of samples adulterated or deficient during the year is 25, which corresponds to 49 per cent, of those examined. It should be added in fairness to the others that it also corresponds to. 95.1 being genuine. 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. 107 Prevalence of, and Control over, Infectious and other Diseases. Acute Polio.Myelitis. During the year three cases of acute polio.myelitis were notified in the Borough. They occurred in females aged 4, 12 and 28. during the last quarter of the year. The two girls aged 4 and 12 were severe cases and received hospital treatment, but are both making satisfactory recoveries and their progress is being carefully observed by my staff. The case of the patient aged 28 was a mild one, and she has already made a satisfactory recovery. Cerebro.Spinal Fever. There was one case of Cerebro.spinal fever notified in the Borough during 1934. It occurred in a male aged 21 years. It was not a severe case and after appropriate treatment with Flexner's serum given intrathecally the patient made a satisfactory recovery without any complications intervening. Diphtheria. During the year there were 122 cases of diphtheria and 8 deaths, as compared with 104 cases and 3 deaths in the previous year. The morbidity rate was 09 per 1,000 of the population and the case mortality was 6 5 per cent. All cases, with 4 exceptions, were removed to hospital. The highest incidence occurred in February when 13 cases were notified during the week commencing the 17th. The incidence of the disease was rather more noticeable on the eastern side of the Borough. Immunisation. In June, 1933, a Scheme was instituted whereby immunising material against diphtheria was made available, free of charge, for use of general practitioners in the Borough. During the year under review this scheme was augmented so that those parents who are unable to afford doctors' fees may have their children immunised free of charge at the Toddlers' Clinic. By the 31st December, 1934, a total of 192 persons had been immunised and this figure had increased to 433 by the 12th March, 1935. 108 At the time of writing the scheme had been still further augmented so that not only do the Council provide the material to general prac— titioners free of charge, but also pay them 7s. 6d. for each child immunised. In addition arrangements are now made for a final Schick test to be performed at the Toddlers' Clinic by a medical officer employed by the Borough Council. Every endeavour is being made to make this scheme a complete success, because, of course, it is realised that unless the proportion of Schick immunes is maintained above a certain percentage (about 30 per cent.) the incidence of diphtheria in the Borough will not be reduced. Dysentery. One case of dysentery was notified during the year in a child aged two years. The condition was mild and the child made a complete recovery. Sonne's dysentery bacillus was grown from the stools. The source of the infection was unknown. Encephalitis Lethargica. One case of this infection was notified during the year, but the medical practitioner in charge of the case eventually decided that it was not a true case of encephalitis lethargica. There were also two deaths recorded from this disease, neither of which had been notified. They were in adults, aged 33 years and 41 years respectively, and both deaths occurred in hospital. Enteric Fever. One case of para.typhoid fever was notified during the year. The patient was a female aged 34 years and was admitted to the New End Hospital from whence she was transferred to the North Western Fever Hospital. The blood serum agglutinated B. Para.typhosus B. in a solution of 1/320. The patient has made an uninterrupted recovery and although careful investigations were made, the source of the infection could not be traced. There were also two deaths recorded during the year from this infection. One case had been notified during the preceding year. The 109 second case was that of a nurse (aged 44 years) who was infected" during the course of her duty in a neighbouring borough. She was a severe case of pneumo.typhoid, and had two severe haemorrhages before death one month after her admission to hospital. Malaria. One case of malaria was notified during the year, a youth aged 17, who had contracted the infection in Africa. Measles. There was a sharp epidemic of measles in the Borough in 1934, which commenced in February and lasted until the end of May. The peak occurred during the months of April and early May; during the week commencing May 5th no less than 130 cases were notified. All cases were carefully supervised by my health visiting staff, who with the co.operation of the school nurse of the London County Council effected a satisfactory control. However, only 207 of these cases were admitted to hospital for treatment and isolation, for unfortunately the time has not yet arrived when the provision of adequate hospital treatment is appreciated and accepted by the parents. The outbreak was particularly noticeable in the Kilburn Ward. In all, 1,311 cases of measles were notified. There were 9 deaths from the infection, occurring chiefly in children of ore.school aee. Measles has been notifiable in Hampstead since 1920, and as a consequence we are in a position to ascertain its case mortality rate and make appropriate comparison with that of scarlet fever and diphtheria, which I append below :— Year. Measles. (Mortality Rate.) Scarlet Fever. (Mortality Rate.) Diphtheria. (Mortality Rate.) 1924 .49 .67 3.26 1925 .68 .65 1.47 1926 .55 .93 5.56 1927 2.45 .78 2.86 1928 .62 .53 3.45 1929 Nil 1.46 508 1930 .25 1.01 2.39 1931 Nil .59 2.89 1932 .42 1.20 635 1933 Nil Nil 2.88 1934 .68 .51 6.56 Average .55 .71 3.89 110 Pneumonia. During the year 98 cases of pneumonia were notified. Of these, 81 cases were of acute primary pneumonia and 17 cases of acute influenzal pneumonia. The total deaths were 25, of which 17 occurred in persons over 45 years of age. The age of the patient would appear to be the most important factor of mortality. Scarlet Fever. During the year there were 194 cases of scarlet fever notified, which is only about one.third of the number which was notified in the previous year. The disease continues to be of a mild type and one case had a fatal termination. 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. Notifiable Diseases during the Year 1934. notifiable diseases. * Total cases notified in age-periods. *Total cases notified in each Ward. "Cases admitted to Hospital. Total deaths in age-periods. At all Ages. At Ages—Years. At all Ages. At Ages—Years. Under 1. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No 3 (Adelaide). ' Ward No. 4 (Central). Ward No. 5 (WTestEnd). Ward No. 6 (Kilburn). Ward No. 7 (Priory). Under 1. 1 and under 2. 2 and , under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 1 65 and over. Cerebro-spinal Fevei 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 122 7 4 10 6 7 42 18 10 13 3 2, ... 32 96 9 27 4 13 11 118 8 2 ... ... ... ... 2 3 ... ... ... 1 ... Dysentery 1 ... ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Erysipelas 31 ... ... ... ... ... 1 2 ... 7 7 9 5 5 4 7 ... 7 5 3 21 3 ... ... ... ... ... ... ... ... ... ... 1 2 Encephalitis Lethargica 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 2 ... ... ... ... ... ... ... ... 1 1 ... ... Malaria 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ophthalmia Neo— natorum 7 7 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 3 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Polio Myelitis 3 ... ... ... ... 1 ... 1 ... 1 ... ... ... ... 1 ... ... 2 ... ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Fever 5 ... ... ... ... ... ... ... ... ?, 2 1 ... ... 1 1 1 ... 1 1 5 2 ... ... ... ... ... ... ... ... ... ... ... ... Puerperal Pyrexia 18 ... ... ... ... ... ... ... 1 14 3 ... ... 1 1 2 ... 4 4 6 18 ... ... ... ... ... ... ... ... ... ... ... ... Pneumonia 1)8 6 9 2, ... 3 2 1 2, 21 14 27 18 13 26 10 8 11 18 12 45 58 8 2 1 ... 2 ... ... 1 2 3 25 14 Scarlet Fever 194 ... 4 8 14 13 53 25 20 42 7 7 1 33 38 23 10 32 32 26 166 1 ... ... ... ... ... ... ... ... ... ... ... ... Typhoid Fever 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... 1 2 ... ... ... ... 1 1 ... ... ... ... ... 1 f Measles 1311 31 111 103 148 165 566 107 29 43 4 4 141 174 91 109 184 411 20 1 207 9 ... 5 2 ... 1 1 ... ... ... ... ... ... X Tuberculosis 94 ... ... ... 1 1 5 4 7 14 16 11 5 18 15 6 6 18 22 9 78 59 1 ... 1 ... ... 1 1 4 23 10 15 3 Totals 1888 51 121 124 169 190 069 158 70 189 56 61 30 243 288 152 161 265 509 270 667 114 11 7 4 ... 3 4 4 5 30 15 42 19 * Cancelled cases have not been included. + Notifiable under the Borough of Hampstead (Measles) Regulations, 1920. X Statistics relating to Tuberculosis are given in subsequent pages. 111 112 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, 1933 1391 2. Number of these :— (a) Successfully vaccinated 806 (b) Insusceptible of Vaccination 7 (c) Had Smallpox — (d) Number in respect of whom Statutory Declarations of conscientious objection have been received 326 (e) Died unvaccinated 33 3. Number of these Births which on 31st January, 1935, remained unentered in the " Vaccination Register " on account of :— (a) Postponement by Medical Certificate 7 (b) Removal to Districts the Vaccination Officers of which have been duly apprised 139 (c) Removal to places unknown, or which cannot be reached; and cases not having been found 61 4. Number of these Births remaining on 31st January, 1935, neither duly entered in the " Vaccination Register " under headings numbered 2 nor temporarily accounted for in the " Report Book" under headings numbered 3 12 5. Total number of Certificates of successful primary vaccination of children under 14 received during the Calendar year 1934 (including any relating to births registered in previous years) 1016 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 1934 302 7. Number of cases of children in entries 1 and 2 (d) successfully vaccinated after the declaration of conscientious objection had been made 1 113 8.. Total number of Certificates for the year 1934 of successful primary vaccination of which copies have been sent to Vaccination Officers 135 It will be seen from the foregoing figures, that approximately 60 per cent, of the children born in Hampstead during 1933 had been vaccinated by the end of the year under review. This figure compares with 38 per cent, for England and Wales and 48 per cent, for London. Hampstead is sixth among the Boroughs in London in regard to the percentage of children vaccinated. The returns for the various Metropolitan Boroughs shew a surprising difference in the percentage of children vaccinated, varying from 11.1 per cent, and 143 per cent, in two of the poorer East-end Boroughs to 73 6 per cent, and 694 per cent, in the Boroughs of Kensington and St. Marylebone. It should be noted that Smallpox has principally occurred in the Boroughs with the lowest percentage of children vaccinated. A considerable number of the children shown in these returns as unvaccinated are, however, vaccinated in subsequent years. In fact, no less than 75 per cent, of the children born in Hampstead between 1919 and 1933 were eventually vaccinated. During the period 1919—1933, 81,933 cases of Smallpox were notified in England and Wales, and 10,583 in London, but in Hampstead only 6 cases were notified during these years. Based on Hampstead's population as compared with that of the County of London, Hampstead should have had upwards of 200 cases during this 15 year period. It is, therefore, only fair to assume from these facts that the high percentage of vaccinated in Hampstead has some definite relationship to its comparative immunity from Smallpox. Of this fact Hampstead may be justly proud. Cancer. Hospitals 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. 114 Radium. Radium is used at the Marie. Curie Hospital, 2, Fitzjohn's Avenue, and at the Westminster Hospital Annexe, 66, Fitzjohn's Avenue. Hospital Accommodation. During the year, 667 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 Examinations. The bacteriological examinations for the Council in connection with infectious disease were carried out by the Hampstead General Hospital. The following is a summary of the work carried out at the Hospital during the year 1934:— Total. Diphtheria 1042 Enteric Fever 4 Dysentery 1 Scarlet Fever (for Hsem. Strep.) 19 Specimens of Sputum 209 X-ray examinations made 90 Public Health Station. The Public Health Station is situated in the Electricity Yard, Lithos Road, Finchley Road, and comprises Disinfecting Station, Bathing Station and Laundry, Garage, and Public Health Stores, with quarters for the resident Senior Disinfector. Ever since the erection of the new Public Health Station in 1931 difficulty has been experienced in connection with the use of the Furnace for destroying bedding, etc., situated in one of the out-buildings at the rear of the main structure, owing to alleged nuisance to adjoining premises from smoke and fumes. In the latter part of the year serious cracks developed in the chimney, which 115 necessitated its demolition. At the present time, therefore, there is no incinerator available in connection with the Public Health Station in which bedding and other articles can be destroyed. The question is now under consideration of converting into an incinerator a small building formerly used in connection with the old Cleansing Station and adjacent to the Shelter in the Electricity Yard. Disinfection. The Public Health Station is equipped with a Washington-Lyons disinfecting 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 1934 :— Number of houses or parts of houses and contents disinfected 2,287 „ verminous rooms disinfested 44 „ „ articles of clothing disin— fested *182 „ „ beds disinfested 86 „ 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 . 3 Children 700 Scabies. Adults 34 Children 85 116 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 44 verminous rooms and contents, and, in addition, as a result of the action of the Sanitary Inspectors, 139 verminous rooms in 68 houses and 35 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 1934, 94 new cases of Tuberculosis were notified, 73 being cases of Pulmonary Tuberculosis, and 21 other forms of the disease. Two certificates relating to Pulmonary cases were subsequently withdrawn. There were 13 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 59 and the ratio of nonnotified tuberculosis deaths to the total tuberculosis deaths was, there— fore, 1 in 4.5. The following statistical table, prescribed by the Ministry of 117 Health, gives an analysis of the newly notified cases and deaths during 1934:— New Cases, Deaths. Age Periods. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0- — — — — 1 — — — 1 — — 1 1 — — — — 5- 2 — 5 2 — — — 2 15- 9 13 2 3 5 8 — — 25- 8 11 — 5 5 8 — 1 35- 9 0 1 — 5 5 — 1 45 6 2 — — 7 3 — — 55 — 3 — — 2 2 — — 65 and upwards 4 — — 1 1 1 — 2 Totals 38 35 9 12 26 27 — 6 Removals to Sanatoria and Hospitals. Sanatorium treatment for insured and non-insured persons is undertaken by the London County Council. By Section 4 of the National Health Insurance Act, 1920, Sanatorium Benefit ceased to be included among the benefits conferred by Part I of the Insurance Act of 1911. Of the 73 cases of Pulmonary Tuberculosis newly notified in 1934:— 41 were treated at Sanatoria. 10 „ „ Hospitals. 15 „ „ L.C.C. Hospitals. 2 notifications were withdrawn. Of the 21 cases of Non-Pulmonary Tuberculosis newly notified in 1934:— 8 were treated at Sanatoria. 9 „ „ Hospitals. 1 was „ L,.C.C. Hospital. The following cases, notified prior to 1934, were also removed : — Pulmonary. Non-Pulmonary. Insured. Ision- Insured. NonInsured. Insured. To Sanatoria ... ... 9 7 — — To Hospitals ... ... — — — To L,.C.C. Hospitals ... 7 3 — — 118 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 1934 totalled 435 —347 pulmonary and 88 non-pulmonary. Tuberculosis Regulations, 1930. Pulmonary. Non-Pulmonary. Totals. Males. Females. Males. Females. Males. Females. Number of cases on the Register at the com— mencement of the year 1934 164 183 37 36 201 219 Number of cases notified under the Regulations for the first time dur— ing the year... 38 35 9 12 47 47 Number of cases re— moved from the Re— gister in a preceding year which have been restored to the Re— gister during the year 3 5 — — 3 5 Number of cases brought under notice otherwise than by notification during the year 20 15 1 8 21 23 225 238 47 56 272 294 *Number of cases re— moved from the Register during the year 53 63 3 12 56 75 Number of cases re— maining on the Regis— ter at the end of the year 172 175 44 44 216 219 These consist of cases which have been denotified, and those which have died or removed from the Borough. 119 Deaths. The number of deaths from Tuberculosis in 1934 was 59; of these 53 were due to pulmonary tuberculosis and 6 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. (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 90 such examinations made during 1934. 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 1934 on 127 occasions by local practitioners (exclusive of the 82 specimens sent for examination by the Tuberculosis Medical Officer). Artificial Pneumo-thorax. Arrangements exist for patients to receive this treatment at Brompton, Victoria Park, St. Mary's, Colindale and University College Hospitals. During the year 1934, there were 15 patients referred to these hospitals entailing 172 attendances. A continued increase in this 120 mode of treatment is apparent. It is unfortunate that the patients are called upon to travel long distances for their treatment, and this point is receiving attention. 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.I, on Wednesdays at 11 a.m. During the year, six patients attended and the total attendances were 21. Finsen-Light Treatment. During 1934, one Dispensary patient attended the London Hospital for Finsen-Light Treatment, the Council paying a sum of 5s. for each attendance at the hospital. During the year the patient made five 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 1934. 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 one case 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. 121 Tuberculosis Care Committee. In 1923 the present voluntary Care Committee was established. The Borough Council makes a grant of £100 per annum towards the administrative expenses, and is represented by Mrs. Councillor Dow, Miss Councillor Glover, Mrs. Councillor Samuel, Mr. Alderman H. Baily and Mr. Councillor F. R. Bailey. The Committee, through its Secretary, Miss Talbot Kelly, keeps in touch with the patient's families whilst in sanatoria, and their conditions and prospects receive consideration upon discharge. In July the London County Council resolved that no contributions should in future be asked from patients towards the cost of residential treatment of tuberculosis or towards the cost of the boarding out of children under the Tuberculosis Regulations, 1930. One of the duties of this Committee had been to assess and collect such contributions. The relief of the Care Committee from this duty should enable them to devote more time to their other, and more important functions. Details of the work carried out by the Committee during the year are tabulated below:— Cases reviewed 306 New cases (included in above) 85 Interviews with patients by Care Committee Secretary :— (a) At homes of patients 120 (b) Otherwise 560 Cases referred to the Hampstead Borough Council:— (a) For extra nourishment 17 (b) For dental treatment 3 Cases referred to the Public Assistance Com— mittee 29 Cases referred to Service Funds 10 Cases referred to Voluntary Associations 23 Cases referred to other Agencies 22 Cases helped directly through the Care Com— mittee :— (a) In cash 18 (b) In clothing 11 122 Provision of Extra Nourishment. The Council has voted the sum of £30 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. During the year 17 patients received help under this scheme. 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, 4 p.m. Fridays, 4.30 and 8 p.m. During the year, 199 sessions were held, and 230 new cases (of which 71 were contacts) were examined. The total attendances of all kinds numbered 1,140, an average of 5 7 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 Tuber— culosis Work, and whose report for the year 1934 I append herewith. Municipal Tuberculosis Dispensary, 75, Dynham Road, Kilburn, N.W.6. February, 1935. 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 1934. 374 patients attended the Dispensary during the year, and the total number of attendances was 1,140, at which 670 systematic physical examinations were made. The attendances were 63 less than last year. New applicants attending numbered 230 (30 less than the previous year), and these have been classified as shown in Sections A and B of the following table :— Tuberculosis Scheme of the Hampstead Metropolitan Borough Council. Return showing the work of the Dispensary during the year 1934. 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 22 25 1 1 2 4 1 2 23 29 2 3 58 (b) Doubtfully tuberculous — — — — — — — — 1 1 2 — 4 (c) Non-tuberculous — — — — — — — — 26 49 12 10 97 B.—Contacts examined during the year :— (a) Definitely tuberculous 5 2 1 — — — 1 — 5 2 2 — 9 (6) Doubtfully tuberculous — — — — — — — — — 2 — 2 (c) Non-tuberculous — — — — — — — — 10 22 17 11 60 C.—Cases written off the Dispensary Register as :— (a) Recovered 5 20 — 2 — — — — 5 20 — 2 27 (6) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) — — — — — — — — 39 75 30 22 166 D.—Number of Persona on Dispensary Register on December 31st:— (a) Diagnosis completed 76 81 11 2 6 12 10 5 82 93 21 7 203 1 J 9. 123 Number of persons on Dispensary Register on January 1st ... 233 Number of visits by Tuberculosis Officer to Homes (including per— Number of patients transferred from other areas and of " lost sight of " cases returned 23 sonal consultations) Number of: — 20 Number of patients transferred to other areas and cases " lost sight of" 57 (a) Specimens of sputum, &c., examined 82 1 b) X-ray examinations made in connection with Dispensary work 90 Died during ihe year 26 Number of Insured Persons under Domiciliary Treatment 011 the Number of attendances at the Dispensary (including Contacts) 1140 31st December 23 Number of visits by Nurses or Health Visitors to Homes for Dis— pensary purposes 1033 Number of " Recovered " cases restored to Dispensary Register, and included—in A (0) and A (i) above Number of consultations with medical practitioners :— (a) Personal 18 Number of " T.B. plus " cases on Dispensary Register on Decem— ber 31st 115 (J) Other 89 124 There have been 18 consultations with doctors in regard to patients at their homes and 89 letters have been sent to 43 doctors concerning cases referred for an opinion. I have made visits to the homes of patients in relation to 20 cases and occasional visits to New End Hospital in connection with tuberculous patients, when there have been any at that Institution, and have to thank Dr. Swindells for his help and courtesy in respect of these patients. Of the cases under treatment:— 48 were referred to the London County Council for treatment in Sanatoria and Hospitals. 9 were admitted to New End Hospital. 2 were admitted to Victoria Park Hospital. 6 were admitted to the Hampstead General Hospital. The number of notifications decreased, the total being 94, 73 pulmonary and 21 non-pulmonary. This total is 10 less than the previous year. Of the total primary notifications:— 43 attended the Dispensary during the year. 14 cases were not of Dispensary class. 45 cases were notified from Hospitals or Sanatoria; many of these are still attending their hospital of origin or are still in sanatoria. 9 were domestic servants. 32 cases were transferred from other boroughs. Of these, 20 attended the Dispensary, three removed again and one died. 14 of the primary cases notified died during the year; only one of these had attended the Dispensary. 13 of the deaths occurred in hospital and one at home. A total of 59 deaths occurred during 1934. This was an increase of 19 on the number of deaths in the previous year. Only 27 of these were Dispensary patients and they were all pulmonary cases. 46 died at Institutions and 13 at home. 90 X-ray examinations have been made, this number tending to 125 increase yearly. I have to thank the Radiologist at the Hampstead General Hospital for the uniformity good films he supplies. Potential contacts during the year numbered 110. 37 of these have been examined, i.e., 34 per cent. A total of 71 contact cases were examined altogether. For the second year in succession an exceptionally fine summer and freedom from a severe influenza epidemic during the winter has acted in the main beneficially on the patients as far as general respiratory disease is concerned. Hot summers, however, are trying to the active tubercular patient and an effect of this is seen in the considerable increase in the death rate for the past year; this increase amounts to SO per cent, on the preceding year and is the highest figure for nine years. During the course of the year several cases were seen who had activated quiescent disease by indiscriminate sun bathing. The primary notifications during the year showed an increase each month for the first six months; during the last six months the notifications were less for each month. A great improvement has been manifest in the small number of Dispensary cases who have died in their homes. In the year under review this amounted to only five and in each case the home conditions were such that there was no objection to the return of the patients to their own homes to die. As New End Hospital is unable to accommodate tuberculosis cases for any length of time the majority of our cases are transferred to Highgate Hospital. At this Hospital the wards are all large and airy with cross ventilation, and leave little to be desired from an institutional point of view. Much has been done since the London County Council took over the general hospitals to make the wards bright and cheerful and to improve the equipment. As I visit this Hospital weekly I am able to keep an eye on any of the Hampstead cases who may be transferred there. It is a pity that the Hospital is rather difficult of access to Hampstead, as it is evident that many of the patients admitted there are in the last stages of the disease, being mostly those who are too advanced for sanatorium treatment. One of our cases continues to work at one of Dr. Jane Walker's Sanatoria and is keeping well. 126 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. 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 1934 230 50 71 1140 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.). 127 INDEX. PAGE. Adulteration, etc.95 Agricultural Produce (Grading and Marking) Act, 1928 94 Ambulance Facilities 23 Analyst, Public, Report of 101 Analytical Work 95 Ante-Natal Clinics 35 Anti-toxin (Diphtheria) 108 Area of Borough 13 Artificial Cream Act, 1929 97 Artificial Pneuino-thorax 119 Bacteriological Work 114, 119 Bakehouses 93, 94 Bathing Station 115 Beauchamp Lodge, Paddington 49 Birth Rate, Decline of 30 Births 19, 29 Bug infestation of houses 68 Butter Factories 94 Cancer 118 Care Committee (see Tuberculosis). Cerebro-spinal Fever 107 Chemical and Bacteriological Examination of Food 98 Child Mortality 31 Children's Hospital, College Crescent 46 Cleansing of verminous houses, persons, etc. 115 Cleansing Station (see Bathing Station). Clearance Areas 80 Clinics and Treatment Centres 24 Closing Orders 78 Common Lodging Houses 64 Compensation to Midwives 52. Complaints Received 81 Condensed Milk 97 Consulting Obstetricians 53 Consumption (see Tuberculosis). Convalescent Homes, etc. 49 Cooked Meat 94 128 PAGE. County Council Housing Estates 77 Creches (see Day Nurseries). Cricklewood Housing Scheme 79 Cross Roads Club, 88, Alexandra Road 50 Day Nurseries 51 Deaths 14, 19, 32, 119 Dental Clinics, etc. 42,120 " Diamond Jubilee" Beds 118 Diphtheria, Anti-toxin, and Immunisation 107 Disinfection 115 Drainage Bye-laws 64 Dried Milk 97 Dysentery 108 Encephalitis Letliargica 108 Enteric Fever 108 Epidemic Diarrhcea 24 Erysipelas 111 Factory and Workshop Acts 65 Factories 65, 67 Finsen Light Treatment 120 Fairfax Place and Yard 83 Food and Drugs (Adulteration) Act, 1928 95 Food and Food Premises 93, 94 Food and Milk for Mothers and Infants 42 Food, Inspection and Supervision of 87 Food Poisoning 95 Food, Preservatives in 98 Food, Unsound 92 Foster Children and Foster Mothers 55 Foster Home, 99, Haverstock Hill 50 Fried Fish Shops 93 Golden Yard Area 82 Hampstead Council of Social Welfare 40 Hampstead General Hospital, Borough Beds 113 Hampstead Hospital for Children 46 Hampstead Hostel for Mothers and Babies 50 Hampstead Housing Association 85 Hampstead and North St. Pancras Day Nursery 51 Health Education and Propaganda 35 Health Services 23 Health Visitors and Work of 34 Home Helps 53 Home Office Tables (Factory and Workshop Act, 1901) 66 Home Nursing 24, 114 Home Workers 67 129 PAGE. Hospitals 25 Hospital accommodation 25, 114 Hospital Beds, Borough Jubilee Beds 113 Houses, Inhabited, number of 13 Houses Let in Lodgings (see Tenement Houses, etc.). Housing Committee 3, 80 Housing Conditions where births occurred 33 Housing" Representations" 78 Housing Section 73 Ice Cream 93 Illegimate Children 30, 47, 50 Immunisation, Diphtheria 107 Imported Foodstuffs 92 Improper Mixing of Sexes 76 Infant Life Protection 55 Infant Welfare Centres 40 • Infantile Mortality 14,31 Infectious Diseases 107, 111 Influenza 110 Inspections and Re-inspections 61 Inspection and Supervision of Food 89 Institutions for Unmarried Mothers and for Infants 50,51 Invalid Children's Aid Association 53 Kings College Mews West Area 80, 84 Laboratory Facilities 23 Legal Proceedings 69 Main Memorial Home 51 Margarine, Wholesale Dealers 94 Malaria 109 Maternal Mortality 32, 52 Maternity and Child Welfare 29 Maternity and Child Welfare Centres 35 Maternity and Child Welfare Committee 3 Maternity Beds 46 Maternity Clinics (see Ante-Natal Clinics). Maternity Outfits 55 Measles 109 Meat and other Foods 92 Medical Investigation Sub-Committee 46 Merchandise Marks Act, 1926 94 Meteorology 15 Midwives and Midwifery Nursing 52 Milk Act, 1934 91 Milk and Dairies Acts, 1915 90 Milk and Dairies Order, 1926 90 130 PAGE Milk and Food for Mothers and Infants 42 Milk, Condensed or Dried ... 97 Milk (Special Designations) Order, 1923 91 Milk for School Children 89 Milk Supply 89 Mortuary, Public 69 Mount Vernon Hospital, Borough Beds 113 Municipal Dwellings 77 New End Area 84 New End Hospital 46 Notification of Births Act, 1907 32 Nursing in the Home 24, 114 Nutrition 98 Offensive Trades 64 Officials, Public Health 4 Ophthalmia Neonatorum 51 Outworkers (see Home Workers). Overcrowding 74 Park Dwellings 77 Pathological Examinations for Sputum 114 Pneumonia, Acute Primary and Acute Influenzal 110 Polio-Myelitis 107 Population 17 Population, Natural Increase of 17 Poultry Slaughterhouses 93 Pre-Maternity Clinics (see Ante-Natal Clinics). Preservatives, &c., in Food Regulations, 1925 to 1927 98 Public Health Committee 3 Public Health Station 114 Public Health (Tuberculosis) Regulations, 1925, 1930 116, 118, 120 Public Vaccinators 4 Puerperal Fever and Pyrexia 51 Puerperal Sepsis 51 Queen Charlotte's Hospital 46 Queen Mary's Maternity Home, Heath Street 46 Rag and Bone Dealers 64 Rats and Mice (Destruction) Act, 1919 68 Ray-Tlierapy 41 Rent Restriction Acts 65 Restaurant Kitchens 93 St. Agatha's House 51 Sale of Food Order, 1921 92 Sanitary Inspectors, Work of 61 Sanocrysin Injections 120 131 PAGIS. Scabies 115 Scarlet Fever and Immunisation 110 School Entrants and School Medical Inspection 43, 44, 45 Seamen's Lodging Houses 64 Shelter 116, 120 Shops Act, 1934 69 Slaughterhouses 93 Smoke Abatement 62 South End Close 78 Special Children 41 Staff of the Public Health Department 4,119 Stalls 95 Statistics and Social Conditions of Borough 13 Stamford Place Clearance Area 81 Still Births 31 Street Traders 95 Student Health Visitors 35 Survey by Ministry of Health 29 Tenement Houses and Bye-laws 62, 63 Toddlers' Clinics 40 Transfer of Powers (London) Order, 1933 55 Treatment Centres 24 Tuberculosis 116 Tuberculosis Care Committee 121 Tuberculosis Dental Clinic 120 Tuberculosis Dispensary 119, 122 Tuberculosis Medical Officer, Report of 122 Tuberculosis Patients, Extra Nourishment for 122 Tuberculosis Regulations, 1925, 1930 116, 118 Underground Rooms 76 Unemployment 13 Unmarried Mothers 50 Unsound Food and Food Inspection 92 Vaccination and Vaccination Order, 1930 112 Vaccination Officer 112 Venereal Diseases, Clinics and Treatment Centres 110 Verminous Persons and Premises, etc. 115 Vital Statistics 13, 17 Water Supply of Tenement Houses 62 Welfare Centres 40 Westcroft Estato 79 Whooping Cough 51 Workshops (see Factory aud Workshops Acts). X-ray Work 119 Young Children, Mortality among 32