AC 4351 HAMP 36 THE Metropolitan Borough of Hampstead REPORT for the year 1938 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. THE Metropolitan Borough of Hampstead. REPORT for the year 1935 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. Pages 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 63 „ 5.—Housing 79 ,, 6.—Inspection and Supervision of Food (including the Report of the Public Analyst) 93 ,, 7.—Prevalence of, and Control over, Infectious and other Diseases (including Tuberculosis) 111 INDEX 127 3 List of Committees concerned with the work of the Department His Worship the Mayor (Mr. Councillor Bernard S. Townroe, m.a., j.p.), *ex-officio member of Committees. PUBLIC HEALTH COMMITTEE. Chairman: Mr. Alderman H. Baily, m.b.e. Mr. Alderman R. H. H. Cust, m.a., j.p. „ „ W. J. Spriggs. „ Councillor F. R. Bailey. „ „ S. A. Boyd, m.s., m.b., f.r.c.s. Councillor Mrs. R. S. G. Carnegie. Councillor Mrs. M. F. Dow, m.a. „ „ M. Evans, r.r.c. Mr. Councillor L. G. Glover, m.a., m.d. „ „ 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: Councillor Miss A. M. Glover. Councillor Mrs. A. J. Arnholz. Mr. Councillor S. A. Boyd, m.s., m.b., F.R.C.S. Councillor Mrs. R. S. G. Carnegie. „ Mrs. M. F. Dow, m.a. Mr. Councillor T. H. Nunn, m.a. Councillor Miss C. M. Richards. Councillor Mrs. C. E. Samuel, m.a., m b e. „ Mrs. M. Townroce. 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. A. W. Evans. Mrs. E. S. Grundy, m.b.e. Miss G. M. MacDonald. 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. (deceased 14th July). Mr. Councillor E. H. Parkes, F.r.i.b.a. (Chairman from September). Mr. Alderman H. Baily, m.b.e. „ „ R. H. H. Cust, m.a., j.p Councillor Mrs. A. J. Arnholz. Mr. Councillor J. Batchelor. „ „ F. Colyer. Councillor Mrs. M. Evans, r.r.c. Mr. Councillor L. G. Glover, m.a., m.d. Councillor Mrs. M. I. Gruner. Mr. Councillor G. E. Hutchinson, M.A. (from November). Councillor Mrs. C. E. Samuel, m.a., m.b.e. Mr. Councillor J. M. Symmons, m.a. Sub-Committee: Westcroft Estate. 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.), (deceased 7th February, 1936). *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) (resigned December). A. J. Anscomb. R. W. King (from December). 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 (6) (Tuberculosis Visitor and Dispensary ] Nurse) Miss N. B. May (a), (b), (d). Sanitary Inspectors—F. H. Hudson (e), (f) (Senior of the Inspectors) (Retired in September on Superannuation). A. Peverett (e), (f) (Senior of the Inspectors from October). J. F. Armstrong (e), (f) J. Grimsley (e), (f) W. F. Horniblow (e), (f) Miss C. Lambe, (a), (b), (d), (e). F. V. Outlaw (e) (Temporary from 10th February, 1936). W. Robinson (e), (f) A. C. Townsend (e), (f) T. Williams (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. Gee (Bathing Station Attendant) *Public Analyst—H. E. Cox, d.sc., Ph.d. (Lond.), f.i.c., 11, Billiter Square, E.C.3. *Public Vaccinators—J. Davies, m.d. (Lond.), m.r.c.p. (Lond.), m.r.c.s., 103, Cholmley Gardens, N.W.6. E. A. Seymour, m.b., b.s. (Lond.), 12, Thurlow Road, N.W.3. H. D. Wyse, m.b., b.s. (Lond.), 23, Hilgrovc Road, N.W.6. * Part-time Officers, † Part-time Officers of Council of Social Welfare approved by the Maternity and Child Welfare Committee. (a) Health Visitor's Certificate. (b) State Registered Nurse. (c) General Nursing Certificate. (d) State Certified Midwife. (e) Sanitary Inspector's Certificate. (f) Food Inspector's Certificate. 5 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. 1st May, 1936. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit to you my Annual Report upon the state of the public health in the Metropolitan Borough of Hampstead for the year 1935. This report is the thirty-fifth of the series. The report contains information required by the Ministry of Health and is arranged in accordance with their suggestions. 1. Staff. It is with the greatest regret that I have to record the loss of A. J. Scott Pinchin, Esq., M.D. (Lond.), F.R.C.P. (Lond.), who died on Friday, the 7th February, 1936. Dr. Scott Pinchin was appointed in October, 1919, as Tuberculosis Officer and Assistant Medical Officer of Health for Tuberculosis Work. For many years he had been in the forefront of research work in his particular branch of medicine; his death is therefore a very serious loss which will be felt not only by his colleagues, but by his patients in hospital, in clinics, and in private practice. Mr. F. H. Hudson, Senior among the Sanitary Inspectors, retired from the Council's service on the 30th September, 1935, having completed over 40 years' municipal service, of which 38 years had been spent in Hampstead. During this time he had earned the well-merited respect and affection, not only of his colleagues in this Department, but of all the builders and architects with whom he came into contact. Mr. A. Peverett, one of the Inspectors in the Department, was appointed to fill the vacancy thus created, and Mr. T. Williams of the Erith Public Health Department was appointed as a Sanitary Inspector. 2. Statistics. The adjusted death rate in Hampstead for 1935 was 10.5 as compared with 11.7 for England and Wales. The birth rate 6 again shows an increase, namely, 11.02 per 1,000 of the population. This is the highest birth rate recorded in the Borough since 1931. The infantile mortality figure, which has remained more or less stationary during the last few years was 49 per 1,000 living births (compared with 53, the average for the last 10 years). The Registrar General's figure for the estimated population was 90,600, which represents an increase of 1,653 since the census of 1931. Hampstead is one of the two Metropolitan Boroughs showing an increase in population since the 1931 census. 3. Maternity and Child Welfare. The progress which has been made in these services during the last few years was well consolidated. The various new schemes which had been brought into operation continued to fulfil a very useful service. The Medical Officer to the Ante-natal Clinics, Dr. Mary Kidd, gives an interesting and important study of the Borough records during the last seven years,—this is contained in the body of the Report. 4. Sanitary Circumstances of the Borough. Some indication of the varied nature of the work of the Department in relation to the general sanitary circumstances of the Borough is given in Section 4 of this Report. I am now required by the Ministry of Health to report specifically upon action taken under the Shops Act, 1934, especially in relation to ventilation, temperature, and sanitary conveniences. The shops are being visited as and when opportunity occurs, and during the year 136 were inspected. The Public Health Committee has given careful consideration to the requirements as to sanitary conveniences and has agreed upon a standard which is set out on page 69. In only six cases were total exemption Certificates granted in this respect. The Ministry this year call for a report on public or privately owned swimming baths or pools open to the public, and this matter is referred to in Section 4. 7 There was an increase in the number of complaints of insanitary conditions, etc., received during the year. These totalled 829. During the year 721 registered tenement houses were inspected, and the need for the supervision of this class of property may be gauged by a study of the list of defects discovered, as set out in the Table on page 64. With regard to decontrolled tenement houses, additional work is placed upon the sanitary staff owing to the requirements of separate water-closet accommodation, sinks, etc., for each family. The maisonetting of houses continues in the Borough, and this involves the careful and detailed supervision of this Department. Limited progress has been made with Underground Room occupation. However, plans have been made with a view to tackling during the next few years this serious and important problem which confronts the Borough. 5. Housing. Considerable attention has been directed throughout the year to the housing of the working classes. The Hampstead "Westcroft" Estate of 290 dwellings was opened on the 29th October by H.R.H. The Duke of Kent. In all, 876 applications were received for accommodation at this Estate, but, apart from those displaced by schemes under the Housing Act, 1930, dwellings were allocated only to those with young families and with incomes not exceeding £3 10s. per week. A statement showing the steps which were taken in 1935 in connection with premises represented in 1935 or previous years may be seen on referring to the Housing Section. Section 1 of the Housing Act, 1935, required every local authority to make an inspection of its district with a view to ascertaining what dwelling houses were overcrowded on the standard laid down in the Act, and to prepare and submit to the Minister of Health a report showing the result of the inspection and the number of new houses required in order to abate the overcrowding disclosed. To this end a temporary staff, 8 prising 10 enumerators, 5 survey assistants, 4 clerks, and 1 supervisor were engaged by the Borough Council from October until the beginning of January, 1936. The results of this Overcrowding Survey are depicted on the Table facing page 88. In order to abate this Overcrowding, and to proceed with our work under the Housing Acts, a further 300 working class dwellings, at rentals similar to those obtaining on the Westcroft Estate, are urgently required. 6. Prevalence and Control of Infectious Disease. I am pleased to record that 1935 was free from any serious outbreak of infectious disease. There was a reduction in the number of cases of Diphtheria, Scarlet Fever and Measles and no death was consequent therefrom. There were, however, five cases of Enteric Fever and 10 cases of Dysentery notified during the year. Reference is made to these in the body of the Report. Further progress has been made in the Diphtheria Immunisation Scheme, and although the numbers are steadily increasing there is still considerable room for improvement. 7. Tuberculosis. Owing to the death of Dr. Scott Pinchin, to which reference has already been made, the usual report of the Tuberculosis Medical Officer is not included. I am again indebted to Mr. E. L. Hawke, M.A., F.R.M.S., who has provided me with a brief meteorological survey of the Borough for 1935. 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 worked loyally and well. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. LESLIE OLDERSHAW, Medical Officer of Health. Section I. Statistics and Social Conditions of the Borough. 11 Statistics and Social Conditions of the Borough. Area (in acres) 2,265 (including 12 acres covered by water). Registrar-General's estimate of resident population, 1935 90,600 Number of inhabited houses (end of 1935) according to Rate Books— 9,651 dwelling houses, 3,128 maisonetted and divided houses, 3,565 separate flats, 2,845 shops and offices. Rateable value £1,531,769. Sum represented by a penny rate £5,945 18s. l0d. 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 1935, 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 553 in December to 1,256 in January, and the unemployed women from 174 in July to 250 in April. Calculated upon the number of insured people in the Borough, the lowest number was 65 per cent. in December and the highest 12.5 in January. Extracts from Vital Statistics of the Year. Total. M. F. Live Births Legitimate 911 475 436 Illegitimate 88 49 39 Birth Rate per 1,000 of the estimated resident population—11.02. Stillbirths 37 18 19 Rate per 1,000 total (live and still) births—35.7. Deaths 1,018 449 569 Crude Death Rate per 1,000 of the estimated resident population—11.2. Death Rate Comparability Factor (C.F.) = 0.94. Adjusted Death Rate = Crude Death Rate x C.F. = 11.2 X 0.94 = 10.5. Deaths from puerperal causes—1. Deaths. The deaths during 1935, after deducting those registered in Hampstead who were non-resident persons and adding the deaths of Hampstead residents who died outside the Borough, were 1,018 as 12 compared with 1,014 in the preceding year. This represents a Crude Death Rate of 112 per 1,000 of the population. Since the populations of all areas are not similarly constituted as regards the proportions of their sex and age group components, their Crude Death Rates (deaths per 1,000 population) cannot be accepted as valid comparative measures of the mortalities experienced by the several populations, and 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 prepared Comparability Factors for adjusting local death rates, and when the Crude Death Rate of an Area is multiplied by the appropriate Factor, an "Adjusted Death Rate" is obtained which is comparable with the Crude Death Rate of the country as a whole, or with the "Adjusted Death Rate" of any other area. The Crude Death Rate for Hampstead is 11.2 which, when multiplied by the local Comparability Factor of 0.94, gives the Adjusted Death Rate of 10.5. The Death Rates for London and for England and Wales were 11.4 and 11.7 respectively. Death Rate of Infants under one year of age:— All infants per 1,000 live births 49 Legitimate infants per 1,000 legitimate live births 36 Illegitimate infants per 1,000 illegitimate live births 182 Deaths from Measles (all ages) — „ Whooping Cough (all ages) 1 „ Diarrhoea (under 2 years of age) 7 Meteorology. Through the kindness of E. L. Hawke, Esq., M.A., F.R.A.S., F.R.Met.S., Secretary of the Royal Meterological Society and Hon. Meteorologist to the Hampstead Scientific Society, I am able to submit his report on meteorology in Hampstead during the year 1935, which is based on records kept at that Society's Observatory on the top of Hampstead Heath adjoining the White Stone Pond:— "An outstanding feature of the weather during 1935 was its predominant warmth: in nine of the twelve months the mean 13 ature was higher than usual. There were, however, periods of exceptional cold in May and December, and owing chiefly to these the year as a whole was somewhat cooler than its two predecessors. The frost on the morning of May 17 was by far the sharpest experienced at Hampstead so late in the spring since records were begun. In the screen the thermometer fell to 29.5 deg., and on the grass to 13.8 deg., the latter figure being as many as 5.2 deg. lower than any registered during the previous winter. So far as can be ascertained, this incidence of the keenest frost within six weeks of midsummer—a phenomenon which was by no means confined to Hampstead—is unique in the meteorological archives of England. A long spell of hard weather in December reached its climax just before Christinas. Early on the 23rd the temperature on the ground sank to 10.2 deg., a point last equalled or under-passed in February, 1929. The summer, though a short one, was notably hot while it lasted. Between June 22nd and August 22nd the sheltered thermometer rose to 80 deg. or higher on 15 days: ou.side the period limited by those dates 70 deg. was attained on only seven occasions. From June 1 to August 31st, the mean temperature was 62.5 deg., normal being 60.1 deg. The corresponding value for 1934 was 61.9 deg., and for 1933, 63.6 deg. No three consecutive summers since 1857-1859 had maintained so high a general level of warmth as those of 1933-1935 at Greenwich Observatory, and in all probability the same holds true for Hampstead. The extreme readings of the thermometers during the year were:— Maximum in the screen, 86.1 deg., on August 22nd. Minimum in the screen, 21.1 deg., on December 23rd. Minimum on the grass, 10.2 deg., on December 23rd. Largely on account of an exceptionally wet autumn, the rainfall of 1935 was greater than in any year since 1928. It amounted to 28.03 in., which, though exceeding the 1910-1934 average by only 0.37 in., is about 1½ in. more than the computed normal for the summit of 14 the Heath. The monthly totals varied from 0.37 in. in March to 4.36 in. in November. Measurable precipitation (i.e., rain, snow, hail, dew. and deposit from wet fog or rime) was found in the standard gauge on 183 days—two more than the average. The trace of the hyetograph showed that the total duration of rain, snow and hail falling at the rate of 0.004 in. or more per hour was 587.2 hours, or about 3½ weeks. For the third year in succession the wettest day failed to yield so much as an inch of rain, or its equivalent, the maximum measurement being 0.88 in. on November 7th. In spite of the fact that nine of the twelve months gave a deficiency, the aggregate duration of sunshine for 1935, 1,495.2 hours, was in excess of the 25-year average by 16.9 hours. This small surplus was due to a notably brilliant July, which contributed 280.3 sunny hours—90 hours more than usual. The best daily record of the year was 14.5 hours, on June 24th. Days that were wholly sunless numbered 74—one fewer than the normal. Snow was noted on 25 days (two of them in May), and covered the ground at 9 a.m. on six days. The fall of four to five inches on the night of January 26th-27th was the heaviest since the Christmas blizzard of 1927. Hail occurred on four days, and thunderstorms, or thunder alone, on 12. The worst gale of 1935, on the night of September 16th-17th, gave an extreme wind-speed estimated at over 70 miles an hour, and did extensive minor damage in the district. Fog developed in varying degrees of density and persistency on 37 days during the year. The number of nights with ground-frost was 144. VITAL STATISTICS. Population. For the purpose of this Report the Registrar-General's estimate of the population at the middle of 1935, which was calculated to have been 90,600, has been adopted. This shows an increase of 1,653, as compared with 88,947 at Census, 1931. 15 The following are estimates of the population of each Ward at the middle of the year under review:— Ward. Estimated Population. No. 1 (Town) 12,620 No. 2 (Belsize) 14,710 No. 3 (Adelaide) 11,300 No. 4 (Central) 10,900 No. 5 (West End) 14,300 No. 6 (Kilburn) 15,270 No. 7 (Priory) 11,500 The Borough 90,600 The following are the statistics for each of the Wards and the Borough:— No. of Deaths. Death Rate. No. 1 (Town) Ward 144 11.4 No. 2 (Belsize) „ 197 13.4 No. 3 (Adelaide) „ 121 10.7 No. 4 (Central) „ 123 11.3 No. 5 (West End) „ 148 10.3 No. 6 (Kilburn) „ 141 9.2 No. 7 (Priory) „ 144 12.5 16 Age and Sex Allocation of Deaths of Hampstead Residents during the Year 1935. 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 and AT 65 years. 65 and under 75 years. 75 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1. Typhoid and Paratyphoid Fevers M ... .... .... .... .... .... .... .... .... .... .... ... f .... .... .... .... .... .... ... .... .... .... .... .... 2. Measles M .... .... .... .... .... .... .... .... .... .... .... ... f .... .... .... .... .... .... .... .... .... .... .... .... 3. Scarlet Fever M .... .... .... .... .... .... .... .... .... .... .... .... f .... .... .... .... .... .... .... .... .... .... .... .... 4. Whooping Cough m .... .... ... .... .... .... .... .... .... .... .... .... f 1 1 .... .... .... .... .... .... .... .... .... .... 5. Diphtheria m .... .... .... .... .... .... .... .... .... .... .... .... f .... .... .... .... .... .... .... .... .... .... .... .... 6. Influenza M 5 .... .... .... .... .... .... 1 2 1 1 .... f 7 .... .... .... .... .... .... .... 1 1 2 3 7 Encephalitis Lethargica M .... .... ... .... .... .... .... .... .... .... .... .... f .... .... .... .... .... .... .... .... .... .... .... .... 8. Cerebro-spinal Fever M 1 .... .... .... .... 1 .... .... .... .... .... .... f 1 .... .... .... 1 .... .... ... .... .... .... .... 9, Tuberculosis of respiratory system m 16 .... .... .... .... 2 3 4 .... 4 3 .... f 13 .... .... .... .... 2 4 2 3 1 1 .... 10. Other Tuberculous Diseases m 5 .... .... 1 .... 2 .... .... .... .... 1 1 f 4 .... .... ... 1 1 1 1 .... .... .... .... 11. Syphilis M 7 .... .... .... .... .... .... .... .... 4 2 1 f 3 .... .... .... .... .... 1 .... .... .... 2 .... 12. General paralysis of the insane, tabes dorsalis M 1 .... .... .... ... ... .... .... 1 .... .... .... f .... .... .... .... .... ... .... .... .... .... .... .... 13. Cancer, malignant disease M 64 .... .... .... .... ... 1 ... 10 19 22 12 f 106 .... .... .... .... 1 .... 8 17 26 32 22 14. Diabetes m 8 .... .... .... .... .... .... 1 1 1 2 3 f 14 .... .... .... .... 1 .... .... 3 .... 5 5 15. Cerebral hemorrhage, Ac. M 19 .... .... .... .... .... .... 1 5 6 4 3 f 28 .... .... .... .... .... .... .... 2 5 7 14 16. Heart Disease M 119 .... .... .... .... 1 1 6 9 20 36 46 f 146 .... .... .... .... .... 3 3 7 18 43 72 17. Aneurysm M 2 .... .... .... .... .... .... .... .... 1 .... 1 f 3 .... .... .... .... .... .... .... .... 1 2 .... 18. Other circulatorydiseases M 25 .... .... .... .... .... .... 1 1 7 9 7 F 35 .... .... .... .... .... .... 1 3 3 12 16 19. Bronchitis m 5 1 .... .... .... .... .... 1 1 .... 1 1 f 6 .... .... .... .... .... .... .... .... .... 1 5 20. Pneumonia (all forms) M 37 7 .... .... 1 1 2 .... 3 7 11 5 F 31 1 .... .... .... .... .... 1 6 7 3 13 21. Other Respiratory Diseases M 5 .... .... .... .... 1 .... .... 1 .... 1 2 F 7 .... .... .... .... .... 1 .... 2 .... .... 4 22. Peptic Ulcer M 6 .... .... .... .... .... 1 .... 1 2 .... 2 F 2 .... .... .... .... .... .... .... .... 2 .... .... 23. Diarrhoea, &c M 4 3 .... .... .... .... .... .... .... 1 .... .... f 5 3 1 .... .... 1 .... .... .... .... .... .... 24. Appendicitis M 2 .... .... .... .... .... .... 1 .... l .... .... f 5 .... .... .... .... 1 .... 1 3 .... .... .... 26. Cirrhosis of Liver M 4 .... .... .... .... .... .... 1 .... .... '3 .... f 3 .... .... .... .... .... .... .... .... 2 .... 1 26, Other diseases of liver, &c. M 2 .... .... .... .... .... .... .... 1 1 .... .... f 6 .... .... .... .... .... .... .... 1 3 2 27. Other digestive diseases M 12 2 .... .... .... 1 1 3 3 1 1 f 16 .... .... .... .... .... 1 2 4 3 3 3 28. Acute and Chronic Nephritis M 11 .... .... .... .... .... .... .... .... 3 4 4 F 24 .... .... .... .... .... .... 1 1 3 9 10 29. Puerperal Sepsis f .... .... .... .... .... .... .... .... .... .... .... .... 30. Other puerperal causes f 1 .... .... .... .... ... 1 .... .... .... .... .... 31, Congenital Debility, premature birth, malformations, &c. M 15 15 .... .... .... ... .... .... .... .... .... .... F 11 11 .... .... .... .... .... .... .... .... .... .... 32. Senility m 5 .... .... .... .... .... .... .... .... .... .... 5 F 6 .... .... .... .... .... .... .... .... .... 1 5 33. Suicide 11 11 .... .... .... .... 1 3 4 2 1 .... .... f 10 2 .... .... .... l 4 1 3 1 .... .... 34. Other violence m 10 2 .... .... .... 1 ... 1 1 1 2 2 f 21 .... ... .... .... 1 1 .... 1 3 4 11 35. Other Defined Diseases M 48 1 .... .... .... 3 5 5 3 3 14 14 f 52 2 .... .... 2 ... 1 5 10 7 14 11 36. Causes ill-defined or unknown M .... .... .... .... ... ... .... .... .... .... .... ... F 2 .... .... .... .... .... 1 .... ... .... 1 ... All causes m 419 31 .... 1 1 14 16 28 45 86 117 110 F 569 18 1 .... 4 9 19 26 66 84 145 197 Totals 1018 49 1 1 5 23 35 54 111 170 262 307 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 1935. 17 Table showing the Birth, Death and Infantile Mortality rates during 1935 in the Metropolitan Cities and Boroughs :— Birth Rate. Adjusted Death Rate. Infantile Mortality Rate. City of London 7.6 Lewisham 10.0 Lewisham 43 Holborn 7.6 Wandsworth 10.2 Woolwich 44 Westminster 8.3 Hampstead 10.5 Poplar 46 St. Marylebone 9.7 Stoke Newington 10.6 Hackney 47 Chelsea 10.2 Chelsea 10.7 Hampstead 49 Hampstead 11.0 Woolwich 10.8 Bethnal Green 51 Wandsworth 11.0 Islington 10.9 Fulham 51 Kensington 12.4 Greenwich 11.0 Stoke Newington 51 Lewisham 12.5 Hackney 11.1 Deptford 52 St. Pancras 13.3 Kensington 11.3 Islington 52 Camberwell 13.4 Deptford 11.5 Shoreditch 52 Lambeth 13.6 Bethnal Green 11.6 Wandsworth 55 Fulham 13.8 Fulham 11.7 St. Marylebone 56 Greenwich 13.8 St. Marylebone 11.7 Chelsea 59 Stoke Newington 13.9 Camberwell 11.8 Finsbury 59 Hackney 14.0 Westminster 11.8 Greenwich 59 Woolwich 14.0 Battersea 11.9 Lambeth 59 Paddington 14.1 Paddington 11.9 Camberwell 60 Battersea 14.2 Lambeth 12.0 St. Pancras 62 Stepney 14.3 City of London 12.2 Stepney 63 Bethnal Green 14.4 St. Pancras 12.2 Battersea 65 Deptford 14.4 Hammersmith 12.3 Southwark 66 Bermondsey 14.5 Poplar 12.3 Bermondsey 69 Shoreditch 14.6 Shoreditch 12.4 Hammersmith 70 Finsbury 14.7 Southwark 12.4 Paddington 71 Hammersmith 14.7 Holborn 12.7 Westminster 72 Islington 14.8 Stepney 12.8 Kensington 79 Southwark 14.8 Bermondsey 13.3 Holborn 89 Poplar 15.4 Finsbury 13.7 City of London 113 Section 2 General Provisions of Health Services for the Borough. 21 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. 2.—Laboratory Facilities. The examination of clinical material (sputum, swabs, etc.) is undertaken by the Laboratories of Pathology and Public Health at 6, Harley Street, W.l (Eastes' Laboratories). 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 98 and 105. 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, if letters of admission to maternity hospitals are produced. (d) Persons suffering from infectious diseases who are to be transferred to the Council's fever hospitals. (e) For conveyance to general hospitals and institutions of non-infectious cases when application is made through the County Council's public assistance department. The London County Council's Ambulances may also be hired 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 22 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 Diarrhcea, 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 Is. 3d. per visit for second and subsequent cases, if visited at the same time. During 1935, 25 cases were nursed under this arrangement by the Kilburn and West Hampstead District Nursing Association, and 15 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 41, 46 and 48 respectively. (b) School Clinics:—Kilburn School Treatment Centre, 107, Kingsgate Road; New End Hospital School Treatment Centre, Heath Street. (c) Tuberculosis Clinic, vide page 121. (d) Venereal Diseases. Persons suffering from venereal disease can receive free treatment under conditions of strict secrecy in pursuance of the scheme prepared by the London County Council, including the following hospitals :—Guy's; Children's Hospital, Great 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). 23 (b) Voluntary :—Hampstead General and North-West London Hospital (138 beds); Children's Hospital, College Crescent (63 beds); Queen Mary's Maternity Home (25 beds); Marie Curie Hospital, Fitzjohn's Avenue (30 beds); Westminster Hospital Annexe, Fitzjohn's Avenue (22 beds); and St. Columba's Hospital, Avenue Road (50 beds). The Borough possesses two endowed beds at both the Hampstead General Hospital and the Mount Vernon Hospital, Northwood, and in addition the Council contributes towards the cost of beds in Queen Charlotte's Hospital, Marylebone, which are available for Hampstead residents. . Section 3. Maternity and Child Welfare. 27 Maternity and Child Welfare. The Medical Officer of Health is required to submit annually to the Ministry of Health a Return (1) showing the arrangements made for maternity and child welfare by the Council and by Voluntary Associations providing maternity and child welfare services in respect of which the Council pay contributions under Section 101 of the Local Government Act, 1929, or otherwise; and (2) giving particulars of the work done during the year. As this Return presents in a succinct form the work of this section of the Public Health Department, it is here reproduced. 1. Population of the area served by the Council:—90,000 (estimate of Registrar-General, 1934). 2. Number of births notified in that area during the year under the Notification of Births Act, 1907, as adjusted by any transferred notifications:— (a) Live births 978; (b) Still births 34; (c) Total 1,012. (d) By midwives 354; (e) By doctors and parents 658. 3. Health Visiting. (a) Number of officers employed for health visiting at the end of the year :— (i) by the Council :—4 whole-time : 1 part-time (40 per cent, health visitor, 60 per cent, woman sanitary inspector). (ii) by Voluntary Associations :—Nil. (b) Equivalent of whole-time services devoted by the whole staff to health visiting (including attendance at infant welfare centres)— (i) in the case of Health Visitors employed by the Council :—4 whole-time : 1 part-time (40 per cent, health visiting). (ii) in the case of Health Visitors employed by Voluntary Associations :—Nil. (c) Number of visits paid during the year by all Health Visitors:— (i) to expectant mothers † First visits 241 Total visits 482 28 (ii) to children under 1 year of age † First visits 792 Total visits 4531 (iii) to children between the ages of 1 and 5 years Total visits 6138 †Excluding cases which are known to have previously been visited in another district and cases visited during the previous year. 4. Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council:—Nil. (b) Number of Centres provided and maintained by Voluntary Associations:—8 (including 2 Toddlers' Clinics). (c) Total number of attendances at all Centres during the year :— (i) by children under 1 year of age, 9471. (ii) by children between the ages of 1 and 5 years, 5563 (including Toddlers). (d) Total number of children who first attended at the Centres during the year and who, on the date of their first attendance, were:— (i) under 1 year of age, *532. (ii) between the ages of 1 and 5 years, 114. (e) Total number of children under 5 years of age who attended at the Centres during the year and who, at the end of the year, were:— (i) under 1 year of age, 461. (ii) over 1 year of age, 998 (including Toddlers). (f) Percentage of notified live births represented by the number in (d) (i) :— 54 per cent. *Excluding children who are known to have previously attended a Centre in another district. 29 5. Ante-natal and Post-natal Services. Antenatal. Postnatal. (a) Ante-natal and Post-natal Clinics (whether held at Infant Welfare Centres or at other premises)— (i) Number of Clinics provided and maintained by the Council 2 Nil. (ii) Number of Clinics provided and maintained by Voluntary Associations Nil. Nil. (iii) Total number of attendances at all Clinics during the year 2019 f210 (iv) Total number of women who attended at the Clinics during the year 451 1117 (b) Total number of expectant mothers antenatally examined and of cases post-natally examined during the year, under arrangements made by the Council with private medical practitioners, excluding cases included under 5 (a) (iv) Nil. Nil. (c) Percentage of total notified births (live and still) represented by the total numbers of women shown under 5 (a) (iv) and 5 (b) per cent. 45 per cent. 11 6. Supply of Milk and Food. The following table indicates what arrangements are made for this service:— Terms of supply. Milk. Meals supplied at Dining Centres. Other Food. Expectant Mothers. Nursing Mothers. Children under 5 years of age. Expectant Mothers. Nursing Mothers. Children under 5 years of age. Expectant Mothers. Nursing Mothers. Children under 5 years of age. Free, or at less than cost price, in necessitous cases Yes Yes Yes No No No No No Yes At cost price in other cases (e.g., sale of dried milk at Centres) No No Yes No No No No Yes Yes † These patients attended at the Ante-natal Clinics. 30 7. Maternity Homes and Hospitals (excluding maternity beds in Homes for Mothers and Babies—see Heading 10). I. Separate maternity institutions provided by the Council. Other Institutions with maternity wards provided by the Council, e.g., those transferred to the Council undei Part I of the Local Government Act, 1929. Institutions provided by Voluntary Associations and subsidised by the Council. Number of Institutions 1 Ward in New End (L.C.C.) Hospital Nil Nil Number of maternity beds (exclusive of isolation and labour beds) 5 Nil Nil Total number of women admitted to these beds during the year 46 Nil Nil II. Number of women (if any) sent by the Council during the year to other Maternity Institutions :—39 to Queen Charlotte's Hospital, for which the Borough Council subscribes £1 per Hampstead case admitted. 31 8. Homes and Hospitals for Sick or Ailing Children under 5 years of age. I. II. Number of such children (if any) sent by the Council during the year to other Institutions:—Nil. 9. Convalescent Homes. (a) Number of convalescent institutions with accommodation for expectant or nursing mothers or children under 5 years of age:— (i) provided by the Council:—Nil. (ii) provided by Voluntary Associations :—Nil. (b) Number of beds for such cases in convalescent institutions : (i) provided by the Council:—Nil. (ii) provided by Voluntary Associations :—Nil. (c) Total number of cases admitted to the beds included in (b) during the year :—Nil. (d) Total number of such cases sent by the Council during the year to other convalescent institutions :—17 mothers convalescent after confinement with their babies. Separate institutions provided by the Council for these cases. Other Institutions (with accommodation for these cases) provided by the Council, e.g., those transferred to the Council under Part I of the Local Government Act, 1929. Institutions provided by Voluntary Associations and subsidised by the Council. Number of Institutions The Children's Hospital, Hampstead (Voluntary Institution). Number of beds provided for such children 16 Beds for children under 5 years— Borough Council pays for accommodation of certain cases admitted under their Scheme. Total number of children admitted to these beds during the year 1 child admitted through the Borough Council. (209 other children admitted). 32 10. Homes for Mothers and Babies. (a) Number of such homes: (i) provided by the Council :—Nil. (ii) provided by Voluntary Associations:—1. (b) Number of beds in homes: (i) provided by the Council:—Nil. (ii) provided by Voluntary Associations:—28. (c) Number of : (i) maternity beds (exclusive of isolation and labour beds) included under (b) (i) or (ii) above :—Nil. (ii) women admitted to these maternity beds during the year:—Nil. (d) Total number of cases admitted to these homes during the year:— (i) expectant mothers :—Nil. (ii) mothers and babies :—Nil. (iii) babies :—7 (the remaining 21 having been admitted prior to 1935). (?) Total number of such cases sent by the Council during the year to other homes for mothers and babies :—Nil. 11. Day Nurseries. (a) Number of day nurseries :— (i) provided by the Council :—Nil. (ii) provided by Voluntary Associtaions 1 (Hampstead and North St. Pancras Day Nursery). 'b) Number of places for children under 5 years of age in the nurseries:— (i) provided by the Council :—Nil. (ii) provided by Voluntary Associations :—50. (c) Total number of attendances of children at these nurseries during the year :—10,627. 33 12. Infectious Diseases. Disease. Number of cases notified during the year. Number of cases visited by officers of the Council. Number of cases for whom home nursing was provided by the Council. Number of cases removed to hospitals. (1) Ophthalmia Neonatorum *15 10 4 11 (2) Pemphigus Neonatorum Not notifiable Nil Nil Nil (3) Puerperal fever 2 Nil Nil 2 (4) Puerperal pyrexia 18 12 1 17 (.5) Measles and german measles (in children under 5 years of age) German Measles is not notifiable. Measles is compulsorily notifiable. 9 8 Nil 2 (6) Whooping Cough (ditto) ... Not notifiable 23 3 5 (7) Epidemic Diarrhoea (ditto) Not notifiable Nil Nil Nil (8) Poliomyelitis (ditto) Nil Nil Nil Nil * Vision unimpaired, 14; patient removed from district, 1. 13. Home Nursing. (a) Number of nurses employed at the end of the year for the nursing of expectant mothers and children under 5 years of age, maternity nursing, or the nursing of puerperal fever:— (i) by the Council :—Nil. (ii) by Voluntary Associations :—14 employed by two Local District Nursing Associations. (10 included in 16 (b) (iii) below.) (b) Total number of cases attended during the year by these nurses :—263. (Of this number the Borough Council paid to the District Nursing Associations for the nursing of 68 maternity cases and 12 cases of infectious illnesses in children under 5 years of age.) 34 14. Consultants. Number of cases in which the services of a consultant have been provided during the year for a private medical practitioner under the Council's maternity arrangements :—3. 15. Home Helps. Number of cases in which home helps have been provided during the year (the numbers of cases where this assistance has been given by Voluntary Agencies, by arrangement with the Council, should, if possible, be stated separately) :—28—under scheme of the Hampstead Borough Council. 16. Midwives. (a) Number practising in the area served by the Council for maternity and child welfare at the end of the year. The London County Council is the Authority. (b) Number : (i) employed by the Council:—Nil. (ii) directly subsidised by the Councils—Nil. (iii) employed by Voluntary Associations :—10 (included in • 13 (a) (ii) above.) (c) Number of cases during the year in which the Council paid or contributed to the fee of a midwife :—89 cases nursed by the midwives of the two local District Nursing Associations. In no case did the Council contribute to the fee of an independent midwife. 17. Maternal Deaths. (a) Number of women who died in, or in consequence of, childbirth in the area served by the Council for maternity and child welfare during the year: (i) from sepsis :—Nil. (ii) from other causes 1. (b) Number of these cases which died : (i) at home :—1. (ii) in institutions :—Nil. 35 18.—Administration of Part T. of the Children Act, 1908, as amended by Part V. of the Children and Young Persons Act, 1932. (a) Number of persons on the Register who were receiving children for reward at the end of the year:—25. (b) Number of children on the Register: (i) at the end of the year:—37. (ii) who died during the year:—1 (P.M. without inquest). (iii) on whom inquests were held during the year :—Nil. (c) Number of Infant Protection Visitors at the end of the year who were :— (i) Health Visitors:—5. (ii) Female, other than Health Visitors :—Nil. (iii) Male:—Nil. (d) Number of persons (in addition to or in lieu of Visitors under (c) above) or societies authorised to visit under the proviso to Section 2 (2) of the Act of 1908:—Nil. (e) Proceedings taken during the year :— No. of Cases. Act and Section under which proceedings were taken. Nil. — (/) Number of cases in which the local authority has given a sanction during the year : (i) under (a) of Section 3 of the Act of 1908:—Nil. (ii) „ (b) „ „ Nil. (iii) „ (c) „ „ Nil. (g) Number of orders obtained during the year under Section 67 of the Act of 1932: (i) from a court of summary jurisdiction :—Nil. (ii) from a single justice :—Nil. 36 Live Births. During 1930, 999 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. Legitmate. Illegitimate. Total. Registered in the Borough 716 73 789 667 66 733 1383 139 1522 Add number occurring outside the Borough whose mothers were Hampstead residents 141 14 155 114 15 129 255 29 284 Deduct number who could not be deemed to belong to Hampstead 857 87 944 781 81 862 1638 168 1800 382 38 420 345 42 387 727 80 807 Nett number belonging to Hampstead, 1935 475 49 524 436 39 475 911 83 999 Nett Hirthi, 1934 414 47 461 441 38 479 855 85 940 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 105 8.3 10 95.2 No. 2 (Belsize) „ 160 10.9 2 12.5 No. 3 (Adelaide) „ 98 8.7 3 30.6 No. 4 (Central) „ 61 5.6 1 16.4 No. 5 (West End) „ 167 11.7 11 65.9 No. 6 (Kilburn) „ 273 17.9 9 32.9 No. 7 (Priory) „ 135 11.7 13 96.3 The Borough 999 11.02 49 49.0 The birth rates for London and for England and Wales were 133 and, 14 7 respectively. The infant death rates were 58 and 57. Legitimate and Illegitimate Births. Of the total 999 nett live births belonging to Hampstead, 911 were those of legitimate and 88 of illegitimate children, the latter being at the rate of 88 per 1,000 births. Of the Hampstead illegitimate infants, 29 were born outside the Borough, chiefly in Lying-in Institutions. 37 Still Births. During 1935, the nett number of registered still births for Hampstead was 37. In the following Table the still births for 1935 have been distributed according to sex, etc.:— STILL BIRTHS. MALES. FEMALES. TOTALS. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Registered in the Borough Add number occurring outside the Borough whose mothers were Hampstead residents 24 1 25 24 1 25 48 2 50 3 1 4 3 — 3 6 1 7 Deduct number who could not be deemed to belong to Hampstead 27 2 29 27 1 28 54 3 57 11 — 11 9 — 9 20 — 20 Nett number belonging to Hampstead, 1935 16 2 18 18 1 19 34 3 37 Nett Still Birth*, 1934 8 1 9 14 4 18 22 5 27 Infant Mortality. During 1935, 49 infants under 1 year of age died, giving an infant death rate of 49 per 1,000 live births. Of these 33 were legitimate children, the rate per 1,000 legitimate live births being 36, while 16 illegitimate children died, equivalent to a rate per 1,000 illegitimate live births of 182. The subject of infant mortality is one of great importance; the mortality among infants is a sensitive index of the conditions existing in a district; and the matter generally is one of national concern. In the following table I have set out the births, deaths and death rate among legitimate and illegitimate infants in Hampstead over a long period of years:— 38 Year. legitimate Infants. Death rate per 1000 legitimate births. Illegitimate Infants. Death rate Mr 1000 illegitimate births. Births. Deaths. Births. Deaths. 1908 1,326 87 66 29 10 345 1909 1,239 88 71 43 11 256 1910 1,233 71 57 36 10 278 1911 1,239 94 76 37 11 297 1912 1,207 68 56 74 11 149 1913 1,252 73 58 73 18 246 1914 1,218 77 63 55 14 254 1915 1,246 82 65 81 19 234 1916 1,088 65 59 76 8 105 1917 1,052 74 70 71 16 225 1918 797 56 70 98 13 132 1919 1,039 77 74 117 19 162 1920 1,478 62 42 88 13 148 1921 1,259 71 56 83 17 205 1922 1,210 59 49 80 13 162 1923 1,162 42 36 76 12 158 1924 1,105 55 50 81 11 136 1925 990 41 41 83 18 216 1926 1,001 48 48 76 17 223 1927 937 45 48 91 8 88 1928 922 32 34 79 22 278 1929 887 42 47 81 10 123 1930 900 50 56 103 8 76 1931 898 54 60 86 6 70 1932 890 38 43 91 15 165 1933 776 21 27 88 12 136 1934 855 35 42 85 14 165 1935 911 33 36 88 16 182 Deaths of Young Children. During 1935, 51 deaths occurred of children under 5 years of age. This is equivalent to a rate of 10 5 per 1,000 live children born in that and the four preceding years. Maternal Deaths. One maternal death occurred during the year 1935, which is a rate of 1 per 1,000 births. This death was carefully investigated by the Medical Sub-Committee and a detailed report sent to the Minister of Health. 39 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 Hampstead births notified during the year:— Number of Births notified under the Notification of Births Act, 1907, as adjusted by any transferred notifications. Live Births 978 Notified by Midwives 354 Still Births 34 „ Doctors and Parents 658 Total 1012 Total 1012 Of the total nett live births only 30 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 202 instances where these births were visited, and where the information was obtainable:— No. of families occupying the following number of rooms. No. of persons in family. 1 room. 2 rooms. 3 rooms. 4 rooms. 5 rooms. 6 rooms. l l — — — — — 2 — 29 41 8 1 1 3 1 21 27 6 — — 4 — 11 21 5 — — 5 — 4 6 — — — 6 — 2 6 2 1 — 7 — — 2 1 — 1 8 — 2 — — — — 9 — — 2 — — — Totals 2 69 105 22 2 2 The newly-born baby has not been included in the above. Of these 202 births :— 1 per cent. occurred in 1-roomcd tentments. 34 „ „ 2 „ 52 „ „ 3 „ 40 The table shows the limited housing conditions in some of the tenements where babies are born at home. It demonstrates that of these 202 babies, 2 were born in one-roomed tenements and 69 in tworoomed tenements. In 1 one-roomed tenement where 3 presons were already living a baby was born. With regard to two-roomed homes, in 4 instances 5 persons were already inhabiting the rooms prior to the birth of the baby, in 2 cases the baby's advent raised the number of occupants to 7, and in 2 cases to 9. In 2 three-roomed tenements there were 7 persons occupying the rooms before the birth, and in 2 cases there were 9. 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. At the close of the year the Health Visitors had under their supervision for systematic visiting 773 infants under one year of age and 1,542 children aged between one and five years. The minimum number of visits which the Health Vistors are now expected to pay to each child is as follows:— Age of child. Visits paid. Under 1 year At 1, 2, 3, 6, 9, 10 and 12 months 7 1—2 years Once every 3 months 4 2—3 years „ 4 „ 3 3—4 years „ 6 „ 2 4—5 years „ 6 „ 2 The following table gives a record of the work of the Health Visitors in 1935 :— † First visits to expectant mothers 245 Re-visits to expectant mothers 237 † First visits to infants under one year 828 Re-visits to infants under one year 3703 Visits to children from 1 to 2 years 2572 Visits to children from 2 to 5 years 3566 Visits to foster-mothers and foster-children 838 Visits re infectious diseases 671 † Including visits to mothers and babies moving into the Borough an< previously visited: 41 Attendances at Borough Council's Ante-natal Clinics 159 Attendances at Borough Council's Dental Clinic 107 Attendances at Borough Council's Immunisation Clinic 33 Attendances at Hampstead Council of Social Welfare Infant Welfare Centres and Toddlers' Clinics 396 Miscellaneous visits 668 Approximately 64 per cent of the infants under one year of age visited for the first time attended the Infant Welfare Centres during 1935. 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 £11Is. 0d. 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. 42 Eastern Clinic: One session weekly (viz., Tuesday at 2 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—2,019. (b) Total number of expectant mothers who attended at the Ante-natal Clinics during the year—451. (c) Percentage of total notified births (live and still) represented by the number in (b)—45 per cent. In addition, 117 mothers attended at the Clinics to receive postnatal care, making a total number of attendances of 210. Of the 117 mothers, 24 attended for the first time during the year. The following is the report for the year 1935 of the Medical Officer of the Council's Ante-natal Clinics, Miss Mary Kidd, M.B., B.S. (Lond.):— To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I beg to submit the following report on the working of the Borough Council's Ante-natal Clinics during the year 1935:— Pond Street Clinic. (1 session weekly.) Kilburn Clinic. (2 sessions weeklv.) 1935. 1934. 1935. 1934. New patients 105 127 292 307 Attendances of old patients 513 551 1319 1252 Number of sessions held 52 51 99 101 Average attendance per session 11 13 16 15 Number of patients referred to Dental Clinic 51 47 139 116 Number of patients sent to Convalescent Homes 5 3 9 14 During the last year, 397 new patients attended the ante-natal clinics. Of these, 169 were normal cases, 197 abnormal, 7 were found 43 not to be pregnant, and 24 were post-natal cases attending the clinics for the first time. The number of births in Hampstead during 1935 was 999. As 360 expectant mothers from the Borough attended our Clinics last year, it is found that 36 per cent. of the Hampstead women who had babies in 1935 received ante-natal care under my auspices. Of the children born to those 360 women, 8 died during the first month of life, 3 of whom were twins and another, a child who had a congenital stricture of the duodenum. The neo-natal death rate, as it is called, or the death rate amongst infants in the first month of life, is still somewhat high in England and Wales, having been 31 per 1,000 in 1934. It is confidently believed that this will diminish yet further, as more expectant mothers receive ante-natal care and extra nourishment when needed. Our neo-natal death rate in Hampstead last year was 20 per 1,000, which is satisfactory. I have been studying our records for the last seven years, viz., 1929 to 1935, inclusive, and it is a cause for great thankfulness to discover that we can show an unbroken series of 1,361 expectant mothers who have attended our Ante-natal Clinics during the last four years without a single maternal death. If we consider, too, the whole seven year period, viz., 1929 to 1935, inclusive, we find that amongst a series of 1,988 expectant mothers there were two maternal deaths in 1931, which gives a maternal mortality rate of 1 per 1,000 for our Clinic cases as against 44 per 1,000 for England and Wales. This happy result has only been obtained of course by constant vigilance and co-operation in team work with the different Hospitals where many of these women were confined and with the practising midwives in the Borough, but I think it helps to demonstrate the value of antenatal care as well as the splendid work of doctors and midwives who attended the various women during their confinements, whether in New End Hospital or at their homes. In this connection I thought it would be interesting to follow up the after histories of a series of cases suffering from pyelitis, an infection of kidneys and bladder, which sometimes attacks pregnant women. Though an infrequent cause of maternal mortality (in a series of 2,465 maternal deaths recently investigated by the Scottish Board of Health, 44 it accounts for only 1 per cent. of the total), yet it sometimes give rise to puerperal pyrexia, that bugbear of obstetricians, and, when acute, may cause abortion or premature labour. For every reason therefore I have constantly endeavoured for years to track down and obtain treatment for all such cases, even the mildest ones. I have been able to collect a series of 14 cases of pyelitis which have been under my supervision and been confined during the 18 months between September, 1934, and February, 1936. Of these 14 cases, 9 were young mothers, pregnant for the first time, the average age being 24. With regard to the condition of the urine, a trace of albumen was found in 13 cases out of the 14, and, after further investigation by a pathologist, pus and B. coli in large numbers. The symptoms pointing to pyelitis were, pain on micturition in seven cases and pain on one or other side of the abdomen in three. It is interesting, however, that two of the remaining cases were absolutely symptomless and attention was only drawn to the state of affairs when the patient was found to have albuminuria combined with a very low blood pressure, so that another cause for albuminuria than toxaemia had to be searched for; pus and B. coli being eventually found. Yet both of these women had severe attacks of pyelitis later in pregnancy, and had to be admitted to New End Hospital for in-patient treatment, one of them developing an attack of puerperal pyrexia subsequently. It would seem, therefore, that further investigation should always be made when albuminuria is unaccompanied by toxaemia symptoms and a raised blood pressure. Incidentally, 10 out of the 14 cases had carious teeth. With regard to treatment, two women were treated entirely at New End Hospital, and a third by her own doctor to whom I had referred her, as the pregnancy was too far advanced to do more than administer alkalies. I sent the remaining 11 cases to Mr. Winsbury White, the urologist, at St. Paul's Hospital, Covent Garden, who undertook most thorough and painstaking investigation and treatment, as far as possible. Pregnancy was not too far advanced in eight of these patients, so that he was able to investigate the condition of their urinary tracts and intravenous urograms showed a greater or less degree of dilatation of the right ureter and renal pelvis and calyces in seven cases. Cystitis was found to be present in five of these. 45 In his Hunterian lecture, Mr. Winsbury White has said that cystitis occurring in women appears to be a constant companion of cervicitis and that it is extremely difficult, in his experience, to get satisfactory response to treatment of a cystitis which is accompanied by a neglected cervicitis. It is most interesting, therefore, that in our series of 11 cases of pyelitis, an eroded cervix was present in seven. The treatment consisted mainly in dilatation of the urethra and attention to the unhealthy cervix when present, the patient attending St. Paul's Hospital frequently for douching and tamponnage, icthyol and glycerin plugs being used. The results of the treatment at St. Paul's Hospital and also at New End Hospital were most satisfactory, only one patient suffering from puerperal pyrexia subsequently. Her case was notified and she was seen by a Consultant and ultimately made a good recovery. With regard to the children born by these women, 13 out of the 14 were well and healthy, one only being a week premature. The fourteenth child was stillborn, death having taken place some little time before birth. These results are the more satisfactory in that four out of the 14 cases were really ill at one time or other during pregnancy and had to go into New End Hospital for in-patient treatment. In conclusion I would pay a tribute to the wonderful help 1 have received from the late Dr. Scott Pinchin during the last 14 years or so, and to record the sense of loss felt by the patients and ourselves who work at the Hampstead Municipal Dispensary. It will readily be understood how important it is to maintain a good liaison between the Ante-natal Clinics and Tuberculosis Dispensary, as so many problems are involved when an expectant mother is a tubercular "suspect"—an especially important one being, whether she should breast feed her baby or not. Each year I had to refer several such cases to Dr. Scott Pinchin and he wrote such helpful reports on them. MARY KIDD, M.P. (Lond.). 46 Infant Welfare Centres. The following Infant Welfare Centres were held in the Borough during 1935:— Name and address of Centre. Day and Time held. Doctor in attendance. Health Visitor. Average attendance per session. "Belsize" gregationa Church Hall, Avenue Road Monday, 2—4 p.m. Dr. M. A. Blandy Mrs. Steward 46 "Rilburn" Health Institute. Kingsgate Road Tuesday and Wednesday, 2—4 p.m. Dr. A. S. Hall- Craggs Miss Evans Miss May 46 14 Branch Health Institute, Kingsgate Road Wednesday, 10—12 noon Do. Miss May 33 "New End", Baptist Chapel Hall, Heath Street Thursday, 10—12 noon Dr. M. A. Blandy Miss Kennedy 21 "Lisburne Koad", Wesleyan Mission Hall, Lisburne Road Thursday, 2—4 p.m. Do. Miss Lambe 39 "Mill Lane", Mission Hall, Broomsleigh Street Friday, 2—4 p.m. Dr. A. S. Hall- Craggs Miss Evans 55 Total number of attendances at all Centres during the year:— (i) By children under 1 year of age—9,471. (ii) By children between the ages of 1 and 5 years— 5,563 (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—532. (ii) Between the ages of 1 and 5 years—114. 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—461. (ii) Between the ages of 1 and 5 years—998 (including Toddlers). *The 532 children under 1 year of age who attended at the Centres represent 54 per cent. of the notified live births. 47 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. The average attendance per session during 1935 was: 27, Pond Street, 14. Health Institute, 19. 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 accept the invitation. 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 474 parents have received invitations, 89 of whom have accepted, and of this number 12 children were found to be suffering from various defects. It is our endeavour to ensure that these defects are remedied before the child commences school. Ray-Therapy. The Council makes an annual subscription of £6 6s. 0d. to the Institute of Ray-Therapy, 152, Camden Road, N.W., which provides free treatment to patients referred to the Institute from the Toddlers' Clinic and the Infant Welfare Centres. Arrangements for the Supply of Milk and Food. There have been 231 families assisted with free milk or milk at half price during the year, for either expectant mothers, nursing 48 mothers or children under the age of 3 years; and in a few "special" cases for children between 3 and 5 years. 159 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 75 Number of New Patients 253 Total Attendances of all patients 1167 Number of Fillings 371 Number of Scalings 45 Extraction cases Total Number of Teeth extracted 854 Gas Administrations 208 Local Administrations 21 Without An æsthetic 1 Number of Dentures (including repairs) 79 Number of Dressings and Root Treatment 158 Number for Advice 314 Number of Denture visits 253 Prior to October, 1933, two Dental Clinics were in operation in the Borough, viz.:—(a) the Municipal Dental Clinic at 27, Pond Street, for patients residing on the eastern side of the Borough, with an average attendance per session of 9 (1 session weekly), and (b) the Dental Clinic held by The Hampstead Council of Social Welfare at the Health Institute, Kingsgate Road, for patients residing on the western side of the Borough, with an average attendance per session of 6 (1 session weekly). This arrangement terminated on the 30th September, 1933, when it was decided to hold a central Dental Clinic only, viz.: the Municipal Dental Clinic at the Public Health Station, Lithos Road. This Clinic was at once a great success. During the 15 months—October, 1933, to December, 1934,—no less than 1,498 attendances were made, with 49 in average attendance per session of 18. Authority was obtained from the Maternity and Child Welfare Committee, as occasion demanded, for extra sessions to be held to cope with the additional work. Early in the year under review it was found necessary to authorise a permanent arrangement for two additional sessions to be held each month, and this was effected as from 1st April, 1935. School Entrants. In order that information relating to the early nurture and illnesses of children and to the general home conditions, in the possession of the Health Visitors and the doctors at the Infant Welfare Centres, may be made available for the School Medical Officer, 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 County School Medical Officer. Through the kindness of the Medical Officer of Health and School Medical Officer of the London County Council, I am enabled to submit the following highly interesting tables, showing the result of routine examinations of 778 elementary school entrants in Hampstead during 1935. I am also informed 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 equiries are made at their 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 1935, indicating the conditions with regard to Clothing, Nutrition, Cleanliness and Teeth of the Children 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 428 420 8 — 111 823 34 — 425 — 3 428 — — 252 113 63 156 Girls 350 342 8 — 105 216 29 — 350 — — 350 — — 188 102 60 144 Total 778 762 16 — 216 499 63 — 775 — 3 778 — — 440 215 123 300 Hampstead per centages 97.9 2.1 — 27.8 64.1 8.1 — 99.6 — 0.4 100.0 — — 56.6 27.6 15.8 38.6 London per centages 56.6 42.9 0.5 16.4 77.9 5.7 97.4 2.3 0.3 99.0 0.9 0.1 55.8 34.3 9.9 40.2 50 51 Table showing Results of Routine Medical Inspection of Entrant Children in Hampstead to Elementary Schools during the year 1935, indicating the Defects found. f = defects found. o = noted for treatment and included in defects found. Disease or Defect. Boys (428). Girls (350). Hampstead. per cent. London, per cent. Hampstead. per cent. London. per cent. Skin disease f 1 0.2 1.1 — — 0.9 o — — 0.7 — — 0.6 Tonsils only f 66 15.4 14.2 47 13.4 13.9 o 12 2.8 4.9 13 3.7 4.4 Adenoids only f 3 0.7 1.0 8 0.9 0.9 o — — 0.6 2 0.6 0.6 Tonsils and Adenoids f 13 3.0 8.1 6 1.7 2.5 o 9 2.1 2.3 3 0.9 1.8 Other Nose and Throat f 3 0.7 1.0 1 0.3 0.9 o — — 0.4 — — 0.4 Glands of Neck f 1 0.2 2.7 3 0.9 2.5 o — — 0.4 — 0.2 Eye disease f 10 2.3 3.1 11 3.1 :3.0 o 2 0.5 1.9 5 1.4 1.8 Otorrhœa f 3 0.7 1.0 1 0.3 0.9 o 1 0.2 0.6 — — 0.5 Other Ear Defects f 1 0.2 0.4 — — 0.3 o — — 0.2 — — 0.2 Hearing f 5 1.2 0.1 2 0.6 0.1 o 3 0.7 0.1 — — 0.0 Speech f 5 1.2 0.4 1 0.3 0.2 o — — 0.1 — — 0.0 Heart f 1 0.2 1.8 1 0.3 1.5 o — — 0.1 — — 0.1 Anæmia f 6 1.4 0.8 4 1.1 0.6 o — — 0.3 — — 0.3 Lungs f 9 2.1 3.4 7 2.0 3.3 o 1 0.2 1.2 1 0.3 1.1 Epilepsy f — — 0.0 — — 0.0 o — — 0.0 — — 0.0 Chorea f — — 0.0 — — 0.1 o — — 0.0 — — 0.0 Paralysis f — — 0.0 — — 0.0 o — — — — — 0.0 Other Nervous Diseases f 1 0.2 0.5 1 0.3 0.4 o — — 0.1 — — 0.1 Pulmonary T.B. f — — 0.0 — — 0.0 o — — 0.0 — — 0.0 Other T.B. f — — 0.0 — — o.o o — — 0.0 — — Rickets f 2 0.5 1.0 — — 0.5 o — — 0.1 — — 0.1 Spinal Deformities f — — 0.1 1 0.3 0.2 o — — 0.1 — — 0.0 Other Deformities f 5 1.2 1.1 — — 0.8 o — — 0.3 — — 0.3 Other Defects f 5 1.2 2.6 4 1.1 2.6 o 2 0.5 1.4 — — 1.5 52 V . Ambulance Facilities. Early in the year the London County Council decided that their Ambulance Service should be available, without charge, throughout the day and night, for the conveyance from any address in the County to hospitals or municipal institutions in the County of parturient women who have made arrangements for their admission thereto. Maternity Beds. (I) New End Hospital. The Borough Council has made an arrangement with the London County Council whereby a ward containing five beds is set aside for Borough Council cases. The Borough Council contribute 9s. per day per bed occupied, and the patients are assessed by the Assistance Sub-Committee of the Borough Council to contribute according to their means. These beds are available for married women only. During the year, 46 patients were admitted to this Ward. (II) Queen Charlotte's Hospital. The Borough Council subscribes £1 in respect of every Hampstead mother confined in this Hospital and receives Hospital Letters of Admission in return. During 1935, the number of Hampstead women for whom such contribution was made was 39. (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 1935, 77 Hampstead mothers were confined there. The Children's Hospital, College Crescent. The Borough Council has an arrangement with this hospital whereby sick and ailing children, and children needing minor operations such as circumcision, removal of tonsils and adenoids, etc., are admitted. The Borough Council pays 21s. per week per bed occupied and the parents are assessed to pay according to their means. During 1935, one child was thus treated at the Hospital. The total number of beds in the Hospital for children under five years of age was 16. Medical Investigation Sub-Committee. The work of this Committee continues to prove of great value. It consists of the medical members of the Council (E. Collingwood 53 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. In addition the following medical officers are present, The Medical Officer of Health, Dr. Kidd (Medical Officer of Ante-natal Clinic), Dr. Blandy and Dr. Hall Craggs (Medical Officers of the Maternity and Child Welfare Centres). Prior to the meeting of the Sub-Committee the Medical Officer of Health ascertains all particulars relating to each case coming under review from the Health Visitors, General Practitioners, and Hospital Medical Officers concerned. All the information obtained is treated confidentially, and as a result of the investigations, either adjustments of the existing administrative procedure, or other measures, are undertaken which may prevent a recurrence of the conditions ascertained to be the cause of the fatality. During the course of investigation the following facts emerged, which are of interest. Of the deaths under 2 year of age, 76 per cent occurred in institutions; and of the 25 deaths occurring during the first month, 20 per cent. of the mothers had not received antenatal supervision, whilst of the 20 deaths between 2 months and one year, 40 per cent. had never attended an infant welfare centre. Of the 37 still births, all the mothers had received ante-natal supervision, either by general practitioners, at hospitals, or at the Council's Clinics, The Committee investigated:— Deaths of Infants under 2 years 50 Still Births 37 Puerperal Fever 2 Puerperal Pyrexia 18 Maternal Death 1 Other deaths of women 2 Total 110 54 There were 16 deaths of illegitimate children under two years of age, which represents a Mortality Rate of 92 per 1,000 illegitimate births as compared with 19 for legitimate children. This Committee has been in existence since 1924. In October, 1923, the suggestion of my predecessor, Dr. Scrase, to the Maternity and Child Welfare Committee was adopted, i.e., 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. 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. A list of the many valuable introductions that have been made into the Council's maternity and child welfare scheme, as a result of the consideration and investigations of the Sub-Committee, were set out in my Annual Report for 1935. Convalescent Homes and Other Institutions. Convalescent Homes. During 1935, 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. The following Homes are managed by Voluntary Committees and receive grants from the London County Council under the Local Government Act, 1929. Beauchamp Lodge. The Borough Council has an arrangement with Beauchamp Lodge Emergency Home for Children, 2, Warwick Crescent, Paddington, for the boarding-out of children under five years of age whose mothers have been admitted to Hospitals for their confinements. The Borough Council pays 12s. 6d. per week per bed occupied, the parents being assessed to contribute according to their means. During 1935, one child from a Hampstead family was admitted under this arrangement 55 An alternative arrangement exists 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 Foster Home, 33, Fitzjohn's Avenue. This institution occupies a house with a large garden. There are 28 beds, which are always occupied, for "first" babies of unmarried mothers. During 1935, 7 babies were admitted, the remaining 21 having been admitted prior to 1935. On an average, one-half of the total children accommodated come from Hampstead. This home removed from "Eagle's Nest," 99, Haverstock Hill to 33, Fitzjohn's Avenue during 1935. The Hampstead Hostel for Mothers and Babies, 7, Fitzjohn's Avenue. This hostel occupies a large house with an extensive garden. During the year 1935 there were beds for 15 mothers and babies in the hostel: 16 unmarried mothers were admitted with their babies. 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 1935, 61 expectant mothers and 41 mothers and babies were admitted. Main Memorial Home, 141, West End Lane. This Home 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. During the year 45 expectant mothers were admitted. The total number of beds available at the Home consists of 14 beds and 8 cots. St. Agatha's House, 39, Lancaster Road. This Home receives unmarried expectant mothers for 3 months prior to their confinements. It has accommodation for 10 mothers. During the year 19 expectant mothers were admitted. 56 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 1935 was 10,627. The Nursery is controlled by a Voluntary Committee and the Borough Council contributed £543 during 1935. By an arrangement with this Voluntary Committee the Borough Council rents a portion of the premises for the purpose of an Ante-natal Clinic. Provision of Midwives. The Borough Council has a scheme whereby the local district Nursing Associations provide for their nurses to attend confinements. Patients are charged by the Associations according to their means; in very poor cases no charge is made. During 1935, the midwives of the Kilburn and West Hampstead District Nursing Association attended 125 cases, whilst those of the Hampstead District Nursing Association attended 32 cases. Of the 157 cases, 68 were attended in the company of a medical practitioner. Compensation to Midwives. The Council compensates private midwives, other than those attached to the District Nursing Associations, Maternity Homes or Hospitals, for loss of cases referred by the Ante-natal Clinics to hospital for confinement at the rate of 10s. 6d. per case, subject to the following conditions:—(a) the patient is 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) the Medical Officer of the clinic certifies that she advised the patient to be confined in a Hospital or Home; (c) no payment is made to the midwife where the patient herself has applied to be confined in a Hospital or Home. Maternal Mortality and Morbidity. One woman died in consequence of child-birth during 1935. This represents a maternal mortality rate of 1 per 1,000 births as compared with 414 and nil for the preceding two years. Consulting Obstetricians. The Council has inaugurated a scheme whereby the services of obstetricians of consultant status are available to all medical 57 tioners in eases 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 three cases. One was a case of difficult confinement—mother removed to Hospital, cæsarian section performed, child born alive, mother made good recovery. The other two were cases of puerperal pyrexia—children born alive—mothers and babies were removed to Hospital and the patients recovered. In one case a nominal charge was made to the patient towards the cost of the services of the Consultant, the full fee being paid by the Borough Council in the other two instances. 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. A panel of Home Helps was formed in 1934 to be available to homes in cases of child-birth occurring in the Borough. They are paid at the rate of 5s. 0d. per day when employed, with no retaining fee. In normal cases they are 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. Their duties consist of general home management, including cooking, certain washing, the care of the children, etc. A doctor or midwife 58 is in attendance on the case and no nursing duties of any description are undertaken by the Home Helps. At the present time there are eight Home Helps on the "panel." Applicants are assessed to pay the whole or a portion of the cost of the Home Helps, according to their means. During the year, 28 mothers availed themselves of this facility, being assessed to contribute at charges varying from 5s. to 6d. a day. Maternity Outfits. Sterilised maternity outfits are supplied to maternity patients in the Borough—the applicants being assessed by the Assistance SubCommittee to contribute towards the cost of the outfits according to their means. Two types of outfits are issued, one containing the minimum contents and the other a somewhat fuller outfit. Under this arrangement 129 outfits were supplied during 1935. In 47 instances the full price was paid for the 5s. 6d. outfit. „ 58 „ „ „ 3s. 8d. „ „ 24 „ the applicants were assessed to contribute towards the cost of the 3s. 8d. outfit, the charges varying from 2s. to Is. Infant Life Protection. (Under Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932.) The five Health Visitors are appointed as Infant Protection Visitors. The following are the statistics relative to this work during the year:— On 31st December, 1935, there were in the Borough 25 fostermothers having charge of 37 foster-children. Number of foster-children removed 76 „ foster-children added 82 „ foster-mothers removed 27 „ foster-mothers added 27 „ visits paid by Health Visitors to foster- children 490 „ visits paid by Health Visitors to foster- mothers 348 59 During the year three foster-mothers were considered unsuitable by the Maternity and Child Welfare Committee; one because of verminous conditions, etc.; the second because of the foster-mother's lack of knowledge and ability concerning child management and her disinclination to abide by the regulations of the Children Acts, 1908 and 1932; and the third because the husband of the foster-mother was found to be suffering from active tuberculosis. In the first two cases the foster-children had already left the foster-mothers' care, and permission to take further foster-children was refused. In the last case the foster-mother was asked to arrange for the removal of the children from her care. During the year one foster-child reached the age of 9 years, and thereby ceased to come within the scope of the Children Acts, 1908 and 1932. In accordance with an arrangement made with the London County Council the records concerning this child were forwarded to the Children's Care Committee of the County Council, who keep such children under special observation. There was one death of a foster-child during 1935 (age six months), but no inquest was held. The cause of death was certified as "Broncho-pneumonia, Status Lymphaticus," after P.M. without inquest. As in previous years, a Certificate of Exemption was granted to the Hampstead Foster-Home, for 12 months—from July, 1935. The Certificate exempts the Home from making various notifications, etc., required by Part I of the Children Act, 1908, as amended by the Children and Young Persons Act, 1932, and also exempts the Home from official inspections by the Officers of the Borough Council. This Certificate was granted in view of the excellent manner in which the children are cared for at the 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. Through the courtesy of the Matron, I am informed, however, of the destination of the babies who leave this Home, so that I am able to notify the Medical Officers of Health of the Districts to which the infants proceed. A similar 60 arrangement exists with regard 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. During December, 1935, the Hampstead Foster Home removed from 99, Haverstock Hill to 33, Fitzjohn's Avenue, and the children were temporarily accommodated in homes at Tunbridge Wells and Ferring-by-Sea. An annual inspection has been made of the 12 boarding schools in the Borough, where children under 9 years of age are received. In all cases general sanitation, etc., was found to be satisfactory. It is interesting to note that two of these boarding schools accommodate children under three years, and more frequent visits are therefore paid to these establishments. 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. 63 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 1935:— Total number of inspections 3,696 Total number of re-inspections and other visits and re-visits 12,729 Total number of dwelling-houses inspected for housing defects 1,946 Number of these found not in all respects reasonably fit for human habitation 1,173 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), 1,202 relating to 992 premises. (2) Statutory 298 relating to 181 premises. Investigation of Complaints, Inspection of Factories, Workshops and Workplaces, etc. Number of complaints investigated 839 „ „ premises inspected after the occurrence of infectious disease 146 „ „ inspections of Factories (excluding bakehouses) 26 64 Number of inspections of Workshops (excluding bakehouses) 64 „ „ inspections of Workplaces 253 „ „ inspections of Bakehouses, Milkshops and other food premises 601 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 10 Cases abated (rooms) after service of notice 5 Cases abated (rooms) without service of notice 2 Underground sleeping rooms. Illegally occupied—found, or brought to the Inspectors' notice 54 Closed, or illegal occupation discontinued 9 Made to conform 12 Verminous conditions. Rooms disinfested 46 Number of houses concerned 23 Beds and bedding disinfested 5 Floors of rooms cleansed 34 Animals. Nuisances from improper keeping in rooms abated 2 Nuisances from improper keeping on the premises abated 2 Smoke nuisances. Complaints received 4 Observations made 8 Notices served — Drainage systems, &c. Drainage systems repaired or renewed, partly or wholly 328 Plumbing defects remedied (soil pipes, waste pipes, &c.) 654 Roofs, rainwater pipes and gutters repaired or renewed 399 Water supply. Water supply provided to separate lettings 277 Number of houses concerned 214 Sinks provided to separate lettings 283 Number of houses concerned 220 Water cisterns cleansed or covered 15 Water Closets. Additional provided 134 Removed from improper position 21 Flushing cisterns repaired 141 Yards, &c., Paving, &c. Yards or open spaces newly paved and drained or repaired 160 Bathrooms. New provided 260 Dust Bins. Repaired or renewed 147 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 16 Cases abated (rooms) after service of notice 3 Cases abated (rooms) without service of notice 4 Underground sleeping rooms. Illegally occupied—found, or brought to the Inspectors' notice 15 Closed or illegal occupation discontinued 7 Made to conform — 65 Totals. Verminous conditions. Rooms disinfested 141 Number of houses concerned 68 Beds and bedding disinfested 11 Floors of rooms cleansed 72 Animals. Nuisances from improper keeping in rooms abated — Nuisances from improper keeping on the premises abated — Drainage systems, &c. Drainage systems repaired or renewed, partly or wholly 58 Plumbing defects remedied (soil pipes, waste pipes, &c ) 109 Hoofs, rainwater pipes and gutters repaired or renewed 243 Water supply. Water supply provided to tenements 27 Number of houses concerned 25 Sinks provided to tenements 67 Number of houses concerned 62 Water cisterns cleansed or covered 17 Water- Closets. Additional provided 8 Flushing cisterns repaired 47 Removed from improper position 3 Yards, &c., Paving, &c. Yards or open spaces newly paved and drained or repaired 84 Bathrooms. New provided 6 Dust Bins. Repaired or renewed 38 Miscellaneous. Window cords repaired or renewed 314 Window fittings repaired or renewed 247 Filth and refuse removed from rooms 31 Washing (of clothes) accommodation provided 3 Coppers repaired or renewed 55 Suitably ventilated food cupboards provided 56 Kitchen ranges repaired or renewed 55 Common staircases repaired 88 Common staircases provided with adequate means of natural light 9 Common staircases provided with adequate means of artificial light 4 Houses or parts cleansed {excluding verminous rooms) 351 Number of rooms concerned 1123 Dampness in houses or parts abated 191 Dilapidated houses or parts repaired 235 Tenement Houses. During the year five 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 1,559. During the year, 721 tenement houses were inspected and 3,325 defects were discovered. 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. 66 Offensive Trades. No offensive trade is carried on in the Borough. Increase of Rent and Mortgage Interest (Restrictions) Acts. Number of certificates applied for 2 „ „ issued 2 Factory and Workshop Acts. Section 132 of the Act of 1901 requires every Medical Officer of Health in his Annual Report specially to report on the administration of these Acts, and tabulated statements were framed by the Home Secretary with a view to such reports being made upon uniform lines. It is the statutory duty of the Borough Council to keep a Register of all Workshops situated within their district. Inspection of Factories, Workshops, and Workplaces, including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Occupiers Prosecuted. (1) (2) (3) (4) Factories (Including Factory Laundries) 26 9 Nil. Workshops (Including Workshop Laundries) 64 13 Nil. Workplaces (Other than Outworkers' premises) 253 56 Nil. Totals 343 78 Nil. 67 Defects found in Factories, Workshops, and Workplaces. Particulars. Number of Defects. Number of offences in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Nuisances under the Public Health Acts*:— Want of cleanliness 82 82 Nil. Nil. Want of ventilation 7 7 1 Nil. Overcrowding Nil. Nil. Nil. Nil. Want of drainage of floors 10 10 Nil. Nil. Other nuisances 135 135 Nil. Nil. Sanitary accommodation insufficient 8 8 Nil. Nil. unsuitable or defective 21 21 Nil. Nil. not separate for sexes 10 10 Nil. Nil. Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) Nil. Nil. 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.) Nil. Nil. Nil. Nil. Totals 273 273 1 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. Factories. The following is a list of the different classes of Factories in Hampstead:— Bakers 30 Dairymen 1 Bootmakers 21 Launderers 2 Butchers 7 Motor and other engineers 24 Cabinet makers and Upholsterers 7 Printers 7 Other trades 47 Carpet beaters 2 Coffee roasters 2 Total 152 Confectioners 2 68 Workshops. At the end of 1935, there were 383 workshops on the Register, including 81 domestic workshops. During the year, 317 inspections were made and 69 notices served. The chief occupations for males were bootmakers, tailors, upholsterers and cabinet makers, builders and carpenters; and for females, dressmakers, outfitters and costumiers, 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 94 such outworkers in Hampstead known to the Public Health Department. Of these, 5 are factories, 30 are workshops, 8 are workplaces and 51 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, 51 lists were received, and 51 lists in August. These lists included the names of 148 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 143, 26 belonged to Hampstead and 117 elsewhere. Particulars of the latter were sent to the Local Authorities concerned, while information concerning 94 outworkers resident in Hampstead was received from other Authorities. In no instance during 1935 was outwork found to be carried on in unwholesome premises. Rats and Mice (Destruction) Act, 1919. The Borough Council issues an advisory leaflet on the 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. During the year advice and help has been given in connection with 52 complaints of nuisance from rats and mice. 69 Bug Infestation of Houses. The scheme in operation in the Borough 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 removel of architraves, etc., and also to decide if rooms, bedding, etc., should be disinfested by the Council. No charge is made for such disinfestation. (b) Tins of Insecticide and hand sprayers are issued by the Public Health Department to tenants. The object aimed at is to secure the co-operation of tenants of infested rooms. During the year 649 tins of Insecticide and 78 hand sprayers were issued. The action taken by the Council in relation to the prevention of bug-infestation in connection with the Westcroft Housing Estate is referred to in the Housing Section of this Report. Shops Act, 1934. This Act 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. The Borough Council has appointed the Medical Officer of Health and all of the Sanitary Inspectors as Officers under the Act. During the year, 136 shops were inspected under the Act. Provision is made in Sub-section 6 of Section 10 of the Act for the exemption of shops from the requirement as to the provision of sanitary conveniences if the Borough Council are satisfied that by reason of restricted accommodation or other special circumstances affecting the shop it is reasonable that a certificate of exemption should be granted and that such sanitary conveniences are otherwise conveniently available. The Public Health Committee has decided that if the number of employees of both sexes does not exceed four, then one sanitary convenience is to be regarded as suitable and sufficient, provided that 70 the door of such convenience is fitted with a proper lock and fastener on the internal side, and an automatic indicator showing on the external side of the door whether the apartment is engaged or vacant; and that a distance of not more than 75 yards from a convenience outside the premises shall be deemed to be reasonable in those instances where it is impracticable to provide accommodation on the premises. During the year exemption certificates were granted in respect of the following premises:— 8, College Crescent. 131a, Finchley Road. Coffee Stall, Hampstead Green. 181, Haverstock Hill. 49b and 61, Heath Street. Cabmen's Shelter, Finchley Road (by Canfield Gardens). These certificates remain in force until withdrawn by the Borough Council. One application for exemption was refused during the year, the Public Health Committee being of the opinion that the provision of a water-closet for males should be insisted upon. Swimming Baths and Pools. (a) Public. (1) The Municipal Central Baths, Finchley Road. These swimming baths consist of 4 baths (Ladies' 1st and 2nd class and Men's 1st and 2nd class). The water in all four baths is filtered, aerated, and chemically treated. In the absence of scum troughs, or overflow channels, the surface of each bath is skimmed every morning, and if possible at other times during the day. This is done by drawing a long bamboo pole across the surface from end to end, and then gathering the scum with a net. All four baths are chlorinated after filtration by means of a Paterson Chlorinome. Each bath has its own unit. The Ladies' 1st Class, and Men's 1st and 2nd Class Baths have the old type Turnover Filter Plant; one filter 7 ft. 8 in. by 5 ft. 11 in. to each of the above baths. The pump rating in each 71 case is 20,000 gals, per hour, thus giving a flow through the filter of approximately 444 gals, per square foot per hour. The Ladies' 2nd Class Bath has two 6 ft. 0 in. Paterson Filters, air and water scoured. Venturi meter attached to register the flow of water in thousands of gals, per hour—average 10,500 gals, per hour, giving a filtration speed of 186 gals, per square foot per hour. A record has been made three times a day since 1930 of the chlorine content of the water at each end of the bath and at the filter. No record has been kept of the alkalinity, but tests are made three times a day. In the absence of any prescribed standards for swimming bath water the National Association of Bath Superintendents (Inc.) have adopted the following standards, which are observed at the Hampstead Municipal Baths. Procedure. (1) Samples be taken 15 minutes after the last bather has left the water on that day. (2) On all occasions when samples are taken, the filter plant and accessories shall be in full operation. (3) The samples be taken from the baths in a position immediately over the main outlet to the filter plant and 12 inches below the surface. (4) A standard sterilized glass stoppered receptacle of onehalf gallon capacity shall be used, and such receptacle shall be rinsed in the bath water prior to taking the samples. (5) Any sample which shall contain any bactericidal properties should be neutralised when taken from the bath. (6) The samples taken shall be packed in ice, or otherwise maintained at a temperature which prohibits incubation. (7) To effect uniformity in procedure a period of twelve hours should elapse before the commencement of the examination of the samples. Chemical standards of Bath Water. (1) The P.H. Value shall be approximate to 7 or be neutral to Phenolps Red. 72 (2) The samples shall be odourless when subjected to a heating test of 80 degrees C. and shaken. (3) The sample shall be bright, clear and colourless. (4) Nitrogen as Nitrites should be absent. (5) The albuminoid Ammonia content shall not exceed 02 parts per 100,000. Bacteriological Examination. (1) That five 1 c.c. counts on Agar at a temperature of 37 degrees C. for 48 hours be made. (2) That the count on any one sample shall not exceed 200 colonies per c.c. (3) That B. Coli shall be absent in 100 c.c. of the water tested. (4) The sample should give a negative "stormy-fermentation" (B. Welchii) reaction in 100 c.c. of the water tested. During 1935, the Public Health Department took samples of water from the various baths, three for chemical and two for bacteriological examination. Two of the chemical and one of the bacteriological samples were returned as satisfactory, whilst one chemical and one bacteriological samples were reported as unsatisfactory. Immediate action was taken in regard to the unsatisfactory samples. (2) The Hampstead Swimming Pond. This is situated on Hampstead Heath. All the ponds on the Heath are flowing water, whilst bathing facilities are provided in the Hampstead pond by the London County Council. It is, of course, impracticable to attempt purification of this pond by means of chlorination or etc., but it is proposed, during the year 1936, to take water samples for chemical and bacteriological examination to ascertain whether or not the pond is safe for bathing. (b) Privately owned swimming baths open to the public. Gilling Court and Holmefield Court, Belsize Grove, Swimming Pool. This swimming pool was constructed in 1934, principally for the use of the tenants of these flats, but is also open to friends of tenants. 73 The water is filtered by means of a Bramwell "Uneek" Filter, and is chlorinated by a Turnover Filter Plant. By the courtesy of the owners we are to take water samples for bacteriological and chemical examination during the year 1936. Schools. In accordance with the requirements of the Public Health (London) Act, 1891, the Head Teachers of Schools are promptly notified of the occurrence of a case of infectious disease whenever a child who is an inmate of a house in which a case has occurred is found to be a scholar. This procedure is also applied to Measles, which is a compulsorily notifiable disease in Hampstead. Legal Proceedings. The following is a list of the summary proceedings taken by the Department during 1935:— Date of Hearing. Nature of Offence. Result of Hearing. 4th Jan. (i) Nuisance under the Public Health (London) Act, 1891. Work done, Summonses withdrawn on payment of £1 l1s. 6d. costs. (ii) Contravention of Tenement House Byelaw No. 14. (iii) Ditto No. 18. (iv) Ditto No. 23. Do. (i) Nuisance under the Public Health (London) Act, 1891. Work done, Summonses withdrawn on payment of £1 1s. costs. (ii) Contravention of Tenement House Byelaw No. 14. (iii) Ditto No. 23. Do. (i) Nuisance under the Public Health (London) Act, 1891. Work done, (i) and (iii) dismissed under the Probation of Offenders Act and (ii) fined 1s. and £1 l1s. 6d. costs. (ii) Contravention of Tenement House Byelaw No. 18. (iii) Ditto No. 23. Do. Nuisance under Public Health (London) Act, 1891. Order made to abate within 21 days and pay £1 1s. costs. 18th Jan. Milk and Dairies Order, 1926 (i) filling milk bottle in street, (ii) removing disc at Hemstal Road Fined £3 and £1 costs. 7th Mar. Non-deposit of plans of work carried out. Plans deposited, £1 1s. costs paid and summons withdrawn. Do. London County Council (General Powers) Act, 1908. Contravention of Section 8 with regard to deposit of food at a Bakehouse. Fined £1 and 10s. 6d. costs. 19th Mar. Nuisance under Public Health (London) Act, 1891. Order made to abate in 28 days and pay £1 1s. costs. Do. Nuisance under Public Health (London) Act, 1891. Order made to abate in 28 days and pay 10s. costs. 74 Date of Hearing. Nature of Offence. Result of Hearing. 14th Aug. Nuisance under Public Health (London) Act, 1891. Order made to abate in 28 days, and 9s. 6d. costs allowed. 16th Aug. Nuisance under Public Health (London) Act, 1891. Order made to abate in 21 days, and 30s. costs allowed. Do. Nuisance under Public Health (London) Act, 1891. Order made to abate in 21 days, and 30s. 29th Oct. Nuisance under Public Health (London) Act, 1891. costs allowed. Nuisance abated. 10s. costs paid. Summons withdrawn. 27th Nov. (i) Selling hot milk containing added water and deficient in milk fat. (i) Fined £3 and £2 2s. costs. (ii) Selling hot milk containing added water. (ii) Dismissed under the Probation of Offenders Act on payment of 4s. costs. Do. Selling hot milk deficient in milk fat. Fined £2 and £1 1s. costs. 13th Dec. (i) Non-deposit of plans. Plans deposited. Work altered. £3 3s. costs paid and summonses withdrawn. (ii) to (vii) Contravention of drainage bye-laws. Public Mortuary, New End. During the year, 102 bodies were brought to the mortuary, 18 by the Police, 82 at the request of friends, and 2 by order of the Coroner. In 21 instances post-mortem examinations were made. Pharmacy and Poisons Act, 1933. Under the provisions of this Act, the Borough Council is required by means of inspection and otherwise to take all reasonable steps to secure compliance by persons not being authorised sellers of poisons with the provisions of Part II of the Act and the Rules so far as those provisions relate to poisons included in Part II of the Poisons List; and for that purpose to appoint Inspectors. Such Inspectors are given specified powers of entry, examination, enquiry and sampling in connection with their respective functions. Certificates of the Public Analyst are admissible in evidence in any proceedings under the Act. The Act provides that in determining the distribution of poisons as between Part I and Part II of the list of poisons, regard shall be had to the desirability of restricting Part II to articles which are in common use, or likely to come into common use, for purposes other than the treatment of human ailments, and which it is reasonably necessary to include in Part II if the public are to have adequate facilities for obtaining them, 75 The Act requires the container of the poison to be labelled in the prescribed manner (i) with the name of the poison, (ii) in the case of a preparation which contains a poison as one of its ingredients, with the prescribed particulars as to the proportion which the poison con¬tained in the preparation bears to the total ingredients, (iii) with the word "Poison" or other prescribed indication of the character of the article, and (iv) with the name of the seller of the poison and the address of the premises on which it was sold. The Borough Council is required to keep a list of persons entitled to sell poisons included in Part II of the Act; and may refuse to register or may remove names from the Register, which must be in the prescribed form and include specified particulars. The date for the coming into operation of these provisions was 1st May, 1936. On the 26th of October, 1933, the Council resolved that the exercise of the powers and duties of the Council under the Act be referred to and be under the supervision of the Public Health Committee with power without requiring the approval of the Council to serve and receive notices and take proceedings thereunder. The Medical Officer of Health and all the Sanitary Inspectors have been appointed as officers under the Act. Section 5. Housing. 79 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) 1946 (6) Number of inspections made for the purpose 2534 (2) (a) Number of dwelling-houses (included under sub-head (1) above which were inspected and recorded under the Housing Consolidated Regulations, 1925 461 (b) Number of inspections made for the purpose 819 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (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 1173 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 :— (o) By owners Nil. (b) By local authority in default of owners Nil. B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 790 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 790 (&) 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 1 (2) Number of dwelling-houses demolished in pursuance of lition Orders Nil. 80 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 14 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 6 Closing Orders on Part of a Building. Closing Orders may now be placed upon any part of a building which is occupied by the working classes, and not only, as heretofore, on any part of a building which was let as a separate habitation; and also upon any part of a house which, though not occupied, is suitable for occupation by the working classes. Underground Rooms. An important step forward has been taken in the new Housing Act in the matter of underground rooms that do not conform to the requirements regarding such rooms. Under the Act of 1925, a Closing Order could be placed upon such a room if it was " habitually used as a sleeping place," but it was permissible to continue to use it for purposes other than those of a sleeping place; in other words, it could be used as a living room with impunity. By the Act of 1930, this permission was cancelled, and it was no longer legal to use as a living room a sleeping room which had been closed for such a purpose. The new Act now gives local authorities power to place Closing Orders upon underground living rooms in the first instance if they are not or cannot be made fit for habitation. The required standards to which underground rooms must conform are prescribed in the Public Health (London) Act, 1891, and in Regulations made under the Housing Act, 1909. During the year, 69 rooms were reported as being illegally occupied. In 16 cases the illegal occupation was discontinued. Twelve rooms were made to conform to the required standard, and in one case a Closing Order was made. At a certain house it was found that two underground rooms, from which a family had been removed to the Westcroft Housing Estate owing to the unsatisfactory conditions under which they were living, had been re-let. The owner was prosecuted and fined £2 with 20s. costs. 81 I have no record of all the underground rooms in Hampstead, but they probably exceed 4,000—they are not all, of course, occupied by members of the working classes. However, more than 50 per cent, require investigation, and some of these may only be capable of remedy under the Public Health (London) Act, 1891. The most satisfactory way, in my opinion, of dealing with underground rooms is, if possible, to persuade the owner to make them conform to the Regulations or Requisites by such means as widening areas, concreting sites, etc. In certain instances it is impracticable for this work to be done, or the owner may refuse to do it. The question then arises of the making of Closing Orders, or, alternatively, of taking other steps to deal with the infringement of the law. 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 66 Number of houses at the Watling Estate at the disposal of the Borough Council under similar arrangements 34 Number of houses allotted to Hampstead under special arrangements with the L.C.C. for relief of overcrowding:— Watling 78 Tottenham 4 Downham 1 Morden 20 Total 203 The total number of families removed from Hampstead to County Council houses since 1927, through action by the Borough Council, is 247 involving 1,335 persons. The additional 44 families are accounted for by changes in tenancies at the subsidy houses (16 at Walling and 28 at Wormholt), the Borough Council having the right to nominate tenants for any of the 100 subsidised houses which become vacant. 82 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. 0d.; three-roomed tenements, 13s. 4d.; four-roomed tenements, 17s.0d. 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. Representations. Statement showing steps taken in 1935 in connection with premises "represented in 1935 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. "Rose Cottage," North End 4-2-35 — 21-3-35 Premises demolished. Palmerston Garage, Palmerston Road 8-4-35 21-4-35 — Closing Order made on upper part of premises. 97, Abbey Road (back basement room) 14-1-29 31-1-29 — Closing Order determined on 21-3-35, room having been made to conform. 31, Flask Walk 13-5-35 — — Consideration deferred sine die; London County Council having served notice under the London Building Act, 1930. Premises subsequently demolished by owners. 83 Premises. Representation. Date of Committee. Closing Order. Date of Council. Demolition Order. Date of Council Remarks. 1, Perrins Court 4-3-35 - - Owners undertook that after the present tenant had vacated the premises, they would not be relet for human habitation but only used as a store. 5, Exeter Mews (upper part) 9-4-34 31-5-34 - Premises demolished. Closing Order determined 25-7-35. 13, Fitzjohn's Avenue 4-11-35 23-1-36 - Three underground rooms represented. Two made to conform and Closing Order made on basement room under front door steps. 3, 5 & 7, Fairfax Place 8-10-34 — — Owners submitted proposals for carrying out work to make premises habitable. Work now satisfactorily completed. 4, 8, 10, 12 & 40, Fairfax Place 4-2-35 21-2-35 — Closing Orders made on the upper parts of these premises. 36, 38, 42, 44, 46, 48, 50 & 52, Fairfax Place 4-2-35 21-2-35 — The owners of Nos. 36, 38, 42, 44 and 46, appealed against the Orders to the County Court, such appeals being allowed on condition that certain works were carried out. These have since been done. 31-55, New End 7-5-34 — — Represented as Clearance Area under Sec. 51 (2). Enquiry by Minister of Health on 20-3-35. Clearance Order made. Premises demolished. New End Area. At its meeting on the 24th of January the Council resolved that Nos. 31-55 (odd numbers) New End be defined as the "New End Clearance Area," and made a Clearance Order, ordering the demolition of the buildings. Under Section 1 (3) of the Housing Act, 1930, the Council are required to proceed to secure the clearance of the Area, or by purchasing the land comprising the Area, themselves to undertake or otherwise secure the demolition of the buildings thereon. It 84 was decided that proceedings should be taken to secure the demolition of the buildings without the Council themselves purchasing the land. This Area consists of 13 houses, comprising 56 rooms; the population consisting of 17 families, composed of 53 adults and 11 children. Alternative accommodation for the residents who would be displaced was made available at the Council's new Westcroft Housing Estate. An Inquiry was held by the Ministry of Health on the 20th of March, and the Order was subsequently confirmed. Applications were received with respect to No. 41, occupied by a fruiterer and greengrocer, and No. 53, occupied by a confectioner, asking for an allowance, having regard to the loss of their business. The Council resolved to pay to the tenants the sums of £50 and £35 respectively as voluntary allowances under Section 41 of the Housing Act, 1930. Fairfax Place. Certain premises in this Mews were reported upon in 1934, and appropriate action duly taken. During the year now under review, the condition of the remaining premises was brought to the notice of the Housing Committee. Nos. 4, 8, 10, 12 and 36-52 (even numbers) were reported upon in January, and the Council at its meeting on the 21st February made Closing Orders with regard to the upper parts of Nos. 4, 8, 10, 12 and 40, and on the 21st March made similar orders with regard to the upper parts of 36, 38, 42-52 (even numbers). The owners of Nos. 36, 38, 42, 44, 46, 48, 50 and 52 subsequently appealed to the County Court against the Closing Orders. The owners submitted to the Court undertakings to carry out certain works at the first five premises, but withdrew their Appeals respecting Nos. 48, 50 and 52. The undertakings were accepted by the Court, and, subject to the execution of the said works, the appeals were allowed. The " Westcroft " Estate. This Scheme, details of which were given in my Annual Report for 1933, has been pushed forward rapidly during the year. The Estate was opened by H.R.H. The Duke of Kent on 29th October. Arrangements have been made whereby a specialist firm undertakes the removal and disinfestation of the effects of all families 85 removing to the Estate, and for other necessary work to be carried out by the Council's disinfecting staff. Full details of these means, adopted for the prevention of infestation of the new Estate by bugs, were set out in detail in my last Annual Report. Hampstead Housing Association, Ltd. This Association now manages 12 houses in the Borough, five situated in Kelson Street, six in Palmerston Road and one in Netherwood Street. The Report submitted to the Seventh Ordinary General Meeting held in June, 1935, states :— " The houses belonging to the Association continue to give satisfaction to the tenants. During the year there have been five changes, but there has been no difficulty in finding new tenants. The character for reasonable rents, clean and tidy rooms and attention to small as well as to large repairs is well established in the neighbourhood, and our regret is that it still seems impossible to secure any other houses at a price that is at all reasonable." Housing Act, 1935. Overcrowding Survey. Section 1 of the Housing Act, 1935, required every local authority to make an inspection of its district with a view to ascertaining what dwelling houses were overcrowded on the standard laid down in the Act, and to prepare and submit to the Minister of Health a report showing the result of the inspection and the number of new houses required in order to abate the overcrowding disclosed. The overcrowding standard. The overcrowding standard laid down in the Act consists of two parts. Section 2 (1) (a) provides that a dwelling house shall be deemed to be overcrowded if the accommodation is such that any two persons being ten years old or more, of opposite sexes and not being persons living together as husband and wife, must sleep in the same room. Section 2 (1) (b), in conjunction with Tables I and II in the First Schedule to the Act, fixes, in relation to the number and size of the rooms in any dwelling house, the maximum number of persons, irrespective of sex, who may be permitted to sleep in that house at one time. 86 The " permitted number of persons " is the number determined in accordance with one or other of the two following tables, whichever 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 1½ „ (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. As was pointed out in the Memorandum of the Ministry of Health, " this standard does not represent any ideal standard of housing, but the minimum which is in the view of Parliament tolerable while at the same time capable of immediate or early enforcement." The Survey. The survey fell into two stages, the first being a preliminary enumeration to ascertain the number of persons in each family, the number of children under 10 years of age, and the number of rooms occupied. The enumeration, which was made in respect of 9,686 structurally separate houses occupied by 17,917 separate families, was begun in the autumn, and showed (i) the families which were overcrowded irrespective of the sizes of the rooms occupied, (ii) the families which were not overcrowded, and (iii) doubtful cases of 87 crowding, i.e., those in which families might be overcrowded when the sizes as well as the numbers of the rooms occupied were taken into consideration. The second stage of the survey consisted of the measurement of the floor area of all the rooms in the houses in which doubtful cases of overcrowding had been disclosed by the preliminary enumeration, with a view to determining definitely whether the families were or were not overcrowded on the standard laid down in the Act. In this second stage of the survey, the ages of children under 10 years of age were recorded and particulars of the numbers of lodgers living with families were obtained. The task of taking the room measurements was completed with the ready co-operation of the families concerned. The survey was concluded in December. The method adopted for selecting the doubtful cases of overcrowding was to fix, in respect of each size of dwelling, an arbitrary number below the maximum permitted number in Table I and to assume that, if the "equivalent number" of persons (i.e., counting each child under 10 years of age as half a person) occupying the dwelling was less than this number, the dwelling would not be overcrowded on the standard of Table II in the Act. If the "equivalent number" of persons in a dwelling house was equal to or in excess of the reduced permitted number and the family was not definitely overcrowded on the standard of Table I, the case was considered doubtful and detailed room measurements were obtained. Statistical summary of the survey. From the information obtained as a result of the survey, tables were prepared showing the distribution of the families concerned in relation to the size of the family and the size of the accommodation occupied, in terms of the maximum number of persons permitted to occupy the dwelling under the Act. The following table gives the information relating to the whole Borough. The vertical columns of the table show the sizes of the rooms occupied in terms of the maximum "equivalent numbers" of persons who could be permitted to occupy the dwellings without causing them to be overcrowded. In cases in which the floor areas of the rooms in 88 dwellings were ascertained it has been possible to determine accurately the perrnitted numbers of persons in respect of the dwellings. In other cases other calculations have been employed. The horizontal divisions represent the sizes of the families in terms of the "equivalent numbers" of persons occupying the dwellings. In cases in which the ages of children were not ascertained a child under 10 years of age was counted as half a person. The table, therefore, gives a picture of the housing conditions (so far as density is concerned) of the families enumerated in Hampstead at the time the survey was taken. The thick black diagonal line in the table separates the overcrowded families from those not overcrowded. The families recorded on the left of the diagonal line are all overcrowded and the worst cases of overcrowding are those farthest from the line. The families recorded to the right of the line are families not overcrowded. During the course of the Survey, two instances were discovered, in one-roomed homes, in which a grown-up son was using the same room as his mother. These are referred to by the * on the preceding table. As a result of the Survey it was found that there were 447 families living in overcrowded conditions in Hampstead. It must, however, be remembered that, as previously indicated, the standard adopted is such that although 447 families are reported as "overcrowded" there must be many others who are living in unduly crowded conditions which might with advantage be improved upon. It may be mentioned that the Report on the Survey does not specifically refer to the number of cases where improper mixing of sexes occurred. It is probably assumed that in many of these cases a re-arrangement of the sleeping accommodation can remedy these conditions. The extent to which the overcrowding is to be remedied by the provision of new housing accommodation is arrived at by a calculation 89 which makes allowance for the release of accommodation owing to the vacation of dwellings. There is a difficulty in applying this factor, as differences in the sizes of dwellings and classes of overcrowding, as well as possible influxes from adjoining areas, have to be provided for; and more important still, the ability to transfer is dependent upon the transferee being able to pay an increased rent for increased accommodation. A formula was suggested by the County Council for calculating the re-housing needs. It indicated a re-housing need of 94 three-roomed, 41 four-roomed, 42 five-roomed, 6 six-roomed and 4 seven-roomed dwellings : a total of 187. This formula assumes that 50 per cent. of one- and two-roomed dwellings are capable of division so that rooms can be added to other dwellings to make the required size of dwelling in existing accommodation and that dwellings above that size will be wholly available. It also takes no cognisance of the increased rent difficulty or influxes from adjoining areas previously referred to. Section 6. Inspection and Supervision of Food. 93 Inspection and Supervision of Food. (A) Milk Supply. Examination of Samples for bacterial content and for tubercle bacilli. During the year samples have been submitted for examination with the following result:— Nature of sample. Examined for (a) Bacterial content or (b) Tubercle bacilli. Result of examination. Pasteurised (a) Satisfactory. Raw milk (b) do. Raw milk (b) do. Raw milk (b) do. Raw milk (a) do. Raw milk (b) do. Pasteurised (a) do. Pasteurised (a) do. Pasteurised (a) do. Pasteurised (a) B. Coli present in .01c.c. Pasteurised (a) Satisfactory. Pasteurised (a) do. Pasteurised (a) do. Pasteurised (a) do. Grade "A" T.T. (b) do. Certified (a) & (b) do. Raw milk (b) do. Pasteurised (a) do. Pasteurised (a) do. Pasteurised (a) B. Coli present in .1c.c. Pasteurised (a) B. Coli present in .0lc.c. Samples art taken from time to time of the pasteurised milk supplied to the County Council Hospitals in the Borough (viz. North Western Fever Hospital and New End Hospital), to ensure that the pasteurised milk conforms with the standards of the Milk (Special 94 Designations) Order (viz.: that it contains less than 100,000 bacteria per c.c.). Three of the samples which have been taken, were found to contain bacteria in excess of the limits allowed by Statute. I immediately communicated with the dairies concerned, and was particularly impressed with the help and co-operation which was afforded me by the technical advisers of these firms. Records and reports were forthcoming which proved conclusively that the milk had been efficiently pasteurised, but the increased count had resulted most probably through some slight contamination during transit of the milk from their depots to the hospitals. The firms themselves arranged to take bacteria samples nightly from the milk to be delivered to the two institutions, and to examine very closely the mode of transit from their depots to the hospitals and to make appropriate modification if found advisable. Further samples have subsequently been taken by officers of this department, all of which have proved satisfactory. Milk for School Children. Milk supplied to Hampstead Scholars under the scheme of the London County Council is required to be pasteurised and to comply with the requirements of the Milk (Special Designations) Order, 1923. (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 92. During the year, 167 inspections were made and 7 notices were served. There were 164 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 12-32 per cent. Fat 3.52 „ Solids not fat 8.80 „ 95 (ii) Milk (Special Designations) Order, 1923. Number of licences in force during 1935 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 13 Sale of " Grade A " Milk from shop or other premises 1 Sale of " Pasteurised" Milk from shop or other premises 36 No licence for graded milk or registration of retailers was refused or revoked during the year. In 12 eases supplementary licences were granted authorising the sale of graded milk within the Borough from premises outside Hampstead. (B) Meat and Other Foods. (i) Meat and Slaughterhouses. There is now no slaughterhouse in the Borough. A general supervision of shops and premises concerned with the meat supply of the Borough is exercised by all the Sanitary Inspectors, and observations kept to see that the Public Health (Meat) Regulations, 1924, are observed. (ii) Sale of Food Order, 1921. No infringement of this Order, which requires the labelling of imported meat, bacon, ham or lard, was discovered during 1935. (iii) Unsound Food and Food Inspection. The following is a list of food seized or voluntarily surrendered during the year :— Apples, 1 barrel (less 16 lbs.). Cherries, 78 tins. Grape fruit, 13 tins. Loganberries, 1 tin. Pineapple, 6 tins. 96 (iv) Premises where foods are manufactured, prepared, stored or exposed for sale. These premises are kept under observation by all the Sanitary Inspectors, and during the year 599 inspections were made. Premises. No. of Premises on Register. No. of Inspections. No. of Notices. Bakehouses:— Factories— Underground 14 26 20 Aboveground 16 33 6 Workshops— Underground 2 3 — Aboveground 11 10 3 Fried Fish Shops 14 21 2 Ice Cream Premises 94 20 6 Milk Premises 92 167 7 Butter and Margarine Manufacturers and Dealers 2 1 Restaurants and Eatinghouses 74 22 10 Other Food Premises, e.g., Butchers, Greengrocers, Grocers, Provision Dealers, etc. 479 296 67 There is no Cowshed, Slaughterhouse or Poultry Slaughterhouse in the Borough. The underground bakehouses at 98, Boundary Road, 225 and 289, Finchley Road are now out of use. (v) Registration of Food Premises (other than Dairies). (a) There are 94 premises on the Register used for the manufacture, storage or sale of ice cream. (b) Cooked Meat, etc.—Up to the end of the year 46 premises had been registered. (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. The Sanitary Inspectors supervise, generally, such of these Regulations as are enforceable by the Borough Council. 97 (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. There is now no butter factory in the Borough. At the end of the year only two traders were registered as wholesale dealers in Margarine :— 304, High Road, Kilburn—Messrs. Maypole Dairy Co., Ltd. 233, Finchley Road—Messrs. Lipton, Ltd. (viii) Stalls and Vehicles (including Street Traders). The Bye-laws with regard to street trading relate, inter alia, to the protection of the food from contamination, the storing of refuse in suitable covered receptacles, etc. 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. Inspection of food sold from street stalls is carried out by the Sanitary Inspectors. (ix) Food Poisoning. Cases of food poisoning or suspected food poisoning are required to be notified to the Medical Officer of Health. During the year, four cases were notified; all of which were subsequently investigated by the staff of this department. London County Council (General Powers) Act, 1908. This Act is found to be of considerable use in ensuring that the food supply shall not be contaminated. Infringements of the law are usually abated upon the occupier's attention being directed to the matter. Legal proceedings were instituted under Section 8 in one outstanding case discovered during the year by a Sanitary Inspector, in which the practice of storing in a water closet articles of food used 98 in connection with a bakehouse was continued after verbal and written notice of the offence. A fine of £1 with 10s. 6d. costs was imposed. (C) Adulteration, etc. (i) Food and Drugs (Adulteration) Act, 1928. 502 samples were taken for analysis during the year by the Sampling Officers under the Act. The number certified to be adulterated was 17, or 3.4 per cent. of the total number, as compared with 25, or 49 per cent. in 1934. Of the total samples taken for analysis, 201 were formal samples and 301 informal. The following table shows the articles of which samples were taken during the year:— Article. Number taken. Number Adulterated Butter 44 2 Bread and Butter 4 2 Cream 9 - Cheese 19 - Condensed Milk 6 - Coffee 10 - Cocoa 14 - Canned Meats, Fish and Fish Pastes 19 - Canned or Dried Fruits or Vegetables 13 - Chocolate Rolls 3 3 Custard Powder 2 - Cereals 16 2 Camphorated Oil 2 - Dripping 12 - Honey 6 - Jams and Jellies ... ... 15 - Lard and Lard Substitutes 14 Lemonade Powders ... 6 - Milk 164 5 Margarine 38 1 Mustard ... 3 - Olive Oil 2 - Pepper 10 - Carried forward 431 15 99 Article. Number taken. Number Adulterated Brought forward 431 15 Sugar 9 — Sausages and Meats 9 — Spirits, Wines and Beer 11 1 Sauces, Spices and Pickles 12 1 Tea 6 — Tomato Puree 3 — Vinegar 6 Various 15 — Totals 502 17 The following table shows the articles adulterated, etc., the nature of adulteration, and the action taken:— No. of Sample. Article. Analyst's Report. Action taken. 43 Butter 16-6 per cent, of water ... No action. 314 Milk Deficient in non-fatty solids Producer cautioned. 315 Milk Deficient in milk fat 316 Milk Deficient in non-fatty solids 60 Tomato Puree Copper 40 parts per million Tin 3 grains per lb. No action. 85 Margarine 16.2 per cent. of water No action. 326 Bread and Butter Bread and margarine Vendor cautioned. 332 Bread and Butter Bread and margarine Vendor cautioned. 196 Butter 16.28 per cent. of water No action. 344 Rum Proof spirit 6348 per cent. Water 2.3 per cent. No action. 252 Pearl Barley Faced with talc. Contained 045 per cent. talc. No action. 386 Pearl Barley Faced with small quantity of talc. Vendor cautioned. 411 Milk Deficient in milk fat to the extent of 57 per cent. Fined £2 2s. and costs. 414 Milk 23 per cent, added water. Deficient in milk fat to extent of 11 per cent. Fined £3 3s. and costs. 427 Chocolate Cream Roll Contained less than 1 per cent, cocoa and the fat was not cream Vendor cautioned. 454 Chocolate Swiss Roll 1 per cent, dry fat free cocoa Vendor cautioned. 455 Chocolate Swiss Roll 2 per cen.t dry fat free cocoa Vendor cautioned. ion (ii) Artificial Cream Act, 1929. The following is the only registered premises in the Borough:— 66-68, High Road, Kilburn. (iii) Public Health (Condensed Milk) Regulations, 1923 and 1927. Six samples were taken during the year and found to be satisfactory. (iv) Public Health (Dried Milk) Regulations, 1923 and 1927. No sample was taken during the year. (v) Public Health (Preservations, etc., in Food) Regulations, 1925 to 1927. 45 samples of articles of food specified in these Regulations were submitted for analysis. The following is a list of those found not to be in conformity with the Regilations:— Nature of Sample. Result of Analysis. Action taken. Tomato Pruree Contaminated in respect of copper and tin Vendor cautioned. (D) Chemical and Bacteriological Examination of Food. The Public Analyst undertakes the chemical analysis of food at his Laboratories at 11, Billiter Square, E.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 Laboratories of Pathology and Public Health, 6, Harley Street, W.l, and details will be found at the beginning of this Section of the Report. 101 The following articles of food were also examined bacteriologically:— Article. Result of examination. Crab and lobster paste Satisfactory. Condensed milk Do. Salmon and Shrimp paste Do. Salmon and Shrimp paste Do. Camembert cheese A gram-negative proteolytic bacillus was present causing decomposition of the cheese. (E) Nutrition. The routine medical inspection of entrant children in Hampstead to Elementary Schools during the year 1935 demonstrates that 216 or 278 per cent. were classed as "good," 499 or 641 per cent. were "average" and 63 or 81 per cent, were "below normal." The corresponding figures for the County of London were 164 per cent., 779 per cent. and 5 7 per cent. REPORT for the year 1935 of the Public Analyst. H. E. COX, D.Sc., Ph.D. (Lond.), F.I.C. 105 The Laboratory, 11, Billiter Square, London, E.C.3. 7th February, 1936. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, In accordance with custom I beg to submit a short summary of the analytical work which I have carried out as your Borough Analyst under the Food and Drugs Adulteration Act during the year 1935. The number of samples of all kinds examined was 502. It included a very wide range of edible products of all kinds including a number of medicinal preparations. The following summary shows the nrincinal materials:— Milk 164 Cream 9 Butter 44 Margarine 38 Lard and Lard Substitutes 14 Cheese 19 Dripping 12 Condensed Milk 6 Coffee 10 Cocoa 14 Tea 6 Jams and Jellies 15 Honey 6 Sausages and Meats 9 Cereals 16 Vinegar 6 Pepper 10 Sugar 9 Bread and Butter 4 Canned Meats, Fish and Fish Pastes 19 Wines, Beer and Spirits 11 Chocolate Rolls 3 Canned or Dried Fruits or Vegetables 13 Sauces, Spices and Pickles 12 106 There have been no changes during the year in the Law or Regulations relating to the composition of food, although several matters have evidently received the attention of the Ministry of Health and some interesting publications have been issued relating, for example, to the presence of aluminium in food stuffs and to the methods which are useful for the investigation of cases of food poisoning. The general question of the occurrence and importance of traces of various substances in foods has received a good deal of attention and refinements in methods of analysis have brought about an extension of our knowledge in this direction, but with the result that it is now known that traces of all kinds of unexpected substances occur in unexpected places, often from natural sources, and we do not know whether their presence is beneficial, negligible or deleterious, though in some cases it may be suspected that they play a part in the normal physiological processes either of the animal or plant concerned. When commenting on the samples examined in Hampstead it is necessary to preface one's observations with the general statement that the quality is good and adulteration is rare, many of the matters noticed being but minor breaches of Regulations. It is necessary to point out this because my reports somewhat inevitably tend to dwell upon the breaches of Regulations rather than on the much greater number of good materials. Milk occupies a considerable place in the list of samples; the average composition is quite good, viz.:— Total milk solids 12.32 per cent. Fat 3.52 Solids not fat 8.80 „ One sample contained 23 per cent. of added water with a further deficiency of fat of 11 per cent. Two were deficient in fat to the extent of 57 per cent. and 9 per cent. respectively, and a third was slightly deficient. Two instances of deficiency of non-fatty solids have occurred, but I was unable to confirm the presence of added water, so they were passed as genuine. Of the Butters and Margarines, three contained excessive proportions of water; none were adulterated with foreign fats, but the same happy result does not always follow when your Inspectors visit a restaurant and ask for Bread and Butter, for in two out of four cases when they did so, they received bread and 107 margarine. Of the Wines and Spirits examined, only one—a specimen of Rum—contained added water. Some attention has been given lately to the composition of Chocolate Swiss Rolls. It is, perhaps, difficult to prescribe what such compounds should contain. Indeed it may not even be desirable to do so, but it would be agreed that they should contain some reasonable proportion of chocolate and not be merely dyed. Methods have been devised for the proximate determination of chocolate in such commodities. One such sample was submitted as "Chocolate and Cream Roll." This was found to be wholly devoid both of chocolate and of cream. Two other samples of Chocolate Swiss Roll likewise contained such small proportions of cocoa that I was of opinion that they were improperly so described. It may be hoped that there will be some improvement in this connection. It is increasingly necessary to examine materials for metallic contamination. Indeed, there is a general tendency for the amount of work which needs to be done on any particular sample constantly to increase. One brand of Tomato Puree was found to be contaminated both with copper and with tin, the figures being in excess of the usually accepted limits. A sauce also showed evidence of some slight contamination with copper which is usually found to be derived from copper or brass sieves or other utensils. Two Pearl Barleys were found to contain small quantities of talc added for facing purposes. This practice is unnecessary and undesirable and is being discouraged. A number of samples of sugar have been examined, following a report that some seriously contaminated sugar was distributed. None of it could be found within the Borough. It will be seen that apart from the few cases of deliberate adulteration, the majority of offences which come to our notice are due to some dereliction of duty on the part of manufacturers or wholesalers rather than the retailers. It is perhaps unavoidable that the development of new methods and new commodities tend to change the composition of various foodstuffs and stress of competition tends to deteriorate them. A difficult, yet most necessary part of the duty of 108 the Public Analyst is to watch such matters and where necessary to call attention to any depreciation of quality or composition which may appear to be to the prejudice of the health or pocket of the purchaser. The total number of samples reported as adulterated was 17, which is equivalent to 3 39 per cent, of those received. I have the honour to remain, Your obedient servant, (Signed) H. E. COX, Borough Analyst. Section 7. Prevalence of, and Control over, Infectious and other Diseases. Ill Prevalence of, and Control over, Infectious and other Diseases. Acute Polio-Myelitis. One case of acute polio-myelitis was notified during the year. It occurred in a schoolboy, aged 13 years, who had a severe attack, with some resulting palsy of his spinal muscles evidenced by scoliosis. He was subsequently admitted to the Royal National Orthopaedic Hospital at Stanmore for rest and re-education of his spinal muscles. Cerebro-Spinal Fever. Three cases of cerebro-spinal fever were notified in the Borough during 1935. Two of the cases were in males aged 5 and 22 years, and one in a girl of 12 years. Unfortunately two of the cases proved fatal within a few days of onset of illness, whilst the third case responded to intrathecal administration of serum, and recovered. Diphtheria. During the year there were 62 cases of diphtheria and no deaths, as compared with 122 cases and 8 deaths in the previous year. The morbidity rate was 07 per 1,000 of the population. All cases, with four exceptions, were removed to hospital. Immunisation. The campaign directed towards the encouragement of immunisation against Diphtheria has been further developed during the year. The practice of immunisation first received active recognition by the Council in June, 1933, when authority was given for the necessary material for immunisation to be provided free of charge for use in the Borough by general medical practitioners. In May, 1934, a further step was taken when permission was given for free immunisation in necessitous cases to be carried out at the Toddlers' Clinic. •In October, 1934, the Council of the Metropolitan Counties Branch of the British Medical Association passed a resoluiion to the eifect that facilities for immunisation against diphtheria should be available to the public through their medical practitioners without 112 ance at any particular Clinic. As will be seen, this was the policy already being pursued in Hampstead. Having formed the opinion that the time was ripe for our arrangements to be yet further developed, I advised the Public Health Committee that the Scheme at present in operation should be augmented, and as and from the 1st of April, 1935, should be as follows:— 1.—The Borough Council to pay a fee of 7s. 6d. to general practitioners for each child completely immunised, and to provide the immunising material free of charge, the practitioner to give the child three injections at weekly intervals, and to enter the necessary particulars on a record card, which card will act as the account for his fees, which will be paid quarterly. The whole of the responsibility for the administration of the injections to be placed on the practitioner, who is to be responsible for any subsequent medical attention necessary, etc. 2.—The Borough Council to arrange for the attendance of a doctor at a Special Clinic as occasion demands (probably fortnightly) to perform the final Schick test, and also to immunise free of charge those patients who either have no family practitioner or whose family practitioner does not wish to participate in the Borough Scheme. These measures were duly approved by the Council. During the year 295 children have been immunised under our Schemes by their private doctor, and 208 at the Council's Clinic, where 130 were also subsequently Schick tested. All these latter gave a negative result with one exception. Encephalitis Lcthargica. No case of this disease was notified during the year. Dysentery. There were no less than ten cases of dysentery notified throughout the year. They were all of the Sonne type and very mild in nature, and all cases made an uninterrupted recovery. . Of the ten Hampstead cases, five occurred in a General Hospital in the Borough, and in addition eight cases were notified of nonHampstead residents in this Hospital. 113 I append an extract from the last Annual Report of the Chief Medical Officer:— "Owing to its great infectivity and its fatality to infants in the first months of their existence, every care should be taken in children's wards to see that the normal routine of nursing and feeding of the children is above reproach. Among obvious precautions are : that the wards shall contain only small numbers of children, that nurses shall wear gowns and wash their hands after attending one patient and before going to the next, that no nurse shall both feed and change an infant and that everything coming into contact with a patient shall be kept separate from other patients. The only certain way of avoiding the spread of dysentery is, as has been indicated, to prevent its entry into the ward. No child with diarrhoea should be admitted direct into a general ward, but should be placed in an observation ward until it is clear that the child is not suffering from dysentery. The faeces should be examined for specific bacteria if there is blood or mucus in the stools, but it must be remembered that bacteriological diagnosis is not always easy, especially in cases which have been ill for some days. It is better, therefore, to err on the side of caution and, if the patient appears clinically to be suffering from dysentery, to keep the patient isolated from other children, even though confirmatory bacteriological evidence of the diagnosis is lacking." Enteric Fever. Five cases of enteric fever were notified during the year, none of which proved fatal. In three of the cases the bacillus typhosis was isolated, and in the remaining two, bacillus paratyphosis B. Investigation as to the possible source of origin was made in all cases, but apart from one case, in which the infection was contracted in Germany, no great satisfaction was obtained. Four of the cases occurred in adults, whilst the fifth occurred in a girl of two-and-a-half years. Malaria. Two cases of malaria were notified during 1935. They were both of the sub-tertian type, and occurred in males aged 26 years and 30 years. In both instances the infection had been contracted abroad, 114 Measles. During the year forty cases were notified, of which 14 were removed to hospital. The ward allocation of the cases was as follows:— Ward No. 1 (Town) 3 Ward No. 2 (Belsize) 7 Ward No. 3 (Adelaide) 6 Ward No. 4 (Central) 5 Ward No. 5 (West End) 4 Ward No. 6 (Kilburn) 7 Ward No. 7 (Priory) 8 No case terminated fatally. Pneumonia. During the year 81 cases of pneumonia were notified. Of these 63 were of acute primary pneumonia and 18 cases of acute influenzal pneumonia. The total deaths were 29, of which 23 occurred in persons over 45 year of age. The age of the patient would appear to be the most important factor of mortality. Scarlet Fever. During the year 112 cases of scarlet fever were notified (cf. 194 in 1934, and 451 in 1933). This disease continues to be of a mild type and no case terminated fatally. 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. 115 Notifiable Diseases during the Year 1935. NOTIFIABLE DISEASES. * Total cases notified in age-periods. *Total cases notified in each Ward. * Cases admitted to Hospital. Total deaths in age-periods. At all Ages. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No 3 (Adelaide). 1 Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). At all Ages. At Ages—Years. Under 1. 1 and i 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. Under 1. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Cerebro spinal Fever 3 .. .. .. .. .. 1 1 .. 1 .. .. .. 2 1 .. .. .. .. .. 2 2 .. .. .. .. .. .. 1 .. 1 .. .. .. Diphtheria 62 1 4 5 2 3 19 10 5 10 2 1 .. 3 18 3 5 11 14 8 58 .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery 10 .. .. .. 2 .. 3 2 .. 3 .. .. .. .. 4 1 1 3 1 .. 9 .. .. .. .. .. .. .. .. .. .. .. .. .. Encephalitis Le thargica .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 35 2 .. .. .. .. 3 l 1 5 8 10 5 6 6 8 2 3 7 3 23 2 .. .. .. .. .. .. .. .. .. .. .. .. Malaria 2 .. .. .. .. .. .. .. .. 2 .. .. .. .. 1 1 .. .. .. .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 15 15 .. .. .. .. .. .. .. .. .. .. .. .. 4 2 .. 1 6 2 9 .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 81 2 1 .. 2 4 7 2 .. 12 12 26 13 11 26 13 6 8 11 6 44 29 2 .. .. .. .. .. .. .. 1 2 18 6 Polio Myelitis 1 .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. .. 1 .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 2 .. .. .. .. .. .. .. .. 1 1 .. .. .. .. .. .. .. .. 2 2 1 .. .. .. .. .. .. .. .. 1 .. .. .. Puerperal Pyrexia 18 .. .. .. .. .. .. .. 1 16 1 .. .. 2 1 .. 2 1 4 5 15 .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 112 .. 2 5 6 8 37 12 12 25 5 .. .. 9 20 10 19 23 23 13 99 .. .. .. .. .. .. .. .. .. .. .. .. .. Typhoid Fever 5 .. .. 1 .. .. .. .. .. 2 1 1 .. 2 1 .. 1 1 .. .. 4 .. .. .. .. .. .. .. .. .. .. .. .. .. † Measles 40 3 2 1 2 1 11 .. 33 9 1 .. .. 3 7 6 5 4 7 8 14 .. .. .. .. .. .. .. .. .. .. .. .. .. ‡ Tuberculosis 81 .. .. 1 1 .. 4 1 11 36 8 14 5 8 15 9 10 11 21 7 63 38 .. .. 1 .. .... 1 • • 3 12 7 8 6 Totals 467 23 9 13 15 16 85 37 33 122 39 52 23 46 104 51 51 67 94 54 345 72 2 .. 1 .. .. 1 1 3 15 9 26 14 * Cancelled cases have not been included. † Notifiable under the Borough of Hampstead (Measles) Regulations, 1920. ‡ Statistics relating to Tuberculosis are given in subsequent pages. 116 Cancer. Hospital Beds. The Borough possesses two endowed beds at the Mount Vernon Hospital for Cancer at Northwood, Middlesex. Letters of admission to these beds are issued by His Worship the Mayor. Radium. Radium is used at the Marie Curie Hospital, 2, Fitzjohn's Avenue, and at the Westminster Hospital Annexe, 66, Fitzjohn's Avenue. Hospital Accommodation. During the year, 282 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 are carried out by the Laboratories of Pathology and Public Health, 6, Harley Street, W.l. The following is a summary of the work carried out during the year 1935:— Total. Diphtheria 576 Typhoid Fever 1 Dysentery 1 Scarlet Fever (for Hæm. Strep.) 46 Specimens of Sputum 182 X-ray examinations made 85 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. In consequence of alleged nuisance to adjoining premises from smoke and fumes, difficulty had been experienced in connection with 117 the use of the Furnace for destroying bedding, etc., situated in one of the buildings at the rear of the main structure of the Station. During 1934 the chimney became seriously cracked and had to be demolished. The Public Health Committee, therefore, decided to convert into an incinerator a small building formerly used in connection with the old Cleansing Station in the Electricity Yard. This improvement was effected during the year and the new incinerator was brought into use on 15th January, 1936. 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. Two Motor Vans are employed in the collection of infected or infested material and its subsequent return. The following is a record of the work carried out by the Disinfecting Staff during 1935:— Number of houses or parts of houses and contents disinfected 1,236 „ verminous rooms disinfested 34 „ „ articles of clothing disinfested *69 „ „ beds disinfested 77 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 — Children 704 Scabies. Adults 41 Children 116 118 Whilst the cleansings and baths are in progress, the persons' clothing is thoroughly disinfected by being passed through the disinfecting apparatus. During the year, the Council's disinfectors disinfested 34 verminous rooms and contents, and, in addition, as a result of the action of the Sanitary Inspectors, 187 verminous rooms in 91 houses and 16 sets of beds and bedding were also cleansed and freed from vermin. Action taken with regard to the disinfestation of the effects of families removed to the Westcroft Housing Estate will be found in the Section of this Report relating to Housing. 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 i. 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 1935, 81 new cases of Tuberculosis were notified, 63 being cases of Pulmonary Tuberculosis, and 18 other forms of the disease. There were three deaths of persons certified dufing the year as due to tuberculosis, who had not previously been notified. The total number of deaths from tuberculosis was 38 and the ratio of nonnotified tuberculosis deaths to the total tuberculosis deaths was, therefore, 1 in 13. 119 The following statistical table, prescribed by the Ministry of Health, gives an analysis of the newly notified cases and deaths during 1935:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0- - - - - - - - - 1- - 1 1 - - - 1 - 5- - - 3 2 - - - 1 15- 3 13 2 3 2 2 2 1 25- 6 16 1 3 3 4 - 1 35- 5 2 - 1 4 2 - 1 45- 4 2 - 2 - 3 - - 55- 5 1 - - 4 1 - - 65 and upwards 4 1 - - 3 1 2 - Totals 27 36 7 11 16 13 5 4 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 63 cases of Pulmonary Tuberculosis newly notified in 1935:- 29 were treated at Sanatoria. 4 „ „ Hospitals. 13 „ „ L.C.C. Hospitals. Of the 18 cases of Non-Pulmonary Tuberculosis newly notified in 1935:- 5 were treated at Sanatoria. 6 „ „ Hospitals. 4 „ „ L.C.C. Hospitals. The following cases, notified prior to 1935, were also removed:- Pulmonary. Non-Pulmonary. Insured. Non- Insured. NonInsured. Insured. To Sanatoria. 1 5 — — To Hospitals — — — 1 To L.C.C. Hospitals 5 — — — The following cases, notified prior to 1935, were also removed:- Pulmonary. Non-Pulmonary. Insured. NonInsured. Insured. NonInsured. To Sanatoria l 5 - - To Hospitals - - - l To L.C.C. Hospitals 5 — - - 120 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 nine 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 1935 totalled 440 —340 pulmonary and 100 non-pulmonary. Tuberculosis Regulations, 1930. Pulmonary. Non-Pulmonary. Totals. Males. Females. Males. Females. Males. Females. Number of cases on the Register at the commencement of the year 1935 172 175 44 44 216 219 Number of cases notified under the Regulations for the first time during the year 28 37 7 11 35 48 Number of cases removed from the Register in a preceding year which have been restored to the Register during the year — 6 — 1 — 7 Number of cases brought under notice otherwise than by notification during the year 13 13 1 5 14 18 213 231 52 61 265 292 *Number of cases removed from the Register during the year 55 49 5 8 60 57 Number of cases remaining on the Register at the end of the year 158 182 47 53 205 235 *These consist of cases which have been denotified, and those which have died or removed from the Borough. 121 Deaths. The number of deaths from Tuberculosis in 1935 was 38; of these 29 were due to pulmonary tuberculosis and 9 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 were in operation for patients under Dispensary supervision to be X-rayed at the Hampstead General Hospital. There were 85 such examinations made during 1935. Pathological Examinations of Sputum. This work is undertaken for the Council by the Laboratories of Pathology and Public Health, 6, Harley Street, W.1, and the facility is available, free of charge, for medical practitioners. During the year 112 specimens were submitted for examination by local practitioners and in addition 70 specimens were also sent by the Tuberculosis Medical Officer. Artificial Pneumo-thorax. Arrangements were made for patients to receive this treatment at Brompton, Victoria Park, St. Mary's, Colindale and University College Hospitals. During the year 1935, there were 21 patients referred to these hospitals entailing 225 attendances. A continued increase in this mode of treatment is apparent. 122 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. During the year one patient made three attendances for this treatment. Dental Treatment. Dental treatment for tuberculous patients is given by arrangement with the British Dental Hospital. Patients in need of dental aid may obtain treatment at this Hospital, 31, Camden Road, N.W.1, on Wednesdays at 11 a.m. During the year, three patients attended and the total attendances were eight. Finsen-Light Treatment. During 1935, one Dispensary patient made 48 attendances at a Light Treatment Centre for Finsen-Light Treatment, the Council paying a fee per attendance. 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. The Borough Council also supply on loan single beds and bedding in order to effect the separation of infectious cases of Tuberculosis. Public Health (Prevention of Tuberculosis) Regulations, 1925. No person suffering from Tuberculosis of the respiratory tract, and being in an infectious state, may work in connection with a dairy which would involve milking, treatment of milk, or handling milk vessels. No case arose during the year necessitating action to be taken under these Regulations. Tuberculosis Care Committee. The Borough Council makes a grant of £100 per annum towards the administrative expenses of the voluntary Care Committee, and is represented upon it by Mr. Alderman H. Baily, M.B.E., Councillor Mrs. M. F. Dow, M.A., and Councillor Mrs. C. E. Samuel, M.A., M.B.E. 123 The Committee, through its Secretary, Miss Talbot Kelly, keeps in touch with the family whilst the patient is in sanatoria, and their conditions and prospects receive consideration upon discharge. Details of the work carried out by the Committee during the year are tabulated below:— Cases reviewed 253 New cases (included in above) 78 Interviews with patients by Care Committee Secretary:— (a) At homes of patients 97 (b) Otherwise 566 Cases referred to the Hampstead Borough Council:— (a) For extra nourishment 17 (b) For dental treatment 2 Cases referred to the Public Assistance Committee 19 Cases referred to Service Funds 6 Cases referred to Voluntary Associations 20 Cases referred to other Agencies 16 Cases helped directly through the Care Committee:— (a) In cash 32 (b) In clothing 14 Provision of Extra Nourishment. The Council has voted the sum of £45 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 19 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, 198 sessions were held, and 188 new cases (of which 63 were contacts) were examined. The total attendances of all kinds numbered 936, an average of 4.7 per session, 124 Tuberculosis Scheme of the Hampstead Metropolitan Borough Council. Return showing the work of the Dispensary during the year 1935. 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 18 16 - 1 2 7 3 2 20 23 3 3 49 (b) Doubtfully tuberculous - - — — — - — - — 2 2 1 5 (c) Non-tuberculous — — — — — — — — 17 44 4 6 71 B.—Contacts examined during the year:— (a) Definitely tuberculous — 1 — — — — — — — 1 — — 1 (b) Doubtfully tuberculous — — — — — — — — — 1 — — 1 (c) Non-tuberculous — — — — — — — — 8 23 15 15 61 C.—Cases written off the Dispensary Register as:— (a) Recovered 3 5 — 2 — 1 1 — 3 6 1 2 12 (b) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) - - - - - - - - 25 67 19 21 132 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 81 81 8 2 6 19 14 7 87 100 22 9 218 (b) Diagnosis not completed — — — — — — — — 1 3 2 — 6 Number of persons on Dispensary Register on January 1st 210 Number of patients transferred from other areas and of "lost sight of" cases returned 32 Number of patients transferred to other areas and cases "lost sight of" 43 Died during the year 19 Number of attendances at the Dispensary (including Contacts) 936 Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1223 Number of consultations with medical practitioners:— (а) Personal 10 (b) Other 94 Number of visits by Tuberculosis Officer to Homes (including sonal consultations) 18 Number of:— (a) Specimens of sputum, &c., examined 70 (b) X-ray examinations made in connection with Dispensary work 85 Number of Insured Persons under Domiciliary Treatment on the 31st December 27 Number of "Recovered" cases restored to Dispensary Register, and included—in A (a) and A (b) above — Number of "T.B. plus" cases on Dispensary Register on December 31st 115 125 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 1935 188 42 63 936 Vaccination. The 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, 1934 1461 2. Number of these:— (a) Successfully vaccinated 855 (b) Insusceptible of Vaccination 6 (c) Had Smallpox - (d) Number in respect of whom Statutory Declarations of conscientious objection have been received 319 (e) Died unvaccinated 47 126 3. Number of these Births which on 31st January, 1936, remained unentered in the "Vaccination Register " on account of:— (a) Postponement by Medical Certificate 11 (b) Removal to Districts the Vaccination Officers of which have been duly apprised 151 (c) Removal to places unknown, or which cannot be reached; and cases not having been found 59 4. Number of these Births remaining on 31st January, 1936, neither duly entered in the "Vaccination Register" under headings numbered 2 nor temporarily accounted for in the "Report Book" under headings numbered 3 13 5. Total number of Certificates of successful primary vaccination of children under 14 received during the Calendar year 1935 (including any relating to births registered in previous years) 1005 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 1935 343 7. Number of cases of children in entries 1 and 2 (d) successfully vaccinated after the declaration of conscientious objection had been made - 8. Total number of Certificates for the year 1935 of successful primary vaccination of which copies have been sent to Vaccination Officers 140 It will be seen from the foregoing figures, that approximately 62 per cent. of the children born in Hampstead during 1934 had been vaccinated by the end of the year under review. This figure compares with 37 per cent. for England and Wales and 46 per cent. for London. 127 INDEX. PAGE. Adulteration, etc. 98 Agricultural Produce (Grading and Marking) Act, 1928 96 Ambulance Facilities 21, 52 Analyst, Public, Report of 105 Analytical Work 98 Ante-Natal Clinics 41 Anti-toxin (Diphtheria) 111 Area of Borough 11 Artificial Cream Act, 1929 100 Artificial Pneumo-thorax 121 Bacteriological Examinations 93, 105, 116 Bakehouses 96 Bathing Station 117 Baths and Pools 72 Beauchamp Lodge, Paddington 54 Births 36 Bug infestation of houses 69 Butter Factories 96 Cancer 116 Care Committee (see Tuberculosis). Cerebro-Spinal Fever 111 Chemical and Bacteriological Examination of Food 100 Child Mortality 37 Children's Hospital, College Crescent 52 Cleansing of verminous houses, persons, etc. 117 Cleansing Station (see Bathing Station). Clearance Areas 83 Clinics and Treatment Centres 22, 42, 46 Closing Orders 80, 82 Common Lodging Houses 65 Compensation to Midwives 56 Complaints Received 63 Condensed Milk 100 Consulting Obstetricians 56 Consumption (see Tuberculosis). Convalescent Homes, etc. 54 Cooked Meat 96 County Council Housing Estates 81 Cowhouses 96 128 PAGE Creches (see Day Nurseries). Cricklewood Housing Scheme 84 Gross Roads Club, 88, Alexandra Road 55 Day Nurseries 56 Deaths 11, 16, 38, 121 Dental Clinics, etc. 48 "Diamond Jubilee" Beds 116 Diphtheria, Anti-toxin, and Immunisation 111 Disinfection 117 Drainage Bye-laws 64 Dried Milk 100 Dysentery 112 Encephalitis Lethargica 112 Enteric Fever 113 Epidemic Diarrhœa 22 Erysipelas 115 Factory and Workshop Acts 66, 68 Factories 67, 96 Finsen Light Treatment 122 Fairfax Place and Yard 84 Food, Bacteriological Examination 105 Food and Drugs (Adulteration) Act, 1928 98 Food and Food Premises 96 Food and Milk for Mothers and Infants 47 Food, Inspection and Supervision of 96 Food Poisoning 97 Food, Preservatives in 100 Food, Unsound 98 Foster Children and Foster Mothers 55 Foster Home, 33, Fitzjohn's Avenue 55 Fried Fish Shops 96 Hampstead Council of Social Welfare 46 Hampstead General Hospital, Borough Beds 23 Hampstead Hospital for Children 23, 52 Hampstead Hostel for Mothers and Babies 55 Hampstead Housing Association 85 Hampstead and North St. Pancras Day Nursery 56 Hampstead Swimming Pond 72 Health Education and Propaganda 41 Health Services 21 Health Visitors and Work of 40 Home Helps 57 Home Office Tables (Factory and Workshop Act, 1901) 66 Home Nursing 21, 122 Home Workers 68 129 PAGE. Hospitals 22 Hospital accommodation 116 Hospital Beds, Borough Jubilee Beds 116 Hospital Milk Supply 93 Houses, Inhabited, number of 11 Houses Let in Lodgings (see Tenement Houses, etc.). Housing Act, 1935 85 Housing Committee 3 Housing Conditions where births occurred 39 Housing "Representations", etc. 82 Housing Section 79 Ice Cream 96 Illegimate Children 36 Immunisation, Diphtheria 111 Imported Foodstuffs 95 Improper Mixing of Sexes 88 Infant Life Protection 58 Infant Welfare Centres 46 Infantile Mortality 17, 37 Infectious Diseases 111, 115 Inspections and Re-inspections 63 Inspection and Supervision of Food 93 Institutions for Unmarried Mothers and for Infants 55 Invalid Children's Aid Association 57 Laboratory Facilities 21 Legal Proceedings 73 Main Memorial Home 55 Margarine, Wholesale Dealers 96, 97 Malaria 113 Maternal Mortality 38, 56 Maternity and Child Welfare 27 Maternity and Child Welfare Centres 46 Maternity and Child Welfare Committee 3 Maternity Beds 52 Maternity Clinics (see Ante-Natal Clinics). Maternity Outfits 58 Measles 114 Meat and other Foods 95 Medical Investigation Sub-Committee 52 Merchandise Marks Act, 1926 97 Meteorology 12 Midwives and Midwifery Nursing 56 Milk and Dairies Acts, 1915 94 Milk and Dairies Order, 1926 94 130 PAGE. Milk and Food for Mothers and Infants 47 Milk, Bacteriological Examination 93 Milk, Condensed or Dried 100 Milk (Special Designations) Order, 1923 95 Milk for School Children 94 Milk, Pasteurised 93 Milk Supply 93 Mortuary, Public 74 Mount Vernon Hospital, Borough Beds 116 Municipal Dwellings 82 New End Area 83 New End Hospital 52 Notification of Births Act, 1907 39 Nursing in the Home 21 Nutrition 101 Offensive Trades 66 Officials, Public Health 4 Ophthalmia Neonatorum 32, 115 Outworkers (see Home Workers). Overcrowding (survey, etc) 85 Park Dwellings 82 Pasteurised Milk 93 Pathological Examinations of Sputum 121 Pharmacy and Poisons Act, 1933 74 Pneumonia, Acute Primary and Acute Influenzal 114 Polio-Myelitis 111 Population 14 Population, Natural Increase of 6 Poultry Slaughterhouses 96 Pro-Maternity Clinics (see Ante-Natal Clinics). Preservatives, &c., in Food Regulations, 1925 to 1927 100 Public Health Committee 3 Public Health Station 116 Public Health (Tuberculosis) Regulations, 1925, 1930 122 Public Vaccinators 4 Puerperal Fever and Pyrexia 44, 115 Puerperal Sepsis 11, 53 Queen Charlotte's Hospital 52 Queen Mary's Maternity Home, Heath Street 52 Rag and Bone Dealers 65 Rats and Mice (Destruction) Act, 1919 68 Ray-Therapy 47 Rent Restriction Acts 66 Restaurant Kitchens 96 St. Agatha's House 55 Sale of Food Order, 1921 95 Sanitary Inspectors, Work of 63 131 PAGE. Sanatorium Treatment 119 Sanocrysin Injections 122 Scabies 117 Scarlet Fever and Immunisation 114 School Children, Milk for 94 School Entrants and School Medical Inspection 49 Seamen's Lodging Houses 65 Shelter 118 Shops Act, 1934 69 Slaughterhouses 95 Smoke Abatement 64 South End Close 82 Special Children 47 Staff of the Public Health Department 4 Stalls and Street Traders 97 Statistics and Social Conditions of Borough 11 Still Births 37 Street Traders 97 Student Health Visitors 41 Survey re Overcrowding 85 Swimming Baths and Pools 70, 72 Tenement Houses and Bye-laws 64, 65 Toddlers' Clinics 47 Treatment Centres 22, 42, 46 Tuberculosis 118 Tuberculosis Care Committee 122 Tuberculosis Dental Clinic 122 Tuberculosis Dispensary 121, 123 Tuberculosis Regulations, 1925, 1930 120 Tuberculous Patients, Extra Nourishment for 123 Underground Rooms 80 Unemployment 11 Unmarried Mothers 55 Unsound Food and Food Inspection 95 Vaccination and Vaccination Order, 1930 125 Vaccination Officer 4 Venereal Diseases, Clinics and Treatment Centres 114 Verminous Persons and Premises, etc. 69 Vital Statistics 11, 14 Water Supply of Tenement Houses 65 Welfare Centres 46 Westcroft Estate 7, 84 Whooping Cough 33 Workshops (see Factory and Workshops Acts). X-ray Work 121 Young Children, Mortality among 37 Distribution of working-class families in relation to size of family and size of dwelling occupied. Size of family ("equivalent number" of persons) Size of dwelling occupied, in terms of the maximum "equivalent number" of persons permitted to occupy it without causing it to be overcrowded. Totals of Families. *0 *½ 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 9½ 10 10½ 11 11½ 12 12½ 13 & over Overcrowded. Not Overcrowded. Total. 1 1 - - 2,675 13 823 6 - 595 - - - 204 - - - 65 - 4 26 - - 11 - - - 19 1 4,441 4,442 1½ - - 1 1 10 20 1 - 13 - - - 4 - - - 2 - - - - - - - - - - 1 51 52 2 1 - 2 - †294 1,529 99 - 2,309 3 9 1 872 - 1 — 319 _ - 170 - - 76 - 1 - 39 †5 5,720 5,725 2½ - - - 32 9 2 250 3 658 2 15 - 190 - - 2 83 - - 26 - - 10 - - - 4 41 1,245 1,286 3 - - - 12 6 3 262 - 1,074 10 54 - 732 - - 7 354 - - 218 2 - 122 - - - 84 21 2,919 2,940 3½ - - - - - 69 9 - 202 - 26 - 137 - - - 89 - - 33 1 - 20 - - - 11 78 519 597 4 - - - 1 - 70 21 3 7 26 228 3 411 9 5 19 223 - - 180 - - 92 - 1 - 76 95 1,280 1,375 4½ - - - - - 14 2 - 1 5 44 - 64 2 - 3 49 - - 31 - - 22 - - - 7 17 227 244 5 - - - - - 34 4 - 3 6 78 3 147 6 3 8 107 - - 98 1 - 50 - 1 - 62 47 564 611 5½ - - - - - 3 - - 22 2 9 - 39 1 2 2 19 - - 20 - - 12 - 1 - 20 36 116 152 6 - - - - - 2 1 - 32 1 12 3 7 1 6 28 37 1 - 49 1 - 29 - 1 - 34 51 194 245 6½ - - - - - 4 - - 10 - - - - 1 - 5 10 - - 10 - - 3 - - - 6 14 35 49 7 - - - - - 1 1 - 16 2 1 - - 1 3 8 19 1 - 20 - - 19 - - - 28 22 98 120 7½ - - - - - - - - 1 - - - - - - 1 4 - 1 4 1 1 2 - - - - 1 14 15 8 - - - - - - - - 3 - - - 3 1 1 1 - 1 2 8 2 - 5 - - - 8 9 26 35 8½ - - - - - - - - - - - - 3 - - - - - - 1 - - - - - - 3 3 4 7 9 - - - - - - - - 1 - - - 1 - - - - - - 1 1 - 3 - - 1 2 6 8 9½ - - - - - - - - 1 - - - 1 - - - - - - - - - 2 - - 1 2 2 5 7 10 - - - - - - - - - -- - - 2 - - - - - 1 - 1 - - - - - 3 3 4 7 10½ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 11½ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12½ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 13 & over - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - TOTALS OF DWELLINGS OVERCROWDEO 2 - 3 45 †17 200 38 3 90 11 22 3 10 2 1 1 - - 1 - - - - - - - - †449 NOT OVER CROWDED - - - 2,676 315 2,374 618 3 4,858 46 454 7 2,807 20 20 83 1,380 3 7 895 10 1 478 - 5 1 407 17,468 TOTAL 2 - 3 2,721 332 2,574 656 6 4,948 57 476 10 2,817 22 21 84 1,380 3 8 895 10 1 478 - 5 1 407 17,917 * O=a dwelling of 1 room under 50 square feet:½ = a dwelling of 1 room between 50 and 70 square feet. † Including 2 families with insufficient accommodation to secure proper sex separation and for that reason overcrowded.