C 4351 M HAMP 37 THE Metropolitam Brough of Hampstead. REPORT for the year 1936 OF THE Medical Officer of Health. H. LESLIE OLDERSHAW. M.D. State Medicine (Lond.), B.S., D.P.H. Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. Printed by F. P. Lewingdon, 26 & 27, Eversholt Street, N.W.1. THE Metropolitam Brough of Hampstead. REPORT for the year 1936 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 Departmen 4 Other Officers associated with Public Health work 5 Introduction 6—10 SECTION 1.—Statistics and Social Conditions of the Borough 13—19 ,, 2.—General Provision of Health Services in the Borough 23—25 ,, 3.—Maternity and Child Welfiire (including the Report of the Medical Officer of the Ante natal Clinics) 29—67 ,, 4.—Sanitary Circumstances of the Borough 71—86 ,, 5.—Housing 89—99 „ 6.—Inspection and Supervision of Food (including the Report of tho Public Analyst) 103—122 ,, 7.—Prevalence of, and Control over, Infectious and other Diseases (including Tuberculosis) 125—148 INDEX 149-154 3 List of Committees concerned with the work of the Department. His Worship the Mayor (Mr. Councillor Bernard S. Town roe, 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. Councillor Mrs. M. F. Dow, m.a. „ „ W. J. Spriggs. „ „ M. Evans, r.r.c. „ Councillor F. R. Bailey. Mr. Councillor L. G. Glover, „ „ S. A. Boyd, m.s., m.b., m.a., m.d. f.r.c.s. „ „ T. H. Nunn, m.a. Councillor Mrs. R. S. G. Carnegie. ,, ,, 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. Mr. Alderman R. H. H. Cust, Councillor Mrs. M. F. Dow, m.a. m.a., j.p. Mr. Councillor T. H. Nunn, m.a. Councillor Mrs. A. J. Arnholz. Councillor Miss C. M. Richards. Mr. Councillor S. A. Boyd, m.s., m.b., „ Mrs. C. E. Samuel, f.r.c.s. m.a., m.b.e. Councillor Mrs. R. S. G. Carnegie. „ Mrs. M. Townroe. The Chairman of the Public Health Committee. (Persons not Members of the Council.) (Appointed in pursuance of Section 2 (2) of the Maternity and Child Welfare Act, 1918.) Mrs. J. M. W. Baily, d.sc. Mrs. A. W. Evans. Mrs. J. Gordon. Mrs. E. S. Grundy, m.b.e. Miss G. M. MacDonald. Sub-Committees:—(a) Applications for Assistance, and (d) Child Mortality and Maternal Diseases or Deaths. HOUSING COMMITTEE. Chairman: Mr. Councillor E. H. Parkes, f.r.i.b.a. Mr. Alderman H. Baily, m.b.E. Mr. Councillor L. G. Glover, R. H. H. Cust, m.a., j.p. m.a., m.d. Councillor Mrs. A. J. Arnholz. Councillor Mrs. M. I. Gruner. Mr. Councillor J. Batchelor. Mr. Councillor G. E. Hutchinson, „ ,, F. Colyer. m.a. Councillor Mrs. M. Evans, r.r.c. 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.), i. r.c.p. (Lond.), d.p.h. Assistant Medical Officer of Health and Clinical Tuberculosis Officer: H. Davis Chalke, m.a., m.r.c.s., d.p.h. *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. A. J. Anscomb. R. W. King. 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), (6), (d), (e) Miss M. Lowen (6) (Tuberculosis Visitor and Dispensary Nurse) Miss N. B. May (a), (6), (d). Sanitary Inspectors—A. Peverett (e), (f) (Senior Inspector). J. F. Armstrong (e), (f) J. Grimsley (e), (f) W. F. Horniblow (e), (f) (Retired in April). Miss C. Lambe, (a), (b), (d), (e). F. V. Outlaw (e), (f). W. Robinson (e), (f) L. Rowley (from September), (e), (f). A. C. Townsend (e), (f) E. Wall (from December), (c), (f). T. Williams (e), (f) (Resigned in October). 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. Morley (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., 308, Finchley Road, N.W.3. (Hampstead 2304.) E. A. Seymour, m.b., b.s. (Lond.), 12, Thurlow Road, N.W.3. (Hampstead 0274.) H. D. Wyse, m.b., b.s. (Lond.), 23, Hilgrove Road, N.W.6. (Primrose 2023.) * Part-time Officers, †Part-time Officers of Council of Social Welfare approved by the Maternity and Child Welfare Committee. (a) Health Visitor's Certificate. (d) State Certified Midwife. lb) State Registered Nurse. (e) Sanitary Inspector's Certificate, (c) General Nursing Certificate. (f) Food Inspector's Certificate. 5 OTHER OFFICERS ASSOCIATED WITH PUBLIC HEALTH WORK, 1936. District Medical Officers (London County Council): Dr. E. A. Seymour, 12, Thurlow Road, N.W.3. (Hampstead 0274.) Dr. H. V. Williams, 46, Iverson Road, N.W.6. (Maida Vale 1009.) Relieving Officer: S. R. Meech, 46, Iverson Road, N.W.6 (Maida Vale 1009, and New End, N.W.3 (Hampstead 0949). Superintendent Registrar: Norman Tolson, Town Hall, Hampstead, N.W.3. Registrar of Births and Deaths: A. E. Griffiths, Town Hall, Hampstead, N.W.3. Daily 9-12; Mondays, Wednesdays, Thursdays, 2-4 (and at Health Institute, 107, Kingsgate Road, N.W.6, Tuesdays 7-8 p.m.). Registrar of Marriages: Edward Best, Town Hall, Hampstead, N.W.3. Certifying Surgeon (Factory and Workshop Acts): Dr. C. W. Cooke, 25, Chichele Road, N.W.2. District Surveyor (London Building Act): D. Whyte, a.m.i.struct.e., 305, Finchley Road, N.W.3 (Hampstead 4867). H.M. Inspector of factories for N.W. District: Miss M. O. Anderson, 68-70, Baker Street, W.l (Welbeck 3352). H.M. Coroner: William Bentley Purchase, m.c., m.a., m.b., d.p.h., Coroner's Court and Office, Cambridge Street, N.W.1. Coroner's Officer: Police Constable T. A. Day, Police Station, Rosslyn Hill, N.W.3 (Hampstead 1111). Divisional Medical Officer (School Medical Service): Dr. M. C. Polhill, Hoxton House, Hoxton Street, N.l (Clerkenwell 1892), 6 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. To the Mayor, Aldermen and Councillors ' of the Metropolitan Borough of Hampstead. Mr. Mayor, 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 1936. This report is the thirty-sixth of the series. The report contains the information required by the Ministry of Health and is arranged in accordance with their suggestions. 1. Staff. In consequence of the death of the part-time Tuberculosis Medical Officer, consideration was given to the question of the appointment of a full-time Assistant Medical Officer of Health and Clinical Tuberculosis Officer. It was felt that such an officer, would, in addition to his duties as Clinical Tuberculosis Officer, be able to undertake certain other part-time and sessional appointments which were being performed by various medical practitioners, viz.: Medical Consultant, Clinical Officer for Diphtheria Immunisation, Dental Anesthetist; and further, he could assist the Medical Officer of Health in the control of infectious disease and in consultations with the Health Visitors concerning their Maternity and Child Welfare work. At its meeting in March, 1936, the Council decided that such a full-time Assistant Medical Officer of Health and Clinical Tuberculosis Officer should be appointed, and that, during the absence of the Medical Officer of Health, he should also act as Deputy Medical Officer of Health. Dr. H. Davis Chalke, Tuberculosis Officer to the Dorset County Council, was appointed to the position and commenced his duties on the 1st September. Mr. Horniblow, who had served with great distinction and loyalty as a Sanitary Inspector in Hampstead since 1913, retired 7 on superannuation in April owing to ill-health. Mr. Outlaw, who had been acting as a temporary inspector, was appointed in June in his place. Mr. Rowley, a Sanitary Inspector under the Enfield Urban District Council, was appointed as an additional Inspector in connection with the survey of Underground Rooms and in view of the general increase of work in the Department. He commenced his duties on the 1st of September. Mr. Williams, one of the Sanitary Inspectors, resigned in October on appointment as an Inspector to the Manchester City Corporation. Mr. Wall of the Islington Metropolitan Borough staff was appointed to fill the vacancy and commenced his duties in Hampstead on 1st December, 1936. 2. Statistics. The Registrar General again gave a slight increase in his estimate of the resident population for 1936. As previously reported, Hampstead is one of the two Metropolitan Boroughs showing an increase in population since the 1931 census. The adjusted Death-rate for Hampstead in 1936 was 10.6, which is less than that of any other Metropolitan Borough. Unfortunately, however, I have to report that the Infantile Mortality Rate increased to 66 (c.f. 53, the average for the previous ten years). 3. Local Government and Other Officers' Superannuation Act, 1922. During the year I medically examined 51 new entrants to the Council's service, 19 of whom were officers and 32 were workmen. In addition, 3 officers were certified by me as being incapacitated by reason of permanent ill-health, and were accordingly retired on superannuation allowances. 4. Maternity and Child Welfare. During the year more than 15,000 visits were paid by the Health Visitors to the homes of the mothers, and nearly 2,000 visits were made by the mothers and children to the various clinics established in the Borough. These figures surely speak 8 for themselves as to the extent to which these services are being used and appreciated. At the same time I must point out that much of the clinic work is done in premises which are not entirely satisfactory for the purpose. Many Metropolitan Boroughs have recently acquired premises in keeping with the present day conception of what Public Health Clinics should be. I sincerely hope that the mothers and children of Hampstead will, in like manner, be provided in due course with more appropriate accommodation. A further extension of the Maternity and Child Welfare Service was made during the year. The Borough Council has now arranged for the District Nursing Association to visit toddlers in their homes for the treatment of minor ailments, etc. 5. Housing, ctc. It is pleasing to note that the Kilburn Vale Area, which was first condemned as long ago as 1903 by the then Medical Officer of Health for Hampstead, was the subject of an official representation by the London County Council on the 7th of July, 1936. In conjunction with the officers of the London County Cuncil T prepared detailed evidence for use at the Inquiry, the result of which will be reported in my Annual Report for 1937. Throughout the year the Borough has been most carefully combed with the object of locating land suitable for the erection of working-class dwellings. It has proved an extremely difficult task. Apart from park-land, and railway land (of which there is approximately 50 acres) there is very little unbuilt-on land left in the Borough. I reported to the Housing Committee that there was an immediate need for some 300 dwellings in the Borough, and in April, 1936, the Council decided to take all practicable steps to provide this need. Two larger sites, which would have been adequate for the purpose on hand, proved unobtainable as the owners desired to retain them for their own use. As a consequence there appears to be the prospect of providing only a small quota of the 300 dwellings which the Housing Committee desired. 9 I would like to draw particular attention to the work which is being done in connection with Underground Rooms, and to which detailed reference is made in the body of the report (pages 92-94). It is now illegal for Underground Rooms to be used either for living or for sleeping purposes. These "Cellar Dwellings" (as they were named in the older Acts), situated three feet or more below the level of the adjoining road, are, because of their position, invariably damp, dark and badly ventilated. For the most part they were originally intended as sculleries, store-places, and the like, but as a result of the house being converted into flats, these rooms are called upon for use for living purposes. Surely it is not too much to expect that the incoming tenant should be protected from the dampness, defective natural lighting and ventilation, by the provision of adequate damp-proof courses, concrete over site and areas—as set out in the Regulations approved by the Minister of Health governing Underground Rooms. 5. Prevalence and Control of Infectious Disease. Full details are given in the body of the report on the outbreak of measles which occurred during the year. These outbreaks occur with unfailing regularity every second year, but on this occasion, although including 918 cases, was fortunately in the main, of a milder type, causing only two deaths. Sixteen cases of Enteric Fever (Typhoid) occurred during the year, four of which proved fatal. The importance of the compulsory pasteurisation of milk, and the advantage of preventive inoculation against Typhoid for those contemplating holidaying abroad are referred to on pages 128 and 129. 7. Air Raid Precautions. A comprehensive scheme has been drawn up by the Chief Officers of the Borough Council representing many months of work, with the object of making every possible provision for the safety of the inhabitants of the Borough in case of air raids. The Medical Officer of Health is concerned in particular with that part of the Scheme relating to the provision of First Aid Posts, 10 So far as can he seen at the moment it will he extremely difficult to allocate buildings which can be adapted for use as First Aid Posts at short notice. I am again indebted to Mr. E. L. Hawke, M.A., F.R.M.S., who has very kindly provided me with a brief Metorological Survey of Hampstead for 1936. In presenting this Report I would like to acknowledge my sincere appreciation of the support given me by the members of the Committees which I serve, and by the Chief Officers of the various departments of the Borough Council. Finally it is a pleasing duty to record the loyal and efficient service given throughout the year by all members of my staff. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. LESLIE OLDERSHAW, Medical Officer of Health. Section I Statistics and Social Conditions of the Borough. 13 Statistics and Social Conditions of the Borough. Area (in acres) 2,265 (including 12 acres covered by water). Registrar-General's estimate of resident population, mid-1936 90,700. Number of inhabited houses (end of 1936) according to Rate Books— 9,747 dwelling houses, 2,997 maisonetted and divided houses, 3,872 separate flats. Rateable value (at 6th April, 1936) £1,515,114. Sum represented by a penny rate £6,312 19s. 6d. Social Conditions. Since the conclusion of the War, the changes that had begun to be noticeable in the social conditions in the Borough have been accentuated. Large houses that can no longer be occupied by one family are frequently maisonetted; mansions with large gardens that become vacant are often demolished and the site covered with blocks of flats; houses in certains streets which were formerly occupied by the middle class are now let in lodgings and are registered and periodically inspected under the byelaws relating to tenement houses. A large part of the Borough was built over in the years following 1851—there was for instance an increase in the population during the decade ending 1861 of 59 per cent., and during the decade ending 1871 of 68 per cent. These houses, except those which are kept in good condition and repair and are often occupied by the owner, are naturally requiring more supervision by the Sanitary Staff. This demand must increase with the passing of time, as the houses approach the end of their leases, for there is naturally a disinclination to spend money on property which will be demolished in the near future. The officers of the Public Health Department are therefore called upon to take action in the case of very many houses which would formerly have been beyond such need of control. 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 1936, 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 567 in August to 973 in January, and the unemployed women from 213 in June to 297 in February. Calculated upon the number of 14 insured people in the Borough, the lowest number was 67 per cent. in August and the highest 10 5 in January. Extracts from Vital Statistics of the Year. Total. M. F. Live Births Legitimate 949 499 450 Illegitimate 99 63 36 Birth Rate per 1,000 of the estimated resident population—11.5 Stillbirths 50 25 25 Rate per 1,000 total (live and still) births—45.5. Deaths 1,029 459 571 Crude Death Rate per 1.000 of the estimated resident population—113. Death Rate Comparability Factor (C.F.) = 0.94. Adjusted Death Rate = Crude Death Rate X C.F. = 113 X 0.4 = 10.6. Since the population 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 Rale" of any other area. Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 2 2 Other puerperal causes 1 1 Total 3 3 15 Death Rate of Infants under one year of age:— All infants per 1,000 live births 66 Legitimate infants per 1,000 legitimate live births 60 Illegitimate infants per 1,000 illegitimate live births 121 Deaths from Cancer (all ages) 161 „ Measles (all ages) 2 „ Whooping Cough (all ages) 6 „ Diarrhœa (under 2 years of age) 12 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 1936, which is based on records kept at that Society's Observatory on the top of Hampstead Heath adjoining the White Stone Pond:— "The year 1936 can best be summarised in a few words as exceptionally dull, rather wet, and for the most part cool. Sunshine was deficient in nine of the twelve months. The total duration 1,2392 hours, was short of the twenty-five year average by 239 hours (nearly 40 minutes a day), and was the smallest since registration was begun at the Observatory in 1910. Hitherto the lowest annual total had been 1,262 hours, in 1932. September set up a new record for lack of sun, and March, too, was notably cloudy. Relatively to the normal, December was the brightest month, its 483 sunny hours representing an excess of 37 per cent. Rainfall during 1936 amounted to 27 63 ins. This is about 1½ ins. more than the computed true average for the summit of Hampstead Heath, although it is almost identical with the 1910-1934 average derived from the records kept at the Observatory. That period, it must be remembered, included a high proportion of very wet years. The monthly totals for 1936 ranged from 461 ins. in January, which appears to have been the most rainy since 1877 in Hampstead, to 0.45 ins. in August, which was the driest back to 1910, and probably to 1899. There were 186 days during 1936 on which the gauges yielded measurable quantities of rain, snow, hail, or deposits from dew, rime or wet fog. The normal number of such days is 181. According to the trace of the hyetograph, which does not register precipitation at 16 the rate of less than 0.004 in. an hour, the year's fall was spread over 545.7 hours, or about 3¼ weeks. The monthly durations varied from 86.1 hours in January to 13.1 hours in May. The wettest day of the year was September 20th, with 1.03 in. of rain—the first daily measurement in excess of one inch since August 1st, 1932. The mean temperature of 1936 was 48.5 deg.—a figure 0.5 deg. below the 1910-1934 average. March, June and August were decidedly warm, and February, April and October cold—April exceptionally so. None of the remaining six months showed a noteworthy departure from the normal. On April 23rd the screened thermometer fell to 26 deg., this being the lowest value for so late in the spring since regular observations were started in 1910. Appended are the extreme temperatures for the year:— Maximum in the screen, 84.2 deg., on June 21st. Maximum in the sun's rays, 144.2 deg., on May 15th. Minimum in the screen, 19.5 deg., on February 4th. Minimum on the grass, 11.1 deg., on February 5th. The screen-minimum reading of 19.5 deg. on February 4th had not been equalled or under-passed since March, 1931. Snow was observed on twenty-one days during the year, the ground being covered at 9 a.m. on six occasions. A fall of five inches (undrifted) during the night of January 16.17th, though closely rivalled on January 26-27th, 1935, ranked, so far as the upper part of the Heath was concerned, as the heaviest since the great snowstorm of Christmas night and Boxing Day in 1927. Hail was noted on five days, and thunderstorms (or thunder alone) on seventeen—all of the latter between May 1st and October 31st. Fog, in varying degrees of density, prevailed at 9 a.m. on 25 days, and was observed at some other hour on an additional 31 occasions, making 56 days in all. Ground-frost was registered on the unusually large number of 167 nights; 28 of these occurred in January, 28 in February, 27 in December, and 23 in April—a remarkably high frequency for that month. June 17th, with 14.3 hours' sunshine, was the brightest day of the year. Tempestuous weather characterised the last quarter of 1936. The most violent gale was that of December 14th, when the speed of the wind approached 70 miles an hour during squalls." 17 VITAL STATISTICS. Population. For the purpose of this Report the Registrar-General's estimate of the population at the middle of 1936, which was calculated to have been 90,700, has been adopted. This shows an increase of 1,753, as compared with 88,947 at Census, 1931. The following are estimates of the population of each Ward at the middle of the year under review:— Ward. Estimated Population. No. 1 (Town) 12,620 No. 2 (Belsize) 14,730 No. 3 (Adelaide) 11,300 No. 4 (Central) 10,910 No. 5 (West End) 14,300 No. 6 (Kilburn) 15,300 No. 7 (Priory) 11,540 The Borough 90,700 The following are the statistics for each of the Wards and the Borough:— No. of Deaths. Death Rate. No. 1 (Town) Ward 132 10·5 No. 2 (Belsize „ 167 11·3 No. 3 (Adelaide) ,, 155 13·7 No. 4 (Central) „ 105 9·6 No. 5 (West-End) „ 155 10·8 No. 6 (Kilburn) „ 175 11·4 No. 7 (Priory) „ 140 12·1 The Borough 1,029 11·3 The Death Rates for London and for England and Wales were 12.5 and 12.1 respectively. 18 Age and Sex Allocation of Deaths of Hampstead Residents during the Year 1936. CAUSES OF DEATH Nett deaths at the subjoined ages of " Residents," whether occurring within or without the Borough. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1. Typhoid and Paratyphoid Fevers M ... ... ... ... ... ... ... ... ... ... ... ... F 4 ... ... ... ... 1 1 ... 1 ... 1 ... 2. Measles M 2 ... 2 ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough M 2 1 ... ... 1 ... ... ... ... ... ... ... F 4 2 1 1 ... ... ... ... ... ... ... ... 5. Diphtheria M ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... 1 ... ... ... ... 6. Influenza M 9 1 ... ... ... 1 ... ... ... 4 1 2 F 9 ... ... ... ... ... ... ... 1 ... 6 2 7. Encephalitis Lethargica M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 8. Cerebro-spinal Fever M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 9. Tuberculosis of respiratory system M 15 ... ... ... ... 2 2 2 6 2 1 ... F 17 ... ... ... ... 5 6 2 1 1 2 ... 10. Other Tuberculous Diseases M 5 1 ... 2 1 ... ... ... ... 1 ... ... F 2 1 ... ... ... ... ... ... ... ... 1 ... 11. Syphilis M 1 1 ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... ... 1 ... ... ... 12. General paralysis of the insane, tabes dorsalis M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 13. Cancer, malignant disease M 67 ... ... 1 ... ... 2 2 11 10 20 21 F 94 ... ... ... ... ... 1 6 14 28 25 20 14. Diabetes m 6 ... ... ... ... ... ... ... ... 2 4 ... F 13 ... ... ... ... ... ... 1 1 5 6 15. Cerebral hæmorrhage, & c. M 4 ... ... ... ... ... ... ... 1 1 ... 2 F 20 ... ... ... ... ... ... 2 ... 2 3 13 16. Heart Disease M 119 ... ... ... 1 2 2 3 5 21 36 49 F 169 ... ... ... ... 2 3 1 7 15 36 105 17. Aneurysm M 3 ... ... ... ... ... 1 ... ... 1 1 ... F 6 ... ... ... ... ... 2 ... 2 ... ... 2 18. Other circulatory diseases M 28 ... ... ... ... ... ... ... 2 4 10 12 F 35 ... ... ... ... ... ... 1 2 5 12 15 19. Bronchitis M 6 1 ... ... ... ... ... ... ... 2 1 2 F 13 ... ... ... ... ... ... ... ... 2 2 9 20. Pneumonia (all forms) M 26 3 ... ... ... ... 2 ... 2 3 7 9 F 23 2 ... 1 ... 2 ... 1 2 2 5 8 21. Other Respiratory Diseases m 7 ... ... ... ... 2 1 1 2 ... ... 1 F 6 ... ... ... ... ... ... 1 ... 1 1 3 22. Peptic Ulcer m 9 ... ... ... ... ... ... 1 4 3 1 F 3 ... ... ... ... ... ... 1 2 ... ... 23. Diarrhœa, &c. M 11 7 1 1 ... ... ... ... ... 1 1 ... F 7 4 ... ... ... ... ... 1 ... 1 ... 1 24. Appendicitis M 6 ... ... 2 ... 1 1 2 ... ... ... ... F 3 ... ... ... ... ... ... ... ... 1 1 1 25. Cirrhosis of Liver M 4 ... ... ... ... ... ... ... 2 1 1 ... F ... ... ... ... ... ... ... ... ... ... ... ... 26. Other diseases of liver. &c. M 1 ... ... ... ... ... ... ... 1 ... ... ... F 2 ... ... ... ... ... ... ... ... ... ... 2 27. Other digestive diseases M 13 ... ... ... ... ... 2 ... 2 2 3 4 F 14 ... ... ... 1 ... 2 ... 1 1 4 5 28. Acute and Chronic Nephritis M 9 ... ... ... ... ... ... ... 3 1 4 1 F 20 ... ... ... 1 1 1 ... 1 4 6 6 29. Puerperal Sepsis F 2 ... ... ... ... 1 ... 1 ... ... ... ... 30. Other puerperal causes F 1 .... ... ... ... ... 1 ... ... ... ... ... 31. Congenital Debility, premature birth, malformation, & c. m 25 25 ... ... ... ... ... ... ... ... ... ... F 11 11 ... ... ... ... ... ... ... ... ... ... 32. Senility M 5 ... ... ... ... ... ... ... ... ... ... 5 F 10 ... ... ... ... ... ... ... ... ... ... 10 33. Suicide M 11 ... ... ... ... 2 1 2 1 2 3 ... F 7 ... ... ... ... 1 ... 1 ... 2 3 ... 34. Other violence M 26 3 ... ... 2 5 1 3 1 4 3 4 F 26 3 1 1 l 2 6 2 2 2 3 3 35 Other Defined Diseases M 38 2 ... ... 2 1 1 3 2 7 9 11 F 47 1 ... ... 1 ... 2 5 6 9 7 16 36. Causes ill-defined or unknown M 1 ... ... ... ... ... ... 1 ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... All causes M 459 45 3 6 7 16 16 19 42 73 108 124 F 570 24 2 3 4 15 25 25 43 79 123 227 Totals 1029 69 5 9 11 31 41 44 85 152 231 351 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 1936. 19 Table showing the Birth, Death and Infantile Mortality rates during 1936 in the Metropolitan Cities and Boroughs:— Birth Rate. Adjusted Death Rate. Infantile Mortality Rate. City of London 7.5 Hampstead 10.6 Stoke Newington 45 Holborn 8.3 Stoke Newington 10.9 Greenwich 49 Westminster 8.5 Lewisham 10.9 Deptford 50 St. Marylebone 9.8 Wandsworth 11.0 Chelsea 53 Chelsea 11.3 Westminster 11.4 Lewisham 55 Hampstead 11.5 Greenwich 11.6 Wandsworth 58 Wandsworth 11.5 Chelsea 11.6 Camberwell 59 Kensington 12.7 Kensington 11.7 Lambeth 59 Lewisham 13.0 Woolwich 11.8 Southwark 59 St. Pancras 13.0 Lambeth 12.4 Woolwich 59 Bethnal Green 13.5 St. Marylebone 12.5 Battersea 59 Stoke Newington 13.7 Islington 12.6 Hammersmith 60 Finsbury 13.8 Deptford 12.6 Bermondsey 60 Paddington 13.8 Hackney 12.6 Islington 61 Woolwich 13.8 Camberwell 12.6 Holborn 62 Greenwich 13.8 City of London 12.6 Hackney 63 Lambeth 13.9 Fulham 12.7 Fulham 64 Camberwell 13.9 Paddington 12.8 Hampstead 66 Hackney 14.4 Holbor.n 12.8 Westminster 66 Battersea 14.6 Hammersmith 12.9 Poplar 72 Stepney 14.7 Battersea 12.9 Paddington 72 Southwark 14.8 Southwark 13.1 Kensington 73 Shoreditch 149 Poplar 13.8 Shoreditch 75 Fulham 14.9 St. Pancras 13.8 St. Marylebone 75 Poplar 15.0 Shoreditch 14.1 St. Pancras 79 Hammersmith 15.1 Bethnal Green 14.3 Finsbury 81 Islington 15.2 Bermondsey 14.6 Bethnal Green 98 Bermondsey 15.4 Stepney 14.7 Stepney 100 Deptford 15.7 Finsbury 15.3 City of London 147 Section 2. General Provisions of Health Services for the Borough. 23 General Provisions of Health Services for the Borough. 1.—Staff. A list of the staff of the Public Health Department will be found on page 4 of this report. 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 by the Borough Council under the Food and Drugs (Adulteration) Act, 1928, 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 110 to 112. 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 and (b) For Infectious Diseases. The Hampstead District Nursing Association, 3, Pond Street, and the Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, provide skilled nurses for the sick poor. 24 During the year the Public Health Committee and the Maternity and Child Welfare Committee considered the question of the fees paid to the two local District Nursing Associations for nursing cases of infectious disease and maternity and child welfare cases, and formed the opinion that the Council should undertake in addition the responsibility of providing facilities for the nursing of the certain other cases which come within the scope of work already carried out by the District Nursing Associations. They also felt that the opportunity should be taken of revising the fees paid for nursing, and that block grant payments should be made. As a consequence the arrangements made by the Borough with the District Nursing Associations are as follows : — Maternity and Child Welfare: Complications of Pregnancy (ante- and post-natal). Certain Notifiable Infectious Diseases, viz. Ophthalmia Neonatorum, Polio-Myelitis, Measles. Certain other non-notifiable Infectious Diseases, viz.:— Whooping Cough, Chicken-pox, Zymotic Enteritis, Pemphigus Neonatorum. Minor ailments. P-ublic Health: All notifiable infectious diseases not included in Maternity and Child Welfare Scheme. Certain other non-notifiable infectious diseases, viz.:— Pneumonia, Influenza, and Bronchitis. Block Grants: Maternity and Child Welfare Kilburn £80 £110. £220. Hampstead £30 Public Health Kilburn £70 £110. Hampstead £40 i.e., Hampstead District Nursing Association to receive a total block grant in respect of these services of £70 per annum, and Kilburn District Nursing Association to receive a total blockgrant in respect of these services of £150 per annum, 25 (c) For Maternity Cases. Both Associations employ fully trained nurses to attend maternity cases. The work carried out in this connection and with maternity and child welfare work in general is referred to in Section 3 of this report. 5.—Treatment Centres atul Clinics, including Clinics solely for diagnosis or consultation. (a) Ante-natal Clinics, Infant Welfare Centres, Dental Clinic, vide pages 44, 48 and 50, respectively. (b) School Clinics:—Kilburn School Treatment Centre, 107, Kingsgate Road; New End Hospital School Treatment Centre, Heath Street. (c) Tuberculosis Clinic, vide page 142. (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: Public and Voluntary. (a) Public:—New End Hospital (260 beds); North-Western Fever Hospital (410 beds). (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. 29 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 pays 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:—90,600 (estimate of Registrar-General, 1935). 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 965; (b) Still births 52; (c) Total 1,017. (d) By midwives 239; (e) By doctors and parents 778. 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 321 Total visits 749 † Excluding cases which are known to have previously been visited in another district and cases visited during the previous year. 30 (ii) to children under 1 year of age. † First visits 710 Total visits 4769 (iii) to children between the aged of 1 and 5 years. Total visits 6637 †Excluding cases which are known to have previously been visited in another district and cases visited during the previous year. 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. (c) Total number of attendances at all Centres during the year:— (i) by children under 1 year of age, 9,000. (ii) by children between the ages of 1 and 5 years, 5,651. (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, *567. (ii) between the ages of 1 and 5 years, 146. (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, 474. (ii) over 1 year of age, 988. (/) Percentage of notified live births represented by the number in (d) (i) :—59 per cent. †Excluding children who are known to have previously attended a Centre in another district. 31 5. Artte-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 1866 †250 (iv) Total number of women who attended at the Clinics during the year 427 †133 (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. 42 per cent. 13 †These patients attended at the Ante-natal Clinics. 6. Supply of Milk and Food. (a) 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. Yes Yes At cost price in other cases (e.g., sale of dried milk at Centres) No Yes Yes No No No No Yes Yes 32 (b) Total quantity of milk supplied during the year to expectant and nursing mothers and young children :— Liquid gallons. Dried pounds. (i) by the Council 3880 ¾ 457 (ii) by Voluntary Associations operating in area Nil. 2254 3880¾ 2711 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 under Part I of the Iyocal 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 37 Nil Nil II. Number of women (if any) sent by the Council during the year to other Maternity Institutions:—45 to Queen Charlotte's Hospital, for which the Borough Council subscribes £1 per Hampstead case admitted. 33 8. Homes and Hospitals for Sick or Ailing Children under 5 years of age. I. 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 2 children admitted through the Borough Council. (198 other children admitted.) 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:—9 mothers convalescent after confinement with their babies. 34 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:—Nil. (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:—Nil. (e) 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 Associations :—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 :—45-50. (c) Total number of attendances of children at these nurseries during the year :—8,570. 35 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 *16 10 7 9 (2) Pemphigus Neonatorum Not notifiable Nil Nil Nil (3) Puerperal fever 1 1 Nil 1 (4) Puerperal pyrexia 20 8 2 17 (5) Measles and german measles (in children under 5 years of age) German Measles is not notifiable. Measles is compulsorily notifiable. 386 348 58 65 (6) Whooping Cough (ditto) Not notifiable 77 6 17 (7) Epidemic Diarrhoea (ditto) Not notifiable Nil Nil Nil (8) Poliomyelitis (ditto) Nil Nil Nil Nil * Vision unimpaired, 16. 13. Home Nursing. (a) Number of nurses employed at the end of the year for the nursing of expectant mothers and children under 5 yeari of age, maternity nursing, or the nursing of puerperal fever:— (i) by the Council:—Nil. (ii) by Voluntary Associations:—15 employed by two Local District Nursing Associations. (12 included in 16 (b) (iii) below.) (b) Total number of cases attended during the year by these nurses:—379. (Of this number the Borough Council paid to the District Nursing Associations for the nursing of 54 maternity cases and 73 cases of infectious illnesses in children under 5 years of age.) 36 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 number of cases where this assistance has been given by Voluntary Agencies, by arrangement with the Council, should, if possible, be stated separately) :—15—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 L,ondon County Council is the Authority. (b) Number : (i) employed by the Council :—Nil. (ii) directly subsidised by the Council Nil. (iii) employed by Voluntary Associations:-12 (included in 13 (a) (ii) above). (<•) Number of cases during the year in which the Council paid or contributed to the fee of a midwife:—61 cases nursed by the midwives of the two local District Nursing Associations. In two cases the Council contributed to the fee of an independent midwife, owing to the patients being transferred to Hospital. 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 :—2. (ii) from other causes :—1. (b) Number of these cases which died : (i) at home :—1. (ii) in institutions :—2. 37 18.—Administration of Part I. 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:—34. (ii) who died during the year :—2. (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. (r) 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. 38 Live Births. During 1936, 1,048 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. 11legiti mate- Total. Legitimate. Illegitimate. Total. Registered in the Borough 759 101 860 730 75 805 1489 176 1665 Add number occurring outside the Borough whose mothers were Hampstead residents 170 25 195 139 19 158 309 44 353 Deduct number who could not be deemed to belong to Hampetead 929 126 10-55 869 94 963 1798 220 2018 430 63 493 419 58 477 849 121 970 Nett number belonging to Hampstead, 1936 499 68 562 450 36 486 949 99 1048 Nett Births, 1935 475 49 524 436 39 475 911 88 999 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 112 89 9 80.4 No. 2 (Belsize) „ 148 100 14 94.6 No. 3 (Adelaide) „ 122 108 5 41.0 No. 4 (Central) „ 92 8.4 5 54.3 No. 5 (West End) „ 188 13.1 17 90.4 No. 6 (Kilburn) „ 246 16.1 13 52.8 No. 7 (Priory) „ 140 121 6 42.9 The Borough 1,048 115 69 65 8 The birth rates for London and for England and Wales were 136 and 148 respectively. The infant death rates were 66 and 59. Legitimate and Illegitimate Births. Of the total 1,048 nett live births belonging to Hampstead, 949 were those of legitimate and 99 of illegitimate children, the latter being at the rate of 94 per 1,000 births. Of the Hampstead illegitimate infants, 44 were born outside the Borough, chiefly in Lying-in Institutions. CHART SHOWING THE INFANT MORTALITY PER IOOO BIRTHS IN HAMPSTEAD. The Infant Death Rate per 1,000 births for the Borough is represented by the chimneys, the lined portion of which shews the death rate amongst newly-born babies (i. e. under 1 month old). The Infant Death Rate for England and Wales is represented by the line, 39 Still Births. During 1936, the nett number of registered still births for Hampstead was 50. In the following Table the still births for 1936 have been distributed according to sex, etc. :— STILL BIRTHS. MALES. FEMALES. TOTALS. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Legitimate. lllegisimate. Total. Registered in the Borough 22 7 29 20 4 30 48 11 59 Add number occurring outside the Borough whose mothers were Hampstead residents 10 2 12 4 2 6 14 4 18 Deduct number who could not be deemed to belong to Hampstead 32 9 41 30 6 36 62 15 77 14 2 16 11 - 11 25 9 27 Nett number belonging to Hampstead, 1936 18 7 25 19 6 25 37 13 50 Nett Still Births, 1935 16 2 18 18 1 19 34 3 37 Infant Mortality. During 1936, 69 infants under 1 year of age died, giving an infant death rate of 65.8 per 1,000 live births. Of these 57 were legitimate children, the rate per 1,000 legitimate live births being 60, while 12 illegitimate children died, equivalent to a rate per 1,000 illegitimate live births of 121. 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 :— 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 :— 40 Year. Legitimate Infants. Death rate per 1000 legitimate births. Illegitimate Infants. Death rate per 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 1023 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 1936 949 57 60 99 12 121 Deaths of Young Children. During 1936, 83 deaths occurred of children under 5 years of age. This is equivalent to a rate of 17.2 per 1,000 live children born in that and the four preceding years. Maternal Deaths. Three maternal deaths occurred during the year 1936, which is a rate of 2.9 per 1,000 births. These deaths were carefully investigated by the Medical Sub-Committee and detailed reports sent to the Minister of Health, 41 Notification of Births. 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 atiy transferred notifications. Live Births 965 Notified by Mid wives 239 Still Births 52 „ „ Doctors and Parents 778 Total 1017 Total 1017 Of the total nett live births registered only 24 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 161 instances where these births were visited, and where the information was obtainable :— No. of persons in family. No. of families occupying the following number of rooms. 1 room. 2 rooms. 3 rooms. 4 rooms. 5 rooms. 6 rooms. 1 2 1 - - 2 2 20 33 2 3 - 24 18 5 3 4 - 7 9 7 5 - 2 10 4 2 6-232 7 - - 1 - - 1 8 - - - - 1 Totals 4 56 74 20 6 1 The newly-born baby has not been included in the above Of these 161 births:— 2 per cent, occurred in 1-roomed tenements. 35 „ „ 2 „ 46 „ 3 „ 42 The table indicates the limited housing conditions in some of the dwellings where babies are born at home. It demonstrates that of these 161 babies, 4 were born in one-roomed tenements and 56 in tworoomed tenements. In 2 one-roomed tenements where 2 persons were already living a baby was born. With regard to two-roomed homes, in 2 instances 6 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 6. In 1 three-roomed tenement there were 7 persons occupying the rooms before the birth of the child. Notification of removal of children from the Borough. It is our practice, as far as possible, to notify the appropriate District whenever a family in which there are young children removes from the Borough. In those cases where the new address is not easily forthcoming, a letter enquiring as to the family's whereabouts is sent to the mother at the old address, the envelope being marked " Please Forward." In all cases where the new address is ascertained a communication in the following terms is sent to the Medical Officer of Health of the Borough or District concerned :— MATERNITY AND CHILD WELFARE. Dear Sir, I beg to inform you that born lately of have removed to Remarks : Yours faithfully, H. Leslie OldERShaw, Mcdical Officer of Health. The Medical Officer of Health. The record cards relating to young children in the family are sent with this communication. By this means information regarding 323 children under 5 years of age was sent to other Medical Officers of Health during the past 43 year. Similarly, notification was received from 32 other Local Authorities from various parts of the country (including 11 Metropolitan Boroughs) regarding 124 children who had removed into Hampstead. Health Visiting staff. In connection with maternity and child welfare work, the Council employs four Health Visitors; while 40 per cent. of the time of the Woman Sanitary Inspector is also devoted to this work. The minimum number of visits which the Health Visitors 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 At the close of the year the Health Visitors had under their supervision for systematic visiting 602 infants under one year of age and 1,586 children aged between one and five years. The following table gives a record of the work of the Health Visitors in 1936 :— †First visits to expectant mothers 330 Re-visits to expectant mothers 419 tFirst visits to infants under one year 739 Re-visits to infants under one year 4030 Visits to children from 1 to 2 years 2712 Visits to children from 2 to 5 years 3925 Visits to foster-mothers and foster-children 823 Visits re infectious diseases 1627 Attendances at Borough Council's Ante-natal Clinics 223 Attendances at Borough Council's Dental Clinic 78 Attendances at Borough Council's Immunisation Clinic 44 Attendances at Hampstead Council of Social Welfare Infant Welfare Centres and Toddlers' Clinics 397 Miscellaneous visits 423 †Including visits to mothers and babies moving into the Borough and previously visited. 44 Approximately 77 per cent. of the infants under one year of age visited for the first time attended the Infant Welfare Centres during 1936. 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, two student health visitors from the College of Nursing have received instruction from time to time. These students are preparing for the examination for the Health Visitors' Certificate and they receive practical instruction in all branches of the work, including tuberculosis. They attend at the Town Hall two or three times a week for a period of six weeks : accompany the health visitors in their routine visits : attend at the Municipal Ante-natal and Dental Clinics and Tuberculosis' Dispensary and visit the voluntary Infant Welfare Centres. The College of Nursing pays to the Borough Council a fee of £1 1s. Od. for each student so instructed. Ante-natal Clinics. The two Ante-natal Clinics in the Borough are provided and maintained by the Borough Council, namely :— Western Clinic: Two sessions weekly (viz., Monday at 2 p.m. and Thursday at 9.15 a.m.) at 75, Dynham Road. Held in the premises rented by the Borough Council from the Health Institute for the purpose of a Tuberculosis Dispensary. Since November an additional session has been held fortnightly on Thursday afternoons, when cases brought to the Ante-natal Clinic by the Kilburn and West Hampstead District Nursing Association are seen by the Medical Officer. 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. 45 (a) Total number of attendances by expectant mothers at the Ante-natal Clinics during the year—1,866. (b) Total number of expectant mothers who attended at the Ante-natal Clinics during the year—427. (r) Percentage of total notified births (live and still) represented by the number in (b)—42 per cent. Post-natal Clinics. No separate clinics for post-natal cases have been established, but such mothers as have attended at the ante-natal clinics have been seen by Dr. Mary Kidd. During the year 100 mothers attended at these clinics to receive post-natal care, making a total number of attendances of 250. Of the 100 mothers 43 attended for the first time, i.e., they had not attended for ante-natal care prior to confinement, but were persuaded to attend upon being visited by a Health Visitor after the birth of the baby or upon attending at an Infant Welfare Centre with their child. The matter of post-natal care is one of some considerable importance, and as opportunity offers this aspect of the work among mothers will be developed. The following is the report for the year 1936 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 1936 :— Pond Street Clinic. (1 session weekly.) Kilburn Clinic. (2 sessions weekly.) 1936. 1935 1936. 1935. New patients 1ll 105 276 292 Attendances of old patients 488 513 1242 1319 Number of sessions held 52 52 100 99 Average attendance per session 11 11 15 16 Number of patients referred to Dental Clinic 42 51 137 139 Number of patients sent to Convalescent Homes 5 5 4 9 46 During the last year, 387 new patients attended the ante-natal clinics; practically the same number as the year before. Of these, 131 were normal cases, 204 were more or less abnormal, 9 were found not to be pregnant, and 43 were women who attended the Clinics for the first time after their confinements, being in need of post-natal care. The number of births occurring in the Borough during 1936 was 1.048 and 327 pregnant women resident there attended our Clinics last year. It is found, therefore. that 31 per cent. of the expectant mothers received ante-natal care at the Borough Council's Clinics. It is a matter for great thankfulness that during the last five years, no deaths in childbirth have been recorded amongst the series of 1,688 expecant mothers who attended the Ante-natal Clinics during that period. Since the year 1929 there have been 2 maternal deaths in a series of 2,315 mothers—a maternal mortality rate of just under 1 per 1,000 during an eight year period. The maternal mortality rate for England and Wales was 3 94 per 1,000 births, in 1935. These favourable results have only been obtained, of course, by constant co-operation with the different Hospitals where these women were confined as well as with the practising midwives in Hampstead, and it demonstrates the value of the splendid work done by the latter and by doctors and midwives in the Hospitals, as well as the value of ante-natal supervision. The neo-natal death rate, as it is called, is the death rate amongst newly-born infants in the first month of life, and it is believed that ante-natal care of the mothers can lower it considerably. Only 3 of the expectant mothers attending the Clinics in 1936 lost their babies in the tirst month of life. This good result is unhappily offset somewhat by the fact that 7 mothers had stillborn infants during the year. It will have been observed that 43 women attended the Clinics for the first time after confinements or miscarriages as they needed post-natal care. In addition, 57 women who had attended the Clinics before their deliveries came up to see me afterwards. Of this series of 100 women, 5 had had miscarriages, 4 of them suffering from subinvolution and 1 from prolapse of the uterus. The remain- 47 ing 95 women attended after full-time deliveries, and nearly all were in need of medical attention. I have prepared a list of the various abnormalities met with; and it makes instructive, though sad, reading. It is as followsProlapse of the uterus, 5; Abscess of Bartholin's gland, 2; Bartholin's cyst, 1; Endocervicitis, 2; Pendulous abdomen needing a surgical belt, 1; "White leg," 1; Subacute phlebitis, 1; Deficient lactation, 6; Cracked nipples, 5; Eczema of breasts, 1; Breast abscess, 6; Pyelitis, 2; Whitlow, 1; Prorians, 1; Suspected sinusitis, 2; Anaemia and debility, 10; Suspected phthisis, 1; Manic depressive insanity, 1; Extreme neurasthenia, 1. In addition, 1 encountered 31 cases of subinvolution of the uterus with persistence of lochia. Eor many years now, I have been struck by the frequency with which subinvolution of the uterus is met amongst working-class women after childbirth, and this little series of cases demonstrates it; for persistence of the lochia was present in a more or less severe degree in 31 out of the 95 women seen by me after their confinements; that is to say, in 33 per cent. In normal circumstances, the lochia should have ceased by the fourteenth day at the very outside, yet in this series of cases the lochia was still present on an average of 24 days after childbirth. The usual sequence of events is, that the patient is discharged from Hospital 10 or 14 days after her confinement with the uterus involuting satisfactorily, the lochia having ceased. As soon, however, as she begins to get about and perform her household duties, the lochia appears again and she comes up to the Clinic complaining of feeling poorly and, indeed, looking so. Frequently too her supply of breast milk begins to fail simultaneously. Some of our most satisfactory results have been obtained in such cases for, after a course of ergot and iron have been taken and our instructions as to " rest periods" have been followed, the uterus involutes well and the patient begins to feel fit again. At the same time too, her supply of breast milk improves, especially if extra milk has been taken. I should add that " rest periods " are attained by feeding the baby in the semirecumbent position, thus ensuring 20 minutes rest every 3 hours and by taking a mid-day rest of at least an hour. 48 Long experience has convinced me that it is desirable that a woman should be kept in Hospital or at rest in her home for at least a fortnight after her confinement, if not longer. The chief hindrance to this, lies in the fact that the pressure on the accommodation in Maternity Hospitals is so great, whilst another is the desire of the working-class woman to return home as soon as possible, after her baby's birth. Consequently, in the majority of normal cases a patient is discharged on the 10th to 12th day after delivery. MARY KIDD, M.B. (LOND.). Infant Welfare Centres. The following Infant Welfare Centres were held in the Borough during 1936:— Name and address of Centre. Day and Time held. Doctor in attendance. Health Visitor. Average attendance per session. "Belsize", Congregational Church Hall Avenue Road Monday, 2—4 p.m. Dr. M. A. Blandy Mrs. Steward 48 " Kilburn Tuesday and Dr. A. S. Hall- Miss Evans 146 Health Insti- Wednesday, 2-4 Cragga Miss May tute. Kingsgate Road p.m. " Branch Health Institute. Kingsgate Road Wednesday, 10—12 noon Do. Miss May 30 " New End Baptist Chapel Hall, Heath Street Thursday, 10—12 noon Dr. M. A. Blandy Miss Kennedy 26 "Lisburne Road". Thursday, 2—4 Do. Miss Lam be 33 Wesleyan p.m. Mission Hall, Lisburne Road " Mill Lane ", Mission Hall, Broomsleigh Street Friday, 2-4 p.m Dr. A.S. Hall- Craggs Miss Evens 49 Total number of attendances at all Centres during the year:— (i) By children under 1 year of age—9,000. (ii) By children between the ages of 1 and 5 years— 5,651. 49 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—567. (ii) Between the ages of 1 and 5 years—146. 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—474. (ii) Between the ages of 1 and 5 years—988 (including Toddlers). *The 567 children under 1 year of age who attended at the Centres represent 59 per cent. of the notified live births. Toddlers' Clinic. Weekly toddlers' sessions are held alternatively on either side oi the Borough. Dr. Ruth Balmer is the Medical Officer in attendance at the Clinic. The average attendance per session during 1936 was : 27, Pond Street, 16. Health Institute, 20. 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, and at the same time 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 418 parents have received 50 invitations, 59 of whom have accepted, and of this number 5 children were found to be suffering from various defects. It is our endeavour to ensure that these defects are remedied before the child commences attendance at school. Ray-Therapy. The Council makes an annual subscription of £6 6s. Od. 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 247 families assisted with free milk or milk at half price during the year, for either expectant mothers, nursing mothers or children under the age of 3 years; and in a few " special cases for children between 3 and 5 years. 160 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, E.D.S., R.C.S. Eng. The following is a summary of the work carried out during the year:— Number of Sessions held 74 Number of New Patients 248 Total Attendances of all patients 1144 Number of Fillings 324 Number of Scalings 44 Total Number of Teeth extracted 812 Gas Administrations 223 Extraction cases Local Administrations 6 Without Anaesthetic 2 Number of Dentures (including repairs) 68 Number of Dressings and Root Treatment 204 Number for Advice 333 Number of Denture visits 198 51 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 school entrants 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 tables, showing the result of routine examinations of 620 elementary school entrants in Hampstead during 1936. 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 enquiries 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 1936, indicating the conditions with regard to Clothing, Nutrition, Cleanliness and Teeth of the Children examined. Number who were examined. Clothing and Boots. Nutrition. Cleanliness of Head. Cleanliness of Body. Teeth. Good. Fair. Poor. Good. Average. Below normal Bad. Clean. Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than 4 decayed. 4 or more decayed. No. rec. for treatment Entrants: Boys 272 272 - — 36 220 16 - 271 1 — 271 1 — 155 88 29 107 Girls 348 346 2 - 71 266 11 - 344 3 1 348 - - 188 117 43 148 Total 620 618 2 - 107 486 27 - 615 4 1 619 1 - 343 205 72 255 Hampstead per centages 99.7 0.3 - 17 2 78.4 4.4 - 99-2 0-6 0-2 998 0-2 - 55 .3 33.1 11.6 41.1 London per centages 57.8 41. 8 0.4 15.1 78.6 6.3 97.8 1.9 | 0.3 99.2 0.8 0.0 57.3 34.5 8.2 39.2 52 53 The number of entrant children found to be below normal as regards nutrition at the routine medical inspections in recent years are set out below :—- 1936 27 1935 63 1934 21 1933 13 1932 19 1931 11 1930 15 1929 7 The Medical Officers attending the Infant Welfare Centres were asked to submit any evidence, statistical or otherwise, that unemployment, low wages, or high rents, have exercised any significant influence on the health or physique of the children attending the Infant Welfare Centres, and I submit their replies :— Margery Blandy, M.B., M.R.C.P. (Medical Officer attending Swiss Cottage, Heath Street, and Lisburne Road Infant Welfare Centres), states that " I compared those families in whom the father was out of work and who therefore received milk forms and for whom 1 recommended free milk either wet or dry, for nursing mother or baby, and cod liver oil. The effect of straightened circumstances does not necessarily become very apparent in the children who attend my Clinics. It would appear that the free milk and cod liver oil is definitely of great benefit in maintaining the health of the babies up to 18 months." Agnes Sidney Hall-Craggs, M.R.C.S., L.RC.P. (Medical Officer attending the Health Institute and Mill Lane Infant Welfare Centres), states " Out of 500 cases investigated, taking an equal number of employed and unemployed families :— (1) Approximately double the number of "unemployed " children are unsatisfactory. Unemployed: 45 per cent. unsatisfactory. Employed: 20 per cent. unsatisfactory. 54 (2) The health of children between the age of 1 and 2 years is very much more unsatisfactory than during the first year of life, the percentage of unsatisfactory children being, in both employed and unemployed classes, as much as double the number of unsatisfactory children during the first year. (This may or may not be accounted for by the fact that this is the main teething period.) (3) on investigating the question of bad housing and bad management in every case, I find that about 50 per cent. of (1) can be to a certain degree accounted for under one or other, or both, of these headings. (4) There is very little bad housing amongst the employed, but bad management accounts for approximately one quarter of the unsatisfactory children of employed parents." 55 Table showing Results of Routine Medical Inspection of Entrant Children in Hampstead to Elementary Schools during the yeat 1936, indicating the Defects found. f = defects found. o = noted for treatment and included in defects found. Disease or Defect. Boys (272). Girls (348). Hanipstead. per cent. London, per cent. Hampstead. per cent. London. per cent. Skin disease f - - 10 - 10 o — — 0.7 — — 0.6 Tonsils only f 24 8.8 14.0 42 121 13.6 o 5 1.8 5.6 10 2.9 5.1 Adenoids only f 3 11 10 — — 0.7 o 1 0.4 0.6 — — 0.6 Tonsils and Adenoids f 4 1.5 3.3 14 40 2.9 o 3 1.1 2.3 11 3.2 2.0 Other Nose and Throat f 1 0.4 1.2 2 0.6 1.0 o - — 0.4 1 0.3 0.4 Glands of Neck f 2 0.7 3.1 2 0.6 2.5 o — — 0.3 — — 0.3 Eye disease f 4 1.5 2.8 6 1.7 3.1 o 2 0.7 1.7 2 0.6 1.8 Otorrhcea f 1 0.4 1.0 — — 0.9 o 1 0.4 0.6 — 0.5 Other Ear Defects f 1 0.4 0.3 2 0.6 0.4 o — — 0.2 2 0.6 0.2 Hearing f 3 1.1 0.2 7 2.0 0.2 o 1 0 .4 0.1 3 0.9 0.1 Speech f — — 0.3 2 0.6 0.2 o — — 0.0 — — 0.0 Heart f — — 1.5 — — 1.3 o — — 0.1 — — 0.1 Anaemia f 8 2.9 0.7 3 0.9 0.6 o — — 0.3 — — 0.3 Lungs f 3 1.1 3.7 4 1.1 3.3 o — — 1.4 — — 1.8 Epilepsy f — — 0.0 1 0.3 0.0 o — — 0.0 — — 0.0 Chorea f — — 0.0 — — 0.0 o — — 0.0 — — 0.0 Paralysis ... f — — 0.1 — — 0.0 o - — 0.0 — — 0.0 Other Nervous Disorders f - — 0.4 2 0.6 0.4 o — — 0.1 — — 0.1 Pulmonary T.B. f — — 0.1 — — 0.0 o — — 0.0 — — 0.0 Other T.B. f — — 0.1 — — o.o o — — 00 — — — Rickets f — — 11 — — 0.5 o — — o.l — — 0.1 Spinal Deformities f — — 0.1 — — 0.1 o — — 01 — — 00 Other Deformities f 3 1.1 1.1 3 0.9 0.9 o — 0.4 — — 0.3 Other Defects f 1 0.4 2.6 7 2.0 2.3 o 1 0.4 1.6 4 1.1 1.4 56 Home Nursing. The scheme for home nursing by the Nurses of the two local Associations was elaborated during the year. Full details of these extensions will be found in Section 2 of this Report. Treatment of Minor Ailments. Since the close of the year I reported upon Circular 1550 of the Minister of Health in connection with the supervision of the health of children under school age. In the majority of cases pre-school children were already receiving treatment for minor ailments through the local District Nursing Associations, and occasionally such children were treated at the London County Council School Clinic, Kingsgate Road, which was under the management of the Hampstead Council of Social Welfare. The Nursing Associations having stated that they were prepared to undertake this work, the Council at its meeting on 28th of January, 1937, agreed to amend the Scheme of Home Nursing accordingly. Full details of the new arrangement will be found in Section 2 of this Report. Ambulance Facilities. The London County Council Ambulance Service is 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 contributes 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, 37 patients were admitted to this Ward, their average duration of stay being fourteen days. 57 (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 1936, the number of Hampstead women for whom such contribution was made was 45. (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 1936, 50 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 1936, two children were 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 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., LC.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. The following medical officers are present, The Medical Officer of Health, the Assistant Medical Officer of Health, Dr. H. D. Chalke, Dr. Kidd (Medical Officer of Ante-natal Clinic), Dr. Blandy and Dr. HallCraggs (Medical Officers of the Maternity and Child Welfare Centres). In addition, the Health Visitors also attend. Prior to the meeting of the Sub-Committee the Medical Officer of Health ascertains from the Health Visitors, General Practitioners, and Hospital Medical Officers concerned, all particulars relating to each case coming under review. All information obtained is treated confidentially, and as a result of the investigations, either adjustments 58 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. The Committee investigated :— Deaths of Infants under 2 years 74 Still Births 52 Puerperal Fever 1 Puerperal Pyrexia 20 Maternal Deaths 3 Other deaths of women 1 Total 151 During the course of investigation the following facts emerged, which are of interest. Of the deaths under 2 years of age, 74 per cent. occurred in institutions. Of the 40 deaths occurring during the first month, 23 per cent. of the mothers had not received ante-natal supervision. Of the 23 deaths between 2 months and one year, 61 per cent. had never attended an infant welfare centre : 2 had had no fixed abode and 3 were found abandoned. Of the 52 still births, 46 of the mothers had received ante-natal supervision, either by general practitioners, at hospitals, or at the Council's Clinics. There were 13 deaths of illegitimate children under two years of age, which represents a Mortality Rate of 69 per 1.000 illegitimate births as compared with 33 for legitimate children. Convalescent Homes and Other Institutions. Convalescent Homes. During 1936, 9 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. 59 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 1936, three children from Hampstead families were admitted under this arrangement. 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, but this facility was not utilised during 1936. 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 1936, 22 babies were admitted, the remaining 6 having been admitted prior to 1936. 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. It receives unmarried expectant mothers and mothers with young babies after discharge from Hospital. During the year 1936, there were beds for 8 expectant mothers and 8 beds, with cots, for mothers and babies in the hostel : 18 expectant mothers were admitted and 12 mothers were admitted with their babies. The Cross Roads Clubs, 88-90, 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 1936, 97 expectant mothers and 99 mothers and babies were admitted. 60 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 42 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, who return, with their infants, for 3 months. It has accommodation for 10 mothers and 5 babies. During the year 20 expectant mothers were admitted. 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 1936 was 8,570. The Nursery is controlled by a Voluntary Committee and the Borough Council contributed £543 during 1936. 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 1936, the midwives of the Kilburn and West Hampstead District Nursing Association attended 99 cases, whilst those of the Hampstead District Nursing Association attended 16 cases. Of the 115 cases, 54 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 61 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. During the year such compensation was made in two cases. Maternal Mortality and Morbidity. Three women died in consequence of child-birth during 1936. This represents a maternal mortality rate of 29 per 1,000 births as compared with 1.0 and 4.14 for the preceding two years. Consulting Obstetricians. Under a scheme of the Borough Council the services of obstetricians of consultant status are available to all medical practitioners in cases of difficulty or abnormality occurring among Hampstead mothers. The following are the consultants:— Basden, Margaret, M.D., F.R.C.S., 114, Harley Street, W.l, and 26, Thurlow Road, N.W.3. Brown, R. Christie, M.S., F.R.C.S., 40, Harley Street, W.l, and 292, Finchley Road, N.W.3. Gray, Arthur O., M.D., F.R.C.S., 114a, Harley Street, W.l. Rivett, L. C., M.C., F.R.C.S., 118, Harley Street, W.l, and 3, Hanover Terrace, Regent's Park, N.W.1. White, Norman, M.D., F.R.C.S., 19, Queen Anne Street, W.l, and 55, Fitzroy Road, N.W.1. During the year the services of the Consultants were called for under this scheme in three cases. Two were cases of difficult confinement—the mothers were removed to Hospitals, both children were stillborn, but the mothers made good recovery. The other was a case of puerperal pyrexia—child born alive—the mother remained at home and 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 62 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 exists, and their services are available for homes in connection with cases of child-birth occurring in the Borough. They are paid at the rate of 5s. Od. 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 is in attendance on the case and no nursing duties of any description are undertaken by the Home Helps. The Home Helps Scheme was adopted in March, 1934. On the recommendation of the Maternity and Child Welfare Committee the Council in February, 1936, extended the Scheme so as to enable a Home Help to be engaged by a patient at any time up to three months after the date of confinement, subject to a medical certificate that the patient is in such a debilitated condition that the services of a Home Help are necessary. In addition, in October, 1936, it was agreed that the Scheme should be further extended, so as to enable the Home Helps to be engaged by a patient during the last three months of pregnancy, or in cases where expectant or nursing mothers are admitted to Hospital, and in December, 1936, in view of an alteration in the rules of the Central Midwives Board, as from 1st January, 1937, requiring the midwife to attend a patient for 14 days instead of 10 days, the Council, upon the recommendation of the Maternity and Child Welfare Committee, decided to extend their Scheme so as to allow the Home Helps to remain in attendance for a normal period of 14 days. At the present time there are 8 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 15 mothers availed themselves of this facility, being assessed to contribute 63 at charges varying from 5s. 0d. to 6d. a day, and in two cases no charge whatever was made. 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 102 outfits were supplied during 1936. In 34 instances the full price was paid for the 5s. 6d. outfit. ,, 52 ,, ,, ,, 3s. 8d. ,, „ 13 „ the applicants were assessed to contribute towards the cost of the 3s. 8d. outfit, the charges varying from 2s. to 1s. „ 3 „ the 3s. 8d. outfit was supplied free of charge. Child Life Protection. Public Health (London) Act, 1936. The five Health Visitors are appointed as Child Protection Visitors. The following are the statistics relative to this work during the vear:— On 31st December, 1936, there were in the Borough 25 fostermothers having charge of 34 foster-children. Number of foster-children removed 78 „ foster-children added 75 „ foster-mothers removed 22 „ foster-mothers added 22 „ visits paid by Health Visitors to fosterchildren 491 ,, visits paid by Health Visitors to fostermothers 332 The supervision of foster-mothers and foster-children has continued to be exercised by the Health Visitors acting as Child Life 64 Protection Visitors, and reports thereon have been regularly submitted to the Maternity and Child Welfare Committee. In special cases, visits have been paid personally, either by myself or the Assistant Medical Officer of Health, Dr. Chalke. It is unfortunate that the number of suitable foster-mothers in this Borough is so limited. During the six months, July—December, 25 applications for placing foster-children (i.e., an average of 50 per annum) were referred to other Authorities as we had no vacancies. All foster-mothers are required to conform to a good standard, and to bring their foster-children to an Infant Welfare Centre. The standard that is required to be attained is indicated in the Annual Report for 1933 of the Chief Officer of the Ministry of Health, in which he states "The Health Visitor must weigh up the advantages and demerits of the circumstances of each applicant for registration as foster-mother and her relative freedom from onerous personal ties. The Visitor must consider the age, state of health and temperament of the mother, her domestic circumstances and setting, the age and sex of the other inhabitants of the household, the cleanliness and reasonable comfort of the home, the dietary, the sleeping arrangements, the opportunities for play and the whole standard of life of the household. The observation, advice and direction of the Health Visitors are required to include all that relates to the health and well-being of the child." In this connection one applicant was refused permission to act as a foster-mother, owing to unsatisfactory home conditions and accommodation. It was not found necessary for any legal proceedings to be taken during the year, but pressure was brought to bear on one foster-mother, owing to her disinclination to carry out her obligations regarding notifications, and because of other important delinquencies; the child was removed from her care by the mother. The foster-mother's name was deleted from the official list, and she was thereby precluded from taking further foster-children. It is interesting to note that one foster-mother legally adopted the child who had already been in her care for two years. 65 During the year two foster-children died, but in neither case was it considered necessary for an inquest to be held. As in previous years, a Certificate of Exemption was granted to the Hampstead Foster-Home, 33, Fitzjohn's Avenue, for 12 months —from July, 1936. The Certificate exempts the Home from making various notifications, etc., required by Part XIII of the Public Health (London) Act, 1936, 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 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. 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 provisions of the Public Health (London) Act, 1936, subject to facilities being given for an annual inspection to be made. Contributions to Voluntary Associations. The following extract from the Scheme made by the Minister of Health under Section 101 (6) of the Local Government Act, 1929, for 66 the payment of contributions by the London County Council and the Councils of the Metropolitan Boroughs to Voluntary Associations providing Maternity and Child Welfare services in the County of London, indicates the financial aid afforded to such local organisations and institutions. Subject to certain conditions, in each of the four financial years 1933-34, 1934-35, 1935-36 and 1936-37, the London County Council is required to pay by way of annual contribution, specified sums to certain voluntary associations and the Borough Council is required similarly to pay to other voluntary associations annual fixed grants. It is a condition of the payment of a contribution to any voluntary association under this scheme:— (i) that the Council are satisfied as to the efficiency of the maternity and child welfare service provided by the association in respect of which the contribution is payable, and that such service is being used by a reasonable number of those persons for whom it is provided; (ii) that no reduction or alteration of such service is made without the consent of the Council; (iii) that such service, and any premises in which it is carried on, are open to inspection at all reasonable times by any officer of the Council duly authorised by the Council, and by any officer of the Ministry of Health appointed for that purpose by the Minister; (iv) that the Association sends to the Council in each year a copy of the annual report of the Association on the maternity and child welfare work of the previous year, together with a statement of the accounts of the Association for that year relating to such work and a copy of the auditor's certificate thereon, and furnishes the Council from time to time with such other information relating to the maternity and child welfare services provided by the Association and the expenditure thereon as the Council may reasonably require. 67 A Council may not, except with the consent of the Minister of Health, terminate or make any reduction in the annual contribution payable to an association in respect of any service on the ground that any of the foregoing conditions are not fulfilled in the case of that service. Name of Association. Services in respect of which contribution is payable. Amount of annual contribution to be paid by the London County Council. £ Queen Mary's Maternity Home Maternity Hospital 1,305 Cross Roads Club, Alexandra Road Mother and Baby Home 752 Hostel for Mothers and Babies, 7, Fitzjohn's Avenue Do. do. 488 St. Agatha's House, St. John's Wood Road Do. do. 331 Main Memorial Home, Cartwright Gardens (removed to 141, West End Lane in 1934) Do. do. 299 Eagle's Nest, Haverstock Hill, Hampstead (removed to 33, Fitzjohn's Avenue) Babies' Home 652 Name of Association. Services in respect of which contribution is payable. Amount of annual contribution to be paid by the Hampstead Borough Council. £ Hampstead Council of Social Welfare (5 Centres): — 107, Kingsgate Road Baptist Chapel, Heath Street Infant Welfare Centres 725 Emmanuel Parish Institute, Broomsleigh Street Wesleyan Church Hall, Lisburne Road Congregational Church Hall, Avenue Road Hampstead and North St. Pancras Day Nursery, 27, Pond Street Day Nursery 543 Section 4. Sanitary Circumstances of the Borough. 71 Sanitary Circumstances of the Borough. Water. The Borough is normally supplied from the River Thames except for a small portion on the eastern side of Haverstock Hill bounded on the north by Pond Street, Hampstead Heath Railway Station, and Nassington Road, which is at present supplied from the New River, but which will eventually be supplied from the River Thames. The water supply is under the supervision and control of the Metropolitan Water Board. Sanitary Inspection. The Council employs eight 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 slight 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 1936:— Total number of inspections 4,369 Total number of re-inspections and other visits and re-visits 13,316 Total number of dwelling-houses inspected for housing defects 1,608 Number of these found not in all respects reasonably fit for human habitation 1,060 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. 72 The total number of Notices served during the year was as follows:— (1) Informal (i.e., intimations), 1,215 relating to 907 premises. (2) Statutory 808 relating to 386 premises. Investigation of Complaints, Inspection of Factories, Workshops and Workplaces, etc. Number of complaints investigated 1,021 „ „ premises inspected after the occurrence of infectious disease 134 „ „ inspections of Factories (excluding bakehouses) 43 „ ,, inspections of Workshops (excluding bakehouses) 121 „ ,, inspections of Workplaces 272 ,, ,, inspections of Bakehouses, Milkshops and other food premises 1053 Details of work, etc., supervised or action taken by the Sanitary Inspectors, whether under notice or voluntary, at premises not registered as Tenement Houses:— Totals Underground rooms. Illegally occupied -found, or brought to the Inspectors' notice 194 Closed, or illegal occupation discontinued 14 Made to conform 65 Verminous conditions. Rooms disinfested 110 Number of houses concerned 56 Beds and bedding disinfested 30 Floors of rooms cleansed 44 Animals. Nuisances from improper keeping in rooms abated 2 Nuisances from improper keeping on the premises abated 2 Smoke nuisances. Complaints received 5 Observations made 20 Notices served 2 Drainage systems, &c. Drainage systems repaired or renewed, partly or wholly 343 Plumbing defects remedied (soil pipes, waste pipes, &c.) 648 Roofs, rainwater pipes and gutters repaired or renewed 328 Water supply. Water supply provided to separate lettings 258 Number of houses concerned 179 Sinks provided to separate lettings 345 Number of houses concerned 224 Water cisterns cleansed or covered 24 Water-Closets. Additional provided 169 Removed from improper position 11 Flushing cisterns repaired 101 73  Totals. Yards, &c. Paving, &c. Yards or open spaces newly paved and drained or repaired 105 Bathrooms. New provided 239 Dust Bins. Repaired or renewed 283 Houses or parts cleansed (other than verminous conditions) 312 Dampness in houses or parts abated 226 Details of work, etc., supervised or action taken by the Sanitary Inspectors, whether under notice or voluntary, at Registered Tenement Houses:— Totals. Underground rooms. Illegally occupied—found, or brought to the Inspectors' notice 202 Closed, or illegal occupation discontinued 7 Made to conform 21 Verminous conditions. Rooms disinfested 46 Number of houses concerned 23 Beds and bedding disinfested 4 Floors of rooms cleansed 8 Animals. Nuisances from improper keeping in rooms abated 2 Nuisances from improper keeping on the premises abated 2 Drainage systems, &c. Drainage systems repaired or renewed, partly or wholly 64 Plumbing defects remedied (soil pipes, waste pipes, &c.) 109 Roofs, rainwater pipes and gutters repaired or renewed 199 Water supply. Water supply provided to tenements 33 Number of houses concerned 31 Sinks provided to tenements 96 Number of houses concerned 77 Water cisterns cleansed or covered 10 Water-Closets. Additional provided 43 Flushing cisterns repaired 1 Removed from improper position 37 Yards, &c., Paving, &c. Yards or open spaces newly paved and drained or repaired 57 Bathrooms. New provided 6 Dust Bins. Repaired or renewed 47 Miscellaneous. Window cords repaired or renewed 183 Window fittings repaired or renewed 146 Filth and refuse removed from rooms 8 Washing (of clothes) accommodation provided 10 Coppers repaired or renewed 32 Suitably ventilated food cupboards provided 201 Kitchen ranges repaired or renewed 77 Common staircases repaired 10 Common staircases provided with adequate means of natural light 4 Common staircases provided with adequate means of artificial light 1 Houses or parts cleansed (excluding verminous rooms) 262 Number of rooms concerned 698 Dampness in houses or parts abated 213 Dilapidated houses or parts repaired 113 74 Tenement Houses. During the year six 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 1,565. During the year, 379 tenement houses were inspected and 2,460 defects were discovered. With the gradual "decontrol" of tenement houses as the result of the creation of new tenancies, there is thrown upon the Borough Council more work under the Tenement House Byelaws. After "decontrol," it is incumbent upon an owner to provide and maintain for the use of each family by whom any part of the house is occupied, and so far as is practicable on the storey or one of the storeys in which are situate the rooms or lodgings in the separate occupation of the family,—(a) Water-closet accommodation; (b) Accommodation for washing clothes; (c) Accommodation for the storage of food; (d) Accommodation for the preparation and cooking of food. A considerable amount of time of the Tenement House Inspectors is taken up in interviewing owners with regard to these additional provisions and in the subsequent supervision of the work involved. During the year forty-three additional water-closets have been provided without recourse to legal proceedings. 75 Common Lodging Houses and Seamen's Lodging Houses. None exists in the Borough. Businesses of Rag and Bone Dealers. There is only one premises in the Borough where the business of a dealer in Rags, etc., is carried on. Legal proceedings were ordered to be instituted by the Council upon information supplied by the Police, against a rag and bone dealer for distributing toys in exchange for bundles of rags, contrary to bye-laws made by the London County Council under their General Powers) Act of 1908. Unfortunately the dealer could not be traced and the summons could not be served. One of the Sanitary Inspectors found another dealer engaged in a similar practice, and in view of the circumstances of this case the vendor was cautioned. Offensive Trades. No offensive trade is carried on in the Borough. Removal of Offensive Matter. As the result of a complaint, observation was kept on the removal of offal tins from the rear of premises occupied by a fishmonger. At 8.10 p.m. a motor lorry drew up and removed four metal bins containing fish offal from the premises and placed them without lids or other covering on a lorry. The Sanitary Inspector examined the receptacles on the lorry before it was driven away and found it contained four uncovered receptacles full of fish offal, and one full of fish offal but properly covered with a metal cover, and a number of empty receptacles without covers. There was a very offensive smell from the lorry. The men in charge declined to give the Inspector the name of the owner of the lorry, saying they had no time to stop. The Inspector made enquiries at another fish shop from which offal had been removed and ascertained from whence the lorry came. The firm had previously been summoned and convicted at the Hampstead Petty Sessions for a similar offence. A summons was accordingly issued against the firm for a breach of the London County Council Byelaws which require that offensive 76 or noxious matter shall be removed in properly covered receptacles between prescribed hours. The defendant was find £ 10 and £2 2s. costs were imposed. Increase of Rent and Mortgage Interest (Restrictions) Acts. Number of certificates applied for 12 „ „ issued 10 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. (1) Number of Inspections. (2) Written Notices. (3) Occupiers Prosecuted. (4) Factories (Including Factory Laundries) 43 11 Nil. Workshops 121 14 Nil. (Including Workshop Laundries) Workplaces 272 59 Nil. (Other than Outworkers' premises) Totals 436 84 Nil. 77 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 91 91 Want of ventilation 8 8 Overcrowding Nil. Nil. Nil. Nil. Want of drainage of floors 5 5 Other nuisances 172 172 Sanitary insufficient 7 7 unsuitable or defective 20 20 accommodation not separate for sexes 10 10 Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) 1 1 Nil. Nil. Other offences 3 3 Nil. Nil. (Excluding offences relating to outwork, and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops, Transfer of Powers) Order, 1921.) Totals 317 317 Nil. Nil. * Including those specified in Sections 2, 3, 7 and 8 of the Factory and W orkshop Act, 1901, as remediable under the Public Health Acts. The following is a list of the different classes of Factories in Hampstead:— Bakers 29 Dyers and cleaners 10 Bootmakers 19 Launderers 3 Butchers 7 Motor and other engineers 27 Cabinet makers and Upholsterers 8 Printers 7 Other trades 32 Carpet beaters 3 Total 157 Coffee roasters 4 Confectioners 3 Dressmakers 5 78 Workshops. At the end of 1936, there were 377 workshops on the Register, including 125 domestic workshops. During the year, 393 inspections were made and 73 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 87 such outworkers in Hampstead known to the Public Health Department. Of these, 7 are factories, 24 are workshops, 5 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, 49 lists were received, and 49 lists in August. These lists included the names of 134 and 129 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 112, 23 belonged to Hampstead and 89 elsewhere. Particulars of the latter were sent to the Local Authorities concerned, while information concerning 37 outworkers resident in Hampstead was received from other Authorities. In no instance during 1936 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 47 complaints of nuisance from rats and mice. 79 Eradication of Bed Bugs. The question of the best means of dealing with bugs has exercised the minds of public health workers for a long time. L,atterly the subject has come into considerable prominence. So far as old wornout properties are concerned, there is no known method that can be applied, without serious risk to human life, that will ensure a complete and effectual eradication of this pest. In connection with the development of large municipal housing estates in various parts of the country, special efforts have been made to prevent their infestation. No. of (a) Council houses in 1936: (i) found to be bug infested 3 (ii) disinfested 3 (b) other houses (i) found to be bug infested 79 (ii) disinfested 79 The procedure now adopted in the Public Health Department following a complaint of bug infestation is as follows:—(i) the complaint is entered in the Register of Complaints, (ii) the Sanitary Inspector visits the premises to verify the complaint and having inspected the structure for defective architraves, etc., serves an intimation notice where necessary. He also arranges, when desirable, for (a) the removal of the bedding, etc., for treatment at the Disinfecting Station, (b) the free disinfestation of the premises by the Council's Disinfecting Staff with a solution of cresylic acid in kerosene, the strength of the cresylic acid in kerosene being 3 per sent. Should a recurrence occur, subsequent disinfestation is done by the occupiers. For this purpose tenants are given, upon application, bottles of the preparation referred to, and they may purchase from the Public Health Department hand sprayers at a cost of Is. In suitable cases no charge is made for these sprayers. A dilute solution of orthodichlor-benzene had been employed until a memorandum from the Ministry of Health advised that its use was not unaccompanied with danger, and subsequently Vermicine (a proprietary product) was used for some time. For a long while it has been acknowledged that 100 per cent. efficiency can be obtained only if HCN is used, whilst a concentrated 80 solution of ortho-dichlor-benzene will produce 90 per cent. efficiency. However, both these substances are fraught with such great danger that they can only be used by men specially trained, and the premises must be vacated before disinfestation. In so far as we in Hampstead have no temporary alternative accommodation to offer to the tenants we have not used this method, although I understand certain Boroughs have already done so. An investigation was made into 76 cases which came to our notice during the twelve months ending 31st October, 1936, and it was found that we received only 5 requests for repeated disinfestation as our first application had not proved sufficiently effective. Additional legislation would be necessary in order to empower Metropolitan Borough Councils to provide temporary accommodation for persons removed from their dwellings whilst their premises were undergoing disinfestation; but it would appear that at the present time there is only a limited need therefor in Hampstead. Alternative accommodation for tenants is required only if HCN or concentrated ortho-dichlor-benzene is used, and in any case the use of these substances is subject to the following disadvantages:—(1) only men specially trained can use these products, and there is no one on the staff of the Council who is trained in their use; (2) even with the greatest precautions there must always be certain dangers, not only to the workmen themselves but to the occupants of adjoining buildings, owing to the likelihood of the gas permeating through the defective structures; (3) accommodation would have to be provided, not only for the particular dwelling to be disinfested but also for the occupants of neighbouring dwellings. When the "Westcroft" Housing Estate was ready for occupation, arrangements were made whereby a specialist firm undertook the removal and disinfestation of the effects of all families removing to the Estate, and for other necessary work to be carried out by the Council's disinfecting staff. Bugs were eradicated from furniture, bedsteads, etc., by subjecting them to a 2.5 per cent. concentration by volume of Hydrogen Cyanide for four hours in specially constructed vans. Ventilation was then carried out until a series of tests made with Sieverts and Hermsdorf reagent showed no dangerous concentration of H.C. remaining. Generally the procedure adopted was as follows:— 81 Early in the morning of the day of removal, the bedding, mattresses, curtains, clothing, etc., were collected and brought to the Public Health Station, where they were subjected to superheated steam (temperature 275° F.) for twenty minutes in the disinfecting chamber at a pressure of 15-20 lbs. per square inch, and were afterwards dried. Furniture removal vans collected the furniture, household effects, carpets, etc., and on arrival at the Public Health Station, the vans were hermetically sealed after hydrogen cyanide (prussic acid gas) had been released. After the expiration of four hours the vans were re-opened and ventilated. The household effects were then transported to the new home. Upholstered furniture was beaten in the open air before being taken into the house. It was decided that this procedure should apply to all families removing to the new Estate. A letter of advice was sent to the prospective tenants when they were notified of the day on which removal to the new Estate was to take place. This communication was in the following terms:— Before delivery to the new premises your furniture and effects will be fumigated. Drawers and boxes, etc., should not be packed tightly, nor should they be locked as their contents must be ventilated after fumigation. Food, plants, or wet clothes must not be packed with the furniture. Money, valuable papers, jewellery, etc., must not be put in the van, but conveyed by yourself to the new premises. Furniture and bedding will be delivered at your new address as early as possible in the afternoon or evening of the same day of collection. All your effects must be carefully cleansed before the day of removal. Do not take unwanted articles of any kind with you to your new house. The rooms must be especially well ventilated on the first evening and night of occupation. This arrangement has been continued in force in the case of all new families subsequently removing to the Estate when vacancies have occasionally occurred. No such procedure was instituted when the Council's fiats known as Park Dwellings and South End Close were originally occupied nor is it in operation there in cases of change of tenancy. 82 Shops Act, 1934. During the year 291 shops were inspected with a view to investigating as to (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. Provision is made in 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 a certificate of exemption should be granted and that such sanitary conveniences are otherwise conveniently available. During the year an exemption certificate was granted in respect of the following premises:— 53, South End Road. This certificate remains in force until withdrawn by the Borough Council. 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). Details of the method employed to treat the Bath Water, etc., were published in my last Annual Report. During 1936 the Public Health Department took samples of water from the various baths at the Central Baths, two for chemical and one for bacteriological examination. All the samples were satisfactory. (2) The H ampstcad Heath Swimming Pond. This Pond of flowing water is situated on the East Heath. It is impracticable to attempt purification of the Pond by means of chlorination or etc. During the year 1936, two water samples were taken for chemical and one for bacteriological examination, the latter analysis being performed in accordance with the 83 standard method recommended by the Ministry of Health. While the water, judged bacteriologically from the point of view of drinking water, showed evidence of pollution, and could not be regarded as suitable for drinking purposes, both the Chemist-inChief and the Principal Assistant Medical Officer of the London County Council thought that the condition of the Pond as disclosed by the examination did not justify condemnation of its use for bathing purposes. (b) Privately owned swimming baths open to the public. Gillittg Court and Holmefield Court, Bel sis e Grove, Swimming Pool. This swimming pool was provided principally for the use of the tenants of these Hats, but is also open to friends of tenants. During the year 1936, one sample of the bath water was taken for chemical and one for bacteriological examination. All the samples were satisfactory. Schools. In accordance with the requirements of the Public Health (London) Act, 1936, the Head Teachers of Schools are promptly informed of the occurrence of a case of notifiable 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 1936:— Date of Hearing. 1936 Nature of Offence. Result of Hearing. 15th Jan. Illegal letting two underground rooms. Fined 20s. and 10s. costs on each of two summonses. 24th Jan. Nuisance under Public Health (London) Act, 1891. Work done, Summons withdrawn, £1 Is. costs paid. 22nd Jan. Nuisance under Public Health (London) Act, 1891. Order made to abate in 14 days and pay £1 Is. costs. 26th Feb. Nuisance under Public Health (London) Act, 1891. Work done, Summons withdrawn, 10s. 6d. costs paid. 84 Date of Hearing. 1936. Nature of Offence. Result of Hearing. 22nd Apr. Selling Dutch mussels containing benzoic acid. Dismissed under Probation of Offenders Act on payment of £1 10s. costs. 5th May (i) Removal of fish offal at an unlawful hour. (i) Fined £5 and £1 1s. costs. (ii) No covers to containers. (ii) Fined £5 and £1 1s. costs. 20th May Selling sausages containing preservatives. (i) Fined £5 and £1 11s. 6d. costs. 25th May (i) Nuisance. (i) Order to abate in 28 days. (ii) Failure to provide dustbin. (ii) Witlfdrawn, dustbin provided. (iii) Failure to provide accommodation for storage of food. (iii) Fined 10s. (iv) Failure to provide accommodation for washing clothes. (iv) Fined 10s. (v) Insufficient water-closet accommodation. (v) Fined 10s. Do. (i) to (v) ditto. (i) Order to abate in 28 days. (ii) Withdrawn, dustbin provided. (iii) Fined 10s. (iv) Fined 10s. (v) Fined 10s. 26th May Selling crcam chccsc deficient in fat. Fined £3 and £5 5s. costs. 8th July Selling sugar containing an excess of sulphur dioxide and tin. Fined £3 and £2 2s. costs. 20th July Selling milk 66 per cent, deficient in milk fat on the Fairground, Hampstead Heath. Fined £10 and £1 15s. costs. 28th July Selling cream cheese deficient in fat. Dismissed under Probation of Offenders Act on payment of £3 3s. costs. 12th Aug. Contravention of the dog nuisance byelaw. Fined 10s. 3rd Sept. Nuisance under Public Health (London) Act, 1891. Order made to abate in 21 days and pay £2 2s. costs. Pharmacy and Poisons Act, 1933. The Pharmacy and Poisons Act, 1933, received the Royal Assent on 28th June, 1933, but the main restrictions relating to the sale, distribution, etc., of Poisons did not come into force until May 1st, 1936, although the Poison List was in operation for the purposes of certain sections of the Act. The Poisons Board prepared a list, referred to as the "Poisons List," of the substances which are to be treated as poisons for the purposes of the Act, which the Home Secretary approved, with certain modifications. The Poisons List is divided into two parts, and the 85 Poisons set out in Part I may only be retailed by authorised sellers of poisons (i.e., registered pharmacists); but a person whose name is entered in the Borough Council's list may, subject to certain conditions, sell poisons set out in Part II. The Poisons Rules, 1935, made by the Secretary of State under Section 25 of the Act set out restrictions as to the sale of Poisons and rules as to the manner of labelling, storing and selling poisons, etc. Section 21 of the Act which came into operation on May 1st, 1936, required the Borough Council to keep a list of persons in Hampstead who, not being entitled to sell poisons included in Part I of the Poisons List, may sell poisons included in Part II. Power is given to the Council to refuse an entry or to remove a name from the list if the person fails to pay the prescribed fees, or is, for any sufficient reason in the opinion of the Council, not fit to be on the list. The traders affected are, chiefly, grocers, ironmongers, oilmen, garage keepers, hairdressers, seedsmen, nurserymen, agricultural merchants, etc., and the class of poisons referred to in Part II of the Poisons List comprises, among other substances, ammonia, carbolic disinfectants, sulphuric and nitric acid, spirits of salts, salts of lemon; and a number of substances—including certain forms of arsenic and mercury—used in agriculture and horticulture as sheep dips, weedkillers and insecticides. The requirements which apply to a seller of Part II poisons are prescribed in Section 18 of the Act and in the Poisons Rules, and may be summarised briefly to be as follows:— 1.—The sale must be effected on the premises specified in the Council's list. 2.—The container must be labelled with the various particulars and in the manner required by the Act and the Rules. 3.—The container must be in the form specified in the rules—an impervious container sufficiently stout to prevent leakage, and, in the case of a glass bottle with the outer surface fluted vertically with ribs or grooves recognisable by touch. 4.—In the case of an arsenical or mercurial substance, unless it contains no more than the small proportions specified, and in the case of certain other substances, the purchaser must either (a) be known to the seller, or to the person in charge of the premises, to be a person to whom the poison may properly be sold or (6) produce a valid certificate in the form prescribed by the Rules. In addition, in the case of such poisons, the particulars of the sale must be entered in the Poisons Book to be kept in the prescribed form, 86 5.—Arsenical or mercurial substances and certain other specified substances may be sold only in particular types of preparation (e.g., sodium arsenates in sheep dips, calcium arsenates in insecticides) and in containers labelled with a notice of the special purpose for which they are to be used and with a warning that they are to be used for that purpose only. 6.—No arsenical substance (other than lead arsenates, calcium arsenates and copper acetoarsenites) nor mercurial substances may be sold to private persons; such substances may be sold only to persons engaged in the trade or business of agriculture or horticulture and for the purpose of that business. 7.—The sale of arsenical or mercurial and other substances (unless they contain no more than the small proportions specified) must be made by the listed shopkeeper himself or by a responsible deputy nominated by him to the Council. The Council resolved that the Town Clerk and the Medical Officer of Health should be authorised to make any necessary arrangements to (a) receive and deal with applications from persons desiring to enter their names in the list of persons entitled to sell poisons in Part II of the Poisons List, and (b) see that the requirements of the Act and the Poisons Rules, 1935, are enforced. The Medical Officer of Health and all the sanitary inspectors were appointed as Inspectors for the purposes of securing compliance with the provisions of the Act and the Poisons Rules. Application forms and leaflets, giving full information concerning the new Regulations, etc., were distributed to the traders in the Borough likely to be affected. Up to 31st December the Council had approved of the entry of the names of 127 persons in the List of Persons who, not being entitled to sell poisons included in Part I of the Poisons List, are, subject to the provisions of the Pharmacy and Poisons Act, 1933, entitled to sell poisons included in Part II of the Poisons List. The Council also agreed that the yearly period for this purpose should be from 1st of May to 30th of April. Public Mortuary, New End. During the year, 84 bodies were brought to the Mortuary, 23 by the Police, 52 at the request of friends, 1 at the request of a medical practitioner, and 8 by order of the Coroner. In 32 instances post-mortem examinations were made. Section 5. 89 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) 1608 (b) Number of inspections made for the purpose 2062 (2) (a) Number of dwelling-houses (included under sub-head (1) above which were inspected and recorded under the Housing Consolidated Regulations, 1925 74 (b) Number of inspections made for the purpose 103 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (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 1060 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 36 3. Action under Statutory Powers during the Year:— A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil. (6) 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 697 (2) Number of dwelling-house's in which defects were remedied after service of formal notices:— (a) By owners 697 (b) By local authority in default of owners Nil. C.—Proceedings under sections 19 and 21 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. 90 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 22 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit Nil. Housing Act, 1935—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 395 (ii) Number of families dwelling therein 395 (iii) Number of persons dwelling therein 1907 (b) Number of new cases of overcrowding reported during the year 8 (c) (i) Number of cases of overcrowding relieved during the year 62 (ii) Number of persons concerned in such cases 194 (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil. (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report Nil. The housing question would be easier of solution if it were one calling only for the provision of additional accommodation. The economic factor is a most important one and probably the least easy to overcome. Most overcrowded families are so situated through no fault of their own. The suggestion which has been made that accommodation can be provided by a process of redistribution is not easily applicable in Hampstead, as it is found that an undue proportion of the income of so many families is already spent in rent; and even though other rooms may become vacant in the houses in which the overcrowded families reside, they are unable to pay for the additional accommodation required. In the Ministry of Health's Circular dated the 1st of January, 1937, it was pointed out that the overcrowding is to be abated by finding the occupier "a house of a suitable size, suitably situated and suitably rented, in which he and his family can lead a healthy and comfortable life." As matters stand at present it does not appear to be easy to house in Hampstead a large family with a low wage under conditions that are indicated by the Ministry of Health. 91 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. 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 3 5 7½ persons. ,, ,, ,, (ii) Two rooms (iii) Three rooms (iv) Four rooms (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." This standard will come into operation on 1st January, 1938, by which date all rent books must contain a specified summary of the provisions of the Act relating to overcrowding, including a statement of the number of persons permitted to sleep in the house. 92 The Housing Committee has continued to give the fullest consideration to the housing question in the Borough and on Saturday, the 4th of April, 1936, they visited certain of the Mews dwellings and other premises. Mews dwellings, of which there are about 400 in the Borough, present a special problem. In my opinion, viewed from modern day standards the Mews dwellings visited did not provide adequate and satisfactory accommodation for the working classes. To a greater or lesser degree Mews dwellings have the following defects in common:—(1) Lack of through ventilation and inadequate lighting of rooms in rear of building. They are in principle "back-to-back" in so far as in most instances they have no "right of lights (2) There is no yard space in which babies and young children may be placed, whilst the mews in which the elder children play is always a constant danger; (3) Inadequate, or in some cases complete absence of, accommodation for washing clothes; (4) These dwellings are situated over garages from which poisonous fumes are constantly permeating through perished or cracked lath and plaster partitions which constitute the ceilings, and lightly constructed staircases; (5) They are approached by steep, narrow, unventilated and inadequately lighted staircases; (6) The landing, which is usually ill-ventilated and ill-lighted, is used for purposes of cooking, and the w.c. also often opens on to this landing. Progress in respect of dealing with the worst of the mews' dwellings in the Borough is however, unfortunately, for the time being at any rate, held up until alternative suitable accommodation can be offered to the mews-dwellers. Underground Rooms. Inspector Rowley, a recently appointed Sanitary Inspector, was detailed to make an inspection of underground rooms in the Borough in order to ascertain if they complied with the requirements relating to such dwellings. This officer commenced his duties on 1st of September, and as a result of his inspections, coupled with, information supplied by the other Sanitary Inspectors, a Register of Underground Rooms is being compiled. The following Tables show the result of the Survey of Underground Rooms so far inspected, and the results of action taken during the year:— Result of Survey of Basement-rooms so far inspected. (January 1st, 1936, to 31st December, 1936.) Total number of Basement-premises inspected 345. Allocation : Percentage of premises inspected (1) Premises found to comply with Underground Room Regulations 63 18 (2) Premises found not to comply, but which can be made to comply with Regulations 183 53 (3) Premises found not to comply, and cannot be made to comply with Regulations (i.e., Closure only alternative—action deferred pending provision of satisfactory accommodation) 65 18.8 (4) Premises found which do not comply with Regulations in minor details only (no action contemplated) 8 2.3 (5) Premises found to be used for purposes other than human habitation, or unoccupied 26 79 Total 345 100 Result of Action during 1936. Number of rooms made to conform. Number of rooms closed or illegal occupation discontinued. Total number of rooms. Number of premises concerned. Action under P.H. Acts (1891 and 1936) 42 8 50 28 Action under Housing Acts (1925-35) Action as the result of volun- 4 11 15 7 tary conversion of premises into flats and in connection with new buildings 30 2 32 18 76 21 97 53 The number of Underground Rooms found not to comply with the requirements, and indicated in the allocation above as (2), (3) and (4), totalled 396. They were found to exist in 256 premises. Of these rooms, 202 were found in 102 Tenement Houses. Now that it has been established by law that underground rooms which do not conform to the prescribed standard may be used, neither for sleeping nor for living purposes, the question should next be considered as to what should be included in the term " living room. 93 94 There are underground rooms that do not conform to the requirements which are occupied by persons for the purposes of trade or business, or in some districts as offices for as long or longer hours than are spent in bed rooms. It is reasonable to suppose that if it is deemed to be undesirable to sleep under such conditions for a few hours it is equally undesirable that such underground rooms should be occupied during as long, or perhaps a longer period of time during working hours. It is prescribed by Section 101 (1) of the Factory and Workshop Act, 1901, that no room which is underground (i.e., so situated that the surface of the floor is more than three feet below the surface of the footway of the adjoining street or of the ground adjoining or close to the room) can be used as a bakehouse unless it was so used in 1901. In the Memorandum upon the Structural Requirements of the Factory and Workshop Acts issued by H.M. Stationery Office in 1912 it is stated that:—" Basements are, in general, unsuitable for use as workrooms, owing to the difficulty in providing proper lighting and ventilation, and in preventing contamination of the atmosphere by dust and other impurities entering the windows from the street level"; but this opinion has not the force of law. It would appear to be desirable for legislation to be introduced which would, at all events, prevent underground rooms which would in all probability be occupied by persons for any considerable length of time by day or by night being constructed in the future, unless they are so constructed as to conform to the prescribed standards. Kilburn Vale Area. An official representation under Section I of the Housing Act, 1930, having been made to the London County Council by one of its Medical Officers of Health, with respect to three areas known as the Kilburn Vale Areas, the County Council on 7th July declared each of the areas to be a clearance area, and resolved to secure the clearance of the areas by purchasing the land comprised in the areas (shown by a pink colour on the map), and itself undertook or otherwise to secure the demolition of the buildings thereon. Further, it was resolved that for the purpose of securing a cleared area of convenient shape and dimensions, and for the satisfactory development or user of the cleared areas that the County Council should, by compulsory purchase orders, acquire the additional lands (shown by a grey colour on the map). 95 The represented areas were 131 acres in extent and comprised 39 houses, including 2 workshops, a garage and 2 stores. The additional lands were 117 acres in extent, and comprised 18 houses, including 3 shops, a beerhouse, a lock-up shop, a shop and workshop, a shop-fitting works, 3 builders' yards and a garage. The total area was 248 acres and the displacement of 249 persons of the workingclasses was involved. The London County Council has decided that in view of the limited amount of new accommodation available in the north-west district of London, it is proposed to utilise the whole of the accommodation to be provided in the Kilburn Vale areas for rehousing purposes in connection with clearance operations under the Housing Act, 1930, which takes precedence over the abatement of overcrowding. The Kilburn Vale Area was first condemned in 1903 by Dr. Herbert Littlejohn, the Medical Officer of Health for Hampstead, who made an official representation under Part I of the Housing of the Working Classes Act, 1890. This representation was considered by the London County Council who resolved that the Area was not of general importance to the County of London, and should be dealt with under Part II of the Act. In 1905 the Housing Committee of the County Council, in reply to an inquiry as to whether, in the event of the Borough Council dealing with the Area, they would contribute towards the cost of a scheme under Part II, replied that they could not see their way to recommend that Council to do so. In these circumstances the houses in the area were referred to the Public Health Committee to deal with and steps were taken to effect those improvements that were possible under the Public Health (London) Act, 1891. Notices were served and a measure of improvement was secured; certain houses were demolished and replaced by proper dwellings; while others were renovated. At the close of the Great War the Area again came under consideration when the Borough Council contemplated acquiring it for the purpose of a Housing Scheme, and in 1920 my predecessor represented the Area as being suitable for dealing with by means of a Scheme under Part II of the Act of 1890. The Borough Council thereupon passed the appropriate resolution directing that a Scheme 96 be prepared, but it was subsequently learnt that the Ministry of Health did not desire the Council to proceed with the Scheme. At the time of compilation of this Report an Inquiry has been held in respect of this Area by the Ministry of Health, and at which I gave evidence as Medical Officer of Health of the Borough. The result of the Inquiry, etc., will be reported in the Annual Report for the year 1937. Fairfax Place. On 11th November, 1935, and on 6th December, 1935 (after the hearing of Appeals in the Marylebone County Court, against Closing Orders made by the Borough Council), written undertakings were accepted from the owners of Nos. 36, 38, 42, 44 and 46, Fairfax Place to carry out certain works and alterations to the upper parts of those premises as indicated in a specification offered to the Court so as to render the parts of the premises fit for human habitation. The works as specified were properly executed. 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 62 Number of houses at the Watling Estate at the disposal of the Borough Council under similar arrangements Number of houses allotted to Hampstead under special arrangements with the E-C.C. for relief of overcrowding:— 38 Watling 81 Tottenham 4 Downham 1 Morden 20 Total 206 97 The total number of families removed from Hampstead to County Council houses since 1927, through action by the Borough Council, is 260 involving 1,395 persons. The additional 54 families are accounted for by changes in tenancies at the subsidy houses (18 at Watling and 36 at Wormholt), the Borough Council having the right to nominate tenants for any of the 100 subsidised houses which become vacant. The Council resolved in March, 1936, to enter into an agreement with the County Council for the purpose of providing accommodation (when required by the Council) on the County Council's Estates for persons of the working classes who might be displaced as a result of the Borough Council's operations under the Housing Acts, in connection with clearance or improvement areas, or the demolition of insanitary houses or the closing of parts of buildings, and agreed to pay in respect of each dwelling provided the sum of £1 17s. 6d. per annum for a period of 40 years, towards the expenses in the provision and maintenance of the dwellings. This agreement was in addition to the existing arrangement with the County Council whereby 100 houses at Wormholt Estate adjoining the White City, or the Watling Estate at Hendon, have been allocated to the Borough Council, in respect of each of which the Borough Council pays £7 per annum. 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 but no bath. 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 living-room, scullery, bathroom. The "Westcroft" Estate. The Borough Council's Housing Estate at Cricklewood was opened in 1935. It provides 32 one-bedroom Hats; 136 two-bedroom flats; 112 three-bedroom houses; and 10 four-bedroom houses with a parlour—a total of 290 dwellings. 98 During the year under review, 11 vacancies occurred on the Estate. These vacancies were allotted after very careful consideration by the Housing Sub-letting Committee to the most deserving applicants. There is, of course, always a very long list of suitable applicants. Representations. Statement showing steps taken in 1936 in connection with premises "represented in 1936 or previous years" by the Medical Officer of Health under the Housing Acts:— Premises. Representation. Closing Order. Remarks. Date of Committee. Date of Council. 13, Fitzjohn's Avenue 4-1-35 23-1-36 Underground room under front steps. 66, Heath Street 6-1-36 20-2-36 Two tenements, totalling six rooms over shop. 89, Abbey Road 6-1-36 20-2-36 Three underground rooms. 9, Hampstead High Street 9-3-36 30-4-36 Underground room, and room without external walls or window at rear of shop. Caretaker's Quarters, Victoria Mansions, Sumatra Road 9-3-36 30-4-36 Two underground rooms. 21, New End 8-6-36 25-6-36 Two underground rooms. Rosslyn Lodge Hotel, Lyndhurst Road (old cottage building in front) 4-5-36 25-6-36 One underground room. 13, Oppidans Road 4-5-36 — Two underground rooms. Caretaker's Quarters, 30, Greencroft Gardens 14-9-36 1-10-36 Two underground rooms. Caretaker's Quarters, Maisemore Mansions, Canfield Gardens 14-9-36 Two underground rooms and underground scullery. Written undertaking given to carry out works and alterations within three months from 17-9-36 to satisfaction of Medical Officer of Health. Under- . taking complied with. 4, Prince Arthur Mews 14-9-36 26-11-36 Three rooms. 82, Palmerston Road 12-10-36 26-11-36 Two underground rooms. 23, King's College Mews, East 12-10-36 26-11-36 One room. 96, Upper Park Road 12-10-36 17-12-36 Three underground rooms. " Albert Edward" P.H., 29, Bolton Road 9-11-36 - One underground room. 14, Willow Road 9-11-36 - Five underground rooms. 52, Belsize Road 12-10-36 — Two underground rooms. 123a, Adelaide Road 30-11-36 - Five underground rooms. 1, South Hill Park Gardens 30-11-36 - Three underground rooms. 44, Hilllield Road 30-11-36 — Two underground rooms. 99 Small Dwellings Acquisition Acts. During the year the Council advanced the sum of £400 in respect of a house in Westbere Road. 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. Section 6. Inspection and Supervision of Food. 103 Food. The good standard of the food supply of Hampstead has been maintained during the year, and in those few instances in which unsound food or food, the consumption of which might be undesirable, was found, the traders concerned readily co-operated with the Sanitary Inspectors by voluntarily surrendering the same and furnishing such information as was necessary as to source of supply, etc. The policy of the Department in the matter of food control is, broadly speaking, that enunciated by the Chief Medical Officer of the Ministry of Health, i.e., it is based upon two general principles; firstly, fair trading, in the sense that members of the public shall have some sort of guarantee that they are getting what they ask and pay for; and secondly, that the food shall not contain any ingredients which will render it injurious to health. Inspection and Supervision of Food. (A) Milk Supply. Examination of milk samples for baeterial 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. Do. (a) B. Coli present in 0.1 c.c. Do. (a) B. Coli present in 0.1 c.c. Raw Milk (b) Satisfactory. Certified (a) Do. Grade "A" (a) Do. Pasteurised (a) Do. Do. (a) B. Coli present in 1 c.c. Grade "A" (T.T.) (a) Satisfactory. Pasteurised (a) Do. Grade "A" (T.T.) (a) B. Coli present in 1 c.c. Certified (a) Satisfactory. Pasteurised (a) Do. Do. (a) Bacteria in 01 c.c. "Uncountable." B. Coli not present in 1 c.c. Do. (a) Satisfactory. Raw Milk (b) Do. Pasteurised (a) Do. Grade "A" (T.T.) (a) B. Coli present in 0.1 c.c. but not in 001 c.c. 104 Nature of sample. Examined for (a) Bacterial content or (b) Tubercle bacilli. Result of examination. Raw Milk (a) Bacteria in 0.1 c.c. "Numerous." B. Coli present in 0.1 c.c. Do. (6) Satisfactory. Do. (a) Bacteria in 0.1 c.c. "Very numerous." B. Coli present in 0.1 c.c. Do. (b) Satisfactory. Grade "A" (T.T.) (a) Do. (b) Do. Pasteurised (a) Do. Raw Milk (b) Do. Do. (b) Do. Pasteurised (a) Do. Do. (a) Do. Raw Milk (a) B. Coli present in 0.01 c.c. (b) Satisfactory. Do. (b) Do. Pasteurised (a) Do. Raw Milk (6) Do. Pasteurised («) B. Coli present in 0.01 c.c. Do. (a) B. Coli present in 0.01 c.c. Do. (a) B. Coli present in 0.01 c.c. Grade "A" (a) B. Coli present in 1 c.c. Pasteurised (a) Satisfactory. Do. (a) B. Coli present in 0.01 c.c. Do. (a) Satisfactory. Do. (a) Do. Do. (a) Bacteria per c.c.: 140,000 B. Coli present in 1 c.c. Do. (a) Satisfactory. Do. (a) Do. Do. (a) Do. Samples are 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 Designations) Order. Chemical examination of Milk Samples. There were 165 samples of milk taken under the Food and Drugs Act, and of these one was unsatisfactory. Only one informal milksample was taken during the year. The average composition of the total milk samples examined was:— Total milk solids 1225 per cent. Fat 3 55 per cent. Solids not fat 870 per cent. 105 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, 1936. (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 105. During the year, 236 inspections were made and three notices were served. In addition 30 persons are registered as purveyors of milk whose premises are situated outside Hampstead. The unsatisfactory condition of a certain premises in the Borough used for the bottling of milk was reported to the Public Health Committee in September, it being my opinion that the public health was, or was likely to be, endangered by the acts and defaults of the person registered as a dairyman at those premises. A Notice was duly served upon the responsible person, in accordance with Section 2 of the Milk and Dairies (Amendment) Act, 1922, to show cause why the Council should not remove his name and the premises from the register of dairymen and dairy premises for the following reasons:— (a) Owing to lack of proper supervision of the dairy; (b) Owing to the dirty condition of the premises; (c) Owing to the dirty condition of the bottles, churns, and utensils; (d) Owing to the premises not being suitable for their present use, viz., the business of bottling milk, cleansing receptacles and the storage of vehicles; (e) Owing to the premises generally not complying with the provisions of the Milk and Dairies Order, 1926. After a careful hearing of the objections of the dairyman and his employee to the proposal to remove his name and address from the Register, the Council, on the recommendation of the Public Health Committee, resolved to remove the entries from the Register. (ii) Milk (Special Designations) Orders, 1923 and 1936. Number of licences in force during 1936, for the sale of milk under special designations:— 106 Number of Purpose of Licence. Licences granted. Sale of Tuberculin tested Milk from shop or other premises (replacing "Certified" and "Grade A Tuberculin Tested" Milk) 21 Sale of Accredited Milk from shop or other premises (replacing "Grade A" Milk) 2 Sale of Pasteurised Milk from shop or other premises 37 No licence for graded milk was refused or revoked during the year. In 14 cases supplementary licences were granted authorising the sale of graded milk within the Borough from premises outside Hampstead. Milk (Special Designations) Order, 1936. This Order made by the Minister of Health on the 18th of April, under Section 3 of the Milk and Dairies (Amendment) Act of 1922, came into operation on the 1st of June, and revoked the Orders of 1923 and 1934. It prescribes that the special designations which may be used in relation to milk are "Tuberculin Tested," "Accredited," and " Pasteurised." Tuberculin-tested Milk. This grade replaces the present "Certified" and "Grade A (Tuberculin-tested)" milks, and is the only designation for raw milk from tuberculin-tested cows. If desired this milk can be pasteurised, and where this is done it must be sold as "Tuberculin-tested Milk (Pasteurised)." When tuberculin-tested milk is bottled on the farm the Order permits it to be described as "Tuberculin-tested Milk (Certified)." Accredited Milk. This designation is used for the milk that is at present termed "Grade A"—that is, milk from cows which are inspected by a veterinary surgeon but are not tuberculin-tested. If the milk has been bottled at the place of production, the words "Farm Bottled" may be added. Pasteurised Milk. As at present, all milk which has been held at a temperature of 145° to 150° F. for thirty minutes will be deemed to be pasteurised. 107 Bacteriological Tests. From December 31st, 1936, the method of prescribing the bacteriological standard by a "plate-count" test of 200,000 bacteria per millilitre was superseded for "Tuberculin-tested" and "Accredited" milks by the methylene-blue test, as recommended in the report of the Medical Research Council; the coliform test will be reserved for occasion. "Plate-count" tests are prescribed for "Tuberculintested Milk (Pasteurised)" and for the "Pasteurised " grades. (B) Meat and Other Foods. Examination of samples for bacterial content. The following articles of food, in addition to the samples of milk mentioned in sub-section (A), were examined bacteriologically:— Article. Result of examination. Anchovy Paste All cultivations made remained sterile after seven days' inoculation. (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 1936. (iii) Unsound Food and Food Inspection. The following is a list of food seized or voluntarily surrendered during the year:— Asparagus, 2 tins. Bahnckes Mustard, 8 glasses. Barbadoes Sugar, 48 lbs. Bread, 650 loaves and 300 rolls. Cheese, double cream, 5 lbs. Danish Mustard, 6 jars, 3 tins, 11 bottles. 108 Dogfish, 4 stone. Ham, 1 tin (14 lbs.) and 14½ lbs. Sardines, 14 tins. Skate, 28 lbs. Tomatoes, 3 lbs. Tongue, 2 6-lb. tins. (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 1,053 inspections were made. Premises. No. of Premises on Register. No. of Inspections. No. of Notices. Bakehouses:— Factories— Underground 13 27 13 Aboveground 16 17 2 Workshops— Underground 1 4 1 Aboveground 9 10 1 Fried Fish Shops 13 4 2 Ice Cream Premises 116 28 7 Milk Premises 105 236 3 Restaurants and Eatinghouses 91 20 8 Other Food Premises, e.g., Butchers, Greengrocers, Grocers, Provision Dealers, etc. 489 707 105 There is no Cowshed, Slaughterhouse or Poultry Slaughterhouse in the Borough. The underground bakehouses at 98, Boundary Road and 289, Finchley Road are now out of use. During the year the premises at 94, Kilburn High Road, formerly used as an underground bakehouse, were used for other trade purposes. Alterations which have been made to 225, Finchley Road render it impossible for these premises to be used as a bakehouse. These two premises have been deleted from the Register. 109 One new factory bakehouse was opened during the year at 126, West End Lane. The premises were suitably altered so as, in my opinion, to conform with the requirements of Section 101 (3) of the Factory and Workshop Act, 1901, which prohibits the establishment anew of an underground bakehouse. (v) Registration of Food Premises (other than Dairies). (a) There are 116 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 47 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. (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. In March and April leaflets were sent to all shopkeepers likely to be affected drawing their attention to the importance of the marking of imported meats and other foodstuffs. During the year a shopkeeper was ordered by the Council to be cautioned for exposing for sale a quantity of tomatoes not marked by means of a show ticket, clearly visible to intending purchasers, bearing the indication of origin of the tomatoes, in accordance with the Merchandise Marks (Imported Goods) No. 4 Order, 1929. 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 whole sale dealers in Margarine:— 304, Kilburn High Road—Messrs. Maypole Dairy Co., Ltd. 233, Finchley Road—Messrs. Lipton, Ltd. 110 (viii) Stalls and Vehicles (including Street Traders). The Bye-laws with regard to street trading relate, inter alia, to the protection of 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, five cases were notified; all of which were subsequently investigated by the staff of this department. (C) Adulteration, etc. (i) Food and Drugs (Adulteration) Act, 1928. 505 samples were taken for analysis during the year by the Sampling Officers under the Act. The number certified to be adulterated was 29, or 5.7 per cent. of the total number, as compared with 17, or 3.4 per cent. in 1935. Of the total samples taken for analysis, 407 were formal samples and 98 informal. 111 The following table shows the articles of which samples were taken during the year:— Article. Formal Samples. Informal Samples. Number taken. Number adulterated. Number taken. Number adulterated. Milk 164 1 1 - Cream 1 — 2 — Butter 16 1 2 — Margarine 3 — — — Lard and Lard Substitutes 7 — 1 — Cheese, Cream Cheese, etc. 9 3 2 — Dripping, Suet, Vegetable Fats, etc. 8 - 4 - Condensed Milk 6 — 3 — Coffee, and Coffee and Chicory 6 — 3 — Sausages, Minced Beef, etc. 32 4 1 1 Canned or Dried Fruits or Vegetables 27 _ 12 1 Canned Meats, Fish and Fish Pastes 35 3 22 5 Jam, Honey and Jellies 11 1 5 — Cereals 10 - 3 — Vinegar 5 — 2 — Pepper 3 - 2 — Mustard 2 - 4 — Sugar 16 7 — — Bread and Butter 3 1 — — Sauces, Pickles, etc. 8 — 9 — Wines, Beer and Spirits 8 — 1 — Fruit Drinks 2 — 5 — Pastry and Cakes 3 — 1 — Sweets 2 — 4 — Drugs 2 — 3 — Syrup — — 1 — Mixed Peel 1 — — — Coconut — — 1 — Savoury Roll 1 — — — Junklets 1 — — — Hot Chocolate Milk Shake 1 1 — — Self Raising Flour 1 — — — Health Salts — — 1 — Tea 1 — — — Mincemeat 7 — — — Ground Almonds 2 — 1 — Custard Powder 1 — 2 — Ground Cinnamon 1 — — — Mushroom Soup 1 - - - Totals 407 22 98 7 112 The following tables show the formal and informal samples found to be adulterated, etc., the nature of adulteration or other irregularity and the action taken:— Formal Samples. No. of Sample. Article. Analyst's Report. Action taken. 29 Cream Cheese Not cream cheese but a product of milk. Soft on account of large proportion of water. Fined £2 and £5 5s. costs. 38 Hot Chocolate Milk Shake. Total solids 14.9 per cent., Fat 1.3 per cent., some evidence of cocoa. Sample deficient in fat. Cautioned. 340 Dutch Mussels Benzoic acid 750 parts per million. Prosecuted, £1 10s. costs only. 368 Beef Sausages Sulphur dioxide 240 parts per million. Fined £5, and £1 11s. 6d. costs. 388 Barbadoes Sugar Sulphur dioxide 140 parts per million; tin 21 grains per lb. Fined £3, and £2 2s. costs. 411 Raw Sugar Tin 0.9 grains per lb. Cautioned. 64 Minced Beef Sulphur Dioxide 50 parts per million. Cautioned. 102 Minced Beef Sulphur Dioxide 60 parts per million. Cautioned. 66 Sardines Lead 80 parts per million Cautioned. 409 Milk Deficient in milk fat to extent of 66 per cent. Fined £10, and £3 3s. costs. 402 Butter Contained a slight excess of water. No action. 89 Cream Cheese Not cream cheese but a product of partly skimmed milk. Soft on account of large proportion of water present. Prosecuted, £3 3s. costs only. 447 Barbadoes Sugar Tin 30 grains per lb. Cautioned. 215 Sardines Lead 30 parts per million Cautioned. 475 Demerara Sugar Tin 10 grain per lb. No action. 274 Plum Jam Deficient in total soluble solids to the extent of 7.5 per cent. Cautioned. 233 | Bread and Butter The fat on this consisted of a mixture of butter and margarine in equal proportions. Cautioned. 480 Demerara Sugar Tin 11 grains per lb. No action. 238 Cream Cheese Not cream cheese, but a product of skimmed milk. Soft on account of the large proportion of water present. Summons withdrawn. 113 No. of Sample. Article. Analyst's Report. Action taken. 288 Beef Sausages Sulphur dioxide 140 parts per million. Cautioned. 250 Barbadoes Sugar Tin .96 grains per lb. No action. 457 Demerara Sugar Tin 1.3 grains per lb. Cautioned. Informal Samples. No. of Sample. Article. Analyst's Report. 450 Sardines Lead 36 parts per million 73 Sardines Lead 18 parts per million 74 Sardines Lead 40 parts per million 71 Asparagus Tin 2.7 grains per lb. 228 Sardines Lead 32 parts per million 317 Minced Beef 80 parts of sulphur dioxide per million. 144 Soft Roes Tin 2.62 grains per lb. (ii) Artificial Cream Act, 1929. The following is the only registered premises in the Borough:— 66-68, Kilburn High Road. (iii) Public Health (Condensed Milk) Regulations, 1923 and 1927. Nine 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 (Preservatives, etc., in Food) Regulations, 1925 to 1927. 165 samples of articles of food specified in these Regulations were submitted for analysis. Infringements were discovered in the following cases:— 114 Description of Foodstuff. Result of Analysis. Action taken. Dutch Mussels Found to contain benzoic acid 750 parts per million Prosecuted, £1 10s. costs only. Beef Sausages Found to contain sulphur dioxide 240 parts per million. Sold without any indication that they contained preservatives. Fined £5 and £1 11s. 6d. costs. Barbadoes Sugar Found to contain (a) sulphur dioxide 140 parts per million, and (b) tin 21 grains per lb. Fined £3 and £2 2s. costs. Remainder of stock of sugar voluntarily surrendered by vendor. Information circulated to other districts. Sardines Found to contain lead 80 parts per million. Cautioned. • Remainder of stock of sardines voluntarily surrendered by vendor. Sardines Found to contain lead 30 parts per million. Cautioned. Stock withdrawn from sale. Minced Beef Found to contain sulphur dioxide 50 parts per million. Cautioned. Tinned Asparagus Found to contain tin 2.7 grains per lb. Cautioned. Remainder of stock of tinned asparagus voluntarily surrendered by vendor. Demerara Sugar Found to contain tin 1.3 grains per lb. Cautioned. Stockwithdrawn from sale. Beef Sausages Found to contain sulphur dioxide 50 parts per million. Cautioned. Beef Sausages Found to contain sulphur dioxide 140 parts per million. Cautioned. Barbadoes Sugar Found to contain tin 0.96 grains per lb. No action. (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. 115 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.1. The nature of the work done at these Laboratories is set out in this Section of the Report. (E) Nutrition. The routine medical inspection of entrant children in Hampstead to Elementary Schools during the year 1936 demonstrates that 107 or 17.2 per cent. were classed as "good," 486 or 78.4 per cent. were "average" and 27 or 44 per cent. were "below normal." The corresponding figures for the County of London were 15.1 per cent., 78.6 per cent. and 6.3 per cent. REPORT for the year 1936 of the Public Analyst. H. E. COX, D.Sc., Ph.D. (Lond.), F.I.C. 119 The Laboratory, 11, Billiter Square, London, E.C.3. 12th February, 1937. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, Following my usual custom I beg to submit a short summary of the work I have carried out as your Borough Analyst under the Food and Drugs Adulteration Act during the year 1936. The number of samples which have been examined was 505. It is unnecessary to enumerate them all, but the range of materials has been wide and some of the principal kinds are shown below:- Milk 165 Cream 3 Butter 18 Margarine 3 Lard and Lard Substitutes 8 Cheese, Cream Cheese, etc. 11 Dripping, Suet, Vegetable Fats, etc. 12 Condensed Milk 9 Coffee and Coffee and Chicory 9 Sausages, Minced Beef, etc. 33 Canned or Dried Fruits or Vegetables 39 Canned Meats, Fish and Fish Pastes 57 Jam, Honey and Jellies 16 Cereals 13 Vinegar 7 Pepper 5 Mustard 6 Sugar 16 Bread and Butter 3 Sauces, Pickles, etc. 17 Wines, Beer and Spirits 9 Fruit Drinks 7 Pastry and Cakes 4 Sweets 6 Drugs 5 Miscellaneous 24 120 Out of these SOS samples, 476 may be regarded as quite satisfactory, and it is, perhaps, inevitable that attention should be given to the 29 adulterated or unsatisfactory samples rather than to comment on the virtues of the others. No new forms of adulteration have been noted during the year, but there is, as often happens, a recrudescence of well known sophistications. The subject of metallic contamination of food continues to call for attention and one may venture to hope that the new legislation which the Minister of Health hopes to introduce during the present year may clarify the law and practice in relation to this rather difficult subject. A number of samples of Sugars of the Demerara type have been found to contain relatively substantial quantities of tin. This is not a new phenomenon; indeed it has been known for about fifty years that a small quantity of tin was used in the manufacture of these types of sugar. Its function is apparently to act as a mordant for the natural colouring matter of the sugar. Rut although sugar has for many years contained traces of tin, the amounts which have been found recently seem to be substantially higher, though only in a few cases did they exceed 2 grains per pound. There is a commonly accepted limit of 2 grains per lb. for tin in canned foods, but this refers primarily to unavoidable contamination due to storage in tinplate, which is not at all the same thing as the deliberate addition of tin, in connection with which the Royal Commission on Arsenical Poisoning, so long ago as 1903 reported that "Chloride of tin appears to us an objectionable and unnecessary addition to sugar and we are of opinion that it should no longer be used." It is, I believe, contended by the manufacturers that the addition of tin to this class of sugar is necessary. The matter has been brought to the notice of the Minister of Health, and I understand that it is being carefully considered by the Minister. The finding of tin in sugar, of lead or tin in canned fish, of traces of copper in pickles and like products, and of various other metals in other foods, renders it necessary to determine these small quantities of metals in a wide variety of products in addition to examining them for preservatives and ascertaining their composition in the ordinary way. Thus, the amount of work which has to be done in examining samples constantly tends to increase. 121 The Dairy produce examined has, in general, been of good quality. The average composition of the milks is:— Total milk solids 1225 per cent. Fat 355 „ Solids not fat 870 ,, and only one of them was adulterated. This sample was 66 per cent. deficient in fat. Butters still occasionally show a slight excess of water; preservative seems quite to have disappeared from it. Bread and Butter as supplied to some eating houses is not always Bread and Butter; one sample examined this year consisted of Bread and Margarine. Three very unsatisfactory samples of Cream Cheese have been examined. Each of these contained about 70 per cent. of water, with only 10 to 14 per cent. of fat, so that they were in fact, products of partly skimmed milk, soft on account of the large proportion of water present and certainly not entitled to the description of Cream Cheese. Infringements of the Preservative Regulations continue to occur; usually this takes the form of the addition of sulphur dioxide without the required statutory declaration, and. there have been three cases of the addition of preservative to Minced Beef, which in England is not permitted to contain preservative, though it is permitted during certain months of the year in Scotland. Some Dutch Mussels were also found to contain Benzoic Acid, which is contrary to the Regulations. Among other matters which are disclosed by examination of the various samples, is a tendency for certain types of manufactured products to differ widely from old fashioned notions of what they should contain. For instance, one finds soft drinks, fruit cordials and the like, which are prepared very largely—if not entirely—from synthetic materials and coloured with artificial dyes. These products may be quite wholesome and it is often difficult to decide whether they are to be regarded as satisfactory or not. Much depends upon the precise description on the label. I have referred on previous occasions to the sale of synthetic mixtures in cream buns and similar products. There is abundant evidence of a slow change in the composition of 122 foods as the result of large scale manufacture, as compared with the old fashioned home production. In some directions this represents an improvement, but in others it does not. Such products usually are of a high degree of purity and if they are correctly described, they appear to be quite unexceptionable. It is to be hoped that the new legislation which is foreshadowed will deal with the matter of descriptions and mis-descriptions, and that it will place some check upon the accuracy of advertisements in relation to food. There are instances which need not be mentioned where extravagant claims which are made in advertisements are not in accordance with the true facts. 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. 125 Prevalence of, and Control over, Infectious and other Diseases. Acute Polio-Myelitis. One case occurred during the year in a male of 19. He was treated at Charing Cross Hospital, as an in-patient, for three months. He had a long course of treatment of massage, splinting, and radiation exercises, for his paralysis. The patient made a remarkably good recovery and is still attending the massage and electrical department of Charing Cross Hospital for out-patient treatment. Cerebro-Spinal Fever. No cases of Cerebro-Spinal fever were notified during 1936. Diphtheria. During the year there were 51 cases of diphtheria and one death as compared with 62 cases and no deaths in the previous year. The morbidity rate was 0 55 per 1,000 of the population. All cases, with one exception, were removed to hospital. Immunisation. The Borough Council pay a fee of 7s. 6d. to general practitioners for each child completely immunised, and provide the immunising material free of charge, the practitioner agreeing to give the child three injections, and to enter the necessary particulars on a record card, which card will act as the account for his fee, which is paid quarterly. The responsibility for the administration of the injections is placed on the practitioner, who is also responsible for any subsequent medical attention necessary, etc. Arrangements for the final Schick test are made by the Borough Council, and special clinics are held for this purpose. During the year 343 children were immunised against Diphtheria; 140 by private doctors, and 203 by the Council's Assistant Medical Officers. 166 Schick tests were performed. There was no preliminary Schick testing in children below 8 years of age. One child was found to be still susceptible after inoculation and was given one further injection. 126 In every case Diphtheria Toxoid Anti-Toxin (Goat) was used for immunisation, three injections at intervals of a week or more being given. In addition to the 203 children immunised, 7 children (3 3 per cent. of the total) ceased attendance after the first or second injection, despite repeated requests to the parents to bring them to the Clinic. This small percentage appears to indicate that it is worth while continuing with the three-injection technique, as against the "one-shot" method, which is much less certain in its results. In no instance was there any alarming reaction. In a very small percentage of the cases there was a local erythema which passed off in a few days and did not require any special treatment. It is, perhaps, of interest to record the only case in which any severe reaction was attributed to the injections. A very irate parent arrived at the Town Hall demanding to see the Doctor who had "nearly killed" his daughter. It was ascertained that the child had been given a first injection ten days previously. There was no obvious reaction until the night of the tenth day, when she became acutely ill in the middle of the night, with symptoms suggesting some form of intestinal obstruction. Enquiry at the school brought to light the fact that the child had swallowed a large piece of plasticine on the previous afternoon and had been sent home. The parent returned to the Town Hall later in the day and was profusely apologetic. The increase in the number of children immunised during 1936 is largely due to the whole-hearted co-operation of Head Teachers in some of the schools in the Borough. Lectures on Immunisation were delivered to the Parents' Associations in the schools, with very gratifying results. In three of the non-provided schools the children were immunised on the school premises. This procedure has many advantages over attendance at the Council's Clinics; the children are much less troublesome to inject at school in the presence of their teachers than at the Clinics, where they are accompanied by their parents. Furthermore, one batch of volunteers in a class usually gives rise to many more on the second visit. Unfortunately, it is not possible to hold Clinics for Diphtheria Immunisation at the provided London County Council Schools. 127 It is a matter for concern that so many children did not re-attend for the Schick test in spite of repeated requests. The feeling of security engendered by the three inoculations is sometimes unfounded, and it is essential that in every case a Schick Test should be performed to see whether or not complete immunity against Diphtheria has been established. There were three instances of alleged diphtheria in children who had been immunised. Details of these cases are set out below. (1) A child aged 3¾ years, who was immunised with 1 c.c. of Toxoid Antitoxin (Goat) on 4th February, 1936, 18th February, 1936, and 3rd March, 1936. No Schick test was performed. She was notified as suffering from nasal Diphtheria in September, 1936, and admitted to Hospital. The Medical Superintendent reports that the child was not suffering from clinical diphtheria but was merely a carrier. (2) A child aged 4½ years (sister of the above) injected on the same dates, was notified as nasal Diphtheria in October, 1936. There was no clinical evidence of diphtheria on admission to Hospital, where all throat swabs were negative. The Medical Superintendent reports that this was not a case of diphtheria and that it was not certain that the child was even a carrier. (3) A child aged 6 years. Toxoid Antitoxin was injected on 1st May, 1936, 15th May, 1936, and 29th May, 1936, but the parent did not bring the child to the clinic for a Schick test when requested. She was notified as a case of diphtheria on 26th January, 1937. On admission to hospital she had a minimal amount of exudate on both tonsils and from this C. diphtheriæ of the gravis type were isolated. A diagnosis of mild faucial diphtheria was made. There were no complications. This case illustrates the necessity for Schick testing all children after injection. The three injections of toxoid antitoxin did, not apparently establish complete immunity to diphtheria in this instance, but there is no doubt that they resulted in the attack being of a very mild nature, without any of the dangerous complications or sequelæ which so frequently accompany this disease. 128 Dysentery. Three cases of Dysentery were notified during the year as compared with 10 cases during the previous year. All the cases occurred in adults. Two were of the Sonne type, and the attack was very mild in each case. The third patient had Amoebic Dysentery, for which she was treated at the Hospital for Tropical Diseases. She had but recently returned to England from abroad, and it was considered that her disease was contracted in Nyasaland, probably during 1933. No cases of dysentery occurred among children, in contrast to 1935, when there were six cases. Encephalitis Lethargica. No case of this disease was notified during the year. Enteric Fever. Sixteen cases of enteric fever occurred during the year, four of which proved fatal. Five of these cases were notified as being due to B. Typhosus. The age incidence is set out in the table on page 133, and it will be seen that in nine cases the age of the patients was between 20 and 35. The patients who died were aged 22, 34, 46 and 74, respectively. Five persons were considered to have been infected at Bournemouth. In two instances the infection presumably took place abroad whilst on holiday in Brittany and Scandinavia respectively. Two of the affected persons were nurses who had been in attendance on cases of enteric fever whilst engaged in their hospital duties (one of these nurses succumbed to the disease). In two cases where the source of infection could not be traced, oysters had been eaten a little time previously, and one of these persons was already an in-patient in a General Hospital undergoing a surgical operation. The remaining five patients resided in the same house and the diagnosis of these cases presented great difficulty; three were admitted to hospital. None of these five cases terminated fatally. 129 It should be noted that two people were infected whilst holiday- making on the Continent. These cases demonstrate the dangers of eating uncooked fruit and vegetables or drinking unboiled water in places abroad, where the sanitation is not of the highest standard. Intending travellers, particularly those who contemplate a visit to the lesser-known places abroad, should bear in mind the fact that complete immunity to Enteric may be established by means of preventive inoculations. The Bournemouth epidemic illustrates how the disease may be propagated by means of infected milk. Pasteurisation is a certain safeguard, and in the presence of an epidemic, no milk should be consumed which has not been rendered safe by pasteurisation or boiling. Malaria. One case of Malaria was notified during the year. The disease was of tertian type, and occurred in a male patient aged 28 years, who contracted the disease in Venezuela in 1935. Measles. During the year, 918 cases were notified, of which 137 were removed to hospital. The illness terminated fatallv in two instances. The following table shows the number of cases notified in each year since 1923:— Year. Cases. 1923 209 1924 1226 1925 293 1926 1617 1927 82 1928 1121 1929 125 1930 1209 1931 225 1932 716 1933 81 1934 1311 1935 40 1936 918 130 Measles epidemics usually occur every two years in London, and following the few cases in 1935, the disease was very prevalent this year. The two deaths were due to broncho-pneumonia in children aged 1 year 7 months, and 1 year respectively. One child was nursed at home, but the other, who was removed to hospital, already had broncho-pneumonia before the onset of measles. The ward allocation of the cases was:— Cases per 1,000 population. Ward No. 1 (Town) 66 5·2 „ 2 (Belsize) 148 10·0 „ 3 (Adelaide) 99 8·7 „ 4 (Central) 70 6·0 „ 5 (West End) 211 14·7 „ 6 (Kilburn) 225 14·7 „ 7 (Priory) 99 8·6 The disease had its greatest incidence in the West End and Kilburn Wards. It was least prevalent in the Town and Central Wards. An analysis of the cases notified shows the following:— Adults 6 per cent. Pre-school children 27 „ School children 65 „ Unclassified 2 „ and of the school children:— 50 per cent. attended Council schools in the Borough. 10 „ „ Private schools in the Borough. 5 „ „ Schools outside this Borough. The tables below show how the cases were distributed in families and houses:— (a) No. of families in which more than one case occurred 135 No. of families in which 2 cases occurred 112 „ „ 3 „ 20 ,, ,, 4 ,, 3 131 (b) No. of houses in which cases occurred in more than one family 59 2 cases in house 39 3 „ „ 16 4 „ „ 4 (f) Where more than one case occurred in the house- Cases probably infected by another person in the family 125 „ „ „ house 49 „ „ from a common outside source 84 The London County Council Scheme of Measles Control was applied in certain schools in the Borough. An analysis of the number of cases occurring in these schools, and also in the schools in which the scheme was not put into operation, is given below:— 1.—Five Schools in which the Measles Scheme was applied. No. of cases occurring in 5 schools. Total. Average attendance. Before Scheme was applied. After Scheme was applied. 92 165 257 2478 In these Schools 10.5 per cent. of the children contracted measles. 2.—Seven Schools in which the Measles Scheme was not applied. No. of cases. Average attendance. 185 988 In these Schools 18 per cent. of the children contracted measles. 822 visits were made by the Health Visitors to 697 homes in respect of measles. Pneumonia. During the year 85 cases of pneumonia were notified. Of these 63 were of acute primary pneumonia and 22 cases of acute influenzal pneumonia. The total deaths were 21, of which 16 occurred in persons over 45 years of age. 132 As is usually the case, the age of the patient appears to be the chief factor of mortality. Influenza. Influenza became prevalent towards the end of the year. The epidemic was of moderate severity, and the attack rate appears to have been fairly high. Influenza is not a notifiable disease, and it is difficult, therefore, to arrive at any satisfactory estimate of the true nature and incidence of this epidemic. The only definite information available is that obtained from Influenzal Pneumonia notifications. On the other hand, the death returns for the year show Influenza as the cause of death in 18 cases, as compared with 5 cases in the previous year. Scarlet Fever. During the year 114 cases of scarlet fever were notified (cf. 112 in 1935, 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. 133 Notifiable Diseases during the Year 1936. NOTIFIABLE DISEASES. * Total cases notified in age-periods. 'Total cases notified in each Ward. *Cases admitted to Hospital. Total deaths in age-periods. At all Ages. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). At all Ages. At Ages—Years. Under 1. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. 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. Diphtheria 51 i 1 8 « 14 i 4 U 2 2 9 2 7 5 26 50 1 1 Dysentery 3 2 i 1 Erysipelas 38 2 1 i 1 7 2 13 6 3 4 6 4 y 5 2 16 Malaria 1 1 1 . Ophthalmia Neonatorum ib 1h 2 2 1 1 8 2 9 Pneumonia 8.5 3 1 8 3 2 16 8 30 14 10 17 15 9 12 19 3 36 21 1 2 7 9 Polio Myelitis 1 1 I Puerperal P ever .. 1 1 1 1 Puerperal Pyrexia Vfl 2 13 5 3 3 1 V •> 6 2 17 Scarlet Fever 114 f, 9, 4 7 33 19 16 9 S 2 1 13 24 11 18 21 18 9 100 Typhoid Fever 15 1 1 2 Q 1 1 4 1 1 1 2 6 9 4 i 1 .. 1 1 f Measles .. 91H 2S KB 63 97 127 393 73 24 41 6 66 148 99 .0 211 225 99 13' 2 J Tuberculosis 94 1 1 1 3 2 12 38 17 13 6 10 13 14 11 13 19 14 79 39 2 2 i 4 11 4 11 4 Totals 1352 50 69 67 111 140 453 100 64 169 43 59 27 109 225 149 126 278 328 137 456 67 1 2 2 — i — 6 14 5 1 19 14 1 * Cancelled cases have not been included. † Notifiable under the Borough of Hampstead (Measles) Regulations, 1920. ‡ Statistics relating to Tuberculosis are given in subsequent pages. 134 Tuberculosis. Notification. During the year 1936, 94 new cases of Tuberculosis were notified, 71 being cases of Pulmonary Tuberculosis, and 23 other forms of the disease. The following statistical table, prescribed by the Ministry of Health, gives an analysis of the newly notified cases and deaths during 1936:— Age Periods. New Cases. Deaths. Respiratory. NouRespiratory. Respiratory. NonKespiratory. M. F. M. F. M. F. M. F. 0- - - - 1 - - 1 1 1- - - 1 1 - - 2 - 5- — — 5 - - — 1 - 15 8 12 3 2 2 5 - - 25- 8 13 3 1 2 6 - - 35- 8 6 2 1 2 2 - - 45- 6 2 - 1 6 1 - - 55- 2 1 - 1 2 1 1 - 65 and upwards 4 1 — 1 1 2 - 1 Totals 36 35 14 9 15 17 5 2 The following table shows the numbers of notified cases of pulmonary tuberculosis amongst males and females. The number of cases between the ages of 15 and 34 is also shown. The figures relate to the five-year period, 1932-1936:— ]Total Cases. 15—34. 15—34. [###Year. Males. Females. Males. Females. 1936 36 35 16 25 1935 27 36 9 29 1934 38 35 17 24 1933 50 44 21 28 1932 35 46 16 33 Totals 186 196 79 139 These figures show that 70 per cent. of the cases of pulmonary tuberculosis in females occur between the ages of 15 and 34, as com- 135 pared with 40 per cent. in males. The excessive incidence of the disease in this period of life is very alarming and constitutes a very serious problem. It must be remembered that, in Hampstead, many of the young adult females affected are persons who have but recently come to London from Ireland. Wales and the North of England. Occupations. The following is an analysis of the occupations of the new cases notified as tuberculous during 1936:— Occupation. Pulmonary cases. Non-Pulmonary cases. Auctioneer 1 — Barber 1 — Barman 1 — Basket-worker (Blind School) 1 — Chartered Accountant 1 — Chauffeur 2 — Clerk 6 1 Cook 2 — Domestic 5 1 Dress Designer 1 — Factory Hand 1 — Garage Attendant 1 — Housekeeper 1 1 Housewife 11 3 Journalist 1 — Labourer 4 1 Manageress — 1 Medical Practitioner 1 — Messenger Boy — 1 Motor Driver 1 — Merchant 2 — Nil 5 5 Novice — 1 Nurse 1 1 Office Boy 1 — Optician — 1 Painter 1 — Porter 3 — Scholar 1 4 School Teacher 1 — Seaman — 1 Sheet Metal Worker — 1 Ship's Cook 1 — Shop Assistant 3 — Stockbroker 1 — Storekeeper 1 — Student 2 - 136 Occupation. Pulmonary cases. Non-Pulmonary cases. Tailoress 1 - Telephonist I - Traveller 2 - Typist 2 — Totals 71 23 A survey of the statistics relating to Tuberculosis in Hampstead in recent years reveals the fact that, according to the number of notifications of new cases received, there has been a decrease, from 361 in 1918, to 94 in 1936, equivalent to 74 per cent. The figures, together with the deaths from Pulmonary Tuberculosis, are as follows:— Year. Persons newly notified. Deaths from Pulmonary Tuberculosis. Pulmonary Tuberculosis (Voluntarily notifiable 1902; compulsorily notifiable 1912). Non-Pulmonary Tuberculosis (compulsorily notifiable from 1st February, 1913). Total. 1918 291 70 361 75 1919 165 48 213 56 1920 118 53 171 41 1921 103 55 158 63 1922 101 34 135 50 1923 88 36 124 51 1924 100 25 125 58 1925 99 14 113 52 1926 69 16 85 51 1927 79 11 90 38 1928 80 8 88 39 1929 72 12 84 48 1930 68 13 81 38 1931 92 17 109 41 1932 74 20 94 32 1933 94 10 104 37 1934 73 21 94 53 1935 63 18 81 29 1936 71 23 94 32 Deaths. The number of deaths from all forms of tuberculosis during 1936 was 39, of which 32 were pulmonary and 7 non-pulmonary. 137 There were nine deaths certified as due to tuberculosis which had not been notified previously. Enquiries are always made in such cases as to the reasons for non-notification. Four of the deaths occurred in children who were patients in hospital; three of these died of meningitis and one of miliary tuberculosis. There were two middle-aged adults; it was ascertained that the disease was of long duration and the necessary notification had presumably been made many years ago. Two young adults died in hospital from a very rapid form of pulmonary disease, and here it is assumed that the short duration of the illness accounted for the failure to notify. The remaining patient died from tuberculosis of the epididymis. 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 71 cases of Pulmonary Tuberculosis newly notified in 1936:— 38 were treated at Sanatoria. 5 „ „ Hospitals. 18 „ „ L.C.C. Hospitals. Of the 23 cases of Non-Pulmonary Tuberculosis newly notified in 1936:— 6 were treated at Sanatoria. 4 „ „ Hospitals. 4 „ „ L.C.C. Hospitals. The following cases, notified prior to 1936, were also removed:— Pulmonary. Non-Pulmonary. Insured. NonInsured. Insured. NonInsured. To Sanatoria 10 4 — - To Hospitals — 1 l — To L.C.C. Hospitals 5 4 1 — 138 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 1936 totalled 341 —268 pulmonary and 73 non-pulmonary. Tuberculosis Regulations, 1930. Pulmonary. Non-Pulmonary. Totals. Males. Females. Males. Females. Males. Females. Number of cases on the Register at the commencement of the year 1936 158 182 47 53 205 235 Number of cases notified under the Regulations for the first time during the year 36 35 14 9 50 44 Number of cases removed from the Register in a preceding year which have been restored to the Register during the year — 2 — — — 2 Number of cases brought under notice otherwise than by notification during the year 10 17 6 5 16 22 204 236 67 67 271 303 *Number of cases removed from the Register during the year 83 89 26 35 109 124 Number of cases remaining on the Register at the end of the year 121 147 41 32 162 179 *These consist of cases which have been denotified, and those which have died or removed from the Borough, 139 Staff engaged on Tuberculosis Work. The Borough Council staff specially engaged in work directly connected with Tuberculosis consists of the following:— (1) The Medical Officer of Health, who is the Administrative Tuberculosis Medical Officer. (2) The Clinical Tuberculosis Officer. (3) Tuberculosis Nurse. (4) Clerk. The Tuberculosis Nurse visits all newly-notified cases and informs them of the Dispensary facilities. If they are suitable cases they are urged to attend. The Nurse also makes periodical visits to patients on the Dispensary register who are unable to attend. In addition, the Clinical Tuberculosis Officer visits bedridden patients at their homes. Medical Practitioners are invited to send their cases to the Dispensary for consultation and advice. If patients are too ill to attend, they are seen at home. X-ray Exatninations. Arrangements were in operation for patients under Dispensary supervision to be X-rayed at the Hampstead General Hospital. There were 95 such examinations made during 1936. Pathological Examinations of Sputum. This work is undertaken for the Council by the Laboratories of Pathology and Public Health, 6, Harley Street, W.l, and the facility is available, free of charge, for medical practitioners. During the year 134 specimens were submitted for examination by local practitioners and, in addition, 173 specimens were sent by the Clinical Tuberculosis Officer. Artificial Pneumo-thorax. Prior to November, 1936, patients undergoing this form of treatment received their refills at Brompton, Victoria Park, St. Mary's, St. Thomas's, University College and Colindale Hospitals. Dr. H. Davis Chalke, the Clinical Tuberculosis Officer, now. carries out this treatment himself, and patients attend at either New End or Paddington Hospitals for this purpose. Sessions are held on Tuesday and Thursday afternoons. 140 This is a much more satisfactory arrangement than the former one, for the Tuberculosis Officer can now keep in much closer touch With his patients than was hitherto possible. There is the further advantage that patients do not have so far to travel. During the year 18 patients who were undergoing this form of treatment made 241 attendances. Contacts, Every effort is made to ensure the attendance at the Dispensary of contacts of cases of tuberculosis, and a scheme has recently been put into operation for the closer following up of all contacts. This aspect of the tuberculosis problem is regarded as being of outstanding importance. 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, seven patients attended and the total attendances were 38. Light Treatment. One patient is receiving Finsen Light treatment at a General Hospital. Many patients, particularly children, attend the Institute of Ray Therapy, Camden Road, for Ultra-Violet Therapy. Home Nursing. The Home Nursing of requisite cases is provided free by arrangement with the two local District Nursing Associations. 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 141 vessels. No case arose during the year necessitating action to be taken under these Regulations. Tuberculosis Care Committee. The Rorough 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. The Committee, through its Secretary, Miss Talbot Kelly, keeps in touch with the families of patients who are receiving institutional treatment, 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 249 New cases (included in above) ... 97 Interviews with patients by Care Committee Secretary :— (a) At homes of patients 95 (b) Otherwise 820 Cases referred to the Hampstead Borough Council:— (a) For extra nourishment 21 (b) For dental treatment 7 Cases referred to the Public Assistance Committee 28 Cases referred to Service Funds 9 Cases referred to Voluntary Associations 15 Cases referred to other Agencies 13 Cases helped directly through the Care Committee:— (a) In cash 41 (b) In clothing 16 Provision of Extra Nourishment. The Council has voted the sum of £65 for the purpose of providing extra nourishment (milk, eggs and butter) to the classes of 142 patients indicated in Circular 257 of the Ministry of Health. During the year, 19 patients received help under the scheme. Patients in receipt of Public Assistance are provided with additional nourishment on the recommendation of the Clinical Tuberculosis Officer. 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, 10 a.m. Wednesdays, 2.30 p.m. Thursdays, 6 p.m. During the year, 194 sessions were held, and 213 new cases (of which 52 were contacts) were examined. Altogether, 361 patients attended the Dispensary in 1936, and the total number of attendances of all kinds numbered 1,236, an average of 5.9 per session, at which 835 systematic physical examinations were made. The attendances were 300 more than last year. 143 Tuberculosis Scheme of the Hampstead Metropolitan Borough Council. Return showing the work of the Dispensary during the year 1936. 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 28 32 — — 4 3 2 3 32 35 2 3 72 (6) Doubtfully tuberculous — — — — — — — — 2 2 1 2 7 (c) Non-tuberculous — — — — — — — — 21 42 8 11 82 B.—Contacts examined during the year:— (a) Definitely tuberculous — 1 — — — — 1 — — 1 1 — 2 (6) Doubtfully tuberculous — — — — — — — — — — — 1 1-V (c) Non-tuberculous — — — — — — — — 8 20 10 11 49 C.—Cases written off the Dispensary Kegister as:— (a) Recovered — 1 — — — — 2 — — 1 2 — 3 (b) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) — — — — — — — — 30 65 20 22 137 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 87 82 5 2 9 13 12 8 96 95 17 10 218 (b) Diagnosis not completed — — — — — — — — 2 2 1 3 8 Number of persons on Dispensary Register on January 1st 224 Number of patients transferred from other areas and of " lost sight of" cases returned 27 Number of patients transferred to other areas and cases " lost sight of" 81 Died during the year 17 Number of attendances at the Dispensary (including Contacts) 1236 Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1768 Number of consultations with medical practitioners:— (а) Personal 17 (б) Other 129 Number of visits by Tuberculosis Officer to Homes (including personal consultations) 63 Number of: — (a) Specimens of sputum, &c., examined 173 \b) X-ray examinations made in connection with Dispensary work 95 Number of Insured Persons under Domiciliary Treatment on the 31st December 24 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 115 144 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 1936 213 39 52 1236 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, 1935 1526 2. Number of these:— (a) Successfully vaccinated 868 (b) Insusceptible of Vaccination 8 (c) Had Smallpox — 145 (d) Number in respect of whom Statutory Declarations of conscientious objection have been received 340 (e) Died unvaccinated 48 3. Number of these Births which on 31st January, 1937, remained unentered in the " Vaccination Register" on account of:— (a) Postponement by Medical Certificate 12 (b) Removal to Districts the Vaccination Officers of which have been duly apprised 147 (c) Removal to places unknown, or which cannot be reached; and cases not having been found 94 4. Number of these Births remaining on 31st January, 1937, neither duly entered in the "Vaccination Register" under headings numbered 2 nor temporarily accounted for in the "Report Book" under headings numbered 3 9 5. Total number of Certificates of successful primary vaccination of children under 14 received during the Calendar year 1936 (including any relating to births registered in previous years) 1127 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 1936 328 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 1936 of successful primary vaccination of which copies have been sent to Vaccination Officers 197 It will be seen from the foregoing figures, that approximately 60 per cent, of the children born in Hampstead during 1935 had been vaccinated by the end of the year under review. This figure compares with 36 per cent, for England and Wales. 146 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, 456 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 1936 :— Diphtheria 631 Typhoid Fever 7 Dysentery 3 Scarlet Fever (for Hsem. Strep.) 23 Specimens of Sputum X-ray examinations made 307 95 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. 147 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 1936:— Number of houses or parts of houses and contents disinfected 2034 ,, verminous rooms disintested 44 „ „ articles of clothing disinfested *155 „ ,, beds disinfested 88 „ 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 15 Children 468 Scabies. Adults 37 Children 150 Whilst the cleansings and baths are in progress, the persons' clothing is thoroughly disinfected by being passed through the disinfecting apparatus. Under an arrangement with the London County Council the Bathing Station is used by that Council for the cleansing of school children on Monday and Wednesday afternoons and on Fridays. 148 During the year, the Council's disintectors disintested 44 verminous rooms and contents, and, in addition, as a result of the action of the Sanitary Inspectors, 156 verminous rooms in 79 houses and 34 sets of beds and bedding were also cleansed and freed from vermin. No action was taken under Section 26 of the London County Council (General Powers) Act, 1928, which provides for the compulsory cleansing of verminous persons, nor was it found necessary to enforce Sections 59 and 105 of the Public Health (London) Act, 1891, as extended by the London County Council (General Powers) Act of 1922, under which the cleansing or destruction of filthy, etc., or verminous articles, and the cleansing of houses infested with vermin can be insisted upon. Shelter. The Council is required to provide, free of charge, accommodation, with any necessary attendants, for any families who have been compelled to leave their dwellings for the purpose of enabling such dwellings to be disinfected. The Shelter consists of a small cottage in the Electricity Yard, Lithos Road. 149 INDEX. PAGE Adulteration, etc. 110-114 Agricultural Produce (Grading and Marking) Act, 1928 109 Air-Raid Precautions 9 Ambulance Facilities 23 Analyst, Public, Report of 119.122 Analytical Work 104, 110.114 Ante-Natal Clinics 31, 44 Area of Borough 13 Artificial Cream Act, 1929 113 Artificial Pneumo-thorax 139 Bacteriological Examinations 103, 104, 107, 115, 146 Bakehouses on Register; Inspections, etc. 108 Bakehouses out of use or removed from Register 108 Bathing Station 147 Baths and Pools 82 Beauchainp Lodge, Paddington 59 Births 38 Bug infestation and eradication 79 Butter Factories 109 Cancer 146 Care Committee (see Tuberculosis). Cerebro-Spinal Fever 125 Chemical Examinations 104, 114 Child Mortality 40 Child Life Protection 37,63 Children, &C., Acts, 1908 and 1932 37 Children, notification of removal 42 Children, sick and ailing, Homes and Hospitals for 33 Children's Hospital, College Crescent, 25, 57 Cleansing of verminous houses, persons, etc. 147 Cleansing Station (see Bathing Station;. Clearance Areas 94 Clinics and Treatment Centres 25 Closing Orders 98 Common Lodging Houses 75 Compensation to Midwives 60 Complaints Received 72 Condensed Milk 113 Consulting Obstetricians 36, 61 150 P'AGE Consumption (see Tuberculosis). Contributions to Voluntary Associations 65 Convalescent Homes, etc. 38, 58 Cooked Meat 109 County Council Housing Estates 96 Cowhouses 108 Creches (see Day Nurseries. Cricklewood Housing Scheme 80, 97 Cross Roads Club, 83, Alexandra Road 59 Day Nurseries 34 Deaths 18 Decontrol of Tenement Houses 74 Dental Clinics, etc. 50, 140 "Diamond Jubilee"Beds 146 Diphtheria, Anti-toxin, and Immunisation 125, 133 Disinfection 147 Dried Milk 113 Dysentery 128, 133 Encephalitis Lethargica 128 Enteric Fever 128, 133 Epidemic Diarrhœa 128 Erysipelas 133 Factory and Workshop Acts 76.78 Factories 77 Fairfax Place And Yard 96 Finsen Light Treatment 140 Food, Bacteriological Examination 103, 107 Food and Drugs (Adulteration) Act, 1928 110,113 Food and Food Premises .. 109 Food and Milk for Mothers and Infants 31, 50 Food, Inspection and Supervision of 103, 122 Food Poisoning 110 Food, Preservatives in 113 Food, Unsound 107 Foster Children aud Foster Mothers 63.65 Foster Home, 33, Fitzjohn's Avenue 59 Fried Fish Shops 108 Hampstead Council of Social Welfare 48 Hampstead District Nursing Association 23, 24 Hampstead General Hospital, Borough Beds 146 Hampstead Hospital for Children 25, 57 Hampstead Hostel for Mothers and Babies 59 Hampstead Housing Association 99 Hampstead and North St. Pancras Day Nursery 60 Hampstead Swimming Pond 82 151 PAGE Health Education and Propaganda 44 Haalth Services 23.25 Health Visitors and Work of 29, 43 Home Helps 36, 62 Home Office Tables (Factory and Workshop Act, 1901) 76.77 Home Nursing 23.25,35 Home Workers 78 Homes and Hospitals for Sick and Ailing Children 33 Homes for Mothers and Babies 34, 58.60 Hospitals 25 Hospital accommodation 146 Hospital Beds, Borough "Jubilee" Beds 146 Hospital Milk Supply 104 Houses, Inhabited, number of 13 Houses Let in Lodgings (see Tenement Houses, etc.). Housing Committee 3 Housing Conditions where births occurred 41 Housing, London County Council, arrangements with 96 Housing"Representationsetc. 98 Housing Section 89.99 Ice Cream 108 Illegitimate Children 38.39.40 Immunisation, Diphtheria 125.127 Imported Foodstuffs 109 Improper Mixing of Sexes 91 Infant Life Protection (see Child Life Protection). Infant Welfare Centres 30, 48 Infant Mortality 39 Infectious Diseases 35, 125.148 Influenza 132 Inspections and Re-inspections 71 Inspection and Supervision of Food 103.122 Institutions for Unmarried Mothers and for Infants 59, 80 Invalid Children's Aid Association 61 Kilburn and West Hanipstead District Nursing Association 23, 24 Kilburn Vale Area 94.96 Laboratory Facilities 23 Legal Proceedings 83 London County Council, Housing arrangements with 96 Main Memorial Home 60 Margarine, Wholesale Dealers 109 Malaria 129, 133 Maternal Mortality 36, 40, 61 Maternity and Child Welfare 29.67 Maternity and Child Welfare Centres 30, 31, 44, 48, 49, 50 152 Page Maternity and Child Welfare Committee 3 Maternity Beds 66 Maternity Clinics (see Ante-Natal Clinics). Maternity Homes and Hospitals 32 Maternity Outfits 63 Measles 129, 133 Meat and other Foods 107.110 Medical Investigation Sub-Committee 57 Merchandise Marks Act, 1926 109 Meteorology 15 Mews Dwellings 92, 96 Midwives and Midwifery Nursing 36, 60 Milk and Dairies Acts, 1915 and 1922 105 Milk and Dairies Order, 1926 105 Milk and Food for Mothers and Infants 31, 50 Milk, Bacteriological Examination 103, 104, 115 Milk, Chemical Examination 104 Milk, Condensed or Dried 113 Milk (Special Designations) Orders, 1923 and 1936 105,106.107 Milk for School Children 105 Milk, Pasteurised 106, 107 Milk Supply 103, 108 Minor Ailments 56 Mortuary, Public 86 Mothers and Babies, Home for 34 Mount Vernon Hospital, Borough Beds 146 Municipal Dwellings 97 New End Hospital 56 Notification of Births Act, 1907 41 Nursing in the Home 23.25, 35 Nutrition 53,115 Offensive Matter, Removal of 75 Offensive Trades 75 Officials, Public Health 4 Ophthalmia Neonatorum 133 Outworkers (see Home Workers). Overcrowding 90, 91,92 Park Dwellings Flats 97 Pasteurised Milk 106, 107 Pathological Examinations of Sputum 139 Pharmacy and Poisons Act, 1933 84.86 Pneumonia, Acute Primary and Acute Influenzal 131,133 Poisons (sec Pharmacy and Poisons Act, 1933). Polio-Myelitis 125, 133 153 PAGE Population Poultry Slaughterhouses 108 Pre-Maternity Clinics (see Ante-Natal Clinics). Preservatives, &c., in Food Regulations, 1925 to 1927 113 Public Health Committee 3 Public Health Station 146 Post-Natal Clinics 31, 45 Public Health (Tuberculosis) Regulations, 1925, 1930 138, 140 Public Vaccinators 4 Puerperal Fever and Pyrexia 133 Puerperal Sepsis 14, 35, 58 Queen Charlotte's Hospital 57 Queen Mary's Maternity Home, Heath Street 57 Rag and Bone Dealers 75 Rats and Mice (Destruction) Act, 1919 78 Ray-Therapy 50 Rent Restriction Acts 76 Restaurant Kitchens 108 St. Agatha's House 60 Sale of Food Order, 1921 107 Sanatorium Treatment 137 Sanitary Inspectors, Work of 71 Scabies 147 Scarlet Fever 132, 133 School Children, Milk for 105 School Entrants and School Medical Inspection 51.55 Seamen's Lodging Houses 75 Shelter 148 Shops Act, 1934 82 Slaughterhouses 107 Small Dwellings Acquisition Acts 99 Smoke Abatement 72 Social Conditions 13 South End Close Flats 97 Special Children 49 Staff of the Public Health Department 4, 6, 7 Stalls and Street Traders 110 Statistics and Social Conditions of Borough 13 Still Births 39 Street Traders 110 Student Health Visitors 44 Superannuation Act examinations 7 Survey re Overcrowding 90 Swimming Baths and Pools 82 Tenement Houses and Bye-laws 73 154 Page Tenement Houses, additional W.C's. 74 Toddlers' Clinics 49 Toys, itinerant vendors 75 Treatment Centres 25 Tuberculosis 133.144 Tuberculosis Care Committee 141 Tuberculosis Dental Clinic 140 Tuberculosis Dispensary 142 Tuberculosis Regulations, 1925, 1930 138, 140 Tuberculous Patients, Extra Nourishment for 141, 142 Typhoid (see Enteric Fever). Underground Rooms 9,72,73,92.94,98 Unemployment 13, 53 Unmarried Mothers 59, 60 Unsound Food and Food Inspection 107 Vaccination and Vaccination Order, 1930 144 Vaccination Officer 4 Venereal Diseases, Clinics and Treatment Centres 132 Verminous Persons and Premises, etc. 72, 73, 147 Vital Statistics 14, 15, 17.19 Voluntary Associations, Contributions to 65 Water Closets, additional in Tenement Houses 74 Water Supply of the Borough 71 Water Supply of Tenement Houses 73 Watling Estate 96 Welfare Centres 30, 48 Westcroft Estate 80, 97 Whooping Cough 35 Workshops (see Factory and Workshop Acts). Wormholt Estate 96 X-ray Work 139 Young Children, Mortality among 40