AC 4351 M HAMP 38 the Metropolitan Borough of Hampstead. REPORT for the year 1937 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. Lewingdos Exers., 216 & 218, Eversholt Street, N.W.I. the Metropolitan Borough of Hampstead. REPORT for the year 1937 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 tha Department 3 Staff of the Public Health Department 4 Other Officers associated with Public Health work 5 Introduction 6—9 SECTION 1.—Statistics and Social Conditions of the Borough 13—19 ,, 2.—General Provision of Health Services in the Borough 23—26 " 3.—Maternity and Child Welfare (including the Report of the Medical Officer of the Ante-natal Clinics) 29—74 ,, 4.—Sanitary Circumstances of the Borough 77—93 ,, 5.—Housing 97—117 „ 6.—Inspection and Supervision of Food (including the Report of the Public Analyst) 121—136 ,, 7.—Prevalence of, and Control over, Infectious and other Diseases (including Tuberculosis) 139—165 INDEX 166—172 3 List of Committees concerned with the work ok the Department. His Worship the Mayor (Mr. Councillor L. G. Glovek, m.a., m.d., j.p.), ex-officio member of Committees. PUBLIC HEALTH COMMITTEE. Chairman: Councillor Mrs. R. S. G. Carnegie. Mr. Alderman H. Baily, m.b.e. Councillor Mrs. M. Evans, r.r.C. „ R. H. H. Cust, m.a., j.p. Councillor Miss A. M. Glover. „ „ W. J. Spriggs. Mr. Councillor T. H. Nunn, m.a. „ Councillor F. R. Bailey. (deceased June, 1937). „ „ S. A. Boyd, m.s., m.b., „ „ E. H. Parkes, f.r.i.b.a. f.r.c.s. Councillor Miss C. M. Richards. Councillor Mrs. M. F. Dow, m.a. The Chairmen of the Maternity and Child Welfare Committee and the Housing Committee. Sub-Committees(a) Drainage Plans, and (&) Tuberculosis. MATERNITY AND CHILD WELFARE COMMITTEE. (Members of the Council.) Chairman: Councillor Mrs. M. Townroe. Mr. Alderman H. Baily, m.b.e. Mr. Councillor T. H. Nunn, m.a. Councillor Mrs. A. J. Arnholz. (deceased June, 1937). Mr. Councillor S. A. Boyd, m.s., m.b., Councillor Miss C. M. Richards. f.r.c.s. „ Mrs. C. E. Samuel, Councillor Mrs. M. F. Dow, m.a. m.a., m.b.e „ Miss A. M. Glover. 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. Miss I. M. Finlayson, m.b., ch.b. (ed.). Mrs. J. Gordon. Mrs. E. S. Grundy, m.b.e. Miss G. M. MacDonald. Sub-Committees :—(a) Applications for Assistance, and (b) 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 F. Colyer. „ R. H. H. Cust, m.a., j.p. (deceased January, 1937). Councillor Mrs. A. J. Arnholz. Councillor Mrs. M. Evans, r.r.c. Mr. Councillor F. R. Bailey. „ Mrs. M. I. Gruner. „ „ J. Batchelor Mr. Councillor G. E. Hutchinson, (deceased January, 1937). m.a. „ „ H. Brooke. Councillor Mrs. C. E. Samuel, m.a., m.b.e. The Chairman of the Public Health Committee. Sub-Conimittee: Westcroft Estate. 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officcr of Health—H. Leslie Oldershaw, m.d. State Medicine (Lond.), b.s., m.r.c.S. (Eng.), l.r.c.p. (Lond.), d.p.h. Assistant Medical Officcr of Health and Clinical Tuberculosis Officcr: 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.). *Mcdical Officer, Post-Natal Clinics—Miss Beatrice Turner, f.r.c.s.(Ed.), m.c.o.g. tMedical 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.) (deceased October, 1937). Mrs. A. Hall-Craggs, m.r.c.S., l.r.c.p. (Lond.). Mrs. F. M. Yule, m.b., ch.b., d.p.h. Clerical Staff—{Frank S. Hill, F.S.S. (Assistant Administrative Officer). W. Sell. R. H. Box, Cert. Soc. of Apotlis. (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), (b), (d), (e) Miss M. Lowen (b) (Tuberculosis Visitor and Dispensary Nurse) Miss N. B. May (a), (b), (d). Sanitary Inspectors—A. Peverett (e), (f) (Senior Inspector). J. F. Armstrong (e), (/) J. Grimsley (e), (/) Miss C. Lambe, (a), (b), (d), (e). F. V. Outlaw (e), (/). W. Robinson (e), (f) L. Rowley (e), (/). A. C. Townsend (e), (/) E. Wall (e), (J). 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, Billiler Square, E.C.3. *Public Vaccinators—J. Davies, m.d (Lond.), m.r.c.i\ (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.) Dentist, Municipal Dental Clinic—Roy M. Hastings, l.d.s., r.c.s. (Eng.). (a) Health Visitor's Certificate. (d) State Certified Midwife. (b) State Registered Nurse. (e) Sanitary Inspector's Certificate. (c) General Nursing Certificate. (/) Food Inspector's Certificate. * Part-time Officers. †Part-time Officers of Council of Social Welfare approved by the Maternity and Child Welfare Committee. ‡lst Class Home Office Certificate, Civilian Anti-Gas School. 5 OTHER OFFICERS ASSOCIATED WITH PUBLIC HEALTH WORK, 1937. District Medical Officers (London County Council): Dr. E. A. Seymour, 12, Thurlow Road, N.W.3. (Hampstead 0274.) Dr. C. Nairnsey, 1, Cholmley Gardens, N.W.6. (Hampstead 4740 ) Relieving Officer (Public Assistance Dept., L.C.C.) 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.IV. 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.i'.h., Coroner's Court and Office, Cambridge Street, N.W.I. Coroner's Officer: Police Constable T. A. Day, Police Station, Rosslyn Hill, N.W.3 (Hampstead 1111). Divisional Medical Officer (School Medical Service): Pr. M. C. Polhill, Hoxton House, Hoxton Street, N.l (Clerkcnwell 1892), 6 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. To the May,or, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, L,adies 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 1937. This report is the thirty-seventh of the series. The report contains the information required by the Ministry of Health and is arranged in accordance with their suggestions. Copies of this report will be transmitted to the Ministry of Health, the Home Office, and the London County Council in accordance with statutory requirements. 1. Staff. The only change in personnel of the department in 1937 was the additional appointment of Miss Beatrice Turner, f.r.c.s., m.c.o.g., as a part-time officer for the Post-Natal Clinics. I would like to pay special tribute to Dr. Blandy who died in October, 1937. Dr. Blandy had for many years conducted the Infant Welfare Centres at Lisburne Road, Heath Street and Swiss Cottage. In addition to being a brilliant pediatrist, Dr. Blandy was beloved by all the mothers and children and her early death came as a grievous blow to all with whom she worked. 2. Maternity and Child Welfare. Details of the work of the Maternity and Child Welfare department and modification and extensions of existing schemes are contained in Section 3 of the Report. In my last Annual Report I stated that certain of the welfare centres were held in premises which are not entirely satisfactory for the purpose. The Maternity and Child Welfare Committee has directed careful and detailed consideration to this point, for 7 it is appreciated that further necessary extensions of the Maternity and Child Welfare Services, e.g., establishment of Breast feeding Clinics, Ray-therapy Clinics, etc., cannot be made unless and until other more suitable premises are obtained. In November the Borough Council established separate PostNatal Clinics on either side of the Borough. Dr. Beatrice Turner was appointed as the part-time officer for this purpose. Assistance to expectant and nursing mothers has now been extended to include the provision of eggs and butter in addition to milk. During the year a vacancy for a co-opted member occurred on the Maternity and Child Welfare Committee. It was decided that the general medical practitioners should be asked to nominate one of their number for this vacancy. Dr. Finlayson was accordingly appointed, thus assisting the very close liaison which already exists between the Public Health Department and the Medical Practitioners of the Borough. 3. Housing, etc. Throughout the year the particular attention and activities of the Public Health Department have been directed to improving the housing conditions of the working classes living in the Borough. The Kilburn Vale Clearance Area scheduled by the London County Council has been confirmed by the Minister. My records shew that 386 families are living in overcrowding conditions. A number of premises are marked for closure and will be dealt with when appropriate alternative accommodation can be found, for many of these tenants express a strong desire not to leave Hampstead. The 46 dwellings which are to be erected on the New End and Garnett Road Sites will be used for the relief of overcrowding, but many of the larger families, and therefore economically the most stressed, will have to continue to live under their present overcrowded conditions until further housing facilities have been provided. It will be remembered that in 8 April, 1936, the Council stated that their housing requirements were in the order of 300 dwellings. 4. Inspection and Supervision of Food. In his Report, the Borough Analyst, Dr. Cox, refers to the difficult subject of metallic contamination in food stuff's, and the increasing need for closer regulations of manufactured products. In conclusion Dr. Cox reports that " the results on the whole are good, the rate of adulteration is 37 per cent. which is not unduly high having regard to the natural tendency to sample more often commodities and places where adulteration is judged to be more likely ". 5. Local Government and Other Officers' Superannuation Act, 1922. During the year T medically examined 24 new entrants to the Council's service, 16 of whom were officers and 8 were workmen. In addition one officer and 6 workmen were certified by me as being incapacitated by reason of permanent ill-health, and were accordingly retired on superannuation allowances. 6. Air Raid Precautions. An ever increasing proportion of the time of the Medical Officer of Health, and selected members of his department, has been devoted to assisting in the preparation of an Air Raid Precautions scheme for the Borough. The administration of a scheme for protection against air raids, and for the treatment of the injured resulting therefrom is now a statutory obligation of the local authority, and the Home Office have decided that the Medical Officer of Health shall be the Controlling Official of the Casualty Services, viz., First Aid Posts and First Aid Parties. The importance and difficulties of these duties cannot be over. estimated, for there is an immense amount of detailed administration associated therewith, and the scheme requires frequent modification and extension to conform with the numerous memoranda which are received from the Home Office on the subject. In order that any Air Raid Precaution scheme may function satisfactorily the Medical Officer of Health is entirely dependent 9 on two factors, viz :—firstly that fully equipped premises for use as First Aid Posts should be immediately available on outbreak of war. and secondly that there shall be available sufficient trained personnel to man these posts. These essentials are not easily obtainable. I am indebted to Mr. E. L. Hawke, M.A., F.R.M.S., who has very kindly provided me with a most interesting Meteorological Survey of Hampstead for 1937. I would like, once again, to express my appreciation of the kindness and support shown me by the members of the Committees which I serve, and to record my thanks to the members of the staff for their loyal co-operation. 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-1937 90,690. Number of inhabited houses (end of 1937) according to Rate Books— 9,687 dwelling houses, 3,170 maisonetted and divided houses, 4,140 separate flats. Rateable value (at 1st April, 1937) £1,545,147. Sum represented by a penny rate £6,438 2s. 3d. 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 1937, 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 690 in August to 872 in January, and the unemployed women from 209 in September to 319 in February. Calculated upon the number of insured people in the Borough, the lowest number was 70 per cent. in September and the highest 93 in January. Extracts from Vital Statistics of the Year. Total. M. F. Live Births Legitimate 916 480 436 Illegitimate 99 51 48 Birth Rate per 1,000 of the estimated resident population- -112 Stillbirths 38 23 15 Rate per 1,000 total (live and still) births 374. Deaths 1,060 496 564 Crude Death Rate per 1,000 of the estimated resident population—116 Death Rate Comparability Factor (C.F.) = 094. Adjusted Death Rate = Crude Death Rate X C.F. = 116 X 094 = 109. 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 14 several populations, and fail as true comparative mortality indexes in that their variations are not due to mortality alone, but arise also from differences in their population constitution, the two elements being combined in indistinguishable proportions. The Registrar General has prepared Comparability Factors for adjusting local death rates, and when the Crude Death Rate of an Area is multiplied by the appropriate Factor, an " Adjusted Death Rate " is obtained which is comparable with the Crude Death Rate of the country as a whole, or with the "Adjusted Death Rate" of any other area. Deaths from puerperal causes :— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 1 Other puerperal causes 2 2 Total 3 3 Death Rate of Infants under one year of age :— All infants per 1,000 live births 54 Legitimate infants per 1,000 legitimate live births 38 Illegitimate infants per 1,000 illegitimate live births 202 Deaths from Cancer (all ages) 169 „ Measles (all ages) — „ Whooping Cough (all ages) 2 „ Diarrhoea (under 2 years of age) 13 Information as to the incidence of infectious disease will be found in the Section of the Report relating to that subject. The Death Rate calculated for each Ward is shown on page 17; and the Ward Birth Rates and Infant Death Rates are set out on page 39. Meteorology. Through the kindness of E. L. Hawke, Esq., M.A., F.R.A.S., Secretary of the Royal Meteorological Society, and Hon. Meteorologist to the Hampstead Scientific Society, 1 am able to submit his report on the weather of the year 1937 in Hampstead, based on records kept at the Hampstead Scientific Society's Observatory on the summit of the Heath, near the Whitestone Pond, established in 1909. 15 "The greatest excess of rain since 1927 and a pronounced dearth of sunshine were the outstanding characteristics of 1937. Last year contained nine wet months and ten dull ones—a bad record to which there has been no parallel since regular climatological observations were begun in Hampstead. Rainfall amounted to 3240 ins., a quantity which exceeds the 1910-1934 average by 17 per cent., and the official " standard average " for the summit of the Heath by 23 per cent. From January 1st to June 30th as much as 19 38 ins. was registered. This is 62 per cent. more than the normal for the first six months of the year, and ranks as the largest total for that period back to 1863, when trustworthy measurements of rain were first made in the suburb. During 1937 there were 186 days on which at least 0005 in. of " precipitation " (i.e., rain, snow, hail, and deposits from dew, rime, hoar frost or wet fog) was found in the gauges, and, according to the trace of the hyetograph, which neglects very slight showers and drizzle at the rate of less than 0004 in. per hour, the aggregate duration of the year's fall was 655½ hours, or nearly four weeks. This may be compared with the 398½ hours recorded in 1933—a very dry year. Ten days during 1937 had ten or more hours of wet weather each, the list being headed by December 13th, with 14¾ such hours, and February 7th, with 14¼ The monthly totals of rainfall ranged from 436 ins. in February, which was the wettest since before 1863, to 068 ins. in July, which was the driest since 1921. On August 13th a violent thunderstorm deposited 1.56 ins., of which 040 in. came down in the ten minutes from 4.10 to 4.20 p.m. (G.M.T.). No day since July 20th, 1929, had yielded so large an amount. In another severe storm on the afternoon of June 12th, 071 in. fell within 27 minutes. Sunshine during 1937 totalled 1,299 8 hours. This is 178 5 hours short of the 1910-1934 average, and thus represents a general deficiency of almost half an hour a day. August and November were the only months to give an excess over the normal. December contributed barely 20 hours; at the other extreme came June, with 2095 hours. The 6th of the latter month gave 14 3 sunny hours—the best daily record for the year. Entirely sunless days numbered 83, eight more than usual. 16 The mean temperature of 1937, 49.1 deg., was virtually in agreement with the 25-year average (490 deg.). Among the chief features of interest in this regard were that Maroh proved 21 deg. colder than January, and 38 deg. colder than February; and that the maximum of 153 5 deg. attained by the thermometer with blackened bulb in vacuo on August 9th was, with the single exception of 1536 deg. on July 22nd, 1928, the highest yet recorded at the Observatory. Monthly mean temperatures varied from 637 deg. (28 deg. above normal) in August to 37.1 deg. (2 9 deg. below normal) in December. Below are given the extreme readings of the sheltered and exposed thermometers during the year ;— Maximum in the screen, 860 deg., on August 6th. Maximum in the sun's rays, 153 5 deg., on August 9th. Minimum in the screen, 23.0 deg.. on December 20th. Minimum on the grass (or snow-surface), 16.0 deg., on December 20th. Ground-frost was registered on 137 nights, a substantially larger number than usual. Snow fell on 29 days (12 in March, 10 in December), and covered the ground at 9 a.m. on 20 days, though never to any great depth. Hail occurred on five days, and thunderstorms on 19, six of which were in June. Fog was observed at one time or another on 55 days; it was abnormally scarce during the first quarter, but frequent during the last quarter. On the afternoon and evening of Christmas Day, Hampstead was afflicted with the worst such visitation for many years; from about 2 p.m. until midnight visibility on and near the Heath was limited to four or five feet for long periods, and traffic by road was brought almost to a standstill. Gales and high winds were notably rare during 1937." VITAL STATISTICS. Population. For the purpose of this Report the Registrar-General's estimate of the population at the middle of 1937, which was calculated to have been 90,690, has been adopted. This shows an increase of 1,743, as compared with 88,947 at Census, 1931. 17 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) 15,290 No. 7 (Priory) 11,540 The Borough 90,690 The following are the statistics for each of the Wards and the Borough:— No. of Deaths. Death Rate. No. 1 (Town) Ward 166 13•1 No. 2 (Belsize) „ 155 10•5 No. 3 (Adelaide) „ 129 11•4 No. 4 (Central) „ 119 10•9 No. 5 (West End) „ 172 12•0 No. 6 (Kilburn) ,, 184 12•0 No. 7 (Priory) „ 135 11•7 The Borough 1,060 11•6 The Death Rates for London and for England and Wales were 12.3 and 12.4 respectively. 18 Age and Sex Allocation of Deaths of Hampstead Residents during the Year 1937. causes of death Nett deaths at the subjoined ages of "Residents," whether occurring within or without the Borough. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1. Typhoid and Paratyphoid Fevers m ... ... ... ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 2. Measles M ... ... ... ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... ... ... ... ... ... f 1 ... ... ... 1 ... ... ... ... ... ... ... 4. Whooping Cough M 2 2 ... ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 6. Diphtheria M 2 ... ... ... 2 ... ... ... ... ... ... ... f 2 ... 1 1 ... ... ... ... ... ... ... ... 6. Influenza M 27 ... ... ... ... ... ... 2 4 6 5 10 F 28 ... ... ... ... ... 2 3 2 1 10 10 7. Encephalitis Lethargica M ... ... ... ... ... ... ... ... ... ... ... ... f 1 ... ... ... ... ... ... ... 1 ... ... ... 8. Cerebro-spinal Fever M 1 ... ... ... ... ... 1 ... ... ... ... ... f 1 ... ... ... ... ... 1 ... ... ... ... ... 9, Tuberculosis of respiratory system m 17 ... ... ... ... 5 2 6 1 3 ... ... f 13 ... ... ... ... 2 5 3 1 ... 2 ... 10. Other Tuberculous Diseases M 2 ... ... ... ... 1 ... ... ... 1 ... ... f 4 ... ... ... ... ... ... ... 1 1 2 ... 11. Syphilis M 4 ... ... ... ... ... ... ... ... 2 2 ... F 2 ... ... ... ... ... ... 1 1 ... ... ... 12. General paralysis of the insane, tabes dorsalis M 2 ... ... ... ... ... ... 1 ... 1 ... ... F 2 ... ... ... ... ... ... 1 ... ... 1 ... 13. Cancer, malignant disease M 77 ... ... ... ... ... 4 ... 11 25 23 14 f 92 ... ... ... ... ... 3 3 7 26 34 19 14. Diabetes M 8 ... ... ... ... ... ... ... ... 3 2 3 f 9 ... ... ... ... ... ... 1 ... ... 5 3 15. Cerebral hemorrhage, &c. M 15 ... ... ... ... ... 1 ... 4 3 2 5 F 26 ... ... ... ... ... ... ... 4 6 8 8 16. Heart Disease M 129 ... ... ... ... ... 1 3 9 19 42 55 f 147 ... ... ... ... 1 ... 3 9 19 43 72 17. Aneurysm M 7 ... ... ... ... ... ... ... ... ... 5 2 f 8 ... ... ... ... ... ... 1 1 2 3 1 18. Other circulatorydiseases M 25 ... ... ... ... ... 1 ... 3 ... 12 9 F 48 ... ... ... ... ... ... ... 2 6 18 22 19. Bronchitis M 14 .... ... ... ... ... 1 3 2 6 2 F 10 ... ... ... ... ... ... ... 3 2 5 20. Pneumonia (all forms) M 25 5 ... 1 ... ... ... 3 2 5 2 7 f 36 5 1 ... ... ... 1 7 2 3 9 9 21. Other Respiratory Diseases M 4 ... ... ... ... ... ... ... ... ... 2 2 f 7 ... ... ... ... ... ... ... 1 1 1 4 22. Peptic Ulcer M 8 ... ... ... ... ... ... 2 1 2 2 1 f 1 ... ... ... ... ... ... ... ... ... 1 ... 23. Diarrhœa, &c. M 8 8 ... ... ... ... ... ... ... ... ... ... f 5 3 ... ... ... ... ... 1 ... 1 ... ... 24. Appendicitis M 7 ... ... 1 ... ... 2 1 ... 2 ... ... f 4 ... ... ... ... 1 ... ... ... 1 1 1 26. Cirrhosis of Liver M 3 ... ... ... ... ... ... 1 2 ... ... ... F 1 ... ... ... ... ... ... ... ... ... 1 ... 26 Other diseases of liver, &c. M 1 ... ... ... ... ... ... ... ... ... 1 ... f 3 ... ... ... ... ... ... ... ... 1 1 1 27. Other digestive diseases M 11 ... ... ... ... ... ... ... 2 2 3 4 f 11 ... ... 1 ... 1 2 1 ... 1 5 ... 28. Acute and Chronic Nephritis M 13 ... ... ... ... ... ... 2 3 1 2 5 f 17 ... ... ... ... 1 ... 1 1 ... 5 9 29. Puerperal Sepsis f 1 ... ... ... ... ... ... 1 ... ... ... ... 30. Other puerperal causes f 2 ... ... ... ... 1 1 ... ... ... ... ... 31. Congenital Debility, premature birth, malformation, &c. M 18 17 ... ... 1 ... ... ... ... ... ... ... F 8 8 ... ... ... ... ... ... ... ... ... ... 32. Senility M 2 ... ... ... ... ... ... ... ... ... ... 2 f 6 ... ... ... ... ... ... ... ... ... 1 5 33. Suicide M 12 ... ... ... ... ... 4 1 1 3 3 ... f 8 ... ... ... ... ... 3 3 1 1 ... ... 34. Other violence M 16 4 ... ... ... 1 ... 2 1 1 3 4 F 12 2 ... ... 1 ... ... ... 1 3 5 35 Other Defined Diseases M 35 1 ... ... ... 1 3 1 ... 5 16 8 f 48 ... 1 ... 1 2 3 2 7 13 10 9 36. Causes ill-defined or unknown M 1 ... ... ... ... ... ... ... ... ... 1 ... F ... ... ... ... ... ... ... ... ... ... ... ... All causes M 496 37 2 3 8 19 26 48 86 134 133 f 564 18 3 2 3 9 21 32 41 87 165 183 Totals 1060 55 3 4 6 17 40 58 89 173 299 316 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 included. Proportions of deaths from principal causes 1937. 19 Table showing the Birth, Death and Infantile Mortality rates during 1937 in the Metropolitan Cities and Boroughs:— Birth Rate. Adjusted Death Rate. Infantile Mortality Rate. City of London 6•1 Hampstead 10•9 City of London 36 Holborn 8•1 Lewisham 10•9 Stoke Newington 37 City of Westminster 8•2 Wandsworth 11•4 Woolwich 40 St. Marylebone 9•3 Hackney 11•7 Hackney 43 Chelsea 10•8 Woolwich 11•7 Deptford 45 Hampstead 11•2 City of Westminster 11•8 Lewisham 46 Wandsworth 11•5 Chelsea 12•0 Greenwich 50 Kensington 12•1 Stoke Newington 12•0 Bethnal Green 54 St. Pancras 13•0 Greenwich 12•2 Hampstead 54 Bethnal Green 13•3 Deptford 12•3 Shoreditch 54 Stepney 13•5 Kensington 12•4 Fulham 56 Paddington 13•6 City of London 12•4 Camberwell 58 Finsbury 13•8 Holborn 12•7 Westminster 58 Hackney 13•8 Battersea 12•7 Bermondsey 59 Greenwich 13•8 Camberwell 12•8 Chelsea 59 Fulham 13•9 Paddington 12•9 Stepney 60 Lewisham 13•9 St. Marylebone 12•9 Poplar 61 Camberwell 14•1 Hammersmith 13•0 St. Pancras 62 Lambeth 14•1 Lambeth 13•0 Wandsworth 62 Woolwich 14•2 St. Pancras 13•0 Southwark 64 Bermondsey 14•4 Islington 13•0 Islington 66 Southwark 14•7 Fulham 13•2 Paddington 66 Shoreditch 14•8 Shoreditch 13•7 Hammersmith 68 Stoke Newington 14•9 Bermondsey 14•0 Lambeth 68 Battersea 14•9 Poplar 14•0 Battersea 70 Deptford 15•1 Bethnal Green 14•1 Finsbury 71 Hammersmith 15•1 Southwark 14•1 St. Marylebone 73 Islington 15•2 Stepney 14•2 Holborn 79 Poplar 15•5 Finsbury 15•9 Kensington 83 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.1 (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 P>orough 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 128 to 130. 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 the conveyance of persons to places other than their hospitals. These services appear to be adequate for the needs of the Borough. 24 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. The P.orough Council arranges with these Associations for them to undertake, in addition to the nursing of cases of infectious disease and maternity and child welfare cases, the responsibility of providing facilities for the nursing of the certain other illnesses, etc. The following is a complete list of the ailments so dealt with 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. Public Health: All notifiable infectious diseases not included in Maternity and Child Welfare Scheme. Certain other non-notifiable infectious diseases, viz.:— Pneumonia, Influenza, and Bronchitis. The Borough Council remunerates the local Nursing Associations by paying to them block grants as follows:- Maternity and Child Welfare work—Kilburn £80} Hampstead £30} Public Health work —Kilburn £70} Hampstead £40} £110.} £110.} £220 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 and Clinics, including Clinics solely for diagnosis or consultation. (a) Ante-natal Clinics, Infant Welfare Centres, Dental Clinic, vide pages 45, 49 and 53, respectively. (b) School Clinics:-—Kilburn School Treatment Centre, 107, Kingsgate Road; New End Hospital School Treatment Centre, Heath Street. (c) Tuberculosis Clinic, vide page 159. (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. (ai) 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 (45 beds); Queen Mary's Maternity Home (30 beds); Marie Curie Hospital, Fitzjohn's Avenue (39 beds); Westminster Hospital Annexe, Fitzjohn's Avenue (22 beds); and St. Columba's Hospital, Avenue Road (30 beds). The Borough possesses two endowed beds at both the Hampstead General Hospital and the Mount Vernon Hospital, Northwood, letters of admission to which are in the gift of His Worship the Mayor. In addition, the Council contributes towards the cost of beds in Queen 26 Charlotte's Hospital, Marylebone, which are available for Hampstead residents. Publicity. Under an arrangement made by the Minister of Health with the Postmaster General in 1928, the Borough Council provided notices for exhibition in all Post Offices and Sub-Post Offices in Hampstead, giving the names and addresses of Infant Welfare Centres and AnteNatal Clinics. In August, 1937, a further communication was received from the Ministry of Health stating that the Minister proposed to supply Post Offices with a Notice directing the attention of the public to medical benefit under the National Health Insurance Scheme, and also to local health services; and suggested that a form should be supplied providing particulars of such services. A leaflet was accordingly prepared for distribution at all Post Offices and Sub-Post ()ffices, designed for handing to inquirers at the Post Offices, giving information concerning local health services in the Borough. The Borough Council assisted in the National Health campaign by causing posters to be exhibited, and by aiding in the distribution of leaflets and bookmarkers at the various Clinics, Public Offices, Libraries, etc. 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:—90,700 (estimate of Registrar-General, 1936). 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 1000; (b) Still births 23; (c) Total 1,023. (d) By midwives 264; (e) By doctors and parents 759. 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. 30 (r) Number of visits paid during the year by all Health Visitors:— (i) to expectant mothers †First visits 467 Total visits 1,139 †Excluding cases which are known to have previously been visited in another district and cases visited during the previous year. (ii) to children under 1 year of age. †First visits 780 Total visits 4,921 (iii) to children between the ages of 1 and 5 years. Total visits 7,305 †Excluding cases which are known to have previously been visited in another district and cases visited during the previous year. 4. Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council:—Nil. (b) Number of Centres provided and maintained by Voluntary Associations:—8. (c) Total number of attendances at all Centres during the year:— (i) by children under 1 year of age, 9,788. (ii) by children between the ages of 1 and 5 years, 5,429. (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, *606. (ii) between the ages of 1 and 5 years, 123. (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, 501. (ii) over 1 year of age, 970. 31 (f) Percentage of notified live births represented by the number in (d) (i):—61 per cent. *Excluding children who are known to have previously attended a Centre in another district. 5. Ante-natal and Post-natal Services. Antenatal. Postnatal. (a) Ante-natal and Post-natal Clinics (whether held at Infant Welfare Centres or at other premises)— (i) Number of Clinics provided and maintained by the Council 2 2 (from 1/11/37. (ii) Number of Clinics provided and maintained by Voluntary Associations Nil. Nil. (iii) Total number of attendances at all Clinics during the year 2081 † 195 ‡57 (iv) Total number of women who attended at the Clinics during the year 458 †104 ‡40 (b) Total number of expectant mothers antenatally examined and of cases post-natally examined during the year, under arrangements made by the Council with private medical practitioners, excluding cases included under 5 (a) (iv) Nil. Nil. (c) Percentage of total notified births (live and still) represented by the total numbers of women shown under 5 (a) (iv) and 5 (b) per cent. 45 per cent. 14 †At Ante-natal Clinic prior to formation of Post-natal Clinic. ‡At Post-natal Clinic. 32 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 Yes Yes Yes At cost price in other cases (e.g., sale of dried milk at Centres) No No. Yes No No No No Yes Yes (b) Total quantity of milk supplied during the year to expect ant and nursing mothers and young children:— Liquid gallons. Dried pounds. (i) by the Council 4508⅜ 580 (ii) by Voluntary Associations operating in area Nil 2746 4508⅜ 3326 33 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 Local Government Act, 1929. Institutions provided by Voluntary Associations and subsidised by the Council. Number of Institutions 1 Ward in New End (L.C.C.) Hospital Nil Nil Number of maternity beds (exclusive of isolation and labour beds) 5 Nil Nil Total number of women admitted to these beds during the year 27 Nil Nil II. Number of women (if any) sent by the Council during the year to other Maternity Institutions:—42 to Queen Charlotte's Hospital, for which the Borough Council subscribes £1 per Hampstead case admitted. 34 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 No children were admitted through the Borough Council. (213 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. 35 (d) Total number of such cases sent by the Council during the year to other convalescent institutions:—5 mothers convalescent after confinement with their babies, and one expectant mother. 10. Homes for Mothers and Babies. (a) Number of such homes: (i) provided by the Council:—Nil. (ii) provided by Voluntary Associations:—Nil. (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 (6) (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:—8,678. 36 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 *22 13 5 17 (2) Pemphigus Neonatorum Not notifiable Nil Nil Nil (3) Puerperal fever 2 2 1 2 (4) Puerperal pyrexia 19 12 1 17 (5) Measles and german measles (in children under 5 years of age) German Measles is not notifiable. Measles is compulsorily notifiable. 39 34 5 8 (6) Whooping Cough (ditto) Not notifiable 47 1 12 (7) Epidemic Diarrhœa (ditto) Not notifiable Nil Nil Nil (8) Poliomyelitis (ditto) Nil Nil Nil Nil *Vision unimpaired, 22. 13. Home Nursing. (a) Number of nurses employed at the end of the year for the nursing of expectant mothers and children under 5 years of age, maternity nursing, or the nursing of puerperal fever:— (i) by the Council:—Nil. (ii) by Voluntary Associations:—15 employed by two Local District Nursing Associations. (b) Total number of cases attended during the year by these nurses:—378. (Of this number the Borough Council paid the District Nursing Associations for the nursing of 56 expectant mothers, 68 maternity cases and 165 cases of infectious illness, bronchitis, influenza, and minor ailments, etc., of children under 5 years of age.) 37 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):—19—under scheme of the Hampstead Borough Council. 16. 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:—1. (ii) from other causes:—2. (b) Number of these cases which died: (i) at home:—1. (ii) in institutions:—2. 17. Administration of Part XIII. of the Public Health (London) Act, 1936. (a) Number of persons on the Register who were receiving children for reward at the end of the year:—23. (b) Number of children on the Register: (i) at the end of the year:—40. (ii) who died during the year:—3. (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 258 (3) of the Public Health (London) Act, 1936: Nil. 38 (e) Proceedings taken during the year:— No. of Cases. Act and Section under which proceedings were taken. Nil. — (/) Number of cases in which the local authority has given a sanction during the year: (i) under (a) of Section 259 of the Public Health (London) Act, 1936:—Nil. (ii)„ (b) „ „ Nil. (iii) „ (c) „ „ Nil. (g) Number of orders obtained during the year under Section 261 of the Public Health (London) Act, 1936. (i) from a court of summary jurisdiction:—Nil. (ii) from a single justice:—Nil. Live Births. During 1937, 1,015 live births of Hampstead children were registered. In the following tables, these live births have been distributed according to sex, wards, etc.:— LIVE BIRTHS. MALES. FEMALES. TOTALS. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Registered in the Borough 801 89 890 752 90 842 1553 179 1732 Add number occurring outside the Borough whose mothers were Hampstead residents 136 20 156 146 21 167 282 41 323 937 109 1046 898 111 1009 1835 220 2055 Deduct number who could not be deemed to belong to Hampstead 457 58 515 462 63 525 919 121 1040 Nett number belonging to Hampstead, 1937 480 51 531 436 48 484 916 99 1015 Nett births, 1936 499 63 562 450 36 486 949 99 1048 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 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 109 8.6 8 73.4 No. 2 (Belsize) „ 130 8.8 9 69.2 No. 3 (Adelaide) „ 121 10.7 2 16.5 No. 4 (Central) ,, 95 8.7 — — No. 5 (West End) „ 168 11.7 14 83.3 No. 6 (Kilburn) „ 251 16.4 14 55.8 No. 7 (Priory) ,, 141 12 .2 8 56.7 The Borough 1,015 11.2 55 542 The birth rates for London and for England and Wales were 13.3 and 14.9 respectively. The infant death rates were 60 and 58. Legitimate and Illegitimate Births. Of the total 1,015 nett live births belonging to Hampstead, 916 were those of legitimate and 99 of illegitimate children, the latter being at the rate of 98 per 1,000 births. Of the Hampstead illegitimate infants, 41 were born outside the Borough, chiefly in Lying-in Institutions. Still Births. During 1937, the nett number of registered still births for Hampstead was 30. In the following Table the still births for 1937 have been distributed according to sex, etc.:— STILL BIRTHS. MALES. FEMALES. TOTALS. Legitimate. Illegitimate. Total, Legitimate. Illegitimate. Total. Legitimate. Illegitimate. Total. Registered in the Borough 30 6 36 17 6 23 47 12 59 Add number occurring outside the Borough whose mothers were Hampstead residents 1 - 1 2 1 3 3 1 4 31 6 37 19 7 26 50 13 63 Deduct number who could not be deemed to belong to Hampstead 16 2 18 12 3 15 28 5 33 Nett number belonging to Hampstead, 1037 15 4 19 7 4 11 22 8 30 Sett Still Births, 1930 18 7 25 19 6 25 37 13 50 40 Infant Mortality. During 1937, 55 infants under 1 year of age died, giving an infant death rate of 54 per 1,000 live births. Of these 35 were legitimate children, the rate per 1,000 legitimate live births being 38, while 20 illegitimate children died, equivalent to a rate per 1,000 illegitimate live births of 202. In the following table 1 have set out the births, deaths and death rate among legitimate and illegitimate infants in Hampstead over a long period of years:— 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 1923 1,162 42 36 76 12 158 1924 1,105 55 50 81 11 136 1925 990 41 41 83 18 216 1926 1,001 48 48 76 17 223 1927 937 45 48 91 8 88 1928 922 32 34 79 22 278 1929 887 42 47 81 10 123 1930 900 50 56 103 8 76 1931 898 54 60 86 6 70 1932 890 38 43 91 15 165 1933 776 21 27 88 12 136 1934 855 35 42 85 14 165 1935 911 33 36 88 16 182 1936 949 57 60 99 12 121 1937 916 35 38 99 20 202 41 Deaths of Young Children. During 1937, 62 deaths occurred of children under 5 years of age. This is equivalent to a rate of 127 per 1,000 live children born in that and the four preceding years. Maternal Deaths. Three maternal deaths occurred during the year 1937, which is a rate of 29 per 1,000 births. These deaths were carefully investigated by the Medical Sub-Committee and detailed reports sent to the Minister of Health. 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 Section 255 Public Health (London) Act, 1936 (Notification of Births), as adjusted by any transferred notifications. Live Births 1,000 Notified by Midwives 264 Still Births 23 „ „ Doctors and Parents 759 Total 1,023 Total 1,023 Of the total nett live births registered only 23 per cent. occurred at the usual place of residence of the mother. 42 Births at home—Housing Conditions. 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 169 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. 1 - - - - - 2 4 16 30 6 - 3 — 21 28 7 1 4 — 8 2 3 1 5 — 1 9 — — 6 — — 4 3 1 7 — — 1 1 — 8 — — 1 — — 9 — — 2 1 — Totals 4 46 95 21 3 The newly-born baby has not been included in the above. Of these 169 births:— 2 per cent, occurred in 1-roomed tenements. 27 „ ,, 2 ,, 56 „ „ 3 ,, The table indicates the limited housing conditions in some of the dwellings where babies are born at home. It demonstrates that of these 169 babies, 4 were born in one-roomed tenements and 46 in tworoomed tenements. In 4 one-roomed tenements where 2 persons were already living, a baby was born. With regard to two-roomed homes, in 1 instance 5 persons were already inhabiting the rooms prior to the birth of the baby, in 8 cases the baby's advent raised the number of occupants to 5. In 2 three-roomed tenements there were 9 persons occupying the rooms before the birth of the child. Notification of removal of children from the Borough. It is our practice to notify the appropriate District whenever a family in which there are young children removes from the Borough. 43 The record cards relating to young children in the family are sent with this communication. By this means information regarding 243 children under 5 years of age was sent to other Medical Officers of Health during the past year. Notification was received from 27 other Local Authorities from various parts of the country (including 9 Metropolitan Boroughs) regarding 86 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 783 infants under one year of age and 1,613 children aged between one and five years. The following table gives a record of the work of the Health Visitors in 1937:— † First visits to expectant mothers 472 Re-visits to expectant mothers 667 † First visits to infants under one year 817 Re-visits to infants under one year 4104 Visits to children from 1 to 2 years 2906 Visits to children from 2 to 5 years 4399 Visits to foster-mothers and foster-children 756 Visits re infectious diseases 959 * Attendances at Borough Council's Ante-natal Clinics 153 ‡ Attendances at Borough Council's Post-natal Clinics 3 44 Attendances at Borough Council's Dental Clinic 75 Attendances at Borough Council's Immunisation Clinics 55 Attendances at Hampstead Council of Social Welfare Infant Welfare Centres and Toddlers' Clinics 392 Miscellaneous visits 444 † Including visits to mothers and babies moving into the Borough and previously visited. *A temporary paid helper was also present at these Clinics in 100 instances. ‡ A temporary paid helper was also present at the Post-natal Clinic in 16 instances. Approximately 74 per cent. of the infanta under one year of age visited for the first time attended the Infant Welfare Centres during 1937. 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. National Society for the Prevention of Cruelty to Children. It is pleasing to make reference to the complete and ready cooperation which exists between the officers of National Society for the Prevention of Cruelty to Children and those of the Borough Maternity and Child Welfare Department, as and when the occasion demands. Happily these occurrences are rare, but the Society advises this department of cases of pre-school children in which they arc interested, whilst we advise the Society of cases in which a visit from their Inspector would appear to be indicated. Student Health Visitors. During the year three student health visitors from the College of Nursing, preparing for the examination for the Health Visitors' Certificate, have received instruction. They attend at the Public Health Department 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. 0d. for each student so instructed. 45 Ante-natal Clinics. The two Ante-natal Clinics in the Borough were 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, were held in the premises rented by the Borough Council from the Health Institute for the purpose of a Tuberculosis Dispensary. An additional session was also held fortnightly on Thursday afternoons, when cases brought to the Ante-natal Clinic by the Kilburn and West Hampstead District Nursing Association were 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: a Health Visitor is present at each session. (a) Total number of attendances by expectant mothers at the Ante-natal Clinics during the year—2,081. (b) Total number of expectant mothers who attended at the Ante-natal Clinics during the year—458. (c) Percentage of total notified births (live and still) represented by the number in (b)—45 per cent. The following is the report for the year 1937 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 1937:— Pond Street Clinic. (1 session weekly.) 1937. 1936. Kilburn Clinic. (2 sessions weekly.) 1937. 1936. New Patients 99 111 302 276 Attendances of old patients 484 488 1391 1242 Number of sessions held 51 52 100 100 Average attendance per session 11 11 16 15 Number of patients referred to Dental Clinic 35 42 132 137 Number of patients sent to Convalescent Homes 3 5 4 4 46 During last year 401 new patients attended the ante-natal clinics; a greater number than the year before. Of these, 211 were normal cases, 161 were more or less abnormal, 9 were found not to be pregnant, and 20 were women who attended the Clinics for the first time after their confinements, being in need of post-natal care. 1015 Hampstead births took place in 1937 and 397 pregnant women resident in the Borough attended our Clinics last year. It is found, therefore, that 39 per cent. of the expectant mothers in Hampstead received antenatal care at the Rorough Council's Clinics. We are thankful to be able to record that for six years now, no deaths in childbirth have occurred amongst a series of 2,056 expectant mothers attending the ante-natal clinics during that period. Since 1929, there have been two maternal deaths in a series of 2,683 expectant mothers, which gives a maternal mortality rate of less than 1 per 1,000 during a nine-year period (the maternal mortality rate for England and Wales was 3.65 per 1,000 in 1936). This happy result has only been achieved, of course, by constant co-operation with the Hospitals where these women were confined, as well as with the practising midwives in Hampstead. It is a tribute to the work of the latter and of doctors and midwives in those particular Hospitals, as well as to the work in the Clinics. The neo-natal death rate as it is called, is the death rate amongst infants in the first month of life and it is believed that it can be lowered considerably by ante-natal care. With regard to the 397 expectant mothers attending the Borough Council's Clinics in 1937, six only of their babies died in the first month of life, and two of these were twins. The neo-natal death rate was only 15 per 1,000 therefore, in 1937. This compares favourably with that for the whole country which was 30.16 per 1,000 in 1936. The number of stillbirths amongst Clinic patients last year was five, which gives a still birth rate of 12 5 per 1,000. The stillbirth rate for the whole country was 40 per 1,000 in 1936. Two measures have recently been introduced at the Clinics which should improve our methods still further. Firstly, the Maternity and Child Welfare Committee are now providing needy expectant mothers 47 with extra nourishment (in addition to the pint of free milk daily) when needed on medical grounds. This nourishment consists of ½lb. butter and seven eggs weekly, and is most helpful, as the value of such foods is very high, and so is their vitamin content. Secondly, we have begun to carry out routine blood tests on each case as far as possible; for the results obtained are sometimes of great value in detecting a particular condition that needs treatment. (Signed) MARY KIDD, M.B. (LOND.). Prevention of Blindness. On the 6th of August, the Ministry of Health issued Circular 1621 relating to the prevention of blindness and drew the attention of Maternity and Child Welfare Authorities to certain matters. It was pointed out that the necessity for improving and extending the arrangements for the supervision of the health of children under school age was emphasised in Circular 1550 of the 29th May, 1936, and it was suggested that a further review of these arrangements should be made with special regard to the early diagnosis and treatment of serious eye defects. The Circular letter referred to the need for the improvement and expansion of ante-natal services, which had been stressed in circulars recently addressed to Maternity and Child Welfare Authorities, and drew attention to the fact that the Report on the Prevention of Blindness issued by the Standing Committee on the Prevention of Blindness of the Union of Counties Associations for the Blind directs attention to the importance of a comprehensive and adequate system of ante-natal supervision. That Committee emphasised that expert examination of the fundus of the eye is called for in cases of failure of reading sight during pregnancy, and that the presence of albumen in the urine may be associated1 with serious retinal changes. The Committee stated that they considered that the proper cleansing of a baby's eyes at birth was the first essential, and drew attention to the most efficient form of prophylactic treatment, over and above the proper cleansing of the eyes. On the subject of Ophthalmia Neonatorum, the Standing Committee expressed certain views as to skilled nursing and hospital treatment, etc., which are already met so far as Hampslead cases are concerned. 48 In regard to children under school age, the Circular invited attention to the following matters:— (i) the success of the system of medical examination of children under school age, and its continuance as a recognised procedure. (ii) the arrangement whereby some Local Authorities utilise the services of the school clinic and of the ophthalmic surgeon attending there for the examination of children under school age. (iii) the desirability that the treatment of external eye conditions at the Minor Ailments Clinic designed for children of school age should be made available for children under school age. (iv) the suggestion that a critical survey by the Medical Officer of Health of the arrangements for children under school age, especially with regard to the early diagnosis and treatment of serious eye defects, might be fruitful in results, it being thought that further measures for the ascertainment of young children with eye conditions which might lead to impairment or loss of sight was desirable. The circular also pointed out that attention is drawn in the Report to the possibility of serious eye trouble accompanying or resulting from certain infectious diseases, especially measles, and the Minister endorsed the recommendation that arrangements should be made, in so far as this had not already been done, whereby the Medical Officer in charge of an Isolation Hospital or other hospital should call in an ophthalmologist to advise on, or treat, any case of infectious disease requiring specialist advice. Reference was also made to the fact that research is being carried out on the problem of the prevention of measles. Other matters referred to in the Circular letter are beyond the scope of the work of the Borough Council; but the field of action covered by the Circular indicated the importance that is now attached to all measures having for their object the prevention of blindness. I reported to the Maternity and Child Welfare Committee on the portions of the circular which affected that Committee, and, in particular, with regard to the steps which could be taken to reduce the number of cases of blindness due to eye diseases. The Committee approved of my suggestions as to an extension of the existing system of routine blood tests in cases attending the Ante-Natal Clinics and authorised the Medical Officer of the Ante-Natal Clinics to make a routine test in the case of all women attending the Clinic. 49 Post-natal Clinics. Up to the end of October, no separate clinics for post-natal cases had been held, but such mothers as had attended at the ante-natal clinics had been seen by Dr. Mary Kidd. During this period 104 mothers attended to receive post-natal care, making a total number of attendances of 195. Of the 104 mothers, 20 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. During 1937, the Council considered the question of the inauguration of separate Post-natal Clinics and appointed Miss Beatrice Turner, F.R.C.S.Ed., M.C.O.G., as Medical Officer. These Clinics are held at 27, Pond Street on Thursdays, and at 75,Dynham Road on Tuesdays from 2.30 to 4.30 p.m. The first clinic was held on Tuesday, 2nd November. From that date to the end of the year 7 clinics were held at Pond Street, and a total number of 15 new patients attended. Eight clinics were held at Dynham Road, and a total number of 31 new patients attended. Infant Welfare Centres. The following Infant Welfare Centres were held in the Borough during 1937:— 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. Yule Mrs. Steward 51 " Kilburn Health Institute, Kingsgate Road Tuesday 2—4 p.m. Dr A. S. Hall- Craggs Miss Evans 44 Wednesday, 10—12 noon and 2—4 p.m. Do. Miss May " New End Baptist Chapel Hall, Heath Street Thursday, 10—12 noon Dr. M. Yule Miss Kennedy 22 "Lisburne Road", Wesleyan Mission Hall, Lisburne Road Thursday, 2—4 p.m. Do. Miss Lambe... 34 " Mill Lane Mission Hall, Broomsleigh Street Friday, 2—4 p.m. Dr. A. S. Hall- Ciaggs Miss Evans . 46 50 Total number of attendances at all Centres during the year:— (i) By children under 1 year of age—9,788. (ii) By children between the ages of 1 and 5 years— 5,429. 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—606. (ii) Between the ages of 1 and 5 years—123. 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—501. (ii) Between the ages of 1 and 5 years—970 (including Toddlers). *The 606 children under 1 year of age who attended at the Centres represent 61 per cent, of the notified live births. Toddlers' Clinic. Weekly toddlers' sessions are held alternatively on either side of the Borough. Dr. Ruth Balmer is the Medical Officer in attendance at the Clinic. The average attendance per session during 1937 was: 27, Pond Street, 22. Health Institute, 28. 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 approaching 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 inlluence in persuading the mother to accept the invitation. The 51 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 534 parents have received invitations, 53 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 paid 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. Ultra-Violet Kay Treatment. At its meeting on 23rd December the Council agreed to purchase an ultra-violet ray lamp for the Tuberculosis Dispensary patients, which might also be available for non-tuberculous children. This lamp has been installed in the Tuberculosis Dispensary at Dynham Road. Nutrition and Arrangements for the Supply of Milk and Food. The Scale of Income for regulating the distribution of milk free and at half cost price is that suggested by the Ministry of Health in their communication of 25th March, 1925. There have been 308 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 " special" cases for children between 3 and 5 years. 188 children under 5 years of age have, in addition to the milk, received free cod liver oil or emulsion. In April, the Maternity and Child Welfare Committee considered Circular 1519, issued by the Minister of Health in reference to the recently issued First Report of the Advisory Committee on Nutrition, 52 and, in particular, to the emphasis laid in Part VI of the Report on the nutritional value of milk, and reviewing its arrangements under Section 251 (I) of the Public Health (London) Act, 1936, in the light of this Report. Reference was made by the Ministry to Circular 1290 of the 27th of October, 1932, in which attention was drawn to the importance of (i) securing that the diet of pregnant and nursing mothers and young children contained a sufficient supply of calcium, phosphates, and Vitamin D; and (ii) increasing the consumption of milk, especially by growing children. It was pointed out in that Circular that all possible steps should be taken to ensure that expectant and nursing mothers and young children receive a sufficient supply of food containing Vitamin D, the principal foods containing this Vitamin being fat fish, fish livers, egg yolk, milk and butter. It was also mentioned that Vitamin D might be provided by the regular administration of cod liver oil. It would appear that some Authorities had tnade it a rule to supply milk to expectant mothers only during the last two or three months of pregnancy, some had limited the supply in every case to one pint per day, and some had supplied milk for children only up to the age of 18 months or two years. The Minister of Health urged that in the interests of the health of the mothers and children it was not desirable to adopt any such limitations. On the contrary he intimated that the arrangements made by each Authority should enable sufficient milk or other food to be provided whenever this provision was necessary for the maintenance of the health of the mother or young child, and reminded the Council that in Circular 1072 of the 12th February, 1930, he expressly sanctioned the extension of the supply of milk or meals under the Maternity and Child Welfare Act to such an extent, and in such a manner, as each Local Authority thought desirable. It had been the practice in Hampstead to supply one pint of milk to expectant mothers at any time during pregnancy, to nursing mothers, and to children up to five years of age if not attending school, all on medical grounds only. Free cod liver oil, emulsion, or malt and oil was also supplied in addition to milk for children when specially ordered and in a few cases for nursing mothers. Stress was laid on the great importance of the scale of income adopted by the Authority being so framed as not to render it difficult 53 for any mothers to take advantage of the Authority's arrangements, and it was suggested that in some cases, Authorities may find it advisable to reconsider their existing scales from this point of view. The suggestion of the Minister that in those cases in which liquid milk was supplied it should, wherever possible, be efficiently pasteurised, and that where that was not practicable the Medical Officer of Health should approve the source and quality of the milk supplied, had already been met in Hampstead since only Pasteurised Milk is allowed to be supplied on the orders of the Council. The Maternity and Child Welfare Committee formed the opinion that, in suitable cases, additional food should be granted, either free of charge or at half price, according to the circumstances of the applicant, and that, for this purpose, the scale of income used in connection with applications for milk should be applied; and upon their recommendation the Council resolved that, in suitable cases, the Committee should be authorised to grant the supply of eggs and butter to expectant and nursing mothers and young children, and informed the Ministry of Health accordingly. In pursuance of this resolution, eggs and/or butter have been supplied in 34 cases. Municipal Dental Clinic. The Municipal Dental Clinic is held at the Public Health Station, I/ithos Road; the Dentist is Mr. Roy M.Hastings, L.D.S., R.C.S. Eng. The following is a summary of the work carried out during the year:— Number of Sessions held 75 Number of New Patients 246 Total Atten(knees of all patients 1156 Number of Fillings 419 Number of Scalings 43 Extraction cases Total Number of Teeth extracted 746 Gas Administrations 192 Local Administrations 11 Without Anæesthetic 1 Number of Dentures (including repairs) 89 Number of Dressings and Root Treatment 149 Number for Advice 314 Number of Denture visits 234 54 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., E.C.C., L. G. Glover, Esq., M.A., M.D., Miss I. Finlayson, M.B., Ch.B.) 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, the Medical Officers of Ante-natal and Post-natal Clinics and the Medical Officers of the Tnfant Welfare Centres. In addition, the Health Visitors also attend. Prior to the meeting of the Sub-Committee particulars relating to each case coming under review are obtained from the Health Visitors, General Practitioners, and Hospital Medical Officers concerned. All information obtained is treated confidentially, and as a result of the investigations, either adjustments of existing administrative procedure, or other measures, are undertaken with a view to preventing a recurrence of the conditions ascertained to be the cause of the fatality. The Committee investigated:— Deaths of Infants under 2 years 58 Still Births 28 Puerperal Fever 2 Puerperal Pyrexia 19 Maternal Deaths 3 Other deaths of women 1 Total 111 During the course of investigation the following facts emerged, which are of interest. Of the 58 deaths under 2 years of age, 72 per cent, occurred in institutions. Of the 25 deaths occurring during the first month, 3 of these babies were found abandoned and 4 had no fixed abode, 28 per cent, of the mothers had not received ante-natal supervision. Of the 30 deaths between one month and one year, 53 per cent, had never attended an infant welfare centre. 55 Of the 28 still births, 22 of the mothers had received ante-natal supervision, either by general practitioners, at hospitals, or at the Council's Clinics. There were 20 deaths of illegitimate children under two years of age, which represents a Mortality Rate of 101 per 1,000 illegitimate births as compared with 51 for legitimate children. 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, T am enabled to submit the following tables, showing the result of routine examinations of 591 elementary school entrants in Hampstead during 1937. 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. 56 Table showing Results of Routine Medical Inspection of Entrant Children in Hampstead to Elementary Schools during the year 1937, 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. Excellent. Normal. Slightly SubNormal. Bad. Clean. Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than 4 decayed. 4 or more decayed. No. rec. for treatment Entrants: Boys 295 259 38 - 53 235 7 - 295 - - 295 - - 183 82 30 104 Girls 296 256 40 - 48 238 10 - 295 - 1 295 1 - 175 87 34 117 Total 591 513 78 - 101 473 17 - 590 - 1 590 1 - 358 169 64 221 Hampstead per centages 868 132 - 171 800 2.9| 99.8 0.2 99.8 0.2 60.6 ' 28.6 10.8 37.4 London per centages 58.2 41.5 0.3 15.3 78.5 6.3 — 98.8 1.7 03 99.1 0.9 0.0 57.9 | 33.8 83 39.3 57 Table showing results of Routine Medical Inspection of Entrant Children in Hampstead to Elementary Schools during the year 1937, indicating the Defects found. f = defects found. o = noted for treatment and included in defects found. Disease or Defect. Boys (295). Girls (296). Hampstead. per cent. London, per cent. Hampstead. per cent. London. per cent. Skin disease f - - 1.0 - 0.9 o — — 0.7 — — 0.6 Tonsils only f 85 11.9 14.0 32 10.8 14.0 o 17 5.8 5.7 16 5.4 5.4 Adenoids only f — — 1.0 - — 0.7 o — — 0.6 - — 0.6 Tonsils and Adenoids f 8 2.7 3.8 4 1.4 3.4 o 6 2.0 2.7 2 0.7 2.4 Other Nose and Throat f — — 1.1 1 0.3 0.9 o — — 0.4 — - 0.2 Glands of Neck 1 — — 2.6 1 0.3 2.2 o — — 0.3 — — 0.2 Eye disease f 2 0.7 2.7 6 2.0 2.9 o 1 0.3 1.7 2 0.7 1.7 Otorrhœa f 2 0.7 0.8 2 0.7 0.9 o 1 0.3 0.4 1 0.3 0.5 Other Ear Defects f - — 0.3 — — 0.4 o — — 0.2 — — 0.2 Hearing f 2 0.7 0.1 1 0.3 0.1 o - — 0.0 — — 0.0 Speech f 2 0.7 0.4 — — 0.1 o — — 0.0 — — 0.0 Heart f — — 1.8 1 0.3 1.3 o — - 0.1 — — 0.1 Anæmia f 2 0.7 0.6 2 0.7 0.4 o — - 0.2 — — 0.2 Lungs f 4 1.4 3.1 4 1.4 2.9 o — - 1.2 — — 1.1 Epilepsy f — — 0.0 — — 0.0 o — 0.0 — — 0.0 Chorea f - 0.0 — — 0.0 o — — 0.0 — — 0.0 Paralysis f — — 0.1 1 0.3 0.1 o — 0.0 — — 0.0 Other Nervous Disorders f — 0.3 — — 0.2 o - - 0.1 — — 0.0 Pulmonary T.B. f — — 0.0 — — 0.0 o — - - - - - Other T.B. f — — 0.0 — — 0.0 o - - - - - 0.0 Rickets f — 1.0 — — 0.5 o — 0.1 — — 0.1 Spinal Deformities f — — 0.1 1 0.3 0.1 o — - 0.0 — — 0.1 Other Deformities f 1 0.3 1.0 2 0.7 0.9 o 1 0.3 0.4 1 0.3 0.3 Other Defects f 1 03 2.3 2 0.7 2.3 o — - 1.4 - - 1.4 58 per cent. per cent. Percentage of Boys requiring treatment for all defects = 41.0. London = 48.1 ,, ,, ,, excluding nutrition and dental defects = 9.5 ,, — 14.8 „ Girls „ ,, for all defects = 43.6 " = 48. 6 „ ,, ,, ,, excluding nutrition and dental defects = 7.8 ,, = 13.9 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:— 1929 7 1933 13 1930 15 1934 21 1931 11 1935 63 1932 19 1936 27 1937 17 Home Nursing. Full details of the scheme for home nursing by the Nurses of the two local Associations will be found in Section 2 of this Report. Treatment of Minor Ailments. In the majority of cases, pre-school children received treatment for minor ailments through the local District Nursing Associations. Such children were also treated at the London County Council School Clinic, Kingsgate Road, which was under the management of the Hampstead Council of Social Welfare. Upon the issue of Circular 1550 of the Minister of Health in connection with the supervision of the health of children under school age, I reported fully on the subject and the Nursing Associations having stated that they were prepared to undertake this work, the Scheme of Home Nursing was amended accordingly. Details of the arrangement with the Nursing Associations 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, 59 Maternity Beds. (I) New End Hospital. By arrangement with the London County Council, a ward containing five beds is set aside for Borough Council cases. The Borough Council contributes 9s. per day per bed occupied, and 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 27 patients were admitted to this Ward, their average duration of stay being fourteen days. (II) Queen Charlotte's Hospital. The Borough Council subscribes £\ in respect of every Hampstead mother confined in this Hospital. During 1937, the number of Hampstead women for whom such contribution was made was 42. (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 1937, 52 Hampstead mothers were confined there. The Children's Hospital, College Crescent. The Borough Council has an arrangement with this hospital whereby sick and ailing children, and children needing minor operations such as circumcision, removal of tonsils and adenoids, etc., are admitted. The Borough Council pays 21s. per week per bed occupied and the parents are assessed to pay according to their means. During 1937, no children were thus treated at the Hospital. The total number of beds in the Hospital for children under five years of age was 16. Convalescent Homes and Other Institutions. Convalescent Homes. During 1937, five mothers and babies and one expectant mother 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. 60 The following Homes are managed by Voluntary Committees and receive grants from the London County Council under the Local Government Act, 1929. Beauchamp Lodge. The Borough Council has an arrangement with Beauchamp Lodge Emergency Home for Children, 2, Warwick Crescent, Paddington, for the boarding-out of children under five years of age whose mothers have been admitted to Hospitals for their confinements. The Borough Council pays 12s. 6d. per week per bed occupied, the parents being assessed to contribute according to their means. No children from Hampstead families were admitted under this arrangement during the year. 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 1937. 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 1937, 15 babies were admitted, the remainder having been admitted prior to 1937. On an average, one-half of the total children accommodated come from Hampstead. 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 1937, there were beds for 10 expectant mothers and 8 beds, with cots, for mothers and babies in the hostel : 24 expectant mothers were admitted and 39 mothers were admitted with their babies; and 3 women were received after still births. The Cross Roads Club, 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 61 babies. It has accommodation for 16 expectant mothers, and 16 mothers and babies. During 1937, 68 expectant mothers and 63 mothers and 59 babies were admitted. Main Memorial Home, 141, West End Lane. This Home receives unmarried expectant mothers and mothers with young babies after discharge from hospital. It has accommodation for 7 expectant mothers and 7 mothers and babies. During the year 37 expectant mothers were admitted. The total number of beds available at the Home consist of 14 beds and 7 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 25 expectant mothers were admitted. Day Nurseries. The Hampstead and North St. Pancras 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 1937 was 8,678. The Nursery is controlled by a Voluntary Committee and the Borough Council contributes £400 per annum towards its expenses. By an arrangement with this Voluntary Committee the Borough Council rents a portion of the premises for the purpose of Ante-natal and Post-natal Clinics. The question of the establishment of another Day Nursery at Kilburn Vale has been under consideration in connection with the replanning of the Clearance Areas which has been undertaken by the County Council. This matter is still under consideration. Nursery Schools. While Day Nurseries provide for children from early infancy to 5 years whose mothers go out to work or whose home conditions are such that their health would benefit from the daily supervision which can be secured in this way, Nursery Schools provide normally for children aged 2—5 years. When this matter was last inquired 62 into by the Maternity and Child Welfare Committee it was found that Nursery Classes existed at the following:— Netherwood Street School, Kingsgate Road School, Fleet Road School, Beckford School, Hampstead Parochial School. Midwifery and Maternity Services. Domiciliary Midwifery Service. The question of the establishment of a domiciliary midwifery service was considered during the year in consequence of the receipt of a communication from the London County Council with reference to the outline proposals for a scheme under the Midwives Act, 1936. Under the scheme the London County Council proposed to make arrangements with voluntary organisations providing domiciliary midwifery services, for the employment by them of whole-time certified midwives, and by the County Council itself employing such midwives as might be necessary, and also to invite the Metropolitan Borough Councils, as the authorities administering the Maternity and Child Welfare Act, to co-operate so far as they were concerned in the provision of certain complementary services. It was indicated that grants were proposed to be made to the voluntary organisations in respect of the midwifery services, but that any payments which the Metropolitan Borough Councils continued to make under the Maternity and Child Welfare Act, 1918, would be deducted. The London County Council proposed to employ a number of whole-time salaried midwives for Area C, which included Hampstead and six other Boroughs and the City of Westminster. The Metropolitan Boroughs' Standing Joint Committee communicated with the Borough Council pointing out that the Borough Councils with their maternity and child welfare staffs could control, as agents for the County Council, the salaried midwifery service in their own districts more efficiently than could be done by the County Council, and pointed out that it appeared to be illogical that the maternity and child welfare authorities should be almost entirely eliminated from the extension of the scheme which was intended to improve the maternity services of London. The Standing Joint Committee submitted alternative proposals, providing for the County 63 Council to make appropriate arrangements with each Borough Council for that Council to provide a salaried midwives service, either by direct employment or through a district nursing association, for any part of their Borough not provided for by a teaching general or maternity hospital (every expectant woman to have free choice of at least two midwives). The Standing Joint Committee recommended that the arrangements already in operation whereby certain Metropolitan Borough Councils employed midwives direct, and other Metropolitan Borough Councils made contribution to voluntary organisations in respect of the provision of midwives in domiciliary work, should be continued. The Hampstead Borough Council had made arrangements previously with the two voluntary nursing associations in the Borough for the provision of domiciliary midwifery services, and made the following financial contributions, viz. : Kilburn & West Hampstead District Nursing Association, £100 per annum for midwifery and £100 per annum for maternity nursing, and Hampstead District Nursing Association—Maternity and Midwifery cases £3 3s. Od. per case. During 1937 the Kilburn Nursing Association midwives attended 109 cases whilst those of the Hampstead Nursing Association attended 23 cases. Of the total 132 cases 57 were attended in the company of a medical practitioner. The Maternity and Child Welfare Committee were of opinion that the existing arrangements provided efficient and adequate domiciliary midwifery services, linked up with the health visiting arrangements and also with the arrangements made in the Borough for attendance of cases at the ante-natal and post-natal clinics, and recommended that the present arrangements should be continued by the Borough Council as agents for the County Council. Upon their recommendation, the Borough Council resolved to inform the County Council that for the time being, the present contributions made to the voluntary nursing associations in respect of domiciliary midwifery services would be continued under any new scheme which was adopted, and also decided to draw the attention of the County Council to the observations of the Standing Joint Committee. Ultimately, the Borough Council ceased to contribute to the Nursing Associations in respect of this work as from 31st March, 1938. The proposals of the London County Council for giving effect to Section (1) of the Act, having been accepted by the Ministry of 64 Health, came into operation on 1st January, 1938. The material provision of the Section applied to London is as follows:— "It shall be the duty of every local supervising authority within the meaning of the principal Act (in this Act referred to as an "authority," and in London it is the County Council) to secure, whether by making arrangements with welfare councils or voluntary organisations for the employment by those councils or organisations of certified midwives as whole-time servants or by itself employing such midwives, that the number of certified midwives so employed who are available in its area for attendance on women in their own homes as midwives, or as maternity nurses during childbirth and from time to time thereafter during a period not less than the lying-in period, is adequate for the needs of the area. In this sub-section the expression 'lying-in period' means the period defined as the lying-in period by any rule for the time being in force under section three of the principal Act." (Note.—Under recent rules of the Central Midwives Board the definition of the normal lying-in period has been extended from 10 to 14 days.) For administrative purposes Hampstead is grouped with Chelsea, Fulham, Hammersmith, Kensington, Paddington, St. Marylebone and Westminster. In this Area there are 11 London County Council Midwives and various hospitals and nursing associations which, by arrangement with the County Council, are employing midwives to undertake the work. These municipal midwives, and those employed by certain of the other bodies referred to, can also be employed as maternity nurses in those cases where a doctor has been engaged for the confinement. In the case both of the municipal midwives and of the midwives employed by voluntary organisations, there is a standard scale of fees chargeable to the patients. These are as follows:— Fee for attendance of a midwife for a first confinement £ s. 2 0 Fee for attendance of a midwife on multipara 1 10 Fee for attendance of a maternity nurse 1 10 Patients who are unable to pay the full fee will be assessed according to rules which have been approved by the Council. 65 Compensation to Midwives. The Council compensates private midwives, other than those attached to the District Nursing Associations, Maternity Homes or Hospitals, for loss of cases referred by the Ante-natal Clinics to hospital for confinement, at the rate of 10s. 6d. per case, subject to the following conditions:—(a) the patient is required to confirm the statement that she had engaged the midwife to attend her confinement and had been referred by the midwife to the clinic; (b) the Medical Officer of the clinic certifies that she advised the patient to be confined in a Hospital or Home; (c) no payment is made to the midwife where the patient herself has applied to be confined in a Hospital or Home. No request for compensation was received in 1937. Maternal Mortality and Morbidity. Three women died in consequence of child-birth during 1937. This represents a maternal mortality rate of 3 per 1,000 births as compared with 2.9 and 1.0 for the preceding two years. On the 22nd July, 1937, the Maternity and Child Welfare Committee reported that they had had under consideration the Circular 1622 of the Ministry of Health, dated 7th May, 1937, upon the subject of Maternal Mortality, drawing attention to the Report (Cmd. 5422) on Maternal Mortality, which Report was the outcome of the special investigations into maternal mortality; and in particular to Section IX of the Report, which set out the essential elements of an efficient Maternity service, and the recommendations in Section X; submitting observations upon the more important of the recommendations and asking that consideration might be given to the Report and suggestions made in the Circular, and that the Minister might be informed of the action to be taken. The Circular drew particular attention to certain aspects of the work in this connection, and the following observations of the Committee were adopted by the Council:— (i) The importance of Team work. There is at present a vacancy on the Committee for a co-opted member, and they are of opinion that the general medical practitioners who attend Hampstead residents should be represented, and they have obtained the nomination of Dr. Isobel Finlayson, of 13, Shoot-up Hill, who is willing to serve upon the Committee. (Dr. Finlayson was accordingly appointed by the Council to the Committee as a co-opted member.) 66 (ii) Consultative Services. Arrangements have been in force for some years for securing the services of a consulting obstetrician, but it is a matter for regret that this service is not utilised to a greater extent. It is hoped that greater use may be made of this service in the future. (iii) Emergency Units. The matter of arranging, in certain types of cases, for the service of skilled hospital staff being brought to the patient appears to be one for the London County Council rather than for the Borough Council. (iv) Maternity accommodation. Arrangements already exist for the provision of Maternity beds and they appear to be adequate, and having regard to the fact that the London County Council control a large number of hospitals it does not seem to be necessary for the Borough Council to make any further provision. (v) Ante-natal Services. They have asked for a special report from the Medical Officer of Health upon this aspect of the circular and are informed that, during the past 16 years, the Medical Officer of Ante-natal Clinics has, at the original direction of an Inspector of the Ministry of Health, sent on the average 20 cases per annum to the Obstetric Specialist at the Royal Free Hospital, who is paid for the work by the Ministry, and that the arrangement has worked well, apart from the fact that occasionally difficulty is experienced in getting the patient to pay her own fares to the Hospital. They are of opinion that the existing arrangement should be continued, but that, where necessary, payment of the patients' fares should be made by the Council, and that the cost of this facility would not exceed £5 per annum, and they have given instructions accordingly. (vi) Post-natal Services. They have also asked for a special report from the Medical Officer of Health on this aspect, and are informed that a small number of post-natal cases (about 10 per cent. of the working class mothers confined) attend at the routine ante-natal sessions, but that otherwise there are no specific facilities available in the Borough. They are of opinion that weekly post-natal sessions should be held at both the Kingsgate Road and Pond Street centres on the lines indicated in the circular, as it is of paramount importance that the facilities should be available at a reasonable distance for mothers living at the eastern side of the Borough, and that a Doctor (preferably female) with appropriate experience in all branches of postnatal work should be appointed to attend the two sessions per week for this purpose. As the Health Visiting staff are otherwise fully engaged, a suitable nurse should be appointed to assist the 67 Doctor at the Sessions. The payments to be made in respect of these services would amount to about £205 per annum; they are anxious that any arrangements approved by the Council should be carried into effect as soon as possible. Arrangements were duly made for two post-natal clinics per week to be held, one at 75, Dynham Road and one at 27, Pond Street. Miss Beatrice Turner, F.R.C.S., Ed., M.C.O.G., was appointed to take charge of the clinics, with a nurse to assist. Dr. Turner's first clinics were held on Tuesday, 2nd November, at 75, Dynham Road, and on Thursday. 4th November, at 27, Pond Street. (vii) Ancillary Services. Arrangements already exist under each of the three headings, (a) arrangements for the supply of milk and other suitable food for expectant and nursing mothers, (b) the services of Home Helps, and (c) the provision of dental treatment, but they desire to mention that the question of the provision of the supply of milk and food to expectant and nursing mothers is the subject of a separate memorandum from the Ministry of Health, and of a report from this Committee; and that, with regard to the Home Helps, an endeavour is being made to increase the panel. (viii) Records. They have no observations to offer upon this matter, as they are of opinion that the records kept are accurate and efficient, and the free interchange of information between all who are professionally concerned with a maternity patient is already operative. (ix) Education for greater enlightenment on the importance of ante-natal supervision, and for further efforts to persuade women to take advantage of facilities provided; the organisation of general educational teaching on this subject and informal talks and lectures at Maternity Centres; and the forthcoming educational campaign. They do not at present organise general educational teaching, and they understand that the question of the coming National Health Campaign is receiving the attention of the Public Health Committee. 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. 68 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., 135, Harley Street, W.l, and 3, Hanover Terrace, Regent's Park, N.W.1. White, Norman, M.D., F.R.C.S., 115a, Harley 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. In two cases 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 instance. Invalid Children's Aid Association. The Hampstead Branch of this Association meets at 51, Howitt Road and valuable help is given to boys up to 14 years of age and girls up to 16 by the way of convalescence in the country or at the seaside; by the provision of surgical appliances, extra nourishment (e.g., milk or cod liver oil and malt), etc. The Local Secretary is Miss Harrison. Home Helps. A panel of Home Helps exists, whose services are available for homes in connection with cases of child-birth occurring in the Borough. They are paid at the rate of 5s. 0d. per day when employed, with no retaining fee. In normal cases they are on duty for 14 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. Under the Borough Council's Scheme as amended in October, 1936, a Home Help may 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, a Home Help may be engaged by a patient during the last three months of pregnancy, or in cases where expectant or nursing mothers are admitted to Hospital, 69 In April, 1937, the Maternity and Child Welfare Committee reconsidered the Scheme for the provision of Home Helps which had been in operation since April, 1934, with a view to making this valuable service more available to the poorer members of the public, and resolved that, for a period of twelve months, the scale of charges should be varied as follows:— (a) Where income of applicant is in the "Free Milk" Scale; no charge to be made instead of previous charge of 1/- per day. (b) Where income of applicant is in the "Assisted Milk" Scale a charge of from 10/- to 14/- for 14 days to be made according to means, instead of 2/- a day. (c) Where income of applicant is above the "Assisted Milk" Scale, instead of a charge of from 3/- to 5/- per day being made according to circumstances at the discretion of the Assistance Sub-Committee, the amount to be assessed in each case according to circumstances. At the close of the year there were 12 Home Helps on the panel, and applicants were assessed to pay the whole or a portion of the cost of the Home Helps, according to their means. During the year 19 mothers availed themselves of this facility, being assessed to contribute at charges varying from 6d. to 5s. 0d. 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 106 outfits were supplied during 1937. In 29 instances the full price was paid for the 5s. 6d. outfit. „ 62 „ „ „ 3s. 8d. „ „ 15 „ the applicants were assessed to contribute towards the cost of the 3s. 8d. outfit, the charges varying from 1s. to 2s. 6d. „ no instance was the 3s. 8d. outfit supplied free of charge. 70 Child Life Protection. Public Health (London) Act, 1936—Section XIII. The five Health Visitors are appointed as Child Protection Visitors. The following are the statistics relative to this work during the year:— On the 31st December, 1937, there were in the Borough 23 fostermothers having charge of 40 foster-children. Number of foster-children removed 71 „ foster-children added 77 „ foster-mothers removed 22 „ foster-mothers added 20 „ visits paid by Health Visitors to children 489 „ visits paid by Health Visitors to mothers 267 The supervision of foster-mothers and foster-children has continued to be exercised by the Health Visitors acting as Child Life 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. It is unfortunate that the number of suitable foster-mothers in this Borough is so limited. During the year 48 applications for placing foster-children were referred to other Authorities as we had no vacancies. It would appear that if a sufficient number of suitable foster-mothers are not available, consideration should be given to the question of the establishment of Foster-Homes in London. The pressing need for such accommodation is not peculiar to the Borough of Hampstead. The Hampstead 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 71 Health, in which he states "The Health Visitor must weigh up the advantages and demerits of the circumstances of each applicant for registration as a 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." It is interesting to note that one foster-mother legally adopted the child who had been in her care for a year. It was not found necessary for any legal proceedings to be taken during the year, but the Maternity and Child Welfare Committee decided that one foster-mother could not be allowed to continue to act in that capacity, owing to unsatisfactory home conditions. She was therefore informed accordingly, and her name removed from the official list. During the year one foster-child reached the age of 9 years, and thereby ceased to come within the scope of Part XIII of the Public Health (London) Act, 1936. In accordance with an arrangement made with the London County Council the records concerning this child were forwarded to the Children's Care Committee of the County Council, who keep such children under special observation. During the year three foster-children died, but in no 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. 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 72 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 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 local organisations and institutions. Subject to certain conditions in each of the five financial years 1937-38, 1938-39, 1939-40, 1940-41, and 1941-42, 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. 73 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. 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, Hampstead 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, 39, Lancaster Road Do. do. 331 Main Memorial Home, 141, West End Lane Do. do. 584 Eagle's Nest, 33, Fitzjohn's Avenue Babies' Home 652 74 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 Infant Welfare Centres 725 Baptist Chapel, Heath Street 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 400 Propaganda. During the year the Health Visitors have continued to distribute printed information concerning the various facilities offered by the Council in respect of its Maternity and Child Welfare services, etc. This literature is posted to "border-line" cases in which it is not easy to decide whether or not a Health Visitor should call. In connection with the National Health Campaign, posters were exhibited and leaflets and bookmarkers were distributed at the various clinics and at the public offices and libraries in the Borough during the period covered by the campaign (October, 1937, to March, 1938). During the year all Post Offices and Sub Post Offices were supplied with leaflets designed for handing to inquirers, giving information concerning local health services. Orthopædic Treatment. The patients found by the Health Visitors in their homes, or in attendance at the Welfare Centres, who are in need of orthopaedic treatment or advice are referred to the Orthopædic Department of one or other of the various London Hospitals. No special scheme for this has been established as to date. The doctors at the Centres have experienced no difficulty in obtaining appropriate treatment for their patients by this means. Section 4. Sanitary Circumstances of the Borough. 77 Sanitary Circumstances of the Borough. Water. Water from Hampstead Ponds. Water from the Hampstead Ponds has not been used for human consumption for many years. Since 1848 the water has gravitated to an open reservoir at Camden Park Road from which mains were connected to supply unfiltered water for non-domestic purposes, chiefly certain railway depots. As long ago as the reign of Henry VIII. an Act was passed by Parliament authorising the City Corporation to make use of "dyvers great and plentyfull springes at Hampstead Hethe" and elsewhere on the northern heights within a radius of five miles from the City, which hitherto had been supplied with water from shallow wells within the City and from outlying sources such as the Springs at Tyburn and elsewhere. In 1589 four reservoirs were formed in the declivity between the summit of Hampstead Heath and Pond Street, and to there in 1777 another was added in the Vale of Health. The five communicated with each other. One of the reservoirs was filled up as late as 1891. In 1692 the City Corporation granted a lease of the ponds renewable every 21 years to a number of lessees who formed the Hampstead Water Company which was acquired by the New River Company in 1859. The lease granted by the Corporation of the City to the Metropolitan Water Board expired in 1936 and since that date the supply from these ponds has been discontinued. I am indebted to the Chief Engineer of the Metropolitan Water Board and to the County Medical Officer of Health for this interesting information. Drainage and Sewerage. The following information is supplied in the Annual Report of the Council for the year ended 31st March, 1937:— "Sewers were reconstructed in Agamemnon Road, Gondar Gardens, Well Walk, Christchurch Road and The Grove. In connection with the Metropolitan Railway Works in Finchley Road, the London Passenger Transport Board constructed at its own expense, and under the supervision of the Borough Engineer, a new 9-in. pipe sewer on the east side of Finchley Road, opposite Nos. 151 and 157. 78 Consent to build over the sewer was granted to the Westminster Bank, Limited, in respect of their new premises at No. 106, Finchley Road. The whole of the sewerage system was efficiently maintained, ventilated and cleansed at a total cost (including £3,515 for the above reconstructions) of £8,198". Public Cleansing. The following information is supplied in the Annual Report of the Council for the year ended 31st March, 1937:— Dust Collection and Disposal. "A total of 30,188 tons of house and trade refuse was collected, as against 29,687 tons in the previous year, and was disposed of by rail to a controlled shoot in Bedfordshire. In the course of their duty the dustmen paid 1,663,475 calls, as against 1,644,011 last year, while an aggregate total of 38,425 hours was worked by the dusting vehicles. The dustmen were provided with heavy leathered coats for use in the winter, and with khaki drill jackets for the summer, the latter being cleaned weekly and kept in repair under contract. Seven Dennis Moving-floor rear-loading vehicles were purchased and put into commission, displacing S.D. Dustless Loaders which had become obsolete". Street and Gully Cleansing. "The streets were efficiently cleansed and watered, a total of 2,607 tons of sweepings being collected and disposed. A total of 17,288 gullies were cleansed and flushed, and 1,530 tons of detritus removed therefrom. The total cost of the cleansing service (including £360 for snow removal) was £18,051. A further 30 Sweepers' Trucks, each fitted with two special bins, were purchased. Waterproof clothing has been provided for the sweepers". 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. 79 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 1937:— Total number of inspections 3,856 Total number of re-inspections and other visits and re-visits 14,975 Total number of dwelling-houses inspected for housing defects 1,811 Number of these found not in all respects reasonably fit for human habitation 1,207 The inspections were occasioned by various causes, e.g., complaints received; special inspections, registration and inspection of tenement houses; examination of premises after the occurrence of infectious disease; sanitary work (voluntary or otherwise) in progress. The total number of Notices served during the year was as follows:— (1) Informal (i.e., intimations), 1,558 relating to 1,176 premises. (2) Statutory 873 relating to 394 premises. Investigation of Complaints, Inspection of Factories, Workshops and Workplaces, etc. Number of complaints investigated 1,023 ., „ premises inspected after the occurrence of infectious disease 213 „ „ inspections of Factories (excluding bakehouses) 54 „ „ inspections of Workshops (excluding bakehouses) 62 ., „ inspections of Workplaces 147 „ „ inspections of Bakehouses, Milkshops and other food premises 718 80 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 425 Closed, or illegal occupation discontinued 19 Made to conform — Verminous conditions. Rooms disinfested 117 Number of houses concerned 75 Beds and bedding disinfested 41 Floors of rooms cleansed 63 Animals. Nuisances from improper keeping in rooms abated 2 Nuisances from improper keeping on the premises abated 2 Smoke nuisances. Complaints received 8 Observations made 20 Notices served 5 Drainage systems, &c. Drainage systems repaired or renewed, partly or wholly 357 Plumbing defects remedied (soil pipes, waste pipes, &c.) 679 Roofs, rainwater pipes and gutters repaired or renewed 340 Water supply. Water supply provided to separate lettings 210 Number of houses concerned 167 Sinks provided to separate lettings 270 Number of houses concerned 212 Water cisterns cleansed or covered 27 Water-Closets. Additional provided 172 Removed from improper position 12 Flushing cisterns repaired 98 Yards, &c. Paving, &c. Yards or open spaces newly paved and drained 91 Paving of yards or open spaces repaired 60 Bathrooms. New provided 222 Dust Bins. Repaired or renewed 135 Houses or parts cleansed (other than verminous conditions) 205 Number of rooms concerned 266 Dampness in houses or parts abated 283 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 195 Closed, or illegal occupation discontinued 21 Made to conform — Verminous conditions. Rooms disinfested 56 Number of houses concerned 41 Beds and bedding disinfested 1 Floors of rooms cleansed 6 Animals. Nuisances from improper keeping in rooms abated — Nuisances from improper keeping on the premises abated — - 81 .Totals Drainage systems, &c. Drainage systems repaired or renewed, partly or wholly 69 Plumbing defects remedied(soil pipes, waste pipes, &c.) 69 Roofs, rainwater pipes and gutters repaired or renewed 233 Water supply. Water supply provided to tenements 24 Number of houses concerned 11 Sinks provided to tenements 65 Number of houses concerned 53 Water cisterns cleansed or covered 9 Water-closets. Additional provided 43 Flushing cisterns repaired 48 Removed from improper position — Yards, &c., Paving, &c. Yards or open spaces newly paved and drained 27 Paving of yards or open spaces repaired 69 Bathrooms. New provided 2 Dust Bins. Repaired or renewed 65 Miscellaneous. Window cords repaired or renewed 145 Window fittings repaired or renewed 111 Filth and refuse removed from rooms 3 Washing(of clothes) accommodation provided 3 Coppers repaired or renewed 44 Suitably ventilated food cupboards provided 262 Kitchen ranges repaired or renewed 92 Common staircases repaired 18 Common staircases provided with adequate means of natural light — Common staircases provided with adequate means of artificial light — Houses or parts cleansed(excluding verminous rooms) 726 Number of rooms concerned 998 Dampness in houses or parts abated 358 Dilapidated houses or parts repaired 409 The sanitary work in the foregoing tables includes drainage and plumbing work for which approval is obtained from the Borough Council. 727 drainage application forms and plans were submitted during the year. 93 of these were for work carried out under notice, and 634 were for alterations and additions carried out voluntarily by the owners. There is a growing tendency for persons of all classes to make their homes in suites of rooms, a tendency brought about by the need for economy and efficiency. The result is that additional sanitary fittings are required and amendments to drains have to be made to provide the necessary sanitary amenities. The interference with existing sanitary systems that these alterations involve requires constant oversight by the Sanitary Inspectors to maintain a standard of work that ensures safety to the occupiers of the rooms. 82 The standard of work is governed by the London County Council Drainage Byelaws. Tenement Houses. Three tenement houses were added to the Register, four tenement houses were the subject of Closing Orders, making a total of 1,564 tenement houses on the Register. During the year, 588 tenement houses were inspected and 3,229 defects were discovered. As tenement houses become "decontrolled" it is incumbent upon the owner to provide for 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 the rooms in the separate occupation of the family are situated)—(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. The enforcement of these requirements occupies a considerable amount of time of the Tenement House Inspectors. During the year 43 additional water-closets have been provided without recourse to legal proceedings. Proper facilities for the storage and cooking of food in tenement houses are required by Section 184 of the Public Health (London) Act, 1936, but, by proviso, the former could only be enforced in such houses as were used or occupied as such before 16th August, 1909, and the beginning of August, 1908, respectively. This proviso limiting the application of the clause was repealed by the London County Council (General Powers) Act, 1937. The Overcrowding Standards in Tenement Houses were affected by the Housing Act, 1936, which came into operation on January 1st, 1937. It consolidated the Housing Acts, 1925 to 1935, and certain other enactments relating to housing. The First Schedule of the Act of 1935, which prescribed the standards by which was ascertained the number of persons permitted to use a house for sleeping purposes, has been carried into the new Act in the Fifth Schedule. Section 6 (2) provides that as from the "appointed day" for the purposes of the abatement of overcrowding,—which for Hampstead has been fixed for the 1st January, 1938,—Byelaws made with regard to working class houses, for fixing the number of persons who may occupy such houses, and for the separation of the sexes therein, shall cease to have effect. 83 The former standards of overcrowding in registered tenement houses, which were based on cubic air space, therefore, no longer exist, and the new standards prescribed by the Act of 1936 are applicable to dwelling-houses whether registered under the tenement house byelaws or not. Common Lodging Houses and Seamen's Lodging Houses. None exists in the Borough. Business 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. Offensive Trades. No offensive trade is carried on in the Borough. Increase of Rent and Mortgage Interest (Restrictions) Acts. Number of certificates applied for 15 „ „ issued 18 Factory and Workshop Acts. Section 132 of the Act of 1901 requires every Medical Officer of Health in his Annual Report specially to report on the administration of these Acts, and tabulated statements were framed by the Home Secretary with a view to such reports being made upon uniform lines. It is the statutory duty of the Borough Council to keep a Register of all Workshops situated within their district. Inspection of Factories, Workshops, and Workplaces, including Inspections made by Sanitary Inspectors. Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories (Including Factory Laundries) 116 27 1 Workshops (Including Workshop Laundries) 69 23 Nil. Workplaces (Other than Outworkers' premises) 147 60 Nil. Totals 332 110 1 84 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*:— Nil. Nil. Want of cleanliness 77 77 Want of ventilation 7 7 Overcrowding Nil. Nil. Want of drainage of floors 1 1 Other nuisances 144 144 Sanitary accommodation insufficient 9 9 unsuitable or defective 17 17 not separate for sexes 7 7 Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) Nil. Nil. Nil. Nil. Other offences (Excluding offences relating to outwork, and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops, Transfer of Powers) Order, 1921.) 1 1 Nil. Nil. Totals 263 263 Nil. Nil. *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. Factories. The following is a list of the different classes of Factories in Hampstead:— Bakers 30 Dyers and cleaners 10 Bootmakers 22 Launderers 2 Butchers 6 Motor and other engineers 31 Cabinet makers and Upholsterers 7 Printers 7 Other trades 36 Carpet beaters 2 Coffee roasters 4 Total 168 Confectioners 7 Dressmakers 4 85 Workshops. At the end of 1937, there were 368 workshops on the Register, including 114 domestic workshops. During the year, 69 inspections were made and 23 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 are controlled by the Factory and Workshop Act, 1901. There are 82 such outworkers (or home-workers) in Hampstead known to the Public Health Department. Of these, 6 are factories, 22 are workshops, 5 are workplaces and 49 are single workers. Persons sending out homework are required to keep lists of their home-workers and to send copies of these lists to the Borough Council on or before the 1st February and the 1st August in each year. In February, 46 lists were received, and 43 lists in August. These lists included the names of 118 and 115 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 121, 27 belonged to Hampstead and 94 elsewhere. Particulars of the latter were sent to the Local Authorities concerned, while information concerning 38 outworkers resident in Hampstead was received from other Authorities. In no instance during 1937 was outwork found to be carried on in unwholesome premises. Factories Act, 1937. This Act, which received the Royal Assent on 30th July, 1937, consolidated, with amendments, the Factory and Workshop Acts, 1901 to 1929, and other enactments relating to factories, etc. Except as otherwise provided, however, it will not come into operation, until 1st July, 1938. Section 128 provides that the Medical Officer of Health shall, in his Annual Report to the Council, report specifically on the administration of, and furnish the prescribed particulars with respect to, the matters under Part I (Health (General Provisions)) and Part VIII. (Homework) of this Act which are administered by 86 the Borough Council, and shall send a copy of his Annual Report or so much of it as deals with those matters to the Secretary of State; and give written notice to H.M. Inspector for the district of any factory coming to his knowledge in which no abstract of the Act is affixed in accordance with the Act. The following Sections are enforceable by the Council in factories where mechanical power in not used, viz.:— Section 1—Maintenance of cleanliness, including the daily removal of dirt and refuse from floors, benches, staircases, &c., and the cleaning and washing of floors, walls and partitions. Section 2—Prevention of overcrowding. Section 3—Maintenance of a reasonable temperature. Section 4—Maintenance of adequate ventilation. Section 6—Provision for draining off the wet where any process is carried on which renders the flooring liable to be wet. Section 8 requires the local authority to keep a register of premises, whilst Section 110 empowers duties in connection with lists of outworkers. Section 7—Provision of sufficient and suitable sanitary conveniences and is enforceable by the Council in all factories. Section 54 provides that a basement bakehouse shall not be used as a bakehouse unless it was so used at the date of the passing of the Act, and a certificate of suitability had been issued by the Council, nor can it be used where there has been a break of user for twelve months. Every basement bakehouse which has a certificate must be inspected in the year beginning at the date of the commencement of the Act and in every fifth succeeding year after that year, and upon the results of such inspection the certificate may be revoked or continued. 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. 87 Advice and help has been given by the Sanitary Inspectors in connection with 64 complaints of nuisance from rats and mice. During "Rat Week" 1st to 6th November, organised by the Ministry of Agriculture and Fisheries, posters were displayed throughout the Borough urging the eradication of this form of vermin. In the past it had been the practice in Hampstead for baits to be laid in the sewers. This method was never entirely satisfactory in so far as many of the baits were washed away, and in any event one could never ascertain the exact results. Towards the end of the year, it was decided that baited-traps should be used instead. The results have been most satisfactory and the method of placing baited-traps will be continued next year. Shops Act, 1934. During the year 340 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 no exemption certificates were granted. Smoke Abatement. During the year eight complaints of smoke nuisance were received. Twenty observations were made and five notices were served. 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 Annual Report for 1935. 88 During 1937 the Public Health Department took samples of water from the various baths at the Central Baths, seven for chemical and seven for bacteriological examination. All the samples were satisfactory. (2) The Hampstead 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 1937, no water samples were taken for chemical or for bacteriological examination. (b) Privately owned swimming baths open to the public. Gilling Court and Holmefield Court, Belsize Grove, Swimming Pool. This swimming pool was provided principally for the use of the tenants of these flats, but is also open to friends of tenants. During the year 1937, no sample of the bath water was taken for chemical or for bacteriological examination. Eradication of Bed Bugs. The question of the best means of dealing with bugs was fully discussed in my Annual Report for 1936. The following statistics relating to the year 1937 are submitted:— No. of dwellings:— (i) found to be bug infested 116 (ii) disinfested 116 Cleansing and Disinfection of Verminous Persons and their Belongings. A reference to these matters will be found on page 164. Removal of aged, infirm, or physically incapacitated persons. During the year an aged and infirm person who was unable to devote to herself, or to receive, proper care and attention was removed to Paddington Hospital, Harrow Road, on the 29th of January under the powers conferred by Section 224 of the Public Health (London) Act, 1936. The premises in which the person was residing had become extremely insanitary, and the court agreed that it was in the interest of the health of the person herself, and for preventing serious nuisance to other persons living in the same block of tenements, that she should be removed from the premises in which she was residing. 89 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 during 1937:— Date of Hearing. Nature of Offence. Result of Hearing. 1937. 15th Jan. Selling cream cheese containing excess of water. Summons withdrawn. 29th Jan. Application under the Public Health (London) Act, 1936, for order for removal of person to hospital. Order made for removal to Paddington Hospital for 3 months. 5th Mar. Nuisancc under Public Health (London) Act, 1936. Order made to abate within one month and pay £1 1s. 0d. costs. 5th Feb. Using premises as a dairy without being registered. Fined £3 and £1 1s. 0d. costs. 10th Mar. Nuisance under the Public Health (London) Act, 1936. Work done. Summons withdrawn. 19th Mar. Nuisance under the Public Health (London) Act, 1936. Order made to abate in 48 hours and pay £1 1s. 0d. costs. 9th April Nuisance under the Public Health (London) Act, 1936. Work done; Summons withdrawn. £1 Is. costs paid. 7th April (i) Non-deposit of plans. (ii) and (iii) contravention of Drainage Byelaws. (i) Fined 40s. (ii) Fined 40s. (iii) Fined 40s. 23rd April (i) Nuisance. (ii) and (iii) contravention of Tenement House Byelaws. (i) Order to abate within 28 days and to pay £3 3s. costs. (ii) Fined 1s. (iii) Fined 1s. 23rd April Selling cream cheese deficient in fat. Dismissed under Probation of Offenders Act on payment of £2 costs. 28th April Application for the retention of Defendant in Paddington Hospital. Order made for further three months. 28th May Nuisance under the Public Health (London) Act, 1936. Order made to abate forthwith and prevent recurrence and to pay £2 costs. 9th June Trading as a dairyman in Netherwood Street without being registered. Fined £10 and £2 2s. costs. 9th June Trading as a dairyman in Netherwood Street without being registered. Summons withdrawn. 27th July Application for retention of Defendant in Paddington Hospital. Order made for retention for a further three months. 90 Date of Hearing. Nature of Offence. Result of Hearing. 1937. 1st Oct. Nuisance under the Public Health (London) Act, 1936. Order made to do the work within 28 days and pay 10s. 6d. costs. 19th Nov. Nuisance under the Public Health (London) Act, 1936. Work done. 10s. 6d. costs paid and summons withdrawn. 18th Nov. (i) Nuisance under Public Health (London) Act, 1936. (ii) Contravention of Tenement House Byelaw No. 23. Work done. £1 1s. costs paid and summons withdrawn. 8th Oct. Nuisance under the Public Health (London) Act, 1936. Order made to abate in 28 days and pay 10s. 6d. costs. 28th Oct. Nuisance under the Public Health (London) Act, 1936. Order made to abate in 28 days and pay £2 2s. costs. 8th Oct. Contravention of Dog Nuisance Byelaw. Fined 2s. 6d. 13th Oct. Contravention of Dog Nuisance Byelaw. Fined 10s. 28th Oct. Contravention of Dog Nuisance Byelaw. Dismissed under the Probation of Offenders Act. Payment of 2s. 6d. costs. 28th Oct. Contravention of Dog Nuisance Byelaw. Dismissed under the Probation of Offenders Act. 28th Oct. Contravention of Dog Nuisance Byelaw. Fined 5s. 18th Nov. (i) to (v) Contravention of Tenement House Byelaws. (vi) Nuisance under Public Health (London) Act, 1936. Work done. £3 3s. costs paid and summons withdrawn. 8th Dec. (i) Selling Milk containing 12.6% added water, contrary to Milk and Dairies (Amendment) Act, 1922. (ii) Ditto, contrary to Food and Drugs (Adulteration) Act, 1928. (i) Dismissed on payment of 4s. costs. (ii) Fined 10s. and £1 11s. 6d. costs. 15th Dec. Contravention of Dog Nuisance Byelaw. Fined 10s. 21st Dec. Nuisance under the Public Health (London) Act, 1936. Order to abate in 42 days and pay 10s. 6d. costs. 29th Dec. (i) and (ii) Two summonses for contravention of Section 181 of Public Health (London) Act, 1936, in respect of a bakehouse, etc. (i) Fined 20s. (ii) Fined 20s. Flooding in Kilburn. In consequence of the phenomenal rainfall which occurred on Friday, 13th August, flooding of buildings occurred, principally in the Netherwood Street, Palmerston Road and Maygrove Road area. Immediate action was taken by the staff of the Public Health Department and of the Borough Engineer's Department who visited the scene of the flooding and inspected a number of houses in the affected area. There was no evidence, however, of sewage contamination, but disinfectant was supplied when required by the householders. The disinfecting staff arranged for the collection of damp bedding and clothes from the affected houses and also from St. James's Mission 91 Hall where a large number of wet articles had been deposited. The work of drying clothes, bedding, &c., continued until a late hour on the Friday night, and by Saturday evening all the articles had been dried and returned to the owners. Certain of the lower rooms were not sufficiently dry for habitation until some days later, but all the persons affected were able to make other arrangements. Everything possible was done to relieve the discomfort and trouble of the people affected. Roth the Public Health Committee and the Works Committee gave careful consideration to the matter and received full reports upon the occurrence. The latter Committee expressed the view that the question of flooding is one which must primarily depend upon the main drainage facilities offered by the County Council's sewers, and expressed the opinion that it might well be that, in the case of such a phenomenal downpour as then occurred no normal and economic system of drainage could cope with the storm. Between 4.35 p.m. and 5.35 p.m. as much as 1.18 inches of rain fell at the Observatory of the Hampstead Scientific Society, Hampstead Heath, and 0.40 inches in the ten minutes from 5.10 to 5.20 p.m. This heavy rainfall was not confined to Hampstead; severe flooding occurred in many parts of London the sewers of which were not designed to take such abnormal quantities of storm water. Upon their recommendation the Borough Council resolved to make representations to the London County Council suggesting that every practicable step be taken with a view to avoiding in future such serious flooding. A subsequent communication from the London County Council referring to the system of drainage of Kilburn and other parts of the Borough into the County Council's Ranelagh Sewer and to other matters, stated that during such exceptional storms as occurred on 13th August, 1936, the sewers became surcharged and some flooding of basements in low lying districts is inevitable. The matter was under consideration at the close of the year. Pharmacy and Poisons Act, 1933. Under the Pharmacy and Poisons Act, 1933, 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 92 the Home Secretary approved, with certain modifications. This List is divided into two parts; the Poisons set out in Part I may only be retailed by registered pharmacists; but a person whose name is entered in the Borough Council's list may 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. 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 acids, 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, weed-killers and insecticides. Up to 31st December, 1936, 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. During 1937 the names of 12 persons were added to and the names of five persons were removed from the Borough Council's List. The number on the Register at the close of the year was 134. The Council has 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, 95 bodies were brought to the Mortuary, 26 by the Police, 67 at the request of friends, 1 at the request of a hospital, and 1 by order of the Coroner. In 27 instances post-mortem examinations were made. 93 Noise Nuisance. By Section 66 of the London County Council (General Powers) Act, 1937, a noise nuisance is deemed to be a nuisance which may be dealt with under the Public Health (London) Act, 1936. Subject to certain qualifications a noise nuisance is deemed to exist where any person makes or continues or causes to be made or continued any excessive or unreasonable or unnecessary noise which is injurious or dangerous to health. Section 5. Housing. 97 Housing. Statistics. The following information is required by the Ministry of Health to be set out in this Annual Report:— 1. Inspection of Dwelling-homes during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1811 (b) Number of inspections made for the purpose 2319 (2) (a) Number of dwelling-houses (included under sub-head (1) above which were inspected and recorded under the Housing Consolidated Regulations, 1925 40 (b) Number of inspections made for the purpose 48 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (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 1207 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 40 3. Action under Statutory Powers during the Year:— A.—Proceedings under sections 17, 18 and 23 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil. (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners Nil. (b) By local authority in default of owners Nil. B.—Proceedings under Public Health Acts: (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 872 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 872 (b) By local authority in default of owners Nil. 98 C.—Proceedings under sections 19 and 21 of the Housing Act, 1930: (1) Number of dwelling-houses in respect of which Demolition Orders were made Nil. (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil. D.—Proceedings under section 20 of the Housing Act, 1930: — (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 30 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 1 4. Housing Act, 1935—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 386 (ii) Number of families dwelling therein 386 (iii) Number of persons dwelling therein 1932½ (b) Number of new cases of overcrowding reported during the year 16 (c) (i) Number of cases of overcrowding relieved during the year 25 (ii) Number of persons concerned in such cases 93½ (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. From the preceding Table it will be seen that the number of overcrowded families known to the Department at the end of the year was 386. At the special survey of the Borough conducted in 1935, 449 families were found to be living in overcrowded conditions. This number has been reduced by cases in which families have removed, or have accepted accommodation provided by municipal efforts; while on the other hand new cases of overcrowding have been reported from time to time. At the same time it must be appreciated that fresh cases of overcrowding may have occurred in the Borough which have escaped the notice of this department. 99 I have analysed the 386 cases of overcrowded families remaining at 31st December and have ascertained their circumstances to be as follows:— Size of home. No. of families. Population. Total. Over 10. Under 10. 1 room 29 68 19 77½ 2 rooms 217 793 225 905½ 3 rooms 117 663 144 735 4 rooms 20 156 12 162 5 rooms 2 17 3 18½ 14 rooms 1 34 — 34 386 1,731 403 1,932½ These cases of overcrowding may be presented in another form, thus:— Families of 2½ persons 5 ,, 3 ,, 19 ,, 3½ „ 69 ,, 4 ,, 75 ,, 4½ „ 18 ,, 5 ,, 44 ,, 5½ „ 32 ,, 6 ,, 52 ,, 6½ ,, 11 ,, 7 ,, 21 „ over 7 „ 40 Total 386 Different standards are set up for the purpose of Local Authorities providing re-housing accommodation, as apart from the standards set down for overcrowding; thus :— Section 136, Housing Act, 1936, states that a Local Authority shall treat a house containing two bedrooms as providing accommodation for four persons, a house containing three bedrooms as providing accommodation for five persons, and 100 a house containing four bedrooms as providing accommodation for seven persons. (Note: 1. It will be seen that no account is taken of the living room accommodation. 2. The bedrooms referred to are of the standard size, viz., 110 square feet or more, 3. A child, of whatever age, is regarded as a "person.") It will be seen therefore that comparatively large type dwellings must be provided if alternative accommodation is to be offered to the large families living in overcrowded conditions. It is in these "larger families" where the overcrowding is most acute, and where, in the main for economic reasons, it is almost impossible for the families themselves to find appropriate accommodation. Let us take an example to stress the point under consideration. A man and wife and a family of one girl and three boys (all under 10 years), although appearing on the overcrowding records as a family of only four persons, will require a five roomed house of four bedrooms for purposes of rehousing. Re-housing Accommodation. On 22nd July, 1937, the Housing Committee submitted to the Council further observations and recommendations with regard to the provision of re-housing accommodation in the Borough. Their report referred to the fact that on the 30th of April, 1936, they reported that the estimated requirements of the Borough by way of re-housing amounted to approximately 300 dwellings, of which 187 were needed for the abatement of overcrowding, and this need the Council on that date decided themselves to take all practicable steps to provide. The Committee felt that it was desirable that any such accommodation should be built as soon as possible, because the penal provisions against overcrowding which are contained in the Housing Act, 1936, would come into force in the Borough on the 1st January, 1938. The Committee reported that in dealing with this question they had been actuated by the desire to provide re-housing accommodation for working-class residents in the Borough in which they were living, and they had therefore made most exhaustive enquiries in an endeavour to overcome the difficulties of obtaining sites in Hampstead. Twenty possible sites 101 were considered but after investigation were, with two exceptions, rejected on the ground of high cost of acquisition, difficulties connected with levels, displacement of persons on the site and town planning and other difficulties. These two sites would give re-housing accommodation to the extent of 46 dwellings. The two sites recommended for acquisition were Garnett Road Playground and New End Clearance Area. Garnett Road Scheme:— Description, etc. The site has an area of 0322 of an acre, and has for many years been held by the Council on an agreement, subject to 14 days notice at a yearly rent of £5, and used as a Children's Playground. The proposed lay-out will permit of the continuance of this user to a limited extent, such limitation being justified in the mind of the Committee in view of the recent provision of a new and well-equipped playground at the foot of Parliament Hill, close to the Borough boundary, which had led to a great falling off in the use of the Garnett Road playground. The Trees, Open Spaces and Allotments Committee concurred with this view, particularly because the playground at the moment needed re-paving, re-fencing and re-equipping at a high cost. The Committee were of the opinion that the site was particularly suitable for a housing scheme as it adjoined the Council's existing estate at Park Dwellings, and would entail no additional cost for supervision; nor involve the displacement of existing tenants. The site will provide accommodation for the following:— Six three-roomed flats. Eight four-roomed flats. Eight five-roomed flats. New End Scheme :— Description, etc. The site has an area of 0 412 of an acre and comprises the cleared area which was the subject of a Clearance Order recently made by the Rorough Council, as well as three cottages and the Ebenezer Chapel, abutting on Christchurch Passage. 102 The site will provide accommodation for the following:— One two-roomed flat. Eleven three-roomed flats. Six four-roomed flats. Five five-roomed flats. One six-roomed flat. In addition three shops will be provided. The type of dwellings proposed on both sites is normally four storeys high, and known as the "Cottage on Cottage" type; the absence of bedrooms on ground or balcony floors makes this arrangement attractive, and no rooms are overshadowed or overlooked by or from access balconies; an added advantage is that the bedrooms are separated horizontally from each other by the living-rooms, etc., making for quietness in each flat in normal conditions. The bedrooms generally are approached from the entrance lobbies and landings, and the livingrooms are mostly planned with the entrance from the lobby in a recess communicating with the scullery, giving direct access to the latter without breaking up the wall space by an extra door. The Committee proposed to utilise the dwellings on both the sites entirely for the relief of overcrowding and to apply for Government and London County Council subsidies. The Council at its meeting on 22nd July approved the Schemes in principle and authorised the Housing Committee to obtain and submit the necessary plans, specifications and tenders for proceeding with the Schemes. Overcrowding. On 17th June, 1937, the Minister of Health, in exercise of his powers under Section 68 of the Housing Act, 1936, issued the Operation of Overcrowding Provisions Order (No. 2) fixing the 1st of July, 1937, as the "appointed day" for the purposes of Section 62 of the Act (which provides for entry in rent books or similar documents of a summary in the prescribed form of certain provisions of the Act relating to overcrowding within six months therefrom), and 1st of January, 1938, as the "appointed day" for the purposes of Sections 59 103 and 64 (which contain provisions as to offences in relation to overcrowding) and Section 60, which empowers the Minister to increase the permitted number temporarily to meet exceptional conditions, and Sub-section (2) of Section 6, which caused the byelaws relating to the number of persons who may occupy Tenement Houses and to the separation of the sexes therein to cease to have effect. The standard of accommodation laid down by the Housing Act, 1936, for determining overcrowding consists of two parts. The first aims at securing proper separation of the sexes; the second restricts the number of persons who may occupy a house. The two requirements are distinct from each other and both must be complied with. A house is 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, are obliged to sleep in the same room. The maximum number of persons, irrespective of sex, who may be permitted to sleep in a house at one time is fixed in relation to the number and sizes of the rooms in the house. The maximum permitted number is ascertained by reference to the two following tables, and is the number obtained by the application of Table I or Table II, whichever is the less. Table I. No of. Rooms. Permitted No. of Persons. 1 2 2 3 3 5 4 7½ 5 10 And two persons extra for each additional room. Table II. Size of Rooms. Permitted No. of Persons. Under SO sq. ft. nil. 50 or more, but less than 70 ½ 70 or more, but less than 90 1 90 or more, but less than 110 l½ 110 or more 2 104 It should be noted that for the purposes of these tables (i) a child under one year of age is not counted and a child between the ages of one and ten years counts as half a person; (ii) only rooms normally used in the locality for sleeping or living purposes are counted as rooms; (iii) no room under 50 square feet is counted; (iv) rooms occupied by a sub-tenant must be regarded as a separate house; (v) in measuring the rooms, the floor area is measured at the level of the floor, and includes bay windows extensions and space taken up by cupboards and projecting chimney-breasts; but where the height of the ceiling above the floor does not exceed five feet, then the floor area below that part of the ceiling is excluded. It is relevant to point out that this standard does not represent an ideal standard of housing, but the minimum which is, in the view of Parliament, tolerable, while at the same time capable of immediate or early enforcement. The Housing Act, 1936, provides that, after a date to be fixed by the Minister of Health, it will be an offence for any occupier or landlord of a house to cause or permit the house to be overcrowded. The date fixed by the Minister for Hampstead is the 1st January, 1938. It is the duty of a Landlord to prevent his house from becoming overcrowded, and he will be deemed to have caused or permitted overcrowding (i) if, after the Borough Council has notified him or his agent in writing that the house is overcrowded, he fails to take all reasonable steps to secure the abatement of such overcrowding, by the removal of a tenant or tenants, including legal proceedings for the recovery of possession of the house, or (ii) if, when letting the house after 1st January, 1938, he or his agent (a) had reasonable cause to believe that it would become overcrowded, or (b) failed to make inquiries of the proposed occupier as to the number, age and sex of persons who would be allowed to sleep in the house. As from 1st January, 1938, every rent book or other similar document 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, 105 After the 1st January, 1938, it is the duty of an occupier to prevent overcrowding in his house. The occupier may defend himself from the charge of permitting overcrowding by proving any of the following facts:—(i) that all persons sleeping there were living there on 1st January, 1938, and since that date have lived there continuously, or were children born since that date of any of those persons; (ii) that the overcrowding is due solely to the fact that since January 1st, 1938, a child has attained the age of one year and is counted as half a person or has attained the age of ten years and is counted as one person, provided that the occupier has applied to the Borough Council for alternative accommodation; (iii) that the overcrowding is due solely to a member of the occupier's family sleeping temporarily but not living in the house. These defences are not conclusive, however, for although he may be able to prove one or other of these facts, the occupier will still have committed an offence if (a) he fails to accept an offer of suitable alternative accommodation; or (b) the removal from the house of some person, not being a member of the occupier's family, becomes reasonably practicable and the occupier fails to require the removal of such person. Early in the year a temporary staff was appointed consisting of four measurers, four assistant measurers and two clerks. Measurements were made of 32,839 rooms, comprising 10,883 separate dwellings, in 4,532 working class houses for the purpose of ascertaining the permitted number for each working class dwelling, and for the furnishing of this information to landlords, or occupiers upon request. In connection with this work it was found that 811 rooms in 277 houses were unoccupied, but advantage was taken of the opportunity to measure such rooms. In addition 137 houses were found to be totally unoccupied. The information secured by this Measurement Survey, together with that obtained by the original Overcrowding Survey, forms the basis of valuable overcrowding records and of the progress made in its reduction. The Minister of Health has stressed the importance of 106 making this a complete record of all existing overcrowded families, and of the action taken to deal with them; of new cases as they arise by reason of births or the growing up of children; and of cases licensed by the Borough Council. Progress in the reduction of overcrowding has not been as rapid as could be wished, but it is realised by those who are closely concerned with the matter, that, with the limited accommodation available and the local difficulties in providing housing facilities, the elimination of overcrowding cannot be achieved immediately and in the meanwhile specially calls for sympathy and understanding in administrative action. Un-dcrgrmind Rooms. Steady progress has continued to be made in dealing with underground rooms that do not comply with the requirements of the law, and where unhealthy conditions exist. At its meeting in September, the Council received a report from the Housing Committee on the subject of underground rooms dealt with by them under the Housing Act. I have thought it desirable to insert in this Annual Report the report referred to, as it includes a statement of the facts regarding such underground rooms and of the policy of the Housing Committee in dealing with them:— " Underground Rooms. We beg to report as follows upon this subject: — (i) Definitions of Underground Room. There are two definitions—one applicable to proceedings under the Housing Act, 1936, and one to proceedings under the Public Health (London) Act, 1936. The definition in the Housing Act, 1936, Section 12 (2), is material to all proceedings undertaken by the Housing Committee (i.e., including all Closing Orders made by the Council) and is as follows: — "A room the surface of the floor of which is more than 3 ft. below the surface of the part of the street adjoining or nearest to the room, or more than 3 ft. below the surface of any ground within 9 ft, of the room." This definition is very wide, as a room is brought within it both by reference to the street adjoining or nearest, or any ground within nine feet. 107 Such a room is unfit for habitation if either the average height from floor to ceiling is not at least seven feet, or the room does not comply with the Regulations made by the Borough Council on the 4th May, 1911, and consented to by the then Local Government Board. The Regulations secure the proper ventilation and lighting and the protection of the rooms against dampness, effluvia or exhalation. The definition contained in the Public Health (London) Act, 1936, Section 132 (4), is material to all proceedings taken by the Public Health Committee and is as follows:— "The expression underground room includes every room of a house being a room the surface of the floor of which is in any part thereof more than 3 ft. 'below the level of the surface of the footway of the street adjoining the room, or of the surface of the ground adjoining or nearest to the room." The use of such underground rooms is prohibited by the Public Health (London) Act, 1936, except on conditions which are very much the same as those prescribed by and under the Section 12 (2) of the Housing Act, 1936, but procedings can only be taken where the underground room or rooms are let or separately occupied as a dwelling. The number of rooms dealt with under its provisions has therefore been relatively small, and restricted to cases where the rooms can be made to comply with the Acts and occupation is confined to one floor. There is nothing revolutionary in the definitions above-mentioned, for as long ago, at least, as 1855, Section 103 of the Metropolis Management Act, 1855, gave a definition of an underground room as a room three feet below the footway of the adjoining street, and made provisions for prohibiting the occupation of such rooms as separate dwellings without the provision of areas, means of lighting, ventilation, drainage and minimum height. These conditions again were much the same as those applied under the regulations and enactments mentioned above. They were re-enacted and made more stringent in Section 96 of the Public Health (London) Act, 1891, which is now replaced by the Section 132 of the Public Health (London) Act, 1936, mentioned above. As regards the Housing Acts, the definition of an underground room was contained in the Housing, Town Planning, &c., Act, 1909, in somewhat the same form as at present, but the prohibition contained therein related only to the use as a sleeping place. It was in 1935 that the Housing Act of that year introduced the important change of prohibiting the use of such rooms for human habitation, and not merely for sleeping. 108 It is important to note that owing to the change in the law made in 1935 it is now illegal for an underground room to be used either for sleeping or living purposes unless it complies with the regulations approved by the Local Government Board, and the illegality cannot be overcome as previously by closing the room for sleeping purposes and arranging its use in the future for "living" purposes only. (ii) Action taken by the Borough Council and its Predecessors. We have had a search made of the Council's records and find that the number of rooms dealt with by the Vestry under the earlier enactments was relatively small; no action being possible where underground rooms were occupied in conjunction with other rooms upstairs. However, in the year 1890, 21 cellar dwellings were closed by the Vestry of the Parish of St. John, whilst in 1910, 115 underground rooms were found to be illegally occupied; of these, 53 were altered to comply with the Public Health Act, two were in process of alteration at the end of the year and 60 were vacated. Between the years 1909 and 1936, no less than 1,234 underground rooms were dealt with by their being closed, their illegal occupation discontinued, or their being made to conform to the regulations. In 1936, the Medical Officer of Health reported on the question of underground room occupation, estimating the number of underground rooms in the Borough at 4,000, some of which already complied with the regulations, while others did not. With the concurrence of the Public Health Committee, in September, 1936, an Inspector was added to the staff whose duty it was to investigate and report on the conditions of the underground rooms in the Borough. The result of the survey of underground rooms from 1st January, 1936, to 30th June, 1937, is set out in paragraph (iv) below, but it must be remembered that his work was considerably interrupted, in so far as he was engaged for a period of approximately six months on the supervision of the work of the temporary staff on the recent overcrowding survey. We have approved the compilation of a card register, setting. out, in various categories, the underground rooms illegally occupied, e.g., those that can be made to comply with the requirements, those that cannot be made to comply with the requirements and those that do not comply with the law in some minor respect and in which case it is not proposed to deal further at the moment. (iii) Policy of the Committee. The obligations with regard to the repair, demolition and closing of insanitary premises imposed by the Housing Act, 1936, are mandatory in form upon the local authority, and, by Section 175 of the Housing Act, 1936, a specific power is given to the London County Council, on 109 Complaint to the Minister of Health, to act in default of the Borough Council in any case where they fail to exercise their powers with regard to underground rooms "in a case where those powers ought to have been exercised." The legal obligation to deal with underground rooms therefore undoubtedly exists. We have been advised that the action which we are obliged to take under the Housing Act is not restricted to houses occupied by the working classes, but extends to all classes, and experience has shown that the higher rents paid in the better class properties render it possible for the owner more easily to incur the expenditure needed to make them comply with the law where occasion arises. Many of the existing underground rooms in terrace houses were originally intended for quite different uses, e.g., for kitchens, sculleries and coal cellars. In recent years the properties of which they form part have been divided, floor by floor, into separate dwellings, with the result that the underground rooms are now called upon for use as living rooms. We have taken the view that it is not only legal but fair and reasonable to insist that landlords who have sub-divided properties containing underground rooms should ensure that their incoming tenants should be protected against inefficient lighting and ventilation, and from dampness, by the provision of appropriate areas, insertion of damp-proof courses, &c., as set out in the regulations approved by the Local Government Board and referred to above. Obviously it is not practicable to deal with all underground rooms in the Borough at the same time. The policy of the Committee has been one of gradual progress, implemented at present as follows:— (1) To deal with the worst cases which have been brought to the notice of the department, either through complaints received from the tenants, or from the report of the sanitary inspector made in the course of his routine inspection. (2) To bring to the special notice of owners the underground room regulations when their properties have become vacant. (3) To enforce the underground room regulations in cases of conversion. (It may be noted here that it is now the practice of the London County Council only to give their consent to conversion, subject to these regulations being complied with.) As required by law, no action is taken by the Housing Committee without an opportunity to appear personally before the Committee being given to all persons interested, where they hear the complaints made against the property and are entitled to answer them and to submit their proposals for works, closure or vacation of the premises,—being given every reasonable opportunity for adjournment and the obtaining 110 of legal and professional advice and guidance. Where Closing Orders are made, printed notice is also given to them of their right of appeal to the County Court. The majority of the underground rooms in the Borough can be made to comply if the owner is prepared to undertake the expenditure. The owner is advised to do the work rather than that the rooms should be closed, but in some underground rooms it is impracticable for the areas to be widened, and, therefore, there is no alternative other than for the rooms to be closed and to provide the tenants with alternative accommodation. This alternative accommodation is provided by arrangement with the London County Council. We find that failure to comply with the statutory requirements as to underground rooms is almost inevitably bound in practice to result in unhealthy conditions. In cases where a failure has been a matter of minor detail, such as a matter merely of failure to comply to the extent of a few inches of height or width, we have found it possible to take no action, but it can safely be said that in every case where steps have been taken in making a Closing Order or requiring the execution of works or the vacation of the premises, some serious unhealthy condition has been present in the rooms in question. (iv) Result of Survey of Basement Rooms so far inspected (January 1st, 1936—June 30th 1937")— Total number of basement premises inspected 579 Allocation:— Percentage of premises inspected. (1) Premises where underground rooms were found to comply with Underground Room Regulations 115 19.9 (2) Premises where underground rooms were found not to comply, but which can be made to comply with Regulations 333 57.5 (3) Premises where underground rooms were found not to comply, and cannot be made to comply with Regulations (i.e., Closure only alternative—action deferred pending provision of satisfactory accommodation) 82 14.2 (4) Premises where underground rooms were found which do not comply with Regulations in minor details only (no action contemplated) 8 1.4 (5) Premises where underground rooms were found to be used for purposes other than human habitation, or unoccupied 41 7.0 Total 579 111 (v) Result of Action (January 1st, 1936, to June 30th, 1937)— Number of rooms made to conform. Number of rooms closed or illegal occupation discontinued. Total number of rooms. Number of premises concerned. Action under Public Health Acts (1891 and 1936) 107 20 127 66 Action under Housing Acts (1925-1936) 4 52 56 22 Action as the result of voluntary conversion of premises into flats and in connection with new buildings 64 2 66 34 175 74 249 122" (End of Report of Housing Committee.) 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 Suri'ey of Basement-rooms so far inspected. (January 1j/, 1937, to 31j< December, 1937.) (1) Premises found to comply with Underground Room Requirements 1936 1937 Total 63 126 189 (2) Premises found not to comply, but which can be made to comply 183 239 422 (3) Premises found not to comply, and cannot be made to comply (i.e., Closure only alternative action deferred pending provision of satisfactory accommodation) 65 33 98 (4) Premises found which do not comply in minor details only (no action contemplated) 8 3 11 (5) Premises found to be used for purposes other than for human habitation, or unoccupied 26 14 40 345 415 760 112 Result of Action during 1937. Number of rooms made to conform. Number of rooms closed or illegal occupation discontinued. Total number of rooms. Number of premises concerned. Action under Public Health Act, 1936 99 Nil. 99 49 Action under Housing Acts 48 40 88 40 Action as the result of voluntary conversion of premises into flats and in connection with new buildings 74 Nil. 74 29 221 40 261 118 The number of Underground Rooms found not to comply with the requirements in the houses in the allocation above (2), (3) and (4), totalled 620. They were found to exist in 275 premises. Of these rooms 195 were found in 136 Tenement Houses. Kilburn Vale Areas. An official representation under Section 1 of the Housing Act, 1930, was made by the London County Council with respect to three areas in Hampstead, known as the Kilburn Vale (Nos. 1 to 3) areas. It was proposed that the areas should be declared to be clearance areas under the Act, and that the properties should be acquired, together with certain additional lands required for re-development purposes. The properties in the represented portions are mostly of two-storey cottage type, many with large forecourts or gardens, situated on slightly sloping ground in narrow streets or cul-de-sac courts. Generally the properties are old, worn-out and congested, and show sanitary or other defects. The represented areas are 131 acres in extent and comprise 39 houses (one vacant), including 2 workshops, a garage and 2 stores. The additional lands are 117 acres in extent and comprise 18 houses, including 3 shops (one vacant), a beerhouse, a lock-up shop, a shop and workshop, a shop-fitting works, 3 builders' yards and a garage. The total area to be dealt with is therefore 2 48 acres and the displacement of 249 persons of the working classes is involved, of whom 177 are in occupation of houses in the clearance areas and 72 are in occupation of houses on the additional lands. It is proposed to utilise the greater portion of the lands for the erection of dwellings for re-housing purposes. 113 A Public Local Inquiry was held at the Hampstead Town Hall on the 8th and 9th February, 1937, by E. E. Hall, Esq., an Inspector of the Ministry of Health, at which the Medical Officer of Health gave evidence and the Ministry on 26th November confirmed the Orders made by the London County Council. The 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 re-housing purposes in connection with clearance operations under the Housing Acts which takes precedence over the abatement of overcrowding. 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 38 Number of houses occupied under special arrangements with the L.C.C. for relief of overcrowding:— Watling 89 Tottenham 4 Downham 1 Morden 20 Kenton 7 Hanwell 2 Total 223 The total number of families removed from Hampstead to County Council houses since 1927, through action by the Borough Council, is 280 involving 1,493 persons. The additional 57 families are accounted for by changes in tenancies at the subsidy houses (19 at Watling and 38 at Wormholt), the Borough Council having the right to nominate tenants for any of the 100 subsidised houses which become vacant. 114 The Borough Council has entered into an agreement with the County Council for the purpose of providing accommodation (when required by the Borough Council) on the County Council's Estates for persons 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 has agreed to pay in respect of each dwelling provided the sum of £1 17s. 6d. per annum for a period of 40 years. Accommodation has been provided in five cases under this agreement. This agreement is in addition to the 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, and in respect of each of which the Borough Council pays £7 per annum. Borough Council Municipal Dwellings. At Park Dwellings, Garnett 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 provides 32 one-bedroom flats; 136 two-bedroom flats; 112 three-bedroom houses; and 10 four-bedroom houses with a parlour—-a total of 290 dwellings. During the year under review vacancies occurred on the Estate. These vacancies were allotted after very careful consideration to the most deserving applicants. There is always a very long list of suitable applicants. 115 Representations. Statement showing steps taken in 1937 in connection with premises "represented in 1937 or previous years" by the Medical Officer of Health under the Housing Acts:— Premises. Representation. Closing Order. Remarks. Date of Committee. Date of Council. 14, Willow Road 9-11-36 28-1-37 3 underground rooms. 29, Bolton Road 9-11-36 28-1-37 2 underground rooms. 44, Hillfield Road 30-11-36 28-1-37 2 underground rooms. 17, Eton Villas 11-1-37 25-2-37 2 underground rooms. 52, Belsize Road 12-10-36 25-2-37 2 underground rooms. 8,King's College Mews West. (Clearance Area Order made by Council 26th April, 1934 in respect of 8, 9, 9a and 10) 5-3-34 - Premises formed part of the King's College Mews West Clearance Area. Council resolved 25th February, 1937, to enter and demolish the building and sell the materials thereof, in default of the Owner. 39, Bolton Road 1-3-37 - 2 underground rooms. Undertaking given not to let the rooms for human habitation without the approval of the Medical Officer of Health. 41, Bolton Road 1-3-37 27-5-37 2 underground rooms. 84, Palmerston Road 1-3-37 - 2 underground rooms. Undertaking given to carry out certain work to the satisfaction of the Medical Officer of Health. 5, Steeles Mews South 2-4-37 - 5 rooms over garage. Leaseholder agreed to carry out certain work to the satisfaction of the Medical Officer of Health. 37, Fleet Road 2-4-37 24-6-37 1 front and 1 back underground room. 79, Messina Avenue 2-4-37 - 1 front and 1 back underground room. Leaseholders agreed to carry out certain work to the satisfaction of the Medical Officer of Health. Caretaker's flat, Inglewood House, West End Lane 3-5-37 24-6-37 3 underground rooms. 1b, Inglewood House, West End Lane 3-5-37 - 3 underground rooms. Undertaking given to carry out certain work to the satisfaction of the Medical Officer of Health. 116 Remarks. Representation. Date of Committee. Closing Order. Date of Council. ses. 32. Willow Road 7-6-37 22-7-37 2 underground rooms. 291, West End Lane 7-6-37 13-9-37 5 rooms (2 underground). Proposals accepted respecting 3 rooms (upstairs) to carry out certain work to the satisfaction of the Medical Officer of Health. Closing Order made upon 2 underground rooms. 86a, Marlborough Mansions, Cannon Hill 7-6-37 4 underground rooms. Undertaking given to carry out certain work to the satisfaction of the Medical Officer of Health. 30, Greencroft Gardens 14-9-36 1-10-36 Caretaker's 2 rooms. Work carried out. Closing Order determined by Council 24th June, 1937. 26, Hemstal Road 5-7-37 2 underground rooms. Undertaking given to carry out certain work to the satisfaction of the Medical Officer of Health. 91, Palmerston Road 5-7-37 28-10-37 2 underground rooms. Closing Order made on front room. Owner to submit proposals re back room. 90, Palmerston Road 13-9-37 28-10-37 2 underground rooms. Closing Order made on front room. Owner to submit proposals re back room. 29, Netherwood Street 13-9-37 28-10-37 2 underground rooms used as Workshop. 33, Netherwood Street 13-9-37 28-10-37 2 underground rooms. 34, Netherwood Street 13-9-37 3 underground rooms. Undertaking given to carry out certain work to the satisfaction of the Medical Officer of Health. 38, Netherwood Street 13-9-37 3 underground rooms. Undertaking given to carry out certain work to the satisfaction of the Medical Officer of Health. 236, Belsize Road 11-10-37 28-10-37 2 underground rooms. Approval given by Council to the user of the back room for the purpose of a scullery subject to the room being used only in conjunc tion with a room or rooms on other floors of the premises. 78, Haverstock Hill 6-12-37 — 2 underground rooms. 79, Haverstock Hill 6-12-37 — 2 underground rooms. 117 Small Dwellings Acquisition Acts. No advances were made by the Council during the year. Hampstead Housing Association, Ltd. This Association now manages houses in the Borough, situated in Kelson Street, in Palmerston Road and in Netherwood Street. Section 6. Inspection and Supervision of Food. 121 Food. The food supply of Hampstead continues to be satisfactory; the traders readily co-operate with the Public Health Department by voluntarily surrendering any foodstuff, the consumption of which might be undesirable, and by furnishing such information as may be necessary as to the source of supply, etc. One of the chief causes of disease is an improper or insufficient food supply. With the exception of the limited action that can be taken in connection with the supply of extra nourishment for mothers and young children, it is not wifhin the sphere of the activities of the Public Health Department to see that the members of the community are nourished properly or sufficiently. The Department is, however, able in some measure to take action in the direction of ensuring that the food supply shall be wholesome, and free from adulteration or the addition of injurious ingredients. To this end, Officers of the Department enforce the provisions of the Food and Drugs Art and kindred Acts, Orders, and Regulations. Hampstead is fortunate in that the criminal practice of tampering with the food supply of the people is rarely practised in the Borough. All the Sanitary Inspectors are appointed as Officers to enforce the provisions of the various Acts, etc.; while certain of their number are specially detailed to purchase samples of food for analysis by the Public Analyst. Closely allied to this matter, although more related to the prevention of fraud than to injury to health, are the provisions of the law relating to the proper labelling of certain articles of food. At the close of the year 1936 and the beginning of the succeeding year it was noticed by the Inspectors that some traders in the Borough were not labelling certain imported articles of food as required by law. All shopkeepers have therefore been communicated with and their attention drawn to the matter. Bye-laws re clean food. The byelaws made by 'the County Council under Section 6 of the London County Council (General Powers) Act, 1932 (now Section 183 of the Public Health (London) Act, 1936, for promoting sanitary and cleanly conditions in the manufacture, preparation, storage, transport and exposure for sale of articles intended to be sold for food 122 came into operation on 1st January, 1937, and imposed new duties of inspection, etc., on the Borough Council, whose duty it is to enforce the byelaws in the Borough as Sanitary Authority under the Public Health (London) Act, 1936. Inspection and Supervision of Food. (A) Milk Supply. Examination of milk samples for bacterial content and for tubercle bacilli. During the year samples have been submitted for examination with the following result:- Nature of sample. Examined for (a) Bacterial content or (b) Tubercle bacilli. Result of examination. Raw Milk (b) Satisfactory. Pasteurised (a) Do. Do. (a) Do. Do. (a) Do. Raw Milk (b) Do. Pasteurised (a) Do. Tuberculin Tested (b) Do. Pasteurised (a) Do. Do. (a) Do. Raw Milk (b) Do. Pasteurised (a) Do. Do. (a) Do. Raw Milk (b) Do. Do. (b) Do. Do. (b) The inoculated guinea pig showed presence of tubercle bacilli. Pasteurised (a) Satisfactory. Do. (a) Do. Do. (a) Do. Do. (a) Do. Do. (a) Bacteria: 157,000per millilitre. Raw Milk (b) Satisfactory. Pasteurised (a) Do. Do. (a) Do. Raw Milk (b) Do. Do. (b) Do. Tuberculin Tested (a) Do. Raw Milk (b) Do. Pasteurised (a) Do. Raw Milk (b) The inoculated guinea pig showed presence of tubercle bacilli. Do. (a) Bacteria: 217,000per millilitre. Do. (a) Satisfactory. 123 Nature of samples. Examined for (a) Bacterial content or (b) Tubercle bacilli. Result of examination. Pasteurised (a) Satisfactory Raw Milk (b) Do. Pasteurised (a) Do. Raw Milk (b) Do. Pasteurised (a) Bacteria: 160,000per millilitre. Do. (a) Bacteria: 108,000 Do. Do. (a) Satisfactory. Do. (a) Bacteria: 480,000per millilitre. Do (a) Satisfactory. Raw Milk (a) Do. Pasteurised (a) Do. Tuberculin Tested (b) Do. Pasteurised (a) Do. Do. (a) Do. Tuberculin Tested (b) Do. Raw Milk (a) Bacteria: 110,000per millilitre. Pasteurised (a) Bacteria: 600,000 per millilitre (approx.). B. Coli present in 0.01 millilitre. 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 137 samples of milk taken under the Food and Drugs Act, and of these three were unsatisfactory. 19 informal milk samples were taken during the year. The average composition of the total milk samples examined was:— Total milk solids1222 per cent. Fat 357 per cent. Solids not fat 865 per cent. 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. 124 (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 107. During the year, 143 inspections were made and 11 notices were served. In addition 37 persons are registered as purveyors of milk whose premises are situated outside Hampstead. On 5th February, 1937, a person whose name in 1936 had been removed from the Register of Dairymen and whose dairy premises had also been removed from the Register, on account of the unsatisfactory manner in which the business was conducted, was, at the Marylebone Police Court, (fined £3 With £1 1s. 0d. costs for using the premises as a dairy without their having been registered. On 9th June he was also prosecuted for selling milk in Kilburn without being registered as a dairyman and was fined £10 and £2 2s. 0d. costs. (ii) Milk (Special Designations) Order, 1936. Number of licences in force during 1937, for the sale of milk under special designations:— Number of Purpose of Licence. Licences granted. Sale of Tuberculin tested Milk from shop or other premises 12 Sale of Accredited Milk from shop or other premises 3 Sale of Pasteurised Milk from shop or other premises 40 No licence for graded milk was refused or revoked during the year. In 13 cases supplementary licences were granted authorising the sale of graded milk within the Borough from premises outside Hampstead. This Order prescribes the special designations which may be used in relation to milk. These are (1) "Tuberculin Tested," which 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 125 be sold as "Tuberculin-tested Milk (Pasteurised).'' When tuberculintested milk is bottled on the farm the Order permits it to be described as "Tuberculin-tested Milk (Certified)"; (2) "Accredited Milk," which is used for the 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, and (3), "Pasteurised Milk," which is milk which has been held at a temperature of 145° to 150° F. for thirty minutes. All these designated milks are periodically tested for cleanliness and in order to ascertain if the required standards are maintained. Milk may, of course, be sold without a Special Designation, but those previously referred to are the only ones that are officially recognised. (B) Meat and other Foods. During the year 3 drinking waters, 15 ice-creams, 1 butter and 1 cream (in addition to the samples of milk mentioned in sub-section A) were examined bacteriologically. It is interesting to note that the bacteriological content of the icecreams varied from 800 per millilitre to 365,000 per millilitre and that B. Coli were found to be present in certain of the samples. It is hoped to report further on this matter in my next Report. (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) Unsound Food and Food Inspection. The following is a list of food seized or voluntarily surrendered during the year:— Curry Powder, 1½ lbs. Ham, 15½ lbs. Potatoes, 22 cwt. Rabbits, 15 cases. 126 (iii) 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 723 inspections were made. Premises. No. of Premises on Register. No. of Inspections. No. of Notices. Bakehouses:— Factories— Underground 14 46 18 Aboveground 16 16 2 Workshops— Underground 1 2 1 Aboveground 10 10 — Fried Fish Shops 13 14 1 Ice Cream Premises 111 44 9 Milk Premises 107 143 11 Restaurants and Eatinghouses 110 42 15 Other Food Premises, e.g,. Butchers, Greengrocers, Grocers, Provision Dealers, etc. 563 406 46 There is no Cowshed, Slaughterhouse or Poultry Slaughterhouse in the Borough. Legal proceedings were instituted against the occupier of an underground bakehouse for not observing due cleanliness in connection with the bakehouse, and in respect of the accumulation of refuse. Fines totalling forty shillings were imposed. Registration of Food Premises (other than Dairies q.v.p.). (a) Ice Cream.—There are 111 premises on the Register used for the manufacture, storage or sale of ice cream. (b) Preserved Food, Cooked Meat, etc.—Up to the end of the year, 47 premises had been registered. (c) Factories of Margarine, Margarine-cheese, or Milk-blended butter. None of these premises exists in the Borough. (d) Wholesale dealers in Margarine, Margarine-cheese, or Milkblended butter.—No premises are registered as wholesale dealers in Margarine. 127 (e) Butter Factories.—No butter factory is registered in the Borough. Premises referred to under (a) and (b) are registered in pursuance of the Public Health (London) Act, 1936, and those under (c), (d) and (e) are registered under the Food and Drugs (Adulteration) Act, 1928. In the case of the latter, registration of the premises is required to be notified by the Council to the Ministry of Agriculture and Fisheries. (iv) 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. (v) 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. (vi) Stalls and Vehicles (including Street Traders), Inspection of food sold from street stalls is carried out by the Sanitary Inspectors. 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. (vii) 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. These cases are more fully described in Section 7 of this Report. 128 (C) Adulteration, etc. (i) Food and Drugs (Adulteration) Act, 1928. 503 samples were taken for analysis during the year by the Sampling Officers under the Act. The number certified to be adulterated was 20, or 3.7 per cent. of the total number, as compared with 29, or 5.7 per cent. in 1936. Of the total samples taken for analysis, 363 were formal samples and 140 informal. 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 118 2 19 1 Cream 4 — 5 — Butter 15 1 5 1 Margarine 13 1 10 — Lard and lard substitutes 9 — 3 — Cheese 9 1 11 — Dripping, suet, etc. 10 — 4 1 Condensed milk — — 2 — Coffee 1 — 3 — Milk shakes 1 — 1 — Ice cream 1 — 2 — Jam, honey, marmalade, jellies, etc. 5 10 — Vinegar 15 3 6 — Pepper 10 — 5 — Mustard 2 — 1 — Sugar 12 2 — — Bread and butter 4 — — — Canned meats, fish and fish pastes 29 1 20 — Sausages and meats 18 — 4 — Canned or dried fruits and vegetables 29 10 — Cream puffs 1 — — — Sauces, spices, pickles, etc. 12 1 10 — Drugs 1 — 3 — Fruit drinks 4 — — — Beer, wines, spirits, etc. 25 5 — — Self raising flour 1 — 1 — Ground rice 3 — — — Creamola — — 1 — Oxtail soup — — 1 - Tomato soup powder 1 — — — 129 Article. Formal Samples. Informal Samples. Number taken. Number adulterated. Number taken. Number adulterated. Ground almonds 3 - - - Peanut paste — — 1 — Blancmange — — 1 — Pearl barley 3 — — — Fruit bars 1 — — — Sylvan savoury roll 1 — — — Chicken and ham roll — — 1 — Ros-rols 1 — — — Currants 1 — — — Totals 363 17 140 3 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. 2 Margarine Contained slight excess of water. No action. 5 Demerara Sugar Tin 1.5 grains per lb. No action. 14 Anchovies Lead 38 parts per million. Letter sent. 364 Malt Vinegar Deficient in acetic acid. No action. 193 Cooking Cheese Water 78.39%; Mineral matter 1.39%; Protein 18.07% ; Fat 0.75%. Prosecuted, £2 costs only. 370 Vinegar Artificial vinegar and not malt vinegar. Cautioned. 220 Vinegar Artificial vinegar and not malt vinegar. No action. 93 Milk 2 to 3% added water. No action. 100 Barbados Sugar Tin 1.7 grains per lb. No action. 107 Curry Powder Contained excess of lead. Cautioned. 276 Butter Contained excess of water. Cautioned. 130 Milk 12.6 % added water. Fined 10/-. £1 11s. 6d. costs. 149 Whisky 4.5% added water. Cautioned. 150 Whisky 4.6% added water. Cautioned. 153 Rum 6.5% added water. Fined £3. £1 11s. 6d. costs. 165 Whisky 5.4% added water. Fined £3. £1 11s. 6d. costs. 319 Whisky 6.9% added water. £5 costs only. 130 Informal Samples. No. of Sample. Article. Analyst's Report. Action taken. 335 Milk Deficient in fat to the extent of 8%. No action. 176 Shredded Beef Suet Moisture 3.2%; Starch 21.0%; Fat 75.8%. No action. 267 Butter Contained excess of water. Cautioned. (ii) Artificial Cream Act, 1929. The following is the only registered premises in the Borough:— 66-68, Kilbum High Road. (iii) Public Health (Condensed Milk) Regulations, 1923 and 1927. Two 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. 59 samples of articles of food specified in these Regulations were submitted for analysis. Infringements were discovered in the following cases:— Description of Foodstuff. Result of Analysis. Action taken. Demerara Sugar Tin 1.5 grains per lb. No action. Barbados Sugar Tin 1.7 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. 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. (E) Nutrition. The routine medical inspection of entrant children in Hampstead to Elementary Schools during the year 1937 demonstrates that 101 or 17.1 per cent. were classed as "excellent," 473 or 80.0 per cent. were "normal" and 17 or 29 per cent. were "slightly sub-normal." The corresponding figures for the County of London were 15.3 per cent., 78.5 per cent. and 6.3 per cent. REPORT for the year 1937 of the Public Analyst. H. E. COX, D.Sc., Ph.D. (L,ond.), F.I.C. 133 The Laboratory, 11, Billiter Square, London, E.C.3. 12th February, 1938. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, In accordance with custom I have the honour to submit a short summary of the work which I have carried out during the year 1937 as your Public Analyst under the Food and Drugs (Adulteration) Act. The total number of samples taken under the Act which have been examined was 503 and the nature of these is shown in the following list:— Milk 137 Cream 9 Butter 20 Margarine 23 Lard and Lard Substitutes 12 Cheese 20 Dripping, Suet, etc. 14 Condensed Milk 2 Coffee 4 Milk Shakes 2 Ice Cream 3 Jam, Honey, Marmalade and Jellies 15 Sausages, Minced Beef, Meats, etc. 24 Canned Meats, Fish and Fish Pastes 49 Canned or dried Fruits or Vegetables 39 Cereals 11 Vinegar 21 Pepper 15 Mustard 3 Sugar 12 Bread and Butter 4 Sauces, Spices and Pickles (including Mincemeat and Candied Peel) 22 134 Wines, Beer, Spirits, etc. 25 Fruit Drinks 4 Cream Puffs 1 Drugs 4 Miscellaneous 8 Of these 503 samples, 20 were reported as adulterated and besides these there were a number of cases in which somewhat unsatisfactory results were obtained, but for various reasons the particular samples were passed as genuine though on the border line. Of the Milks three were adulterated; one contained 12 per cent. added water, one was 8 per cent. deficient in fat and a third showed a deficiency corresponding to 2 or 3 per cent. of added water, and my suspicion that it was really watered was strengthened by the fact that samples taken in the course of delivery proved to be of quite good quality. Water still holds pride of place as the adulterant and cropped up during the year in excessive quantity in butters, margarines, cheese, whisky and rum, besides the already mentioned milk cases. For many years controversy has raged round vinegar and its definition. The Local Government Board made a tentative definition in 1911, but left undecided the vexed question as to whether artificial vinegar could be sold as vinegar. Since then several attempts have been made to produce an agreed definition, but without success. In 1934 the Society of Public Analysts published definitions arrived at in consultation with the Vinegar Brewers' Federation, but all such proposals lacked legal force. This year, however, the issue has been clarified by the decision of the Chief Magistrate at Bow Street, upheld by the Court of Quarter Sessions, and it was decided that the word "Vinegar" connotes the brewed article; so in effect diluted coloured acetic acid cannot be sold as "Vinegar" or "Table Vinegar." The Court held that the word "Vinegar" implied a process of brewing; but there is still no finality as it is now customary to label the artificial product "Non-brewed Vinegar" which involves a curious contradiction in terms the legality of which has not been tested. In accordance with this decision I have reported artificial vinegars as adulterated unless there has been a clear declaration of the fact; but what should be done with "Non-brewed Vinegar"? 135 The subject of metallic contamination continues to present difficulties. This year lead in excess appeared in Anchovies, Curry Powder and Fish Roe; tin continues to appear in varying quantities in certain types of sugar and copper to an undesirable extent in Candied Peel. It is observed that the Minister of Health in his Annual Report published in 1937 suggests a maximum of 5 parts per million for lead in Sardines and so presumably for lead in other like commodities. It is satisfactory that in the new Food and Drugs Bill, a draft of which has been published, it appears that the Minister of Health may acquire power to prescribe limits for impurities as well as rules for the composition of articles of food. There is in my opinion an increasing need for the closer regulation of manufactured products. Owing to the absence of such Regulation the administration of the Food and Drugs Act varies from area to area according to the opinion of the officers in that area, and there is evidence that the composition of some commodities tends to progressive deterioration as the result of competition, so it is that many commodities as now sold, particularly in the less expensive shops, are not as they used to be; yet it is difficult to draw the line aright between legitimate trade processes and sophistication. Some of the jams of today are very poor as compared with the better old-fashioned jams. They may be fortified with acid, pectin and artificial dye, the need for which is in part due to the use of sulphited pulp and the necessity for producing a jam which will set well and stand carriage. On the one hand it is desirable that wholesome jam should be available to all at a low price; on the other a deficiency of fruit ought not to be permitted to be made up by artificial pectin. This problem was considered by the Society of Public Analysts and the Food Manufacturers' Federation a few years ago and standards were promulgated which met with general but not universal acceptance. It is to be hoped that these and other standards will be adopted by the Ministry of Health in due course, with perhaps some modification. Another instance that occurs is Shredded Suet. The sale of Shredded Suet has undoubted advantages to the housewife. Manufacturing difficulties were overcome by the use of a small amount of rice flour, then stress of competition caused the amount of rice flour to be increased to an excessive degree in certain instances. This was also considered 136 by an Analysts' Committee and a tentative minimum of 83 per cent. of fat was adopted. One sample examined this year showed over 20 per cent. of rice flour, so it was regarded as adulterated. There are other instances which might be recited to show the change which takes place in manufactured foods and the need for constant investigation. So far as the Borough of Hampstead is concerned the results on the whole are good. The rate of adulteration is 3.7 per cent., which is not unduly high, especially having regard to the natural tendency to sample more often commodities and places where adulteration is judged to be the more likely. The general standard of food sold in the Borough is quite high. 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. 139 Prevalence of, and Control over, Infectious and other Diseases Notifiable Diseases during the Year 1937. 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 87 1 6 3 10 4 29 4 5 19 3 3 •• 9 13 9 7 11 34 4 84 4 •• 1 •• 1 •• 2 •• •• •• •• •• •• Dysentery 11 1 1 1 •• •• 2 •• •• 3 1 1 •• 2 1 2 2 •• 3 1 7 •• •• •• •• •• •• •• •• •• •• •• •• •• Erysipelas 25 •• •• •• •• 1 •• •• •• 4 1 13 6 2 3 •• 2 5 11 2 10 •• •• •• •• •• •• •• •• •• •• •• •• •• Malaria 1 •• •• •• •• •• •• •• •• 1 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Ophthalmia natorum 22 22 •• •• •• •• •• •• •• •• •• •• •• 4 3 3 1 •• 4 7 18 •• •• •• •• •• •• •• •• •• •• •• •• •• Pneumonia 91 5 3 2 i 3 2 '2 3 18 10 21 21 13 18 7 13 9 24 7 31 22 •• •• •• •• •• •• •• •• 1 2 8 11 Polio Myelitis 2 •• •• •• •• •• •• •• 2 •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• •• Puerperal Fever 3 •• •• •• •• •• •• •• •• 2 l •• •• •• 1 •• •• •• 1 1 3 1 •• •• •• •• •• •• •• •• 1 •• •• •• Puerperal Pyrexia 19 •• •• •• •• •• •• •• •• 17 2 •• •• •• 4 1 2 3 6 3 17 •• •• •• •• •• •• •• •• •• •• •• •• •• Scarlet Fever 177 2 7 10 9 63 31 11 37 6 I •• 15 28 31 19 14 42 28 148 1 •• •• •• •• •• 1 •• •• •• •• •• •• Typhoid Fever 1 •• •• •• •• •• 1 •• •• •• •• •• •• •• •• •• •• 1 •• •• 1 •• •• •• •• •• •• •• •• •• •• •• •• •• † Measles 90 4 7 4 8 16 34 5 6 5 1 •• •• 28 26 7 4 5 18 2 12 •• •• •• •• •• •• •• •• •• •• •• •• •• Cerebro Spinal Meningitis 4 •• •• •• 1 •• •• •• •• •• •• •• •• •• •• 2 •• •• •• 2 3 2 •• •• •• •• •• •• •• •• 2 •• •• •• Encephalitis Lethargia 1 •• •• •• •• •• •• •• •• •• •• 1 •• •• •• •• •• 1 •• •• 1 1 •• •• •• •• •• •• •• •• •• •• 1 • • Totals 534 33 19 17 30 33 131 42 27 109 25 40 28 73 98 62 50 51 143 57 335 31 - 1 - 1 - 3 - - 4 2 9 11 * Cancelled cases have not been included. † Notifiable under the Borough of Hampstead (Measles) Regulations, 1920. Statistics relating to Tuberculosis are given in subsequent pages. 140 Acute Anterior Polio Myelitis. Two brothers aged 15½ and 16½ years, respectively, were notified during July. Two days elapsed between the onset of illness. The boys were treated at home. It is interesting to record two cases in one family. The illness was of a very mild nature in one of the cases and it is possible that it would have remained undetected but for the presence of a much more serious attack in the brother. In the mild case there was complete recovery in a few days without wasting or paralysis. The other boy also made a satisfactory recovery, but the arm was still slightly affected six months later: he is receiving appropriate treatment for this. Cerebro-Spinal Fever. There were four cases of Cerebro-spinal Fever during the year. One female aged 27 years was notified in January and three males aged 32, 33 and 2½ years were notified in May, June and December respectively. Two of the patients died, and one made a complete recovery. The fourth patient is still under treatment. The diagnosis was confirmed bacteriologically in every case. In one patient the meningococcus was of group I, in the other, group II; the organism was not typed in one case, while no information as to type is available about the patient who died. All the patients were treated with specific serum, and in addition, one patient was given prontosil. Diphtheria. During the year there were 87 cases of diphtheria and four deaths as compared with 51 cases and one death in the previous year. The.morbidity rate was 095 per 1,000 of the population. All cases, with three exceptions, were removed to hospital. Immunisation. Immunisation is available in the Borough by private arrangement of inhabitants with their own family doctor, in which case the cost is not borne by the Borough Council, but the material is supplied free to the Medical Practitioner. It is also available entirely free of cost to the parents under the Borough Council's Scheme:— 141 (a) by the family doctor for children under 14 years of age. In these cases the residents are advised that they should approach their own doctor and inform him that they wish to avail themselves of the Borough Council's Scheme. The practitioner agrees to give the child three injections and to enter the necessary particulars on a record sheet, which sheet acts as the account for his fee, which is paid quarterly. The responsibility for the administration of the injection is placed on the practitioner; he is also responsible for any subsequent medical attention necessary, etc. (b) at the Borough Council's Clinics especially devoted to this purpose, upon application to the Public Health Department, Town Hall, Haverstock Hill, N.W.3. This service, for children under 14 years of age, is provided free. Arrangements for the final Schick test are made by the Borough Council, and special clinics are held for this purpose. During the year 328 children were immunised against Diphtheria; 134 by private doctors, and 194 by the Council's Assistant Medical Officers. 282 Schick tests were performed. There was no preliminary Schick testing in children below 8 years of age. Diphtheria Toxoid Anti-Toxin (Goat) is used for immunisation; three injections of 1 c.c. at weekly intervals are given. As in previous years there were no instances of the injections being followed by any severe reactions. A transient local erythema occurred in a very small number of cases, but there was no constitutional disturbance. Further lectures on immunisation were delivered in some of the schools, but, as is generally the case, were attended in greater number by the already converted than by the unconverted. Once again, the advantages of giving the child the injections in the schools was demonstrated. This appears to be the ideal method of procedure, and it is to be regretted that it is not yet possible to adopt it in the case of the provided L,.C.C. Schools. 142 It was again found that a number of children did not attend the Clinics for the final Schick test; particularly was this the case where a private doctor had given the injections. The fact that 11 children out of 282 still gave a 'positive Schick reaction, and required a fourth injection, demonstrates the importance of Schick Testing. The apathy shown by the public towards the question of active protection against diphtheria is to be deplored. It has been estimated that only 117 per cent. of the population under 15 years has been immunised. A further point of importance is the fact that an attack of Diphtheria does not necessarily confer immunity, and a recent worker has shown that 10 per cent. of those who have had the disease remain susceptible. These people respond well to artificial immunisation. A circular letter, explaining the working of the immunisation scheme, and mentioning the extreme desirabilty of parents taking advantage of it, is sent to each parent in the Borough soon after the child has attained the age of one year. In addition, where routine visits are made by the Health Visitors, the importance of diphtheria immunisation is stressed, and a pamphlet is left at the house. In spite of these measures, but a small percentage of the child population of the Borough has been protected from the ravages of this dangerous disease. In certain cities abroad, such as New York and Montreal, the incidence of diphtheria has assumed almost negligible proportions since the introduction of protective inoculation on a large scale. In order that we may achieve our object, the public must cooperate to the fullest extent, and in this the support of the family doctor is essential. Preventive medicine has been given a new and invaluable weapon in the fight against disease. Let us make the fullest possible use of it. One child who had been given anti-diphtheria inoculations was notified as suffering from diphtheria eight months later, and admitted to hospital. The child had not been brought to the Schick-testing Clinic, although the parents had been asked to do so. The Medical Superintendent of the Hospital reported that all throat cultures had been negative and the condition suggested streptococcal tonsillitis. 143 Immunisation (Schick Testing). In eleven cases a positive Schick test was obtained in children who had received the usual three injections. Two of these were referred to the Medical Practitioner concerned, and the remainder were given a fourth injection. Three further children who had been immunised in another Borough were referred to the Schick Clinic and found to be positive. They were also given a further injection. Six nurses in a Day Nursery were Schick tested, and four were found to be susceptible to diphtheria. They were immunised by the Medical Officer. The value of anti-diphtheria injections is well demonstrated by the following case. A child of 5 years was given three injections at weekly intervals, the final dose being administered on the 24th of November. He was notified as suffering from faucial diphtheria on the 12th of December, having been ill for about 5 days previously, and was admitted to hospital. The Medical Superintendent reports that the case was of a very mild nature; the disease was distinctly modified by the injections, and the child would have recovered, possibly without complications, without having received anti-toxin serum. Immunity is not established for at least six weeks after the last injection, and in this case exposure to diphtheria infection took place within a week of the final inoculation; nevertheless, what would probably have been a severe illness was transformed into a very mild attack, in which the symptoms were slight and short-lived. Diphtheria Anti-Toxin (London) Order, 1910. In accordance with this Order the Borough Council supply antitoxin free to medical practitioners for use for the poorer inhabitants of the Borough. Dysentery. Ten cases of Dysentery were notified, as compared with three during 1936; there were no deaths. Two of the patients suffered from the amoebic form of the disease, contracted in Hong Kong in one instance, and in Egypt or Syria in the other. 144 Of the remaining patients six suffered from the Sonne type, confirmed bacteriologically. The diagnosis was made without any bacteriological examination in one case. Four of the ten patients were children. The youngest of these— aged 74 months—was discharged from hospital as "Enteritis." and the Diagnosis of Dysentery was not confirmed. On the other hand, two of the children aged 3 years and 6 years, respectively, were admitted to hospital as "Enteritis," and subsequently found to be suffering from Dysentery of the Sonne Type. There was a large increase in the number of cases of Dysentery and Enteritis notified in London and Greater London, towards the end of 1936, but the cases .were apparently of a mild type in most instances, the usual symptoms being vomiting and diarrhæa of two or three days' duration, with abdominal pain in some cases and generally a slight pyrexia. The bacteriological services of the Borough Council are available for differential diagnosis and the appropriate outfit for the collection of faeces is sent to any Medical Practitioner on request. A circular letter was sent to the Medical Practitioners of the Borough, pointing out that there was an increase in the number of cases of Dysentery and Enteritis, and drawing attention to the facilities available for bacteriological investigation. This met with a ready response, and there were numerous requests for diagnostic outfits. Encephalitis Lethargica. One case was notified during the year, the affected person being a cook aged 52. She was admitted to an Infectious Diseases Hospital, and the Medical Superintendent reported that the mode of onset indicated that the patient was suffering from a cerebrovascular disease rather than an acute infection, and a revised diagnosis of cerebral thrombosis was made. Enteric Fever. One case occurred during the year. The patient, a boy of 5 years, was notified on, the 29th of December; he died in Hospital on the 5th of January, 1938. 145 This case presented many unusual features. The practitioner in charge of the case communicated with the Public Health Department on the 20th of December, and the patient was seen with him in consultation. The signs and symptoms were not typical of typhoid, but admission to hospital for diagnosis and treatment was urged. The parents did not consent to his entering hospital. A specimen of the feces was obtained and was examined for organisms of the typhoid group with negative results. The child did not make any progress, and on the 24th of December was admitted to Hospital. A Widal reaction was positive (B.Typhosus in 240) on the 28th, but a specimen of blood taken on the 29th did not agglutinate suspensions of B.Typhosus or Paratyphosus. A Post-mortem examination made on the 6th of January showed that the cause of death was septicaemia due to typhoid fever, and the bacillus was recovered from the blood. In spite of exhaustive enquiry, no source of infection in this case was discovered. The child had not left the Borough for at least two months before the onset of his illness. He was taken to school and brought home by his mother every day and had not, as far as could be discovered, been in contact with anyone who might conceivably have infected him. There was no obvious connection between this case and the epidemic existing at that time in the County Borough of Croydon. The patient was an only child, and neither of the parents gave a history of any recent illness or of any former illness suggestive of typhoid. There had been few visitors, and none of these could be implicated. The feces of the parents were examined with negative results. No record of the consumption of any unusual food could be obtained, and indeed, it appeared that great care had always been exercised in regard to the child's dietary. The water supply was investigated chemically and bacteriologically, and found to be pure, while milk samples showed no bacteriological abnormality. Both the parents were given injections of anti-typhoid vaccine immediately the diagnosis was established. There were no further cases. Isolated cases such as this, which appear out of the blue, occur periodically. However exhaustive the investigation, the source of infection is not unearthed, neither are any contact cases brought to 146 light despite the rigid supervision of contacts. In this particular instance, it must be remembered, however, that the parents were given anti-typhoid vaccine, although medical opinion differs as to its preventive value so late after the primary contact. Measles. Measles epidemics in London generally occur in alternate years, and during 1937, 90 cases were notified as compared with 918 during the previous year. Twelve children were treated in Hospital and there were no deaths. Malaria. One case of Malaria was notified during the year. This occurred in a male patient aged 30 who contracted the disease on the Gold Coast. Pneumonia. During the year 91 cases of Pneumonia were notified. Of these 50 were of acute primary Pneumonia, and 41 cases of acute InfluenzalPneumonia. The total deaths were 22, of which 19 occurred in persons over 45 years of age (13 in persons of 60 years or more). As is usually the case, the age of the patient appears to be the ohief factor of mortality. Seventeen of the deaths occurred during the first quarter of the year. Influenza. Lnfluenaa became prevalent at 'the beginning of the year. Influenza is not a notifiable disease, and it is difficult, therefore, to arrive at any satisfactory estimate of the true nature and incidence of an epidemic. The only definite information available is that obtained from Influenzal-Pneutnonia notification's which numbered 41, as compared with 22 in 1936. On the other hand, the death returns ior the year show Influenza as the cause of death in 55 cases, as compared with 18 cases in the previous year. Scarlet Fever. During the year 177 cases of scarlet fever were notified (cf. 114 in 1936, 112 in 1935, 194 in 1934, and 451 in 1933). This disease continues to be of a mild type and only one case terminated fatally. 147 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. Enteritis. Gastro-enteritis is not a notifiable disease, and the exact number of cases occurring cannot be computed. Fourteen children were, however, admitted to Hospital with this complaint, eight of whom were aged less than one year. In most instances the disease was of a mild nature. It has been mentioned under "Dysentery" that in the case of two children admitted to Hospital with "enteritis," a revised diagnosis of "dysentery" was made. It is possible that a number of cases of mild enteritis treated at home are, in reality, caused by one or other of the bacilli of dysentery. Examination of the stools is thus of great importance particularly when the disease begins to assume epidemic proportions. Outfits for bacteriological examination of the faeces are available to Medical Practitioners on application to the Medical Officer of Health. A small scale epidemic of "gastro-enteritis" occurred in a Foster-Home. The affected children were all admitted to hospital very soon after the commencement of illness, but the disease was of an extremely virulent character, and two of them succumbed. In no case were pathogenic organisms discovered in the faeces. A postmortem examination in one of the fatal cases revealed that the cause of death was a supperative meningitis, and the pneumococcus was isolated from the brain; there was no abnormality in the gastrointestinal tract. Haemolytic streptococci were found in the throat of one of the other patients, whilst in another case a throat swab yielded an almost pure growth of B.Coli. On investigation it was discovered that the 'nurses in charge of the ward at the Foster-Home had recently suffered from sore throats, which were shown to be streptococcal. Haemolytic streptococci were found to be present in the case of only one of these nurses, and these 148 were of a different group from those isolated from the throat of the baby. All the children showed marked inflammation of the throat at the commencement of illness. In spite of conflicting bacteriological findings, it is believed that the epidemic was streptococcal in origin. The affected nurses were suspended from duty and given appropriate treatment; the patients themselves were sent to hospital, and disinfection was carried out, whilst the children remaining in the ward were isolated. In addition, strict attention to cleanliness in the preparation of feeds and general care of the unaffected children was enjoined. As a result of these measures no further cases occurred. Examples of similar minor outbreaks amongst babies in Institutions are not uncommon, and investigation usually establishes the fact that infection is carried from child to child by a nurse, but the exact nature of the infectious condition in these outbreaks remains obscure. Food Poisoning. There were five cases of illness attributed to food. The illness was attributed to the consumption of frying steak, fried fish, pork pie (two cases) and kippers. All the cases were investigated. Six cases of food poisoning occurred in a neighbouring Rorough following the consumption of a pie made at a private residence in Hampstead. The affected persons were factory employees, and the proprietor and his wife, at whose house the pie was made, were also taken ill. Examination of the faeces of all the affected persons was carried out at the Ministry of Health Laboratories, and a portion of the pie was also examined. It was reported that none of the usual pathogenic bacteria were identified, but that all the specimens except one contained a non-lactose-fermenting bacillus resembling Morgan's bacillus. It was not possible to state whether this was the cause. The illness was not of a severe nature, and all the patients made an uninterrupted recovery. Although cases of food poisoning occur with great regularity and certain food-stuffs are implicated, investigation is usually difficult, and bacteriological confirmation is not easy to obtain. Illness said to be 149 "dysentery," "gastroenteritis," and "food poisoning," ranging from the very mild to the intensely severe ease, should always be carefully investigated, and examination of the faeces carried out. Tuberculosis. Notification. During the year 1937, 98 new cases of Tuberculosis were notified, 86 being cases of Pulmonary Tuberculosis, and 12 of 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 1937:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0. 1. — 5. 2 2 — 15. 9 11 3 2 5 2 1 25. 15 11 1 2 5 35. 11 7 2 6 3 45. 6 5 1 1 1 55. 7 3 1 1 65 and upwards 2 2 — 2 2 Totals 50 36 5 7 17 13 2 4 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 number of newly notified cases each year during tihe five-year period, 1933-1937:— Total Cases. 15—34. 15—34. Year. Males. Females. Males. Females. 1937 50 36 24 22 1936 36 35 16 25 1935 27 36 9 29 1934 38 35 17 24 1933 50 44 21 28 Totals 201 186 87 128 150 These figures show that during the last quinquennium 69 per cent. of the cases of pulmonary tuberculosis in females occurred between the ages of 15 and 34, as compared with 43 per cent. in males. The excessive incidence of the disease in this period of life is very alarming and constitutes a very serious problem. There was an increase in the number of notified males from 36 in 1936 to 50 in 1937. The increase is fairly evenly distributed amongst the various age groups. Occupations. The following is an analysis of the occupations of the new cases notified as tuberculous during 1937:— Occupation. Pulmonary cases. Non-Pulmonary cases. Actor 2 Bank Clerk 2 Barman 1 1 Chauffeur 1 Chef 1 Children's Nurse 2 Civil Servant 1 Clerk 4 2 Commercial Traveller 2 Domestic 6 Dressmaker 3 Electrical Engineer 1 Engineer 1 Gardener 1 Greengrocer 1 Grocer 1 Housewife 16 1 Labourer 2 Manageress 1 Mannequin 1 Merchant 1 Milk Roundsman 1 Nil 6 1 Optician's Assistant 1 Painter and Decorator 2 Parquet-floor Layer 1 Policeman Printer 1 Property Man 1 Public Lavatory Attendant 2 Publican 1 Publisher 1 Scholar 3 School Teacher 1 Sculptor 1 Seaman 1 Secretary 3 Shop Assistant 1 1 Silversmith 1 151 Occupation. Pulmonary cases. Non-Pulmonary cases. Storekeeper 1 Student 4 1 Tailor 1 Textile Agent 1 Travel Agent 1 Van Driver 1 Waitress 1 Totals 86 12 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 98 in 1937, equivalent to 73 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 1937 86 12 98 30 152 Deaths. The number of deaths from all forms of tuberculosis during 1937 was 36, of which 30 were pulmonary and 6 non-pulmonary. Deaths of Non-notified Cases. There were seven 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. Removals to Sanatoria and Hospitals. Sanatorium treatment for insured and non-insured persons is undertaken by the London County Council. Of the 86 cases of Pulmonary Tuberculosis newly notified in 1937:— 39 were treated at Sanatoria. 4 „ „ Hospitals. 20 ,, „ L.C.C. Hospitals. Of the 12 Cases of Non-Pulmonary Tuberculosis newly notified in 1937:— 4 were treated at Sanatoria. 1 „ „ Hospitals. 3 ,, „ L.C.C. Hospitals. The following cases, notified prior to 1937, were also removed:— Pulmonary. Non-Pulmonary. Insured. NonInsured. Insured. NonInsured. To Sanatoria 10 3 - l To Hospitals 1 1 - - To L.C.C. Hospitals 6 4 - - 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. 153 At the present time nine discharged soldiers in receipt of a pension for tuberculosis are resident in Hampstead. The number of cases of tuberculosis k'nown to the department at the end of 1937 totalled 331 —270 pulmonary and 61 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 1937 121 147 41 32 162 179 Number of cases notified under the Regulations for the first time during the year 50 36 5 7 55 43 Number of cases removed from the Register in a preceding year which have been restored tn the Register during the year 5 7 1 — 6 7 Number of cases brought under notice otherwise than by notification during the year 17 23 1 8 18 31 193 213 48 47 241 260 *Number of cases removed from the Register during the year 67 69 13 21 80 90 Number of cases remaining on the Register at the end of the year 126 144 35 26 161 170 *These consist of cases which have been denotified, and those which have died or removed from the Borough. 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. 154 (2) The Clinical Tuberculosis Officer, who is also the Assistant Medical Officer of Health. (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 Clinical Tuberculosis Officer and the Nurse also make periodical visits to patients on the Dispensary register who are unable to attend. In addition, the Clinical Tuberculosis Officer visits bedridden patients and also makes himself personally acquainted with the home conditions of the majority of patients. 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 Examinations. Patients requiring X-ray examinations now attend at either New End or Paddington London County Council hospitals, and this arrangement is working very satisfactorily. It is found, however, that certain patients who are at work, find it difficult to attend for this purpose during the day. It would be of a great advantage if an occasional evening session could be inaugurated for this purpose, and it is proposed to consider the possibility of making the necessary arrangements for this. During the year 121 X-ray films were taken and 250 patients were screened. Pathological Examination of Sputum. This work is undertaken for the Council by the Laboratories of Pathology and Public Health, 6, Harley Street, W.I, and the facility is available, free of charge, ,for medical practitioners. During the year 141 specimens were 'submitted for examination by local practitioners and, in addition, 186 specimens were sent by the Clinical Tuberculosis Officer Artificial Pneumothorax. Dr. H. Davis Chalke, the Clinical Tuberculosis Officer, carries out this treatment, and patients attend at New End Hospital for this purpose. Sessions are held on Tuesday and Thursday afternoons. 155 This is a much more satisfactory arrangement than the former one, in which refills were given at a number of different hospitals in London, 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 22 patients who were undergoing this form of treatment made 273 attendances. Mantoux Tests. All children are given a routine intra-dermal tuberculin test. A dilution of 1/1000 being used. The following figures show the results of sixty tests:— No. of Mantoux tests 60 No. positive 25 No. giving a very slight reaction 10 No. negative 25 No. positive. Below 1 year 1 — 1 to 2 2 — 2 to 5 8 3 5 to 7 27 11 7 to 10 12 6 10 to 12 6 2 12 to 14 2 1 14 to 16 2 2 Of the contacts of T.B.+ cases, seven gave a positive result and one a negative. Contacts. Some difficulty is still being experienced in persuading a sufficient number of contacts to attend for examination, but it is gratifying to note that the numbers are gradually increasing. No effort should be spared to keep in close touch with contacts and to examine them periodically. Where contacts fail to attend the Dispensary, they are, when possible, visited at home. The importance of close co-operation with the School Medical Officers and the Medical Officers of the Infant Welfare Centres in 156 respect of the supervision of child contacts cannot be too strongly stressed. Every opportunity is taken to bring to their notice children of tuberculous parents. These children who require very careful watching may be given milk and cod liver oil at school. Dental Treatment. Dental treatment for tuberculous patients is given by arrangement with the British Dental Hospital. Patients in need of dental aid may obtain treatment at this Hospital, 31, Camden Road, N.W.I, on Wednesdays at 11 a.m. During the year, seven patients attended and the total attendances were 32. Light Treatment. One patient is receiving Finsen Light treatment at a General Hospital. Many patients, particularly children, have attended at the Institute of Ray Therapy, Camden Road, for Ultra-Violet Therapy. Ultra-Violet Ray Lamp. At its meeting on the 23rd December, the Council agreed to equip the Tuberculosis Dispensary with an ultra-violet ray lamp, the Clinical Tuberculosis Officer being prepared to give the necessary treatment during his clinical sessions at the Dispensary. Hitherto, patients had either not received this treatment at all, or had obtained it at the Sunlight Clinic in Camden Town, where most of the patients could only attend at irregular intervals. 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. During the year one family took advantage of this facility. Home Helps. A scheme for the provision of home helps for tuberculous patients, the helpers themselves to be patients, is being submitted to the Council for approval. 157 Public Health (Prevention of Tuberculosis) Regulations, 1925. No person suffering from Tuberculosis of the respiratory tract, and being in an infectious state, may work in connection with a dairy which would involve milking, treatment of milk, or handling milk vessels. No case arose during the year necessitating action to be taken under these Regulations. Handicrafts Class. In consequence of the establishment of a Handicrafts Class for tuberculous patients, which was organised by the Hampstead Tuberculosis Care Committee and the St. Pancras Care Committee, the Council in May considered a letter from the Secretary of the Hampstead Borough Tuberculosis Care Committee with regard to the cost of organising the class, and resolved that during the current financial year, the grant of £100 to the Borough Tuberculosis Care Committee in respect of their administrative services should be increased by the sum of £10 to £110. Additional financial assistance in establishing the class was obtained from the National Association for the Prevention of Tuberculosis. The class is under the care of a qualified Handicrafts Instructress supplied by the London County Council. It has proved to be a great success, and has been consistently well attended. A class of this sort is a very necessary adjunct to a tuberculosis after-care scheme. It provides the patients with a hobby to relieve the drab existence of chronic ill-health, and brings a new interest into their lives. Most of the patients showed a distinct aptitude for this sort of work and articles made by them were displayed and sold at the Exhibition of Handicrafts, arranged by the Tuberculosis After-care Committees of (London. Under the present arrangements, whereby most of the London Boroughs have classes of (their own, working more or less independently, the scheme has a very restricted scope. This applies particularly to male patients, who could, with advantage, attend larger centres for woodwork, etc. Many of the males who are fit only for 158 "light work"—which they can seldom obtain—would have an opportunity of attending for three or four days weekly. They should then be enabled to produce saleable articles which would provide them with a small weekly income. There are, therefore, indications for the establishment of a central organisation for handicrafts work for tuberculous patients in London. It should be concerned with London as a whole rather than with individual Boroughs. A number of centres for instruction could be established, to include, particularly, workshops for woodwork. In one London Borough, where a skilled voluntary worker gives his services as a woodwork instructor, the patients, in the space of a few months, are producing articles which are readily saleable in the open market at a satisfactory profit. It is difficult in any one Borough to find a sufficient number o,f patients who have a natural aptitude for work of this nature. The solution lies in the setting-up of a number of centres for both sexes in different parts of London, each one serving a group of Boroughs. The finished articles could be displayed in a West-end shop entirely devoted to the sale of handicrafts. Tuberculosis Care Committee. The Borough Council makes a grant of £110 per annum towards the administrative expenses of the voluntary Care Committee, and is refpresented upon it by Mr. Alderman H. Baily, M.B.E., Councillor Mr. Sidney Boyd, M.S., F.R.C.S., Councillor Mrs. F. Cayford, Councillor Mrs. M. F. Dow, M.A., and Councillor Mr. S. B. Morgan. The Secretary of the Committee is Miss M. Talbot Kelly, 73, Dynham Road, N.W.6. The Committee keeps in touch with the families of patients who are receiving institutional treatment, and their conditions and prospects receive consideration upon discharge. Details, supplied by the Secretary of the Committee, of the workcarried out by the Committee during the year are tabulated below :— Cases reviewed 261 New cases (included in above) 88 Interviews with patients by Care Committee Secretary :— (a) At homes of patients 84 (b) Otherwise 912 159 Cases referred to the Hampstead Borough Council:— (a) For extra nourishment 21 (b) For dental treatment 10 Cases referred to the Public Assistance Committee; Unemployment Assistance Board and I/jndon County Council 46 Cases referred to Service Funds 8 Cases referred to Voluntary Associations 17 Cases referred to other Agencies 11 Cases helped directly through the Care Committee :— (a) In cash 40 (b) In clothing 14 Provision of Extra Nourishment. The Council has voted the sum of £80 for the purpose of providing extra nourishment (milk, eggs and butter) to the classes of patients indicated in Circular 257 of the Ministry of Health. During the year, 21 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, 153 sessions were held, and 253 new cases (of which 77 were contacts) were examined. Altogether, 386 patients attended the Dispensary in 1937, and the total number of attendances of all kinds numbered 1,687, an average of 110 per session, at which 1,291 systematic physical examinations were made. The attendances were 451 more than last year. 160 Tuberculosis Scheme of the Hampstead Metropolitan Borough Council. Return showing the work of the Dispensary during the year 1937. 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 32 22 — — 1 2 1 1 33 24 1 1 59 (b) Doubtfully tuberculous — — — — — — — 1 — 1 (c) Non-tuberculous — — — — — — — — 29 66 13 8 116 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 — — — — — — — 1 — — — 1 (b) Doubtfully tuberculous — — — — — — — — — — — 2 2 (c) Non-tuberculous — — — — — — — — 11 32 15 16 74 C.— Cases written off the Dispensary Register as:- (a) Recovered 8 3 — — — — 2 1 8 3 2 1 14 (b) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) - - - - - - - - 42 100 29 27 198 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 100 89 4 1 6 10 12 7 106 99 16 8 229 (b) Diagnosis not completed — — — - - — - — - — 1 2 3 Number of persons on Dispensary Register on January 1st 226 Number of visits by Tuberculosis Officer to Homes (including per Number of patients transferred from other areas and of "lost sight sonal consultations) 153 of" cases returned 37 Number of:— Number of patients transferred to other areas and cases " lost sight (a) Specimens of sputum, etc., examined 186 of" 54 (b) X-ray examinations made in connection with Dispensary work 121 Died during the year 18 Number of Insured Persons under Domiciliary Treatment on the Number of attendances at the Dispensary (including Contacts) 1687 31st December 26 Number of visits by Nurses or Health Visitors to Homes for DisNumber of "Recovered " cases restored to Dispensary Register, and pensary purposes 1232 included—in A (a) and A (b) above — Number of consultations with medical practitioners:— Number of " T.B. plus " cases on Dispensary Register on (а) Personal 89 ber 31st 130 (б) Other 198 161 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 l60l 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 1937 253 20 77 1687 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, 1936 1671 2. Number of these:— (at) Successfully vaccinated 922 (b) Insusceptible of Vaccination 19 (c) Had Smallpox — 162 (d) Number in respect of whom Statutory Declarations of conscientious objection have been received 345 (e) Died unvaccinated 68 3. Number of these Births which on 31st January, 1938, remained unentered in the "Vaccination Register " on account of:— (a) Postponement by Medical Certificate 9 (b) Removal to Districts the Vaccination Officers of which have been duly apprised 195 (c) Removal to places unknown, or which cannot be reached; and cases not having been found 88 4. Number of these Births remaining on 31st January, 1938, neither duly entered in the "Vaccination Register " under headings numbered 2 nor temporarily accounted for in the "Report Book" under heading numbered 3 25 5. Total number of Certificates of successful primary vaccination of children under 14 received during the Calendar year 1937 (including any relating to births registered in previous years) 1160 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 1937 377 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 1937 of successful primary vaccination of which copies have been sent to Vaccination Officers 204 It will be seen from the foregoing figures, that approximately 59 per cent. of the children born in Hampstead during 1936 had been vaccinated by the end of the year under review. This figure compares with 36 per cent. for England and Wales. 163 Hospital Accommodation. During the year, 335 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. 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. 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 1937:— Diphtheria 419 Typhoid Fever 9 Dysentery 3 Cerebro Spinal Fever 5 Scarlet Fever (for Hœm. Strep.) 57 Specimens of Sputum 327 X-ray examinations made 121 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. 164 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 1937:— Number of houses or parts of houses and contents disinfected 1429 „ verminous rooms disinfested 102 „ articles of clothing disinfested *44 „ „ beds disinfested 106 ,, persons accommodated at Shelter - *Excluding the clothing of persons dealt with at the Bathing Station. Cleansing and Disinfection of Verminous Persons and their Belongings. 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 5 Children 389 Scabies. Adults 73 Children 216 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. During the year, the Council's disinfectors disinfested 102 verminous rooms and contents, and, in addition, as a result of the action of the Sanitary Inspectors, 173 verminous rooms in 116 houses and 42 sets of beds and bedding were also cleansed and freed from vermin. 165 Neither the compulsory cleansing of verminous persons nor the cleansing or destruction of filthy, etc., or verminous articles were insisted upon in any case during the year but notices were served for the compulsory cleansing of houses infested with vermin whenever found to be necessary. 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 consist of a small cottage in the Electricity Yard, Lithos Road. 166 INDEX. Page Adulteration, etc. . 128 Aged and infirm persons, removal of 88 Agricultural Produce (Grading and Marking) Act, 1928 127 Air-Raid Precautions 8 Ambulance Facilities 23,58 Analyst, Public, Report of 133-186 Analytical Work 122, 123 Ante-Natal Clinics 31,45 Anti-Toxin, Diphtheria 140 Area of Borough 13 Artificial Cream Act, 1929 130 Artificial Pneumo-thorax 154 Bacteriological Examinations 122, 130, 154, 163 Bakehouses on Register; Inspections, etc. 126 Bakehouses, Underground 86, 126 Basement Rooms (see Underground Rooms). Bathing Station 164 Baths and Pools 87 Beauchamp Lodge, Paddington 60 Births 38,39 Blindness, Prevention of 47 Bug infestation and eradication 88, 164 Butter Factories 127 Cancer 163 Care Committee (see Tuberculosis). Cerebro-Spinal Fever 139, 140 Chemical Examinations 123,130 Child Mortality 41 Child Life Protection 37,70 Children, notification of removal 42 Children, sick and ailing, Homes and Hospitals for 34 Children's Hospital, College Crescent 39 Cleansing of verminous houses, persons, etc. 88 Cleansing. Public 164 Cleansing Station (see Bathing Station). Clearance Areas 112,115 Clinics and Treatment Centres 25 Closing Orders 115, 116 Common Lodging Houses 83 Compensation to Midwives 65 Complaints Received 79 167 PAGE Condensed Milk 130 Consulting Obstetricians 37,67 Consumption (see Tuberculosis). Contributions to Voluntary Associations 72 Convalescent Homes, etc. 34, 59 Cooked Meat 126 County Council Housing Estates 113 Cowhouses 126 Creches (see Day Nurseries). Cricklewood Housing Scheme (see Westcroft Estate). Cross Roads Club, 88, Alexandra Road 60, 73 Day Nurseries 35, 61 Deaths 17-19 Decontrol of Tenement Houses 82,83 Dental Clinics, etc. 53 " Diamond Jubilee" Beds 163 Diphtheria, Anti-toxin, and Immunisation 139, 140 Disinfection 88, 164 Domiciliary Midwifery Service 62 Drainage and Sewerage 77 Dried Milk 130 Dust Collection and Disposal 78 Dysentery 139, 143 Encephalitis Lethargica 139, 144 Enteric Fever 139, 144 Enteritis 147 Epidemic Diarrhœa 36 Erysipelas 139 Factory and Workshop Acts 83-86 Factories 83, 84 Finsen Light Treatment 156 Flooding in Kilburn 90 Food, Bacteriological and Chemical Examination 130 Food, Byelaws 121 Food and Drugs (Adulteration) Act, 1928 128 Food and Food Premises 121-130 Food and Milk for Mothers and Infants 32 Food, Inspection and Supervision of 121-136 Food Poisoning 127, 148 Food, Preservatives in 122,123, 130 Food, Unsound 125 Foster Children and Foster Mothers 37, 70 Foster Home, 33, Fitzjohn's Avenue 60,73 Fried Fish Shops 126 Garnett Road Housing Scheme 101 168 PAGE Gully Cleansing 78 Hampstead Council of Social Welfare 74 Hampstead District Nursing Association 24 Hampstead General Hospital, Borough Beds 163 Hampstead Hospital for Children 25, 59 Hampstead Hostel for Mothers and Babies 60 Hampstead Housing Association 117 Hampstead and North St. Pancras Day Nursery 74 Hampstead Swimming Pond 8 Handicraft Class 157 Health Education and Propaganda 74 Health Services 23-26 Health Visitors and Work of 29, 43 Home Helps 37,68 Home Office Tables (Factory and Workshop Act, 1901) 83, 84 Home Nursing 36, 58 Home Workers 85 Homes and Hospitals for Sick and Ailing Children 34 Homes for Mothers and Babies 35 Hospitals 25 Hospital accommodation 163 Hospital Beds, Borough "Jubilee" Beds 163 Hospital Milk Supply 123 Hostel for Mothers and Babies 73 Houses, Inhabited, number of 13 Houses Let in Lodgings (see Tenement Houses, etc.). Housing Committee 3 Housing Conditions where births occurred 42 Housing, London County Council, arrangements with 113 Housing " Representations", etc. 115 Housing Section 97.117 Ice Cream 126 Illegitimate Children 38, 39,40 Immunisation, Diphtheria 140 Imported Foodstuffs 127 Improper Mixing of Sexes 103 Infant Life Protection (see Child Life Protection). Infant Welfare Centres 30, 49 Infant Mortality 40 Infectious Diseases 36, 139-165 Infirm Persons, Removal of 88 Influenza 146 Informal Samples 130 Inspections and Re-inspections 79 Inspection and Supervision of Food 121-136 169 Page Institutions for Unmarried Mothers and for Infants 60, 61 Invalid Children's Aid Association 68 Kilburn and West Hampstead District Nursing Association 24 Kilburn Vale Area 112 King's College Mews West 115 Laboratory Facilities 23 Legal Proceedings 89 London County Council, Housing arrangements with 113 Main Memorial Home 61, 73 Malaria 139, 146 Margarine, Wholesale Dealers, Factories, &c. 126 Maternal Mortality and Morbidity 37, 41, 65 Maternity and Child Welfare 29-74 Maternity and Child Welfare Centres 45, 49, 50 Maternity and Child Welfare Committee 3 Maternity Beds 39 Maternity Clinics (see Ante-Natal Clinics). Maternity Homes and Hospitals 33 Maternity Outfits 69 Measles 36, 139, 146 "Measurements",Survey 105 Meat and other Foods 125 Medical Investigation Sub-Committee 54 Merchandise Marks Act, 1926 127 Meteorology 14 Midwifery Service, Domiciliary 62 Midwifery and Maternity Services 62 Midwives' Compensation 65 Milk and Dairies Acts, 1915 and 1922 124 Milk and Dairies Order, 1926 124 Milk and Food for Mothers and Infants 32, 51 Milk, Bacteriological Examination 122 Milk, Chemical Examination 123 Milk, Condensed or Dried 130 Milk (Special Designations) Order, 1936 124 Milk for School Children 123 Milk, Pasteurised 125 Milk Supply 122, 126 Minor Ailments 58 Mortuary, Public 92 Mothers and Babies, Home for 35 Mount Vernon Hospital, Borough Beds 163 Municipal Dwellings 114 National Health Campaign 26 National Society for Prevention of Cruelty to Children 44 170 Page New End Hospital 39 New End Housing Scheme 101 Noise Nuisance 93 Northwood Hospital Borough Beds 163 Notification of Births Act, 1907 41 Nursery Schools 61 Nursing in the Home 24 Nutrition 130 Offensive Trades 83 Officials, Public Health 4 Ophthalmia Neonatorum 36, 139 Orthopædic Treatment 74 Outworkers (see Home Workers). Overcrowding 82,98, 102 Overcrowding. Standards 108 Park Dwellings Flats 114 Pasteurised Milk 125 Pathological Examinations of Sputum 154, 163 Pemphigus Neonatorum 36 Pharmacy and Poisons Act, 1933 91 Pneumonia, Acute Primary and Acute Influenzal 139, 146 Poisons (sec Pharmacy and Poisons Act, 1933). Polio-Myelitis 36, 139, 140 Population 17 Post-Natal Clinics 31,49,66 Poultry Slaughterhouses 126 Pre-Maternity Clinics (see Ante-Natal Clinics). Preservatives, &c., in Food Regulations, 1925 to 1927 130 Preserved Food, &c. 126 Prevention of Blindness 47 Propaganda 74 Public Cleansing 78 Public Health Committee 3 Public Health Station 163 Publicity 26 Public Health (Tuberculosis) Regulations, 1925, 1930 152, 157 Public Vaccinators 4 Puerperal Fever and Pyrexia 36,139 Puerperal Sepsis 14 Queen Charlotte's Hospital 39 Queen Mary's Maternity Home, Heath Street 39, 73 Rag and Bone Dealers 83 Rats and Mice (Destruction) Act, 1919 86 "Rat Week" 87 Ray-Therapy 51 171 Page Re-housing Accommodation 100 Removal of Aged and Infirm Persons 88 Rent Restriction Acts 83 Restaurant Kitchens 126 St. Agatha's House 61, 73 Sanatorium Treatment 152 Sanitary Circumstances of the Borough 77-93 Sanitary Inspectors, Work of 78-92 Scabies 164 Scarlet Fever 139, 146 School Children, Milk for 123 School Entrants and School Medical Inspection 55 Schools 89 Seamen's Lodging Houses 83 Sewerage 77 Shelter 165 Shops Act, 1934 87 Slaughterhouses 125, 126 Small Dwellings Acquisition Acts 117 Smoke Abatement 80, 86 Social Conditions 13 South End Close Flats 114 " Special" Children 50 Staff of the Public Health Department 3 Stalls and Street Traders 127 Statistics and Social Conditions of Borough 13 Still Births 39 Street and Gully Cleansing 78 Street Traders 127 Student Health Visitors 44 Superannuation Act examinations 8 Survey re Overcrowding 98 Swimming Baths and Pools 87 Tenement Houses and Bye-laws 82 Tenement Houses, additional W.C's. and Water supply 81, 82 Toddlers' Clinics 50 Treatment Centres 25 Tuberculosis 149-161 Tuberculosis Care Committee 158 Tuberculosis Dental Clinic 156 Tuberculosis Dispensary 153-161 Tuberculosis, Handicrafts Class 157 Tuberculosis, Non-notified Cases 152 Tuberculosis Regulations, 1925, 1930 152, 157 Tuberculous Patients, Extra Nourishment for 159 172 Page Typhoid (see Enteric Fever). Ultra-Violet Ray Treatment 51 Underground Rooms 80, 106-112 Unemployment 13 Unmarried Mothers 60, 61 Unsound Food and Food Inspection 125 Vaccination and Vaccination Order, 1930 161 Vaccination Officer 4 Venereal Diseases, Clinics and Treatment Centres 147 Verminous Persons and Premises, etc. 80, 88, 164 Vital Statistics 13, 16-19 Voluntary Associations, Contributions to 72 Water Closets, additional in Tenement Houses 81, 82 Water Supply of the Borough 77 Water Supply of Tenement Houses 81 Watling Estate 113 Welfare Centres 49 Westcroft Estate 114 Whooping Cough 36 Workshops and Workplaces (see Factory and Workshop Acts). Wormholt Estate 113 X-ray Work 154 Young Children, Mortality among 41