p 160 M AC 4351 Outbreak of food poisoning The Metropolitan Borongh of Sampstead. REPORT for the year 1938 of the Medical Officer of Health. H. LESLIE OLDERSHAW, M.D. State Medicine (Lond.), B.S., D.P H. Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. Printed by F. P. Lewingdon's Exors., 216 & 218, Eversholt Street, N.W.1. REPORT for the year 1938 of the Medical Officer of Health. H. LESLIE OLDERSHAW, M.D. State Medicine (Lond.), B.S., D.P H. Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. 2 CONTENTS. PAGES Lists of Committees concerned with the work of the Department 3 Staff of the Public Health Department 4 Other Officers associated with 1'ublic Health work 5 Health Services, Timetable, &c- 6 Introduction 7 SECTION 1.—Statistics and Social Conditions of the Borough 11 ,, 2.—General Provision of Health Services in the Borough 23 ,, 3.—Maternity and Child Welfare (including the Reports of the Medical Offioers of the Ante-natal and Postnatal Clinics) 31 „ 4.—Sanitary Circumstances of the Borough 79 ,, 5.—Housing 103 „ 6.—Inspection and Supervision of Food (including the lleport of the Public Analyst) 121 ,, 7.—Prevalence of, and Control over, Infectious and other Diseases (including the Report of the Clinical Tuberculosis Officer) 151 „ 8.—Air Raid Precautions 195 INDEX 198 3 List of Committees concerned with the work of this Department. His Worship the Mayor (Mr. Councillor L. G. Glover, 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. Mr. Councillor A. t. Bucknell. „ „ R. H. H. Cust, m.a., j.p. Councillor Mrs. M. F. Dow, m.a. „ Councillor h. Brooke, m.a. „ Miss A. M. Glover. „ Alderman W. J. Spriggs Mr. Councillor S. B. Morgan. (deceased in November). „ „ E. Snowman. „ Councillor S. A. Boyd, m.s., F.r.c.s. „ „ L. F. D. Tranter, f.s.m.c., f.i.o., f.b.o.a. The Chairmen of the Maternity and Child Welfare Committee and the Housing Committee. Sub-Committees:—(a) Drainage Plans, and (b) Tuberculosis. MATERNITY AND CHILD WELFARE COMMITTEE. (Members of the Council.) Chairman: Councillor Mrs. M. Townroe. Mr. Alderman H. Baily, m.b.e. Mr. Councillor S. M. Copeman, Councillor Mrs. A. J. Arnholz. m.a., m.d., f.r.c.p., f.r.s. Mr. Councillor S. A. Boyd. m.s., F.r.c.s. Councillor Mrs. M. F. Dow, m.a. Councillor Mrs. F. E. Cayford. „ Miss A. M. Glover. Mr. Councillor H. Smith. 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.) Miss I. M. Finlayson, m.b , ch b.(ed). Mrs. J. Gordon. Mrs. E. S. Grundy, m.b.e. Miss G. M. MacDonald (deceased August, 1938). Mrs. C. E. Samuel, m.a., m.b.e. Sub-Committees:—(a) Applications for Assistance, and (b) Child Mortality and Maternal Diseases or Deaths. HOUSING COMMITTEE. Chairman: Mr. Councillor K. H. Parkes, F.r.i.b.a. Mr. Alderman H. Baily, m.b.e. Mr. Councillor r. C. Byng. „ „ r. H. H. Cust, m.a., j.p. Councillor Mrs. M. i. Gruner. Councillor Mrs. A. J. Arnholz. Mr. Councillor O. P. Milne, F.r.i.b.a. Mr. Councillor H. Brooke, m.a. „ „ G. B. Sankey. „ „ G. Buckle. „ „ E. Snowman. M. L. F. Burnet. The Chairman of the Public Health Committee. Sub-Committee: Westcroft Estate. 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health— H. Leslie Oldershaw, m.d. State Medicine (Load.), b.s., m.r.c.s. (Eng.), l.r.c.p. (Lond.), d.p.h. Assistant Medical Officer of Health and Clinical Tuberculosis Officer : H. Davis Chalke, m.a. (Cantab.), m.r.c.s. (Eng.), l.r.c.p. (Lond.), d.p.h. *Medical Officer, Ante-Natal Clinics—Miss Mary Kidd, m.b., b.s. (Lond.). *Medical Officer, Post-Natal Clinics—Miss Beatrice Turner, f.R.C.s.,(Ed.), f.r.c.o.g. †Medical Officers, Maternity and Child Welfare Centres and Toddlers' Clinics— Miss R. Balmer, o.b.e., m.b., b.s. (Lond.). Mrs. A. Hall-Craggs, m.r.c.s., l.r.c.p. (Lond.). Mrs. F. M. Yule, m.b., ch.b. (Aberd.), d.p.h. Clerical Staff—‡Frank S. Hill (Assistant Administrative Officer). W. Sell. R. H. Box, Cert. Soc. of Apoths. (Also Vaccination Officer). A. Slade. A. J. Anscomb. R. W. King. R. G. Newton (from April, 1938). Miss E. M. Blakeman (retired on Superannuation 30th September, 1938). Miss B. C. Tucker (from 1st November, 1938). Miss E. Selwood. Miss C. Montague (resigned in July, 1938). Miss M. E. Alexander (from July, 1938). Miss M. Talbot Kelly (Temporary part-time assistant for Tuberculosis Care Work from 1st November). 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), (f) J. Grimsley (e), (f) (retired on Superannuation 6th November, 1938). Miss C. Lambe, (a), (b), (d), (e). W. F. Newport (e), (f) (from 7th November, 1938). F. V. Outlaw (e), (f). W. Robinson (e), (f) L. Rowley (e), (f). A. C. Townsend (e), (f) L. E. Trigg (c), (f) (from 30th May, 1938). E. Wall (e), (f). F. C. Cobb (Assistant to Inspectors) from June, 1938. J. Cuskin (Assistant to Inspectors). R. Martin (Assistant to Inspectors and Mortuary Keeper). E. Stratton (Assistant to Inspectors) (retired on Superannuation, June, 1938). Public Health Station Staff—W. Bell (Senior Disinfector and Resident Caretaker). W. Day (Disinfector) J. R. Williams (Disinfector) *Mrs. Morley (Bathing Station Attendant). (a} Health Visitor's Certificate. (d) State Certified Midwife. (b) State Registered Nurse. (c) Sanitary Inspector's Certificate. (c) General Nursing Certificate. (f) Food Inspector's Certificate. * Part-time Officers, †Part-time Officers of Council of Social Welfare approved by the Maternity and Child Welfare Committee. ‡1st Class Home Office Certificate, Civilian Anti-Gas School. 5 Staff of the Public Health Department -continued. *Public Analyst—H. E. Cox, d.sc., ph.d. (Lond), f.i.c., 11, Billiter Square, E C.3. *Public Vaccinators—J. Davies, m.d. (Lond.), m.r.c.P. (Load.), 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.). OTHER OFFICERS ASSOCIATED WITH PUBLIC HEALTH WORK. 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., LC.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: V. A. Craghill, Town Hall, Hampstead, N.W.3. Daily 9 a.m.—12 noon; Mondays, Wednesdays, Thursdays, 2—4 p.m. (and at Health Institute, 107, Kingsgate Road, N.W.6, Tuesdays 7-8 p.m.). Registrar of Marriages: D. A. Boreham, Town Hall, Hampstead, N.W.3. Certifying Surgeon (Factory Act): Dr. C. R. McClure, 68, Loudoun Road, N.W.8. District Surveyor (London Building Act): D. Whyte, a.m.i.struct.e., 305, Finchley Road, N.W.3 (Hampstead 4867). H.M. Inspector of Factories for N.W. District: Miss M. O. Anderson, 68-70, Baker Street, W.l (Welheck 3352). H.M. Coroner: William Bentley Purchase, m.c., m.a., m.b., d.p.h., Coroner's Court and Office, Camley Street, N.W.I. Coroner's Officer: Police Constable T. A. Day, Police Station, Rosslyn Hill, N.W.3 (Hampstead 1113). Divisional Medical Officer (School Medical Service): Dr. M. C. Polhill, Hoxton House, Hoxton Street, N.1 (Clerkenwell 1892). *Part-time Officers. 6 Health Services Timetable. MATERNITY AND CHILD WELFARE. ANTE-NATAL CLINICS. Mondays : 75, Dynham Road, N.W.6, 2—4 p.m. Wednesdays and Thursdays: 75, Dynliam Road, N.W.6, 9.15 to 11.15 a.m. Thursdays : 27, Pond Street, N.W.3, 2—4 p.m. POST-NATAL CLINICS. Tuesdays : 75, Dynham Road, N.W.6, 2.30—4.30 p.m. Thursdays : 27, Pond Street, N.W.3, 2—4 p.m. INFANT WELFARE CENTRES. (Hampstead Council of Social Service.) Mondays: Avenue Road Congregational Church Hall, Swiss Cottage, 2—4 p.m. Tuesdays : Health Institute, Kingsgate Road, 2—4 p.m. Wednesdays : Health Institute, Kingsgate Road, 10—12 noon and 2—4 p.m. Thursdays : Baptist Chapel Hall, Heath Street, 10.15—12 noon. Wesleyan Church Hall, Lisburne Road, 2—4 p.m. Fridays : Mission Hall, Broomsleigh Street, 2—4 p.m. *Health Institute, Kingsgate Road, 10—12 noon. *27, Pond Street, 10—12 noon. * Alternate weeks for Toddlers only. DENTAL CLINIC. For Children under five years of age and Expectant or Nursing Mothers. Tuesdays: Public Health Station, Lithos Road, Finchley Road, 10 a.m.—12 noon. DIPHTHERIA IMMUNISATION CLINICS. Held as required at 27, Pond Street, N.W.3, and 75, Dynham Road, N.W.6. TUBERCULOSIS DISPENSARY. 75, Dynham Road, Kilburn, Tuesdays : 10 a.m. Wednesdays : 2.30 p.m. Thursdays : 6 p.m. 7 Public Health Department, Town Hall, Haverstock Hill, Hampstead, N.W.3. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit to you my Annual Report upon the state of the public health in the Metropolitan Borough of Hampstead for the year 1938. This report is the thirty-eighth of the series. Staff Mr. John Grimsley, who had been a Sanitary Inspector in the Department since 1902, retired on Superannuation in November and Mr. W.F. Newport, Sanitary Inspector of the Borough of Twickenham, was appointed to fiill the vacancy. Mr. E. Stratton, who had served since 1907 as an Assistant to the Sanitary Inspectors, retired on superannuation in June, his place being filled by Mr. F. C. Cobb. Miss Montague, shorthand-typist resigned in June, her place being filled by Miss M. E. Alexander. Miss Blakeman was retired on superannuation in September owing to ill-health. Miss Blakeman, who was senior woman clerk in the Maternity and Child Welfare Section, had served in the Public Health Department since 1915; she had been a highly conscientious and indefatiguable worker and had assisted in the development of the Maternity and Child Welfare services of the Department since their inception. Her retirement was an appreciable loss to the Council and to her colleagues. Miss B. C. Tucker, of the Public Health Department, Royal Borough of Kensington, was appointed in her place and commenced duty on 1st November. The Council also agreed to appoint an additional Sanitary Inspector and an additional clerk. Air Raid Precautions. The importance of this work has become so manifest that I have considered it advisable to add an additional section to the report dealing with this subject. 8 I would like to place on record my sincere appreciation of the invaluable help T have received from Miss Robinson, O.B.E., and her many colleagues of the British Red Cross and the St. John Ambulance. In 1937, I reported " In order that any Air Raid Precautions scheme may function satisfactorily the Medical Officer of Health is entirely dependent 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." Before one is satisfied that any Air Raid Precautions scheme will function adequately, these conditions must be fulfilled. Local Government and Other Officers' Superannuation Act. During the year I made 127 medical examinations under the above Act, of whom 20 were officers and 107 workmen. I am indebted to Mr. E. L. Hawke, M.A., F.R.A.S., who has again kindly provided me with the Meteorological Survey of Hampstead for 1938 which he himself describes as a record of some of the most remarkable climatic eccentricities most of us can remember. During the year an investigation into the preparation and sale of Ice Cream was conducted by Dr. Chalke, Assistant Medical Officer, and his report thereon will be found in Section 6. I beg to record my appreciation of the kindness and support shewn me by the members of the Committees which I serve, and by the members of the staff of the department. I have the honour to be, Mr. Mayor, Indies and Gentlemen, Your obedient Servant, H. LESLIE OLDERSHAW, Medical Officer of Health. Section I. Statistics and Social Conditions of the Borough. 11 Statistics and Social Conditions of the Borough. Area (in acres) 2,265 (including 12 acres covered by water). Registrar-General's estimate of resident population, mid-1938 90,480. Number of inhabited houses (end of 1938) according to Rate Books— 9,627 dwelling houses, 3,367 maisonetted and divided houses, 4,558 separate flats. Rateable value (at 1st April, 1938) £1,574,088. Sum represented by a penny rate £6,237. With the exception of public open spaces, and of the extensive gardens and grounds of a relatively few remaining large houses, the Borough has been built-over for several years. The practice continues of pulling down large houses with extensive gardens as they become vacant and of erecting blocks of flats on the site. This helps to account for the number of new dwellings which have been provided in the Borough, as each newly erected flat is deemed to be a separate dwelling. A decrease of 60 in the number of dwelling houses was due to the division of houses into flats and maisonettes or to their demolition in order to make way for the erection of blocks of flats; and an increase of separate assessments of 197 was due to the division of houses. The following table shews the new dwellings provided in recent years:— 1928 79 1933 71 1929 58 1934 277 1930 52 1935 171 1931 96 1936 119 1932 97 1937 279 1938 549 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 1938, 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 863 in March to 1140 in November, and the unemployed women from 277 in July to 354 in October and November. Calculated upon 12 the number of insured people in the Borough, the lowest number was 91 per cent. in January, March and June and the highest 113 in November. Extracts from Vital Statistics of the Year. Total. M. F. Legitimate 932 485 447 Live Births Illegitimate 127 63 64 Birth Rate per 1,000 of the estimated resident population—117. Stillbirths 34 Rate per 1,000 total (live and still) births—311. Deaths 1029 Crude Death Rate per 1,000 of the estimated resident population—11.4. Death Rate Comparability Factor (C.F.) = 0.94. Adjusted Death Rate = Crude Death Rate X C.F. = 11.4 X 0.94 = 10.7. Since the populations of all areas are not similarly constituted as regards the proportions of their sex and age group components, their Crude Death Rates (deaths per 1,000 population) are not valid comparative measures of the mortalities experienced by the several populations, and fail as true comparative mortality indexes in that their variations are not due to mortality alone, but arise also from differences in their population constitution, the two elements being combined in indistinguishable proportions. The Registrar General has prepared Comparability Factors for adjusting local death rates, and when the Crude Death Rate of an Area is multiplied by the appropriate Factor, an "Adjusted Death Rate" is obtained which is comparable with the Crude Death Rate of the country as a whole, or with the "Adjusted Death Rate" of any other area. Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis — — Other puerperal causes 1 0•9 Total 1 0•9 — — 13 Death Rate of Infants under one year of age :— All infants per 1,000 live births 57 Legitimate infants per 1,000 legitimate live births 46 Illegitimate infants per 1,000 illegitimate live births 134 Deaths from Cancer (all ages) 184 „ Measles (all ages) 2 „ Whooping Cough (all ages) — „ Diarrhœa (under 2 years of age) 8 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 16; and the Ward Birth Rates and Infant Death Rates are set out on page 4. 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, I am able to submit his most valuable and interesting report on the weather of the year 1938 in Hampstead, based on records kept at the Hampstead Scientific Society's Observatory, established in 1909, on the summit of the Heath, near the Whitestone Pond. "An abnormal year; severe droughts and torrential rains; exceptionally mild periods." These words headed the official summary of the weather during 1938 issued by the Air Ministry, and they are no less applicable to the London area than to the British Isles as a whole, for which they were intended. The outstanding features of the year in Hampstead were the extraordinary warmth and brightness of March, the drought of the late winter and spring months, the unparalleled mildness of November, and the heavy rainfall during the last quarter. March gave a mean temperature of 48.1 deg., a figure exceeding the normal by 62 deg., the previous highest for that month in the Observatory records by 2 deg., and the ordinary level for April by 22 deg. Statistics from other parts of the London district indicate that no March between 1764 and 1937 was so warm. From February 1st to April 30th Hampstead's total rainfall was 1.06 in., representing 18 per cent. of the average allowance. As this 14 was in all probability the driest three-month period for England and Wales in general back to 1785, it is not surprising to find that Hampstead has had no comparable spell of drought at any season since 1858, when measurements of rain were first made in the Borough. November rivalled March for unseasonable warmth. Its mean temperature of 481 deg. surpassed the normal by 58 deg. and the previous highest for that month in the Observatory records by 1 deg. The maximum of 68.2 deg. on the 5th outstripped by the wide margin of 6 deg. any hitherto registered after the end of October, and was within 1¼ deg. of the July average. April and May, on the other hand, were both cold months. The former gave ground-frost on as many as 21 nights, and the latter a grass-minimum temperature 11 deg. below the freezing-point early on the 8th. The summer (June to August), though rather warmer than usual and notably dry, was very dull. As compared with the respective averages over 25 years, temperature was in excess to the extent of 0.5 deg., and rainfall in defect by 3 22 in. (45 per cent.); yet the mean daily duration of sunshine was subnormal by nearly 50 minutes. To the end of September, 1938 was extremely dry. The next three months were all wet, together yielding, in fact, 1.41 in. more rain than had fallen between February 1st and September 30th and raising the year's total to 22 31 in. This is 5 35 in. short of the 1910-1934 average, and is, with three exceptions, the smallest annual measurement yet recorded at the Observatory. The monthly aggregates ranged from 015 in. in April to 413 in. in December. Days with measurable rain (or other forms of " precipitation ") numbered 165—16 fewer than usual. According to the trace of the automatic gauge, which does not record thin drizzle or very light showers, the year's fall was spread over 4957 hours, or just under three weeks. November 25th, with 103 in., was the wettest day. The sun shone during 1938 for 1,406 3 hours, 72 hours less than the 1910-1934 average. Notwithstanding this deficiency, the year was notable for its freedom from wholly sunless days. There were only 60 of these, against the normal of 75 and the previous smallest number of 63, in 1929. June was the brightest month, with 205 2 sunny hours 15 (March, with 1589 hours, taking second place), and January, with 40.6 hours, was the dullest. June 21st, the summer's most brilliant day, yielded 146 hours—a record unequalled since July 1st, 1934. The mean temperature of 1938 was 50.0 deg.— 1 deg. above the average. No year since 1921 has been appreciably warmer. Below are set out the extreme readings of the sheltered and exposed thermometers:— Maximum in the screen, 83 8 deg., on August 1st. Maximum in the sun's rays, 1594 deg., on August 1st. Minimum in the screen, 174 deg., on December 21st. Minimum on the grass (or snow-surface), 130 deg., on December 21st. The maximum of 1594 deg. by the radiation thermometer (with blackened bulb in a partial vacuum) attained on August 1st was 5 8 deg. higher than any hitherto recorded at the Observatory back to 1910. Snow was observed on 20 days during the year, and covered the ground at 9 a.m. on 14 days, 12 of which were in December. The accumulated average depth of 9 in. at noon on December 26th was the greatest since the Christmastide blizzard of 1927. Thunderstorms (or thunder alone) occurred on ten days, and hail on two days. Gales were frequent and often severe, particularly on January 14th-15th, January 28th-29th, February 12th, June lst-2nd and November 23rd. Fog was rare; on only 14 occasions was it observed at any time during the 24 hours. Ground-frosts were registered on 131 nights, July alone amongst the twelve months being free from them." VITAL STATISTICS. Population. For the purpose of this Report the Registrar-General's estimate of the population at the middle of 1938, which was calculated to have been 90,480 has been adopted. This shows an increase of 1,533 as compared with 88,947 at Census, 1931. 16 The following are estimates of the population of each Ward at the middle of the year under review:— Ward. Estimated Population. No. 1 (Town) 12,600 No. 2 (Belsize) 14,700 No. 3 (Adelaide) 11,280 No. 4 (Central) 10,900 No. 5 (West End) 14,300 No. 6 (Kilburn) 15,200 No. 7 (Priory) 11,500 The Borough 90,480 The following are the statistics for each of the Wards and the Borough:— No. of Deaths. Death Rate. No. 1 (Town) Ward 129 10•2 No. 2 (Belsize) „ 164 11•1 No. 3 (Adelaide) „ 121 10•7 No. 4 (Central) „ 126 11•6 No. 5 (West End) „ 177 12•4 No. 6 (Kilburn) „ 179 11•8 No. 7 (Priory) „ 133 11•6 The Borough 1,029 11•4 The Death Rates for London and for England and Wales were 11.4 and 11.6 respectively. 17 Age and Sex Allocation of Deaths of Hampstead Residents during the Year 1938. causes of death Nett deaths at the subjoined ages of "Residents," whether occurring within or without the Borough. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1. Typhoid and Paratyphoid Fevers M 1 ... ... ... 1 ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 2. Measles M 1 ... 1 ... ... ... ... ... ... ... ... ... f l 1 ... ... ... ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough M ... ... ... ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 5. Diphtheria M ... ... ... ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 6. Influenza M 3 ... ... ... ... ... ... ... 1 1 1 ... f 4 1 1 ... ... ... ... 1 ... 1 ... ... 7.Encephalitis Lethargic M ... ... ... ... ... ... ... ... ... ... ... ... f ... ... ... ... ... ... ... ... ... ... ... ... 8. Cerebro-spinal Fever M 1 1 ... ... ... ... ... ... ... ... ... ... f 1 ... 1 ... ... ... ... ... ... ... ... ... 9. Tuberculosis of respiratory system M 21 ... ... ... ... 2 3 8 4 2 2 ... f 13 1 ... ... ... 2 5 3 ... ... 2 ... 10. Other Tuberculou Diseases M 1 ... ... ... ... 1 ... ... ... ... ... ... f 2 ... ... ... 1 ... ... ... 1 ... ... ... 11. Syphilis M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 12. General paralysis of the insane, tabes dorsalis m 5 ... ... ... ... ... ... ... 2 1 2 ... F ... ... ... ... ... ... ... ... ... ... ... ... 13. Cancer, malignant disease M 69 ... ... ... ... ... 3 1 6 20 28 11 f 115 ... ... ... ... ... 1 3 18 25 36 29 14. Diabetes M 5 ... ... ... ... ... ... ... ... 2 3 ... f 12 ... ... ... ... ... ... ... 2 2 2 6 15. Cerebral haemorrhage, &c. M 14 ... ... ... ... ... ... 3 1 3 5 2 f 18 ... ... ... ... ... ... 1 1 5 3 8 16. Heart Disease m 105 ... ... ... ... 2 ... 4 6 17 30 46 f 178 ... ... ... ... ... 3 1 2 18 54 100 17. Aneurysm M 6 ... ... ... ... ... ... ... 1 2 1 2 f 7 ... ... ... ... ... ... ... 1 3 2 1 18. Other circulatory diseases M 23 ... ... ... ... ... ... 1 2 5 8 7 F 43 ... ... ... ... ... ... 2 3 9 10 19 19. Bronchitis M 4 ... ... ... ... ... ... 1 ... 1 ... 2 F 7 ... ... ... ... ... ... ... ... 1 1 5 20. Pneumonia (all forms) m 29 5 ... 1 1 2 1 ... 5 2 10 2 f 34 3 ... ... 2 ... ... 3 ... 3 8 15 21. Other Respiratory Diseases M 2 ... ... ... ... ... ... ... ... ... ... 2 F 8 ... ... ... ... 2 ... 1 ... 2 2 1 22. Peptic Ulcer M 8 ... ... ... ... ... 1 1 3 1 1 1 F 5 ... ... ... ... 1 ... ... ... ... 2 2 23. Diarrhœa. &c. m 5 5 ... ... ... ... ... ... ... ... ... ... F 3 3 ... ... ... ... ... ... ... ... ... ... 24. Appendicitis M 8 ... ... ... ... 1 ... ... l ... 1 ... f 2 ... ... ... ... ... ... ... ... 2 2 ... 26. Cirrhosis of Liver m 1 ... ... ... ... ... ... ... ... 1 ... ... f 2 ... ... ... ... ... ... ... ... 2 ... ... 26 Other diseases of liver, &c. m 1 ... ... ... ... ... ... ... ... ... ... 1 f 3 ... ... ... ... ... ... ... ... ... 3 ... 27. Other digestive diseases M 8 ... 1 ... ... ... ... ... l 1 2 3 f 11 ... ... ... ... ... ... 1 2 5 3 ... 28. Acute and Chronic Nephritis M 11 ... ... 1 ... ... ... ... 2 2 1 5 f 19 ... 1 ... ... 1 1 ... 2 6 5 3 29. Puerperal Sepsis f ... ... ... ... ... ... ... ... ... ... ... ... 30. Other puerperal causes f 1 ... ... ... ... ... 1 ... ... ... ... ... 31. Congenital Debility, premature birth, malformation, &c. M 21 20 1 ... ... ... ... ... ... ... ... ... f 12 11 ... ... ... 1 ... ... ... ... ... ... 32. Senility m ... ... ... ... ... ... ... ... ... ... ... ... f 8 ... ... ... ... ... ... ... ... ... ... 8 33. Suicide M 17 ... ... ... ... ... 1 3 5 4 3 1 f 11 ... ... ... ... ... 1 3 4 2 ... 1 34. Other violence m 23 3 ... ... 3 2 1 1 ... 6 2 5 f 23 ... ... ... ... 1 1 1 ... 3 9 8 35 Other Defined Diseases m 46 4 ... ... ... ... 3 1 4 8 11 15 f 47 2 ... ... ... 2 3 ... 6 9 9 16 36. Causes ill-defined or unknown m ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... All causes m 436 38 3 2 5 10 13 24 46 80 111 105 f 593 22 3 ... 3 10 20 21 42 98 152 222 Totals 1029 60 6 2 8 20 33 45 87 178 263 327 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, hare in like manner been excluded. 18 Ward and Sex allocation of Deaths of Hampstead Residents during the year 1938. CAUSES OF DEATH. Town 1. Belsize 2. Adelaide 3. Central 4. West End 5. Kilburn 6. Priory 7. Totals. M. F. M. F. M. F. M. F. M. F. M. F. M. K. M. F. All Causes 56 73 67 97 54 67 49 77 71 106 91 88 48 85 436 593 1. Typhoid and Paratyphoid Fevers ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 2. Measles ... ... 1 ... ... ... ... ... ... 1 ... ... ... ... 1 1 3. Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5. Diphtheria ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6. Influenza ... ... 1 1 ... ... 1 ... ... 2 ... 1 1 ... 3 4 7. Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8. Cerebro-spinal Fever ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 1 9. Tuberculosis of respiratory system 1 1 6 ... 3 2 ... 2 1 4 4 ... 6 4 21 13 10. Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 2 11. Syphilis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 12. General paralysis of the insane, tabes dorsalis 1 ... 1 ... 3 ... ... ... ... ... ... ... ... ... 5 ... 13. Cancer, malignant diseases 7 11 10 15 6 16 11 17 11 20 14 19 10 17 69 115 14. Diabetes 1 5 ... ... 1 1 1 1 1 2 ... 2 1 1 5 12 15. Cerebral hæmorrhage, &c. 6 1 2 4 2 3 ... 3 2 3 1 2 1 2 14 18 15. Heart Disease 11 18 21 27 11 14 14 26 17 36 21 35 10 23 105 178 17. Aneurysm ... 1 ... 2 1 1 1 ... 2 1 2 1 ... 1 6 7 18. Other circulatory diseases 7 10 3 7 2 4 3 2 3 9 3 4 2 7 23 43 19. Bronchitis 1 1 ... 1 1 1 ... 2 ... 1 2 1 ... ... 4 7 20. Pneumonia (all forms) 2 4 2 6 4 4 5 6 8 5 6 4 2 5 29 64 21. Other Respiratory Diseases ... 2 1 ... ... 2 ... 1 ... 1 1 ... ... 2 2 8 22. Peptic Ulcer ... 1 3 1 ... ... ... ... 1 ... 4 ... ... 3 8 5 23. Diarrhœa, &c. 1 ... 1 2 1 ... ... 1 ... 1 3 ... 1 2 7 6 24. Appendicitis ... ... ... 1 ... ... 1 ... 2 1 ... ... ... ... 3 2 25. Cirrhosis of Liver ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... 1 2 26. Other diseases of liver, &c. ... ... ... 3 ... ... ... ... ... ... 1 ... ... ... 1 3 27. Other digestive diseases 1 3 1 2 ... 1 1 1 2 1 3 2 ... 1 8 11 28. Acute and Chronic Nephritis ... 3 ... 5 1 2 1 1 3 3 3 1 3 4 11 19 29. Puerperal Sepsis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 30. Other Puerperal causes ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 31. Congenital debility, premature birth, malformations, &c. 6 2 3 1 2 2 1 ... 3 1 4 3 2 3 21 12 32. Senility ... ... ... 2 ... 2 ... ... ... ... ... 3 ... 1 ... 8 33. Suicide 1 1 2 2 4 2 1 2 3 2 3 2 3 ... 17 11 34. Other violence 2 4 2 7 6 2 3 3 1 2 8 2 1 3 23 23 35. Other defined diseases 8 5 7 7 5 7 5 8 10 10 7 5 4 5 46 47 36. Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Special Causes (included in No. 35 above) ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Proportions of deaths from principal causes 1938. 19 Table showing the Birth, Death and Infantile Mortality rates during 1938 in the Metropolitan Cities and Boroughs:— Birth Rate. Adjusted Death Rate. Infantile Mortality Rate. City of London 6.6 Wandsworth 10.3 Greenwich 42 Holborn 7.3 Lewisham 10.5 Stoke Newington 43 City of Westminster 8.3 Stoke Newington 10.5 Bermondsey 45 St. Marylebone 8.8 Hampstead 10.7 Wandsworth 46 Chelsea 10.2 City of Westminster 10.7 Lewisham 47 Hampstead 11.7 Kensington 10.9 Woolwich 50 Wandsworth 11.9 St. Marylebone 11.0 Fulham 51 Kensington 12.8 Woolwich 11.0 Lambeth 51 Finsbury 13.0 Greenwich 11.1 City of London 52 Stepney 13.1 Hackney 11.2 Battersea 53 Hackney 13 .4 Holborn 11.2 Deptford 54 St. Pancras 13.5 Paddington 11.2 City of Westminster 55 Greenwich 13.6 Chelsea 11.5 Hackney 56 Woolwich 13.6 Hammersmith 11.6 Hampstead 57 Paddington 13.7 Battersea 11.7 Southwark 57 Stoke Newington 13.8 Fulham 11.7 Bethnal Green 59 Camberwell 13.9 Lambeth 11.7 Poplar 60 Lewisham 13 .9 St. Pancras 11.7 St. Marylebone 60 Southwark 14.0 City of London 11.8 Camberwell 61 Lambeth 14. 1 Islington 12.0 Hammersmith 61 Bethnal Green 14.2 Camberwell 12 .2 Stepney 61 Fulham 14.2 Bermondsey 12 .5 St. Pancras 64 Deptford 14.4 Shoreditch 12 .5 Shoreditch 64 Shoreditch 14.7 Poplar 12. 7 Islington 65 Bermondsey 14.8 Bethnal Green 12 .8 Paddington 66 Battersea 14.9 Stepney 12.9 Finsbury 73 Poplar 14.9 Southwark 13.4 Kensington 78 Islington 15.3 Finsbury 14.1 Chelsea 80 Hammersmith 15.5 Deptford ? Holborn 84 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 pages 4 and 5 of this report. 2.—Laboratory Facilities. The examination of clinical material (sputum, swabs, etc.) is undertaken by the Laboratories of Pathology and Public Health, Ltd., at 6, Harley Street W.l (Eastes' Laboratories). Information relating to the work carried out in this connection will be found in those parts of this report relating to infectious disease. Dr. H. E. Cox is the Public Analyst appointed by the Borough Council under the Food and Drugs (Adulteration) Act, 1928, and his Laboratories are situated at 11, Billiter Square, E.C.3; his report will be found in Section 6. A report on the samples taken for analysis during the year will be found on pages 145 to 147. 3.—Ambulance Facilities. The London County Council provides ambulances, free of cost, for the conveyance to (a) Hospitals or private residences of persons meeting with accidents or suffering from sudden illnesses in the streets, public places, places of employment, etc. (b) Hospitals of (i) Persons meeting with accidents in their homes; (ii) Persons suffering from illnesses in their homes if a medical practitioner certifies that the case is one of life or death, and provided that arrangements have been made for the reception of the patient in a hospital; (iii) Parturient women, if the case is one of urgency, w hether from the home, place of business or elsewhere, on the application of a qualified medical practitioner or certified midwife, provided that either a doctor or midwife accompanies the case; and (iv) Non-urgent cases of parturition provided that admission to a maternity bed has previously been arranged and a card (issued by the County Council to hospitals, municipal maternity homes, etc.) for such admission obtained; 24 (c) The Council's hospitals for infectious diseases of patients subject to the fulfilment of certain conditions; and (d) The Council's hospitals and institutions for non-infectious cases of patients when application is made:— (i) through the Council's public assistance department; and (ii) by, or on behalf of, the Council's special, general, and mental hospitals. Ambulances and ambulance-omnibuses are also provided by the Council, when not required for the purposes stated above, on payment of charges, as laid down from time to time by the Council, for the conveyance of infectious and non-infectious cases between private houses, hospitals (other than to the Council's hospitals, etc., under the provisions of (a), (b), (c) and (d) above), and nursing homes, and for examinations, consultations and treatment by specialists or at special establishments. The minimum charge is at the rate of 12s. 6d. between any two addresses within the administrative County of London, or 1s. 6d. a mile, up to 50 miles and thereafter 1s. 3d. a mile, if any portion of the journey extends beyond the county boundary. The conveyance of private persons between addresses both of which are outside the administrative County of London is not undertaken. except in circumstances of exceptional urgency. The telephone number of the Headquarters of the London Ambulance Service is Waterloo 3311. These services appear to be adequate for the needs of the Borough. 4.—Nursing in the Home. (a) General and (b) For Infectious Diseases. The Hampstead District Nursing Association, 3, Pond Street, and the Kilburn and West Hampstead District Nursing Association, 20, Dennington Park Road, provide skilled nurses for the sick poor. The Borough 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 certain other illnesses, etc. 25 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. Whooping Cough. Certain other non-notifiable Infectious Diseases, viz.:— 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 £ 110. £220. Public Health work —Kilburn £70 £110. Hampstead £40 i.e., Hampstead District Nursing Association to receive a total block grant in respect of these services of £70 per annum, and Kilburn District Nursing Association to receive a total block grant in respect of these services of £150 per annum. (c) For Maternity cases. For the expectant mother who wishes to have her confinement at home, a scheme has been approved by the London County Council, under which a midwife can be engaged (i) to act as a midwife, who will be in charge of the confinement; or (ii) if the services of a doctor have been secured, a midwife can be engaged as a maternity nurse, in which case she will act under the instructions of the doctor. The fee charged for the services of the midwife or maternity nurse will be very moderate. If the full fee cannot be paid it will be reduced or remitted altogether according to the patient's circumstances. 26 The Nurses of the two local Nursing Associations are available under this scheme. 5.—Treatment Centres and Clinics, including Clinics solely for diagnosis or consultations. (a) Ante-natal Clinics, Infant Welfare Centres, Dental Clinic, vide pages 33, 46, 52 and 73, respectively. (b) School Clinics Kilburn School Treatment Centre, 107, Kingsgate Road; New End Hospital School Treatment Centre, Heath Street. (c) Tuberculosis Clinic, vide page 182. (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, amongst others, the following hospitals:—Guy's; Children's Hospital, Great Ormond Street; Royal Free; Royal Northern; St. George's; St. Mary's; University College; Westminster. 6.—Hospitals: Public and Voluntary. (a) Public:—New End Hospital (260 beds); North-Western Fever Hospital (410 beds). (b) Voluntary:—Hampstead General and North-West London Hospital (138 beds); Children's Hospital, College Crescent (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 Charlotte's Hospital, Marylebone, which are available for Hampstead residents. 27 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 Centres and Clinics. Post Offices also exhibit a Notice directing the attention of the public to medical benefit under the National Health Insurance Scheme, and also to local health services; and leaflets are supplied by the Public Health Department, designed for handing to inquirers, at the Post Offices, giving information concerning local health services in the Borough. Health Propaganda. Health propaganda was undertaken locally in connection with the national campaign to secure a wider use of the health services. The special posters and leaflets were widely distributed and in this matter I am indebted to the Librarian for the publicity given at all the Council's Libraries, and to the Hampstead Council of Social Service who similarly helped through the medium of their Infant Welfare Centres. The booklet of the London County Council entitled "Highways to Health " was also widely circulated. In addition to this special effort, although no so-called Health Week is held in the Borough, consistent propaganda is always going on. Notably in this connection may be mentioned the literature taken into the home by the Health Visitors, i.e., Card containing full information concerning all Clinics. Leaflets " Your Teeth, Your Health and Your Baby's Teeth " Safety in the Home". " Advice to Expectant Mothers". "Tonsils and Adenoids". "Protection against Diphtheria". Booklet "To Mothers and Fathers". Special leaflets relating to Tuberculosis are distributed by the Tuberculosis Nurse. These include:— " How can I protect my child from Tuberculosis". " Disinfection". " On leaving the Sanatorium". 28 Leaflets for general distribution comprising the following:— "Influenza." "Measles". "Smallpox." "Whooping Cough". "To all Boys and Girls" (a health and dental leaflet). " Destruction of Rats and Mice". "Local Health Services" ( a comprehensive leaflet including information as to practically all local health services). At every "first" visit paid by a Health Visitor after the birth of a child, a special letter is handed in which describes all the activities of the Department in connection with Maternity and Child Welfare, etc. This communication invites application to be made to the Medical Officer of Health if help is needed at any time and gives information concerning Ante-natal Clinics. Maternity Outfits. Post-natal Clinics. Home Helps. Infant Welfare Centres. Maternity Beds. Toddlers' Clinics. Milk or Food Grant. Dental Clinics. Notification of Births Act. Convalescent Treatment. Registration of Births Act. Hospital Beds. Vaccination Acts. Home Nursing. Day Nursery. Midwifery and Maternity Relieving Officers. Nursing in the Home. Section 3. Maternity and Child Welfare. 31 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:—90,480 (estimate of Registrar-General, 1938). 2. Number of births notified in that area during the year under Section 255 of the Public Health (London) Act, 1936, as. adjusted by any transferred notifications:— (a) Live births 1091; (b) Still births 34; (c) Total 1,125. (d) By midwives 289; (e) By doctors and parents 836. 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. 32 (c) Number of visits paid during the year by all Health Visitors:— (i) to expectant mothers †First visits 518 Total visits 1,276 (ii) to children under 1 year of age. †First visits 876 Total visits 5,014 (iii) to children between the ages of 1 and 5 years. Total visits 7,392 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:—9. (c) Total number of attendances at all Centres during the year:— (i) by children under 1 year of age, 11,376. (ii) by children between the ages of 1 and 5 years, 6,958. (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, *669. (ii) between the ages of 1 and 5 years, 144. (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, 544. (ii) over 1 year of age, 1,110. 1 .Excluding cases which are known to have previously been visited in another district and cases visited during the previous year. Excluding children who are known to have previously attended a Centre in another district. 33 (f) Percentage of notified live births represented by the number in (d) (i):—613 per cent. 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 (ii) Number of Clinics provided and maintained by Voluntary Associations Nil. Nil. (iii) Total number of attendances at all Clinics during the year 2287 483 (iv) Total number of women who attended at the Clinics during the year 492 279 (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. 43.7 per cent. 24.8 34 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 expectant and nursing mothers and young children:— Liquid gallons. Dried pounds. (i) by the Council 7668⅜ 821 (ii) by Voluntary Associations operating in area Nil 3007 7668⅜ 3828: 35 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 44 Nil Nil II. Number of women (if any) sent by the Council during the year to other Maternity Institutions:- 29 to Queen Charlotte's Hospital, for which the Borough Council subscribes £1 per Hampstead case admitted. 36 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. (272 other children admitted.) II. Number of such children (if any) sent by the Council during the year to other Institutions:—Nil. 9. Convalescent Homes. (o) 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. 37 (d) Total number of such cases sent by the Council during the year to other convalescent institutions:—15 mothers convalescent after confinement with their babies. 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 (b) (i) or (ii) above:—Nil. (ii) women admitted to these maternity beds during the year:—Nil. (d) Total number of cases admitted to these homes during the year:— (i) expectant mothers:—Nil. (ii) mothers and babies:—Nil. (iii) babies:—Nil. (e) Total number of such cases sent by the Council during the year to other homes for mothers and babies:—Nil. 11. Day Nurseries. (a) Number of day nurseries:— (i) provided by the Council:—Nil. (ii) provided by Voluntary Associations:—1 (Hampstead and North St. Pancras Day Nursery). (b) Number of places for children under 5 years of age in the nurseries:— (ij 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:—7,702. 38 12. Infectious Diseases. Disease. Number of cases notified during the year. Number of cases visited by officers of the Council. Number of cases for whom home nursing was provided by the Council. Number of cases removed to hospitals. (1) Ophthalmia Neonatorum *15 8 3 12 (2) Pemphigus Neonatorum Not notifiable Nil Nil Nil (3) Puerperal fever 4 2 †1 3 (4) Puerperal pyrexia 20 8 1 19 (5) Measles and german measles (in children under 5 years of age) German Measles is not notifiable. Measles is compulsorily notifiable. 399 253 51 55 (6) Whooping Cough (ditto) 26 Notifiable from 1-10-38. 26 2 5 (7) Epidemic Diarrhœa (ditto) Not notifiable Nil Nil Nil (8) Poliomyelitis (ditto) Nil Nil Nil Nil *Visiion unimpaired, 13—(one case under treatment at the end of the year—one case admitted to Hospital with Ophthalmia Neonatorum died in Hospital of Gastro-enteritis.) † Subsequently removed to Hospital. 13. Home Nursing. (a) Number of nurses employed at the end of the year for the nursing of expectant mothers and children under 5 years of age, maternity nursing, or the nursing of puerperal fever:— (i) by the Council:—Nil. (ii) by Voluntary Associations:—14 employed by two Local District Nursing Associations. (b) Total number of cases attended during the year by these nurses:-329. 39 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:—5. 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):—22—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:—Nil. (ii) from other causes:—1. (b) Number of these cases which died: (i) at home:—Nil. (ii) in institutions:—1. 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:—21. (b) Number of children on the Register: (i) at the end of the year:—35. (ii) who died during the year:—1. (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. 40 (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. (End of Return.) Live Births. During 1938, 1,059 live births of Hampstesd childern were regis- tered as follows:- Males. Females. Total. Legitimate 485 447 932 Illegitimate 63 64 127 Totals 548 511 1059 CHART SHOWING THE INFANT MORTALITY PER 1OOO 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). for England and Wales is represented by the line. 41 The following are the statistics for each of the Wards and the Borough:— Births. Birth rate. Infant deaths. Infant death rate. No. 1 (Town) Ward 105 8•3 11 104•7 No. 2 (Belsize) „ 168 11•4 4 23•8 No. 3 (Adelaide) „ 100 8•9 10 100•0 No. 4 (Central) „ 84 7•7 2 23•8 No. 5 (West End) „ 198 13•8 9 45•5 No. 6 (Kilburn) „ 241 15•9 16 66•4 No. 7 (Priory) „ 163 14•2 8 49•1 The Borough 1059 11•7 60 57•0 The birth rates for London and for England and Wales were 13 4 and 151 respectively. The infant death rates were 57 and 53. Legitimate and Illegitimate Births. Of the total 1,059 nett live births belonging to Hampstead, 932 were those of legitimate and 127 of illegitimate children, the latter being at the rate of 119 per 1,000 births. still Births. During 1938, the nett number of registered still births for Hamp- stead was 34, as follow:- Males. Females. Total. Legitimate 16 14 30 Illegitimate 2 2 4 Totals 18 16 34 Infant Mortality. During 1938, 60 infants under 1 year of age died, giving an infant death rate of 57 per 1,000 live births. Of these 43 were legitimate children, the rate of 1,000 legitimate live births being 46 while 17 illegitimate children died, equivalent to a rate per 1,000 illegitimate live births of 134. 42 In the following table I have set out the births, deaths and death rate among legitimate and illegitimate infants in Hampstead over a long period of years:— 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 1938 932 43 46 127 17 134 When considered over a long period of years it will be seen that the death rate among illegitimate infants in Hampstead is more than three times as great as that among legitimate infants. 43 Puerperal Fever and Pyrexia. Four cases of puerperal fever—none of which terminated fatally— were reported during the year. Two of the cases were notified from Nursing Homes, while two others were removed to hospital—20 cases of puerperal pyrexia, none of which proved fatal, were notified. Nine of the cases occurred in hospitals while 10 others were removed to hospital. Deaths of Young Children. During 1938, 68 deaths occurred of children under 5 years of age. This is equivalent to a rate of 13 4 per 1,000 live children born in that and the four preceding years. Maternal Deaths. One maternal death occurred during the year 1938, which is a rate of 0.9 per 1,000 births. This death was carefully investigated by the Medical Sub-Committee and a detailed report 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 1,091 Notified by Midwives 289 Still Births 37 „ „ Doctors and Parents 839 Total 1,128 Total 1,128 Of the total nett live births registered only 25 per cent. occurred at the usual place of residence of the mother. 44 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 172 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. l - - - - - 2 1 13 30 7 — 3 1 25 32 14 2 4 - 6 13 4 — 5 — 4 10 3 — 6 — — 4 — — 7 — — 1 1 — 8 — — — — 1 9 - - - - - Totals 2 48 90 29 3 The newly-born baby has not been included in the above. Of these 172 births: — 1 per cent. occurred in 1-roomed tenements. 28 „ „ 2 „ 52 „ „ 3 „ The table indicates the limited housing conditions in some of the dwellings where babies are born at home. It demonstrates that of these 172 babies, 2 were born in one-roomed tenements and 48 in tworoomed tenements. In 1 one-roomed tenement where 3 persons were already living, a baby was born. With regard to two-roomed homes, in 4 instances, 5 persons were already inhabiting the rooms prior to the birth of the baby, in 6 cases the baby's advent raised the number of occupants to 5. 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. 45 The record cards relating to young children in the family are sent with this communication. By this means information regarding 293 children under 5 years of age was sent to other Medical Officers of Health during the past year. Notification was received from 30 other Local Authorities from various parts of the country (including 7 Metropolitan Boroughs) regarding 92 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 Sanitarv 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 997 infants under one year of age and 1,742 children aged between one and five years. The following table gives a record of the work of the Health Visitors in 1938:— †First visits to expectant mothers 525 Re-visits to expectant mothers 751 †First visits to infants under one year 924 Re-visits to infants under one year 4090 Visits to children from 1 to 2 years 2868 Visits to children from 2 to 5 years 4524 Visits to foster-mothers and foster-children 772 Visits re infectious diseases 1678 *Attendances at Borough Council's Ante-natal Clinics 161 ‡Attendances at Borough Council's Post-natal Clinics 5 †Including visits to mothers and babies moving into the Borough and previously visited. *A temporary paid helper was also present at these Clinics in 146 instances. ‡A temporary paid helper was also present at the Post-natal Clinic in 91 instances. 46 Attendances at Borough Council's Dental Clinic 74 Attendances at Borough Council's Immunisation Clinics 6 Attendances at Hampstead Council of Social Service Infant Welfare Centres and Toddlers' Clinics 391 Miscellaneous visits 419 Approximately 72 per cent. of the infants under one year of age visited for the first time attended the Infant Welfare Centres during 1938. 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. Active co-operation exists between the officers of National Society for the Prevention of Cruelty to Children and the officers of the Public Health Department, as and when the occasion demands. Fortunately, these cases are extremely rare. The Society advises this department of cases of pre-school children in which they are interested, whilst we advise the Society of cases in which a visit from their Inspector would appear to be desirable. Student Health Visitors. During the year two 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 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. Ante-natal Clinics. Two Ante-natal Clinics in the Borough are provided and maintained by the Borough Council, namely:— 47 Western Clinic: Three sessions weekly (viz., Monday 2 to 4 p.m., Wednesday 9.15 to 11.15 a.m., and Thursday 9.15 to 11.15 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. Eastern Clinic One session weekly (viz., Thursday 2 to 4 p.m.) at 27, Pond Street. Held in the premises of the Day Nursery. These rooms are also used by the Borough Council for their Post-natal Clinic, the Day Nursery being paid a rent of £100 per annum. The Medical Officer in attendance at the Western Clinic (Dr. Mary Kidd) is a part-time officer appointed by the Borough Council : a Health Visitor is present at each session. Miss Beatrice Turner is the Medical Officer in attendance at the Eastern Clinic which is held at the same time as the Post-natal Clinic for the Eastern portion of the Borough, which she also conducts. Dr. Mary Kidd was in charge of the Eastern Ante-natal Clinic up to and including February 22nd; Miss Turner commenced with the two combined clinics (ante-natal and post-natal) on March 3rd as a part-time officer of the Council. (a) Total number of attendances by expectant mothers at the Ante-natal Clinics during the year—2,287. (b) Total number of expectant mothers who attended at the Ante-natal Clinics during the year—492. (c) Percentage of total notified births (live and still) represented by the number in (b)—437 per cent. The following is the report for the year 1938 on the Council's Ante-natal Clinics by Miss Mary Kidd, M.B., B.S. (Lond.):- I beg to submit the following report on the working of the Borough Council's Ante-natal Clinics during the year 1938:- Pond Street Clinic. (1 session weekly.) Kilhurn Clinic. (3 sessions weekly.) 1938. 1937. 1938. 1937. New Patients 92 99 283 302 Attendances of old patients 434 484 1498 1391 Number of sessions held 52 51 144 100 Average attendance per session 10 11 12 16 Since March, 1938, some re-arrangement of the work has taken place and I have held three weekly sessions instead of two, at the Kilburn Clinic; whilst Dr. Beatrice Turner has held one session for 48 both ante-natal and post-natal cases at the Pond Street Clinic each week. The following figures, therefore, have been partly contributed by her. During last year 375 new patients attended the Clinics as against 401 in 1937. The number of births in the Borough was 1,059 in 1938, as against 1,015 in 1937. It is calculated, therefore, that 34 per cent. of Hampstead's expectant mothers received ante-natal care at the Council's Clinics. We are thankful to record that during the last seven years, no death in childbirth has occurred in a series of 2,422 expectant mothers attending the Clinics during that period. Since the year 1929 there have been two maternal deaths in a series of 3,049 expectant mothers which gives a maternal mortality rate of only 65 per 1,000 during a ten year period (the maternal mortality rate for England and Wales being 3.12 per 1,000 in 1937). This happy result has only been achieved, of course, by constant co-operation with the Hospitals where many of these women were confined as well as with the District Midwives in Hampstead and not only shews the value of ante-natal care but is a tribute also to the work of the doctors and nurses in the particular Hospitals concerned as well as to the work of the District Midwives. In view of recent research work, too, there seems to be no doubt that the adequate provision of milk for needy expectant mothers (and latterly, extra nourishment in the form of butter and eggs, when necessary) has played its part in keeping our maternal mortality rateso low. In this connection also, it is of interest to note that the neonatal death rate amongst Hampstead infants whose mothers had attended the Clinics, remained comparatively low in 1938, viz., 13 per 1.000 as against 29 per 1,000 for England and Wales in 1937. The neo-natal death rate, so-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 and provision for the proper nutrition of the expectant mother. The number of still births amongst Clinic patients last year was 4, which gives a still birth rate of 10 per 1,000. This, too, compares favourably with the still birth rale for England and Wales which was 39 per 1,000 in 1937. 49 During last year, routine blood tests have been performed on the majority of expectant mothers attending the Ante-natal Clinics whilst some have also been carried out at New End Hospital, on our cases. It is becoming increasingly evident that these tests will detect any latent condition in the expectant mother which might lead to miscarriage, still births or to the birth of premature and diseased infants. In October, 1937, therefore, it was decided to carry them out at our Clinics, the blood being collected and sent to the Pathologist at the Royal Free Hospital where it is examined at the expense of the London County Council. Little difficulty has been experienced in persuading the mothers to consent to this investigation when the importance of ascertaining that the blood is healthy during pregnancy is explained to them. It is of interest to note that of 270 blood tests, the Wasserman and Kahn reactions proved negative in 259 cases and positive in 11. Each of the latter 11 women was persuaded to go to the Special Clinic at the Royal Free Hospital so that the tests might be repeated after a provocative injection of novarsenobillon had been given. In only 4 cases was the "repeat test" still found to be positive and these were definitely considered to have a taint and to need treatment. As in the remaining 7 cases the "repeat tests" proved negative, the Medical Officer at the Special Clinic advised that the first positive test should be disregarded and no treatment given. It is found, therefore, that only 4 out of 270 tests yielded a persistently positive Wasserman reaction, i.e., a percentage of 1.4. This figure agrees closely with that obtained in another London Borough where routine blood tests have been carried out for some years. In 1937, 934 tests were carried out there, with a percentage of 18 persistent positives, the first positive test being always repeated after a provicative injection of novarsenobillon. It may be of interest to note one anomalous case which shewed a negative Wasserman reaction. A month later she developed severe endocervicitis and was sent to the Special Clinic at the Royal Free Hospital for diagnosis and treatment. There a routine blood test was carried out and proved positive, remaining so after a provocative injection of novarsenobillon had been given. (Signed) MARY K1DD, M.B. (Lond.). 50 Electro cardiograms. During the year seven patients have been referred from the Antenatal Clinics to the Royal Free Hospital and to the National Hospital for Diseases of the Heart for electro cardiograms, the Borough Council paying the fee. Post-natal Clinics. Two Post-natal Clinics in the Borough are provided and maintained by the Borough Council, namely:— Western Clinic. Held on Tuesday 2.30 to 4.30 p.m. at 75, Dynham Road in the premises rented by the Borough Council from the Health Institute for the purpose of a Tuberculosis Dispensary. Eastern Clinic. Held on Thursday 2 to 4 p.m. in the premises of the Day Nursery. These rooms are also used by the Borough Council for their Ante-natal Clinic, the Day Nursery being paid a rent of £100 per annum. The Medical Officer in attendance (Miss Beatrice Turner) is a part-time officer appointed by the Borough Council; a voluntary worker and a paid helper are also present at these clinics. During the year 196 mothers attended at Dynham Road to receive post-natal care, making a total number of attendances of 339, and 83 mothers attended at Pond Street, making a total number of attendances of 144. The following is the report of Miss Turner, F.R.C.S. (Ed.), F.R.C.O.G.:- I beg to submit the following report on the working of the Borough Council's Post-natal Clinics during the year 1938:— Dynham Road. (1 session weekly). Pond Street (held in conjunction with Ante-natal Clinic). (1 session weekly). Multipara 90 39 Primiparæ 97 38 Birth control 9 5 Referred elsewhere 29 15 Dental treatment advised 24 5 Cervical erosions 18 6 Retroverted uterus 24 9 51  Dynham Road (1 session weekly). Pond Street (held in conjunction with Ante-natal Clinic). (1 session weekly). Subinvoluted uterus 21 20 Urinary infection 10 3 Breast abscess 7 5 For diagnosis of pregnancy 21 7 Wasserman test done 5 - For treatment of sterility - 1 To Convalescent Home 5 2 No treatment required 14 - 52 On the whole I think the clinics are proving their worth and I feel sure that after a little while even more of the mothers will come back to us as soon as they have had their babies. (Signed) BEATRICE TURNER, F.R.C.S., F.R.C.O.G. Infant Welfare Centres. The following Infant Welfare Centres were held in the Borough during 1938:— Name and address of Centre. Day and Time held. Doctor in attendance. Health Visitor. Average attendance per session. " Belsize", Congregational Church Hall, Monday, 10.30—12 noon. 2—4 p.m. Dr. M. Yule Mrs. Steward 46 Avenue Road "Kilburn", Health Institute. Kingsgate Road Tuesday 2—4 p.m. Wednesday, 10—12 noon and 2-4 p.m. Dr A. S. Hall- Craggs Do. Miss Evans Miss May 49 "New End", Baptist Chapel Hall. Heath Street Thursday, 10—12 noon Dr. M. Yule Miss Kennedy 23 "Lisburne Road", Wesley an Mission Hall, Lisburne Road Thursday, 2—4 p.m. Do. Miss Lambe 46 "Mill Lane", Mission Hall, Broomsleigh Street Friday, 2—4 p.m. Dr. A. S. Hall- Craggs Miss Evans 62 Infant Welfare Centre Premises. The suitability of premises used by the Hampstead Council of Social Service as Infant Welfare Centres has for some time been the subject of consideration by the Maternity and Child Welfare Committee. The premises used for this purpose are Church Halls, etc., and certain rooms at the Health Institute, Kingsgate Road. The question was raised again early in the year by reason of the necessity for the provision of First Aid Posts in connection with the Air Raid Precautions Scheme of the Borough Council. In view of the fact that First Aid Posts would be required in certain positions in the Borough, if possible, one in the neighbourhood of Winchester—Adelaide— Harley Roads, and one in the neighbourhood of Broomsleigh Street, 53 and as it appeared that these localities were convenient ones for the establishment of new Infant Welfare Centres, the Committee in April resolved in favour of exploring the matter with a view to combining First Aid Posts with Centres, and appointed a small Sub-Committee to discuss preliminary matters with the Sub-Committee of the Air Raid Precautions Committee. This matter was under discussion at the close of the year. The Maternity and Child Welfare Committee resolved to inspect all the Infant Welfare Centres in the Borough and invited all the members of the Council to accompany them. Accordingly on the 23rd February, 1938, members of the Council visited the various premises in question and subsequently visits were paid to Municipal Centres in other London Boroughs. In June a communication was received from the Chairman of the Infant Welfare Committee of the Hampstead Council of Social Service stating that owing to the increase in the number of mothers attending the Belsize Infant Welfare Centre (held in the Congregational Church Hall, Avenue Road) it was considered necessary to hold an additional weekly session, but that they could not undertake the additional expense. It was stated that the Infant Welfare Committee would be prepared to organise and staff another session if the Borough Council would give an annual grant of £155 to cover the expense. The Maternity and Child Welfare Committee reported to the Council that they were of opinion that the whole position with regard to the Infant Welfare Centres should be the subject of very careful consideration, having regard, amongst other circumstances, to proposals which they had under discussion concerning the erection of new Centres, but that in view of the immediate need for additional facilities, arrangements should be made for the suggested additional session to be held during the period of three months commencing on the first Monday in July. The Council resolved that a sum of £40 should be paid to the Hampstead Council of Social Service to cover the expenses of an additional session at the Belsize Infant Welfare Centre during the three months commencing the first Monday in July. In view of the favourable report on the working of the additional session, the Council on 27th October granted a further sum of £80 to cover the expenses of the additional session until the expiration of the financial year. 54 Inspection of Maternity and Child Welfare Centres. In 1938 arrangements were made for officers of the Ministry of Health to visit and report upon the Maternity and Child Welfare Centres in the Borough. The Centres were duly inspected during the month of September and a letter, dated 10th November, 1938, was subsequently received from the Secretary, Ministry of Health, stating that on consideration of the report made by his Medical Officer the Minister desired to express his appreciation of the excellent work for mothers and children which had been, and was being, carried out in the Borough. The letter further stated that the Minister was advised that the character of the accommodation available for the Infant Welfare Centres at "Belsize". "Mill Lane" and "Lisburne Road" tended to handicap in important respects the work carried on at the Centres, as the accommodation, besides suffering from defects of convenience and general amenities, was unsuited for adequate development of educational work by collective instruction, classes and demonstrations,—a development which in the Minister's opinion is of the highest importance in order that the best results may be obtained,— and that the Minister thought that the Borough Council, in conjunction with the Hampstead Council of Social Service, should consider all practicable steps for meeting the needs of the service in the way of more adequate accommodation. The letter further stated that, in conjunction with the Hampstead Council of Social Service, the desirability of further measures of co-ordination of municipal work with that of the Voluntary Centres should be considered by the Council, and suggested that, in this connection, the present limitations of the duties performed by the Health Visitors at the Infant Welfare Centres and Clinics for children between one and five years of age should receive consideration. The Maternity and Child Welfare Committee decided to invite the observations of the Hampstead Council of Social Service upon the contents of the Ministry of Health's letter. The matter was under consideration at the close of the year. Total number of attendances at all Centres during the year:— (i) By children under 1 year of age—11,376. (ii) By children between the ages of 1 and 5 years— 6,958. 55 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—669. (ii) Between the ages of 1 and 5 years—144. 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—544. (ii) Between the age of 1 and 5 years—1,110 (including Toddlers). *The 669 children under 1 year of age who attended at the Centres represent 61.3 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 1938 was : 27, Pond Street, 20. Health Institute, 28. The parents of every child approaching the age of three years are invited by the Health Visitor to bring the child to the Toddlers' Clinic for a routine examination. The examination by the Doctor at the Clinic is on the lines of a school medical inspection. " Defective " children are referred either to their family doctor or to a hospital and are subsequently followed up by the health visitor to ensure that they are receiving the requisite treatment. The " defective " children are called up again to the Clinic for subsequent examination. 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 £10 0s. 0d. to the Institute of Ray-Therapy. 152, Camden Road, N.W., which provides free treatment to patients referred to the Institute from the Toddlers' Clinic and the Infant Welfare Centres, and the Ante-natal Clinics. Ultra-Violet Ray Treatment. The Council has purchased an ultra-violet ray lamp for the Tuberculosis Dispensary patients, which might also be available for 56 non-tuberculous children. This lamp has been installed in the Tuberculosis Dispensary at Dynham Road. Arrangements have been made for the provision of ultra-violet ray treatment for persons residing on the western side of the Borough to supplement the arrangements with the Institute of Ray Therapy, of 152, Camden Road, whose services are more easily utilised by persons from the eastern side of the Borough, owing to the difficulties experienced in travelling to the Institute. The Willesden Physical Treatment Clinic, of 159, Willesden L,ane, stated that they were able to accommodate about six cases for two sessions per week at their ordinary ultra-violet ray sessions, and that, if a sufficient number of persons were sent for treatment, say a minimum of 12 to 20, arrangements might be made for opening the department for two extra sessions per week. Arrangements were accordingly made for sending cases to the ordinary ultra-violet ray sessions for an experimental period of three months. 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 411 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. 245 children under 5 years of age have, in addition to the milk, received free cod liver oil or emulsion. An analysis of the cases shows that 608 per cent. were in full work, but the income per head of the family was sufficiently low to bring them within the scale of income adopted by the Council. These circumstances were due to one. or some, or all, of the following causes :—low wages, large number of children, high rents. 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 57 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. In accordance with Circular 1519 issued by the Ministry of Health in 1938, eggs and butter are granted to expectant and nursing mothers and young children, in suitable cases, either free of charge or at half price, according to the circumstances of the applicant, and, for this purpose, the scale of income used in connection with applications for milk is applied. During 1938, eggs and/or butter have been supplied in 81 cases. Medical Investigation Sub-Committee. The work of this Committee continues to prove of great value. It consists of the medical members of the Council, S. Boyd, Esq., M.S., F.R.C.S., S. Monckton Copeman, Esq., M.D., F.R.C.P., F.R.S., L.C.C., and L. G. Glover, Esq., M.A., M.D. Miss I. Finlayson, M.B., Ch.B., who was a co-opted member of the Maternity and Child Welfare Committee until November, was also a member of this sub-committee. (Miss M. E. Drew, M.B., Ch.B., took her place after November, both on this Sub-Committee and as a co-opted Member of the Maternity and Child Welfare Committee.) The late Alderman Collingwood Andrews, M.A., M.D., served on the sub-committee until his death. The sub-committee investigated 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 Infant 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. 58 The Committee investigated:— Deaths of Infants under 2 years 66 Still Births 37 Puerperal Fever 4 Puerperal Pyrexia 20 Maternal Deaths 1 Total 128 During the course of investigation the following facts emerged, which are of interest. Of the 66 deaths under 2 years of age, 76 per cent. occurred in institutions. Of the 34 deaths occurring during the first month, 2 of these babies were found abandoned, and 15 per cent. of the mothers had not received ante-natal supervision. Of the 26 deaths between one month and one year, 50 per cent. had never attended an infant welfare centre. Of the 37 still births, 34 of the mothers had received ante-natal supervision, either by general practitioners, at hospitals, or at the Council's Clinics. There were 19 deaths of illegitimate children under two years of age, which represents a Mortality Rate of 84 per 1,000 illegitimate births as compared with 25 for legitimate children. School Entrants. In order that information relating to the early nurture and illnesses of children and to the general home conditions, may be made available for the School Medical Officer, records relating to the health of school entrants are entered on special cards supplied by the London County Council for that purpose, which are forwarded to the County School Medical Officer. Through the kindness of the Medical Officer of Health and School Medical Officer of the London County Council, I am enabled to submit the following tables, showing the results of routine examinations of 588 elementary school entrants in Hampstead during 1938. I am also informed of any school children in the Borough who are found, at the routine School Medical Inspection, to be slightly below normal, or bad, 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 ill-nourished who may, by chance, be unknown to my Health Visitors. 65 Table showing Results of Routine Medical inspection of Entrant Children in Hampstead to Elementary Schools during the year 1938, indicating the conditions with regard to Clothing, Nutrition, Cleanliness and Teeth of the Children examined. Number who were examined. Clothing and Boots. Nutrition. Cleanliness of Head. Cleanliness of Body. Teeth. Good. Fair. Poor. Good. Average. Below normal. Bad. Clean. Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than 4 decayed. 4 or more decayed. No. rec. for treatment Entramts: Boys 300 280 19 1 55 229 16 - 300 - - 300 - - 181 93 26 119 Girls 288 281 7 - 61 212 15 - 287 1 - 288 - - 156 92 40 126 Total 588 561 26 1 116 441 31 - 587 1 - 588 - - 337 185 66 245 Hampstead per centages 95.4 4.4 0.2 19.7 75.0 5.3 - 99.8 0.2 0.0 100.0 0.0 0.0 57.3 31.5 11.2 41.7 London per centages 55.8 43.9 0.3 15.3 78.2 6.5 98.1 1.7 0.2 98.9 1.0 0.1 59.7 32.7 7.6 380 60 Table; showing results of Routine Medical Inspection of Entrant Children in Hampstead to Elementary Schools during the year 1938, indicating the Defects found. f=defects found. o=noted for treatment and included in defects found. Disease or Defect. Boys (300). Girls (288). Hampstead. per cent. London. per cent. Hampstead. per cent. London. per cent. Skin disease f - 0.0 1.3 - 0.0 1.1 o - 0.0 0.9 - 0.0 0.7 Enlarged Tonsils f 35 11.7 14.2 22 7.6 13.2 o 9 3.0 5.6 9 3.1 4.7 Enlarged Adenoids f 1 0.3 1.1 1 0.3 0.7 o 1 0.3 0.8 - 0.0 0.5 Tonsils and Adenoids f 5 1.7 3.3 3 1.0 2.9 o 4 1.3 2.3 3 1.0 2.0 Other Nose and Throat f - 0.0 1.2 - 0.0 1.0 o - 0.0 0.4 - 0.0 0.4 Glands of Neck f 1 0.3 2.6 2 0.7 2.1 o - 0.0 0.3 - 0.0 0.2 Eye disease f 6 2.0 3.0 6 2.1 3.0 o 3 1.0 2.0 3 1.0 2.0 Otorrhœa f 2 0.7 0.8 - 0.0 0.9 o 1 0.3 0.5 - 0.0 0.5 Other Ear Defects f - 0.0 0.3 - 0.0 0.4 o - 0.0 0.2 - 0.0 0.2 Defective Hearing f 3 1.0 0.1 - 0.0 0.1 o 1 0.3 0.0 - 0.0 0.0 Defective Speech f - 0.0 0.3 - 0.0 0.2 o - 0.0 0.1 - 0.0 0.0 Heart f 1 0.3 1.3 - 0.0 1.3 o - 0.0 0.1 - 0.0 0.1 Anaemia f 2 0.7 0.5 - 0.0 0.4 o - 0.0 0.2 - 0.0 0.2 Lungs f 2 0.7 3.0 1 0.3 3.0 o - 0.0 1.2 - 0.0 1.1 Epilepsy f - 0.0 0.0 - 0.0 0.0 o - 0.0 0.0 - 0.0 0.0 Chorea f - 0.0 0.0 - 0.0 0.0 o - 0.0 0.0 - 0.0 0.0 Paralysis f - 0.0 0.1 - 0.0 0.0 o - 0.0 0.0 - 0.0 0.0 Other Nervous Disorders f - 0.0 0.3 - 0.0 0.3 o - 0.0 0.0 - 0.0 0.1 Pulmonary T.B. f - 0.0 0.0 - 0.0 0.1 o - 0.0 0.0 - 0.0 0.0 Other T.B. f - 0.0 0.0 - 0.0 0.0 o - 0.0 0.0 - 0.0 0.0 Ricket - 0.0 1.0 - 0.0 0.4 o - 0.0 0.1 - 0.0 0.0 Spinal Deformities f - 0.0 0.1 - 0.0 0.1 o - 0.0 0.1 - 0.0 0.1 Other Deformities f 2 0.7 1.2 - 0.0 0.9 o 1 0.3 0.6 - 0.0 0.4 Other Defects f 3 1.0 2.5 2 0.7 2.5 o 2 0.7 1.5 1 0.3 1.6 61 per cent. per cent. Percentage of Boys requiring treatment for all def-cts = 43.7 London = 47.5 ,, ,, ,, ,, excluding nutrition and dental defects = 7. 0 „ = 14.9 ,, Girla ,, ,, for all defeats = 47..2 ,, = 47.2 ,, , ,, ,, excluding nutrition and dental defects = 5.6 ,, = 13.5 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 1934 21 1930 15 1935 63 1931 11 1936 27 1932 19 1937 17 1933 13 1938 31 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. The Scheme of Home Nursing has been amended to include the treatment of minor ailments. Details of the arrangements 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. 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 44 patients were admitted to this Ward, their average duration of stay being fourteen days. 62 (II) Queen Charlotte's Hospital. The Borough Council subscribes £1 in respect of every Hampstead mother confined in this Hospital. During 1938, the number of Hampstead women for whom such contribution was made was 29. (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 1938, 50 Hampstead mothers were confined there. The Children's Hospital, College Crescent. The Borough Council has an arrangement with this hospital whereby sick and ailing children, and children needing minor operations such as circumcision, removal of tonsils and adenoids, etc., are admitted. The Borough Council pays 21s. per week per bed occupied and the parents are assessed to pay according to their means. During 1938, 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 1938, 15 mothers, convalescent after their confinements, with their babies were sent to Convalescent Homes; the Borough Council being responsible for the payment and the applicants being assessed by the Assistance Sub-Committee to contribute according to their means. The Convalescent Homes concerned were as follows:Wayside Cottage Convalescent Home 14 Aston Clinton „ ,, 1 The following Homes are managed by Voluntary Committees and receive grants from the London County Council under the Local Government Act, 1929. Beauchamp Lodge, Paddington. 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 63 assessed to contribute according to their means. No child from a Hampstead family was admitted under this arrangement during the year. An alternative arrangement exists whereby such children may be boarded-out with approved "foster-mothers" at the charge of 15s. per week, the parents being assessed to contribute towards the cost as heretofore. During 1938, 3 children were placed with a foster-mother under this arrangement. 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 1938, 17 babies were admitted, the remainder having been admitted prior to 1938. On an average, one-half of the total children accommodated come from Hampstead. The Hampstead Hostel for Mathers 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 1938, there were beds for 9 expectant mothers and 8 beds, with cots, for mothers and babies in the hostel: 39 expectant mothers were admitted and 43 mothers were admitted with their babies. 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 babies. It has accommodation for 16 expectant mothers, and 16 mothers and babies. During 1938, 95 expectant mothers and 84 mothers and 79 babies were admitted. Main Memorial Home, 141, West End Lane. This Home receives unmarried expectant mothers before confinement and mothers with young babies after discharge from hospital. It has accommodation for 7 expectant mothers and 7 mothers and babies. During the year 41 expectant mothers were admitted. The total number of beds available at the Home consist of 14 beds and 7 cots. 64 St. Agatha's House, 39, Lancaster Grove. 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 24 expectant mothers were admitted. Day Nurseries. The Hampstead and North St. Pancras Day Nursery occupies commodious premises at 27 & 29, Pond Street. There are 45-50 places in the Nursery for children under 5 years of age. The total number of attendances made during 1938 was 7,702. 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. Proposed Day Nursery at Kilburn. For some time consideration has been given to the question of the establishment of a Day Nursery or Creche in the Kilburn area. Representations had been made by various bodies in the district, and as a result of investigations which were made the Maternity and Child Welfare Committee were satisfied that a need existed for the establishment of a Day Nursery in the area. This need was further emphasised by the fact that the London County Council had in hand a scheme for rehousing some 550 persons at Kilburn Vale. The greatest difficulty has been experienced in finding a suitable site for the purpose, and even had such a site been available, the cost of acquisition and of the erection of a suitable building would, probably, have been prohibitive. The Borough Council had previously decided that in the event of any County Council housing estates being built in Hampstead the Borough Council would consider the necessity for the provision of a Day Nursery upon the site, on the understanding that the accommodation would be available for the purposes of Maternity and Child Welfare throughout the Borough or otherwise, as the Borough Council, being the Maternity and Child Welfare authority, should decide. It was subsequently agreed between the Metropolitan Boroughs' Standing Joint Committee and the County Council that the latter should be authorised to provide sites or buildings on their housing estates for 65 the purposes of Day Nurseries and Infant Welfare Centres where such sites or buildings were desired by the Borough Council concerned, the equipping, managing, staffing, etc., of such Day Nurseries being carried out by the Borough Council. In these circumstances the County Council was approached with a view to ascertaining whether they would be willing to allocate a portion of one of the new buildings to be erected at Kilburn Vale for the purposes of a Day Nursery, and it is satisfactory to record that great assistance has been received from them in connection with the matter. Tentative proposals were submitted by the County Council providing for a portion of the ground floor of the blocks of flats to be erected on the Kilburn Vale site to be used for the purpose, including living accommodation for residential staff; the accommodation proposed to be allocated having a southern aspect, it being also proposed that a portion of the open space adjoining should be allocated as a play space for the Nursery. These proposals provided accommodation for approximately 40 infants and nurses' quarters, and it was suggested by the County Council that the Borough Council should take a lease for 40 years. It is contemplated that the Staff needed would include a matron, a sister, one staff nurse, three probationers, a cook and a general domestic, and the Scheme provided for living accommodation for all except the cook and a general domestic, such accommodation being provided in the same block of buildings as that in which the proposed Day Nursery would be situated. At its meeting on the 27th January, 1938, the Council approved the proposals in principle and asked the County Council to proceed therewith and to submit actual figures in due course, subject to ultimate agreement, in particular as to the terms upon which the lease may be renewed, as to the use by the Council of the accommodation for other purposes, and to any necessary sanction of the Ministry of Health. Midwifery and Maternity Services. Midwifery and Maternity Nursing in the Home. For the expectant mother who w ishes to have her confinement at home, a scheme has been approved by the London County Council under which a midwife can be engaged (i) to act as a midwife, who 66 will be in charge of the confinement; or (ii) if the services of a doctor have been secured, a midwife can be engaged as a maternity nurse, in which case she will act under the instructions of the doctor. The fee charged for the services of the midwife or maternity nurse will be very moderate. If the full fee cannot be paid it will be reduced or remitted altogether according to the patient's circumstances. The Nurses of the two local Nursing Associations are available under this scheme. Unqualified Maternity Nurses. A further step in the direction of improving the maternity services is provided in Section 6 of the Midwives Act, 1936, which prohibits unqualified persons acting as maternity nurses for gain after the date when the Minister of Health by Order applies the provisions of the Section to any area; which he may do when he is satisfied that an adequate domiciliary midwives' service has been provided in pursuance of the Act. By the County of London (Midwifery—Prohibition of Unqualified Persons) Order, 1938, which came into operation on 1st November, 1938, the Minister of Health applied to London the provisions of Section 6. By virtue of the Order and Section 6 any unqualified woman or any male person who receives any remuneration for attending in London as a nurse on a woman in childbirth, or at any time during the ten days immediately after childbirth, becomes liable on summary conviction to a fine not exceeding ten pounds. Persons not debarred from such attendances are :— (a.) Women certified under the Midwives Act, 1902, or registered in the general part of the register of nurses required to be kept under the Nurses Registration Act, 1919. (b) Persons who, while undergoing training with a view to becoming a duly qualified medical practitioner or a certified midwife, attend on a woman as aforesaid as part of a course of practical instruction in midwifery recognised by the General Medical Council or by the Central Midwives Board. (c) Persons attending on a woman as aforesaid in any nursing home which is registered or which is exempt from registration under Part XI of 67 the Public Health (London) Act, 1936, or in any hospital or other premises excluded from the definition of "nursing home" in section 304 of the same Act. (d) Women, who before 1st January, 1937, have been certified by the authorities of a hospital or institution approved by the Minister to have been trained in obstetric nursing and who have notified the local supervising authority in writing accordingly. 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 referrd 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 1938. Maternal Mortality and Morbidity. One woman died in consequence of child-birth during 1938. This represents a maternal mortality rate of 091 per 1,000 live and still births as compared with 3 0 and 29 for the preceding two years. Obstetric Consultant Service and Emergency Obstetric Service for domiciliary use. . The Borough Council's Scheme for a Consultant Service has been in operation in the Borough for many years. The Consultant can be called upon direct by any medical practitioner in the Borough, but not by midwives. in any case of difficulty or abnormality and for diagnostic purposes in connection with puerperal fever and pyrexia. The medical practitioner calling upon the Consultant is required to inform me at once and to supply some information concerning the case, and a Consultant is required to notify me directly his services have been invoked. The Borough Council guarantees a fee of £5 5s. to a Consultant, and this fee covers his services however limited or extended they may be. It may include the Consultant causing the patient to be removed to a hospital, and any operation performed by him. Upon being informed 68 that a Consultant's services have been utilised, a financial inquiry form is sent to the husband and the facts are submitted to the Assessment Sub-Committee of the Maternity and Child Welfare Committee who assess him to pay part or all of the fee or, if the circumstances justify it, remit the charge. The following are the consultants Basden, Margaret, M,D., F.R.C.S., F.C.O.G., 114, Harley Street, W.l (Welbeck 2157) and 26, Thurlow Road, N.W.3 (Hampstead 0293). Brown, R. Christie, M.S., F.R.C.S., M.C.O.G., 40, Harley Street, W.l (Langham 2638) and The Orchard, 292, Finchley Road, N.W.3 (Hampstead 2628). Gray, Arthur O., M.D., F.R.C.S., F.C.O.G., 114a, Harley Street, W.l (Welbeck 4886). Rivett, L. C., M.C., F.R.C.S., F.C.O.G., 135, Harley Street, W.l (Paddington 0061) and 3, Hanover Terrace, Regent's Park, NW.1 (Paddington 0061). White, Norman L., M.D., F.R.C.S., M.C.O.G, 115a, Harley Street, W.l (Welbeck 6077) and Avenue House, Belsize Park Gardens, N.W.3 (Primrose 5147). The Borough Council's Scheme applies to Hampstead residents only, who cannot afford a Consultant's ordinary fee. During the year the services of the Consultants were called for under this Scheme in five cases. In four instances a nominal charge was made to the husband towards the cost of the services of the Consultant, the whole fee being paid by the husband in the other instance. The London County Council, in pursuance of the suggestion of the Ministry of Health expressed in Circular No. 1622 of 1937 has established an Emergency Obstetric Service for domiciliary use in connection with its hospitals—the County Council being the hospital authority in London and not the Metropolitan Borough Councils. This service is for the purpose of dealing with acute obstetric emergencies in cases in which patients cannot be moved to hospital without undue risk. Medical practitioners telephone to the London Ambulance Service of the London County Council, and an ambulance is sent to one of the County Council Hospitals to pick up a unit which consists 69 of (1) a doctor with special obstetric experience, (2) midwife and (3) the appropriate equipment. If a blood transfusion is considered essential, and no relative being a suitable donor, arrangements are made with the British Red Cross Blood Transfusion Service. A midwife has the right to call out the Emergency Service, but only if it is found impossible to obtain a doctor locally and the emergency is grave. In connection with this service the County area has been zoned into districts and Hampstead, Hammersmith, St. Mary Abbots and Paddington form one district. The Council at its meeting on December 22nd agreed to make use, where necessary, of the service, and to pay the sum of £5 5s. in respect of each patient attended. In their letter outlining the procedure proposed for working the service the County Council pointed out that they had no power to incur expenditure in connection with the provision of this service, any such expenditure having to be borne by the Metropolitan Borough Councils under their Maternity and Child Welfare powers in Part XII of the Public Health (London) Act, 1936. The cost of the service was fixed at £5 5s. in respect of each occasion on which it is utilised, and the County Council asked to be informed if the Borough Council desired to make use of this service, where necessary, and whether it agreed to the payment of £5 5s. in respect of each patient attended. As previously stated, arrangements already existed in the Borough for the services of a consulting obstetrician to be available in any case of difficulty or abnormality, but the new emergency service was not intended to conflict in any way with the existing facilities. There were two matters in connection with the scheme which it appeared to the Borough Council required further consideration, viz.:-(i) the actual arrangements in connection with the appointment of a doctor with special obstetrical experience, who it was intended could form part of the ambulance unit; and (ii) the precise arrangements in connection with the zoning of districts and the division of the service between hospitals within those districts. The Maternity and Child Welfare Committee were of opinion that the proposal generally would be likely to prove an excellent addition to the maternity services available, although it was not anticipated that any very considerable use of any such scheme would 70 be required. At its meeting in October the Borough Council resolved that the County Council should be informed that they approved in principle of the scheme for an emergency obstetrical service, but desired to have an opportunity of considering the matter further when details upon the points referred to were available. 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. Od. 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. The Maternity and Child Welfare Committee agreed to vary the scale of charges in 1937 with a view to making this valuable service more available to the poorer members of the public. The scale is now 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. 71 (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 22 mothers availed themselves of this facility, being assessed to contribute at charges varying from 10d. to 5s. Od. a day, and in nine 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 135 outfits were supplied during 1938. In 31 instances the full price was paid for the 5s. 6d. outfit. „ 75 „ „ „ 3s. 8d. „ „ 17 „ the applicants were assessed to contribute towards the cost of the 3s. 8d. outfit, the charges varying from 1s. to 2s. „ 12 „ the 3s. 8d. outfit was supplied free of charge. 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, 1938, there were in the Borough 21 fostermothers having charge of 35 foster-children. 72 Number of foster-children removed 101 „ foster-children added 96 „ foster-mothers removed 18 „ foster-mothers added 16 „ visits paid by Health Visitors to foster- children 497 „ visits paid by Health Visitors to foster- mothers 275 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 57 applications for placing foster-children were referred to other Authorities as we had no vacancies. The need for such accommodation is as pressing as ever and 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. 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. During the year one foster-child died, but it was not 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 73 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 Rorough where infants are accommodated, viz.:— St. Agatha's House, 39, Lancaster Grove. The Cross Roads Club, 88, Alexandra Road. The Hampstead Hostel for Mothers and Rabies, 7, Fitzjohn's Avenue, and The Main Memorial Home, 141, West End Lane. An annual inspection has been made of the 11 boarding schools in the Rorough, 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. The Municipal Dental Clinic is held at the Public Health Station, Lithos Road; the Dentist is Mr. Roy M. Hastings, L.D.S., R.C.S. Eng. Municipal Dental Clinic. The following is a summary of the work carried out during the year:— Number of Sessions held 76 Number of New Patients 360 Total Attendances of all patients 1489 Number of Fillings 483 Number of Scalings 53 Extraction cases Total Number of Teeth extracted 920 Gas Administrations 248 Local Administrations 10 Without Anaesthetic 2 74 Number of Dentures (including repairs) 91 Number of Dressings and Root Treatment 297 Number for Advice 444 Number of Dentures visits 239 In June, owing to the increased attendances and in consequence of the insufficiency of the accommodation available for properly treating the patients, it was resolved to increase by six sessions yearly the number of dental sessions at which anaesthetics are administered by the Assistant Medical Officer of Health. 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 Orthopaedic 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. Grants to Voluntary Associations. It had been the practice of the Borough Council to contribute to the local Nursing Associations in respect of their midwifery and maternity nursing work as follows:— Kilburn and West Hampstead District Nursing Association:— £100 per annum for midwifery, and £100 per annum for maternity nursing. Hampstead District Nursing Association:— Maternity and Midwifery cases £3 3s. per case. As, however, these services were no longer rendered under the agreements as services arranged for by the Borough Council, they having been included in the County Council's Scheme for London under the Midwives Act, 1936, the Borough Council resolved on the 24th March, 1938, to discontinue the grants at the end of that financial year, 75 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. 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, 76 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 Grove. Do. do. 331 Main Memorial Home, 141, West End Lane Do. do. 584 Eagle's Nest, 33, Fitzjohn's Avenue Babies' Home 652 Name of Association. Services in respect of which contribution is payable. Amount of annual contribution to be paid by the Hampstead Borough Council. £ Hampstead Council of Social Service (5 Centres):— 107, Kingsgate Road Baptist Chapel, Heath Street Infant Welfare Centres 725 Emmanuel Parish Institute, Broomsleigh Street Wesleyan Church Hall, Lisburne Road | Congregational Church Hall, Avenue Road Hampstead and North St. Pancras Day Nursery, 27, Pond Street Day Nursery 400 Section 4. Sanitary Circumstances of the Borough. 79 Sanitary Circumstances of the Borough. Water. The water supply of the Borough is under the supervision and control of the Metropolitan Water Hoard. No samples of the general water supply were taken for examination by the Council. Public Cleansing. The collection and disposal of house refuse in the Borough is under the jurisdiction of the Works Committee and the scheme is administered by the Borough Engineer (Mr. J. E. Swindlehurst, M.A., A.M.I.C.E.), to whom I am indebted for the following information. Dust Collection and Disposal. The quantity of house and trade refuse collected and sent to shoot was 31.632 tons, as against 30,327 tons in the previous year, while the dustmen paid no fewer than 1,722,885 calls, compared with 1,663,475 last year. Five of the S.D. Dustless Loaders which had reached the end of their useful life were withdrawn from service, and a further two obsolescent vehicles kept in reserve as spares, the whole being replaced by six rear-loading Dennis Machines of 15 cubic yards capacity and one of 10 cubic yards. A new shelter for the workmen was erected at the dust shoot on the L.M.S. Railway siding at Finchley Road. The Council agreed to join with the other London Boroughs in a proposed publicity scheme with reference to the health and economic aspects of the storage and disposal of house refuse. The net cost of the Dusting Service was £35,261. Sanitary Inspection. The Council employs nine male Sanitary Inspectors, and also one woman Sanitary Inspector, 40 per cent. of whose time is devoted to the work of a Health Visitor. The following statements contain particulars required to be submitted under Article 19 (15) of the Sanitary Officers Order, 1926, and affords some slight indication of the work performed by the Sanitary Inspectors. These Inspectors attend at the Offices of the 80 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 1938:— Total number of inspections 4,126 Total number of re-inspections and other visits and re-visits 15,130 Total number of dwelling-houses inspected for housing defects 1,714 Number of these found not in all respects reasonably fit for human habitation 1,180 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), 1,664 relating to 1,281 premises. (2) Statutory 906 relating to 409 premises. Investigation of Complaints, Inspection of Factories. Number of complaints investigated 906 ,, „ premises inspected after the occurrence of infectious disease 170 „ ,, inspections of Factories with mechanical power (excluding bakehouses) 144 ,, „ inspections of Factories without mechanical power (excluding bakehouses) 62 „ „ inspections of Other Premises under the Factories Act 101 ,, „ inspections of Bakehouses, Milkshops and other food premises 830 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 376 Closed, or illegal occupation discontinued 28 Made to conform 113 81 Verminous conditions. Totals. Rooms disinfested 94 Number of houses concerned 51 Beds and bedding disinfested 45 Floors of rooms cleansed 36 Animals. Nuisances from improper keeping in rooms abated — Nuisances from improper keeping on the premises abated 1 Smoke nuisances. Complaints received 7 Observations made 14 Notices served 1 Drainage systems, &c. Drainage systems repaired or renewed, partly or wholly 366 Plumbing defects remedied (soil pipes, waste pipes, etc.) 564 Roofs, rainwater pipes and gutters repaired or renewed 258 Water supply. Water supply provided to separate lettings 176 Number of houses concerned 148 Sinks provided to separate lettings 240 Number of houses concerned 197 Water cisterns cleansed or covered 11 Water-Closets. Additional provided 130 Removed from improper position 18 Flushing cisterns repaired 78 Yards, &c. Paving, &c. Yards or open spaces newly paved and drained 70 Paving of yards or open spaces repaired 79 Bathrooms. New provided 187 Dust Bins Repaired or renewed 123 Houses or parts cleansed (other than verminous conditions) 167 Number of rooms concerned 341 Dampness in houses or parts abated 226 Details of work, etc., supervised or action taken by the Sanitary Inspectors, whether under notice or voluntary, at Registered Tenement Houses:— Totals. Underground rooms. Illegally occupied—found, or brought to the Inspectors' notice 61 Closed, or illegal occupation discontinued 14 Made to conform 49 Verminous conditions. Rooms disinfested 83 Number of houses concerned 69 Beds and bedding disinfested 4 Floors of rooms cleansed 3 Animals. Nuisances from improper keeping in rooms abated 1 Nuisances from improper keeping on the premises abated — Drainage systems, doc. Drainage systems repaired or renewed, partly or wholly 91 Plumbing defects remedied (soil pipes, waste pipes, &c.) 105 Roofs, rainwater pipes and gutters repaired or renewed 239 Water supply. Water supply provided to tenements 10 Number of houses concerned 10 Sinks provided to tenements 45 Number of houses concerned 43 Water cisterns cleansed or covered 7 82 Totals Water-closets. Additional provided 32 Flushing cisterns repaired 49 Removed from improper position — Yard, &c., Paring, &c. Yards or open spaces newly paved and drained 16 Paving of yards or open spaces repaired 52 Hath rooms. New provided 3 Dust Bins. Repaired or renewed 92 Miscellaneous. Window cords repaired or renewed 236 Window fittings repaired or renewed 167 Filth and refuse removed from rooms 2 Washing (of clothes) accommrdation provided 2 Coppers repaired or renewed 62 Suitably ventilated food cupboards provided 337 Kitchen ranges repaired or renewed 106 Common staircases repaired 34 Common staircases provided with adequate means of natural light 1 Common staircases provided with adequate means of artificial light - Houses or parts cleansed (excluding verminous rooms) 758 Number of rooms concerned 1329 Dampness in houses or parts abated 447 Dilapidated houses or parts repaired 616 The sanitary work in the foregoing tables includes drainage and plumbing work for which approval is obtained from the Borough Council. 618 drainage application forms and plans were submitted during the year. 68 of these were for work carried out under notice, and 550 were for alterations and additions carried out voluntarily by the owners. The standard of work is governed by the Bye-laws of the London County Council. Byelaws as to Lodging Houses for the Working Classes. The London County Council, on 1st March and 19th July, 1938, made new byelaws under Section 6 of the Housing Act, 1936, with respect to houses which are occupied, or are of a type suitable for occupation, by persons of the working classes and let in lodgings or occupied by members of more than one family. These byelaws replace the byelaws made in 1926, and 1931, under the Public Health (London) Act, 1891, and the Housing Act, 1925. The new byelaws are in similar terms to the old byelaws, but the following three important points should be noted, viz.:—(1) The new byelaws are intended to apply to houses in which two or more families reside, whether or not the "occupier" himself resides on the premises. The "occupier" is defined as the person (whatever may be the nature or extent of his interest in the premises) by whom or on whose behalf a lodging-house 83 is let in lodgings or for occupation by members of more than one family, or who, for the time being, receives or is entitled to receive the profits arising from the said letting; (2) Provision is included relating to the prevention of nuisances arising from or in part of a building or an underground room in respect of which a closing order under Section 12 of the Housing Act, 1936, is in force; (3) It is necessary to provide and maintain, in connection with every tap from which water may be drawn, a suitable sink or other efficient means for carrying off any waste water from the tap. Fifteen tenement houses were added to the Register, and six tenement houses were removed from the Register, making a total of 1,573 tenement houses on the Register. During the year, 649 tenement houses were inspected and 3,500 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 are situate *the rooms or lodgings in the separate occupation of the family (a) Water-closet accommodation; and (b) Accommodation for washing clothes. The enforcement of these and other Byelaw requirements occupies a considerable amount of time of the Sanitary Inspectors. During the year 32 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, and by the London County Council (General Powers) Act, 1937, no less than 337 suitably ventilated food cupboards were provided during 1938. Other statistics relating to improvements effected in tenement houses will be found on reference to the table earlier in this Section of the Report. 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, viz.:—6, Kelson Street, where the business of a dealer in Rags, etc., is carried on. 84 Offensive Trades. No offensive trade is carried on in the Borough. Increase of Kent and Mortgage Interest (Restrictions) Acts. Number of certificates applied for 25 „ „ issued 19 Factories Act, 1937. Section 128 of the Act requires every Medical Officer of Health in his Annual Report specially to report on the administration of these Acts and to send a copy of his Annual Report to the Secretary of State. It is the statutory duty of the Borough Council to keep a Register of all Factories situated within their district, with respect to which the Council is responsible for the enforcement of any of the provisions of Part 1 of the Act. At the close of the year there were 510 Factories on the Register. 287 inspections were made and 52 written notices were served. It was not found necessary to institute legal proceedings in any case. The following is a list of the different classes of Factories in Hampstead:— Tailors 62 Opticians 3 Milliners and dressmakers 64 Carpet beaters 3 Bootmakers 69 Basket makers 3 Builders 19 Radio repairs 4 Motor and other engineers 56 Glass works 5 Cabinet makers and upholsterers 33 Saddle and trunk makers 4 Monumental masons 3 Picture frame makers 11 Timber merchants and wood sawyers 5 Watchmakers and jewellers 14 Confectionery and ice cream 6 Shop and exhibition fitters 3 Florists 5 Coachbuilders 4 Hand knitting 6 Laundries 2 Corsets and surgical belt makers 5 Coffee roasters 4 Electricians 4 Photographers 6 Butchers 6 Hair curlers makers 20 Ironmongers and fitters 7 Miscellaneous 41 Furriers 3 Total 510 Hairdressers 10 Dyers and cleaners 13 Printers 7 85 The following Tables are submitted at the suggestion of the Secretary of State on the administration of the Factory and Workshop Act, 1901, and the Factories Act, 1937 (which superseded the Act of 1901 on 1st July, 1938). 1.—Inspections for purposes of provisions as to health, including inspections made by Sanitary Inspectors :— Premises. Number of Inspections. Written Notices. Occupiers Prosecuted. (1) (2) (3) (4) Factories (With mechanical power) 211 42 Nil. Factories (Without mechanical power) 76 10 Nil. *Other premises Under the Act (including works of building and engineering construction but not including outworkers' premises) 101 20 Nil. Total *Electrical Stations reckoned as factories. 388 72 Nil. 2.—Defects found:— Particulars. Number of Defects. Number of defects in respect of which Prosecutions were instituted. Found. Remedied. Referred to H.M. Inspector. (1) (2) (3) (4) (5) Want of cleanliness (S. 1) 59 59 Nil. Nil. Overcrowding (S. 2) Nil. Nil. Nil. Nil. Unreasonable temperature (S. 3) Nil. Nil. Nil. Nil. Inadequate ventilation (S. 4) 3 3 Nil. Nil. Ineffective drainage of floors (S. 6) 4 4 Nil. Nil. Sanitary Conveniences (S. 7) insufficient 9 9 Nil. Nil. unsuitable or defective 11 11 Nil. Nil. not separate for sexes Nil. Nil. Nil. Nil. Other offences 86 86 Nil. Nil. (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) Total 172 172 Nil. Nil. 86 Outwork in unwholesome premises (Section 108 of Act of 1901; Section 111 of Act of 1937). No case arose during the year of outwork being conducted in unwholesome premises. Abstract of the Act.—The Medical Officer of Health is required to give written notice to H.M. Inspector of any factory coming to his knowledge in which no abstract of the Act is affixed in accordance with the Act. During the year two factories were so reported. The Factories Act, 1937, consolidated, with amendments, the various Acts that had been passed from 1901 to 1929 relating to factories and workshops. It came into operation on the 1st July, 1938. The term "workshop" has been omitted and a factory is defined by Section 151 as, inter alia, any premises in which, or within the close or curtilage or precincts of which, persons are employed in manual labour in any process for or incidental to any of the following purposes, namely:—(a) the making of any article or of part of any article; or (b) the altering, repairing, ornamenting, finishing, cleaning, or washing, or the breaking up or demolition of any article; or (c) the adapting for sale of any article; being premises in which, or within the close or curtilage or precincts of which, the work is carried on by way of trade or for purposes of gain and to or over which the employer of the persons employed therein has the right of access or control. Any Workplace in which, with the permission of or under agreement with the owner or occupier, two or more persons carry on any work which would constitute the workplace a factory if the persons working therein were in the employment of the owner or occupier, is to be deemed to be a factory for the purposes of this Act. The former principal Act of 1901 applied to some extent provisions of the Public Health Acts to Workshops and treated defaults as nuisances under those Acts. Under the new Factories Act this method is abandoned. The operative provisions for factories generally are contained in the Factories Act itself, and when these are not observed the factory occupier or other person responsible becomes liable to a fine on summary conviction. Thus, Section 106 of the 87 Public Health (London) Act, 1936, which relates to sanitary conveniences for factories, Section 120 which relates to nuisances and Section 129 which relates to the lime washing and washing of certain factories, workshops and workplaces no longer apply to any factory to which the new Act applies. Requirements are enforceable by the Borough Council in factories in which mechanical power is not used, relating to (i) Cleanliness; (ii) Overcrowding, which is deemed to exist, subject to certain provisos, if the number of persons employed is such that the amount of cubic space allowed for every person employed in the work-room is less than 400 cubic feet (a Notice must be exhibited in every workroom specifying the number of persons who may be employed therein); (iii) Temperature and (iv) Ventilation (effective and suitable provision must be made for securing and maintaining a reasonable temperature in every workroom and for adequate ventilation), (v) Drainage of floors—where any process is carried on which renders the floor liable to be wet to such an extent that the wet is capable of being removed by drainage, effective means are required to be provided and maintained for draining off the wet. Requirements relating to Sanitary Conveniences are enforceable by the Rorough Council in all factories, whether mechanical power is used or not; and, where persons of both sexes are employed, separate accommodation must be provided for persons of each sex. Bakehouses.—The Act repeats previous sanitary regulations and requirements relating to these premises. 500 cubic feet per person are still required for underground bakehouses and 400 cubic feet per person between 9 p.m. and 6 a.m. for other bakehouses where work is carried on at night by artificial light other than electric light. The Act contains new and important clauses relating to Underground Bakehouses. Tt is illegal to use any such premises unless it was used at the date of the passing of the Act, and unless a certificate of suitability had been issued by the Borough Council in respect thereof. Any basement bakehouse which, for a period exceeding one year, is not used as a bakehouse may not be so used again. The Council is required to examine every basement bakehouse and if they are not satisfied as to its suitability it may not be used as such. This special examination of basement bakehouses, which is distinct from routine inspections, is required to be carried out every fifth year. The survey is referred to in Section 6 of this Report, 88 Outworkers—(Home Work). Certain specified classes of work done at the homes are controlled by the Act. There are 82 such outworkers (or home-workers) in Hampstead known to the Public Health Department. Of these 57 arc 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 during February and August in each year, and to show thereon all outworkers employed during the previous six months. In February, 38 lists were received, and 37 lists in August. These lists included the names of 111 and 101 home-workers 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 133, 20 belonged to Hampstead and 113 elsewhere. Particulars of the latter were sent to the Local Authorities concerned, while information concerning 27 outworkers resident in Hampstead was received from other Authorities. In no instance during 1938 was homework found to be carried on in unwholesome premises. Rats and Mice (Destruction) Act, 1919. The Borough Council issues an advisory leaflet on the eradication of rats and mice, and rat poison 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. Advice and help has been given by the Sanitary Inspectors in connection with 66 complaints of nuisances 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, and baited traps were used in the sewers. Shops Act, 1934. During the year 383 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 conveniences for use of persons employed in or about the shop. 89 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 seven complaints of smoke nuisance were received. Fourteen observations were made and one notice was served. Camping Sites. No sites in the Borough were used for camping purposes during 1938. Swimming Baths and Pools. (a) Public. (1) The Municipal Central Baths, Finchley Road. These swimming baths consist of three baths (Ladies' 1st and 2nd class and Men's). Details of the method employed to treat the Bath Water, etc., were published in my Annual Report for 1935. During 1938 the Public Health Department took samples of water from the various baths at the Central Baths, three for chemical and three 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 1938, 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 1938, no sample of the bath water was taken for chemical or for bacteriological examination, 90 Eradication of Bed Bugs. The following particulars indicate the action taken for the eradication of bed bugs. (1) The number of (a) Council Houses, (b) other houses, (i) found to be infested, (ii) disinfested. No. of (A) (i) Council Houses situated in the Borough of Hampstead. (a) found to be bug infested 2 (b) disinfested 2 (ii) Council Houses situated outside the Borough of Hampstead (in Hendon). (a) found to be bug infested 3 (b) disinfested 3 (B) Other Houses. (a) found to be bug infested 120 (b) disinfested 120 (2) The methods employed for freeing infested houses from bed bugs and the name of the fumigant and/or insecticide used. In premises other than Council property the routine procedure now adopted by the Public Health Department following a complaint of bug infestation is as follows:—(i) the complaint is entered in the register of complaints, (ii) the Sanitary Inspector visits the premises to verify the complaint. If defects are found in the premises that are likely to harbour vermin, an Intimation Notice is served on the Owner. The Sanitary Inspector also arranges, when desirable, for (a) the removal of the bedding, etc., for treatment at the Disinfecting Station, free of charge, (b) the free disinfestation of the premises by the Council's Disinfecting Staff with a solution of cresylic acid in kerosene, the strength of the cresylic acid in kerosene being 3 per cent. Should a recurrence occur, subsequent disinfestation is done by the occupiers. For this purpose tenants are given, upon application, bottles of the preparation referred to, and they may purchase from the Public Health Department hand sprayers at a cost of 1s. In suitable cases no charge is made for these sprayers. In any special case where there has been an excessive application for the solution or special complaint of a recurrence of bugs, a repeat inspection is made by a 91 Sanitary Inspector and disinfestation is again carried out by the Council's Disinfectors. Whenever disinfestation is asked for by builders or landlords, a nominal charge is made except in exceptional cases. In the cases of infestation of the Council's housing property, the woodwork of the rooms was removed, a blow-lamp was used, and the woodwork was treated with carbolic acid before being replaced. (3) The methods employed for ensuring that the belongings of tenants are free from vermin before removal to Council houses. In the case of all families removing to the Borough Council's "Westcroft" Housing Estate, the following procedure is adopted. Arrangements are made whereby a specialist firm undertakes the removal and disinfestation of the effects of all families removing to the Estate, and for other necessary work to be carried out by the Council's disinfecting staff. Bugs are eradicated from furniture, bedsteads, etc., by subjecting them to a 2 5 per cent. concentration by volume of Hydrogen Cyanide for four hours in specially constructed vans. Ventilation is then carried out until a series of tests made with Sieverts and Hermsdorf reagent show no dangerous concentration of H.C. remaining. Generally the procedure adopted is as follows:— Early in the morning of the day of removal, the bedding, mattresses, curtains, clothing, etc., are collected and brought to the Public Health Station, where they are subjected to superheated steam (temperature 275° F.) for twenty minutes in the disinfecting chamber at a pressure of 15-20 lbs. per square inch, and are afterwards dried. Furniture removal vans collect the furniture, household effects, carpets, etc., and on arrival at the Public Health Station, the vans are hermetically sealed after hydrogen cyanide (prussic acid gas) has been released. After the expiration of four hours the vans are re-opened and ventilated. The household effects are then transported to the new home. Upholstered furniture is beaten in the open air before being taken into the house. It was decided that this procedure should apply to all families removing to the Westcroft Estate, and no objection has been met with 92 in any case. A letter of advice is sent to the prospective tenants when they are notified of the day on which removal to the new Estate is to take place. This communication is in the following terms:— Before delivery to the new premises your furniture and effects will be fumigated. Drawers and boxes, etc., should not be packed tightly, nor should they be locked as their contents must be ventilated after fumigation. Food, plants, or wet clothes must not be packed with the furniture. Money, valuable papers, jewellery, etc., must not be put in the van, but conveyed by yourself to the new premises. Furniture and bedding will be delivered at your new address as early as possible in the afternoon or evening of the same day of collection. All your effects must be carefully cleansed before the day of removal. Do not take unwanted articles of any kind with you to your new house. The rooms must be especially well ventilated on the first evening and night of occupation. No such procedure has been instituted in the case of the Council's flats in the Borough known as Park Dwellings and South End Close. In the list of Regulations and Conditions of Tenancy of "Westcroft" Housing Estate, printed on the Form of Application for Tenancies and to which every applicant is required to agree to conform, there is the following entry:— "If on vacation by a tenant the premises shall be found to be in a dirty or verminous condition requiring special cleansing, etc., the tenant shall pay the cost of such cleansing, etc." (4) Whether the work of disinfestation is carried out by the Local Authority or by a contractor. The work of disinfestation indicated in paragraph 3, is carried out by a specialist firm of contractors. In the case of disinfestation of premises referred to in (1) (A) (i) and (ii) this has been carried out by the Borough Council's Staff, and in (B) by the tenants, builders, or landlords, 93 (5) The measures taken by way of supervision or education of tenants to prevent infestation or re-infestation after cleansing. In the case of tenants of other than Council owned premises the Sanitary Inspectors give every possible help and advice, and excrcise such supervision as is desirable with the object of preventing infestation or re-infestation after cleansing. In the case of an infested tenant of Council housing property, the Superintendent gives verbal advice, lends a hand-sprayer and gives the solution referred to in answer to Question No. 2, to the tenant. Cleansing and Disinfection of Verminous Persons and their Belongings. A reference to these matters will be found in Section 7. Removal of aged, infirm, or physically incapacitated persons. The powers conferred by Section 224 of the Public Health (London) Act, 1936, were not employed during 1938. Nuisance by Dogs. The practice of exhibiting warning posters throughout the Borough calling the attention of the general public to fines imposed for breaches of the Byelaw relating to nuisance caused by dogs has been continued during the year. Early in 1938 the General Purposes Committee gave consideration to a resolution from the Public Health Committee on the subject of a letter considered by the latter Committee from the Home Office with reference to the fouling of footways by dogs with which letter was enclosed a memorandum, forwarding a copy of a new Bye-law in a form which the Home Office were prepared to allow for an experimental period of not more than two years in the first instance. The Bye-law on the subject hitherto in force provided that an offence was only committed while the dog was on the lea-d. In view of the fact that many complaints had been received as to the condition of the fouling of the footways, the Council concurred in the opinion that for an experimental period such new Bye-law should be made, the terms of which are as follows:- (1) No person being in charge of a dog shall allow the dog to foul the footway of any street or public place by depositing its excrement thereon, 94 Provided that a person shall not be liable to be convicted of an offence against this bye-law, if he satisfies the Court that the fouling of the footway by the dog was not due to culpable neglect or default on his part. (2) For the purposes of this bye-law the owner of the dog shall be deemed to be in charge thereof, unless the Court is satisfied that at the time when the dog fouled the footway it had been placed in or taken into the charge of some other person. (3) Any person offending against this bye-law shall be liable on summary conviction to a fine not exceeding forty shillings. (4) This bye-law shall cease to be in force on the 24th March, 1940, unless a bye-law re-enacting its provisions has come into operation before that date. (5) As from the date on which this bye-law comes into operation, the byelaw made by the Council on 27th June, 1929, under Section 23 of the Municipal Corporations Act, 1882, Section 16 of the Local Government Act, 1888, and Section 5 of the London Government Act, 1899, as to nuisances by dogs upon the public footways shall be and is hereby repealed. The Borough Council formally approved the new Bye-law at its meeting on the 24th March, 1938, and, having received the approval of the Secretary of State it came into operation on the 1st July, 1938. There have been 22 prosecutions under these bye-laws during the year. Rag Flock. The sale and use of Rag Flock is regulated by the Public Health (London) Act, 1936, and by the Regulations made by the Ministry of Health in 1912. By Section 136 no person may (a) sell rag flock, (b) have rag flock in his possession for the purpose of selling it, or (c) use rag flock for the purpose of making bedding, cushions or any article of upholstery, or have in his possession rag flock intended to be used for that purpose unless it conforms to a standard of cleanliness prescribed by Regulations made by the Minister. These Regulations prohibit the sale or use of unclean flock manufactured from rags in making any article of upholstery, cushions, bedding, etc., and provide that when 95 not less than 40 grams of flock are thoroughly washed with distilled water at a temperature below 25° C. the chlorine must not exceed 30 parts per 100,000 of flock. There are no sellers of rag flock in the Borough, and only two firms use rag flock for the purposes referred to above. 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 1938:- Date of Hearing. Nature of Offence. Result of Hearing. 1938. 5th Jan. Contravention of Dog Nuisance Byelaw. Fined 10s. 5th Jan. Non-deposit of plans. Fined 10s. 12th Jan. Nuisance under Public Health (London) Act, 1936. Order made to abate in 28 days and pay 9s. Court costs. 17th Jan. Nuisance under the Public Health (London) Act, 1936. Order made to abate in 21 days and pay £5 5s. costs. 9th Feb. Selling rum containing 6.5 per cent. added water. Fined £3 and £1 11s. 6d. costs. 9th Feb. Selling whisky containing 5.4 per cent. added water. (a) Fined £3 and 15s. 6d. costs. (b) Fined £3 and 15s. 6d. costs. 10th Feb. Contravention of Dog Nuisance Byelaw. Dismissed. 10th Feb. Contravention of Dog Nuisance Byelaw. Fined 2s. 6d. 16th Feb. Contravention of Dog Nuisance Byelaw. Fined 10s. 16th Feb. Contravention of Dog Nuisance Byelaw. Dismissed. 25th Feb. Selling whisky containing 6.5 per cent. added water. (a) Dismissed under the Probation of Offenders Act on payment of £5 costs. (b) Do. do. 18th Mar. Nuisance under the Public Health (London) Act, 1936. Work done, costs paid, withdrawn. 15s. 6d. Summons 18th Mar. Contravention of Drainage Byelaw. Fined 20s. and 20s. costs. 23rd Mar. Selling beef sausages containing preservatives (sulphur dioxide) without being labelled. Fined £1 and £1 11s. 6d. costs. 31st Mar. Contravention of Dog Nuisance Byelaw. Fined 2s. 6d. 31st Mar. Contravention of Dog Nuisance Byelaw. Fined 2s. 6d. 31st Mar. Contravention of Dog Nuisance Byelaw. Withdrawn. 96 Date of Hearing. Nature of Offence. Result of Hearing. 1938. 14th Oct. Selling minced beef containing sulphur dioxide. Dismissed under the Probation of Offenders Act on payment of £2 2s. costs. 14th Oct. Contravention of Dog Nuisance Byelaw. Dismissed under the Probation of Offenders Act on payment of 2s. costs. 14th Oct. Contravention of Dog Nuisance Byelaw. Fined 5s. 14th Oct. Contravention of Dog Nuisance Byelaw. Fined 2s. 6d. 14th Oct. Contravention of Dog Nuisance Byelaw. Fined 5s. 6th April. Contravention of Dog Nuisance Byelaw. Fined 10s. 6th April. Contravention of Dog Nuisance Byelaw. Fined 10s. 6th April. Selling cream cheese deficient in fat. Fined £1 and £1 11s. 6d. costs. 7th April Selling sardines containing lead 27 parts per million. Dismissed under the Probation of Offenders Act on payment of £10 10s. costs. 10th April Contravention of Dog Nuisance Byelaw. Fined 10s. 21st April Nuisance under the Public Health (London) Act, 1936. Nuisance abated and summons withdrawn. 21st April Nuisance under the Public Health (London) Act, 1936. Order to abate in 28 days and to pay 10s. 6d. costs. 15th June (i) Non-deposit of plans. (ii) Contravention of Drainage Byelaw. Plans deposited. Work altered. £1 1s. costs paid and summons withdrawn. 19th May Contravention of Dog Nuisance Byelaw. Dismissed under Probation of Offenders Act on payment of 2s. costs. 19th Mav Contravention of Dog Nuisance Byelaw. Fined 5s. and 5s. costs. 1st June Nuisance under the Public Health (London) Act, 1936. Order made to abate within 21 days and pay 10s. 6d. costs. 14th July Contravention of Tenement House Byelaws. Work done. £1 1s. costs paid and summons withdrawn. 14th Oct. Non-compliance with nuisance order. Fined £1 and £5 5s. costs. 18th Oct. Adjourned hearing of summons for seffing raspberry jam deficient in fruit content. Dismissed. 21st Oct. Contravention of Dog Nuisance Byelaw. Dismissed under the Probation of Offenders Act on payment of 2s. costs. 28th Oct. Selling minced beef containing 70 parts per million sulphur dioxide. Dismissed under the Probation of Offenders Act on payment of £2 2s. costs. 4th Nov. Selling bread and mixture of margarine and butter. Dismissed under the Probation of Offenders Act on payment of 15s. costs. 11th Nov. Contravention of Dog Nuisance Byelaw. Fined 5s. 2nd Dec. (i) Nuisance. (ii) and (iii) contravention of Tenement House Byelaws. Work done. £1 1s. costs paid and summons withdrawn. 97 Date of Hearing. Nature of Offence. Result of Hearing. 1938. 2nd Dec. Selling bread and mixture of margarine and butter. Dismissed under the Probation of Offenders Act on payment of £1 costs. 2nd Dec. Contravention of Dog Nuisance Byelaw. Fined 5s. 2nd Dec. Nuisance. Order made to abate in 21 days and pay £1 1s. costs. 21st Dec. Selling sugar containing tin. F'ined £2 and £24 costs. 30th Dec. (i) Failure to register margarine factory. (ii) Selling margarine in a plain wrapper. (iii) Selling margarine containing more than 10 per cent. of fat derived from milk. (i) Dismissed. (ii) Dismissed under the Probation of Offenders Act on payment of 10s. 6d. costs. (iii) Do. do. £l 1s. costs. Proposed Public Convenience at Kilburn High Road. The Willesden Borough Council communicated with the Hampstead Borough Council early in the year with reference to a proposal to erect a new public convenience for both sexes at the junction of Brondesbury Villas and Kilburn High Road, and asked whether the Hampstead Council would be prepared to co-operate with them and pay one half of the cost of the construction and future maintenance of the proposed convenience. The pressing need for a convenience in that district had been appreciated for a long time and although a close inspection had been made, it was impossible to find any site in Hampstead suitable for the purpose. The proposal of the Willesden Borough Council offered a convenient opportunity for the Hampstead Council to ensure that proper lavatory accommodation in that portion of Kilburn High Road was provided. The Council at its meeting on the 24th February, 1938, resolved to co-operate with the Willesden Council for the construction of the convenience. The proposed new convenience will provide ten stalls, three W.C.'s and washing facilities for men, and six W.C.'s for women. Provision of Sanitary Conveniences in Public Houses. During the year consideration was given by the Public Health Committee to a Minute of the Metropolitan Boroughs' Standing Joint Committee with reference to the provision of sanitary conveniences in 98 public houses, and to the suggestion that Parliamentary powers should be sought for Metropolitan Borough Councils upon lines similar to those of section 89 (1) of the Public Health Act, 1936, requiring sanitary conveniences, separate for sexes, to be installed in all licensed premises for the use of customers. At the present time there are no equally satisfactory means by which the provision of sanitary conveniences can be obtained for this type of premises. The Council resolved that the Metropolitan Boroughs' Standing Joint Committee should be informed that the Council are in favour of powers on the lines sugges ed being sought. Pharmacy and Poisons Act, 1933. The "Poisons List" prepared by the Poisons Board 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, set out restrictions as to the sale of Poisons and rules as to the manner of labelling, storing and selling poisons, etc. The Borough Council is required to keep a list of persons in Hampstead who, not being entitled to sell poisons included in Part I 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, 1937, the Council had approved of the entry of the names of 134 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 1938 the names of 12 persons were added to and the names of seven persons were removed from the Borough Council's List. The number on the Register at the close of the year was 139. The Council has agreed that the yearly period for this purpose should be from 1st of May to 30th April. 99 Public Mortuary, New End. During the year, 95 bodies were brought to the Mortuary, 18 by the Police, 61 at the request of friends, and 16 by order of the Coroner. In 33 instances post-mortem examinations were made. Section 5, Housing. 103 Housing. Statistics. The following information is required by the Ministry of Health to be set out in this Annual Report:— 1. Inspection of Dwelling-houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1714 (6) Number of inspections made for the purpose 2061 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 158 (b) Number of inspections made for the purpose 165 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (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 1180 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 38 3. Action under Statutory Powers during the Year:— A.—Proceedings under sections 9, 10 and 16 of the Housing Act, 1936: (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 1009 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 1009 (б) By Local Authority in default of owners Nil 104 C.—Proceedings under sections 11 and 13 of the Housing Act, 1936 : (1) Number of dwelling-houses in respect of which Demolition Orders were made 1 (2) Number of dwelling-houses demolished in pursuance of Demo- lition Orders 1 D.—Proceedings under section 12 of the Housing Act, 1936:— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 40 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 9 4. Housing Act, 1936—Part IV.—Overcrowding:— (a) (i) Number of dwellings overcrowded at the end of the year 123 (ii) Number of families dwelling therein 123 (iii) Number of persons dwelling therein 5814 (b) Number of new cases of overcrowding reported during the year 34 (c) (i) Number of cases of overcrowding relieved during the year 297 (ii) Number of persons concerned in such cases 1453½ (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. During November, 1938, all the recorded cases of overcrowding were visited by the Sanitary Inspectors in order to ascertain whether overcrowding still existed. The records now shew that at 31st December there were 123 cases (comprising 515 adults and 133 children between 1 and 10 years of age) of overcrowding in the Borough known to this Department as compared with 449 at the time of the overcrowding survey in 1935. I must emphasize the fact that certain cases of overcrowding may have occurred without the knowledge of this Department, although as much publicity as possible has been given to the Act by means of posters and leaflets. Landlords and agents have been advised as to the permitted 105 number of tenants allowed in their properties, but many landlords have not yet entered into the rent book the permitted number of persons as is required by Section 62, Housing Act, 1936. Their attention is being drawn to this. This "unknown" overcrowding will have been caused principally in two ways, viz. (1) Immigration into the Borough of families, (2) Families not overcrowded at the 1935 survey may subsequently have become overcrowded by reason of further children born into the family and/or children attaining the age of 10 years. There is a further point to which I wish to draw attention. The overcrowding is calculated on the assumption that kitchens and living rooms may be used for sleeping purposes. This is, of course, highly undesirable and the Ministry of Health's Overcrowding Memorandum B, dated October, 1935, states "It is relevant to point out that this standard does not represent any ideal standard of housing, but the minimum which is, in the view of Parliament, tolerable while at the same time capable of immediate or early enforcement". The following Tables show a detailed analysis of the cases of overcrowding:- Table 1. No. of families on Register of Overcrowding at date of survey (1935) 449 * New cases found since 1935 58 507 No. of families removed since survey 215 No. of families overcrowding abated by increase in accommodation or decrease of family 135 No. of families removed to L.C.C. or Borough dwellings 33 In receipt of licence 1 No. of families still on register 123 384 *These new cases have come to our knowledge through various sources, including :— (1) Routine inspection by Sanitary Inspectors of Tenement Houses, etc., (2) Applications for rehousing from tenants, (3) Routine visiting by Health Visitors, etc., (4) Investigation of complaints, 106 Table 2. Table shewing size of family where Overcrowding obtains, i.e., Cases on Overcrowding Basis. No. of Cases. * Persons. 7 cases of overcrowding in families of 2½ persons. 3 „ „ „ 3 „ 21 „ „ „ 3½ „ 28 „ „ „ 4 „ 9 „ „ „ 4½ „ 22 „ „ „ 5 „ 6 „ „ „ 5½ „ 9 „ „ ,, 6 „ 7 ,, ,, ,, 6½ „ 6 ,, ,, ,, 7 ,, 1 ,, ,, ,, 7½ „ 1 ,, ,, ,, 8 ,, 1 ,, ,, ,, 9 ,, 2 ,, ,, ,, 10 ,, 123 * Persons—Child between 1 and 10 years counts as ½ person. Table 3. Table indicating (in persons) extent to which families are overcrowded. No. of Cases. 36 dwellings are overcrowded by ½ person. 41 „ „ 1 „ 15 „ „ 1½ persons. 18 „ „ 2 „ 9 „ „ 2½ „ 1 „ „ 3 „ 1 „ „ 3½ „ 2 „ 4 „ 123 Table 4. Details of the 4 cases, where overcrowding is 3 persons and over. 1. A family of 6 over 10 living in 2 rooms. 2. A family of 6 over 10 and 1 under 10 living in 2 rooms. 3. A family of 7 over 10 (and 1 child 10 months not counted) living in 2 rooms. 4. A family of 6 over 10 and 2 under 10 living in 2 rooms. 107 Table 5. Table showing type of dwelling overcrowded. No. of one-roomed dwellings overcrowded 11 No. of two-roomed dwellings overcrowded 80 No. of three-roomed dwellings overcrowded 25 No. of four-roomed dwellings overcrowded 7 123 The work of the Measurement Survey 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, was continued until the end of May, 1938. From its inception until this date, measurements were made of 33,261 rooms, comprising 11,028 separate dwellings, in 4,605 workingclass houses. In 283 houses where measurements were taken, 827 rooms were found to be unoccupied, but advantage was taken of the opportunity to measure such rooms. In addition 139 houses were found to be totally unoccupied. In all instances in which application was made for the "permitted numbei", the information has been promptly supplied. Towards the end of the year it was thought desirable to remind house agents and others of the necessity for inserting this and other information in rent books and a circular letter was addressed to all known agents, etc., drawing their attention to the obligations imposed by Sections 4 and 62 of the Housing Act, 1936. Whenever a Sanitary Inspector discovers that a rent book does not contain the information prescribed by Sections 4 and 62, an intimation is sent. Should this fail to secure compliance with the law a special letter is sent by registered post or served by hand, pointing out the requirements of the Statute and failing compliance therewith the matter is reported to the Housing Committee, who may authorise the institution of legal proceedings. A case was brought to notice during the year in which it appeared that a man, his wife and three children were living in overcrowded conditions in contravention of Section 59 of the Housing Act, 1936. The landlord had been informed of the permitted number on the 7th 108 December, 1937, and that the tenant occupied the premises in February, 1938. The facts were reported to the Housing Committee, who authorised the Town Clerk to institute the necessary proceedings to secure abatement of the overcrowding. The family were given alternative accommodation by the London County Council and no proceedings were taken. It is interesting to note how certain aspects of the housing problem remain notwithstanding the reduction that has taken place in overcrowding. I find on reference to an exhaustive report of the Housing Committee presented to the Council in 1902, statements submitted in support of housing activity on the part of the Council that may well be repeated to-day. Thus, the Committee then stated in their Report:— "It is no uncommon thing to find that one-fifth to one-third of the wageearners' total wages is absorbed by the single item of rent". "While there is a general demand for more, better and cheaper housing accommodation in Hampstead, the general deficiency strikes with special force upon the breadwinners of families including three or more children especially those in which the children have arrived at a time of life when separate sleeping accommodation is desirable, no less for moral than for physical considerations The high rents of to-day still in many cases press unduly heavily on the wage-earners, and the difficulty specially experienced by other than small families in obtaining adequate accommodation is a very real one. This factor of high rents is witnessed in the Maternity and Child Welfare Assistance Sub-Committee where it was found that 608 per cent. of applicants were eligible for milk grant although in full work. The Housing Committee has pushed forward during 1938 with the negotiations in connection with the schemes for the erection of dwellings at Garnett Road and at New End.. The Committee has expressed its desire to provide re-housing accommodation at reasonable rents for working-class residents if possible in the Borough in which they now live. Licence to Sleep Persons in excess of Permitted Number. An application from Messrs. B. B. Evans & Co., Ltd., of 140-162, Kilburn High Road, for a licence under Section 61 of the Housing 109 Act, 1936, authorising them to permit seven persons in excess of the permitted number of twenty-eight to sleep in their premises, 54, West End Lane, was granted by the Council on 22nd December. Garnetf Road Housing Scheme. The Borough Council approved of a housing scheme on the Children's Playground at Garnett Road in 1937. The layout will still permit the continuance of its use as a playground to a limited extent. It is the intention to utilise the dwellings on the site entirely for the relief of overcrowding and to apply for Government and London County Council subsidy. At its meeting on the 30th June, 1938, the Council received a report from the Housing Committee stating that they had instructed the Architect to prepare the necessary working drawings, etc., and to take steps to obtain the approvals of the London County Council as to Town Planning, etc. Plans showing the layout and types of dwellings were submitted to the Council on 22nd December. These indicated the provision of the following accommodation:—6 three roomed flats, 8 four roomed flats, 8 five roomed flats—a total of 22. Each flat will, in addition, contain a scullery and a bathroom. In submitting the plans to the Council, the Housing Committee stated:— "In the report submitted to the Council on 22nd July, 1937, it was pointed out that the type of dwellings proposed 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 landing, and the living rooms are mostly planned with the entrance from the lobby in a recess communicating with the scullery, giv.ing direct access to the latter without breaking up the wall space by an extra door; it is found that a large proportion of tenants prefer such an arrangement on entering the scullery from the lobby. In order to provide an additional measure of protection against damage in the event of air raids, the floors and roofs of the flats will be constructed of reinforced concrete and the walls will be of reinforced concrete with panel walls, 110 Owing to a portion of the site being low in relation to the road, the provision of living accommodation at this part would not be suitable, and therefore the proposals provide for this portion being utilised as perambulator and cycle sheds, a covered playground and a store for dust bins. In the event of a national emergency suitable protective measures would be taken which would enable the covered playground to be utilised as an air raid shelter for persons occupying the flats and, so far as space will allow, for members of the public. The rental basis approved in principle by the Council was as follows, viz.:— Three roomed flats—15s. per week (Net rent 11s. 8d.). Four roomed flats—17s. per week (Net rent 13s. 1d.). Five roomed flats—19s. per week (Net rent 13s. 11d.). The Council, however, in approving the proposals in principle in July, 1937, decided to reconsider the suggested rents at a later date if they thought fit. In the view of your Committee it is considered desirable that reconsideration should be given to the suggested rents at the same time as the suggested rents of the New End housing scheme come under review, and they propose therefore to submit a report to the Council on the matter at an early date ". New End Honsiny Scheme. The Borough Council approved of a housing scheme on the New End Site in 1937. This involved the acquisition of two separate interests, viz.:—(i) that of Mrs. Lane and her co-trustees in the larger portion, and (ii) that of the Trustees of the Ebenezer Chapel in the Ebenezer Chapel and the cottage adjoining. Difficulty was experienced by the Borough Council in agreeing with the Trustees' advisers as to the interpretation to be placed upon the term "equivalent reinstatement". In view, therefore, of the uncertainty of the expenditure involved and the desirability of having a cleared site, the Housing Committee pressed the Trustees to accept a lump sum in payment of all their interests and claims so that the freehold of the Chapel and cottage could be transferred to the Council free of restriction. It was not, however, until March, 1938, that the Housing Committee was able to recommend the Council to acquire the property referred to It is the intention to utilise the dwellings on the site entirely for the relief of overcrowding and to apply for Government and London County Council subsidy. At its meeting on the 30th June, 1938, the Council received a report from the Housing Committee stating that they had instructed the Architect to prepare the necessary working 1ll drawings, etc., and to take steps to obtain the approvals of the London County Council as to Town Planning, etc. In view of the fact that the question of the reinstatement of the Chapel on the site has been disposed of, it has been possible to make provision for an increased number of dwellings above that at first contemplated and the number now planned is 24 flats as compared with 20 in the original proposal. In addition, three shops will be provided. Housing Consolidated Regulations, 1925. These Regulations, with amendments made in 1932 provide, inter alia, for the systematic recording of houses inspected in pursuance of Section 8 of the Act of 1925 which was subsequently repealed and reenacted in Section 5 of the Housing Act, 1936. A card register indicating the defects scheduled in the Regulations is being compiled of the houses inspected. During 1938, 158 houses were inspected and recorded in this connection. 165 inspections were made for the purpose. Underground Rooms. The following Tables show the result of the Survey of groung Rooms so far inspected, and the results of action taken. Statistical Satatement re primises containing Underground Rooms. 1936 1937 1938 (1) Premises found to comply with Underground Room Requirements 63 126 135 (2) Premises found not to comply, but which can be made to comply 183 239 180 (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 47 (4) Premises found which do not comply in minor details only (no action contemplated) 8 3 2 (5) Premises found to be used for purpose other than for human habitation, or unoccupied 26 14 20 345 415 384 112 Result of Action during 1938. 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 95 Nil. 95 45 Action under Housing Acts 34 42 76 36 Action as the result of voluntary conversion of premises into flats and in connection with new buildings 33 Nil. 33 15 162 42 204 96 The number of Underground Rooms found not to comply with the requirements in the houses in the allocation above (2), (3) and (4), totalled 437. They were found to exist in 229 premises. Of these rooms 61 were found in 25 Tenement Houses. Summary of Underground Room Register at 31st December, 1938. (1) Premises found to comply with Underground Room Requirements 433 (2) Premises found not to comply but which can be made to comply 515 (3) Premises found not to comply and cannot be made to comply (i.e., Closure only alternative, action deferred pending provision of satisfactory accommodation) 118 (4) Premises found which do not comply in minor details only (no action contemplated) 14 (5) Premises found to be used for purposes other than for human habitation, or unoccupied 64 1144 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 Carried forward 62 113 Brought forward 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 E.C.C. for relief of overcrowding, viz. :— Watling estate 98 Other L.C.C. estates 38 Total 236 The total number of families removed from Hampstead to County Council houses since 1927, through action by the Borough Council, is 298 involving 1,583 persons. The additional 62 families are accounted for by changes in tenancies at the subsidy houses (22 at Watling and 40 at Wormholt), the Borough Council having the right to nominate tenants for any of the 100 subsidised houses which become vacant. (Note.—The above figures do not take into account the number of Hampstead families removed by the L-C.C. who were not overcrowded, but who made direct application to the E.C.C. The number so removed is not available.) 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 redevelopment areas, or individual unfit houses or parts of houses, and pays in respect of each dwelling provided the sum of £4 10s. per annum for a period of 40 years. Accommodation has been provided in three cases in 1938 under this agreement which 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 which the Borough Council pays a yearly subsidy of £7 per house. 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. 114 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 Borough Council's "Westcroft" Housing Estate at Cricklewood provides 32 one-bedroom flats; 136 two-bedroom flats; 112 threebedroom houses; and 10 four-bedroom houses with a parlour—a total of 290 dwellings. Various improvements continue to be effected for the benefit of the tenants on this estate. Sums of money have been voted by the Council in connection with a Play Leadership Scheme and for the provision of a children's slide in the Playground. It was also decided to enter into an agreement with the Tenants' Association in regard to the allocation of No. 1 Howard Close for use by the tenants, in which they might hold meetings, social activities, etc. Two plots of grass land were set aside, one for use as a playing ground for toddlers and for very young children, and one for the purpose of providing a miniature putting green and for playing darts. Four 6 ft. seats have been provided in the children's playground and two in each of the plots of land. Representations. Statement showing steps taken in 1938 in connection with premises " represented in 1938 or previous years" by the Medical Officer of Health under the Housing Acts :— Premises. Representation. Date of Committee. Closing Order. Date of Council. Remarks. 78, Haverstock Hill 6-12-37 27-1-38 Two underground rooms. 79, Haverstock Hill 6-12-37 27-1-38 Two underground rooms. Council at its meeting on 27th October, 1938, allowed the back basement room to be used as an upholsterer's workshop and the front basement room to be used for storage purposes only in connection with the same trade, subject to specified works being carried out. 98, Upper Park Road 10-1-38 24-2-38 Four underground rooms. 126, Belsize Road 10-1-38 24-2-38 Two underground rooms. Works carried out and Council on 22nd December, determined the Closing Order. 115 Remarks. Representation. Date of Committee. Closing Order. Date of Council. Premises. 117, Adelaide Road 10-1-38 Five underground rooms. On 7th February, 1938, considered by Housing Committee and adjourned for one month. Certain work carried out to three back rooms. Undertaking to carry out work to two front rooms. 20, Springfield Lane 10-1-38 Dwelling house. Demolition Order made on 24th February, 1938. Premises demolished by owner in August. 36, Gayton Road 7-2-38 24-3-38 Two underground rooms. 19, Gardnor Road 7-2-38 24-3-38 Two underground rooms. 8, Holly Mount 7-2-38 24-3-38 One underground room. 19, New End 7-2-38 24-3-38 Two underground rooms. 5, Steeles Mews South (Five rooms over garage) 5-4-37 Undertaking to carry out works complied with. Undertaking cancelled by Council 24th February, 1938. 86a, Marlborough Mansions 7-6-37 — Ditto ditto Cannon Hill (Four underground rooms) 1, Gayton Road 7-3-38 28-4-38 One underground room. Permission given to use room as a washhouse. 11, Church Row 7-3-38 28-4-38 One underground room. Permission given to use room as a bathroom. Closing Orders made on front underground rooms. Back underground rooms; under- 90, Palmerston Road 13 9-37 28-10-37 J taking to carry out works 91, Palmersto Road 5-7-37 | to render rooms fit for habitation accepted by Housing Committee. Work in hand at end of year. 291, West End Lane 7-6-37 - Undertaking to carry out necessary work at three above ground rooms complied with, and cancelled by Council on 24th March, 1938. 26, Hemstal Road 5-7-37 - Undertaking to carry out necessary work at two underground rooms complied with and cancelled by Council on 24th March. 1938. 116 Premises. Representation. Date of Committee. Closing Order. Date of Council. Remarks. 3, Greville Road 4-4-38 21-7-38 Part of building, i.e., front and back basement rooms and ground floor back room. Undertaking to carry out necessary work at ground floor back room and a portion of basement rear room to be used as bath room and w.c. Closing Order made on front basement room and a portion of rear basement room. 162. Belsize Road 4-4-38 26-5-38 Two underground rooms. 84, Palmerston Road 1-3-37 Undertaking accepted 3rd May, 1937, for specified works to be carried out to front and back underground rooms. On 4th April, 1938, reported to Committee that undertaking had been carried out. 60, Gavton Road 9-5-38 30-6-38 Two underground rooms. 44, Adelaide Road 9-5-38 30-6-38 Two underground rooms. Rooms still occupied although alternative accommodation offered to tenant and Council on 22nd December authorised the institution of legal proceedings. Rooms vacated. 34, Netherwood Street 13-9-37 — Undertaking to carry out works at three underground rooms complied with. Undertaking cancclled by Council 26th May, 1938. 210, Belsize Road 13-6-38 29-9-38 Two underground rooms. 33, Fleet Road 1-7-38 29-9-38 Two underground rooms. 39, Fleet Road 4-7-38 29 9-38 Two underground rooms. 29, Dennington Park Road 12-9-38 27-10-38 Two underground rooms. 23, Alexandra Road 12-9-38 27-10-38 Two underground rooms. 27. Alexandra Road 12-9-38 27-10-38 Two underground rooms. 52, Belsize Road 12-10-36 25-2-37 The Council on 29th September, 1938, gave permission, subject to certain specified works, for the two underground rooms to be used for photography business. 129, Adelaide Road 10-10-38 22-12-38 Three underground rooms. 52, Ainger Road 5-12-38 26-1-39 Two underground rooms. .14, Harben Road 5-12-38 26-1-39 Three underground rooms. 39, Denning Road 5-12-38 26-1-39 Two underground rooms. 9, New End Square 5-12-38 - Whole house. 117 Premises. Representation. Date of Committee. Closing Order. Date of Council. Remarks. 38, Netherwood Street 13-9-37 Three underground rooms. On 28th October, 1937, Council accepted a written undertaking from the owners to carry out necessary works. Works carried out and undertaking cancelled by Council on 22nd December, 1938. 123, Adelaide Road 30-11-36 18-3-37 Five underground rooms. Three of the rooms at rear allowed to be used as a non-residential studio. The Council on 22nd December, 1938, agreed to four of the rooms being used as a nonresidential members' club, subject to specified works being carried out. Small Dwellings Acquisition Acts. No advance was made by the Council during the year. Hampstead Housing Association, Ltd. This Association manages houses in the Borough, situated in Kelson Street, in Palmerston Road and in Netherwood Street. Section 6. Inspection and Supervision of Food. 121 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. Pasteurised (a) Satisfactory. Do. (a) Do. Tuberculin Tested (b) Do. Do. do. (b) Do. Pasteurised (a) Do. Do. (a) Do. Raw (6) Do. Pasteurised (a) Do. Do. (a) Do. Do. (a) Do. Tuberculin Tested (b) Do. Raw (a) B. Coli present in 0 01 millilitre. Pasteurised (a) Do. do. Do. (a) Satisfactory. Do. (a) Do. Do. (a) Do. Do. (a) Total bacteria 259,000. Do. (a) Total bacteria 248,000. Do. (a) Satisfactory. Do. (a) Do. Do. (a) Do. Raw (b) Do. Tuberculin Tested (6) Do. Pasteurised (a) Total bacteria 166,000. Do. (a) Total bacteria 160,000. Do. (a) B. Coli present in 001 millilitre. Do. (a) Satisfactory. Do. (a) Total bacteria 212,000. Do. (a) Satisfactory. Do. (a) Do. Tuberculin Tested (b) Do. Pasteurised (a) Do. Do. (a) Do. Do. (a) Do. Tuberculin Tested (b) Do. Pasteurised (a) Do. Tuberculin Tested (b) Do. Pasteurised (a) Total bacteria 116,000. Do. (a) Satisfactory. Do. (a) Do. 122 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 158 samples of milk taken under the Food and Drugs Act, and of these one was unsatisfactory. 18 informal milk samples were taken during the year. The average composition of the total milk samples examined was :— Total milk solids 1216 per cent. Fat 3 59 per cent. Solids not fat 865 per cent. Milk for Schoal Children. Milk supplied to Hampstead Scholars under the scheme of the London County Council is required to be pasteurised and to comply with the requirements of the Milk (Special Designations) Order, 1936. (i) MUk and Dairies (Consolidation) Act, 1915. Milk ami Dairies Order, 1926. The number of premises in respect of which persons are registered as purveyors of milk is 110. During the year, 125 inspections were made and 4 notices were served. In addition 40 persons are registered as purveyors of milk whose premises are situated outside Hampstead. (ii) Milk (Special Designations) Order, 1936. Number of licences in force during 1938, 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 9 Sale of Accredited Milk from shop or other premises 4 Sale of Pasteurised Milk from shop or other premises 44 No licence for graded milk was refused or revoked during the year, 123 In 23 cases supplementary licences were granted authorising the sale of graded milk within the Borough from premises outside Hampstead. The special designations which may be used in relation to milk 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 be sold as "Tuberculintested Milk (Pasteurised)." When tuberculin-tested 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 5 drinking waters and 45 ice creams were examined bacteriologically. It is interesting to note that the bacteriological content of the ice creams varied from 60 per millilitre to 3,600,000 per millilitre and that B. Coli were found to be present in 16 of the samples. In addition to the Chemical Analysis of Food referred to under the heading of "C" Adulteration, etc., the following were examined bacteriologically :— Nature of Sample. Result. Rhubarb and Apple Pie Cut Tongue No pathogenic bacteria were found. Cultures proved sterile when incubated by aerobic and anaerobic methods. Enrichment methods, however, yielded a copious growth of B. Coli and a few colonies of non-lactose fermenting organisms. The latter organisms proved to be B. Dysenteriæ (Sonne) as shown by serological and biochemical reactions. Do. Similar results were obtained as from previous specimen. 124 Nature of Sample. Result. Ox Tongue (Tin) This was an intact tin and shewed no signs of spoilage. All cultures remained sterile after incubation for five days. Cooked Lunch Tongue (Tin) Do. do. do. Cut Tongue Cultures yielded a copious growth of Bacillus Coli and of non-lactose fermenting organisms. The latter proved to be B. Dysenteriæ. Do. Cultures yielded a copious growth of Bacillus Coli but non-lactose fermenting organisms were not found. Ham Cultivations from this ham yielded a growth of Staphylococcus and Proteus Morgani, Sonne Dysentery was not found. Proteus Morgani is pathogenic giving rise to diarrhoea. Pressed Beef Cultures yielded a growth of B. Coli and proteus vulgaris. B. Sonne and other pathogenic types were not found. Mutton Wrapper Cultures yielded a good growth of B. Coli. No. B. dysenteriæ were found. Do. Cultures yielded a copious growth of Friedlanders bacillus, B. Coli and other nonlactose fermenting organisms. None of the Typhoid-Dysentery group were found. Counter Knives Cultures were made from material after wiping the blades of the knives. B. Coli and few streptococci; no B. dysenteriæ. Cut Tongue Cultures yielded a scanty growth of gram positive cocci. No pathogenic bacteria was found. Veal and Ham Pie Cultivations from this specimen did not yield any growth of B. dysenteriæ or any other pathogenic organisms. Counter Cloth Cultivations from this cloth yielded a growth of bacillus coli, staphylococci and lactose nonfermenting alkaligenes. Sonne dysentery or other food poisoning bacteria were not found. Tinned Tongue No food poisoning organisms were found. Lamb's Tongue No pathogenic organisms were found. Cooked Duck The cultures from this specimen yielded a growth of bacillus of the Salmonella group. The bacillus was finally identified culturally and serologically as B. aertryche. (i) Meat and Slaughterhouses. There is no slaughterhouse in Hampstead. 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. 125 (ii) Unsound Food and Food Inspection. The following is a total of the ten items of food seized or voluntarily surrendered during the year :— Meat—Corned Beef, one 6 lb. tin. Ham, 14 lbs. Pig's plucks, 105. Sheep carcase, 1. Fish—Herring roes, 5 tins. Plaice, 7 stone. Sardines, 9 tins. Fruit—Nil. Miscellaneous—Ice cream, 33 dozen 1d. „ 20 dozen 2d. „ 9 Id. chocolate bars. (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 830 inspections were made. Premises. No. of Premises on Register. No. of Inspections. No. of Notices. Bakehouses:— With mechanical power— Underground 14 36 5 Aboveground 20 31 11 Without mechanical power— Underground 1 3 2 Aboveground 13 11 3 Fried Fish Shops 13 .26 3 Ice Cream Premises 111 57 2 Milk Premises 110 125 4 Restaurants and Eatinghouses 102 79 12 Other Food Premises, e.g,. Butchers, Greengrocers, Grocers, Provision Dealers, etc. 557 462 67 Cleansing of Bakehouses.—The periodic cleansing of walls, ceilings, passages and staircases, etc., of bakehouses is prescribed in the Third Schedule of the Factories Act, 1937, and the general sanitary 126 provisions as to premises used for sale, etc., of food for human consumption are contained in Section 181 of the Public Health (London) Act, 1936. Paintwork is required to be washed down and limewashing renewed once at least in every six months. It has been our practice for many years past to supply cards of foolscap size to occupiers of bakehouses on which are entered the dates and details of cleansings, etc. On these cards, which are exhibited in the bakehouses, are printed the clauses of Section 181 of the Public Health (London) Act, 1936, and extracts from the Third Schedule of the Factories Act, 1937. Underground bakehouses.—These were specially dealt with by the Factory and Workshop Act, 1901, and no such bakehouse was allowed to be used unless certified by the Council to be suitable for that purpose. This was the first occasion that underground bakehouses were required to be certified as suitable, and it is interesting to note that the Medical Officer of Health reported in 1903:— "From personal inspection, as well as from the reports of the Inspectors, I am satisfied that much has still to be done to ensure that the making of bread, confectionery, etc., and the processes incidental thereto, shall be carried on under proper hygienic conditions. Such important matters as ventilation and lighting have been in many instances neglected, while general cleanliness, whether of the bakehouse itself or of its sanitary arrangements, appears to have in most instances been considered one of little importance. Bakehouses, especially those in connection with dwelling houses, have been employed for the storage of all kinds of unnecessary stores, and in some instances they were also used as a family washhouse." In consequence of the Act of 1901, some of the underground bakehouses were closed, i.e., in certain instances the Council refused to grant the necessary certificates; while in some cases the occupiers transferred their baking business to more suitable rooms above the ground level, or voluntarily closed the bakehouse. The Factories Act of 1937 provides that any basement bakehouse which, for a period exceeding one year, is not used as a bakehouse, may not be so used again. It is further provided that the Council 127 must examine every basement bakehouse and if they are not satisfied as to its suitability, it may not be used as a bakehouse. This special examination and certification is required to be carried out every fifth year. As a result of this requirement a special inspection is being made of the underground bakehouses in use in the Borough with a view to their certification or otherwise. The following is a list of these premises:— 64, Belsize Lane. 4, Kelson Street. 202, Belsize Road. 354, Kilburn High Road. 228, Belsize Road. 2, King's College Road. 44, Englands Lane. 41-3, Mill Lane. 93, Fairfax Road. 98, West End Lane. 7, Fairhazel Gardens. 126, West End Lane. 65, Fleet Road. 279, West End Lane. 63, Hemstal Road. (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. Cowsheds, Slaughterhouses or Poultry Slaughterhouses. None of these exists in the Borough. 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 52 premises had been registered. (c) Factories of Margarine, Margarine-cheese, or Milk-blended buller. 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. 128 (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. 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, ten 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. (C) Adulteration, etc. (i) Food and Drugs (Adulteration) Act, 1928. 501 samples were taken for analysis during the year by the Sampling Officers under the Act. The number certified to be adulterated was 26, or 5 2 per cent. of the total number, as compared with 20, or 3 7 per cent. in 1937. Of the total samples taken for analysis, 389 were formal samples and 112 informal. 129 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 140 1 18 - Cream 1 — 2 — Butt er 30 2 4 1 Margarine 22 — 5 — Mixture of Butter and Margarine Lard and Lard substitutes 1 10 1 2 — Cheese 7 2 2 — Dripping and Suet 8 — — — Sausages, Minced Beef and Canned Meats 37 4 1 - Fish, Fish Pastes, etc. 36 3 20 2 Tinned and Dried Fruits and Vegetables 23 - 8 _ Fresh Fruit (Apples) — - 3 - Flour, Cereals, etc. 12 - 3 - Bread and Butter 5 2 — - Sugars 8 4 - - Jam, Honey, Marmalade and Jellies 18 2 6 Ice Creams 7 — 25 - Sauces, Spices and Pickles, including Mincemeat 9 1 5 Condiments (Mustard and Pepper) 2 — — - Vinegar 3 — 2 — Spirits 7 1 — - Fruit Juices 1 — 1 - Drugs — — 1 — Chocolate Roll 1 — — - Yellow Crystals 1 — — — Cut Celery (Tin) — — 1 - Almond Pudding Powder — — 1 - Olive Oil — — 1 - Tomato Juice (Tin) — — 1 - Totals 389 23 112 3 130 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. 10 Butter Contained excessive proportion of water. Cautioned. 102 Butter Contained excess of water Cautioned. 149 Bread and Butter Bread and a mixture of butter and margarine. Summons dismissed. Probation of Offenders Act. Costs 15s. 502 Bread and Butter Bread and a mixture of butter and margarine. Summons dismissed. Probation of Offenders Act. £1 costs. 540 Butter and Margarine mixture (1) Failure to register margarine factory. (2) Selling margarine in plain wrapper. (3) Section 11 of the Act limit of water is 16 per cent.; Section 6, margarine may not contain more than 10 per cent. butter fat. Summons (1) Dismissed. Summons (2) Dismissed. Probation of Offenders Act. Costs 10s. 6d. Summons (3) Dismissed. Probation of Offenders Act. Costs £1 Is. 13 Barbados Sugar Sulphur Dioxide 13 parts, per million; Tin 1.8 grains per pound. No action. 32 Barbados Sugar Tin 2 grains per pound Cautioned. 488 Barbados Sugar Tin 27 grains per pound Fined £2. Costs £24. 562 Barbados Sugar Tin 1.5 grain per pound; Sulphur Dioxide 20 parts per million. Cautioned. Withdrawn from sale. 335 Milk Deficient in non fatty solids 3.3 per cent. Cautioned. 16 Sausages Contained undeclared preservative Sulphur Dioxide 250 parts per million. Fined £1. Costs £1 11s. 6d. 86 Sausages Contained 026 per cent. Boric acid. Cautioned. 27 Cream Cheese Not cream cheese. Made from skimmed milk; 1.3 per cent. deficient in fat. Fined £1. Costs £1 11s. 6d. 131 No. of Sample. Article. Analyst's Report. Action taken. 424 Cream Cheese Contained 66 per cent. water; Total Solids 33.6 per cent.; Fat 140 per cent.; Fat on dry cheese 41-7 per cent. Cautioned. 375 Jam Deficient in fruit Summons dismissed. 566 Jam Deficient in fruit Cautioned. 26 Sardines Lead 8 parts per million No action. 359 Sardines Lead 27 parts per million (9 tins surrendered). Fined £10 10s. 373 Sardines Lead 9 parts per million Cautioned. 224 Minced Beef Sulphur Dioxide 48 parts per million. £2 2s. costs only. 234 Minced Beef Sulphur Dioxide 70 parts per million. Summons dismissed. £2 2s. costs. 477 Curry Powder Lead 30 parts per million Cautioned. 613 Whisky 12 per cent. added water Fined £2. Costs £1 1s. Informal Samples. No. of Sample. Article. Analyst's Report. Action taken. 190 Butter Small excess of water Cautioned. 187 Sardines Lead 8 parts per million No action. 365 Sardines Lead 40 parts per million Cautioned. (ii) Artificial Cream Act, 1929. The following is the only registered premises in the Borough :— 66-68, Kilburn High Road. (iii) Public Health (Condensed Milk) Regulations, 1923 and 1927. No samples were taken during the year. (iv) Public Health (Dried Milk) Regulations, 1923 and 1927. No sample was taken during the year. 132 (v) Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. 96 samples of articles of food specified in these Regulations were submitted for analysis. Infringements were discovered in the following cases:— No. of Sample. Article. Result of Analysis. Action taken. 13 Barbados Sugar Sulphur dioxide 13 parts per million; Tin 1.8 grains per pound. No action. 32 Barbados Sugar Tin 2 grains per pound Cautioned. 488 Barbados Sugar Tin 2.7 grains per pound Fined £2. Costs £24. 562 Barbados Sugar Tin 1.5 grains per pound; Sulphur dioxide 20 parts per million. Cautioned. Withdrawn from sale. 16 Sausages Contained undeclared preservative Sulphur dioxide 250 parts per million. Fined £1. Costs £1 ls. 6d. 86 Sausages Contained 026 per cent. Cautioned. 224 Minced Beef Sulphur dioxide 48 parts per million. Costs £2 2s. 234 Minced Beef Sulphur dioxide 70 parts per million. Costs £2 2s. (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.l. (E) Nutrition. The routine medical inspection of entrant children in Hampstead to Elementary Schools during the year 1938, demonstrates that 116 or 19.7 per cent, were classed as " good," 441 or 75.0 per cent, were "normal" and 31 or 5.3 per cent, were " below normal." The corresponding figures for the County of London were 15 3 per cent., 782 per cent, and 6.5 per cent. 1 append herewith notes made by H. Davis Chalke, M.A., M.R.C.S., D.P.H., Assistant Medical Officer of Health on the results 133 of Chemical and Bacteriological Examination of Ice Cream Samples taken in the Borough of Hampstead:— The popularity of ice cream in recent years has brought into prominence the question of the desirability for the establishment of certain standards of purity. In this Country the matter has not yet received the attention it deserves. Ice cream is an excellent food if made from cream, sugar and milk, containing as it does proteins, fats and carbohydrates, with vitamins and mineral salts. It is readily utilised by the body and if eaten slowly and in moderation, it is in 110 way harmful. Mention was made of Ice Cream in the time of the Stuarts, but it was not until the middle of the last century that it began to be popular in this country, when it was introduced by an Italian restaurant proprietor. He used a mixture of eggs and milk, which was boiled and frozen in a hand machine. For many years it has been a popular sweet in hotels and restaurants, and long before the war the Italian itinerant vendor was much in evidence during the summer months. The London County Council (General Powers) Act, 1902, laid down standards of cleanliness for premises in which ice cream was manufactured and made it an offence to fail to notify any case of infectious disease amongst any persons living on or employed in the premises. It is interesting to record that public notice of the effect of these provisions by advertisement and handbills was set out in English and Italian: this was repeated in 1931. In 1902 there were 69 premises where ice cream was made or sold in the Borough of Hampstead. In 1937 there were 111, but there has also been a considerable increase in the number of street vendors, most of them selling ice cream manufactured by large firms outside the Borough. Inspections of premises in 1902 shewed that ice cream was often prepared under very dirty conditions, such as in living or sleeping rooms or workshops, and its further manufacture on many premises was prohibited. Since that time there has been a great improvement in conditions of manufacture and frequent inspections ensure that the premises are suitable. The fact that ice cream has such a large outdoor sale during the summer months, especially among children, makes it a matter for regret and concern that what could be a valuable foodstuff is so often a concoction of negligible food value. In addition, ice cream is a good vehicle for the introduction of bacteria into the body. Typhoid and tubercle bacilli, streptococci, the organisms of dysentery and many other types of pathogenic bacteria have at various times been found in ice cream samples. The bacteria are capable of surviving for long periods. Epidemics of typhoid, paratyphoid, dysentery, septic sore throats, scarlet fever and food poisoning in this and other countries have been traced to ice cream consumption. As recently as August, 1937, cases of Paratyphoid B fever occurring in Southampton were traced to the consumption of ice cream. The Medical Officer of Health reported that samples of ice cream were found to be infected with 134 the bacillus typhosus and a growth of this organism was obtained from the urine of the proprietor and the fseces of an employee who packed the ice cream. Between 30 and 40 gallons of ice cream were manufactured daily in this factory, and that a major epidemic was averted must be attributed to prompt action in tracking down the epidemic to its source. The infection may be introduced in. milk, cream and other ingredients, or by carriers or sufferers from a particular disease, if care is not exercised in the sterilisation of utensils and personal cleanliness. Contamination from flies and dust may take place after production when the ice cream is kept in a churn with a poorly fitting lid, and is stored or exposed for sale under unsuitable conditions. Spoons and servers are often dirty. Nowadays, much of the ice cream sold by the large firms is hygienically wrapped and the opportunities of contamination after manufacture are considerably reduced. Although many serious epidemics have been proved to be caused by ice cream, it is probable that a number of minor epidemics are also due to it, but definite proof of this is often lacking, Sore throat and summer diarrhoea, especially in children, and isolated cases of mild illness are almost certain in many cases, to be the result of eating infected ice cream. Tubercle bacilli have been found in ice cream, and recently, of 72 samples examined in Bristol, one contained these organisms. Of the raw milk that comes into London a high percentage contains tubercle bacilli, and where pasteurisation is not carried out, the ice cream must be infected. This is a point of the utmost importance, particularly for children, and it requires further investigation. The small vendor is, perhaps, the greatest offender in the matter of cleanliness. He may be quite ignorant of the most elementary principles of sterilisation and he seldom realises that washing with warm water does not kill bacteria. There arc no bacteriological or chemical standards in force in Great Britain, but in many parts of the world ice cream production is strictly controlled by legislation. This is the case in most of the States and large Cities of the U.S.A., and in Australia, Tasmania, New Zealand, Holland, Belgium and Northern Ireland. The maximum number of bacteria allowed in one cubic centimetre of ice cream varies in different places from 250,000 to 50,000 per c.c. Certain countries also prohibit the bacillus Coli in ccrtaiu dilutions. These figures may be compared with our own standard for pasteurised milk, i.e., not more than 100,000 bacteria per c.c. Ice Cream was originally made in pewter containers, placed in tubs containing a freezing mixture of ice and salt. The container was rotated by hand and the contents stirred by means of a paddle. Two vendors in Hampstead use an apparatus of this nature. 135 The advent of the electrically operated counter-freezer in which the mix is not heated has considerably increased the risks of contamination. There are a number of counter-freezers of this type in Hampstead. In large scale manufacture the mix is usually heated for a variable period in a large vat and is either run off from a tap or transferred by a pipe to the freezing receptacle. There is one fairly large scale manufactory in this Borough which will be referred to later. Ice Cream manufactured by the well-known firms is sold by itinerant vendors; it is also sold in a number of shops and restaurants. It is wrapped at the manufactory and kept in the shops in refrigerators supplied by the producers. Many small shop-keepers who formerly made their own ice cream now adopt the latter method. Such a practice should be encouraged, for it is much easier to keep one or two large factories under strict observation than it is to supervise a large number of small manufacturers. Further, the reputable firms have up-to-date machinery and sanitary premises, with adequate facilities for steam sterilisation—a state of affairs which is conducive to the preparation of a product of a purity which could not be obtainable in the back yard. The wrapping also minimises the risk of subsequent contamination. The chemical composition of ice cream varies within very wide limits. On the one hand it may be a nutritious product made of butter, eggs and cream, on the other, an article of almost negligible food value composed of a little milk and starchy ice cream powders. "Ice Cream" is accordingly difficult to define. The New York Department of Health Sanitary Code states that: — "Ice Cream shall be taken to mean and include the pure, clean and wholesome frozen product or mixture made from milk products sweetened with sugar and with or without the use of eggs, harmless flavouring or colouring, added stabiliser composed of wholesome, edible material and which contains not less than 10 per cent, by weight of milk fat and not less than 18 per cent. by weight of milk solids." Chemical standards have been fixed in most of the States of the U.S.A. and in other parts of the world. The minimum allowable percentage of fat averages about 8 per cent. In Tasmania a minimum of 10 per cent. of butter fat in the form of cream is required. Canada and Northern Ireland have adopted 7 per cent. and 5 per cent. respectively, as the least amount of butter fat, whilst the Sanitary Code of New York City stipulates that there shall be present not less than 10 per cent. of milk fat and 18 per cent. of milk solids. Ice cream manufacturers who are members of the Ice Cream Association of Great Brtiain have decided on a minimum figure of 8 per cent. of fat and 10 per cent. of milk solids not fat. The U.S.A. Federal Fat Standard is 14 per cent., but this does not appear to be rigidly enforced. Each State has its own legislation on this 136 point, the standards varying from 8 per cent. to 14 per cent. In some places mention is also made of the total milk solids or the milk solids not fat content which must be attained. A good deal of the Ice Cream sold in this Country is a very inferior article having a fat content much below the average figure. The Examination of Ice Cream sold in Hampstead. The results of the examination of Ice Cream in Hampstead are given below. Sixty-three samples were examined bacteriologically and thirty-two chemically. Bacteriological Investigations. Number of samples. Bacterial Counts per c.c. 9 5,000 or less. 10 5,000 to 10,000. 14 10,000 to 30,000. 6 30,000 to 50,000. 5 50,000 to 100,000. 6 100,000 to 200,000. 4 200,000 to 300,000. 5 300,000 to 500,000. 2 500,000 to 750,000. — 750,000 to 1,000,000. 2 over 1 million. The figures refer to samples from 25 sources; it should be borne in mind that they include both initial and subsequent sampling, and that many of the low counts are the result of special supervision of vendors whose initial samples were much contaminated. The samples originated as follows: — (a) Manufactured in Hampstead. (1) Fairly large scale modern manufactory, mix pasteurised 1 (2) Electric counter freezers (the mix is heated in only 2 of these) 8 (3) Old fashioned bucket and pail with freezing mixture (one boiled; one unheated) 2 (b) Manufactured outside the Borough and sold in Shops or by Itinerant Vendors. (1) Large scale reputable firms using up-to-date machinery, and pasteurised mix 8 (2) Fairly large-scale manufacture with up-to-date plant and pasteurised mix 3 (3) Old fashioned pail and bucket and freezing mixture, hand operated, in which the mix is boiled 1 (4) Covered electric revolving freezer, pasteurised mix 1 (5) Small Electric Freezer, pasteurised mix 1 25 137 More than half the samples contained B. Coli:— In 7 cases it was present in .001 c.c. In 21 „ „ „ .01 c.c. In 4 „ „ „ .1 c.c. In 1 case 1.0 c.c. (It is laid down in the Milk and Dairies Order that Tuberculin Tested and Accredited Milks shall not contain B. Coli in 01 c.c.) A comparison between ice cream made in Counter Freezers (small shopkeepers) and pasteurised-mix ice cream (large scale manufacturers) is interesting. Shop No. Counter Freezers. (Cold Mix) No. of Bacteria per c.c. B. Coli. Firm No. Large Scale Manufacture (Pasteurised Mix). No. of Bacteria per c.c. B. Coli. 1 (mix heated) 13,000 Present in 001 c.c. 1 35,000 Absent 2 528,000 Do. 2 44,000 Absent 3 10,000 Absent in .01 c.c. 3 850 Absent 4 800,000 Present in .01 c.c. 4 40,000 Present in 01 c.c. 5 299,000 Do. 5 620 Absent 6 164,000 Do. 6 19,000 Absent 7 173,000 Do. 7 8,000 Absent 8 (mix heated) 28,000 Absent in .01 c.c. 8 1,000 Absent Five of the eight "cold mix" samples were heavily contaminated. In no case did the "pasteurised-mix" ice cream give a high bacterial count, and B. Coli was present in one only out of the eight samples. Contamination may very readily occur when the old type bucket and pail freezing process is used. A comparison between the products of two manufacturers in Hampstead who adopt this method is set out below. The apparatus was almost identical in each case and the tubs were placed in the yards behind the shop:— Sample from Shop 1. Number of bacteria per c.c. 17,000. B. Coli absent. Sample from Shop 2. Number of bacteria per c.c. 2,500,000. B. Coli present in 01 c.c. Shop 1 is a very good class establishment. The mix is boiled and there is a high standard of cleanliness, 138 In the second case the mixture, which was not boiled, was prepared in the kitchen, which was dirty. Little attention was paid to the proper cleanliness of the utensils used. Even when the old method of manufacture is in vogue a satisfactory product is possible if the producer is scrupulously clean and conscientious. The second shop-keeper was visited repeatedly and told that he would not be allowed to sell ice cream unless it was of reasonable bacteriological purity. A great improvement took place and successive bacterial counts in this case were :— 2,500,000 316,000 40,000 188,000 14,000 B. Coli in B. Coli in B. Coli in B. Coli in No B. Coli 1/10 c.c. 1/10 c.c. 1/10 c.c. 1/10 c.c. The effect of visiting the small producer and impressing upon him the importance of cleanliness and sterilisation is shewn by the following figures. He was generally anxious to co-operate. The results refer to ice cream manufactured in Counter freezers without any previous heating of the mix. First Sample No. of bacteria per c.c. Final Sample No. of bacteria per c.c. Shop A 528,000. 208,000. B. Coli in 001 c.c. No B. Coli. Shop B 3,000,000. 5,000. B. Coli in 01 c.c. No B. Coli. Shop C 299,000. 6,000. B. Coli in 01 c.c. No B. Coli. Shop D 164,000. 80,000. B. Coli in .01 c.c. No B. Coli. Before the final satisfactory results were obtained it was often necessary to make frequent visits and take many intermediate samples. A number of samples of milk used for ice cream making were also examined; with two exceptions the results were good. Where the mix is not pasteurised it is essential that pasteurised milk should be used. Milk taken from an open churn in a small restaurant where ice cream was made, which was proved to be unfit for consumption, was found to contain B. Coli. The milk was sold as "pasteurised," but it was two days old, and the churn (kept in the kitchen) was uncovered. A sample of milk supplied to this shop was sampled on delivery the following day and was found to be quite satisfactory. The milk used by a vendor who made his ice cream in a counter freezer was found to have a very high bacterial content, and B. Coli were present. Despite the greatest care in the preparation of his ice cream, he could not 139 produce a pure product although his utensils were sterilised. He was persuaded to boil the mix; and further samples proved to be very satisfactory. A sample of ice cream powder proved to be sterile. One vendor received Ice Cream from a firm in another part of London. The ice cream was supplied in a container packed in a box filled with dry ice. The Box and Container were placed on the pavement outside the shop. In addition the spoons used for serving the ice cream were of doubtful cleanliness and the shop-keeper generally had no idea of the importance of cleanliness and the dangers of allowing the ice cream to become infected B. Coli were found in 01 c.c. of a sample taken with the spoons normally used. The ice cream was manufactured in a small electric plant—a Fern's emulsifier and pasteuriser— and samples taken at the source by the Medical Officer of Health of the Borough concerned proved to be quite satisfactory. Contamination in this case probably took place during or after delivery. Many examinations were made of ice cream manufactured on a fairly large scale in a local factory, with modern apparatus. Most of the samples shewed a high bacterial count and B. Coli were present:— Sample No. 1. 365,000 bacteria per c.c. B. Coli in 001 c.c. 2. 280,000 „ „ „ 001 c.c. 3. 48,000 „ „ „ 001 c.c. 4. 11,000 „ „ „ 01 c.c. 5. 18,000 „ „ „ 01 c.c. The proprietor appeared to be conscientious. The ingredients used were of good quality and the mix was pasteurised. Some of the samples were taken immediately after production, so the possibility of contamination at a later stage was eliminated. Samples No. 4 and No. 5 were of ice cream made after special precautions had been taken to ensure a clean product. Despite this B. Coli were present. After many consultations with the owner it was suggested to him that his pasteurising plant was not efficient. He alleged that the mix was kept at 150° F. for 30 minutes. The plant was again inspected, and it was found that the recording thermometer was fixed outside the vat near the drawing-off tap in a situation where the true internal temperature could not be recorded with any accuracy. This was confirmed by plunging a second thermometer into the vat. This registered 130° F. when the outside thermometer shewed 150°. The necessary adjustments were made, and a further sample of ice cream shewed:— Total bacteria per c.c. No B. Coli present in any 80 dilution. It is apparent that strict supervision of ice cream manufacture is necessary, and the extra work placed on a Public Health Department by so doing is amply repaid by results. In addition, all persons whose premises are registered for the manufacture or sale of ice cream should be given printed 140 information as to the methods to be adopted for ensuring that their product is of high bacteriological purity. No new premises should be registered unless there are satisfactory arrangements for sterilisation. In a recent investigation in the Manchester district* it was found that when "cold mix" ice cream was made in the Laboratory for experimental purposes, its bacterial content depended on the state of the milk, and, to a lesser extent, on the purity of the ice cream powder. Polluted milk yielded polluted ice cream; when the mix was heated, satisfactory samples were produced. Storing for long periods—especially when the ice cream is already polluted —and re-freezing may cause an enormous increase in the bacterial content. The State of Michigan requires all mix to be dated and used within a week of pasteurisation. *The Bacterial Content of Ice Cream in relation to manufacture, storage and standard of purity. Doris A. Bardsley. Journal of Hygiene, September, 1938. Chemical Analyses. The fat content of 32 samples was:— Percentage of Fat. Number of Samples. Above 20 per cent. 1 18-20 per cent. 3 16-18 per cent. 0 14-16 per cent. 3 12-14 per cent. 1 10-12 per cent. 4 8-10 per cent. 4 6-8 per cent. 3 4-6 per cent. 2 2-4 per cent. 10 below 2 per cent. 1 It is generally agreed that if a chemical standard were adopted a minimum fat content of 8 per cent. should be required. In Hampstcad 50 per cent. of samples had less than 8 per cent. of fat, indeed, in a third of the cases the figure was less than 4 per cent., while in a quarter it was less than 3 per cent. All the samples were free from preservative. A comparison of the results in samples from different sources. (1) Counter Freezers. Shop No. 1 2 3 4 5 6 7 Average 2.6 per cent Percentage of Fat 3.3 2.5 2.7 2.7 2.5 2.5 2.1 (2) Large Scale Manufacturers and reputable Firms. Firm No. 1 2 3 4 5 6 Average 12.4 per cent, Percentage of Fat 14.2 19.0 8.3 18.3 11.8 3.1 141 In the case of vendors on Hampstead Heath, sampled on a Bank Holiday, the fat percentage was 21 in one instance and 1 per cent. in another. Frozen products of this nature should surely not be designated " ice cream." That the small manufacturer can produce an excellent article is illustrated by a comparison of the ice cream made in old fashioned outside freezers. The chemical differences are as striking as the bacteriological counts of these two samples which were commented on previously. Total Solids. Fat. Solids not fat. Shop 1 40.8 per cent. 20.4 per cent. 20.4 per cent. Shop 2 30.9 per cent. 5.1 per cent. 25.8 per cent. In (1) the whole of the 20 per cent. of fat was butter fat. Such wide differences in fat content make it clear that "ice cream" can be anything from a valuable food stuff, rich in fat, to a poor commodity of negligible value as a food. The small vendor is the worst offender. He uses milk, sugar, and a proprietory brand of ice cream powder or a starchy filler. Skimmed or condensed milk may be used with custard powder; gelatine is often added. In marked contrast to this is the ice cream from Shop No. 1 above, made from milk, sugar, eggs and cream. Conclusions. Ice cream consumption has increased a great deal in this country during recent years, yet, much of the so-called "ice-cream" sold is little more than frozen custard powder, having a low fat content. From a bacteriological standpoint it also leaves much to be desired. The small vendor is the worst offender in both respects. The laying down of standards of purity, both chemical and bacteriological, is a matter which merits further consideration in Great Britain. The popularity of the Counter Freezer and the failure to heat the mix greatly increases the risk of contamination. It is essential in these cases that pasteurised milk be used. The ideal to be aimed at is the single large unit as opposed to a number of small ones. Any sanitary standards required of the former should also be insisted on in the latter. "Disease is no respector of size" and where so much ice cream is contaminated the occurrence of an epidemic from this source is always a possibility. Strict supervision and control are essential and the small manufacturer requires education in the arts of cleanliness. By these methods he can produce a clean product although its value as a food, especially for children, will not be bettered without the enforcement of certain requirements as to the nature of the ingredients used, and the minimum fat content, 142 Various suggestions have been made as to the bacteriological requirements which should be enforced by legislation. These have emanated from both the manufacturers themselves and from members of the Public Health Services. For example, bacteriological standards could become more severe after the first year:— First Year—a maximum of 500,000 bacteria per c.c. with no B. Coli in 001 c.c. Second Year—a maximum of 250,000 bacteria per c.c. with no B. Coli in 01 c.c. Third Year—a maximum of 100,000 bacteria per c.c. with no B. Coli in 1 c.c. The requirements for the first year appear to be too generous, for it seems unreasonable to legalise the production of a highly contaminated ice cream even for one year, when with the exercise of due care a clean product can easily be manufactured. Another suggestion is that there should be two different grades of ice cream. In Grade "A" the total count should not be more than 250,000 organisms per c.c. with no B. Coliform organisms in less than .1 c.c.; Grade "B" would allow 500,000 organisms and B. Coli in 001 c.c. Here again there is little excuse for allowing the public to consume an infected ice cream, and "Grade B" comes within this category. Pasteurisation of the mix at 150° F. for 30 minutes is also a desirable enactment. Chemical and bacteriological standards are necessary not only for ice cream, but for other milk products such as cheese, butter and cream, and if they are adopted for one they should be insisted on in the others. At the present time infected milk is permitted to be sold and it is even more necessary to insist on a pure milk supply than it is to demand a bacteriologically sound ice cream, but although the desirability of enforcing the pasteurisation of ice cream mix is clearly demonstrated it would appear to be anomalous to insist on this whilst the major deficiency is allowed to continue. Fortunately, pasteurisation of the mix is carried out by all the large firms and by many of the smaller ones; and the very small manufacturer can often be prevailed upon to do so, failing this he may be persuaded to use only pasteurised milk. However, until appropriate legislation comes into being much can be done by propaganda and education of the producer, by constant inspection of his plant and premises, and close scrutiny of his methods of manufacture. H. DAVIS CHAUCF. REPORT for the year 1938 of thE Public Analyst. H. E. COX, D.Sc., Ph.D. (Lond.), F.I.C. 145 The Laboratory, 11, Billiter Square, London, E.C.3. 23rd February, 1939. 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 I have carried out as your Public Analyst during the year 1938. The total number of samples taken under the Food and Drugs (Adulteration) Act has been 501, and the nature of these is shown in the following list:— Milk 158 Cream 3 Butter 34 Margarine 27 Mixture of Butter and Margarine 1 Lard and Lard Substitutes 12 Cheese 9 Dripping, Suet, etc. 8 Sausages, Minced Beef, Canned Meats, etc. 38 Fish, Fish Pastes, etc. 56 Tinned and Dried Fruits and Vegetables 31 Fresh Fruit (Apples) 3 Flour, Cereals, etc. 15 Bread and Butter 5 Sugars 8 Jam, Honey, Marmalade and Jellies 24 Ice Creams 32 Sauces, Spices and Pickles (including Mincemeat) 14 Condiments (Mustard and Pepper) 2 Vinegar 5 Spirits 7 Fruit Juices or Drinks2 Drugs 1 Miscellaneous 6 501 146 Of these 501 samples, 26 were reported as adulterated. These included one milk which contained added water, three butters which also contained an excess of water, a mixture of butter and margarine (the sale of which is illegal), two alleged cream cheeses in which the only claim to creaminess was due to an excessive proportion of water; four samples of Barbados sugar contained substantial quantities of tin, two jams were deficient in fruit, two sausages contained preservative (one contained sulphur dioxide without declaration and the other contained boric acid which is in no circumstances permitted). Five specimens of canned sardines contained excessive proportions of lead (in one case so much as 40 parts per million), two bread and butters bought at restaurants proved to be bread and margarine; two minced beefs contained preservative contrary to the Regulations, a curry powder showed an excessive proportion of lead and one whiskyobtained during the Christmas season showed 12 per cent. of added water. There have as usual been a number of cases which give some difficulty. Tomato products are not infrequently contaminated with copper. One such sample showed 75 parts per million reckoned on the dry matter. The proposed limit is 50 parts, but this limit is in my view rather stringent. Tomato Purees may contain as much as 85 per cent. or more of water, so that 50 parts of copper per million on the dry matter means only about 7 parts in the sample. It is difficult to determine the copper more accurately than one or two parts per million, and such an error when it is multiplied by 7 in order to show the result on the dry matter would be important. Cheese has long been the subject of some difficulty because there is no proper standard. A cheese of the Cheddar type contains about 35 per cent. of water. When processed cheese was first introduced 15 years or more ago, little or no water was added. Then the water content in processed cheese crept up to 38 or 40 per cent. It is gradually going up and some samples have now been found to have as much as 55 per cent. of water,—that is some 20 per cent. more water than the original cheese contained, and sold at the price of cheese. It is in my view desirable that a limit should be prescribed. 147 Cream cheese has often given difficulty and lately I had a sample called "Triple Cream Cheese." It is difficult to decide what these words mean. The specimen in question was no more or less than an ordinary whole milk cheese, so 1 recommended that the label should be altered. It is hoped that some of the administrative difficulties which arise in connection with the Food and Drugs Acts will be cleared up now that the new Food and Drugs Act, 1938, has been passed. This Act takes effect on October 1st next and tightens the law in several directions. It also gives power to the Minister to make Regulations governing the composition and purity of food-stuffs and it may be hoped that he will, after due enquiry, fix standards for certain of the more important commodities. In my view standards are desirable in two directions—the prevention of excessive dilution and the sale of inferior products which prejudice the pocket of the purchaser; the other in the setting of limits for certain impurities arising either by deliberate addition as in the case of tin in sugar or by accidental contamination during manufacture. Notwithstanding these various adulterations and difficulties the food sold in the Borough is as a whole very good. The rate of adulteration is 5 2 per cent., but even this figure may be misleading because it naturally happens that more samples are taken of commodities which are likely to be adulterated or which are suspected than of foods which experience shows are not frequently adulterated. 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. 151 Prevalence of, and Control over, Infectious and other Diseases Notifiable Diseases during the Year 1938. NOTIFIABLE DISEASES. * Total cases notified in age-periods. * Total cases notified in each Ward. * Cases admitted to Hospital. At all Ages. Total deaths in age-periods. At all Ages. At Ages—Years. At Ages—Years. Under 1. ] and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and 1 under 15. 15 and under 2 ). 20 and under 35. 35 and under 45. 45 and under 65. 1 (15 and over. ' Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). 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. i 15 and under 20. 20 and under 35. 35 and under *15. 45 and under 65. 65 and over Cerebro Spinal Meningitis 6 .. 2 .. 2 .. .. .. 1 1 .. .. .. .. .. 2 .. .. 2 2 6 2 1 1 .. .. .. .. .. .. .. .. .. .. Diphtheria 80 1 3 .. 6 8 28 7 9 12 2 2 12 13 10 2 15 ?A 4 79 .. .. .. .. .. .. .. .. .. .. .. .. .. Dysentery 7 .. 2 .. 2 .. .. .. .. 2 .. 1 .. 2 1 1 .. 1 1 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. Erysipelas 31 .. 1 .. .. .. 1 .. .. 7 4 13 5 2 5 3 3 6 10 2 17 .. .. .. .. .. .. .. .. .. .. .. • • .. † Measles 345 31 81 60 119 108 323 41 29 45 7 1 .. .. 109 67 51 189 9.49, 109 132 2 1 1 .. .. .. .. .. .. .. .. .. • • Ophthalmia Neonatorum 15 15 .. .. .. .. .. .. .. .. .. .. .. 1 .. 1 .. 2 4 7 13 .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 93 3 3 2 4 2 11 1 4 15 9 23 16 7 19 10 11 90 18 8 17 13 1 .. .. .. .. .. .. .. .. .. .. .. Puerperal Fever 4 .. .. .. .. .. .. .. .. 4 .. .. .. 1 1 .. 2 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 3 9 Puerperal Pyrexia 20 .. .. .. .. .. .. .. .. 17 3 .. .. 1 6 2 2 4 4 1 19 .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 156 .. 4 5 15 11 53 26 9 15 8 2 .. 18 14 13 20 23 52 16 136 .. .. .. .. .. .. .. .. .. .. .. .. .. Typhoid Fever 8 .. .. .. .. .. .. .. 1 3 1 2. 1 .. 2 2 1 2. .. 1 7 1 .. .. .. .. .. .. .. .. .. .. .. .. ‡Whooping Cough 26 2 4 2 7 4 7 .. .. .. .. .. .. 2 15 2 .. 2 4 1 5 .. .. .. .. .. .. .. .. .. .. .. ..i .. Totals 1291 52 100 71 155 141 423 75 53 121 34 44 22 124 185 113 92 264 361 152 471 18 3 2 - 1 - - - - 3 9 * Cancelled cases have not been included. †Notifiable under the Borough of Hampstead (Measles) Regulations, 1920, up to 30th September, and from 1st October under the Count, of London (Measles and Whooping Cough) Regulations, 1938 ‡ Notifiable from 1st October, 1938. Statistics relating to Tuberculosis are given in subsequent pages. 152 Acute Anterior Polio Myelitis. (Infantile Paralysis.) No case of acute Poliomyelitis occurred in Hampstead during the year. One patient aged 10 was notified as suffering from this disease, and was removed to a hospital for infectious diseases, but the diagnosis was not confirmed. There was no paralysis and the final diagnosis was myalgia. Cerebro-Spinal Fever. There were six cases of Cerebro-Spinal Fever during 1938; the ages of the patients were 4 months, 1½ years, 3½ years, 3½ years, 16 years and 28 years respectively. In every instance the diagnosis was confirmed bacteriologically and all the cases were treated in hospital. Unfortunately two of the patients died. The Medical Officer in charge of one of the patients—aged 4 months— states that the child was almost moribund on admission to hospital and the cerebro-spinal fluid was thick and purulent. Prontosil Rubra was given intrathecally and intramuscularly. The patient recovered. Another child treated with Prontosil died. The remaining four patients were given the appropriate serum. The female patient aged 28 years was admitted to hospital in the first instance as a case of Para-typhoid fever. No bacteriological confirmation of this was obtained and she was diagnosed in hospital as a cases, with one exception, were removed to hospital. Diphtheria. During the year there were 80 cases of diphtheria with no death as compared with 87 cases and four deaths in the previous year. All cases, with one exception were removed to hospital. Immunisation. Immunisation is available in the Borough by private arrangement of inhabitants with their own family doctors, in which case the cost 153 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 under the Borough Council's Scheme:— (c) 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 the 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. On 24th January, 1935, the Council agreed to augment the scheme then in operation for diphtheria immunisation under which the Council provided the necessary immunising material free of charge, by agreeing as and from the 1st April, 1935, to pay to general practitioners a fee of 7s. 6d. for each child completely immunised against diphtheria. It was found that in the majority of cases this scheme worked satisfactorily, but that certain difficulties occasionally arose, as it is sometimes necessary for a patient to receive four injections before he is completely immunised, and in certain other cases the patient is not prepared to receive the full course of three injections. At its meeting on 24th November, 1938, the Council resolved that the scheme should be amended, and that the general practitioners should be paid a sum of 2s. 6d. in respect of each injection given. Such an arrangement, it was felt, would overcome the difficulty associated with the cases referred to, and is in addition, in accordance with that approved by the British Medical Association. 154 During the year 296 children were immunised against Diphtheria; 116 by private doctors, and 180 by the Council's Assistant Medical Officer. Of these (a) 132 were pre-school children. (b) 164 were school children. 126 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. Alleged Diphtheria in an immunised child. A boy aged 5 was given three injections of diphtheria toxoid antitoxin in July, and in December he was notified as a case of Diphtheria. The Medical Superintendent of the Fever Hospital stated that he was admitted a week after the onset of a sore throat for which he was given anti-toxin by the attending practitioner. On admission there was no evidence of disease but virulent Diphtheria bacilli were found in the throat and nose. The Medical Superintendent reports that a provisional diagnosis of tonsillar diphtheria was made, but that it is possible that the patient suffered from tonsillitis and was at the same time a diphtheria carrier. A routine Schick test was not performed in this case. The child first attended the Immunising Clinic in January but did not attend for the second dose until July when two further injections were given. Although requested to come again for a fourth injection his parents did not bring him. It should again be emphasised that even should diphtheria occur in an immunised subject, the disease usually runs a mild course. It is probable, however, that many such cases are not due to true diphtheria, but are cases of tonsillitis in diphtheria carriers. Diphtheria Anti-Toxin (London) Order, 1910. In accordance with this Order the Borough Council supplies antitoxin free to medical practitioners for use for the poorer inhabitants of the Borough. 155 Enteric Fever. Nine persons were notified during the year as suffering from Typhoid or Paratyphoid Fever, but in one case the diagnosis was not confiimed and the patient was found to be suffering from Cerebrospinal Fever. There were no deaths, but a case notified on the 30th December, 1937, died in hospital on the 5th January, 1938. In seven instances the disease was typhoid, whilst one case was paratyphoid fever (B). This latter patient was a recent arrival in Hampstead and was infected elsewhere. One patient was infected whilst on holiday in Denmark, another in Spain and a third in Belgium. Cases of typhoid contracted abroad occur with great regularity. They illustrate the importance of preventive inoculation for all persons who contemplate a visit to places abroad where the water supply and general sanitary arrangements are not above reproach. In one case infection presumably took place elsewhere in England, but in the remaining three cases no obvious source of infection could be traced. One patient—a domestic servant aged 22—was recovering when admitted to a General Hospital. The occurrence of sporadic cases of typhoid represents a very complex problem. Often no source of infection can be traced and there is no record of the consumption of any unusual food stuffs. It may be extremely difficult to arrive at a correct early diagnosis on purely clinical grounds. In all cases of obscure illness, specimens of blood, faeces and urine should be examined. There is little doubt that individual susceptibility and resistance to infection vary within very wide limits and this, combined with the multiplicity of sources from which typhoid can be transmitted, accounts for the regular appearance of sporadic cases. Prophylaxis. In two of the cases the immediate contacts were given a preventive inoculation of Felix' Serum. In no instance did further cases occur in the families concerned. Doses of 10 and 20 c.c. of the Serum were administered to nine contacts, but in many of these the injections were followed by rather severe local and general reactions which necessitated treatment in hospital in two cases, 156 Encephalitis Lethargica. There was no case during 1938. Malaria. No case of Malaria was notified during the year. Dysentery. Seven cases of Dysentery were notified in 1938 as compared with ten during the previous year. All cases were of the Sonne type. Two of them occurred in June, two in October. The other cases were notified in January, April and December respectively. With one exception the patients were treated in hospital. There were four children aged three years or less, and three adults. In no case was there a fatal termination. The bacteriological services of the Borough Council are available for differential diagnosis, and the appropriate outfit for collection of faeces is sent to any medical practitioner on request. It is particularly important, especially in the case of young children, or children in Foster Homes or other Institutions, that bacteriological investigation of the faeces should be immediately undertaken whenever any suspicious illness of a gastro-intestinal nature occurs. Unfortunately, it is frequently impossible to detect any pathogenic organisms in these cases, and it is probable that the enteritis is not caused by any of the known organisms. These cases form a distinct group in which the mortality is very high in children under one year, and the disease very infectious from child to child. In hostels and children's homes scrupulous cleanliness is necessary, particularly after the occurrence of a case of gastro-enteritis, in order to prevent the spread of infection, Pneumonia. During the year 93 cases of Pneumonia were notified. Of these 78 were of acute Primary Pneumonia, and 15 cases of acute InfluenzalPneumonia. The total deaths were 13, of which 12 occurred in persons over 45 years of age (9 in persons of 60 years or more). As is usually the case, the age of the patient appears to be the ?hief factor of mortality. 157 Seven of the deaths occurred during the first quarter of the year. Influenza. 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-Pneumonia notification's which numbered 15, as compaired with 41 in 1937. On the other hand, the death returns for the year show Influenza as the cause of death in 7 cases, as compared with 55 cases in the previous year. Scarlet Fever. During the year 156 cases of Scarlet Fever were notified. (Of these 136 were treated in Hospital.) There were no deaths. The following table shews the number of cases notified during the past 5 years :— 1937 177 1936 114 1935 112 1934 194 1933 451 The value of taking throat and nose swabs of contacts for bacteriological examination for the presence of hemolytic streptococci should be emphasized. It is an especially important procedure where other members of the family have been ill prior to the diagnosis of Scarlet Fever. In one case the mother and father and four children contracted Scarlet Fever. One of the children who had been discharged from an Isolation Hospital after Scarlet Fever, had an acute coryzal attack a few days after his return home and a nasal swab demonstrated the presence of hemolytic streptococci. He was again removed to hospital, but all the remaining members of the family were infected by him during his short period at home. Measles. Comity of London (Measles and Whooping Cough) Regulations, 1938. Measles has been a notifiable disease in Hampstead since 1916, in which year the Public Health (Measles and German Measles) Regulations, 1915, issued by the late Local Government Board began to 158 operate. When these Regulations were rescinded at the end of 1919, the Borough Council obtained approval for the Borough of Hampstead (Measles) Regulations, 1920, which continued in force until 1st October, 1938, when they were superseded by the County of London (Measles and Whooping Cough) Regulations, 1938. These latter Regulations apply, with certain modifications, Sections 192 and 193 of the Public Health (London) Act, 1936, relating to notification of cases by medical practitioners, to both these diseases. Such medical certificate is not required, inter alia, where to the knowledge of the medical practitioner measles or whooping cough as the case may be has occurred in the house and has been notified within the two months immediately preceding the date on which he first became aware of the disease in the case he is attending. It has been our practice for very many years to visit all known cases of Measles with a view to ensuring that where necessary the patients in suitable cases are removed to hospital, that adequate nursing is available, or if this is not so, to arrange for nurses of the local District Nursing Associations to attend; and also to notify head teachers of schools attended by children in the family, etc. An advisory leaflet is left in each case visited. All medical practitioners were supplied with a copy of the new Regulations and reminded of the facilities for the hospitalling of cases. There were 845 cases of Measles during 1938, of which 132 were removed to hospital, as compared with 90 during the previous year and 918 in 1936. There were two deaths. The Measles epidemic occurred between the 1st November, 1937, and the 31st August, 1938, during which period there were 940 cases with 2 deaths in children of 1 year and 10 years respectively. The following table shews the incidence and mortality of measles between 1st November, 1937, and 31st August, 1938:— Ages. Tinder 1 1-2 2 3 3-4 4-5 5-6 6-7 7-8 8-14 14 and over. Total No. of cases. 29 80 70 133 132 158 102 53 94 89 940 'No. of deaths — 1 — — — — — — 1 — 2 159 The Council make a grant to the two local Nursing Associations in respect of home nursing in which cases of Measles are included. During the epidemic, 979 visits were made to 95 homes. The use of Serums by General Practitioners. (1) Adult Serum was given to six children, five of whom did not develop Measles; one had a slight attack. (2) Convalescent Serum was given to 14 children. In every case the child had a modified attack. Once again it is necessary to stress the importance of trying to prevent or modify the disease in young children in whom the mortality tends to be high. Isolation of a patient is often very difficult at home and removal to Hospital is advisable if isolation facilities are not satisfactory. Hospital treatment is also indicated in very severe cases in which broncho-pneumonia and other complications are present. It is hoped that a more liberal supply of serum will be available in future epidemics. Whooping Cough. Whooping Cough has never previously been compulsorily notifiable in the Borough, but such cases as had come to our knowledge, principally through the notifications received from School Teachers of children absent from school on account of their suffering from, or being contacts of the disease, had been visited by the Health Visitors in order to offer hospitalling of suitable cases or to ensure that cases were being properly nursed. All medical practitioners were duly informed of the new arrangements which, as in the case of Measles, came into operation on the 1st October, 1938. From 1st October, when this disease became compulsorily notifiable, until the end of the year, 26 cases were reported. Of these cases five were removed to hospital, while in one case, the nurses of the local District Nursing Association were asked to attend. An advisory leaflet is left in each case visited. Venereal Disease. Skilled treatment can be obtained by anyone free of charge and under conditions of secrecy at any of the Centres that have been set 160 up under he scheme of the London County Council. Information as to the days and hours of consultation can be obtained from any medical practitioner; from placards posted in the public lavatories; or from the Borough Medical Officer of Health at the Town Hall, or the County Medical Officer of Health at the County Hall, Westminster Bridge, S.E.I. This information is given under the strictest secrecy to persons who apply personally or by letter. The nearest Centres to Hampstead are at 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. Disinfection of clothing, bedding, etc., is carried out free of charge by the Public Health Department. Food Poisoning. There were 10 cases of food poisoning notified in pursuance of Section 7, London County Council (General Powers) Act, 1932. Such foodstuffs as veal and ham pie, steak and kidney pie, fried fish, tinned tongue and duck's liver were mentioned as the possible cause in the different cases. In three instances no bacteriological examination was made and the illness was of a mild nature. In two instances examination of the faeces shewed no pathogenic organisms. The tinned tongue was examined bacteriologically but nothing abnormal was discovered. B. Aertrycke was identified in the portion of cooked duck which gave rise to illness in three persons. All the affected persons were adults; nine females and one male. In every case of food poisoning exhaustive enquiries are made and wherever possible a sample of the food implicated is examined bacteriologically. Unfortunately it is often impossible to obtain such a sample. Food Poisoning by B. Sonne. On the 4th March, 1938, it was reported that a party of live adults who bad partaken of a meal of Tongue on the previous day were all taken ill with severe abdominal pains and diarrhœa some 12 hours later. 161 The Tongue had been obtained from a local branch of a firm of well-known provision dealers owning multiple shops. Samples of sliced Tongue of two varieties were taken from this shop by the Sanitary Inspector on the following day, and submitted to Eastes Laboratories, 6, Harley Street, for bacteriological examination. On the 8th March, 1938, the Laboratories reported that both samples contained B. Dysentery (Sonne) in large numbers. Apparently the practice of the firm in question is to receive in 6-lb. tins two types of prepared tongue, viz.:—(1) Swift Plate Ox Tongue (Tinned in the Argentine), and (2) Morris & Co. Cooked Lunch Tongue (Tinned in Chicago). These tongues are taken out of their tins as required, and subsequently retailed in slices as required by the Customers. The bacteriological results of all the material referred to Eastes Laboratories, Harley Street, are as under:— Date. Material. Bacteriological Report. 8th March Cut Tongue "A" B. Sonne present. 8th March Cut Tongue "B" „ „ 9th March Tinned Tongue "A" Negative. 9th March Tinned Tongue "B" „ 9th March Cut Tongue "A" B. Sonne present. 9th March Cut Tongue "B" B. Sonne absent, B. Coli present. 15 March Fæces Assistant A. B. Sonne absent. „ „ B. „ „ c " " „ „ 15th March Counter knives B. Sonne absent, B. Coli present. 15th March Mutton Cloths (material on which knives are wiped). B. Sonne absent, B. Coli, B. Fæcalis, and Friedlander's Bacillus present. 15th March Counter cloths B. Sonnt absent, B. Coli present. Observations:— L—The bacteriological results, as was anticipated, exonerated the Tinned Tongue. 2.—The absence of Sonne B. from the faeces of the shop assistants would perhaps exclude them as the source of infection. 162 3.—The mutton wrappers which were used for the purpose of wiping the knives proved to be grossly contaminated. 4.—The firm arranged that in the future all mutton wrappers (cloths) should be first of all boiled in disinfectant at their headquarters before distribution for use at their branches. Previously the wrappers were taken off the imported meat at their several branches, and washed in the various shops. It was arranged that in future all wrappers should, in the first place, be returned from the various branch-shops to headquarters, where special facilities would be provided to ensure their adequate boiling, etc., before re-distribution to the branches. It is probable that any dangerous contamination to the wrappers would occur during their transit from abroad, and it appeared that the facilities for the washing of the cloths at the various branches were not adequate to ensure their being " sterilized Aircraft from Infected Localities. In May the Public Health Committee gave consideration to Section 143 of the Public Health Act, 1936, which empowers the Minister of Health to make regulations to prevent the spread of infectious diseases, and imposes upon the Council the duty of carrying out such regulations. They also considered the Public Health (Aircraft) Regulations, 1938, which had been made under that Section and which came into force on 1st July, 1938. Under these regulations Metropolitan Borough Councils are responsible for the execution thereof as respects any aerodromes maintained by them or any aerodromes in their area. There are no aerodromes in the Borough and the only provisions which apear to afiect the Council are those which deal with cases of forced landings of aircraft coming from infected localities. It was resolved by the Council that their powers and duties under the Act should be referred to the Public Health Committee. Tuberculosis Report of H. DAVIS CHALKE, M.A., M.R.C.S., D.P.H., Clinical Tuberculosis Officer. 165 Tuberculosis. New Cases and Mortality during 1938. During the year 1938, 89 new cases of Tuberculosis were notified, 76 being cases of Pulmonary Tuberculosis, and 13 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 1938:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M F. M. F. M. F. 0 - - - - - 1 - - 1 - - 1 - - - 5 1 4 3 1 - 1 15 2 12 3 2 2 2 1 25 8 16 1 2 3 5 - - 35 10 3 8 3 - 45 5 4 — 4 — - 1 55 5 2 — 2 — - 65 and upwards 1 2 — — 2 2 - — Totals 32 44 7 6 21 13 1 2 Occupations The following is an analysis of the occupations of the new cases notified as tuberculous during 1938:- Occupation. Pulmonary cases. Non-Pulmonary cases. Accountant 1 — Army Officer (Retired) 1 — Artist 1 — Assembler 1 — Bank Clerk 1 — Barmaid 1 — Barman 2 — Barrister 1 — Bookstall Assistant — 1 Business Manager 2 — Butcher 1 — Child (under school age) 1 1 166 Occupation. Pulmonary cases. Non-Pulmonary cases. Children's Nurse 1 — Civil Engineer 1 — Civil Servant 2 -— Clerk 5 — Commercial Agent 1 — Domestic 6 3 Draughtsman 1 — Entertainer 1 — Hall Porter 1 — Handyman 1 — Housewife 16 1 Kitchen-man — 1 Laboratory Assistant — 1 Labourer 1 — Laundry-hand 1 — Masseur 1 — Mechanical Engineer 2 — Milk Roundsman 1 — Motor Driver 1 - Musical Director 1 — Nil 3 — Nun 1 — Nurse 2 — Publican 1 — Salesman 1 — Saleswoman 2 — Scholar 1 4 Secretary 2 — Shop Assistant 1 — Student 1 — Tailor 1 — Typist 1 — Waitress 2 — Warehouse-boy — 1 Totals 76 13 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 167 361, in 1918, to 89 in 1938, equivalent to 75 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 1938 76 13 89 34 Deaths. The number of deaths from all forms of tuberculosis during 1938 was 37, of which 34 were pulmonary and 3 non-pulmonary. The death rate per 1,000 population from tuberculosis was 40. Deaths of Non-notified Cases. There were seven deaths certified as due to tuberculosis which had not been notified previously. The ratio of non-notified tuberculosis deaths to total tuberculosis deaths was 1 in 5. Enquiries are always made in such cases as to the reasons for non-notification. The reasons given for failure to notify were:— (1) Meningitis, rapidly fatal issue. 168 (2) Primary cause of death Uræmia and chronic Nephritis with tuberculous glands of neck. (3) Silicosis. Existent tuberculosis discovered at P.M. The sputum had repeatedly been "negative" on examination and on guinea pig inoculation. (4) Patient did not obtain medical advice until a late stage of his illness. He died very soon after admission to hospital. A post-mortem examination was performed. (5) A very acute illness. The practitioner forgot to notify until after death. (6) The practitioner was of opinion that the patient had previously been notified. (7) A child age five months. A contact of her mother, an open case of pulmonary tuberculosis: miliary and pulmonary tuberculosis was discovered on post-mortem examination Removals to Sanatoria and Hospitals. Sanatorium treatment for insured and non-insured persons is undertaken by the London County Council. Of the 76 cases of Pulmonary Tuberculosis newly notified in 1938:— 41 were treated at Sanatoria. 6 „ „ Hospitals. 11 „ „ L-C.C. Hospitals. Of the 13 cases of Non-Pulmonary Tuberculosis newly notified in 1938:— 7 were treated at Sanatoria. — „ „ Hospitals. 3 „ „ L.C.C. Hospitals. The following cases, notified prior to 1938, were also removed:— Pulmonary. Non-Pulmonary. Insured. NonInsured. Insured. NonInsured. To Sanatoria 8 2 — 1 To Hospitals — 1 — — To L.C.C. Hospitals 6 2 — — 169 Public Health (Tuberculosis) Regulations, 1930. The following table, compiled from the Register of Notifications kept in pursuance of Article 10 of the Tuberculosis Regulations, 1930, indicates the number and distribution of cases during the year. At the present time five discharged soldiers in receipt of a pension for tuberculosis are resident in Hampstead. The number of cases of tuberculosis known to the department at the end of 1938, totalled 340 —285 pulmonary and 55 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 1938 126 144 35 26 161 170 Number of cases notified under the Regulations for the first time during the year 32 44 7 6 39 50 Number of cases removed from the Register in a preceding year which have been restored to the Register during the year 9 4 1 1 10 5 Number of cases brought under notice otherwise than by notification during the year 19 23 4 7 23 30 186 215 47 40 233 255 *Number of cases removed from the Register during the year 53 63 17 15 70 78 Number of cases remaining on the Register at the end of the year 133 152 30 25 163 177 #These consist of cases which have been denotified, and those which have died or removed from the Borough, 170 Staff engaged on Tubcrculntsis Work. The Borough Council staff specially engaged in work directly conneoted with Tuberculosis consists of the following:— (1) The Medical Officer of Health, who is the Administrative Tuberculosis Medical Officer. (2) The Clinical Tuberculosis Officer, who is also the Assistant Medical Officer of Health. (3) Tuberculosis Nurse. (4) Assistant for Care Work (part-time). (5) Clerk. The Tuberculosis Nurse visits all newly-notified cases and informs them of the Dispensary facilities. She also, where necessary, obtains information as to the financial circumstances of the family. Where any financial difficulties are anticipated the case is referred to the Assistant for Care Work and to the Care Committee. If they are suitable cases they are urged to attend the Dispensary. 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. The Tuberculosis Death rate in Hampstead. It is matter for great satisfaction that the tuberculosis death-rate for Hampstead is so low, being 41 per 100,000. I am unable to compare this figure with that of other districts as such statistics are not yet available. In 1937, the rate was 40 per 100,000 population:—33 in respect of pulmonary and 7 non-pulmonary tuberculosis. That was the third lowest rate in England and Wales. If pulmonary tuberculosis, only, is considered the death-rate is lower in but three rural Counties. There are many factors which may influence this low death-rate. First of all, Hampstead has a small working-class population, the majority of the inhabitants being very well housed. Overcrowding is at a minimum. Similarly, there are relatively few insanitary houses or damp basement dwellings in occupation. The standard of living of 171 a well-to-do population is high, and malnutrition, a factor of the utmost importance in the tuberculosis problem, is little in evidence. Hampstead, by reason of its situation and elevation, has a reputation as a healthy district, and this is borne out by its low tuberculosis death-rate. This reputation as a Health Resort, tends, however, to bring to Hampstead a number of tuberculous immigrants from other parts of London, and this also applies to many tuberculous persons from the Provinces who come to London to live. One would expect this factor to have an adverse influence on the death-rate. A further point of interest is the presence amongst the population of Hampstead of a large number of Domestic Servants. Many of these come from Wales, Ireland and the "depressed areas" of the North of England. Previous experience has shown that they form a very susceptible group, and as one would expect, numbers of them become victims of tuberculosis. In a very large number of cases they suffer from malnutrition and many come from tuberculous homes. There is little doubt that some of them have been heavily infected previously, and that open tuberculosis represents a break down of a quiescent focus under the strain of urban life. Rut this section of the population, although occupying a prominent part in the Dispensary Register, does not very materially affect the death-rate, for most of these patients return to their homes in Wales, Ireland, Durham, etc., before or after they have received Sanatorium treatment. Experience in the Tuberculosis Service in Wales fully bears out this assumption; in the Tuberculosis Dispensaries there, numbers of girls who have worked in towns and cities in England are seen on their return home after the onset of tuberculous disease. Nationality of Dispensary patients. It is of interest to note the following details of birthplace and nationality of some of the patients on the Dispensary Register:- Hungarian 1 Scottish 5 Russian 5 Italian 1 Polish 5 Dutch 1 German and Austrian 6 Turkish 1 Rumanian 1 Indian 9 Latvian 1 Anglo-Indian 1 Swedish 1 Japanese 1 French 2 West Indian 2 Irish 36 Jewish 18 Welsh 21 172 Eighty patients were born in London, 21 in other English cities and 28 in rural England. Privation and mental anxiety are two potent factors in the aetiology of tuberculosis. It is not surprising, therefore, that refugees from Spain and Central Europe are numbered amongst the Dispensary patients. At least two English people, who had worked for many years in Spain—during the past two years under very trying conditions with an unsuitable and inadequate diet—returned to Hampstead suffering from Tuberculosis. Refugees and Immigrants. Tuberculosis is relatively uncommon among the Jewish Race. The rather large number of Jews on the Register is partly made up of Central European refugees. Indeed, it is a fortunate circumstance that they have such a high natural resistance to tuberculosis, for the conditions of living and worry which they have been, and continue to be, subjected to in Central Europe, would otherwise inevitably bring about an enormous increase in its incidence. Despite this natural resistance, that the disease will become very much more prevalent amongst them seems to be a distinct possibility and it is not unlikely that it will reflect itself on the health of those on whom responsibility for it lies. Physical culture displays and military parades are but a poor mask for that malnutrition which cannot fail to be present in any nation whose expenditure on suitable food must be curtailed. The sharp rise in the tuberculosis death-rate which occurred throughout Europe during and immediately after the War, is a sufficient proof of the close association of privation and mulnutrition, and tuberculosis. Although the number of Austrian and German refugees who come to Hampstead suffering from open pulmonary tuberculosis is not at present very considerable, it appears to be increasing. In some cases the affected people are temporarily housed in boarding houses or in flats where they cannot be satisfactorily isolated, and many of them are, unfortunately, almost destitute, and in urgent need of institutional treatment. In this country, when the tuberculous patient changes his address, his notification and medical dossier are transferred to the Public Health Department at his new place of residence. This valuable public health measure does not operate in the case of foreign immigrants. It would appear that due consideration will have to be given to this question in the near future, 173 In the above table it will be noticed that the Welsh and Irish form a very large group. The Welsh males are usually ex-miners who have come to London to find work. Cases of Silicosis in association with tuberculosis have been found in this group. The female patients work as Domestic Servants or Shop Assistants, whilst there are large numbers of Irishmen employed as Labourers. The Indian patients are nearly all Students. It should be noted that the figures given in the above Table do not refer to all dispensary patients but to notified patients only. Variation in natural resistance to Tuberculosis. The majority of adults have been infected with tuberculosis at some time or other. In relatively few cases is this infection followed by active disease. In those persons in whom it occurs it is probable that the infecting dose of tubercle bacilli has been large and repeated, and there have also been present one or more of those factors which lower the body resistance. In young adult life—especially in females during the onset of puberty and adolescence—there appears to be a marked lowering of this resistance to tuberculous infection. In addition, it must be remembered that natural resistance varies within very wide limits in individuals, and in different nationalities. Those whose forebears have lived in towns for centuries, are, generally, (like the Jewish people) less susceptible than the peoples who have remained isolated until comparatively recent times. The North American Indians who died of tuberculosis in large numbers form a striking example of this; the white man introduced a new disease to which they had little resistance through previous infection. If, in addition, there are famine, malnutrition and privation it is clear that the resistance of a susceptible people will be lowered even more. Differences in susceptibility are well demonstrated in the British Isles. The inhabitants of the West of Scotland and Ireland, and the rural districts of Wales are much more prone to attack than, say, the Londoner or the Wessex farmer. The people of North Wales, for example, have lived for centuries in the Welsh uplands in comparative isolation and they were not brought into contact with tuberculosis until fairly recent times. Wessex was the seat of, perhaps, the earliest civilisation in Britain and the people there were in contact with outside influences more than a thousand years ago. These two groups of people when they develop 174 tuberculosis react very differently. The former has little resistance and tends to succumb rapidly—the latter responds much more readily to treatment, often when there is quite extensive disease. The need for special supervision of susceptible people. A recent investigation in Jarrow has shown that the high tuberculosis death-rate there is to a large extent made up of Irish immigrants. It is evident that in London these racial differences will be very obvious. Large numbers of these susceptible people whose Standard of living, never very high, has suffered recently because of the industrial depression, have flocked to London to seek work. No effort should be spared to keep them under close medical supervision, and to improve their dietary and housing conditions. It is essential to give those of them who develop tuberculosis prolonged institutional treatment, even when they have made considerable progress. The dangers of allowing these low-resistant patients to return too soon to an unsatisfactory environment are very great. Indeed, in assessing a tuberculous subject a sort of fourth dimension—the patient's nationality—should be taken into account. The "Contacts" of these people must be carefully watched at the Tuberculosis Dispensary. It should not be difficult to evolve a scheme whereby an X-ray examination of the chest could be made in the case of all young people—particularly the racially susceptible ones —who come to London to find work. The cost would be repaid by the detection of early cases who would not require such a long period of institutional treatment as those (who form the present majority) who have advanced disease when first brought to the notice of the Dispensary Medical Officer. Housing. Satisfactory conditions of housing are of especial importance for both the tuberculous patient and his family. When he returns from Sanatorium to live in a damp, ill-ventilated, overcrowded house, he soon breaks down in health again. Life in an insanitary, overcrowded dwelling is also a cause of the transmission of the disease to other members of the family. For these reasons every effort is made to re-house tuberculous families who live in unsuitable homes, and 175 many of them have been found other accommodation on the London County Council Housing Estates. The number of tuberculous people who leave the Borough in this way probably tends to counteract the immigration from other parts of London. If Local Authorities would make greater provision in their housing schemes for the re-housing of the tuberculous population, it would be a great step forward towards the ultimate eradication of the disease. Persons who live in small, dark, insanitary houses cannot be expected to adhere rigidly to those rules of personal cleanliness and hygiene which are so essential in improving their own health and preventing the spread of infection. Age and Sex incidence of Tuberculosis. The following table shows the number of notifications of cases of pulmonary tuberculosis during the past decade. The number of notified males and females between the ages of 15 and 34 is also shown:— Year. Total Cases. Between 15 and 34. Males. Females. Males. Females. 1938 32 44 10 28 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 1932 35 46 16 33 1931 51 41 25 28 1930 25 43 15 23 1929 40 32 27 21 Totals 384 392 180 261 It is seen that 261, or 33 per cent. of the total of 776 cases, occurred in females between the ages of 15 and 34 years. A comparison of the two five-year periods, 1929-1933 and 1934-1938, shows that the notifications amongst both males and females at all ages have fallen appreciably:—from 211 males and 216 females in the first quinquennium, to 176 183 males and 186 females in the second, i.e., by 14 per cent. in both cases. When one examines the 15-34 age period, however, it is observed that the number of notified males has fallen by 27 per cent., whilst the female number is only 10 per cent. less. The fact that the incidence of tuberculosis of the lungs in young females remains at such a high level throughout the Country is a matter for great concern. The dangers of contact with an "open" case of tuberculosis may be conclusively demonstrated by a scrutiny of the patients' histories. Particularly does this apply to young females. The premonitory symptoms are: vague ill-health and tiredness, poor appetite and loss of weight, with, perhaps, very frequent colds, and later, a persistent cough. Those who employ young females, whether as domestic servants or in shops or offices, should be warned by such symptoms and should insist that medical advice be sought immediately. Employers could also perform a valuable service by insisting on a Medical Certificate of fitness in the case of every young person whom they are about to employ; such a certificate is, in fact, required by law in the case of employment of young persons in factories. The services of the Borough Tuberculosis Officer are always available in all cases in which tuberculosis is suspected. The Tuberculosis Dispensary. The Tuberculosis Dispensary has an unfortunate name. It is neither a Dispensary, nor does it cater solely for the tuberculous. Of the patients who attend there for investigation, but a small percentage ultimately prove to be tuberculous. The aim of a Tuberculosis Service is prevention as well as cure, and to detect the early case those responsible must be prepared to examine anyone in whom there is even the vaguest suspicion of tuberculosis. These functions of the Tuberculosis Dispensary cannot be made too widely known. In addition, it should be emphasised that the detection of early tuberculosis is often no easy matter. It demands skilled examination by one accustomed to such work as well as expert radiological and other investigations. For those patients who dislike the idea of visit ing the "Tuberculosis Dispensary" arrangements can always be made for them to be seen at home. It is to be deplored that so few patients come for examination when their disease is in an early stale. The solution lies in greater co-operation between the Public, the Medical Practitioner and the Tuberculosis Service. It is also high time that the Dispensary were given a more appropriate name. 177 Occupational Therapy. Occupational therapy has an important role in a Tuberculosis Scheme. It gives those who have so much time on their hands a new interest, as well as providing them with a little financial help. The Handicrafts Class which is being undertaken in conjunction with St. Pancras has proved very successful. Many of the patients have shown a distinct aptitude in this direction and the sale of the goods has been encouraging. In addition, a small class was started at the Tuberculosis Dispensary at the end of the year for the manufacture of Christmas Crackers. The patients learned very quickly and more than 80 boxes were made and sold in the few weeks before Christmas. The Dispensary is hardly a suitable Handicraft Centre and it is hoped that other premises for use as workrooms will be available in the future. The desirability of a complete reorganisation of Handicraft Schemes in London has already been mentioned. The different Boroughs should co-operate; the formation of three or four groups with common workrooms and a well-organised system for the sale of goods would be a great advantage. One of the biggest loopholes in the tuberculosis service is made by our inability to find work for those discharged from Sanatorium as fit for suitable work. The Village Settlement or Training Colony offer solutions, but there are not many of these, and, in any case, the majority of patients could not be persuaded to become settlers. Commerce has little use for the unfit, and many patients who are fit for work are doomed to lives of idleness. The Handicrafts Class helps a little to relieve their monotonous existence and to augment their incomes a little, but until such schemes are extended they can do very little to solve the main problem of unemployment amongst the tuberculous. Home Helps. The provision of Home Helps for tuberculous Housewives has been approved by the Council and the scheme is now in operation. Its aim is to employ a person (who is herself a patient, capable of a little work prior to resuming full domestic work) to assist the housewife newly returned from sanatorium. So often the housewife is forced to do all her housework as soon as she conies home after a period of 178 institutional treatment. Like the patient who will help her, she should resume full work by easy stages, otherwise there is a grave risk of the improvement she has made not being maintained. The scheme, has of course, a rather restricted scope, but it is gratifying to know that patients have already benefitted by it. It can, if necessary, be extended a little to include assistance for those who are awaiting admission to a sanatorium, in whose case complete rest is essential. Extra Nourishment. The provision of extra nourishment is a valuable adjunct to the Tuberculosis Scheme. Its worth has been proved beyond question, especially in the case of patients who on return from sanatoria, with or without an artificial Pneumothorax, have to subsist on sickness insurances until they are tit to commence working again. Without assistance, they are unable to get the nourishment which was supplied them at the Sanatorium. Financial reasons often cause these people to resume work too soon and it is difficult to dissuade them from doing so. It is gratifying to note that many of the patients who have been in receipt of grants for extra nourishment from the Council are now back at work. The extra nourishment given to these patients is indeed in the nature of a profitable investment. Every tuberculous person in receipt of Public Assistance is recommended for additional food, and I would like to take this opportunity of expressing my appreciation of the splendid way in which the Local Public Assistance Department have co-operated in this and other matters affecting the Tuberculosis Services. There is a steady increase in the number of patients attending for artificial Pneumothorax refills. These are given by me at the New End Hospital, London County Council, on Thursday afternoons. Many of the patients are at work during the day and when necessary they are given an opportunity of attending at other times after business hours. During the year 34 patients who were undergoing this form of treatment made 482 attendances. There has also been an increase in the number of X-ray films taken. X-ray work is performed at New End Hospital, where patients are also screened when necessary. During the year 261 X-ray films were taken and in addition many were screened as well as the routine screen examination made for A.P. patients. 179 Pathological Examination of Sputum. This work is undertaken for the Council by the Laboratories of Pathology and Public Health, 6, Harley Street, W.l, and the facility is available, free of charge, for medical practitioners. During the year 130 specimens were submitted for examination by local practitioners and, in addition, 205 specimens were sent by the Clinical Tuberculosis Officer. Mantoux Tests. All children are given a routine intra-dermal tuberculin test. A dilution of 1/1000 being used. Recently the Volmer Patch Test has been used in conjunction with the Mantoux Test. The results so far obtained are satisfactory. Dental Treatment. Dental treatment for tuberculous patients is given by arrangement with the British Dental Hospital. Patients in need of dental aid may obtain treatment at this Hospital, 31, Camden Road, N.W.1, on Wednesdays at 11 a.m. During the year, seven patients attended and the total attendances were 56. Light Treatment. One patient received 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. The Tuberculosis Dispensary is equipped with an ultra-violet ray lamp, the Clinical Tuberculosis Officer giving the necessary treatment during his clinical sessions at the Dispensary. During the year 207 treatments were given to 17 patients. 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 180 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. Public Health (Prevention of Tuberculosis) Regulations, 1925. No person suffering from Tuberculosis of the respiratory tract, and being in an infectious state, may work in connection with a dairy which would involve milking, treatment of milk, or handling milk vessels. No case arose during the year necessitating action to be taken under these Regulations. Tuberculosis Care Work. In July, 1938, a letter was received from the Hampstead Borough Tuberculosis Care Committee, intimating that in view of financial difficulties the Care Committee wished that the Council would take over the work of that Committee. The Care Committee, which was formed in September, 1922, took over the work of the joint Tuberculosis Care Committee of the Hampstead Council of Social Welfare which had acted since 1915 as the Interim Tuberculosis Care Committee of the London County Council. The Borough Council had made a grant towards the administrative expenses of the Care Committee of £100 per annum since March, 1934, and an additional sum of £10 was voted for the years 1937-8 and 1938-9 in connection with the expenses of a handicraft class. It was ascertained that if the work of the Care Committee was undertaken by a Committee of the Borough Council any representatives of other bodies could serve only in an advisory capacity, as there did not appear to be any power to co-opt members from outside the Council. The Public Health Committee agreed that it was desirable that the tuberculosis care work should be a matter for the Public Health Committee, the actual detailed work being carried out through a Sub-Committee consisting of six members of the Public Health Committee, who would have the assistance in an advisory capacity of representatives of certain outside bodies, and were of opinion that one of the London County Council representatives should be from the Public Assistance Section. It was felt desirable to appoint an assistant for the purposes of tuberculosis care work, such person to be a 181 porary part-time assistant in the Public Health Department under the administrative control of the Medical Officer of Health, and to give not less than 16 hours weekly to the work. The Council at its meeting on the 27th October resolved that the tuberculosis care committee work in Hampstead should be taken over by the Council as from 1st November, 1938, such work to be one of the functions of the Public Health Committee and that a Sub-Committee should be appointed by that Committee to deal with the actual detailed work, consisting of six members of the Public Health Committee and advisory representatives appointed by the following bodies, viz.:— London County Council—2 representatives; London Insurance Committee—1 representative; Hampstead Council of Social Welfare—2 representatives; Invalid Children's Aid Association—1 representative. It was thought that the County Council representatives should be from the Public Assistance Section and that a temporary part-time assistant should be appointed whose duties would include general clerical work and interviews, attendance at dispensary sessions, and such other duties as the Medical Officer of Health might from time to time direct; such officer not to engage in home visiting other than in exceptional cases as directed by the Medical Officer of Health, since the information as to home conditions is obtained by the Tuberculosis Health Visitor during her routine visits. With regard to certain outstanding amounts incurred by the Tuberculosis Care Committee in respect of administrative expenses, it was decided to make a grant of £255 for administrative expenses to enable the affairs of the Committee to be wound up forthwith. Details of the work carried out during the year are tabulated below:— Cases reviewed 299 New cases (included in above) 60 Interviews with patients by Assistant for Care Work:— (a) At homes of patients 54 (b) Otherwise 637 182 Cases referred to the Hampstead Borough Council:— (a) For extra nourishment 27 (b) For dental treatment 7 Cases referred to the Public Assistance Committee; Unemployment Assistance Board and London County Council 33 Cases referred to Service Funds 6 Cases referred to Voluntary Associations 21 Cases referred to other Agencies Cases helped directly through the Care Committee:— (a) In cash 33 (b) In clothing 20 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, 23 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, 154 sessions were held, and 286 new cases (of which 107 were contacts) were examined. Altogether, 444 patients attended the Dispensary in 1938, and the total number of attendances of all kinds numbered 2,245, an average of 146 per session. The attendances were 558 more than last year. 183 Tuberculosis Scheme of the Hampstead Metropolitan Borough Council. Return showing the work of the Dispensary during the year 1938. 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 23 24 — 2 3 2 1 25 27 2 1 55 (b) Doubtfully tuberculous — — — — — — — — 3 — 1 4 (c) Non-tuberculous — — — — — — — 34 58 15 13 120 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 1 — — — 2 — 1 1 2 — 4 (6) Doubtfully tuberculous — — — — — — — — 2 1 1 4 (c) Non-tuberculous — — - — — — — — 12 33 24 30 99 C.—Cases written off the Dispensary Register as:— (a) Recovered 4 1 — 1 1 2 — 5 2 2 — 9 (b) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) - - - - - - - - 46 91 40 45 222 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 99 100 3 1 8 7 14 7 107 107 17 8 239 (b) Diagnosis not completed - — — - - — - - - 5 1 2 8 Number of persons on Dispensary Register on January 1st 232 Number of patients transferred from other areas and of "lost sight of" cases returned 36 Number of patients transferred to other areas and cases " lost sight of 61 Died during the year 15 Number of attendances at the Dispensary (including Contacts) 2245 Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 683 Number of consultations with medical practitioners:— (а) Personal 132 (b) Other 356 Number of visits by Tuberculosis Officer to Homes (including personal consultations) 218 Number of:— (a) Specimens of sputum, &c., examined 205 (b) X-ray examinations made in connection with Dispensary work 261 Number of Insured Persons under Domiciliary Treatment on the 31st December 16 Number of "Recovered" cases restored to Dispensary Register, and included—in A (a) and A (b) above - Number of "T.B. plus " cases on Dispensary Register on December 31st 128 184 An analysis of the number of tuberculous cases on the Dispensary Register during 1938:— Per 1000 of child population (0 to 15). Per 1000 of adult population (15 and over). (a) Pulmonary Tuberculosis. 2.25 1.59 Number of quiescent cases per 1000 of population 0.67 Number of T.B. plus cases 0.00 1.42 Number of T.B. minus cases 0.04 0.79 Of the total cases of pulmonary tuberculosis 1.97 per cent, were children under 15 years of age. (b) Non-pulmonary Tuberculosis. Total number of cases of non-pulmonary tuberculosis per 1000 of the population 0.4 Number of active cases 0.04 0.09 Number of quiescent cases 0.19 0.08 Number of cases, divided according to the part affected:— Bones, joints and spine 0.04 0.04 Abdomen 0.03 0.01 Peripheral glands 0.13 0.07 Other organs 0.02 0.02 185 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 1938 286 30 107 2245 H. DAVIS CHALKE. 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, 1937 1734 2. Number of these:— (a) Successfully vaccinated 966 (b) Insusceptible of Vaccination 8 186 (c) Had Smallpox — (d) Number in respect of whom Statutory Declarations of conscientious objection have been received 385 (e) Died unvaccinated 49 3. Number of these Births which on 31st January, 1939, remained unentered in the "Vaccination Register" on account of:— (a) Postponement by Medical Certificate 15 (b) Removal to Districts the Vaccination Officers of which have been duly apprised 196 (c) Removal to places unknown, or which cannot be reached; and cases not having been found 97 4. Number of these Births remaining on 31st January, 1939, neither duly entered in the "Vaccination Register" under headings numbered 2 nor temporarily accounted for in the "Report Book" under heading numbered 3 18 5. Total number of Certificates of successful primary vaccination of children under 14 received during the Calendar year 1938 (including any relating to births registered in previous years) 1180 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 1938 415 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 1938 of successful primary vaccination of which copies have been sent to Vaccination Officers 201 It will be seen from the foregoing figures, that approximately 58 per cent. of the children born in Hampstead during 1937 had been vaccinated by the end of the year under review. This figure compares with 35 per cent. for England and Wales. 188 Metropolitan Borough ok Hampstead, 1938. Deaths from Cancer. MALES. Site. All Ages 0- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85- Tongue 3 - - - - - - - 1 - 2 - - - - Mouth 1 - - - - - - - - 1 - - - - - Jaw 1 - - - - - - - - - - 1 - - - Pharynx 1 - - - - - - - - - - 1 - - - (Esophagus 3 — — — - - - - - 1 2 - - - - Stomach 13 — - 1 - - - 2 3 3 2 1 - 1 - Rectum 2 - - - - 1 - - - - 1 - - - - Liver 1 - - - - - - - - 1 - - - - - Gall Bladder 1 - - - - - - - - - - - 1 - - Pancreas 1 - - - - - 1 - - - - - - - - Colon 7 - — - - - - 1 - - 1 3 - 1 1 Splenic Flexure 1 - - - - - - - 1 - - - - - - Sigmoid Flexure 3 - — - - - - - - 1 2 - - - - Intestine—not stated 1 - - - - - - - - 1 - - - - - Lung 8 - - - - - - - 1 3 3 - 1 - - Mediastinum 2 - 1 1 - Bladder 5 1 - - 1 1 2 - - Prostate 9 - - - - - - - - 1 3 - 3 1 1 Skin 1 - - - - - - - - - 1 - - - - Brain 2 — - 1 — 1 — — — — Bones 2 - - - - - - - - - 1 1 Muscles 1 - - 1 - - - - - - - - - - - All Sites 69 - - 3 — 1 3 3 6 14 19 9 5 4 2 FEMALES. Site All Ages 0- 25- 30- 35- 40- 45- 50- 55- 60- 65- 70- 75- 80- 85- Tongue 1 - - - - - - 1 - - - - - - - Œsophagus 2 - - - - - - - - - 1 - - - 1 Stomach 12 — 1 — — 1 1 1 2 3 1 — 2 Rectum 8 — — — — — - 1 — 1 — 2 1 2 1 Gall Bladder 1 - - - - - - - - 1 - - - - - Pancreas 4 - - - - - - - - 1 1 2 - - - Cæcum 1 - - - - - - - - - - - 1 - - Colon 12 - - - - - - - 2 — 2 4 3 1 - Splenic Flexure 1 - - - - - - - - - - 1 - - - Hepatic Flexure 1 - - - - - - - - - 1 - - - - Sigmoid Flexure 5 — — — — — — — 1 — 1 — 1 — 2 Intestine—not stated 3 - - 1 - - - - - - - - 1 — 1 Mesentery 1 - - - - - - 1 - - - - - - - Peritoneum 1 - - - - - - - - - 1 - - - - Lung 5 — - — — 1 2 1 1 — — Uterus 13 — — — 1 — 2 2 1 2 2 — 2 — 1 Ovary 11 — — — — — 2 — 1 2 5 1 — — — Breast 25 — 1 1 1 1 2 3 5 2 1 2 4 — 2 Skin 1 - - - - - - 1 - - - - - - - Kidney 1 - - - - - - - - - - - 1 - - Bladder 2 - - - - - - - - - 1 — 1 — - Brain 1 1 Glands 2 — — — — — — 1 — — 1 — — — — Bones 1 — — — — — 1 — — — — — — — — All Sites 115 - 1 3 2 1 7 11 13 12 20 16 16 3 10 189 Hospital Accommodation. During the year, 471 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 1938:— Diphtheria 471 Typhoid Fever 34 Dysentery 11 Malaria 1 Scarlet Fever (for Hæm. Strep.) 91 Specimens of Sputum 335 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. 190 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 1938:— Number of houses or parts of houses and contents disinfected 2035 „ verminous rooms disinfested 140 „ „ articles of clothing disinfested *177 „ „ beds disinfested 123 „ 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 2 Children 342 Scabies. Adults 91 Children 268 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, 177 verminous rooms in 120 houses and 49 sets of beds and bedding were cleansed and freed from vermin. 191 Neither the compulsory cleansing of verminous persons nor the cleansing or destruction of filthy, etc., or verminous articles was 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 consists of a small cottage in the Electricity Yard, Lithos Road. Section 8. Air Raid Precautions. 195 Air Raid Precautions. Of the multifarious duties allotted to the Medical Officer of Health during the past half century, there are few which compare with the tasks which have recently been given him in the preparation of Air Raid Precautions Schemes. The administration of a scheme for protection against air raids, and for the treatment of the injured should such air raids take place, is now a statutory obligation on the local authority, and as such must be carried out. Most medical officers of health will view their new obligations with a certain amount of misgiving, but this misgiving will not be because they do not think them sufficiently important. Rather is it due to a feeling that, for some months to come, a disproportionate amount of his time will have to be given to the drawing-up of his part of the scheme, with the thousand and one details of organisation involved. The Council have appreciated this fact and have agreed that "New Schemes must take second place to work in connection with Air Raid Precautions that so far as the call upon the time of the Chief Officers and their staffs is concerned, priority should be given to Air Raid Precautions work." The drawing up of a paper scheme for first-aid parties and posts is more difficult than most of the tasks with which the Medical Officer of Health is confronted. How many casualties can be reasonably expected? Will gas be used? Will sufficient skilled voluntary nursing assistance be available? How long will the air raids last—a week, or a few months? Will the bomber always get through? In this task the administrator cannot learn by experience. He may alter his scheme, and change his mind, but, unless war comes, his theories will remain theories. The Home Office may learn some lessons from China and Barcelona, and they probably have studied the warfare there closely, but conditions will be vastly different when two first-class powers clash. The task of preparation is so vast that most schemes must of necessity be fluid, and each authority will modify its scheme many times within the next few months, so, although there will be uniformity in essentials, there will be wide disparity in details. General opinion seems to be veering round to the view that gas will not be used, and that the chief dangers to be expected will be high 196 explosive and incendiary bombs. It would appear therefore that the principal task of the Medical Officer of Health in wartime will be the treatment of casualties from incendiary bombs and high explosive. It is unnecessary, I think, for me to refer to the days of the crisis in September. This Public Health Department, in common with all other Departments throughout the country, spared no efforts in order to attempt to provide a Casualty Service for the Borough should the need have arisen. Considerable alterations and modifications, both centrally and locally, have occurred since then, but 1 append below an outline of the Borough Scheme as now submitted to the Ministry of Health. First-aid Posts. A.—St. John's Parochial School, Holly Bush Vale. B.—Kingsgate Road LC.C. School, Kingsgate Road. C.—Children's Hospital, College Crescent. D.—Bartrams Roman Catholic School, Rowland Hill Street. E.—United Services Club, Fleet Road. F.—Berridge House, Fortune Green Road. Stretcher Parties. There are to be 30 First-aid Parties which are to be centred on three Depots, viz:—(1) Works Depot, Lymington Road, 16 parties; (2) St. John's House, Shepherds Walk, 8 parties; (3) The Blind School, Swiss Cottage, 6 parties. Mobile Units. There are to be two Mobile Units in the Borough centred respectively at the Children's Hospital and Bartrams R.C. School. Ambulance Depots. Tower Garages, 35, Hampstead High Street. Mill Lane Garages, 69, Mill Lane. H. E. Knight, 365a, Finchley Road. Street & Duller, Ltd.. 47, West End Lane. W. H. Gidden, 41, England's Lane. L.C.C. Ambulance Station, Lawn Road. 197 Personnel. Controlling Official—Medical Officer of Health. Executive Head—Miss D. F. Robinson, M.B.E. (Hon. Divisional Secretary of the British Red Cross Society, Hampstead). Medical Officers in charge of First-aid Posts:— A.—F. N. Parsons, M.A., M.B. (Camb.), B.Ch., 326, Finchley Road, N.W.3. B.—M. W. Geffen, M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H., 2, Frognal, N.W.3. C.—E. T. Shann, M.A., M.B., B.Ch. (Camb.), 19, Buckland Crescent, N.W.3. D.—J. Kennedy, M.B., B.Ch., F.R.S.C.I., 13, Belsize Lane, N.W,3. E.—L. Batten, M.B. (Camb.), M.R.C.P. (Lond.), 12, Lyndhurst Road, N.W.3. F.— J. Fairbrother, B.A. (Camb.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), 33, Heath Drive, N.W.3. Medical Officers in charge of Mobile Units:— 1.—N. Sprott, M.D. (Oxon.), M. Ch., F.R.C.S. (Eng.), 53, Belsize Park, N.W.3. 2.—I. J. Brock, O.B.E., F.R.C.S.E., 3, Redington Gardens, N.W.3. Officers in Charge of Staffs of Posts. A.—Mrs. Hill, 51, Hale Lane, Mill Hill, N.W.7. B.—Mrs. Isaacs, 36, Harman Drive, N.W.2. C.—Mrs. Dare Bryan, 24, Adamson Road, N.W.3. D.—Mrs. Webber, 31, King Henry's Road, N.W.3. E.—Not yet appointed. F.—Miss Samuels, 29, Avenue Mansions, N.W.3. Enrolment (31st December, 1938). First Aid Posts:— Establishment: Male 90. Female 270. No. Enrolled: Male 3. Female 581. Stretcher Parties:— Establishment: Male 450. No. Enrolled: Male 95. 198 INDEX. PAGE Adulteration, etc. 128 Aged and infirm persons, removal of 93 Agricultural Produce (Grading and Marking) Act, 1928 128 Aircraft from Infected Localities 152 Air-Raid Precautions 7, 195 Ambulance Facilities 23,61 Analyst, Public, Report of 145 Analytical Work 132 Ante-Natal Clinics 3, 33, 46 Anti-Toxin, Diphtheria 152 Area of Borough 11 Artificial Cream Act, 1929 131 Artificial Pneumo-thorax 178 Bacteriological Examinations 189 Bakehouses on Register; Inspections, etc. 125 Bakehouses, Underground: Certification of 87, 126 Basement Rooms (see Underground Rooms). Bathing Station 190 Baths and Pools 89 Beauchamp Lodge, Paddington 62 Births 19,31, 40 Bug infestation and eradication 90 Butter Factories 127 Cancer 189 Cancer Hospital, Borough Beds 26 Care Committee (see Tuberculosis). Casualty Hospitals and Service 196 Cerebro-Spinal Fever 152 Chemical Examinations 132 Child Mortality 41 Child Life Protection 71 Children, notification of removal 44 Children, sick and ailing, Homes and Hospitals for 62 Children's Hospital, College Crescent 62 Cleansing of verminous houses, persons, etc. 91, 93, 190 Cleansing, Public 190 Cleansing Station (see Bathing Station). Clinics and Treatment Centres 26 Closing Orders 114 Common Lodging Houses 83 Compensation to Midwives 67 Complaints Received 80 199 PAGE Condensed Milk 131 Consulting Obstetricians (see also Obstetric Consultant Service) 39, 68 Consumption (see Tuberculosis). Contributions to Voluntary Associations 74 Convalescent Homes, etc. 36, 62 Convenience, Public, in Kilburn High Road 97 Cooked Meat 127 County Council Housing Estates 112 Cowhouses 127 Creches (see Day Nurseries). Cricklewood Housing Schema (see Westcroft Estate). Cross Roads Club, 88, Alexandra Road 63 Day Nurseries 37, 64 Deaths 17, 167 Decontrol of Tenement Houses 83 Demolition Order 114 Dental Clinics, etc 6,73 " Diamond Jubilee" Beds 26 Diphtheria, Anti-toxin, and Immunisation 9, 152 Disinfection 190 Dogs, Nuisance by 93 Domiciliary Midwifery Service 65 Dried Milk 131 Dust Collection and Disposal 79 Dysentery 156 Electro-cardiograms 50 Emergency Obstetric Service 67 Encephalitis Lethargica 156 Enteric Fever 155 Enteritis 38 Epidemic Diarrhœa 38 Erysipelas 151 Factories Act, 1937 84 Factories 85, 127 Finsen Light Treatment 179 First Aid Posts and Parties 196 Food, Bacteriological and Chemical Examination 130,132 Food and Drugs (Adulteration) Act, 1928 128 Food and Food Premises 125 Food and Milk for Mothers and Infants 34 Food, Inspection and Supervision of 121 Food Poisoning 128,160 Food, Preservatives in 132 Food, Unsound 125 Foster Children and Foster Mothers 39 200 PAGE Foster Home, 33, Fitzjohn's Avenue 63 Fried Fish Shops 125 Garnett Road Housing Scheme 109 Grants, &c., to Voluntary Associations 74 Hampstead Council of Social Service 52, 74 Hampstead District Nursing Association 25 Hampstead General Hospital, Borough Beds 26 Hampstead Hospital for Children 62 Hampstead Hostel for Mothers and Babies 63 Hampstead Housing Association 117 Hampstead and North St. Pancras Day Nursery 37 Hampstead Swimming Pond 89 Handicraft Class 177 Health Education and Propaganda 27 Health Services 6,23 Health Visitors and Work of 81, 45 Home Helps 39, 70 Health Week 27 Home Office Tables (Factories Act, 1937) 85 Home Nursing 38, 61 Home Workers 88 Homes and Hospitals for Sick and Ailing Children 36 Homes for Mothers and Babies 37 Hospitals 26 Hospital accommodation 189 Hospital Beds, Borough "Jubilee" Beds 26 Hospital Milk Supply 122 Hostel for Mothers and Babies 63 House Refuse 79 Houses, Inhabited, number of 11 Houses Let in Lodgings (see Tenement Houses) Housing Committee 3 Housing Conditions where births occurred.44 Housing Consolidated Regulations, 1925 and 1932 1ll Housing, London County Council, arrangements with 112 Housing" Representationsetc 114 Housing Schemes 109 Housing Section 103 Ice Cream 125, 127, 133 Illegitimate Children 41 Immunisation, Diphtheria 6, 151 Imported Foodstuffs 128 Infant Life Protection (see Child l ife Protection). Infant Welfare Centres 6, 32, 52 Infant Mortality 41 201 PAGE Infectious Diseases 38, 151 Infirm Persons, Removal of 93 Influenza 157 Informal Samples 131 Inspections and Re-inspections 79 Inspection and Supervision of Food 121 Institutions for Unmarried Mothers and for Infants 63 Inspection of Maternity and Child Welfare Centres 54 Invalid Children's Aid Association 70 Kilburn and West Hampstead District Nursing Association 26 Kilburn Vale Day Nursery 64 Laboratory Facilities 23 Legal Proceedings 95 Lodging Houses (see Tenement Houses). London County Council, Housing arrangements with 112 Main Memorial Home 63 Malaria 156 Margarine, Wholesale Dealers, Factories, &c. 127 Maternal Mortality and Morbidity 39, 43, 67 Maternity and Child Welfare 31 Maternity and Child Welfare Centres 47 Maternity and Child Welfare Committee 3 Maternity Beds 61 Maternity Clinics (see Ante- and Post-Natal Clinics). Maternity Homes and Hospitals 35 Maternity Nurses, Unqualified 66 Maternity Outfits 71 Measles 157 "Measurements " Survey 107 Meat and other Foods 123 Medical Investigation Sub-Committee 57 Merchandise Marks Act, 1926 128 Meteorology 13 Midwifery Service, Domiciliary 65 Midwifery and Maternity Services 65 Midwives' Compensation 67 Milk and Dairies Acts, 1915 and 1922 122 Milk and Dairies Order, 1926 122 Milk and Food for Mothers and Infants 34, 56 Milk, Bacteriological Examination 121 Milk, Chemical Examination 122 Milk, Condensed or Dried 131 Milk (Special Designations) Order, 1936 122 Milk for Mothers and Infants 34, 55 Milk for School Children 122 202 PAGE Milk, Pasteurised 123 Milk Supply 121 Minor Ailments 61 Mortuary, Public 99 Mothers and Babies, Home for 63 Mount Vernon Hospital, Borough Beds 26 Municipal Dwellings 113 National Health Campaign 27 National Society for Prevention of Cruelty to Children 46 New End Hospital 61 New End Housing Scheme 110 Nortliwood Hospital Borough Beds 26 Notification of Births 43 Nursing in the Home 24 Nutrition 56, 132 Obstetric Consultant Service (see also Consulting Obstetricians) 67 Offensive Trades 84 Officials, Public Health 5 Officials. Allied 5 Ophthalmia Neonatorum 38 Orthopaedic Treatment 74 Outworkers (see Home Workers) 88 Overcrowding 104 Park Dwellings Flats 113 Pasteurised Milk 123 Pathological Examinations of Sputum 189 Pemphigus Neonatorum 38 Pharmacy and Poisons Act, 1933 98 Pneumonia, Acute Primary and Acute Influenzal 156 Poisons (see Pharmacy and Poisons Act, 1933). Polio-Myelitis 152 Population 11, 15 Post-Natal Clinics 6, 33, 50 Poultry Slaughterhouses 127 Pre-Maternity Clinics (see Ante-Natal Clinics). Preservatives, &c., in Food Regulations, 1925 to 1927 132 Preserved Food, &c. 127 Propaganda 27 Public Cleansing 79 Public Convenience, Kilburn High Road 97 Public Health Committee 3 Public Health Station 189 Public Health (Tuberculosis) Regulations, 1925, 1930 169 Publicity 27 Public Vaccinators 4 203 PAGE Puerperal Fever and Pyrexia 43 Puerperal Sepsis 39 Queen Charlotte's Hospital 62 Queen Mary's Maternity Home, Heath Street 62 Rag and Bone Dealers 83 Rag Flock 94 Hats and Mice (Destruction) Act, 1919 88 "Rat Week" 88 Kay-Therapy 55 He-housing Accommodation 112 Removal of Aged and Infirm Persons 93 Rent Restriction Acts 84 "Representations" under Housing Act 114 Restaurant Kitchens 125 St. Agatha's House 64 Sanatorium Treatment 168 Sanitary Circumstances of the Borough 79 Sanitary Inspectors, Work of 79 Scabies 190 Scarlet Fever 157 School Children, Milk for 122 School Entrants and School Medical Inspection 58, 59 Schools 95 Seamen's Lodging Houses 83 Shelter 191 Shops Act, 1934 88 Slaughterhouses 124, 127 Small Dwellings Acquisition Acts 117 Smoke Abatement 89 Social Conditions 11 South End Close Flats 114 "Special" Children 55 Staff of the Public Health Department 4, 5, 7 Stalls and Street Traders 128 Statistics and Social Conditions of Borough 11, 12 Still Births 41 Street Traders 128 Student Health Visitors 46 Sunlight Treatment 55 Superannuation Act examinations 7 Survey re Overcrowding 107 Swimming Baths and Pools 89 Tenement Houses and Bye-laws 81,82 Tenement Houses, additional W.C's. and Water supply 81, 83 Toddlers' Clinics 55 204 PAGE. Trade refuse 79 Treatment Centres 26 Tuberculosis 165 Tuberculosis Care Committee 180 Tuberculosis Dental Clinic 179 Tuberculosis Dispensary 6, 170, 176, 182 Tuberculosis, Handicrafts Class 177 Tuberculosis, Non-notified Cases 167 Tuberculosis Regulations, 1925, 1930 169 Tuberculous Patients, Extra Nourishment for 178, 182 Typhoid (see Enteric Fever). Ultra-Violet Ray Treatment 55 Underground Rooms 80, 111 Unemployment 11 Unmarried Mothers 63 Unsound Food and Food Inspection 125 Vaccination and Vaccination Order, 1930 185 Vaccination Officer 4 Venereal Diseases, Clinics and Treatment Centres 159 Verminous Persons and Premises, etc. 91 Vital Statistics 12, 15 Voluntary Associations, Grants, &c., to 75 Water Closets, additional in Tenement Houses 81, 83 Water Supply of the Borough 79 Water Supply of Tenement Houses 81, 83 Westcroft Estate 113 Welfare Centres 6, 32, 52 Westcroft Estate 114 Whooping Cough 159 Workshops and Workplaces (see Factories). Westcroft Estate 112 X-ray Work 178 Young Children, Mortality among 43 fl\ &