HAMP 40 THE Metropolitan Boraugh of Hampstead. REPORT for the year 1939 OF THE Medical Officer of Health. H. LESLIE OLDERSHAW, M.D. State Medicine (Lond.), B.S., D.P.H. Public Health Department, 33 & 35, Lancaster Grove, Hampstead, N.W.3. Printed by F. P. Lewingdon, 216 & 218, Eversholt Street, N.W.1. Metropolitan Borough of Hampstead. With the Medical Officer of Health 's Compliments.. Public Health Department, Town Hall, Haverstock Hill, N.W.3. S.98.—3OOO—9-39 THE Metropolitan Borough of Hamstead. REPORT for the year 1939 OF THE Medical Officer of Health. H. LESLIE OLDERSHAW, M.D. State Medicine (Lond.), B.S., D.P H. Public Health Department, 33 & 35, Lancaster Grove, Hampstead, N.W.3. 3 List of Committees concerned with the work of the Department. His Worship the Mayor (Mr. Councillor S. A. Boyd, m.s., f.r.c.s., j.P.). ex-officio member of Committees. PUBLIC HEALTH COMMITTEE. Chairman: Mr. Councillor E. H. Parkes. Mr. Alderman H. Baily, m.b.e. Mr. Councillor L. G. Glover, „ „ R. H. H. Cust, m.a., j.p. m.a., m.d. „ Councillor C. A. B. Borrett. Councillor Mrs. M. I. Gruner. „ „ A. T. Bucknell. Mr. Councillor S. B. Morgan. Councillor Mrs. R. S. G. Carnegie. „ „ L. F. D. Tranter, „ Mrs. M. F. dow, m.a. f.s.m.c., f.i.o., f.b.o.a. „ Miss A. M. Glover. 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: Mr. Councillor S. M. Copeman, m.a., m.d., f.r.c.p., f.r.s. Mr. Alderman H. Baily, m.b.e. Councillor Miss A. M. Glover. Councillor Mrs. A. J. Arnholz. Mr. Councillor L. G. Glover, „ Mrs. R. S. G. Carnegie. m.a., m.d. „ Mrs. F. E. Cayford. „ „ H. Smith. „ Mrs. M. F. Dow, m.a. Councillor Mrs. M. Townroe. The Chairman of the Public Health Committee. (Persons not Members of the Council.) (Appointed in pursuance of Section 252 (3) of the Public Health (London) Act, 1936.) Miss M. E. Drew, m.b., ch.b., m.r.c.s., L.r.C.P. Mrs. J. Gordon. Mrs. E. S. Grundy, m.b.e. Mrs. Watson Shields. Sub-Committees :—(a) Applications for Assistance, and (b) Child Mortality and Maternal Diseases or Deaths. HOUSING COMMITTEE. Chairman: Mr. Councillor G. B. Sankey. Mr. Alderman H. Baily, m.b.e. Mr. Councillor M. L. F. Burnet. „ „ R. H. H. Cust, m.a., j.p. „ „ R. C. Byng. Councillor Mrs. A. T. Arnholz. „ „ O. P. Milne, f.r.i.b.a. Mr. Councillor C. A. B. Borrett. „ „ S. B. Morgan. „ „ G. Buckle. Councillor The Lady Pentland. The Chairman of the Public Health Committee. Sub-Committee: Housing Estates. GENERAL EMERGENCY COMMITTEE. This Committee was appointed as an Emergency Committee to excrcise any of the powers and duties of the Council other than Air Raid Precautions, with power to act; and assumed its duties on 31st August, 1939. 4 STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health—H. Leslie Oldershaw, m.d. State Medicine (Lond.), b.s., m.r.C.S. (Eng.), l.r.C.p. (Lond.), d.p.h. 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 Assistant Medical Officer (Air Raid Precautions and Welfare Centres): Mrs. F. M. Yule, m.b., ch.b. (Aberd.), 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' ClinicsMrs. F. M. Yule, m.b., ch.b. (Aberd.), d.p.h. †Miss R. Balmer, O.b.E., m.b., b.s. (Lond.). †Mrs. A. Hall-Craggs, m.r.c.s., l.r.C.p. (Lond.). 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 (resigned in September). J. L. T. Cousins (from September). Miss B. C. Tucker. Miss E. Selwood. Miss M. E. Alexander (resigned in August). Miss I. Furlong (from September). Miss M. Talbot Kelly (Part-time assistant for Tuberculosis Care Work). 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) Miss C. Lambe, (a), (b), (d), (?). W. F. Newport (e), (/). F. V. Outlaw (e), (/). W. Robinson (e), (/) L. Rowley (e), (/). (ff). A. C. Townsend (e), (J) L. E. Trigg (e), (f). E. Wall (e), (/). F. C. Cobb (Assistant to Inspectors). J. Cuskin (Assistant to Inspectors) R. Martin (Assistant to Inspectors and Mortuary Keeper) Public Health Station Staff—W. Bell (Senior Disinfector and Resident Caretaker). W. Day (Disinfector) J. R. Williams (Disinfector) *Mrs. Morley (Bathing Station Attendant). Resigned in August. *Mrs. N. Price (Bathing Station Attendant). From August. (а) Health Visitor's Certificate. (d) State Certified Midwife. (б) State Registered Nurse. (e) Sanitary Inspector's Certificate. (c) General Nursing Certificate. (f) Food Inspector's Certificate. (g) Smoke Inspector's Certificate. * Part-time Officers, † Part-time Officers of Council of Social Service 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. (Lond.), m.r.c.S., 308, Finchley Road, N.W.3. (Hampstead 2304.) E. A. Seymour, m.b.,b.s. (Lond.), 12, Thurlow Road, N.W.3. (Hampstead 0274.) H. D. Wyse, m.b., b.s. (Lond.), 23, Hilgrove Road, N.W.6. (Primrose 2023.) Dentist, Municipal Dental Clinic—Roy M. Hastings, L.d.s., r.C.s. (Eng.). Air Raid Precautions—See Section 8. 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. S. Grasse, 55, Messina Avenue, N.W.6. (Maida Vale 5155.) Relieving Officer (Public Assistance Dept., L.C.C.): S. R. Meech, 46, Iverson Road, N.W.6 (Maida Vale 1009. Superintendent Registrar: Norman Tolson, Town Hall, Hampstead, N.W.3. Registrar of Births and Deaths: V. A. Craghill, Town Hall, Hampstead, N.W.3. 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. C. Anderson, 68-70, Baker Street, W.l (Welbeck 3352). H.M. Coroner: William Bentley Purchase, m.c., m.a., m.b., d.p.h., Coroner's Court and Office, 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.l (Clerkenwell 1892). *Part-time Officers, 6 Public Health Department, 33-35, Lancaster Grove, Belsize Park, 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 1939. This report is the thirty-ninth of the series, and it has been curtailed and materially shortened in pursuance of the instructions of the Ministry of Health. In January, 1939, the Council decided upon the Five-Years' Programme of Capital Expenditure to which special consideration had been given in view of Circular No. 1687, dated the 6th May, 1938, from the Minister of Health; which referred to the desirability of preparing a survey of prospective works involving capital expenditure. In the preparation of this programme certain considerations applied, including the arrival in an order of priority of capital works conditioned by consideration of their relative urgency : Air Raid Precautions were, accordingly, given precedence, and the duties in this connection have, therefore, been given priority over all other activities of the Department. In so far as they relate to Casualty Services they are dealt with on the next page of this report. It was agreed that Housing and Health services should receive relatively early consideration, and the programme was arranged so as to secure that Housing should come after Air Raid Precautions, with Infant Welfare Centres and the Tuberculosis Dispensary third. The two housing schemes, i.e., those at New End and at Garnett Road, providing a total of 46 dwellings for relief of overcrowding were included in the programme, and provision was also made for an expenditure sufficient to cover the provision of 150 dwellings, in addition to the New End and Garnett Road schemes. These matters are further referred to in the Housing Section of this report. Provision was inserted for three welfare centres in the Swiss Cottage, Hillfield Road and Lisburne Road areas respectively, with the addition of tuberculosis dispensary accommodation in conjunction with the Swiss Cottage Scheme. The outbreak of the War unfortunately checked the development of these Social Services. Staff. In view of the additional duties arising out of Air Raid Precautions, the Council on the 27th April, 1939, agreed to the appointment of Dr. Marjorie Yule as a temporary part-time Medical Officer in the Department of the Medical Officer of Health in connection with Air Raid Precautions work. The resolve to make this appointment, 7 coincided with the decision, made with the approval of the Hampstead Council of Social Service (with a view to the further co-ordination of the Maternity and Child Welfare Services in the Borough), to appoint one of their Welfare Centre doctors as a temporary part-time Officer of the Borough Council. Dr. F. Marjorie Yule was accordingly appointed as an Officer of the Council to devote one half of her time to Maternity and Child Welfare work. Dr. Yule commenced her duties in connection with Air Raid Precautions on 1st May, 1939, and in connection with Maternity and Child Welfare work on 15th May, 1939, and was subsequently appointed as acting Deputy Medical Officer of Health pending the return of Dr. Chalke from Active Service. The following members of the Staff were on Active Service on 31st December, 1939:— Dr. H. Davis Chalke, Clinical Tuberculosis Officer and Deputy Medical Officer of Health, Royal Army Medical Corps. Mr. R. W. King, a member of the clerical staff, King's Royal Rifle Corps (Queen's Westminster's). Air Raid Precautions. During the year a considerable amount of work has been performed by the staff of the Public Health Department in connection with the Casualty Services and other forms of A.R.P. activities. I wish to take this opportunity of expressing my special thanks to the members of the staff of the Public Health Department for the cheerful and willing way in which they have taken on additional duties and responsibilities. It is most opportune that the Council appointed Dr. Yule as Assistant (part-time) for A.R.P. duties; her help, especially in connection with the nursing services, has been invaluable. In my last Annual Report, I recorded my sincere appreciation of the great assistance which I had received from Miss Robinson, M.B.E. (B.R.C.S.), and from other officers and members of the British Red Cross Society and St. John Ambulance Brigade. During 1939, these ladies have continued to give a most enthusiastic and unselfish service. Miss Robinson and her staff are given accommodation in the Public Health Department offices. A word of praise must also be given to Miss Blaikley, M.B.E., whose experience and tact has overcome numerous difficulties in connection with the Stretcher Party Service. After the crisis of September, 1938, definite steps were initiated for the intensive training of men and women volunteers of the First Aid Posts in First Aid and Anti-Gas. Examinations were held, personnel allocated to Posts, monthly Post practices instituted with the result that when general mobilisation was ordered, each First Aid Post was ready for action. By Christmas, 1939, all the buildings which were to be used as First Aid Posts had been completed, whilst from September onwards, in order to maintain the efficiency of the personnel, lectures and demonstrations were held daily. In addition, local 8 exercises where 50 "casualties" reported for treatment at one time, were initiated and found to be very valuable as it gave good practice in perfecting the organisation of personnel in dealing quickly and efficiently with large numbers of casualties. The two Mobile Units are stationed at First Aid Posts and were being used in exercises in June, 1939, with the result that they, too, were ready for immediate action when general mobilisation was ordered. A nucleus only of Stretcher Party personnel was available in September last but as a result of strenuous efforts in recruiting and concentrated training, the permitted war time establishment was obtained within a month. In order to enable personnel to qualify for recognised First Aid certificates, Dr. Rees conducted a course of lectures at each Depot and 94 per cent, of the candidates passed the examination. Parades and physical training, etc., were instituted with the result that a good standard of discipline has been maintained. I beg to record my appreciation of the kindness and support shewn me by members of the Council and of the Committees which I serve, and by the members of the staff of the department. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. LESLIE OLDERSHAW, Medical Officer of Health. 9 Section 1. Statistics and Social Conditions of the Borough. Area (in acres) 2,265 (including 12 acres covered by water). Registrar-General's estimate of (a) resident population, mid-1939— 90,170; (b) average population appropriate to the calculation of death-rates—84,930. Number of inhabited houses (end of 1939) according to Rate Books— 9,580 dwelling houses; 8,135 separate flats; 1,006 houses and shops combined. Rateable value (at 1st April, 1939) £1,618,340 Sum represented by a penny rate £6,313 Extent of Unemployment. I am indebted to the Director of Statistics, Ministry of Labour, for the following information relating to unemployment in the year 1939. Numbers of insured persons, aged 16-64, resident in the Borough recorded as unemployed at the undermentioned dates, and these numbers expressed as percentages of the estimated total numbers of insured persons of the same ages resident in the Borough. Date. Numbers. Percentages. Males. Females. Males. Females. 1939. 16th January 1,516 401 10•4 3•5 13th February 1,418 419 9•8 3•6 13th March 1,296 399 8•9 3•5 17th April 1,149 316 7•9 2•7 15th May 1,070 312 7•4 2•7 12th June 945 262 6•5 2•3 10th July 1,076 289 7•4 2•5 14th August 954 305 6•6 2•6 Note.—The figures are exclusive of persons insured under the Agricultural Scheme. Extracts from Vital Statistics of the Year. Total. M. F. Live Births Legitimate 902 460 442 Illegitimate 78 43 35 Birth Rate per 1,000 estimated resident population mid-1939- 10•9 Stillbirths 30 10 Rate per 1,000 total (live and still) births— 11•2. Deaths 993 Death Rate per 1,000 estimated average population— 11•6. Adjusted Death Rate (C.F.—0•94)—10•9. Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis — — Other puerperal causes 1 1 Total 1 1 Death Rate of Infants under one year of age:— All infants per 1,000 live births 38 Legitimate infants per 1,000 legitimate live births 31 Illegitimate infants per 1,000 illegitimate live births 118 Deaths from Cancer (all ages) 163 „ Measles (all ages) — ,, Whooping Cough (all ages) 1 ,, Diarrhœa (under 2 years of age) 4 VITAL STATISTICS. Population. For the purpose of this Report the Registrar-General's estimate of the population at the middle of 1939, which was calculated to have been 90,170 has been adopted. This shows an increase of 1,223 as compared with 88,947 at Census, 1931. It is not easy to estimate the number of persons who removed from Hampstead on or shortly after the outbreak of War, but I think it is not unreasonable to suppose that about 25,000 left the district. 10a Age and Sex Allocation of Deaths of Hampstead Residents During the Year 1939. CAUSES OF DEATHS Nett deaths at the subjoined ages of "Residents," whether occurring within or without the Borough. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 years and upwards. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1. Typhoid and Paratyphoid Fevers M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... .... ... ... ... ... ... ... ... ... 2. Measles M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 4. Whooping Cough M 1 1 ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 5. Diphtheria M 1 ... ... 1 ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 6.. Influenza M 13 1 1 1 ... 1 ... 1 ... 2 5 1 F 12 ... ... ... ... 1 ... 1 ... 2 3 5 7. Encephalitis Lethargica M ... ... ... ... ... ... ... ... ... ... ... ... F 2 ... ... ... ... 1 ... 1 ... ... ... ... 8. Cerebro-spinal Fever M 1 1 ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... 9. Tuberculosis of respiratory system M 21 ... ... ... ... l 4 6 3 3 3 1 F 18 ... ... ... ... 5 4 ... 3 3 2 1 10. Other Tuberculous Diseases M 2 ... ... ... 1 ... 1 ... ... ... ... ... F 3 1 1 ... ... ... ... ... ... 1 ... ... 11. Syphilis M 4 ... ... ... ... ... ... 1 2 ... ... 1 F 1 ... ... ... ... ... ... ... ... 1 ... ... 12. General paralysis of the insane, tabes dorsalis M ... ... ... ... ... ... ... ... ... ... ... ... F 1 ... ... ... ... ... ... 1 ... ... ... ... 13. Cancer, malignant disease M 65 ... ... ... ... 1 2 2 6 17 23 14 F 98 ... ... 1 ... ... ... 7 16 34 25 15 14. Diabetes M 11 ... ... ... ... ... ... ... ... 3 3 5 F 17 ... ... ... ... ... ... ... 1 3 5 8 15. Cerebral haemorrhage, &c. M 9 ... ... ... ... ... ... 1 1 3 2 2 F 23 ... ... ... ... 1 ... ... 2 3 5 12 16. Heart Disease M 143 ... ... ... ... l ... 2 11 27 54 48 F 165 ... ... ... ... l 4 3 5 17 27 108 17. Aneurysm M 5 ... ... ... ... 1 ... ... ... ... 3 1 F 4 ... ... ... ... ... ... ... ... 1 3 ... 18. Other circulatorydiseases M 30 ... ... ... ... ... ... ... 5 5 7 13 F' 45 ... ... ... ... ... ... ... 4 5 13 23 19. Bronchitis M 3 ... ... ... ... ... ... ... 1 1 ... 1 F' 10 ... ... ... ... ... ... ... ... 1 1 8 20. Pneumonia (all forms) M 18 2 ... ... ... ... ... ... 4 6 4 2 F 20 3 ... ... ... ... ... 1 3 2 4 6 21. Other Respiratory Diseases M 3 ... ... ... ... ... 1 ... 1 ... ... 1 F 1 ... ... ... ... ... ... ... 1 ... ... ... 22. Peptic Ulcer M 9 ... ... ... ... ... ... 2 1 1 4 1 F 6 ... ... ... ... ... ... ... ... 2 2 2 23. Diarrhoea, Ac. M 5 3 ... ... ... ... ... 1 ... ... ... 1 F 3 1 ... ... ... ... ... ... ... ... ... 2 24. Appendicitis M 1 ... ... ... ... ... ... ... 1 ... ... ... F 2 ... ... ... ... ... ... ... 1 ... 1 ... 2o. Cirrhosis of Liver M 2 ... ... ... ... ... ... ... ... 2 ... ... F 1 ... ... ... ... .. ... ... 1 ... ... ... 26 Other diseases of liver, & c. M 3 ... ... ... ... ... 1 ... 1 ... ... 1 F 2 ... ... ... ... ... ... ... 1 ... ... 1 27. Other digestive diseases M 9 ... ... ... ... 2 1 ... 1 2 1 2 F 10 ... ... ... ... ... ... 1 2 3 ... 4 28. Acute and Chronic Nephritis M 11 ... ... ... ... ... ... ... 1 3 5 2 F 13 ... ... ... ... 1 ... 1 1 5 2 3 29. Puerperal Sepsis F ... ... ... ... ... ... ... ... ... ... ... ... 30. Other puerperal causes F 1 ... ... ... ... ... ... 1 ... ... ... ... 31. Congenital Debility, premature birth, malformation, &c. M 10 10 ... ... ... ... ... ... ... ... ... ... F 12 10 2 ... ... ... ... ... ... ... ... ... 32. Senility M 4 ... ... ... ... ... ... ... ... ... 3 1 F 7 ... ... ... ... ... ... ... ... 1 1 5 33. Suicide M 10 ... ... ... ... ... 1 2 ... 7 ... ... F 14 ... ... ... ... 2 1 5 1 2 1 2 34. Other violence M 21 ... ... 1 1 3 4 ... 1 5 3 3 F 18 1 ... ... 1 1 ... ... 2 3 2 8 35 Other Defined Diseases M 41 ... ... ... ... ... ... 2 3 13 8 13 F 28 2 ... ... ... 1 3 3 4 4 5 6 36. Causes ill-defined or unknown M ... .... ... ... ... ... ... ... ... ... ... ... F ... ... ... ... ... ... ... ... ... ... ... ... All causes M 456 18 1 3 2 10 17 20 43 100 128 114 F 537 18 3 2 1 14 12 25 48 93 102 219 Totals 993 36 4 5 3 24 29 45 91 193 230 333 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 Wale3 who died in the Borough, have in like manner been excluded. 11 Section 2. General Provisions of Health Services for the Borough. Nursing in the Home. (a) General and (b) For Infectious Diseases. In January, 1939, the grants to Nursing Associations came under consideration as a result of communications from the Associations. All the circumstances were carefully considered, and in view of the increased number of visits paid and the financial position of the Associations, the Borough Council decided that during the financial year 1939-40 the grants should be increased as follows :— Public Health Maternity and Child Cases. Welfare Cases. Kilburn and West Hampstead From £70 to From £80 to District Nursing Association £90. £120. Hampstead District Nursing From £40 to From £30 to Association. £50. £50. It was decided, however, that there should be a modification in connection with the nursing of cases of bronchitis, which should be visitable only in respect of pre-school children to a maximum of 25 visits per case. Hospitals: Public and Voluntary. (a) Public: New End Hospital and- North Western Fever Hospital. These hospitals are Air Raid Precaution Casualty Clearing Hospitals and certain of their accommodation is earmarked for this purpose. (b) Voluntary: Hampstead General and North West London Hospital. This hospital is an Air Raid Precaution Casualty Clearing Hospital and certain of its accommodation is available in this connection. The Children's Hospital, College Crescent and Queen Mary's Maternity Home, Heath Street, have been evacuated. Marie Curie Hospital, Fitzjohn's Avenue, is used by the Borough Council in connection with food and coal control and it functions as a Hospital Out-Patient department only. St. Columba's Hospital, Avenue Road, continues to function for its original purpose. 12 Section 3. Maternity and Child Welfare. 1. Population of the Borough mid-1939:—90,170 (estimate of Registrar-General. 2. Number of births notified under Section 255 of the Public Health (London) Act, 1936, adjusted by transferred notifications :— (a) Live births 877; (b) Still births 22; (c) Total 899. (d) By midwives 229; (e) By doctors and parents 670. 3. Health Visiting. (a) Number of officers employed at the end of the year :— (i) by the Council:—4 whole-time: 1 part-time (40 per cent, health visitor, 60 per cent, woman sanitary inspector). (ii) by Voluntary Associations :—Nil. (b) Equivalent of whole-time services devoted by the whole staff to health visiting (including attendance at infant welfare centres) :— (i) in the case of Health Visitors employed by the Council:—4 whole-time : 1 part-time (40 per cent, health visiting). (ii) in the case of Health Visitors employed by Voluntary Associations:—Nil. (c) Number of visits paid by Health Visitors: — (i) to expectant mothers. †First visits 547 Total visits 1,375 (ii) to children under 1 year of age. †First visits 730 Total visits 4,867 (iii) to children between the ages of 1 and 5 years. Total visits 7,803 4. Infant Welfare Centres. (a) Number of Centres provided and maintained by the Council up to 31st OctoberNil.; from 1st November to 31st December—7. (b) Number of Centres provided and maintained by Voluntary Associations up to 31st October:—9. † Excluding cases which are known to have previously been visited in another district and cases visited during the previous year. 13 (c) Total number of attendances at all Centres during the year:— (i) by children under 1 year of age, 10,040. (ii) by children between the ages of 1 and 5 years, 5,661. (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, *523. (ii) between the ages of 1 and 5 years, 192. (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, 394. (ii) over 1 year of age, 1,092. (/) Percentage of notified live births represented by the number in (d) (i) :—59 6 per cent. •Excluding children who are known to have previously attended a Centre in another district 5. Ante-natal and Post-natal Services. Antenatal. Postnatal. (a) Ante-natal and Post-natal Clinics (whether held at Infant Welfare Centres or at other premises)— (i) Number of Clinics provided and maintained by the Council 2 2 (ii) Number of Clinics provided and maintained by Voluntary Associations Nil. Nil. (iii) Total number of attendances at all Clinics during the year 2205 399 (iv) Total number of women who attended at the Clinics during the year 444 202 (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. 49•3 per cent. 22•4 14 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 Dried gallons. pounds, (i) by the Council 11500¾ 946 (ii) by Voluntary Associations operating in area Nil 4108 11500¾ 5054 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 Up to outbreak of war, 1 Ward in New End (L.C.C.) Hospital with 5 maternity beds. After 3rd Sept., 1939, no Ward reserved for Borough Council cases. Nil Nil Number of maternity beds (exclusive of isolation and labour beds.) , Nil Nil Total number of women admitted to these beds during the year. 54 Nil Nil 15 II. Number of women (if any) sent by the Council to other Maternity Institutions:—30 to Queen Charlotte's Hospital, for which the Borough Council subscribes £1 per Hampstead case admitted. 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. (204 other children admitted.) *This Hospital functioned up to the outbreak of war. II. Number of such children (if any) sent by the Council to other Institutions:—Nil. 9. Convalescent Homes. During the year five mothers after confinement, with their babies, were sent by the Council to Convalescent Institutions. 10. 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), evacuated on outbreak of war to a Reception Area. (b) Number of places for children under 5 years of age in the nurseries:— (i) provided by the Council:—Nil. (ii) provided by Voluntary Associations:—45-50. 16 (c) Total number of attendances of children at these nurseries from 1st January, 1939, to date of evacuation : 6,803. 12. Infectious Diseases. Disease. Number of cases notified. 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 *11 7 2 9 (2) Pemphigus Neonatorum Not notifiable Nil Nil Nil (3) Puerperal fever 1 1 – 1 (4) Puerperal pyrexia 14 10 Nil 13 (5) Measles and german measles (in children under 5 years of age) German Measles is not notifiable. Measles is compulsorily notifiable. 6 6 – 1 (6) Whooping Cough (ditto) 156 156 7 50 (7) Epidemic Diarrhoea (ditto) Not notifiable Nil Nil Nil (8) Poliomyelitis (ditto) Nil Nil Nil Nil * Vision unimpaired, 11. 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:—7 employed by two Local District Nursing Associations. (b) Total number of cases attended by these nurses :—272. 14. Consultants. Number of cases in which the services of a consultant have been provided for a private medical practitioner under the Council's maternity arrangements 2. 17 15. Home Helps. Number of cases in which home helps have been provided:— 35—under scheme of the Hampstead Borough Council. 16. Maternal Deaths. (a) Number of women who died in, or in consequence of, childbirth:— (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:—11. (b) Number of children on the Register : (i) at the end of the year:—17. (ii) who died during the year:—2. (iii) on whom inquests were held :—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. (e) Proceedings taken:— No. of Cases. Act and Section under which proceedings were taken. Nil. — (f) Number of cases in which the local authority has given a sanction: (i) under (a), (b) or (c) of Section 259 of the Public Health (London) Act, 1936:—Nil. (g) Number of orders obtained under Section 261 of the Public Health (London) Act, 1936. (i) from a court of summary jurisdiction or from a single justice:—Nil. 18 Live Births. During 1939, 980 live births of Hampstead children were registered as follows:— (a) legitimate 460 males : 442 females; (b) illegitimate 43 males : 35 females. The following are the statistics for each of the Wards and the Borough:— Births. Infant, deaths. Infant death rate per 1000. Stillbirths. Still birth rate per 1000 (live and still births). No. 1 (Town) Ward 110 5 44.6 2 17.5 No. 2 (Belsize) „ 154 2 12.9 6 37.5 No. 3 (Adelaide) „ 113 4 35.4 2 174 No. 4 (Central) „ 63 3 47.6 1 15 .6 No. 5 (West End) „ 172 8 46.5 4 22.7 No. 6 (Kilburn) „ 232 8 34.5 7 29.3 No. 7 (Priory) „ 136 6 44.1 4 28.6 The Borough 980 36 36.7 26 25.8 Still Births. During 1939, the nett number of registered still births for Hampstead was 26 as follows:—(a) legitimate 12 males: 10 females, (b) illegitimate 3 males: 1 female. Infant Mortality. During 1939, 36 infants under 1 year of age died, giving an infant death rate of 38 per 1,000 live births. Of these 27 were legitimate children, the rate per 1,000 legitimate live births being 31 while 9 illegitimate children died, equivalent to a rate per 1,000 illegitimate live births of 118. Health Visitors. The following table gives a record of the work of the Health Visitors in 1939:— † First visits to expectant mothers 553 Re-visits to expectant mothers 828 † First visits to infants under one year 765 Re-visits to infants under one year 4137 Visits to children from 1 to 2 years 3253 Visits to children from 2 to 5 years 4550 Visits to foster-mothers and foster-children 480 Visits re infectious diseases 671 Attendances at Borough Council's Ante-natal Clinics 148 † Including visits to mothers and babies moving into the Borough and previously visited. 19 Ante- and Post-natal Clinics. Up to 31st August, 1939, one session weekly for both ante-and post-natal cases was held at the Eastern Clinic. Miss Beatrice Turner, F.R.C.S., F.R.C.O.G., was the Medical Officer. Three sessions weekly for ante-natal cases were held at the Western Clinic by Miss Mary Kidd, M.B. (Lond.). Miss Turner held one session weekly at this Clinic for post-natal patients only. On the outbreak of war the Clinics were closed until the 14th September. It was subsequently approved that one session for both ante- and post-natal cases should be held weekly at the Eastern Clinic and two sessions for ante- and post-natal cases be held weekly at the Western Clinic. Miss M. Kidd is, at present, acting as the Medical Officer at both Clinics. Attendances at the Ante- and Post-natal Clinics for the year 1939. Eastern Clinic Western Clinic (27, Pond Street). (75, Dynham Road). Ante-natal. Post-natal. Ante-natal. Post-natal. No. of new patients 101 52 280 130 No. of attendances of old patients 409 66 1415 151 No. of sessions held 49 130 60 Average attendance per session 13 *13 5 *Ante- and Post-natal Clinics combined September, 1939. Ministry of Health's inspection of Maternity and Child Welfare work in the Borough. On 10th November, 1938, a letter was sent by the Secretary, Ministry of Health, with reference to the visit made by one of the Medical Officers of the Ministry for the purpose of inspecting the Maternity and Child Welfare Centres submitting certain observations, and suggesting, inter alia, that in conjunction with the Hampstead Council of Social Service the desirability of further measures of coordination of municipal work with that of the voluntary centres should be considered by the Council. The Maternity and Child Welfare Committee invited the observations of the Council of Social Service upon the contents of this letter and discussed the whole matter with representatives of that Council. The attendances at all the Centres, with the exception of the one at Heath Street, were growing, and the Committee were of the opinion that further measures of co-ordination of the municipal work with that of the voluntary centres could best be effected by a gradual transference of certain paid officers engaged at the Welfare Centres of the Hampstead Council of Social Service to the Council. As a first step in this direction they considered the question of transferring one of the medical staff. Mrs. F. Marjorie Yule, M.B., Ch.B., D.P.H., had been on the medical staff of the Council of Social Service for some time, and was recognised as a doctor performing very valuable clinical 20 Work in connection with the Centres. At that time she was attending such Centres for four sessions per week, and the Committee were of the opinion that Dr. Yule should be engaged by the Council as a temporary part-time medical officer in connection with the Maternity and Child Welfare services, and that her salary should, in future, be paid direct by the Council. In a letter, dated 28th February, 1939, the Organising Secretary of the Council of Social Service, stated that her Executive Committee welcomed the suggestion that the Council should, if it thinks fit, take Dr. Yule on the staff of the Public Health Department. The Council, therefore, resolved that, with a view to the further co-ordination of the Maternity and Child Welfare Services in the Borough, Mrs. F. Marjorie Yule, M.B., Ch.B., D.P.H., one of the Welfare Centre Doctors appointed by the Council of Social Service, should be appointed as a temporary part-time officer of the Council to devote half her time to Maternity and Child Welfare work, and the Ministry of Health agreed that, as from 15th May, there should be a reduction of the annual contribution to the Hampstead Council of Social Service under the provisions of the Maternity and Child Welfare Contributions (London) Scheme, 1937, from £725 to £425. In October a letter was received from the Assistant Secretary, Hampstead Council of Social Service, stating that at a meeting of the Emergency Committee of the Council of Social Service held on October 16th, it was reported by their Infant Welfare Committee that, in view of the serious depletion of income which may be expected owing to the present international crisis, they regret they cannot undertake any financial responsibility for the work of the Infant Welfare Centres after 31st October, 1939, and that it was, therefore, resolved to request the Borough Council to take over the responsibility of the Centres as from such date. The letter further stated that the Infant Welfare Committee express their desire to assist the Borough Council with the work of the Centres in any way possible. The Council at its meeting on the 14th December agreed that in view of the necessity for some immediate action to be taken, the Committee do accept the principle of the Infant Welfare Centres being taken over by the Borough Council as from 31st October, 1939, and that the Medical Officer of Health, in consultation with the Chairmen of the various Committees concerned, be authorised to make the necessary emergency arrangements accordingly, and to submit a detailed scheme in due course for the consideration of the Committee, and, if necessary, for the approval of the Council. The annual grant paid to the Hampstead Council of Social Service was discontinued as and from 1st November. Infant Welfare Centres. These Centres have been varied owing to War conditions and to the change over from the Voluntary Body and are now as follows:- Infant Welfare Centres. These Centres have been varied owing to War conditions and to the change over from the Voluntary Body and are now as follows :- 21 Name and address of Centre. Day and Time held. Doctor in attendance. Health Visitor. "Belsize" Congregational Church Hall, Avenue Road Monday, 2—4 p.m. Dr. F M. Yule Mrs. Steward "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 27, Pond Street, N.W 3 Tuesday, 2—4 p.m. Thursday, 2—4 p.m. Dr. F. M. Yule Miss Kennedy Health Visitor's Session— Miss Lambe Berridge House, Fortune Green Road (entrance in Hillfield Road) Thursday, 2—4 p.m. Dr. F. M. Yule Miss Evans Toddlers' Clinic. Weekly toddlers' sessions were, prior to the outbreak of war, held alternatively on either side of the Borough, but have for the present been suspended. Nutrition and Arrangements for the Supply of Milk and Food. There have been 463 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. Eggs and butter were supplied 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, in 98 cases. Foster Home and Homes for Mothers and Babies. These Homes, to which reference has been made in my previous Reports, functioned during part of the year and were variously affected on the outbreak of hostilities. Some were evacuated, and others temporarily closed. Day Nurseries. The Hampstead and North St. Pancras Day Nursery, evacuated on the outbreak of the war to Northampton. Municipal Dental Clinic. The Municipal Dental Clinic is held at the Public Health Station, Lithos Road; the Dentist is Mr. Roy M. Hastings, L,.D.S., R.C.S. Eng. The following is a summary of the work carried out during the year:— Number of Sessions held ... ... ... 66 Number of New Patients ... ... ... 261 Total Attendances of all patients 1210 22 Number of Fillings 343 Number of Scalings 42 Total Number of Teeth extracted 934 Gas Administrations 248 Extractioncases. Local Administrations 7 Without Anaesthetic 1 Number of Dentures (including repairs) 89 Number of Dressings and Root Treatment 152 Number for Advice 337 Number of Dentures visits 260 23 Section 4. Sanitary Circumstances of the Borough. 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. Statement showing the number of premises inspected, etc., by the Sanitary Inspectors during 1939:— Total number of inspections 2,704 Total number of re-inspections and other visits and re-visits 11,491 Total number of dwelling-houses inspected for housing defects 1,237 Number of these found not in all respects reasonably fit for human habitation 904 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), 1,503 relating to 1,075 premises. (2) Statutory 935 relating to 386 premises. Investigation of Complaints, Inspection of Factories. Number of complaints investigated 786 ,, ,, premises inspected after the occurrence of infectious disease 77 „ „ inspections of Factories with mechanical power (excluding bakehouses) 80 „ ,, inspections of Factories without mechanical power (excluding bakehouses) . 62 „ „ inspections of Other Premises under the Factories Act 6 „ „ inspections of Bakehouses, Milkshops and other food premises 748 24 Details of work, etc., supervised or action taken by the Sanitary Inspectors, whether under notice or voluntary:— Registered Tenement Houses. Premises not registered as tenement houses. Underground rooms. Illegally occupied—found, or brought to the Inspectors' notice 29 64 Closed, or illegal occupation discontinued 11 5 Made to conform 24 56 Verminous conditions. Rooms disinfested 80 21 Number of houses concerned 73 13 Beds and bedding disinfested 12 9 Floors of rooms cleansed 18 12 Animals. Nuisances from improper keeping in rooms abated 1 1 Nuisances from improper keeping on the premises abated – 1 Drainage systems, & c. Drainage systems repaired or renewed, partly or wholly 48 142 Plumbing defects remedied (soil pipes, waste pipes, &c.) 139 201 Roofs, rainwater pipes and gutters repaired or renewed 355 186 Water supply. Water supply provided to tenements or separate lettings 9 124 Number of houses concerned 9 78 Sinks provided to tenements or separate lettings 32 258 Number of houses concerned 28 122 Water cisterns cleansed or covered 10 11 Water-closets. Additional provided 8 88 Removed from improper position 2 9 Flushing cisterns repaired 53 39 Yards, &c. Paving, &c. Yards or open spaces newly paved and drained 9 21 Paving of yards or open spaces repaired 65 41 Bathrooms. New provided 2 103 Dust bins. Repaired or renewed 47 72 Cleansing. Houses or parts cleansed (excluding verminous rooms) 698 207 Number of rooms concerned 1178 435 Dampness. Dampness in houses or parts abated 386 150 Miscellaneous. Window cords repaired or renewed 238 62 Window fittings repaired or renewed 211 51 Filth and refuse removed from rooms . 5 3 Washing (of clothes) accommodation provided 1 – Coppers repaired or renewed 52 5 Suitably ventilated food cupboards provided 262 8 Kitchen ranges repaired or renewed 143 28 Common staircases repaired 31 7 Common staircases provided with adequate means of natural light 5 – Common staircases provided with adequate means of artificial light 5 – Dilapidated houses or parts repaired 622 130 Smoke nuisances. Complaints received 9 5 Observations made 3 8 Notices served 1 – Refuse. Accumulations of refuse removed 26 47 25 The sanitary work in the foregoing tables includes drainage and plumbing work for which approval is obtained from the Borough Council. 479 drainage application forms and plans were submitted during the year. 30 of these were for work carried out under notice, and 449 were for alterations and additions carried out voluntarily by the owners. Lodging Houses, etc. 64 tenement houses were added to the Register, and 24 tenement houses were removed from the Register, making a total of 1,613 tenement houses on the Register. During the year, 585 tenement houses were inspected and 3,624 defects were discovered. 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. Offensive Trades. No offensive trade is carried on in the Borough. Increase of Rent and Mortgage Interest (Restrictions) Acts. Number of certificates applied for 10 „ „ issued 10 Factories Act, 1937. At the close of the year there were 534 Factories on the Register. 232 inspections were made and 44 written notices were served. Legal proceedings were instituted in one case only. 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) 80 17 Nil. Factories (Without mechanical power) 62 9 Nil. *Other premises Under the Act (including works of building and engineering construction but not including outworkers' premises) 6 Nil. Nil. Total *Electrical Stations reckoned as factories. 148 26 Nil. 26 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) 36 36 Nil. Nil. Overcrowding (S. 2) Nil. Nil. Nil. Nil. Unreasonable temperature (S. 3) 1 1 Nil. Nil. Inadequate ventilation (S. 4) 9 9 Nil. Nil. Ineffective drainage of floors (S. 6) 4 4 Nil. Nil. Sanitary Conveniences (S. 7) insufficient Nil. Nil. Nil. Nil. unsuitable or defective 3 3 Nil. Nil. not separate for sexes Nil. Nil. Nil. Nil. Other offences (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.) 53 53 Nil. Nil. Total 106 106 Nil. Nil. Outwork in unwholesome premises (Section 111). No case arose during the year of outwork being conducted in unwholesome premises. Bakehouses. The special survey of underground bakehouses is referred to in Section 6 of this Report. Outworkers—(Home Work). Certain specified classes of work done at the homes are controlled by the Act. There are 67 such outworkers (or home-workers) in Hampstead known to the Public Health Department. Of these 42 are single workers. Persons sending out homework are required to keep lists of their home-workers and to send copies of these lists to the Borough Council during February and August in each year, and to show thereon all outworkers employed during the previous six months. In February, 33 lists were received, and 31 lists in August. These lists included the names of 81 and 103 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 104, 18 belonged to Hampstead and 86 elsewhere. Particulars of the latter were sent to the Local Authorities concerned, while information concerning 59 outworkers resident in Hampstead was received from other Authorities. In no instance during 1939 was homework found to be carried on in unwholesome premises. 27 Shops Act, 1934. During the year 384 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. 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 1 (b) disinfested 1 (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 86 (b) disinfested 86 (2) The methods employed for freeing infested houses from bed bugs and the name of the fumigant and/or insecticide used. These are the same as in previous years. (5) The methods employed for ensuring that the belongings of tenants are free from vermin before removal to Council houses. The same procedure continues to be employed. (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. Pharmacy and Poisons Act, 1933. The number of persons licenced to sell poisons on the Register at the close of the year was 132. Public Mortuary, New End. During the year, 73 bodies were brought to the Mortuary, 19 by the Police, 20 at the request of friends, and 34 by order of the Coroner. In 51 instances post-mortem examinations were made. 28 Section 5. Housing. Statistics. 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) 1237 (b) Number of inspections made for the purpose 1356 (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 103 (b) Number of inspections made for the purpose 108 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (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 904 2. Remedy of Defects during the Year without scri'ice of formal Notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 30 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 :— (а) 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 944 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (а) By owners 944 (b) By Local Authority in default of owners Nil. 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 Nil. (2) Number of dwelling-houses demolished in pursuance of Demo- lition Orders Nil. 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 21 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 2 4. Housing Act, 1936—Part IV.—Overcrowding :— (a) (i) Number of dwellings overcrowded at the end of the year 118 (ii) Number of families dwelling therein 118 (iii) Number of persons dwelling therein 564½ 29 (b) Number of new cases of overcrowding reported during the year 20 (c) (i) Number of cases of overcrowding relieved during the year 25 (ii) Number of persons concerned in such cases 108 (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. New End Housing Scheme. The War has deferred the carrying out of the Scheme on this site and the contract for the Scheme has been abandoned. The Council approved the proposal to provide a First Aid Post by adaptation of a portion of the basement of the proposed Scheme but the Ministry of Health would not authorise the further procedure with that proposal. The Council, therefore, decided to utilise as far as practicable the whole of the site for Shelter purposes. Garnett Road Housing Scheme. In view of the outbreak of War and with the approval of the Ministry of Health, the Council decided to complete the carcass of the building comprising this scheme and to take the necessary steps for the protection of the works. It was also agreed that the lower ground floor should temporarily be reinforced and in other ways made suitable as an Air Raid Shelter. Housing Consolidated Regulations, 1925. During 1939, 103 houses were inspected and recorded in this connection. 108 inspections were made for the purpose. Underground Rooms. The following Tables show the result of the Survey of Underground Rooms so far inspected, and the results of action taken. Statistical Statement re premises containing Underground Rooms. 1936 1937 1938 1939 (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 37 (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 5 (4) Premises found which do not comply in minor details only (no action contemplated) 8 3 2 – (5) Premises found to be used for purposes other than for human habitation, or unoccupied 26 14 20 – 345 415 384 42 30 Result of Action during 1939. 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 55 Nil. 55 24 Action under Housing Acts 14 16 30 15 Action as the result of voluntary conversion of premises into flats and in connection with new buildings 11 Nil. 11 3 80 16 96 42 The number of Underground Rooms found not to comply with the requirements in the houses in the allocation above (2), (3) and (4), totalled 93. They were found to exist in 42 premises. Of these rooms 29 were found in 15 Tenement Houses. Summary of Underground Room Register at 31 st December, 1939. (1) Premises found to comply with Underground Room Requirements 475 (2) Premises found not to comply but which can be made to comply 516 (3) Premises found not to comply and cannot be made to comply (i.e., Closure only alternative, action deferred pending provision of satisfactory accommodation) 117 (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 1186 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 62 Number of houses at the Watling Estate at the disposal of the Borough Council under similar arrangements 38 Number of houses occupied under special arrangements with the L.C.C. for relief of overcrowding, viz. :— Watling estate 103 Other L.C.C. estates 40 Total 243 31 Representations. Statement showing steps taken in 1939 in connection with premises "represented in 1939 or previous years" by the Medical Officer of Health under the Housing Acts:— Premises. Representation. Date of Committee. Closing Order. Date of Council. Remarks. 52, Ainger Road 5-12-38 26-1-39 Two underground rooms. Necessary works carried out and Closing Order determined by Council 23rd March, 1939. 14, Harben Road 5-12-38 26-1-39 Three underground rooms. 39, Denning Road 5-12-38 26-1-39 Two underground rooms. 57. Fleet Road 6-2-39 27-4-39 One underground room. 123, Adelaide Road 30-11-36 18-3-37 Council on 23rd February, 1939, agreed to the front basement room being used as an Air Raid Wardens' Post. 1, Lutton Terrace, Flask Walk 3-4-39 25-5-39 Two underground rooms. 2, Lutton Terrace, Flask Walk 3-4-39 25-5-39 Two underground rooms. 3, Lutton Terrace, Flask Walk 3-4-39 25-5-39 Two underground rooms. 49, Ainger Road 3-4-39 25-5-39 Two underground rooms. 9, Bolton Road 3-4-39 – One underground room. Matter deferred pro tem. 90, Palmerston Road 5-7-37 – Basement back room. Work completed and undertaking of March, 1938, cancelled. 91, Palmerston Road 13-9-37 – Ditto ditto 9, New End Square 5-12-38 – Undertaking to render the premises fit for human habitation accepted by the Council, 23rd March, 1939. Premises empty. 31, Fleet Road 6-2-39 25-5-39 Two underground rooms. 3, Greville Road 4-4-38 21-7-38 Part of a building, i.e., front and back basement rooms and ground floor back room. Closing Order made on 21st July, 1938, on basement rooms, and undertaking to carry out work to another part of house accepted by Council. Owners' amended proposals for dealing with ground floor and basement accepted by Council 25th May, 1939, and permission given for rear basement rooms to be used as a workshop and storage room. Necessary work to ground floor and basement carried out and undertaking cancelled by Council 20th July, 1939. 32 Section 6. Inspection and Supervision of Food. (A) Milk Supply. Examination of milk samples for bacterial content and for tubercle bacilli. During the year 28 samples were submitted for examination. These included 14 Pasteurised, 6 Tuberculin Tested, 7 Raw and 1 Accredited. All of these with the exception of 1 Pasteurised were found to be satisfactory. Chemical examination of Milk Samples. There were 125 samples of milk taken under the Food and Drugs Act, and of these one was unsatisfactory. 11 informal milk samples were taken during the year. The average composition of the total milk samples examined was :— Total milk solids 1226 per cent. Fat 3.57 per cent. Solids not fat 8.68 per cent. (i) Milk and Dairies (Consolidation) Act, 1915. Milk and Dairies Order, 1926. The number of premises in respect of which persons are registered as purveyors of milk is 119. During the year, 149 inspections were made and 17 notices were served. In addition 43 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 1939, 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 0 Sale of Pasteurised Milk from shop or other premises 39 No licence for graded milk was refused or revoked during the year. In 21 cases supplementary licences were granted authorising the sale of graded milk within the Borough from premises outside Hampstead. 33 (B) Meat and other Foods. During the year, seven ice creams were examined bacteriologically. (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 has been exercised by all the Sanitary Inspectors, and observations kept to see that the Public Health (Meat) Regulations, 1924, are observed. (ii) Unsound Food and Food Inspection. The following is a total of the items of food seized or voluntarily surrendered during the year :— Meat—Beefsteak, 25 lbs. Beef, frozen, 96 lbs. Ox-tongues, 23. Sheep's heads, 9. Fish—Haddocks, 3 boxes. Miscellaneous—Flour, 9½ stone. Potatoes, 16 cwt. (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 748 inspections were made. Premises. No. of Premises on Register. No. of Inspections. No. of Notices. Bakehouses:— Underground 14 56 12 Aboveground 33 34 6 Fried Fish Shops 12 26 2 Ice Cream Premises 130 17 1 Milk Premises 117 149 17 Restaurants and Eatinghouses 110 78 16 Other Food Premises, e.g,. Butchers, Greengrocers, Grocers, Provision Dealers, etc. 542 388 47 Underground Bakehouses.—A special inspection is being made of underground bakehouses with a view to their certification or otherwise. The following is a list of these premises :— 64, Belsize Lane. 63, Hemstal Road. 202, Belsize Road. 4, Kelson Street (Closed 20-1-40). 34 228, Belsize Road. 354, Kilburn High Road. 44, England's Lane. 2, King's College Road. 93, Fairfax Road. 41-3, Mill Lane. 7, Fairhazel Gardens. 98, West End Lane. 65, Fleet Road. 279, West End Lane. The following underground bakehouse was voluntarily closed as a bakehouse:— 126, West End Lane. No underground bakehouse was compulsorily closed. Underground bakehouse prosecution.—Proceedings were instituted against the occupier of an underground bakehouse at Kilburn for not observing due cleanliness in connection with the bakehouse, and in respect of the accumulation of refuse. The occupier was similarly prosecuted in the previous year and despite the visits and warnings of the Sanitary Inspectors had continued to fail to maintain the necessary standards of cleanliness, etc. The case was heard by the Magistrate at Marylebone Police Court on 11th July, 1939, who inflicted a fine of £10 and £2 2s. costs. It is regrettable that no more stringent action can be taken against such a person engaged in an essential food business such as the baking of bread, etc., than after repeated warnings, the infliction of a relatively small fine. 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 130 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 49 premises had been registered. (c) Factories of Margarine, Margarine-cheese, or Milk-blended butter.—None of these premises exists in the Borough. (d) Wholesale dealers in Margarine, Margarine-cheese, or Milkblended butter.—Premises adjoining Southampton Road were registered in 1939 as wholesale dealers in Margarine. (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 Act, 1938. 35 (iv) Agricultural Produce (Grading and Marking) Act, 1928. (v) Merchandise Marks Act, 1926. The Sanitary Inspectors supervise, generally, such of the Regulations of the former and the requirements of the latter as are enforceable by the Borough Council. Merchandise Marks (Imported Goods) No. 4 Order, 1939. This Order came into force on the first day of November, 1939, and its observance is among the duties of the Sanitary Inspectors. For the purposes of the Order, the expression "margarine" means any food, whether mixed with butter or not, which resembles butter and is not milk-blended butter. (vi) Stalls and Vehicles (including Street Traders), Inspection of food sold from street stalls has been carried out by the Sanitary Inspectors. (vii) Food Poisoning. During the year, one case was notified. It was investigated by the staff of this department. (C) Adulteration, etc. (i) Food and Drugs Act, 1938. 500 samples were taken for analysis during the year by the Sampling Officers under the Act. The number certified to be adulterated was 24, or 4.8 per cent. of the total number, as compared with 26, or 5.2 per cent. in 1938. Of the total samples taken for analysis, 371 were formal samples and 129 informal. 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. 40 Butter Contained excess of water Cautioned.. 56 Sausages Contained undeclared sulphite. Cautioned. 68 Milk Deficient in fat Summons. Fined £2. £1 ls. Costs. 82 Butter Contained excess of water Cautioned. 86 Curry Powder Lead. 12 parts per million Cautioned. 36 Formal Samples (continued). No. of Sample. Article. Analyst's Report. Action taken. 94 Curry Powder Lead. 13 parts per million Cautioned. 106 Beef Dripping Acidity 3.7 per cent. Cautioned. 162 Butter Contained excess of water Cautioned. 179 Beef Sausages Sulphur Dioxide 300 parts per million Cautioned. 226 Green Cheese Contained excess of water Cautioned. 228 Beef Sausages Sulphur Dioxide 320 parts per million Cautioned. 265 Green Cheese Contained excess of water Cautioned. 297 Full Cream Cheese It is a whole Milk Cheese Cautioned. 333 Tinned Cream Deficient in fat Cautioned. 374 Lard Lard Compound Summons dismissed. 381 Lard Lard Substitute Summons. £1 1s. Costs. 384 Grey Powders Weight deficiency Cautioned. 387 Grey Powders Not in accordance with B.P. Standard Cautioned. 401 Butter Contained excess of water Cautioned. 458 Lard Consists of Vegetable Fats Cautioned. 474 Bread and Butter Bread and Margarine Summons. £1 1s. Costs. 484 Beef Sausages Sulphur Dioxide 360 parts per million Summons. Fined 40s. £5 5s. Costs. 488 Lard Consists of Vegetable Fats Cautioned. Informal Sample. 436 Lard Lard Substitute No action. (ii) Artificial Cream Act, 1929. There are no premises registered in the Borough. (iii) Public Health (Condensed Milk) Regulations, 1923 and 1927, and Public Health (Dried Milk) Regulations, 1923 and 1927. Two samples were taken under the former, and no samples under the latter during the year. (iv) Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. 112 samples of articles of food specified in these Regulations were submitted for analysis. Four infringements were discovered. 37 Report for the year 1939 by the Public Analyst. H. E. COX, D.Sc., Ph.D. (Lond.), F.I.C. The Laboratory, 11, Billiter Square, London, E.C.3. 13th March, 1940. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, Following my usual custom I have the honour to submit a short summary of the work carried out as your Public Analyst during the year 1939. The number of samples examined under the Acts has been 500. The nature of these is summarised in the following table:- Milk 105 Cream 8 Butter 38 Margarine 50 Lard and Lard Substitutes 30 Cheese 11 Condensed Milks 2 Dripping, Suet, Cooking Fats 18 Sausages, Canned Meats, etc 37 Fish and Fish Pastes 36 Tinned and Dried Fruits and Vegetables 29 Flour, Baking Powder, Cereals 27 Bread and Butter 7 Sugars 24 Jam, Honey, Marmalade, Jellies 11 Ice Cream 1 Mincemeat 1 Condiments and Spices 14 Vinegar 7 Spirits, Beer 18 Tea, Cocoa, Coffee and Coffee Extract 9 Yeast 2 Drugs 10 Miscellaneous 5 500 The outstanding event during the year affecting this work has been the coming into force, on October 1st, of the new Food and Drugs Act. This Act, while consolidating all the main provisions of the Food and Drugs (Adulteration) Act which it replaced, has introduced several 38 reforms, both administrative and in relation to such matters as the composition of food, correct labels and advertisements, provisions as to warranties and various other matters. In particular, the Minister of Health has been given powers which he did not formerly possess for the making of Regulations dealing with the composition of various foods, and various steps were being taken in this connection until the outbreak of the War, which has necessitated the suspension of such deliberations. There is no doubt that the new Act is a real improvement on the old Act, though naturally there are various doubtful matters, the effect of which remains to be proved when times are more normal. Of the 500 samples examined during the year, 24 had to be reported as adulterated, and it is perhaps inevitable that my report should deal with these 24 sinners rather than with the 476 which needed no repentance. The deficient or adulterated samples included a Milk which was deficient in fat to the extent of 7 per cent., a Tinned Cream also deficient in fat, four Butters and one Dripping which contained excess of water, five Lards which contained substantial proportions of hydrogenated vegetable fats such as are commonly sold as Lard Substitutes, three Cheeses, two of which contained large additions of water and one described as a Cream Cheese which was not a cream cheese; four specimens of Sausages contained preservative contrary to the Regulations, one Bread and Butter was found to consist of bread and a mixture of margarine and butter; two Curry Powders were somewhat heavily contaminated with lead; and two Grey Powders had a composition which differed materially from that prescribed by the British Pharmacopoeia. Considerable attention has been given to the subject of Cheese. This is in my opinion particularly necessary now that cheese is becoming an increasingly important article of diet, and there has been an increased tendency to incorporate large quantities of water in processed cheeses. It may be recalled that the processing of cheese consists in heating the cheese with the addition of certain stabilizing salts to a pasteurizing temperature. It is subsequently wrapped in metal foil and will keep for a long period. Originally it was the practice to add a trifling percentage of water in which to dissolve the salts, but of late years the amount of water has increased, so that some brands instead of containing one-third water, i.e., 33 per cent., have contained as much as 60 and 64 per cent. of water,—that is, there has been an addition of water nearly equal to the weight of the cheese. I have participated in successful prosecutions in other parts of the Country to suppress this adulteration, but, perhaps fortunately, we have not had to take such a case in Hampstead. Negotiations were in progress with the Ministry of Health for the adoption of an agreed standard, but were suspended as the result of the War. The position with regard to tin in sugar is still somewhat doubtful. Sometimes it is present in small quantity, sometimes not. In view of 39 the fact that a good deal of the Demerara Sugar does not show any appreciable proportion of tin, there seems no reason why quantities such as one grain per lb. and upwards should be tolerated. Some of the Margarines examined were subjected to detailed investigation to determine as far as possible the nature of fats from which they were prepared and confirming the presence of Vitamin A. The reports were sent to the Medical Officer of Health dealing as far as possible with the relative merits of the different types. Close watch has been kept for various additions and impurities such as preservatives and metallic contamination in a wide variety of products, but apart from tin in sugar, a small amount of copper in some Beans and Tomato Sauce, there have been no matters to complain of, and it is right to say that in general the food sold within the Borough is of very good quality. There is very little deliberate adulteration and cases of impurity or of unsatisfactory quality are comparatively rare. The rate of adulteration is just under 5 per cent., which is not unduly high, especially when it is remembered that the Inspectors quite naturally take samples of articles which are liable to be adulterated rather than of those which experience has shown to be of good quality. I have the honour to remain, Your obedient servant, (Signed) H. E. COX, Borough Analyst. 40 NOTIFIABLE DISEASES. * Total cases notified in age-periods. *Total cases notified in each Ward. *Cases admitted to Hospital. Total deaths in age-periods. Section 7. Prevalence of, and Control over, Infectious and other D At all Ages. At Ages—Years. Ward No. 1 (Town). Ward No. 2 (Belsize). Ward No 3 (Adelaide). Ward No. 4 (Central). Ward No. 5 (West End). Ward No. 6 (Kilburn). Ward No. 7 (Priory). At all Ages. At Ages—Years. Under 1. 1 and under 2. 2 and under 3. 3 and under 4. 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over. Under 1. 1 and under 2. 2 and under 3. 8 and under 4 4 and under 5. 5 and under 10. 10 and under 15. 15 and under 20. 20 and under 35. 35 and under 45. 45 and under 65. 65 and over Diphtheria 26 1 .. 1 6 .. 6 6 4 9 .. .. .. 6 2 2 6 2 6 2 25 1 .. .. .. 1 .. .. .. .. .. Encephalitis Lethargica 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. .. .. .. 1 .. .. 2 .. .. .. .. .. .. .. 1 .. 1 .. .. Erysipelas 31 2 .. .. .. .. 1 1 1 3 6 13 4 4 7 2 4 4 5 5 17 1 .. .. .. .. .. .. .. .. .. 1 .. .. Malaria 1 .. .. .. .. .. .. .. .. .. .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. Measles 17 .. 3 1 1 1 1 2 1 4 3 .. .. 2 3 4 .. 4 3 1 4 .. .. .. .. .. .. .. .. .. .. .. .. .. Ophthalmia Neonatorum 11 11 .. .. .. .. .. .. .. .. .. .. .. .. 1 1 1 2 5 1 11 .. .. .. .. .. .. .. .. .. .. .. .. .. Pneumonia 57 3 3 2 5 1 2 1 3 10 5 18 4 8 13 9 4 7 12 4 30 38 5 .. .. 1 .. .. .. .. .. 1 15 16 Puerperal Fever 1 .. .. .. .. .. .. .. .. 1 .. .. .. .. .. 1 .. .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Puerperal Pyrexia 14 .. .. .. .. .. .. .. .. 14 .. .. .. 1 4 1 2 .. 3 3 14 .. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet Fever 60 .. .. .. 4 2 15 19 4 9 7 .. .. 4 20 5 5 12 11 3 50 .. .. .. .. .. .. .. .. .. .. .. .. .. Typhoid Fever 2 .. .. .. .. 1 .. .. .. .. .. 1 .. 1 .. .. 1 .. .. .. 1 .. .. .. .. .. .. .. .. .. .. .. .. .. Whooping Cough 248 27 35 19 37 38 86 3 1 .. 1 1 .. 22 26 16 15 54 85 30 58 1 1 .. .. .. .. .. .. .. .. .. .. .. Totals 469 44 41 23 53 43 111 32 14 44 22 33 9 48 76 41 39 85 131 49 212 43 6 – – 2 – – – 1 – 3 15 16 * Cancelled cases have not been included. Statistics relating to Tuberculosis are given in subsequent pages. 41 Diphtheria. Immunisation. Immunisation is available in the Borough by private arrangement of inhabitants with their own family doctors, in which case the cost is not borne by the Borough Council, but the material is supplied free to the Medical Practitioner. It is also available entirely free of cost under the Borough Council's Scheme. During the year 220 children were immunised against Diphtheria: 143 by private doctors, and 77 by the Council's Assistant Medical Officer. Of these (a) 112 were pre-school children. (b) 108 were school children. 70 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 being given. Tuberculosis. New Cases and Mortality during 1939. During the year 1939, 80 new cases of Tuberculosis were notified, 69 being cases of Pulmonary Tuberculosis, and 11 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 1939:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M F. M. F. M. F. 0- – 1 – – – – – 1 1- – – – – – – – 1 5- 2 1 1 – – – 1 – 15- 7 11 1 1 1 5 – – 25- 11 8 2 4 4 4 1 – 35- 4 8 – – 6 – – – 45- 6 1 1 1 3 3 – – 55- 2 5 – – 3 3 – 1 65 and upwards – 2 – – 4 3 – – Totals 32 37 5 6 21 18 2 3 Deaths. The number of deaths from all forms of tuberculosis during 1939 was 44, of which 39 were pulmonary and 5 non-pulmonary. The death rate per 1.000 population from tuberculosis was 49. 42 Deaths of Non-notified, Cases. There were 6 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 7. Enquiries are always made in such cases as to the reasons for non-notification 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 four 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 1939, totalled 318 —263 pulmonary and 55 non-pulmonary. Tuberculosis Regulations, 1930. Pulmonary. Males. Females. Non-Pulmonary. Males. Females. Totals. Males. Females. Number of cases on the Register at the commencement of the year 1939 133 152 30 25 163 177 Number of cases notified under the Regulations for the first time during the year 32 37 5 6 37 43 Number of cases removed from the Register in a preceding year which have been restored to the Register durinsr the vear 5 8 2 5 10 Number of cases brought under notice otherwise than by notification during the year 14 13 2 3 16 16 *Number of cases removed from the Register during the year 184 210 37 36 221 246 59 72 10 8 69 80 Number of cases remaining on the Register at the end of the year 125 138 27 28 152 166 •These consist of cases which have been denotified, and those which have died or removed from the Borough. 43 Extra Nourishment. The provision of extra nourishment is a valuable adjunct to the Tuberculosis Scheme, and during the year 26 patients received this form of assistance. Tuberculosis Care Work. Details of the work carried out during the year are tabulated below:— Cases reviewed 51 New cases (included in above) 47 Interviews with patients by Assistant for Care Work:— (a) At homes of patients 87 (b) Otherwise 623 Cases referred to the Hampstead Borough Council:— (a) For extra nourishment 26 (b) For dental treatment 3 (c) For Home Help 2 Cases referred to the Public Assistance Committee; Unemployment Assistance Board 36 Cases referred to Service Funds 4 Cases referred to Voluntary Associations 18 Cases referred to other Agencies 8 Cases helped directly through the Care Committee:— (a) In cash 15 (b) In clothing 9 The Municipal Tuberculosis Dispensary. During the year, 132 sessions were held, and 361 new cases (of which 136 were contacts) were examined. Altogether, 496 patients attended the Dispensary in 1939, and the total number of attendances of all kinds numbered 1,549, an average of 117 per session. The attendances were 696 less than last year. 44 Tuberculosis Scheme of the Hampstead Metropolitan Borough Council. Return showing the work of the Dispensary during the year 1939. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total. Adults. Children. Adults. Children, Adults. Children. M. F. M. F. M. F. M. F. M. F.. M: F. A.— New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 22 20 1 1 2 3 1 – 24 23 4 1 52 (b) Doubtfully tuberculous – – – – – – – – 4 5 – – 9 (c) Non-tuberculous – – – – – – – – 40 79 10 24 153 B.— Contacts examined during the year :— (a) Definitely tuberculous 2 ] 1 – – – – – 2 1 1 – 4 (b) Doubtfully tuberculous – – – – – – – – 2 2 – 1 5 (c) Non-tuberculous – – – – – – – – 10 54 34 28 126 C.— Cases written off the Dispensary Register as :— (a) Recovered 3 7 1 1 1 1 3 3 4 8 4 4 20 (b) Diagnosis not confirmed or nontuberculous (including cancellation of cases notified in error) ... – – – – – – – – 50 138 45 54 287 D.— Number of Persons on Dispensary Register on Dscember 31st:— (a) Dingnosis completed 94 91 3 1 9 12 6 2 103 103 9 3 218 (b) Diagnosis not completed – – – – – – – – 6 7 – 1 14 Number of persons on Dispensary Register on January 1st 247 Number of visits by Tuberculosis Officer to Homes (including personal consultations) 162 Number of patients transferred from other areas and of "lost sight of "cases returned 23 Number of:— Number of patients transferred to other areas and cases "lost sight of" 67 (a) Specimens of sputum, Ac., examined 160 (b) X-ray examinations made in connection with Dispensary work 264 Died during the year 13 Number of ineured Persons under Domiciliary Treatment on the 31st December 17 Number of attendances at the Dispensary (including Contacts) 1549 Number of visits by Nurses or Health] Visitors to Homes for Dispensary purposes 1034 Number of "Recovered" cases restored to Dispensary Register, and included—in A (a) and A (b) above – Number of consultations with medical practitioners:— Number of " T.B. plus " cases on Dispensary Register on December 31st 118 (a) Personal 83 (b) Other 268 45 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, 1938 1752 2. Number of these:— (a) Successfully vaccinated 950 (b) Insusceptible of Vaccination 11 (c) Had Smallpox – (d) Number in respect of whom Statutory Declarations of conscientious objection have been received 411 (e) Died unvaccinated 54 3. Number of these Births which on 31st January, 1940, remained unentered in the "Vaccination Register "on account of:— (a) Postponement by Medical Certificate 7 (b) Removal to Districts the Vaccination Officers of which have been duly apprised 193 (c) Removal to places unknown, or which cannot be reached; and cases not having been found 101 4. Number of these Births remaining on 31st January, 1940, neither duly entered in the "Vaccination Register "under headings numbered 2 nor temporarily accounted for in the "Report Book" under heading numbered 3 25 5. Total number of Certificates of successful primary vaccination of children under 14 received during the Calendar year 1939 (including any relating to births registered in previous years) 1016 6. Number of Statutory Declarations of conscientious objection actually received, irrespective of dates of birth of the children to which they relate, during the Calendar year 1939 349 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 1939 of successful primary vaccination of which copies have been sent to Vaccination Officers 172 It will be seen from the foregoing figures, that approximately 58 per cent. of the children born in Hampstead during 1938 had been vaccinated by the end of the year under review, 46 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 vear 1939:— Diphtheria 307 Typhoid Fever 8 Dysentery 3 Malaria. – Scarlet Fever (for Hæm. Strep.) 41 Specimens of Sputum 269 Disinfection. The following is a record of the work carried out by the Disinfecting Staff during 1939:— Number of houses or parts of houses and contents disinfected 936 „ verminous rooms disinfested 68 „ „ articles of clothing disinfested *136 articles and 3 cases of clothes. „ „ beds disinfested 41 persons accommodated at Shelter – * Excluding the clothing of persons dealt with at the Bathing Station. Cleansing and Disinfection of Verminous Persons and their Belongings. The following cleansings and medicinal baths were carried out at the Bathing Station, which forms part of the Public Health Station, during the year:— Verminous conditions. Adults 5 Children 209 Scabies. Adults 91 Children 177 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, 101 verminous rooms in 86 houses and 41 sets of beds and bedding were cleansed and freed from vermin. 47 INDEX. Page Adulteration, etc. 35 Agricultural Produce (Grading and Marking) Act, 1928 35 Air-Raid Precautions 7 Analyst, Public, Report of 37 Ante-Natal Clinics 13, 19 Area of Borough 8 Artificial Cream Act, 1929 36 Bacteriological Examinations 46 Bakehouses 26, 33, 34 Basement Rooms (see Underground Rooms). Bathing Station 46 Births 8, 12, 18 Bug infestation and eradication 27 Butter Factories 34 Cancer 9 Care Committee (see Tuberculosis). Casualty Services 7 Chemical Examinations 32, 35, 37 Child Life Protection 17 Children, sick and ailing, Homes and Hospitals for 15 Cleansing of verminous houses, persons, etc. 46 Common Lodging Houses 25 Complaints received 23 Condensed Milk 36 Consulting Obstetricians 16 Consumption (see Tuberculosis). Convalescent Homes, etc. 15 County Council Housing Estates 30 Cowhouses 34 Creches (see Day Nurseries). Day Nurseries 15, 21 Deaths 10 Dental Clinics, etc. 21 Diphtheria, Anti-toxin, and Immunisation 40, 41 Disinfection 46 Dried Milk 36 Encephalitis Lethargica 40 Enteric Fever 40 Erysipelas 40 Factories 25 Food, Bacteriological and Chemical Examination 32 Food and Drugs Act, 1938 35 Food and Food Premises 32,34 Food and Milk for Mothers and Children 14,21 Food Poisoning 35 Food, Unsound 33 Foster Children and Foster Mothers 17, 21 Fried Fish Shops 33 Garnett Road Housing Scheme 29 General Emergency Committee 3 Hampstead District Nursing Association 11 Health Services 11 48 PAGE Health Visitors and Work of 12,18 Home Helps 16 Home Nursing 16 Home Workers 26 Homes for Mothers and Babies 15, 21 Hospitals Houses, Inhabited, number of 8 Houses Let in Lodgings (see Tenement Houses). Housing Committee 3 Housing Consolidated Regulations, 1925 and 1932 28 Housing Section 28 Ice Cream 33 Illegitimate Children 8 Infant Life Protection (see Child Life Protection). Infant Welfare Centres 12, 20 Infant Mortality 9, 18 Infectious Diseases 16, 40 Inspections and Re-inspections 23 Kilburn District Nursing Association 11 Laboratory Facilities 46 Lodging Houses (see Tenement Houses). Malaria 40 Margarine, Wholesale Dealers, Factories, &c. 34 Maternal Deaths 17 Maternity and Child Welfare 12,19 Maternity and Child Welfare Committee 3 Maternity Homes and Hospitals 14 Measles 9 Meat and other Foods 33 Merchandise Marks Act, 1926 38 Milk and Dairies Acts and Orders 32 Milk and Food for Mothers and Children 14, 21 Milk, Bacteriological and Chemical Examination 32 Milk Supply 32, 33 Mortuary, Public 27 Municipal Dwellings 30 New End Housing Scheme 29 Notification of Births 12 Nursing in the Home 11 Offensive Trades 25 Officials, Public Health 4 Ophthalmia Neonatorum40 Outworkers (see Home Workers). Overcrowding 28 Pharmacy and Poisons Act, 1933 27 Pneumonia, Acute Primary and Acute Influenzal 40 Poisons (see Pharmacy and Poisons Act, 1933). Population 9 Post-Natal Clinics 13, 19 Poultry Slaughterhouses 34 Preserved Food, Cooked Meat, etc., Premises 34 Preservatives, &c., in Food Regulations, 1925 to 1927 36 Public Health Committee 3 Public Health (Tuberculosis) Regulations, 1925, 1930 42 Puerperal Fever and Pyrexia 9, 40 49 Page Rag and Bone Dealers 25 Rent Restrictions Acts 25 Restaurant Kitchens.33 Sanitary Circumstances of the Borough 23 Sanitary Inspectors, Work of 23 Scabies 46 Scarlet Fever 40 Seamen's Lodging Houses 25 Shops Act, 1934 27 Slaughterhouses 33 Staff of the Public Health Department 4 Stalls and Street Traders 35 Statistics and Social Conditions of Borough 9 Still Births 8, 18 Street Traders 35 Tenement Houses and Bye-laws 24, 25 Toddlers' Clinics 21 Tuberculosis 41 Tuberculosis Regulations, 1930 42 Typhoid (see Enteric Fever). Underground Rooms 29 Unemployment 9 Vaccination and Vaccination Order, 1930 45 Vaccination Officer 4 Verminous Persons and Premises, etc. 46 Vital Statistics 9, 10 Welfare Centres 12 Westcroft Estate 40 Whooping Cough 9 Workshops and Workplaces (see Factories).