LIBRARY HAMP 41 the Metropolitan Borough of Hampstead. REPORT for the year 1940 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, Eversholtt Street, N.W.I. Report of the Medical Officer of Health, 1940. 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-1940—71,520. Rateable value (at 1st April, 1940) £1,570,000 Sum represented by a penny rate £4,600 Extracts from Vital Statistics of the Year. Total. M. F. Legitimate 704 364 340 Live Births Illegitimate 92 38 54 Birth Rate per 1,000 estimated resident population mid-1940—11.1 Stillbirths 36 Rate per 1,000 total (live and still) births—116. Deaths 1159 Death Rate per 1,000 estimated average population—16.2. Adjusted Death Rate (C.F.—094)—15.4. Deaths from puerperal causes:— Deaths. Rate per 1,000 total (live and still) births. Puerperal sepsis 1 1.2 Other puerperal causes 3 3.6 Total 4 4.8 Death Rate of Infants under one year of age:— All infants per 1,000 live births 49 Legitimate infants per 1,000 legitimate live births 46 Illegitimate infants per 1,000 illegitimate live births 88 2 Age and Sex Allocation of Deaths of Hampstead Residents during the Year 1940. 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 5 years. 5 and under 15 years. 15 and under 45 years. 45 and under 05 years. 65 years and upwards. 1 2 3 4 5 6 7 8 9 1. Typhoid and Paratyphoid Fevers M ... ... ... ... ... ... ... F 1 ... ... ... ... 1 ... 2. Cerebro spinal Fever M 3 ... ... 1 1 1 ... F 1 ... ... ... 1 ... ... 3. Scarlet Fever M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 4. Whooping Cough M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 5. Diphtheria M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 6, Tuberculosis of respiratory system M 26 ... ... ... 14 10 2 F 12 ... ... 1 5 5 1 7. Other Tuberculous Diseases M 4 1 ... ... 1 1 1 F 3 ... ... ... 2 ... 1 8. Syphilitic disease M 4 ... ... ... ... 4 ... F ... ... ... ... ... ... ... 9. Influenza M 9 ... ... ... 2 3 4 F 15 ... ... ... 1 1 4 10. Measles M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 11. Acute Polio-myelites and Polio-encephalitis M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 12. Acute Infantile Encephalitis M ... ... ... ... ... ... ... F ... ... ... ... ... ... ... 13 Cancer of Bucal Cavity and (Esophagus (M) Uterus (F) M 11 ... ... ... 1 4 6 F 7 ... ... ... ... 3 4 14. Cancer of Stomach and Duodenum M 11 ... ... ... ... 5 6 F 14 ... ... ... ... 5 9 15. Cancer of breast F 18 ... ... ... 3 9 6 16. Cancer of all other sites M 53 ... ... ... 1 24 28 F 56 ... ... ... 6 20 30 17. Diabetes M 4 ... ... ... 1 ... 3 F 7 ... ... ... 1 2 4 18. Intracranial vascular lesions M 41 ... ... ... 3 17 21 F 64 ... ... ... ... 11 53 19. Heart Disease M 129 ... ... ... 2 43 84 F 160 ... ... ... 3 20 137 20. Other diseases of circulatory system M 11 ... ... 1 ... 1 9 F 19 ... ... ... ... 2 17 91. Bronchitis M 33 2 ... ... 1 14 16 F 25 ... ... ... ... 2 23 22. Pneumonia (all forms) M 27 2 ... ... ... 7 18 F 17 ... ... ... 2 4 11 23. Other Respiratory Diseases M 5 ... ... 1 1 1 2 F 7 ... ... ... ... 3 4 24. Ulcer of stomach or duodenum M 10 ... ... ... 1 4 5 F 6 ... ... ... 1 4 1 25. Diarrhœa under 2 years M 3 3 ... ... ... ... ... F ... ... ... ... ... ... ... 26. Appendicitis M 5 ... ... ... ... 4 1 F 4 ... ... 1 ... 2 1 27. Other digestive diseases M 10 ... ... ... 1 5 4 F 18 ... ... ... 2 5 11 28. Nephritis M 14 1 ... ... 1 7 5 F 12 1 ... ... 1 5 6 29. Puerperal and post abort Sepsis F 1 ... ... ... 1 ... ... 30. Other maternal causes F 3 ... ... ... 3 ... ... 31. Premature birth M 11 11 ... ... ... ... ... F 6 6 ... ... ... ... ... 32. Congenital malformation birth inj. infant dis. M 8 6 1 ... 1 ... ... F 4 3 ... ... 1 ... ... 33. Suicide M 11 ... ... ... 1 7 3 F 5 ... ... ... 1 3 1 34. Road traffic accidents M 8 ... 1 3 1 3 ... F 3 ... ... ... 1 2 ... 35. Other violence causes M 57 2 ... 1 21 25 8 F 79 1 3 1 21 32 21 36. All other causes M 46 ... ... ... 3 8 35 F 47 ... ... 1 7 9 30 All causes M 554 28 2 7 58 198 261 F 605 10 3 4 63 150 375 Totals 1159 38 5 11 121 348 636 All " Transferable Deaths" of residents, i.e., of persons resident in the Borough who died outside it, have been included. Transferable deaths of non-residents, i.e., of persons resident elsewhere in England and Wales who died in the Borough, have in like manner been excluded. 3 Maternity and Child Welfare. Health Visiting. The following table gives a record of the work of the Health Visitors in 1940:- First visits to expectant mothers 452 Re-visits to expectants mothers 942 First visits to infants under one year 734 Re-visits to infants under one year 3482 Visits to children from 1 to 2 years 2832 Visits to children from 2 to 5 years 4442 Visits to foster-mothers and foster-children 217 Visits re infectious diseases 311 Attendances at Borough Council's Ante-natal Clinics 152 Infant Welfare Centres. As from the 1st November, 1939, the Borough Council took over the Infant Welfare Clinics at the request of the Hampstead Council of Social Service, who were no longer able to undertake the financial responsibility. As a consequence, the Council of Social Service do not now receive from the Borough Council the annual grant of £425. The additional work, nursing and clerical, has been undertaken by the existing staff of the Department. Up to the outbreak of War there were 6 Infant Welfare Clinics in the Borough holding 9 sessions weekly. At the present time there are 4 Clinics holding 6 sessions weekly. Clinics are still held at the Health Institute, but have been discontinued in the other buildings where they were previously held, viz. :—Wesleyan Church Hall, Lisburne Road; The Mission Hall, Broomsleigh Street; and the Baptist Chapel Hall, Heath Street. Advantage was taken of the Borough Council's First Aid Post at Berridge House, where Clinics are now held, together with one in the Borough Council's rooms at 27, Pond Street. This alteration is eminently satisfactory, as the former premises, whose use is now discontinued, were always regarded as entirely unsuitable and unsatisfactory. It is pointed out that the premises at Berridge House will not be available after the conclusion of the War. Nane and address of Centre. Day and Time held. Doctor in attendance. Health Visitor. Congregational Church Hall, Avenue Road, Swiss Cottage Monday, 2—4 p.m. Dr. F. M. Yule tMrs. Steward Health Institute, Kingagate Road, N.W.6. Tuesday 2—4 p.m. Wednesday, 10—12 noon and 2—4 p.m. ‡Dr. A. S. Hall- CraggB 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 Miss Kennedy Berridge House, Hillfield Road, N.W.6. Thursday, 2— 4 p.m. Dr. F. M. Yule Miss Evans * The Wednesday morning session was closed in December, 1940. t Replaced by Mrs. Home after June 30th, 1940. | Replaced by Dr. M. Fletcher after August 14th, 1940, 4 Total number of attendances at all Centres during the year (i) by children under 1 year of age 7292 (ii) by children between the ages of 1 and 5 years 5316 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 535 (ii) between the ages of 1 and 5 years 161 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 442 (ii) over 1 year of age 942 Ante-natal and Post-natal Clinics. During the year under review there were 3 combined Ante- and Post-natal sessions a week, which were attended by 476 patients who made a total of 2,025 attendances. Supply of Milk and Food. On the 1st August, 1940, the Government introduced the National Milk Scheme, whereby expectant mothers, nursing mothers, and children under 5 years of age, could obtain 1 pint of wet milk per day either free or at 2d. per pint according to income. From 1st October, 1940, this scheme extended so that 1 packet of National Dried Milk per week, either free or at 1s. 2d. per packet (according to income), could be supplied to infants for whom wet milk was not suitable. One additional packet per week could be bought for 1s. 2d., or supplied by the Borough Council where the family income fell within the assessment scale used for the various maternity and child welfare services. There have been 274 families assisted with free milk or milk at half price during the period January 1st, 1940, to 27th July, 1940, 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. Under this scheme the Borough Council provided 6,764 gallons of liquid milk and 4,586 pounds of Dried Milk. Eggs and margarine 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 81 cases. Municipal Dental Clinics. During the year 60 sessions were held with an average attendance of 16. Nursing in the Home. The number of home visits paid by the 2 District Nursing Associations in accordance with the Borough Council Scheme were 2,923, 5 Maternity Homes and Hospitals. At the outbreak of War, New End Hospital was unable to reserve a special maternity ward for Borough Council cases. There were 12 cases admitted to Queen Charlotte's Hospital. Home Helps. There have been 48 cases in which Home Helps have been provided under the scheme of the Hampstead Borough Council. Sterile Maternity Outfits. 54 Sterile Maternity Outfits were sold at cost or at reduced prices. Convalescent Homes. During the year 2 mothers were admitted to Convalescent Homes. Day Nurseries. The Hampstead and North St. Pancras Day Nursery was evacuated to Kelmarsh Hall, Northants, at the outbreak of war. There is accommodation for 27 children, of whom about one third were admitted from Hampstead. Monthly reports on the condition of the children are sent by the Hon. Secretary to the Medical Officer of Health. Child Life Protection. During the year 217 visits were made to 14 foster-mothers and 27 foster-children in the Borough. On the 31st December, 1940, the number of foster-mothers on the register was 6, and the number of foster-children was 8. Sanitary Inspection. The following statement affords an indication of the work performed by the Sanitary Inspectors for the year 1940 :— (1) Total number of premises inspected 2414 (2) Total number of re-inspections and other visits and revisits 5755 (3) Number of inspections (recorded in (1) above) in respect of:— (a) Dwelling houses for housing defects :— (i) Non-tenement houses 370 (ii) Tenement houses 192 562 (b) Complaints 600 (c) Factories, excluding bakehouses 91 (d) Food premises :— (i) Bakehouses 66 (ii) Milk premises 148 (iii) Restaurants and Eating houses 110 (iv) Other food premises 688 1012 (e) Shops (under Shops Act, 1934) 367 6 682 informal notices (i.e., intimations) relating to 608 premises and 175 statutory notices relating to 127 premises were served during the year. Details of work, etc., supervised or action taken by the Sanitary Inspectors may be summarised as follows :— Registered Tenement Houses. Premises not registered as tenement houses. Underground rooms. Closed, or illegal occupation discontinued 1 1 Made to conform 2 3 Verminous conditions. Rooms disinfested 37 7 Number of houses concerned 25 4 Beds and bedding disinfested 10 — Floors of rooms cleansed 13 17 Animals. Nuisances from improper keeping on the premises abated — 2 Drainage systems, &c. Drainage systems repaired or renewed, partly or wholly 24 52 Plumbing defects remedied (soil pipes, waste pipes, &c.) 51 60 Roofs, rainwater pipes and gutters repaired or renewed 171 87 Water supply. Water supply provided to tenements or separate lettings 13 30 Number of houses concerned 10 25 Sinks provided to tenements or separate lettings 5 98 Number of houses concerned 5 40 Water cisterns cleansed or covered 10 12 Water-closets. Additional provided 1 19 Removed from improper position — 2 Flushing cisterns repaired 34 32 Yards, &c. Paving, &c. Yards or open spaces newly paved and drained 5 7 Paving of yards or open spaces repaired 28 11 Bathrooms. New provided — 23 Dust bins. Repaired or renewed 22 38 Cleansing. Houses or parts cleansed (excluding verminous rooms ) 296 104 Number of rooms concerned 431 178 Dampness. Dampness in houses or parts abated 184 55 Miscellaneous. Window cords repaired or renewed 139 61 Window fittings repaired or renewed 153 21 Filth and refuse removed from rooms . 3 1 Washing (of clothes) accommodation provided 4 —_ Coppers repaired or renewed 14 12 Suitably ventilated food cupboards provided 80 4 Kitchen ranges repaired or renewed 29 6 Common staircases repaired 29 20 Common staircases provided with adequate means of artificial light 5 7 Dilapidated houses or parts repaired 341 59 Smoke nuisances. Complaints received Refuse. 1 1 Accumulations of refuse removed 18 34 7 Housing. 1. Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 562 2. Number of dwelling houses (included in (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 44 3. Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 4. Number of dwelling houses (exclusive of those referred to under (3)) found not to be in all respects reasonably fit for human habitation 391 The two houses referred to in (3) above were numbers 5 and 7, Mill Lane, in respect of which Demolition Orders were made on the 24th April, 1940. The premises have now been demolished. Inspection and Supervision of Food. Wartime conditions demand the strict supervision of food supplies and the Sanitary Inspectors paid particular attention to premises where foods are manufactured, prepared, stored or exposed for sale. The amounts of food seized or voluntarily surrendered as unfit for human consumption showed a considerable increase on quantities condemned in previous years. Food Sampling. The Sanitary Inspectors took 398 samples during the year under the Food and Drugs Act, 1938, for analysis by Dr. H. E. Cox, the Public Analyst. The number certified to be adulterated was 16, or 4.0 per cent. of the total number, as compared with 24 or 4.8 per cent. in 1939. During the year 25 samples of milk were submitted for examination for bacterial content and for tubercle bacilli. Five out of thirteen samples of pasturised milk were found to have unsatisfactory bacterial contents. Public Mortuary, New End. During the year 111 bodies were brought to the mortuary, 9 by the Police, 14 at the request of friends, and 88 by order of the Coroner. In 90 instances post-mortem examinations were made. 8 Infectious Disease during 1940. Notifications. Removals to Hospitals. Deaths. Diphtheria 10 10 — Erysipelas 17 7 — Measles 53 12 — Cerebro Spinal Fever 4 4 4 Ophthalmia Neonatorum 10 9 — Pneumonia 63 32 10 Puerperal Fever 1 1 — Puerperal Pyrexia 12 12 — Scarlet Fever 35 30 — Typhoid Fever 4 4 1 Whooping Cough 9 1 — Total 218 122 15 Cancelled cases have not been included. Diphtheria. Immunisation. During the year 24 children were immunised against Diphtheria by private doctors. Owing to the war the clinics were suspended and did not reopen until the commencement of the year 1941. Tuberculosis. New Cases and Mortality during 1940. During the year 1940, 96 new cases of Tuberculosis were notified, 86 being cases of Pulmonary Tuberculosis, and 10 of other formsof the disease. The following statistical table, prescribed by the Ministry of Health, gives an analysis of the newly notified cases and deaths during 1940:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0- — — — — 1 — — — 1- — 1 — — — — — — 5- — — 1 — — 1 — — 15- 9 15 — 1 1 1 1 — 25- 12 15 1 3 12 4 — — 35- 6 6 2 1 2 2 — — 45- 5 4 — — 3 4 1 — 55- 7 2 — 1 6 1 — — 65 and upwards 3 1 — — 3 1 — — Totals 42 44 4 6 28 14 2 — 9 The number of deaths from all forms of tuberculosis during 1940 was 44 of which 42 were pulmonary and 2 non-pulmonary. The death rate per 1,000 population from tuberculosis was 61. Public Health (Tuberculosis) Regulations, 1930. There were 246 Pulmonary and 48 Non-pulmonary cases of tuberculosis known to the Department at the end of the year 1940. Municipal Tuberculosis Dispensary. During the year, 149 Sessions were held, and 187 new cases (of which 86 were contacts) were examined. Altogether, 444 patients attended the Dispensary in 1940, and the total number of attendances of all kinds numbered 1,384, an average of 9 per session. The attendances were 201 less than last year. The Tuberculosis Officer made 162 visits to the homes of patients, and the Tuberculosis Nurse made 1,565 visits. Artificial Pneumothorax Treatment. 37 patients received artificial pneumothorax treatment. Extra Nourishment. 20 patients were in receipt of extra nourishment provided by the Borough Council. Tuberculosis Dental Clinic. 3 patients received Dental treatment. 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, 1939 1409 2. Number of these successfully vaccinated 717 (54 per cent. of total births) 3. Total number of Certificates of successful primary vaccination of children under 14 received during the Calendar year 1940 (including any relating to births registered in previous years) 589 4. 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 1940 143 10 Bacteriological Examinations. The following is a summary of the work carried out during the year 1940 :— Diphtheria . 132 Typhoid Fever 1 Scarlet Fever (for Hæm. Strep.) 7 Specimens of Sputum 268 Disinfection. The following is a record of the work carried out by the Disinfecting Staff during 1940 :— Number of houses or parts of houses and contents disinfected 545 „ verminous rooms disinfected 62 „ „ articles of clothing fested *350 „ „ beds disinfested 2 „ articles dried from bombed houses 749 * 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 16 Children 34 Scabies. Adults 18 Children 9 During the year, 62 verminous rooms in 36 houses and 9 sets of beds and bedding were cleansed and freed from vermin.