Metropolitan Borough of Hampstead. Abridged Report on the Health of the Borough. 1 942. H. LESLIE OLDERSHAW. M.D. Slate Medicine (Lond.), B.S., D.P.H., Medical Officer of Health, Area of Borough 2,265 acres. Rateable value £1,530,000 Sum produced by 1d. rate £5,320 Births 917 Deaths 901 Maternal deaths 5 Maternal death rate 53 Infant deaths 45 Infant mortality rate 49 2 Deaths. The causes of death, arranged under the headings of the short list used by the Registrar-General, were as follows :— 1. Typhoid and paratyphoid fevers — 2. Cerebro-spinal fever 1 3. Scarlet fever — 4. Whooping cough — 5. Diphtheria 1 6. Tuberculosis of the respiratory system 43 7. Other forms of tuberculosis 8 8. Syphilitic disease 9 9. Influenza 5 10. Measles . 2 11. Acute polio-myelitis and polio-encephalitis — 12. Acute infective encephalitis — 13. Cancer of buccal cavity and oesophagus (m) uterus (f) 10 14. Cancer of stomach and duodenum 17 / 147 15. Cancer of breas 26| 16. Cancer of all other sites 94 17. Diabetes 13 18. Intra cranial vascular lesions 70 19. Heart disease 244 20. Other diseases of circulatory system 35 21. Bronchitis 55 22. Pneumonia 35 23. Other respiratory diseases 8 24. Ulcer of stomach or duodenum 13 25. Diarrhoea (under 2 years) 6 26. Appendicitis 6 27. Other digestive diseases 24 28. Nephritis 22 29. Puerperal and post-abortion sepsis 1 30. Other maternal causes 4 31. Premature birth 15 32. Congenital malformations, birth injuries, infantile diseases 9 33. Suicide 12 34. Road traffic accidents 8 35. Other violent causes 39 36. All other causes 66 Total 901 Maternity and Child Welfare. Health Visitors and Home Visits. The four full-time and one part-time Health Visitors paid 12,716 visits during the year. In addition the Health Visitors made 1,068 attendances at Clinics and Centres during the year. Infant Welfare Centres. Up to the outbreak of war there were 6 Infant Welfare Clinics in the Borough holding 9 sessions weekly. At the end of 1942 there were 4 Clinics holding 8 sessions weekly. Social and Sewing Clubs are also attached to each Centre and these are being well patronised by the mothers. Name and address of Centre. Day and time held. Doctor in attendance. Health Visitor. Children's Hospital, College Crescent, N.W.3. Monday 10—12 noon Monday 2—4 p.m. Monday 2—4.30 p.m. (Social and Sewing Club). Dr. C. Meade Miss Riley. Miss Riley. Health Institute, Kingsgate Road, N.W.6. Tuesday 1.30—4 p.m. Wednesday 1.30—4 p.m. Dr. C. Meade Dr. M. Yule Miss Evans. Miss Evans. 3 Name and address of Centre. Day and time held. Doctor in attendance. Health Visitor. 27, Pond Street, N.W.3 (moved to 241, Haverstock Hill, N.W.3 on 9-3-42). Tuesday 1.30—4 p.m. Dr. M. Yule Miss Kennedy. Thursday 1.30—4 p.m. — Miss Kennedy. Friday 2.30—4.30 p.m. — Miss Kennedy. (Social and Sewing Club and Play Centre). Monday 2.30—4 p.m. — Miss Kennedy. Wednesday 2.30—4 p.m. (Play Centres). Berridge Road, House, Hillfield N.W.6. Monday 2—1 p.m. Thursday 1.30—4 p.m. Thursday 2—4.30 p.m. (Social and Sewing Club). Dr. M. Yule Miss Miss May. May, Methodist Church Hall, Quex Road, N.W.6. Thursday 3—5 p.m. (Social Club). — Miss Evans. Total number of attendances at all Centres during the year:— (i) by children under 1 year of age 10428 (ii) by children between the age of 1 and 5 years 4664 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 784 (ii) between the ages of 1 and 5 years 165 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 629 (ii) over 1 year of age 1022 Ante-natal and Post-natal Clinics. During the year under review there were 3 combined Ante-natal and Post-natal sessions a week, which were attended by 711 patients who made a total of 2992 attendances. Orthopedic Clinic. Held at the Children's Hospital, College Crescent. Two sessions weekly, Tuesdays and Fridays from 2 to 4 p.m. Total attendances during 1942 1855 No. of children attending 135 Municipal Dental Clinic. During the year 66 sessions were held with an average attendance of 12. 4 Ultra-Violet Ray Treatment. Children receive artificial sunlight treatment at all the War-time Day Nurseries, and by arrangement with the Willesden Physical Treatment Clinic, and the Institute of Ray Therapy. Day Nurseries. War-time Day Nurseries. (a) 11, Woodchurch Road, N.W.6. Nursery opened on 23rd October, 1941, to accommodate 40 children. On 9th June, 1942, No. 13, Woodchurch Road was acquired, increasing total accommodation at the Woodchurch Road Nursery to 80 children. (b) 2, Parkhill Road, N.W.3. Opened on 5th October, 1942. to accommodate 60 children. In accordance with Ministry of Health request, this number was increased to 65 in November, 1942. (c) 27-29, Pond Street, N.W.3. Negotiations commenced in November, 1942, for the opening next year of this Nursery to accommodate 45 children. Hampstead and North St. Pancras Day Nursery. This Nursery to whom the Borough Council pays a grant of £200 per annum, is still evacuated to Silchester, Nr. Reading Maternity Homes and Hospitals. At the outbreak of War, New End Hospital was unable to reserve a special maternity ward for Borough Council cases. Hampstead maternity cases continue to be admitted to the general wards. During 1942, there were 103 Hampstead cases admitted to Queen Charlotte's and other Voluntary Hospitals. In addition, 87 mothers were evacuated for confinement under the Government Evacuation Scheme.. Nursing in the Home. The number of home visits paid by the two District Nursing Associations in accordance with the Borough Council Scheme were 2,893. Home Helps. There have been 45 cases in which Home Helps have been provided under the scheme of the Hampstead Borough Council. Convalescent Homes. During the year, arrangements were made for 9 mothers and babies to be admitted to Convalescent Homes under the Borough Council Scheme. 5 Consulting Obstetricians. During 1942, the services of a Consultant under the Borough Council Scheme were not called upon. Supply of Milk and Food. Under the Borough Council Scheme 630 packets of Proprietary Brands of Dried Milk were issued either free or at half price to 35 infants. In 6 necessitous cases eggs and margarine were supplied free to expectant or nursing mothers and children under 5 years of age. Supply of Vitamins, etc. By arrangement with the local Ministry of Food Office, fruit juices, etc., have been distributed at the Welfare Centres and Antenatal Clinics. Supplementary Clothing Coupons for Expectant Mothers. During 1942, a total of 1,088 applicants were issued with supplementary clothing coupons granted by the Board of Trade to expectant mothers in the last five months of pregnancy. Child Life Protection. During the year, 196 visits were made by Health Visitors to foster-mothers and foster-children in the Borough. On the 31st December, 1942, the number of foster-mothers on the register was 11 and the number of foster-children was 18. Sanitary Inspection. The following statement affords an indication of the work performed by the Sanitary Inspectors for the year 1942 :— (1) Total number of premises inspected 2970 (2) Total number of re-inspections and other visits and revisits 9313 (3) Number of inspections (recorded in (1) above) in respect of:— (a) Dwelling houses for housing defects:— (i) Non-tenement houses 244 (ii) Tenement houses 145 389 (b) Complaints 619 (c) Factories, excluding bakehouses 210 (d) Food premises :— (i) Bakehouses 44 (ii) Milk premises 207 (iii) Restaurants and eating houses 215 (iv) Other food premises 1342 1808 (e) Shops (under Shops Act, 1934) 124 6 720 informal notices (i.e., intimations) relating to 449 premises and 197 statutory notices relating to 125 premises were served during the year. Housing. 1. Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 389 2. Number of dwelling houses (included in (1) above) which were inspected and recorded under the Housing Con solidated Regulations, 1925 and 1932 25 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 found not to be in all respects fit for human habitation 252 Inspection and Supervision of Food. The amounts and varieties of foods seized or voluntarily surrendered as unfit for human consumption during the year were :— Tinned and bottled foods 3,549; Fish 569 lbs.; Meat and meat products 2,494 lbs.; Fruit 230 lbs.; Confectionery (cakes, loaves, pastries, etc.) 745; Biscuits 548 lbs.; Eggs 633; Cheese 147 lbs. ; Butter and Margarine 49 lbs. Care is taken by your Inspectors to ensure that no such foodstuffs are destroyed which are capable of being salvaged, and notification of all condemned foods is given to the Ministry of Food's Salvage Organisation in order that they may deal therewith. Food and Drugs Act, 1938. Food Sampling. During the year, the Sanitary Inspectors took 500 Samples for analysis by Dr. H.E. Cox, the Public Analyst. The number certified to be adulterated was 56 or 112 per cent, of the total number, as compared with 46 or 9 4 per cent, in 1941. Prosecutions were instituted in 18 cases, and fines and costs amounting to £254 1s. were imposed. The increase in the number of adulterated samples is due to the high percentage of soft drinks, sold under the names of Orange or Lemon Squash, Orange, Lemon, or Lime Juice Cordials, and the like, which were found to be unsatisfactory. It is gratifying to note that the Public Analyst reports that the major articles of diet which are now so completely under state control are generally satisfactory. Thus, the milks, butters, margarines and lards, for example, have all been found to be genuine, whereas the 7 doubtful or adulterated samples have been, in the main, accessory foods of a semi-luxury kind, such as pudding mixtures, jellies, and various drinks. During the year, 8 samples of food were submitted for bacterial examination. All were found to be satisfactory. Public Mortuary, New End. During the year 61 bodies were brought to the mortuary, 9 by the Police, and 52 by order of the Coroner. In 60 instances post-mortem examinations were made. Infectious Disease during 1942. Notifications. Removals to Hospitals. Deaths. Diphtheria 18 18 1 Encephalitis Eethargica - - — Dysentery 9 8 — Erysipelas 14 2 — Measles 456 69 2 Cerebro Spinal Fever 11 10 1 Ophthalmia Neonatorum 13 12 — Pneumonia 80 43 35 Puerperal Fever 2 1 1 Puerperal Pyrexia 19 18 — Scarlet Fever 47 38 — Whooping Cough 129 26 — Total 798 245 40 Cancelled cases have not been included. Diphtheria. Immunisation. During the year 1336 children were immunised against Diphtheria. Of these 743 were pre-school children and 593 were school children. By the end of the year approximately 63 per cent. of the pre-school children and 85 per cent. of the school children in the Borough had been immunised. Tuberculosis. New Cases and Mortality during 1942. During the year, 1942, 134 new cases of Tuberculosis were notified, 115 being cases of Pulmonary Tuberculosis, and 19 of other forms of the disease. 8 The following statistical table, prescribed by the Ministry of Health, gives an analysis of the newly notified cases and deaths during 1942:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F, M. F. M. F. 0-1 1 - - 1 - 1 1 - 1-5 1 — 1 1 3 — — — 5-15 2 1 3 4 — — 1 1 15-25 13 19 1 1 5 3 1 — 25-35 7 21 3 1 3 5 1 1 35-45 20 10 1 1 5 4 - - 45-55 8 6 - - 7 - - - 55-65 3 2 — 1 3 1 1 65 and upwards 1 - — — 1 2 1 — Totals 56 59 9 10 27 16 6 2 Public Health (Tuberculosis) Regulations, 1930. There were 384 Pulmonary and 74 Non-pulmonary cases of tuberculosis known to the Department at the end of the year 1942. Municipal Tuberculosis Dispensary. During the year, 181 Sessions were held, and 458 new cases (of which 125 were contacts) were examined. Altogether, 623 patients attended the Dispensary in 1942, and the total number of attendances of all kinds numbered 2,492,. an average of 13 8 per session. The attendances were 564 more than last year. The Tuberculosis Officer made 59 visits to the homes of patients, and the Tuberculosis Nurse made 1,690 visits. During the year 39 patients received artificial pneumothorax treatment, 15 patients were in receipt of extra nourishment provided by the Council, and 4 patients received dental treatment under the Borough Scheme. Vaccination. There were 532 births registered during 1941, and of these 296 were successfully vaccinated, and 85 Statutory Declarations were received during the year 1942. Bacteriological. Examinations. The following examinations were carried out:—Diphtheria 125; Scarlet Fever (for Hæm. Strep.) 5; Sputum for T.B. 316; Dysentery 2; Food Poisoning 1. 9 Disinfection. The following is a record of the work carried out by the Disinfecting Staff during 1942 :— Number of houses or parts of houses and contents disinfected 864 „ verminous rooms disinfected 255 „ „ articles of clothing disinfested* 34 „ „ beds disinfested 323 *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 44 Children 38 Scabies. Adults 164 Children 95 During the year, 255 verminous rooms in 229 houses and 323 sets of beds and bedding were cleansed and freed from vermin. Scabies. Concern has been expressed by the Ministry of Health at the rising incidence of scabies which has resulted from wartime conditions such as overcrowding, the conditions of sleeping in air-raid shelters and the communal use of bedding, towels, etc. The disease and such consequences of it as loss of sleep lead to a loss of efficiency detrimental to the war effort. Scabies is essentially a household disease and ascertainment of a particular case, whether through the school medical service or in any other way, indicates the possibility of scabies in the household. It is, therefore, essential that all contacts with a known case of scabies— including members of the same family or household and children of other families who are playmates with an infected child—should be followed up and, if necessary, treated. The Scabies Order, 1941, was designed to assist Local Authorities to ascertain and treat cases of scabies and the powers of the Order extend to verminous conditions generally, since they may lead to similar results. Upon information being given by a medical practitioner or otherwise that a person is in a verminous condition, the Order provides for the inspection of premises, the medical examination of persons, the treatment of verminous persons and the cleansing, 10 ment or destruction of any article which is or is likely to be verminous. The weakness of the Order is that the information " given by a medical practitioner or otherwise " is not provided systematically but voluntarily and haphazard. It is to be hoped, in the near future, that scabies will be made a notifiable infectious disease. The London County Council are responsible through the school medical service for the examination of school children and for the treatment of scabies among school children. Notifications under the Scabies Order are given by the London County Council to enable the Borough Health Visitors to follow up contacts in the households of infected school children. Adults and children, other than school children, may receive free treatment of scabies at the Public Health Station in Lithos Road. Treatment involves the use of benzyl benzoate emulsion or of Marcussen's Ointment. During 1942, 164 adults and 95 children attended for treatment at the Public Health Station for scabies. The number of adults treated represents an increase of 82 per cent, in the number treated in pre-war years. It is not possible to give comparable figures regarding children, as school children are treated by the London County Council. In 1938, when school children were treated locally no fewer than 268 children received treatment at the Public Health Station, so the magnitude of the problem may be realised. Recent investigations have shown that whilst articles of clothing and bedding may play some part in the spread of scabies the importance of these as a means of dissemination has been much overestimated. Clothing and bedding are now only disinfested when necessary owing to overcrowded conditions, the communal use of bedding and clothing, or if reliance cannot be placed on a patient to take suitable preventive measures.