LIBRARY HAMP 44. Metropolitan Borough of Hampstead. Abridged Report on the Health of the Borough. 1943. H. LESLIE OLDERSHAW, M.D. State Medicine (Lond.), B.S., D.P.H., Medical Officer of Health. Presented by G. CLARK TROTTER, M.D., D.P.H., F.R.S.E., Temporary Medical Officer of Health. (In the absence of Dr. Oldershaw who joined H.M. Forces on 18th December, 1943.) Area of Borough 2,265 acres. Rateable value £1,564,468 Sum produced by ld. rate £5,600 Births 1,153 Deaths 991 Maternal deaths 2 Maternal death rate 17 Infant deaths 50 Infant mortality rate 43 2 Deaths. The causes of death, arranged under the headings of the show list used by the Registrar-General, were as follows:— 1. Typhoid and paratyphoid fevers 1 2. Cerebro-spinal fever 2 3. Scarlet fever - 4. Whooping cough 1 5. Diphtheria 1 6. Tuberculosis of the respiratory system 33 7. Other forms of tuberculosis 5 8. Syphilitic diseases 12 9. Influenza 16 10. Measles 2 11. Acute polio-myelitis and polio-encephalitis 1 12. Acute" infective encephalitis — 13. Cancer of buccal cavity and œsophagus (m) uterus (f) 131 14. Cancer of stomach and 149 duodenum 19 15. Cancer of breast 21 16. Cancer of all other sites 96f 17. Diabetes 8 18. Intra cranial vascular lesions 85 19. Heart disease 275 20. Other diseases of circulatory system 28 21. Bronchitis 77 22. Pneumonia 57 23. Other respiratory diseases 18 24. Ulcer of stomach or duodenum 14 25. Diarrhœa (under 2 years) 11 26. Appendicitis 4 27. Other digestive diseases 26 28. Nephritis 14 29. Puerperal and post-abortive sepsis - 30. Other maternal causes 2 31. Premature birth 15 32. Congenital malformations, birth injuries, infantile diseases 19 33. Suicide 20 34. Road traffic accidents 5 35. Other violent causes 21 36. All other causes 69 Total 991 Public Mortuary, New End. During the year 79 bodies were brought to the mortuary, 17 by the Police, five at the request of friends, and 57 by order of the Coroner. In 65 instances post-mortem examinations were made. Maternity and Child Welfare. Health Visitors and Home Visits. The five full-time and one part-time Health Visitors paid 14,900 visits during the year. In addition the Health Visitors made 1,629 attendances at Clinics and Centres. 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 1943 there were 4 Clinics holding 8 sessions weekly. Social and Sewing Clubs are attached to each Centre and these are being well patronised by the mothers. 3 Name and address of Centre. Children's Hospital, College Crescent, N.W.3. Health Institute, Kingsgate Road, N.W.6 (removed to 60, West End Lane on 29th December, 1943). 241, Haverstock Hill, N.W.3. Berridge House, Hillfield Road, N.W.6. Day and time held. Monday 10—12 noon Monday 2—4 p.m. Monday 2—4.30 p.m. (Social Club). Tuesday 1.30—4 p.m. Wednesday 1.30—4 p.m. Thursday 2—4.30 p.m. (Social Club). Tuesday 1.30—4 p.m. Thursday 1.30—4 p.m. Friday 2.30—4.30 p.m. (Social and Sewing Club and Play Centre). Monday 2.30—4 p.m. Wednesday 2.30—-4 p.m. (Play Centres). Monday 1.30—4 p.m. Thursday 1:30—4 p.m. Thursday 2-4.30 p.m. (Social Club). Doctor in attendance. Dr. M. E. Cryer Dr. J. G. Lewis Dr. J. G. Lewis Dr. M. E. Cryer Dr. J. G. Lewis Health Visitor. Miss Riley. Miss Riley. Miss Evans. Miss Evans. Miss Evans. Miss Kennedy. Miss Kennedy. Miss Kennedy. Miss Kennedy. Miss May. Miss May. Following the report of the Ministry of Health in 1942 that the premises at the Health Institute were not altogether satisfactory for Infant Welfare work the Council took steps to acquire alternative premises. During the year they purchased the premises 60, West End Lane for use as a Maternity and Child Welfare Centre and it commenced on the 29th December, 1943. The premises consist of a detached house with garden and is on two floors. It serves an area of approximately 800 children under five years of age and the expectant mothers from the whole of West Hampstead. Total number of attendances at all Centres during the year (i) by children under 1 year of age 13775 (ii) by children between the age of 1 and 5 years 5258 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 876 (ii) between the ages of 1 and 5 years 134 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 714 (ii) over 1 year of age 1281 Ante-Natal and Post-Natal Clinics. During the first 11 months of 1943, there were 3 Ante-natal Clinics weekly, and 4 Post-natal Clinics monthly. During the last 4 month of 1943, Ante-natal and Post-natal Clinics were combined, and 4 combined sessions weekly were held. The number of patients who attended during the year was 923, making a/ total of 3713 attendances. Massage Clinic. At the Children's Hospital, College Crescent, 2 sessions weekly were held prior to the 1st April, after which date 4 weekly sessions were held. Total attendances during 1943 2518 Number of children attending 141 Municipal Dental Clinic. During the year 66 sessions were held with an average attendance of 14. Ultra-Violet Ray Treatment. Children receive artificial sunlight treatment at 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 the total accommodation at the Nursery to 80 children. (b) 2, Parkhill Road, N.W.3. Opened on the 5th October, 1942, to accommodate 65 children. (c) 27-29, Pond Street, N.W.3. Opened on 12th April, 1943, to accommodate 45 children. (d) At the end of the year preliminary arrangements were put in hand for the opening of a Day Nursery at Berridge House, Hillfield Road, to accommodate 47 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, near 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 1943, there were 26 Hampstead cases admitted to Queen Charlotte's. In addition, 115 mothers were evacuated for confinement under the Government Evacuation Scheme. 5 Nursing in the Home. The number of home visits paid by the two District Nursing Associations in accordance with the Borough Council Scheme were 3,650. Home Helps. There have been 66 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 3 mothers and babies to be admitted to Convalescent Homes under the Borough Council Scheme. Consulting Obstetricians. During 1943, the services of a Consultant under the Borough Council Scheme were called for on 3 occasions. Supply of Milk and Food. Under the Borough Council Scheme 463 packets of Proprietary Brands of Dried Milk were issued either free or at half price to 17 infants. 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 the first seven months of 1943, a total of 724 applicants were issued with supplementary clothing coupons granted by the Board of Trade to expectant mothers in the last five months of pregnancy. After July 24th, clothing coupons were issued to expectant mothers from the Food Office. Child Life Protection. During the year, 200 visits were made by Health Visitors to fostermothers and foster-children in the Borough. On the 31st December, 1943, the number of foster-mothers on the register was 10 and the number of foster-children was 22. Sanitary Administration. It is pleasing to record that the essential work of sanitary supervision of the Borough has been very well maintained during the year despite war-time difficulties and the depletion of staff caused by the 6 release of two inspectors and one assistant for service with H.M. Forces. There is, in fact, a substantial increase in the number of inspections compared with previous war years, mainly due to extra work entailed by the issue of the Infestation Order, 1943, and of surveys of premises made as a result of various Housing Circulars of the Ministry of Health. The Infestation Order alone accounted for 2100 visits, and for this purpose the staff was implemented by personnel of the Light Rescue Service. The following statement affords an indication of the work performed by the Sanitary Inspectors for the year 1943:— (1) Total number of premises inspected 4913 (2) Total number of re-inspections and other visits and revisits 9534 (3) Number of inspections (recorded in (1) above) in respect of (a) Dwelling houses for housing defects:— (i) Non-tenement houses 517 (ii) Tenement houses 199 716 (b) Complaints 1180 (c) Factories, excluding bakehouses 136 (d) Infestation Order, 1943 (excluding re-visits) 1803 (e) Food premises:— (i) Bakehouses 34 (ii) Milk premises 96 (iii) Restaurants and eating houses 184 (iv) Other food premises 680 994 (f) Shops (under Shops Act, 1934)84 1057 informal notices (i.e., intimations) relating to 742 premises and 303 statutory notices relating to 201 premises were served during the year. Housing. 1. Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 716 2. Number of dwelling houses (included in (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 19 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 536 7 Ministry of Health Circular 2845. Requisitioning for families inadequately housed. During the latter part of the year a survey of vacant premises was made with a view to recommending for requisition accommodation which could readily be made suitable for housing. Sixty-four premises were submitted for further detailed architectural reports. A large number of premises were rejected as being unsuitable by reason of:— (a) dampness, dilapidations, dry rot, etc., (b) unsuitability for adaptation, (c) mews dwellings, bad planning, part occupation. Quite a considerable proportion of the empty premises inspected were found to be affected with dry rot in varying degrees. This highly contagious and infectious disease of timber was consequently the subject of a special Memorandum from the Ministry of Health. Consideration is being given to this important matter, particularly with regard to the service of Notices requiring the execution of remedial works to combat dry rot. . The total number of applications for accommodation in requisitioned premises received up to the 31st December was 233, of which 24 families were given accommodation. Disinfection. The following is a record of the work carried out by the Disinfecting Staff during 1943:— Number of houses or parts of houses and contents disinfected 1000 „ verminous rooms disinfe6ted 152. „ „ articles of clothing disin- fested *8 „ „ beds disinfested 159 *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 43 Children 22 Scabies. Adults 227 Children 84 8 During the year, 152 verminous rooms in 117 houses and 159 sets of beds and bedding were cleansed and freed from vermin. Inspection and Supervision of Food. This most important duty, particularly in war time, has again received the closest attention of your Inspectors. The amounts and varieties of foods seized or voluntarily surrendered as unfit for human consumption during the year were :— Tinned and bottled foods 3125; Fish 2435 lbs.; Meat and meat products 1210 lbs.; Fruit and vegetables 728 lbs.; Confectionery (cakes, loaves, pastries, etc.) 148; Eggs 280; Cheese 210 lbs.; Fishcakes 617; Rolled Oats, Semolina, etc., 592 lbs.; Other foods 278 lbs. Food Premises. The number of inspections carried out during the year was 994. Special attention was paid to restaurants and catering establishments generally. All applications to the Food Control Committee for licences for catering establishments are referred to me by the Food Executive Officer. The Sanitary Inspector then makes an inspection of the applicants' premises to ensure they are hygienically satisfactory and in conformance with the sanitary and other requisites of Section 13, Food and Drugs Act, 1938. Should the premises not be suitable, the attention of the Food Control Committee is directed to any deficiency and the catering licence is not issued until this Department is satisfied that all the necessary works have been carried out. Forty-one applications for licences or transfers of licences were made during the year. Substantial improvements were effected in seventeen premises, twenty-two premises were found to be satisfactory and in two cases the licences were not issued owing to applicants failing to carry out the required improvements. Adulteration of Food. The normal number of samples—500—was again taken by the Sanitary Inspectors for submission to the Public Analyst, Dr. H. E. Cox. There was a considerable reduction in the number of samples found to be adulterated. This was 23 or 46 per cent. of the total number as compared with 56 or 112 per cent. in 1942. The decrease in the number of adulterated samples is due partly to the issue of Food Control Orders. For instance the " Soft Drinks Order " has put an end to the manufacture of spurious concoctions of worthless value masquerading at comparatively high prices, under the 9 name of Cordials. The contention made by the Council in the frequent summonses issued in 1942 that these drinks must contain sugar has now been confirmed in the Order. One unusual example of fraudulent substitution was the sale of chalk as Talcum Powder. The latter is now scarce and chalk is a cheap and inferior substitute. The remaining adulterated samples were as follows:— Gelatines (5); Vinegars (2); Baking Powder (2); Egg Substitute Powder (1); Curry Powder (1); Spice (1); Essences (2); Margarine (1); Butter (2); Sausages (1); Table Cream (1); Frying Mixture (1); Soft Drinks (2). The Public Analyst has reported that the standard of foodstuffs on the whole is good and in his opinion reflects credit upon the directive control of the Ministry of Food and upon the honesty of the traders and manufacturers concerned. Milk. The composition of the milk sold in the Borough continues to be quite good and all the samples taken of this important war-time commodity were found to be genuine and of good quality. Complaints by householders as to dirty bottles were investigated and communications sent to the Dairies concerned. Legal Proceedings. The number of prosecutions taken out was 7 in respect of which fines amounting to £272 10s. and costs amounting to £64 10s. were imposed. In cases where the shopkeeper holds a warranty or is obviously not responsible for the adulteration every effort is made to trace and prosecute the original manufacturer or supplier, although this often entails complicated enquiries through perhaps five or six middlemen. Magistrates have commended the Council's action in this respect. Rats and Mice (Destruction) Act, 1919. Infestation Order, 1943. In accordance with a Direction made by the Minister of Food, a survey of the whole of the Borough was made to ascertain the extent of rodent infestation. This was carried out in conjunction with the Ministry of Food's publicity campaign. From the 1st of July to the end of the year, 350 complaints of infestation were received and these were the subject of special treatment in accordance with the Ministry's instructions. No less than 2,100 visits were paid during the course of the survey, which is not yet completed. Six areas of the Borough were reported as being the sites of " major " infestations. These were also the subject of special action. 10 I am indebted to the members of the Light Rescue Service for their assistance during the survey and the subsequent treatment. A temporary rat-catcher was also engaged. Sewers. In co-operation with the Borough Engineer's Department, the sewers were treated by a system of "pre-baiting" and poison baiting with very successful results. It is intended after testing by "postbaiting " to undertake further sewer treatments where necessary. The merit of the scheme lies, not only in the extermination of rats infesting the sewer system, but also in draining surface premises of rats by ensuring their destruction in the sewers. Although the results cannot yet be fully assessed, I feel that much useful work in rat eradication has been accomplished and I have no doubt that it will be found to be of inestimable benefit to the community. Infectious Disease during 1943. Notifications. Removals to Hospitals. Deaths. Cerebro-Spinal Fever 5 5 . 2 Diphtheria 15 15 1 Dysentery 15 15 — Erysipelas 24 10 1 Malaria :— Contracted abroad 1 1 — Induced in institutions 2 1 — Measles 377 74 1 Ophthalmia Neonatorum 2 1 — Paratyphoid Fever 2 2 — Pneumonia 84 33 8 Poliomyelitis 1 1 1 Puerperal Fever 2 1 — Puerperal Pyrexia 26 25 — Scabies (notifiable from 1st August, 1943) 104 — — Scarlet Fever 123 101 ' — Typhoid Fever 2 1 Whooping Cough 117 32 1 Total 902 318 15 Cancelled cases have not been included. 11 Diphtheria. Immunisation. During the year 837 children were immunised against Diphtheria. Of these 616 were pre-school children and 221 were school children. By the end of the year approximately 56 per cent. of the children under 5 years of age and 85 per cent. of school children in the Borough were immunised. Tuberculosis. New Cases and Mortality during 1943. During the year, 1943, 139 new cases of Tuberculosis were notified, 126 being cases of Pulmonary Tuberculosis, and 13 of other forms of the disease. Public Health (Tuberculosis) Regulations, 1930. There were 471 Pulmonary and 81 Non-pulmonary cases of tuberculosis known to the Department at the end of the year 1943. Municipal Tuberculosis Dispensary. During the year, 156 Sessions were held, and 448 new cases (of which 31 were contacts) were examined. Altogether, 779 patients attended the Dispensary in 1943, and the total number of attendances of all kinds numbered 2,362, an average of 15.1 per session. The attendances were 130 less than last year. The Tuberculosis Officer made 32 visits to the homes of patients, and the Tuberculosis Nurse made 1,424 visits. During the year 62 patients received artificial pneumothorax treatment, 16 patients were in receipt of extra nourishment provided by the The following statistical table, prescribed by the Ministry of Health, gives an analysis of the newly notified cases and deaths during 1943:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0-1 — — — — — — 1 — 1-5 — — 1 1 — 1 — — 5-15 6 1 — 2 1 — — 1 15-25 5 20 — 2 1 1 — — 25-35 11 13 — 2 3 2 — — 35-45 14 16 2 3 4 4 — 1 45-55 15 8 — — 7 2 — 1 55-65 6 4 — — 3 1 — — 65 and upwards 4 3 — — 2 1 1 — Totals 61 65 3 10 21 12 2 3 12 Council, and 1 patient received dental treatment under the Borough Scheme. 791 X-ray films were taken and in addition many were screened as well as the routine screen examination made for A.P. patients. Vaccination. There were 1,070 births registered during 1942, and of these 713 were successfully vaccinated. 125 Statutory Declarations were received. Bacteriological Examinations. The following examinations were carried out:—Diphtheria 130; Scarlet Fever (for Hæm. Strep.) 13; Sputum for T.B. 377; Dysentery 1; Food Poisoning 1.