HAMP 45 LIBRARY Metropolitan Borough of Hampstead. Abridged Report on the Health of the Borough. 1 944. G. CLARK TROTTER, m.d., d.p.h., f.r.s.e., Temporary Medical Officer of Health. 2 STATISTICS AND SOCIAL CONDITIONS. Area (acres) 2,265 Population 69,840 Rateable Value, March, 1944 £1,524,000 Sum produced by 1 d. rate £5,660 BIRTHS. Live Births. Total. Males. Females. Legitimate 1,009 565 444 Illegitimate 112 56 56 1,121 621 500 . Birth rate per 1,000 of the estimated resident population 16.1 (Rate for London : 15.0) Number of Stillbirths 26 Rate of Stillbirths per 1,000 (live and still) births 22.6 DEATHS. Net deaths (males, 440 ; females, 577) 1,017 Death rate per 1,000 of the estimated resident population 14.6 (Rate for London : 15.7) Deaths from maternal causes (0.9 per 1,000 births) 1 Deaths of infants under 1 year (males, 33 ; females, 37) 70 Infants under 1 year : Infantile Mortality Rate All infants per 1,000 live births 62 Legitimate infants per 1,000 legitimate live births 58 Illegitimate infants per 1,000 illegitimate live births 98 The causes of death, arranged under the headings of the short list used by the Registrar-General, were as follows :— 1. Typhoid and paratyphoid 19. Heart disease 269 fevers . . .. ... — 20. Other diseases of circulatory 2. Cerebro-spinal fever — system 29 3. Scarlet fever — 21. Bronchitis 50 4. Whooping cough — 22. Pneumonia 42 5. Diphtheria . . 1 23. Other respiratory diseases 7 6. Tuberculosis of the respira- 24. Ulcer of stomach or duo- tory system . . 47 denum 12 7. Other forms of tuberculosis. . 6 25. Diarrhoea (under 2 years) 7 8. Syphilitic diseases 5 26. Appendicitis 3 9. Influenza 4 27. Other digestive diseases 23 10. Measles — 28. Nephritis 18 11. Acute polio-myelitis and polio- 29. Puerperal and post-abortive encephalitis — sepsis — 12. Acute infective encephalitis 1 30. Other maternal causes 1 13. Cancer of buccal cavity 31. Premature birth 31 and oesophagus (m) 32. Congenital malformations, uterus (f) 16 birth injuries, infantile 14. Cancer of stomach and >-169 diseases 16 duodenum 28 33. Suicide 14 15. Cancer of breast 19 34. Road traffic accidents 5 16. Cancer of all other sites 106 35. Other violent causes 90 17. Diabetes 8 36. All other causes 45 18. Intra cranial vascular lesions 77 Total 1,017 Public Mortuary, New End. During the year 110 bodies were brought to the mortuary, 12 by the Police and 98 by order of the Coroner. In 106 instances post-mortem examinations were made. 3 MATERNITY AND CHILD WELFARE. Health Visitors and Home Visits. The five full-time and one part-time Health Visitors paid 15,917 visits during the year. In addition the Health Visitors made 1,303 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 1944 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. Name and address Day and time Doctor in Health of Centre. held. attendance. Visitor. Children's Hospital, Monday 1.30—4 p.m. Or. M. E. Cryer Miss Riley College Crescent, Monday 2—4.30 p.m. — Miss Riley N.W.3 (Social Club) Wednesday 1.30—4 p.m. — Miss Riley 60, West End Lane, Tuesday 1.30—4 p.m. Dr. J. G. Lewis Miss Evans N.W.6 Wednesday 1.30—4 p.m. Dr. J. G. Lewis Miss Evans Thursday 2—4.30 p.m. J — Miss Evans (Social Club) 241, Haverstock Hill, Tuesday 1.30—4 p.m. Dr. M. E. Cryer Miss Kennedy N.W.3 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. — Miss Kennedy (Play Centres) Berridge House, Hill- Monday 1.30—4 p.m. — Miss May field Road, N.W.6 Thursday 1.30—4 p.m. Dr. J. G. Lewis , Miss May Thursday 2—4.30 p.m. — j — (Social Club) Total number of attendances at all Centres during the year (i) By children under 1 year of age 9,529 (ii) By children between the ages of 1 and 5 years 3,777 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 752 (ii) Between the ages of 1 and 5 years 84 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 712 (ii) Over 1 year of age 1,317 Ante-Natal and Post-Natal Clinics During 1944 Ante-natal and Post-natal Clinics were combined, and up till the end of October 4 combined sessions weekly were held. During 4 the last 2 months of the year 5 weekly sessions were held. The number of patients who attended during the year was 1,070, making a total of 3,867 attendances. Massage Clinics. At the Children's Hospital, College Crescent, 2 sessions weekly were held. At 60, West End Lane 4 sessions weekly were held until the end of June, when all sessions at this Clinic were temporarily suspended owing to fly-bombs. The Massage Clinic was reopened on 6th November, holding 2 sessions weekly. Children's 60, West End Hospital Lane Total attendances during 1944 631 684 Number of children attending 43 31 Municipal Dental Clinic. During the year 63 sessions were held with an average attendance of 12. 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) Berridge House, Hillfield Road, N.W.6.—Opened on 8th May, 1944, to accommodate 47 children. Hampstead and North St. Pancras Day Nursery. This Nursery, to which 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 of L.C.C. Hospitals. During 1944 there were 20 Hampstead cases admitted to Queen Charlotte's. In addition, 180 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 was 3,595. 5 Home Helps. There have been 42 cases in which Home Helps have been provided during home confinements under the scheme of the Hampstead Borough Council. Convalescent Homes. During the year arrangements were made for 1 mother and baby to be admitted to a Convalescent Home under the Borough Council Scheme. Consulting Obstetricians. During 1944 no call was made on the services of a Consultant under the Borough Council Scheme. Supply of Milk and Food. Under the Borough Council Scheme 129 packets of Proprietary Brands of Dried Milk were issued either free or at half-price to 9 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 Ante-natal Clinics. Priority Utility Sheet Dockets for Expectant Mothers. Commencing on the 3rd November, 1944, an arrangement was made whereby Board of Trade Priority Utility Sheet Dockets were issued by this Department to expectant mothers only, on receipt of a signed certificate from a midwife stating that the patients were in need of sheets for home confinement. A maximum of 3 Dockets could be issued to each expectant mother. During the last two months of 1944, 2 applications were received and 4 Dockets issued. Child Life Protection. During the year, 114 visits were paid by health visitors to fostermothers and foster-children in the Borough. On the 31st December, 1944, the number of foster-mothers on the register was 6, and the number of foster-children was 8. Care of Illegitimate Children—Ministry of Health Circular No. 2866 (revised). This Circular has been before the Council on several occasions, and as a result it was agreed in principle that close co-operation was necessary between the Borough Council and existing Moral Welfare Organisations. Subject to these Moral Welfare Organisations undertaking additional work and increasing their staffs, it was agreed that, in conjunction with the other Metropolitan Boroughs, annual contributions (on a rateable value basis) should be made to these organisations. Hampstead's contribution has been calculated at £161 for the years 1944-45 and 194546, subject to a pro rata contribution for 1944-45 and a review in April, 1946. The Council also agreed in principle to a scheme for guaranteed payments to foster-mothers, but owing to a variety of causes, it was found impossible at this time to obtain suitable foster-mothers, and therefore the scheme is held in abeyance for the present. 6 Care of Premature Infants (i.e., infants weighing 5½ lbs. or less at birth)— Ministry of Health Circular 20/44. This Circular makes certain suggestions for the care of premature infants, in view of the important bearing of this matter on the problem of neo-natal mortality. A number of these suggestions cannot be dealt with adequately at the present time, but are being borne in mind in considering possible future developments of the maternity and child welfare services. Arrangements have been made for the weight of each newly-born child to be entered on the birth notification, so that early contact can be made between the Health Visitor and the mothers of premature babies born at home. Close liaison is also maintained with Hospitals, so that Health Visitors can follow up as soon as a premature infant is discharged to its own home. In addition, the equipment already used by the District Nursing Associations for the nursing of premature infants born at home has been supplemented by certain items provided by the Borough Council and loaned to the Associations, i.e.,—rubber hot-water bottles, special feeding bottles, mucus catheters, etc.). Domestic Helps—Ministry of Health Circular 179/44. This Circular deals with (i) the provision by the Borough Council of domestic helps to be available at any time to households where such help is urgently required owing to sickness or infirmity; (ii) the question of payment to domestic helps; and (iii) the assessment and recovery of the cost from households. The Council agreed that there is a need for such a service in the Borough, and in order to achieve uniformity of action throughout London regarding assessment and recovery of cost the Metropolitan Boroughs' Standing Joint Committee are considering a uniform scale of assessment to be recommended for use by the Metropolitan Boroughs. The question of rates of pay is before the Joint Industrial Council. Contact has already been made with the local branch of the Ministry of Labour, and although there is a very great shortage of suitable women able to undertake this work, every effort will be made by the Ministry of Labour to co-operate with us in making the scheme workable. SANITARY ADMINISTRATION. One Sanitary Inspector returned to duty after being discharged on health grounds from H.M. Navy. The recurrence of enemy air activity in the early part of the year, followed by the attacks by flying-bombs and long-range rockets from June onwards, seriously affected the normal work of sanitary inspection. The services of the Sanitary Inspectors were very much in demand in connection with post-raid activities and they rendered invaluable assistance in the many problems arising. Rehousing, furniture salvage, food salvage, the mortuary service—to name only a few—took up a great deal of their time. 7 The following statement affords an indication of the normal sanitary work performed by the Sanitary Inspectors during the year:— (1) Total number of premises inspected 2,978 (2) Total number of reinspections and other visits and revisits 11,868 (3) Number of inspections (recorded in (1) above) in respect of:— (a) Dwelling-houses for housing defects:— (i) Non-tenement houses 554 (ii) Tenement houses 189 (b) Factories, excluding bakehouses 180 (c) Infestation Order, 1943 (excluding revisits) 790 (d) Food premises:— (i) Bakehouses 42 (ii) Milk premises 70 (iii) Restaurants and eating houses 221 (iv) Other food premises 702 1,035 (e) Shops (under Shops Act, 1934) 63 The total number of complaints received was 1,338, of which 588 referred to rat infestation. Nine hundred and ninety-seven informal notices (i.e., intimations) relating to 695 premises and 258 statutory notices relating to 170 premises were served during the year. Housing. 1. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 743 2. Number of dwelling-houses (included in (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 4 3. Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil 4. Number of dwelling-houses found not to be in all respects fit for human habitation 569 The concentration of building labour and materials on the vital work of war damage repairs and the issue of the Civil Building Control (Ministry of Works) Order tremendously affected housing and sanitary work generally. Arrangements were made with the Borough Engineer (who is the Licensing Officer under the Civil Building Control Order) whereby licences are granted or Certificates of Essentiality recommended to all applicants upon whom Statutory Notices are served. Such notices have been restricted throughout the year to repairs of an urgent character which are prejudicial to health, and I regret to state that many have been outstanding for excessively long periods, solely owing to the inability of owners and agents to find builders able and willing to execute the necessary repairs. The problem of the arrears of normal maintenance work, particularly in our registered tenement houses, is one of some gravity. I trust that, as soon as the concentration on war damage repairs eases, labour and materials will be made speedily available to cope with these arrears. 8 Post-War Housing Programme. In accordance with the Ministry of Health's housing circular of the 4th March, 1943, the Housing Committee has energetically directed a programme to enable the Council to start on one or two years' building work as soon as conditions permit and they are authorised to do so. Various sites have been considered which will eventually provide approximately 400 dwellings in this period. So far the following proposals have been made :— Proposed number of dwellings. (i) Sites already held by the Council for housing purposes :— (a) Garnett Road (partly constructed and used for shelter purposes) 22 (b) New End area (also used for 2 large surface 24 shelters) (and 3 shops) (ii) Sites not held by the Council:— (a) Parkhill Road and Upper Park Road 100 (Compulsory Purchase Order confirmed by the Minister of Health.) (b) New End Square and Well Walk 68 (Compulsory Purchase Order made by Council. This scheme was subsequently the subject of an Inquiry by the Minister of Health). 214 Also it has been suggested to the London County Council that they should proceed with the Kilburn Vale housing proposals in their first year's programme. This will provide 114 additional dwellings—a proportion only of which will be allocated to Hampstead families. Inadequately Housed Persons. During 1944 and the closing months of 1943, 397 applications were received by me from persons inadequately housed for accommodation in requisitioned property under the procedure outlined in Ministry of Health Circular 2845. Had not the advent of flying-bombs resulted in a large-scale evacuation from the Borough many more applications for accommodation would have been received (and indeed are being received in a veritable flood as this report is in preparation). A few families were offered accommodation, but air raids early in 1944 and flying-bomb attacks which subsequently developed rapidly resulted in a worsening of the housing situation, and lettings to persons other than those rendered homeless by enemy action were abandoned and have not been resumed. Furthermore, in my opinion, the machinery of Circular 2845 is incapable of dealing with the desperate housing situation of the present time. More definite powers of requisitioning are required before it will be possible to utilise the many empty properties in the Borough. 9 The following statement indicates the position existing at the end of 1944:— 1. (a) Total number of applications received 397 (6) Number of applications cancelled or withdrawn 12 (c) Number of applications for consideration :— (i) From local residents 316 (ii) From other persons 69 385 2. Number of families accommodated 33 3. Number of applications outstanding:— (a) From local residents : (i) Prima facie worthy of consideration 206 (ii) Apparently unworthy of consideration 81 287 (b) From other persons : (i) Prima facie worthy of consideration 9 (ii) Apparently unworthy of consideration 56 — 65 352 Inspection and Supervision of Food. This question has received the closest attention and the following list shows the amounts and varieties of foodstuffs seized or voluntarily surrendered as unfit for human consumption during the year:— Tinned and bottled foods, 3,733; fish, 1,368 lbs.; meat and meat products, 1,361 lbs.; fruit and vegetables, 3,995 lbs.; confectionery (cakes, loaves, pastries, etc.), 2,558; eggs, 60; cheese, 101 lbs.; sugar, 58 lbs.; flour, 1,972 lbs.; other foods, 2,227 lbs. The above list includes those foodstuffs destroyed or damaged by enemy action. Nothing was destroyed that could be salvaged either by reconstitution for human food at Ministry of Food Depots or for use as animal feedingstuffs or fertilisers. Food Premises and Restaurant Sanitation. The number of inspections carried out was 1,035. Limitations of labour and materials have restricted the Department's activities in connection with existing restaurants and catering establishments. Special attention has, however, been paid to the premises of all new applicants to the Food Executive Officer for catering licences, and in the event of any such premises being structurally or hygienically unsuitable, or otherwise not conforming with the requisites of Section 13 of the Food and Drugs Act, 1938 (precautions to be taken against contamination of food), the Food Executive Officer is informed accordingly and the licence is not issued until the necessary work is executed to the satisfaction of the Sanitary Authority. Seventeen applications to the Food Executive Officer for new licences were referred to me of which six applicants did not proceed further after being informed of the requirements of the Food and Drugs Act. Owing to the danger to the public of the spread of diseases of the alimentary type commonly conveyed by food, i.e., diseases of the enteric type (typhoid and paratyphoid fevers, dysentery, food poisoning and intestinal parasitism), strong representation was made to the owners regarding the insanitary and unsatisfactory state of a restaurant at which the following conditions existed : The w.c. and ablutionary 10 modation and the accommodation for storage and preparation of food were totally inadequate and unsatisfactory ; there were open gullies in the food store and the walls and ceilings were not in a proper state of repair. The premises were subsequently closed down by the owners. Adulteration of Food. Five hundred samples were taken by the Sanitary Inspectors for submission to the Public Analyst, Dr. H. E. Cox. The number of samples found to be adulterated was 37 or 7.4 per cent., compared with 23 or 4.6 per cent. in 1943, and 55 or 11.2 per cent. in 1942. The following list gives particulars of the foodstuffs classed as adulterated and the action taken thereon by my Department. Cautions have been issued to traders in respect of what may be termed the more " venial " offences, but in two cases prosecutions were instituted, and are referred to below:— Article of Food Number of samples found to be adulterated and particulars of adulteration. Curry Powderj Four samples adulterated. In one case contained 50 parts per million of lead. In three cases contained from 25 to 50 per cent, pea or bean flour. Baking Powder Six samples adulterated. In five cases there was a deficiency of carbon dioxide ; in one case an excess of acid instead of the usual small excess of bicarbonate of soda. Self Raising Flour Seven samples adulterated. All samples were deficient in carbon dioxide. Egg Substitute Powder Three samples adulterated. Deficient in carbon dioxide. Gelatine Two samples of leaf gelatine were not of edible quality. One sample of powdered gelatine contained an excess of copper. Vinegar Three samples were found to be concentrated solutions of acetic acid in water. White Acid One sample was found to be a solution of 38 per cent, acetic acid. Cod Liver Oil One sample was deficient in units of vitamin A. Essence of Lemon Four samples adulterated. Three contained very small percentages of lemon oil ; one consisted of paraffin oil with a limited amount of lemon grass oil. Unsweetened Lemonade One sample was found to be a mixture of citric acid 67.5 per cent. with 25 per cent. of sucrose—so incorrectly labelled as unsweetened. Coffee with Chicory One sample was found to contain only 0.17 per cent. caffeine. Pork Sausages Two samples contained preservative without declaration. Fruit Cup, Orange Base, One sample contained only 2.7 per cent. alcohol. ("Cup" Alcoholic connotes an alcoholic drink comparable in strength with wine.). Legal Proceedings. Two prosecutions were instituted as follows :— Particulars of Adulteration. Result of Prosecution. Essence, Lemon Flavour—con- Vendor fined £5 and ordered to sisted of paraffin oil with a pay £4 4s. costs. limited amount of lemon grass oil. Curry Powder—50 per cent. bean Vendor fined £3 and £4 4s. costs. flour. 11 The Labelling of Food (No. 2) Order, 1944, S.R. & O. 1447, made under the Emergency Powers (Defence) Regulations, was issued during the year and when it comes into complete force in November, 1945, should be of great value to Food and Drugs Authorities. Labels and advertisements of foods will then have to indicate the true nature of the ingredients and the presence of minerals and vitamins must be disclosed as prescribed in the Order. Standards have also been laid down (under Emergency Powers (Defence) Regulations) for the following articles: self-raising flour, shredded suet, baking powder and golden raising powder, jam, marmalade, fruit curd and mincemeat. It is to be hoped that, in the near future, legal standards will also be prescribed for other foods, for which only trade and presumptive standards at present exist, e.g., ice cream, vinegar, coffee essence, alcoholic drinks, pudding and dessert mixtures, various essences, gelatine, etc. This will considerably ease the burden at present falling upon the public, traders, Analysts, Local Authorities, and Magistrates alike. Rats and Mice (Destruction) Act, 1919. Infestation Order, 1943. No fewer than 588 complaints of rats and mice infestation were received during the year ; this compares with an average annual number of 59 for the three years preceding the war. This large increase is primarily due to the destruction or disturbance of houses, shops, underground drains, and sewers caused by bombing. The continuation of the Ministry of Food's publicity campaign has also doubtless contributed by urging the public to become rat reporters. The investigation of complaints is undertaken by the Sanitary Inspectors and the actual operational work involved is carried out by a full-time rat catcher. Certain firms and property owners employ their own servicing companies, who act in conjunction with this Department. Notices under the Act are served in cases where there is neglect to comply with the Council directions, or where rat proofing of land or buildings has to be carried out. Six areas which were reported as being sources of " major infestation " during the Survey of 1943 have been systematically dealt with. The repeat complaints from these areas have been sporadic and isolated and it can be stated with confidence that they are now reduced to areas of " minor infestation." Further work will be undertaken as soon as possible with a view to reducing still further the rodent population in these areas. The pre-baiting, poisoning, and post-baiting system advocated by the Ministry of Food is used and has, on the whole, been very successful. Householders have expressed particular satisfaction with the steps taken for the eradication of mice, for which we use the following formula : Zinc phosphide 5 parts by weight, oatmeal flour or wheat 95 parts by weight. Recovery of Expenditure from Private Parties. This question is a most vexatious one and takes up a great deal of the time of the Sanitary Inspectors. It must be remembered that it is still the law of the land (and has been for the past 25 years) that the statutory 12 liability for the destruction of rats and mice rests with the occupier. The Ministry of Food's very energetic publicity campaign exhorting everyone to become a " rat reporter " unfortunately, from the point of view of the recovery of charges, did not give equal prominence to the financial and other responsibilities of the occupier. In consequence after a very enthusiastic rat reporter reports to his Local Authority the presence of rats on his land or premises he is very highly indignant when told that if he wishes the Borough Council to carry out the necessary work of extermination he will have to pay their charges. Numbers of people have expressed their dissatisfaction to me in no unqualified terms, and their general opinion is that the Council are imposing a " fine " or " penalty " on them for " doing their duty." They have my sympathy and I have made strong representations to the Ministry of Food asking that charges to occupiers for rat destruction in private dwelling-houses be waived, unless the infestation is palpably due to the act, neglect, or default of the occupier. The assessment of responsibility in certain areas is a matter of the utmost difficulty and is complicated by factors such as war damage, the keeping of animals, and the preponderant proportion of rats in the sewers. Sewers. The concentration of work on war damage has precluded the systematic treatment of sewers during the year, but it is hoped to resume this work as soon as conditions permit. Water Supply. The supply provided by the Metropolitan Water Board has been satisfactory (a) in quality, (6) in quantity ; no complaints were received as to any form of contamination and no samples were taken for chemical or bacteriological analyses. All the dwellings in the Borough are supplied from public water mains direct to the houses. Disinfection. The following is a record of the work carried out by the Disinfecting Staff during 1944 :— Number of houses or parts of houses and contents disinfected 895 ,, verminous rooms disinfested 216 ,, „ articles of clothing disinfested 9* ,, „ beds disinfested 300 * 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 35 Children under 5 1 „ over 5 10 13 Scabies: Adults 189 Children under 5 13 over 5 60 Two hundred and twenty-four adults and 84 children received treatment at the Cleansing Station during 1944. In addition 76 Hampstead school children received treatment at Cleansing Stations outside the Borough. During the year, 216 verminous rooms in 183 houses and 300 sets of beds and bedding were cleansed and freed from vermin. One hundred and fifty-nine cases of scabies were notified during the year. These were investigated by the Health Visitors, and, where necessary, treatment arranged at the Public Health Station. Close contacts of patients are followed up and instructed to attend a special Scabies Clinic for examination and, if necessary, subsequent treatment. This clinic is held weekly. Notices under the Scabies Order were served where difficulty arose in obtaining the attendance of contacts, but in no case were legal proceedings required to be taken. Infectious Disease during 1944. Notifications Removals to Hospitals Deaths Cerebro-Spinal Fever 3 2 - Diphtheria 14 14 1 Dysentery 15 3 — Erysipelas 13 5 — Malaria— Contracted abroad 1 1 - Induced in institutions 1 1 — Measles 178 59 Ophthalmia Neonatorum 5 2 Paratyphoid Fever 2 1 - Pneumonia 62 36 10 Polioencephalitis 1 1 - Poliomyelitis 1 1 Puerperal Fever 4 4 - Puerperal Pyrexia 26 24 - Scabies 159 — - Scarlet Fever 83 73 - Typhoid Fever 1 1 - Whooping Cough 82 37 - Total 651 265 11 Cancelled cases have not been included. Diphtheria Immunisation. Free immunisation against diphtheria may be obtained:— (a) At Borough Council clinics held weekly at No. 241, Haverstock Hill, N.W.3 (Wednesdays, 2 to 4 p.m.), and No. 60, West End Lane, N.W.6 (Fridays, 2 to 4 p.m.). 14 (b) In L.C.C. Schools under the school medical service. (c) Through private doctors in accordance with a scheme operated by the Borough Council whereby prophylactic, i.e., alum precipitated toxoid, is made available to medical practitioners who receive payment in accordance with the approved scale of the British Medical Association. Sessions for immunisation are arranged from time to time in private schools and in the war-time day nurseries. The Borough Council assumes responsibility for post-Schick testing all children, including those immunised in L.C.C. schools. During 1944, 468 children were immunised under the arrangements described above; of these 386 were of pre-school age and 82 attended school. Comparative figures for 1943 and 1942 were 837 (616 of preschool age ; 221 attending school) and 1,336 (743 of pre-school age and 593 attending school) respectively. While the results achieved during 1944 are not so satisfactory as those for the previous two years, it must be remembered that during the latter half of 1944 large-scale evacuation took place on account of flying-bombs and for five months the usual weekly clinics were held at less frequent intervals. It is difficult to estimate the percentage of pre-school children immunised in the Borough as many of these are immunised privately and a large number of temporarily evacuated children have been immunised in reception areas. In schools reliable figures may be obtained and at mid-1944 a survey conducted by the London County Council indicated that 79.4 per cent. of Hampstead schoolchildren were immunised, a percentage equalled by Westminster but excelled only by the City of London (83.3 per cent.), where the school population was 502. At the end of 1944, in a return to the Ministry of Health, I estimated the percentages of children immunised as : pre-school children, 48 per cent. ; schoolchildren, 75 per cent. In view of recent enquiries, it appears that the percentage of pre-school children immunised is much higher, but it is perfectly clear that if immunisation is to keep in line with the birth-rate more than 1,000 children must be immunised in the Borough every year. Three hundred and fourteen children were presented at clinics for Schick testing after having received immunising injections ; in only two cases did the test prove positive and necessitate further inoculations. Two children under 15 years of age were notified as suffering from diphtheria during 1944 ; both were not immunised. Comparative figures for 1943 and 1942 are 3 and 10 children respectively, all non-immunised. A recent Ministry of Health Circular (No. 170/44, dated the 4th December, 1944) has stated : " It is of interest also to note, even though no causal connection can be positively demonstrated, that a decline in the number of deaths from diphtheria, from 2,480 in 1940 and 2,641 in 1941 to 1,827 in 1942 and 1,370 in 1943, has coincided with an increasing proportion of children protected by immunisation." The local experience is indicated in the remarkable statistics relating to Hampstead as given below. (It should be noted that free immunisation was commenced in the Borough in mid-1933 ; since that time 5,418 children have been immunised under official arrangements.) 15 Children : 0—15 years. Year. Number immunised Number of Number of under official cases of deaths from arrangements. Diphtheria. Diphtheria. 1928 .. .. Nil 55 3 1929 .... Nil 42 2 1930 .... Nil 63 2 1931 .... Nil 44 2 1932 .... Nil 46 3 1933 81 3 1934 .. / 94 7 1935 .... 503 44 Nil 1936 .... 343 31 Nil 1937 .... 328 57 4 1938 .... 343 55 Nil 1939 .... 220 20 1 1940 .... 24 5 Nil 1941 .... 824 9 2 1942 .. .. 1,336 10 Nil 1943 .... 837 3 1 1944 .... 468 2 Nil Vaccination. There were 1,331 births registered during 1943, and of these 924 were successfully vaccinated. One hundred and thirty-nine Statutory Declarations were received. Bacteriological Examinations. The following examinations were carried out:—Diphtheria 94 j Scarlet Fever (for Haem. Strep.) 5 ; Sputum for T.B. 377 ; Dysentery 6 ; Vincents Angina 3. Tuberculosis. New Cases and Mortality during 1944. During the year 1944, 125 new cases of Tuberculosis were notified, 106 being cases of Pulmonary Tuberculosis and 19 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 1944:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. m. #] 0—1 - - - - - - - - 1—5 — 1 1 — — — — 1 5—15 1 3 1 1 — — — — 15—25 10 19 2 3 1 4 1 25—35 13 14 2 4 6 8 1 _ 35 -15 13 6 1 - 5 3 2 1 45—55 5 5 - 1 6 1 - - 55—65 9 2 1 1 3 1 - - 65 and upwards 5 — - 1 6 3 — — Totals 56 50 8 11 27 20 3 3 16 Public Health (Tuberculosis) Regulations, 1930. There were 524 Pulmonary and 101 Non-pulmonary cases of tuberculosis known to the Department at the end of the year 1944. Municipal Tuberculosis Dispensary. During the year, 155 sessions were held, and 433 new cases (of which 90 were contacts) were examined. Altogether, 895 patients attended the Dispensary in 1944 and the total number of attendances of all kinds numbered 2,194, an average of 14.2 per session. The attendances were 168 fewer than last year. The Tuberculosis Officer made 35 visits to the homes of patients and the Tuberculosis Nurse made 1,313 visits. During the year 57 patients received artificial pneumothorax treatment, 14 patients were in receipt of extra nourishment provided by the Council, and 5 patients received dental treatment under the Borough Scheme. Eight hundred and twelve X-ray films were taken and in addition many were screened as well as the routine screen examination made for A.P. patients. Mass Radiography. In July arrangements were made with the London County Council whereby an X-ray unit was made available at St. Margaret's Hospital, Kentish Town, for persons resident or working in this Borough. Employers of large bodies of workers in the Borough were approached, and as a result of this appeal 877 names were submitted of persons wishing to have the examination. Only 616 of these people presented themselves for examination, and of these, 25 were referred for large films to be taken. An analysis of these 25 showed 11 with no abnormality ; 7 with calcified and other lesions ; and 7 were referred to their general practitioners. Of these 7 cases 4 were probably tuberculous. Financial Allowances for Tuberculosis Patients. The Ministry of Health scheme for the grant of maintenance allowances to persons undergoing treatment for pulmonary tuberculosis commenced in this Borough on 30th June, 1943. The patients entitled to benefit are those who may be expected to return to work within a reasonable period. The Tuberculosis Officer decides whether the patient is eligible from the medical point of view, and an Assessing Officer from the London County Council with the help of our Local Care Committee Assistant, decides from the financial side. During the year 1944, 60 new applications were considered, of which 50 were granted maintenance, and a total of 109 persons were in receipt of the allowances at some time or other during the year. The cost of these allowances for the year amounted to £3,412, and the whole cost is borne by the Government. The scheme, taking into account its limitations, is working well, but there is a definite need for its extension to cover all cases of tuberculosis, both early and chronic pulmonary and non-pulmonary. (5602/957) Harrison & Sons Ltd., 44-47, St. Martin's Lane, W.C.2.