HAMP 46 Metropolitan Borough of Hampstead Abridged Report on the Health of the Borough. 1945. H. LESLIE OLDERSHAW, m.d. State Medicine (Lond.), b.s., d.p.h., Medical Officer of Health. 2 STATISTICS AND SOCIAL CONDITIONS. Area (acres) 2,265 Population 74,390 Rateable Value, March, 1945 £1,546,000 Sum produced by 1d. rate £5,880 BIRTHS. Live Births. Total. Males. Females. Legitimate 1,056 520 536 Illegitimate 146 69 77 1,202 589 613 Birth rate per 1,000 of the estimated resident population 16.2 (Rate for London : 15·7) Number of Stillbirths 21 Rate of Stillbirths per 1,000 (live and still) births 17·2 DEATHS. Net deaths (males, 476; females, 522) 998 Death rate per 1,000 of the estimated resident population 13·4 (Rate for London: 13·8) Deaths from maternal causes (1·6 per 1,000 births) 2 Deaths of infants under 1 year (males, 36; females, 15) 51 Infants under 1 year: Infantile Mortality Rate All infants per 1,000 live births 42 Legitimate infants per 1,000 legitimate live births 37 Illegitimate infants per 1,000 illegitimate live births 82 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 19. Heart disease 254 - 20. Other diseases of circulatory system 33 2. Cerebro-spinal fever 1 3. Scarlet fever — 21. Bronchitis 70 4. Whooping cough 1 22. Pneumonia 49 5. Diphtheria — 23. Other respiratory diseases 14 6. Tuberculosis of the respiratory system 49 24. Ulcer of stomach or duodenum 14 7. Other forms of tuberculosis. 8 25. Diarrhœa (under 2 years) 7 8. Syphilitic diseases 8 26. Appendicitis 4 9. Influenza 2 27. Other digestive diseases 26 10. Measles — 28. Nephritis 24 11. Acute polio-myelitis and polioencephalitis ­ 29. Puerperal and post-abortive sepsis 1 12. Acute infective encephalitis 1 30. Other maternal causes 1 13. Cancer of buccal cavity and œsophagus (m) uterus (f) 14 177 31. Premature birth 18 32. Congenital malformations, birth injuries, infantile diseases 12 14. Cancer of stomach and duodenum 25 33. Suicide 19 15. Cancer of breast 20 34. Road traffic accidents 5 16. Cancer of all other sites 118 35. Other violent causes 38 17. Diabetes 8 36. All other causes 74 18. Intra cranial vascular lesions 80 Total 998 Public Mortuary, New End. During the year 172 bodies were brought to the mortuary, 13 by the Police and 159 by order of the Coroner. In 172 instances post-mortem examinations were made. 3 MATERNITY AND CHILD WELFARE Health Visitors and Home Visits. The six full-time Health Visitors paid 11,348 visits during the year. In addition the Health Visitors made 1,265 attendances at Clinics and Centres. Infant Welfare Centres. For the first 8 months of 1945 there were 4 Infant Welfare Centres holding 8 sessions weekly. After the end of August, the Infant Welfare Centre held in Berridge House, Hillfield Road, had to be closed down, as it was no longer possible to hold the premises under requisition. The mothers and children who usually attended this Centre were transferred to 60, West End Lane, but instead of continuing to hold 2 sessions weekly for these mothers, it was only possible to fit in one weekly session. To achieve this, it was unfortunately necessary to close the weekly Social Club at 60, West End Lane, and hold an Infant Welfare Session in its place. Also in August, 1945, it was necessary to relinquish the premises at 241, Haverstock Hill, which had been rented for Welfare Centre purposes since March, 1942. The Centre was therefore transferred to the premises which had been built for a Gas Cleansing Station during the war, at 230, Haverstock Hill. The Infant Welfare Centres open at the end of 1945 were as follows:— Name and address of Centre. Day and time held. Doctor in attendance. Health Visitor. Children's Hospital, College Crescent, N.W.3 Monday 1.30—4 p.m. Dr. Cryer Miss Riley Wednesday 2—4.30 p.m. (Social Club) — Miss Riley Thursday 1.30—4 p.m. - Miss Riley Friday 2—4.30 p.m. (Nursery Centre) - Miss Riley 60, West End Lane, N.W.6 Tuesday 1.30—4 p.m. Dr. Lewis Miss Lambe Wednesday 1.30—4 p.m. Dr. Lewis Miss Lambe Thursday 1.30—4 p.m. Dr. Lewis Miss May 230, Haverstock Hill, N.W.3 Monday 2—4.30 p.m. (Nursery Centre) — Miss Kennedy Tuesday 1.30—4 p.m. Dr. Cryer Miss Kennedy Wednesday 2—4.30 p.m. (Nursery Centre) — Miss Kennedy Thursday 1.30—4 p.m. — Miss Kennedy Friday 2—4.30 p.m. (Social Club and Nursery Centre) - Miss Kennedy Total number of attendances at all Centres during the year :— (i) By children under 1 year of age 11,739 (ii) By children between the ages of 1 and 5 years 5,050 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 978 (ii) Between the ages of 1 and 5 years 207 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 834 (ii) Over 1 year of age 1,480 4 Ante-Natal and Post-Natal Clinics During 1945 Ante-natal and Post-natal Clinics were combined, and 5 combined sessions weekly were held. The number of patients who attended during the year was as follows:— Ante-natal patients Post-natal patients Total attendances 60, West End Lane 677 146 2,999 230, Haverstock Hill 469 83 1,895 Massage Clinics. At the Children's Hospital, College Crescent, 2 sessions weekly were held and at 60, West End Lane, 4 sessions weekly were held. Children's Hospital 60, West End Lane Total attendances during 1945 866 1170 Number of children attending 48 55 Municipal Dental Clinic. During the year the following sessions were held at the Dental Clinic, Lithos Road:— No. of Sessions Total attendances Average attendance Ordinary 47 Mothers 564 12 Children 130 3 Gas 13 Mothers 129 10 Children 25 2 Special 3 Mothers 19 6 Children 8 3 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. 5 Hampstead and North St. Pancras Day Nursery. This Nursery, to which the Borough Council pays a grant of £200 per annum, was still evacuated at the end of 1945, to Silchester, near Reading. Maternity Homes and Hospitals. New End Hospital was closed to maternity patients during the first 8 months of 1945, owing to the condition of the premises. During that time, Hampstead patients were admitted either to Paddington L.C.C. Hospital or to St. Mary, Islington, L.C.C. Hospital. The Maternity Ward in New End Hospital reopened in September. In addition, 146 Hampstead mothers were evacuated for confinement under the Government Evacuation Scheme, and 34 were admitted to Queen Charlotte's Hospital. Nursing in the Home. The number of home visits paid by the two District Nursing Associations in accordance with the Borough Council Scheme was :— Hampstead District Nursing Association 1,947 Kilburn and West Hampstead Nursing Association 2,552 Home Helps. There have been 53 cases in which Home Helps have been provided during confinement cases under the scheme of the Hampstead Borough Council. Convalescent Homes. No applications were received for mothers and babies to be admitted to Convalescent Homes under the Borough Council Scheme. Consulting Obstetricians. During 1945 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 70 packets of Proprietary Brands of Dried Milk were issued free to 1 infant during 1945. 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. Board of Trade Priority Utility Sheet Dockets are issued by this Department to expectant mothers, on receipt of a signed certificate from a midwife stating that the patients are in need of sheets for home confinement. A maximum of 3 Dockets can be issued to each expectant mother. During 1945, 77 applications were received and 209 Dockets issued. 6 Child Life Protection. During the year, 351 visits were paid by health visitors to fostermothers and foster-children in the Borough. On the 31st December, 1945, the number of foster-mothers on the register was 8, and the number of foster-children was 12. In addition there were 3 boarding schools taking altogether 14 children under the age of 9 years. The Eagle's Nest Foster Home returned from evacuation to 33, Fitzjohns Avenue, where 28 children up to 3 years of age can be accommodated. Care of Illegitimate Children—Ministry of Health Circular No. 2866 (revised). After consideration of this circular, the Council agreed in principle that close co-operation is 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 1945-46, 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 is still not possible to obtain suitable foster-mothers, and therefore the scheme is held in abeyance for the present. Care of Premature Infants (i.e., infants weighing 5½ lbs. or less at birth)— Ministry of Health Circular 20/44. 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. During the year there were 45 births notified where the birth weight was 5½ lbs. or less. 15 of these were nursed at home and 30 in hospital or nursing homes. 12 of those born at home and 17 of those born in hospital or nursing homes were alive at the end of one month. One child born in hospital we are unable to trace since discharge. 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 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 suggested a uniform scale of assessment which has now 7 been adopted in Hampstead, and payment to the Domestic Helps at the rate of 1s. 9¾d. an hour, which was agreed. Contact has been made with the Ministry of Labour, and advertisements have been inserted in the Local Press, but so far it has not been possible to inaugurate a scheme for Domestic Helps, since no applicants have been forthcoming. Every effort is being made to recruit suitable women for this work. SANITARY ADMINISTRATION. Inspectorial Staff.—Mr. E. Wall resigned on being appointed as Sanitary Inspector to the Wandsworth Borough Council. Mr. R. Staples was still on Naval Service at the end of the year. Further devastation caused by long-range rockets early in the year resulted in the temporary upheaval of the normal work of sanitary inspection and the services of the Sanitary Inspectors were again fully utilised in connection with post-raid services, particularly those of rehousing and food salvage. Inspections. 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 4,103 (2) Total number of reinspections and other visits and revisits 9,104 (3) Number of inspections (recorded in (1) above) in respect of:— (a) Dwelling-houses for housing defects :— (i) Non-tenement houses 621 (ii) Tenement houses 257 (b) Factories, excluding bakehouses 156 (c) Infestation Order, 1943 (excluding revisits) 849 (d) Food premises :— (i) Bakehouses 39 (ii) Milk premises 112 (iii) Restaurants and eating houses 279 (iv) Other food premises 736 1,166 (e) Shops (under Shops Act, 1934) 117 The total number of complaints received was 2,084, of which 804 referred to rat infestation. Nine hundred and one informal notices (i.e., intimations) relating to 703 premises and 441 statutory notices relating to 287 premises were served during the year. It was found necessary to institute legal proceedings for noncompliance with a statutory notice in one case only. The nuisance was subsequently abated and the summons withdrawn on payment of costs. Housing. 1. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 878 2. Number of dwelling-houses (included in (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 8 METROPOLITAN BOROUGH OF HAMPSTEAD. With the Medical Officer of Health's Compliments. Public Health Department, 33/35, Lancaster trove, Hampstead, N.W.3. 8 3. Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 4. Number of dwelling-houses found not to be in all respects fit for human habitation 703 It will be seen that housing work under the Public Health and Housing Acts has again been on a reduced scale and Notices under these Acts were confined to defects of such an urgent character as to be classified as being prejudicial to health. Nevertheless, mainly owing to the acute difficulties experienced with regard to labour and materials, the time taken to comply with such Notices was, in the main, excessively prolonged. New End and Well Walk Housing Site. On the 15th and 16th February, 1945, the Minister of Health, through his Inspector, Mr. H. H. Jewell, F.R.I.B.A., held a Public Inquiry into the Borough Council's application for a Compulsory Purchase Order on 1 4/5ths acres of land and property at New End Square and Well Walk. Apart from the Owners of the properties involved and from residents in the vicinity, objections were raised to the scheme on architectural, aesthetic and historic grounds by the Hampstead Heath and Old Hampstead Protection Society ; the Hampstead Artists Council and the Georgian Group. In June, 1945, the Minister of Health formally sanctioned the Compulsory Purchase Order and in his letter to the Council he drew attention to the recommendation of the Royal Fine Arts Commission " that the buildings should be planned with special regard for the amenities of the area and should be in harmony with Burgh House." Post-War Housing Programme. In accordance with the Ministry of Health's housing circular of the 4th March, 1943, the Housing Committee has proceeded energetically with its programme of building and at the end of the year, the following sites had either been acquired, were in course of acquisition, or under consideration:— Proposed number of dwellings. Gannett Road (partly constructed) 22 New End area 24 (and 3 shops) Parkhill Road and Upper Park Road (Compulsory Purchase Order confirmed by the Minister of Health.) 100 New End Square and Well Walk (Compulsory Purchase Order made by Council. This scheme was subsequently the subject of an Inquiry by the Minister of Health.) 68 King Henry's Road 102 Kilburn Priory 94 Temporary houses at Cricklewood 80 Total 490 9 The London County Council are proceeding with the Kilburn Vale housing proposals. This will provide 102 additional dwellings—a proportion only of Which will be allocated to Hampstead families. Rehousing of the Homeless and the Inadequately Housed. The Rehousing Department, constituted originally to provide dwelling accommodation for persons rendered homeless by enemy action, continued to function under my supervision as Rehousing Officer throughout the year. The rehousing of the " inadequately housed " is now a function of the Department. During 1945 accommodation was provided for 789 "bombed-out" persons and for 429 inadequately housed persons. From December, 1940, to the end of 1945 the total number of persons rehoused at various times in requisitioned properties was 2,674. At the end of the year 695 dwelling-units in requisitioned premises were occupied by 2,085 persons and 172 further units were in course of preparation. This scattered estate embraces houses of all types and provides for all classes of the community. The problem of management has gained in magnitude and complexity. 2,154 families applied for housing accommodation during 1945. 135 of these families were provided with accommodation in requisitioned properties. Applications were accepted only from persons living in the Borough and from those who resided locally prior to joining the forces, direction to industry, evacuation, etc. A "Points System" was inaugurated in view of the large number of applicants. 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, 2,454; fish, 2,067 lbs.; meat and meat products, 1,379 lbs.; Fruit and vegetables, 2,413 lbs.; confectionery (cakes, loaves, pastries, etc.), 836 lbs.; eggs, 570; cheese, 90 lbs.; sugar, 55 lbs.; flour, 134 lbs.; fats, 110 lbs.; jams, 389 lbs. ; other foods, 1,007 lbs. The above list includes those foodstuffs destroyed or damaged by enemy action. I am grateful for the willing co-operation of the food traders of the Borough. They, seek the advice of the Sanitary Inspectors in various complicated problems arising in connection with unsound foodstuffs and so prevent the sale thereof to the public. Certificates are issued to the traders to enable them to recover their "points," and the Inspectors are frequently able to make suggestions with regard to salvage, thus obviating wastage of food. 10 Food Premises and Restaurant Sanitation. The number of inspections carried out was 1,126. 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. During the year forty-one applications to the Food Executive Officer for new licences were referred to me. The adequate supervision of restaurant sanitation is of primary importance 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). Bacteriological Examination of Foodstuffs. The following samples were submitted for bacteriological analysis during the year :— Milk 9 Dehydrated egg 1 Ice cream 4 Chocolates 2 No pathogenic organisms were found. The milk samples satisfactorily passed the "Methylene Blue" test in respect of keeping quality and, with one exception, the "Phosphatase" test, indicating efficient pasteurisation. It was necessary to call the attention of the vendors to the following unsatisfactory samples :—3 ice cream; 3 milk; 2 chocolates and one dehydrated egg. Visits were paid by the Sanitary Inspectors to the premises concerned and suggestions made, designed to improve the conditions of manufacture as regards cleanliness. Further test samples are being taken from the unsatisfactory cases. Food Adulteration. 500 samples were taken from retail and wholesale premises by the Sanitary Inspectors for analyses by the Public Analyst, Dr. H. E. Cox, D.Sc., Ph.D. (Lond.), F.I.C. The number of samples classed as adulterated was 28 or 5 per cent. of the total number as compared with 37 or 7.4 per cent. in 1944. The adulterated foodstuffs have been tabulated hereunder. Three prosecutions were instituted in respect of adulterated curry powder; in the remaining cases the offending foodstuffs were withdrawn from 11 sale and formal cautions sent to the retailers and manufacturers concerned. Notifications of certain contraventions of Food Orders were also sent to the Ministry of Food. Article of food. No. of samples found to be adulterated and particulars of adulteration. Grape fruit flavoured beverage 1. Coloured flavoured solution of citric acid. Flour 2. Both deficient in CO2. Egg substitute powder 2. Both deficient in CO2. Baking powder 1. Deficient in CO2. Compound ginger wine 1. Contained 6 per cent. phosphoric acid. Pork sausages 1. Deficient in meat. Gelatine 1. Excess arsenic and SO2. Curry powder 5. Contained excessive proportion bean flour. Concentrated vinegar 1. Contained excess acetic acid. Butter 1. Contained excess water. Parsley 2. Contaminated with arsenic and excess ash. Sweet herbs 1. Contaminated with arsenic and excess ash. Sage 1. Excess ash. Pea flour 1. Damaged by maggots. Cocoa 2. 50 per cent. deficient in fat. Glaubers salt 2. Excess strength. Cupids Bow cocktail tonic 1. False label. Cheritone iron tonic cup 1. False label. Earl Eton cocktail 1. False label. • Legal Proceedings. Prosecutions were instituted against three wholesalers in respect of diluted curry powder as follows :— 1. Containing 30 per cent. Summons withdrawn on payment of bean meal costs (£21). 2. Containing 50 per cent. Warranties proved. Summons dismissed. ground rice 3. Containing 50 per cent. Warranty proved. Summons dismissed. bean flour Samples of curry taken subsequent to these cases showed that such excessive dilutions had ceased. Food Standards and Labelling. The good work of the Ministry of Food in prescribing standards for foodstuffs continues and this year has seen legal standards laid down for mayonnaise and salad cream, and for liquid coffee essences, while the labelling of British wines was regulated. In July the Ministry made recommendations on the wording of advertisements for foods claimed to be sources of vitamins and minerals. Rats and Mice (Destruction) Act, 1919. Infestation Order, 1943. The staff engaged in rat destruction consists of three full-time men (two temporary). The services of the Sanitary Inspectors are always available to give advice and assistance to the public on this problem. The Ministry of Food's publicity campaign for the destruction of rats has received an impetus owing to the gravity of the world food situation. The depredations of rats are a serious drain on food resources 12 and the Minister of Food strongly urges an intensification of rat destruction activities. Apart from these endeavours to prevent food wastage, rat destruction from a public health aspect is important as rats are notorious disease carriers. That the public is exceedingly rat conscious is borne out by the fact that 804 complaints were received during the year. This figure is 14 times greater than the average yearly complaints received for the three years prior to the outbreak of the war. Arrangements were in hand at the end of the year for systematic rat destruction treatment of the sewers to be undertaken. Water Supply. The supply provided by the Metropolitan Water Board has been satisfactory (a) in quality, (b) 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 1945 :— Number of houses or parts of houses and contents disinfected 906 ,,verminous rooms disinfested 232 ,, ,, articles of clothing disinfested 43* ,, ,, ,, beds disinfested 321 * 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 36 Children under 5 12 „ over 5 9 Scabies: Adults 548 Children under 5 112 „ over 5 11 Two hundred and eleven adults and 58 children received treatment at the Cleansing Station during 1945. In addition 66 Hampstead school children received treatment at Cleansing Stations outside the Borough under the L.C.C. Scheme. During the year, 232 verminous rooms in 191 houses and 321 sets of beds and bedding were cleansed and freed from vermin. One hundred and ninety-six cases of Scabies were notified during the year. These were investigated by the Health Visitors, and, where 13 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 1945. Notifications Removals to Hospitals Deaths Cerebro-Spinal Fever 3 3 1 Diphtheria 12 12 — Dysentery 31 22 — Erysipelas 22 9 — Malaria— Contracted abroad 2 2 — Measles 486 63 — Ophthalmia Neonatorum 2 1 — Pneumonia 100 55 20 Poliomyelitis 3 2 — Puerperal Fever 3 2 1 Puerperal Pyrexia 17 17 — Scabies 196 — Scarlet Fever 58 37 — Typhus Fever 1 1 — Whooping Cough 45 15 1 Total 981 241 23 Cancelled cases have not been included. Diphtheria Immunisation. Free immunisation against diphtheria may be obtained:— (a) At Borough Council clinics held weekly at No. 230, Haverstock Hill, N.W.3 (Wednesdays, 2 to 3 p.m.), and No. 60, West End Lane, N.W.6 (Fridays, 2 to 3 p.m.). (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 and by private doctors. During 1945, 725 children were immunised under the arrangements described above ; of these 690 were of pre-school age and 35 attending school. Comparative figures for 1944 and 1943 were 468 (386 of preschool age ; 82 attending school) and 837 (616 of pre-school age and 221 attending school) respectively. 14 Figures obtained from the Head Teachers of Schools within the Borough indicate that the percentage of school children immunised is being maintained, and the estimated figure for this year is 78 per cent. The publicity campaigns have been directed principally to young children and there has been an increase in the number of pre-school children immunised; this figure is now estimated to be 54 per cent. These figures are based principally on the number of immunisations carried out through the Council schemes, and if the number of children immunised privately by their own doctor could be ascertained it might well be found that these figures are somewhat low. Six hundred and two children were presented at clinics for Schick testing after having received immunising injections; in only four cases did the test prove positive and necessitate further inoculations. One child under 15 years of age was notified as suffering from diphtheria during 1945. The patient was aged 6 and had been immunised at the age of one year. Comparative figures for 1944 and 1943 are 2 and 3 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 6,143 children have been immunised under official arrangements.) Year. Children: 0—15 years. Number immunised under official arrangements. Number of cases of Diphtheria. Number of deaths from Diphtheria. 1928 Nil 55 3 1929 Nil 42 2 1930 Nil 63 2 1931 Nil 44 2 1932 Nil 46 3 1933 192 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 1945 725 1 Nil • Vaccination. There were 1,104 births registered during 1944 and of these 688 were successfully vaccinated. 101 Statutory Declarations were received. 15 Bacteriological Examinations. The following examinations were carried out:—Diphtheria 91; Scarlet Fever (for Hæm. Strep.) 7; Sputum for T.B. 358; Dysentery 13; Vincents Angina, 6 ; cerebro-spinal fever, 1. Tuberculosis. New Cases and Mortality during 1945. During the year 1945, 120 new cases of Tuberculosis were notified, 105 being cases of Pulmonary Tuberculosis and 15 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 1945:— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0—1 1 — 1 — — ...— — — 1—5 1 1 2 — — — 2 — 5—15 3 2 3 — — — 1 — 15—25 17 14 1 3 5 4 — — 25—35 17 16 3 — 5 6 — — 35—45 15 2 1 — 4 3 1 — 45—55 8 1 1 — 5 3 — 1 55—65 4 — — — 3 1 — 1 65 and upwards 3 — — — 9 1 — 2 Totals 69 36 , 12 3 31 18 4 4 Public Health (Tuberculosis) Regulations, 1930. There were 566 Pulmopary and 99 Non-pulmonary cases of tuberculosis known to the Department at the end of the year 1945. Municipal Tuberculosis Dispensary. During the year, 145 sessions were held, and 478 new cases (of which 105 were contacts) were examined. Altogether, 898 patients attended the Dispensary in 1945 and the total number of attendances of all kinds numbered 2,115, an average of 14.6 per session. The attendances were 79 fewer than last year. The Tuberculosis Officer made 15 visits to the homes of patients and the Tuberculosis Nurse made 1,172 visits. During the year 64 patients received artificial pneumothorax treatment, 12 patients were in receipt of extra nourishment provided by the Council, and 8 patients received dental treatment under the Borough Scheme. 897 X-ray films were taken and in addition many were screened as well as the routine screen examination made for A.P. patients. 16 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 1945, 52 new applications were considered, of which 41 were granted maintenance, and a total of 176 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 £3,210, and the whole cost is borne by the Government. 1369 P.H. 7/46 (6610) Harrison Sc Sons Ltd., 44 47, St. Martin's Lane, W.C.2.