LIBRARY HAMP 47 Metropolitan Borough of Hampstead. Abridged Report on the Health of the Borough. 1946. 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 89,720 Rateable Value, March, 1946 £1,546,347 Sum produced by 1 d. rate £5,978 BIRTHS. Live Births. Total. Males. Females. Legitimate 1,421 708 713 Illegitimate 143 62 81 1,564 770 794 Birth rate per 1,000 of the estimated resident population 17.4 (Rate for London : 21.5) Number of Stillbirths 35 Rate of Stillbirths per 1,000 (live and still) births 21.8 DEATHS. Net deaths (males, 513 ; females, 547) 1,060 Death rate per 1,000 of the estimated resident population 11.8 (Rate for London : 12.7) Deaths from maternal causes (.64 per 1,000 births) 1 Deaths of infants under 1 year (males, 33 ; females, 24) 57 Infants under 1 year : Infantile Mortality Rate All infants per 1,000 live births 36 Legitimate infants per 1,000 legitimate live births 34 Illegitimate infants per 1,000 illegitimate live births 63 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 319 20. Other diseases of circulatory system 35 2. Cerebro-spinal fever — 3. Scarlet fever — 21. Bronchitis 58 4. Whooping cough — 22. Pneumonia 52 5. Diphtheria — 23. Other respiratory diseases . . 11 6. Tuberculosis of the respiratory system 30 24. Ulcer of stomach or duodenum 14 7. Other forms of tuberculosis. . 4 25. Diarrhoea (under 2 years) . . 4 8. Syphilitic diseases 8 26. Appendicitis 6 9. Influenza 9 27. Other digestive diseases 22 10. Measles 1 28. Nephritis 17 11. Acute polio-myelitis and polioencephalitis 2 29. Puerperal and post-abortive sepsis _ 12. Acute infective encephalitis . . 1 30. Other maternal causes 1 13. Cancer of buccal cavity and oesophagus (m) uterus (f) 13 178 31. Premature birth 15 32. Congenital malformations, birth injuries, infantile diseases 2 14. Cancer of stomach and duodenum 32 33. Suicide 12 15. Cancer of breast 22 34. Road traffic accidents 6 16. Cancer of all other sites 111 35. Other violent causes 47 17. Diabetes 10 36. All other causes 82 18. Intra cranial vascular lesions 90 Total 1,060 Public Mortuary, New End. During the year 139 bodies were brought to the mortuary, 11 by the Police and 128 by order of the Coroner. 139 post-mortem examinations were made. 3 Infectious Disease during 1946. Notifications Removals to Hospitals Deaths Cerebro-Spinal Fever 2 2 – Diphtheria 13 12 – Dysentery 14 11 1 Erysipelas 17 7 – Measles 324 33 1 Ophthalmia Neonatorum 3 1 – Pneumonia 77 39 12 Poliomyelitis 2 2 2 Puerperal Fever 4 3 — Puerperal Pyrexia 20 16 — Scabies 197 — — Scarlet Fever 115 52 — Smallpox 2 2 — Typhoid Fever 1 1 — Whooping Cough 92 12 — Total 883 193 15 Cancelled cases have not been included. Smallpox. Two cases of smallpox were notified in this Borough on 9th February, and they were removed to Hospital the same day. The circumstances were that a Doctor discharged from the Army, left India on the 9th January, immediately prior to which he had been in contact with smallpox. He arrived in this country on the 15th January, and it would appear that he infected his wife and daughter, as the history shows that he himself had symptoms of smallpox. A thorough disinfection of the premises was carried out immediately after removal of the patients and every endeavour was made to trace all possible contacts. The main difficulty was in connection with the school which the child had attended up to four days prior to notification. The Head Mistress of the school was most co-operative, and we were able to vaccinate all the school children who might have been possible contacts. In all some 250 children at the school were vaccinated, and approximately a further 50 people were vaccinated who feared they might have some association with the patients. Both patients recovered, and no further case of smallpox occurred. 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. (5572) A 2 4 Sessions for immunisation are arranged from time to time in private schools and in the 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 1946, 931 children were immunised under the arrangements described above; of these 810 were of pre-school age and 121 attended school. One adult was immunised. Comparative figures for 1945 and 1944 were 725 (690 of pre-school age; 35 attending school) and 468 (386 of pre-school age and 82 attending school) respectively. The estimated percentages of children immunised up to 31st December, 1946, are : — under 5 years, 55 per cent.; of school age, 78 per cent. The total number of children immunised since free immunisation was commenced in the Borough in mid-1933 is 7,074. As will be seen from the following table, the figures relating to the numbers of cases and deaths among young children continue to be very satisfactory. Ox the 13 cases of Diphtheria only two had been immunised, and 10 were adults. 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 1946 931 3 Nil In Hampstead each Health Visitor is responsible for securing the immunisation of children under school age in her district. Particular effort is made to secure immunisation about the age of one year and of Ninety-nine sessions were held at the Borough Immunising Clinics and the attendances were as follows: — Total attendances. Average attendances per clinic. First injections 774 78 Second ,, 759 7-7 Schick Tests 697 70 Schick Readings 554 5 6 2,784 28 1 5 the 931 children immunised in 1946, 592 were born in 1945. This is the highest number of " one-year-olds " ever immunised in a single year in the Borough. Every child who reaches the age of one year and has not commenced immunising injections receives a Brithday Greetings leaflet inviting the parent to have the child immunised. This leaflet is most successful. Bacteriological Examinations. The following examinations were carried out:—Diphtheria 144 ; Scarlet Fever (for Haem. Strep.) 56; Sputum for T.B. 491 ; Dysentery 7 ; Vincents Angina, 12; Malaria, 1 ; Meningococci, 1. Vaccination. 1,751 Certificates of successful primary vaccination were received during the year, and of the 999 births registered during 1945, 73 per cent, had been successfully vaccinated by the end of the year 1946. This percentage is the highest ever recorded in the Borough. Tuberculosis. New Cases and Mortality during 1946. During the year 1946, 114 new cases of Tuberculosis were notified, 100 being cases of Pulmonary Tuberculosis and 14 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 1946 :— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0—1 — — — — — — — — 1—5 2 1 2 — — — — — 5—15 5 1 3 1 — — 1 — 15—25 12 7 1 3 1 1 — — 25—35 13 18 — 2 2 4 35—45 12 6 1 1 5 3 — 1 45—55 8 6 — — 2 3 — — 55—65 4 1 — — 4 — 1 1 65 and upwards 2 2 — — 5 — — — Totals 58 42 7 7 19 11 2 2 Public Health (Tuberculosis) Regulations, 1930. There were 559 Pulmonary and 83 Non-pulmonary cases of tuberculosis known to the Department at the end of the year 1946. (5572) A 3 6 Municipal Chest Clinic and Tuberculosis Dispensary. (a) Chest Clinic and Tuberculosis Dispensary. 1946. 1945. Number of sessions 152 145 Number of patients' attendances 2,633 2,115 Average attendance 173 146 Number of patients attending 980 898 New patients 428 373 New contacts 130 105 Number of patients examined for National Service Medical Board 41 Blood examinations (E.S.R.) 84 — (b) Chest Clinic and Dispensary, New End Hospital and Home Visits by T.M.O. Attendances at Chest Clinic and Dispensary 2,633 ,, ,, New End Hospital 1,192 Visits by Tuberculosis Officer to Homes 116 Total 3,941 (c) Visits by Tuberculosis Health Visitors. Number of visits to Homes 1,033 Artificial Pneumothorax. Induction of Artificial Pneumothorax was carried out in 15 cases. 1,129 refills were given to 85 patients during the year. X-ray Examination. During the year, 843 films were taken at New End Hospital. In addition, approximately 1,180 X-ray screenings have been carried out there by the Tuberculosis Officer. Dentures. Dentures were supplied to five patients. The total cost being £24 17s. 6d., of which the Council contributed £13 Is. lOd. 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 1946, 56 new applications were considered, of which 49 were granted maintenance and one application was withdrawn, and a total of 98 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 £3,490, and the whole cost is borne by the Government. It is unfortunate that this scheme does not embrace the chronic case or the sufferer from non-pulmonary tuberculosis. 7 Mass Miniature Radiography. . In November, the London County Council's Mass Miniature Radiography Unit was established at St. Pancras L.C.C. Hospital and became available for use by persons resident or working in this Borough. Employers of the larger firms in Hampstead were approached, and as a result, application was made for 1,912 persons to be X-rayed. Of this number, 1,290 were referred direct to the London County Council for central appointment, by reason of difficult times requested for X-raying, or very large numbers of examinees. Appointments at St. Pancras Hospital were made for the remaining 622, of which only 537 presented themselves for examination. Of these, nine showed some abnormality and large films were taken. Three of these films were found to be within normal limits, two showed healed tuberculous lesions, whilst four patients, who were probably tuberculous, were referred to the General Practitioner concerned. Chest Clinic and Tuberculosis Dispensary. The Dispensary premises remain uriatisfactory. The situation, on the west side of the Borough, makes it difficult of access to a large percentage of patients. The building itself is unsuitable, owing to the noise from the streets and a neighbouring garage. It is also badly planned; the waiting, reception and changing facilities for patients leave much to be desired, and there is no X-ray plant. A centrally situated Clinic designed on modern lines, with an attractive waiting room, reception room, undressing cubicles and an X-ray plant, is an urgent necessity if the tuberculosis service of the Borough is to function satisfactorily. This matter is now being considered by the Public Health Committee. Hospital and Sanatorium Assommodation. The greatest defect in the tuberculosis scheme nowadays is the long waiting period which elapses before the patient can be found a bed in a tuberculosis hospital or sanatorium. This long delay increases the opportunities for the spread of infection to others, particularly nowadays, when housing accommodation is so unsatisfactory. Furthermore, the early case, or the quiescent case that commences to breakdown, cannot receive that immediate treatment which is so essential. Thus, the early detection of cases of pulmonary tuberculosis, which has been brought about by Mass Radiography, as well as the careful supervision of contacts, close liaison with general practitioners, and the education of the public, is being largely nullified. The bed shortage also makes it difficult or impossible to find hospital accommodation for acute emergencies, such as cases of haemoptysis, and for patients who require observation for the establishment of a diagnosis. The home-help scheme, which was introduced before the War, is proving invaluable, but whilst it is of great service to both the early and the advanced patient, it only offsets to a small degree the lack of hospital accommodation. The bed shortage is surely one of the most urgent national problems of to-day. Housing. The tuberculosis problem is closely associated with the shortage of suitable housing accommodation. Overcrowding is a potent factor in the spread of tuberculosis. Many houses occupied by tuberculous patients 8 are not only seriously overcrowded but are also in a poor state of repair and are damp and cold. Every endeavour is made to find alternative accommodation for patients who are unsuitably housed, but although the rehousing department co-operates to the full, only a relatively small number can be given priority. Beds and bedding are supplied in those all too frequent cases, where the patient not only has no bedroom to himself, but has to share a bed. Resettlement. Tuberculous persons (both pulmonary and non-pulmonary) are now brought within the arrangements for giving effect to The Disabled Persons Employment Act, 1944. The Disablement Resettlement Officer is furnished with particulars as to the nature and amount of work patients are capable of performing. Although this Act is a distinct step forward in the resettlement of the tuberculous, the results have as yet proved a little disappointing. Extra Nourishment. Twelve patients were supplied with free milk during the year. MATERNITY AND CHILD WELFARE Health Visitors and Home Visits. The six full-time Health Visitors paid 11,573 visits during the ytar, In addition the Health Visitors made 1,443 attendances at Clinics ar.d Centres. The Infant Welfare Centres open at the end of 1946 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 Kuhn-R£gnier Wednesday 2—4.30 p.m. (Social Club) — Miss Kuhn-R6gnier Thursday 1.30—4 p.m. Miss Kuhn-R^gnier Friday 2—4.30 p.m. (Nursery Centre) — Miss Kuhn-Regnier 60, West End Lane, N.W.6 Tuesday 1.30—4 p.m. Dr. Williams Mrs. Whaley Wednesday 1.30—4 p.m. Dr. Lewis Miss Leahy 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. Fletcher 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 14,010 (ii) By children between the ages of 1 and 5 years 5,186 9 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 1,160 (ii) Between the ages of 1 and 5 years 215 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 1,036 (ii) Over 1 year of age 1,603 Ante-Natal and Post-Natal Clinics During 1946 Ante-natal and Post-natal Clinics were combined, and 6 combined sessions weekly were held. The number of patients who attended during the year was as follows :— Ante-natal Post-natal Total Average patients patients attendances attendance 60, West End Lane 958 123 4,222 23 230, Haverstock Hill 573 36 2,148 21 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 60, West End Hospital Lane Total attendances during 1946 650 1,058 ( Number of children attending 20 47 Municipal Dental Clinic. During the year 231 mothers, 93 children and 8 T.B. patients attended the Dental Clinic, Lithos Road. No. of Sessions Total attendances Average attendance Ordinary 68 Mothers 881 13 Children 263 4 Gas 13 ' Mothers 117 9 Children 30 2 Ultra-Violet Ray Treatment. Children receive artificial sunlight treatment by arrangement with the Willesden Physical Treatment Clinic, and the Institute of Ray Therapy. 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. 10 (d) Berridge House, Hillfield Road, N.W.6.—Opened on 8th May, 1944, to accommodate 47 children. Closed on 16th March, 1946, as the original tenants of the premises returned from evacuation and wished to re-open the Domestic Science Training College. For the children in this nursery whose mothers continued full-time work, accommodation was arranged in the Nursery Class at Beckford L.C.C. School for those over three years of age, and in Woodchurch Road Day Nursery for the younger ones. Throughout the year every care and attention has been given to the supervision of the Day Nurseries. It must never be forgotten that the Nurseries serve a dual function. Not only do they look after the child whilst the parent is at work, but what in my opinion is of even greater value, is that they provide an education and outlet for a child who might otherwise be a lone child in a back basement or top attic. The cost per child per day has been 4s. 6d., of which the mother is asked to contribute 2s. per day for the first child in a family and Is. 6d. per day for second and subsequent children in a family admitted at the same time. In necessitous cases, where the parent is unable to afford the full cost, an assessment is made according to means. During 1946, six applications were received for reduction in charge, and all these applications were allowed. Maternity Homes and Hospitals. During the year, 66 Hampstead mothers were evacuated for confinement under the Government Evacuation Scheme, 54 were admitted to Queen Charlotte's Hospital, and 485 were admitted to New End Hospital. Nursing in the Home. The number of home visits paid by the two District Nursing Associa tions in accordance with the Borough Council Scheme was :— Hampstead District Nursing Association 2,117 Kilburnand West Hampstead Nursing Association 2,324 Domestic and Home Help Service. A scheme for the provision of Home Helps for maternity cases only, has been in operation since 1934, but this scheme was extended to include provision of Domestic Helps in November, 1946. The present scheme covers the following types of cases: — (a) During home confinement. (b) Post-operative patients, and patients discharged from hospital and still under medical supervision. (c) Aged and infirm. (d) Sickness causing domestic difficulties, where help from friends or relatives is unavailable. The Committee appointed a Home Help Organiser to supervise this service, which at the time of the writing of this report consists of eight full-time and ten part-time helps. The Home Helps are provided with overalls and are paid at the rate of 2s. per hour. The applicant is assessed to pay in accordance with the approved scale. During the first ten months of 1946, when help was available only for maternity cases, assistance was provided for 99 applicants. Since the inception of the augmented scheme in November, a total of 28 domestic, and 31 maternity cases have been assisted. 11 Convalescent Homes for Children under Five Years. Arrangements are made through the Invalid Children's Aid Association for children under five years of age to be sent to Convalescent Homes, on the special recommendations of the Doctors at the Welfare Centres. During 1946, 30 Hampstead children were sent away through this service. Unfortunately, particularly during the summer months, the demand greatly exceeds the vacancies available, with the consequence that children may have to wait for at least a month. The Borough Council contributes £10 per year to the Invalid Children's Aid Association in respect of this service. Consulting Obstetricians. During 1946 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 10 packets of Proprietary Brands of Dried Milk were issued free to one infant during 1946. In addition 23,077 packets of Dried Milk were sold at full cost. Other food and medicaments to total value of £630 were also sold. 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 1946, 197 applications were received and 542 Dockets issued, as compared with 200 Dockets issued to 77 applicants in 1945. Child Life Protection. During the year, 276 visits were paid by health visitors to fostermothers and foster-children in the Borough. On the 31st December, 1946, the number of foster-mothers on the register was 4, and the number of foster-children was 26. (These figures include a Nursing Home accommodating 18 foster-children). In addition the Eagle's Nest Foster Home, 33, Fitzjohns Avenue, can accommodate 28 children up to three years ot age. Care of Premature Infants—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. 12 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. The following analysis of the premature births occurring in Hampstead in 1946 has been made (a " premature " is defined as any baby whose birth weight is 5£ lbs. or less): — Premature births in Hampstead (including non-residents): 146. Premature births to Hampstead mothers (irrespective of place of birth): — (a) Born in hospital, etc., in Hampstead 76 (b) Born at home 16 127 (c) Born in hospital, etc., outside Hampstead 35 Of the 76 premature babies born in hospital, etc., in Hampstead, eight died before discharge, and of the 16 born at home six died (one at home, five in hospital), and of the 35 born outside Hampstead, four died before discharge. . The seriousness of the problem of the Premature Birth will be appreciated when it is pointed out that of the 57 deaths of Hampstead infants under one year, no less than 18 were in respect of prematures. Further consideration of this problem will be made by the Committee during the forthcoming year. Care of Illegitimate Children—Ministry of Health Circular 2866 (revised). In conjunction with other Metropolitan Boroughs, this Council continues to make its annual payment (on a rateable value basis) of £161 to the Moral Welfare Organisations. The Health .Visitors and the Moral Welfare Workers are in close cooperation when any assistance can be given either to unmarried expectant mothers and/or illegitimate children. There are three Voluntary Associations operating in the Borough whose work during the year is analysed below: — (a) London Diocesan Council for Moral Welfare Work: There were 29 cases referred to this Body, 17 by the Borough Council and 12 from New End Hospital. These were dealt with as follows: — Ten returned to relatives, one married, five remained in situations until the birth of the baby, two went to Institutions (being unsuitable cases for Mother and Baby Homes), 11 were accommodated in Pre-natal Hostels. (b) Westminster Catholic Social Welfare Committee: Six cases were referred to this Committee, of which three went to Special Homes, two remained in situations until confined, one was boarded out. (c) Jewish Association for the Protection of Girls, Women and Children : Three cases were referred to this Association and were accommodated in Homes of Voluntary Organisations, and one case refused this assistance. 13 Unfortunately the Infant Mortality Rate of Illegitimate infants remains unduly high in comparison with that of Legitimate Infants. Thus: — Year. Infant Mortality Rate Legitimate. Infant Mortality Rate Illegitimate. 1946 34 63 1945 37 82 1944 58 98 1943 44 36 1942 46 71 1941 49 123 1940 46 88 1939 31 118 1938 46 134 1937 38 202 1936 60 121 It is apparent from these figures that there remains a considerable task confronting those concerned in reducing the Illegitimate Infant Mortality Rate. SANITARY ADMINISTRATION. Staff. The Council now employs nine Sanitary Inspectors. This is slightly below the pre-war figure which was nine, plus a woman Inspector 60 per cent, of whose time was devoted to Sanitary work. Inspections. The following brief statement shows the number and details of premises inspected by the Sanitary Inspectors during the year: — (1) Total number of premises inspected 7,271 (2) Total number of re-inspections and other visits and revisits 11,982 (3) Number of inspections (recorded in (1) above) in respect of:— (a) Dwelling-houses for housing defects :— (i) Non-tenement houses 1,216 (ii) Tenement houses 346 (b) Factories, excluding bakehouses 186 (c) Infestation Order, 1943 (excluding revisits) 668 (d) Food premises :— (i) Bakehouses 38 (ii) Milk premises 80 (iii) Restaurants and eating houses 140 (iv) Other food premises 483 741 (e) Shops (under Shops Act, 1934) 183 The balance of the number of inspections is made up of visits in connection with infectious diseases and " contacts flooding; checking of re-housing applications; maintenance of requisitioned premises, voluntary drainage work, etc. The total number of complaints received was 2,284 of which 668 referred to rat infestation. 2,641 informal notices (i.e., intimations) relating to 1,493 premises and 890 statutory-notices relating to 551 premises were served during the year. 14 In twenty-three cases of non-compliance with Statutory Notices, evidence was submitted to the Town Clerk for legal action to be taken. Summary proceedings were subsequently instituted in regard to nine premises, Abatement Orders being obtained and a total of £2 fines and £12 lis. 6d. costs being imposed. Proceedings in respect of breaches of the L.C.C. Drainage Bye-laws resulted in the offender being fined £8 with £2 2s. costs. Housing. 1. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,562 2. Number of dwelling-houses (included in (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 47 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 1,289 Problems arising out of the arrears of maintenance repairs to every class of premises, particularly those of the tenement type, are the cause of increasing concern to Medical Officers of Health throughout the country. Statutory Notices under the Public Health and Housing Acts are still restricted to housing defects of so urgent a nature as to be classified as being prejudicial to health. I have to call attention to the increase in the number of such notices served during the year—-890—as compared with 441 during the previous year. The need of building labour and materials for the erection of new or converted houses for families without a separate home of their own is obviously of paramount importance. Until this need is substantially met, it appears inevitable that the long delays and difficulties experienced in getting statutory notices complied with will, unfortunately, continue. Post-war Housing Programme. The Council has continued throughout the year with the execution of its post-war programme, and the following sites have been under consideration by the Housing Committee in their varying stages of progress: — Proposed number of dwellings. Garnett Road 22 Now completed and occupied. Temporary houses at Cricklewood 80 Ditto. New End area 24 Under construction. Parkhill Road and Upper Park Road 92 Ditto. King Henry's Road 102 Well Walk .. • .. 63 Kilburn Priory 94 West End Lane 80 Broadhurst Gardens 168 725 15 Hutted Camps—Squatters. During August onwards, " Squatters " took possession of three hutted camps in the Borough: — (1) East Heath Road—on Hampstead Heath—used during the war as part of the anti-aircraft battery. (2) Primrose Hill—Office of Works—used as No. 1. (3) Lawn Road—Huts previously used by war damage repair personnel under the control of the Ministry of Works. At one time, forty-one families comprising 141 persons were occupying these camps. Constant visits were paid by the Sanitary Inspectors to each camp and steps were taken to provide fundamental facilities of main water, sanitation, and refuse storage and collection. The conditions at East Heath Camp were particularly unsatisfactory and, in order to prevent any extension of occupancy, all the vacant huts were demolished by the Council. Instructions were also given by the Housing Committee for the demolition of all huts at East Heath and Lawn Road as and when they were vacated. A deputation from the Council interviewed officers of the Ministry of Works and Ministry of Health regarding the future of the camps, as a result of which certain proposals were put forward whereby the Council will administer the Primrose Hill Camp only until the end of December, 1948. These huts are to be improved and rents fixed. The occupiers of the remaining huts in the other camps will be transferred thereto and steps will be taken to ensure that any vacant huts are immediately rendered uninhabitable. Flooding by Storm Water. On the 26th July, 1946, a torrential rainstorm occurred, resulting in severe flooding of basements in many parts of the Borough. The areas most severely flooded were Sumatra Road, Kilburn High Road, Netherwood Street, Palmerston Road, Kingsgate Road, Eresby Road and Iverson Road. Individual basements were also flooded in Fleet Road, Vale of Health, Compayne Gardens, Hilgrove Road and North End. Some Sumatra Road premises were inundated to a depth of 5 ft., and in the Netherwood Street area depths of 3 ft. 6 in. were recorded. This was the most severe flooding ever experienced in the Borough. Previous floods have been confined principally to the Kilburn Area at the foot of Shoot-up Hill. Readings obtained by the Borough Engineer from the Willesden Borough Council's Recorder at Stonebridge Park show that the equivalent hourly intensity of rainfall between 5.0 and 5.10 p.m. reached the phenomenal peak of 4-80 in. The storm was not confined to this locality but was general throughout the London area. The Kelson Street Mission Hall was opened for the accommodation of persons whose premises had been rendered uninhabitable. Bedding, blankets, etc., were supplied by the Borough Engineer's Department; the Council's workmen were sent to the worst flooded areas to assist occupiers to clean up the silt and other debris which had been desposited; saturated carpets, bedding and clothing were collected, washed and disinfected und dried at the Central Baths and the Public Health Station. A quantity ol foodstuffs in shop cellars was condemned as being unfit for food. The Sanitary Inspectors made detailed inspections of all the flooded basements, and 68 Intimation Notices under the Public Health Act, 1936, were served on the Owners of these premises requiring them to " take up floorboards, thoroughly cleanse and disinfect the site; thoroughly cleanse and disinfect the floors, and to strip, cleanse, repair and redecorate the walls as necessary." All these Notices were eventually complied with without recourse to legal proceedings, which indicates the tact displayed by the Sanitary Inspectors concerned. Three families were rehoused permanently, and six families temporarily by the Council. The question of the main drainage of the Borough is now under discussion with the L.C.C. Factories Act, 1937. Many changes have taken place in the Factory Register during the war, but owing to pressure of other work it has not yet been possible to complete a new Register. Excessive noise, night work, dust and fumes, have all been the subject of a large number of complaints and petitions to the Council, and have entailed constant observation by the staff of the Department. Wherever possible, the assistance of the L.C.C., the Town Planning Authority, has been invoked, with a view to the factory being transferred to a nonresidential area. This procedure seems the obvious solution, but in practice is slow and unsatisfactory. The following table gives details of the Factories inspected and defeci found during the year: — Premises. Inspections. Re-inspections. Notices served. Factories with mechanical power (excluding bakehouses) 87 23 17 Factories without mechanical power (excluding bakehouses).. 99 38 33 Outworkers premises 43 1 — Defects found. No. Referred to H.M. Inspector. Defects remedied Want of cleanliness 34 1 26 Unreasonable temperature 6 — 6 Inadequate ventilation 16 — 14 Overcrowding 2 — 2 Defective floors or insufficient drainage of floors 11 1 8 Washing facilities 7 7 5 Sanitary accommodation. (a) insufficient 10 — 6 (b) unsuitable or defective 6 — 4 (c) not separate for sexes 11 — 8 Other offences 42 1 36 Rats and Mice (Destruction) Act, 1919. Infestation Order, 1943. The staff engaged on the above 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. 16 17 The number of complaints of infestation by rats or mice received during the year was 668 compared with 804 during 1945. Two poisoning operations for the eradication of sewer rats were carried out resulting in a total estimated kill (vide Ministry of Food formula) of 3,650 rats. Water Supply. Tho supply provided by the Metropolitan Water Board has been satisfactory both in quality and in quantity. Disinfection. " D.D.T." which was so successfully used as an insecticide in H.M. Forces during the war, is now available for home use. Experiments have been carried out with various preparations containing D.D.T. and at present we are using a proprietary liquid insecticide, containing 5 per cent. D.D.T. and 3 per cent. Lethane in Kerosene. This preparation is sprayed over all affected surfaces, the Kerosene evaporates and leaves a fine deposit of D.D.T. crystals which remain as a lethal film. This insecticide has been used with success in dealing with complaints of bugs, cockroaches, flies, silverfish and crickets. In cases where powder is more suitable for use than a Kerosene spray, " Gammexane " is employed. The following is a record of the work carried out by the Disinfecting Staff during 1946 :— Number of houses or parts of houses and contents disinfected 880 ,, verminous rooms disinfested 202 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: — During 1946, 129 adults and 39 children received treatment at the Cleansing Station. In addition 67 Hampstead school children received treatment at Cleansing Stations outside the Borough under the L.C.C. Scheme. During the year, 202 verminous rooms in 172 houses were cleansed and freed from vermin. One hundred and ninety-seven 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 Verminous conditions : Adults 12 Children under 5 5 „ over 5 Nil Scabies : Adults 392 Children under 5 97 ,, over 5 9 18 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 was legal proceedings required to be taken. Inspection and Supervision of Food. The need for the conservation of food supplies, both local and national, continues to be of paramount importance, and the services of your Sanitary and Food Inspectors are always available for advice and assistance to the general public and food traders throughout the Borough. I am grateful for the continued co-operation of the Ministry of Food ^nd the food traders in connection with numerous problems of food salvage. Food Premises and Restaurant Sanitation. It is more than ever necessary to emphasise the special need for cleanliness in every phase of food production. Section 13 of the Food and Drugs Act, 1938, lays down specific requirements for, not only the sanitation, ventilation and cleanliness of all premises where food or drink is manufactured or sold, but also for the cleanliness of the apparatus and utensils used, the provision of proper and adequate washing facilities for the staff, and the cleanliness of the staff. Bacteriological Examination of Foodstuffs. During the year 36 samples of food were examined bacteriologically, as follows: — Milk (graded) 13 Milk (heat treated) 8 Tomatoes (bottled) 1 Fish paste 1 Ice Cream 12 Tap Water 1 All heat-treated milks were submitted to the prescribed tests laid down by the Milk {Special Designations) Regulations which came into operation on the 1st March, 1946. These tests are the Phosphatase test for adequate heat treatment, and the Methylene Blue test which is designed to ensure that consumers will receive their milk sufficiently fresh to remain drinkable, if kept reasonably cool, until the next day's supply is received. The milk samples passed these tests satisfactorily. No pathogenic organisms were found. The plate-count test, as prescribed for milks in the Milk (Special Designations) Order, 1936, is now found to be defective, not only because a wide margin of error appears inevitable in arriving at the result of the count, but more particularly because the test takes account of heatresistant organisms whose presence is of no material signficance for the safety or the keeping quality of the milk. Appropriate action has also been taken with regard to various complaints concerning dirty milk bottles. The attention of five vendors was called to unsatisfactory ice-cream samples which had excessive bacterial counts, and in which B. Coli were present. 19 Food Adulteration. 500 samples were taken during the year by the Sampling Officers under the Food and Drugs Act, 1938. The number certified to be adulterated was 20, or 4 per cent, of the total number as compared with 28, or 5 6 per cent, in 1945. The attention of the Ministry of Food was drawn to certain infringements of Food Orders and warnings were given to retailers, wholesalers and manufacturers in what may be termed the more venial offences. Legal Proceedings. Prosecutions were instituted in the following cases; — 1. Pork Sausages, containing excessive Dismissed under Probation of Offenders' preservative without the statu- Act. Costs, £5 5s. 0d. tory declaration 2. Butter (mixed with margarine) Fine, £10. Costs, £10. 3. Gin, containing 11-7 per cent. Dismissed. Appeal pending to Divisional added water. Court. 2116 p.h. 200 6/47 (5572) printed by Harrison and sons, ltd , st. martin's lane, London Particulars of adulterated samples are as follows: — Article of Food. How Adulterated. No. 28. Selecto Jelly Dessert . . Contains 2 • 5 parts per million arsenic (recognised limit. 1 -40 parts per million). .. 31. Pork Sausages Contain sulphur dioxide, 220 parts per million. No declaration of preservative in shop or on wrapper. „ 35. Butter (informal) Admixed with 30 per cent, margarine. „ 54. Butter (formal) Admixed with 30 per cent. Margarine. Sample combines almost every possible offence ; there is excess water ; there is prohibited preservative, it is not. butter, but a mixture and being by definition margarine, contains an excess of butter fat. „ 98. Chocolate Pudding Mix A mixture of wheat and rye flour and only a negligible amount of cocoa. „ 106. Egg Substitute Deficient in strength. „ 113. Lemonade Contravenes Soft Drinks Order. Contains 0-49 per cent. Citric Acid with 0-04 per cent, saccharin, but there is no sugar. „ 121. Ground Coffee Mixture of Coffee and Chicory. „ 184. Vinegar Not a vinegar at all, but a solution of Acetic Acid. 64-8 per cent, strength. 209. Ice Cream Water Ice. Contains no fat. 213. Parsley Contains 20 per cent, grit, mostly sand. „ 215. Ginger Wine Concentrate (Informal) Does not comply with Food Labelling Order. 253. Ice Cream Fat negligible. ,, 282. Baking Powder Slightly deficient in aerating power. „ 284. Curry Powder Contains an excessive proportion of bean meat, 25 per cent. „ 89. Curry Powder Contains an excessive proportion of bean meat. 25 per cent. „ 312. Baking Powder Deficient in strength. ,, 362. Lard Not Lard, but sesame oil. „ 392. Concentrated Artificial Vinegar Contains excessive Acetic Acid, 69 per cent. „ 490. Gin Contains 11-7 per cent, added water.