Metropolitan Borough of Hampstead. Abridged Report on the Health of the Borough. 1 947. H. LESLIE OLDERSHAW, m.d. State Medicine (l.ond.), b.s., d.p.h., Medical Officer of Health 3 Public Health Department, 33-35, Lancaster Grove, N.W.3. To The Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I have the honour to submit to you an Abridged Annual Report upon the state of the Public Health in the Metropolitan Borough of Hampstead for the year 1947. This report is the 47th of the series. I am glad to record that the health of the borough has been good, as is witnessed by the very satisfactory figures given in the statistical section of the report. The population of Hampstead is higher today than in all its history. The Birth Rate of 18.1 compares with 17.4 of the previous year, whilst the Infantile Mortality Rate of 29 is the lowest yet recorded. The occurrence of Infectious Disease remained at a low level, but unfortunately the wide-spread outbreak of Poliomyelitis also affected the Borough ; there were 19 notified cases of this dread disease, two of which were fatal. For the first time since immunisation was commenced in Hampstead, no case of diphtheria occurred among children of 0-15 years of age. It is interesting to note that 40 years ago the Medical Officer of Health of Hampstead recorded 96 cases of diphtheria with a fatality of over 20 per cent. With the pending transfer of the Maternity and Child Welfare functions of the Borough Council to the London County Council it is, I think, appropriate that Mrs. Grundy, M.B.E., should have included in this report the history of the Voluntary Infant Welfare movement in Hamp¬stead. It is exactly 40 years since the first Mothers' Welcome for weighing infants was opened at the Provident Dispensary in New End. Today the Borough Council has 3 maternity and child welfare centres from which operate a team of highly qualified doctors and health visitors, assisted by enthusiastic voluntary workers. The success of all these workers can be judged by the following figures :— 1880 Infantile Mortality Rate 140 1900 „ ,, ,, 100 1920 „ „ „ 83 1940 „ „ „ 49 1947 „ „ „ 29 Special reference must be made to the highly successful Domestic and Home Help Service. During the year, 257 Maternity Cases and 312 Domestic Cases were assisted, and at the end of 1947 there were 21 full-time and 11 part-time helpers. The Committee appointed a 4 Home Help Organiser to supervise this service, and to her, great credit must be given for the success of the schemc. There has been a great increase in the work of the Sanitary Inspector's Department. The number of Intimation Notices served is more than double that of pre-war years. The supervision of the Borough's food supplies continues to receive their close attention. I am pleased to report that this section of the Public Health Department has worked with particular success and efficiency throughout the year. In presenting this Report I would like to acknowledge my sincere appreciation of the support given me by the Members of the Committees which I serve, and by the Chief Officers of the various departments of the Borough Council. Finally, it is a pleasing duty to record the loyal and efficient service given throughout the year by all members of my staff, and to express my indebtedness to Mr. Armstrong (Chief Sanitary Inspector) and Mr. Box (Chief Clerk) in the preparation of this Report. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, H. LESLIE OLDERSHAW, Medical Officer of Health. 5 STATISTICS AND SOCIAL CONDITIONS. Area (acres) 2,265 Population 95,650 Rateable Value, March, 1947 £1,582,458 Sum produced by 1 d. rate £6,480 BIRTHS. Live Births. Total. Males. Females. Legitimate 1,590 804 786 Illegitimate 137 72 65 1,727 876 851 Birth rate per 1,000 of the estimated resident population 18.1 (Rate for London : 22.7) Number of Stillbirths 39 Rate of Stillbirths per 1,000 (live and still) births 22.1 DEATHS. Net deaths (males, 481 ; females, 597) 1,078 Death rate per 1,000 of the estimated resident population 11.2 (Rate for London : 12.8) Deaths from maternal causes (1.7 per 1,000 births) 3 Deaths of infants under 1 year (males, 30 ; females, 21) 51 Infants under 1 year : Infantile Mortality Rate All infants per 1,000 live births 29 Legitimate infants per 1,000 legitimate live births 33 Illegitimate infants per 1,000 illegitimate live births — 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 308 fevers — 20. Other diseases of circulatory 2. Cerebro-spinal fever — system 50 3. Scarlet fever — 21. Bronchitis 66 4. Whooping cough — 22. Pneumonia 43 5. Diphtheria — 23. Other respiratory diseases 16 6. Tuberculosis of the respira- 24. Ulcer of stomach or duo- tory system 31 denum 16 7. Other forms of tuberculosis 11 25. Diarrhoea (under 2 years) 5 8. Syphilitic diseases 5 26. Appendicitis 4 9. Influenza 9 27. Other digestive diseases 26 10. Measles— 28. Nephritis 33 11. Acute poliomyelitis and polio- 29. Puerperal and post-abortive encephalitis 2 sepsis — 12. Acute infective encephalitis —- 30. Other maternal causes 3 13. Cancer of buccal cavity 31. Premature birth 8 and oesophagus (m) 32. Congenital malformations, uterus (f) 18 birth injuries, infantile 14. Cancer of stomach and 178 diseases 26 duodenum 23 33. Suicide 13 15. Cancer of breast 18 34. Road traffic accidents 5 16. Cancer of all other sites 119 35. Other violent causes 29 17. Diabetes 7 36. All other causes 76 18. Intra cranial vascular lesions 108 Total 1,078 Public Mortuary, New End. During the year 190 bodies were brought to the mortuary, 20 by the Police and 169 by order of the Coroner. 189 post-mortem examinations were made. (7258) A 2 6 Infectious Disease during 1947. Notifications Removals to Hospitals Deaths Cerebro-Spinal Fever 1 1 - Diphtheria 3 3 - Dysentery 4 2 - Erysipelas 17 10 - Malaria 3 - -- Measles 848 48 - Ophthalmia Neonatorum 1 1 - Pneumonia 54 30 9 Poliomyelitis 19 15 2 Puerperal Fever 1 1 — Puerperal Pyrexia 11 8 — Scabies 88 - — Scarlet Fever 63 20 - Typhoid Fever 1 1 - Whooping Cough 212 27 — Total 1,326 167 11 Cancelled cases have not been included. Poliomyelitis. During the year 1947, there have been 19 cases of Infantile Paralysis notified in the Borough, in the following age groups :— 0-5 years 5 5-15 ,, 5 Over 15 ,, 6 There were two deaths. In addition, 14 cases were removed to hospital for observation but subsequently diagnosed as non-poliomyelitis. As a consequence of this comparatively small incidence of notified cases of poliomyelitis in the Borough, our actions throughout were essentially a matter of compromise limited by consideration of public convenience and of the minimum possible interference with the ordinary routine of life. It was not considered necessary to close Day Nurseries, Swimming Baths or Infant Welfare Centres, but action was taken to cancel Swimming Galas and any other activity which involved unnecessary aggregation of young persons. All the homes of the notified cases were visited, but in no case was it possible to trace any association with any other case. It is difficult, therefore, to refrain from assuming that the reservoir of infection was in the missed ambulant case. Smallpox. No case of smallpox occurred in the Borough during 1947. 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.). 7 (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. (d) Re-inforcing doses, which it is advised should be given at 5 years and 10 years of age, may be obtained through a private doctor, or at the Borough Council clinics. The Borough Council assumes responsibility for post-Schick testing all children, including those immunised in L.C.C. schools and by private doctors. During 1947, 904 children were immunised under the arrangements described above ; of these, 837 were of pre-school age and 67 attended school. Three adults were immunised. Comparative figures for 1946 and 1945 were 931 (810 of pre-school age ; 121 attending school) and 725 (690 of pre-school age and 35 attending school), respectively. One hundred and two sessions were held at the Borough Immunising Clinics with a total of 3,048 attendances. Although the number of children immunised at the Borough Clinics showed an increase of 28 over the previous year, the numbers immunised by the L.C.C. and by private doctors decreased by 55, and the total number of children immunised during the year shows a corresponding decrease of 27 compared with 1946. The estimated percentages of children immunised up to 31st December, 1947, are :—Under 5 years, 57 per cent. ; of school age, 79 per cent. The total number of children immunised since free immunisation was com¬menced in the Borough in mid-1933 is 7,978. For the first time since immunisation was commenced, no case of diphtheria occurred among children of 0-15 years of age. Three cases occurred among adults, none of whom had been immunised. Children : 0—15 years. Year 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 1947 904 Nil Nil (7258) A3 8 The following analysis shows the number of children immunised at each age group up to 14 years of age. It will be seen that the number of children immunised in infancy is steadily increasing. Year of birth. Total immunised up to 31.12.46. Immunised during 1947. Total immunised at 31.12.47. 1933 264 1 265 1934 273 — 273 1935 297 1 298 1936 305 2 307 1937 322 5 327 1938 341 3 344 1939 334 13 347 1940 368 14 382 1941 476 14 490 1942 524 14 538 1943 415 14 429 1944 620 17 637 1945 592 118 710 1946 5 662 667 1947 — 26 26 5,136 904 6,040 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 the 904 children immunised in 1947, 662 were born in 1946. 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 Birthday Greetings leaflet inviting the parent to have the child immunised. This leaflet is most successful. Bacteriological Examinations. The following examinations were carried out :—Diphtheria 141 ; Scarlet Fever (for Haem. Strep.) 20 ; Sputum for T.B. 503 ; Vincents Angina 7 ; Malaria 4 ; Typhoid, Dysentery (faeces) 5, Typhoid (Widal) 1 ; Food Poisoning (faeces) 3. Vaccination. 2,403 Certificates of successful primary vaccination were received during the year, and of the 2,508 births registered during 1946, 69 per cent, had been successfully vaccinated by the end of the year 1947. Food Poisoning. 12 cases of food poisoning were notified under the Food and Drugs Act, 1938. These were investigated and where necessary samples of the suspected food were examined. 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 9 sprayed over all affected surfaces, the Kerosene evaporates and leaves a line 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 1947 :— Number of houses or parts of houses and contents dis¬infected 876 ,, verminous rooms disinfested 430 Cleansing and Disinfection of Verminous Persons and their Belongings. Early in the year the London County Council decided to vary the agree¬ment for the use of the Cleansing Centre at the Public Health Station and to provide for a partial resumption of the County Council's use of the Centre. Arrangements were accordingly made for the centre to be reserved for the treatment of London County Council school pupils on two successive afternoons, and this arrangement commenced at the end of April. It was also agreed that the London County Council school nursing sister would assist in the treatment of any parents and children of pre-school age, of the same families as school pupils. During the period April to December, the following treatments were carried out at the School Centre :— Verminous conditions :— No. of school children treated 29 No. of treatments given 56 No. of pre-school children treated 2 No. of treatments given 3 Scabies :— No. of school children treated 12 No. of treatments given 40 No. of pre-school children treated 4 No. of treatments given 7 In addition, 17 Hampstead school children were treated at London County Council Cleansing Stations outside the Borough. The following cleansings and medicinal baths were carried out at the Borough Council Cleansing Centre, during the year, where 76 adults and 12 children received treatment :— Verminous conditions :— Adults 13 Children under 5 2 over 5 1 Scabies :— Adults 228 Children under 5 21 „ over 5 3 During the year, 430 verminous rooms in 202 houses were cleansed and freed from vermin. 10 Eighty-eight 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. 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. Tuberculosis. New Gases and Mortality during 1947. During the year 1947, 96 new cases of Tuberculosis were notified, 87 being cases of Pulmonary Tuberculosis and 9 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 1947 :— Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F. 0—1 - - - - - - - 1 1—5 3 — — 2 — — — 1 5—15 2 2 2 — — 1 — 1 15—25 8 13 2 — 1 4 — 1 25—35 9 16 — — 2 6 1 — 35—5 3 4 1 1 1 — 1 — 45—55 6 5 — 1 5 3 1 1 55—65 10 3 — — 5 1 — 2 65 and upwards 1 2 — — — 2 — 1 Totals 42 45 5 4 14 17 3 8 Public Health (Tuberculosis) Regulations, 1930. There were 567 Pulmonary and 77 Non-pulmonary cases of tuberculosis known to the Department at the end of the year 1947. Municipal Chest Clinic and Tuberculosis Dispensary. (a) Chest Clinic and Tuberculosis Dispensary. 1947. 1946. Number of sessions 155 152 Number of patients' attendances 3,227 2,633 Average attendance 20.8 17.3 Number of patients attending 1,046 980 New patients 369 428 New contacts 136 130 Number of patients examined for National Service Medical Board 21 41 Blood examinations (E.S.R.) 91 84 11 (b) Chest Clinic and Dispensary, New End Hospital and Home Visits by T.M.O. Attendances at Chest Clinic and Dispensary 3,227 ,, ,, New End Hospital 1,163 Visits by Tuberculosis Officer to Homes 325 Total 4,715 (c) Visits by Tuberculosis Health Visitors. Number of visits to Homes 1,007 Artificial Pneumothorax. Induction of Artificial Pneumothorax was carried out in 5 cases. 1,244 refills were given to 76 patients during the year. X-ray Examination. During the year, 986 films were taken at New End Hospital. In addition, approximately 1,160 X-ray screenings have been carried out there by the Tuberculosis Officer. Dental Clinic. Eight patients have attended and the total attendance was 32. Dentures were supplied to one patient at a cost of £2 15s. 0d., the Council contributing the full amount. Financial Allowances for Tuberculosis Patients. The Ministry of Health scheme for the grant of maintenance allow¬ances 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. 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. 24 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 15,896 visits during the year, In addition the Health Visitors made 1,291 attendances at Clinics and Centres. 12 The Infant Welfare Centres open at the end of 1947 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-Regnier Tuesday 2—4.30 p.m. (Nursery Centre) — Miss Kuhn-Regnier Wednesday 1.30—4 p.m. Dr. Cryer Miss Kuhn-Regnier 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. Richards Mrs. Whaley Wednesday 1.30—4 p.m. Dr. Lewis Miss Leahy Thursday 1 30—4 p.m. Dr. Lewis Miss Thornton 230, Haverstock Hill, N.W.3 Monday 2—4.30 p.m. (Nursery Centre) — Miss Bushill Tuesday 1.30—4 p.m. Dr. Fletcher Miss Bushill Wednesday 2—4.30 p.m. (Nursery Centre) — Miss Bushill Thursday 1.30—4 p.m. — Miss Bushill Friday 2—4.30 p.m. (Social Club and Nursery Centre) Miss Bushill Total number of attendances at all Centres during the year :— (i) By children under 1 year of age 15,694 (ii) By children between the ages of 1 and 5 years 3,896 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 1,214 (ii) Between the ages of 1 and 5 years 119 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 1,088 (ii) Over 1 year of age 1,784 Ante-Natal and Post-Natal Clinics During 1947 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:— A nte-natal Post-natal Total Average patients patients attendances attendance 60, West End Lane 908 145 3,635 18 230, Haverstock Hill 516 21 1,663 16 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 1947 538 1,018 Number of children attending 29 56 Municipal Denial Clinic. During the year 306 mothers, 149 children and 8 T.B. patients attended the Dental Clinic, Lithos Road. 13 No. of Sessions Total attendances Average attendance Ordinary 87 Mothers 887 10 Children 401 5 Gas 15 Mothers 130 9 Children 42 3 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. 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 6s. 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 1947, 9 applications were received for reduction in charge, and all these applications were allowed. Maternity Homes and Hospitals. During the year, 17 Hampstead mothers were evacuated for confine¬ment under the Government Evacuation Scheme, and 334 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 1,416 Kilburn and West Hampstead Nursing Association 3,005 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. 14 The Committee appointed a Home Help Organiser to supervise this service, which increased considerably during the year, and at the end of 1947 there were 21 full-time and 11 part-time helps. 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, the maximum hourly charge being 2s. 6d. During the year, 257 Maternity cases and 312 Domestic cases have been assisted. Convalescent Homes for Children under Five Years. Arrangements are made through the Invalid Children's Aid Associa¬tion 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 1947, 32 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 1947 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, 20,358 packets of Proprietary Brand Dried Milk were sold at full cost. Other food and medicaments to total value of £634 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 1947, 172 applications were received and 498 Dockets issued, as compared with 542 Dockets issued to 197 applicants in 1946. Child Life Protection. During the year, 278 visits were paid by health visitors to fostermothers and foster-children in the Borough. On the 31st December, 1947, the number of foster-mothers on the register was 7 and the number of foster-children was 11. In addition the Eagle's Nest Foster Home, 33, Fitzjohns Avenue, can accommodate 28 children up to three years of 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 15 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. The following analysis of the premature births occurring in Hampstead in 1947 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) : 139. Premature births to Hampstead mothers (irrespective of place of birth):— (a) Born in hospital, etc., in Hampstead 37 (b) Born at home 12 93 (c) Born in hospital, etc., outside Hampstead 44 Of the 37 premature babies born in hospital, etc., in Hampstead, 7 died before discharge, and of the 12 born at home 2 died (at home) and of the 44 born outside Hampstead, 6 died before discharge. The seriousness of the problem of the Premature Birth will be appreciated when it is pointed out that of the 51 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 con¬tinues 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 co¬operation when any assistance can be given either to unmarried expectant mothers and/or illegitimate children. There are three Voluntary Associa¬tions operating in the Borough whose work during the year is analysed below :— (a) London Diocesan Council for Moral Welfare Work : There were 26 cases referred to this Body, 10 by the Borough Council and 16 from New End Hospital. These were dealt, with as follows :— Three returned to relatives, 1 went to friends, 3 went to Institutions (being unsuitable cases for Mother and Baby Homes), 19 were accommodated in Pre-natal Hostels. (b) Westminster Catholic Social Welfare Committee : 10 cases were referred to this Committee, of which 3 were repatriated to Ireland, 3 obtained situations with their babies, 1 returned to relatives, 2 babies were adopted and 1 was cared for by a foster mother. (c) Jewish Association for the Protection of Girls, Women and Children : One case was referred to this Association and was accommo¬dated in a Nursing Home. The child was adopted. 16 THE HISTORY OF THE VOLUNTARY INFANT WELFARE MOVEMENT. (Mrs. Grundy, M.B.E.) It was in 1906 that Mr. Hancock Nunn, Hon. Sec. of the Hampstead Health Committee, suggested the formation of a committee to organise the friendly visiting of mothers with infants on the east side of the Borough. Dr. McCleary, the M.O.H., was thoroughly in sympathy with the suggestion, and became a member of the Infant Welfare Com¬mittee, of which Dr. Collingwood Andrews was Chairman and Mrs. Phospher Mallam and Mrs. Grundy were hon. sees. Information of babies was obtained from Church Maternity Societies, District Visitors, Mothers' Meeting Superintendents, Public Health Departments, etc. Several doctors gave lectures to the visitors, who reported their cases at fortnightly meetings to Dr. McCleary or to Mrs. Fisher, the Lady Sanitary Inspector. In 1907, about 60 babies were on the visiting list. In 1908 the first Mothers' Welcome for weighing infants was opened at the Provident Dispensary in New End. The Lady Inspector was in charge with a voluntary helper. Also in this year a Visitors' Committee was formed for the area west of Finchley Road and a Mothers' Welcome opened at the Hemstal Road Creche. In 1913 the East and West Committees combined under the chairman¬ship of Dr. Claude Taylor, and the babies were still visited by voluntary visitors. In 1914, a Medical Officer attended the Welcomes and the supervision of children up to five years was undertaken whose record cards were passed on to the School Medical Officer; the East Hampstead Welcome was moved to Lyndhurst Hall, Rosslyn Hill. In 1916, Welcomes were opened at the Wesleyan Church Hall, Lisburne Road, and at the Friends' Meeting House, Heath Street, in place of the one at Lyndhurst Hall. Another was opened at the Health Institute, Kilburn—making four Welcomes or Centres in all. The Health Visitor—Mrs. Roche, paid the first visit to the home and, where needed, this was followed up by a Voluntary Visitor, until the child was three years old. It was considered desirable to extend the educational scale of the Welfare Work and Miss Atherton was appointed as Educational Organiser for the Centres. She soon started Home Makers' Guilds, with lectures and classes, clothes stalls, savings banks, milk sales, at all the Centres. In 1920, a Centre was opened in the Belsize district at New College Chapel, Swiss Cottage. This was later moved to St. Paul's Church Hall, Avenue Road. A system of Mothers' Helps was organised for all the Centres. In 1921, the Maternity and Child Welfare Committee appointed Health Visitors, and visits paid by Voluntary Visitors were discontinued. In 1923 Dr. Claude Taylor resigned the chairmanship of the Infant Welfare Committee ; Mrs. Grundy was elected as Chairman and Miss Macdonald as Vice-Chairman. In 1928 the Kilburn Centre held at the Health Institute was overcrowded and it was also realised that only a few of the mothers from Netherwood Street and Palmerston Road, the poorest streets in the 17 neighbourhood, came to the Clinic, so a Branch Centre was opened in St. James' Mission Hall, Netherwood Street, which soon became popular with the mothers in that district. Later, in 1933, this Branch moved to better premises in the Health Institute. Toddlers Clinics were started at the Health Institute in 1931. They were only held every two months, but this increased by 1933 to weekly Clinics. In 1939, at the threat of war, the Clinics closed down on the 1st September, but the Health Institute opened again on the 12th September. Owing to a serious drop in income caused by the war, the Infant Welfare Committee resolved that it could not take any financial responsi¬bility for the Centres after the 31st October, but would willingly continue to assist in the work. The Infant Welfare Committee was dissolved and the Voluntary Helpers Committee for Infant Welfare was formed, with Mrs. Grundy as Chairman, Miss Forsyth as Vice-Chairman, and Mrs. Watson Shields as Hon. Secretary and Treasurer. SANITARY ADMINISTRATION. On the whole, despite the stress and strain of the abnormal conditions prevailing throughout the year, I think it may be fairly stated that there has been steady progress in the field of environmental sanitation. There has undoubtedly been a heavy increase in the work of your Sanitary Inspectors, particularly with regard to the maintenance repairs of houses. This alone has resulted in the service of 2,844 Intimation Notices, a figure which almost trebles the number of such Notices served during the pre-war years. The condition of bombed sites and water tanks with the constantly recurring nuisances arising thereon has caused much concern. Organic refuse is being removed from these sites almost daily by the Borough Engineer's staff and this Department is likewise dealing with any rat infestations which arise. The National Fire Service has also been most co-operative in pumping out water from the E.W.S. tanks, on request. Despite these efforts, the problem which is common throughout the Metropolitan area, continues to be an urgent one and representation has been made to the Metropolitan Boroughs Standing Joint Committee thereon. Food and drink infections and the inspection and supervision of food supplies, continue to receive close attention. The problems of rodent control and vermin are being actively combated, and it is pleasing to record the successful results being achieved by the use of D.D.T. preparations in the eradication of vermin pests. Staff.—Mr. Thomas H. Marshall was appointed a District Sanitary Inspector and commenced duty in September, 1947. The duties of Miss C. G. Lambe, Lady Sanitary Inspector, who formerly devoted 40 per cent, of her time to Maternity and Child Welfare work, have been revised so that she is now engaged full time on enquiries into rehousing applications and infectious diseases. In November, 1947, the question of the adequacy of the number of Sanitary Officers in the Department was considered by the Public Health Committee. It was pointed out that despite the increases in duties and responsibilities placed upon Sanitary Inspectors by new legislation and otherwise, the present inspectoral staff of ten was only two more than 18 in 1914. However, in view of the unprecedented difficulties existing, principally in connection with Licensing and shortage of building materials, it was felt that an additional appointment would result merely in an increase in the number of applications for licences which could not be met. The Committee therefore, recommended that the question of an additional appointment be deferred. 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 8,164 (2) Total number of re-inspections and other visits and revisits 14,117 (3) Number of inspections (recorded in (1) above) in respect of:— (a) Dwelling-houses for housing defects :— (i) Non-tenement houses 1,835 (ii) Tenement houses 762 (b) Factories, excluding bakehouses 190 (c) Infestation Order, 1943 (excluding revisits) 547 (d) Food premises (i) Bakehouses 156 (ii) Milk premises 162 (iii) Restaurants and eating houses 325 (iv) Other food premises 543 1186 (e) Shops (under Shops Act, 1934) 214 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 ; voluntary drainage works, etc. The total number of complaints received was 2,053, of which 499 referred to rat infestation. 2,844 informal notices (i.e., intimations) relating to 2,457 premises and 1,082 statutory notices relating to 884 premises were served during the year. Legal Proceedings. In thirty-two cases of default of compliance with Statutory Notices it was found necessary to prepare evidence for submission to the Town Clerk for the institution of legal proceedings. The number of Summonses actually issued was twenty, resulting in Abatement Orders being obtained. Fines totalling £28 0s. 0d. were imposed and costs amounting to £25 5s. 6d. allowed. Twelve Summonses for breaches of the L.C.C. Drainage Bye-Laws resulted in Fines totalling £20 0s. 0d. and costs of £10 8s. 0d. Housing. 1. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,597 2. Number of dwelling-houses (included in (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 20 19 3. Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 9 4. Number of dwelling-houses found not to be in all respects fit for human habitation 2,160 The Provision of Housing Accommodation. From 1st January, 1941, to 1st January, 1948, the Council have found accommodation for 1,713 families, comprising 5,671 persons. 893 of these families (2,995 persons) were found accommodation during the past two years. 80 per cent. of the families rehoused during 1947 were those of ex-service men. The Council itself provides accommodation in the following ways :— (a) The repair of war-damaged property. (b) The requisitioning and adaptation of vacant properties. (c) The erection of prefabricated bungalows. (d) The construction of new permanent dwellings. The Council also encourages, so far as possible, the provision by others of additional housing accommodation :— (e) By issuing licences to private owners to reconstruct large houses for multi-family occupation. Licences have been granted for the provision of 821 flats in this way. In many instances the owners have agreed to the Council nominating tenants for some of the flats. War Damage. From 1st April, 1945, 4,502 war-damaged premises have been repaired by the Council. 281 of these were severely damaged and required substantial repairs and works of reinstatement. Many of the individual properties are now occupied by several families. The total cost of war damage repairs carried out by the Council has been £1,094,750. Requisitioning. The Council now holds under requisition 515 large houses and flats in the Borough. Of these, 424 have been converted into flats and are occupied by 1,233 families, whilst the remaining 91 premises are being repaired and adapted to provide additional accommodation for some 363 families. Prefabricated Bungalows. On a site suitable for this type of dwelling, 80 " Prefabs " have been erected and occupied. New Housing Estates. Garnett House, a block of 22 flats, has been completed and occupied. The following schemes for new blocks of flats are now in hand:— New End 24 flats. Building works well advanced. Parkhill Road 92 flats. Building works well in progress. 20 Well Walk 64 flats. Construction to be commenced soon. King Henry's Road 102 flats. Builders' tenders to be obtained soon. Kilburn Priory 94 flats. Builders' tenders to be obtained soon. Broadhurst Gardens 168 flats. Use of site approved. Plans in preparation. West End Lane 80 flats. Use of site approved. Plans in preparation. Shoot-up-Hill 110 flats (approx.). Site to be purchased subject to Minister of Health's approval. The Council are considering further sites for housing development. All new blocks of flats are being carefully planned and adequate provision is being made for playrooms, workshops, laundries and open spaces, etc. On the Well Walk site, Burgh House, a building of historical and architectural interest, is being preserved for cultural purposes. Old People. The Council have in mind the special needs of old people and intend to make special provision for them in the new housing schemes. The Council are not empowered to manage hostels, but encouragement and financial assistance have been given to a voluntary body, the Hampstead Old People's Housing Trust Ltd., who have provided a hostel for 26 old people in Eton Avenue. Hutted Camps. The camp on Hampstead Heath adjoining East Heath Road has now been demolished, but eleven families are still living in the Primrose Hill and Lawn Road huts. Main water, sanitation and refuse storage and collection have been provided by the Council, and the Sanitary Inspectors keep these camps under constant observation. Factories Act, 1937. Owing to pressure of other work it is still not possible to carry out a systematic inspection of all the factories in the Borough. There has been a considerable reduction in the number of complaints received from the public with regard to nuisances caused by excessive noise, dust and fumes and night work. This is due to the transference to non-residential areas of factory processes causing such annoyances and these removals have only been effected after constant pressure by the Department. Every complaint is investigated forthwith and appropriate action taken, wherever possible, in conjunction with the Town Planning Department of the L.C.C. The under mentioned table gives details of Factories inspected and defects found during the year. These inspections are made primarily as a result of complaints made by H.M. Inspector of Factories. 21 Premises. Inspections. Reinspections. Notices served. Factories with mechanical power (excluding bakehouses) 102 153 47 Factories without mechanical power (excluding bakehouses) 88 73 30 Outworkers premises 30 5 — Defects found, No. Referred to H.M. Inspector. Defects remedied. Want of cleanliness 37 7 30 Unreasonable temperature 3 1 2 Inadequate ventilation 8 2 6 Overcrowding — — — Defective floors or insufficient drainage of floors 14 4 10 Washing facilities 13 — 9 Sanitary accommodation (a) Insufficient 13 — 11 (b) Unsuitable or defective 10 — 9 (c) Not separate for sexes 7 — 5 Other offences 36 — 25 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. No major infestation of premises was reported during the year, but minor infestations, particularly in the vicinity of Hampstead Heath and the Railway land and tunnels, continue to be a source of trouble requiring constant action. The number of complaints relating to rats and mice infestation again shows a reduction—499 as compared with 668 for last year and 804 during 1945. Systematic poisoning of the sewers was again undertaken and the two treatments accounted (vide the Ministry of Food formula) for the destruction of 4,310 rats. Water Supply. There is now no well in the Borough from which drinking water is supplied. The supply provided by the Metropolitan Water Board has been satisfactory. 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. % 22 I am grateful for the continued co operation of the Ministry of Food and 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 Art, 1938, lays down specific require¬ments 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. 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 eighteen, or 3.6 per cent. Particulars of the adultered samples are as follows :— Articles of Food. How adulterated. No. 26 Concentrated Artificial Vinegar Contains excessive Acetic Acid, 70 per cent. No. 29 Milk (informal) Defective in Milk fat—13 per cent. No. 37 Gelatine Contains high percentage of copper— 50 parts per million. No. 48 No. 59 Coffee and Chicory (informal) Contains only 1.2 per cent, caffeine. No. 65 Gelatine Contains excessive proportion of Ash, Copper and Arsenic. No. 72 Self-raising flour Deficient in Carbon dioxide. No. 77 Salt Anchovies Contains high percentage of lead—12 parts per million. No. 92 Rum and Orange Does not comply with Food Labelling Order. No. 93 Jubilee Wine Cocktail „ ,, „ No. 125 Curry Powder Poor sample. Contains high percentage of bean flour (15 per cent.) and 14 parts per million lead. No. 158 Mixed Spice Contains small live beetles. No. 195 Margarine Contains 0.2 per cent. above the legal standard of water. No. 317 Starch Reduced Flour Does not comply with the Food Labelling Order. No. 318 Ginger Wine Concentrate ,, ,, „ No. 335 Primix Salad Dressing „ „ „ No. 339 Cocktail Tonic „ ,, „ No 438 Frying Oil This is a vegetable oil containing 6 per cent. paraffin. All the above offences were dealt with by means of warnings to retailers and/or wholesalers and manufacturers, and where necessary the attention of the Ministry of Food was drawn to the infringements of the Labelling of Food Orders. It is very gratifying to note that although the activities of the Inspectors have ranged over a wide field, the results on the whole can be classed as satisfactory. Another noteworthy and pleasing factor is that this is almost the first year in which it has not been found necessary to institute legal proceedings in respect of the fraudulent adulteration of samples. 23 Dr. Cox, the Public Analyst, commented on the chemical composition of the ice cream samples he analysed. The fat content varied from the quite good figure of 11 per cent. in one case down to " traces of fat " in several samples. These latter cannot properly be called cream, but in the absence of a legal standard for this increasingly popular commodity, further action was not taken. Bacteriological Examination of Foodstuffs, During the year, 62 samples of food were examined bacteriologically, as follows :— Milk (Cert.) 2 Milk (Past.) 28 Milk (Ungraded) 2 Ice Cream 20 Custard Powder 1 Dried Milk 1 Egg Powder 1 Liver Sausage Sandwich 2 Dutch Mussels 1 Chocolate Dragees 1 Bottled Beans 1 Herring Paste 2 Also examined were :— 9 Samples of Swimming Bath Water. 1 Milk Bottle 1 Jar In connection 1 Wiping Cloth with food 2 Faeces poisoning enquiries. 1 Washing Powder 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 significance 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 Ice Creams were also submitted to the Methylene Blue Test. Nine samples were Grade 1, one Grade 2, two Grade 3 and eight Grade 4 (the worst). The attention of the Vendors and also of the Medical Officers of Health of the districts from which they came, was drawn to the unsatis¬factory samples. An itinerant vendor of ice cream was summonsed for not having his his name and address inscribed on his vehicle in accordance with Section 16 of the Food and Drugs Act, 1938. A fine of 10s. was imposed by the Bench. The samples of water taken from the Central Swimming Baths were of uniform excellence from a bacteriological point of view. 2566 P.H. 200 8/48 (7258) Printed by Harrison and sons, ltd., st. martin's lane, London