HAMP 49 Metropolitan Borough of Hampstead. Abridged Report on the Health of the Borough. 1948. H. LESLIE OLDERSHAW, m.d. State Medicine (Lond.), b.s., d.p.h., Medical Officer of Health (7609) 3 COMMITTEES CONCERNED WITH THE WORK OF THE DEPARTMENT. His Worship the Mayor (Mr. Councillor O. P. Milne, F.R.I.B.A., J.P.), ex-officio member of Committees. Public Health Committee Chairman : Mr. Alderman S. A. Boyd, M.S., F.R.C.S., J.P. Councillor Miss D. R. Bailey. Mr. Councillor G. Mihill. Mr. Councillor F. R. Bailey. ,, ,, S. B. Morgan. ,, ,, L .H. H. G. Baldwin. Councillor Miss D. Reeve-Flaxman. ,, ,, C. A. B. Borrett. Mr. Councillor B. West. Councillor Mrs. S. M. Dennys. „ ,, A. W. Yeoman. Mr. Councillor A. W. J. Greenwood. The Chairmen of the Maternity and Child Welfare Committee and the Housing Committee. Sub-Committees :—(a) Drainage Plans, and (b) Tuberculosis. Maternity and Child Welfare Committee (Members of the Council) Chairman : Alderman Mrs. R. S. G. Carnegie. Alderman Mrs. F. E. Cayford, J.P., L.C.C. Councillor Miss D. R. Bailey. Councillor Miss D. Newman. ,, Mrs. J. Browne. ,, Mrs. D. Page. ,, Mrs. T. C. Burke. ,, Miss D. Reeve-Flaxman. ,, Mrs. M. F. Dow, M.A. ,, Mrs. C. L. Sadler. The Chairman of the Public Health Committee. (Persons not Members of the Council) (Appointed in pursuance of Section 2 (2) of the Maternity and Child Welfare Act, 1918.) Miss M. E. Drew, M.B., Ch.B., M.R.C.S., L.R.C.P., Mrs. K. Ford, Mrs. J. Gordon, Mrs. E. S. Grundy, M.B.E., Mrs. F. Krusin. Sub-Committees :—(a) Applications for Assistance, and (b) Medical Advisory Committee re Infant and Maternal Deaths. Staff of the Public Health Department Medical Officer of Health : H. Leslie Oldershaw, M.D. State Medicine (Lond.), B.S., M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Appointed to L.C.C. as from 5th July.) Deputy Medical Officer of Health : H. Davis Chalke, O.B.E., T.D., M.A. (Cantab.), M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. (Appointed to L.C.C. from 1st May.) J. Gastrell Lewis, MB., Ch.B., D.P.H. (from 1st May.) Assistant Medical Officer for Maternity and Child Welfare : *J. Gastrell Lewis, M.B., Ch.B., D.P.H. (7609) a 2 4 Medical Officers, Maternity and Child Welfare Centres : *A. D. Burns, M.B., *M. E. Cryer, M.D., Ch.B., *N. MacRae, M.B., Ch.B., D.P.H. *M. D. Fletcher, M.R.C.S. (Eng.), L.R.C.P. (Lond.). Sanitary Inspectors: J. F. Armstrong (f), (g). (Chief Sanitary Inspector.) A. C. Townsend (f), (g) (deceased 14th July, 1948). W. Robinson (f), (g). Miss C. Lambe (a), (b), (d), (f). F. V. Outlaw(f), (g). L. E. Trigg (f), (g). W. F. Newport (f), (g). R. Staples (f), (g). D. W. Malcolm (f). T. H. Marshall (f), (g). G. L. Nicklin (f). Clerical Staff'. R. H. Box, Cert. Soc. of Apoths. (Chief Clerk and Vaccination Officer. Appointed to L.C.C. 5th July, 1948.) A. H. C. Slade (Chief Clerk from 5th July, 1948). A. J. Anscomb (Tuberculosis Records Clerk). R. Johnson (Sanitary Records Clerk). G. W. Bedell (Infectious Disease Clerk from 5th July, 1948). F. E. Jackson (from 5th July). G. Young (from 30th August, 1948). Miss M. Stokes (Resigned 20th August, 1948). Mrs. M. B. M. Familton (Senior Shorthand Typist. Resigned 4th September, 1948). Mrs. M. C. Rabin (Senior Shorthand Typist from 28th September 1948). Mrs. C. D. Matthews (Senior Shorthand Typist. Resigned 30th April, 1948). Miss E. Selwood (Senior Clerk M. & C. W. Resigned 10th January, 1948). *Miss A. Calver (Senior Clerk M. & C. W. from 10th January, 1948). *Miss P. Hart. Mss B. E. Brennan. *Mrs. D. Shipham (Home Help Organiser). Miss M. Pritchard. *Mrs. N. Court (Senior Shorthand Typist from 30th April, 1948). Health Visitors: Miss E. Beattie (a), (b\ (d) (Senior Visitor. Appointed to L.C.C. 1st May, 1948). Miss E. M. Leahy (a), (b), (d). *Mrs. E. D. Whaley (a), (b), (e). *Miss K. R. Thornton (a), (b) (e). *Miss J. H. Bushill (a), (b), (e). *Miss W. L. Clark (a), (b), (e) (from 5th May, 1948). *Mrs. J. Foulkes (a), (b), (d) (from 1st June, 1948). *Miss F. M. Robson (a), (b), (d). *Miss M. Lowen (b) (Tuberculosis Visitor and Dispensary Nurse). *Miss M. Talbot Kelly (Tuberculosis Welfare Officer). 5 Public Analyst: H. E. Cox, D.Sc., Ph.D. (Lond.), F.I.C., 10, Billiter Square, E.C.3. Dentist, Municipal Dental Clinic : *Roy M. Hastings, L.D.S., R.C.S. (Eng.). (a) Health Visitor's Certificate. (b)State Registered Nurse. (c) General Nursing Certificate. (d) State Certified Midwife. (e) Central Mid wives Board, Part 1. (f) Sanitary Inspector's Certificate. (g) Food Inspector's Certificate. * Transferred to L.C.C. on 5th July, 1948. 6 STATISTICS AND SOCIAL CONDITIONS. Area (acres) 2,265 Population 95,480 Rateable Value, March, 1948 £1,617,098 Sum produced by 1d. rate £6,410 BIRTHS. Live Births. Total. Males. Females.  Legitimate 1,389 719 670 Illegitimate 111 52 59 1,500 771 729 Birth rate per 1,000 of the estimated resident population (Rate for London: 20.1) 15.7 Number of Stillbirths 30 Rate of Stillbirths per 1,000 (live and still) births 20 DEATHS. Net deaths (males, 472; females, 507) 979 Death rate per 1,000 of the estimated resident population (Rate for London: 11.6) 10.3 Deaths from maternal causes (·7 per 1,000 births) 1 Deaths of infants under 1 year (males, 25; females, 18) 43 Infants under 1 year: Infantile Mortality Rate All infants per 1,000 live births 29 Legitimate infants per 1,000 legitimate live births 23 Illegitimate infants per 1,000 illegitimate live births 99 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 271 20. Other diseases of circulatory system 58 2. Cerebro-spinal fever — 3. Scarlet fever — 21. Bronchitis 32 4. Whooping cough 1 22. Pneumonia 27 5. Diphtheria — 23. Other respiratory diseases 6 6. Tuberculosis of the respiratory system 37 24. Ulcer of stomach or duodenum 11 7. Other forms of tuberculosis 1 25. Diarrhœa (under 2 years) 3 8. Syphilitic diseases 8 26. Appendicitis 1 9. Influenza 1 27. Other digestive diseases 23 10. Measles — 28. Nephritis 23 11. Acute poliomyelitis and polioencephalitis - 29. Puerperal and post-abortive sepsis 1 12. Acute infective encephalitis — 30. Other maternal causes — 13. Cancer of buccal cavity and œsophagus (m) uterus (f) 19 191 31. Premature birth 9 32. Congenital malformations, birth injuries, infantile diseases 23 14. Cancer of stomach and duodenum 21 33. Suicide 26 15. Cancer of breast 25 34. Road traffic accidents 5 16. Cancer of all other sites 126 35. Other violent causes 38 17. Diabetes 8 36. All other causes 62 18. Intra cranial vascular lesions 113 Total 979 Public Mortuary, New End. During the year 206 bodies were brought to the mortuary, 17 by the Police and 179 by order of the Coroner. 205 post-mortem examinations were made. 7 Infectious Disease during 1948 Notifications Removals to Hospitals Deaths  Cerebro-Spinal Fever 1 1 - Diphtheria 3 3 — Dysentery 41 8 — Erysipelas 8 2 — Malaria 2 — — Measles 577 33 — Ophthalmia Neonatorum 2 1 — Pneumonia 53 15 1 Poliomyelitis 4 3 — Puerperal Pyrexia 12 11 — Scabies 36 — — Scarlet Fever 85 33 — Typhoid Fever 1 1 — Whooping Cough 256 15 1 Total 1,081 126 2 Cancelled cases have not been included. Smallpox No case of smallpox occurred in the Borough during 1948. Dysentery During 1948 there were two outbreaks of Sonne dysentery in the Hampstead Day Nurseries. The one in Parkhill Road day nursery was small, and only four positive cases were found; the other in Woodchurch Road day nursery was more extensive, and involved 37 suspected children, 20 of whom were found to have Sonne dysentery. The outbreak at Parkhill Road was small, and readily responded to appropriate measures, i.e., exclusion of the positive cases (one staff and three children), and swabbing of all suspects. The first case at Woodchurch Road occurred on 5th July, 1948, when a child was found to be suffering from diarrhoea and vomiting. A swab was taken on that date and was returned negative. The child was re-admitted to the nursery, certified fit, on 12th July, 1948. A second swab, as a precautionary measure, was taken on that date and was returned positive for Sonne dysentery, and the child was then immediately excluded. During this week, 7 other children developed similar symptoms, and swabs showed positive Sonne dysentery. Swabs were then taken from all staff and children attending the nursery. However, during the week commencing 19th July, another 8 children developed dysentery. At the end of this week, the epidemic began to abate, and during the week commencing 26th July, only three new cases occurred. Fourteen other children who had loose motions had repeated negative swabs, and did not develop dysentery. A rigid technique was imposed on the nursery, and implicit instructions on hand washing were given to all members of nursery and kitchen staff. None of the nursing or domestic staff had any symptoms or any positive swabs. All cases where a positive swab was obtained were excluded from the nursery until three consecutive negative swabs at weekly intervals were obtained. (7609) a3 8 In all, 200 bacteriological examinations were made, and the last affected child returned to the nursery on the 11th October. This outbreak would indicate: 1. The importance of keeping constant watch on the children in day nurseries to exclude any infection, and that loose motions in all cases should be investigated. 2. That one negative swab cannot be regarded as a final diagnosis of freedom from infection. 3. That a constant high standard of cleanliness is essential for all staff who are handling the children or the foodstuffs, and that this high standard of cleanliness is dependent on adequate washing facilities. Diphtheria Immunisation. During the first half of the year free immunisation against diphtheria was obtainable:— (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, was made available to medical practitioners who received 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, were obtainable through a private doctor, or at the Borough Council clinics. The estimated percentages of children immunised up to 4th July, 1948, are :—Under 5 years, 59 per cent.; of school age, 81 per cent. The total number of children immunised since free immunisation was commenced in the Borough in mid-1933 is 8,570. 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 1 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 1948 (half year) 592 Nil Nil 9 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. Immunised during 1948 (half year). Total immunised at 4.7.48.  1934 — 273 1935 — 298 1936 1 308 1937 4 331 1938 5 349 1939 5 352 1940 10 392 1941 6 496 1942 8 546 1943 4 433 1944 5 642 1945 17 727 1946 124 791 1947 403 429 1948 (half year) — — 592 6,367 On the 5th July the administration of this service passed to the London County Council. Vaccination 1,044 Certificates of successful primary vaccination were received up to 4th July, 1948, and of the 1,488 births registered during the first half of 1947,51 per cent. had been successfully vaccinated at 4th July, 1948. On the 5th July the administration of this service passed to the London County Council. Insulin Under Section 227 of the Public Health (London) Act, 1936, foul patients received assistance up to the 5th July, 1948. The cost to the Borough Council was £13 17s. 1d. Bacteriological Examinations The following examinations were carried out :—Diphtheria, 107 ; Scarlet Fever (for Haem. Strep.), 23; Sputum for T.B., 456; Vincents Angina, 8 ; Typhoid, 2 ; Dysentery, 249; Food Poisoning, 6. These services were carried out by the Laboratories of Pathology and Public Health, 6, Harley Street, W.l. The basis of payment is a comprehensive fee of £2 10s. Od. per 1,000 inhabitants of the Borough per annum. Food Poisoning Twelve 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 and appropriate action taken. (7609) a 4 10 Disinfection and Disinfestation The following is a record of the work carried out by the Disinfecting Staff during 1948 :— Number of houses or parts of houses and contents disinfected 724 Number of verminous rooms disinfested 291 Aged and Infirm Persons No case arose which necessitated the use of powers under the Public Health (London) Act, 1936, or the National Assistance Act, 1948, to secure the removal of an aged or infirm person. Cleansing and Disinfection of Verminous Persons and their Belongings The following cleansings and medicinal baths were carried out at the Borough Council Cleansing Centre, during the year, where 45 adults and 28 children received treatment :— Verminous conditions :— Adults 15 Children under 5 8 Children over 5 7 Scabies :— Adults 90 Children under 5 15 Children over 5 9 During the year, 291 verminous rooms in 142 houses were cleansed and freed from vermin. Thirty-six 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. During the year, the following treatments were carried out at the Centre by staff of the London County Council:— Verminous conditions :— No. of school children treated 54 No. of treatments given 79 No. of pre-school children treated No. of treatments given Scabies :— No. of school children treated 9 No. of treatments given 27 No. of pre-school children treated 3 No. of treatments given 9 The Scabies Order, 1941, which was introduced as a war-time measure, expired on 31st December, 1947, and reliance is now placed on the Public Health (London) Act, 1936, for dealing with verminous conditions. Since the war, however, there has been a great decrease in the number of cases notified, i.e., 1945 196 1946 197 1947 88 1948 36 and no difficulty has been experienced in the treatment and investigation of cases. 11 National Assistance Act, 1948 Section 50 of this Act imposed on the Borough Council, as from 5th July, 1948, the duty to arrange for the burial or cremation of persons in cases where no private funeral arrangements were being made. This work was formerly carried out by the L.C.C. and the Borough Council made temporary arrangements to continue in force the L.C.C. contracts with two firms of undertakers for the carrying out of funerals in the Borough. The costs of funerals vary in accordance with the age of the deceased, the maximum cost for the interment of an adult in a Third Division grave being £9 Is. 6d. Interments are carried out at the Hampstead Cemetery, Fortune Green Road, N.W.6. Provision is made in the Act for the recovery of the cost of the funeral, where possible, from the estate of the deceased or from certain liable relatives. Up to the 31st December, 1948, seven funerals had been carried out at a total cost of £45 8s. 6d., of which £21 15s. Ojd. had been recovered. Sanitary Administration I am pleased to report that steady progress has been maintained in this section of the Department's activities. The following important public health functions are the responsibility of the Local Authority, and receive the close attention of your Sanitary Officers :— General. Disinfestation. Drainage. Factories. Houses let in Lodgings. Nuisances. Offensive Trades. Pharmacy and Poisons Registration. Rag Flock Regulations. Rats and Mice Destruction. Shops Act Inspection. Smoke Abatement. Food and Drugs. Bakehouses. Butter and Margarine Premises. Chemical Analysis and Bacteriological Examination of Food. Food Adulteration and Labelling. Fried Fish Vendors and Fish Curers. Horseflesh Premises. Ice Cream Makers and Vendors. Inspection and Condemnation of Unsound Food. Meat Regulations. Preserved Food Manufacturers. Restaurants. Housing. Inspections of Individual Properties. Overcrowding. Surveys of Areas. Underground Rooms. 12 Housing—Works of Maintenance and Repair Early in the year I reported to the Public Health Committee that " the cumulative effect of war damage, the lack of elementary maintenance work during and after the war years, the difficulties of obtaining building labour and materials, and high costs generally, had resulted in a large amount of deterioration and dilapidations in dwelling houses in the Borough I stressed also the additional complication, particularly in the Adelaide and Priory Wards, of large numbers of dilapidated premises where the leases had either expired or had only very few years to run. The improved supply of building labour and materials, coupled with the removal or relaxation of many building licence controls or restrictions, materially offset some of these difficulties and in consequence, there was a very considerable increase in the amount of repairs carried out to remedy urgent disrepair of dwelling houses. The urgent need of new homes obviously overshadows the problem of the many unfit, lease-expired, basement dwellings in the Borough; nevertheless, the condition of such premises is a cause of increasing concern from the health point of view. Staff It is with great regret I have to report the death of Mr. A. C. Townsend, a highly esteemed and respected Sanitary Inspector in the Department for nearly 40 years. Mr. G. Lewis Nicklin was appointed as Sanitary Inspector and commenced duty on 13th December, 1948. Flooding by Storm Water On the evening of May 11th, 1948, following a heavy rainstorm, areas of the Borough were again flooded. The basement dwellings in Sumatra Road, Maygrove Road, Iverson Road, Netherwood Street, Palmerston Road, Kingsgate Road, Goldhurst Terrace, Belsize Road, Fleet Road, and the basements of shops in Kilburn High Road were all affected. The depth of flooding varied from a few inches to approximately 3 ft. In the majority of cases the immediate cause was a surcharge of the sewers, but in many premises surface flooding was responsible. Relief measures were immediately organised—supplies of wood, coal, soap and disinfectant were issued to all the affected families and the Borough Engineer's and Public Health Department's staffs assisted in cleaning out and disinfecting the basements. I am indebted to the Borough Engineer for the following information as to sewer relief works carried out during the year and completed early in 1949, at an approximate cost of £33,500 :— Portion of Palmerston Road sewer relaid. Enlargement or supplementation of Netherwood Street sewer. New Honeybourne Road sewer. Enlargement of Lymington Road sewer. New relief sewer across railway and other property. Enlarging sewer in Goldhurst Terrace. The effect of these works will be to secure a more equable distribution of storm water throughout the sewers of the Borough which will reduce the risk of flooding in the present danger areas. It is, nevertheless, emphasised by the Borough Engineer that these works cannot be regarded as a remedy for all flooding. 13 On the instructions of the Housing Committee, action was also taken under Section 12 of the Housing Act, 1936, to deal with the more severely flooded basements. Closing Orders were made, or Undertakings not to relet the basements for human habitation, accepted, from the owners of the following premises:— 51 and 61, Fleet Road (Closing Orders). 127, Sumatra Road (Closing Order). 131a, Sumatra Road (Undertaking). 34, 36, 38, Netherwood Street (Closing Orders). 48, Netherwood Street (Undertaking). 78, Loveridge Road (Undertaking). Except in the case of 127, Sumatra Road, where the family was rehoused by the London County Council, all the tenants will be rehoused by the Council. Steps to secure the gradual closing of the worst flooded basements continue. Sanitary Inspection The following summarises the inspections carried out by the Sanitary Officers during the year :— Total complaints received 2,590 Public Health (London) Act, 1936. Premises inspected on complaint 2,590 Premises inspected after infectious disease 127 Special visits and re-inspections 12,843 Smoke observations 8 Noise nuisances 5 Housing Act, 1936. Overcrowding Regulations 375 Rehousing. Applications investigated 1,214 Drainage. Plans and applications received (excluding structural conversions and new buildings which are dealt with by the Borough Engineer). (a) Under Notice 50 (b) Voluntary 205 Food premises:— (i) Bakehouses 111 (ii) Milk premises 151 (iii) Restaurants and eating houses 416 (iv) Other food premises 424 1,102 Shops Act. Inspections 110 Pharmacy and Poisons Act Inspections 87 Notices. Intimation Notices served 2,701 Statutory Notices served 907 14 Legal Proceedings Nuisances.—Eighty-nine outstanding Statutory Notices were referred to the Town Clerk and Solicitor of the Council for legal action. In the great majority of these cases a warning letter from the Town Clerk had a sufficiently salutary effect, and the Notices were subsequently complied with. The number of summonses issued during the year for various nuisances under the Public Health (London) Act, 1936, totalled 18. Again, the receipt of the Summons was a sufficient spur for the necessary works to be executed and 14 Summonses were withdrawn. Four Abatement Orders were obtained and £5 5s. Od. costs awarded to the Council. In 2 cases where Abatement Orders had not been complied with the work was executed by the Council at a total cost of £100 14s. 0d., which is being recovered from the Owners by instalments. L.C.C. Drainage By-Laws. Eleven Summonses were issued for infringements of these By-Laws. £8 0s. Od. fines were imposed and £4 4s. Od. costs awarded to the Council and the drainage works were made to comply with the By-Laws. Food and Drugs Act, 1938. One Summons for selling ice cream from a stall not bearing the dealer's name and address was proved and the Defendant fined £1 0s. 0d. One Summons was proved for selling ice cream over 28° F. and the Defendant fined £2 0s. 0d. One Summons for failing to protect ice cream from dirt and dust was dismissed. A similar summons was proved and the Defendant fined £5 0s. 0d. One Summons in respect of adulterated Epsom salts was dismissed under the Probation of Offenders Act on payment of £3 3s. Od. costs. Two Summonses were issued under the Defence (Sale of Food) Regulations, 1943, for a label falsely describing food and giving a misleading label as to the nature and substance of the food. Defendants fined £15 and £10 10s. Od. costs. (Olive oil substitute consisting of 99.5 per cent, liquid paraffin.) Increase of Rent and Mortgage Interest (Restrictions) Acts No certificate was issued during the year. Housing (1) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2,590 (2) Number of dwelling-houses (included in (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 10 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (4) Number of dwelling-houses found not to be in all respects fit for human habitation 1,820 Action under statutory powers during the year. (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936 :— (i) Dwelling-houses in respect of which notices were served requiring repairs 1 15 (ii) Dwelling-houses which were rendered fit after service of formal notices 1 (Work completed early in 1949 at a cost of £1,166 19s. 0d.) (b) Proceedings under Public Health Acts :— (i) Dwelling-houses in respect of which notices were served requiring defects to be remedied 1,820 (ii) Dwelling-houses in which defects were remedied after service of formal notices :— (a) by owners 1,818 (b) by local authority in default of owners 2 (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:— (i) Dwelling-houses in respect of which demolition orders were made NIL (ii) Dwelling-houses demolished in pursuance of demolition orders NIL (d) Proceedings under Section 12 of the Housing Act, 1936:— (i) Separate tenements or underground rooms in respect of which closing orders were made 11 (ii) Separate tenements or underground rooms in respect of which closing orders were determined the tenements or rooms having been rendered fit nil The Provision of Housing Accommodation. During the year, no less than 1,214 housing applications were referred to my department for a Sanitary Inspector's report as to the urgency of the case. These reports were supplied not only to our own Housing Estates Department but also to the London County Council and other Local Authorities, from whom enquiries were received. A large number of housing applicants base their claims primarily on insanitary conditions, and appropriate action is taken by the service of sanitary notices where the complaints are well founded. The Housing Estates Manager of the Council has supplied me with the following information :— (a) Total number of families rehoused by the Council from 1st January, 1941, to 31st December, 1948 2,161 (b) Total number of families housed during 1948 418 (c) Number of prefabricated dwellings 80 (id) Hutted camps.—I am glad to be able to report that at the end of 1948 there were only two families in occupation of the hutments at Primrose Hill and steps were in active progress to ensure the early demolition of this camp. Three families were still in occupation of the hutments at Lawn Road. (e) Requisitioned Properties.—The Council hold 511 properties, comprising 1,606 dwellings under requisition. 17 properties comprising 68 dwellings are in the process of conversion. During 1948, 305 extra dwellings were provided in requisitioned properties. 16 (f) New Housing Estates. New End. Area of site : 0.41 acres. No. of dwellings : 24. (2 1-room flats ; 11 3-room dwellings ; 4 4-room dwellings ; 7 5-room dwellings.) Three lock-up shops are included in the scheme. Work started : 22nd July, 1946. Dwellings completed and occupied : 21st September, 1948. Estimated Cost of Scheme : Land £6,250 Building £41,000 Parkhill Road. Area of site : 2.35 acres. Number of dwellings : 92. (8 1-room flats, 8 2-room flats, 8 3-room flats, 60 4-room flats and maisonettes, 8 6-room flats.) Work started : 3rd February, 1947. By the end of 1948, 19 flats were ready for occupation and the remaining 73 flats were nearing completion. The Scheme is arranged in two blocks of 46 flats on the Parkhill Road and Upper Park Road frontages, varying from four to five storeys. Lifts, a communal laundry, playrooms and store rooms are to be included. Estimated Cost of Scheme : Land £45,800 Buildings £194,100 Well Walk. Area of site : 1.8 acres. No. of dwellings : 64. (4 2-room flats, 25 3-room flats, 31 4-room flats, 4 5-room flats.) Work started : 3rd March, 1948. Contract date of completion : March, 1950. The new buildings are of Georgian style and vary from two to five storeys. Lifts to the five-storey sections and communal rooms are included. Estimated Cost of Scheme : Land £35,000 Buildings £134,000 King Henry's Road. Area of site : 2.25 acres. No. of dwellings : 102. (11 1-room flats, 15 2-room flats, 24 3-room flats, 35 4-room flats, 17 5-room flats.) Work started : 8th November, 1948. Contract date of completion : November, 1950. 17 The Scheme has frontages to King Henry's Road and Oppidans Road. The buildings, which are of steel frame and brick construction, vary from five to seven storeys. Lifts, a communal laundry, workshop, playrooms, store sheds and a bicycle store are included. Estimated Cost of Scheme : Land £18,500 Buildings £227,400 Kilburn Priory. Area of site : 2.5 acres. No. of dwellings : 60 flats (first stage). (8 1-room flats, 9 2-room flats, 19 3-room flats, 15 4-room flats, 9 5-room flats.) 34 additional flats (second stage) are to be erected at a later date. Work started on first stage : 15th December, 1948. Contract date of completion : December, 1950. The first stage consists of two blocks of steel frame and brick construction, varying from three to five storeys. A playroom, workshop, communal laundry, store rooms and lifts are included. Estimated Cost of Scheme : Land £36,680 Buildings £123,630 Proposed Estates. Broadhurst Gardens 168 flats. West End Lane 80 flats. Shoot-up Hill 105 flats. Lawn Road 25 flats. Agamemnon Road 8 houses. Total 386 dwellings. Factories Act, 1937 The following table gives details with regard to inspections, etc. under this Act:— (1) Inspections. Premises Number on Register Number of Inspections Written notices Occupiers prosecuted  (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 277 123 45 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 261 86 21 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 4 — — — Total 542 209 66 — 18 (2) Defects Found. Particulars Number of cases in which defects were found Found Remedied. Referred by H.M. Inspector.  Want of cleanliness (S.1) 45 40 — Overcrowding (S. 2) 1 1 — Unreasonable temperature (S. 3) 3 3 — Inadequate ventilation (S. 4) 10 8 — Ineffective drainage of floors (S. 6) 12 10 — Sanitary Conveniencies (S. 7):— (a) Insufficient 4 4 — (b) Unsuitable or defective 13 13 1 (c) Not separate for sexes 6 6 1 Other offences against the Act (not including offences relating to workers) 42 38 - Total 136 123 2 During 1948 no prosecution was instituted under the Factories Act, 1937. Rodent Control Three full-time men are engaged on this work. They act under the instructions of the District Sanitary Inspectors, who first investigate all rat complaints. No major infestation is reported, but the number of complaints received during the year—641—is a substantial increase over last year's figure of 499. Complaints of mice infestation account for a considerable part of this increase. Despite persistent eradication work carried out on land in the vicinity of the honeycomb of railways and tunnels across the Borough, re-infestations occur with almost monotonous regularity. Your staff co-operate with that of the Railways on this problem, but it is obvious that much intensive work will be required, particularly on railway lands, if successful results are to be achieved. Three sewer treatments were carried out during the year—in January, February and June—the estimated kill (vide the Ministry of Agriculture formula) being 2,700. Water The Borough's water supply is provided entirely by the Metropolitan Water Board and has been satisfactory in quality and quantity. No complaint of contamination was received. All the dwelling-houses in the Borough are supplied from public water mains direct to the houses. There are no wells or stand pipes. Bath Waters. Samples of water were regularly taken from the Hampstead Swimming Baths. These proved to be 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. 19 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. At the beginning of the year, a series of lectures, and practical demonstrations on food and drink infections and the hygiene of food premises were given by Dr. Norman C. Parfit, of the Central Council for Health Education, at the Children's Hospital, Swiss Cottage. Some 400 invitations to attend were sent out to all the restaurateurs, bakehouse proprietors and Catering Workers' Associations in the Borough. The response, despite repeat invitations and personal calls by the Sanitary Inspectors, was extremely disappointing, only some thirty food traders attending. All new applications for catering licences and transfers of existing licences are referred to me and the premises visited by the Sanitary Inspectors before approval by the Food Executive Committee, with the object of encouraging improvements in the general hygienic conditions and sanitary and ablutionary accommodation of such establishments. Special visits were paid by the Sanitary Inspector to Hampstead Heath at Bank Holiday periods, when all food stalls engaged in the preparation and sale of foods, and the many itinerant ice cream vendors' vehicles were inspected. On the whole, a reasonable standard of " safety" of the foodstuffs was maintained but serious criticism is recorded concerning the almost entire absence of hot water and/or detergent facilities. The attention of the Chief Officer of the Parks Department, London County Council, was drawn to the need for the provision of waste bins at central sites for refuse from the stalls and this he agreed to do. Samples of foodstuffs were taken for both chemical and bacteriological analyses, and appropriate action taken in respect of those which were unsatisfactory, including two Grade 3 and three Grade 4 ice creams. One ice cream vendor gave a false name and address and could not subsequently be traced. There was a general lack of knowledge by the ice cream vendors of the Regulations governing the Heat Treatment of this commodity. Legal proceedings were subsequently instituted in respect of one unsatisfactory ice cream stall. Bakehouses. There are 27 bakehouses in use in the Borough, of which 9 are underground. Adulterated and Unsatisfactory Samples. Five hundred samples of foodstuffs were submitted to the Public Analyst, Dr. H. E.Cox. The number classed as " adulterated " (detailed in the following list) was 23 or 4.6 per cent., compared with 3.6 per cent, for the previous year. Offence How dealt with 1. Tin of Whiting containing a pellet of Cautionary letter sent to Manufacturers. solder and seam of tin defective. 2. Mutton and Beef sausages slightly Food Executive officer notified. deficient in meat content. 3. Epsom Salts, admixed with 56.5 per Summons dismissed under Probation of cent, boric acid crystals. Offenders Acton paymentof33s.0d. costs. 4. Grape-puree. Contained 2 p.p.m. Cautionary letter sent to Manufacturer. arsenic. 5. Little Giant Powder Orange flavoured, Vendor cautioned. Ministry of Food falsely labelled. notified. 20 Offence How dealt with 6. Tinned Rabbit. Contents decomposed Stock surrendered. 7. Dried Mint. Adulterated with 15 per Importers cautioned. Ministry of 8. cent, foreign leaf (ailanthus glanduFood notified. 9. losa). 10. Sherbert. Contained a small amount of' Vendor cautioned. Stock exhausted— bicarbonate and tartaric acid which not possible to obtain a " formal " have re-acted so that there is no sample. effervescence. 11. Sarsaparilla—incorrectly labelled Manufacturers cautioned. 12. "| Chugs Plugs (Clear mint chewing gum Manufacturers cautioned. Ministry of & J- compound). Contained 85 per cent. Food notified. 13. J paraffin wax and 40 p.p.m. of copper. 14. Olive Oil Substitute. Contained 99.5 Manufacturer fined ,£15 and £10 10s. 0d. per cent, liquid paraffin. costs. 15. Liviar. Contained less Vitamin "A" Manufacturer cautioned. than stated. 16. Cooking oil. Contained 5 per cent. Manufacturer cautioned. mineral oil. 17. Tomato Ketchup. Contained 8.3 per Ministry of Food notified. cent, solids, mainly wheat starch. 18. Egg Powder Substitute. Only half Vendor cautioned. Remainder of old proper strength. stock surrendered. 19. Sweetened Pudding mixture. Contained Vendor cautioned. Remainder of old mites. stock surrendered. 20. Frying oil. Contained 0.5 per cent, dirt Vendor cautioned. 21. Beef suet. Deficient in fat Manufacturer cautioned. 22. Doughnuts. Contained 15 per cent. Manufacturers cautioned. paraffin oil. 23. Shortbread. Contained 7 per cent. Manufacturers cautioned. paraffin oil. Bacteriological Examination of Foodstuffs One hundred samples were submitted to the Laboratories of Pathology and Public Health, 6, Harley Street, W.l. Of these 30 were in respect of Ice Cream which were graded under the Methylene Blue Test as follows :— Grade 1 16 Grade 2 5 Grade 3 3 Grade 4 6 Visits were paid by the Sanitary Inspectors to the producers of the Grades 3 and 4 products with a view to advising them as to the best methods of securing a more cleanly product. It must be pointed out that the Methylene Blue Test is only a provisional one, and is not a legal standard with which statutory compliance is demanded. Twenty samples of Pasteurised Milk and one T.T. (Pasteurised) Milk satisfied the tests prescribed by the Milk (Special Designation) Regulations, 1936 to 1946, and the Heat Treated (Prescribed Tests) Order, 1944. The majority of the remaining samples were obtained in connection with food poisoning enquiries, but no pathogenic organisms were found. Meat. There is no slaughterhouse in the Borough. 21 Unsound Food. The following list shows the amount of food seized or voluntarily surrendered during the year. This was salvaged wherever possible. Article. Quantity. Bread 2 cwt. Biscuits 40 lbs. Butter 16 lbs. Cereals (Packets) 300 packets. ,, (Grain) 242 lbs. Cheese—-Camembert 126 ,, Carre de l'est 63 ,, Cheddar 82 boxes. Coffee 43 tins. Confectionery 67£ lbs. Crumpets 525 Custard Powder 503 packets. Dates 17 lbs. Egg (dried) 9 tins. Figs 65 lbs. Fish (tins) 717 „ (potted) 49 „ (fresh) Bream 6 stones. Buckling 4½ Cod 34 Haddock 9 Halibut 6 Herrings 9½ Kippers 33 Ling 9 Mackerel 9 Plaice 6 Rock Salmon 5½ Roe 6 Skate 43 Sole 4½ Trout 2 (Total— Whiting 9 196 stones) Flour 42 lbs. Fruit (tins) 580 tins. Fruit Juice (tins) 113 Jam 230 Marmalade 162 Meat (tins) 531 „ (potted) 13 jars. ,, (fresh) Beef 9J lbs. Chicken 107 Duck 19½ Goose 56 Lamb 231½ Liver 41 Mutton 65 Pigeons 28 Rabbit 176 Salami 1½ Calves Feet 60 Sausages 28 22 Article Quantity. Meat (fresh) Steak lbs. (Total— Turkey 9½ 842 lbs.) Milk 776 tins. Nuts 288 lbs. Pears 220 Peas (dried) 50 Pickles 204 jars. Sauces 6 bottles. Soups 243 tins. Sugar 177 lbs. Syrup 13 tins. Tomato Puree 557 Vegetables 932 Tuberculosis New Cases and Mortality during 1948. During the year 1948, 99 new cases of Tuberculosis were notified, 90 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 1948:- Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. F.  0-1 - - - - - - - - 1-5 — — — — — — — — 5-15 — 1 1 1 — 2 — — 15-25 17 13 - 1 2 3 — — 25-35 11 17 — 3 1 3 — — 35-45 5 4 — — 5 3 — — 45-55 12 2 — 2 2 4 — — 55-65 3 1 — — 4 1 — — 65 and upwards 4 — 1 — 8 — — 1 Totals 52 38 2 7 22 16 — 1 Public Health (Tuberculosis) Regulations, 1930. There were 590 Pulmonary and 78 Non-Pulmonary cases of tuberculosis known to the Department at the end of the year 1948. Municipal Chest Clinic and Tuberculosis Dispensary. (a) Chest Clinic and Tuberculosis Dispensary. 1947. 1948 (half year) Number of sessions 155 79 Number of patients' attendances 3,227 1,817 Average attendance 20.8 23.0 Number of patients attending 1,046 766 New patients 369 236 New contacts 136 89 Blood examinations (E.S.R.)91 56 23 (b) Chest Clinic and Dispensary, New End. Hospital and Home Visits by T.M.O. Attendances at Chest Clinic and Dispensary 1,817 ,, ,, New End Hospital 523 Visits by Tuberculosis Officer to Homes 112 Total 2,452 (c) Visits by Tuberculosis Health Visitors. Number of visits to Homes 439 Artificial Pneumothorax. 566 refills were given to 55 patients during the period. X-ray Examination. During the period 703 films were taken at New End Hospital. In addition, approximately 520 X-ray screenings have been carried out there by the Tuberculosis Officer. Dental Clinic. Four patients have attended and the total attendance was 14. Tuberculosis Care Work. Up to the 5th July, 1948, this work was carried out by a SubCommittee of the Public Health Committee. During the half year 44 grants amounting to £40 15s. 9d. were made to tuberculous patients to cover such items as fares to visit patients in sanatoria, insurance premiums, material for occupational therapy, students' fees for re-entry to the London University, and emergency grants pending the adjustment or granting of Tuberculosis Allowances. Financial Allowances for Tuberculous Patients. On the 5th July, 1948, all cases in receipt of Tuberculosis Allowances were transferred to the National Assistance Board, under the new Health Service Act. During the half year ended 5th July, 1948, 32 new applica -tions were received of which 29 were granted allowances, 1 was found to be not eligible and 2 were still under consideration on the 5th July. The total cost involved was £1,044 17s. 5d. The number of current cases transferred to the National Assistance Board on the 5th July was 49, two later being withdrawn. Under the National Assistance Board chronic cases are eligible for allowances, but non-pulmonary cases are still excluded, nor is it possible for full-time earnings to be supplemented however inadequate they may be. Formerly, when need was proved, assistance could be granted both to patients in full employment and their contacts. Part-time earnings can still be supplemented but only a total amount of £1 of the income can be ignored when calculating allowances, nor can quite the full extent of discretionary payments be granted under the new scheme, although in general the scales have been increased, primarily to meet the cost of extra nourishment. Beds and Bedding. At the 5th July, 1948, the following bedding was on loan to 13 tuberculous patients 4 bedsteads, 6 mattresses, 17 sheets, 32 blankets, 3 pillows, 10 pillow cases, 2 bolsters. 24 Mass Miniature Radiography Unit. The Mass Miniature Radiography Unit was not available for the use of Hampstead residents or employees during the year 1948. Resettlement. Tuberculous persons (both pulmonary and non-pulmonary) are now brought within the arrangements for giving effect to the Disabled Persons Employment Act, 1944, and the Disablement Resettlement Officer is furnished with particulars as to the nature and amount of work patients are capable of performing. Extra Nourishment. 26 patients were supplied with free milk during the half year. ***** (On the 5th July the after-care treatment of Tuberculosis became the responsibility of the London County Council, and the clinical work of the Dispensary the responsibility of the Regional Hospital Board.) MATERNITY AND CHILD WELFARE (These services and staff passed to the control of the London County Council on the 5th July, 1948.) Health Visitors and Home Visits. The Health Visitors paid 8,755 visits during the first half year of 1948. In addition the Health Visitors made 675 attendances at Clinics and Centres. The Infant Welfare Centres open at 4th July, 1948, 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 Robson Tuesday 2—4.30 p.m. (Nursery Centre) — Miss Robson Wednesday 1.30—4 p.m. Dr. Cryer Miss Robson Friday 2—4.30 p.m. (Nursery Centre) - Miss Robson 60, West End Lane, N.W.6 Monday 1.30—4 p.m. Dr. Burns Miss Thornton Tuesday 1.30—4 p.m. Dr. MacRae 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 6 months ended 4th July, 1948:— (i) By children under 1 year of age 8,589 (ii) By children between the ages of 1 and 5 years 2,823 25 Total number of children who first attended at the Centres during that period and who, on the date of their first attendance, were (i) Under 1 year of age 567 (ii) Between the ages of 1 and 5 years 74 Total number of children under 5 years of age who attended at the Centres during the year and who, at the 4th July, 1948, were :— (i) Under 1 year of age 847 (ii) Over 1 year of age 1,124 Ante-Natal and Post-Natal Clinics During 1948 Ante-natal and Post-natal Clinics were combined, and 6 combined sessions weekly were held. The number of patients who attended up to 4th July, 1948, was as follows:— Ante-natal Post-natal Total Average patients patients attendances attendance 60, West End Lane 556 43 1,262 14 230, Haverstock Hill 327 18 701 13 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 up to 4th July 334 557 Number of children attending 18 31 Municipal Dental Clinic. During the 6 months ended 4th July, 1948, 159 mothers, 90 children and 4 T.B. patients attended the Dental Clinic, Lithos Road. No. of Total Average Sessions attendances attendance Mothers 375 9 0rduiary 41 Children 178 4 Gas 9 Mothers 76 8 Children 29 3 Ultra-Violet Ray Treatment. Children received 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. The day nurseries are under the direct administration of Dr. J. Gastrell Lewis, Assistant Medical Officer for M. & C.W. At the end of June there were 229 on the waiting list, of which 43 were priority cases. The waiting list is revised every 3 months. 26 Maternity Homes and Hospitals. 278 Hampstead mothers were admitted to New End Hospital during the six months ended 4th July, 1948. Nursing in the Home. The number of home visits paid during the first half of 1948 by the two District Nursing Associations in accordance with the Borough Council Scheme was :— Hampstead District Nursing Association 661 Kilburn and West Hampstead Nursing Association 1,626 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, and covered 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 increased considerably during the half year, and at 4th July, 1948, there were 24 full-time and 19 part-time helps. Home Helps were provided with overalls and paid at the rate of 2s. per hour. The applicant was assessed to pay in accordance with the approved scale, the maximum hourly charge being 2s. 6d. During the six months ended 4th July, 1948, 77 Maternity cases and 624 Domestic cases were assisted. Convalescent Homes for Children under Five Years. Arrangements were 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 the half year ended 4th July, 1948, 37 Hampstead children were sent away through this service. The Borough Council contributed £10 per year to the Invalid Children's Aid Association in respect of this service. Consulting Obstetricians. During 1948 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, 9,608 packets of Proprietary Brand Dried Milk were sold at full cost. Other food and medicaments to total value of £410 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. 27 Priority Utility Sheet Dockets for Expectant Mothers. Board of Trade Priority Utility Sheet Dockets were issued by this Department to expectant mothers, on receipt of a signed certificate from a midwife stating that the patients were in need of sheets for home confinement. A maximum of 3 Dockets was issued to each expectant mother. 83 applications were received and 237 Dockets issued during the half year. Child Life Protection. Up to 4th July, 143 visits were paid by health visitors to fostermothers and foster-children in the Borough. On the 4th July, 1948, the number of foster-mothers on the register was 4 and the number of foster-children was 7. 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 were made for the weight of each newly-born child to be entered on the birth notification, so that early contact could be made between the Health Visitor and the mothers of premature babies born at home. Close liaison was also maintained with Hospitals, so that -Health Visitors could follow up as soon as a premature infant was discharged to its own home. The following analysis of the premature births occurring in Hampstead . up to 4th July, 1948, has been made (a " premature " is defined as any baby whose birth weight is lbs. or less) :— Premature births in Hampstead (including non-residents) : 109. Premature births to Hampstead mothers (irrespective of place of birth):— (a) Born in hospital, etc., in Hampstead 25 (b) Born at home 14 63 (c) Born in hospital, etc., outside Hampstead 24 Of the 25 premature babies born in hospital, etc., in Hampstead, 4 died before discharge, and of the 14 born at home 2 died (in hospital) and of the 24 born outside Hampstead, 10 died before discharge. Care of Illegitimate Children—Ministry of Health Circular 2866 [revised). In conjunction with other Metropolitan Boroughs, this Council made an annual payment (on a rateable value basis) of £161 to the Moral Welfare Organisations. The Health Visitors and the Moral Welfare Workers were in close co-operation when any assistance could be given either to unmarried expectant mothers and/or illegitimate children. There were three Voluntary Associations operating in the Borough during the half year. Play Centres. Play centres were begun in 1942, and have as their object educational play for children who attend the welfare centres. "Only" children and difficult children particularly, benefit from association with other children in group activities. 28 They are held at: 230 Haverstock Hill, Monday, Wednesday and Friday afternoons. Children's Hospital, Tuesday and Friday afternoons. 60, West End Lane, Wednesday mornings. Family Planning and Gynaecological Clinic. Arrangements are made with the North West Women's Welfare Centre whereby the medical officers of the centres can send patients on medical grounds for advice on family spacing. During the half year 2 patients were sent. The Borough Council contributes at the rate of 10s. per patient. Foot Clinic. No foot clinic is in operation in the Borough, but the medical officers arrange for treatment of their patients privately. Ante-natal and Post-Natal Exercises. The class is held at the Children's Hospital on Mondays at 2 p.m., with Mrs. Kersley, physiotherapist, in charge. During the half year 29 ante-natal and 5 post-natal cases attended. Student Health Visitors. There were no health visitor students in Hampstead during the first half year, as there were several vacancies on our health visiting staff, and it was not practicable to have students for training. 2804 200 8/49 (7600) printed by harrison ANb sons, ltd., st. martin's lane, london